Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka s31

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALURU, KARNATAKA

COMPLETED DISSERTATION PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

TITLE: “CLINICAL STUDY ON PASANABHEDA AND GOKSHURA KWATH GHANA

SATTVA VATI IN THE MANAGEMENT OF MUTRASHMARI

(RENALCALCULUS)”

BY: DR.PARMESH KUMAR M.S. (AYU.) SCHOLAR DEPARTMENT OF SHALYA TANTRA, P.G.STUDIES & RESEARCH S.J.G. AYURVEDIC MEDICAL COLLEGE AND HOSPITAL, KOPPAL-583231, KARNATAKA

GUIDE: DR. B.S. SAVADI, M.D. (AYU) PROFESSOR AND HEAD, DEPARTMENT OF SHALYA TANTRA, P.G.STUDIES & RESEARCH S.J.G. AYURVEDIC MEDICAL COLLEGE AND HOSPITAL, KOPPAL- 583231, KARNATAKA

CO-GUIDE: DR. SRIKANTH P.L., M.S. (AYU.) LECTURER. DEPARTMENT OF SHALYA TANTRA, P.G.STUDIES & RESEARCH S.J.G. AYURVEDIC MEDICAL COLLEGE AND HOSPITAL, KOPPAL- 583231, KARNATAKA

2010-2011 SHREE JAGADGURU GAVISIDDHESHWAR AYURVEDIC MEDICAL COLLEGE AND HOSPITAL, GAVIMATH CAMPUS, KOPPAL-583231, KARNATAKA From: Dr. PARMESH KUMAR Ist Year M.S., Department of Post Graduate Studies in Shalya tantra S.J.G. Ayurvedic Medical College & Hospital, Gavimath Campus Koppal-583231, Karnataka.

To: The Registrar, Rajiv Gandhi University of Health Sciences Bengaluru, Karnataka.

Through: The Principal and the Head of the Department of Shalya tantra S.J.G. Ayurvedic Medical College & Hospital, Gavimath Campus Koppal-583231, Karnataka.

Respected Sir,

Sub: Regarding the submission of completed Proforma for Registration of subject For Dissertation

I request you to kindly register the below mentioned subject against my name for the submission of dissertation to the Rajiv Gandhi University of Health Sciences, Bengaluru, Karnataka for the partial fulfillment of M.S. (Ayurveda).

Title of the Dissertation “CLINICAL STUDY ON PASANABHEDA AND GOKSHURA KWATH GHANA

SATTVA VATI IN THE MANAGEMENT OF MUTRASHMARI

(RENAL CALCULUS)”

Here with I am enclosing complete Performa for registration of the subject for dissertation. Thanking you,

Yours faithfully

(Dr. PARMESH KUMAR) Place : Koppal Date : RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BENGALURU, KARNATAKA Performa for registration of subject for dissertation

1) NAME OF THE CANDIDATE Dr. PARMESH KUMAR

ADDRESS (in block letters) S/O SH. AMAR SINGH

MOHALLA LOWER JULAKHARI

DIST.CHAMBA H.P 176310 2) NAME OF THE INSTITUTE S.J.G.AYURVEDIC MEDICAL COLLEGE,

HOSPITAL & POST GRADUATE STUDIES AND

RESEARCH CENTRE, GAVIMATH CAMPUS,

KOPPAL, KARNATAKA -583231 3) COURSE OF STUDY AYURVEDA VACHASPATI

AND SUBJECT M.S. (AYU.) SHALYA TANTRA 4) DATE OF ADMISSION 31st OCTOBER 2010 5) TITLE OF THE TOPIC “CLINICAL STUDY ON PASANABHEDA AND

GOKSHURA KWATH GHANA SATTVA VATI IN

THE MANAGEMENT OF MUTRASHMARI (RENAL

CALCULUS)”

6). BRIEF REVIEW OF INTENDED WORK:

6.1) - Need for the study:

The word “Ashmari” has been derived from “Ashman” the Sanskrit

word, which literally means ‘a structure resembling stone’. Thousands of years

ago, Acharya Susrutha and Caraka identified the disease and named it as

mutrashmari. This literally means ‘a structure resembling stone’. Thus in this

disease, there is development of a calculus, a foreign body in the urinary tract. This is a common disorder affecting 1% - 3% of the population. In the list of

Urinary tract disorder urinary calculi is said to be the third most common disorder. Stones are most commonly present in the third-fifth decade and male are more frequently affected than female individual.

Kidney is one of the three vital organs in the body; the other two being heart & brain. It is the most important organ maintaining the homoeostatis by regulating the excretion of the metabolites and waste products.

Ayurveda states that suppression of micturition is one of the most important causes of disease of urinary tract.Vegavarodha i.e. suppression of natural urges is an important cause of various diseases.

According to Susruta, the father of surgery, any foreign body in our biological system that causes discomfort comes under the category of Shalya.

सरर्वशररीरराबराधकररं शललरं, तददिहहोपददिशलत इतलत: शललशरासस्त्रम म !! ( सस. स.स २६/४)

It is said to be one of the eight most troublesome diseases (Mahagada).

ववातवववाधवशश्मररीकक षष्ठश्ममेहहोदरभगनदरवार! अरवार्शांससि ग्रहणणीतवषषष्टौ श्महवारहोगवारसिकदसतरवारक !!

(अ. ह. नन. ८/३०) According to Ayurveda,

आहरार भराररा: शररीर भराररा: भरननत !

In present day changing food habits must have brought about change in the body as well as mind. In renal calculi, diet plays an important role, as all types of calculi are solid; they dominate in pruthvi mahabhuta and kaphadosa. Hence, kaphanashak measures form the basis of treatment of all varities of calculi.

Formation of excessive waste product of vataja, pittaja and kaphaja variety due to

improper diet. Diet and decreased activity increases kapha. Eating in excess,

cold, sweet food item, sleeping during day etc are kapha increasing factors.

The aim of this study is to attribute the possible pharmaocological action of

ingredients of the yoga which could be; analgesic (shoolaghna), diuretic

(Mutrala), lithotriptic (Ashmarighna), propelling out urinary stones (Anulomana,

bhedana) & anti-calcifying property.

In conventional systems of medicine some of the drugs are effective in

expulsion and prevention in formation of stone but their other factors like long

treatment, pain, infection etc are hurdles in regular usage. Although surgical

treatment has taken great strides, yet the common man in our country may not

find it affordable. Therefore, there is need to revive the therapies described in

classics for the better management of Mutrashmari. Hence, the present study is

aimed at this point.

6.2) Review of Literature:

Review of the literature includes thorough screening of classical and contemporary literatures, and periodicals.

Till today different works have been done on the related subject on the present work at various P.G. research CENTREs. Few of them are as follows,  Role of Varunaka guda in the management of Mutrashmari and assessment with

imaging techniques; Dr. Manju Rani, Paprola; Rajiv Gandhi Govt P.G. Institute of

Ayurveda , Himachal University, Shimla (H.P.;2004).

 Management of Mutrashmari (Renal Calculus) by Mustadikalpa; Dr. Salimath

Mahantesh M. ; SDM Colloege of Ayurveda, Rajiv Gandhi University of Health

Sciences, Banglore (Udupi; 2002).

 Role of Punarnavadi compound in the management of Mutrashmari; Dr. Deepak

Kulshrestha; Institute for Post Graduate teaching & Research in Ayurveda;

Gujarat Ayurveda University, Jamnagar; 1996.

 Role of Kulatha in the management of Mutrashmari with special reference to

renal function; Dr. Pramod Kumar; Faculty of Ayurveda; Institute of Medical

Sciences, Banaras Hindu University, Varanasi; 1971.

6.3) Objectives of the study:

 To evaluate the therapeutic efficacy of Pasanabheda & Gokshura kwatha

ghana sattva vati in the management of Mutrashmari.

 To study the significance of Pathya & Apathya in the management of

Mutrashmari.

 To study the literature related to Mutrashmari in both Ayurveda and

contemporary science. 7) MATERIALS & METHODS:

(a) The patients:

The patients attending the O.P.D. and I.P.D. of the S.J.G. Ayurvedic

Medical College & Hospital, Koppal will be selected for the study.

(b) The Drugs:

The formulations with their respective ingredients will be prepared in the pharmacy section of S.J.G. Ayurvedic Medical College & Hospital, Koppal.

7.1) Source of data:

1) Literary source

2) Experimental source

7.1. a) Literary source:-

A detailed review of the available literature on the drug and disease, such as classical text of Ayurveda, Nighantus and other compendium will be done.

Data will be also collected from various scientific books on the field of herbal medicines, periodicals and papers published in the e-journal etc.

7.1. b) Experimental source:

It is a human clinical trial. No animal experiment will be conducted. 7.2) Composition of the drug: 7.2. a) Pasanabheda and Gokshura kwatha Ghana Sattva Vati

Sl. Ingred- Botanical Rasa Guna Virya Vipaka Doshakarma no. -ients Name

1 Pasana- Bergenia Kasaya Laghu Sita Katu Tridosahara

-bheda ciliate Royle Tikta Snigdha Mutravirecaniya 2 Goksura Tribulus Madhura Guru Sita Madhura Vata-Pitta

terrestris Linn Snigdha hara,Vrsya,

Mutrala,Rasayana (Ref - Ayurvedic formulary of india Vol.II)

7.2. b) Preparation of Medicine:

Drug to be collected from local area and accordingly medicine will be prepared in the

college pharmacy according to the classical text.

7.3) Method of collection Data: 7.3. a) Study design:  Literature Review

 Ayurvedic Review

 Modern Review

 Drug Review

 Clinical Review

7.3. b) Sample size & grouping: Pre-test & post-test single blind randomized study, where in minimum of 30 patients of either sex fulfilling the inclusion criteria will be put in a single group.

7.3. c) Inclusion criteria:

1. Age between 30 to 50 years

2. Sex: either sex

3. Any three of the following sign and symptoms if present:

(i) Intermittent dull/colicky pain in back which increase on movements/jerks.

(ii) Haematuria

(iii) Frequency of micturition

(iv) Burning micturition

4. Evidence of Calculus as per modern imaging techniques.

5. More than 5mm and less than 12mm will be taken for the study.

7.3. d) Exclusive criteria:

1. Age: below 30 and above 50 years.

2. Stag horn renal stone.

3. Hydronephrosis.

4. Pyelonephritis.

5. Other systemic illness.

6. Severe urinary Tract infection.

7.3. e) Criteria of Diagnosis: According to signs and symptoms mentioned in the classical text and also through modern diagnostic procedures.

7.3. f) Posology

(i) Medicine: Pasanabheda Goksura Kwatha Ghana Satva Vati

Route : Oral.

Dose : One gram daily in two divided doses.

Anupana: Water.

Patient is educated about diet (diet to be taken in renal diseases) and life style to prevent the recurrence. (Ref: Therapeutic diets by Swaminathan)

7.3. g) Study duration:

3 months

Observation (review & visit) - every week

7.3. h) Follow up:

6 months.

7.3. i)Assessment of results:

Subjective and objective parameters, before and after the treatment will be

compared and statistically analyzed.

7.3. j) Subjective parameters:  Pain

 Haematuria

 Frequency of micturition

 Burning micturition

7.3. k) Objective parameters:

 Pus cells

 Calcium oxalates

 RBC’s

 Epithelial Cells

 Site of calculus

 Size of calculus

7.3. l) Investigations:

 X-Ray KUB

 USG KUB region

 Urine routine

 Routine Blood investigations.

7.4) Ethical clearance:

“Obtained and enclosed” 8) LIST OF REFERENCES

8.1 Kaviraj Ambika Dutta Shastri: Susruta Samhita, Part-I Hindi commentary

(1989), 7th Edn, Published by Chaukhamba Sanskrit Sansthan, Office

Varanasi.

8.2 Pt. K. Kashinath Shastri and Dr. Gangasahay Pandey: Caraka Samhita

Part-II with Vidyotini Hindi commentary,Published by Chaukhambha

Sanskrit Series, Office Varanasi.

8.3 Pt. Lal Chandra Vaidya: Astanga Hrdaya, Sarvangasundari Vyakhya, Ist

Ed. – 1963, Published by Motilal Banarasi Das Publication, Office

Varanasi.

8.4 Anonymous (2003) The Ayurvedic Formulary of India, Govt. of India,

Ministry of Health and Family Welfare, Part I, 2nd Revised English

Edition.

8.5 Hodder Arnold: Russell,Williams, Bulstrode, Bailey and Loves Short

Practice of Surgery, 24th Edition.

8.6 K.C.Chunekar: Bhava prakasha Nighantu, comments, Edited by Ganga

Sahay Pandey 4th edition, Hindi.

8.7 Acharya Yadav ji & Trkam ji: Siddha Yoga Samgraha, 5th edition,

Published by baidyanath Ayurved bhawan, Calcutta, page 98.

8.8 Dr.Das.Soman: Concise Text Books of Surgery- Published by S.Das

Calcutta. 9. SIGNATURE OF THE CANDIDATE :

10. REMARKS OF GUIDE : Recommended for Approval

11. NAME AND DESIGNATION : DR. B .S. SAVADI . M.D (AYU) PROFESSOR & HEAD, P.G DEPT, SHALYATANTRA 11.1. Guide : DR.B.S.SAVADI, M.D. (AYU) PROFESSOR AND HEAD, P.G DEPT OF SHALYA TANTRA,

11.2. Signature :

11.3. Co-Guide: : DR. SRIKANTH P.L. M.S. (AYU.) LECTURER, P.G DEPT, SHALYA TANTRA

11.4. Signature : -

11.5. Head of the department : DR.B. S. SAVADI, M.D. (AYU)

11.6. Signature

12.1. REMARKS OF CHAIRMAN : The above synopsis is scrutinized by the AND PRINCIPAL Scientific Committee post graduate studies & Research Center, of S.J.G. Ayurvedic Medical College, Koppal & submitted for registration as subject of dissertation at R.G.U.H.S, Bengalaru, Karnataka.