RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. NAME OF THE CANDIDATE : DR. RAJKUMAR MISHRA
AND ADDRESS S/O SHRI SACHIDA NANDA MISHRA
AT-RAMESWAR NAGAR,
POST- BOLANGIR,
DIST - BOLANGIR
ODISHA, 767001
2. NAME OF INSTITUTION : SHRI D.G.M.AYURVEDIC MEDICAL
COLLEGE AND HOSPITAL
POST GRADUATE STUDIES AND
RESEARCH CENTRE, GADAG
3. COURSE OF STUDY : AYURVEDA VACHASPATI,M.D.(AYU)
SUBJECT PANCHAKARMA
4. DATE OF ADMISSIO: OCTOBER - 2011.
5.TITTLE OF THE TOPIC : “ EVALUATION OF EFFECT OF
PIPPALYADI GOMUTRA BASTI
IN THE MANAGEMENT OF
STHOULYA (OBESITY)”.
6. BRIEF REVIEW OF INTENDED WORK
6.1. Need for thestudy:
In modern era man is constantly distancing himself from the nature.He is gaining the wealth but loosing health.He wants to live a luxurious, sedentary life style and is accustomised to improper dietary habit such as over eating, consumption of high calorie and highly processed food stuffs.This leads to accumulation of more and more fat in the body causing ‘Sthoulyata’, which have grasped almost one quarter of earth population1. Hence Sthoulya is a global problem and more common in modernized present era.
Sthoulya is the abnormal and excess accumulation of meda dhatu. Frequent and excess intake of kapha increasing factors, sedentary life style, lack of mental and physical exercise are the most common etiological factors. Sthoulya can also occur due to Beeja dosha2i.e.hereditary cause.
In modern medical scienceSthoulya is compared with Obesityand it is defined as excess body fat that possess a health risk3. It caused by excess calorie intake, but endocrine disorders like hypothalamic disorders, hypothyroidism, cushing’s syndrome etc. can also be cause of Obesity.Obesity can also be drug induced or due to genetic inheritance.
This Obesity (Sthoulya) is certainly the mother of dangerous diseases4 and most burning problem in present society.Obesity has reached epidemic proportion in India in 21st century, with morbid Obesity affecting 5% of the country population5. It has been estimated to affect 20 to 40 % of the adult and 10 to 20 % of children and adolescents in developed countries6.
As it is said that “whenever is the carcass there will be vultures gathered together” in the similar fashion, the Obesityis such a physical state whereHypertension, Diabetes Mellitus, Impotency, Coronary Artery Disease (CAD), Respiratory insufficiency, Venous stasis, Osteoarthritis, Depression, Breast and Prostate cancers7 and many other grave complication are vulturous invited.
In Ayurveda,Sthoulya is considered as the the Santarpanajanya Vyadhi8 and the Atisthoola is considered one among the Asta nindita purasha’s9. One who is suffering from Sthoulya roga beomes miserably pathetic because of Javoparodha (hampered physical activity), Kruchravyavayata (hampered sexual life), Dourbalya (extreme lassitude), Ayusha hrasata (decreased the life span)1Oetc.
The term Panchakarma consist of two words ‘Pancha’ and ‘karma’. It includes five fold therapy i.e Vamana, Virechana, two types of Bastis and Nasya. Sushruta included Raktamokshana under the Panchakarma. Among them archaryas have given prime importance to Bastikarma, because it has got multifarious action on body11 and also considered as ‘Ardhachikitsa’12. Basti plays significance in the Panchakarma therapy It is praised as “Aakeshhagranakhagrebhyo Basti naran”13by Kashyapa.
The 21st century continously changing the life style, environment and dietary habits which have been made man the victim of many diseases. Sthoulya is one of the most common disease which affect someone’s social, physical and mental features.
So after looking the vital importance of Sthoulya, hence selected for the present study.
Research point
Sthoulyadisease, is gaining more and more attention of scientists at global level.So the need of treatment of higher efficacy is required for treating this disease.
Ayurvedic treatments havefewer side effects, less relapsing rate so it can be preferred. More over, treatment is cost effective.Generally people who are health conscious, wants to reduce the body weight or control the weight, during that process they prone to different stress factors to reduce body weight, in this study main concentration is given to Obesity questionnaire which will give the data about the psychological factors to reduce the body weight.
Keeping the view in mind this clinical study is a humble attempt to evaluate the
“Efficacy of Pippalyadi GomutraBasti in the management of Sthoulya(Obesity).”
Hypothesis
Sthoulya is Meda and Mamsa vikara pradhana14 Santarpanajanya Vyadhi15 so it needs Apatarpanachikitsa16, which may be achieved by Pippalyadi GomutraBasti17.It is composed of drugs like pippali, chitraka, yavakshara. They all have kapha shamaka property, whereas drugs like madhu and gomutra are well known for kapha hara properties. And also in the present study Moorchita Tila Taila 18 is taken for Anuvasan Basti which have the capacity to reduceSthoulya.As the drugs are composed of properties like Lekhana, Karshana, Medahara and Kaphahara.
Hence one should always be craving for some new remedy for a disease.So it is forbidden moral responsible of Ayurvedic scholar to search any effective and curative procedure and drugs from Ayurvedic treasure of therapeutics.
So we have selected to show theEfficacy of PippalyadiGomutra Basti in the management of Sthoulya(Obesity).
6.2) Review of literature
Acharya Charaka has describedSthoulya in sutrastana. He has considered Sthoulya as Sleshmaja Nanatmaja vikara19, Santarpana Nimmitaja vikara20 and Adhika doshayukta roga21.
Sushruta has described the nidana, rupa, purva rupa, samprapti and chikitsa of Sthoulya. It is described as a Rasa Nimittaja vyadhi22.
In Astanga Hridya, Vagbhata discussed Sthoulya inDwividopakramayee chapter and included it under ‘Langhanatherapy’ Classification of Sthoulya and itsManagement23 symptom and pathogenesis are highlighted24.
In Kashyapa Samhita,Sthoulya is considered as one among the astanindita purushawhile explaining the anthropology25.
In Bhela Samhita Sthoulya is described as a disorder of vitiated meda26.
In Madhava Nidhana, Madhavkar has elaborated the pathophysiology of this disease based on fat tissue and fat deposit site27.
In Sharangadhara Samhita, heconsidered vitiation of vata as a cause of Medodosha28.
Review of previouswork
1. Effect of indigenous drug on lipid metabolism w.s.r.t Obesity and atherosclerosis by
Satyavati.G,.Faculty of Ayurveda,IMS,Banaras Hindu university,Varanasi,1966.
2. A comprehensive study of Chakramarda w.s.r.t.Sthoulya by Zala Jyotsanaba,
Dept. of Dravya guna, Jamnagar, 1998.
3. A clinical study on Sthoulya(Obesity) to its management through Lekhana Basti and
Amritadi guggulu by Kerur Prasanna,HASS’s Ayurveda mahavidyalaya,Hubli,Rajiv Gandhi university of Health sciences,Bangalore,1999.
4.The study of lukewarm water (ushna jala) on Obesity by Velhal A.R, Dept. of
Swasthavritta, Pune, 2000.
5.A clinical study on the management of Sthoulyaby Panchatikta and lekhana vasti
by Rekha Savajani, Dept. of Kayachikitsa, Jamnagar, 2001.
6.Comparative study of Lekhana therapies in the management of Sthoulya, by Anand
Prasad Nayak, Govt. Ayurveda College, Dept. of PGKC of Kayachikitsa,
Ahmedabad . 2003.
7. Evaluation of efficacy of Bhadradi Asthapana Vasti in Sthoulya(Obesity) by
Vijaya Kumar Swami, Dept. of Panchakarma, Gadag, 2006.
8. Evaluation of the efficacy of mushkadi yoga in Sthoulya by Shekhar Shakti
Sharma, Dept. of Kayachikitsa, Gadag, 2008.
6.3) Aims and Objectives
- To evaluate the efficacy of Bastikarma in Sthoulya.
- To evaluate the efficacy of Pippalyadi GomutraBasti in Sthoulya.
7) Material And Methods
7.1) Source of data
a)Patient -Patients are selected from OPD and IPD of Panchakarma Dept. PGs and RC, DGM AMC and Hospital, Gadag.
b)Literary-Literary aspect of study will be collected from classical Ayurvedic and Modern texts and updated recent medical journals.
c)Therapy-Yoga Basti karma-:(5 Anuvasana +3 Niruha )
- Niruha Basti - Pippalyadi gomutra yoga
- Anuvasana Basti - Moorchita tila taila
d)Selection of drugs- The trial drugs required for the preparation of medicine are collected from local areas and market.
e)Preparation of medicine
1)Madhu+Saindhava lavana+Tilatail+ Shatapushpakalka+ Pippalyadi kwatha+
Yava kshara+Gomutra are mixed in proper quantity and administered as Niruha Basti.
2) Moorchita tila taila will be prepared according to the Taila pakavidhi as explained in
the classics and administered as AnuvasanaBasti.
7.2) Methods of collection of data
a)Study design – A simple randomized clinical trial.
b)Sample size – Minimum of 30 patients.
c)Inclusion criteria –
- The patient’sSthoulya diagnosed according to the classical features like Ati kshudha, Ati pipasa, Ati sweda etc.
- Patients of both sex between the age group 20 to 60 years.
- Patient with BMI 30 kg /m2 and above.
- Patient fit for Basti karma.
d)Exclusion criteria-
- Subjects not fulfilling the inclusion criteria.
- Subjects having associated complications like Cardiac diseasesand diabetes.
- Subjects having Obesity due to endocrinal or genetic abnormalities.
- Pregnant and Lactating women.
- Subjects having fissure, fistula and hemorrhoids.
e)Diagnostic criteria-Diagnosis will be made on the basis of objective and subjective parameter.
f)Posology- Niruha Basti dravya dose - 600 ml (approx)-in between 8.30 to 9.30 am on empty stomach.
Anuvasana Basti dravya dose - 75 ml (approx) - in between11 am to 1 pm
after food.
g)Study duration –
Pippalyadi Gomutra Basti - 08 days
Follow up - 16 days
Total study duration - 24 days
h)Assessment of result– Subjective and objective parameters of base line data to the final data are assessed with paired “t” test with the help of a statistician.
i)Parameters of the study –
Subjective parameters:-
- Ati kshudha,
- Ati pipasa
- Ati sweda
- Ati nidra
- Kshudra shwasa/Alpa shwasa
- Alasya/ utsaha hani
- Daurbalya/Alpa vyayam
- Daurgandhya.
Objective parameters:-
- Body mass index (BMI)
- Waist Hip Ratio
- Lipid profile
- Larocque Obesity Questionnaire29
7.3) INVESTIGATION:-
Hb%,
DC,
TC,
ESR
RBS (For Diagnosis only)
LIPID PROFILE INCLUDING –HDL
LDL
Total Cholesterol
Serum Triglycerides.
7.4) ETHICAL CLEARANCE: Obtained and enclosed.
8) LIST OF REFERENCES-
1. Google search, mass.com.
2. Agnivesh, Charaka samhita, Sutrasthana, chapter 21, sloka 4,Editor Dr. Gangasahaya
Pandeya,5th edition, Varanasi. chaukhamba Sanskrit samsthan, 1997. P- 278.
3. Harrison’s Principle of Internal Medicine, Vol-1, Part-5, Chapter75, Editor Anthony.
S.Fauci and Joseph. B. Martin, 14th Edition, International edition, 1998, P-454.
4. Google search, cached
similar pages.
5. Google search “India facing Obesity epidemic experts”. The Hindu 2007-10-12.
6. Park K, Text book of preventive and social medicine, Twientieth edition, Jabalpur;
Banarasidas Bhanot publishers, 2009. P-345.
7. Google search,
8. Agnivesh, charakasamhita, sutrastana, chapter 23, sloka 6, Pt Kashinatha Shastri and
Dr. Gorakhanath chaturvedi editor. 17th Ed. Varanasi ; chaukhamba Bharati Academy
1991, P-436.
9. Agnivesh, charakasamhita, sutrastana, chapter 21, sloka 3, Pt Kashinatha Shastri and
Dr. Gorakhanath chaturvedi editor. 17th Ed. Varanasi; chaukhamba bharati academy,
1991, P-407.
10. Agnivesh, charakasamhita, sutrastana, chapter 21, sloka 4, Pt Kashinatha Shastri and
Dr. Gorakhanath chaturvedi editor, 17th Varanasi ; chaukhamba bharati academy,
1991,P-409.
11. Sushruta, Sushruth samhita, chikitsastana, chapter 35, Sloka 3,Editor Kaviraja
Ambikadutta Shastri,14th edition,Varanasi ; chaukambha sanskrit sanstana, 2003
P-152.
12. Agnivesh, charaka samhita, siddisthana, chapter 1, sloka 40, Rajeswara Datta Shastri,
Reprint 1998, Varanasi; chaukamba bharati academy, P-971.
13. Vriddha Jivaka, Kashyappa samhita,Siddhistana,chapter 1, sloka38,3rdedition,
Varanasi; chaukambha sanskrit samstan,P-149.
14. ShriMadhavakara,Madhavanidana,uttararda, chapter 34, sloka 9,editorProf
Yadunanda Upadhyaya, 26th edition,Varanasi; chakambha sanskrit sansthan, 1996,
P- 26.
15. Agnivesh,charaka samhita, sutrastana, chapter 23, sloka 6, Pt Kashinatha Shastri and
Dr. Gorakhanath chaturvedi editor. 17thedition. Varanasi; chaukhamba bharati
academy, 1991, P- 436.
16. Vagbhata, Astanhga Hridaya, Sutrasthana, chapter14,sloka 36, Dr Indradev Tripathi
and Dr Srikanth Tripathy editor, 1st edition,Varanasi; krishnadas academy,1994,
P-152.
17. Agnivesh, Charakasamhita, Siddhistana, chapter 10, sloka 24,Acharya Vidyadhar
Shukla and Prof. Ravi Dutt Tripathi editor. 17thedition. Varanasi ;chaukhamba
sanskrit pratishthan, reprint edition 2007. P- 966.
18. Vagbhata,AstanhgaHridaya,Sutrasthana, chapter5,sloka 56, Dr Indradev Tripathi
and Dr Srikanth Tripathy editor. 1stedition. Varanasi; krishnadas academy,1994,
P-44
19.Agnivesh,charaka samhita, sutrastana, chapter 20,sloka 17, editor pt Rajeshwara Datta
shastri, Reprint,varanasi; chaukhamba barati academy , 1998, P- 275.
20. Agnivesh,charaka samhita, sutrastana, chapter 23,sloka 06, editor pt Rajeshwara
Datta shastri, Reprintvaranasi; chaukhamba barati academy , 1998, P- 296.
21. Agnivesh,charaka samhita, sutrastana, chapter 16,sloka 13-16, editor pt Rajeshwara
Datta shastri, Reprint ,varanasi; chaukhamba barati academy , 1998, P- 224-225.
22. Sushrutha,sushruta samhitha,sutrastana, chapter 15,sloka 37,editor Kaviraja
Ambikadatta Shastri,14th edition, Varanasi; chaukambha sanskrit sansthan , 2003,
P- 62.
23. Vriddhavagbhata,Astangasangraha,sutrastana, chapter 19,sloka 26,Editor Dr.Ravi
dutt Tripathy,Delhi; chaukambha sanskrit pratistan, 1992,P- 368.
24.Vriddhavagbhata,Astangasangraha,sutrastana, chapter 24,sloka 23-27,Editor
Dr.Ravi dutt Tripathy,Delhi; chaukambha sanskrit pratistan, 1992,P- 437-438.
25. Vriddha Jivaka,Kashyappa samhita,sutrastana,chapter 28,sloka 6, edition,Varanasi,
chaukambha sanskrit sanstana, P- 48.
26. Bhelaacharya,Bhela samhita sutrasthana, chapter 11,sloka 10, editior prof.
Priyavrutsharma ,Reprint,Varanasi,Chaukhamba vishvabhavati,2005,P-52.
27.Shri Madhavakara, Madhava nidana , Part 2 , chapter 34,sloka 4, editor
prof.Yadunanda Upadhyaya,Reprint, Varanasi ,Chakambha Sanskrit samsthan,2005,
P-28.
28.Sharangadhara, Sharangadhara samhita,Prathama-khandha, chapter 7, sloka 65,
4thedition , Varanasi, chaukambha orientalia,2001,P- 37.
29.