From,

RushikeshVijaykumarTikole

Preliminary M.D. (Ayu) Scholar,

Dept. of Post Graduate Studies in Kaumarabhritya,

S.D.M.College of Ayurveda and Hospital,

Hassan –573201.

To,

The Registrar,

RajivGandhiUniversity of Health Sciences,

Karnataka, Bangalore.

Through,

The Principal &Head of the Dept. of Post Graduate studies in Kaumarabhritya,

S.D.M.College of Ayurveda and Hospital,

Hassan- 573201.

Subject: Submission of completed proforma for Registration of Subject for

Dissertation.

Respected Sir,

I request you to kindly register the below mentioned subject against my name for the submission of the dissertation to Rajiv Gandhi University of Health Sciences Karnataka, Bangalore for partial fulfillment of M.D. (Ayurveda).

Title of the Dissertation:

“A clinical study on the effect of ashvagandhadi lehya IN MANEGEMENT of karshya (UNDERWEIGHT) children”.

Herewith, I am enclosing completed proforma of synopsis for registration of subject for Dissertation.

Thanking you,

Yours faithfully,

Place: Hassan

Date: (RushikeshVijaykumarTikole)

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.

ANNEXURE – II

COMPLETED PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. Name of the Candidate: RUSHIKESH VIJAYKUMAR TIKOLE,

and AddressPRELIMINARY M.D. (AYU) SCHOLAR.

(IN BLOCK LETTERS)Dept. of Post Graduate studies

in KAUMARBHRITYA,

S.D.M.College of Ayurveda,

AND Hospital, P.O. Box 164,

HassaN–573201.

PERMANENT ADDRESS :RUSHIKESH VIJAYKUMAR TIKOLE

s/o VIJAYKUMAR D. TIKOLE

5 ’vijay heights ’opp. z.p.

kalyani camp,sadar bazar ,satara.

MAHARASHTRA.

2. Name of the Institution: S.D.M.College of Ayurveda

& Hospital, HASSAN – 573 201.

3. Course of the Study in:M.D. (Ayu), KAUMARABHRITYA

SUBJECT

4. Date of Admission to: 25TH October 2010

the course

5. TITLE OF THE DISSERTATION: “A clinical study on the effect of ashVagandhadi lehya IN MANEGEMENT of karshya (underweight) children”.

6. BRIEF RESUME OF THE STUDY:

6.1 need for the study:

Karshya(Underweight) is one of the common problem in Indian school children & 47% Indian children are Underweight.1One of important factor for Karshyais HinaMatra Ahara.2Human body takes origin from food substances that one consumes3& it is said that ‘’ we are what, we eat’’. The majority of population in underdeveloped & developing countries are not getting nutritious food, whereas children who take sufficient food may not be able to digest because of poor digestive power& due to lifestyle changes there is suppression of natural urges like hunger, thirst, sleep which affects general health status of children, it may leads to undernourishment. A child suffering from Karshya may not tolerate thirst, excessive cold & heat, invasion of any disease, if he/she is not treated in proper time complications like Shwasa, Kasa, Gulma, Pliha, Kshaya, Arsha, Udararoga, Grahaniroga may occur.4This grievous condition especially in children requires immediate medical attention. Karshya being nutritional deficiency has been selected for present study.

Charaka mentionsBrimhana for Karshya through Laghudravya’s&Santarpana karma. Ashvagandhadi Lehya5is selected for this study which contains Deepana, Pachana, Brimhana&Rasayana drugs to combat over all condition of Karshyapatient.Ashvagandha is having Laghu&SnighdhaGuna, Tikta,Katu and Madhura Rasa and is Balya and Rasayana properties. ShwetaSariva is having Guru, SnigdhaGunaMadhuraTikta Rasa and is Rasayanaproperties.Jiraka is having Laghu, RukshaGuna and Katu Rasa and is Rochan,Deepana,Pachana properties. Draksha is having Snighdha, Guru, MriduGuna&Madhura Rasa, Balya and Brimhana properties.Madhusnuhi is having Laghu, RukshaGuna&TiktaRasa &Anulomana properties. Ela is having Laghu,RukshaGuna and Tikta Rasa and Rochan,Deepana,Pachana properties. For this study Avaleha form of above drugs is selected considering palatability in children & may act effective nutritional remedy to overcome problems faced by children suffering fromKarshya.So here is an effort made to see the efficacy of AshvagandhadiLehyain the management of Karshya.

6.2 Review of the literature:

There is no direct reference available in our Samhitas regarding the disease

Karshya in children but after a gross outlook of the Samhitas, we can say that Karshya

has been described as a prestage of other diseases.

1. In KashyapaSamhita:The reference of SandashiJataharini is similar to

Parigarbhika, and Karshya found as a early symptom of Parigarbhika.6Karshya as a

Symptom of Kshudita person has been mentioned in Ka.Bhojanakalpa.7Karshya has

been described as a prestage of KshirajaPhakka.8KshinaMamsa has been described

as a symptom of VyadhijaPhakka.9

2. In AshtangaSamgraha:MaharshiVagbhata has mentioned Karshya as an early

Symptom of Parigabhika.10 “Kumarahshushyati “this reference is found in the

Description of Balshosha.11

3. In CharakaSamhita:AcharyaCharaka in Chikitsasthana said that child become

krisha due to intake of Vatadushtastanya.12

4. In MadhavaNidana:Madhavakar also said that child become krisha due to intake of

Vatadushta stanya.13The above references are the indirect references of the disease

Karshya and other extreme form of malnutrition in children.

5. In Yogaratnakar:It is only Yogaratnakar who has devoted a chapter to the treatment

of the disease Karshya in children in BalrogachikitsaKarshyadhikar. 14

6.Sushruta:Atikarshya has been described with its Nidana,

SampraptiLakshana and Chikitsa.OnSushruta Sutra chapter 15 AcharyaDalhana

comments as “karshammamsakshaya”15

7.Bhavaprakashhasbeen devoted a separate chapter “Karshyadhikar for describing the symptomatology,aetiology, pathogenesis, prognosis and treatment of krisha person.16

8.Sharangadharhadincluded it under the heading of NanatmajaVyadhi of Vata, those diseases causedabsolutely by VataDosha. AcharyaKashyapa includes the condition Karshya as adisease caused by Vata.17

Previous Research Works Conducted:

So far no specific work has been done on the mentioned subject in this direction.

But few works are found on the subject of Brimhana or anabolic effect or on the Basti

chikitsa in Karshya or Shosha – pradhanavyadhi separately they are as follows.

1)Anabolic effect of certain Ayurvedic drugs in infancy and childhood.

Dr.ShashtriKrishna (1983)

2) Brimhana effect of certain Ayurvedic drug compound in underweight child

Dr. K.S. Patel – (1985)

3)A study of nutritional status in children based on Ayurvedic concept

Dr.SharmaSurendra (1986)

4)Brimhana effect of certain indigenous drug in pediatric practice.

Dr.SharmaChamanlal (1987)

5)A clinical study on Brimhana effect of kshiraBasti in Neonates and children.

Dr.Kinarlekar (1998)

6)A comparative study on Brimhana effect of Ashvagandha granules and

Ashvagandha siddha kshiraBasti in Krisha children.Dr.V. B. Kori (1999)

7)A Study on the effect of An Indigenous drug compound in underweight children. By Dr.P.VijayaSaradi, R.G.U.H.S Bangalore (2005)

8) Randomised control trial on effect of KushmandaAvaleha in Mild to Moderate malnutrition at coastal area of Thiruvananthapuram’’ (2008) Dr.Senthi

6.3 Objectives of the Study

  • To study effect of Ashwagandhadi Lehya in Karshya(Underweight) children.

7. Materials and Methods

7.1 Source of Data:

Patients of Karshya(Underweight) will be selected from Kaumarabhritya O.P.D & I.P.D of S.D.M.C.A & H Hassan. These patients constitute the source material for data.

7.2 Methods of Collection of Data:

30Patients suffering from Karshya(Underweight) as per clinical criteria framed for the study will be selected randomly.

Diagnostic Criteria:

Diagnosis will be made on the basis of

  • Weight for Age criteria.

Inclusion Criteria:

Subjects who are having age group 5-7 years will be selected irrespective of sex, caste & religion, with following complaints of -

  • Dourbalya
  • AlpaKshudha
  • Poor Growth & Weight Gain
  • Lean & Thin body
  • Less than Weight for Age criteria
  • Grade 1 Malnutrutition (I.A.P Grading of Malnutritition)

After taking a complete history emphasizing on milestones diet history & deworming selection of patient will be done for study.

Exclusion Criteria:

Children who supposed to have

  • Infectious diseases like Tuberculosis
  • Systemic diseases
  • Congenital problems
  • Malignancies
  • Mal-absorption syndrome
  • Errors of Metabolism
  • Children less than 70 % of Ideal weight for age

Method of Treatment:

A minimum 30 cases of age group 5-7 years who come in underweight will be randomly selected.AshvagandhadiLehya will be administered 5 gmstwice a day with SukhoshnaDugdha After food For period of 45 days.

Assessment Criteria:

  • Assessment is done on the basis of improvement in cardinal signs and symptom before & after completion of treatment.

Subjective Parameters:

  • Daurbalya
  • State of hunger
  • Time taken for Digestion
  • Activity
  • Concentration/ Interest

Objective Parameters:

  • Weight in Kg
  • Height in cm
  • Chest Circumference
  • Mid Thigh circumference
  • Mid calf circumference
  • Skin fold thickness

Follow up Study:

During treatment the patients will be asked to attend O.P.D. at interval of 15 days for 3 times.

7.3 Laboratory Investigation:

Sr.Protien level.

Urine Albumin.

7.4 Has Ethical Clearance been obtained from your institution?Yes

8. LIST OF REFERENCES

1) National Family Health Survey, 1998

2)SushrutaSamhita of MaharshiSushruta edited with Ayurveda TatvaSandipika byKavirajaAmbikadattaShastri Part – I ChaukhambhaSanskritaSamsthana, CharuPrinters, Reprint edition year 2007 Sutra sthana 1/36

3)CharakaSamhita,CharakaChandrika Hindi commentary First part by Dr.BramhanandTripathi, ChaukhambhaSurbharatiPrakashan Varanasi, First

edition 2004, Vimanasthana 2/6.

4)CharakaSamhita,CharakaChandrika Hindi commentary First part by Dr.BramhanandTripathi, ChaukhambhaSurbharatiPrakashan Varanasi, Firstedition 2004,Sutra Sthana 21/13.

5) Ayurvedic Formulary Of India (Pharmacopoeia of Hospital of Integrated medicine,Madras,SectionVII, Page no.93)

6)KashyapaSamhita, with Vidyotini Hindi commentary and Hindi translation ofSanskrit introduction by AyurvedalankarshriSatyapalBhisagacharya,Chukhambha Sanskrit samsthana Varanasi, Charu printers, Tenth edition, year -2005, Kalpasthana, Ch. 9/193/53.

7)KashyapaSamhita, with Vidyotini Hindi commentary and Hindi translation ofSanskrit introduction by AyurvedalankarshriSatyapalBhisagacharya,Chukhambha Sanskrit samsthana Varanasi, Charu printers, Tenth edition, year -2005, Kalpasthana, Ch. 10/202/10.

8)KashyapaSamhita, with Vidyotini Hindi commentary and Hindi translation of

Sanskrit introduction by AyurvedalankarshriSatyapalBhisagacharya,

Chukhambha Sanskrit samsthana Varanasi, Charu printers, Tenth edition, year -

2005, Chikitsasthana, Phakka Chi. Page 139/4.

9)KashyapaSamhita, with Vidyotini Hindi commentary and Hindi translation of

Sanskrit introduction by AyurvedalankarshriSatyapalBhisagacharya,

Chukhambha Sanskrit samsthana Varanasi, Charu printers, Tenth edition year -

2005, Chikitsasthana, Phakka Chi. Page 140/12.

10)Ashtangasangraha of VriddhaVagabhatta with ShashilekhaSanskrita

commentary by Indu, Prologue in sanskrita& English by Prof. JyotirMitra,

Edited by Shivaprashadasharma, Chaukhambhasanskrita series Varanasi,

Chaukhambha press, First edition 2006, Uttartantra Ch. 2/34.

11)Ashtangasangraha of VriddhaVagabhatta with ShashilekhaSanskrita

commentary by Indu, Prologue in sanskrita& English by Prof. JyotirMitra,

Edited by Shivaprashadasharma, Chaukhambhasanskrita series Varanasi,

Chaukhambha press, First edition 2006, Uttartantra Ch. 2/42.

12)CharakaSamhita,CharakaChandrika Hindi commentary First part by Dr.BramhanandTripathi,ChaukhambhaSurbharatiPrakashanVaranasi, Firstedition 2004,ChikitsaSthana 30/239.

13)Madhavanidanama of ShriMadhukosha Part – II with VidyitiniHindiCommentary by ShriSudarshanaShastri, edited by Pro. YadunandanaUpadhyaya,ChaukhambhaSanskritasamsathana Varanasi, Thirtyoneth edition 2002 page68/1.

14)Yogaratnakar with Vidyotini Hindi commentary by VaidyanShriLaxmipatiShastri, edited by BhisagratnaBrahmashankarShastri, ChaukhambhaSanskritasansthana Varanasi, Charu printers, Seventh edition 2002 page 444/1.

15)SushrutaSamhita of MaharshiSushruta edited with Ayurveda TatvaSandipika by

KavirajaAmbikadattaShastri Part – I ChaukhambhaSanskritaSamsthana, Charu

Printers, Reprint edition year 2007 Sutra sthana15/13.

16)BhavaprakashaBhisagratnaShriBrahmashankar Mishra with Vidyotini Hindi

commentary by ShrihariprashadPandey, ChaukhambhaSanskrita series

Varanasi, Vidyavilasa press, Second edition 1949, UttarardhaChikitsaprakarana

Cha.40/399-400.

17)SharangadharaSamhita of Pt. Sharangadhara, Annoted with DipikaHini

commentary by Dr.Brahmanandatripathi, ChaukhambhaSanskritaprakashana

Orientalia publishers Varanasi, Reprint edition 2004, PurvaKhanda Cha.

7/65.

9. Signature of the Candidate :

10. Remarks of Guide:

11. Name and Designation

(IN BLOCK LETTERS)

11.1 Guide : DR.NITHIN S.A. M.D.(AYU)

READER,

DEPT.OF P.G. STUDIES IN

KAUMARABHRITYA,

S.D.M.C.A & H, HASSAN.

11.2 signature:

11.3 Co-Guide:

11.4 Signature:

11.5 Head of the Department: DR.SHAILAJA .U M.D. (AYU)

PROFESSOR & H.O.D.

DEPT.OF P.G. STUDIES IN

KAUMARABHRITYA,

S.D.M.C.A & H, HASSAN.

12. Signature:

12.1 Remarks of the

Chairman and Principal :

12.2 Principal: DR. PRASANNA N. RAO

M.S. (AYU), IMS, BHU, PhD

S.D.M.COLLEGE OF AYURVEDA AND

HOSPITAL, HASSAN – 573 201

12.3Signature: