6. BRIEF RESUME OF THE INTENDED WORK
6.1 NEED FOR THE STUDY
Ayurveda as a comprehensive health system is gaining incontrovertible acceptibility. Among which Panchakarma has got a great importance. Panchakarmas are shodhana procedures, where if doshas are in prabhuta avastha they are expelled out through the nearest route. Virechana karma is one of the supreme shodhana modality which is for elimination of vitiated pitta dosha from the body.
The disease Pandu is considered as a Sautarpanajanya and Rasapradoshaja vyadhi. In this Virechana karma is considered as supreme treatment modality as it is Pitta pradhana vyadhi. Here raktalpata, Pandu varnata and dourbalyata are the main signs and symptoms which strikingly resembles with “Anaemia’’ of modern science, where there reduction in hemoglobin concentration and number of RBC’s per cu. mm. of blood and paleness is the main pathognomonic.
Globally 30% of total world population are anaemic, anaemia is probably as old as human kind itself and very much prevalent in developing countries like India. It is not merely due to the lack of resources but other poverty related factors such as illiteracy, superstition also have a role.
Its known factor that complete cure to this illness is remote possibility, but when utklishta doshas are expelled out by the process of shodhana, chances of recurrence are less. As Pandu roga has pittapradhanatha Virechana karma plays a major role which comes under langhana and apatarpana chikitsa. Because of this reason Panduroga was selected to assess the efficacy of Virechana karma with two different yogas as a comparative study.
As yogas like Vyoshadhi gutika and Dantihareetaki lehya are strikingly indicated in Panduroga and are considered as shreshta for Virechana karma in Charaka samhita, these are selected for the present study.
6.2 REVIEW OF LITERATURE
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Removal of doshas through the adhobhaga is called as Virechana.
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Virechana karma is indicated in all pittajanya, pittapradhana and pittasthanagata vyadhis. As Pandu roga is pitta pradhana vyadhi, virechana karma plays a major role.
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In saadhya Panduroga, snehanartha gritha is advised, followed by urdhwa and adho shodhana.
So Virechana is considered as a line of treatment for Pandu roga as it is pittapradhana tridoshaja vyadhi.
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Symptoms of pandu roga are pallor, weakness, fatigue, hampered digestive fire, exertional dyspnoea, palpitation, etc
Clinical features of Anaemia 6:
Fatigue, lassitude, breathlessness exertion, palpitation, audible pulse in the ear particularly in bed, anorexia, dyspepsia, dizziness, dimness of vision, headache, insomnia and paraesthetic in the fingers and toes.
Signs :
Pallor of skin, mucus membrane, tachycardia, cardiac dilation, systolic murmurs, and in severe cases oedema of ankles.
As there are many yogas mentioned, dantihareetaki lehya4 and vyoshadhi gutika1i are selected for Virechana karma.
· Dantihareetaki lehya indicated in Pandu roga. In this yoga, dantimoola, chitrakamoola, hareetaki, trivrit choorna, pippali, shunti, tila taila, chaturjatha and guda are main ingredients.
· Vyoshadhi gutika reference we can get from Charaka samhita in kalpasthana1i, the ingredients are vyosha, twak, patra, musta, ela, vidanga, amalaka, abhaya, danti, trivrit and sharkara.
· These drugs are having paachana, chedana, lekhana, anulomana and rechana properties also these yogas are shreshata for Virechana karma.
PREVIOUS WORK DONE : 5
· 1987; Dr. Raval.K.R, Study of Virechana Poorvaka Snehana in Panduroga, Dept.of K.C, Ahmedabad.
· 2000; Dr. Jain Sangoota. A study on Panduroga w.s.r to Anaemia and its management with shodhana and Yogaraja Rasayana. Dept.of Vikrit Vignana, Jamnagar.
· 2003; Dr. Shaila Gurappa, Clinical evaluation of Virechana therapy in the Management of Panduroga ,RGUHS.
· 2006; Dr. Biradar Rajeshwari, To assess the effect of Virechana in Pittaja Pandu, Bijapur, RGUHS.
6.3 OBJECTIVES OF THE STUDY
· To evaluate the efficacy of Virechana karma with Vyoshadi gutika in Panduroga.
· To evaluate the efficacy of Virechana karma with Danti Hareetaki lehya in Panduroga.
· To compare the efficacy of Virechana karma with Vyoshadi Gutika and Danti Hareetaki lehya in Panduroga.
7. MATERIALS AND METHODS:
7.1 SOURCE OF DATA
Patients diagnosed with Panduroga will be taken for the study from O.P.D and I.P.D section of SJIIM Hospital, Dhanwantari Road, Bangalore.
7.2 METHOD OF COLLECTION OF DATA:
30 Patients fulfilling the inclusive criteria will be selected irrespective of sex, religion, marital status, socio economic status are randomly distributed.
A) DIAGNOSTIC CRITERIA:
· Presence of signs and symptoms of Panduroga that include Pandu varnatva, Hridravatva, Balahani, Shrama, Arohanayasa.
· In anaemia, Hb gm%, TC, DC, ESR.
B) INCLUSION CRITERIA:
· Patients fit for Virechana karma.
· Patients of both sex between age group of 18 to 60 years.
· Patients presenting with the classical signs and symptoms of Panduroga.
· Patients with Hemoglobin concentration of above 8 gm% and below the lower limit of the normal range for the age and sex of individual.
· According to the WHO criteria, anemia was defined as a hemoglobin concentration below 12 g/dL in women and below 13 g/dL in men. 8
C) EXCLUSION CRITERIA:
· Patients not fit for Virechana.
· Age group below 18 and above 60 years.
· Patients with severe Anaemia due to and associated with systemic disorders.
· Hereditary disorders like Thalassaemia, Sideroblastic anemia etc.
· Hemorrhagic diathesis like Hemophilia, ITP, Vit.K deficiency etc.,
D) ASSESSMENT CRITERIA:
The assessment will be made based on following subjective and objective parameters.
Subjective parameters / Objective parametersPanduvarnatva / Hb gms%
Hridravatwa
Dourbalyatha
Shrama
Arohanayasa
Both subjective and objective parameters will be given with suitable gradings and evaluated and statistically analysed before and at the end of the treatment.
Study DESIGN:
Total 30 patients selected will be divided randomly distributed between each group ‘A’ and group ‘B’ with 15 patients in each group. Procedure for both the groups ‘A’ and group ‘B’ will include Poorva, Pradhana and Paschat Karma
Group A / Group BPoorva Karma / Deepana Pachana with Jeerakadi choorna7. 3g bid. till nirama lakshanas are seen / Deepana Pachana with Jeerakadi choorna. 3g bid. till nirama lakshanas are seen
Snehapana with Kalyanaka ghrita1h in Arohana krama depending on Koshta till samyak snigdha lakshana / Snehapana with Kalyanaka ghrita1h in Arohana krama depending on Koshta till samyak snigdha lakshana
Abhyanga with Murchita tila taila followed by Ushnajala snana for 3 days / Abhyanga with Murchita tila taila followed by Ushnajala snana for 3 days
Pradhana Karma / After Abhyanga and ushnajala snana,the very next day,Vyoshadi gutika will be given for the purpose of Virechana.
Dose:20-40grams.(depending on koshta) / After Abhyanga and ushnajala snana,the very next day,Danti Hareetaki lehya will be given for the purpose of Virechana.
Dose:1-2karsha.(depending on koshta)
Paschat Karma / Samsarjana krama depending on shuddhi / Samsarjana krama depending on shuddhi
Follow up STUDY:
After completion of Virechana karma follow up of patients will be done for 14 days, patya-apatya will be advised for both groups during this period.
Total study duration: 30 days.
CRITERIA FOR THE TOTAL EFFECT OF THERAPY
Total effect of therapy will be assessed in terms of marked response, moderate response, and mild response and unchanged.
Marked response: When the relief is partially observed above 70% in both signs and symptoms are considered as marked response.
Moderate response: When the relief is about 50-70% of both signs and
Symptoms considered as moderate response.
Mild response: When the relief is about 30-50% in signs and symptoms are stated as mild response.
Unchanged: When the relief is found below 30% will be considered as unchanged.
7.3 INVESTIGATIONS
Hb gm%
TC
DC
ESR
FBS
PPBS
Urine for Sugar, Albumin and microscopic
Stools ova, cyst and microscopic.
Other investigations if necessary.
7.4 Whether the ethical clearance has been obtained from the institution?
Yes
8. BIBLIOGRAPHY
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· 1a Sutrasthana 22nd Chapter Shloka No.18, Page No.121.
· 1b Sutrasthana 23rd Chapter Shloka No.05, Page No.122.
· 1c Sutrasthana 23rd Chapter Shloka No.26, Page No.123.
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· 1f Chikitsasthana 16th Chapter Shloka No.13-16, Page No.527.
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8. http://jama.ama-assn.org/content/281/18/1714
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