Department of Post Graduate Studies in Shalya Tantra

From,

RAMYA. R,

Preliminary M.S (Ayu.) Scholar,

Department of Post Graduate Studies in Shalya Tantra,

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

HASSAN- 573201.

To,

The Registrar,

Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore.

Through,

The Principal and Head of the Department of P.G Studies in Shalya Tantra,

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

Hassan – 573 201.

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.S (Ayurveda).

Title of the Dissertation:

“EFFECT OF NYAGRODHADI LEPA IN THE MANAGEMENT OF

ANKLE SPRAIN”

Herewith I am enclosing a completed proforma of synopsis for Registration of subject for Dissertation.

Thanking you,

Yours faithfully,

Place: Hassan.

Date: (RAMYA. R)

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA BANGALORE

ANNEXURE-II

COMPLETED PROFORMA FOR REGISTRATION OF SUBJECT

DISSERTATION

1. NAME OF THE CANDIDATE : RAMYA. R,

AND ADDRESS PRELIMINARY M.S. (AYU) SCHOLOR,

(IN BLOCK LETTERS) DEPARTMENT OF POST GRADUATE STUDIES IN SHALYA TANTRA,

S.D.M.COLLEGE OF AYURVEDA AND HOSPITAL,

HASSAN- 573201.

D/O K.RAJU,

DOOR NO. 2880, 6TH CROSS,

GANDHI NAGAR,

MANDYA-571401

2. NAME OF THE INSTITUTE : S.D.M.COLLEGE OF AYURVEDA

AND HOSPITAL, HASSAN-573201.

3. COURSE OF STUDY IN : M.S. (AYU) SHALYATANTRA.

SUBJECT

4. DATE OF ADMISSION TO : 16.06. 2008.

THE COURSE

5. TITLE OF THE DISSERTATION:

“EFFECT OF NYAGRODHADI LEPA IN THE MANAGEMENT OF

ANKLE SPRAIN.”

6. BRIEF RESUME OF THE STUDY

6.1 Need for the study:

Ankle is one of the most common site for acute musculo-skeletal injuries and sprains, which account for 85% of ankle injuries. Acute ankle trauma is responsible for 10-30% of sports related injuries in young athletes. Every year an estimated one million people present to physician with acute ankle injuries. More than 40% of ankle sprain has the potential to cause chronic problems.

These injuries appear to be simple, but are more painful and hamper the routine activities of the patient. Ankle Sprain is characterized by pain, swelling with or without deformity.

Sushruta in the context of Asthi-Bhagna1 has mentioned “Patanabhighatatva” which means Patana, Abhighata or both are the main causes for sprain, where it is advised to apply Sheeta Pradeha to reduce Vedana and Shopha. Sushruta has mentioned Nyagrodhadi Gana, which is having Shothahara and Vedana Sthapana actions. But this Gana has many drugs. We have selected five drugs from this Gana which are having Sheetha Virya, Pitta Shamaka, Shothahara & Vedhana Sthapaka properties.

Hence this Lepa is selected to evaluate the efficacy of Nyagrodhadi Lepa in comparison to Manjistadi Lepa in the management of Ankle Sprain.

6.2 Review of Literature:

1. Acharya Sushruta has mentioned the Lepana Upakrama for Asthi-Bhagna in Chikitsa sthana 4:47.

2. The drugs of Nyagrodhadi Lepa (Nyagrodha, Udumbara, Ashwatha, Plaksha & Kapeethana) are mentioned in Sushruta Samhitha, suthrasthana. 38:48.2

3. Acharya Sushruta has mentioned the Lepana Upakrama for Shoonanga Chikitsa in Chikitsasthana using Manjistadi Lepa, 3:7.3

4. The therapeutic actions and properties of all the five drugs selected for this study are mentioned in Dravya Guna Vignana by Priya Vruth Sharma are as follows: 4

Nyagrodha: It is Pitta & Kapha Shamaka, Sheetha Virya, Vedhana Sthapaka and Shothahara.

Udumbara: It is Pitta & Kapha Shamaka, Sheetha Virya, Vedhana Sthapaka and Shothahara.

Ashwatha: Pitta & Kapha Shamaka, Sheetha Virya, Vedhana Sthapaka and Shothahara.

Plaksha: It is Pitta & Kapha Shamaka, Sheetha Virya and Shothahara.

Kapeethana: It is Pitta & Kapha Shamaka, Sheetha Virya and Shothahara.

5. In Dravya Guna Vignana by Dr.J.L.N.Shastry 2nd volume also the details of the drugs are explained.5

6. Acharya Sushruta has mentioned method of application of Lepa in Pratiloma gati, 6a with the thickness as Ardra Mahisha Charmavat6b and properties of Lepa are Shodhana, Ropana, Shopha and Vedanapaham.6c

7. Causes, types, signs, symptoms and management of Ankle sprain is mentioned in

-Essentials of Orthopedics and Applied Physiotherapy by Jayant Joshi and Prakash

Kotwal .7

-Watson Jones Fracture and Joint Injuries by J.N.Wilson. 8

-Text Book of Orthopedics by John Ebnezar.9

-Text Book of Orthopedics by Rajesh Malhotra & Surya Bhan.10

-Text Book of Orthopedics by Sreenivasalu Kavala, MS (Ortho).11

-Orthopedic Knowledge Update by Kenneth J Kaval.12

Many research works have been conducted on Asthi Bhagna using different Lepas, but the efficacy of Nyagrodhadi Lepa has not been studied as per recent research review.13

Previous Research works:

Chandramohan (2000): Effect of Manjistadi Lepa in the Management of Bhagna and its associated complaints.14

Hemanth T & Hemanthakumar (2000-2001): Sushrutha’s Technique of management of Avrana Kanda Bhagna.15

Siddanagouda & Hemanthakumar (2002-2003): Management of Kanda Bhagna with special reference to Radius fracture.16

Pallavi A. Hegde (2004-2005): Effect of Manjistadi Lepa in the management of ankle sprain.17

6.3 Objectives of the study:

1. To Evaluate the efficacy of Nyagrodhadi Lepa in the management of Ankle Sprain.

2. To compare the efficacies of Nyagrodhadi Lepa & Manjistadi Lepa to see which

Lepa is more effective in relieving the ankle sprain.

7. MATERIALS AND METHODS:

7.1. Source of data:

Patients from the Out Patient and In Patient Department of PG studies in Shalyatantra, S. D. M. College of Ayurveda and Hospital, Hassan, will be selected irrespective of their age, sex, religion.

Diagnostic criteria

The Ankle Sprain patients will be selected after diagnosing clinically by the following features of the ankle sprain mentioned in the texts.

1. Pain

2. Swelling

3. Tenderness

4. Joint stiffness

5. H/o trauma

Inclusion criteria:

Patients of first and second grade of Ankle Sprain.

Grade 18a

1. Mild pain.

2. Mild swelling.

3. Mild joint stiffness.

4. Little or no loss of function.

Grade II18b

1. Moderate to severe pain.

2. Moderate swelling.

3. Moderate joint stiffness.

4. Moderate loss of function.

Exclusion criteria:

1. Patients with fracture and dislocation of ankle joint.

2. Patients with third grade Ankle sprain.

Grade III18c

1. Severe pain.

2. Profuse swelling.

3. Complete joint stiffness.

4. Complete loss of function.

7.2. Methods of Collection of data:

The selected patients will be randomly divided into two groups, each group consisting of 15 patients.

M Group: Manjistadi Lepa

N Group: Nyagrodhadi Lepa

Ingredients of Nyagrodhadi Lepa:

1) Nyagrodha(Ficus bengalensis) 4) Plaksha(Ficus locar)

2) Udumbara(Ficus glomerata) 5) Kapeethana(Thespesia populnea)

3) Ashwatha(Ficus religiosa) 6) Water

Ingredients of Manjistadi Lepa:

1) Manjista (Rubia Cordifolia) 4) Shalipisti (Oryza sativa)

2) Yastimadhu (Glycyrrhiza glabra) 5) Shatadhauta Gritha

3) Raktachandana (Pterocarpus santalinus)

Method of preparation of Nyagrodhadi Lepa:

All the drugs will be taken in equal quantity and Lepa will be freshly prepared by mixing in Water at the time of its application. It will be applied twice daily over affected part and removed before it dries completely.

The duration of the treatment will be 7days.

Method of preparation of Manjistadi Lepa:

All the drugs will be taken in equal quantity, mixed with Water & the Lepa will be prepared freshly. It will be applied in the same way as mentioned for treated group.

Assessment criteria:

Assessment will be made on the basis of Subjective and Objective parameters before and after treatment

Subjective:

1. Pain

2. Disturbed sleep

Objective:

1. Tenderness

2. Swelling

3. Joint movements

Duration of treatment:

The Lepa will be done in both the groups for 7 days.

Follow-Up:

Follow up of patients will be done at regular intervals for every week up to one month.

Investigations:

X-ray of Ankle joint- Antero-Posterior and Lateral view.

7.4. Has ethical clearance obtained from your institution: Yes

8. LIST OF REFERENCES:

1.  Sushruta – Sushrutasamhita Chikitsa Sthana, Bhagna Chikitsa Adhyaya, Commentary of Sri. Dalhanacharya, Edited by -Vaidya Yadavji Trikamji Acharya, Published by: Chaukhambha Orientalia, Varanasi, Edition 7th 2002, 3:47.

2.  Sushruta-Sushrutasamhita Sutra Sthana, Dravya Sangrahaniya Adhyaya, Commentary on Sri Dalhanacharya, Edited by Vaidya Yadavji Trikamji Acharya, Published by: Chaukhambha Orientalia, Varanasi, 7th Edition.

3.  Sushruta-Sushrutasamhita Chikitsa Sthana, Commentary on Sri Dalhanacharya, Edited by Vaidya Yadavji Trikamji Acharya, Published by : Chaukhambha Orientalia, Varanasi, 7th Edition.3:7.

4.  Dravya guna vignana: By Priya Vruth Sharma 2nd volume published by Chaukhambha Bharati Academy. Varanasi. a )Nyagrodha Pg No-664, b) Udumbara Pg No-666, c) Ashwatha Pg No-668, d) Plaksha Pg No-670, e) Kapeethana Pg No-680, f) Arjuna Pg No-195.

5.  Dravya guna vignana: By Dr.J.L.N.Shastry 2nd volume published by Chaukhambha Orientation.Varanasi. a) Nyagrodha Pg No-941, b)Udumbara Pg No-499, c) Ashwatha Pg No-944, d) Plaksha Pg No-946, e) Kapeethana Pg No-627.

6.  Sushruta: Sushruta Samhitha Sutra Sthana, Vrana Lepanabandhana Vidhi Adhyaya, Commentary of Dalhanacharya, Published by: Chaukhambha Orientalia, Varanasi. a)18:4 b)18:12 c)18:7

7.  Jayant Joshi and Prakash Kotwal: Essentials of Orthopedics and Applied Physiotherapy. Reprinted 2002, Published by: B. I. Churchill Livingstone Pvt Ltd- New Delhi. Page no. 555-558.

8.  J.N. Wilson: Watson Jones Fracture and Joint Injuries. 6th Edition, Published by: B. I. Churchill Livingstone Pvt Ltd- New Delhi. Page no.1117-1119.

9.  Text Book of Orthopedics: By John Ebenezer- Jaypee Brothers, Medical Publishers (P) LTD. New Delhi. Pg No 250, 151.

10.  Text Book Of Orthopedics: By Rajesh Malhotra and Surya Bhan. CBS Publishers and Distributors. New Delhi. Bangalore. Pg No 457-458.

11.  Text Book Of Orthopedics: By Sreenivasalu Kalava, MS [Ortho] [AIIMS] Paras Medical Publishers, Hyderabad-500095, India. Pg No 97, 119.

12.  Orthopedic Knowledge Update: By Kenneth J Kaval, MD. Jaypee

Brothers Medical Publishers (P) Ltd.557, 558.

13.  M. S. Baghel: Research in Ayurveda, Published by Mridu Ayurvedic

Publications and sales Jamanagar. 2nd Edition.

14.  Chandramohan K.R: Effect of Manjistadi Lepa in Management of Bhagna and its associated complaints, 2000, Trivandrum

15.  Hemanth. D. Toshikane: Sushrutha’s technique of Management of Avrana Kanda Bhagna, 2000-2001, R.G.U.H.S, Bangalore.

16.  Siddanagouda A Patil: Management of Kanda Bhagna W.S. R to Radius fracture, 2002-2003, R.G.U.H.S, Bangalore.

17.  Pallavi A Hegde (2004-2005)-Effect of Manjistadi Lepa in the management of Ankle Sprain.

18.  www.nismat.org/ptcor/Anklesprain/19K

9. SIGNATURE OF THE CANDIDATE:

10. REMARKS OF THE GUIDE :

11. NAME AND DESIGNATION OF :

(IN BLOCK LETTERS)

11.1 GUIDE : DR. PRASANNA. NARASIMHA .RAO,

M.S. (AYU) (IMS, BHU), Ph. D.

PRINCIPAL, PROFESSOR,

DEPARTMENT OF PG

STUDIES IN SHALYA TANTRA,

S.D.M.COLLEGE OF AYURVEDA

AND HOSPITAL, HASSAN.

11.2 SIGNATURE :

11.3 CO-GUIDE : DR. GOPIKRISHNA .B.J.

M.S. (AYU) ASST. PROFESSOR OF THE

DEPARTMENT,

P. G. STUDIES IN SHALYA TANTRA, S.D.M.COLLEGE OF AYURVEDA

AND HOSPITAL, HASSAN

11.4 SIGNATURE :

11.5 HEAD OF THE DEPARTMENT : DR. P.HEMANTHA KUMAR

M.S. (AYU) (IMS, BHU) ,Ph.D

PROFESSOR AND HEAD OF THE

DEPARTMENT,

P. G. STUDIES IN SHALYA TANTRA, S.D.M.COLLEGE OF AYURVEDA

AND HOSPITAL, HASSAN

11.6 SIGNATURE :

12.1 REMARKS OF THE

CHAIRMAN AND PRINCIPAL : DR. PRASANNA N. RAO

M.S. (AYU) (IMS, BHU), Ph. D.

S.D.M.COLLEGE OF AYURVEDA

AND HOSPITAL, HASSAN – 573 201

12.2 SIGNATURE :

5