Rajiv Gandhi University of Health Sciences s34

From, Dr. Mahantagouda Biradar Preliminary M.D.(Ayu) Scholar Department of Post Graduate Studies in Panchakarma N.K.Jabshetty Ayurvedic Medical College & PG Research Centre Gumpa, Bidar-585403. To, The Registrar, Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka. Through, The Principal/Dean N.K. Jabshetty Ayurvedic Medical College & PG Research Centre Gumpa, Bidar-585403.

Subject: Submission of Completed Proforma for registration of Synopsis for Dissertation.

Respected Sir, I request you to kindly register the below mentioned subject against my name for the submission of dissertation to Rajiv Gandhi University of Health Sciences, Bangalore, for the partial fulfillment of M.D (Ayu) in Panchakarma. TITLE OF DESSERTATION:

“A CLINICAL STUDY ON THE EFFECT OF UTKLESHANA, DOSHAHARA AND SAMSHAMANIYA BASTI IN THE MANAGEMENT OF AMAVATA” Herewith, I am enclosing completed Proforma for registration of subject for dissertation. Thanking you, Yours Sincerely

(Dr. Mahantagouda Biradar) Date: Place: Bidar

1 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA-BANGALORE ANNEXURE-II PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1.Name of the Candidate and Dr.Mahantagoda Biradar Address S/O: Malakajappagouda Biradar At post: kalakeri Tq: Sindagi Dist: Bijapur, Pin: 586118 State: Karnataka

2.Name of institution N.K.JABSHETTY AYURVEDIC MEDICAL COLLEGE AND P.G. RESEARCH CENTRE, BIDAR-585403. KARNATAKA

3.Course of study and subject M.D.(PANCHAKARMA)

4.Date of admission to course 10 Nov 2010

5.TITLE OF TOPIC: - “A CLINICAL STUDY ON THE EFFECT OF UTKLESHANA, DOSHAHARA AND SAMSHAMANIYA BASTI IN THE MANAGEMENT OF AMAVATA”

6. BRIEF RESUME OF THE INTENDED WORK:

2 6.1 NEED FOR THE STUDY: Man is the most precious creature on the earth, health is the supreme foundation & disease destroys the health. The fundamental principle of Ayurveda is based on doha-dhatu and mala’s, an individual achieves absolute health in their equilibrium status & if any derangement leads to ill heath. In the treatment of various diseases Ayurveda nurtures two notions i.e. shodana and shaman chikitsa .As Shodana is a unique therapy enjoys the superiority over the mode of treatment. Vaata is the amoortha, anavastita and swayambu in nature while pitta and kapha are moorta dosha’s so called as mala’s, having their common quality of sneha that is being targeted for utkleshana and doshahara finally looks for samshamana therapy.2 Shodhana denotes mala shodana i.e utklista pitta and utklista kapha including other mala’s. As per classics, dosha utkleshana is mainly by snehana and swedana but acharya Sushruta opines – utkleshana of dosha’s via basti chikitsa also, in some context i.e. mainly in dhatugata doshayukta vyadhi as told by dalhana1 Amavata is one among the most crippling disorder, most hazardous to the patient and challenging to physician. The etio-pathogenesis of amavata in jeerna avasta is suggestive of vata kapha pradana- datugata bahudoshayukta vyadhi. So looking to the etiopathogenesis of amavata, samprapti vighatana chikitsa demands shodana chikitsa to eliminate the anubandita dosha along with vata dosha. In these conditions basti is choice of treatment not only in regulating and co-coordinating vata dosha in its site; but also controls the other anubandita dosha’s involved in the pathogenesis. Acharya sushruta opines basti as superior to all other therapeutic measures on account of its various actions like samshodana, samshamana, samgrahana, utkleshana etc of dosha’s, based on properties of drugs used for it. So an attempt is made to find out efficacy of utkleshana, doshhahara and samshamana basti in sequence in amavata as it is bahudoshayukta dhatugata vyadhi.

3 6.2 REVIEW OF LITERATURE:-

NIDAANA & SAMPRAPTI: Amavata is not described as a disease entity in bruhatrayi but described detail in laghu trayi. Acharya Madhavakara, vangasena chakradatta and Bhavamishra described the etiopathogenesis, symptom atology and treatment in detail in similar fashion. 1) In the context of madhava nidana due to specific causation, ama formed circulates through the dhamani’s, propelled by vaata associated with Kapha and pitta obstructs the channels to give rise weakness of digestive fire and feeling of heaviness of body later on this ama increases morbidity and readily enters specific joints which causes stiffness, pain and sluggishness of the activity. 2) Later on in chronic condition symptoms are suggestive of tridosha vitiation specifically pain, swelling, stiffness etc in multiple joints.3 3) Langhana, swedana, use of bitter and pungent carminative drugs , virechana and Basti are the treatments of amavata.5 4) In the management of threedoshaja vyadhi and specially Dhatugata doshayukta vyadhi aacharya Sushruta explained a special course/set of basti package administration I.e. दधधध्यादतततत्क्लेशननंद परर्वं मधधत्क्ले ददोषहरनं पदननः । पशशध्यात त सनंशमननधनं श दधधध्यावदससत वरशक्षण||सद.स.चश.३८/९२ 5) I.e. prior administration of utkleshana basti followed by doshahara and then a course of Samshaman basti is to be adopted for achievement of better doshanirharana followed by dhatu samyata.

Drugs used in the above mentioned Basti are tridoshagna mainly vatakaphahara, deepaniya, srotomarga visuddakara and dhatu poshanakara which fulfills in the principles of treatment of amavata.

PREVIOUS WORKS DONE: 1) Dr Srinivasalu M: A clinical study of the effects of gandharva hastyadi quatha in amavata PGTRU, GAC, Osmaniya University Hyderabad 1983. 2) Dr Singh Vinod k: Aclinical study on the disease modifying effect of certain ayurvedic drugs in Amavata vis-a-via Rheumatoid arthritis BHU 2001.

4 3) Dr Ladda trupti: Clinical trials of vaitarana vasti and pippali rasayana in amavaata- Amaravati University 2002. 4) Dr Shailaja gupta: Effeect of sankara sweda and thrivruth choorna virechana in amavata gadag, RGUHS Bangalore 2006-09.

6.3 OBJECTIVES OF THE STUDY:- 1) To study the disease Aamavaata in detail.

2) To assess the impact and consequences of utkleshsana basti, doshahara basti and samshamaniya basti in Aamavaata.

3) An analytical study over Doshotkleshata, Doshaharatwa and Doshashamana by Basti Procedure.

7:MATERIALS AND METHODS:

7.1:SOURCE OF DATA:- 1) The present study is a clinical trial. Hence the patients will be selected from N.K.J Aayurvedic medical college and hospital along with other attached hospitals of college. 2) Ayurveda classics and Modern texts. 3) National and international journals/magazines. 4) National and international seminars.

7.2 METHODS OF COLLECTION OF DATA:- 1) Patients will be selected by simple randomised sampling procedure. 2) Separate Charts (proforma) will be prepared, recording the signs and symptoms of Aamavata and Laxana’s of Utkleshana, Doshahara and Samshamana of dosha, due to the impacts of basti karma procedure respectively. Based on the same the follow up study is carried out. 3) Procedure will be conducted under the supervision of guide and co guide

RESEARCH DESIGN  30 Patients will be selected by simple randomised method for the study within a single group.

5  Utkleshana, doshahara and samshamana basti as explained by aacharya sushruta chikitsa 38/92 will be administered to all patients.

 Pre procedures i.e. poorvakarma should be compulsory and mandatory.

 Before starting treatment thorough counselling of patient and brief explanation regarding the procedure of Basti karma will be done All Patients shoud be advised to follow the specific diet chart during the therapy and till parihara kaala completes.

SELECTION OF CHIKITSA:  Basti chikitsa selected.

SELECTION OF BASTI:  Utkleshana Basti,

 Doshahara Basti,

 Samshamana Basti in sequence.

SCHEDULE OF BASTI: Utkleshana, doshahara and samshamana vasti in sequence will be administered in the frame work of kala vasti as shown below.

No of 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 vasti Type A U A U A DH A DH A SS A SS A A A A of vasti

Here U= Utkleshana Basti DH = Doshahara Basti, SS = Samshamana Basti

DURATION OF BASTI:  16 days followed by Parihaara kala.

6 INTERVENTION CHART: Sl PROCEDURE DRUG DOSE DURATION no 1 Poorva karma sarvanga abhyanga Moorchita tila taila Q.S 30 to 40 mins Bhaspa sweda Dashamoola dravya’s 2 Pradhana karma (kaala vasti) Anuvasanavasti Bruhat saindavadhya 120 ml 1st,3rd, 5th, 7th, 9th, taila 11th,13th,14th,15th,16th Nirooha vasti a) Utkleshana basti Eranda bija, Dravya’s madhuka, pippali, saindavalavana, vacha, haphushakalka. 2nd ,4th day Saindavalavana 10gm Madhu 40-60gm Moorchita tilataila 100-120ml Utkeshana bastigata 50-60gm dravya kalka Eranda beeja quatha 500-550ml Total Appro 800ml b)Doshahara basti Shatahwa,madhuka,k Dravya’s utaja beeja,madanaphala,k aanjika and gomootra Saindavalavana 10gm 6th and 8th day Madhu 40-60gm Moorchita tilataila 100-120ml Dishahara bastigata 50-60gm dravya kalka Doshahara bastigata 500-550ml kashaya Total Appro 800ml

7 c)Samshamana basti Priyangu, madhuka, dravya’s musta, rasanjana and ksheera Saindavalavana 10gm Madhu 40-60gm Moorchita tilataila 100-120ml Samshamana bastigata 50-60gm 10th and 11th day dravya kalka Samshamana bastigata 500-550ml kashaya Total Appro 800ml 3 Paschath karma Lift the legs, padding 8-10 mins to the buttocks, anti clockwise massage to abdomen etc Follow up: There will be two follow ups conducted i.e. 1st soon after the treatment (on 16TH Day) and 2nd will be 32nd day after the treatment.

METHODOLODY:- The progress will be noted on the basis of assessment parameters (both subjective and objective) before and after treatment in a specially prepared case sheet. STATISTICAL ANALYSIS: The observation will be analyzed critically and scientifically by employing statistical test and also with suitable statistical analysis.

SELECTION CRITERIA:-

INCLUSION CRITERIA:- 1 Patients presenting with the clinical signs and symptoms of Aamavata will be selected. 2 Patients age between 18-60 years irrespective of sex and socio economic state. 3 Patients fit for Basti chikitsa.

8 EXCLUSION CRITERIA:- 1 Aamavaata associated with upadrava and arista laxana. 2 Amavaata associated with cardiac diseases other severe complicated diseases. 3 Amavata condition followed by or associated with involvement of pitta, rakta, paka and acute dhatu kshaya. 4 Patients with severe deformities, severe ankylosed joints, septic arthritis and gouty arthritis etc. 5 Patients with genetic and hereditary disorders. 6 Pregnant women.. 7 Patients not fit for Basti chikitsa.

ASSESMENTCRITERIA: Subjective and objective parameters will be assessed based before and after treatment with appropriate statistical analysis.

PARAMETERS FOR ASSESSMENT:- SUBJECTIVE PARAMETERS :- 1) Bahu sandhi Rooja(Pain)

2) Bahu sandhi shota(Inflamation)

3) Sandhi Graha(Restricted movements)

4) Vivarnata (Discolourisation)

5) Gourava (Heavyness)

OBJECTIVE PARAMETERS:-

 Hb%

 ESR

 CRP

 RA Test

7.3 INVESTIGATIONS REQUIRED if necessary;

9  X-Ray

 ASO titre

 Immunological tests

7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUTION - Yes obtained.

8. LIST OF REFERENCES:

1) Acharya P.V Sharma: Shree Dalhana acharya virachita nibhanda samgraha vyakyaya, edited by acharya yadavaji trikamj chap 38 chi, sloka 92-95, and reprint on 2007 published by choukamba

orienntalia, Varanasi. Ed 2007, 546-547pp

2) Acharya Yadavaji thrikamji: Charaka samhita sootra stana 12th chap with chakrapanidatta commentary edited by acharya yadavaji trikamji reprint on 2009 choukamba orienntalia, Varanasi. Ed 2009,

79-80pp

3) Acharya Yudananda upaadhya: madhava nidhana chap 25, with madhukosha commentary by Sri Vijayarakshita and srikantadatta with vidyotini tika, revised, reprint on 2009 choukamba orienntalia,

Varanasi. Ed 2009, 508-511pp.

4) Pandith parashuram shastri: Sharanghadara samhita, adamalla virachita deepika and kaashiraam goodartha deepika commentary, sloka no 17-19, reprint 2008, published by choukamba orienntalia,

Varanasi. Ed 2008, 333-334pp.

5) Shri Ambhikadatta shastri: Bhaisajya ratnaavali hindi version edited by Acharya govindadas sen, 2007 chap 29 sloka 1, published th by choukamba orienntalia, Varanasi. Ed 18 , 434pp.

nd 6) Srinivasalu. M: Concept of Ama in Ayurveda 2 edition 2010 published by choukamba orienntalia, Varanasi.

7) Vaidhya Laxmipati Shastri: yogaratnakara, vidhyotini Hindi teeka

sloka no 1 and 8, published by choukamba orienntalia, Varanasi. Ed

2005, 564-566pp.

10 9. SIGNATURE OF CANDIDATE:

10. REMARKS OF THE GUIDE:

11. NAME & DESIGNATION OF (In block letters)

11.1 Guide: : Dr. MANIKRAO KULKARNI, M.D.(P.K) Lecturer, PG Dept., of Panchakarma NKJ AMC & PGC, Bidar

11.2 Signature:

11.3 Co-Guide:

11.4 Signature:

11.5 Head of Department : DR. N. HANMANTRAO, M.D. (K.C.) Professor, Dept., of Panchakarma

11 NKJ AMC & PGC, Bidar

11.6 Signature:

12.1 Remarks of the Chairman & Principal/Dean

12.2 Signature: 