INDEX

Sr. No. Topics Page No.

1 Introduction 1-2
2 Aims And Objectives 3-3
3 Review of Literature 4-100
A. Historical Review 4-7
B. Previous Work Done 8-9
C. Disease Review 10-58
D. Drug Review 59-100
4 Materials And Methods 101-109
5 Observations And Results 110-144
6 Discussion 145-163
7 Conclusion 164-164
8 Summary 165-166
9 Annexure 167-186
A. Abbrivations 167-168
B. References 169-173
C. Bibliograpy 174-176
D. Consent Form 177-177
E. Case Record Form 178-183
F. Master Charts 184-186

0
 INTRODUCTION

The terminology or Nirukti of word Kamala is_

“ÌuÉÌuÉkÉÉlÉ MüÉqÉÉlÉ sÉÉÌiÉ MüÉqÉsÉÉ |”

Means a disease in which there is loss of desire of doing work,

eating etc. It can be called as „Severe Anorexia or malaise‟. To be more
specific Kamala Vyadhi can be defined according to Ayurveda text as as-
“WûËUSì lÉå§É: xÉÑpÉ×zÉÇ WûËUSìiuÉQèlÉZÉÉlÉlÉ: |” which means the disease which is

characterized by yellowish discoloration of sclera, urine, faeces, skin and

face (buccal cavity) due to increased billurubin level in blood and it is
called as Jaundice/ Icterus.
Bahupittakamala as the name suggest it is a Pitta Pradhan Vyadhi
and its Udbhav sthana is Yakrut. It shows similarity with signs and
symptoms of Hepatocellular Jaundice like loss of apetite, malaise,
abdominal pain, fatigue etc. This Hepatocellular Jaundice is an initial of
Infectitious disease of liver i.e. Hepatitis.
The main constituents of Kamala i.e. Samprapti Ghatak are Rakta
and Ranjak Pitta. Both of these reside in Yakrut i.e. liver. So, while
enlisting the causes of Kamala, we can take into consideration all the Pitta
Prakopaka and thus -Rakta dushtikara Hetus. Katu-Amla-Lavan Rasa &
Kshar dravyas are mainly responsible for vitiation of Pitta Dosha.
As far as today‟s lifestyle issues and circumstances are considered,
hot and humid environment, contaminated food and water consumption,
Alcohol abuse are seem to be common. Owing to lots of complexities
breed by modernization, unfortunately this is causing various hazardous
disorders to the mankind. Bahupittakamala is one of the hazardous
disorders emerging out of these grounds.
The 21st century, the vast era of Globalization and Industrialization,
has changed everything related to the lifestyle, Healthcare, thinking
attitude. So, man has started to keep earning money at first preference
while learning about health care and health issues at the least preference.

1
 Therefore, there is lack of concern about „Dincharya and
Rutucharya‟. Irregular times of taking meal i.e. Adhyashan, Samashan,
Atitkal bhojan, Vishamashan and Ati Katu-Amla- Lavan rasa sevan like
Vada-pav, missal, Noodles and road side food items, increased alcohol
consumption, increased krodha due to stress full life, all these are
responsible for vitiation of Pitta Dosha by causing increased Dravta,
Tikshanata, Sarta Guna of Samyaka Pitta. Hence, most of the population
suffers from Agnimandya, Aruchi, Fatigue, and Nervousness which are the
common symptoms of any Pittaj Vyadhi.
In Ayurveda, „Kamala‟ vyadhi is known from Ancient times i.e. Right
from vedik kala. Aacharyas of Bruhatrayi i.e. Charaka, Sushruta and
Vagbhata had explained‟ Kamala‟ as „Pravardhaman avastha‟ or „updrava
of Pandu vyadhi‟. Also at the same time „Kamala‟ is explained as
„Swatantra vyadhi‟.
The liver plays major role in the maintenance of metabolic
Homeostasis. The development of clinically important liver disease is
accompanied by diverse manifestation of disordered metabolism. Jaundice
is a Hallmark symptom of liver disease and the most reliable marker of
severity.
In the present study, selection of Vasadi kwath from
Ashtanghrudayam is done on the basis of the fact that these ayurvedic
herbs act on the root of disease i.e on Vitiated pitta dosha by their
Madhur-Tikta rasa, sheeta virya and are Mrudu virechana, Rakta
prasadana, saraka and thus Pitta shamaka. Pathya –apathya also plays an
important role since they regulate Aahara- vihara and dincharya. Also,
this herbal preparation is cost effective,as per socio-economical status of
the patient.

2
 AIMS AND OBJECTIVES

AIMS:

1. The study of effect of Vasadi kwath in the management of Bahupitta

kamala (Hepatocellular Jaundice).
2. To provide easy drug administration and best remedy that acts on
the root of Kamala Vyadhi.

OBJECTIVES:

1. To study the disease Bahupitta kamala and Jaundice.

2. To assess the efficacy of Vasadi kwath in Bahupitta kamala.
3. To evaluate the efficacy of Darvi kwath in Bahupittakamala.
4. To comparethe effects in these two groups.

3
 REVIEW OF LITERATURE

Kamala is known to Indians since ancient times, so before preceding

the detail subject it will be very worth to have a brief idea about historical
review of Kamala Vyadhi in order to understand it in a better way.

A. Historical review of Kamala Vyadhi:

Historical review had been classified into 3 kalas as follows_

A.VEDIC KALA: (4000BC-6000BC)

Since Vedic times Kamala can be seen in recorded form.Vedas are
proved to be the oldest testimonials of information regarding diseases and
medicinal plants. Vedic literature states the grave nature of this disease
presenting it with numerous synonyms.

1. RUGVEDA:
In Rugveda, in one of its hymn referring to the submission to
remove Hariman, mentioned prayer of Surya (God sun) i.e. to remove
yellowish pigmentation and make the complexion normal. So, word
“Hariman” refers to kamala in Rugveda. In Puranas, word Harima is used
as synonym of kamala which depicts greenish discoloration of body.

AlÉÑxÉÑrÉïprÉÑSiÉÉÇ.............................WûËUqÉÉ cÉ iÉå

(Ref. – Rigveda 150-11)

2. ATHARVAVEDA:
Atharvaveda is the most important and authentic source of
Ayurveda. Ayurveda is the upaveda of Atharvaveda.In Atharvaveda, the

4
word “Harima” refers to Kamala – It is so because all the body becomes
Haridravarna in Kamala Vyadhi.
(Ref. – Atharvaveda 1.22-1)

In Suryakiran chikitsaPrakaran of Atharvaveda „Hrudroga‟ and

„Kamala‟ were described together.

B.SAMHITA KALA: (200BC-400AD)

This can be called as scientific age of Indian medical system. In this
period “Bruhatrayi” i.e. Charaka, Sushruta & Vagbhatta had explained
Kamala in details in their different Adhyayas.

1. CHARAK SAMHITA: (2000 BC) Aacharya Charaka had given

detailed description about Kamala in the context of Pandu roga:

* Sutrasthana:
Kamala as swatantra Vyadhi (Ad. No. 19)

* Chikitsasthana
 Kamala as Pravardhamana avastha of Pandu Vyadhi in
Chikitsasthana(Ad.No-16)
 Nidanas, Lakshanas,Prakaras,Samprapti of Kamala.
 Under Chikitsa, he explained mrudu virechana and shaman
chikitsa with various kalpas.
 Charaka described that kamala becomes Kumbhakamala if it is
not treated properly.

2. SUSHRUTA SAMHITA: (2nd century)-(1000BC-500AD)

In Uttartantra (Ad.No-44) - Kamala is mentioned as synonym of

Pandu roga. Aacharya Sushruta described kamala vyadhi as the “Updrava
of Pandu” as well as other Vyadhi‟s also.

5
 In the same context description of liver and spleen is found.
„Kamala‟, „Panaki‟, „Kumbhavhaya‟, „Lagharaka‟, „Alasakhya‟ are
synonyms given by Sushrutacharya.
 Lakshanas & chikitsa are also explained in Ad No. 44. Sushruta
commentator Dalhanacharya explained that, Kamala can occur.
a) Amante- Due to Ama
b) Pandu Rogante- At the end of Pandu Vyadhi
c) Anya Rogante- At the end of other Vyadhi
Explaination about Raktavaha srotodushti and its chikitsa also
mentioned there.

3. ASHTANGA SAMGRAHA AND ASHTANG HRIDAYA:

Followed by the views of Charaka and Sushruta, Vagbhatacharya
described 4 types of Pandu and Kamala vyadhi –

In Nidansthana: Ad No. 13
“Lodhra” word is used for Kamala. He stated that Kamala can
appear at the end of Pandu Vyadhi and Kamala can also appear as a
swatantra vyadhi.
He explained that if Kamala is not treated properly, it turns into
Kumbhakamla. Even if not treated, then turns into Lodhar, Halimaka.

4. MADHAVANIDANA (700AD): Full description of Kamala-its stages

with Nidan, Rupa, and Samprapti is found in Madhavanidan.

5. SHARANGADHARA SAMHITA: (1400 AD)

Sharangadhara had described different types of Kalpas and
formulations for Kamala in the context of Pandu roga.

6. BHAVAPRAKASHA (1600AD):
In Bhavaprakasha Madhyam khanda, description of Kamala along
with Pandu is found.

6
7. HARITA SAMHITA (1400 AD):
He has described 8 types of Pandu, in which 2 types of Kamala and
Halimaka are mentioned.

8. YOGARATNAKARA (17th century AD):

He described Kamala vyadhi in swantantra adhyaya with
Nidanpanchaka.

9. BHAISHAJYA RATNAVALI (19th century AD):

Kamala has been mentioned in Pandu Rogadhikara.

C. ADHUNIKA KALA:
In this period of 18th century which is called as Adhunikakala, many
authors have compiled materials from classical texts.
Numbers of researches have been carried out on liver disorders and
their management.

7
PREVIOUS WORK DONE:

1. An etio-Pathological Study of Kamala-Chaturvedi Jyotsna, Banaras

Hindu University, Varanasi (B.H.U)-1992.
2. Clinical studies on the role of Amruta in the treatment of the
Kamala roga-Prasad Mahendra, Varanasi (B.H.U) -1996.
3. Clinical evaluation of some indigenious drug in the treatment of
Kamala roga, Gupa S.K., Banaras Hindu University, Varanasi
(B.H.U)-1998.
4. Clinical and experimental study on viral hepatitis (kamala) and its
management with an indegenious compound-Lavanya
V.K.M.Banaras Hindu University, Varanasi B.H.U-2001.
5. An experimental and clinical study on Hepatitis (Kamala) w.s.r.to
antioxident properties of some indegenious drugs-Seth Vijay,
Banaras Hindu University, Varanasi (B.H.U)-2002.
6. Clinical evaluation of Markanyadi Hima in the management of
kamala rog w.s.r.to Viral Hepatitis-Yadav P.S. Jaipur-2003
7. Effect of Darvyadi Choorna in kamala, Dr.B.K.R.R. Gov .Ayu.
College A.P.University, Pridhvi Raj,Vijayvada-2003
8. A comparative clinical evaluation of some Ayurvedic drugs in the
treatment of infective Hepatitis(Kamala) –Sisodiya V.K.
2004(B.H.U.)
9. Effect of phalatrikadi kwath in the management of Koshtha-
shakhashrit Kamala w.s.r.hepato-cellular jaundice.-Kaushik
Sandeep (A& U Tibia College Delhi University)
10. To study the effect of Dhatri Avaleha in the management of
Bahupitta Kamala (MUHS Nashik, 2012-13)
11. To assess the efficacy of phalatrikadi kwatha in the patient of
kamala special reference to hepatocellular jaundice(a clinical study)
tripathi R.I.,state ayurvedic college,lucknow-1984

8
12. A clinical study of Yogaraj rasayana in the patients of kamala
with spl. Ref. to hepatocellular jaundice. Mishra s.n- state ayurvedic
college, Lucknow.
13. Role of Kutaki yoga in the management ofkamala with spl.
Ref. to hepatocellular jaundice. Mahanty P. -Gopa bandhu ayurved
mahavidyalaya, Puri.
14. Effect of indigenous drug kutaki on jaundice- Pandey A.N,
BHU, Varanasi.
15. Clinical & conceptual studies on kamala roga & its treatment
with berberis aristate-adhikari b.m.das,university of Calcutta-1

9
DISEASE REVIEW:

AYURVEDIC ASPECT OF KAMALA VYADHI

KAMALA NIRUKTI (ETYMOLOGY):-
The compound word Kamla is developed as –“Kamam kantim harati,
Haridra varna lati iti Kamala” which means the disease in which desires
and Kanti (complexion) are abolished is named as Kamala. It is Pittaj
Nanatmaj vyadhi and Raktapradoshaja vyadhi.

Paribhasha:
The term Kamala can be defined as:
AjÉ MüÉqÉsÉåÌiÉ MüÉqÉzÉoS ArÉqÉç xÉÉkÉÉUhÉ zÉoS

ÌuÉzÉåwÉiÉ:xuÉsmÉ pÉ£üÉÌS AÍpÉsÉÉwÉ: mÉëuÉiÉïiÉå iÉÇ sÉÑlÉiÉÏÌiÉ MüÉqÉsÉÉ||

MüÉrÉqÉç qÉsÉÉrÉiÉå CÌiÉ MüÉqÉsÉÉ |

Disease in which mala is vitiated and denatured, and there is excess

accumulation of mala sthanas (purish, mutra, twak, nayanadi sthanas).
The term lunathi means nashta and kantim lunathi means a
pathological condition in which normal colour of skin is lost.Thus kamala
can be defined as a pathological state in which apetite for food is
diminished, all malas get vitiated and discolourated (peeta,haridra) the
whole body.

RACHANA SHARIR

YAKRITA SHARIRA

Since Yakrita is important avayaya in samprapti of Kamala and it is

a mula sthana of raktavaha strotasa. It is necessary to know yakruta
sharira in detailed as follows:

10
 VYUTPATTI :-
The term yakrit is formed from the root kru by prefixing
yamupasarg and suffixing tuk pratyaya.
 NIRUKTI:
Yam iti samyayam karoti, yaman iti niyamanam karoti iti kruth i.e.
samyayam karoti iti yakrit, implies one which controls. [1]

SYNONYMS OF YAKRITA:
Pinda (Su.U.6/14)
Prakasha (Visheshana) (Su.Ni.2/11)
Kaleyam

UTAPATTI OF YAKRUTA:
Yakruta is a Matrija Avayava. According to Ayurvedic embryological
consideration given by Sushruta (Su.Sha.4/25) [9] and Vagbhatta, Yakrut
isderived from the Accha portion of the fetal blood [1]. According to
modernEmbryology, the liver developes from hollow endodermal bud from
theForegutduring 3rd week of pregnancy, Hence the structure is soft,
wellorganized and secretary in nature.
Yakruta is formed from the Rakta dhatu from the beginning and also
it is mulasthana of Raktavaha strotasa. (Su.Sha.4/25)[9]

 STHANA OF YAKRUTA:

Aacharya Charaka mentioned Panchadasha Kosthangani and

included Yakrit in it (Cha.Sha.7/10). Also Aacharya Sushruta described
Yakrit as a part of Kostha. (Su.Sha.4/17)[7] and stated that Yakrit is
situated Adho-daskhintha (Interior and Rt. Side) to Hridya.
(Su.Sha.4/31)[10, 11]

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 RAKTAVAHA SROTAS AND RAKTADHARA KALA:
Since Formation of Rakta dhatu occurs in Yakruta by means of
RanjakaPitta. (Su.Su.21/10)[3] Yakrit is a Mulasthana of Raktavaha
srotasa (Su.Sha. 9/12[5], Cha.Vi.5/8 [4]. Yakruta is a site of Raktadhara
Kala. (Su.Sha.4/10-17)[7] Formation of Raktadhatu is done by
Raktadhara Kala.

CONCEPT OF RAKTOTAPATTI:
Rakta Dhatu is stated to be formed from ras dhatu through Dhatu
parinaman krama. (Cha.chi.15/16).
Three factors which participate in the formation of raktdhatu are
1. Rasagni
2. Raktagni
3. Ranjak pitta
Rasagni, Raktagni are the Dhatvagnis, which are specific in function
and are helpful in the formation of the respective Dhatus.Ranjak pitta is
located in Yakruta, Pleeha and Amashya (As.Hr.Su12)(Su.Su.21).
It has been stated that production of the Rakta dhatu takes place in
Raktavaha srotasa and the moola sthana of them is Yakrit and Pleeha
(Cha.Vi.5/8) [4]. Both Yakrit and Pleeha are also the sites of Ranjak pitta
and store houses of Rakta dhatu. As Kamla is a Rakta pradoshaj vikara,
Yakrita and pleeha are also involved in pathogenesis.

PANCHABHAUTIKATVA OF YAKRITA: - Yakrita is made up of 5 Pro-

elements (Mahabhuta)

1. Ghana bhaga is- made up of „Parthiva‟ elements.

2. Lymphatic & serum are- „Apya‟ in nature.
3. The colour & luster is due to- „Tejasa‟ elements.
4. Gatiswarupa functions are due to- „Vayu‟
5. The ducts and openings are- „Akasiya‟

12
RELATION BETWEEN TRIDOSHA & YAKRITA:

Actually, all 3 doshas are related to Yakrit but the original & basic
pitta dhatu is formed in Yakruta. (Su.Su.21/7)[1]
It is primary place of Ranjaka Pitta. This Ranjaka pitta is a creator
of Rakta Dhatu from Rasa dhatu. (Su.Su.21/10)[3]

RELATION BETWEEN DUSHYA & YAKRITA (DHATU)

Formation of Rakta dhatu takes place in Yakrita.Yakrita is formed

from Rakta dhatu and mula sthana of Rakta vahastrotasa is Yakrita
(Su.Sha.9/12) [5].

NIDANA PANCAKA OF KAMALA:

In order to understand pathophysiological aspect of a disease

hypothesis of Tridosha therapy had been put forth by Ayurvedic Acharyas.

Pitta dosha is considered to be of prime importance in kamala

vyadhi.Kamala is described in Raktavaha srotrodushti lakshana and
vyadhi of Raktavahastrotasa. (Cha.Su.28/11-13)

NIDANA PANCHAKA of Kamala is stated as follows:

A. NIDANA OR HETU (ETIOLOGY) :-

The factors which are responsible for pathogenesis of disease are
Nidan or hetu. The word nidana is applied for etiological factor of the
concerned disease. These factors bring out dosha imbalance and cause
disease.

13
 In Ayurvedic texts, various etiological factors of Kamala have been
mentioned by different aacharyas. They can be effectively assembled as
below:
1) Nij Hetu:

Koshthashakhashrit Kamla- Pittala ahar vihar sevan by Pandu rogi

or by any pittolbana purusha.
Shakhashrit Kamala– Guru, sheeta, ruksha and madhur
ahara sevan.

2) Agantu-Bhoot, Visha etc.

NIDANA OF KOSHTHASHAKHASHRITA (BAHUPITTA) KAMALA:

Since, Pittakara aahara-vihara is the main causative factor for

Kamala, have a brief look on Pittaprakopaka hetu.

Pittaprakopaka Aahara Dravya

Rasa: Katu-Amla-Lavana rasa
Kshara: kshara are known to be pitta and rakta dushtikara
param.
Guna: Ushna, Tikshna, Vidahi gunatmaka aahara
Types of aahara: Asatmya bhojana, Viruddha aahara, Mamsahara
(fish, mutton, chiken, aja, avi)
Fermented food: Idly, pav, dhokala, dosa, curd.
Fried food ietems: Shev, bhel, pickles, spicy food

 Nishpava, Mansha, Pinyaka

 Mrudabhakshana
 Harita varga: Shigru, yavani, Shaleya
 Shaka varga:Changeri, Chukrika
 All Madya( Alcohol)

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Manasa Hetu: Kama, krodha, chinta, bhaya, shoka, irsha

Vyasana: Alcohol, Tobacco chewing, Smoking, Tea, Coffeee

Vihara: Aatapa sevan, Rajo- dhoom sevan, Diwaswapa,

Ati vyayam-maithun-sharirik shrama, Veg
vidharana, Jagarana

Aushadhi: Ushna- Tikshna gunatmaka aushadhi like-

Chitraka, Maricha, Vacha, Rifampicin, Barbiturates

Kala: Sharada rutu, Madhyanha, Madhyaratri

Nidanarthakari vyadhi: Pandu, Amlapitta

NIDAN OF SHAKHASHRITA (RUDHAPATHA) KAMALA:

Intake of Guru, sheeta, ruksha aahara and madhura rasa
Ativyayama, Vegavidharana. (Cha. Chi.16/125) [13]
Kamla is rakta pradoshaj vyadhi.(Cha.Su.28/11-12) And it is due to
raktvaha srotodushti respectively.(As.Hr.Su.11/8-9) Etiological factors
causing rakta dushti are almost similar to that of the pittaprakopaka hetu,
which causes Kamla.The above mentioned Nidanas causes pittaprakopa
and thus rakta dushti.When rakta is vititated the srotas through which it
circulates also gets vititated ultimately leading to vitiation of the
mulasthanas i.e. Yakrit and Pleeha and causing Kamla.Thus the Nidanas
of rakta dushti also causes Kamla.(Cha.Vi.5/10)

15
 B. PURVARUPA :-
Purvaroopa marks the Sthanasanshraya awastha of dosha. These
are the prodromal symptoms that occur in rudimentary form before
complete manifestation of disease. This means that causative factor
(guna vishesha) of the dosha is not clear as yet. So some of the signs
occur fully or with a lesser intensity at this stage which is known as
purvarupa (Premonitory symptoms) of the disease.
Specific prodromal symptoms for Kamla have not been mentioned
either in Brihatrayi or Laghutrayi. But Aachrya Charaka and Sushruta
included general purvaroopas of Pandu as of Kamala (Su.u.44/6).

According to Sushruta: Twak sphotanam (cracking of skin), Sthivana

(salivation), Gatra saad, Mrudbhakshan, Akshikuta shotha, peeta mutrata,
peeta varchha, Avipaka.

According to Charaka: Nissara (devoid of strenth), Alparaktata

(anemia), Alpa medasa(hypo activity of bone marrow), Gatra
vaivarnya(discoloration), Shithendriya (loss of interest)
In practice seen symptoms are:
 Anannabhilasha
 Chhardi
 Hrullasa
 Praseka
 Angasada
 Tandra

C. ROOPA :-
Roopa of the Vyadhi are Vyakta Lakshanas of the Vyadhi. They
exhibit 5th stage of kriyakala that is Vyaktavastha. They are specific
identification of vyadhi. The clear manifestation of the prodromal is called
as Roopa. In kamala, there are- Haridra varna of mala, mutra, netra,
anana and twaka.

16
 The roopa gives us an important information for vyadhiviniscchaya
(Diagnosis), vyadhiawastha (Stage of disease), vyadhivyavaccheda
(differential Diagnosis), Vyadhiupashama (Prognosis) and Chikitsa
(treatment of the disease).
These Roopa of Kamala can be summarized in tabular form as
follows_
Tabular presentation of various Roopani :-

Cha. Su. Vag. M.N. Y.R. Bh.P.

Haridra Netra + _ + + + +

Haridra Twak + _ + + + +

Haridra Anana + _ + + + +

Haridra Nakha + _ + + + +

Rakta-Pitashakruta + _ + + + +

Rakta-PitaMutra + _ + + + +

Bhekvarna + _ + + + +
Hatendriya + _ + + + +
Daha + _ + + + +
Avipaka + _ + + + +

Dourbalya + + _ + + +

Sadana + + _ + + +
Aruchi + _ _ + + +
Trishna - - + - - -

Tandra _ + _ _ _ _

Karshyata _ + _ _ _ _
Balakshaya _ + _ _ _ _

Bhrama _ + _ _ _ _

17
SHAKHASHRIT KAMLA LAKSHANAS: Found only in Charaka samhita and
Ashtang Hridaya. They are_

Haridra Netrata Daurbalya

Haridra Mutrata Alpagni
Haridra Twaka Hikka

Til pishtha nibha varchas Atopa Vishtambha

Kasa
Aruchi
Jwara

These Til pishtha nibha varchas, Atopa, Vishtambha are the

differentiating symptoms, to differ Rudhapath kamala from Bhupitta
kamala.

Effect of Vitiated Pittadosha on Dhatu, Mala, Indriyas and Agni:-

 Dhatu :-
Rasagata
Twaka-Haridrata, Bhek Varna, Trushna, Aruchi

Raktagata
Netra, Nakha Haridratwam

Mamsagata
Daha, Daurbalya, Bala kshaya, Sadan, Twak Haridratwa
 Mala :-
Haridra Mala
Haridra Mutra

18
  Indriyas :-
Hatendriya( Blunting of senses)
Tandra
 Agni:-
Avipaka
Aruchi

CLASSIFICATION OF KAMALA:
The classification of the Kamla is described by different Acharyas as
follows:-

Sr.no. Type of kamla Ch.sa Su.sa As.Hr M.N Sha.sa Bh.Pr

Koshthashrit
1 + + + + +
kamala

Shakhashrit
2 + + + + +
Kamala

3 Kumbhakamala + + + + + +

4 Halimaka + + + + + +

5 Lagharaka +

6 Panaki +

7 Alasakhya +

Apart from this, Madhavakara classified kamala according to its

development as_
1) Swantantra kamala
2) Paratantra kamala

19
Samprapti:

rÉjÉÉ SÒ¹ålÉ SÉåwÉåhÉ rÉjÉÉ cÉÉlÉÑÌuÉxÉmÉïiÉÉ |

ÌlÉuÉ×̨ÉUÉqÉrÉxrÉxÉÉæ xÉÇmÉëÉÎmiÉeÉÉïÌiÉUÉaÉÌiÉ: ||

(A.WØû.ÌlÉ.1/8)

The development of a disease by the co-relation of various

components in a particular manner for a particular disease is called as
Samprapti of that disease or jati or Agati. Hetu, utpadaka dosha and
dushya are essential factors for a disease. Strength of relation between
these components decides severity of the disease.
The presentation of the disease depends on dosha dusti, its
visarpana and its sthana which is viguna in nature.The whole process of
Samprapti is based on vitiated doshas. It gives us an insight for the
development of the disease and gives exact idea about howdo the
etiological factor gives rise to this interacted formation.
Koshthashrita and Shakhashrita kamala samprapti are
separately.(Cha.chi.16)Here koshtha refferfs to one of the trividh
rogmargas.It is the abhyanatar rogmarg.(Cha.Su.11/48)

mÉÉhQÒû UÉåaÉÏ iÉÑ rÉÉåÅirÉjÉïÇ ÌmɨÉsÉÉÌlÉ ÌlÉwÉåuÉiÉå |

iÉxrÉ ÌmɨÉqxÉ×aqÉÉÇxÉÇSakuÉÉ UÉåaÉÉrÉ MüsmÉiÉå||

(cÉ,ÍcÉ.16/34)

1) BAHUPITTAKAMALA: -

When Pandu rogi consume more pittaprakopaka ahara, his pitta get
aggrevated, goes with blood and it vitiates the Rakta & Mamsa dhatu.

20
DESCRIPTION: -
While considering the samprapti of Panduvyadhi, it is clear that, in
Panduvyadhi, pittadominant vatadi tridosha vitiates the Raktadi dhatu and
produce looseness, heaviness of the body.
As a result of this Dosha- Dushya- Pradushana, prakrut bhavas of
Rasa dhatu like Bala, Varna, and Sneha are abolished. So there is no
prakrut utappatti of next raktadi dhatus. So, body bocomes „Nissar‟,
„Alpamedska”.
At this stage, consumption of more pittaprokopak ahara by
pandurogi, leads to less production of sarbhuta Rakta dhatu due to
Dhatvagnimandya& more production of malaswaroopa pitta due afflicted
dhatu parinaman krama. This excess malaswaroopa pitta spreads all over
the body & produce lakshanas like :- Netrapitata, Twaka- Nakha-Mukha
pitata, Rakta pitata of Mala- Mutra, Bhekavarna, Hatendriya, Aruchi,
Avipaka, Daha ,Daurbaly etc.

Samprapti ghataka of Bahupitta Kamala are as follows:-

Dosha - Pachaka Pitta, Ranjaka Pitta

Dushya - Rasa, Rakta, Mamsa
Udbhavasthana - Koshtha (Yakrut, Pleeha)
Vyaktasthana - Netra, Twaka,Nakha, Aanana, Mala,
Mutra dushti
Adhishthana - Yakrita
Sancharasthana - Rasa, Rakta
Strotasadushti - Rasavaha, Raktavaha, Annavaha
Agni - Jatharagni, Rasadhatwagni
Raktadhatwagni
Sadhya Asadhyatwa - Kashtasadhya
Strotodushti Laxana - Atipravrutti, Vimargamana
Marga - Bahya and Aabhyantra

21
WAY OF VITIATED PITTA DOSHA IN BAHUPITTAKAMALA:-

As Kamala is Pitta dominant disease, Pittaj nanatmaja vyadhi, a

brief look on its way of vitiation of dushyas in the body can be
summerized as follows:

YAKRUT
Yakrutta

Due to Dhatwagni mandya, there is excess production of pitta and

less production of sarabhoot Rakta dhatu. Therefore, improper dhatu
poshana leads to Sadan and Daurbalya. This vitiated pitta travel along
with Rasa and Rakta dhatu in the following way:

MalaswarupaCirculation Malaswarupa pitta Pitta goes to

of pitta All Over the body goes to Basti Aamashaya
Pakwashaya

Netrapitata Rakta-pitata of Mutra

Twakapitata Purisha pitata
Nakha-Mukhapitata

2) RUDHAPATHAKAMALA :-

Here the term Shakhashrita kamala refers to one of the trividha

rogmargas and that is the Bahyarogmarga. (Cha.Su.11/48)

22
 The causative factors explained for Shakhashrita Kamala are
Ruksha, sheeta, guru, madhur dravya sevana, Ativyayama
andVeganigraha. These etiological factors aggrevate Vata doshaa by
ruksha, sheeta guna and ativyayama, veganigrahawhereas Guru,
madhura rasa and sheeta guna aggrevates Kapha dosha, resulting in
Srotorodha.

This srotovrodha further aggrevates vata and causes sammurchana

of vata with kapha, leading to Vimarga gamana of pitta.Kapha obstructs
this pitta from entering into koshta. As obstruction is because of Kapha it
is called as Rudhpatha kamala.Malaranjana,one of the functions of this
malarupa pitta gets hampered, since there is no pitta in Pakwashaya,tila
pishtanibha varchas lakshana.

Lakshanas of Shakhashrit Kamala:

Haridra netrata, Haridra mutrata, Haridra twaka, Tilapishtanibha

mala, Atopa, Vishtamaba, Hridya gaurava, Daubarla, Agnimandya,
Parshwarti, Hiccka, Shwasam, Aruchi, Jwara.
From the above describtion, it is clear that Vata-Kapha and Pitta
are main doshas in the samprapti of Rudhapatha Kamala.
Other cause of obstruction in Pittavahini are- Pittashmari,
Gandupada krimi, Arbuda, Stricture, Head of Pancreas

23
 WAY OF VITIATED PITTADOSHA IN RUDHAPATHA KAMALA:
Hetusevana

Ruksha, Sheeta Ahara Guru and

Madhura Ahara

Vataprakopa Kaphaprakopa

Vatasammurchhana with Kapha

Causing obstruction in Pittanalika

Causes obstruction to passage of pitta in Koshtha

Vimargagamana of Absence of Pitta

accumulated Pitta via Rasa in Mahastrotas

Netra- Mukha-Twaka pitata Tilpishta nibha varchas pravrutti

24
UPASHAYA – ANUPASHAYA:
Aushadhi, Anna and Vihara which relieves the symptoms of vyadhi
are called asUpashaya and also called as Satmya. [19,20]
The opposite of upashaya, means the factors that aggrevate the
symptoms of vyadhi are called as Anupashaya.

Upashaya in Kamala:-
Aushadhi: Madhura rasa, sheeta virya, madhura
Vipaki, Pittashodhaka, Tikta and kashaya
rasa
Aahara: Madhura, sheeta aahara, Godhum, Shali
Vihara: Vishrama
Anupshaya: Masha, madya, ajamamsa, tiltailam

UPADRAVA:-
Upadrava is the occurrence of separate disease as a complication in
the wake of a primary disease. It can occure during or immediately after
the course of the disease.
In classical texts, specific upadrava of Bahupitta kamala are not
explained under separate heading, but „Kumbha Kamala‟ which occure in
the late stage due to neglection of disease, is described as Updrava in
Charka, Sushruta and Vagbhata.[22]
Charaka:-
Due to long standing kamala there is Saptadhatukarshan,
Rukshana, Krishna-peeta-mutrata, Sarvanga shotha called
Kumbhakamala, which is a Kruchhasadhya awastha. [21]

Sushruta:-
Shotha, Parvabheda

25
Halimaka:-
It is due tovata-pitta predominance. The varna of rugna will be
harita or neela. Jwara, Aruchi, bhrama, loss of natural desire of
intercourse are associated symptoms. [23]
According to Dalhana, in Kumbhakamal, when there is Harita, Pita,
Neelavarna to the body then that awastha is called as „Halimaka‟.

Panaki:-
It is characterised by Santap, atisara, yellowishness of all body.
[24]

VYADHIVYAVACCHEDA OF BAHUPITTAKAMALA:-
Bahupittakamala can be differentiated with Pittaja Pandu,
Haridrameha, Sannipataka jwara, Pittaja Gulma, Pittaja Apasmara,
Pittavrutta Apaana.

SADHYA-ASADHYATA OF BAHUPITTA KAMALA:

To understand disease progress, the concept of sadhya –

Asadhyata is necessary, so that further treatment can be arranged
accordingly. It suggests prognosis of the disease. This concept of sadhya
–asadhyatva is established before the commencement of treatment.
According to Aacharyas, Bahupitta kamala is Kashtasadhya vyadhi.
If not treated properly it becomes asadhya. Aacharya Charaka explained
following lakshanas in asadhya kamala vyadhi:-Sarvanga shotha,
Raktavarni Netra and Mutra, Saraktachhardi, krushnapita shakruta,
Tandra, Moha, Nashtagni, anaha, daha, trishna, aruchi.
Yogratnakar explained anotherAsadhya laxanas of kumbhakama:-
Jwara, arochaka, chhardi, hrullasa, klama, shwasa-kasa, vibhe

26
Chikitsa:-
 Chikitsa siddhanta of Bahupittakamala is- “Kamali tu virechane”
which includes mainly-
 Shodhana (Purificatory theory)- Sneha virechana
 Samshamana (Palliative treatment)-Kapha pitta harnam chikitsa

Samprapti of Bahupitta Kamala includes:-

1. Pittaprakopa
2. Raktavaha strotodushti
3. Jatharagnimandya and Dhatwagnimandya
4. Increased quantity of malaswaroopa pitta
5. Vimargagamana of malaswaroopa pitta.
6. Vitiation of Rakta and Mamsadhatu.

So in order to break down this pathology, following chikistahad

been explained by samhitakara:-
Aacharya Charaka, mentioned “kamali tu virechanam”
Aacharya Sushruta, mentioned drug and dietery regimen.
Aacharya Vagbhata, mentioned “kamalayam tu pittaghanam pandu
rogavirodiyat‟ which means the drug that pacify pitta and drugs that do
not interfere with panduroga as well, should be used.
SNEHANA:-
Ghruta shares an excellent property of “sanskarasya anuvartanam”
which enhance the the effectiveness of kalpa. Also, ghruta is a best Pitta
shmaka dravya.
In the treatment of Bahupittakamala, ghrutaprocessed in dravyas,
having kashaya, tikta, madhur rasa is given for shehan e.g. Tikta Grit,
Mahatiktaka ghruta, Drakshadi ghruta, Dadimadi ghruta.
MRUDU VIRECHANA:-
The principle chikitsa of pitta dosha is Virechana and cheif causative
factor of Bahupitta Kamala is pittadosha prakopa. Virechana is a process
of purgation which is done by Tikta and Mrudu dravya.

27
 This Tikta rasa improves digestion and liver function and thus
causes pitta, kapha and kleda shodhana in bahupitta kamala. The function
of virechana is not limited to mahastrotas but can reach all over the body
and it removes vitiated pitta dosha.

SAMSHAMAN CHIKITSA:-
After dosha shodhana by Virechna karma, it is also necessary to
give shaman chikista with respect to Dosha, Dushya, Bala, Kala, Prakriti,
Vaya. The shaman aushadhi of Pachana, Deepana guna in the form of
single or compound drugs can be given.
Owing tothis line of concept, in Ashtanga Hridayam, Acharya
Vgbhata, has advised oral administration of Vasadi kwath along with
madhu (As. Hr.Chi.16) .This is shaman in the form of Pittahara, Yakruta
uttejana, Deepana, Rechana, Jwarhara, Rakta shodhana, Rasyana dravya.
On this reference, an attempt was made to put forward the results of this
remedy.

PATHYAPATHYA:
According to Charaka, the diet which is beneficial for srotasa and
oris favourite to mana is called as Pathya.(Cha.su.25/45). Pathya means
which is compatible to the body. The opposite of Pathya, means not
favorite or liking to particular srotasa and or mana is Apathya. Apathya is
harmful to vital elements of the body also.
Nidana parivarjana is first line of treatment of any disease which
can be aopted by Pathyakara aahra-vihara.Yogaratnakar&Bhaishjya
Ratnawali described detail Pathy-apathya aahra-vihar in kamala Vyadhi.

PATHYA AAHARA:-Laghu and Hitakara anna, Tikta rasa,Mudga,

Adhaki, Masura Yusha, Jangal Rasa ,Patola, Jivanti, Punarnava, Dhatri,
Ghrita, Abhaya, Bimbi,Kadali,Lasuna ,Dronapushpi, Yava, Godhuma, Shali

28
PATHYA VIHARA:-Virechana, Vishrama

APATHYA DRAVYA:-Guru, Amla, Lavana, Ushna, Tikshna,

VidahiPittakara Annapana, Shimbi dhanya, Patrashaka, Masha, Pinyaka,
Sarshapa, Sura.

APATHA VIHARA:-Vegavarodha, Divaswapa, Atapsevana, Excessive

Physical Exertion, Raktamokshana, Swedana, Maithuna, Krodha
Virrudhanna, Mrudbhakshana.

CHIKITSA OF SHAKHASHRITA KAMALA:-

The principle of chikitsa for Rudhapatha kamala, requires special
emphasisbecause Malaranjaka pitta is situated in Shakha. Here, first step
is to clear Vibandha of Kapha by Amla, Katu, Ruksha, Ushna and Lavana
dravya and thereafter treat Pitta dosha. For this purpose, Soup of
peacock, tittira, and cock is used. Matulunga swarasa with honey, Pippali,
Maricha, Shunthi, Kullathha are given till the stool of the patient acquires
colour of Pitta and vayu is alleviated. Thereafter, chikitsa of Bahupitta
kamala is given.

CHIKITSA OF KUMBHA KAMALA:-

This type of kamala is Asadhya or Kruchhasadhya. Aacharya
Sushrutaexplained its treatment as –Mandura bhasma with cow‟s urine
andsaindhava lavana foe 1 month. Another combination as Mandura
bhasma with Bibhitaka falamajja and sunthi churna in equal proportion
with cow‟s urine.

HALIMAKA CHIKITSA:-
According to Chrakac aacharya, Mahisham ghrita with guduchi
swarasaNishottara churna with Aamalaki swarasa, Madhura rasatmaka
aahara, Drakshaleha, Yapana basti, Ksheer basti, Anuvasan basti.

29
MODERN LITERATURE REVIEW

INTRODUCTION:-
Liver is the largest gland of the body. It is an organ having dual
functions- secretory and excretory functions. It occupies a substantial
portion of upper abdominal cavity.
LOCATION:-
Liver is located in the upper and the right quadrants of abdominal
cavity that is right hypochondrium and epigastrium, immediately beneath
the diaphragm.
WEIGHT:-
Liver weighs about 5% of the body weight in infancy and it
decreases approximately to 2% in adulthood. It weighs 1.4 to 1.6 kg in
males and 1.2 to1.4 kg in females.
COLOUR:-
The colour of liver is reddish brown normally but can vary according to fat
content.
SHAPE:-
Liver is a wedge shaped organ.The narrow end of the wedge lies
towards theleft hypochondrium and anterior edge points antero-inferiorly.
TEXTURE:-
Normal structure of the liver is soft to firm, depending upon volume
of the blood and fat it contains.
LOBES OF LIVER:-
There are 2 main anatomical lobes-right and left. The right being
six times thesize of left and largest in the volume. The right lobe has
quadratelobe on its inferior surface and a caudate lobe on posterior
surface. The right and the left lobes are separated by anteriorly by a fold
of peritoneum called falciforligament, inferiorly by fissure of
ligamentum teres, and posteriorly byfissure of ligamentum
venosum.The porta hepatis is a region on the inferior surface of theright

30
lobe where blood vessels, lymphatics, and common hepatic duct form
theHilum of the Liver.Liver is made up of many lobes called hepatic
lobes.A firm smooth layer ofconnective tissue called Glissons capsule
encloses the liver.
Hepatic lobules-
This is the structural & functional unit of liver. There are about
50,000 to1,00,000 lobules in the liver. The lobule is a honey comb like
structure & it is made up of liver cells called hepatocytes.

SURFACES OF LIVER:-
1. Superior
2. Inferior
3. Anterior
4. Posterior
5. Right
Of these, superior, anterior and right surface are continuous and no
definable border can separate them.
Superior surface: - It is the largest one and lies immediately below the
diaphragm.
Anterior surface- It is triangular and convex surface, covered by
peritoneum except at the attachment of falciform ligament.
Right surface- It is covered by peritoneum and lies adjacent to the right
dome of diaphragm.
Posterior surface- It is convexwide onright but narrow at left. It is
attached to diaphragm by loose connective tissue, forming triangular
„Bare area‟. The inferior vena cava lies at the medial end of „bare area‟.
Inferior surface- It is bounded by inferior edge of liver marked near the
midline by shrap fissure which contains Ligamentum teres. Gall bladder
usually lies in the shallow fossa.
BORDERS OF LIVER:-
Superiorborder: - It seperates anterior surface from inferior surface.
Inferior border- It is sharp.

31
Histology:
In section through the liver, the substance of the organ appears to
be made up of hexagonal areas that constitute hepatic lobules each being
about 1 mm in diameter.In transverse section each lobule appears to be
made up of cord of liver cells that bare separated by sinusoids. However
the cells are really in the form of plates that branch and anastomose with
one another to form a network space.
Along the periphery of each lobule ther are angular intervals filled
by connective tissue
These are called portal canals.Each canal consists of
1. A branch of portal vein
2. A branch of hepatic artery
3. An inter lobular bile duct from posterior to anterior
respectively.

32
 These three structures collectively form a portal triad, blood form
the branch of hepatic artery enters the sinusoids at the periphery of the
lobule and passes towards its center.
Here the sinusoids open into a cental vein which occupies the centre
of the lobule.The vessel in a portal triad usually give branches to the parts
of three adjoining lobules.

Portal lobule:
A polygonal territory centered on aportal triad its boundry line
passing through adjacent central veins.It consists of adjoining parts of 3
hepatic lobules.Bile from which drains into bile ductile in the portal canal
at the meeting place ofthree hepatic lobule.

Portal acinus:
This unit is centered on a pre- terminal branch of a hepatic arteriole
and includes the parenchyma served by this vessel bounded by the
territories of the other portal acini and by two adjacent cental
veins.Several phenomenon e.g. Zones of anoxic damage,glycogen.

Functional Anatomical division-

The functional anatomy of the liver is based on Couinaud‟s

division of the liver into eight (subsequently nine) functional segment,
which is based upon the distribution of portal venous branches & the
location of the hepatic veins in the parenchyma. Liver is divided into four
portal sectors by the four main branches of the portal vein, which are
right lateral, right medial, left lateral & left medial. The three main hepatic
veins lie between these sectors as intersectorial veins are also called as
Portal fissures.
3 major fissures: - Main portal fissure
- Left portal fissure
- Right portal fissure

33
 3 minor fissures: - Umbillical fissure
-Venous fissure
- Fissure of Gans

VASCULAR SUPPLY AND LYMPHATIC DRAINAGE OF LIVER:-

Blood supply to liver is from 2 sources: - 20% through Hepatic

artery (oxygenated blood) and 80% through Portal vein ( deoxygenated
blood). Liver receives maximum of 1.5 lit/min of blood supply.

VENOUS DRAINAGE: Through Hepatic vein

NERVE SUPPLY: Hepatic plexus

LYMPHATIC DRAINGE: Superficial lympphatics terminate in Caval, Hepatic

and Paracardial, celiac lymph nodes. The deep lymphaticsend partly in the
nodes around the end of inferior vena cava and partly in the hepatic
nodes.

FUNCTIONS OF THE LIVER:-

1) Metabolism of carbohydrates, proteins, fats and vitamin. Liver is a

well equipped chemical laboratory of the body.
2) Drugs toxins, poisons, cholesterol, bile pigments and heavy metals
are detoxified by liver. Liver is a best seat for metabolism of alcohol
and it metabolizes 90% of ingested alcohol.
3) Defensive function: The reticuloendothelial cells (Kupffers cells) play
important role in defence of the body. Liver is a protective organ by
the way of Conjugation, Destruction, Phagocytosis, Antibody
formation.

34
 4) Liver stores glycogen, fats, Vitamin A, B12, D, E, K, and minerals
like Iron and the Copper.
5) Bile is secreted by the liver which contains bile salts, bile pigments,
cholesterol, and lecithin. This bile is used to break down and digest
fatty acids.
6) Blood coagulation: Liver synthesizes–Fibrinogen (factor I)
prothrombin, and factor V, VII, IX, X, XI and XII.

EXTRA HEPATIC BILLIARY SYSTEM:-

The billiary system collects bile from liver and stores it in the gall
bladder. The gall bladder transmits it to the second part of the duodenum.
This billiary system comprises of – Riht and Left hepatic ducts
-Common hepatic duct
-gall bladder
-Cystic duct
- Bile duct

Hepatic Ducts:
Right and left hepatic ducts emerge at the porta hepatis from the
right and left lobes of liver.

Common hepatic duct:-By the union of right and left hepatic ducts near
the right end of the porta hepatis, common hepatic duct is formed.

Bile duct:-This common hepatic duct runs downwords for about 3 cms
and is joined on its right side at an acute angle by cystic duct to form the
bile duct.

Cystic duct:-it is 3-4 cm long begins at the neck of the gall bladder. It is
8 cm long and has a diameter of about 6 mm.

35
 Near the middle of the left side of the second part of the duodenum,
it comes in contact with the pancreatic duct and accompanies it through
the wall of the duodenum, within the wall of the duodenum. Both the two
ducts usually unite to form Hepato pancreatic ampullaof vater.

GALL BLADDER: -This is aReservoir of the bile.

Surface marking- The fundus at theAngle between the rectus
abdominiscalled as linea semilunaris.
Dimention- Long 7-10cm, broad- 3cm at its widest part
Shape- pear shape
Site- In a fossa on the inferior surface of the right lobe
of the liver.
Capacity- 30 to 50ml.
Parts- Fundus, body, neck.

FUNCTIONS OF THE GALL BLADDER-

 Storage of bile & its release into the duodenum when required.
 Absorption of water & concentration of bile.
 Regulates pressure in the biliary system
 Blood supply of the biliary system:-cystic artery,pancreatico
duodenal artery,right hepatic artery,common hepatic artery.
 Veinous drainage- hepatic vein, cystic vein, portal vein.
 Lymphatic drainage- cystic duct, common hepatic duct.
 Nerve supply- cystic plexus.

PROPERTIES OF BILE-
volume- 800 to 1200ml/day.
Reaction- alkaline
Colour- golden yellow/green.
PH- 8 to 8.6
Specific gravity- 1.010 to 1.011.

36
COMPOSITION OF BILE:-
Water- 97.6%
Solids- 2.45% (organic and inorganic substance)
STORAGE OF BILE-
The bile is primarily stored in gall bladder,it undergoes many
changesboth in quality & quantity such as volume & PH decrease; organic
substances concentration, sp.gravity increase.
SECRETION OF BILE-
Bile is secreted by hepatocytes.Hepatocytes→canaliculi→small duct
& hepatic duct→common hepatic duct from here bile is diverted either
directly into the intestine or into the gall bladder. Sodium bicarbonate &
water are added to bile when it passes through the duct.
BILE SALTS-
Bilesalts are the sodium & potassium salt of bile acid,which are
conjugated with glycine or taurine. These bile salts are formed from bile
acids- Primary bile acid in human-1. cholic acid and 2.Chenodeoxycholic
acid, which are formed in liver and enter intestine through bile. These
primary bile acids are converted into secondary bile acids as a result of
bacterial action in the intestine.

FUNCTIONS OF BILE SALTS-

1. Emulsification and Absorption of fat.
2. Choleretic action-stimulation of the secretion of bile from
liver.
3. Cholagogue action- hormone cholecystokinin cause
contraction ofgall bladder, resulting in release of bile.
4. Laxative action-by stimulating peristaltic movement of
intestine.
5. Prevention of gallstone formation-by keeping the cholesterol
and Lecithin in solution.

37
BILE PIGMENTS: -
Bile pigments are formed during the breakdown of haemoglobin,
which is released from the destroyed RBC‟s in the reticuloendothelial
system. Bile pigments are the excretory products in bile. Bilirubin &
biliverdin are two bile pigments and bilirubin is the major bile pigments
in human beings.
NORMAL BILIRUBIN METABOLISM:
In a normal healthy individual, about 250mg of bilirubin is
produced per day.The metabolism can be described under 4 stages-

1) Breakdown phase: Primarily mens about 80%of the bilirubin is

derived from the catabolism of haemoglobin present in the senescent
RBCs and remaining 15-20%of Bilirubin comes partly from non
haemoglobin, heam containing pigment such as myoglobin, catalase and
cytochrome, and partly from ineffective erythropiosis. Bilirubin is formed
from biliverdin by biliverdin reductase.
Bilirubin is found in body fluids in proportion to their albumin content such
as CSF, joint effusion, cyst etc.Bilirubin on release from macrophages
circulates as unconjugated Bilirubin. In plasma, it is tightly bounded to
albumin.

2) Hepatic phase or Conjuation phase: Albumin bounded

unconjugated Bilirubin is dissociated into Bilirubin and albumin, Bilirubin
gets bound to cytoplasmic protein ligandin.
Conjuagation: Unconjugated bilirubin is water insoluble but alcohol
soluble and is converted to water soluble compound by
conjugation.Conjuagation occurs in endoplasmic reticulum and involves
conversion to Bilirubin diglucoronide by action of the microsomal enzyme
,Bilirubin UDP glucuronosyl transferase. Conjugated Bilirubin is bound to
albumin in two forms: reversible and irreversible. Reversible is similar to
that of the conjugatred. However when present in serum for long time

38
then it is bound to albumin irreversibly and is termed as delta-bilirubin or
biliprotein. This irreversible conjugated delta bilirubin is not excreted from
the kidneys and remains detectable in serum for long time after recovery
from disease.
Conjugated Bilirubin is rapidly excreted into bile canaliculi and then
passes into the bile.
3) Intestinal phase: The conjugated Bilirubin which is excreted through
bile canaloculi reaches to the intestinal lumen where it is converted into
stercobilinoen followed by either direct excretion in stool as
stercobilinogen and urobilinoen by intestinal bacteria which imparts
normal colour to stools and urine respectively. About 70% of this is
reabsorbedin the colon and brought back to liver and re-excreted (entero
–hepatic circulation). Unabsorbed stercobilinoen ives brown colour to the
faeces.

Excretion phase:-Some of absorbed urobilinogen is restricted into bile

while rest is excreted in the urine as urobilinogen.

JAUNDICE

39
 Jaundice or Icterus can be defined as yellowish dicolouration of tissue
(skin, mucous membrane and sclera) resulted due toincreased bilirubin
level in the blood.Scleral icterus is seen when bilirubin level exceeds
from2.5 to 3 mg/dl.
Pathophysiology of Jaundice:-
Both unconjugated bilirubin and bilirubin glucuronides may
accumulate systemically and deposit in tissues, giving rise to the yellow
discoloration of jaundice. This is particularly evident in the yellowing of
the sclerae (icterus).
In the normal adult, serum bilirubin levels vary between 0.3 and 1.2
mg/dl and the rate of systemic bilirubin production is equal to the rates of
hepatic uptake, conjugation, and biliary excretion.
Jaundice occurs when the equilibrium between bilirubin production
and excretion is disturbed by one or more of the following mechanisms:
a. Excessive production of bilirubin
b. Reduced heapatocellular uptake
c. Impaired conjugation
d. Decreased hepatocellular excretion and
e. Impaired bile flow (Both intra and Extra Hepatic).
The first three mechanisms produce unconjugatedhyper
bilirubinemia, and the latter two produce predominantly conjugated
hyper bilirubinemia. More than one mechanism may operate to produce
jaundice, especially in hepatitis, which may produce unconjugated and
conjugated hyper bilirubinemia.
Prevalence
Jaundice is prevalent more in underdeveloped and developing
countries. But it is also seen in developed countries.

Epidemiological Factors
The etiology of jaundice is complex and includes multiple causes:
1. Age:
Jaundice can occur at any age.

40
2. Sex:
Jaundice is seen both in males as well as females. Sexual
promiscuity is one factor contributes to the jaundice.

3. Genetic factor:
Thallessemia major, Gillbert's syndrome, criggler-Najjar syndrome-I
& II. (Rh - incompatibility) Also Wilson's disease is preceded by family
history.

4. Socioeconomic Status:
Jaundice is mostly seen inlower socioeconomic groups. It is mostly
due to poor quality of drinking water.

5. Eating habits:
Eating and drinking habits are important. Because eating and
drinking contaminated food constitutes jaundice.

6. Blood transfusions:
Infective blood transfusion can cause hepatitis B.

7. Drugs:
Drugs like Rifampicin, INH, propranolol, probenecid for long
term lead to jaundice.

8. Alcohol:
Long term alcohol abuse may constitute jaundice which may be
acute.
TYPES OF JAUNDICE: -3 TYPES.
 Prehepatic / Hemolytic jaundice
 Hepatic / Hepatocellular jaundice.
 Post-hepatic / Obstructive jaundice.

41
Hemolytic jaundice: -
Excessive destruction of RBSs resulting in increasedblood level of
free(unconjugated) bilirubin.
The excretory function of the liver is normal but the quantity of
bilirubin is increased enormously. The liver cells can notexcrete that much
excess bilirubin rapidly. Unconjugated bilirubin is insoluble inwater & is
not excreted in urine. So it accumulates in the blood resulting in
jaundice.Formationof urobilinogen also increases resulting in the excretion
of more amount of urobilinoen in urine.Excess un-conjugated (mainly)
bilirubin due to excess red cells breakdown. Icterus is mild and has lemon
hue.
Classical Triad
i) Jaundice
ii) Splenomegaly
iii) Anaemia
Tests done are
i) Peripheral
ii) Reticulocytosis.
iii) Bone marrow - erythroid hyperplasia
Above tests suggests increase RBC destruction.

CAUSES: -
Any conditionthat causes hemolyticanemia can lead to hemolytic jaundice.
 Renal disorder, Hypersplenism and Auto immune diseases.
 Burn
 Infections such as- malaria,babesiosis,
 Haemoglobin abnormalities-such as sickle cell anaemia or
thalassemia, spur cell anaemia.
 Drug or chemical substances causing red cell damage.
 Drugs –Rifampicin, Probenecid, Ribavirin.
 Inherited conditions- Crigler-najjar types 1 & 2. Gilbert‟s
syndrome.

42
HEPATOCELLULAR / HEPATIC / CHOLESTATIC JAUNDICE: -
Hepaticjaundice occures due to damage of hepatic cells.As a result
of this damage, the conjugated bilirubin from liver cannot be excreted &
it returns to blood.
CAUSES:-Causes may be
a) Injury
b) Destruction
c) Dysfunction
a) Infections:
1) Weil's disease
2) Septicemia
3) Typhoid, malaria.
b) Toxic:
i. Drugs : Rifampicin, INH halothane, chloroform, propranolol,
probenecid.
ii. Chemicals : DDT
iii. Metals : Arsenic, mercury, gold, bismuth
iv. X-ray radiation

c) Cirrhosis of liver.
d) Starvation

Alcoholic hepatitis
Inherited conditions- 1) Dubin-johnson syndrome
2) Rotor‟s syndrome.
Viral hepatitis A B C D & E.
Epstein barr virus.

43
EXTRAHEPATIC / POSTHEPATIC / OBSTRUCTIVE JAUNDICE: -
Post hepatic type of jaundice occure because of the obstruction of
bile flow at any level of the biliary system. The bile cannot be excreted
into small intestine. So,bile salts and bile pigments enter the
circulation.Therefore, blood contains more amount of conjugated
bilirubinemia.There may be biliary colic and pain at right hypochondrium.
Jaundice may be dark yellow or greenish yellow. Faeces are clay coloured.
Alkaline phosphatase is raised.
Causes:-
a) Extra Hepatic:
i. Inflammatory: stone, stricture, parasites, acute cholangitis.
ii. Neoplasm: Carcinoma of head of the pancreas, tumours of
bile duct or gall bladder.
Malignant Benign
Cholangiocarcinoma -Choledocholithiasis
Gall bladder cancer -Post operative biliary
Ampullary cancer -Chronic pancreatitis
Malignant involvement of the hepatis lymph node – Ascariasis

b) Intrahepatic:
i. Cholestatic phase of infective hepatitis, infiltrating diseases
like amyloid, lymphoma causing cholestasis.
ii. Drugs: steroids, chlorpromazine, tolbutamide, ethanol
intoxication, carbon tetrachloride, phosphorus.
iii. Pregnancy.

IMPORTANT POINTS OF HISTORY TAKING:-

A complete medical history is the most important part of evaluation
of the study of jaundice. We shouldask for the following:
 Exposure to people with jaundice either in the family, or locality or
outside
 Recent travel history

44
 Any change in appetite, taste, weight and bowel habits
 Recent travel history
 Duration of jaundice
 Exposure to possibly contaminated food
 Any history of blood transfusions, IV injections, tattooing,
unprotected sexual activity
 Exposure to possibly contaminated food
 Occupational exposure to hepatotoxins or chemicals
 Detailed drug history, i.e. taken in the past or are being taken.
 History of taking herbal or indigenous medicine
 History of alcohol intake
 History of pregnancy
 History of epistaxis, haematemesis or bleeding tendency
 Family history for congenital hyperbilirubinaemia, i.e. Gilbert‟s,
Criggler Najjar and Dubin-Johnson and Rotor syndromes
 Presence of any accompanying symptoms such as arthralgias,
myalgias, weight loss, fever, pain in abdomen, pruritus and change
in colour of stool or urine
 Symptoms of encephalopathy, i.e. mental features

General Physical Examination: This includes:-

 Assessment of nutritional status of the patient.

 Look for stigmas of chronic liver disease, which are commonly seen
in alcoholic cirrhosis like-Spider naevi, palmar erythema,
Gynaecomastia, Caput medusa, Parotid glands enlargement,
Testicular atrophy, axillary and pubic hair loss.
 Temporal and proximal muscule wasting suggests lon standing
disease such as pancreatic cancer or cirrhosis.

 Look or enlarged lymph nodes –In abdominal malignancy- An

enlarged left supraclavicular node (Virchow‟s node) or periumbilical
nodule (Sister Mary Joseph‟s nodule) is found.
45
 JVP and other signs of right heart failure

 Pulse rate (bradycardia in obstructive jaundice), anaemia and

scratch marks, Xanthelasma/xanthomatosis occur due to
hypercholesteraemia in obstructive jaundice.

Clinical Presentations:-
The clinical presentation of a case with jaundice varies according to
the cause.
1. Patients with hepatitis present with fever, abdominal pain, jaundice,
tender hepatomegaly, anorexia, distaste to food and smoking.
2. A patient with haemolytic jaundice usually complains of insidious
onset and long duration of jaundice with dark coloured urine and
stools.
3. Patients with obstructive jaundice present with seviour abdominal
pain in right upper quadrant and respiratory arrest on inspiration
(murphys traid) suggestive of Cholecystitis or rarely ascending
cholangitis.
4. Carcinoma of the pancreas produces painless progressive jaundice
with palpable gall bladder.
5. Patient with cirrhosis of liver present with features ofportal
hypertension (ascites, haematemesis, malaena, splenomegaly) and
jaundice develops during decompensation of liver disease, i.e.
hepatic encephalopathy (mental features will be present)
6. In benign intrahepaticcholestaticjaundice of pregnancy-Jaundice
may present during each pregnancy.
7. A young patient with recurrent jaundice of long duration usually
suffers from congenital hyperbilirubinaemia.

46
Systemic Examination Of jaundice patients:-
Abdominal Examination for
 Hepatomegaly, e.g. note, size, shape, surface, movement with
respiration, consistency and whether pulsatile or not. Elicit
tenderness
 Splenomegaly-define its characteristics
 Ascitis, elicit all the signs for detection of fluid
 Prominent venous collaterals or veins must be looked for.
Determine the flow of blood
 Look at the hernial sites
 Look for scratch marks.

Other Systems Examination

 Cardiovascular, i.e. valvular heart disease, pericardial effusion

 Respiratory System for Pleural effusion especially right-sided.
 Examination of excreta – Urine, Stool

HEPATITIS:-
Hepatitis implies injury to liver characterized by presence of
inflammatory cells in the tissue of organ.It is divided into two main types
depending on the cause.
1. Viral
2. Non viral (Alcohol/Drug induced)

1. VIRAL HEPATITIS:-
Viral hepatitis defined as infection of the liver caused by any of
A,B,C,D,E & G viruses. Many other viruses may be implicated in hepatitis
such as- Cytomegalo-virus, Epstein -barr virus, Yellow fever virus and
Rubella virus and virus of Herpes simplex, varicella and adeno viruses

47
can also cause severe hepatitis in immune-compromised individuals, but
are rare .

a. Heapatits A virus(HAV)-feacally spred & self limiting disease.

b. Hepatitis B virus(HBV)-parenterally transmitted.may become
chronic.
c. Hepatitis C virus(HCV/NANAB)transfusion related,chronic
d. Hepatitis D virus(HDV)-super infection with HBV
e. Hepatitis E virus (HEV)-water born.

Hepatitis-A:-
It is formerly known as “Infectious hepatitis”or”Epidemic hepatitis”.
It is an acute infection caused by Hepatitis –A virus.

Host factors:-
Age: - More frequent among children than in adult, however people from
all ages
may be infected if susceptible.
Sex: - Both sexes.
Immunity:- probably lasts for life after attack
Environmental factors: - Period of heavy rainfall, water borne & food-
borne epidemics.
Mode of transmission: -Faecal-oral route, parenteral route, sexual
transmission.
Incubation period: -10-50 Days(usually 25-30days).
Clinical symptoms:-Nausea, vommitig, anorexia & mild fever.
Diagnosis-Test for abnormal liver function such as- serum
alanineaminotransferase (ALT) & bilirubin
-ELISA for measuring HAV antibodies.
-Anti-HAV appear in the IgM fraction during the acute phase.
-HAV particles or specific viral antigen in the faeces, bile & blood.

48
Epidemioloical factors:-
Causative agent: - The hepatitis “A‟ virus is an enterovirus (type-72)
of the picornaviri dae family .It multiplies only in hepatocytes. The faecal
shedding of the virus is at its highest during the later part of the
incubation period & early acute phase of illness.
Resistance -The virus is fairly resistant to heat & chemicals. It has been
shown to survive more than 10 weeks in well water.
Reservoir of infection -The human cases are the only reservior of
infection.
Period of infectivity -The risk of transmissitting HAV is greatest from 2
weeks beforeto 1 weekafter the onset of Jaundice.
Infective Material- Mainly human faeces, blood, serum & other fluids
are infectiveduring thebrief stage of Viraemia.
Viral excretion-In the faeces for about 2 weeks before the onset of
jaundice & forupto 2 weeks thereafter.
 igM AntiHAV-Indictes acute infection
 IgG Anti HAV-Indicates chronic infection
Prevention:-
Control of reservoir is difficult because faecal shedding of the virus
is at itsheight during the incubation period. The occurrence of large
number of subclinicalcases is due to absence of specific treatment and low
socio-economic profile.

Control of transmission-
-Personal& community hygiene,
-Proper autoclaving of syringes, needles & other equipment.

Control of susceptible population-

Human immunoglobin: - Normal human immunoglobin is prepared from
pooled plasma of healthy donars (gamma globulin) to induce passive
immunity. It is recommended for- succeptible persons travelling to highly

49
endemic areas, close personal contacts ofpatients with HAV, for control of
outbreaks in institutions.
Vaccines:- 4 inactivated hepatitis-A vaccines,given parenterally as a 2
dose series 6 to18 months apart.A combination vaccine containing
inactivated hepatitis-A andrecombinant hepatitis-B vaccines has been
licensed since 1996 for used in childrenaged 1 year or older in several
countries.
The combination vaccine is given as a 3 doses, using a 0, 1, 6 month
schedule.

HEPATITIS-B: - This is formerly known as “serum hepatitis”. It is caused

by hepatitisB virus (HBV) and transmitted usually by the parenteral route.
It is an acute systemic infection with major pathology in the liver. It is an
acute self-limiting infection, which may be either subclinical or
symptomatic. Hepatitis-B virus can form a dangerousalliance with delta
virus & produce a new foem of virulent hepatitis which is consideredto be
a widespread threat for much of the world.

Host factors-
Age- Acute hepatitis-B occurs in approximately 1% ofperinatal, 10% of
earlychildhood& 30% of late HBV infection. High risk group-recipients of
bloodtransfusion, health careand laboratory personnel, homosexuals,
prostitutes, percutaneous drug abuse, infants of HBV carrier mother and
parents who are immunocompromised.
-Humoral & cellular responses-HBV has3distinct antigens-
 surface antigen/Australia antigen(HBsAg)
 Core antigen(HBcAg)
 e- antigen( HBeAg)
Mode of transmission: - parenteral route, perinatal transmission,
sexual transmission, other route- horizontaltransmission- child to child.
Incubation period: - 50 to 180 days.
Clinical picture: -Chronic liver diseaseprogress to primary liver cancer.

50
Epidemiological determinant-

Agent factor: -Hepatitis-B virus was discovered by Blumberg in

1963.HBV is acomplex, 42nm, double shelled DNA virus, originally known
as the“Daneparticle‟.It replicates in the liver cells, HBV occure in three
morphologicalforms in the serum of patients.
1) Small spherical particles with an average diameter of
22nm. These are antigenic.
2) Tubules of varying length and diameter.

3) The Dane particles which corresponds morphologically to

Hepatitis- B virus, only dane particles are infectious.

Reservoir of infection: -The man is the only reservoir of infection which

can be spread either from carriers or from cases.the persistant carrier
state has beendefined as the presence of HBsAg for more than 6 months.

Infective material: -Contaminated blood, body secretion such assaliva,

vaginal secretion & semen of infected persons. Resistance-heat
sterilization in as auto clave for 30-60 minutes. Quite stable & capable of
surviving for days on environmental surfaces.

Period of communicability: -Usually several months or until

disappearance of HBsAg & appearance of surface antibody.
 HBSAg-General marker for HBV
 HBsAb-Marks recovery or immunity
 HBeAg-active replication
 Anti-HBe-no longer replication
 HBV DNA-active rplication

51
Prevention: –
Hepatitis-B vaccine -Plasma derived vaccine-this is based
on the surfaceantigen (HBsAg) 1ml dose contains 20 micrograms of
hepatitis surface antigen.
RDNA-YEAST derived vaccine -in USA 1987, the recombinant DNA
vaccine elaborated from cultures ofyeast cloned with HBsAg s-gene.
Dose: - Adult - 10 to 20 micrograms initially & again at 1 & 6
month.
Children -half of the adult dose & the same time interval.
Site: - Deltoid muscle is preferred for injection i/m.
Hepatitis-B Immunoglobulin (HBIG) - Used for those acutely exposed
to HBsAg-positive blood, given as soon as possible after an accidental
inoculation (within 6hrs to 48 hrs).
Dose: -0.05 to 0.07 ml/kg body weight.
2 doses should be given 30 days apart.
Passive active immunization the simultaneous administration of
HBIG and
Hepatitis-B vaccine is more efficacious than HBIG alone.

HEPATITIS-C:-
HCV was identified in 1989, has been shown to be the major Cause of
parenterally transmitted non-A, non-B (PT-NANB) hepatitis.
-In India, HCV antibodies have been found in 2% of voluntary
blooddonars.
- The voluntary blood donars have a very high prevalence of
HCV infectionespecially in the developing world.
-HCV is a single stranded RNA virus with properties similar to
those Offlavivirus.
 IgM Anti-HBc-Indicates acute infection
 IgG Anti-HBc-chronic infection
 Anti HCv-Acute infection by HCV
 HCV-RNA-active replication

52
 -It bears no genomic resemblance to hepatitis B to D.
Mode of transmission: -
- Intravenous drug user who share needles
- Transfusion of contaminated blood or blood products.
- Circumcision, tattooing & scarification with contaminated
instruments.
Incubation period: - 6-7weeks

Clinical picture: -Clinical illness is often mild, usually asymptomatic with

aHighrate of chronic hepatitis, which may lead to cirrhosis of liver or
livercancer.
Prevention –
Interferon is the only drug found effective in the treatment of HCV
infection.
- Supplement recombinant immunoblot assay (RIBA) test used to
confirm anti-HCV positive result.

HEPATITIS-D:-
The etiologic agent of delta hepatitis-HDV, causes infection only in
presence of HBV.
 Anti-HDV-Acute infection
 HDV-RNA-active replication

Delta antigen (delta-Ag) is detectable only in early acuteHDV infection.

Presence of delta-Ag (anti-delta), indicatespast or present infection

with HDV.
Mode of transmission-
-Multiple transfusion and Intravenous drug abusers

53
Incubation period-
It varies from 2-12 weeks.
2 epidemiological pattern of HDV infection have been identified:-
1. In Non-endemic areas, HDV infection is confined to personsexposed
frequently to blood, drug addicts & haemophilias.
2. HDV infection is endemic among person with hepatitis-B and most of
the infections are transmitted by intimate contact.

Prevention-
Vaccinating HBV susceptible persons with Hepatitis-B vaccine.

HEPATITIS-E:-
HEV is essentially water born disease. HEV was discovered in 1980.
 Formerly termedas enterically transmitted hepatitis non-A, non-B
(HNANB)
 HEV is a 29-nm to 32-nm RNA virus, self limiting, acute viral
hepatitis, appears lasting for a period of several weeks, which is
followed by recovery.
 Formerly termed enterically transmitted hepatitis non-A, non-B
(HNANB).
 HEV is a 29-nm to 32-nm RNA virus, self limitingacute viral
hepatitis appears lasting for a period of several weeks, which is
followed by recovery.
Incubation period -2-9 weeks

Age -15 to 40 years.

Mode of transmission - Feaco-oral route

54
Diagnosis: -
It can be diagnosed by the level of anti-HEV antibodies in the
serum.Anti HEV IgM antibodies have been determined in the blood
sample.
Prevention:-
To take the usual elementary food and hygiene precaution.

HEPATITIS-G
HGV was discovered recently in 1996, the prevalence of this
infection is still not known.

NON VIRAL (ALCOHOL/DRUG INDUCED) HEPATITIS:-

Injury to Hepatocyte by alcohol or certain hepatotoxic drugs leading
to inflammation of liver is called Non-Viral Hepatitis.Alcoholic hepatitis is
one stage of the ALD i.e. Alcoholic liver disease.
Alcoholic Liver Disease is the term used to describe the spectrum of
the liver injury associated with acute and the chronic alcoholism.There is
3 stages-

Alcoholic Steatosis (fatty liver):-

Fatty change or the steatosis is the accumulation of the fatty acids in the
liver cells.This can be seen as the fatty globules under the microscope. In
this stage, higher level of fatty acid is formed in the liver cells to
compound it to glycerol to form triglycerides. These triglycerides
accumulate, resulting in fatty liver.
Alcoholic Hepatitis:
It is characterised by the inflammation of the hepatocytes.About
10-35%of the heavy drinkers develop alcoholic hepatitis.This is called
alcoholic steatonecrosisand the inflammation appears to predispose to
liver fibrosis.

55
 Inflammatory cytokines (TNF-alpha, IL-6,IL-8)are thought to be
essential in the initiation and perpetuation of the liver injury by inducing
apaoptosis and necrosis.

Alcoholic Cirhossis:-
It is a late stage of ALD marked by inflammation, fibrosis and
damaged membranes preventing detoxification of chemicals in the body,
ending in scarring and necrosis. Between 10% and 20% of heavy drinkers
will develops cirrhosis of liver.
Symptoms include jaundice, liver enlargement, pain and
tenderness from the structural changes in the damaged liver architecture.
Late complications of cirrhosis or liver failure include portal
hypertension, coagulation disorder, ascites, and other complication
including hepatic encephalopathy and hepatorenal syndrome.
Cirrhosis can also results from other causes than alcohol abuse,
such as viral hepatitis and heavy exposure toxins other than alcohol.
Fatty change and alcohol hepatitis with abstinence can be
reversible.The later stage of fibrosis and cirrhosis tends to be irreversible,
but can usually be contained with abstinenece for long periods of time.

Treatment:
Abstinenece from alcohol intake and nutritional modification form
the backbone of the treatment.Symptomatic treatment can include
corticosteroid for severe cases,anticytokines,propylthiouracil to modify
metabolism and colchicine to inhibit hepatic fibrosis.When all else fails
and the liver is severly damaged,the only alternative is liver transplant.

INVESTIGATIONS
LFTs are useful in evaluation and management of patients with liver
dysfunction and used to-
1. Detect presence of liver disease.
2. Distinguish among different type of liver disorders.

56
 3. Guage the extension of known liver damage.
4. Follow the response to treatment.

Classification of LFTs:
Based on detoxification and Excretory functions:
a) Sr.bilirubin-Direct,Indirect
b) Urine-BS,BP,Urobilinogen
c) Blood Ammonia
d) Sr.Enzymes

Measures biosynthetic functions of liver:

a) Sr.Albumin
b) Sr.Globulin
c) Coagulation Factors

Other diagnostic tests are_

a) USG
b) CT(ABDOMEN)

Bile acids and Bile salts:

Normal fasting serum bile acids levels are 2u g /ml.with about two
hrs after the meal.In hepatic biliary disease the levels are higher due to
obstruction.
Sr.Proteins:
Albumin and all globulin except the gama globulin are formed in
liver.The normal concentration of serum globulin is 3.5to4.5gm %. The
serum albumin concentration indicates nutritional status of the patient.
Albumin values are low in hepatic damage.

57
Blood coagulation tests:
The coagulation of blood depends upon the several compounds.The
factors usually affected by liver damage are Fibrinogen,Prothrombin,and
factors V,VII,IXand X.It can be used as a prognostic test in acute and
chronic hepatic damage.In acute condition the coagulation defect is due
to diminished formation of factors .

Enzyme study:
Serum Alkaline Phosphatase:
The enzyme which is hydrolized in an alkaline medium is known as
alkaline phosphatase.The alkaline phosphatase originates in the liver and
is localised in the hepatocytes.
Normal values are 21-85IU.It is slightly increased in liver cell
damage.
Serum Transaminase:
The transaminase is found in the mitochondrial cells,being essential
for the metabolic activity.Acute injury to hepatic cells release
transaminase that rise its level in blood.Significant elevations are noted in
early stages of Viral Hepatitis even prior to any evidence of jaundice.
SGOT: Serum Glutamic Oxalo Acetic Transaminse
It is present in large quantity in heart, Liver and muscles.The
normal value is 5to 17 IU.
SGPT: Serum Glutamic Pyurvic Transaminase
Since the content of this enzyme in liver is higher than in any other
oragn,the SGPT test provides a useful and the specific index of the acute
liver damage.The normal SGPT value is 35 u or 4to 13IU.But with acute
liver cell injurythe increase in the SGPT value may nbe for more than that
of the SGOT.
For viral hepatitis –
A battery of serological tests used.

58
 DRUG REVIEW

VASA

Vasa is Known as the Powerful Herb used in treating Asthma,

Bronchitis and excess mucous condition. But the interesting fact about
Vasa is that, it is coolant herb, but still it is useful in Respiratory tract
conditions. And of Course, with coolant nature it is useful in Pitta
predominant Vikaras.
Latin Name: Adhathoda vasica

Family : Acanthaceae (Vasa Kula)

Classical Categarization:-
Charaka : Tikta skandha – Bitter tasting groups of herbs
Vagbhata : Durvadi Gana

Synonyms : -
Sanskrit : Vasak, Vasika, Simhasya, Vajidant, Vrush Aatrushak, Simhi,
Bhishagmata, Tamruka, Simhaparni.
Hindi : Adosa, Arusha, Rus, Bansa, Adusa
Marathi : Adulsa, Adusa

59
Distribution: - Found Through out India, Usually grown on beside
compounds includes Shri Lanka, Nepal, Bangladesh, India, Pakistan,
Indonesia.

Types : Mentioned in Bhavaprakasha nighantu only:-

1. Krushna Vasa : Justica gendarusa – Black Variety Or Asthiparni
,Foundin Bengal
2. Adhathoda beddomei – Found in kerala
3. Rakta Pushpa vasa – Justica picta – More effective

External Features:-
 Shrub of 1-3 meters height Perennial
 Leaf 8-10 cm long, Blackish Green soft and long like a Spear.
Flowers - Inflorescence looks like lion’s jaw.
Fruit - In 2cm long legume, fruits are pubescent & are with club-
shaped Capsules.

Chemical Compositions: - The leaves of Adhatoda vasica contain

phytochemicals such as alkaloids, Tannins, saponins, phenolics &
flavonoids.
The most important is vasicine, a quinazoline alkaloid. Vasicline
acetate, Vasicione, Vasicine 2-Acetyle benzyle, Vit.C, Adhatodine, vasicol,
Adhatodic acid etc.

Bio-energetics:
Rasa - Tikta Kashaya
Virya - Sheeta
Vipaka - Katu
Guna - Laghu, Ruksha
Doshaghnata – Kapha – Pittaghnam, Vatakara.

60
Parts Used: -Leaf, Root, Flower, and Whole Plant

Systemic Action and Uses:

Annavaha srotasa (Gastro-Intestinal System):-
Useful in Diarrhoea, Dysentry, due to its Kashaya Rasa-Sheeta virya
it acts as Purish-sthambhana. Specially Useful in bleeding types.
Chardi: Useful in Kapha-Pittaj Chhardi (Vomitting).

Pranavaha srotasa (Respiratory system):-

Useful In kasa, shwasa, swarbheda, due to its Tikta-kashaya Rasa
and katu vipaka, it acts as mucolytic and therefore eases expectoration &
thus enables normal breathing. It also acts as Anti-inflamatory thus useful
in Bronchitis & laryngitis.

Udakvaha srotasa:-
It is useful in increased thirst especially kaphaj & pittaj type, due to
its tikta rasa & sheeta virya it acts as Trishna – shaman.

Rasa- Raktavaha Srotasa (Circulatory system):-

Hrudya: Vasa acts as Cardiac Tonic. Reduces Blood Pressure.
Jwaraghnam: Useful in Kaphaj, Pittaj & Visham Jwara.
Hrudroga: Useful in Kapha – Pittaj Hrudroga where vitiated kapha
causes obstruction in Pranvaha Srotas.

Raktapitta (Bleeding disorders):-

It is an excellent medicine on Raktapitta. It reduces ushna-Tikshna
Guna of vitiated pitta by tikta-Kashaya Rasa & Sheeta Virya.

Kshya: Useful in chronic respiratory tract infections.

61
Mamsa – Medovaha srotes:
Kushtha: Useful in skin disorders Reduces Kandu, Daha because
of its Swedajanan & Kushthaghnam actions.

Netra and Nasa roga: Useful in conjunctivitis, Epistaxis

Mutravaha srotas (Urinary system): Useful in Urinary tract disorders

& Diabetes.

ExternalUses: Its leaves are made into paste and applied to relieve
inflammation, pain, Rheumatoid arthritis, worm infested wounds and skin
disorders.

Research: Rsearches have proved itsanti-Microbial activity, anti-ulcer

activity, Hepato-protectivity, anti-oxidant, anti-microbial activity.

Matra: Leaves or flower juice – 10 -20 ml

Kwatha – 40-80 ml

Kalpa: Vasaavleha, Varsarishta, Vasakasava, Vasa ghrita.

REFERENCES:-

uÉ×wÉmÉÑwmÉÇ: MüTüÌmɨÉWûUå ÌiÉ£Çü zÉÏiÉÇ MüOÒû ÌuÉmÉcrÉiÉå || (cÉ.xÉÑ. 27)

uÉ×wÉÉaÉxirÉrÉÉå: mÉÑwmÉÉÍhÉ ÌiÉ£üÉÌlÉ MüOÒûÌuÉïrÉÉ MüÉÌlÉ ¤ÉårÉMüÉxÉmÉÉÌlÉcÉ ||

AÉOÒûÂwÉÉå ÌWûqÉÎxiÉ£ü: ÌmɨÉzsÉåwqÉÉxÉ MüÉxÉeÉÏiÉç |

¤ÉrÉSØiÉ NûÌSïMÑü ¸WûlÉÉå euÉUiÉ×whÉÉÌuÉlÉÉzÉlÉ: || (kÉ.ÌlÉ.)

62
uÉxÉMüÉå uÉÉiÉM×üixuÉrÉï: xÉTüÌmɨÉÉxÉ lÉÉzÉlÉ: |

ÌiÉ£üxiÉÑuÉU MüÉå WØûSrÉÉå sÉbÉÑzÉÏiÉxiÉ×QûÌSïiÉ: |

µÉÉxÉ MüÉxÉ euÉU NûÌSïqÉåWû MÑü¸ ¤ÉrÉÉmÉWû: || (pÉÉ.mÉë.)

uÉ×wÉÉå xÉSrÉÉå eÉrÉirÉxÉëÇ xÉWûrÉxrÉ mÉUqÉÉæwmÉÉkÉqÉç | (A.Wû.ÍcÉ. 2)

uÉÉxÉÉ ÌiÉ£üÉ MüOÒû: zÉÏiÉÉ MüÉxÉWûlÉÏ U£üÌmɨÉÎeÉiÉ |

MüÉqÉsÉÉ MüTüuÉæMüsmÉ euÉUµÉÉxɤÉrÉÉmÉsÉÉ || (UÉ.ÌlÉ.)

AMRUTA

Amruta i.e Guduchi is a famous Ayurvedic Herb, used extensively in

treatment for fever, diabetes, urinary tract disorders, anemia, jaundice,
asthma etc.
Latin Name: Tinospora cordifolia

Family: Meinispermaceae

63
Classical categorization:
Charka: Vayasthapana, Daha prashamana, Trishna nigrahana,
Triptighna, Stanyashodhana.
Sushruta: Guduchyadi, Patoladi, Kakolyadi, Vallipanchamool,
Aragvadhadi
Bhavpraksha: Guduchyadi varga.

Synonyms:
Sanskrit: Chakra lakshana, Madhuparni, Cchinnaruha, Kundalin,
Cchina, AmrutvalliAmruta, Chakrangi
Hindi: Giloy, Gulvel, Gurach
Marathi: Guduchi, Gulvel

Distribution: It occurs all over India uainly hot climates. In konkan, it is

found in large quantity.

External features:
It is a perenial small creeper, mainly found on Mango, Nimba trees
going in a spiral manner.

Leaf: It is heart shaped, smooth with reticular.

Male flowers: Small, greenish yellow bunches.
Female flowers: Mostly solitary
Fruits: Small oval in shape, fleshy, Riped fruit becomes red.
Parts Used: Kanda (Stem), Leaves

Chemical Composition:
Guduchi is highly rich in Anti-oxidants. It has wound healing
property, Antipyretic and Anti-viral properties.

64
Alkaloids: Berberine, choline, Mangoflorine, Tinosporin,
Palmetine.
Glyocosides: 18- Norclerodane glucoside, Tinocordiside,
cordioside, cordifolio
Streoids: B sitosteral, Delta – sitosteral 20/3
hydroyecdysone.
Nutritional compostion: Calcium, Phosphorus, Iron, copper, zinc,
Manganese.

Bio – Energetics:

Rasa – Tikta – katu- kashaya

Virya – Ushna
Vipaka – Madhur
Guna – Fresh – Snigdha-Mrudu
Dry – Ruksha, Laghu, Mrudu
Doshaghnata: Doshatrayahara – Balances Vata, Pitta –
Kapha Dosha.

Systemic Action &Uses:

It is best Dhatvagnideepak due to Tikta Rasa and best Dhatuposhan
due to Madhur Vipaka. Therefore, it acts on all the Sapta Dhatus and
proved as a Rasayan.

Annavaha Srotas (Gastro-intestinal system):-

 Deepak-Pachan therefore Aampachaka & Agnideepan

 Pittasaraka, Krimighanam
 Malasamgrahi

a) Role of Guduchi in Amalpitta:

65
 Guduchi Aampachan & Agnideepan due to Tikta Rasa therefore
balances niram pitta & causes absorption of saam pitta. Reduces kapha
vibandha.

b) In Kamala-Yakrit Vikara :
Guduchi reduces inflammation of liver by purgation of vitiated &
vimargag Pitta dosha. Yakrit-Uttejana occurs by its Tikta Rasa. Due to
Tikta Rasa Vitiated Ranjak Pitta becomes normal and stimulates normal
circulation of Rasa & Rakta Dhatu. Therefore, Guduchi is said to be a Best
Hepatoprotective drug.

c) Atisara – Pravalika (Diarrhoea-Dysentry) – Being Grahi, Deepak &

Pachan Dravya it absorbe abnormal Dravansh in intestine. Therefore
useful in Atisara & Pravalika.

Rasa – Raktavaha Srotos: - Useful in

a) Kamala and Pandu

b) Jwara – Being Tikta Rasa, chief use of Guduchi is in Jwara.
c) Aamvata, Vatarakta- Being Aampachan absorbs Rasagat&
Sandhigat Aama.
d) Balya , Hrudya and Rasayana
e) Dahahara and Kushthaghna

Pranvaha Srotas (Respiratory System): –

Kasa – Dhatukshaya janya cough.

Mutravaha srotas (Urinary system)-

Mehahara – useful is treatment of diabetes, urinary tract
disorder

66
Matra (Dose): Kwath (Decoction) 40-80 ml.
Stem powder –churna – 1 -3 gm

Kalpa: Guduchyadi Churna, Amrutarishta, Guduchi satva,

Guduchyadi Kwath.

REFERENCES: -

aÉÑÂcÉÏ MüOÒûMüÉÌiÉ£üÉ xuÉÉSÒmÉÉMüÉ UxÉÉrÉlÉÏ |

xÉÇaÉëÉÌWûhÉÏ MüwÉÉrÉÉåwhÉÉ sÉbuÉÏ oÉsrÉÎalÉSÏmÉlÉÏ |

SÉåwɧÉrÉÉqÉç iÉ×OûSÉWûqÉåWûMüÉxÉÉÇ¶É mÉÉhQÒûiÉÉqÉç |

MüÉqÉsÉÉ MÑü¸uÉÉiÉÉxÉëeuÉUM×üÍqÉuÉqÉÏï WûUåiÉç || (pÉÉ.mÉë. 3/8-10)

bÉ×iÉålÉ uÉÉiÉÇ xÉaÉÑQûÉ ÌuÉoÉÇkÉÇ ÌmɨÉÇ ÍxÉiÉÉžÉ qÉkÉÑlÉÉ MüTÇü cÉÇ |

uÉiÉÉxÉaÉë qÉÑaÉëÇ ÂoÉÑiÉæsÉÍqÉ´ÉÉ zÉÑhPûrÉÉqÉuÉÉiÉÇ zÉqÉrÉåiÉç aÉÑQÒûcÉÏ || (kÉ.ÌlÉ-)

aÉÑÂcÉÏ qÉkÉÑUÉ mÉÉMåü MüwÉÉrÉÉ MüOÒûMüÉ sÉbÉÑ: |

ÌiÉ£ü xÉÇaÉëÉÌWûhÉÏ SØwœÉ oÉsrÉÉåwhÉÉå uÉÎlWûM×ü‹rÉåiÉç || 9||

SÉåwÉMÑü¸M×üÍqÉcNûÉÌSïSÉWû uÉÉiÉÉxÉëmÉÉhQÒûiÉÉ: |

euÉU MüÉqÉsÉÉ qÉåWû iÉ×whÉÉ MüÉxÉÉlÉ UxÉÉrÉlÉÏ ||10||

̧ÉSÉåwÉSlÉå xuÉÉSÒ mÉjrÉï cɤÉÑirÉÇ SÏmÉlÉÇ sÉbÉÑ| oÉrÉxÉ: xjÉÉmÉlÉÇ qÉåkrÉqÉqÉ×iÉÉzÉÉMüqÉç EcrÉiÉå ||11|| (Mæü. ÌlÉ.)

67
 NIMBA

Latin name: Azadiracta indica

Family: Meliaceae (Nimbakula)

Classical Categorization:

Charaka: Kandughna, Tiktaskandha

Sushruta: Aaragvadhadi, Guduchiyadi, Lakshadi

Synonyms:

Sanskrit: Nimb, Arishta, Paribhdar, Hinguniryasa, Chhardan,

Subhadra, Sutiktak, Pichumarba
Hindi: Neem
Marathi: Kadunimb, Balantnimb
English: Margoasa tree or neem tree

68
Utapttisthana (Habitat):
It occurs all over in India, especially in dry places of west & north
India.

External Features:
It is thick widely spread shadowing tree with height approximately
40-50 feet.
Leaves: At the end of small sub branches, there are 8-15 inch
long leaves. Leaflets are 14-14 in muber, opposite,
curved and bhalakar

Flowers: small, white, scented flowers grow in inflorescence.

Fruits: Fruits are approximately ½ inch long, round contained

one seed inside it which is known as Nimboli.

Bark: It is approximately 10 mm thick. Externally it is brown

in colour, rough and cracked. Internally it is yellowish in
colour and fibrous. The bark secretes a clear, shinning,
amber coloured resin.

Upyukata Anga (Parts Used):

Every part of the plant is useful. Bark, root bark, young fruit, seed,
flowers, leaves and gum.

Chemical Composition:
The bark and stem contains the bitter alkaloid priniciple Morgosine.
It also contains Nimbidin (0.5%), nimbin (0.03%), Nimbinin, Nimbasterol
and Volatile Oil. It also contains 6% Tannin.
The Neem oil contains all above priniciples with oleic acid, Linoleic
acid, palmitic acid, stearic acid and lignoceric acid.

69
Bio-Enegetics:
Rasa: Tikta, Katu, Kashaya
Virya: Sheeta
Vipaka: Katu
Guna: Laghu – Ruksha

Doshaghnata: Balances Kapha due to laghu – Ruksha Guna,

Balances Pitta by Sheeta Virya and Increases Vata
i.e. Vatakara due to laghu-Rukshna Guna &
Sheeta Virya.

External Uses: Jantughna, Vranapachan, Kandughna,

Kushthaghana, Vedanasthapana.

Systemic Action and Uses:

Action on Dhatu: It purifies Rakta Dhatu by its tikta Rasa and sheeta
Virya & Reduces Kleda & kandu in skin disorders. Due to Tikta Rasa-
Laghu Ruksha Guna it Purifies kapha-Pitta Dushta Stanya.

Annavaha srotasa:
Rochan, Grahi, Krimghna, Yakrit uttejana therefore useful in Aruchi,
Chhardi, Grahani, Krimi, Atisara, and Yakrita, Vikara, Kamala.
It is a best drug for urdhwaga Amalpitta and Kapha-Pittaj Charadi
due to its tikta Rasa & Ruksha guna. Also, it is very useful in kaphaj krimi
& Raktaj Krimi due to its tikta rasa.
Aruchi – Being tikta Rasa – Vishad guna balances vitiated Kapha
kleda and mala of Jivhasthana. Therefore, Rochan function occurs. In
arsha & vimbandha- Nimboli is useful for Vatanuloman.

70
Udaka vaha Srotas: –
Trishna: Pittaj and Jwaraj trishna shamak. AlsoNimba siddhajala is
useful in Prameha to quench thirst.
Rasa: Raktavaha Srotas
Jwara: Aamjwara, Pittaj and Kaphaj Jwara.
Daha: Being Tikta and sheeta, Nimba is best Dahashamaka.

Kamal-Pandu-Raktapitta:
Nimba Balances vitiated Pitta, raktagata and Yakritastha pitta due
to its Tikta Rasa. Therefore, useful in Kamala & Raktapitta.
Firang- Updansh: Nimba works as anti-toxin.
Mamsa-Medovaha Srotas:
Useful in Pittaj and kaphaj kushtha namely Arunshi, Pama, Kandu,
Vicharchika, Eczema.
Prameha: Balances vitiated drava kapha, Kleda, & Reduces
Bahumutrata Symptoms.
Matra (Dose):
Churna -1-3gm
Swarasa (Leaves Juice) -10-20 ml c honey
Oil (Nimb tail) – 5-10 drops

Kalpa (formulations): - Nimbadi churna, Nimbagandhak churna,

Nimba Haridra Khand.

REFERENCES:-

ÌlÉqoÉ: zÉÏiÉÉå sÉbÉÑaÉÉïWûÏ MüOÒûÌiÉ£üÉåÅÎalÉuÉÉiÉM×üiÉç |

A¬SrÉ: ´ÉqÉiÉ×OèMüÉxÉeuÉUÉÂÍcÉM×üÍqÉmÉëMüiÉç |

uÉëhÉÌmɨÉMüTücNûSÏïMÑü¸¬ssÉÉxÉqÉåWûlÉÑiÉç || pÉÉ. mÉë.

71
 KUTKI

Latin name – Pichrorhiza Kurroo

Family – Scrophularaceae (Tikta Kula)

Classical Categorizaion –

Aacharya Charaka: Bhedaniya, Lekhaniya, Stanyashodhona, Tikta

Skandha
Aacharya Vagbhata: Patolyadi, Mustadi (A.H.), Pippalyadi (A.S.)
Aacharya Sushruta: Patoladi, Pippalyadi, Mustadi

Classical Name:-
Sanskrit: Katuka, Tikta, Katurohini, Shakuladani,
Kandaruha, Matsya Shakala, Chakrangi,
Krushnabheda, Katvi, Katumbhara.

72
Hindi: Kutki, Katuka
English: Picrorrhiza, Hellebare, Picroliv
Marathi: Kali Katuki, Bala Kadu.

Varieties:-

There are 2 varieties described in the Nighantu_

1) Katuka Rohini (P. Kurroa)
2) Ashoka Rohini (E. Paniculata)

Habitat: Small, Perineal shrub

Distribution: found in Alpine Himalayas at 3000-5000m

Chemical Constitution: D-Mannitol, Kutkiol, Kutkisterol, Apocyanin,
Phenol glucosides, androsim and Piecein iridoid
glycosides, Kutkin Picroside I, II, III, Kutkoside,
Minecoside, Picrorrhizin etc.
Bio-energetics:-
Rasa: Tikta
Virya: Sheeta
Vipaka: Katu
Guna: Laghu, Ruksha

Effect on Tridosha: Balances Kapha & Pitta, Mostly Pittashodhan,

Increases Vata Dosha.

Part Used: Root, Underground stem (Rhizome & Roots)

73
Actions and Uses:-

Annavaha and Purishwaha Srotas:

Being Tikta Rasa – It is best Ruchikara, Deepana, Yakrut-uttejana
and Pittasaraka. Therefore it is useful in Aruchi, Agnimandya, Yakrit
Vikara & Kamala. Being Bhedana – In Rudhapatha Kamala, it break down
Kapha Srotorodha and Causes Purgation of Pitta Dosha. Also in Aanaha,
Vibandha and Udar Vyadhi for the purpose of Doshasanghat Bhedana and
malabhedana and Pitta Shodan, Kutki is useful.
Rasa-Raktavaha Sroasa:

Hrudya Being Tikta Rasa and Sheeta Virya, it balances Pitta

Dosha and causes Dhatu- Prasadna, Therefore,
Hrudayastha dosha shodhan happens & Hrudya function
of Kutki Occures.

Jwara In Visham Jwara and Satata Jwara causes Aampachan

and Kapha-Pitta Shaman.

Kamala As explained earlier under Annavaha srotasa.

Stanyashodana Causes shodhan of Kapha & Pitta dushta Stanya by its
Tikta Rasa.
Mamsavaha Srotasa:
Kushthaghana For Jhodhan of vitiated Kapha-Pitta Dosha and Bhedana
of Mala, Kutki is useful.

Medavaha Srotasa: Useful in Daurbalya and Medoroga.

Dose (Matra) – 0.5 – 1 gm – Churna and 1 – 3 gm – for

virechana.

74
Kalpa (formulations) - Aarogyavardhini Vati, Tiktadighrita, Tiktadi
Kwath

REFERENCES:-
MüOÒûMüÉ ÌmɨÉÎeĘ́ɣüÉ MüOÒû: zÉÏiÉxÉëSÉWûÎeÉiÉç |

oÉsÉÉxÉÉUÉåcÉMüÉlÉç WûÎliÉ ÌuÉwÉqÉeuÉUlÉÉÍzÉlÉÏ || (kÉluÉliÉUÏ ÌlÉbÉhOÒû )

MüOûuÉÏ iÉÑ MüOÒûMüÉ mÉÉMåü ÌiÉ£üÉ Â¤ÉÉ ÌWûqÉÉ sÉbÉÑ: |

pÉåSlÉÏ SÏmÉlÉÏ WØûSrÉÉ MüTüÌmɨÉeuÉUÉmÉWûÉ |

mÉëqÉåWû µÉÉxÉ MüÉxÉÉxÉë SÉWû MÑü¸ Ì¢üÍqÉmÉëhÉÑiÉç || (pÉÉuÉmÉëMüÉzÉ)

MüOÒûMüÉÅÌiÉMüOÒûÎxiÉ£üÉ zÉÏiÉÌmɨÉÉxÉëSÉåwÉÉÎeÉiÉç |

oÉsÉÉxÉ AÉUÉåcÉMçü µÉÉxÉ euÉUyiÉç UåcÉlÉÏ cÉ xÉÉ || (UÉeÉÌlÉbÉhOÒû)

MüOÒûMüÐ sÉåZÉlÉÏ xiÉlrÉzÉÉåkÉlÉÏ cÉ | (cÉ.xÉÑ. 4)

BHUNIMBA

75
Bhunimb / Kirata Tikta-
The word meaning of Kirata Tikta is – Utterly bitter. It is a very
famous ayurvedic herb used in treatment of Infectious and Inflamatery
conditions like fever, skin diseases, kamala etc.

Botanical / Latin Name: Swertia chiraita

Family: Gentianaceae

Classical Categorization:

Aacharya Charaka: Tiktaskandha, Stanyashodhan,

Trishnanigrahan
Aacharya Sushruta: Aaragvadhadi

Classical Names: -
Sanskrit: Kirat, Bhunimb, Kiratak, Naditikta,
Jwarantaka, Katutikta, Nidrari, Ramsevaka.
Marathi: Kadechiraita, Kirait, Chirait
Hindi: Chirayata
English: Chitretta

Varieties: - Kirata Tikta and Kalmegha (Andrographis paniculata)

are usually confused to each other and used interchangeably.
According to Bhavaprakasha there are 2 types
 Tikta and
 Ardha Tikta.

Habitat: -0.5-1.5 meter shrub

76
Distribution: - Found in temperate Himalayas between kashmir and
Bhutan at 1200-1500 meter altitude.

Chemical Constitution: -Swertinin, Chiraranin, Mavgiferin, Swertianin,

Amarogentin, Gentipion, Chiratol, 7-0 methy lswertianin, B – Sitostetol
etc.
Chiartin is a chief bitter active constituent which is very bitter and
amorphous glycosides.

Bio- energetic:-
Rasa: Tikta
Virya: Sheeta
Vpaka: Katu
Guna: Laghu, Rooksha

Effect on Tridosha: -

 Balance Kapha and Pitta.

 Increases Vata Dosha.

Annavaha and Purishavaha Srotasa: -

 Agnideepan and Aampachan by Tikta Rasa
 Trishnanigrahan by Sheeta Virya
 Pittasaraka and Krimighna by Tikta Rasa and Katu Vipaka.
Therefore useful in Agnimandya, Ajeerna, Trishna, yalerutvikara,
kamala, Vibandha & Krimi, (Parakritivighatkara)

Rasa and Rakta Vaha Srotasa: -

Hrudya, Rakta shudhhikara and Kledanashak. Hence useful in
Hrudadaurbalya, Rautadueshti Vikara, Shotha.
Mainly useful in Jwara. It is used as a “Vyadhipratyanik Dravya” in
all types of Jwara due to its Tikta Rasa.

77
 It is useful in relieving burning sensation. i.e. Dahahara. It is widely
used in the treatment of liver disorders. It reduces inflammation of liver
and spleen also.
Pranavaha Srotasa (Respiratoy System): -
Being Pittakaphaghna, it is useful in Pittakaphaj Kasa and Shwasa.
Mamsavaha Srotas: -
It is useful in Pittakaphaj, Kushtha, because it reduces Keda &
Kapha and thus Kandu, Daha, Kleda symptoms are deoreased.
It is used as a “Tiktapaushtika” being Agnidecpana, General Debility
fellowed by Jwara is easily relieved by Bhunimb.

Matra (Dose): Kwath – 25-50 ml

Churna – 1–4 gm
Kalpa (Formulations): Sudarshan Churna.
Bhunimbadi Kwath,
KirataTiktadi Kuath.

REFERENCES:-
ÌMüUÉiÉ: xÉÉUMüÉå ¤É: zÉÏiÉsÉ: ÌiÉ£üMüÉå sÉbÉÑ: |

xÉͳÉmÉÉiÉç euÉU µÉÉxÉ MüTüÌmɨÉÉxÉ SÉWûlÉÑiÉ |

MüÉxÉ zÉÉåjÉ iÉ×whÉÉMÑü¸euÉU uÉëhÉ M×üÍqÉmÉëhÉÑiÉ || (pÉÉuÉmÉëMüÉzÉ)

pÉÑÌlÉqoÉ: zÉÏiÉsÉÉå ¤ÉÉå UxÉå ÌiÉ£üÉå sÉbÉÑ: xÉU: |

uÉÉiÉsÉ: MüTüÌmɨÉÉxÉ MÑü¸qÉåWûÉåmÉWûÉå WûUåiÉç |

µÉÉxÉ MüÉxÉ iÉ×whÉÉSÉWû AÂÍcÉ zÉÉåTüeuÉU M×üqÉÏlÉç ||

(MæürÉSåuÉ ÌlÉbÉhOÒû)

Triphala: -
Triphala is combination of Haritaki, Bibhitaki and Aamalaki. Triphala is
Kapha-pitta shamak, Dipan, Chakshusya, Meha, Kushta, Vishama jwara
nashak.

78
“mÉjrÉÉÌoÉpÉÏiÉkÉɧÉÏhÉÉÇ TüsÉæÈ xrÉÉÎi§ÉTüsÉÉ xÉqÉæÈ |

TüsȨ́ÉMÇü cÉ Ì§ÉTüsÉÉ xÉÉ uÉUÉ cÉ mÉëMüÐÌiÉïiÉÉ ||”

pÉÉ. mÉë.

“̧ÉTüsÉÉ MüTüÌmɨÉblÉÏ qÉåWûMÑüwPûWûUÉ xÉUÉ |

cɤÉÑwrÉÉ SÏmÉlÉÏ ÂcrÉÉ ÌuÉwÉqÉeuÉUlÉÉÍzÉlÉÏ ||”

xÉÑ. xÉÔ. 38

79
 HARITAKI

Latin name: Terminalia chebula

Family: Combretaceae (Haritaki kula)

Classical categorization:
Acharya Charaka: Prajasthapana, Jwaraghna, Kasaghna, Kusthaghna
Arshaghna
Acharya Sushruta: Triphala, Amalakyadi, Parushakadi

Classical Names:
Sanskrit: Shiva, Haimamati, Rohini, Kayastha, Shreyasi,
Chedanika, Abhaya, Pathya, Haritaki, Pachani
Hindi: Harad
English: Chebulic myrobalan

Bio-energetics: -
Rasa: Pancharasa (Lavana Varjita), Kashayapradhana
Virya: Ushna
Vipaka: Madhura
Guna: Laghu, Ruksh
Doshaghnata: Tridosha Shamaka (Vishesha Vatashamaka)

Parts used: Fruit

80
Chemical Composition:
Fruit contains tannin up to 30%, chebulinic acid; and it also
contains Gallic acid, resin etc, and some purgative of the nature of
anthraguinone. It contains tannic acid 45%, rich Gallic acid, mucilaginous
and colouring matter; its content chebulinic acid disintegrates into tannic
and Gallic acids on boiling in water.

Actions and Uses:

External uses: -
Local application of haritaki is anti inflammatory. In Conjunctivitis, it
can be used for application on the eyelids. A decoction of haritaki is used
for washing wounds and also used for gargaling in diseases of mouth and
throat.

Internal Uses: -

Annavaha srotasa (Digestive system): -

Useful in loss of Appetite, Pain in Abdomen, Constipation, Gulma,
Ascitis, Haemorrhoids, Hepatomegaly, Splenomegaly and Parasites. The
bark of haritaki, if eaten after chewing it properly in mouth, improves
digestion.
It relieves constipation in chronic abdominal diseases and also helps
in digestion of “ama”.

Pranavaha srotasa (Respiratory system): -

Rhinitis (due to Constipation), Cough, Hoarsness of Voice, Hiccups
and Dyspnoea are relived by Haritaki as it reduces congestion.

Raktavaha srotasa (Circulatory system): -

Since haritaki is raktagami it is used in weakness of heart,
Vatarakta and other disorders of blood

81
Majjavaha srotasa (Nervous system): -
Useful in weakness of nerves and brain as well as in vata disorders
and diminished vision.

Reproductive system: -
Useful in Shukrameha, Leucorrhoea and acts as an Uterine tonic.

Urinary system: -
Useful in Dysuria, Retention of Urine, Calculus and Kaphaj Prameha.

Skin: -
Useful in Erysipelas and other Skin disorders.Haritaki preventes
accumulation of pus in skin diseases.

Temprature: -
Useful in Typhoid fever and also chronic fever.

Restorative effect: -
Haritaki acts as a rejuvenator, but to produce rasayan effects, it
needs various supportive herbs in different seasons.This concept had
been explained by Bhavaprakashakara as Rutu haritaki.
 Varsha - Saindhav
 Sharad - Sugar
 Hemant - Sunthi
 Shishir - Pippali
 Vasant - Honey
 Greeshma - Guda.

82
Rogaghnata: -
It is useful in Prameha, Shwasa, Kasa, Grahani, Shopha, Kustha,
Udararoga, Hridroga etc. According to Bhavaprakasha it is effective in
Vibanda, Krimi, Trishna, Hikka, Kandu, Vedana, Yakritroga, Mutraroga
and Santarpanajanya Vikara.

Formulations:-

Abhayadi modak, Abahayarista, Pathyadikadha, Pathyadivati,

Vyagriharitaki leha, Ghandharvaharitaki churna.

Srotogamitva: -
 Dosha -Tridoshanashak
 Dhatu -Ras, Majja, Rakta, Mamsa, Meda, Asti, Shukra.
 Mala -Purisha, Mutra.

References: -
“WûËUiÉMüÐ mÉjrÉÉlÉÉÇ ´ÉãwPû: ||”

cÉ. xÉÔ. 25

“ÌuÉeÉrÉÉ UÉåÌWûhÉÏ cÉãuÉ mÉÑiÉlÉÉ cÉÉqÉ×iÉÉpÉrÉÉ |

ÎeÉuÉliÉÏ cÉåiÉMüÐ cÉåÌiÉ mÉjrÉÉrÉÉ: xÉmiÉ eÉÉiÉrÉ: ||”

pÉÉ. MÉë

“xuÉÉSÒÌiÉ£üMüwÉÉrÉiuÉÉiÉç ÌmɨɾûiÉç MüTü¾û¨ÉÑ xÉÉ |

MüOÒûÌiÉ£üMüwÉÉrÉiuÉÉSqsÉiuÉÉSè uÉÉiɾûÎcNûuÉÉ ||”

pÉÉ. mÉë

“mÉëqÉjrÉÉ sÉåZÉlÉÏ sÉbuÉÏ qÉåkrÉÉ cɤÉÑÌWûïiÉÉ xÉSÉ |

qÉåWûMÑüwPûuÉëhÉcNûÌSïzÉÉåwÉuÉÉiÉÉxÉëM×cNíûÎeÉiÉç ||

uÉÉiÉÉlÉÑsÉÉåqÉlÉÏ ¾è±É xÉåÎlSìrÉÉlÉÉqÉç mÉëxÉÉSlÉÏ |

xÉÇiÉmÉïhÉM× iÉÉlÉç UÉåaÉÉlÉç mÉëÉrÉÉå WûÎliÉ WûËUiÉMüÐ ||”

kÉ. ÌlÉ.

83
 BIBHITAKA

Latin name: Terminalia bellirica

Family: Combretaceae

Classical categorization:
Acharya Charaka: Jwarahara, Virechanopaga
Acharya Sushruta: Triphala, Mustadi

Classical Names:
Sanskrit: Karshaphala, Aksha, Kalidrum, Bibhitaka,
Kalivruksha,
Telpushpak, Bhootawas, Romaharsha, Kalind.
Hindi: Bheda
English: Romaharsha, Kalind Belliric myrobalan

Bio-energetics:
Rasa: Kashaya
Virya: Ushna
Vipaka: Madhura
Guna: Ruksha, Laghu
Doshaghnata: Tridosha shamaka (Vishesha Kapha shamaka)

84
Parts used: Fruit

Chemical Composition:
The fruit contain gallo-tannic acid, colouring matter and resin.
Seeds yield greenish yellow oil.

Pharmacological Actions:
Astringent, Expectorant, Tonic and Laxative.

Actions and Uses:

External uses:
Anti-inflammatory, Analgesic, Heamostatic and gives black colour to
skin and hair.
Internal uses:
Annavaha srotasa (Digestive system): -

Being Ushna, it is Deepan, Laxative and Anthelmintic. It is used in

Indigestion, Flatulence, Excessive Thirst, Emesis, Haemorroids, and
Helmenthiasis.

Pranavaha srotasa (Respiratory system): -

It helps in Asthma and Cough by reducing the inflammation of the
bronchi.
Raktavaha srotasa (Circulatory system): -

It is used as a blood coagulant due to its astringent property. It is

used in internal bleeding and haemoptysis.

Majjavaha srotasa (Nervous system): -

The pulp is Intoxicant and Analgesic.The pulp is used in Vata
disorders and insomnia.

85
Reproductive system: -
The pulp is an Aphrodisiac. Used in Impotency and Libido.

Satmikaran: -
Rasa, Rakta, Mamsa and Meda gami, Dhatuvrardhak because of its
madhur vipak.

Rogaghnata:
It is useful in Kasa, Krimi, Ashmari, and Swarabhanga. The ripe fruit
is Laxative. Fruits are also effective in Bronchitis, Sore throat,
Inflammation, Asthma and Liver Diseases.

Formulations: -
Bibhitaka taila, Triphala churna, Phalatrikadi kwath, Lavangadi vati,
Bibhitaki sura.

Srotogamitva: -
 Dosha -Tridosha
 Dhatu -Majja, Rakta, Shukra, Rasa, Mamsa, gami.
 Mala -Purisha, hair tonic
 Organs -Eyes, Respiratory system.

Reference: -
“ÌoÉÍpÉiÉMÇü xuÉÉSÒmÉÉMÇü MüwÉÉrÉÇ MüTüÌmɨÉlÉÑiÉç |

EwhÉuÉÏrÉï ÌWûqÉxmÉzÉïÇ pÉåSlÉÇ MüÉxÉlÉÉzÉlÉqÉç ||

¤ÉÇ lÉå§ÉÌWûiÉÇ MåüzrÉÇ M×ÍqÉuÉæxuÉrÉïlÉÉzÉlÉqÉç |

ÌoÉpÉÏiÉqÉ‹É iÉ×OèNûÌSïMüTüuÉÉiÉWûUÏ sÉbÉÑÈ ||

MüwÉÉrÉÉ qÉSM×üŠÉjÉ kÉɧÉÏqÉ‹ÉÌmÉ iÉSè aÉÑhÉÉ |”

pÉÉ.mÉë.

86
 AMALAKI

Latin name: Embilica officinalis

Family: Euphorbiaceae (Eranda kula)

Classical categorization:

Acharya Charaka: Vayasthapana, Virechanopaga

Acharya Sushruta: Triphala, Parushakadi

Classical Name:
Sanskrit: Amalaki, Dhatri, Gayatri, Shriphala, Vrushya,
Tishyaphala, Amruta, Kayastha, Pancharasa.
Hindi: Amla
English: Emblica myrobalan

87
Bio-energetics:
Rasa: Pancharasa (Lavana Varjita), Amla Pradhana
Virya: Sheeta
Vipaka: Madhura
Guna: Laghu, Ruksha, Sheeta
Doshaghnata: Tridosha shamaka

Parts Used: Fruit

Chemical Composition: -
It contains Gallic acid, tannic acid, Sugars, Albumin, Cellulose and
Minerals. It is rich source of Vitamin C.
Other contents are as follows (per 100gms of fruit):
 Moisture: 81.20 mg
 Protein: 0.5mg
 Fat: 0.1mg
 Minerals: 0.7 mg
 Phosphorus: 0.02 mg
 Iron: 1.2 mg
 Nicotinic acid: 0.2 mg.

Pharmacological Actions:
Fresh fruit is diuretic and laxative. Fruit is also carminative.

Actions and Uses:

External uses:
Refrigerant, Hair tonic, Complexion enhancer. Paste is applied
locally in Burning, Headache due to Pitta, and Retention of urine. Leaf
Juice is used in Eye disorders. Toothache is relieved by chewing fruit skin.

88
Internal uses: -
Annavaha srotasa (Digestive system): -
It improves taste and Appetite, Curative, Antacid. It acts in loss of
taste, loss of Appetite, Anorexia, Constipation, Liver Disorders, Acid Peptic
Diseases, Eructations, Ascites and Piles through its properties of
digestion, laxation and rasayan.

Prana vaha srotasa (Respiratory system): -

It Reduces cough. Also it is Useful in diseases like Cough, Asthma,
and Tuberculosis etc. being a rejuvenating agent. Amalki is good brain
tonic. It pacifies vitiated Sadhak pitta.

Raktavaha srotasa (Circulatory system): -

Cardiac tonic and haemostatic. Useful in heart diseases

Majjavaha srotasa (Nervous system): -

Strengthens nervous system, bone marrow and sense organs.

Skin: -
Useful in Skin disease and erysipelas.

Temperature: -
Antipyretic, Refrigerant. Useful in Chronic fever, Thirst, burning
sensation etc.

Satmikran: - Rasayan, Rejuvenator.

Rogaghnata: - Prameha, Hridroga, Yakritroga, Kustha.

Dose: Fruit juice – 12 ml,

Powder – 3 to 6 gm.

89
Formulations: -Chavanprash, Bramharasayan, Dhatriloha, Amrutprash,
Amalaki rasayan.

Srotogamitva: -
Dosha: Pitta– nashak,
Kapha– nashak,
Vata – nashak
Dhatus: Rakta -Haemorrhagic disease, Jaundice.
Meda -Prameha
Shukra -Aphrodisiac
All Dhatus -Rasayan especially muscle
Mala: Purisha – laxative
Organs: Eyes, spleen, Liver, Lungs.

References: -
“WûUÏiÉMüÐ xÉqÉÇ kÉɧÉÏTüsÉÇ ÌMüliÉÑ ÌuÉzÉåwÉiÉÈ |

U£üÌmɨÉmÉëqÉåWûblÉÇ mÉUÇ uÉ×wrÉÇ UxÉÉrÉlÉqÉç ||”

pÉÉ.mÉë.

“AqsÉÇ xÉqÉkÉÔUÇ ÌiÉ£ MüwÉÉrÉÇ MüOÒûMÇü xÉUqÉç|

cɤÉÑwrÉÇ xÉuÉïSÉåwÉblÉÇ uÉ×wrÉqÉÉqÉsÉMüÐ TüsÉqÉç||

WûÎliÉ uÉÉiÉÇ iÉSqsÉiuÉÉÎimɨÉÇ qÉÉkÉÑrÉï zÉæirÉiÉÈ|

MüTÇü ¤ÉMüwÉÉrÉiuÉÉiTüsÉåprÉÉåÅprÉÉÍkÉMÇü cÉ rÉiÉç||”

xÉÑ. xÉÔ. 46

90
 DARUHARIDRA

Latin name: Berberis aristata De.

Classical categorization:
Arshaghna, Kandughna, Lekhaniya, Haridradi, Mustadi, Laksadi (S)
Kula: Daruharidra kula
Family: Berberidae (from Berberys = Arabic name)

Berberis: Belonging to the Berberis family

Aristata: Furnished with an elongated projecting bristle, in
connection with the costa.
Classical names:
Sankrit Names: Daruharidra (having yellow colours wood like
turmeric), Darvi, katankateri, Sthiraraga, Kamini,
Peetachandana, Hemakanta, Peeble, Haridra,
Nisa.

English Name: Indian berbery.

91
Botonical Description:
Evergreen shrub having height 1.25 to 3 mtrs. The leaves are
strong with fine shorled venation, straight, but with dentate or corrugated
margins. Inflorescence 5 to 8 cms long, with large yellow coloured
flowers. The fruits are bluish purple and small (called zarishka in yunani).
Flowers bloom in spring and fruits in winter. The stem is ash
coloured from outside but is dark yellow coloured inside. Rasanjana
(rasot) is prepared from the chemical or juice of the chitra variety of
daruharida types. There are 12/13 types, the important ones being
Berberis aristata, Berberis chitra, and Berberis lycium.

Habitat: Himalaya, Parasnath, Nilgiri, Nepal at the height

of 0.75 to 4.25 thousand mtrs.

Bio- energetic:
Rasa: Tikta Kashaya
Virya: Ushna
Vipaka: Katu
Guna: Laghu, ruksha

Karma: Arshoghna, Kandughna, Lekhaniya

Dosha: Kaphapitthara, the fruit is pittasamaka, hence

used in diseases originating from kapha pitta.
Parts Used: Roots, stem and fruit

External Uses:

Shothaghna or reduces inflammation or oedema, removes pain,

cures and heals ulcers, also used for eye diseases. Hence in severe
conjunctivitis, the paste is applied around the eyes and 250 mg rasanjana
mixed with 20 ml. of rosewater is used as eyedrops or can be applied on

92
eyelids. The fluid can also be applied in the ears in earache or ear
discharge.
In diseases of the mouth and throat, rasanjana is used for gargling.
Rasanjana can be used to wash wounds or its paste can be applied on
ulcers. Chancroid ulcers, goitre, fistula, crysielas and other diseases are
treated by the application of the paste. Vaginal discharges are treated by
the vaginal douche prepared from berberis. Peripheral diseases are
treated by the application of rasanjana on perianal wounds.
Internal Uses:

Annavaha srotasa (Digestive System):

Appetiser, liver stimulant, cholagogue but astringent. A larger dose
is laxative. The fruit is very tasty and antidipsectic. Because of these
actions, daruharidra is a superior Medicine in agnimandya, dysentry,
jaundice and other liver disorders. The tablet of rasanjana prepared in
radish juice is useful in bleeding piles. It is also effective in diarrhoea.
Daruharidra formulation gives excellent results in cholera.

Pranavaha srotasa (Respiratory System):

It is useful in the treatment of cough being kaphaghna

Raktavaha srotasa (Circulatory System):

Blood purifier and haemostatic agent. Daruharidra decoction is
given in syphilis and other sexual diseases. Hematemesis, malena and
menorrhagia respond only to ranjan or coagulant preparations rasanjana.
Reduces pus. Daruharidra acts on rakta dhatu. Because of daruharidra,
the inactive forms of malarial parasite in the spleen come out in the blood
steam and this is very useful for the diagnostic test for malarial parasite
by peripheral smear.

Reproductive System:
Useful in uterine inflammations and vaginal discharges.

93
Skin:
Diaphoretic, useful in diseases of the skin like pruritus, boils etc.
Daruharidra decoction is useful in cleansing wounds. Rasanjana + honey
is used extemally in puerperal diseases. It is specially useful in ulcer. The
decoction is used for gargling in stomatitis.

Temperature:
Febrifuge and Diaphoretic and is a prophylactic treatment for
typhoid. Hence it is useful in common fever and also in chronic fever. It
causes sweating, is antipyretic and is useful in recurrent malaria. When
malarial parasites hide in the liver, quinine is not effective but
Daruharidra is very effective.

Satmikaran:
It is bitter and strengthening, hence useful in general debility.

Adulteration:
Daruharidra is adulterated with shoots of plants like samudrashosha
after boiling them in decoction of turmeric. The shoots of real daruharidra
are elastic and do not lose their yellow colour even after boiling.

Formulations:
Darvyadikwath, Daryadileha, Darvyaditaila
Dosage: Juice of root: 10 to 20 ml
Decoction: 50 to 100 ml
Rasanjana: ¼ to ½ gm.
Fruit: 1 gm.
In malaria (total) 5 to 10 mg as a stimulant for heart but larger
dose can lead to cardiac depression.

94
Rasanjanasuddhi:

Rasanjanasuddhi available in the market should be purified by

mixing in four parts of hot water and subsequent straining. Then it
should be cooked on fire after mixing with milk or should be dehydrated
by exposure to sunlight.

Srotogamitva:

Dosha: Reduces kapha

Dhatu: Meda, rsayan, raktagami
Mala: Mootra – purisha – sweda.
Organs: Eyes, liver, spleen and skin.

References: -

ÌiÉ£üÉ SÉÂWûËUSìÉ xrÉÉSìè¤ÉÉåwhÉÉ oÉëWûqÉåWûlÉÑiÉç|

MühÉïlÉå§ÉqÉÑZÉÉå°ÕiÉÉ ÂeÉÇMühQÒÇû cÉ zÉÉåwÉrÉåiÉ ||

(kÉ.ÌlÉ.)

SÉuÉÏïYuÉÉjÉxÉqÉÇ ¤ÉÏUÇ mÉÉS mÉYiuÉÉ rÉSÉ bÉlÉqÉç|

iÉSÉ UxÉÉÇeÉlÉÇ ZrÉÉiÉÇ lÉå§ÉrÉÉå: mÉUqÉÇ ÌWûiÉqÉç||

UxÉÉÇeÉlÉÇ MüOÒû zsÉåwqÉÌuÉwÉlÉå§ÉÌuÉMüÉUlÉÑiÉç |

EwhÉ UxÉÉrÉlÉÇ ÌiÉ£ü NåûSlÉç uÉëhÉSÉåwÉM×üiÉ||

(pÉÉ.mÉë.)

95
 MADHU

Ayurveda has described Honey as the best medicine for Kapha

Dosha.It is a jangam dravya.
Synonyms: Madhu, Madha, Makshika, Kshaudra, Honey.
Latin Name: Mel
Gana: Vamanopaga (charaka)
Class: Hymenoptera
Characters:
It is a viscid, saccharine substance, translucent fluid. It is light
yellowish in color.
Odour: Aromatic.
Taste: sweet, acrid.

96
Types of Honey:
Acharya Sushruta and Acharya Charaka has described various types
of Honey.
“qÉÉ̤ÉMÇü pÉëÉqÉUǤÉÉæSìÇ mÉÉæ̨ÉMÇü qÉkÉÑeÉÉiÉrÉ:|

qÉÉ̤ÉMÇü mÉëuÉUÇ iÉåwÉÉ ÌuÉvÉåwÉÉSç pÉëÉqÉUÇ aÉÑÂ: ||”

cÉ.xÉÔ. 27/243

“mÉÉæ̨ÉMÇü pÉëÉqÉU ¤ÉÉæSìÇ qÉÉ̤ÉMü NɧÉqÉåuÉ cÉ|

AÉkrÉïqÉÉæ²ÉsÉMÇü SÉsÉÌqÉirÉ·Éæ qÉkÉÑeÉÉiÉrÉ:||”

xÉÑ.xÉÔ. 45/133

As per Acharya Charaka there are four types of Honey_

1. Makshika
2. Bhramar
3. Kshaudra
4. Pautik

As per Acharya Sushruta there are eight types of honey.

1. Makshik 2. Bhramar
3. Kshaudra 4. Pautik
5. Chatra 6. Aardhya
7. Daal 8. Auddalak

Makshik Madhu is best among all varities.

Properties of Honey:
Rasa: -Madhur, Kashaya
Guna: -Ruksha, Guru
Veerya: -Sheet
Vipak: -Madhur
Satmikaran: -Tridosha shamak.

97
Action on Doshas:
Madhu acts on all the doshas. It acts on Kapha Dosha through its
Kashaya Rasa, Ruksha, Guru guna and pacifies Vata-pitta by its viscocity,
sweet astringent properties. (According to Vagbhata Honey increases
Vata).

Dhatu-gamitva:
It acts on Meda, Shukra, Majja (Beneficial to Eye, Improves
intellect).

Guna karma:
By Acharya Charaka -
“uÉÉiÉsÉÇ aÉÑà vÉÏiÉÇ cÉ UYiÉÌmÉ¨É MüTüÉmÉWqÉç|

xÉlkÉÉiÉ×cNåSlÉÇ Ã¤ÉÇ MüwÉÉrÉÇ qÉkÉÑUÇ qÉkÉÑ||”

cÉ.xÉÑ. 27/245

Externally:
Locally when it is applied to mucous membrane it causes
stimulation of mucous membranes.

Internally:
Increases the Agni, used in Constipation, Indigestion, Abdominal
distention and Thirst. It improves complexion and voice, increase softness
of the Skin, Cardiac tonic, Aphrodisiac, Reunion of the bones, removes
vitiated doshas, improves wound healing, promote mental health.

Action on Diseases:
Diabetes, Hiccups, Asthma, Cough, Diarrhoea, Vomiting, Excessive
thirst, Helminthiasis, Toxins, Dermatosis, Jaundice, Haemmorhoids,
Abdominal distention, diseases of the Throat, Uneasiness, Intoxication,
Burning sensation, Constipation.

98
By Vagbhatacharya:

“cɤÉÑwrÉÇ NåÌS iÉ×OvsÉåwqÉÌuÉwÉÌWkqÉÉx§É ÌmɨÉlÉÑiÉç |

qÉåWMÑü¸ M×üÌqÉcNÌSï µÉÉxÉMüÉxÉÉÌiÉxÉÉUlÉÑiÉç ||52||

uÉëhÉvÉÉåkÉlÉ xÉÇkÉÉlÉ UÉåmÉhÉÇ uÉÉiÉsÉÇ qÉkÉÑ |

Ã¤É MüwÉÉrÉ qÉkÉÑUÇ iɨÉÔsrÉÉ qÉkÉÑvÉMïüUÉ ||53||”

A.xÉÇ.xÉÔ.

Madhu is Vatkaraka, Ruksha, Kashaya, Madhura, Lekhana and

useful to eye. Madhu is useful in Trushna, uchaki, Raktapitta, Kapha,
Vishadosha, Meha, Kusta, Krimi, Chardi, Shwas, Kasa, Atisar.

Yogvahi Madhu:

“iɱÑYiÉÇÌuÉÌuÉkÉærÉÉæaÉæÌlÉWlrÉÉSÉqÉrÉÉlÉç oÉWÔlÉç |

lÉÉlÉÉSìurÉÉiqÉMüiuÉÉŠ rÉÉåaÉuÉÉÌW mÉUÇ qÉkÉÑ ||”

xÉÑ.A. 45/142

“rÉÉåaÉÉiÉç rÉÉåÌaÉlÉÉå aÉÑhÉÇ uÉWiÉÏÌiÉ rÉÉåaÉuÉÉW: |

aÉ×»ÉÌiÉ rÉÉåaÉuÉÉÌW SìurÉÇ xÉÇxÉÌaÉïuÉxiÉÑaÉÑhÉÉlÉç |

mÉcrÉqÉÉlÉÇ rÉjÉæiÉlqÉkÉÑeÉsÉiÉæsÉÉerÉxÉÔiÉsÉÉåWÉÌS: |”

pÉÉ.mÉë. 6/230

Madhu is yogvahi, dravya when yogawahi dravyas are given along

with other dravyas then it works by adding the properties of other
dravyas with its own properties also.

Chemical composition of honey:

 Glucose – 84.9%
 Formic acid, sucrose – 2.69%
 Alkaloids – 0.12%
 Water – 10.03%
 Nitrogen – 1.29%
 Specific gravity – 1.36

99
  Dextrose – 23 – 36%
 Gulcose – 30 – 44
 Dextrine – 0.7%
 Ash – 0.1 – 7

References:
“iÉssÉbÉÑiuÉÉiÉç MüTüblÉ mÉæÎcNsrÉÉlqÉÉkÉÑrÉÉïiÉç|

MüwÉÉrÉpÉÉuÉÉŠ uÉÉiÉÌmɨÉblÉqÉç

oÉ×WÇhÉÏrÉ qÉkÉÑÇ lÉuÉÇ lÉÉÌiÉvsÉåwqÉWUÇ xÉUqÉç|

qÉåS: xjÉÉæsrÉÉmÉWÇ aÉëÌW mÉÑUÉhÉ qÉÌiÉsÉåZÉlÉqÉç||

SÉåwɧÉrÉWUÇ mÉYuÉqÉÉqÉqsÉÇ Ì§ÉSÉåwÉM×üiÉç|”

xÉÑ.xÉÔ.45/141

“qÉkÉÑ xÉÇkÉÉrÉÌiÉ qÉkÉÑvsÉåwqÉÌmÉ¨É mÉëvÉqÉlÉÉlÉÉqÉç|”

cÉ.xÉÔ.27/4

“qÉkÉÑ iÉÑ qÉkÉÑUÇ MüwÉÉrÉÉlÉÑUxÉÇÃ¤É vÉÏiÉqÉÉÌalÉSÏmÉlÉÇ uÉhrÉïÇ xuÉrÉïÇ sÉbÉÑ |

xÉÑMÑüqÉÉUÇ sÉåZÉlÉÇ ¾û±Ç uÉÉeÉÏMüUhÉÇ xÉlkÉÉlÉÇ vÉÉåkÉlÉÇ UÉåmÉhÉÇ xÉÇaÉëÌW |

cɤÉÑwrÉÇ mÉëxÉÉSlÉÇ xÉѤqÉqÉÉaÉÉïlÉÑxÉÉÌU ÌmɨÉvsÉåwqÉ ÌWYuÉÉvuÉÉxÉ........

.......... uÉÉiÉÌmɨÉblÉqÉç|| xÉÑ.xÉÔ.AÇ.45/132

100
 MATERIALS AND METHODS

Materials:
Patients: The patients were selected from indoor and outdoor patients of
our hospital.
Drugs:
Trial Group: - Vasadi kwath with Madhu

Control Group: - Darvi kwath with Madhu

A. Conceptual Study:
All sorts of references have been collected and compiled from
ayurvedic and modern texts, classes, commentaries, dissertations and
journals etc.

Mode of Action:
Vasadi kwath is pitta shamak, yakrut prabhavkar, Ruchikar, Deepan
and ampachan because of it‟s tikta, madhur and kashay rasa and sheeta
virya and katu, madhur vipaka.
Darvi Kwath is also pitta shamak and yakrut prabhavkar.

uÉÉxÉÉÌS YuÉÉjÉ

uÉÉxÉÉ aÉÑQÒûÍcÉ Ì§ÉTüsÉÉ MüOûuÉÏ pÉÑÌlÉqoÉ ÌlÉqoÉeÉ: |

YuÉÉjÉ: ¤ÉÉæSìrÉÑiÉÉå WûÎliÉ mÉÉhQÒûÌmɨÉÉx§ÉMüÉqÉsÉÉ: ||

(A¹ÉÇaÉWØûSrÉ ÍcÉ. 16 mÉÉhQÒûUÉåaÉÍcÉÌMüixÉÉ)

SÉuÉÏï YuÉÉjÉ

̧ÉTüsÉÉrÉÉ aÉÑQÒûcrÉÉ uÉÉ SÉurÉÉï ÌlÉqoÉxrÉ uÉÉ UxÉqÉç |

zÉÏiÉÇ qÉkÉÑrÉÑiÉÇ mÉëÉiÉ: MüÉqÉsÉÉiÉï ÌmÉoÉå³ÉU: ||

(cÉUMü ÍcÉ. 16 mÉÉhQÒûUÉåaÉÍcÉÌMüixÉÉ)

101
 B. Pharmaceutical Study:
Preparation of the Kwatha:
Both the Kwathas were prepared according to Kwath vidhi told in
Sharangdharsamhita.

mÉÉlÉÏrÉwÉÉåQûwÉaÉÑhÉÇ ¤ÉÑhhÉåSìurÉmÉsÉÇͤÉmÉåiÉç|

qÉ×imÉɧÉåYuÉÉjÉrÉåSè aÉëɽqÉ·ÉzÉÉuÉzÉÉåÌwÉiÉqÉç ||

(zÉÉ.qÉ.ZÉÇ.2/1)

20 gm bharad of Vasadi churna is taken for trial group and 30 gm of

bharad of Darvi churna is taken for control group.
 Its 16th times i.e.320 ml of water to Vasadi churna and 480 ml of
water to Darvi churna was added.
 Then the mixture was heated on Mandagni up to 1/8th of its water
so that 40 ml of Vasadi kwath and 60 ml of Darvi kwath will remain
after decoction process.
 Then it is filtered.
 These ready kwaths were advised to be taken with 5ml of madhu .

VASADI KWATH DARVI KWATH

C. Analytical Study
Drug Standardization
Drugs required: Vasadi kwath - Vasa, Amruta, Triphala, Kutki, Nimb,
Bhunimb bharad choorna. Daruharidra Kwath – daruharidra bharad
choorna. These choorna were purchased from pharmacy and the

102
standardization of all this content was done by following parameters as
per API guidelines. Authentication and Standerdization certificates are
attached.
1. Pharmacognostic method
a. Organoleptic study
b. Foreign matter
c. Microscopic and macroscopic study

2. Physiochemical method
a. Moisture percentage
b. TLC (Thin layer chromatography)

Methodology:
This was randomized, single blind control clinical trial. Thorough
history and the complaints of the patients were taken in their
chronological order.
Each and every patient was carefully examined clinically for general
and systemic examination. Full explanation about the trial was given top
the each patient and informed written consent of each and every patient
was taken before the commencement of treatment, after that total 60
patients were selected for present clinical trial on the basis of clinical
diagnosis.
Total 60 patients of Bahupitta Kamala were randomly selected and
equally divided into two groups.
1) Trial Group: In this group, 30 patients of Bahupitta Kamala were
given 40 ml Vasadi kwath with 5ml honey for maximum of 60 days.
2) Control Group:
In this group, 30 patients of Bahupitta Kamala were given 60 ml
Daruharidra kwath with 5ml Madhu for maximum of 60 days.

103
STUDY DESIGN: -
Randomised Control Study

Screening of the patients for inclusion (counseling, informed concent)

Initial Assessment of patients (Dietary & Behavioral advice is given)

Group allocation by Randomizaton

ControlGroup – 30 Patients Trial Group30 Patients

Intervention by Darvi Intervention by vasadi kwath
kwath with madhu internally with madhu

Duration of therapy 45 days with observations of patients for Sr.
Billirubin, Haridra netrata, Pita mutrata, Purish pitata, Agnimandya
(loss of Apetite), Aruchi (loss of desire to eat), Daurbalya
(Weekness), Daha (Burning sensation)

Follow up at the end of every week upto 8th week

Assessment during treatment (before study and after study)

Statistical analysis

Conclusion

104
SAMPLE SIZE CALCULATION:
η = t2 x P (1-P)/e2
Determination of sample size
η - Required sample size
t - Confidence level at95 %(Standard value of 1.96)
e – Margin of error at 5 % (Standard value of 0.5)
P- Estimated prevalence of Bahupitta Kamalain selected patients95
% (Standard value of 0.95)
η = t2 x P (1-P)/e2
= [(1.96)2 x 0.95 (1-0.950)]/ (0.05)2
= [3.84 x 0.95 x 0.05] / 0.025
= 0.1475 / 0.025
= 59.00 ≈ 60
= Approximately 60 Patients
i. e. Sample size: Total 60 Patients (30 in each group)

D.CLINICAL STUDY

1. Grouping and Randomization of Patients with Drug

Administration details:
Group A Group B
No. of patients 30 30
Treatment Darvi Kwath Vasadi kwath
Dose (Matra) 60 ml O.D 40 ml B.D
Kala Abhaktakala MadhyaBhakta
(Pratah kala)
Kalpana /Vidhi Kwath vidhi Kwath vidhi
Route Oral Oral
Duration 45 Days 45 Days
Pathya Madhur rasa adhar, Ikshu Madhur rasa adhar, Ikshu
rasa, Wheat, Green Dal rasa, Wheat, Green Dal

105
Criteria for Assessment
a. Inclusion Criteria
I. Patient willing for clinical trial.
II. Either sex
III. Occupation no barrier
IV. Religion-no barrier
V. Age between 18 to 60 yrs
VI. Having lakshanas of Bahupittakamala
VII. Hyperbillirubinemia having raised sr.billirubin (more
than 3mg/dl)

a. Exclusion Criteria
I. Patient not willing for clinical trial
II. Age less than 18 years and more than 60 years
III. Pregnant women and lactating mothers
IV. Obstructive jaundice
V. Sr. billirubin more than 10 mg per dl.
VI. Diebetes mellitus
VII. Liver cancer
VIII. Haemolytical Jaundice
IX. Patients of Hepatic Encephalopathy, Ascitis.
X. Patients having other systematic disorders like
Hypertention, Renal failure, Internal Bleeding

Diagnostic Criteria

I. Patients having Sr. billirubin level>1.2 mg/dl

II. Pita Mootrata
III. Hrullas
IV. Haridra Netrata
V. Purish Pitata

106
 The patients having above lakshanas predominantly along with
some lakshanas from subjective and objective criteria will be selected for
clinical study.

Subjective and Objective Criteria along with Gradation for Clinical

Assessment:-

Sr. Symptoms Criteria Grades

No.
Absent (White) 0
Mild (Pale Yellow) 1
Haridra Netrata Can be seen in sunlight
1. 2
(Yellow Sclera) (Yellow)
Can be seen without sunlight(
3
Dark Yellow)
Bile salt, Bile pig absent
0
(clear)
Pita Mootrata Bile salt, Bile pig present +
1
(Yellow (Pale Yellow)
2.
Micturition) Bile salt, Bile pig present ++
2
Purish Pitata (Yellow)
Bile salt, Bile pig present
3
+++ or more ( Dark Yellow)
Normal 0
Less desire to eat 1
Aruchi& Less desire to eat with
2
3. Avipaka nausea
(Anorexia) Less desire to eat with severe
nausea 3

107
 Normal 0
Up to 10 % reduced appetite 1
4. Agnimandya
Up to 50 % reduced appetite 2
Complete loss of appetite 3
Absent 0
Daha (Burning Occasionally 1
5.
Sensation) Occurs at particular time 2
Occur everytime 3
Absent 0
Daurbalya Mild 1
6.
(Weakness) Moderate 2
Severe 3
Normal 0
Less desire to eat with
1
nausea
7. Hrullas
Less desire to eat with severe
2
nausea
Vomitting 3
Sr. Billurubin 1 mg/dl 0
Sr. Billurubin > 2 mg/dl 1
8. Sr. Billurubin
Sr. Billurubin > 3 mg/dl 2
Sr. Billurubin > 6 mg/dl 3

Criteria for the total effect of therapy

1. Complete Relief - 100%
2. Marked Relief - 75%
3. Moderate Relief - 50%
4. Mild Relief - 25%
5. No Relief - <25%

108
Informed Consent
Patient fulfilling criteria for selection will be under the study after
receiving their written consent.

Withdrawal for Study

Withdrawal of patient was done on ethical ground just as not giving
proper follow up and after discussion with respected guide.

Investigations (As per requirement according to susceptibility)

a. Sr. Billirubin
b. Urine test: Bile salt, Bile Pigment
c. SGOT & SGPT
d. USG Abdomen as per requirement
Follow up
Clinical follow up of patients of both the groups was advised
every week in duration of 45 days and thereafter at 7th, and 8th week.

Pathypathya
It was explained to every patient, especially madhur rasa ahar,
Milka, Ikshu rasa (Laghu, Snigdha, Deepan, Pachan ahar).

109
 OBSERVATION AND RESULTS

5.1. General Observations

A) Distribution of patients
Table 5.1 Shows distribution of patients in groups

Group No of Patients
Control Group (A) 30
Trial Group (B) 30
Total 60

Figure 5.1 Shows distribution of patients in groups

Distribution

Control Group
(A) Trial Group (B)
50% 50%

B) Age
Table 5.2 Shows Age wise distribution in both groups
Sr. No of Patients Total
No. Age (yrs) Group Group
A B
1 18 to 31 7 11 18
2 32 to 46 17 15 32
3 47 to 60 6 4 10
4 Total 30 30 60

110
Figure 5.2 Shows Age wise distributions in both groups

Age (yrs)
Group A Group B

17
15

11
7
6
4

18 to 31 32 to 46 47 to 60

C) Gender
Table 5.3 Shows Gender wise distribution in both groups
Sr. No of Patients Total
No. Gender Group Group
A B
1 Female 15 18 33
2 Male 15 12 27
3 Total 30 30 60

Figure 5.3 Shows Gender wise distributions in both groups

Gender
Female Male
18
15 15
12

Group A Group B

111
D) Occupation
Table 5.4 Shows Occupation wise distribution in both groups
Sr. No of Patients Total
No. Occupation Group Group
A B
1 Business Man 4 0 4
2 Business 2
0 2
Women
3 Driver 0 1 1
4 Farmer 3 2 5
5 House wife 9 7 16
6 Labour 4 6 10
7 Service 6 6 12
8 Student 4 6 10
9 Total 30 30 60

Figure 5.4 Shows Occupation wise distributions in both groups

Occupation
Group A Group B
9

6 6 6 6

4 4 4

2 2

0 0 0

Business Business Driver Farmer House Labour Service Student

Man Women wife

112
E) Prakruti
Table 5.5 Shows Prakruti wise distribution in both groups
Sr. No of Patients Total
No. Prakruti Group Group
A B
1 KP 0 2 2
2 KV 0 0 0
3 PK 8 8 16
4 PV 9 9 18
5 VK 4 6 10
6 VP 9 5 14
7 Total 30 30 60

Figure 5.5 Shows Prakruti wise distributions in both groups

Prakruti
Group A Group B

9 9 9

8 8

0 0 0

KP KV PK PV VK VP

113
F) Addiction
Table 5.6 Shows Addiction wise distribution in both groups
Sr. No of Patients Total
No. Addiction Group Group
A B
1 No 18 21 39
2 Tea 3 2 5
3 Tea + Alcohol 0 4 4
4 Tea + Tobacco 2 3 5
5 Tea + Tobacco + Alcohol 2 0 2
6 Tobacco + Alcohol 1 0 1
7 Tobacco +Gutkha + Alcohol 1 0 1
8 Tobacco + Gutkha 3 0 3
9 Total 30 30 60

Figure 5.6 Shows Addiction wise distributions in both groups

Addiction
21 Group A Group B

18

4
3 3 3
2 2 2
1 1
0 0 0 0 0

No Tea Tea + Tea + Tea + Tobacco + Tobacco + Tobacco +

Alcohol Tobacco Tobacco + Alcohol Gutkha + Gutkha
Alcohol Alcohol

114
G) Religion
Table 5.7 Shows Religion wise distribution in both groups
Sr. No of Patients Total
No. Religion Group Group
A B
1 Hindu 24 28 52
2 Muslim 6 2 8
3 Other 0 0 0
4 Total 30 30 60

Figure 5.7 Shows Religion wise distributions in both groups

28 Religion
24 Group A Group B

2
0 0

Hindu Muslim Other

H) Diet
Table 5.8 Shows Diet wise distribution in both groups
Sr. No of Patients Total
No. Diet Group Group
A B
1 Mixed 18 16 34
2 Veg 12 14 26
3 Total 30 30 60

115
Figure 5.8 Shows Diet wise distributions in both groups

Diet
Mixed Veg
18
16
14
12

Group A Group B

I) Agni
Table 5.9 Shows Agni wise distribution in both groups
Sr. No of Patients Total
No. Agni Group Group
A B
1 Manda 7 3 10
2 Tikshna 15 17 32
3 Vishama 8 10 18
4 Total 30 30 60

Figure 5.9 Shows Agni wise distributions in both groups

Agni
Group A Group B

17
15

10
8
7

Manda Tikshna Vishama

116
J) Koshtha
Table 5.10 Shows Koshtha wise distribution in both groups

Sr. No of Patients Total

No. Koshtha Group Group
A B
1 Krura 10 9 19
2 Madhya 2 5 7
3 Mrudu 18 16 34
4 Total 30 30 60

Figure 5.10 Shows Koshtha wise distributions in both groups

Koshtha
Group A Group B
18
16

10
9

Krura Madhya Mrudu

117
5.2. Changes in symptoms before and after treatment

A) Changes in Haridra Netra (BT and AT) in Group A and Group B

Table 5.11 Shows Changes in Haridra Netra in Group A and Group B

No. of Patients of Grade
Grade Group A Group B
BT AT BT AT
Grade 3 16 0 20 0
Grade 2 14 2 8 0
Grade 1 0 15 2 9
Grade 0 0 13 0 21
Total 30 30 30 30
Figure 5.11 Shows Changes in Haridra Netra in Group A and Group B

Haridra Netra
Grade 3 Grade 2 Grade 1 Grade 0

21
20

16
15
14
13

9
8

2 2
0 0 0 0 0 0

BT AT BT AT

Group A Group B

It was observed that, Haridra Netra has decreased more in Group B

than in Group A.

118
B) Changes in Pita Mutrata (BT and AT) in Group A and Group B
Table 5.12 Shows Changes in Pita Mutrata in Group A and Group B
No. of Patients of Grade
Grade Group A Group B
BT AT BT AT
Grade 3 19 0 20 0
Grade 2 11 3 10 0
Grade 1 0 15 0 11
Grade 0 0 12 0 19
Total 30 30 30 30

Figure 5.12 Shows Changes in Pita Mutrata in Group A and Group B

Pita Mutrata
Grade 3 Grade 2 Grade 1 Grade 0

20
19 19

15

12
11 11
10

0 0 0 0 0 0 0

BT AT BT AT

Group A Group B

It was observed that, Pita Mutrata has decreased more in Group B

than in Group A.

119
C) Changes in Purisha Pitata (BT and AT) in Group A and Group B
Table 5.13 Shows Changes in Purisha Pitata in Group A and Group B
No. of Patients of Grade
Grade Group A Group B
BT AT BT AT
Grade 3 19 0 20 0
Grade 2 11 7 10 3
Grade 1 0 21 0 16
Grade 0 0 2 0 11
Total 30 30 30 30

Figure 5.13 Shows Changes in Purisha Pitata in Group A and Group B

Purisha Pitata
Grade 3 Grade 2 Grade 1 Grade 0

21
20
19

16

11 11
10

3
2
0 0 0 0 0 0

BT AT BT AT

Group A Group B

It was observed that, Purish Pitata has decreased more in Group B

than in Group A.

120
D) Changes in Aruchi (BT and AT) in Group A and Group B
Table 5.14 Shows Changes in Aruchi in Group A and Group B
No. of Patients of Grade
Grade Group A Group B
BT AT BT AT
Grade 3 15 0 18 0
Grade 2 13 0 12 0
Grade 1 2 11 0 4
Grade 0 0 19 0 26
Total 30 30 30 30

Figure 5.14 Shows Changes in Aruchi in Group A and Group B

Aruchi
Grade 3 Grade 2 Grade 1 Grade 0

26

19
18

15
13
12
11

4
2
0 0 0 0 0 0 0

BT AT BT AT

Group A Group B

It was observed that, Aruchi has decreased more in Group B than in

Group A.

121
E) Changes in Avipaka (BT and AT) in Group A and Group B
Table 5.15 Shows Changes in Avipaka in Group A and Group B
No. of Patients of Grade
Grade Group A Group B
BT AT BT AT
Grade 3 15 0 19 0
Grade 2 13 0 10 0
Grade 1 2 10 1 4
Grade 0 0 20 0 26
Total 30 30 30 30

Figure 5.15 Shows Changes in Avipaka in Group A and Group B

Avipaka
Grade 3 Grade 2 Grade 1 Grade 0

26

20
19

15
13

10 10

4
2
1
0 0 0 0 0 0

BT AT BT AT

Group A Group B

It was observed that, Avipaka has decreased more in Group B than

in Group A.

122
F) Changes in Sadana (BT and AT) in Group A and Group B
Table 5.16 Shows Changes in Sadana in Group A and Group B
No. of Patients of Grade
Grade Group A Group B
BT AT BT AT
Grade 3 0 0 2 0
Grade 2 23 0 24 0
Grade 1 7 29 4 5
Grade 0 0 1 0 25
Total 30 30 30 30

Figure 5.16 Shows Changes in Sadana in Group A and Group B

Sadana
Grade 3 Grade 2 Grade 1 Grade 0

29

25
24
23

7
5
4
2
1
0 0 0 0 0 0 0

BT AT BT AT

Group A Group B

It was observed that, Sadana has decreased more in Group B than

in Group A.

123
G) Changes in Daha (BT and AT) in Group A and Group B
Table 5.17 Shows Changes in Daha in Group A and Group B

No. of Patients of Grade

Grade Group A Group B
BT AT BT AT
Grade 3 15 0 20 0
Grade 2 9 0 10 0
Grade 1 6 16 0 4
Grade 0 0 14 0 26
Total 30 30 30 30

Figure 5.17 Shows Changes in Daha in Group A and Group B

Daha
Grade 3 Grade 2 Grade 1 Grade 0

26

20

16
15
14

10
9

6
4

0 0 0 0 0 0 0

BT AT BT AT

Group A Group B

It was observed that, Daha has decreased more in Group B than in

Group A.

124
H) Changes in Daurbalya (BT and AT) in Group A and Group B
Table 5.18 Shows Changes in Daurbalya in Group A and Group B

No. of Patients of Grade

Grade Group A Group B
BT AT BT AT
Grade 3 7 0 8 0
Grade 2 17 7 22 0
Grade 1 6 0 0 5
Grade 0 0 23 0 25
Total 30 30 30 30

Figure 5.18 Shows Changes in Daurbalya in Group A and Group B

Daurbalya
Grade 3 Grade 2 Grade 1 Grade 0
25
23
22

17

8
7 7
6
5

0 0 0 0 0 0 0

BT AT BT AT

Group A Group B

It was observed that, Daurbalya has decreased more in Group B

than in Group A.

125
I) Changes in Hrullas (BT and AT) in Group A and Group B
Table 5.19 Shows Changes in Hrullas in Group A and Group B
No. of Patients of Grade
Grade Group A Group B
BT AT BT AT
Grade 3 8 0 11 0
Grade 2 17 0 15 0
Grade 1 5 13 2 6
Grade 0 0 17 2 24
Total 30 30 30 30

Figure 5.19 Shows Changes in Hrullas in Group A and Group B

Hrullas
Grade 3 Grade 2 Grade 1 Grade 0

24

17 17
15
13
11

8
6
5

2 2
0 0 0 0 0

BT AT BT AT

Group A Group B

It was observed that, Hrullas has decreased more in Group B than

in Group A.

126
5.3. Changes in Objective parameters before and after treatment
5.3.1. Decrease in Objective parameters before and after
treatment
Table 5.20 Shows decrease in objective parameters BT and AT
Sr. Sr. Billirubin Bile-Salt/Pigments
No. A B A B
1 3.7 6.1 3 3
2 4.9 8 2 2
3 6 4.4 2 2
4 8.1 5.9 1 2
5 4.2 6.8 2 2
6 4.7 7.7 1 3
7 4.5 5.3 3 2
8 4 7.1 2 2
9 5.5 7.1 1 2
10 4.9 2.3 1 2
11 3.1 4.8 2 2
12 4.8 6.5 2 2
13 3.3 3.5 2 3
14 4.5 6.7 2 2
15 3.3 6.7 1 2
16 3.4 6.8 2 2
17 2.3 6.6 2 3
18 4.6 6.6 2 2
19 4.9 6.1 2 2
20 4.4 5.3 2 2
21 4.9 5.8 2 3
22 6.4 5.2 2 2
23 3.8 6 2 2
24 4.4 6.7 2 3
25 4 3.2 2 3
26 4.8 5.4 3 3
27 2.9 6.2 2 3
28 3.5 3.1 1 2
29 3.8 4.8 1 3
30 4.8 3.8 2 2
Avg. 4.41 5.68 1.87 2.33
It was observed that all objective parameters were decreased more
in Group B than in Group A. (Table 5.20)

127
5.3.2. Average decrease in Objective parameters before and after
treatment
Table 5.21 shows average decrease in objective parameters Group A and
Group B
Sr. Parameter Average Decrease
No. Group A Group B
1 Sr. Billirubin 4.41 5.68
2 Bile-Salt/Pigments 1.87 2.33
Table 5.20 shows average decrease in objective parameters Group A and
Group B

Decrease in Objective Parameters

Sr. Billirubin Bile-Salt/Pigments

5.68

4.41

2.33
1.87

Group A Group B

Average Decrease

128
5.4. Statistical Analysis within Group A and Group B

5.4.1. Subjective Parameters (By Wilcoxon Singed Rank Test)

A) Haridra Netra

Table 5.22 Wilcoxon Signed Rank Test within the Group A and Group B
Group BT/AT N Mean SD W P
Group A BT 30 2.533 0.507 465 <0.0001
AT 30 0.633 0.614
Group B BT 30 2.600 0.621 465 <0.0001
AT 30 0.300 0.466

Group A
As value of p is far less than 0.05 extremely significant difference
was observed between mean of BT and AT score in Haridra Netra
symptom. Hence it was concluded that Darvi Kwatha is highly effective to
reduce Haridra Netra in Bahupitta Kamala (Hepatocelluar Jaundice).

Group B
As value of p is far less than 0.05 extremely significant difference
was observed between mean of BT and AT score in Haridra Netra
symptom. Hence it was concluded that Vasadi Kwatha is highly effective
to reduce Haridra Netra in Bahupitta Kamala (Hepatocelluar Jaundice).

B) Pita Mutrata
Table 5.23 Wilcoxon Signed Rank Test within the Group A and Group B
Group BT/AT N Mean SD W P
Group A BT 30 2.633 0.490 465 <0.0001
AT 30 0.700 0.651
Group B BT 30 2.667 0.479 465 <0.0001
AT 30 0.366 0.490

129
Group A
As value of p is far less than 0.05 extremely significant difference
was observed between mean of BT and AT score in Pita Mutrata symptom.
Hence it was concluded that Darvi Kwatha is highly effective to reduce
Pita Mutrata in Bahupitta Kamala (Hepatocelluar Jaundice).

Group B
As value of p is far less than 0.05 extremely significant difference
was observed between mean of BT and AT score in Pita Mutrata symptom.
Hence it was concluded that Vasadi Kwatha is highly effective to reduce
Pita Mutrata in Bahupitta Kamala (Hepatocelluar Jaundice).

C) Purisha Pitata
Table 5.24 Wilcoxon Signed Rank Test within the Group A and Group B
Group BT/AT N Mean SD W P
Group A BT 30 2.633 0.490 465 <0.0001
AT 30 1.167 0.530
Group B BT 30 2.667 0.479 465 <0.0001
AT 30 0.733 0.639

Group A
As value of p is far less than 0.05 extremely significant difference
was observed between mean of BT and AT score in Purisha Pitata
symptom. Hence it was concluded that Darvi Kwatha is highly effective to
reduce Purisha Pitata in Bahupitta Kamala (Hepatocelluar Jaundice).

Group B
As value of p is far less than 0.05 extremely significant difference
was observed between mean of BT and AT score in Purisha Pitata
symptom. Hence it was concluded that Vasadi Kwatha is highly effective
to reduce Purisha Pitata in Bahupitta Kamala (Hepatocelluar Jaundice).

130
D) Aruchi
Table 5.25 Wilcoxon Signed Rank Test within the Group A and Group B
Group BT/AT N Mean SD W P
Group A BT 30 2.433 0.626 465 <0.0001
AT 30 0.366 0.490
Group B BT 30 2.600 0.498 465 <0.0001
AT 30 0.133 0.345

Group A
As value of p is far less than 0.05 extremely significant difference
was observed between mean of BT and AT score in Aruchi symptom.
Hence it was concluded that Darvi Kwatha is highly effective to reduce
Aruchi in Bahupitta Kamala (Hepatocelluar Jaundice).
Group B
As value of p is far less than 0.05 extremely significant difference
was observed between mean of BT and AT score in Aruchi symptom.
Hence it was concluded that Vasadi Kwatha is highly effective to reduce
Aruchi in Bahupitta Kamala (Hepatocelluar Jaundice).
E) Avipaka
Table 5.26 Wilcoxon Signed Rank Test within the Group A and Group B
Group BT/AT N Mean SD W P
Group A BT 30 2.433 0.626 465 <0.0001
AT 30 0.333 0.479
Group B BT 30 2.600 0.563 465 <0.0001
AT 30 0.133 0.345

Group A
As value of p is far less than 0.05 extremely significant difference
was observed between mean of BT and AT score in Avipaka symptom.
Hence it was concluded that Darvi Kwatha is highly effective to reduce
Avipaka in Bahupitta Kamala (Hepatocelluar Jaundice).

131
Group B
As value of p is far less than 0.05 extremely significant difference
was observed between mean of BT and AT score in Avipaka symptom.
Hence it was concluded that Vasadi Kwatha is highly effective to reduce
Avipaka in Bahupitta Kamala (Hepatocelluar Jaundice).
F) Sadana
Table 5.27 Wilcoxon Signed Rank Test within the Group A and Group B
Group BT/AT N Mean SD W P
Group A BT 30 1.767 0.430 300 <0.0001
AT 30 0.966 0.182
Group B BT 30 1.933 0.449 465 <0.0001
AT 30 0.166 0.379

Group A
As value of p is far less than 0.05 extremely significant difference
was observed between mean of BT and AT score in Sadana symptom.
Hence it was concluded that Darvi Kwatha is highly effective to reduce
Sadana in Bahupitta Kamala (Hepatocelluar Jaundice).
Group B
As value of p is far less than 0.05 extremely significant difference
was observed between mean of BT and AT score in Sadana symptom.
Hence it was concluded that Vasadi Kwatha is highly effective to reduce
Sadana in Bahupitta Kamala (Hepatocelluar Jaundice).

G) Daha
Table 5.28 Wilcoxon Signed Rank Test within the Group A and Group B
Group BT/AT N Mean SD W P
4Group BT 30 2.300 0.794 435 <0.0001
A AT 30 0.533 0.507
Group B BT 30 2.667 0.479 465 <0.0001
AT 30 0.133 0.345

132
Group A
As value of p is far less than 0.05 extremely significant difference
was observed between mean of BT and AT score in Daha symptom. Hence
it was concluded that Darvi Kwatha is highly effective to reduce Daha in
Bahupitta Kamala (Hepatocelluar Jaundice).

Group B
As value of p is far less than 0.05 extremely significant difference
was observed between mean of BT and AT score in Daha symptom. Hence
it was concluded that Vasadi Kwatha is highly effective to reduce Daha in
Bahupitta Kamala (Hepatocelluar Jaundice).

H) Daurbalya
Table 5.29 Wilcoxon Signed Rank Test within the Group A and Group B
Group BT/AT N Mean SD W P
Group A BT 30 2.033 0.668 465 <0.0001
AT 30 0.466 0.860
Group B BT 30 2.267 0.449 465 <0.0001
AT 30 0.166 0.379

Group A
As value of p is far less than 0.05 extremely significant difference
was observed between mean of BT and AT score in Daurbalya symptom.
Hence it was concluded that Darvi Kwatha is highly effective to reduce
Daurbalya in Bahupitta Kamala (Hepatocelluar Jaundice).

Group B
As value of p is far less than 0.05 extremely significant difference
was observed between mean of BT and AT score in Daurbalya symptom.
Hence it was concluded that Vasadi Kwatha is highly effective to reduce
Daurbalya in Bahupitta Kamala (Hepatocelluar Jaundice).

133
I) Hrullas
Table 5.30 Wilcoxon Signed Rank Test within the Group A and Group B
Group BT/AT N Mean SD W P
Group A BT 30 2.100 0.661 465 <0.0001
AT 30 0.433 0.504
Group B BT 30 2.167 0.833 430 <0.0001
AT 30 0.200 0.406

Group A
As value of p is far less than 0.05 extremely significant difference
was observed between mean of BT and AT score in Hrullas symptom.
Hence it was concluded that Darvi Kwatha is highly effective to reduce
Hrullas in Bahupitta Kamala (Hepatocelluar Jaundice).

Group B
As value of p is far less than 0.05 extremely significant difference
was observed between mean of BT and AT score in Hrullas symptom.
Hence it was concluded that Vasadi Kwatha is highly effective to reduce
Hrullas in Bahupitta Kamala (Hepatocelluar Jaundice).

5.4.2. Objective Parameters (By Student’s t Test for Paired data)

A) Sr. Billirubin
Table 5.31 Shows Paired t Test within the Group A and Group B
Group BT/AT N Mean SD t P
Group A BT 30 6.840 1.817 21.33 <0.0001
AT 30 2.427 1.315
Group B BT 30 7.407 2.074 21.90 <0.0001
AT 30 1.723 1.031

134
Group A
As value of p is far less than 0.05 extremely significant difference
was observed between mean of BT and AT score in Sr. Billirubin. Hence it
was concluded that Darvi Kwatha is highly effective to decrease Sr.
Billirubin level in Bahupitta Kamala (Hepatocelluar Jaundice).

Group B
As value of p is far less than 0.05 extremely significant difference
was observed between mean of BT and AT score in Sr. Billirubin. Hence it
was concluded that Vasadi Kwatha is highly effective to decrease Sr.
Billirubin level in Bahupitta Kamala (Hepatocelluar Jaundice).
B) Bile salt / Bile pigments
Table 5.32 Shows Paired t Test within the Group A and Group B
Group BT/AT N Mean SD T P
Group A BT 30 2.633 0.490 17.89 <0.0001
AT 30 0.766 0.626
Group B BT 30 2.700 0.466 26.65 <0.0001
AT 30 0.366 0.490

Group A
As value of p is far less than 0.05 extremely significant difference
was observed between mean of BT and AT score in Bile Salts and Bile
Pigments. Hence it was concluded that Darvi Kwatha is highly effective to
decrease Bile Salts and Bile Pigments level in Bahupitta Kamala
(Hepatocelluar Jaundice).
Group B
As value of p is far less than 0.05 extremely significant differences
was observed between mean of BT and AT score in Bile Salts and Bile
Pigments. Hence it was concluded that Vasadi Kwatha is highly effective
to decrease Bile Salts and Bile Pigments level in Bahupitta Kamala
(Hepatocelluar Jaundice).

135
5.5. Statistical Analysis in between the Group A and Group B

5.5.1. Subjective Parameters (By Mann Whitney’s U Test)

A) Haridra Netra
Table 5.33 Mann Whitney‟s Test in between the Group A and Group B
Group N Mean SD U P
Group A 30 1.900 0.607 304.5 0.0294
Group B 30 2.300 0.596

As value of p is less than 0.05, highly significant difference was

observed between the mean of difference of Group A and Group B in
Haridra Netra symptom. Mean difference score of Group B is more than
that of Group A. Hence it was concluded that Vasadi Kwatha is more
effective than Darvi Kwatha to reduce Haridra Netra in Bahupitta Kamala
(Hepatocellular Jaundice).

B) Pita Mutrata
Table 5.34 Mann Whitney‟s Test in between the Group A and Group B
Group N Mean SD U P
Group A 30 1.933 0.520 307.5 0.0312
Group B 30 2.300 0.466

As value of p is less than 0.05, highly significant difference was

observed between the mean of difference of Group A and Group B in Pita
Mutrata symptom. Mean difference score of Group B is more than that of
Group A. Hence it was concluded that Vasadi Kwatha is more effective
than Darvi Kwatha to reduce Pita Mutrata in Bahupitta Kamala
(Hepatocellular Jaundice).

136
C) Purisha Pitata
Table 5.35 Mann Whitney‟s Test in between the Group A and Group B
Group N Mean SD U P
Group A 30 1.467 0.507 248 0.0023
Group B 30 1.933 0.365

As value of p is less than 0.05, highly significant difference was

observed between the mean of difference of Group A and Group B in
Purisha Pitata symptom. Mean difference score of Group B is more than
that of Group A. Hence it was concluded that Vasadi Kwatha is more
effective than Darvi Kwatha to reduce Purisha Pitata in Bahupitta Kamala
(Hepatocellular Jaundice).
D) Aruchi
Table 5.36 Mann Whitney‟s Test in between the Group A and Group B
Group N Mean SD U P
Group A 30 2.067 0.639 305 0.0300
Group B 30 2.467 0.507

As value of p is less than 0.05, highly significant difference was

observed between the mean of difference of Group A and Group B in
Aruchi symptom. Mean difference score of Group B is more than that of
Group A. Hence it was concluded that Vasadi Kwatha is more effective
than Darvi Kwatha to reduce Aruchi in Bahupitta Kamala (Hepatocellular
Jaundice).
E) Avipaka
Table 5.37 Mann Whitney‟s Test in between the Group A and Group B
Group N Mean SD U P
Group A 30 2.100 0.661 317 0.0474
Group B 30 2.467 0.628

137
 As value of p is less than 0.05, highly significant difference was
observed between the mean of difference of Group A and Group B in
Avipaka symptom. Mean difference score of Group B is more than that of
Group A. Hence it was concluded that Vasadi Kwatha is more effective
than Darvi Kwatha to reduce Avipaka in Bahupitta Kamala (Hepatocellular
Jaundice).

F) Sadana
Table 5.38 Mann Whitney‟s Test in between the Group A and Group B
Group N Mean SD U P
Group A 30 0.800 0.406 96 <0.0001
Group B 30 1.767 0.504

As value of p is less than 0.05, highly significant difference was

observed between the mean of difference of Group A and Group B in
Sadana symptom. Mean difference score of Group B is more than that of
Group A. Hence it was concluded that Vasadi Kwatha is more effective
than Darvi Kwatha to reduce Sadana in Bahupitta Kamala (Hepatocellular
Jaundice).

G) Daha
Table 5.39 Mann Whitney‟s Test in between the Group A and Group B
Group N Mean SD U P
Group A 30 1.767 0.626 184 <0.0001
Group B 30 2.533 0.507

As value of p is less than 0.05, highly significant difference was

observed between the mean of difference of Group A and Group B in Daha
symptom. Mean difference score of Group B is more than that of Group A.
Hence it was concluded that Vasadi Kwatha is more effective than Darvi
Kwatha to reduce Daha in Bahupitta Kamala (Hepatocellular Jaundice).

138
H) Daurbalya
Table 5.40 Mann Whitney‟s Test in between the Group A and Group B
Group N Mean SD U P
Group A 30 1.567 0.504 229.5 0.0008
Group B 30 2.100 0.305

As value of p is less than 0.05, highly significant difference was

observed between the mean of difference of Group A and Group B in
Daurbalya symptom. Mean difference score of Group B is more than that
of Group A. Hence it was concluded that Vasadi Kwatha is more effective
than Darvi Kwatha to reduce Daurbalya in Bahupitta Kamala
(Hepatocellular Jaundice).

I) Hrullas
Table 5.41 Mann Whitney‟s Test in between the Group A and Group B
Group N Mean SD U P
Group A 30 1.667 0.479 315 0.0431
Group B 30 1.967 0.889

As value of p is less than 0.05, highly significant difference was

observed between the mean of difference of Group A and Group B in
Hrullas symptom. Mean difference score of Group B is more than that of
Group A. Hence it was concluded that Vasadi Kwatha is more effective
than Darvi Kwatha to reduce Hrullas in Bahupitta Kamala (Hepatocellular
Jaundice).

139
5.5.2 Objective Parameters (By Student’s t Test for Unpaired
data)
A) Sr. Billirubin
Table 5.42 Shows Unaired t Test within the Group A and Group B
Group N Mean SD t P
Group A 30 4.413 1.133 3.827 0.0003
Group B 30 5.683 1.421

As value of p is far less than 0.05, extremely significant difference

was observed between the mean of difference of Group A and Group B in
Sr. Billirubin. Mean difference score of Group B is more than that of Group
A. Hence it was concluded that Vasadi Kwatha is more effective than
Darvi Kwatha to reduce Sr. Billirubin level in Bahupitta Kamala
(Hepatocellular Jaundice).

B) Bile Salts / Bile Pigments

Table 5.43 Shows Unaired t Test within the Group A and Group B
Group N Mean SD t P
Group A 30 1.867 0.571 3.427 0.0011
Group B 30 2.333 0.479

As value of p is far less than 0.05, extremely significant difference

was observed between the mean of difference of Group A and Group B in
Bile Salts and Bile Pigments. Mean difference score of Group B is more
than that of Group A. Hence it was concluded that Vasadi Kwatha is more
effective than Darvi Kwatha to reduce Bile Salts and Bile Pigments level in
Bahupitta Kamala (Hepatocellular Jaundice).

140
 5.6. Effect of therapy

5.6.1. Effect of therapy according to relief in Patients’ score

Table 5.44 Relieved score and % relief in Patients‟ score
Pt. Group A Pt. Group B
No. B.T. A.T. Relieved Relief No B.T. A.T. Relieved Relief
% %
1 20 2 18 90 1 26 5 21 80.77
2 15 2 13 86.67 2 23 7 16 69.57
3 23 8 15 65.22 3 22 4 18 81.82
4 25 13 12 48 4 18 0 18 100
5 23 7 16 69.57 5 22 2 20 90.91
6 21 6 15 71.43 6 24 2 22 91.67
7 19 3 16 84.21 7 22 0 22 100
8 16 3 13 81.25 8 24 2 22 91.67
9 25 12 13 52 9 24 2 22 91.67
10 24 12 12 50 10 20 1 19 95
11 12 1 11 91.67 11 19 0 19 100
12 20 2 18 90 12 21 3 18 85.71
13 24 6 18 75 13 23 1 22 95.65
14 23 10 13 56.52 14 23 2 21 91.3
15 22 6 16 72.73 15 19 3 16 84.21
16 22 7 15 68.18 16 23 1 22 95.65
17 14 4 10 71.43 17 22 2 20 90.91
18 25 10 15 60 18 27 6 21 77.78
19 23 3 20 86.96 19 23 2 21 91.3
20 20 5 15 75 20 18 0 18 100
21 25 8 17 68 21 25 3 22 88
22 24 7 17 70.83 22 22 2 20 90.91
23 21 6 15 71.43 23 25 9 16 64
24 25 7 18 72 24 26 4 22 84.62

141
25 24 5 19 79.17 25 21 2 19 90.48
26 24 5 19 79.17 26 23 1 22 95.65
27 14 2 12 85.71 27 22 2 20 90.91
28 18 2 16 88.89 28 14 0 14 100
29 16 1 15 93.75 29 23 2 21 91.3
30 19 3 16 84.21 30 21 0 21 100
31 74.63 31 90.04
Average Relief (A)
% Average Relief (B) %

The relieved symptom score and percent relief are given in the
Table 5.44. Overall average relief in Patients‟ score in Group A is 74.63%
and in Group is 90.04%.

5.6.2. Effect of therapy according to relief in Symptoms’ score

Table 5.45 Relieved score and %relief in Symptoms‟ score in Group A

S/O Symptoms B.T. A.T. Relieve %
No. (Group A) d Relief
1 Haridra Netra 76 19 57 75
2 Mutra Pitata 79 21 58 73.42
3 Purisha Pitata 79 35 44 55.7
4 Aruchi 73 11 62 84.93
5 Avipaka 73 10 63 86.3
6 Sadana 53 29 24 45.28
7 Daha 69 16 53 76.81
8 Daurbalya 61 14 47 77.05
9 Hrullas 63 13 50 79.37
10 Average Relief (A) 72.65 %

142
Table 5.46 Relieved score and %relief in Symptoms‟ score in Group B
S/O Symptoms B.T. A.T. Relieve %
No. (Group B) d Relief
1 Haridra Netra 78 9 69 88.46
2 Mutra Pitata 80 11 69 86.25
3 Purisha Pitata 80 22 58 72.5
4 Aruchi 78 4 74 94.87
5 Avipaka 78 4 74 94.87
6 Sadana 58 5 53 91.38
7 Daha 80 4 76 95
8 Daurbalya 68 5 63 92.65
9 Hrullas 65 6 59 90.77
10 Average Relief (B) 89.63 %

The relieved symptom score and percent relief are mentioned in the
Table 5.45 and Table 5.46. Overall average relief in Symptoms‟ score in
Group A is 72.65% and in Group is 89.63%.

5.6.3 Average Relief % in Patients’ and Symptoms’ score

Table 5.37 Shows Average Relief % in Patients‟ and Symptoms‟ score
Sr. Group Avg.Patient Avg. Symptom
No. Score (%) score (%)
1 Group A 74.63 72.65
2 Group B 90.04 89.73
3 Difference 15.41 17.08

143
Figure 5.14 Shows Average Relief % in Patients‟ and Symptoms‟ score

Avg. % Relief
Avg. Patient Score (%) Avg. Symptom score (%)

90.04 89.73

74.63 72.65

15.41 17.08

Group A Group B Difference

It was observed that average relief is more in Group B than Group

A. Hence it can be said that according to average relief % Vasadi
Kwatha is effective than Darvi Kwatha in Bahupitta Kamala
(Hepatocellular Jaundice) to reduce Patients‟ and Symptoms‟ score. (Table
5.37)

144
 DISSCUSSION

The present study type was Randomized Controlled study. It was

entitled as “The Clinical Study of Efficacy of Vasadi Kwath in the
Management of Bahupitta Kamala(Hepatocellular
Jaundice)”Control Group (Group A) and Trial Group (Group B) comprised
30 patients each of Bahupitta Kamala (Hepatocellular Jaundice).Patients
of Trial group were treated with Vasadi Kwathawhile Patients of Control
group were treated with Darvi Kwatha. Research question and Hypothesis
of the present study were defined as follows-

Research Question
Does the treatment of Bahupitta Kamala (Hepatocellular Jaundice)
with Vasadi Kwatha is significantly effective than treatment with Davrvi
Kwatha or not?

Null Hypothesis (H0)

There is no difference between efficacy of Vasadi Kwatha and Darvi
Kwatha in the management of Bahupitta Kamala (Hepaticellular
Jaundice).

Alternate Hypothesis (H1)

Vasadi Kwatha is significantly effective than Darvi Kwatha in the
management of Bahupitta Kamala (Hepatocellular Jaundice).

Collected data was tabulated, classified and presented in the forms

of tables and graphs and finally analyzed statistically in order to draw
interference and to accept/reject hypothesis. Discussion and critical
analysis is as follows.

145
6.1. General Observations
A) Distribution of patients
60 patients were included in the study. Further they were classified
in two equal groups viz. Group A and Group B. Group A was Control group
whether Group B was Trial group, each comprising 30 patients. (Table
5.1)
B) Age
In Group A: 7 patients were of age group 18 to 31 yrs, 17 of age group
32 to 46 yrs and 6 of age group 47 to 60 yrs.
In Group B: 11 patients were of age group 18 to 31 yrs, 15 of age group
32 to 46 yrs and 4 of age group 47 to 60 yrs.

Maximum patients (32) were found in age group 32 to 46 yrs. It

can be said that Bahupitta Kamala is more prevalent in middle age group
i.e. Pitta avastha of Vaya, probably in 4th and 5th decade. It may be due
to dominance of Pitta is in middle age and Kamala is Pitta pradhan
vyadhi. Table 5.2)
C) Gender
In Group A: 15 patients were Female while 15 were Male.
In Group B: 18 patients were Female while 12 were Male.
Female patients (33) were found maximum. It was observed,
females are more prone to Kamala. It may be because of more Pitta
prakopaka ahara and vihara e.g. Working in Kitchen near heat, working in
farms (in hot climate), eating paryushit anna, aniymit bhojana etc.
(Table 5.3)
D) Occupation
In Group A: 4 patients were business men, 0 were business women, 0
were drivers, 3 were farmers, 9 were housewives, 4 were labors, 6 were
servicemen and 4 were students.
In Group B: 0 patients were business men, 2 were business women, 1
was driver, 2 were farmers, 7 were housewives, 6 were labors, 6 were
servicemen and 6 were students.

146
 Housewives (16), Servicemen (12), Labors (10) and Students (10)
were found maximum among all occupations. (Table 5.5)
E) Prakruti
In Group A: 0 patients were having Kapha-Pitta, 0 were having Kapha-
Vata, 8 were having Pitta-Kapha, 9 were having Pitta-Vata, 4 were having
Vata-Kapha and 9 were having Vata-Pitta prakruti.
In Group B: 2 patients were having Kapha-Pitta, 0 were having Kapha-
Vata, 8 were having Pitta-Kapha, 9 were having Pitta-Vata, 6 were having
Vata-Kapha and 6 were having Vata-Pitta prakruti.
Maximium patients were found having Pitta-Vata (18), Pitta-Kapha
(16), Vata-Pitta (14) and Vata-Kapha (10) prakriti. Total patients having
Pitta dosha dominant in Prakruti are 34, total patients having Pitta dosha
as at least one of the constituents in prakruti were 48. It is clear that
patients having Pitta dosha in prakruti are more prone to Bahupitta
Kamala in future. Bahupitta Kamala is mentioned as Pitta pradhan vyadhi
by all Acharyas. (Table 5.5)

F) Addiction
In Group A: 3 patients were addicted to Tea, 0 were addicted to Tea and
Alcohol, 2 were addicted to Tea and Tobacco, 2 were addicted to Tea,
Alcohol and Tobacco, 1 was addicted to Tobacco and Alcohol, 1 was
addicted to Tobacco, Alcohol and Gutakha, 3 were addicted to Tobacco
and Gutkha and 18 were non-addicted.
In Group B: 2 patients were addicted to Tea, 4 were addicted to Tea and
Alcohol, 3 were addicted to Tea and Tobacco, 0 were addicted to Tea,
Alcohol and Tobacco, 0 were addicted to Tobacco and Alcohol, 0 were
addicted to Tobacco, Alcohol and Gutakha, 0 were addicted to Tobacco
and Gutkha and 21 were non-addicted.
Maximium patients (39) were found non-addicted. It doesn‟t mean
that non-addicted people are more prone to Bahupitta Kamala. It was by
chance only. Among addicted none addiction have been shown significant
incidence. (Table 5.6)

147
G) Religion
In Group A: 24 patients were Hindu, 6 patients were Muslim and 0
patients were from other religion.
In Group B: 28 patients were Hindu, 2 patients were Muslim and 0
patients were from other religion.
Hindu patients (52) were found maximum. But it doesn‟t at all
mean that Bahupitta Kamal is common in Hindu people. It was only by
chance as most of the population was Hindu. (Table 5.7)
H) Diet
In Group A: 12 patients were Vegetarian while 18 were having mixed
diet.
In Group B: 14 patients were Vegetarian while 16 were having mixed
diet.
Mixed diet patients (34) were found maximum. It can be said that
meat, eggs, fish etc in diet causes pitta prakopa and there by rakta
dushti, which may lead to disease like Bahupitta Kamala. (Table 5.8)

I) Agni
In Group A: 7 patients were having mand, 15 patients were having
tikshna and 8 patients were having vishama agni.
In Group B: 3 patients were having mand, 17 patients were having
tikshna and 10 patients were having vishama agni.
Maximum patients (32) were found with tikshna agni. Tikshna agni
is seen dominant in Pitta pradhan prakruti and Bahupitta Kamala is also
Pitta pradhan vyadhi. Hence incidence of Bahupitta Kamala could have
been found maximum in Tikshna agni patients. (Table 5.9)

J) Koshtha
In Group A: 18 patients were having mrudu, 2 patients were having
Madhya and 10 patients were having krura koshtha.
In Group B: 16 patients were having mrudu, 5 patients were having
Madhya and 9 patients were having krura koshtha.

148
 Maximum patients (34) were found Mrudu koshtha. Mrudu Koshtha
is seen dominant in Pitta pradhan prakruti and Bahupitta Kamala is also
Pitta pradhan vyadhi. Hence incidence of Bahupitta Kamala could have
been found maximum in Mrudu Koshtha patients. (Table 5.10)

6.2. Changes in symptoms before and after treatment

A) Changes in Haridra Netra (BT and AT) in Group A and Group B

Group A: Before treatment, 16 patients were of Grade Three, 14 of
Grade Two, 0 of Grade One and 0 of Grade Zero, while After treatment,
0 patients were of Grade Three, 2 of Grade Two, 15 of Grade One and 13
of Grade Zero.
Group B: Before treatment, 20 patients were of Grade Three, 8 of
Grade Two, 2 of Grade One and 0 of Grade Zero, while After treatment,
0 patients were of Grade Three, 0 of Grade Two, 9 of Grade One and 21
of Grade Zero.
It was observed that, Haridra Netra has decreased more in Group B
than in Group A. It suggests that, Vasadi Kwatha has better efficacy than
Darvi Kwatha to reduce Haridra Netra in Bahupitta Kamala. (Table 5.11)

B) Changes in Pita Mutrata (BT and AT) in Group A and Group B

Group A: Before treatment, 19 patients were of Grade Three, 11 of
Grade Two, 0 of Grade One and 0 of Grade Zero, while After treatment,
0 patients were of Grade Three, 3 of Grade Two, 15 of Grade One and 12
of Grade Zero.
Group B: Before treatment, 20 patients were of Grade Three, 10 of
Grade Two, 0 of Grade One and 0 of Grade Zero, while After treatment,
0 patients were of Grade Three, 0 of Grade Two, 11 of Grade One and 19
of Grade Zero.
It was observed that, Pita Mutrata has decreased more in Group B
than in Group A. It suggests that, Vasadi Kwatha has better efficacy than
Darvi Kwatha to reduce Pita Mutrata in Bahupitta Kamala. (Table 5.12)

149
C) Changes in Purisha Pitata (BT and AT) in Group A and Group B
Group A: Before treatment, 19 patients were of Grade Three, 11 of
Grade Two, 0 of Grade One and 0 of Grade Zero, while After treatment,
0 patients were of Grade Three, 7 of Grade Two, 21 of Grade One and 2
of Grade Zero.

Group B: Before treatment, 20 patients were of Grade Three, 10 of

Grade Two, 0 of Grade One and 0 of Grade Zero, while After treatment,
0 patients were of Grade Three, 3 of Grade Two, 16 of Grade One and 11
of Grade Zero.
It was observed that, Purisha Pitata has decreased more in Group B
than in Group A. It suggests that, Vasadi Kwatha has better efficacy than
Darvi Kwatha to reduce Purisha Pitata in Bahupitta Kamala. (Table 5.13)

D) Changes in Aruchi (BT and AT) in Group A and Group B

Group A: Before treatment, 15 patients were of Grade Three, 13 of
Grade Two, 2 of Grade One and 0 of Grade Zero, while After treatment,
0 patients were of Grade Three, 0 of Grade Two, 11 of Grade One and 19
of Grade Zero.
Group B: Before treatment, 18 patients were of Grade Three, 12 of
Grade Two, 0 of Grade One and 0 of Grade Zero, while After treatment,
0 patients were of Grade Three, 0 of Grade Two, 4 of Grade One and 26
of Grade Zero.
It was observed that, Aruchi has decreased more in Group B than in
Group A. It suggests that, Vasadi Kwatha has better efficacy than Darvi
Kwatha to reduce Aruchi in Bahupitta Kamala. (Table 5.14)

E) Changes in Avipaka (BT and AT) in Group A and Group B

Group A: Before treatment, 15 patients were of Grade Three, 13 of
Grade Two, 2 of Grade One and 0 of Grade Zero, while After treatment,

150
0 patients were of Grade Three, 0 of Grade Two, 10 of Grade One and 20
of Grade Zero.
Group B: Before treatment, 19 patients were of Grade Three, 10 of
Grade Two, 1 of Grade One and 0 of Grade Zero, while After treatment,
0 patients were of Grade Three, 0 of Grade Two, 4 of Grade One and 26
of Grade Zero.
It was observed that, Avipaka has decreased more in Group B than
in Group A. It suggests that, Vasadi Kwatha has better efficacy than Darvi
Kwatha to reduce Avipaka in Bahupitta Kamala. (Table 5.15)

F) Changes in Sadana (BT and AT) in Group A and Group B

Group A: Before treatment, 0 patients were of Grade Three, 23 of
Grade Two, 7 of Grade One and 0 of Grade Zero, while After treatment,
0 patients were of Grade Three, 0 of Grade Two, 29 of Grade One and 1
of Grade Zero.
Group B: Before treatment, 2 patients were of Grade Three, 24 of
Grade Two, 4 of Grade One and 0 of Grade Zero, while After treatment,
0 patients were of Grade Three, 0 of Grade Two, 5 of Grade One and 25
of Grade Zero.
It was observed that, Sadana has decreased more in Group B than
in Group A. It suggests that, Vasadi Kwatha has better efficacy than Darvi
Kwatha to reduce Sadana in Bahupitta Kamala. (Table 5.16)

G) Changes in Daha (BT and AT) in Group A and Group B

Group A: Before treatment, 15 patients were of Grade Three, 9 of
Grade Two, 6 of Grade One and 0 of Grade Zero, while After treatment,
0 patients were of Grade Three, 0 of Grade Two, 16 of Grade One and 14
of Grade Zero.
Group B: Before treatment, 20 patients were of Grade Three, 10 of
Grade Two, 0 of Grade One and 0 of Grade Zero, while after treatment,
0 patients were of Grade Three, 0 of Grade Two, 4 of Grade One and 26
of Grade Zero.

151
 It was observed that, Daha has decreased more in Group B than in
Group A. It suggests that, Vasadi Kwatha has better efficacy than Darvi
Kwatha to reduce Daha in Bahupitta Kamala. (Table 5.17)

H) Changes in Daurbalya (BT and AT) in Group A and Group B

Group A: Before treatment, 7 patients were of Grade Three, 17 of
Grade Two, 6 of Grade One and 0 of Grade Zero, while After treatment,
0 patients were of Grade Three, 7 of Grade Two, 0 of Grade One and 23
of Grade Zero.
Group B: Before treatment, 8 patients were of Grade Three, 22 of
Grade Two, 0 of Grade One and 0 of Grade Zero, while after treatment,
0 patients were of Grade Three, 0 of Grade Two, 5 of Grade One and 25
of Grade Zero.
It was observed that, Daurbalya has decreased more in Group B
than in Group A. It suggests that, Vasadi Kwatha has better efficacy than
Darvi Kwatha to reduce Daurbalya in Bahupitta Kamala. (Table 5.18)

I) Changes in Hrullasa (BT and AT) in Group A and Group B

Group A: Before treatment, 8 patients were of Grade Three, 17 of
Grade Two, 5 of Grade One and 0 of Grade Zero, while After treatment,
0 patients were of Grade Three, 0 of Grade Two, 13 of Grade One and 17
of Grade Zero.
Group B: Before treatment, 11 patients were of Grade Three, 15 of
Grade Two, 2 of Grade One and 2 of Grade Zero, while After treatment,
0 patients were of Grade Three, 0 of Grade Two, 6 of Grade One and 24
of Grade Zero.
It was observed that, Hrullasa has decreased more in Group B than
in Group A. It suggests that, Vasadi Kwatha has better efficacy than Darvi
Kwatha to reduce Hrullasa in Bahupitta Kamala. (Table 5.19)

152
6.3. Changes in objective parameters before and after treatment

A) Changes in Sr Billirubin level (BT and AT) in Group A and Group

B
Group A: Average decrease in Sr. Billirubin was 4.55.
Group B: Average decrease in Sr. Billirubin was 5.68.

B) Changes in Bile – salts/pigments level (BT and AT) in Group A

and Group B
Group A: Average decrease in Bile – salts/pigments was 1.87.
Group B: Average decrease in Bile – salts/pigments was 2.33.
It was observed that, Sr. Billirubin and Bile salts/pigments levels
have been decreased more in Group B than in Group A. It suggests that,
Vasadi Kwatha has better efficacy than Darvi Kwatha to reduce Sr.
Billirubin and Bile salts/pigments in Bahupitta Kamala. (Table 5.21)

153
6.4. Statistical Analysis within Group A and Group B

6.4.1. Subjective Parameters (By Wilcoxon Singed Rank Test)

Table 6.1 Statistical analysis within the Group A and B by Wilcoxon Signed
Rank Test
Sr. No. Symptoms Gr. W P Significance
1 Haridra A 465 <0.0001 Significant
Netra B 465 <0.0001 Significant
2 Pita A 465 <0.0001 Significant
Mutrata B 465 <0.0001 Significant
3 Purisha A 465 <0.0001 Significant
Pitata B 465 <0.0001 Significant
4 Aruchi A 465 <0.0001 Significant
B 465 <0.0001 Significant
5 Avipaka A 465 <0.0001 Significant
B 465 <0.0001 Significant
6 Sadana A 300 <0.0001 Significant
B 465 <0.0001 Significant
7 Daha A 435 <0.0001 Significant
B 465 <0.0001 Significant
8 Daurbalya A 465 <0.0001 Significant
B 465 <0.0001 Significant
9 Hrullasa A 465 <0.0001 Significant
B 430 <0.0001 Significant

Wilcoxon Ranked Sign test was applied to both groups separately to

observe whether the difference between BT and AT score is significant or
not.

154
Group A
Null Hypothesis (H0)
Darvi Kwatha is not effective to reduce symptoms in Bahupitta
Kamala (Hepatocelluar Jaundice).

Alternate Hypotheis (H1)

Darvi Kwatha is effective to reduce symptoms in Bahupitta Kamala
(Hepatocelluar Jaundice).
In the caseof all symptoms Haridra Netra, Pita Mutrata, Purish
Pitata, Aruchi, Avipaka, Sadana, Daha, Daurbalya and Hrullasa the test
has shown highly significant difference between BT and AT symptom
scores. H1 is accepted and H0 is rejected here.It was hence concluded
that Darvi Kwatha is effective to reduce Haridra Netra, Pita Mutrata,
Purish Pitata, Aruchi, Avipaka, Sadana, Daha, Daurbalya and Hrullasa in
Bahupitta Kamala (Hepatocelluar Jaundice).

Group B
Null Hypothesis (H0)
Vasadi Kwatha is not effective to reduce symptoms in Bahupitta
Kamala (Hepatocelluar Jaundice).

Alternate Hypotheis (H1)

Vasadi Kwatha is effective to reduce symptoms in Bahupitta Kamala
(Hepatocelluar Jaundice).
In the caseof all symptoms Haridra Netra, Pita Mutrata, Purish
Pitata, Aruchi, Avipaka, Sadana, Daha, Daurbalya and Hrullasa the test
has shown highly significant difference between BT and AT symptom
scores. H1 is accepted and H0 is rejected here.It was hence concluded
that Vasadi Kwatha is effective to reduce Haridra Netra, Pita Mutrata,
Purish Pitata, Aruchi, Avipaka, Sadana, Daha, Daurbalya and Hrullasa in
Bahupitta Kamala (Hepatocelluar Jaundice).

155
6.4.2. Objective Parameters (By Student’s t Test for Paired data)
Table 6.2 Statistical analysis within the Group A and B by Paired t Test
Sr. Parameters Gr. T P Significance
No.
1 Sr. A 21.33 <0.0001 Significant
Billirubin B 21.90 <0.0001 Significant
2 Bile Salts, A 17.89 <0.0001 Significant
Pigments B 26.65 <0.0001 Significant

Paired t test was applied to both groups separately to observe

whether the difference between BT and AT score is significant or not.

Group A
Null Hypothesis (H0)
Darvi Kwatha is not effective to reduce objective parameters in
Bahupitta Kamala (Hepatocelluar Jaundice).
Alternate Hypotheis (H1)
Darvi Kwatha is effective to reduce objective parameters in
Bahupitta Kamala (Hepatocelluar Jaundice).
In the caseof all objective parameters Sr. Billirubin and Bile Salts-
Bile Pigments the test has shown highly significant difference between BT
and AT symptom scores. H1 is accepted and H0 is rejected here.It was
hence concluded that Darvi Kwatha is effective to reduce objective
parametersSr. Billirubin and Bile Salts-Bile Pigments in Bahupitta Kamala
(Hepatocelluar Jaundice).

Group B
Null Hypothesis (H0)
Vasadi Kwatha is not effective to reduce symptoms in Bahupitta
Kamala (Hepatocelluar Jaundice).

156
Alternate Hypotheis (H1)
Vasadi Kwatha is effective to reduce symptoms in Bahupitta Kamala
(Hepatocelluar Jaundice).
In the caseof all objective parameters Sr. Billirubin and Bile Salts-
Bile Pigments the test has shown highly significant difference between BT
and AT symptom scores. H1 is accepted and H0 is rejected here.It was
hence concluded that Vasadi Kwatha is effective to reduce objective
parametersSr. Billirubin and Bile Salts-Bile Pigments in Bahupitta Kamala
(Hepatocelluar Jaundice).

6.5. Statistical Analysis in between the Group A and Group B

6.5.1. Subjective Parameters (By Mann Whitney’s U Test)

Table 6.2 Mann Whitney‟s U Test in between the Group A and Group B
Sr. Symptom U P Significance Efficay
No.
1 Haridra Netra 304.5 0.0294 Singnificant B>A
2 Pita Mutrata 307.5 0.0312 Singnificant B>A
3 Purisha Pitata 248 0.0023 Singnificant B>A
4 Aruchi 305 0.0300 Singnificant B>A
5 Avipaka 317 0.0474 Singnificant B>A
6 Sadana 96 <0.0001 Singnificant B>A
7 Daha 184 <0.0001 Singnificant B>A
8 Daurbalya 229.5 0.0008 Singnificant B>A
9 Hrullasa 315 0.0431 Singnificant B>A

Both groups were compared and analyzed statistically by Mann

Whitney‟s U test.

157
Null Hypothesis (H0)
There is no difference between efficacy of Vasadi Kwatha and Darvi
Kwatha to reduce symptoms in Bahupitta Kamala (Hepaticellular
Jaundice).
Alternate Hypothesis (H1)
Vasadi Kwatha is significantly effective than Darvi Kwathato reduce
symptoms in Bahupitta Kamala (Hepatocellular Jaundice).

In the caseof all symptoms Haridra Netra, Pita Mutrata, Purish

Pitata, Aruchi, Avipaka, Sadana, Daha, Daurbalya and Hrullasa the test
has shown highly significant difference between BT and AT symptom
scores. H1 is accepted and H0 is rejected here because mean
difference score of Group B is more than that of Group A.It was
hence concluded that Vasadi Kwatha is significantly effective than Darvi
Kwathato reduce Haridra Netra, Pita Mutrata, Purish Pitata, Aruchi,
Avipaka, Sadana, Daha, Daurbalya and Hrullasa in Bahupitta Kamala
(Hepatocellular Jaundice).

6.5.2. Objective Parameters (By Student’s t Test for Unpaired

data)
Table 6.4 Unpaired t Test in between the Group A and Group B
Sr. No. Parameters t P Significance Efficay
1 Billirubin 3.287 0.0003 Singnificant B>A
2 BS/BP 3.427 0.0011 Singnificant B>A

Both groups were compared and analyzed statistically by Mann

Whitney‟s U test.

Null Hypothesis (H0)

There is no difference between efficacy of Vasadi Kwatha and Darvi
Kwatha to reduce objective parameters in Bahupitta Kamala
(Hepaticellular Jaundice).

158
Alternate Hypothesis (H1)
Vasadi Kwatha is significantly effective than Darvi Kwathato reduce
objective parameters in Bahupitta Kamala (Hepatocellular Jaundice).
In the caseof all objective parameters Sr. Billirubin and Bile Salts-
Bile Pigments the test has shown highly significant difference between BT
and AT symptom scores. H1 is accepted and H0 is rejected here because
mean difference score of Group B is more than that of Group A.It
was hence concluded that Vasadi Kwatha is significantly effective than
Darvi Kwathato reduce objective parameters Sr. Billirubin and Bile Salts-
Bile Pigments in Bahupitta Kamala (Hepatocellular Jaundice).

6.6. Overall Effect of the Therapy

6.6.1. According to Patients’ score

Table 6.5 Effect of therapy according to Patients‟ score
Sr. Improvement Criteria No of patients
No. Grade Group Group
A B
1 Excellent 75% - 15 28
100%
2 Good 50% - 14 2
74%
3 Moderate 25% - 1 0
49%
4 Poor 00% - 0 0
24%

In Group A, 15 patients have shown Excellent improvement, 14 patients

have shown Good improvement, 1 patient has shown Moderate
improvement while none patients have shown Poor improvement.

159
In Group B, 28 patients have shown Excellent improvement, 2 patients
have shown Good improvement, none patients have shown Moderate
improvement while none patients have shown Poor improvement.
It suggest that Group B has shown overall good effect than Group A
to reduce patients‟ score.

6.6.2. According to Symptoms’ score

Table 6.6 Effect of therapy according to Symptoms‟ score
Sr. Improvement Criteria No. of
No. Grade Symptoms
Group Group
A B
1 Excellent 75%-100% 6 8
2 Good 50% - 74% 2 1
3 Moderate 25% - 49% 1 0
4 Poor 00% - 24% 0 0

In Group A, 6 symptoms have shown Excellent improvement, 2

symptoms have shown Good improvement, 1 symptom has shown
Moderate improvement while none symptoms have shown Poor
improvement.
In Group B, 8 symptoms have shown Excellent improvement, 1
symptom has shown Good improvement, none symptoms have shown
Moderate improvement while none symptoms have shown Poor
improvement.
It suggest that Group B has shown overall good effect than Group
AS to reduce symptoms‟ score.

160
6.6.3 Effect of therapy according to Average Relief %
Table 6.5 Shows Average Relief % in Patients‟ and Symptoms‟ score
Sr. Group Avg.Patient Avg. Symptom
No. Score (%) score (%)
1 Group A 74.63 72.65
2 Group B 90.04 89.73

It was observed that average relief is more in Group B than Group

A. Hence it can be said that,
1. According to average relief % Vasadi Kwatha is effective than Darvi
Kwatha in Bahupitta Kamala (Hepatocellular Jaundice) to reduce Patients‟
and Symptoms‟ score. (Table 5.37)

2. According to statistical analysis:

 Vasadi Kwatha is significantly effective than Darvi Kwathato reduce

Haridra Netra, Pita Mutrata, Purish Pitata, Aruchi, Avipaka, Sadana,
Daha, Daurbalya and Hrullasa in Bahupitta Kamala (Hepatocellular
Jaundice).
 Vasadi Kwatha is significantly effective than Darvi Kwatha to reduce
objective parameters Sr. Billirubin and Bile Salts-Bile Pigments in
Bahupitta Kamala (Hepatocellular Jaundice).

161
6.6. Mode of Action:-
Drug description of Vasadi Kwath:-
LATIN
DRAVYA GUNA RASA VIRYA VIPAKA KARMUKTA
NAME
Pitta shaman
Adhatoda Laghu Tikta
Vasa Sheeta Katu & Rakta
vasica Ruksha Kashaya
Prasadan
Mrudu Tikta Pitta shaman
Tinospora
Amruta Laghu Katu Ushna Madhur & Yakruta
cordifolia
Ruksha Kashaya Uttejana

Deepan,
Pachan,
Tikta
Terminalia Laghu Yakrut-
Haritki Katu Ushna Madhur
chebula Ruksha Uttejan,
Kashaya
Anuloman,
Mruduvirecha,

Deepan,
Pachan,
Terminalia Guru,
Bibhitak Kashaya Ushna Madhur Anuloman,
belerica Ruksha
chhardi
nigrahan
Lavanrahit
Agnideepan,
Embelica Laghu 5 rasa
Amalaki Sheet Madhur Ruchikar,
officinalis Ruksha mainly
Amanpachan
Amla
Tikta Raktagataa &
Azadiracta Laghu
Nimba Katu Sheeta Katu Yakrutastha
indica Ruksha
Kashaya Pitta Shaman
Pitta Saraka
Swertia Laghu
Bhunimba Tikta Sheeta Katu Shodhan
chiraita Ruksha
Agnideepan
Yakruta
Picrorrhiza Laghu
Kutki Tikta Sheeta Katu Uttejana
kurroo Ruksha
Pitta Sarak
Guru, Madhur Tridosha
Madhu Sheeta Madhur
Ruksha Kashaya Shamaka

162
Drug Description for Darvi Kwath:
LATIN
DRAVYA GUNA RASA VIRYA VIPAKA KARMUKTA
NAME
Berberis Laghu Tikta Kapha Pitta
Darvi Ushna Katu
aristata Ruksha Kashaya Shaman
Guru, Madhur Tridosha
Madhu - Sheeta Madhur
Ruksha Kashaya Shamaka

6.7. Scope and Limitations

6.7.1. SCOPE OF STUDY:

 Bahupitta kamala occurrence is increasing day by day. Hence such
study has got mere importance.
 This is cost effective therapy and also acting on root doshas by its
guna-karma.
 There is no proper remeady for Bahupittakamala in modern science,
therefore such a study need to be put forth.
 There is scope for new researchers to study efficacy of Vasadi kwath
along with Shodhan for more fruitful results.

LIMITATIONS OF STUDY:-

The present study was conducted with limited facilities and limited no. of
patients.Larer the representative sample drawn from lare population
would have been yielded more fruitful results.
Here only oral intervention was studied without any Shodhan. Oral
intervention against shodhan or any other dravya formulation along with
shodhan may be studied in future.

163
 CONCLUSION

 After analysis of the observations and the results found, it is

concluded that Vasadi kwath with madhu used in trial group shown
significant results as compared to Darvikwath with madhu used in
control group.
 Statistically significant effect of trial group B treatment on
Sr.Bilirubin, Netrapitata, Mutrapitata,Purishpitata, Aruchi,
Avipak,Daha, Daurbalya as compared to control group A is may be
due to:-
- Vasadi kwath cause mruduvirechana.
- Virechan has the quality to eliminate the vitiated doshas.
- Dooshita and malaswaroop pitta is eliminated from the koshtha.
A) As, the vitiated pitta is eliminated from the koshtha,
Sr.Bilirubinthesymptoms like Netrapitata, Mutrapitata,
Purishpitatadecreases.
B) Vasa, Amruta, Triphala, Bhunimb, Nimb and Kutki all have
hepatoprotective actions.
 The therapy is safe.
 Faster relief can be achieved in patients of Bahupitta Kamala by
using Vasadi kwath with madhu.

164
 SUMMARY

 Bahupitta Kamala is a pitta and raktapradoshajavikara,

characterised by Netrapitata, Mutrapitata, Purishpitata, and raised
Sr.Bilirubin above 1.2mg/dl.

 This study was aimed to assess the efficacy of Vasadi kwath in

BahupittaKamla.

 60 patients were randomly selected and divided into 2 groups. Trial

group B 30 patients were given 40ml Vasadi kwath with 5ml madhu
for 60 days.

 Control group A 30 patients were given 60ml Darvi kwath with 5ml
Madhu for 60 days. Both groups were advised same pathya diet.

 Prevalence of Bahupitta Kamala was found more in 32-46 years age

group, mostly in patients having Non sedentary life style, having
mix diet, Pittakaphaj and Pittavatajprakruti.

 Due analysis of the results of both trial group and control group was
done and comparison of results of both groups were assessed by
applying Mann Whitney”s test for paired data and Student”s t-test
for unpaired data (unpaired t-test) at 5% level of significance.

 It showed that Sr.Bilirubin, Bile salts and bile piments, Netrapitata,

Mutrapitata, Purishpitata, Aruchi, Avipaka, Daha, Hrullas,
Agnimandya, were significantly reduced in both trial group B and
control group A.

 After complete assessment it was found that in trial group B in case

of Sr.Bilirubin and symptoms-28 patients were cured and came to

165
 normal level. Only 2 patients had shown good improvement and
none shown moderate or poor improvement.

 In control group A, in case of Sr.Bilirubin and symptoms, 15

patients were cured and came to normal level, 14 patients had
shown good improvement, 1 patient had moderate improvement,
and no patient had mild improvement.

166
 ABBRIVATIONS

cÉ.(Ch.) - Charak Samhita

cÉ.xÉÔ. (Ch.Su.) - Charak Sutrasthana

cÉ. ÌlÉ.(Ch.Ni.) - Charak Nidansthana

cÉ.zÉÉ.(Ch.Sha.) - Charak Sharirsthana

cÉ.ÌuÉ.(Ch.Vi.) - Charak Vimansthana

cÉ.ÍxÉ.(Ch.Si) - Charak Siddhisthana

xÉÑ.xÉ (S.S.) - Sushrut Samhita

xÉÑ.xÉÑ.(Su.su) - Sushrut Sutrasthan

xÉÑ.ÌlÉ.(Su.Ni.) - Sushruta Nidansthana

xÉÑ. zÉÉ. (Su.Sha.) - SushrutaSharirsthana

xÉÑ. ÍcÉ. (Su.Chi.) - SushrutaChikitsasthana

xÉÑ. E¨É. (Su.Utt.) - SushrutaUttartantra

A. ¾û. xÉÔ. (A.H.Su.) - AshtangHridayaSutrasthana

A.xÉÇ (A.S.) - AshtangSangraha

A.xÉÇ.ÌlÉ. (A.S.Ni) - AshtangSangrahaNidanSthana

qÉÉ.ÌlÉ. (M.N.) - MadhavaNidan

pÉÉ.mÉë. (B.P.) - Bhavprakash

pÉÉ.mÉë.mÉÔ. (Bh.P. Pu) - BhavprakashPurvakhanda

rÉÉå.U. (Y.R.) - Yogrtnakar

zÉÉ.xÉ. (Sha.s) - SharangadharSamhita

zÉÉ.mÉÔ. (Sha.Pu) - SharangdharSamhitaPurvakhand

cÉ¢ü (C.D.) - Chakradatta

pÉæ.U. (Bhai.R) - BhaishajyaRatnavali

Sr. - Serum
P - Probability
t test - Student t test

167
W - Wilcoxon Signed Rank test
U - Mann Whitney”s test
S.D. - Standard Deviation
S. E. - Standard Error
B. T. - Before Treatment
A. T. - After Treatment
BS/BP - Bile salts and bile pigments

168
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25. ÎxjÉUÉÌSÍpÉ: ´ÉÔiÉÇ iÉÉårÉÇ mÉÉlÉÉWûÉUå mÉëzÉxrÉiÉå |

mÉÉhQÒûlÉÉÇ MüÉqÉsÉÉiÉÉïlÉÉ qÉ×̲MüÉqÉsMüÏ UxÉ: |

cÉ. ÍcÉ. 16/114-115

26. oÉÌWïûÌiĘ́ÉUÏ S¤ÉÉhÉÉÇ Â¤ÉÉqsÉæ: MüOÒûMæü UxÉæ: |

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172
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zÉÏiÉÇ qÉkÉÑrÉÑiÉÇ mÉëÉiÉ: MüÉqÉsÉÉiÉï: ÌmÉoÉå³ÉU: |

cÉ. ÍcÉ. 16/63

173
 BIBLIOGRAPHY

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Chaukhamba Sanskrit sansthan, Varanasi, Reprint year 2006,
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2) Charak samhita with the Ayurved –Dipika commentary of
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4) Sushruta samhita of sushruta with the Nibandhsangrah
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Chapter no. 44, Page no.732.
5) Ashtanghridya composed by Vagbhata with Vidyotini Hindi
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Chikitsa sthana, Page no.396, Shloka no.13.
6) Bhãvaprakãśha by Bhãvamiśhra, Editor Brahmashankar Mishra,
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7) Madhavnidanam1 & 2 of shri .Madhavkara with the Sanskrit
commentary Madhukosha, edition by BrahmanandTripathi,
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Hindi commentary ,Editor Shri.Brahma Shankar Shastri,
Chaukhabha Sanskrit series ,Varanasi, 5th edition ,1983,page
no.111.

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9) Sharangdharsamhita of Shrangdhar with Dipika commentary,
Editor BrahamanadTripathi ,Chaukhamba prakashan Varanasi,year
2004 –Madhyama khanda, Chapter no.2,Page no.133
10) BhaişhajyaRatnãvalî with Vidyotinî commentary, Editor Ambika
Dutta Shastri, published by Chaukhambã Sanskrita
Sansthãna,Vãrãņasî-18th Edition, Page no.269.
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by Ãtreya Prakãśana-1980, chapter no.16 of Chikitsa sthana,
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12) BhavprakashNighantu of Shri.Bhavmishra commentary by
Dr.K.C.Chunekar edited by Dr.G.s.Pandey, 2004 edition,
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13) Dravya gun vidnyan voi.2 16th edition 1994, by Prof.P.V.Shrama,
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Prakaśaņa -3rd Edition, 1999
20) Dravya gun vidnyan vol.2 16th edition 1994, by prof. P. V.
Shrama, ChaukhambaBhrati academy, Varanasi.
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Website
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23) www.jpsionline.com/pdf
24) WWW.eMedicine.com
25) www.pubmed.org
26) www.ayurveda.hu/api

176
 ANNEXURE

Written Consent of Patient

-----------------------------------------------------------------

qÉsÉÉ uÉUÏsÉ qÉÉÌWûiÉÏ mÉÔhÉïmÉhÉå xÉqÉeÉÉuÉÔlÉ xÉÉÇaÉhrÉÉiÉ AÉsÉÏ AxÉÔlÉ rÉÉÌuÉwÉrÉÉ xÉÇSpÉÏïrÉ mÉëzlÉ ÌuÉcÉÉUhrÉÉcÉÏ xÉÇkÉÏ

iÉxÉåcÉ ÌuÉcÉÉUsÉåsrÉÉ mÉëzlÉÉÇcÉÏ E¨ÉUå qÉsÉÉ SåhrÉÉiÉ AÉsÉåsÉÏ AÉWåûiÉ.

qÉÏ ÍcÉÌMüixÉÉ bÉåhrÉÉxÉ iÉrÉÉU AÉWåû. qÉsÉÉ rÉÉ AÉæwÉkÉÉÇcÉÉ mÉËUhÉÉqÉ AÉÍhÉ xÉÑUͤÉiÉiÉÉ qÉÉlÉuÉÉÇqÉkrÉå mÉëxjÉÉÌmÉiÉ

AxÉsrÉÉcÉÏ eÉÉhÉÏuÉ AÉWåû. qÉsÉÉ rÉÉ xÉÇqÉiÉÏmɧÉÉcÉÏ mÉëiÉ SåhrÉÉiÉ AÉsÉÏ AÉWåû.

ÂahÉÉcÉå lÉÉuÉ................................................................................................................

ÂahÉÉcÉÏ xuÉɤÉëUÏ

qÉÏ ZÉÉsÉÏ xÉWûÏ MüUhÉÉU, rÉÉÇlÉÏ ÂahÉÉxÉ sÉbÉÑmÉëoÉÇkÉÉcrÉÉ xÉÇSpÉÉïiÉÏsÉ xÉÇmÉÔhÉï qÉÉÌWûiÉÏ ÂahÉÉxÉ/ÂahÉÉxÉWû AxÉhÉÉ-rÉÉ

xÉÇqÉiÉÏ bÉåiÉsrÉÉ eÉÉhÉÉ-rÉÉ eÉoÉÉoÉSÉU urÉ£üÏxÉç xÉqÉeÉÉuÉÔlÉ xÉÉÇÌaÉiÉsÉÏ AÉWåû. rÉÉÌuÉwÉrÉÏ qÉÏ mÉëÍzÉͤÉiÉ AÉWåû.

...........................................................

ÌSÇlÉÉMü:

xÉɤÉÏSÉU:

ÂahÉÉzÉÏ lÉÉiÉå:

mɨÉÉ: xÉɤÉÏSÉUÉcÉÏxuÉɤÉUÏ

177
 CASE RECORD FORM

Subject: The Clinical Study of Efficacy of Vasadikwath in the

Management of Bahupittta kamala (Hepatocellular jaundice)

Sr. No. : OPD NO. :

Name of Patient : IPD No. :
Education Status : Age :
Profession : Sex : M/F
Place of Birth : Prakruti :
---------------------------------------------------------------------
Diagnosis (Vyadhinidan):
-----------------------------------------------------------------

Chief complaints and Duration:

---------------------------------------------------------------------
No. Complaints Existence Duration
---------------------------------------------------------------------
1.
---------------------------------------------------------------------
2.
---------------------------------------------------------------------
3.
---------------------------------------------------------------------
4.
---------------------------------------------------------------------
5.
---------------------------------------------------------------------

178
History of Present illness:
Past History
Drug History
Family History
Personal History
a) Aahar –
Time: Regular/Irregular
Kshudha: Samyakpravartan/Mandya/Visham
Rasapriti: Madhur/Amla/Lavan/Katu/Tikta/Kashaya
Vegetarian/Mixed
Adhyshan/Alpashan/Vishamashan/Atimatrashan
Paryushitanna/Abhishyandi/Virudhaaaharasevan
Ushapan/nishapan
Atiruksha/Atisnigdha/Atiushana/Atiguru

b) Vihar-

Occupation: Nature of work:

Working hours: Stress at work:

c) Vyasan-
1. Tea 4. Gutkha 7. Alcohol

2. Coffee 5. Beetle 8. Drug

3. Cold-drink 6. Smoking

General Examination:
Ashtavidha Parikshan:
i) Nadi -/min ii) Mala
iii) Mutra iv) Jivha
v) Shabda vi) Sparsha
vii) Druk viii) Akruti

179
Dashavidha Parikshana
i) Prakrititah :
ii) Saratah : Pravar / Madhya / Avar
iii) Samhanana : Pravar / Madhya / Avar
iv) Satmyatah : Pravar / Madhya / Avar
v) Satvatah : Pravar / Madhya / Avar
vi) Pramanatah : ht - wt –
vii) Aharshaktitah : Pravar / Madhya / Avar
viii) Vyayamshaktitah : Pravar / Madhya / Avar
ix) Vayatah (Age) : Bal / Madhyam / Vriddha
x) Balatah : Pravar / Madhya / Avar
SROTAS PARIKSHNA:
1) Pranavaha Srotas :

2) Udakvah Srotas : Talu, Twak, Netra

3) Annavaha Srotas : Jivha, Purish, Agni

4) Rasavaha Srotas : Hridaya, Nadi, Dehoshma

5) RaktavahaSrotas : Yakruta, Pleeha, Nakha

6) MamsavahaSrotas :

7) MedovahaSrotas :

8) AsthivahaSrota :

9) MajjavahaSrotas :

180
 10) Shukravaha / Artavaha Srotas:

11) MutravahaSrotas :

12) PurishvahaSrotas :

13) SwedvahaSrotas :

14) ManovahaSrotas :

INVESTIGATION:

Lab Investigation: As per requirement-

● Blood Hb%_________ TLC

DLC N L E B M
Sr.Billirubin
Urine test-Bile salts, Bile pigments
SGOT, SGPT

181
DOSHA-DUSHA SAMUCCHAYA:

Dosha Prakar Guna

● Vata
● Pitta
● Kapha
Dushya:
● Dhatu ● Mala
● Srotodushtiprakar ● Rogmarga
● Samuthatwa
NidanPanchak:-
●Hetu :

●Purvaroopa :

●Roop :

●Samprapti :

●Upashaya / Anupashaya:

CHIKITSA:

Trial Group: Will be given 40 ml VasadiKwath with 5 ml honey twice a

day along with pathya –Apathya.

Control Group: Will be given Darvikwath 60 ml with Madhu in the

morning along with pathya-Apathya.

182
 OBSERVATION TABLES:

Objective Follow up Weeks

Parameters 0th 1st 2nd 3rd 4th 5th 6th 7th 8th
Sr. Bilirubin
Urine test:
Bile salt, Bile
pigment

Subjective Follow up Weeks

Parameters 0th 1st 2nd 3rd 4th 5th 6th 7th 8th
HaridraNetra
ta
PitaMootrata
Purishpitata
Aruchi
Sadan
Daha
Daurbalya
Hrullas
Avipak

RESULT:

183
MASTER CHARTS

184
185
186