From,
DR. DATTANI KALPESH
M D. (Ayu) Scholar
Department of Post Graduate Studies in KAYA-CHIKITSHA
Dr.B.N.M.E Trust’s ShriMallikarjunSwamiji
Post Graduate and Research Centre.
Smt. SushiladeviNagur Colony, College Road,
Bijapur – 586101.
To,
THE REGISTRAR,
RajivGandhiUniversity of Health Sciences, Karnataka
BANGALORE.
Through,
THE PRINCIPAL AND HEAD OF THE DEPARTMENT OF KAYA-CHIKITSA
Dr.B.N.M.E Trust’s ShriMallikarjunSwamiji
Post Graduate and Research Centre,
Smt. SushiladeviNagur Colony, College Road,
Bijapur – 586101.
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 the submission of dissertation to the Rajiv Gandhi University of Health Sciences, Karnataka Bangalore, for the partial fulfillment of M.D. (Ayurveda) in Kayachikitsa
TITLE OF DISSERTATION
“A COMPARATIVE CLINICAL STUDY ON LAVANOTTAMADI CHOORNA AND CHIRABILWADI CHOORNA WITH TAKRA IN THE MANAGEMENT OF RAKTARSHA.”
Here with I am enclosing completed Proforma for the registration of the subject for Dissertation
Thanking you,
Yours faithfully,
Place: Bijapur
Date: 27-04-2012 (Dr. DATTANI KALPESH M. D.(Ayu) Scholar)
RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE.
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. NAME OF THE CANDIDATE: DR. DATTANI KALPESH
M D. (Ayu) Scholar
AND ADDRESS
C/O Mr. ASHOKBHAI DATTANI,
RAJNAGAR-1, SARU SECTION ROAD,
JAMNAGAR-361006
GUJARAT.
2. NAME OF THE INSTITUTION:Dr.B.N.M.E TRUST’S
SHRI MALLIKARJUN SWAMIJI
POST GRADUATE AND
RESEARCH CENTRE
BIJAPUR - 586101
3. COURSE OF STUDY AND:AYURVEDA VACHASPATI
SUBJECT MD (AYU) IN KAYA-CHIKITSHA
4. DATE OF ADMISSION TO:20/08/2011
THE COURSE
5. TITLE OF THE TOPIC: A COMPARATIVE CLINICAL STUDY ON
LAVANOTTAMADI CHOORNA AND CHIRABILWADI CHOORNA WITH TAKRA IN THE MANAGEMENT OF RAKTARSHA.
6) BRIEF RESUME OF THE INTENDED WORK:
6.1) NEED FOR THE STUDY:
AstangaAyurveda, the 8 branches of Ayurveda, Kayachikitsa is one among the prime which involves the measures for medical management while understanding word kaya it is referred as agni and Kayachikitsa as agnichikitsa. All the vyadhis are said to be by mandagni, the prime among them is considered as arsharoga. Arsharoga is included under Astamahagadas,it’s enough to show the severity of vyadhi. This disease is given more importance as it involves guda which is one among sadhyo-pranaharamarma as well as involvement of Vatadi three doshas. The definition of arsha as per Madhukosa, it is the disease which pricks the normal lifestyle of human being just as an enemy.
Arsas is correlated as haemorrhoid and defined as vascular tumour made up of infected varices involving one or more isolated portions or all of the haemorrhoidal plexus of vein. The occurrence of haemorrhoid is mainly seen in human being and not in animals due to the horizontal posture and gravitational force. Nesselrod believes infection as the principal cause of haemorrhoid disease. During pregnancy haemorrhoids commonly appear, “Pregnancy Piles” are due to compression of superior haemorrhoidal veins by the pregnant uterus.
Haemorrhoids are common in both men and women. Those who exposed to improper dietary habits, sedentary lifestyle, etc. have a greater incidence of haemorrhoid. According to a recent health estimates, over 40% of the people worldwide suffer from haemorrhoid and as many as 40% of the populations have experienced symptoms of this disease sometime in life. According to Burkit in a British medical journal of 1972 haemorrhoids are common in economically developed communities, rare in developing countries and almost unknown in tribal communities. In India, approximately 80% of sufferers are in the age group of 21-50 years.
Bleeding, pain and prolapsed mass are the three main symptoms which draws the attention of patient towards the need for consultation. Allopathic science considers haemorrhoid to be a surgically curable disease and the medical management given by these science are few and rarely effective. Further the operative procedure such as injection therapy, rubber band ligation, manual dilatation of anus, cryo surgery, haemorroidectomyetc. but all are palliative treatment and not the curative one where reoccurrence are also high. The complication associated with surgery such as pain, anal incontinence and stricture also prevails at high ratio.
Ayurveda has mentioned about raktarsha in same manner as modern where the gadha mala pratipidana (constripation) is said to be the cause of raktasrava (bleeding). Now looking forward the westernization of Indian culture, prevalence of this disease would go on increasing day by day as well as there is need for very good medical care so that not onlyarsha can be cured but also re-occurrence can be prevented.
The treatment principle of Ayurveda for arshroga includes bhaisaja, ksharakarma, agnikarma and shastra karma. AcharyaCharaka has given more importance to medical management while AcharyaSusruta being a surgeon also mentions bhaisaja as a fold of treatment. AcharyaCharaka mentioned the line of treatment for arsharoga is vatanulomaka and agnibalavruddhi karaka dravyas and he further told that takrasevana is the best chikitsa for person suffering from mandagni associated with arsas. AcharyaCharaka mentions the importance of takra as when it poured on truna destroys it from root similarly the arsha sprout gets destroyed when takra is administered. AcharyaYogratnakara has considered the takra as AMRUTA in many diseases including arshas.
In Ayurvedic classical texts we find number of yogas for the treatment of arsharoga. LAVANOTTAMADI CHOORNA and CHIRABILWADI CHOORNA along with TAKRA mentioned in BHAISAJYA RATNAVALI are indicated in raktarsha. The ingredients are easily available, medicines are easy to prepare and duration of treatment is comparatively less, preparations are palatable and convenient for patients. Hence the study will be undertaken to evaluate the efficacy and compare the effect of Lavanottamadichoorna and Chirabilwadichoorna with takra in raktarsha.
6.2) REVIEW OF LITERATURE:
Madhukosha defines arshas as that which causes hindrance in life just as enemy.1 Vagbhatta mentions arsas as mamsakilaka which brings disturbance in once life like an enemy specially in gudamarga.2
Charaka mentions various aharaja and viharajanidana for arshas such as viruddhaahara, ajeernapramitasana, asatmiyabhojana, bastikarma vibramsha, divaswapna, avyayama, sukhasayana, utkata-vishama-kathina asana, samudirnavegavinigrahat etc. specially in female amagarbabramshad, garbhotpidana, vishama prasava.3
According to Susrutha, all three Doshas either single or in combination of raktadosha, from pradhanadhamani moves to gudabhaga causes vitiations and there form mamsapraroha.4
Charakabased on treatment classified arsha into 2 types- ardraarsha and suska arsha5, where as Susrutha classified arsha into 6 types- vataja,pittaja, kaphaja, raktaja, sannipataja and sahaja.6
Raktarshasankuras are similar to pittajanyaankuras and looks like vatapraroha, gunja or vidruma. Usna and Dustaraktasrava is mainly due to gadha mala pratipidana. Patient looks like bheka due to pandu and suffers with the symptoms of raktakshaya. There is decrease of varna, bala, utsaha, ojas and indriyabala.7
Modern science explains in detail the signs & symptoms such as splash in the pan, pain/discomfort, constipation, discharge of mucous, pruritis etc. and classified into two types based on location that is internal and external haemorrhoids. Management of haemorrhoids is mainly by para-surgical or surgical methods like Lord’s dilatation, Inj. of sclerosant, Barron’s band application, haemorrhoidectomy and cryo surgery.8&9
Lavanottamadichoorna and Chirabilwadichoorna arementioned in bhaisajyaratnavali. These are the specific preparation which is prescribed for 7 days along with takrafor the treatment of raktarsha.10
Takra is considered as the best medicine for arsharoga. In commentary of CharakaSamhita it has been mentioned that takra should be given in vata, pitta, kaphajaarsha as it is bala karaka and dosha nasaka.11
PREVIOUS WORKS DONE:
- Nakrani M. H. – The study of Dosha-Dooshya in arsharoga (piles) and its management, Ahmedabad-1988.
- Deshmukh V.B. – Effect of lavanottamadichoorna along with butter milk in Arsharoga, Trivendrum-1988.
- Anjaneyalu– The management of arshas with chitrakaditaila (externally) and chitrakadichoorna (internally), Hyderabad-1999.
- SudhaKumari V. – A clinical study on the management of Arshas with Vyoshadichoorna (internally) and Shireeshabeejalepa (externally), Hyderabad-2004.
- LondheNavnath – To study efficacy of sunthi-pathachoorna with navneeta and sugar in raktarsha, Pune Tillak-2005.
6.3) OBJECTIVE OF THE STUDY:
- To study in detail aboutraktarsha.
- To clinically assess and compare the effect of Lavanottamadichoorna and Chirabilwadichoorna with takra in raktarsha.
7) MATERIALS AND METHODS:
7.1) SOURCE OF DATA:
Patient of either sex diagnosed as raktarsha based on classical signs & symptoms andproctoscopic examination will be taken from OPD, IPD and camps conducted by Dr. B.N.M.E. Trust’s, Sri MallikarjunaSwamiji Post Graduate and Research Centre,Bijapur.
Literary source of the present study will be collected from classical Ayurvedic texts, modern texts, published articles from reputed journals and related source of internet.
Drug source includes the ingredients of Lavanottamadichoorna and Chirabilwadichoorna as well as takra.
7.2) METHOD OF COLLECTION OF DATA:
Diagnosed patient of raktarsha will be selected in between the age group of 21 to 50 years, irrespective of sex, occupations and socio-economic status.
STUDY DESIGN:
A minimum of 40 patients will be selected excluding the dropouts. They will berandomly assigned in to 2 groups consisting of 20 patients in each group;
Group A - Lavanottamadichoorna with takra
Group B- Chirabilwadichoorna with takra
The data will be collected from each group before and after the treatment. Interventions will be compared and analyzed by using Student’s t-test and chi-square test with the consultation of a bio-statistician.
INCLUSIVE CRITERIA:
- Patients diagnosed by classical signs & symptoms and proctoscopic examination of raktarsha (haemorrhoid).
- Patients of either sex.
- Patients of age group between 21 to 50 years.
EXCLUSIVE CRITERIA:
- Patients age below 21 and above 50 years.
- Sahajaarsha, bhagandara,arsa associated with carcinoma of rectum, prolapsed piles.
- Patients suffering from any systemic disorders and congenital anomalies of rectum.
- Haemorrhoids related to pregnancy.
PARAMETERS OF THE STUDY:
SUBJECTIVE PARAMETERS:
Classical signs & symptoms of raktarsha (haemorrhoid) such as
- Pain
- Bleeding
- Nature of stool
- Pressure on defecation
OBJECTIVE PARAMETERS:
Proctoscopic examination
- Number of internal pile mass
- Size
7.3) DOES THE STUDY REQIRE ANY INVESTIGATIONS OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMAN OR ANIMALS? IF SO PLEASE DESCRIBE BRIEFLY.
YES,
Blood routine(If found necessary).
INTERVENTIONS:
Group A
Sample size- 20 patients
Drug -Lavanottamadichoorna with takra
Dose-Choorna = 1 karsha (6 gm bid)
Takra = 2 pala (approx. 100 ml bid)
Time-Pragbhakta (before food)
Duration-7 days
Post Treatment-On 8th and 21st day
Follow up
Group B
Sample size- 20 patients
Drug -Chirabilwadichoorna with takra
Dose-Choorna = 1 karsha (6 gm bid)
Takra = 2 pala (approx. 100 ml bid)
Time-Pragbhakta (before food)
Duration-7 days
Post Treatment-On 8th and 21st day
Follow up
7.4) HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?
YES,
Ethical committee has recommended this project and advised to inform the patient about the risk involved & to take the consent of the patient participating in this clinical study.
8) LIST OF REFERENCES:
- Sri MadhavkaravirachitMadhavaNidanaMadhukosavyakhya by Ayurvedacharya Sri YadunandanUpadhyaya Part-1, Chaukhambha Sanskrit Sansthan, Varanasi, 28th edition-1999, Page no. 174. (M.N. madhukosha 5/1)
- VagbhattarachitaAstangaHrudaya with Sarvangasundari commentary of Arundatta and Ayurvedarasayana commentary of Hemadri, edited by PanditHariSadasivaSastriParadakara, Chaukhambha Sanskrit Sansthan, Varanasi, Reprint-2009, Page no. 490. (A.H.N.7/1)
- ShrimadAgniveshapranitaDridhabalapratisamskarta, ChakrapaniduttvirachitaCharakaSamhitaAyurvedadipikavyakhya by VaidyaYadavjiTrikamjiAcharya and Priyavat Sharma, Chaukhambha Sanskrit Sansthan, Varanasi, Part-2 Reprint-2009, Page no. 345. (C.C.14/9)
- MaharshiSusrutavirachitasusrutaSamhita with nibandhasamgraha commentary by DalhanaAcharya edited by VaidyaYadavjiTrikamjiAcharya,Chaukhambha Sanskrit Sansthan, Varanasi, Reprint 2009, Page no. 271. (S.N.2/4)
- ShrimadAgniveshapranitaDrdabalapratisamskarta, ChakrapaniduttvirachitaCharakaSamhitaAyurvedadipikavyakhya by VaidyaYadavjiTrikamjiAcharya and Priyavat Sharma, Chaukhambha Sanskrit Sansthan, Varanasi, Part-2 Reprint-2009, Page no. 352. (C.C.14/38)
- MaharshiSusrutavirachitaSusrutaSamhita with NibandhaSamgraha commentary by DalhanaAcharya edited by VaidyaYadavjiTrikamjiAcharya,Chaukhambha Sanskrit Sansthan, Varanasi, Reprint 2009, Page no. 270. (S.N.2/3)
- VagbhattarachitaAstangaHrudaya with Sarvangasundari commentary of Arundatta and Ayurvedarasayana commentary of Hemadri, edited by PanditHariSadasivaShastriParadakara, Chaukhambha Sanskrit Sansthan, Varanasi, Reprint-2009, Page no. 494. (A.H.N.7/43-45)
- Manipal Manual of Surgery by Dr. RajgopalShenoy K., CBS publishers and distributors, New Delhi-Bangalore, 2nd edition, Page no. 525-529.
- A concise text book of surgery by Somen Das, published by Dr. S. Das, Calcutta, 3rd edition-2001, page no. 1055-1061.
- ShriGovindadasavirachitaBhaisajyaRatnavaliBhisagratnaShriBhramankarparishkrtyavyakhyakarKavirajShriAmbikaduttaShastriChaukhambha Sanskrit Samsthan 11th edition-1993, page no. 215. (BR. 9/36 &39)
- CharakaSamhita by Agnivesha, revised by Charaka and Dridhabala with the Ayurveda-Dipika commentary of Chakrapanidatta, edited by VaidyaYadavjiTrikamjiAcharya, Chaukhambhaprakashan, Varanasi, Reprint-2007, page no. 505 (C.C.14/76-88 commentry).
9. SIGNATURE OF THE CANDIDATE:
10. REMARKS OF THE GUIDE :
11. NAME AND DESIGNATION OF :
11.1 GUIDE : Dr. S. P. MANGOOLI
M.D.(AYU)
Professor, Dept of Kayachikitsa
Dr.B.N.M.E Trust’s
ShriMallikarjunSwamiji
Post Graduate & Research Centre
BIJAPUR – 586101
11.2 SIGNATURE :
11.3 CO GUIDE :
11.4 SIGNATURE :
11.5 HEAD OF THE DEPARTMENT :Dr. S. P. MANGOOLI
M.D.(AYU)
H.O.D, Dept of Kayachikitsa
Dr.B.N.M.E Trust’s
ShriMallikarjunSwamiji
Post Graduate & Research Centre
BIJAPUR – 586101
11.6 SIGNATURE :
12.
12.1 REMARKS OF THE CHAIRMAN :
AND PRINCIPAL
12.2 SIGNATURE :