Efficacy of Triphalaguggulu in the Managememt Of

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES

BANGLORE,KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

EVALUATION OF THE EFFICACY OF TRIPHALAGUGGULU

IN FISSURE-IN-ANO

J.RAMYA RAJALAKSHMI

M.S(AY)SCHOLAR,

DEPT. OF PG STUDIES IN SHALYA TANTRAM,

ALVASAYURVEDAMEDICALCOLLEGE,

MOODBIDRI,D.K. DISTRICT,

KARNATAKA.

GUIDE CO-GUIDE

DR.P.N.MOHAN KUMAR M.D (AY), DR.MANJUNATHABHAT M.S(AY),

PROFESSOR, LECTURER,

DEPT.OF P.G STUDIES IN SHALYA TANTRA , DEPT.OF IN SHALYATANTRA,

ALVA’S AYURVEDAMEDICALCOLLEGE, ALVA’S AYURVEDAMEDICALCOLLEGE,

MOODBIDRI MOODBIDRI.

2007-2008

Alva’s AyurvedaMedicalCollege

Moodbidri

From

J.RAMYA RAJALAKSHMI

M.S (AY) SCHOLAR,

DEPT. OF PG STUDIES IN SHALYA TANTRAM,

ALVASAYURVEDAMEDICALCOLLEGE,

MOODBIDRI, D.K. DISTRICT,

KARNATAKA.

THE REGISTRAR,

Rajiv Gandhi university of Health Sciences,

Bangalore, Karnataka.

Through,

THE PRINCIPAL,

Alva’s AyurvedaMedicalCollege,

Moodbidri, Dakshina Kannada,

Karnataka – 574227

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 submission of dissertation to the Rajiv Gandhi University of Health Sciences, Bangalore as partial fulfillment of M.S. (Ay) in Shalyatantra.

Title of dissertation:-

EVALUATION OF THE EFFICACY OF TRIPHALAGUGGULU

IN FISSURE-IN-ANO

Herewith I am enclosing the completed proforma for registration.

Thanking you,

Moodbidri Yours sincerely

J.RAMYA RAJALAKSHMI

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. Name of the candidate & address: J.RAMYA RAJALAKSHMI

M.S. (Ay) Scholar,

Dept. of Shalyatantra,

Alva’s AyurvedaMedicalCollege,

Moodbidri, Dakshina Kannada,

Karnataka – 574227.

Permanent address: J.RAMYA RAJALAKSHMI,

D/O Dr.D.Jayakanthan, No:7, Sathyamoorthystreet, Swalpet, Arakkonam, Vellore (Dist), Tamilnadu.

2. Name of the institution : Alva’s AyurvedaMedicalCollege,

Moodbidri, Dakshina Kannada,

Karnataka-574227.

3. Name of faculty : M.S (Ayurveda) Shalyatantra

4. Date of admission to the course: 1’st june,2007

5. Title of the topic to study : EVALUATION OFTHEEFFICACY OF

TRIPHALA GUGGULU IN FISSURE-IN-ANO

6. BRIEF RESUME OF THE INTENDED WORK

6.1 NEED FOR THE STUDY:

Fissure-in-ano is a linear boat shaped ulcer in the anal canal. It is always associated with spasm of anal sphincter,bright streaks of blood with the passage of stool and pain after defecation. Patient desist defecation rather than going through the agony,leading to constipation. Among ano-rectal disorders nearly 87% of patients are suffering from fissure-in ano. The incidence and prevalence of this disease are on the increase due to the life style and dietary regimen of the present era.

Now-a-days people are busy with their daily schedule; they don’t prefer hospitalization and other operative procedures. Under the above circumstances, there is a need to find out a new innovative and simpler medicament, that which ideally suits, in-offering relief for the sufferer of this disease.

Triphalaguggulu is the best drug of shothagna,vranaropana,vedana nashanam.Hence Triphala guggulu is preferred in fissure-in-ano. Moreover Triphalaguggulu is the drug of choice in any form of vrana and is considered as”Agroushadha” of vrana .Considering the above facts, an attempt is madeto evaluate the clinical efficacy of Triphala guggulu in the management of fissure-in-ano.

6.2 REVIEW OF LITERATURE:

The review of literature include an exhaustive and thorough screening of related internet sources, modern literature, classical and contemporary, Ayurvedic literatures and journals to collect sufficient data for the study.

Few of the text books are as follows:

1)Parikarthika is explained in Sushruthasamhitha1, 2

2)Aetiopathogenesis,signs and symptoms, investigations of fissure-in-ano is explained in

a)A Manual on Clinical Surgery 3

b)Bailey and Love Short Practice of Surgery 4.

c) Concise Text Bookof Surgery 5.

3)Triphalaguggulu is explained in the text book of Sharangadhara Samhitha 6, Bhaishajya kalpana vijnanam7, Chakradhatta8.

PREVIOUS WORK DONE:

1) Management of parikarthika (fissure-in-ano) using Gudavarti of Yastimadu Tailam- 1998-

Dr. Jay Krishna Nayak- S.D.M college of Ayurveda – Udupi.RajivGandhiUniversity of Health Science.

2) Role of Manibhadra Guda in the management of parikarthika -2002 - Dr. Bharghav v.k- RajivGandhiUniversity of health science-Bangalore.

3) Management of fissure-in-ano with Dantyarista, Madhukadiyoga and Kshara application-2004, Dr.Joshipashmina – Jamnagar Ayurveda University-Jamnagar.

4) Efficacy of Jatyadi Tailam in the management of guda parikarthika-2004- Dr.Thumma madhu, Uttarpradesh Ayurveda medical college, Uttar Pradesh.

6.3OBJECTIVES OF THE STUDY :

To evaluate the Shodana , Ropana and Vedanahara property of Triphalaguggulu in fissure-in-ano.

6.4 HYPOTHESIS :

H0: There is no effect of Triphalaguggulu in fissure-in-ano.

Ha: There is significant effect of Triphalaguggulu in fissure-in-ano

7. MATERIALS AND METHODS

7.1 SOURCE OF DATA:

Patients will be selected from the outpatient and inpatient department of shalya tantra of Alva’s Ayurveda medical college andhospital,Moodbidri, Special camps and other referrals.

7.2 METHOD OF COLLECTION OF DATA:

Minimum 30 patients fulfilling the inclusion criteria will be randomlyselected.

A)PROCEDURE OF ADMINISTRATION OF DRUG:

30 patients will be given internally 400mg of Triphala guggulu with hot water before food twice daily.

B) OBSERVATION PERIOD

Oral medication will be continued daily for a maximum period of 45days.Clinical response will be assessed at an interval of 9 days .Follow up will be done for 15 days during the study.

C)INCLUTION CRITERIA:

1)Patients with fissure-in-ano will be randomly selected irrespective of sex and occupation.

2)Age group between 20 years and 60 years.

3)Fissure with or without sentinelpile.

D) EXCLUTION CRITERIA:

1) Patients with CA-rectum and CA-anus.

2) Fissure secondary to ulcerative colitis,tuberculosis,syphilis,crohn’s disease, and other systemicdisorders pertaining to colo-rectum will be excluded from the treatment.

3) Patients with fistula and hemorrhoids.

E) DIAGNOSTIC CRITERIA:

HISTORY:

1)Severe pain the anal region on defecation.

2) Pain lasting for few hours after defecation.

3) Fresh blood streaks on feaces.

4) Associated constipation.

ON EXAMINATION:

1) Canopy shaped ulcer at the anterior or posterior midline on anal verge.

2)Puckered anus due to sphincteric spasm.

3) Sentinel tag, if present.

F) ASSESMENT CRITERIA:

Patient’s response is based on subjective and objective parameters.

SUBJECTIVE:

1)Pain

2)Blood streaks on feaces

OBJECTIVE:

1) Laxity of anal sphincter

2) Tenderness

3)Size of the ulcer

Assessment of the condition will be done based on a detailed proforma and will be analysed statistically by using paired ‘t’-test.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS,IF SO PLEASE DESCRIBE BRIEFLY.

This study will be conducted clinically. No animal experiments will be carried out.

LABORATARY INVESTIGATION:

1)Routine blood examination viz.,

Hemoglobin percentage

Total leucocytes count

Differential count

Erythrocyte sedimentation rate

2)Occult stool examination

3)If needed other tests will be carried out.

7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE 7.3?

Yes, clearance has been obtained through the ethical committee formulated in the institution

LIST OF REFERENCES:

1)Acharya Susrutha- Sushrutha samhitha (with commentatory of Dalhana) chikithsa sthana –34:16edited – V.D Yadhavji Trikamji. Acharya Chaukambha orientalia -1997. Page no: 688, volume: 2nd

2)Acharya Susrutha- Susrutha samhitha ( with commentatory of Dalhana) nidana sthana- 2:7 edited - V.D Yadhavji Trikamji. Acharya Chaukambha orientalia -1997. Page no: 688,

Volume: 2nd

3)S. Das- A Manual on clinical surgery – 4th edition – 36th chapter. Page no: 396.

4)Charles.v.mann, R.C.G Russel. – Bailey and Loves short practice of surgery. 23rd edition. Publisher- Arnold 2000. Chapter: 72 .Page no: 1252.

5)S.Das – A Concise text book of surgery – 3rd edition-2001. Chapter:54 Page no: 1062

6)Acharya Sharangadhara- Sharangadhara samhitha- Edited by Shailaja srivatsava. Published by Chaukhamba orientalia varanasi. Chapter:7 Page no: 204

7)Acharya Ramachandra Reddy- Bhaisajya kalpana vijnanam (A Science of Indian pharmacy) 3rd edition .Published by Chaukambha Sanskrit bhavan,Varanasi. Chapter:4, Page no: 328

8)Acharya Chakrapanidatta- Chakradatta-3rd edition -2002. Edited by P.V.Sharma and published by Chaukhamba orientalia.Chapter: 55 Page no: 367.

9)Acharya Vagbhatta- Astanga hridayam- translated by Professor K.R. Srikantha murthy ,4th edition -2000 . Published by Krishnadas academy, Varanasi. Chapter-19, Pageno: 477.

9. Signature of candidate:

10. Remarks of the guide :

11. Name and designation of

11.1 Guide: DR.P.N.MOHAN KUMAR M.D (AY),

PROFESSOR,

DEPT. OF P.G STUDIES INSHALYATANTRA,

ALVA’S AYURVEDAMEDICALCOLLEGE,

MOODBIDRI, DAKSHINA KANNADA,

KARNATAKA – 574227

11.2 Signature of the Guide :

11.3 Co-guide: DR.MANJUNATH BHATT M.S. (Ay)

DEPT. OF SHALYATANTRA,

ALVA’S AYURVEDAMEDICALCOLLEGE,

MOODBIDRI, DAKSHINA KANNADA, KARNATAKA-574227.

11.4 Signature:

11.5 Head of the department: DR.SURESH NEGALAGULI M.D.(AY)

PROFESSOR AND HEAD,

DEPT. OF PG STUDIES IN SHALYA TANTRA

ALVA’S AYURVEDAMEDICALCOLLEGE,

MOODIDRI, DAKSHINA KANNADA,

KARNATAKA - 574227

11.6 Signature & Seal:

12.1 Remarks of Principal :

12.2 Signature & Seal: