Rajiv Gandhi University of Health Sciences s193

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.

COMPLETED PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

“CLINICAL MANAGEMENT OF PRASRAMSINI YONI W.S.R TO UTERINE PROLAPSE WITH CHANGERYADI GHRITA.”

AMRUTHA S

PG, SCHOLAR DEPT., OF PG STUDIES IN PRASOOTI TANTRA EVAM STREE ROGA, SKAMCH & RC, VIJAYANAGAR, BANGALORE – 560 104

DR.RAMESH M MD (AYU)

PROFESSOR DEPT., OF PG STUDIES IN PRASOOTI TANTRA EVAM STREE ROGA, SKAMCH AND RC, VIJAYANAGAR, BANGALORE – 560 104

CO-GUIDE DR.JAYASUDHA G C MS (AYU) READER DEPT., OF PG STUDIES IN PRASOOTI TANTRA EVAM STREE ROGA, SKAMCH AND RC, VIJAYANAGAR, BANGALORE – 560 104

2012 – 2013

SRI KALABYRAVESHWARASWAMY AYURVEDIC MEDICAL COLLEGE, HOSPITAL & RESEARCH CENTRE, VIJAYANAGAR, BANGALORE – 560 104 2

From, AMRUTHA S DEPT., OF PG STUDIES IN PRASOOTI TANTRA EVAM STREE ROGA, SKAMCH AND RC, BANGALORE – 560 104. To, THE REGISTRAR, RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.

Through: THE PRINCIPAL, DEAN OF PG STUDIES AND HOD OF PG STUDIES PRASOOTI TANTRA EVAM STREE ROGA, SKAMCH AND RC, BANGALORE – 560 104.

Respected Sir,

Subject: Submission of Completed Proforma for Registration of the Subject for Dissertation.

I request you to kindly register the below mentioned subject against my name for the submission of the dissertation to the Rajiv Gandhi University of Health Sciences, Bangalore, for partial fulfilment of MS (Ayu) in Prasooti Tantra Evam Stree Roga.

Title of the Dissertation

“CLINICAL MANAGEMENT OF PRASRAMSINI YONI W.S.R TO UTERINE PROLAPSE WITH CHANGERYADI GHRITA”

Here with I am enclosing completed proforma for registration of the subject of dissertation. Thanking You. Yours faithfully, Date: Place: Bangalore (AMRUTHA S) 3

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.

ANNEXURE- II

1) NAME OF THE CANDIDATE AMRUTHA S AND ADDRESS I YEAR PG SCHOLAR DEPT OF PG STUDIES IN PRASOOTI TANTRA EVAM STREE ROGA SKAMCH & RC #10 PIPELINE ROAD, RPC LAYOUT VIJAYANAGAR, BANGALORE 560 104

PERMANENT ADDRESS D/O SRIKRISHNA #26/A, 2ND STAGE 3RD MAIN MICHEAL PALYA, INDIRANAGAR, NEW TIPPASANDRA, BANGALORE KARNATAKA 560 075

2) NAME OF THE INSTITUTION: SRI KALABYRAVEHWARASWAMY AYURVEDIC MEDICAL COLLEGE, HOSPITAL AND RESEARCH CENTRE VIJAYANAGAR, BANGALORE 560 104 3) COURSE OF STUDY AND SUBJECT: MS (AYU) IN PRASOOTI TANTRA EVAM STREE ROGA

4) DATE OF ADMISSION TO THE COURSE: 23rd NOVEMBER 2012

5) TITLE OF THE TOPIC:

“CLINICAL MANAGEMENT OF PRASRAMSINI YONI W.S.R TO UTERINE PROLAPSE WITH CHANGERYADI GHRITA” 4

6) BRIEF RESUME OF THE INTENDED WORK

6.1) Need for the Study

Prasramsini yoni vyapad is mentioned by Sushruta1 which correlates with 1st and 2nd degree Uterine Prolapse. This condition is seen in peri menopausal or postmenopausal period although the disease can be seen rarely in young age group who are subjected to strained labour. If a Woman succumbs to disorder of this kind, she will have to undergo considerable amount of ill health which can have a significant impact on her self-esteem and self-image. According to ‘WHO’ estimation, the global prevalence of uterine prolapse is 2-20%. In India it is found that among women visiting private clinics in Bengal, Delhi, Punjab and Uttar Pradesh with gynecological problems one in five are suffering from uterine prolapse. In Northern India the incidence of uterine prolapse is 7.6%, Eastern India 20%, In Southern India, Tamilnadu, 0.7% and in Karnataka it is 3.4%.2 Though there is a conservative line of management with pessary it is associated with side effects. 3 Surgery; the next option, is contraindicated in many conditions. It is also reported that 30% of women suffer from recurrence.4 There are many women who do not prefer surgical option, in such cases it will be a boon if an effective remedy can be identified in 1st and 2nd degree uterine prolapse. Prasramsini is a Pittaja yoni vyapad as per Sushruta and Vata is the main dosha involved in all Yonivyapads.5 Changeryadi Ghrita is the drug of choice in Bhramsha.6 Ghrita is known for its Vatapittahara properties. Hence an attempt is made to treat Prasramsini Yoni by Changeryadi Ghrita Sevana and Yoni Pichudharana.

6.2) Review of Literature Prasramsini Yoni explained in Sushruta Samhita.7

A description regarding Uterine Prolapse mentioned in contemporary sciences.8,9,10

Changeryadi Ghrita mentioned in Astangahrudaya.11

Yoni Pichu Dharana mentioned in Sushruta Samhita.12

Previous work done  Ramadevi G - A study on the effect of Vesavara Dharana in Prasrasta - yoni Trivandrum Government Ayurveda college - Kerala University -1998.  V Swarnalatha - A clinical management of Prasramsini yonivyapath by oral medication of Phala ghruta along with pichu of Mooshika taila - Dr.BRKR Govt. Ayurvedic College - Vijayawada - AP University - 2004 5

Anupama.V - Effect of phalagrhita pichu in Prasramsini Yoni Vyapad - SDMCA, Udupi - RGUHS - 2005  H Rajeshwari - Clinical management of Prasramsini Yoni with Bala Choorna and Mooshaka - mamsa taila pichu - SNK Jabshetty Ayurvedic Medical College, Bidar - RGUHS - 2005.  Vandana Raina - A Clinical study to evaluate the therapeutic effect of Lodhradi Kalka Pichu and Ashwagandha Kshirapaka & Changeri Ghruta orally in Prasramsini Yoni Vyapath -SDMCA, Udupi - RGUHS - 2011.

6.3) Objectives of the study

 To evaluate the effect of Changeryadi Ghrita Sevana along with Changeryadi Ghrita Yoni pichu dharana in Prasramsini Yoni w.s.r to 1st and 2nd degree uterine prolapse.

7) MATERIALS AND METHODS

7.1) Source of Data

 A minimum of 40 patients diagnosed with Prasramsini Yoni coming under the inclusion criteria approaching the OPD and IPD of S.K.A.M.C.H. & R.C., Bangalore will be selected for the study.

7.2) Method of collection of data

 It is a clinical study where in 40 patients diagnosed with Prasramsini Yoni w.s.r.to 1st and 2nd degree Uterine Prolapse will be randomly assigned into two groups each comprising of 20 patients.

 A special case proforma containing all the necessary details pertaining to the study will be prepared.

 The data obtained in both groups will be recorded, tabulated and statistically analysed using suitable statistical methods.

Diagnostic criteria

Diagnosis will be done on the basis of per vaginal examination.

 First degree Uterine Prolapse when the cervix descends but lies short of introitus. 6

 Second degree Uterine Prolapse when cervix passes to the level of introitus.

Inclusion criteria  Patient presenting with lakshanas of Prasramsini Yoni.  Patients with signs & symptoms of 1st and 2nd degree Uterine Prolapse.  Married women.  Parous women.  Patients between the age group of 25 - 65 years.

Exclusion Criteria  3rd degree uterine Prolapse.  Associated with decubitus ulcer.  Patient with Carcinoma of cervix.  Patient with systemic diseases which may interfere with the course of treatment.  Gravid women.  History of Any other pelvic pathology.

Study design  It is a Clinical Study in the management of Prasramsini Yoni w.s.r to 1st and 2nd degree Uterine Prolapse.  Minimum of 40 patients of Prasramsini Yoni w.s.r. to1st and 2nd degree Uterine Prolapse who fulfil, the inclusion criteria will be selected.

Intervention

40 patients with Prasramsini Yoni will be randomly selected and assigned into two groups, each comprising of 20 patients.

 Group A - Patients in Group A will be considered as control group and placed on pathya ahara vihara alone.

 Group B - Patients in Group B will be given Changeryadi Ghrita 2 tsf on empty stomach twice a day

for 45days along with Changeryadi Ghrita Yoni Pichu after sthanika Snehana and Swedana for 7 days for two consecutive cycles. In menstruating women, Changeryadi ghrita yoni pichu will be carried out from the 7th day of menstruation, for 7days during each menstrual cycle for two consecutive cycles. 7

In post-menopausal women, Changeryadi ghrita yoni pichu will be carried out for two courses of 7days each with an interval of 21 days.

Duration of Procedure – 45 days.

Follow up – 15 days after treatment.

Assessment criteria Assessment will be done based on the subjective and objective parameters as per the proforma.

7.3) Does the study require any investigation or intervention to be conducted on patient or other humans or animals? If so please describe briefly YES

LABORATORY INVESTIGATIONS:  Blood investigation - Hb, TC, DC, ESR, RBS  Urine routine  USG of abdomen and pelvis

7.4) Has ethical clearance been obtained from your institution in case of 7.3? YES

8) LIST OF REFERENCES 1. Sushruta, Sushruta Samhita, Nibandha Sangraha Commentry Of Sri Dalhanacharya and Nyayachandrika Panjika and Nidanasthana Commentry Of Sri Gayadasacharya, By; Vaidya Yadavji Trikamji Acharya, Cha ukambha Surabharati Prakashan, Varanasi, reprint-2011, Chikitsa sthana, 38thChapter, Verse-13, pp-956, p g -669 2. Anata Raj Bajracharya. Uterine prolapse: A Hidden Tragedy for women [Online]. [2007 Nov 23]; Available from: URL: http://www.Shvoong.com/medicine and health /gynaeology/1711392 3. Midnight Authors. The Side Effects And Complications Of Using Pessaries (online). (2010 May 12); Available from URL:http//healthmad.com/women/ 4. Kumar P, Malhotra N. Jeffcott’s Principle of Gynecology. 7th Ed. New Delhi: (India) Jaypee brother’s medical publishers (p) ltd; 2008. pg. 275- 85. 5. Agnivesha, Charaka Samhita ,Ayurveda Dipika Commentary by Chakrapanidatta, edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi, Reprinted – 2011, Chikitsa Sthana 30th Chapter, Verse – 115, pp-738, pg -639 8

6. Vagbhata, Astanga Hrudaya, Sarvanga Sundara Commentary of Arunadatta and Ayurveda Rasayana Com mentary of Hemadri, edited by; Pandit Hari Sadasiva Sastri Paradakara Bhisagacharya, Chaukambha Sura bharati Prakashan, Varanasi, reprint-2010, Chikitsa sthana, 8th Chapter, Verse-77-78, pp-956, pg -.649 7. Sushruta, Sushruta Samhita, Nibandha Sangraha Commentry Of Sri Dalhanacharya and Nyayachandrika Panjika and Nidanasthana Commentry Of Sri Gayadasacharya, By; Vaidya Yadavji Trikamji Acharya, C haukambha Surabharati Prakashan, Varanasi, reprint-2011, Chikitsa sthana, 38thChapter, Verse-13, pp-956, pg -669 8. D.C.Dutta-Text Book of Gynecology edited by Hiralal Konar 5th edition, New Central book Agency (p) Ltd. London, 15th Chapter, pp- 688, pg -200

9. Jonathan’s Berek, Berek & Novak’s Gynaecology; 14th edition,Wolter’s Kulwer(India) pvt.ltd. New Delhi; pp-1671; pg-898-899.

10. Obstetrics And Gynecology For Post Graduates. Vol2; Edited by Sabaratnam Arulkumaran, Sarala Gopalan, Pratap Kumar, 3rd edition, Universities Press Hyderabad, 10th Chapter, pp675, pg151-170.

11. Vagbhata, Astanga Hrudaya, Sarvanga Sundara Commentary of Arunadatta and Ayurveda Rasayana Com mentary of Hemadri, edited by; Pandit Hari Sadasiva Sastri Paradakara Bhisagacharya, Chaukambha Sura bharati Prakashan, Varanasi, reprint-2010, Chikitsa sthana, 8th Chapter, Verse-77-78, pp-956, pg -.649 12. Sushruta, Sushruta Samhita, Nibandha Sangraha Commentry Of Sri Dalhanacharya and Nyayachandrika Panjika and Nidanasthana Commentry Of Sri Gayadasacharya, By; Vaidya Yadavji Trikamji Acharya, C haukambha Surabharati Prakashan, Varanasi, reprint-2011, Chikitsa sthana, 38thChapter, Verse-23, pp-956, pg -669

9) SIGNATURE OF THE CANDIDATE

10) REMARKS OF GUIDE

11) NAME AND DESIGNATION 11.1) GUIDE : DR. RAMESH.M M.D. (AYU) PROFESSOR, DEPT OF PG STUDIES IN PRASOOTI TANTRA EVAM STREE ROGA SKAMCH AND RC, BANGALORE - 560104

11.2) SIGNATURE :

11.3) CO-GUIDE : DR. JAYASUDHA G C M.S (AYU) READER, DEPT OF PG STUDIES IN PRASOOTI TANTRA EVAM STREE ROGA, SKAMCH & RC, BANGALORE - 560 104

11.4) SIGNATURE :

11.5) HEAD OF THE DEPARTMENT : DR. SUNITA SIDDESH MD (AYU), READER AND HOD, DEPT OF PG STUDIES IN PRASOOTI TANTRA EVAM STREE ROGA, SKAMCH & RC, BANGALORE - 560 104

12. 1) REMARKS OF THE CHAIRMAN & PRINCIPAL : 10

12.2) SIGNATURE :