Post on 24-Feb-2023
“A COMPARATIVE CLINICAL STUDY ON THE
EFFECT OF ELADI GUTIKA AND MATULUNGA
AVALEHA IN GARBHINI CHARDI”
By
Ambily.V.N B.A.M.S.
Dissertation submitted to the Rajiv Gandhi University of Health
Sciences, Bangalore, for the partial fulfillment of the Degree
Of
Master of Surgery
(AYURVEDA DHANVANTARI)
in
PRASOOTI TANTRA EVAM STREE ROGA
Under the Guidance of
Dr. Sunita Siddesh M.D (Ayu)
Professor & H.O.D
And
Co-guidance of
Dr. Jayasudha G.C. M.S (Ayu)
Lecturer
Department of Prasooti Tantra Evam Stree Roga
S K A M C H and R C, Bangalore
DEPARTMENT OF POST GRADUATE STUDIES IN PRASOOTI TANTRA EVAM STREE
ROGA
SRI KALABYRAVESHWARA SWAMY AYURVEDIC MEDICAL COLLEGE, HOSPITAL &
RESEARCH CENTRE,
VIJAYANAGAR, BANGALORE - 560104.
2011- 2014
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,
KARNATAKA
I hereby declare that this dissertation entitled “A COMPARATIVE CLINICAL
STUDY ON THE EFFECT OF ELADI GUTIKA AND MATULUNGA
AVALEHA IN GARBHINI CHARDI” is a bonafide and genuine research work
carried out by me under the guidance of Dr.Sunita Siddesh, Professor & H.O.D, and
co-guidance of Dr.Jayasudha G.C, Department of P.G Studies in Prasooti Tantra
Evam Stree Roga, S K A M C H & R C, Bangalore.
Date: Signature of the Candidate
Place: Ambily.V.N
DECLARATION BY THE CANDIDATE
SRI KALABYRAVESHWARA SWAMY AYURVEDIC MEDICAL
COLLEGE, HOSPITAL & RESEARCH CENTRE,
VIJAYANAGAR, BANGALORE - 560104.
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled “A COMPARATIVE CLINICAL
STUDY ON THE EFFECT OF ELADI GUTIKA AND MATULUNGA
AVALEHA IN GARBHINI CHARDI” is a bonafide research work by
Ambily.V.N in partial fulfillment of the requirement for the degree of Ayurveda
Dhanvantari - MS (Prasooti Tantra Evam Stree Roga) of the Rajiv Gandhi
University of Health Sciences, Bangalore.
Guide
Dr.Sunita Siddesh
Date: Professor & H.O.D
Place: S K A M C H & R C
Bangalore.
SRI KALABYRAVESHWARA SWAMY AYURVEDIC MEDICAL
COLLEGE, HOSPITAL & RESEARCH CENTRE,
VIJAYANAGAR, BANGALORE - 560104.
CERTIFICATE BY THE CO- GUIDE
This is to certify that the dissertation entitled “A COMPARATIVE CLINICAL
STUDY ON THE EFFECT OF ELADI GUTIKA AND MATULUNGA
AVALEHA IN GARBHINI CHARDI” is a bonafide research work by
Ambily.V.N in partial fulfillment of the requirement for the degree of Ayurveda
Dhanvantari - MS (Prasooti Tantra Evam Stree Roga) of the Rajiv Gandhi
University of Health Sciences, Bangalore.
Co-Guide
Dr.Jayasudha G.C
Date: Lecturer
Place: S K A M C H & R C
Bangalore.
SRI KALABYRAVESHWARA SWAMY AYURVEDIC MEDICAL
COLLEGE, HOSPITAL & RESEARCH CENTRE,
VIJAYANAGAR, BANGALORE - 560104.
ENDORSEMENT BY THE H.O.D AND PRINCIPAL
This is to certify that the dissertation entitled “A COMPARATIVE CLINICAL
STUDY ON THE EFFECT OF ELADI GUTIKA AND MATULUNGA
AVALEHA IN GARBHINI CHARDI” is a bonafide research work done by
Ambily V.N under the guidance of Dr. Sunita Siddesh, Professor & H.O.D,
Department of P.G Studies in Prasooti Tantra Evam Stree Roga, S K A M C H & R C,
Bangalore.
Dr. Sunita Siddesh Dr.Kiran. M. Goud
Professor & H.O.D. Principal
Dept. of P.G. Studies in PT & SR S K A M C H & R C
S K A M C H & R C Bangalore.
Bangalore.
Date: Date:
Place: Place:
COPYRIGHT
I hereby declare that the Rajiv Gandhi University of Health
Sciences, Karnataka shall have the rights to preserve, use and
disseminate this dissertation in print or electronic format for
Academic/ Research purpose.
Date: Signature of the Candidate
Place: (Ambily.V.N)
Acknowledgement
A COMPARATIVE CLINICAL STUDY ON THE EFFECT OF ELADI GUTIKA AND
MATULUNGA AVALEHA IN GARBHINI CHARDI Page I
ACKNOWLEDGEMENT
With bowed head before Almighty and
Joined hands before my parents and teachers.
At the moment of the completion of my thesis work I prostrate at the feet of
Almighty for providing this opportunity and easy completion of this work.
I am indebted to Late Paramapoojya Jadguru Padmabhushana Sri Sri Sri
Dr.Balagangadharanatha MahaSwamiji, who is founder of many Educational and
Health institutions of Adichunchanagini Shikshana Trust including our own
institution. On the first day of our PG studies, he showered us with his blessings,
which gave us strength to overcome all the hurdles and complete our works with
success. Parama Poojya Swamiji dedicated his life to serve humanity and his social
deeds have inspired us to follow the path of service and charity.
I bow my head at the lotus feet of Sri Sri Sri Nirmalanandanatha Swamiji and seek
his blessings.We are elevated by his dynamic nature.
I also bow my head at the holy feet of Paramapoojya Sri Sri Sowmyanatha Swamiji
who is the mentor of our institution. Swamiji has been of utmost support for us as
students at each and every step of our works
I am indebted to my parents V.V.Nethran Namboodiripad and N.Vijayakumari
whose affection and care has helped me to build up my career. I take this
opportunity to remember the physical and mental support and prayers of my
mother without whom I would never be able to accomplish this work.
I also express my sincere gratitude to my better half and soul mate
Mr.KrishnanK.C for his inspiration and never ending support and for making me
believe in my capabilities.
My love filled thanks to my daughter Baby Malavika Krishnan who supported me
throughout my studies even though she missed my presence in many of her
important events.
Acknowledgement
A COMPARATIVE CLINICAL STUDY ON THE EFFECT OF ELADI GUTIKA AND
MATULUNGA AVALEHA IN GARBHINI CHARDI Page II
I also express my sincere thanks to my sister Sreedevi.V.N who supported and
helped in all my works.
My sincere gratitude to my in-laws Mr.K.C.K Chithrabhanu and Mrs.A.Savithri for
their care, love and support.
I express my thanks to my sisters, sister in law and all my family members for their
support.
It is a matter of great pleasure and honour to express my gratitude to our Respected
Principal, Dr. Kiran M Goud whose profound knowledge and constant monitoring
have helped us throughout our study.
I would like to impress my immense gratitude to the Dean of PG studies
Dr.N.Anjaneya Murthy for his valuable guidance at each step of our study.
My sincere thanks to the Medical superintendent Dr.Venkatshamiah for his support
throughout my study.
I am obliged to Dr.M.Ramesh who has always been with us in all our difficult
situations and supported us throughout our work.
It is my privilege to express my respect and gratitude to my Guide and HOD of our
department Dr.Sunita Siddesh for her guidance, constant support and invaluable
help throughout this study. The mental and physical support extended by her
encouraged me for successful completion for this work.
I extend my sincere gratitude to my Co-Guide Dr.Jayasudha.G.C whose inspection
and support have helped me throughout my PG studies.
I am grateful to my teacher Dr.Anupama for her guidance and mental support
throughout my work.
I wholeheartedly thank my teacher Dr.Padmasarita who has guided me for the
successful completion of this work.
I am extremely thankful to my teacher Dr.Usha Kiran who has supported me in my
study.
Acknowledgement
A COMPARATIVE CLINICAL STUDY ON THE EFFECT OF ELADI GUTIKA AND
MATULUNGA AVALEHA IN GARBHINI CHARDI Page III
I extend my sincere thanks to Dr.Abdul Khader, who has always extended a helping
hand in all my obscure situations.
I am grateful to my teachers Dr.Gopal, Dr.Bhrahmanand and Dr.Sunitha G.S for
their guidance and support for the preparation of my drug.
I would like to extend a heartfelt thanks to my teachers Dr.Byresh, Dr.Satish,
Dr.Amarnath, Dr.Mahesh, Dr.Vinay Kumar, Dr.Nayan, Dr.Sharada, Dr.Swati,
Dr.Neeta, Dr.Keerthi, Dr. Dr.Shubha Hegde, Dr.Sujatamma, Dr.Shailaja for their
helping hand whenever I approached them for help.
I also thank Dr.Vanajakshi, Dr.Kumaraswamy and Dr.Lalita for their help in my
studies.
I extend my warm thanks to my batch mates and friends especially Dr.Divya,
Dr.Jyothi, Dr.Megha Dr.Rakesh, Dr.Sindhu, Dr.Sunanda. Dr.muneeb, Dr.Rohit and
Dr.Varun for being always a support for me.
My sincere thanks to my seniors Dr.Reshma, Dr.Chetana, Dr.Priya, Dr.Swetha and
Dr.Shubha for their support and timely advice.
My affectionate thanks to my juniors Dr.Sarang, Dr.Shivakumar, Dr.Amruta,
Dr.Shridevi and Dr.Shriniwas for their help.
I also am indebted to Mr.Lancy’D Souza and Mr. Nanda Kumar for their guidance
in my statistical work. I also thank our librarian Mr.Satish for his help.
I also extend my gratitude to all teaching and non-teaching staff for their support.
Finally I would like to thank all my patients for being so co-operative and having
faith in me.
I acknowledge my sincere thanks to all who helped me directly or indirectly during
the course of my study.
Place
Acknowledgement
A COMPARATIVE CLINICAL STUDY ON THE EFFECT OF ELADI GUTIKA AND
MATULUNGA AVALEHA IN GARBHINI CHARDI Page IV
Date Dr.Ambily .V.N
Abbreviations
Page IV
LIST OF ABBREVIATIONS
HCG Human chorionic gonadotropin
CS Charaka Samhita
SS Sushruta Samhita
AS Ashtanga Samgraha
AH Ashtanga Hrudaya
BP BhavaPrakasha
MN MadhavaNidana
YR Yogaratnakara
KS Kashyapa Samhita
GIT Gastro-intestinal tract
CTZ Chemoreceptor trigger zone
LES Lower oesophageal sphincter
USO Upper oesophageal sphincter
PR Prithvi
sAP Aapa
TJ Teja
VY Vayu
AK Akasha
OPD Out patient department
IPD In patient department
Hb% Haemoglobin percentage
RBS Random blood sugar
USG Ultra sound sonography
Kg Kilogram
Gm % Gram percentage.
Abbreviations
Page V
PE Primary Education
SE Secondary Education
HS Higher secondary
GR Graduate
LMC Lower middle class
MC Middle class
UMC Upper middle class
VP Vata pitta
VK Vata kapha
PK Pitta kapha
BT Before treatment
AT After treatment
AT1 Follow up after treatment.
HS Highly significant
SS Statistically significant
NS Non significant
SD Standard deviation
SE Standard error
PSE Pooled standard error
Abstract
Page VII
ABSTRACT
Pregnancy and mother hood is an exclusive privilege for women. The
transformation of motherhood is the only instance in the world when both
pleasure and pain work in unison. Acharyas have explained chardi as one of
the vyakta lakshanas of garbhini.
Vomiting is a symptom seen in the first trimester of pregnancy. It usually
commences in the early part of the day. Sometimes, it may persist longer and
may occur at other times of the day. About 50% of the pregnant women
complain of vomiting which is considered as a physiological condition.
Emesis Gravidarum or Vomiting needs to be treated as it causes physical and
psychological impact on mother’s health which in turn affects the health of the
foetus. So this study was done to find a safe and effective remedy for emesis
gravidarum.
Material and methods
A minimum of 40 pregnant women in their 1st trimester of pregnancy who
were willing to take part in the study and fulfilling the inclusion criteria were
selected randomly from OPD and IPD of Prasooti Tantra Evam Stree Roga
Department of S.K.A.M.C, H and R.C, Bangalore.
Study design: A comparative clinical study with pre test and post test
design was conducted on 40 pregnant patients in 1st
trimester. 40 patients
complaining of Chardi in 1st trimester were randomly divided into the
following two groups, each comprising of 20 patients.
Group A: Eladi Gutika was given for 2 weeks.
Dose: 2 tablets thrice daily (each 500mg) with Honey.
Group B: Matulunga Avaleha with Eladi Gutika was given for 2 weeks.
Dose:Matulunga Avaleha 24gms in divided dose of 6gms 4 times
daily followed by Water.
Eladi gutika: : 2 tablets thrice daily (each 500mg) with Honey .
Abstract
Page VIII
Investigations: Investigations done were urine pregnancy test, Hb%,
RBS and USG.
Assessment criteria: The parameters assessed before and after treatment
were Frequency of vomiting, Contents of vomitus, Nausea, Salivation,
Increase in weight and Increase in Hb%.
Results: Group A consisting of Eladi Gutika and Group B consisting of Eladi
Gutika and Matulunga Avaleha showed highly significant result in all
parameters of the assessment criteria. The Group B patients had comparatively
more significant result in the parameters like nausea and salivation and also in
improvement of weight.
Conclusion: Overall improvement was more in Group B as compared to
Group A.
Key Words: Emesis Gravidarum, Eladi Gutika, Matulunga Avaleha.
Contents
Page IX
TABLE OF CONTENTS
Ch. No:
CHAPTERS Pg. No:
1
INTRODUCTION 1-2
2
OBJECTIVES 3
3 REVIEW OF LITERATURE
3a)HISTORICAL REVIEW
3b)DISEASE REVIEW
3c)DRUG REVIEW
4-5
6-26
27-44
4
METHODOLOGY 45-49
5
OBSERVATIONS 50-68
6
RESULTS 69-86
7
DISCUSSION 87-102
8
CONCLUSION 103-104
9 SUMMARY
105-106
10 BIBLIOGRAPHY
107-120
11 ANNEXURE
121-131
Tables
Page X
LIST OF TABLES
Sl.No. CONTENTS OF THE TABLES Page No. 1. Features of Shadbhavas.
6-7
2. Vyakta garbha lakshanas according to different
Acharyas.
9-10
3. Nidana of chardi according to different Acharyas.
12
4. Vishishta nidana of chardi.
13
5. Purva roopa of chardi according to different Acharyas.
13
6. Classification of chardi.
14
7. Pathya of Chardi.
18
8. Apathya of Chardi.
19
9. Garbhopakhatakara bhavas.
19-20
10. Panchabhautikata composition of ingredients of
Matulunga Avaleha.
35
11. Panchabhautikata component of ingredients of Eladi
gutika.
44
Observations
Distribution of patients based on Age.
50 12.
13. Distribution of patients based on Religion.
51
14. Distribution of patients based on Occupation.
52
Tables
Page XI
15. Distribution of patients based on Education.
53
16. Distribution of patients based on Socio-economic status.
54
17. Distribution of patients based on Habitation.
55
18. Distribution of patients based on Gravidity.
56
19. Distribution of patients based on Dietary Habits.
57
20. Distribution of patients based on Appetite.
58
21. Distribution of patients based on Dominant rasa
consumed.
59
22. Distribution of patients based on Prakruti.
60
23. Distribution of patients based on Abhyavarana Shakti.
61
24. Distribution of patients based on Jarana Shakti.
62
25. Distribution of patients based on Bowel Habits.
63
26. Distribution of patients based on Duration of Vomiting.
64
27. Distribution of patients based on Time of Vomiting.
65
28. Distribution of patients based on Contents of Vomiting.
66
29. Distribution of patients based on Associated Complaints.
67
Results
Effect of treatment on frequency of vomiting in Group A.
69 30.
31. Effect of treatment on frequency of vomiting in Group B.
69
32. Comparative effect in frequency of vomiting as compared
between groups
70
33. Effect of treatment on contents of vomitus in Group A. 72
Tables
Page XII
34. Effect of treatment on contents of vomitus in Group B.
72
35. Comparative effect in contents of vomitus as compared
between groups.
73
36. Effect of treatment on nausea in Group A.
75
37. Effect of treatment on nausea in Group B.
75
38. Comparative effect on nausea as compared between
groups.
76
39. Effect of treatment on salivation in Group A.
78
40. Effect of treatment on salivation in Group B.
78
41. Comparative effect on salivation as compared between
groups.
79
42. Effect of treatment on improvement of weight in Group A.
81
43. Effect of treatment on improvement of weight in Group B.
81
44. Comparative effect on improvement of weight as
compared between groups.
82
45. Effect of treatment on improvement in Hb% in Group A.
84
46. Effect of treatment on improvement in Hb% in Group B.
84
47. Comparative effect on improvement in Hb% as compared
between groups.
85
48. Pharmacodynamics of ingredients of Eladi Gutika
92
49. Pharmacodynamics of ingredients of Matulunga
Avaleha.
93
50. Mode of action of drugs according to chemical
constituents.
94
Graphs
Page XIII
LIST OF GRAPHS
Sl No. TITLE
Page No.
Observations
Distribution of patients based on Age.
50 1.
2. Distribution of patients based on Religion.
51
3. Distribution of patients based on Occupation.
52
4. Distribution of patients based on Education.
53
5. Distribution of patients based on Socio-economic
status.
54
6. Distribution of patients based on Habitation.
55
7. Distribution of patients based on Gravidity.
56
8. Distribution of patients based on Dietary Habits.
57
9. Distribution of patients based on Appetite.
58
10. Distribution of patients based on Dominant rasa
consumed.
59
11. Distribution of patients based on Prakruti.
60
12. Distribution of patients based on Abhyavarana
Shakti.
61
13. Distribution of patients based on Jarana Shakti.
62
14. Distribution of patients based on Bowel Habits.
63
Graphs
Page XIV
15. Distribution of patients based on Duration of
Vomiting.
64
16. Distribution of patients based on Time of Vomiting.
65
17. Distribution of patients based on Contents of
Vomiting.
66
18. Distribution of patients based on Associated
Complaints.
67
Results
Comparative effect in frequency of vomiting as
compared between groups
71
19.
20. Comparative effect in contents of vomitus as
compared between groups.
74
21. Comparative effect on nausea as compared between
groups.
77
22. Comparative effect on salivation as compared
between groups.
80
23. Comparative effect on improvement of weight as
compared between groups.
83
24. Comparative effect on improvement in Hb% as
compared between groups.
86
Flow charts
Page XV
LIST OF FLOW CHARTS
Sl.No: TITLE
Page No.
1. Samprapti of chardi
16
2. Physiology of vomiting
22
3. Act of vomiting
23
4. Involvement of dosha dushti in garbhini chardi
91
Plates
Page XVI
LIST OF PLATES
Sl.No:
Contents
Pg.No
1
Matulunga
28
2
Kola
29
3
Laja
30
4
Sharkara
30
5
Daruharidra
31
6
Dadima
32
7
Kshoudra
33
8
Preparation of Avaleha
34
9
Ela
37
10
Patra
38
11
Twak
39
12
Mridvika
40
13
Pippali
41
14
Madhuka
42
15
Kharjura
43
Introduction
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 1
INTRODUCTION
God has bestowed many precious things on human beings of which women are
endowed with the unique gift of the power of giving birth to an offspring.
Acharya Charaka highlights greatness of women by saying that virtue, wealth
affluence and creation depend on women. Pregnancy and motherhood is a
unique experience of every woman. The growing foetus depends entirely on
the body of the mother for all its needs. So the pregnant mother should remain
always healthy and well-nourished to have a healthy baby.
Acharya Charka has given specific importance to pregnant lady and given the
comparison of a pot filled with oil because slight oscillation may cause spilling
of oil. Many physiological and psychological changes happen in the body of a
woman during pregnancy. The body of the mother adjusts to these changes and
results in many symptoms of pregnancy.
Garbhini Chardi is mentioned as a vyakta garbha lakshana which is due to the
presence of garbha and due to vata vaigunya. Almost 50% of the women
suffer from emesis gravidarum in the first trimester of pregnancy. It is also
called as morning sickness because most of the time, vomiting occurs in the
early morning hours and associated with nausea and salivation. Even though it
is physiological, it is a common symptom in obstetric practise. It is better to
treat these conditions in early stage and prevent complications like Hyper
emesis gravidarum. Emesis gravidarum is due to the presence of hormones
like hCG and progesterone.
Many yogas are told in classics for the treatment of garbhini chardi. In the
present study Eladi gutika and Matulunga Avaleha are selected and given for
15 days in diagnosed patients of garbhini chardi.
Eladi gutika is deepana, pachana and ruchya and thus helps in reducing the
agnimandya which is mostly present in the first trimester of pregnancy. The
drugs are aromatic in nature and help the mother to have better palatability.
Since it is in the tablet form, it can be easily taken by the patients. So Eladi
gutika was selected for this study.
Introduction
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 2
Leha is one among four types of food items having good palatability because
of the sweetening agents. The metabolism and absorption of medicine starts
from the mouth itself because of the presence of enzyme ptyalin in the salivary
secretion. Vomiting in pregnancy is seen mainly due to carbohydrate
starvation. As honey and sugar is seen more in leha preparation along with
other ingredients, it helps in supplementing carbohydrates. Matulunga, the
main ingredient of avaleha is amla in rasa and amla rasa is better liked by the
pregnant woman. It also contains the chemical constituent Limonene which is
used as a flavouring agent and will have better palatability. So Matulunga
avaleha was selected for this study.
Objectives
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 3
OBJECTIVES OF THE STUDY
To evaluate the effect of Eladi Gutika in Garbhini Chardi.
To evaluate the effect of Matulunga Avaleha with Eladi Gutika in Garbhini
Chardi.
To compare the effect of both Eladi Gutika and Matulunga Avaleha with Eladi
Gutika in Garbhini Chardi
Historical review
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 4
. HISTORICAL REVIEW
VEDIC PERIOD
Description of Kola as chardi nigrahana dravya has been told.
VISHNU PURANA
In Vishnu Purana description regarding chardi has been told.
SAMHITA PERIOD. (1000BC-500AD)
Charaka Samhita (1000 BC)
Acharya Charaka has described five types of chardi and its chikitsa in detail.1
He has also explained chardi as one of the vyakta lakshana of garbha.2
Susruta Samhita (600BC-400BC)
Acharya Susrutha has given detailed description of nidana, types of chardi and its chikitsa in
detail.3 In the nidana of chardi, Acharya Susruta has given one nidana aryaascha
aapanna satwa4 and Dalhana in hiscommentary explains aapanna satwa as garbhini.
5
In the types of chardi,Acharya Susruta considers the fifth type as caused by Dauhrida.6
Dalhanaacharya has explained in commentary that dauhrida is due to garbha.7
Astanga Samgraha (5TH
CENTURY)
Acharya Vagbhata has mentioned chardi as one of the vyakta lakshanas of garbha.8
Astanga Hrudaya (5TH
CENTURY)
Acharya Vagbhata has also considered chardi as one of the vyakta lakshanas of garbha.9
Historical review
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 5
SANGRAHA KALA (500AD-1700AD)
Madhava Nidana (7TH
CENTURY)
Acharya Madhava also have mentioned about chardi and chikitsa in detail. He has explained
one nidana as garbhini.10
Bhavaprakasha (16TH
CENTURY)
Bhavamisra has mentioned nidana and chikitsa of chardi.11
Kasyapasamhita
Kasyapa has mentioned garbhini vyadhis in detail and explained different types of chardi and
its chikitsa separately.12
Hareeta samhita
Hareeta has explained chardi as one of the upadravas in garbhini.13
Historical review
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 6
BIBLOGRAPHY
1 Agnivesha, Charaka Samhita, Ayurvedadipika Commentary by Chakrapanidatta, edited by;
Vaidya Yadavji Trikramji Acharya, Chaukhamba Surbharati Prakashan, Varanasi, reprint-
2011,Chikitsa Sthana 20th
Chapter, Verse-4-5, pp- 738, pg -555.
2 Agnivesha, Charaka Samhita, Ayurvedadipika Commentary by Chakrapanidatta, edited by;
Vaidya Yadavji Trikramji Acharya, Chaukhamba Surbharati Prakashan, Varanasi, reprint-
2011,Shareera Sthana 4th
Chapter, Verse-16, pp- 738, pg -320.
3 Sushruta, Sushruta Samhita, Nibandha Samgraha commentary of Sri Dalhanacharya edited
by Acharya Yadavji Trikamji, Choukhamba Surabharati Prakashan Varanasi 2008, Uttara
tantra 49th Chapter Verse-4 teeka pp-824, pg – 754.
Historical review
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 7
4 Sushruta, Sushruta Samhita, Nibandha Samgraha commentary of Sri Dalhanacharya edited
by Acharya Yadavji Trikamji, Choukhamba Surabharati Prakashan Varanasi 2008, Uttara
tantra 49th Chapter Verse-4 teeka pp-824, pg – 754.
5 Sushruta, Sushruta Samhita, Nibandha Samgraha commentary of Sri Dalhanacharya, edited
by Acharya Yadavji Trikamji, Choukhamba Surabharati Prakashan Varanasi 2008, Uttara
tantra 49th Chapter Verse-3-5 teeka pp-824, pg – 754.
6 Sushruta, Sushruta Samhita, Nibandha Samgraha commentary of Sri Dalhanacharya, edited
by Acharya Yadavji Trikamji, Choukhamba Surabharati Prakashan Varanasi 2008, Uttara
tantra 49th Chapter Verse-12 pp-824, pg – 755.
7 Sushruta, Sushruta Samhita, Nibandha Samgraha commentary of Sri Dalhanacharya, edited
by Acharya Yadavji Trikamji, Choukhamba Surabharati Prakashan Varanasi 2008, Uttara
tantra 49th Chapter Verse-12 teeka pp-824, pg – 755.
8 Vagbhata, Ashtanga Samgraha ,Sasilekha commentary of Indu Prologue in Sanskrit by
Prof.Jyotir Mitra, Edited by Shivprasad Sharma, Chaukhambha Sanskrit Series, Reprinted
2008, Choukhamba Krishnadas Academy,Varansi, Sharira Sthana 2/8, pp-965,P-276.
9 Vagbhata, Astanga Hrudaya, SarvangaSundara Commentary of Arunadatta and Ayurveda
Rasayana Commentary of Hemadri, edited by; Pandit Hari Sadasiva Sastri Paradakara
Bhisagacharya, Chaukhamba Surbharati Prakashan, Varanasi, reprint-2010, Shareera sthana
1st
Chapter, Verse-50-51, pp- 956, pg -370.
10 Acharya Madhava, Madhava Nidana,Madhukosha Commentary, Hindi trasalation by
Acharya Narendranath Shastry, Motilal Banaraseedas, Delhi, reprint- 2009, Chardi
nidana,Verse 2-4,pp-, pg316.
11
Acharya Bhavamishra, Bhavaprakasha, Vidyotini teeka of Pandit Brahma Sankara Misra,
Chaukhambha Sanskrit Bhavan, Varanasi, 11th
edition 2010,17th
Chapter, Verse 1-4, pp-
836,pg- 172.
12 Vruddha Jeevaka, Revised Vatsya Kashyapa samhita with Vidyotini hindi commentary by
Ayurvedalankara SriSatyapala Bhishagachayara, Chaukhamba press Varanasi, reprint –
1998,Khila Sthana 10th
Chapter, Verse 182 pp-364, pg -300
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13 Hareeta Samhita, Pandit HariharaprasadTripathi, Chaukhamba Krishnadas Academy,
Varanasi, reprint 2005, Chapter No: 51, Verse-1-2, pp-524, pg-456.
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DISEASE REVIEW
GARBHA
Garbha is derived from the word Garbha which means the womb (or) the belly.14
According
to Medini Kosha “Garbhe bhroone arbhake kukshou”.It means that the smallest 'Bhruna'
which stays in Kukshi is called as 'Garbha'.
DEFINITION
“Shukra shonitam garbhashayastham aatma prakruti vikaara sammoorchitam garbha
ityuchyate.”15
“Shukra shonitajeevasamyoge tu khalu kukshi gate garbha samgjya bhavati.”16
The union of shukra, shonitha, aatma, ashta vidha prakruti and shodasha vikaaras in the
Garbhashaya is termed as Garbha.
SHADBHAVAS
Along with the five factors (Panchamahabhootas), another six more factors have been
described by Acharyas. They are Matrija, Pitrija, Atmaja, Satmyaja, Rasaja and Satvaja
bhavas. Garbha is formed and developed by the combination of these bhavas.
TABLE NO: 1 FEATURES OF SHADBHAVAS
BHAVA FEATURES
1. Matrija Twak, Rakta, Mamsa, Meda, Majja,
Nabhi, Hridayam, Kloma, Yakrit,
Pleeha,Vrikka,Vasti,Purishadhanam
Amasaya, Pakvasaya, Antra, Uttara
Guda, Adhara Guda, Kshudrantra,
Sthulantra,VapaVapavahanam,
Garbhasaya and all Mridu Angas.
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2. Pitrija Shukra, Kesha, Smasru, Nakha,
Loma, Danta, Asthi, Sira, Snayu,
Dhamani and all Sthira Angas
3. Atmaja Taasu Taasu Yonishu Utpatti (Birth
in specific species), Ayu (lifespan),
Atmagnanam Vignanam, Prerana of
Prana and Apana, Swara, Sukha,
Dukha,Ichcha,Dvesha,Chetana,
Dhriti, Buddhi, Smriti, Ahankara,
Prayatna, Kama, Krodha, Lobha,
Bhaya, Harsha,
Dharmadharmaseelata,Mana,
Indriyas, Akriti, Varna.
4 Satmyaja
Arogyam, Analasyam,
Alolupatvam, Indriya
Prasadanam,Svara Varna Beeja
Sampat, Praharsha, Veeryam,
Balam,Medha, Ayu, Ojas, Prabha,
Uthanam, Santosham.
5 Rasaja Sarirasya Abhinivritti, Sarirasya
Abhivriddhi, Prananubandhata,
Tripti, Pushti, Utsaham, Balam,
Varnam, Sthiti Hani, Aloulyam,
Buddhi, Vritti
6 Satvaja BhaktiSeelam, Saucham, Dvesham,
Smriti, Moham, Tyagam,
Matsaryam, Souryam, Bhayam,
Krodham, Tandra, Utsaham,
Taikshnyam, Mardavam,
Gambhiryam, Anavasthitatvam
The mentioned Matrija, Pitrija and Atmaja bhavas cannot be changed as they come from the
parents and Poorvajanma Samskaras respectively. The other three bhavas viz. Satmyaja,
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Rasaja and Satvaja bhavas can be changed by proper medication and proper Ahara and
Vihara.
SATMYAJA BHAVA
Those are called as Satmya substances which stabilize the health in a healthy person and
which help in alleviation of the disease or vitiated doshas in an unhealthy person. This Satmya
depends upon many factors like Desa, Kala, Jati, Ritu, Roga, Vyayama, Udaka etc. Satmya, in
this context, refers to the Ahara Rasa which is favourable to mother and foetus. The Satmyaja
food when taken by the mother provides proper nutrition to her and foetus. When the same
Ahara which is taken by the mother is not suitable to herself and foetus, it will result in poor
nutrition of the both. It may also lead to improper organogenesis of foetus, disproportion in
various organs of foetus, small for gestation age babies etc. In severe conditions, Garbha
Srava and Garbha Pata are also likely to occur.
RASAJA BHAVA
Definition
“Rasyate aaswaadyate rasanena iti rasah”17
Rasa is that substance which flows continuously and which is tasted by tongue and felt by
mind. In this context, Rasa refers to balanced Ahara Rasa. The balanced Ahara Rasa which is
taken by the pregnant woman helps in formation of Sapta Dhatus in required amount in the
foetus. Rasa Dhatu of the mother performs three functions. (1) Matru Pushti (2) Garbha Pushti
(3)Stana/Stanya Pushti.18
GARBHINI
Garbhini is considered as a woman walking with a filled pot in her head.19
There is always a
need of gentle care for her as any slight changes can cause problem to the foetus.
GARBHINI LAKSHANAS
(Physiological changes in mother during pregnancy)
During pregnancy, there are progressive anatomical and physiological changes not only
confined to the genital organs but also to all systems of the body. This is principally a
phenomenon of maternal adaptation to the increasing demands of the growing foetus.
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Charaka and Chakrapani have said that after Dauhrida's Abhivyakti, Grihita (Vyakta) Garbha
Lakshanas start. According to Vagbhata-II, Dauhridavastha starts in the 2nd month. Probably,
because of this reason, Vagbhata-II has explained the Vyakta Garbha Lakshanas in 2nd
month, whereas, Charaka in 3rd month. Sushruta and Vagbhata I have not specified the period
of Vyakta Garbha Lakshanas.
The signs and symptoms of Vyakta Garbha Lakshanas are tabulated below
TABLE NO: 2 VYAKTA GARBHA LAKSHANAS ACCORDING TO DIFFERENT
ACHARYAS
No
Sign/Symptom CS20
SS21
AS22
AH23
1 Artava
Adarsanam
+ + + _
2 Asya
Samsravanam
- - _ -
3 Praseka _ - + +
4 Anannabhilasha - + +
5 Chardi + + + +
6 Arochaka + - + +
7 Amla Kamata + - + +
8 Uchchavacheshu
Bhaveshu
Sraddha
+ - + +
9 Gurugatrata + - _ -
10 Chakshushor
Glani
+ - + -
11 Stanayoh
Stanyapravritti
+ - _ +
12 Oushtha, Stana
Mandala
Krishnata
+ + _ +
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13 Padayoh
Svayathu
+ - + +
14 Roma
Rajyudgamah
+ + _ +
15 Yonyascha
Atalatvam
+ - - +
16 Subhagandhat
Udvejanam
_ - - +
17 Sadanam - - - +
18 Kukshi
Gauravam
- - + +
19 Akshi Pakshma
Sammilanam
- + + -
20 Swara Kshamata - - + -
21 Nidradhikyata - - + -
22 Jrimbha - - + +
23 Moorcha - - + +
24 Kshamata - - - +
25 Stana Peenata - - - +
26 Vidaha - - - +
GARBHINI CHARDI
Garbhini chardi is a common complaint in obstetric practice. Pregnancy is a condition in
which many physiological changes happen in the body of a woman. These changes can lead
to many symptoms in her body. One of these includes Garbhini Chardi. Chardi is mentioned
as one of the vyakta lakshanas of Garbha in all Ayurvedic classics.
In Charaka samhita, there is a detailed description of classification of chardi and its
chikitsa.24
Susruta samhita also mentions about chardi in detail.25
In the nidana of chardi,
Acharya Susruta has given one nidana as naryaascha aapanna satwa and Dalhana in his
commentary explains aapanna satwa as garbhini.26
He has explained douhrudaja as nidana for
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agantuja chardi, and Dalhana commentary explains douhrudaja as caused by garbha.27
Acharya Vagbhata also explains types of chardi and has mentioned dwishtardhaja as one
classification of chardi and explained dauhrida as a cause of chardi. Acharya Hareeta has
explained chardi as one of the upadravas of garbha.28
There is no separate chapter explaining about garbhini chardi in classics. Acharya Kashyapa
have explained that there is no difference of the physical and psychological disorders of a
pregnant woman from any other individual.29
The diseases manifested in her will also be like
other persons. So the nidana panchakas of chardi can be considered for garbhini chardi also.
But the principles of treatment differ because it should be aimed at the proper development of
garbha and the pregnant lady.
NIRUKTI OF CHARDI
The word “chardi” is a stree linga pada.30
The word chardi is derived from two words “chad” dhatu and “inn” pratyaya.31
The word chard is with two words “chad” meaning to fill and “ardh” means with discomfort.
PARYAYA OF CHARDI32
Vamanam Vamathu Vamah
Vanthi Chardanam Prachardika
PARIBHASHA OF CHARDI.
Chardi is so called as the vitiated doshas comes out of mouth with forceful impulses covering
the mouth and producing discomfort to the whole body.33
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NIDANA
There is no direct reference regarding garbhini chardi. So the nidana of chardi is considered in
detail.
TABLE NO: 3 NIDANA OF CHARDI ACCORDING TO DIFFERENT ACHARYAS
SS34
MN35
YR36
BP37
Atidrava + + + +
Atisnigdha + + + +
Ahrudya + + + +
Atilavana + + + +
Akalabhojna + + + +
Atimatra + + + +
Asatmya
Bhojana
+ + + +
Shrama + + + _
Kshaya + + + _
Udvega + + _ +
Ajeerna + + _ +
Krimi + + + +
Apannasatwa + + + +
Atidruta
Mashnata
+ + _ +
Ama + + + +
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Acharya Charaka has explained vishishta nidanas for chardi.
TABLE NO: 4 VISHISTA NIDANA OF CHARDI38
TYPE OF CHARDI NIDANA
VATAJA Vyayama,teekshanaoushadha,shoka,bhaya,upavasa.
PITTAJA Ajeerna,katu,amla,vidahi ahara
KAPHAJA Snigdha,atiguru ,vidahi ahara,atinidra
SANNIPATAJA Sarvarasa aharasevana,amadosha,rituviparyayaahara.
DWISHTARTHAJA Ashuchi,pooti,amedhya,beebhatsa
PURVARUPA
Prodromal symptoms are nausea with uneasy feeling in chest region, excessive salivation and
aversions of food.
TABLE NO: 5 PURVA RUPA OF CHARDI ACCORDING TO DIFFERENT
ACHARYAS.
CS39
SS40
MN41
BP42
Hridayotklesha + + _ +
Kapha praseka + + + +
Annadwesha + _ + +
Bhaktasya
anabhinanadanam
_ + _ _
Hrullaasa _ _ + +
Udgararodha _ _ + +
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CLASSIFICATION OF CHARDI.
TABLE NO: 6TABLE SHOWING CLASSIFICATION OF CHARDI
CS
43
SS
44
AH45
AS
46
MN
47
BP
48
VATAJA + + + + + +
PITTAJA + + + + + +
KAPHAJA + + + + + +
SANNIPAT
AJA
+ + + + + +
DWISHTAR
THAJA
+ + + + + +
ROOPA
Vataja chardi: In vatika chardi,the person experiences hrid parswa peeda, mukhasosha,
moordha nabhi vedana, kasa, swarabheda, prabala udgara shabda. The chardi is saphena,
vichinna, krushna, tanu and with kashaya rasa. The vomitus is alpa, but with forceful vegas.49
Pittaja Chardi: In pittaja chardi the patient experiences moorcha, pipaasa, mukhasosha,
moordha talu akshi santaapa, tama and bhrama. The vomitus is peeta or harita and ushna and
tikta and takes place with daha.50
Kaphaja Chardi: In kaphaja, the chardi is with roma harsha and asya madhurya. There will
be kapha praseka, nidra, aruchi, and shareera gourava.51
Sannipatika Chardi: The chardi in which all the above features are found should be known
as caused by all the doshas.52
Dwishtarthaja chardi: No specific roopa is mentioned .
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SAMPRAPTI Nidanas will lead to the vitiation of kapha dosha and pitta dosha which inturn vitiates vata
which forces the doshas to move upward leading to chardi.53
During pregnancy, nidana like garbha peedana together with lack of proper garbhini
paricharya will cause agnimandya. Manasika karanaas like douhrida avamana can lead to vata
vrudhi and may also lead to kapha dushti. The kapha dushti together with the pitta dushti will
lead utklishtata of dosha or aamasanchaya. These utklishta doshas can cause avarodha to the
gati of vata which inturns brings about kshobha to amashaya. The utklishta doshas are
expelled out through the mouth by the action of udana and vyana vata resulting in chardi.
SAMPRAPTI GHATAKAS
Dosha –Tridosha
Dooshya-Rasa
Srotas-Annavaha and Rasavaha
Agni-Jatharaagni,rasadhatwagni
Adhishtana-Amashaya
Vyakta Sthana-Mukha
Srotodushti-Vimargagamana
Roga marga-Abhyantara
Saadhyasadhyata-Sadhya
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SAMPRAPTI
FLOW CHART NO: 1 SHOWING THE SAMPRAPTI OF CHARDI
PEEDANA DUE TO GARBHA VRUDHI IMPROPER GARBHINI PARICHARYA
DOUHRUDA AVAMANA
AGNIMANDYA
KAPHA DUSHTI IN AMASHAYA + PITTA DUSHTI+VATAVRUDHI
UTKLISHTATA OF DOSHA OR AMA SANCHAYA
CAUSE AVARODHA TO VATA GATI
CAUSE KSHOBHA IN AMASHAYA
VILOMA GATI OF UTKLISHTA DOSHAS BY VYANA AND UDANA VATA
MUKHA POORANA
CHARDI
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The pathogenesis clarifies three types of causes for garbhini chardi.54
1) VATA-VAIGUNYA
Vata denotes nervous system including psychology of individual. Abnormality of this factor
may produce reflux and psychogenic factors.
2) DAUHRUDA (Avamana or non-fulfilment of Dauhruda)
Normally the woman desires for the substances when she is deficient. Non fulfilment of these
may produce certain deficiency and this may initiate vomiting.
3) GARBHANIMITTA (Due to foetus)
Presence of Garbha itself is a nidana for chardi.
UPADRAVA55
Kasa
Swasa
Jwara
Hikka
Trushna
Vaichintya
Hrudroga
CHIKITSA
SAMANYA CHIKITSA
Chikitsa for garbhini chardi is explained in Yogaratnakara and Bhavaprakasha.
1) Use of pestled bhoonimba with equal quantity of sugar.
2) Shunti vilwa kashaya with yava saktu.
3) Paste of dhanyaka with rice water and sugar.
4) Vilva phala majja with lajambu
VISHESHA CHIKITSA
Acharya Kasyapa has mentioned doshanusara chikitsa for chardi.
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CHIKITSA IN VAJAJA GARBHINI CHARDI 56
Leha of matulunga rasa, laaja, kolamajja, daadimasara, rasanjana, sarkara and madhu.
Pakva rasa of amla dadima without salt.
Samskaarita mahisha mamsa rasa.
CHIKITSA IN PITTAJA GARBHINI CHARDI 57
Rice water with Laaja choorna , sarkara and madhu mixed with chaturjata kalka and with
pushpa to make hrudya.
Peya of laja with sita and kshoudra.
Jangala mamsa rasa with sarkara.
CHIKITSA IN KAPHAJA GARBHINI CHARDI58
Kwatha of jambu pallava and amra pallava mixed with kshoudra.
Yoosha of mudga and dadima mixed with salt and sneha.
CHIKITSA IN SANNIPATAJA GARBHINI CHARDI59
Combination of all above treatments.
PATHYA
TABLE N0: 7 PATHYA OF CHARDI60
AHARA VIHARA
Laja manda Narikela Sugandha lepana
Purana shali
Dhatri Manoanukoola roopa,rasa
gandha,sparsa
Mudga Nagakesara Mano anukoola pushpa,phala
darsana
Godhooma Draksha
Jangalamamsa Kola
Hareetaki Nimbu
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APATHYA
TABLE NO: 8 SHOWING APATHYA OF CHARDI61
AHARA VIHARA
Bimbiphala Chinta
Teekshna ushna ahara Shoka
Akala bhojana Bhaya
Bheebhatsya darshana
Aarohana
Bharodwahana.
GARBHOPAKHATAKARA BHAVAS.
Garbhopakhatakara bhavas are considered as apathyas in pregnancy. All acharyas have
mentioned about garbhopakhatakara bhavas.
TABLE NO: 9 SHOWING GARBHOPAKHATAKARA BHAVAS
CS62
SS63
AS64
AH65
KS66
Uccha
bhashana
Maithuna Yana Apriya
avalokana
Looking at
declining sun
and moon
Avarohana Vyayama Ajeerna Apriya
sravana
Exposed to
solar and
lunar eclipse
Kupa
avalokana
Ati-
tarpana
Krodha Bharavah
ana
Excessive
laughing
Rakta
vasana
dharana
Ati-
karshana
Shoka Guru
pravarana
Wearing tight
garments
Snehadi
kriya
Diva-
swapna
Bhaya Uttana
shayana
Staying in
erect or
flexed
posture in
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long
intervals.
Vyayama Rathri
jagarana
Trasa Shodhana Viewing the
filled pots,
garlands,
pot filled
with gruta or
dadhi.
Vyavaya Kukkuta
Asana
Upavasa
Udvartana Excitement
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VOMITING.
Vomiting is considered as one of the symptom of many diseases especially of gastro intestinal
tract rather than a separate entity. It is present as a cardinal symptom in many diseases which
helps in diagnosis. Nausea and vomiting are seen together in many diseases or conditions
among which pregnancy is one such condition where with history of amenorrhea and presence
of nausea and vomiting it can be diagnosed that woman is pregnant. It is present in most
mammals except rodents, a species that lacks the vomiting centre.
The word nausea is derived from the Greek “naus” meaning “ship”67
and thus originally
carried the idea of sickness from sea travel.
Definition:-
It can be defined as a reflux which serves to relieve the upper G.I tract by forcible expulsion
of gastric contents through the mouth68
. The strongest stimuli include unpleasant sights and
dizziness or irritation and distension of the stomach.
Causes of vomiting:-
Indulgence of foods which are very fatty, unpleasant, very watery and salty
Taking meals at odd times, in excess of quantity
Infection by worms
Pregnancy
Sight of terrific, fearsome, ugly and unpleasant things
Ingestion of toxins i.e. food poisoning
Gastritis, peptic ulcer with or without pyloric stenosis, dyspepsia, intestinal obstruction etc
Raised intra cranial tension, meningial irritation, motion sickness, encephalitis, labrynthitis
and migraine
Acute hepatitis
Psychogenic vomiting
Drugs which produce gastritis, over dose of digitalis etc
PHYSIOLOGY OF VOMITING69
The act of vomiting is accompanied by a complex of movements which are controlled by the
vomiting centre in the dorsal portion of the lateral reticular formation. The efferent and
afferent pathways which bring about vomiting are caused by vagus and symphathetic nerves.
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A major sensory relay station in the afferent vomiting pathway is the chemoreceptor trigger
zone (CTZ) situated in the lateral border of the area postrema of the medulla oblongata. It is
in direct contact with the circulating blood and is outside the blood brain barrier. CTZ being a
purely sensory relay station is incapable of initiating vomiting in the absence of vomiting
centre while direct chemical stimulation of the latter can evoke vomiting irrespective of the
CTZ. Vomiting is usually preceded by the sensation of nausea and increased secretion of
saliva, bronchial fluid and sweat. The muscles involved in the act of coughing take part in the
act of vomiting and the vagal vomiting and cough centre have a close functional relationship.
FLOW CHART NO: 2 SHOWING PHYSIOLOGY OF VOMITING
CORTEX
VOMITING CENTRE
GIT
G.I.IRRITATION,
INFECTION,
DRUGS,
RADIATION
CEREBELLUM
INNER EAR
CTZ
SMELL, PAIN, SIGHT
STIMULI
VEGAL
STIMULATION
MOTION
SICKNESS
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ACT OF VOMITING
The vomiting act encompasses three types of outputs initiated by CTZ
Increased salivation to protect the enamel from the gastric acid.
Retro peristalsis movement which starts from the middle of the small intestine and moves
upward sweeping all the contents into the stomach through the relaxed pyloric stenosis.
A lowering of intra thoracic pressure, coupled with an increase in abdominal pressure making
abdominal muscles to contract and propels stomach contents into oesophagus as the
oesophageal sphincter relaxes causing vomiting which is followed by retching.
FLOW CHART NO: 3 SHOWING ACT OF VOMITING70
Taking a deep breathe
Raising the hyoid bone and larynx to pull the USO open
Closing of the glottis-prevents aspiration in the trachea
Soft palate lifted to close the posterior nares
Subsequently strong downward contraction of diaphragm
Simultaneous contraction of abdominal wall muscles
Squeeze stomach to build up high intra gastric pressure
Finally LES relaxes allowing expulsion of gastric contents upward.
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CHANGES IN ALIMENTARY SYSTEM DURING PREGNANCY:
The gums become congested and spongy and may bleed to touch71
. A focal, highly vascular
swelling of the gums develops called as epulis of pregnancy develops occasionally but
regresses after delivery.As pregnancy progresses, the stomach and intestines are displaced by
the enlarging uterus . The appendix is usually displaced upward and somewhat laterally as the
uterus enlarges and at times it may reach the right flank.72
There is diminished gastric secretion and delayed emptying time of the stomach. Muscle tone
and motility of the entire gastrointestinal tract are diminished due to high progesterone level.73
Decreased levels of motilin, a hormonal peptide is known to have smooth –muscle stimulating
effect74.
This can lead to conditions like vomiting, nausea and gastric irritation. Cardiac
sphincter is relaxed and regurgitation of acid gastric content into the oesophagus may produce
chemical oesophagitis and heart burn. The altered position of the stomach probably
contributes to its frequent occurrence.75
However lower oesophageal sphincter tone is also
reduced. Intra oesophageal pressures are reduced and intra gastric pressures are greater in
pregnant woman. At the same time oesophageal peristalsis has lower wave speed and lower
amplitude. Atonicity of the gut leads to constipation, while diminished peristalsis facilities
more absorption of food materials.76
Vomiting in pregnancy can be classified as 77
1. Physiological Vomiting (Simple Vomiting).
2. Pathological Vomiting (Hyperemesis Gravidarum).
1) SIMPLE VOMITING (EMESIS GRAVIDARUM)78
In simple vomiting, the patients have nausea and occasional sickness on rising in the morning.
Slight vomiting is common in early pregnancy (about50%) that is considered as a symptom of
pregnancy. It may however occur at other times of the day. The vomit is small and clear or
bile stained. It does not produce any impairment of health or restrict the normal activities of
the women. The feature disappears with or without treatment by 12-14th
week of pregnancy.
High level of serum human chorionic gonadotrophin, oestrogen and altered immunological
states are considered responsible for initiation of the manifestation which is probably
aggravated by the neurogenic factor.
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2) HYPEREMESIS GRAVIDARUM79
Hyperemesis gravidarum is a severe type of vomiting which has got a deleterious effect on the
health of mother and incapacitates in her day to day activities.
ETIOLOGY
The aetiology of emesis gravidarum is obscure.
THEORIES SUPPORTING EMESIS GRAVIDARUM
1) Hormonal 80
HUMAN CHORIONIC GONADOTROPIN
Excess of chorionic gonadotropin will stimulate the vomiting centres of brain. An increase in
HCG also causes nausea. The reason can be because of the HCG stimulates the maternal
ovaries to secrete oestrogen in turn causes nausea.
PROGESTERONE
Excess of progesterone will lead to relaxation of the cardiac sphincter and simultaneous
retention of gastric fluids due to impaired motility.
OESTROGEN
High level of oestrogen will lead to more vomiting in pregnancy.
2) Psychogenic causes81
Psychogenic factors probably aggravate nausea and vomiting.
3) Dietetic causes82
Probably the low carbohydrate reserve, starvation may lead to excessive vomiting.
4) Allergic or immunological83
5) Decreased gastric motility can lead to nausea in pregnancy.
Disease review
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6) An increase in salivation during the first trimester, that is often bitter tasting Ptyalin is
ingested during the mother’s sleep. This can upset the stomach enough to cause the morning
nausea.84
Whatever may be the cause of initiation of vomiting, it is probably aggravated by neurogenic
element. Unless it is rectified, features of dehydration and carbohydrate starvation supervene
and a vicious cycle of vomiting appears.85
Vomiting
Carbohydrate starvation
Keto-acidosis
Vomiting
MANAGEMENT 86
The principles in the management of vomiting are
1) To control vomiting.
2) To correct electrolyte and fluid imbalance
3) To correct metabolic disturbances.
4) To prevent the complications of severe vomiting.
Disease review
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A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 28
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A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 31
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Drug review
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 27
DRUG REVIEW
The two medicines used in the present study are Matulunga Avaleha and Eladi
Gutika.
Group A - Eladi gutika.
Group B - Eladi Gutika and Matulunga Avaleha .
MATULUNGA AVALEHA87
अथ चछरदिचिकितसा त परोचयमसनसा ननबोधत/
मसतलनगरो लसजसाःिोलमजजस तथस अनजनम//
तथस दसडिमसरशि शिि रस कषौदरमव ि/
एष वसतसततमिसा छरदि हतनत लहोववशषताः//(िस.ा.स.१०/११५)
Drug review
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 28
MATULUNGA88
Botanical Name – Citrus medica
Family Name – Rutaceae
PHOTO PLATE NO: 1 MATULUNGA
Vernacular Names –
English – Citron
Hindi – Barenimbu
Kannada – Madala
Malayalam – Ganapathy Narakam
Synonyms – Beejapooraka,Ruchaka,Madiphala
Chemical Constituents: Abscisic acid, AbscisinII, Limonin, Limonene,
Limocitrol, Rutin
RASAPANCHAKA
Rasa Amla
Anurasa Madhura
Guna Laghu snigdha
Veerya Ushna
Vipaka Amla
Karma VataKapha hara
Drug review
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 29
KOLA89
Botanical Name – Ziziphus jujuba
Family Name – Rhamnaceae
PHOTO PLATE NO: 2 KOLA
Vernacular Names –
English – Indian Jujube
Hindi – Beri
Kannada – Bore
Malayalam – Lantappazham
Synonyms – Badara,Ajapriya
Parts used: - Fruit
Chemical constituents: Jujubosides A&B (seeds), Zizogenin, Zeatin,
Frangufoline, Saponin, etc.
RASAPANCHAKA
Rasa Madhura
Anurasa Amla
Guna Guru snigdha
Veerya Sheeta
Vipaka Madhura
Karma Vata Pitta hara
Drug review
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LAAJA
PHOTO PLATE NO: 3 LAAJA
RASAPANCHAKA
Rasa Madhura Kashaya
Guna Laghu
Veerya Seetha
Vipaka Madhura
Karma VataPitta hara.
SHARKARA
PHOTO PLATE NO: 4 SHARKARA
RASAPANCHAKA
Rasa Madhura
Guna Laghu snigdha
Veerya Sheeta
Vipaka Madhura
Karma Tridosha hara
Drug review
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DARUHARIDRA90
Botanical Name – Berberis aristata
Family Name – Menispermaceae
PHOTO PLATE NO: 4 DARUHARIDRA
Vernacular Names –
English – Tree turmeric
Hindi – Jha-i-haldi
Kannada – Maradarsina.
Synonyms – Darunisa, Pitadaru, Darvi
Parts used: - Stem
Chemical constituents: Karachine, Taxilamine, Berberine, Palmatine,
Oxycathine
RASAPANCHAKA
Rasa Tikta Kashaya
Guna Laghu Ruksha
Veerya Ushna
Vipaka Katu
Karma Kapha Pittahara
Drug review
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 32
DAADIMA91
Botanical Name – Punica granatum
Family Name – Punicacae
PHOTO PLATE NO: 5 DAADIMA
Vernacular Names
Eng – Pomegranate
Hindi – Anar
Kannada – Dalimbe
Malayalam – Matalanaraka
Synonyms – Raktabija, Karaka, Raktapushpa
Parts used: Fruit
Chemical constituents: Estrone, Punicic acid
RASAPANCHAKA
Rasa Madhura Amla
Anurasa Kashaya
Guna Laghu snigdha
Veerya Ushna
Vipaka Madhura
Karma Tridosha hara
Drug review
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 33
KSHOUDRA
PHOTO PLATE NO: 6 KSHOUDRA
RASAPANCHAKA
Rasa Madhura Kashaya
Guna Laghu rooksha
Veerya Sheeta
Vipaka Madhura
Karma Tridosha hara
PREPARATION OF AVALEHA92
One part of swarasa was mixed with 16 parts of sarkara and heated on
mandagni till the tantumat paka was obtained and 1 part of choorna was added.
When it was cooled sufficient quantity of honey and ghee was added.
Avaleha paaka lakshana93
Tantumatvam
Apsumajjati
Kharatvam
Pidite mudra
Gandhavarnarasobhavata
Dose of Avaleha94
1 pala (48gms)
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PREPARATION OF AVALEHA
PHOTO PLATE NO: 7 PREPARATION OF AVALEHA
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TABLE NO: 10 SHOWING PANCHABHAUTIKA COMPOSITION OF
INGREDIENTS OF MATULUNGA AVALEHA95
Drug Ras
a
PR AP TJ VY AK
Matulunga Amla
madhura
+ ++ + - -
Kola Madhura
Amla
+ ++ + - -
Laaja Madhura
++ + - + -
Dadima Amla
Madhura
++ ++ + + -
Sarkara Madhura
+ + - - -
Rasanjana Tikta
+ - - - -
Madhu Madhura
Kashaya
++ + - + -
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ELADI GUTIKA
एलसपतरतविो अधसिकषसाःवपपपलयसधि पला तथस/
सतसमधि खजजिर सिदवीिसाशि पलोतनमतसाः//
ािजरणयि मधनस यकतस गरििसाःिसरयत सिषि/
अकषमसतरसाततशििसा िकषयत न रदनरदन//
िसा सवसा जवरा रहकिसा चछरदि मजचछसि मदा भरमा/
रकतननषिीवनातरषसा पसशविशजलमरोििा
शोथपलीहसढयवसतसमशशि सवरिदा कषतकषया/
गरििस तपि ी वरषयस रकतवपतता ि नसशयत// 96
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ELA97
Botanical Name – Eletteria cardamomum
Family Name – Zingiberacae
PHOTO PLATE NO: 8 ELA
Vernacular Names –
Hindi – Choti Elaychi
English – Lesser Cardamom
Malayalam – Elam
Kannada – Elakki
Synonyms – Korangi, Dravidi, Tuttha, Triputa
Parts used: - Seeds
Major chemical constituents:Bornneol, Camphene, P-cymene, Heptane, D-
limonene, Linalool, Menthone, Sitosterol etc.
RASAPANCHAKA
Rasa Katu Madhura
Guna Laghu Ruksha
Veerya Sheeta
Vipaka Katu
Karma Kapha Vata hara
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PATRA98
Botanical Name – Cinnamomum tamale
Family Name – Lauraceae
PHOTO PLATE NO: 9 PATRA
Vernacular Names:
Hindi – Tejapatra
Telugu – Lavanga Patri
Synonyms – Patra,Dala
Parts used:-Leaf
Major chemical constituents: Eugenol,Cinnamic Aldehyde, d-phelladrene
RASAPANCHAKA
Rasa Katu Madhura
Guna Laghu Ruksha
Veerya Sheeta
Vipaka Katu
Karma Kapha Vata hara
Drug review
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TWAK99
Botanical Name – Cinnamomum zeylanicum
Family Name – Lauraceae
PHOTO PLATE NO: 10 TWAK
Vernacular Names
Hindi – Dalchini
English – Cinnamon
Telungu – Lavange Patta
Synonyms – Utkada, Tanutwak, Ramapriya
Parts used: - Barks
Chemical constituents: Cinnamaldehyde, Eugenol, Cumic Aldehyde,
Caryophyllene, Methyl Eugenol, Borneol, Cinnamyl Alcohol, Cinnzeylanin
etc
RASAPANCHAKA
Rasa Katu Tikta Madhura
Guna Laghu Ruksha Teekshna
Veerya Ushna
Vipaka Katu
Karma Vata Pitta hara
Drug review
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MRIDVIKA100
Botanical Name – Vitis vinifera
Family Name – Vitaceae
PHOTO PLATE NO: 11 MRIDVIKA
Vernacular Names
English – Common grape vine
Malayalam – Munthiri
Telugu – Draksha
Tamil – Kolumuntiri,
Synonyms - Mridwika,Gostani.
Parts used:-Ripe Fruits (dried).
Chemical constituents: Catechin, Epicatechin, B-sitosterol, Jasmonic acid.
RASAPANCHAKA
Rasa Madhura
Guna Guru snigdha
Veerya Sheeta
Vipaka Madhura
Karma Vata Pitta hara
Drug review
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PIPPALI101
Botanical Name – Piper longum
Family Name – Piperaceae
PHOTO PLATE NO: 12 PIPPALI
Vernacular Names:
Hindi – Pipala
English – Long Pepper
Malayalam – Tippali
Syn – Magadhi,Krishna
Chemical constituents: Essential oil, caryophhyllene mainly Piperine,
Piplartine, Piperlongumine, Pipernonaline, Piperundecalidine, Pipercide,
Sesamin.
Parts used-Fruit
RASAPANCHAKA
Rasa Katu
Guna Laghu Snigdha
Veerya Ushna
Vipaka Madhura
Karma Vata Kapha hara
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MADHUKA102
Botanical Name – Madhuca longifolia
Family Name – Sapotacae
PHOTO PLATE NO: 13 MADHUKA
Vernacular Names.
Hindi – Mahua
English – Butter tree
Kannada – Hippe
Synonyms – Guda Puspa
Parts used: - Twaksara
Chemical constituents: Saponins, Myricetin, Quercetin
RASAPANCHAKA
Rasa Madhura Kashaya
Guna GuruSnigdha
Veerya Sheeta
Vipaka Madhura
Karma Vata Pitta hara
Drug review
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KHARJURA103
Botanical Name – Phoenix sylvestris
Family Name – Arecaceae
PHOTO PLATE NO: 14 KHARJURA
Vernacular names
Hindi – Kharjur
English – Dates palm
Synonyms – Skandha phala, Bhumikharjurika
Parts used: - Fruit
RASAPANCHAKA
Rasa Madhura
Guna GuruSnigdha
Veerya Sheeta
Vipaka Madhura
Karma Vata Pitta hara
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PREPARATION OF GUTIKA104
All the ingredients are made into fine powder and the gutika is prepared by
mixing with two parts of honey and it is dried in shade.
Dose of Gutika.105
1 tola.
According to Ayurveda Pharmacopia the dose of Eladi Gutika is given as 2
tablets each of 500 gms to be given thrice daily with Honey.106
The same dose
was used in this study.
TABLE NO: 11SHOWING PANCHABHAUTIKA COMPOSITION OF
INGREDIENTS OF ELADI GUTIKA107
Drug
Rasa PR AP TJ VY AK
Ela Katu
madhura
+ + + + -
Patra Madhura,
katu
+ + + + -
Twak Katu.tikta.
madhura
++ + + + -
Mridvika
Madhura + + - - -
Pippali
Katu - - - - +
Madhuka Madhura,
kashaya
++ + - - -
Kharjura Madhura,
kashaya
++ + - - -
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BIBLIOGRAPHY
87 Vruddha Jeevaka, Revised Vatsya Kashyapa samhita with Vidyotini hindi commentary
by Ayurvedalankara SriSatyapala Bhishagachayara, Chaukhamba press Varanasi, reprint –
1998,Khilasthana Chapter10, Verse -115- 116 pp-364, pg -300
88 Dr.J.L.N.Sastry, Foreword by K.C.Chunekar, Chaukhambha Orientalia Varanasi,
Edition-2004, pp-, pg 650.
89 Dr.J.L.N.Sastry, Foreword by K.C.Chunekar, Chaukhambha Orientalia Varanasi,
Edition-2004, pp-, pg 669.
90 Dr.J.L.N.Sastry, Foreword by K.C.Chunekar, Chaukhambha Orientalia Varanasi,
Edition-2004, pp-, pg 54, 55.
91 Dr.J.L.N.Sastry, Foreword by K.C.Chunekar, Chaukhambha Orientalia Varanasi,
Edition-2004, pp-, pg 232-235.
92
Acharya Sarangadhara, Sarangadhara samhita, Jiwanprada hindi commentary by
Dr.Shailaja Srivastava, Chaukhambha orientalia Varanasi,Second edition 1998, pp-578,pg-
208.
93 Acharya Sarangadhara, Sarangadhara samhita, Jiwanprada hindi commentary by
Dr.Shailaja Srivastava, Chaukhambha orientalia Varanasi,Second edition 1998, pp-578,pg-
208.
94 Sarangadhara samhita, Acharya Sarangadhara, Sarangadhara samhita, Jiwanprada hindi
commentary by Dr.Shailaja Srivastava, Chaukhambha orientalia Varanasi,Second edition
1998, pp-578,pg-208.
95 Vagbhata, Astanga Hrudaya, SarvangaSundara Commentary of Arunadatta
and Ayurveda Rasayana Commentary of Hemadri, edited by; Pandit Hari
Sadasiva Sastri Paradakara Bhisagacharya, Chaukhamba Surbharati
Prakashan, Varanasi, reprint-2010, Sutra sthana 10th
Chapter, Verse-1,
pp- 956, pg -174.
Drug review
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 46
96 Sree Govindadasa, Bhaishajyaratnavali edited and translated by SreeLalchandraji
Vaidya, Motilal Banarasidas Publication,NewDelhi 8th
Edition 1997,
Raktapittaadhikaara; Verse - 32-35, pp-832, pg -236.
97 Dr.J.L.N.Sastry, Foreword by K.C.Chunekar, Chaukhambha Orientalia Varanasi,
Edition-2004, pp-, pg 527-529.
98 Dr.J.L.N.Sastry, Foreword by K.C.Chunekar, Chaukhambha Orientalia Varanasi,
Edition-2004, pp-, pg 918-919.
99 Dr.J.L.N.Sastry, Foreword by K.C.Chunekar, Chaukhambha Orientalia Varanasi,
Edition-2004, pp-, pg 464-466.
100 Dr.J.L.N.Sastry, Foreword by K.C.Chunekar, Chaukhambha Orientalia Varanasi,
Edition-2004, pp-, pg 673-674.
101 Dr.J.L.N.Sastry, Foreword by K.C.Chunekar, Chaukhambha Orientalia Varanasi,
Edition-2004, pp-, pg 452-454.
102 Dr.J.L.N.Sastry, Foreword by K.C.Chunekar, Chaukhambha Orientalia Varanasi,
Edition-2004, pp-, pg 824-825.
103 Dr.J.L.N.Sastry, Foreword by K.C.Chunekar, Chaukhambha Orientalia Varanasi,
Edition-2004, pp-, pg 1014-1015.
104Acharya Sarangadhara, Sarangadhara samhita, Jiwanprada hindi commentary by
Dr.Shailaja Srivastava, Chaukhambha orientalia Varanasi,Second edition 1998, pp-578,pg-
195.
105 Sree Govindadasa, Bhaishajyaratnavali edited and translated by SreeLalchandraji
Vaidya, Motilal Banarasidas Publication,NewDelhi 8th
Edition 1997,
Raktapittaadhikaara; Verse - 32-35, pp-832, pg -236.
106 The Ayurvedic Formulary of India-Part1, Government of India, Ministry of Health
and Family Welfare 2003 Department of Indian Systems of Medicine and
Homeopathy, Revised English Edition, Published by The Controller of Publications,
Civil lines, Delhi,pp:488, pg -181-182.
Drug review
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107 Vagbhata, Astanga Hrudaya, SarvangaSundara Commentary of Arunadatta
and Ayurveda Rasayana Commentary of Hemadri, edited by; Pandit Hari
Sadasiva Sastri Paradakara Bhisagacharya, Chaukhamba Surbharati
Prakashan, Varanasi, reprint-2010, Sutra sthana 10th
Chapter, Verse-1,
pp- 956, pg -174.
Methodology
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 45
METHODOLOGY
This clinical study entitled “A COMPARATIVE CLINICAL STUDY ON THE EFFECT
OF ELADI GUTIKA AND MATULUNGA AVALEHA IN GARBHINI CHARDI” was
carried out on 40 patients who attended the OPD and IPD sections of Prasooti Tantra and
Stree Roga Department, SKAMCH & RC, Bangalore.
OBJECTIVES OF THE STUDY
To evaluate the effect of Eladi Gutika in Garbhini Chardi.
To evaluate the effect of Matulunga Avaleha with Eladi Gutika in Garbhini Chardi.
To compare the effect of both Eladi Gutika and Matulunga Avaleha with Eladi Gutika
in Garbhini Chardi.
Source of Data:
40 patients diagnosed with Garbhini Chardi were selected from O.P.D and I.P.D of SKAMC
H& RC, Bangalore and randomly divided into two groups.
Methods of Collection of Data
It was an open comparative clinical study with a pre- test and post-test design and the
patients were randomly assigned into two groups.
A case proforma was specially designed with all points of history taking, physical
signs and symptoms, and necessary laboratory investigations.
The parameters of signs and symptoms were scored using a special case proforma.
Following statistical methods were employed to analyse data collected – descriptive
statistics and t test (paired and unpaired) using SPSS for windows software.(version
21 for windows 7)
Methodology
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 46
Diagnostic Criteria
Patients were diagnosed as per diagnostic criteria of Garbhini chardi which includes:
Pregnant women in their 1st trimester.
Pregnant women with Chardi (Vomiting)
Pregnant women with Praseka (Salivation)
Pregnant women with Hrullasa(Nausea)
Pregnant women with Aruchi (Anorexia)
Inclusion criteria
Pregnant women in between 18 to 40 years of age.
Pregnant women with Chardi in 1st trimester.
Both primi and multi gravida.
Exclusion criteria
Pregnant women with Hyperemesis Gravidarum.
Patient with Twin pregnancy.
Patient with Molar pregnancy.
Patient with history of Diabetes Mellitus.
Assessment criteria
Signs and symptoms were assessed using the following objective and
subjective parameters:
Frequency of vomiting.
Contents of vomitus.
Nausea.
Salivation.
Increase in weight.
Increase in Hb%
Methodology
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 47
Laboratory investigations
Blood investigations: Hb%, RBS.
Urine examination: Pregnancy test
USG: OBG
Study design
A comparative clinical study with pre- test and post- test analysis was conducted on 40
randomly assigned patients with signs and symptoms of Garbhini Chardi.
Intervention
40 patients complaining of Chardi in 1st trimester were randomly divided into the following
two groups, each comprising of 20 patients.
1) Group A: Eladi Gutika was given for 2 weeks.
Dose: 2 tablets thrice daily (each 500mg) with Honey.
2) Group B: Matulunga Avaleha with Eladi Gutika was given for 2 weeks.
Dose: Matulunga Avaleha 24gms in divided dose of 6gms 4 times daily
followed by Water .
Eladi gutika: 2 tablets thrice daily (each 500mg) with Honey
Duration of the study
The study was done for a period of 30 days which included the first follow-up on 14th
day and second follow-up on 28th
day.
Methodology
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 48
Assessment Criteria
The results of the treatment were assessed on the following scoring patterns
1) FREQUENCY OF VOMITING No Vomiting Grade 0
Less than 2 times Grade 1
2-5 times Grade 2
>5times Grade 3
2) CONTENTS OF THE VOMITUS No vomiting and salivation Grade 0
Only saliva Grade 1
Saliva with gastric juice Grade 2
Saliva with gastric juice and food Grade 3
3) NAUSEA No nausea Grade 0
Nausea only in the morning Grade 1
Nausea only in the morning Grade 2
&evening
Nausea throughout the day Grade 3
4) SALIVATION No salivation Grade 0
Salivation only in the morning Grade 1
Salivation throughout the day Grade 2
Salivation persisting to hamper Grade 3
day to day activities
5) IMPROVEMENT IN WEIGHT More than 1kg Grade 0
½ to 1 kg Grade 1
Up to ½ kg Grade 2
No improvement Grade 3
Methodology
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 49
6) IMPROVEMENT IN THE Hb% >0.5 gm% Grade 0
0.25 – 0.5 gm% Grade 1
Up to 0.25 gm % Grade 2
No change Grade 3
Observations
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 50
OBSERVATIONS
The data recorded are presented under the following headings:
Demographic Data
Data related to Disease
Data related to Clinical Trial
DEMOGRAPHIC DATA
TABLE NO: 12 DISTRIBUTIONS OF PATIENTS BASED ON AGE IN YEARS
GRAPH NO: 1
Group A-8 patients were in the age group of 18-22 years, 9 patients in the age group of 23 to 27
yrs and 3 patients were in the age group of 28-32 years.
Group B-8 patients were in the age group of 18-22 years, 9 patients in the age group of 23 to
27 yrs and 3 patients were in the age group of 28-32 years.
Among 40 patients included in the study, 16(40%) were in the age group of 18 to 22 yrs, 18
(45%) in the age group of 23 to 27 yrs and 6 (15%) were of age group 28-32 yrs.
Age in years Group A Group B Total %
18-22 8 8 16 40
23-27 9 9 18 45
28-32 3 3 6 15
Total 20 20 40 100
0
2
4
6
8
10
18-22 23-27 28-32
8 9
3
8 9
3
Age in years
Group A
Group B
Observations
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TABLE NO: 13 DISTRIBUTIONS OF PATIENTS BASED ON RELIGION
GRAPH NO: 2
Group A-13 patients were of Muslim community and 7 patients were belonging to Hindu
community.
Group B-15 patients were of Muslim community and 5 patients were belonging to Hindu
community.
Among 40 patients in the study, 28(70%) were Muslims and 12(30%) were Hindus.
0
2
4
6
8
10
12
14
16
GROUP A GROUP B
7
5
13
15
Religion
HINDUS
MUSLIMS
Group A Group B Total %
Hindus 7 5 12 30
Muslims 13 15 28 70
Total 20 20 40 100
Observations
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TABLE NO: 14 DISTRIBUTIONS OF PATIENTS BASED ON OCCUPATION
GRAPH NO: 3
Group A-In group A, 18 patients were home makers, and 2 patients were working.
Group B-In group B, 17 patients were home makers, and 3 patients were working.
In the study, majority of the women that is 35 (87.5%) were home-makers, 3(7.5%)
were private employees and 2(5%) were teachers.
0
2
4
6
8
10
12
14
16
18
homemakers teachers employee
18
1 1
17
1
2
Occupation
Group A
Group B
Occupation Group
A
Group B Total %
Homemaker 18 17 35 87.5
Teacher 1 1 2 5
Employee 1 2 3 7.5
Total 20 20 40 100
Observations
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TABLE NO: 15 DISTRIBUTIONS OF PATIENTS BASED ON EDUCATION
GRAPH NO: 4
Group A- In Group A, 6 patients were with primary education, 9 patients were with
secondary education, 4 patients were with higher secondary education and 1 patient was a
graduate.
Group B- In Group B, 7 patients were with primary education, 6 patients were with
secondary education, 3 patients were with higher secondary education and 4 patients were
graduates.
Among 40 patients in the study, 13(32.5%) were primary educated, 15(37.5%) had got
secondary education, 7(17.5%) had higher secondary education and 5 (12.5 %) were
Graduates.
0
2
4
6
8
10
PE SE HS GR
6
9
4
1
7
6
3
4
Education
Group A
Group B
Education Group A Group B Total %
PE 6 7 13 32.5
SE 9 6 15 37.5
HS 4 3 7 17.5
GR 1 4 5 12.5
Total 20 20 40 100
Observations
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TABLE NO: 16 DISTRIBUTIONS OF PATIENTS BASED ON SOCIO ECONOMIC
STATUS
GRAPH NO: 5
Group A- In Group A, 2 patients were from lower middle class, 15 patients were from middle
class, and 3 patients were from upper middle class.
Group B- In Group B, 4 patients are from lower middle class, 13 patients are from middle
class, and 3 patients were from upper middle class.
Among 40 patients included in the study, 6 (15%) were from lower middle class, 28(70%)
were from middle class, and 6 (15%) were from upper middle class.
Socio Economic Status Group A Group B Total %
LM 2 4 6 15
M 15 13 28 70
UM 3 3 6 15
Total 20 20 40 100
0
2
4
6
8
10
12
14
16
LM MC UMC
2
15
3 4
13
3
Socio economic status
Group A
Group B
Observations
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TABLE NO: 17 DISTRIBUTIONS OF PATIENTS BASED ON HABITATION
GRAPH NO: 6
Group A- In Group A, all patients were from the urban habitation.
Group B- In Group B, all patients were from the urban habitation.
Among 40 patients included in the study, all patients (100%) were from the urban habitation.
Habitation Group A Group B Total %
Urban 20 20 40 100
Suburban 0 0 0 0
Rural 0 0 0 0
Total 20 20 40 100
0
2
4
6
8
10
12
14
16
18
20
URBAN SUBURBAN RURAL
20
0 0
20
0 0
Habitation
Group A
Group B
Observations
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TABLE NO: 18 DISTRIBUTIONS OF PATIENTS ACCORDING TO GRAVIDITY
GRAPH NO: 7
Group A- In Group A, 12 patients were primi gravida and 4 patients were second gravida, 4
patients were third gravida and 1 patient was 4th
gravida.
Group B- In Group B, 11 patients were primi gravida and 3 patients were second gravida, 4
patients were third gravida and 1 patient was 4th
gravida.
Among 40 patients, 23 (57.5 %) were primi gravida and 7 patients were second gravid, 8
patients were third gravid and 1 patient was 4th
gravida.
0
2
4
6
8
10
12
G1 G2 G3 G4
12
4 4
1
11
3 4
1
Gravidity
Group A
Group B
Group A Group B Total %
G1 12 11 23 57.5
G2 3 4 7 17.5
G3 4 4 8 20
G4 1 1 2 5
Total 20 20 40 100
Observations
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TABLE NO: 19 DISTRIBUTION OF PATIENTS BASED ON DIETARY HABITS
GRAPH NO: 8
Group A- In Group A, 13 patients were of mixed diet and 7 were vegetarians.
Group B- In Group B, 15 patients were of mixed diet and 5 were vegetarians.
Among 40 patients, 28 (70%) patients had mixed diet, whereas 12 (30%) were vegetarians.
0
2
4
6
8
10
12
14
16
Group A Group B
7
5
13
15
Dietery Habits
veg
mixed
Group A Group B Total %
Vegetarian 7 5 12 30
Mixed 13 15 28 70
Total 20 20 40 100
Observations
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TABLE NO: 20 DISTRIBUTION OF PATIENTS BASED ON APPETITE
GRAPH NO: 9
Group A: In Group A, 3 patients had normal appetite and 17 patients had decreased appetite.
Group B: In Group B, 4 patients had normal appetite, 15 patients had decreased appetite and
1 patient had poor appetite.
Among 40 patients, 7 (17.5%) patients had a normal appetite, 32(80%) had decreased appetite
and 1(2.5%) patient had poor appetite.
0
2
4
6
8
10
12
14
16
18
normal decreased Poor
3
17
0
4
15
1
Appetite
Group A
Group B
Appetite Group A Group B Total %
Normal 3 4 7 12.5
Decreased 17 15 23 85
Poor 0 1 1 2.5
Total 20 20 40 100
Observations
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 59
TABLE NO: 21DISTRIBUTION OF PATIENTS BASED ON DOMINANT RASA
CONSUMED
GRAPH NO: 10
Group A: In Group A, 15 patients were consuming more amla katu rasa, 2 were consuming
more madhura lavana rasa,2 were consuming more amla lavana katu rasa and 1 was
consuming sarva rasa ahara.
Group B: In Group A, 12 were consuming more amla katu rasa, 1 was consuming more
madhura lavana rasa,2 were consuming more amla lavana katu rasa,2 were consuming more
madhura katu rasa and 3 were consuming sarva rasa ahara. Among 40 patients, 27(67.5 %)
patients were mainly consuming amla katu rasa, 3(7.5%) were mainly consuming Madhura
Lavana rasa, 4(10%) patients were mainly consuming Amla Lavana Katu and 2(5%) patients
were mainly consuming Madhura Katu rasa and 4(10%)were mainly consuming sarva rasa.
0
2
4
6
8
10
12
14
16
AK ML ALK MK SR
15
2 2
0 1
12
1 2 2
3
Main Rasa Consumed
Group A
Group B
Group A Group B Total %
Amla Katu 15 12 27 67.5
Madura Lavana 2 1 3 7.5
Amla Lavana Katu 2 2 4 10
Madhura Katu 0 2 2 5
Sarva Rasa 1 3 4 10
Total 20 20 40 100
Observations
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 60
TABLE NO: 22 DISTRIBUTION OF PATIENTS BASED ON PRAKRUTI
GRAPH NO: 11
Group A: In Group A 6 patients were of vata pitta prakruti, 14 patients were of vata kapha
prakruti .
Group B: In Group B, 4patients were of vata pitta prakruti, 12 patients were of vata kapha
prakruti and 4 were of pitta kapha prakruti.
Among 40 patients, 10(25%) patients were of vata pitta prakruti, 26(65%) patients were of
vata kapha prakruti, 4(10%) were of pitta kapha prakruti.
.
0
2
4
6
8
10
12
14
VP VK PK
6
14
0
4
12
4
Prakruti
Group A
Group B
Prakruti Group A Group B Total %
VP 6 4 10 25
VK 14 12 26 65
PK 0 4 4 10
Total 20 20 40 100
Observations
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 61
TABLE NO: 23 DISTRIBUTIONS OF PATIENTS BASED ON ABHYAVARANA
SHAKTI
GRAPH NO: 12
Group A: In Group A, 14patients had avara abhyavaharana shakti and 6 patients had madhyama
abhyavarana shakti.
GroupB: In Group B, 12patients had avara abhyavaharana shakti and 8 patients had madhyama
abhyavarana shakti.
Among 40 patients, 26 (65%) patients had avara abhyavarana shakti while 14 (10%) patients were
having madhyama abhyavarana shakti.
0
2
4
6
8
10
12
14
Avara Madhyama pravara
14
6
0
12
8
0
Abhyavarana shakti
Group A
Group B
Group A Group B Total %
Avara 14 12 26 65
Madhyama 6 8 14 35
Pravara 0 0 0 0
Total 20 20 40 100
Observations
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 62
TABLE NO: 24 DISTRIBUTIONS OF PATIENTS BASED ON JARANA SHAKTI
Group A Group B Total %
Avara 14 12 26 65
Madhyama 6 8 14 35
Pravara 0 0 0 0
Total 20 20 40 100
GRAPH NO: 13
Group A: In Group A, 14patients had avara jarana shakti and 6 patients had madhyama
jarana shakti.
GroupB: In Group B, 12patients had avara jarana shakti and 8 patients had madhyama jarana
shakti.
Among 40 patients, 26 (65%) patients had avara abhyavarana shakti while 14 (10%) patients
were having madhyama abhyavarana shakti.
0
2
4
6
8
10
12
14
Avara Madhyama pravara
14
6
0
12
8
0
Jarana shakti
Group A
Group B
Observations
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 63
TABLE NO: 25 DISTRIBUTIONS OF PATIENTS BASED ON BOWEL HABITS
Group A Group B Total %
Regular 20 16 36 90
Constipated 0 4 4 10
Total 20 20 40 100
GRAPH NO: 14
Group A: In Group A,all patients had regular bowel habits.
GroupB: In Group B, 16 patients had regular bowel habits and 4 patients had constipated
bowel habits.
Among 40 patients, 36 (90%) patients had regular bowels while 4(10%) patients were said to
have constipated bowels.
0
5
10
15
20
Regular Constipated
20
0
16
4
Bowel Habits
Group A
Group B
Observations
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 64
DATA RELATED TO DISEASE.
TABLE NO: 26 DISTRIBUTIONS OF PATIENTS BASED ON THE DURATION OF
VOMITING.
GRAPH NO: 15
Group A: In Group A, 16 patients had duration of vomiting of 0-15 days and 4 patients had
duration of 16-30days.
Group B: In Group B, 13 patients had duration of vomiting of 0-15 days,5 patients had
duration of 16-30 days and 2 patients had duration of 31-45 days.
Among the patients selected for the study, 29 patients (72.5%) were having vomiting of 0-15
days, 9 patients (22.5%) were having vomiting of 16-30 days and 2 patients were suffering
with vomiting of 31-45 days.
0
2
4
6
8
10
12
14
16
0-15 days 16-30 days 31-45 days
16
4
0
13
5
2
Duration of vomiting
Group A
Group B
Duration of vomiting Group A Group B Total %
0-15 days 16 13 29 72.5
16-30 days 4 5 9 22.5
31-45 days 0 2 2 7.5
20 20 40 100
Observations
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 65
TABLE NO: 27 DISTRIBUTIONS OF PATIENTS BASED ON TIME OF VOMITING.
Time of vomiting Group A Group B Total %
Morning only 10 7 17 42.5
Morning and evening 5 4 9 22.5
Through out the day 5 9 14 35
Total 20 20 40 100
GRAPH NO:16
Group A: In Group A, 10 patients had vomiting in the morning time, 5 patients had vomiting
in morning and night times and 5 patients had vomiting throughout the day.
Group B: In Group B, 7 patients had vomiting in the morning time, 4 patients had vomiting
in morning and night times and 9 patients had vomiting throughout the day.
Among the patients selected for the study, 17 patients (42.5%) were having vomiting more in
the morning time. 9 patients (22.5%) were having vomiting in the morning and night time and
14 patients were having vomiting throughout the day.
0
1
2
3
4
5
6
7
8
9
10
morning only morning and evening throughout the day
10
5 5
7
4
9
Time of vomiting
Group A
Group B
Observations
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 66
TABLE NO: 28 DISTRIBUTIONS OF PATIENTS BASED ON THE CONTENTS OF
VOMITING.
GRAPH NO:17
Group A: In Group A, 11patients had watery type of vomiting and 9 patients had vomiting of
whole food.
Group B: In Group B, 8patients had watery type of vomiting and 12 patients had vomiting of
whole food.
Among the patients selected for the study, 19 patients (47.5%) were having watery type of
vomiting and 21patients (52.5%) were having vomiting of the whole food.
0
2
4
6
8
10
12
Watery Whole food
11
9
8
12
Contents of vomiting
Group A
Group B
Group A Group B Total %
Watery 11 8 19 47.5
Whole food 9 12 21 52.5
20 20 40 100
Observations
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 67
TABLE NO: 29 DISTRIBUTIONS OF PATIENTS BASED ON ASSOCIATED
COMPLAINTS
Signs and Symptoms Group A Group B Total %
Anannabhilasha 11 5 16 40
Dourbalya 19 17 36 90
Bhrama 12 9 21 52.5
Aversion to smell 3 2 5 12.5
Udarashoola 5 0 5 12.5
Malabadhata 0 4 4 10
Sweta pradara 1 0 1 2.5
Kateeshoola 1 0 1 2.5
Deha shoola 1 0 1 2.5
GRAPH NO: 18
0
2
4
6
8
10
12
14
16
18
20
5
17
9
3
0 0 0 0 0
11
19
12
2
5 4
1 1 1
Associated Complaints
Group A
Group B
Observations
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 68
Among 40 patients, 16 (40%) had anannabhilasha, 36(90%) had dourbalya, 21 (52.5%) had
bhrama,5(10%) had aversion to smell, 5(10%) had udarashoola, 3 (7.5%) had malabadhata, 1
patient (2.5%) had sweta pradara,1 patient(2.5%)had kateeshoola and 1 patient (2.5%) had
dehashoola.
Results
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi.. Page 69
RESULTS
FREQUENCY OF VOMITING
TABLE NO: 30
Effect of treatment on frequency of vomiting in group A
TABLENO: 31
Effect of treatment on frequency of vomiting in group B
Mean S.D S.E t value p value Remarks
BT-AT 1.05
0.76 0.17 6.09 <0.001 HS
BT-AT1 1.45
0.83 0.19 7.73 <0.001 HS
Mean SD SE t value p value Remarks
BT-AT 1.10
0.55 0.13 8.8 <0.001 HS
BT-AT1 1.55 0.69 0.16 9.9 <0.001 HS
Results
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi.. Page 70
TABLENO: 32
COMPARATIVE EFFECT IN FREQUENCY OF VOMITING AS
COMPARED BETWEEN GROUPS
Mean
SD
SE
PSE
t value
p value
Remarks
BT
Group A
1.95
0.60
0.14
0.22
0
------
-------
Group B
1.95
0.76
0.17
AT
Group A
0.9
0.72
0.16
0.26
0.19
>0.05
NS
Group B
0.85
0.93
0.21
AT1
Group A
0.5
0.69
0.16
0.235
0.43
>0.05
NS
Group B
0.4
0.75
0.17
Results
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi.. Page 71
GRAPH NO:19
The effect of treatment on patients in Group A is statistically highly significant
with p value <0.001 after treatment and in the follow up respectively.
The effect of treatment on patients in Group B is statistically highly significant
with p value <0.001 after treatment and in the follow up respectively.
Comparing the effect of treatment in between the two groups, it is shown that
the t values in Group A are 6.09 and 7.73 after treatment and in follow up
respectively whereas the t values in Group B are 8.8 and 9.9 after treatment
and in follow up respectively. Since Group B is having a higher t value, Group
B has a better result as compared to Group A, but statistically it is showing a
non-significant result with p value >0.05.
1.95
0.9
0.5
1.95
0.85
0.4
0
0.5
1
1.5
2
2.5
BT AT AT1
FREQUENCY OF VOMITING
GROUP A GROUP B
Results
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi.. Page 72
CONTENTS OF VOMITUS
TABLE NO: 33
Effect of treatment on contents of vomiting on group A
TABLE NO: 34
Effect of treatment on contents of vomiting on group B
Mean
S.D S.E t value p value Remarks
BT-AT 1.3
0.73 0.17 7.81 <0.001 HS
BT-AT1 1.85
0.81 0.18 10.02 <0.001 HS
Mean S.D S.E t value p value Remarks
BT-AT 1.65
0.93 0.21 7.8 <0.001 HS
BT-AT1 2.2
7.8 0.20 10.8 <0.001 HS
Results
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi.. Page 73
TABLE NO: 35
COMPARATIVE EFFECT IN CONTENTS OF VOMITUS AS
COMPARED BETWEEN GROUPS
BT
Mean
SD
SE
PSE
t value
p value
Remarks
BT
Group A
2.3
0.57
0.13
0.214
1.4
>0.05
NS
Group B
2.6
0.75
0.17
AT
Group A
1
0.79
0.18
0.3
0.167
>0.05
NS
Group B
0.95
1.65
0.24
AT1
Group A
0.45
0.69
0.16
0.236
0.212
>0.05
NS
Group B
0.40
0.75
0.17
Results
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi.. Page 74
GRAPH NO:20
The effect of treatment on patients in Group A is statistically highly
significant with p value <0.001 after treatment and in the follow up
respectively.
The effect of treatment on patients in Group B is statistically highly significant
with p value <0.001 after treatment and in the follow up respectively.
Comparing the effect of treatment in between the two groups, it is shown that
the t values in Group A are 7.81 and 10.02 after treatment and in follow up
respectively whereas the t values in Group B are 7.8 and 10.8 after treatment
and in follow up respectively. Since Group B is having a higher t value, the
effect of treatment is better in Group B, but statistically it is showing a non-
significant result.
2.3
1
0.45
2.6
0.95
0.4
0
0.5
1
1.5
2
2.5
3
BT AT AT1
CONTENTS OF VOMITING
GROUP A GROUP B
Results
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi.. Page 75
NAUSEA
TABLE NO: 36
Effect of treatment on nausea on group A
Mean S.D S.E t value p value
Remarks
BT-AT 0.55
0.51 0.12 4.74 <0.001 HS
BT-AT1 0.85
0.49 0.11 7.64 <0.001 HS
TABLE NO: 37
Effect of treatment on nausea in group B
Mean
S.D S.E t value p value Remarks
BT-AT 1.05
0.22 0.05 20.7 <0.001 HS
BT-AT1 1.55
0.51 0.12 13.4 <0.001 HS
Results
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi.. Page 76
TABLE NO: 38
COMPARATIVE EFFECT ON NAUSEA AS COMPARED
BETWEEN GROUPS
BT
Mean
SD
SE
PSE
t value
p value
Remarks
BT
Group A
1.8
0.41
0.09
0.166
0
-----
------
Group B
1.8
0.62
0.14
AT
Group A
1.25
0.55
0.13
0.139
3.571
<0.01
HS
Group B
0.75
0.64
0.15
AT1
Group A
0.95
0.39
0.09
0.135
5.185
<0.001
HS
Group B
0.25
0.44
0.1
Results
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi.. Page 77
GRAPH NO :21
The effect of treatment on patients in Group A is statistically highly significant
with p value <0.001 after treatment and in the follow up respectively.
The effect of treatment on patients in Group B is statistically highly significant
with p value <0.001 after treatment and in follow up respectively.
Comparing the efficacy of treatment in between the two groups, it can be
observed that the t values in Group A are 4.74 and 7.64 after treatment and in
follow up respectively whereas the t values in Group B are 20.7 and 13.4 after
treatment and in follow up respectively. So the higher t values seen in Group B
signify better outcome to treatment in this group. The treatment shows
statistically also highly significant result with p value <0.001.
1.8
1.25
0.95
1.8
0.75
0.44
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
BT AT AT1
NAUSEA
GROUP A GROUP B
Results
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi.. Page 78
SALIVATION.
TABLE NO: 39
Effect of treatment on salivation in group A
TABLE NO: 40
Effect of treatment on salivation in group B
Mean
S.D S.E t value p value Remarks
BT-AT 1.05
0.22 0.05 20.7 <0.001 HS
BT-AT1 1.55
0.51 0.12 13.4 <0.001 HS
Mean
S.D S.E t value p value Remarks
BT-AT
0.55
0.51
0.12
4.74
<0.001
HS
BT-AT1
0.9
0.55
0.13
7.17
<0.001
HS
Results
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi.. Page 79
TABLE NO: 41
COMPARATIVE EFFECT ON SALIVATION AS
COMPARED BETWEEN GROUPS
BT
Mean
SD
SE
PSE
t value
p value
Remarks
BT
Group A
1.8
0.41
0.09
1.48
0
-------
---------- Group B
1.8
0.62
0.14
AT
Group A
1.25
0.55
0.13
0.139
3.571
<0.001
HS
Group B
0.75
0.64
0.15
AT1
Group A
0.9
0.05
0.1
0.141
4.60
<0.001
HS
Group B
0.25
0.44
0.10
Results
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi.. Page 80
GRAPH NO:22
The effect of treatment on patients in Group A is statistically highly significant
with p value <0.001 after treatment and in the follow up respectively.
The effect of treatment on patients in Group B is statistically highly significant
with p value of <0.001 after treatment and in follow up respectively.
Comparing the efficacy of treatment in between the two groups, it can be
observed that the t values in Group A are 4.74 and 7.17 after treatment and in
follow up respectively whereas the t values in Group B are 20.7 and 13.4 after
treatment and in follow up respectively. So the higher t values seen in Group B
signify better outcome to treatment in this group. The treatment shows
statistically highly significant result with p value <0.001.
1.8
1.25
0.9
1.8
0.75
0.25
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
BT AT AT1
SALIVATION
GROUP A GROUP B
Results
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi.. Page 81
IMPROVEMENT IN WEIGHT
TABLE NO: 42
Effect of treatment on improvement in weight on group A
Mean S.D S.E t value p value Remarks
BT-AT
0.025
0.50
0.11
0.22
>0.05
NS
BT-AT1
0.475
0.88
0.20
2.37
<0.05
SS
TABLE NO: 43
Effect of treatment on improvement in weight in group B
Mean S.D S.E t value p value Remarks
BT-AT
0.25
0.44
0.10
2.5
<0.05
S
BT-AT1
0.60
0.50
0.11
5.3
<0.001
HS
Results
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi.. Page 82
TABLENO: 44
COMPARATIVE EFFECT IN INCREASE IN WEIGHT AS
COMPARED BETWEEN GROUPS
BT Mean SD SE PSE t value p value Remarks
BT Group A
49.9
8.05
1.83
3.05
2.23
<0.05
SS
Group B
57
10.75
2.44
AT Group A 49.93
8.09 1.84
3.09
2.27
<0.05
SS
Group B
56.95
10.93
2.48
AT1 Group A
50.38
8.18
1.86
3.08
2.25
<0.05
SS
Group B
57.3
10.77
2.45
Results
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi.. Page 83
GRAPH NO: 23
The effect of treatment on patients in Group A is statistically non-significant
with p value >0.05 after treatment and is statistically significant with p value
<0.05 in the follow up respectively
The effect of treatment on patients in Group B is statistically significant with p
value<0.05 and statistically very highly significant with p value <0.001 in
follow up respectively.
Comparing the efficacy of treatment in between the two groups, it can be
observed that the t values in Group A are 0.22 and 2.37 after treatment and in
follow up respectively whereas the t values in Group B are 2.5 and 5.3 after
treatment and in follow up respectively. So the higher t values seen in Group B
signify better outcome to treatment in this group. The treatment shows
statistically significant result with p value <0.05.
49.9 49.93 50.38
57 56.95 57.3
0
10
20
30
40
50
60
BT AT AT1
IMPROVEMENT IN WEIGHT
GROUP A GROUP B
Results
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi.. Page 84
INCREASE IN Hb%
TABLE NO: 45
Effect of treatment on improvement in Hb% in group A
Mean S.D S.E t value p value Remarks
BT-AT 0
0 0 0 ------ -------
BT-AT1 0.04
0.13 0.03 1.14 >0.05 NS
TABLE NO: 46
Effect of treatment on improvement in Hb% in group B
Mean S.D S.E t value p value Remarks
BT-AT 0.03
0.08 0.02 1.4 >0.05 NS
BT-AT1 0.10
0.22 0.05 2 <0.05 SS
Results
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi.. Page 85
TABLE NO: 47
COMPARATIVE EFFECT IN INCREASE IN Hb% AS
COMPARED BETWEEN GROUPS BT Mean Std
Dev
Std
Error
PSE t value p value Remarks
BT
Group A
9.97
0.56
1.3
2.9
0.131
>0.05
NS
Group B
9.59
1.16
2.6
AT
Group A
9.965
0.56
0.13
0.29
0.948
>0.05
NS
Group B
9.61
1.15
0.26
AT1
Group A
10
0.58
0.13
0.29
1.07
>0.05
NS
Group B
9.69
1.13
0.26
Results
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi.. Page 86
GRAPH NO: 24
The effect of treatment on patients in Group A after treatment cannot be
elicited and it is statistically non-significant with p value >0.05 in the follow
up treatment.
The effect of treatment on patients in Group B is statistically non- significant
with p value >0.05 after treatment and statistically significant with p value
<0.05 in the follow up respectively.
Comparing the efficacy of treatment in between the two groups, it can be
observed that the t values in Group A are 0 and 1.14 after treatment and in
follow up respectively whereas the t values in Group B are 1.4 and 2 after
treatment and in follow up respectively. So the higher t values seen in Group B
signify better outcome to treatment in this group. But the treatment shows
statistically non-significant result with p value >0.05.
9.97 9.97 10 9.59 9.61 9.69
0
2
4
6
8
10
12
BT AT AT1
IMPROVEMENT IN Hb%
GROUP A GROUP B
Discussion
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi . Page 87
DISCUSSION
Discussion is considered to be the heart of any clinical study. The purpose of discussion is to
state our interpretations and opinion and explain the implication of our findings. It is
important for the proper understanding of the disease and its probable causes, mechanism of
the action of drugs and the treatments. With the help of discussion on various aspects of the
disease together with the statistical calculations, a clear conclusion for the study can be
achieved.
Discussion can be done under the following headings.
1) Discussion on selection of Disease.
2) Discussion on Disease Review.
3) Discussion on Selected drugs.
4) Discussion on probable Mode of action of drugs.
5) Discussion on Observations and Results.
1) DISCUSSION ON SELECTION OF THE DISEASE.
Many physiological and psychological changes occur in the life of a woman from menarche
to menopause. The physiological changes occurring in pregnancy is unique because it helps
in the creation of a new life. The changes are body’s own adaptation for an environment
needed for the growing baby. 50% of the women suffer from emesis gravidarum.
There is rapid cell division in embryo and formation of vital organs takes place in the first
trimester. Nutritional deficiencies can interfere with the proper development of the foetus. So
prevention of emesis gravidarum is important for the normal development of all the vital
organs.
It is a known fact that pregnancy is most of the time associated with vomiting but the quality
of the life of a woman is hampered. These can also lead to Hyperemesis gravidarum during
pregnancy if not treated. Hence emesis gravidarum should be treated, to improve the quality
of the day to day life of a woman.
2) DISCUSSION ON DISEASE REVIEW
Chardi is one of the vyakta garbha lakshanas mentioned by all the acharyas. Acharya Hareeta
has mentioned chardi as one of the ashta upadravas. As chardi is described as an upadrava, it
clearly emphasises the importance of treating the chardi in garbhini. The vyakta garbha
Discussion
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi . Page 88
lakshana told by Acharyas can be probably correlated as Emesis Gravidarum and the
upadrava told by Acharya Hareeta can be considered as Hyperemesis Gravidarum.
Emesis gravidarum is due to the physiological changes in pregnancy like relaxation of cardiac
sphincter and decreased peristalsis leading to stasis of food. These changes are happening due
to the increased secretion of the hormone progesterone. It is needed for the relaxation of
uterine muscles so that the foreign paternal genes are accepted and does not lead to first
trimester abortions. The same effect of relaxation of smooth muscles over the gastro intestinal
tract leads to emesis gravidarum in first trimester. So the treatment should be given in
improving the intestinal motility thereby improving the nausea and vomiting of pregnancy.
According to classics, the role of panchamahabhoota is told as “vayur vibhajati.108
” Vata is
helping in the normal organogenesis of the embryo.109
Normalcy of vata is important in the
first trimester of pregnancy to prevent defective organogenesis and abortions. Vatavaigunya is
one of the reasons for Garbhini Chardi. So Garbhini Chardi should be treated with deepana
and pachana drugs which can regularise vata vaigunya and thereby regularising the normal
peristalsis.
Discussion on nidana.
Acharyas have mentioned nidanas for Garbhini Chardi as Apanna satwa ,Dauhrida Avamana
and Vata Vaigunya.
Apanna Satwa.
Acharya Sushruta has considered apanna satwa as one of the nidana of chardi.110
In the
NibandhaSamgraha teeka,Acharya Dalhana mentions “Apanna satwa” as Garbhini.111
So
garbhini can be considered as with changing psychological status. This can be correlated to
psychological causes of vomiting. This can be considered as to seek attention from other
family members.
The garbha can cause peedana to the mother which may be the reason for vata prakopa.
According to modern science, pregnancy is considered as an immune suppressed condition
where in the pregnancy specific proteins suppresses the immune system so that the paternal
genes are not expelled out by the body of the mother.112
Further, progesterone together with
hCG and desidual cortisol inhibits T-lymphocyte mediated tissue rejection and protects the
conceptus.113
Due to action of progesterone, there is relaxation of the smooth muscles. This
leads to the relaxation of cardiac sphincter and delayed emptying of gastric contents leading
to emesis gravidarum in the first trimester of pregnancy.114
Discussion
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Dauhrida Avamana.
During the Garbha avastha, the lady may develop desire for certain foods. These desires can
be considerd as the ways to achieve the needs of the body. Amlakamata is one of the vyakta
garbha lakshana.115
It can be considered as Rakta kshaya lakshana also116
. Amla rasa is
necessary for the proper assimilation of the iron by which the rakta kshaya can be
compensated. Pregnant woman may also develop desire for chalk, mud etc. These can be due
to Calcium deficiency which has to be corrected for the proper development of the foetus. If
the desires are not fulfilled, it can lead to manasika peeda which can cause vata vrudhi. The
vata vrudhi can lead to chardi.
Acharya Vagbhata 117
and Acharya Charaka have told about the development of sarva indriya
and chetasi at the 3rd
month. They also explained that by 3rd
month the hrudaya of mother will
be attached to the hrudaya of baby by the rasavahini nadi and the lady is considered as
dauhridini.118
In Indu teeka it is also mentioned that other Acharyas have consider mother as
dauhridini from any time from 45 days of conception to the 4th
month.119
From this, it can be
considered that the mother can develop dauhrida any time from 45 days to the 4th
month of
pregnancy. So dauhrida avamana at any time during this period can lead to the vatavrudhi
causing chardi. The desires expressed by the mother are the desires of the foetus. If it is not
fulfilled it can lead to the defective organogenesis leading to the vairoopya or vinasha of
garbha.120
According to modern science also, foetal heart develops at the 5th
week and from that time
the desires of the mother may be according to the needs of the baby. It should be satisfied
without causing harm to the foetus.
Vata-Vaigunya.
The vata-vaigunya can be attributed to ahara, vihara and vichara of garbhini. Katu and
rooksha ahara can cause vataprakopa.121
Improper garbhini paricharya also can lead to vata
vrudhi.Viharas like nishajagarana and vegadharana can cause vata prakopa122
. In
vichara,Udwega which is told as a nidana for chardi123
can cause vata prakopa.
According to modern parlance, it may be probably correlated that carbohydrate starvation can
lead to vomiting in pregnancy as it happens after a night without food124
. It is also told that
spicy and fatty foods can increase nausea and vomiting in pregnancy.125
Psychogenic causes
also play a major role in emesis gravidarum.126
It is evident from the fact that emesis
Discussion
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gravidarum gets subsided after shifting the patient from the home surroundings. Anxiety also
plays a role in vomiting as it is more in primi gravida and also in unplanned pregnancies.127
Discussion on purva roopa
Poorva roopa includes Hrullasa, Annadwesha and Praseka. Hrullasa, Praseka and
Annadwesha can be considered as rasavrudhi lakshanas. This may be due to
rasadhatwagnimandya leading to rakta dhatu kshaya which is seen in garbhini avastha. These
can be further understood as ama lakshanas due to the dourbalya of jatharagni.
Discussion on Roopa.
The lakshanas of chardi based on dosha predominance are as follows:
Vata Dosha Predominant
If vata is the predominant dosha the chardi will be alpa with forceful vegas. It is tanu, krushna
and with kashaya rasa. In this study, many of the patients were having watery and less
quantity of vomitus which may be correlated to predominance of vata dosha.
Pitta Dosha Predominant
In chardi, if pitta is the predominant dosha, it is peeta, tikta and associated with daha and
bhrama. In this study, some of the patients were having bhrama and watery vomiting which
was yellow in colour and this may be correlated to the predominance of pitta dosha.
Kapha Dosha Predominant
If kapha is predominant, chardi is with romaharsha and asya madhurya and associated with
shareera gaurava. In this study, many patients had vomiting of the whole food and this may be
correlated to agnimandya and the predominance of kapha dosha.
Discussion on Samprapti
During pregnancy, sudden physiological changes happen in the body of mother. These sudden
physiological changes will lead to kapha dushti in amashaya causing agnimandya. The
agnimandya will lead to pittavikruti and causing amasanchaya. Later,improper garbhini
paricharya and indulgence in garbhopakhatakara bhavas will lead to the dushti of samana
vata and apanavata. This avarodha of vata causes kshobha to amashaya. Garbha peedana also
will lead to vyana vataprakopa. By the action of prakupita vata the utkishta doshas are
expelled out through the mouth resulting in chardi.
Discussion
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FLOW CHART NO: 4 INVOLVEMENT OF DOSHA DUSHTI IN GARBHINI
CHARDI
Kapha dushti
Agnimandya
Pitta dushti (Improper garbhini paricharya+Garbha peedana+
Indulgence in garbhopakhatakara bhavas)
Vata prakopa
Mukha poorana resulting in chardi
This can be explained in correlation to the contemporary science. During pregnancy, excess of
progesterone will lead to relaxation of the cardiac sphincter and simultaneous retention of
gastric fluids due to impaired motility. This can lead to kapha dushti. There is diminished
gastric secretion and delayed emptying time of the stomach which may cause pitta and vata
dushti. Further dietary causes and psychogenic causes can lead to vata prakopa. Relaxation of
cardiac sphincter together with delayed emptying of gastric contents, together with other
reasons like psychological, dietetic causes and immunosuppressed state of mother will result
in the nausea and vomiting of pregnancy.
Retention of food and gastric fluids due to impaired motility and leading to vomiting can be
probably correlated to the rasasesha ajeerna. This also implies the importance of pachana in
the treatment of Garbhini Chardi.
3) DISCUSSION ON SELECTED DRUGS
The drugs selected for the present study were Eladi Gutika and Matulunga Avaleha. The
ingredients of Eladi Gutika are Ela, Patra, Twak, Pippali, Madhuka, Kharjura, Mridvika, Sita
Discussion
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and Madhu. Ela, Patra and Twak are katu madhura in rasa, Madhuka,Kharjura ,Sita ,Madhu
and Mridvika are madhura rasa, and pippali is katu rasa. The ingredients of Matulunga
Avaleha are Matulunga, Kola, Laaja, Dadima, Sarkara, Daruharidra and Kshoudra.
Matulunga,Kola, Dadima are Madhura Amla in rasa, Laja and Sarkara are madhura in rasa.
4) DISCUSSION ON PROBABLE MODE OF ACTION OF DRUGS.
TABLE NO: 48
PHARMACODYNAMICS OF INGREDIENTS OF ELADI GUTIKA
Rasa Guna Veerya Vipaka Karma
Ela Katu
Madhura
Laghu Rooksha Seeta Katu Kapha
vata hara
Patra Madhura
Katu
Laghu Ushna Katu Kapha
vata hara
Twak Katu
Tikta
Madhura
Laghu Rooksha Ushna Katu Kapha
vata hara
Pippali Katu Laghu Snigdha Ushna Katu Vata
kapha
hara
Madhuka Madhura,
Kashaya
Snigdha,Guru Seeta Madhura Vata
hara
Kharjoora Madhura,
Kashaya
Snigdha,Guru Seeta Madhura Vatapitta
hara
Mridvika Madhura Snigdha,Guru Seeta Madhura Vatapitta
hara
Most of the drugs are having katu as pradhana rasa and madhura as anurasa. The drugs
possessing katu rasa have laghu rooksha guna, ushna veerya and katu vipaka. Due to ushna
veerya and katu vipaka, it is vatapitta hara. The Katu rasa helps in the deepana and pachana of
ahara128
which causes proper digestion as agnimandya is a one reason for chardi in Garbhini.
Madhura rasa is preenana and vatashamaka129
and the medicines for garbhini should be
palatable to have better effect. In Indu commentary ,preenena is told as tushtikara. Most of the
Discussion
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important drugs like ela,patra and twak are kapha vata hara and chardi nigrahana in action..
Drugs like twak, patra and ela are aromatic drugs. Medicines for garbhini will be better
palatable because of the use of these aromatic drugs. By these actions, eladi gutika helps in
reducing chardi.
TABLE NO: 49
PHARMACODYNAMICS OF INGREDIENTS OF MATULUNGA AVALEHA
Most of the drugs are hrudya and belong to chardi nigrahana gana which directly implies that
these medicines will help in reducing the chardi. Matulunga,kola and dadima are amla in rasa
and madhura in anurasa. Amla rasa helps in deepana, pachana, and rochana of ahara. It is also
vatashamana and vatanulomana in nature.130
Deepana and pachana property helps in reducing
agnimandya and imparting ruchi to ahara. Kashaya rasa helps in the kleda soshana 131
and
tiktha rasa helps in kandha vishodhana132
thereby helps to reduce hrullasa and praseka. The
amla dravyas are liked in pregnancy as “Amleshtata” is told as a vyakta garbha lakshana. The
drugs like laaja,sarkara which are vatashamaka help in reducing chardi.
Ingredients Rasa Guna Veerya Vipaka Karma Gana
Matulunga Amla Laghu
Snigdha
Ushna Amla Vata
Kapha
hara
Chardi
Nigrahana
Kola Madhura,
Amla
Guru
Snigdha
Seeta Madhura,
Amla
Vata
pittahara
Chardi
Nigrahana
Laaja Madhura,
Kashaya
Laghu Seeta Madhura Vata
pittahara
Chardi
Nigrahana
Daru
haridra
Tikta
,Kashaya
Laghu Ushna Katu Kapha
pittahara
Haridradi
Dadima Madhura,
Amla
Laghu
Snigdha
Ushna Madhura,
Amla
Tridosha
hara
Chardi
Nigrahana
Sarkara Madhura Guru Seeta Madhura Vata hara Ikshu
varga
Madhu Madhura
,Kashaya
Laghu Seeta Katu Tridosha
hara
Madhu
varga
Discussion
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The “Amleshtata” can be considered as a rakta kshaya lakshana which is seen in
garbhavastha. This also implies the presence of rasa dhatwagnimandya in this stage. The
medicines can help in the deepana and pachana, thereby helps to correct the rasa dhatu. Rasa
dhatu is helping the mother in three ways –for the proper nourishment of garbha, nourishment
of garbhini and also for the utpatti of stanya.133
According to Contemporary science, Anaemia is a common sign in pregnancy. It is due to the
haemodilution because of the increase level of plasma which is a physiological change
happening in pregnancy. The drugs of Matulunga avaleha helps to correct the agni by
correcting the jarana shakti and increase in abhyavaharana shakti can help in correcting dhatu
kshaya. The drugs of Matulunga avaleha like dadima are rich source of iron which can help in
correcting the anaemia. Madhura rasa dravyas are dhatu vardhaka which may also helps for
the same. The brumhana guna may help in the proper development of the foetus and also
helps to improve the health of the mother. Even though there will be a slight decrease in the
weight of the mother in the first trimester, in the present study there was an increase in weight
of the mother. This may be due to the brumhana guna of the drugs in the Matulunga avaleha.
TABLE NO:50
MODE OF ACTION OF DRUGS ACCORDING TO CHEMICAL CONSTITUENTS.
Piperine134
Pippali Stimulate digestive
enzymes.
Increases digestion.
Tannin135
Daruharidra,
Dadima
Astringent Decreases salivation
Limonene136
Matulunga Flavouring agent.Relieve
gastro-oesophageal reflux
disease.
Improves taste.
Decreases heart burn
Eugenol,
Cinnamyl
aldehyde,
Catechine
Twak,Patra,Ela Aromatic Improves taste
and digestion,
Ela, Patra, Twak improves digestion and helps to combat nausea. Ela is digestive and
stomachic. Ela is a good supply of minerals like potassium. The balancing of electrolytes may
also helps to reduce vomiting. They have chemical constituents like eugenol, cinnamyl
Discussion
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aldehyde, catechine which are aromatic in nature and palatable to pregnant woman and there
by reduces vomiting. Kharjoora help in improving bowel movements and is good for
digestive system. It is also a rich supplier of iron. Piperine which is present in pippali
stimulates the digestive enzymes and increases the digestive capacity.
Matulunga contains limonene which is used to relieve gastro oesophageal reflux diseases and
heart burn. It is used as a flavouring agent to mask the bitter taste of alkaloids. Hence, it may
help in flavouring the avaleha and may probably mask the tikta rasa of rasanjana. The
astringent property of rasanjana controls the secretion of mucous and thereby reduces
salivation. Dadima helps to prevent smooth muscle dysfunction and helps in curing digestive
problems. Dadima extract supplies iron to blood and helps to prevent anaemic symptoms.
5) DISCUSSION ON OBSERVATIONS AND RESULTS.
DISCUSSION ON OBSERVATIONS
Age
In the study, majority of the patients ( 45% ) were in age group 23-27 years and 40% patients
were from age group 18-22 years and only 15% patients were from age group 27 -32 years.
This correlates with the view that young girls are more suffering with emesis gravidarum. It
may be probably due to the increased anxiety which is more in young age leading to nausea
and vomiting in pregnancy. (This correlates to the findings of Klebanoff MA, Koslowe PA,
Kaslow R, et al 1985)137
Religion
Among the 40 patients, 70% were Muslims and the rest belongs to the Hindu religion. It may
be because of the dominance of the Muslim population in and around the institution.
Occupation
Majority of the women (87.5%) in the study were home makers. There was a smaller
percentage of 12.5% of women who were employed. Research works have shown that
homemakers are most prone to vomiting in pregnancy. There was a similar finding in this
study also. This can be probably correlated to the environmental changes of a working woman
because if the change in environment happens, it can decrease emesis gravidarum.
Discussion
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Education
Majority of the women were having primary education (32.5%) and secondary education
(37.5%). This can be probably due the marriage of girls at a younger age in the particular, by
which they don’t have proper awareness about pregnancy and associated changes in the body.
This also correlates with the other studies that women with lesser education are prone to
pregnancy induced vomiting. (This correlates to the findings of Klebanoff MA, Koslowe PA,
Kaslow R, et al 1985)138
Socio-economic status
In the study, majority of the people (70%) were from middle class. This shows that the area
around the institution have more population belonging to the middle class. It may also be
considered that the women of this economic status may be deprived of proper nutrition which
can be a reason for pregnancy induced vomiting.
Parity
A larger percentage of the women (57.5%) were primigravida in the study. It is seen that
primigravidas are more prone to pregnancy induced vomiting or Emesis gravidarum. This can
be probably due to the psychological factor as pregnancy is first experience for her and
anxiety may lead to emesis gravidarum. According to classics also, udwega is told as a reason
for chardi. (This correlates to the findings of Klebanoff MA, Koslowe PA, Kaslow R, et al
1985)139
Dietary habits
Most of the pregnant women (70%) in the study were having a mixed diet. Carbohydrate
starvation is a reason for Emesis Gravidarum and intake of carbohydrate rich diet is advised
as a treatment. The intake of more of fatty foods can probably be a reason for increased
vomiting in these patients. (This correlates to the findings of Klebanoff MA, Koslowe PA,
Kaslow R, et al 1985,)140
Appetite
Majority of the patients (80%) in the study were having decreased appetite which clearly
shows agnimandya is found in pregnant women in their first trimester. Hence the treatment
should be deepana and pachana which can reduce agnimandya and reduce vomiting. It is also
Discussion
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explained that excess of the hormone progesterone will lead to relaxation of cardiac sphincter
and simultaneous retention of gastric fluids due to impaired motility. This may be leading to
decrease in appetite.
Predominant rasa consumed.
In the study, a large group (67.5%) were in the habit of consuming more of Amla Katu rasa
ahara. This correlates with the classical reference of “amleshtata” as a vyakta garbha
lakshana. Even the intake of more of amla katu ahara can cause pitta and vata dushti leading
to increased vomiting. Even contemporary science explains that spicy foods can increase
emesis gravidarum.
Prakruti
Most of the women (65%) in the study were of vata kapha prakruti. It can be considered that
vata kapha predominant prakruti people will be suffering more with Garbhini Chardi. It may
be because of the reason that in vata kapha prakruti, there is increased chance of agnimandya.
It may also correlated like vata kapha prakruti people can have increased incidence of
vomiting of whole food and the agnimandya can happen more in kapha predominant prakruti.
It may also be considered that the watery type of vomiting was more in vatapitta predominant
persons and the colour of vomitus was peeta which shows the involvement of pitta.
Bowel habits.
Majority of the patients (90%) were having a regular bowel habit. Even though the women
were of vata predominant prakruti, the regular bowel habits can be attributed to the increased
liquid and fruit diet followed by them in their first trimester.
DISCUSSION ON THE COMPLAINTS.
Duration of vomiting
A larger group of patients (72.5%) were having vomiting for a period of 0-15 days. This can
be discussed like that the patients approach the doctors even at early stages of the vomiting.
This emphasises that the women are worried if the vomiting may cause harm or even growth
retardation for their babies. So they will be following the proper ante natal care even from the
first trimester of pregnancy.
Discussion
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Time of vomiting
Most of the women (42.5%) in the study were having vomiting in the morning hours. Emesis
Gravidarum is also referred to as Morning sickness. It may be because of the low
carbohydrate reserve after a night starvation without food. According to our classics, it can be
considered as chardi occurring more in Kapha kala as we have a classical reference for the
same.
Contents of vomitus
There were an almost equal percentage of the patients regarding the contents of the vomitus.
While52.5% of women were vomiting the whole food, 47.5% of women were having a watery
type of vomiting. The vomiting of whole food may be probably due to the hampered agni
which was seen in majority of the patients. The watery type of vomiting may be suffered by
the patients who did not have much of the agnimandya. It may also be correlated as that the
vata kapha prakruti persons were having more of the vomiting of the whole food. The vata
pitta prakruti persons were having more of watery type of vomiting.
DISCUSSION ON RESULTS.
Frequency of vomiting
Effect of treatment in frequency of vomiting in Group A: The effect of treatment in
Group A was statistically highly significant with p value <0.001after treatment and in the
follow up respectively. As drugs of eladi gutika are deepaka,pachaka and ruchya, and have
the property of vatashamaka, it helped in reducing the chardi vega. The main ingredient of
Eladi gutika, Ela belongs to Chardi nigrahana gana. The drug contain constituents like
piperine have digestive property which helps to reduce agnimandya and thus reduce vomiting.
Effect of treatment in frequency of vomiting in Group B: The effect of treatment in
Group B also was highly significant with p value <0.001after treatment and in the follow up
treatment respectively. The ingredients of matulunga avaleha also are deepaka,pachaka and
ruchya, and have the property of vatashamaka thus helped in reducing the chardi vega. Some
of the drugs like kola,laja,ela belongs to chardinigrahana gana. The constituent limonene
helps to relieve gastro oesophageal reflux and reduces vomiting. Moreover, dadima and
khajoor helps in digestive problems.
Discussion
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Comparison between the groups: The comparison between the groups showed statistically
non-significant result with p value>0.05 which means that both the groups were having highly
significant result and there was no marked difference in the frequency of vomiting in between
the groups.
Contents of vomitus
Effect of treatment in contents of vomitus in Group A: The effect of treatment in
Group A was statistically highly significant with p value <0.001 after treatment and in the
follow up respectively. The effect of the treatment on the contents of vomitus may be
probably due to the deepana and pachana effect of the drugs which may be helping to reduce
the agnimandya. Piperine present in the helps to stimulate digestive enzymes and thus reduces
agnimandya.
Effect of treatment in contents of vomitus in Group B: The effect of treatment in
Group B was statistically highly significant with p value <0.001 after treatment and in the
follow up respectively. The effect of treatment may be due to deepana and pachana properties
of matulunaga avaleha and eladi gutika.
Comparison between the groups: The comparison between the groups showed statistically
non-significant result with p value>0.05 which means that both the groups were having highly
significant result and there was no marked difference in the contents of vomitus in between
the groups.
Nausea
Effect of treatment in nausea in Group A: The effect of treatment in Group A was
statistically highly significant with p value <0.001 after treatment and in the follow up
respectively. The drugs of eladi gutika are hrudya and vatanulomana which is helping in
reducing the nausea.
Effect of treatment in nausea in Group B: The effect of treatment in Group B was
statistically highly significant with p value <0.001 after treatment and in the follow up
respectively. The drugs of matulunga avaleha are also hrudya and vatanulomana which is
helping in reducing the nausea.
Comparison between the groups: The comparison between the groups also showed
statistically highly significant result with p value<0.001 by which can conclude that group B
were having a more significant result in reducing nausea.The drugs of both eladi gutika and
Discussion
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matulunga avaleha are hrudya and vatanulomana which is helping in reducing the nausea.
Even though both groups are giving highly significant result, Group B showed statistically
significant result on comparison. The drugs in matulunga avaleha is mostly from the phala
vargas and amla rasa is more hrudya and vatanulomana, thus giving a better result in Group
B. More over the property of avaleha is lehana which also brings down the nausea. According
to classics the bheshaja kala in chardi is muhurmuhu and when the avaleha was given in
divided doses it gave better result in nausea and vomiting.
The contents like limonene, P-cymene,eugenol cinnamyl aldehyde are natural aromatic
compounds and helps to reduce vomiting. Moreover the astringent property of the drugs helps
to reduce the secretion of the mucous and thus reduce nausea as hrullasa is defined as
“Tuthkaranam hrullasam”
Salivation
Effect of treatment in salivation in Group A: The effect of treatment in Group A was
statistically highly significant with p value <0.001 after treatment and in the follow up
respectively. The drugs of eladi gutika are hrudya and vatanulomana which is helping in
reducing the salivation.
Effect of treatment in salivation in Group B: The effect of treatment in Group B was
statistically highly significant with p value <0.001 after treatment and in the follow up
respectively. The drugs of matulunga avaleha are also hrudya and vatanulomana which is
helping in reducing the salivation.
Comparison between the groups: The comparison between the groups also showed
statistically highly significant result with p value<0.001 by which can conclude that group B
were having a more significant result in reducing salivation.The drugs of both eladi gutika
and matulunga avaleha are hrudya and vatanulomana which is helping in reducing the nausea.
Some of the drugs in matulunga avaleha are of kashaya rasa and kashaya rasa helps in the
kleda soshana which would have helped to reduce the excessive salivation. The rasayana also
have tikta rasa drug which may help in the asya sodhana which may also reduce the
salivation. The astringent property of berberine helps in reducing the secretion of mucous and
thus reduces salivation.
Improvement in weight
Discussion
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Effect of treatment in improvement in weight in Group A: The effect of treatment in
Group A was statistically non- significant with p value >0.05 after treatment and statistically
significant with p value <0.05 in the follow up respectively. The drugs of eladi gutika like
Kharjoora,mridvika are hrudya, balya and brumhana. So it may helped in the mild increase in
the weight of the patient.
Effect of treatment in improvement in weight in Group B: The effect of treatment in
Group B was statistically significant with p value <0.05 after treatment and statistically highly
significant with p value <0.001 in the follow up respectively. The drugs of matulunga avaleha
are hrudya, balya and brumhana which helped in increase in weight of the patients.
Comparison between the groups: The comparison between the groups also showed
statistically significant result with p value<0.05 after treatment and in follow up by which can
conclude that group B were having a more significant result in increasing the weight. The
drugs of matulunga avaleha and eladi gutika are hrudya, balya and brumhana. So it can help
in the increase in the weight of the patient. Since the avaleha is more hrudya, it helps in
reducing the salivation and nausea as it is evident from the statistical results. This can
probably help in proper intake of food by the patients and thereby increase in the body weight.
Matulunga avaleha also contains ghruta and madhu. Most of the avalehas have the action of
rasayana also. By these gunas the avaleha probably helped to increase the weight of patients
in Group B.
Improvement in Hb%
Effect of treatment in improvement in Hb% in Group A: The effect of treatment in Group
A was statistically non- significant with p value >0.05.
Effect of treatment in improvement in weight in Group B: The effect of treatment in
Group B was statistically non-significant with p value >0.05 after treatment and statistically
significant with p value <0.05 in the follow up respectively.
Comparison between the groups: The comparison between the groups also showed
statistically non-significant result with p value >0.05 after treatment and in follow up by
which can conclude that none of the groups were having an effect on the increase in Hb%.
The drugs of matulunga avaleha have drugs like dadima which is a rich supplier of iron and
helps to decrease anaemic symptoms and help in increasing the Hb%. But the formation of
RBC takes 4 days and the medicine was given only for a short duration which may not be
sufficient to have an increase in Hb%. Even though the t value shows significant result in
Discussion
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi . Page 102
increasing the Hb% in Group B in the follow up treatment, the result is statistically non-
significant. So the study has to be done in a larger sample and also for a longer duration to
draw a proper conclusion regarding the effect of the drugs in the increase of Hb%. Also we
can supplement some panduhara drugs which is not contraindicated in pregnancy for the
improvement in Hb%.
OVERALL EFFECT OF THERAPY
At the end of the trial, all 20 patients in Group A and Group B showed marked response in all
subjective parameters. Group B showed a better result in parameters like nausea and
salivation. In objective parameters like increase in weight also, the Group B showed a better
result over group A. There was no significant result in increase in Hb% in both Groups.
Overall improvement was more in Group B as compared to Group A.
Discussion
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi . Page 103
108 Sushruta, Sushruta Samhita, Nibandhasangraha Commentary of Sri
DalhanaAcharya,editedbyVaidya Yadavji Trikamji Acharya, Choukhamba Surabharati
Prakashan Varanasi,reprint 2010,Shareera sthana 5th Chapter,Verse 3, pp-824, pg-363.
109 Vruddha Jeevaka, Revised Vatsya Kashyapa samhita with Vidyotini hindi commentary by
Ayurvedalankara SriSatyapala Bhishagachayara, Chaukhamba press Varanasi, reprint –
1998,Shareera sthana 3rd
Chapter, Verse 4, pp-364, pg -73.
110 Sushruta, Sushruta Samhita, Nibandhasangraha Commentary of Sri
DalhanaAcharya,editedbyVaidya Yadavji Trikamji Acharya, Choukhamba Surabharati
Prakashan Varanasi,reprint 2010,Uttara tantra 49th
Chapter,Verse 3-5, pp-824, pg-754
111 Sushruta, SushrutaSamhita, Nibandhasangraha Commentary of Sri DalhanaAcharya,edited
byVaidya Yadavj Trikamji Acharya, Choukhamba Surabharati Prakashan Varanasi,reprint
2010, Uttara tantra 49th
Chapter,Verse 3-5 Dalhana acharya teeka, pp-824, pg-754.
112
D.C.Dutta-Text Book of Obstetrics edited by Hiralal Konar 6th
edition 2004, New Central book
Agency (p) Ltd. London, pp- 666, pg -61.
113
D.C.Dutta-Text Book of Obstetrics edited by Hiralal Konar 6th
edition 2004, New Central book
Agency (p) Ltd. London, pp- 666, pg -61.
Discussion
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi . Page 104
114
D.C.Dutta-Text Book of Obstetrics edited by Hiralal Konar 6th
edition 2004, New Central book
Agency (p) Ltd. London, pp- 666, pg -56.
115 Vagbhata, Astanga Hrudaya, SarvangaSundara Commentary of Arunadatta and Ayurveda
Rasayana Commentary of Hemadri, edited by; Pandit Hari Sadasiva Sastri Paradakara
Bhisagacharya, Chaukhamba Surbharati Prakashan, Varanasi, reprint-2010, Shareera sthana
1st
Chapter, Verse-50-51, pp- 956, pg -370.
116 Vruddha Vagbhata, Astanga samgraha, Sashilekha commentary of Indu, Edited by
Shivprasad Sharma,Chowkhanba Sanskrit Series Office, Varanasi,reprint 2008, Sutra sthana
19th Chapter,Verse 9, pp-965, pg-150.
117 Vruddha Vagbhata, Astanga samgraha, Sashilekha commentary of Indu, Edited by
Shivprasad Sharma,Chowkhanba Sanskrit Series Office, Varanasi,reprint 2008, Shareera
sthana 2nd
Chapter,Verse 15 teeka, pp-965, pg-278.
118 Vruddha Vagbhata, Astanga samgraha, Sashilekha commentary of Indu, Edited by
Shivprasad Sharma,Chowkhanba Sanskrit Series Office, Varanasi,reprint 2008, Shareera
sthana 2nd
Chapter,Verse 16, pp-965, pg-278.
119 Vruddha Vagbhata, Astanga samgraha, Sashilekha commentary of Indu, Edited by
Shivprasad Sharma,Chowkhanba Sanskrit Series Office, Varanasi,reprint 2008, Shareera
sthana 2nd
Chapter,Verse 17 teeka, pp-965, pg-278.
120 Vruddha Vagbhata, Astanga samgraha, Sashilekha commentary of Indu, Edited by
Shivprasad Sharma,Chowkhanba Sanskrit Series Office, Varanasi,reprint 2008, Shareera
sthana 2nd
Chapter,Verse 19, pp-965, pg-278.
121Vagbhata, Astanga Hrudaya, SarvangaSundara Commentary of Arunadatta and Ayurveda
Rasayana Commentary of Hemadri, edited by; Pandit Hari Sadasiva Sastri Paradakara
Bhisagacharya, Chaukhamba Surbharati Prakashan, Varanasi, reprint-2010, Nidana sthana
1st
Chapter, Verse-14-15, pp- 956, pg -444.
122 Vagbhata, Astanga Hrudaya, SarvangaSundara Commentary of Arunadatta and Ayurveda
Rasayana Commentary of Hemadri, edited by; Pandit Hari Sadasiva Sastri Paradakara
Discussion
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi . Page 105
Bhisagacharya, Chaukhamba Surbharati Prakashan, Varanasi, reprint-2010, Nidana sthana
1st
Chapter, Verse-14-15, pp- 956, pg -444.
123 Sushruta, Sushruta Samhita, Nibandhasangraha Commentary of Sri
DalhanaAcharya,editedbyVaidya Yadavji Trikamji Acharya, Choukhamba Surabharati
Prakashan Varanasi,reprint 2010,Uttara tantra 49th
Chapter,Verse 3-5, pp-824, pg-754.
124 D.C.Dutta-Text Book of Obstetrics edited by Hiralal Konar 5
th edition 2001, New Central
book Agency (p) Ltd. London, pp- 705, pg -166.
125 D.C.Dutta-Text Book of Obstetrics edited by Hiralal Konar 5
th edition 2001, New Central
book Agency (p) Ltd. London, pp- 688, pg -166.
126 D.C.Dutta-Text Book of Obstetrics edited by Hiralal Konar 5
th edition 2001, New Central
book Agency (p) Ltd. London, pp- 705, pg -166.
127 D.C.Dutta-Text Book of Obstetrics edited by Hiralal Konar 5
th edition 2001, New Central
book Agency (p) Ltd. London, pp- 705, pg -166.
128 Vagbhata, Astanga Hrudaya, SarvangaSundara Commentary of Arunadatta and Ayurveda
Rasayana Commentary of Hemadri, edited by; Pandit Hari Sadasiva Sastri Paradakara
Bhisagacharya, Chaukhamba Surbharati Prakashan, Varanasi, reprint-2010, Sutra sthana
10th
Chapter, Verse-17-19, pp- 956, pg -176.
129Vruddha Vagbhata, Astanga samgraha, Sashilekha commentary of Indu, Edited by
Shivprasad Sharma,Chowkhanba Sanskrit Series Office, Varanasi,reprint 2008, Sutra sthana
18th
Chapter,Verse 5, pp-965, pg-144.
130 Vruddha Vagbhata, Astanga samgraha, Sashilekha commentary of Indu, Edited by
Shivprasad Sharma,Chowkhanba Sanskrit Series Office, Varanasi,reprint 2008, Sutra sthana
18th
Chapter,Verse 6, pp-965, pg-144.
Discussion
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi . Page 106
131 Vruddha Vagbhata, Astanga samgraha, Sashilekha commentary of Indu, Edited by
Shivprasad Sharma,Chowkhanba Sanskrit Series Office, Varanasi,reprint 2008, Sutra sthana
18th
Chapter,Verse 10, pp-965, pg-145.
132
Vruddha Vagbhata, Astanga samgraha, Sashilekha commentary of Indu, Edited by
Shivprasad Sharma,Chowkhanba Sanskrit Series Office, Varanasi,reprint 2008, Sutra sthana
18th
Chapter,Verse 8, pp-965, pg-144.
133 Agnivesha, Charaka Samhita, Ayurvedadipika Commentary by Chakrapanidatta, edited by;
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2011,Shareera Sthana 6th
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134
www.ncbi.nib.gov/pubmed/17987447 Black pepper and its pungent principle- piperine-
A Review of diverse physiological effects.
135
en.wikipedia.org/wiki/tannin
136
en.wikipedia.org/wiki/limonene.
137 www.ncbi.nib.gov/pubmed/3903578 Epidemology of vomiting in early pregnancy.
138
www.ncbi.nib.gov/pubmed/3903578 Epidemology of vomiting in early pregnancy.
139
www.ncbi.nib.gov/pubmed/3903578 Epidemology of vomiting in early pregnancy.
140 www.ncbi.nib.gov/pubmed/3903578 Epidemology of vomiting in early pregnancy.
Conclusion
A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 103
CONCLUSION
Conclusion is the extract of the work done in the study. In this study 40
patients of Garbhini Chardi were divided into 2 groups Group A and Group B
each comprising of 20 patients. Group A patients were given Eladi Gutika 2
tablets thrice daily for 2 weeks. Group B patients were given Eladi Gutika 2
tablets thrice daily for 2 weeks and Matulunga Avaleha 1 tsp, four times daily
for 2 weeks. The assessment of the treatment was done on 15th
day and 30th
day of the treatment. The effect of the treatment were statistically analysed
within the group and in between the groups.
The following conclusions were made from the study.
Emesis Gravidarum is a condition which is affecting 50% of the pregnant
women.
The condition is more prevalent in primigravida than in multiparous women.
It generally affects the patients in the early morning hours.
Eladi Gutika showed a highly significant result in treating vomiting, nausea
and salivation but was not giving any increase in weight or Hb%.
As it was in the tablet form, the medicine was appreciated by the patients for
easy consumption.
The combination of Eladi Gutika and Matulunga Avaleha showed highly
significant results in all parameters. It helped in decreasing vomiting, nausea
and salivation and also helped in increasing the body weight. The medicines
also helped in mild increase of Hb% .
The difference between the results of two groups is due to the effect of
Matulunga Avaleha used in the second group.
Avaleha form was not much appreciated by the patients for its consistency and
smell.
Matulunga avaleha also helped in correcting associated complaints like
constipation.
There were no side effects seen in patients of both the Groups.
Overall effect of the treatment was more significant in Group B than in Group
A.