Ragiv Gandhi University of Health Sciences Karnataka

RAGIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA BANGALORE

COMPLETED PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

“CLINICAL EVALUATION OF EFFICACY OF AVACHURNANA WITH CERTAIN INDIGENOUS DRUGS [Tuttha, kasisa, Gairika Lodhra] IN GARBHASHAYA MUKHA SHOTHA ( PRIMITIVE CERVICAL CELL PATHOLOGY )” BY DR. K. PADMA SARITHA M.D(Ayu), SCHOLAR DEPARTMENT OF P.G. STUDIES IN PRASOOTI TANTRA EVUM STREE ROGA S.D.M COLLEGE OF AYURVEDA, KUTHPADY, UDUPI GUIDE DR. V.N.K. USHA M.D. (AYU) PROFESSOR Head of the department DEPT. OF P.G. STUDIES IN PRASOOTI TANTRA EVUM STREE ROGA S.D.M. COLLEGE OF AYURVEDA, KUTHPADY, UDUPI-574118 CO- GUIDE DR. SUCHETHA M.D. (AYU) PROFESSOR LECTURER DEPT. OF SHAREERA – KRIYA S.D.M. COLLEGE OF AYURVEDA, UDUPI

2008-09 S.D.M. COLLEGE OF AYURVEDA, KUTHPADY, UDUPI-574118

1 From, Dr. K. Padma Saritha Ist Year M.S. Scholar DEPT. OF P.G. STUDIES IN PRASOOTI TANTRA EVUM STREE ROGA S.D.M. COLLEGE OF AYURVEDA, KUTHPADY, UDUPI - 574118 To, THE REGISTRAR RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE Through, THE PRINCIPAL S.D.M. COLLEGE OF AYURVEDA KUTHPADY, UDUPI - 574118

Respected Sir, SUB: 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 the dissertation to the Rajiv Gandhi University of Health Sciences, Bangalore for the partial fulfillment of M.D.( AYU ) in Prasooti tantra Evum Stree roga Title of Dissertation: “CLINICAL EVALUATION OF EFFICACY OF AVACHURNANA WITH CERTAIN INDIGENOUS DRUGS [Tuttha, kasisa, Gairika Lodhra] IN GARBHASHAYA MUKHA SHOTHA ( PRIMITIVE CERVICAL CELL PATHOLOGY )” Here with, I am enclosing completed proforma for registration of subject for Dissertation. Thanking You, Place: Udupi yours sincerely, Date: (Dr. K. PADMA SARITHA)

2 1) NAME OF THE CANDIDATE: DR. K. PADMA SARITHA. Ist Year M.S. Scholar DEPT. OF P.G. STUDIES IN PRASOOTI TANTRA EVUM STREE ROGA S.D.M. COLLEGE OF AYURVEDA, KUTHPADY, UDUPI - 574118 PERMANENT ADDRESS : DR. K. MADHUSUDHAN TULASI GARDENS SAINIKPURI, SECUNDERABAD, ANDHARA PRADESH.

2) NAME OF THE INSTITUTION: S.D.M. COLLEGE OF AYURVEDA, KUTHPADY, UDUPI-574118 KARNATAKA 3) COURSE OF STUDY AND SUBJECT : M.S.(AYURVEDA)IN PRASOOTI TANTRA EVUM STREE ROGA

4) DATE OF ADMISSION OF COURSE : 2ND JUNE 2008

5) TITLE OF THE TOPIC:

“CLINICAL EVALUATION OF EFFICACY OF AVACHURNANA WITH CERTAIN INDIGENOUS DRUGS [Tuttha, kasisa, Gairika Lodhra] IN GARBHASHAYA MUKHA SHOTHA ( PRIMITIVE CERVICAL CELL PATHOLOGY )”

3 6) BRIEF RESUME OF THE INTENDED WORK

6.1) NEED FOR THE STUDY:

The active reproductive years of female are quite interesting to observe as it includes different physiological changes. The peak levels of Estrogen are inevitable for feminine orientation which sometimes leads to certain pathological problems, cervical pathology being one of that. Injuries to during parturition, infections result in inflammation of cervix and conditions like lacation, pregnancy, unopposed estrogen action, inevitable estrogen therapy lead to histocytological changes with increase e in cell size, multiplication of cells, destruction of epithelial tissue, and lastly atypical cell formation.1,2 These changes clinically give rise to many pathological conditions. Among them Cervical Hypertrophy2, Cervical Hyperplasia2, Chronic Cervicitis3.4, Cervical Erosion which can be considered as Garbhashaya Mukha Shotha5,6, should be treated promptly, if not may lead to malignancy2,4. Eventhough modern science has effective treatment methods like Cryotherapy, Laser technique, Chemotherapy etc, are not out of side effects like secondary bleeding, cervical stenosis, etc2. Hence here is an effort made to treat the disease in early stages eliminating the root to progress further, which is utmost important. The drugs which are having shothahara, ropana, lekhana, vranaropana properties [Tuttha, Kaseesa, Gairika, Lodhra] have been selected for avachoorna5 in primitive cervical cell pathology.

6.2) REVIEW OF LITERATURE 1. In Sushruta Samhita chikitsasthana 23rd chapter, sushruta has explained shopha, its types & treatment methods including Bahirparimarjana chikishta.5 2. In charaka samhita chikitsasthana Shwayathu chikistha has been explained in 12th chapter.6 3. Ashtangahrudaya chikitsasthana 17th chapter explains about Shwayathu Chikitsa.7

4 DRUG REVIEW

1. Kaseesa, Tuttha, Lodhra and Gairika for their granthihara properties have been included in the treatment of granthi by Sushruta in chikitsasthana 19th chapter, Granthyapachyarbudagalaganda chikitsadhyaya,5

2. Lodhra for its granthihara guna has been explained in Granthyadi pratishradhadaya” of Ashtangasangraha 35th chapter.8

PREVIOUS WORKS DONE ON THE SUBJECT :

1. M.A. Mehta (1973), GAU,Jamnagar has done work on Apathyapatha Shotha.

2. M.P.Makhane (1981), GAU,Jamnagar has done work on Role of local application of Indrayava Moola on Endocervicitis with Cervical Erosion.

3. R.Sharma (1988), GAU, Jamnagar has done Comparative study in Effect of Cauterization ( Agnikarma) in Cervical Erosion.

6.3) OBJECTIVES OF THE STUDY:

1. Conceptual study of Garbhashaya Mukha Shotha (Cervical Hypertrophy, Cervical Hyperplasia, Cervical Erosion, Chronic Cervicitis)

2. Clinical evaluation of effect of Avachurna of Tutthadi drugs (Tuttha, Kaseesa, Gairika, Lodhra) on Garbhashaya Mukha Shotha

5 7) MATERIALS AND METHODS :

7.1) Source of data: Minimum 15 patients diagnosed, as Garbhashaya Mukha Shotha will be taken for study from OPD and IPD section of SDM Ayurveda Hospital, Udupi, Karnataka.

7.2) Method of collection of data:

It is a single blind study with a pre-tests & post-test design, whrere 15 patients diagnosed with Garbhashaya Mukha Shotha will be selected. The selected 15 patients will be subjected to Avachurna of Tutthadi drugs. A special format will be prepared considering all the points pertaining to history in our classes and allied sciences. Patient will be analised and selected accordingly.

A Inclusion Criteria: - Age – 18 to 35 yrs. - Married women. - Clinically diagnosed cases of Chronic Cervicitis & Cervical Erosion. - Patients diagnosed with PAP SMEAR test as Cervical Hypertrophy & Cervical Hyperplasia

B. Exclusion Criteria: - Unmarried & pregnant women. - Cervical polyps - Carcinoma of cervix - Other systemic disorders like Diabetes mellitus, HTN etc

6 ASSESSMENT CRITERIA:

SUBJECTIVE PARAMETERS: 1) Dysmenorrhoea . 2) Back ache.

OBJECTIVE PARAMETERS 1) Cervical features: a) Area of Erosion b) Nabothian cysts c) Cervical enlargement. d) Irregularity. e) Changes in papsmear reports.

2) Vaginal discharge.

Final assessment: Cures: Normal coloured cervix with no discharge and normally of clinical features with normal cell patterns Improved: Moderate relief in clinical features. No response: No relief

7.3) Does the study require any investigations or interventions to be conducted on patients or other humans or animals? The study will be human clinical study; the study will be done on patients who match inclusion criteria only.

7 INVESTIGATIONS: 1) Blood analysis. 2) Urine routine. 3) PAP SMEAR TEST if needed. 4) CERVICAL BIOPSY, USG if necessary.

INTERVENTATIONS: Patients diagnosed as Garbhashaya Mukha Shotha will be subjected to Avachurna with Tutthadi drugs (Tuttha, Kaseesa, Gairika, Lodhra) once daily for 5 days. Follow up: After treatment and later after 28 days.

7.4) Has ethical clearance been obtained from your institution in case of 7.3? Yes. Concurrence has been obtained from the ethical committee of S.D.M Ayurveda Hospital.

8) List of References: 1. Reid Robin, Roberts Fiona. Pathology Illustrated; 6th Edition. U.K: Elsevier Ltd; 2005. Pp - 677, P- 31,114, 115. 2. Hatch Kenneth D, Hacker Neville F. Berek Jonathan .S, Editor. Novak’s Gynecology, Intraepithelial Disease of Cervix, Vagina and Vulva. 12 th Edition. U.S.A: Williams and Wilkins; 2001. Pp-1359, P-451, 464-472. 3. Shafi M. I. Edmonds D. Keith, Editor. Dewhurst’s Textbook of Obstetrics and Gynecology for Post graduates. Premalignant and malignant disease of Cervix. 6th Edition. London: Blackwell Science; 1999. Pp- 622, P-577. 4. MacLean A. B, Edmonds D. Keith, Editor. Dewhurst’s Textbook of Obstetrics and Gynecology for Post graduates. Benign Diseases of Vagina, Cervix and Ovary. 6th Edition. London: Blackwell Science; 1999. Pp - 622, P-587. 5. Sushruta. Sushruta Samhita with Nibandhasangraha com of Dalhanacharya and Nayayachandrika Panjika of Gayadasacharya. Acharya Yadavji

8 Trikamji, Acharya Narayanram, Editors.Varanasi; Chaukhamba Surbharati Prakashan; 2008. Pp-824, P- 87, 103-105. 6. Agnivesha. Charaka Samhita. Shukla Vidyadhara, Tripati Ravidutta, Editors. Vol 2, Delhi: Chaukhamba Sanskrit Pratishthan; 2007. Pp- 999, P- 270 274. 7. Vagbhata. Ashtanga Hrudaya with sarvangasundara and Ayurveda rasayana commentary. Tripati Brahmananda, Shastri HariSadashiva Padakara, Editors. Varanasi:Chaukhamba Surbharati Prakashan; 2007. Pp- 956, P- 705-708. 8. Vagbhata.Ashtangasangraha. Murthy Shrikantha K.R, Editor.2nd Edition. Varanasi: Chaukhamba Orientalia; 2000. Pp-654, P-306-314. 9. Baghel M.S.Research in Ayurveda. 2nd Edition. Jamnagar: Mrudu Ayurvedic Publications and Sales; 2005. Pp-381, P-51, 52.

9) Signature of the candidate:

10) Remark of the Guide:

11) Name and designation: 11.1) Guide: DR. V. N. K. USHA. M. D. (AYU) H.O.D.& PROFESSOR. DEPT OF P. G. STUDIES IN PRASOOTI TANTRA & STREEROGA S. D. M. COLLEGE OF AYURVEDA. KUTHPADY, UDUPI-574118

11.2) Signature:

11.3) Co-Guide: DR. SUCHETHA KUMARI M.S. (AYU) ASST. PROFESSOR. DEPT OF P. G. STUDIES IN PRASOOTI TANTRA & STREEROGA

9 S.D.M.COLLEGE OF AYURVEDA KUTHPADY, UDUPI – 574118

11.4) Signature:

11.5) Head of the Department: DR. V. N. K. USHA. M. D. (AYU) H.O.D.& PROFESSOR. DEPT OF P. G. STUDIES IN PRASOOTI TANTRA & STREEROGA S. D. M. COLLEGE OF AYURVEDA. KUTHPADY, UDUPI-574118

11.6) Signature:

12) 12.1) Remarks of the chairman & the Principal:

12.2) Signature: