“Study the efficacy of Gandharvahasthadi Kwatha in the management of Grudhrasi ”

By

Dr. Christy J Thundiparambil M.D.(Ay)

Under the guidance of

Vaidya Pramod .V.Kulkarni MD (Rogvidhyan )& MD (Kayachikitsa)

Reader,

Department of panchakarma,

Rashtriya shikshan Mandal’s

Tilak Ayurveda mahavidhyalaya,

Rasta peth, Pune.

CONTENTS

Aims and objectives Introduction Review of literature

Disease review Drug review Clinical study Observations Results Discussion Conclusion Summary

Aims and objectives AIM OF THE STUDY Study the efficacy of Gandharvahasthadi Kwatha in the

management of Grudhrasi.OBJECTIVES1) Establish efficacy and safety of Gandarvahasthadi kwatha, as trial

drug in the management of Grudhrasi.2) Study the Vatahara, Agnideepana, Malashodhana properties of

Gandarvahasthadi kwatha in the management of Grudhrasi.3) Detailed study of the individual drugs.4) Detailed analytical study of the Gandarvahasthadi kwatha. HYPOTHESIS:Null Hypothesis – Gandarvahasthadi kwatha doesn’t have

Grudhrasihara property,when administrated internally in case of Grudhrasi.

Alternate Hypothesis - Gandarvahasthadi kwatha when administrated internally in case of Grudhrasi have Grudhrasihara property.

Part 1. Literary reviewChapter1. Disease review of Grudhrasi

A. Historical Review B. Vyutpathi,Nirukthi &Paribhasha C. Paryaya and Bheda D. Nidana Panchaka

Chapter 2. Modern Disease Review A. Anatomy of Vertebral Column B. Vertebral Column Injuries C. Anatomy of Disc D. Degenerative Disc Diseases E. Anatomy of Sciatic Nerve F. Etiology of Sciatic Neuralgia G. Specific Tests for Sciatica

Chapter 3. Management Of Sciatica

A. Naturopathy in Sciatica

B. Acupressure in Sciatica

C. Acupuncture in Sciatica

D. Diet Therapy

E. Homeopathy in Sciatica

Chapter 4. Ayurvedic Management Of Grudhrasi

A. Principles of treatments

B. Shamanoushadhi

Part 2 Drug study Chapter1. Identification Chapter2. Preparation and standardization of the

medicine Chapter3. Individual drug study

A. Gandharvahastha/ErandaB. ChirabilwaC. Hutashwa/ChitrakaD. Vishwa/ShuntiE. Patdhya/HareetakeeF. PunarnavaG. YavasakaH. Bhoomithalam/Musali

Part 3 Clinical study

Chapter 1- Methodology of the study Chapter 2- Observations Chapter 3- Results Chapter 4- Discussion Chapter 5- Summary Chapter 6- Conclusion

Clinical trial

Prospective open labeled controlled clinical trial

Screening of subjects for inclusion

Initial assessment

Gandharvahasthadi kwatha

Assessment at before, intervals of 15days, And after follow-up

Statistical assessment

Overall assessment

Conclusion

Study design

CLINICAL WORKProspective open labeled clinical trial on Grudhrasi with

Gandhrvahasthadi Kwatha

1) Treatment Schedule Trial group

100 patients were given Gandharvahasthadi kwatha Dosage : 50 ml twice daily Timing : Morning 6-am & evening 7pm ½ hour before

food Anupana : Gula and Saindhava

2) Place of Study(a) Center for post graduate studies and research in Ayurveda, Tilak Ayurveda Mahavidhyalaya, Rasthapet, Pune (b) Nangelil Ayurveda Medical College Hospital,

Nellikkuzhi,kothamangalam,ernakulam,kerala.

3) Study patterna) 30% patents were taken at Saith Tharachand Hospital Rasthapeth, Pune.b) 70 % patents were taken at Nangelil Ayurveda Medical College Hospital, Nellikkuzhi, Kothamangalam, Ernakulam, Kerala.

4) Duration of the study – 45 days5) Follow up period

Every 15 days, 30 th day and 45 th day after the treatment

MATERIAL AND METHODS 1. Study population

All patients attending Kayachikitsaout patient department with cases of Grudhrasi.

2. Sampling method and sample size All Grudhrasi patients were selected as per exclusion and inclusion criteria,100 patients were selected.

INCLUSION CRITERIA Patients of both sex with the age group between 18-60

years Grudhrasi diagnosed on the basis of signs& symptoms

described in Ayurveda Patients with a positive SLR test.

EXCLUSION CRITERIA Congenital Deformities Disease developed due to any post surgical

complications. Grudhrasi due to IVDP with bowel and bladder

involvement. Patients suffering from other systemic diseases like

Renal failure, Vertebral T.B, Diabetes, Neoplasm. Patients with R A test are positive During pregnancy, lactation period & during breast

feeding

STATISTICAL ANALYSISAll data were recorded before the treatment, after the treatment and after follow up. The mean, Percentage, S.D, S.E,t-Value(Paired t- Value) and P value were analyzed statistically using student ‘t’ test. The total result including the over all effect of the therapy is presented in tables

ASSESSMENT OF THE OVER ALL EFFECTThe overall effects of therapy is assessed in the following mannerUnchanged - Less than 25% relief in the complaintsMild Improvement -More than 25% and up to 50% relief Moderate Improvement - More than 50% and up to 75% relief

along with improvement in SLR testMarked Improvement - More than 75% relief as well as

significant improvement in SLR testComplete Relief - 100% relief in the complaints along with

best S.L.R. test

RESULT & SUMMARY

1)Effect of Gandharvahasthadi Kwatha on mainsymptoms of 100patients of Grudhrasi after 45 days of treatment.Gandharvahasthadi Kwatha provided highly significant relief( P<0.001 ) for all symptoms, %of relief for the symptoms are given as belowIn Sthambham by 50.00%, in Ruk and Gruhnam by 80.00% each, in Todam it was 78% 75%relief shown in Spandanam.

2)Effect of Gandharvahasthadi Kwatha on main symptoms of 100 patients of Grudhrasi after Follow up.

Gandharvahasthadi Kwatha provided highly significant relief ( P<0.001 ) for all symptoms%of relief for the symptoms are given as belowIn Sthambham by 60.00%. In Ruk by 90.00% In Todam, Spandanam and Gruhnam, by82%,81%&85% respectively.

In short after follow up the percentage of relief was increased in all the main symptoms and the trial drug Gandharvahasthadi kwatha is providing long lasting result

3)Effect of Gandharvahasthadi Kwatha on associated symptoms of 100 patients of Grudhrasi after 45days of treatment.Gandharvahasthadi Kwatha provided highly significant relief(P<0.001)) in all symptoms

%of relief for the symptoms are given as below In Aruchi by 40.00%,

In Gouravam and Tandra,by 30% & 36.36% respectively

4)Effect of Gandharvahasthadi Kwatha on associated symptoms of 100 patients of Grudhrasi after Follow upGandharvahasthadi Kwatha provided highly significant relief (P<0.001) in all symptoms

%of relief for the symptoms are given as belowIn Aruchi, Gouravam and Tandra by 72.00%, 80% and 72.72.% respectively.

In short the trial drug is relieving the associated symptoms after therapy and follow-up. This is clear that the trial drug Gandharvahasthadi kwatha is providing long lasting result.

5)Effect of Gandharvahasthadi Kwatha on SLR test of 100 patients of Grudhrasi after 45days of treatment.Gandharvahasthadi Kwatha provided highly significant improvement (p<0.001) in patients suffering from positive Right and Left leg S.L.R.Test ,where as moderately significant improvement (P<0.010) was achieved in those patients suffered from positive S.L.R test of both legs

%of relief for the SLR Test are given as belowIn positive Right and Left leg S.L.R.Test by 50 %&51.16% respectively, Positive S.L.R test of both legs is by 41.17%.

6)Effect of Gandharvahasthadi Kwatha on SLR test of 100 patients of Grudhrasi after Follow upGandharvahasthadi Kwatha provided highly significant improvement(P<0.001) in patients suffering from positive Right leg Left leg S.L.R.Test and for those patients suffering from both legs

%of relief for the SLR Test are given as below In positive Right and Left leg S.L.R.Test by75%&76.74%

respectively. Patients suffered from positive S.L.R test of both legs by 64.70%.

7)Comparative effect of therapies on main symptoms of 100 patients of Grudhrasi after 45 days of treatment and after follow up (in % wise of relief)

50

60

80

90

7882

7581 80

85

0

10

20

30

40

50

60

70

80

90

100

sthambham ruk todam spandanam gruhnam

after treatment

after follow up

8)Comparative effect of therapies on main symptoms of 100 patients of Grudhrasi after 45 days of treatment and after follow up (in statistical way )

The Sthambham shown moderately significant (p-value <0.010) results which means after follow up the result of the treatment is better than the result after the treatment period.

While other symptoms, shown in significant result (P>0.100) from this data it is clear that, the treatment shown not significant improvement after the follow up period than the therapy time.

From the statistical studies it is clear that the trial drug Gandharvahasthadi Kwatha provided long lasting results on the main symptoms even after the follow up period ie, the results obtained during the treatment period were well maintained.

9)Comparative effects of therapies on the associated symptoms of 100 patients of Grudhrasi after 45 days of treatment and follow up(in % wise of relief)

40

72

30

80

36.36

72.72

01020

304050

607080

90100

aruchi gouravam tandra

after treatment

after follow up

10)Comparative effects of therapies on the associated symptoms of 100 patients of Grudhrasi after 45 days of treatment and follow (in statistical way )

Aruchi shown Highly significant (p-value <0.001) results which means after follow up the result of the treatment is better than the result after the Treatment period.

While other symptoms, shown in significant result (P>0.100) from this data it is clear that the treatment shown not significant improvement after the follow up period than during therapy time.

From the statistical studies it is clear that the trial drug Gandharvahasthadi Kwatha provided long lasting results on the associated symptoms even after the follow up period ie, the results obtained during the treatment period were well maintained.

11)Comparative effect of therapies on the S.L.R. Test of 100 patients of Grudhrasi after 45 days of treatment and follow up (in % wise of relief)

50

75

51.16

76.74

41.17

64.7

0

10

20

30

40

50

60

70

80

90

100

rt leg lt leg both legs

after treatment

after followup

12)Comparative effect of therapies on the S.L.R. Test of 100 patients of Grudhrasi after 45 days of treatment and follow up (in % wise of relief)

Left leg , SLR Test Positive shown Highly significant (p-value <0.001) results which means after follow up the result of the treatment is better than the result after the Treatment period.

While Right leg and Both legs SLR Test Positive shown in significant result (P>0.100) from above data it is clear that the treatment shown not significant improvement after the follow up period than the therapy time

From the statistical studies it is clear that the trial drug Gandharvahasthadi Kwatha provided long lasting results on the S.L.R.Test even after the follow up period ie, the results obtained during the treatment period were well maintained.

TRIAL DRUG

The ingredients of trial drug Gandharvahasthadi kashaya are Gandarvahastha, Chirabilwa, Hutaswa, Viswa, Pathya, Punarnava, Yavasaka, and Bhumithala.

“Gandharvahastha chiruvilwa huthaswa viswa| Patdhya punarnava yavashaka bhoomithalai: || Kwatha:sasaindhavagulampavanasyashanthair| Vahnerbalaaya ruchaye malasodhanaya||” (SAHASRAYOGA )

Reference : SAHASRAYOGA Context : Vatavikara, kashayayoga Anupana : Saindhava & Gula

chirubilwa

ch

viswa

pathyapunarnava

yavasa

bhoomithala

Gandharva hastha

PROPERTIES AND ACTION OF INDIVIDUAL DRUGS

Drug name Rasa Veerya Vipaka Guna Karma

Eranda Madhura, Katu, Thiktha

Ushna Madhura Snigdha, Theekshna, Sookshma, Guru

Kapha Vata Shamaka, Shoola hara, Angamarda Prasamana, Deepana,Bhedana, RechanaVataghna, ParswaShoolaghna

Kateeshoolaghna.

Chirabilwa Tiktha, Kashaya

Ushna Katu Laghu,

Rookha

Deepana,

Paachana, useful in inflammations, dyspepsia, flatulence, rheumatism

Hutashwa Katu Ushna Katu Laghu, Rookha, Theekshna

Kaphavatahara,

Deepana,PaachanaArshoghna,Thripthikhna & Shoolaghna

Drug name Rasa Veerya Vipaka Guna Karma

Vishwa Katu Ushna Madhura Laghu

Snigdha

Deepaka,Paachaka, Ruchya, Kaphavatashama Swarya,Shothahara,

Vedanasthapana,Truptigna

Patdhya Madhura, Amla, Katu,Tiktha, Kashaya

Ushna Madhura Laghu, Rooksha

Anti inflammatory.It is mild laxative.

Prabhava of Hareetaki is

Tridosha Shaamaka

Punarnava Tiktha Ushna Katu Laghu, Rooksha

Kaphapittahara

Sothahara & Visaghna.

It is effectively in dysuria, fever, anemia and colic

Yavasaka Madhura, Tiktha, Kashaya

Sheetha Madhura Laghu, Snigdha

KaphapitaShamaka

Sodhahara,Jwaraghna,

Vedanasthapana, Vrushya

and Medohara

Musali Madura Sheetha Madura Guru, Snigdha

vatapitta Shamaka,

Snehana, Mutrajanana, Balya & Vrushya

1)The trial drug as such provided mild laxative effect which will lead to the vatanulomana.

The main drugs which help for that are gandharvahastha, hareethakee, chirabilwa & punarnava.

These all drugs are ushna veerya drugs. Thus these three drugs act both prakruthivighata and apakarshana drugs in the management of grudhrasi.

2)The drugs like chitraka & shunti are helping to do the deepana pachana of the kapha dosha which causes the srotorodha, and leads to srotoshodhana

These drugs mainly helpful for the vatakapha type of grudhrasi. These drugs are having ushna veerya ,ushna & theeshna guna. Thus these drugs also act as both prakruthivighata and apakarshana drugs in the management of grudhrasi.

MODE OF ACTION OF TRIAL DRUG

3)The drugs yavasa and musali along with hareethkee punarnava and shunti having brumhana property thus leads to the dhatuposhanam, as a result vatashamana occur. Thus these drugs act as prakruthivighata drugs in the management of grudhrasi

4)Almost all the drugs have the qualities like shoolahara, vedanasthapana, deepana , pachana, ruchya, malasodhana as well as vathashamana property by there combined action to get the vatha dosha anulomanam.

5)Deepana, pachana, chedana properties help the drug to do srothoshodhana thus it helps to relieve vatakopa developed due to the margavarodha by kaphadosha –vatakapha grudhrasi

6)Malashodhana property helps the vathanulomanam which ultimately helps to relieve vatakopa and thus it relieves pain

The above mentioned combined or synergic action of all the ingredients help the trial drug Gandharvahasthadi Kwatha to do the effective management in the progression of both type of Grudhrasi ie VATHIKA and VATHKAPHAJA

CONCLUSION

Grudhrasi affects persons of any age group, even though the incidences were more in the age group of 40-50 years.

Chronicity of the disease was definitely affecting the strength of the patient as well as the prognosis.

Nidana parivarjana have a major role in controlling the progression of this disease and hence as a first step, a strict advice against hard work, continuous sitting etc. has been given.

The trial drug of Gandarvahasthadi kwatha has a prime role in the management of Grudhrasi by Srotovisodhana, Pachana, deepana, rochana, malasodhana, vatanulomana and Dhatuposhana.

The medication with the trial drug of Gandarvahasthadi kwatha showed significant improvement in the SLR test and did not have any untoward effect on the patients.

The trial drug of Gandarvahasthadi kwatha provided

long lasting result on almost all the complaints which was well appreciated during the follow up period.

The study revealed that results are statistically significant in the management of both vatika and vatakaphaja types of grudhrasi