A STUDY ON

VATHA PITHAM

Dissertation Submitted To

THE TAMIL NADU DR.M.G.R Medical University

Chennai – 32

F or the Partial fu lfillm ent in A w arding the D egree of

DOCTOR OF MEDICINE (SIDDHA)

(Branch – I Pothu Maruthuvam)

Department of Pothu Maruthuvam

Government Siddha Medical College

Palayamkottai – 627 002

APRIL – 2012

CONTENTS

Page No

ACKNOWLEDGEMENT

I. INTRODUCTION 1

II. AIM AND OBJECTIVES 5

III. ABSTRACT 7

IV. REVIEW OF LITERATURE

a. SIDDHA ASPECTS 8

b. MODERN ASPECTS 55

V. MATERIALS AND METHODS 81

VI. RESULTS AND OBSERVATION 85

VII. DISCUSSION 103

VIII. SUMMARY 112

IX. CONCLUSION 115

X. ANNEXURES

� PREPARATION AND PROPERTIES OF

THE TRIAL MEDICINE 117

� BIO-CHEMICAL ANALYSIS 124

� PHARMACOLOGICAL ANALYSIS 127

� TOXICOLOGICAL STUDY 129

� CASE SHEET PROFORMA 133

XI. BIBLIOGRAPHY 148

Acknowledgement

ACKNOWLEDGEMENT

First, I thank Almighty for his showered blessings which is the

ultimate source of my success.

I express my gratitude to our Siddhars for all their manifold mercies.

I would like to offer my reverence to My Beloved Parents who are

an epitome of Love, Sacrifice, Encouragement and inspiration.

I wish to express gratitude and acknowledgement to the

Vice-Chancellor, The TamilNadu Dr.M.G.R. Medical University, Chennai,

The Special Commissioner, Director of Indian Medicine and Homeopathy,

Chennai and Joint Director of Indian Medicine and Homeopathy, Chennai.

I also wish to convey my deep gratitude to

Prof. Dr.N.Chandramohan Doss M.D.(s)., Principal, Government Siddha

Medical College, Palayamkottai for patronizing the work by providing all

the necessary facilities.

I also wish to convey my deep gratitude to

Prof. Dr. S.Soundarrajan M.D.(s)., Vice Principal, Government Siddha

Medical College, Palayamkottai for patronizing the work by providing all

the necessary facilities.

I express my deep sense of gratitude to Dr.S.Mohan, M.D.(s)., Head

of the Department, P.G. Pothu Maruthuvam, Government Siddha Medical

College, Palayamkottai for his valuable guidance and suggestion in caring

out the dissertation.

I express my deep sense of gratitude to Dr. R.Thangamoney,

M.D.(S), former HOD Department of PG Pothu Maruthuvam, Government

Siddha Medical College, Palayamkottai, for him guidance and suggestions

in the selection of topic.

I am extremely grateful to Assistant Lecturer

Dr. S. Justus Antony M.D.(s)., Department of P.G Pothu Maruthuvam,

Government Siddha Medical college, Palayamkottai for their kind and

affectionate encouragement to my work.

I am extremely grateful to Assistant Lecturer

Dr. G.Subash Chandran M.D.(s)., Department of P.G Pothu Maruthuvam,

Government Siddha Medical college, Palayamkottai for their kind and

affectionate encouragement to my work throughout the study period.

I am extremely grateful to Reader Dr.A.Manoharan M.D.(s).,

Department of P.G Pothu Maruthuvam, Government Siddha Medical

college, Palayamkottai for his valuable guidance to my work.

It is my responsibility to express my thanks to Dr.V.Sree Loganathan

B.I.M., RMO, GSMC, Palayamkottai for offering his suggestion and advices

whenever needed.

I extend my deep sense of gratitude to Dr.S.Nazer, M.D General

Medicine Former Professor, Department of Modern Medicine for their

valuable suggestion in this study.

I express my deep sense of gratitude to

Prof. Dr.V. Thiru Neelakandan M.B.B.S., M.D, HOD, Modern Medicine,

Government Siddha Medical College, Palayamkottai for his Valuable

guidance in modern aspects.

I thank Dr. S. Bageerathy for the help rendered in analysing urine

and blood for my patients in Laboratory during the study.

I thank to staff nurses, pharmacist and attenders for their help in

varius stage of my study.

I express my heartfelt thanks to Mr. R.Parthasarathy, former in the

salem districy for the collection of herbal drug for my dissertation work.

I take this opportunity to express my deep sense of gratitude to

Mr. M. Kalaivanan M.Sc., M.Phil., Lecturer and other staffs of Modern

Pharmacology Department, Government Siddha Medical College,

Palayamkottai for their help during the entire course of my work.

I would like thanks to Mrs. T. Poongodi, M.L.I.S., M.Phil., for

permitting me to utilize the college library for my dissertation work.

I would like thanks to Mr.Chelladurai, M.Sc., Botany, for their

identification of herbal drung for my dissertation work.

I also thanks to Mrs. N. Nagaprema M.Sc. M.Phil., Lecturer Head

of the Department and all the staffs of Department of Bio-Chemistry, for

their help in Biochemical Analysis for this work.

I wish to thank Mrs. M.Alagammal M.Sc., Head of the Department

and Mrs.S.Sudha M.Sc., Ph.D., Lecturer., Department of herbal botany and

pharmacognosy Government Siddha Medical College for her kind help in

botanical aspect of my study.

I would like to convey my thanks to Shakthi Diagnostics,

Vannarpet, Tirunelveli , for their Co-operation to diagnostic the disease.

Finally I convey my thanks to Mr. M.Maharaja, Maharaja DTP Services, Palayamkottai for his expertise typing and printing work.

Introduction

INTRODUCTION

“ngv!Lkz!wPk<okz<zil<!Nkq!

hgue<!Lkx<Ox!dzG/”!

! ! ! ! ! ! ! .!kqVg<Gxt<!himz<.2!

! ‘Man is the most wonderful creature of ‘Nature’. When discussing the

issue of health, it is common for people in all cultures to talk just about their

body, its ailments and the medicines they right to treat these ailments.

However health is not merely a matter of the state of the body, since it is

obvious we are much more than just this material forms.

A system of health that only takes into account the structure and the

functioning of the physical body can not effectively address human health in

its totality. “Siddha” is not just a medical approach to health, rather it is a

complete philosophy of life. It gives equal importance to the parts of life,

which are more subjective and intangible as well as those, which are

objective and material, those aspects we can observe with out physical

senses. In fact, it is a view of life which understands that the non-material

components of our life, our consciousness, mind, thoughts and emotions

animate and direct our more physical parts.

The term “Siddhar” has been derived from the word “Siddhi” which

literally means accomplished, achieved or perfected success and so it referes

to one who had attained his end in spiritual goal. They were mystics, yogis,

poets, devotees and medical men of various combinations.

In “Siddha” system of medicine we can save our body from diseases

and attain our soul to the “Nature”. The Siddha system of medicine is the

ancient system of medicine, which has been presented by the ‘siddhars’. The

unique nature of this system is its continuous service to humanity in

computing diseases and in maintaining the physical, mental and moral

health, while many of these contemporaries had completed their forces long

ago. The Siddha system of medicine is purely scientific and the peculiar

complex system of science and philosophy. It provides rational methods for

the treatment of many diseases, which are considered to be obstinate and

incurable in other system of medicine.

The “Siddha” focuses on maintaining a balanced integrated

relationship among them. In balance, whether physical, mental or emotional

arises when there is a disconnection between the subjective and objective

areas of life.

More over they labored much in the field of alchemy and medicines

and also attained success in Yoga and Philosophy. They were of extra sense

perception and highly spiritual, having complete control over all the

elements. They had full awareness of the nature and activities of all objects

on the planets of all times past, present and future.

They were said to be mostly “Tamilians” who were familiar with the

wonderful properties of rare drugs peculiar to south India in their both

physiological & psychological aspects. They choose not only to keep their

bodies and souls together but also prolong their lives to a considerable

extent. Their motive life was the service of god through humanity.

“Nature cures everything”

– Hippocrates

Hipprocates, famous Greek Physician and Philosopher (460-367 B.C)

is considered to be the “Father of Medicine”. Even earlier than Hipprocates,

Vedas and Puranas of ancient India especially in Tamilnadu, a system of

Medicine called “Siddha” system was evolved. The basic principle of

Siddha medicine states that the entire body, both physical and mental, is

made up of “96 Thathuvas” and “Tri-Dhosas”. The three aspects are Vatha,

Pitha, Kabha. Tri-Dhosa or mukkutrangal forms the basic of the human body

and character. The Tri-Dhosas are maintained in the body in a particular

ratio (ie) vatha-1 unit, pitha-1/2 unit and kabha-1/4 unit. Imbalance or any

derangements in Tri-Dhosas cause diseases.

From the verse’s “Theraiyar Maruthuva Bharatam”

! “uiklib<h<!hjmk<Kh<!hqk<k!ue<eqbib<g<!gik<Ks<!Osm<h!

! ! sQklib<k<!Kjmk<K…//”!

! It is clearly understood that Vatha is constructive in nature, Pitha is

protective in nature and Kabha is destructive in nature.In general all systems

of medicine, the combination of various herbs and minerals are used in

judicious proportion activate Vatha, Pitha, Kabha doshas (defects) and bring

about the needed balance of these three to the human body.

For instance the combination of herbs or roots is done in such a

fashion that one herb adverse action will be neutralized by the other herb.

“Siddhars” who had experienced with very many herbs and found-out

the efficacy of each and every herb in the human system.

The cure from intake of herbal medicines is astonishing; So it has

attracted the attention of people world over.

Luckily the Siddhars were all Tamil Saints and so Tamilnadu has the

previlage of possessing the knowledge of Siddha system. The Siddhars have

thoroughly studied the human Psychology and the mind set is important for

cure.

The mind, soul and the body have to have the absolute coordination

for keeping the health, intact.

Faith in the medicine is necessary before taking them. Mental health

is necessary for Physical well being. That is why the popular Tamil Saint.

Agathiyar Says….

“ lelK!osl<jlbieiz<!lf<kqvR<!oshqg<g!Ou{<mi!

! ! lelK!osl<jlbieiz<!uiBju!dbi<k<k!Ou{<mi!

! ! lelK!osl<jlbieiz<!uisqjb!fqXk<k!Ou{<mi!

! ! lelK!osl<jlbieiz<!lf<kqvR<!osl<jlbiOl”

Manmurikiyam states that

“hqk<kf<!kiOe!GVkqbqx<!Oxie<Xl<”!

1. Vatha pitham is similarly compare in modern science as systemic

Hypertension.

2. Systemic Hypertension are produced several risk facters. It affects all

the organs.

3. The normal level of Systolic Blood Pressure is 120-140/mmHg and

diastolic Blood Pressure is 80-90mmHg.

4. Any alternation of systolic and diastolic pressure may leads to

systemic hypertension.

This dissetation work has selected “Vatha Pitham” under the Pitha

diseases by “Yugi Vaidhya Chinthamani - 800” and a clinical entity

comparable to “Hypertension” in modern medicine. The incidence of this

disease as mentioned above is increasing, so I have tried to formulate a

treatment methodology to treat this disease.

The choice of drugs for clinical study was

1.IRUVELI KIYALAM – Internally,

Ref: Agathiar Vaithiya Pooranam - 205

The drug was prepared personally by me and tried in 20 selected cases

of vatha pitham in IP and OP. The clinical study was undertaken in the post

graduate department of Pothu Maruthuvam at Government Siddha Medical

College, Palayamkottai. Those cases were treated with trial drug.

Aims and Objectives

AIM AND OBJECTIVES

Vatha Pitham (Hypertension) - “The silent killer of the society is

probably most important public health problem. Because according to

current report, about 15% of the population can be regarded as hypertensive

and 7% of death occur due to this. So as a preliminary effect, Vatha Pitham

(Hypertension) was selected for the dissertation. IRUVELI KIYALAM

was selected for evaluating its clinical efficacy in patients with Essential

Hypertension.

Vatha Pitham (Hypertension) is a staggering public health problem for

three reasons.

1. It is very common.

2. Its effects are sometimes devastating (Myocardial infarction,

stroke).

3. It remains asymptomatic until late in its clinical course.

Hypertension is an important cause of death. There deaths are due to

cerebral haemorrhage or dissecting aneurysm or heart failure. They are

important because, they are almost entirely prevented by treatment. But the

great majority of deaths due to Hypertension are caused by coronary artery

Heart disease (CAHD).

If the hypertension patients remain untreated, it affects all the organs

in the body. To bring a light and hope in the lives of the hypertensive

individuals with the siddha medicines. Vatha Pitham (Hypertension) was

selected for the dissertation work as a maiden attempt.

The ultimate aim of the present study on Vatha Pitham is:

� To make a clinical study on the course of the disease under careful

examination on the Aetiology, Pathogenesis, Treatment and

Prognosis by making use of Siddha concept.

� To explore the unique diagnostic methods mentioned by Siddhars.

� To have an idea of the incidence of the Vatha Pitham with regards

to Age, Sex, Socio-economic status, Family history and Personal

history.

� To know how the disease Vatha Pitham alters the normal

conditions under the topic Mukkutram, Poripulangal, Udalkattugal,

Envagai thervugal, Naadi, Neerkuri, Neikuri.

� To know the extend of correlation of Aetiology, Signs, Symptoms

and Complications of Vatha Pitham in Siddha aspect with

Hypertension in modern aspect.

� To have a clinical trial on Vatha Pitham patients with Iruveli

Kiyalam in the post-graduate studies and Research Centre,

Govt.Siddha Medical College Hospital, Palayamkottai, under the

guidance of the staff of the post-graduate department of Pothu

Maruthuvam.

� To use modern parameters to confirm the diagnosis, progress of the

disease.

� To evaluate and to produce pharmacological and biochemical

analysis reports of the test drugs.

� To estimate the toxic effects of the drugs.

Abstract

ABSTRACT

Since the commonest disease in the society, number of sufferers

increasing day by day, I have chosen the disease “Vatha Pitham” for my

dissertation work.

20 patients of either sex were selected as In patients and 20 patients of

either sex as Out patient were selected and administered with the trial

medicine .

IRUVELI KIYALAM- 90ml internally twice a day during the whole

study period.

The trial medicine was subjected to Biochemical, pharmacological and

toxicological analyis

At the end of the trial study, the majority of the cases show good

results.

Siddha Aspect

REVIEW OF SIDDHA LITERATURE

Definition of Pitha

Pitha is one of three major Uyir thathukkal namely Vatha, Pitha and

Kabha Otherwise called as MUKKUTRAM.

“fqzl<!fQi<kQutq!uqSl<Ohijmf<Kl<!

gzf<klbg<!gLzgl<!Nkzqe<”!!

- Sadhaga naadi

According to this lines, the world is made up of five elements known

as “PANCHA BOOTHA”.

These are

1. Prithivi - Earth

2. Appu - Water

3. Theyu - Fire

4. Vayu - Air

5. Aahayam - Space

In these, pitha consists the element Thee (Fire).

The relation between Uyir thathukkal and Pancha bootha is as follows,

Uyir thathuikkal Pancha bootha

Vatha Vayu (Air)

Aahayam (space)

Pitha Theyu (Fire)

Kabha Appu (Water)

Prithivi (Earth)

Thus Vayu and Aahayam combine to become vatha uyir thathu, which

controls all aspects of movements. The words dry, light, cold, quick, rough

minute and mobile describe the characteristics for Vatha Uyir thathu.

Theyu alone becomes pitha Uyir thathu, which controls all the body’s

conversion processes, produce heat and energy producing capacities. The

words hot, pungent, aggressive, liquid, mobile and acid describe the

characteristics, of Pitha Uyir thathu.

Appu supported by Prithivi becomes Kabha Uyir thathu and controls

liquifaction, lubrication and cohesion. It is also responsible for giving

solidity and structure to the body. Kabha Uyir thathu primarily reflects the

qualities of the water but also some traits of the earth element, consequently

kabha is heavy, slow, cold, steady, solid and oily.

Formation of Muthoda

“NglK!fic!fvl<H!obPhk<kQvibqvl<!

-Vh<hi!fic!WPh!OkiOvi!

bqvlie!Okgk<kqz<!gzh<Oh!fic!

Wg<gs<!slk<!okipqz<!Dg<g!sguiB!

kg<g!fic!we<Ox!siM” !

- Yugi Vaidhya Chinthamani - 800

“-Vh<hie!fic!WPhOkiCvi!

bqvlie!Okgk<kqz<!Wzh<!ohVfic!

yg<gkslk<!okipqjz!Dg<g!ks!uiBg<gt<!

kg<ghc!we<Ox!siVl<” !

!

“siVf<ks!fic!ke<eqz<!&zl<!&e<X!

OhVlqml<!hqr<gjzBl<!hqe<eZme<!.!liXl<!

djvg<guqvx<!gix<oxim<Mek<KOl!fisq!!

ujvs<!SpqObi!jlbk<kqz<!uf<K!gjz!&e<xqz<!uiBuil!

hieEme<!

kf<k!hqvi{e<!slieEg<GR<!sf<klxg<!!

%m<MxU!Ovgqk<kz<!dXl<!uikl<!hqk<kl<!

fim<Mr<!ghOlbil<!fiM” !

- Kannusamiyam

According to this verse, the human body is composed of 72,000 naadi

narambugal.

Among this 72,000 naadies, ten are prominent naadies (Dasa naadies).

Of these ten naadies 3 are known as moolathara naadies.

These are

� Edagalai.

� Pingalai.

� Suzhumunai.

Ten Vayus present in the body are

1. Piranan.

2. Abhaanan.

3. Udhanan.

4. Viyanan.

5. Samanan.

6. Nagan.

7. Koorman.

8. Kirugaran.

9. Devathathan.

10. Thananjeyan.

Among these Abhaanan conjugates with edagalai to form ‘Vatha’.

Piranan conjugates with pingalai to form ‘Pitha’.

Samanan conjugates with suzhumunai to form ‘Kabha’.

These three humours vatha, pitha and kabha are more or less

correlated with excrete, gastric juice, and saliva respectively.

They circulate in the body system in different proportions and help in

the digestion of food and other general physiological functions of the body.

Each of them has different functions.

The right proportion of each in proper combination are responsible for

maintaining the good health.

When some of the environmental factors like diet, weather etc.,

disturb pitha, it looses its control, which may be diminished or exaggerated.

So the other two Uyir thathus are also disturbed which are in peculiar

equilibrium state. Finally this may leads to pitha diseases.

Natural Characteristics of Pitha

Locations

Generally pitha lives in

1. Piranan.

2. Pingalai.

3. Head.

4. Heart.

5. Blood.

6. Stomach.

7. Urinary bladder.

8. Sweat.

9. Eye.

10. Skin.

11. Umblicus.

12. Saliva.

1. According to Thiru Moolar,

! “hqiqf<kqMl<!hqk<kl<!OhviR<szk<kqeqz<”!

! It means, ‘pitha’ lives in urine.

2. According to Yugi muni,

“Ohiole<x!hqk<kk<Kg<!gqVh<hqmOl!Ogtib<!

! ! Ohvie!g{<mk<kqe<!gQpkiGl<”!

! ! It means, place of the ‘pitha’ in body is below the neck.

NATURAL PROPERTIES

Pitha in its natural habit may cause

1. Digestion.

2. Hunger or hungry (poly phagia).

3. Taste.

4. Thirst.

5. Vision.

6. Light.

7. Concentration.

8. Knowledge.

9. Softness.

10. Warm.

11. Hardness.

12. Heat production in the body.

13. Bluish colour formation.

14. Production of heat during digestion.

15. Memory power.

QUALITIES OF PITHA

Own Qualities – 6

1. Akkini - Hot

2. Kaaram - Pungent

3. Kurooram - agressive

4. Salaroopam - Liquid

5. Oodumthanmai - Mobile

6. Pulippu - Acid

Opposite qualities – 6

1. Kulirchi - Cold

2. Getti - Solid

3. Santham - Mild or harmless

4. Kasappu - Bitter

5. Inippu - Sweet

6. Nilaitthiruthal - Immobile

Hyper Pitha - Signs

1. Yellowish discolouration of eye, skin urine and motion.

2. Poly phagia and poly dypsia.

3. Burning sensation all over the body.

4. Sweating.

5. Giddiness.

6. Haemorrhage.

7. Angry.

8. Immovable.

9. Emaciation.

10. All taste to be like sour or bitter.

Hypo Pitha - Signs

1. Cold.

2. Decrease in colour.

3. Disturbance in natural growth of Iyam.

4. Less heat.

Pitha Thegi - Natural Characterestics

Physical characters

� The person has high thee thoda.

� The muscle content can be less beyond the bones and joints.

� Body may appear always with heat, sweating and with unpleasent

smell.

� Wrinkled skin.

� Colour of the skin can be yellowish red with shining.

� Face, palm and sole are reddish yellow in colour.

� Thin eyelids.

� Reddish discoluration of eyes due to heat, anger and hungry.

� Black moles with pimples.

� More heat in the body.

� Yellow or red colour of the body.

� Reddishness in upper and Lower limbs.

� Lesser hair in body.

� Giddiness.

Behavioural characters :

� Willing to take sweet, astringent, bitter and cold foods.

� Lesser intake of food.

� Intolerence to appetite, thirst, heat, angry and fear.

� Willing to be garlanded.

� Low sukkilam.

� Low kaamam.

� Reduced lust.

� Hatefullness, respect, courage, clear knowledge, talkative, good

habits, discipline and love with others.

� In dream, there will be sun, wind, light of fire, lightening and

kongu tree with flowers, caeasapenia tree (Sarakkondrai)

Murukkan tree are found.

� Happier and has good education.

� Age will be 65 years and has 3/4 vitality.

� Higher appetite.

� Willing to eat more.

Pitha thega kuri

“nxquie!hqk<kk<kiozMk<k!Okgl<!

! bxolzqU!fqxl<!out<jt!biqjuObiM!

hqiqbik!SgzQjzbx<h!U{<c!

! ohVl<Htqh<!H{U!ogit<tz<!ohiqObii<!kl<jl!

Gxqbik!uisivl<!h{<{z<!Hk<kq!

! Gpl<hqh<!hqe<!Okxz<!gjzg<!Rie!Ohikl<!

ofxqbigg<!gx<xxqU!osiz<zz<!uQvl<!

! !! fqjzh<H!lkqbqz<!glkq!bxuliOl”!

!! ! ! ! ! ! .!Noi Naadal noi mudhal naadal

According to this verse, the natural characteristics of pitha thegi are

� Emaciation.

� White coloured skin.

� Low intake of food.

� Willing to take sour taste foods.

� Confused minds.

� Interest in Arts.

� Respect to elders.

� Intelligency.

� Courage.

� Excessive lust.

Place and function of pitha

“kieie!hqk<kl<!hqr<gjzjbh<!hx<xqs<!

! ! sib<uie!hqvi{!uiBU!ke<jes<!osi<f<K!!

! Deie!fQi<h<jhbqz<!n[gq!!&zk<!

! ! Kkqk<okPf<k!ug<gqeqjb!dxU!osb<K!

! liOeOgtqVkbk<kqzqVh<H!ligq!

! ! lbzigq!fqjeuigq!lbg<gligq!

! gieie!sqvf<keqOz!-vg<gligqg<!

! ! ogi{<M!fqe<x!hqk<kfqjz!%xqOeiOl”!

- Noinaadal Noi Mudhal Naadal

According to this verse, pitha is associated with piranan and pingalai,

goes to urinary bladder and mix with seevakkini to lives in heart and head

SYMPTOMS DUE TO EXCESS IN PITHA

“dXkqBt<t!hqk<klK!Okie<xqz<!ouh<H!

! d]<{uiBuk<kq!Svlkq!sivir<gt<!!

lxkqBme<!gqXgqXh<H!hbqk<kqb!Ovigl<!

! uti<!Osijg!bpoziqU!gif<kz<!jgh<H!

-Vkbk<kqz<!gzg<glK!lxh<H!kigl<!

! wPr<geU!OlbjeU!lbg<g!&i<s<js!

sqxqK!ohVl<hiM!vk<kl<!hqvOlgr<gt<!

! Osi<f<K!lqG!hq{q!hzUR<!sqxg<Gf<!kiOe”!

.!Sadhaga Naadi

According to this verse, , the symptoms due to excess in pitha are

� Excess heat.

� Fever.

� Dysentry.

� Loss of memory.

� Giddiness.

� Mental disorders.

� Dropsy, burning.

� Palpitation, thirst, dreams.

� Loss of consciousness.

� Menorrhogia.

� Gonorrhoea.

“hqk<kOl!oseqk<kix<!S,M!

ohzk<Km!Zzvs<!osb<Bl<!

hqk<kOl!lqGf<kizQjt!

bqVlZl<!ohzk<K!fqx<Gl<!

hqk<kOl!lqGf<k!kieiz<!ohzr<!Gjxf<Kl<!hPk<Kl<!

hqk<kOl!kqvm<cF~zqx<!

Ohsqeii<!ohiqObii<!kiOl”

.!GunaVaagada Naadi

!

“hqk<kOl!gkqk<k!OhiK!ohVf<kqMl<!uikL{<mil<!

hqk<kOl!gkqk<k!OhiK!ohVf<kqMl<!ubqx<xqz<!uiB!

hqk<kOl!gkqk<k!OhiK!hqkx<xqMl<!hqk<Ok!OgT!

hqk<kOl!gkqk<k!OhiK!hqxf<kqMl<!hq{qbOegl</” !

.!GunaVaagada Naadi

According to this verse the excess in pitha may cause symptoms as follows

� Increase in heat leads to dryness of body.

� Cough and expectoration.

� Loss of strength.

� Increase in Vatha.

� Excess gas in abdomen.

� Unwanted talkativeness.

� A state of delirium.

“ hGk<kqcx<!hqk<kl<!hzhz!sqf<jkbil<!

uVk<kqMl<!uif<kqBl<!uib<!fQi<lqg!U,Xl<!

lGk<kqM!Oleqbqz<!lim<c!wiqh<OhXl<!

lqGf<k!ue<eqg<G!lqg!uqmr<jgg<GOl” !

. kqV&zi<!

According to this verse the symptoms due to excess in pitha are

� Many thinkings.

� Vomiting.

� Excess secretion of saliva.

� Burning sensation in body.

� Bitter taste in tongue.

“%xqmOu!uqk<klK!lQxqx<xieiz<!

! ogiMr<gik<k!Zm!zpx<sq!fMg<g!L{<mil<!

lQxqmOu!Ovisqbf<kie<!fiuxm<sq!

! Olzie!OgihlK<!uqg<gz<!&i<s<js!

K~xqmOu!!gqX!gqXh<H!gikjmh<H!

! okif<klir<!gsh<HmOe!l{<jmg<!Gk<K!

NOl!kie<!bk<kq!Svl<!hi{<M!Osijg!

! Nmie!uqmis<!SvLl<!hqvOlgf<kie<!

OhiOlkie<!gilijz!hqk<k!oum<jm!

! ohiz<zik!hi{<MmOe!squf<k!fQvil<!

OkgOl!kie<!squh<hiB!lR<stiBR<!!

! sqX!sqXk<KbqV{<M!uVr<Gpq!uqPf<K!

fiOl!kie<!osie<OeiOl!hqk<kg<!%X!!

fuqe<!xqm<hii<!uisLeq!fuqe<!xqm<miOv”!

- Agathiyar

In these verse, Agathiyar says the symptoms of excess pitha are the

follows:

� Heat.

� Allergy.

� Shivering.

� Dryness of tongue.

� Angry.

� Hiccough.

� Loss of consciousness.

� Giddiness.

� Hearing loss.

� Bitter taste in tongue, headache.

� Fever, continuous fever.

� Oedema, anaemia.

� Jaundice.

� Leucorrhoea.

� Red coloured urine.

� Red or yellow coloured skin.

� Emaciation.

“hqk<k!Ovigq!ohVLmz<!S,miGl<!

!fqk<kli!Lgl<!Ofi<!uqpq!fiU!hz<!

!Lk<k!fQV!Lbi<k<k!sqh<hiGl<!

!Sk<k!lR<stib<k<!Okie<xqmg<!g{<cOm”!

- Kali Virutham

According to this verse the excess in pitha leads to following symptoms

1. Excessive body heat.

2. Red and yellowish discolouration of face, eyes, teeth, tongue and urine.

“Wzuib<!Gpzib<!hqk<kR<!osb<G{l<!uqtl<hg<!Ogtib<!

!Ogiz!Ouz<!uqpq!squf<K!Gtqi<f<kqciqVg<G!lz<ziz<!

!sQzOu!fQi<!gMk<K!ofif<K!SXg<oges<sq!uf<K!uQPl<!

!RizOl!gqXgqoxe<X!fiUzi<f<kqVg<Gr<!giO{”!

.!Raththina churukka naadi

According to this verse, the excess in pitha cause the following symptoms

� Reddish discolouration and feverishness.

� Burning micturition with pain and pricking.

� Giddiness.

� Dryness of tongue.

“hqk<kk<kqz<!hqk<kligqz<!hqkx<xqMr<!gqXgqXg<Gl<!

!sk<kqBlkqg!liGR<!siQvk<kqjth<!H{<mig<Gl<!

!nk<kqbiBzVOleq!bigLl<!OuxkiGl<!

!ux<xqObouTk<Kg<!gibl<!oux{<M!hqe<!uQg<gL{<mil<”!!

- Agathiyar Naadi

According to this verse, the excess in pitha may cause the symptoms

� Unwanted talking.

� Giddiness.

� Vomiting.

� Breathlessness.

� Dryness of body.

� Paleness and oedema of body can occur. !

“kioee<x!hqk<k!lQxz<!smolz<zir<!gif<kz<!gi[l<!

!Doee<x!uif<kq!uib<!fQ'xqOb!YPGR<!siuie<!

!uioee<x!lm<cz<!ouGl{<jmbqz<!Gk<K{<miGl<!

!Okoee<x!uqg<gz<!&i<s<js!osuqbjmh<H{<mil<!hiOv” !!!

- Kavviyaththin Naadi

According to this verse, the excess in pitha may cause the symptoms such as,

� Burning sensation all over the body.

� Vomiting.

� Excess secretion of Saliva.

� Pricking pain in head.

� Hiccough.

� Unconsciousness.

� Loss of hearing.

� Death.

Relation with taste

Taste, in common is divided into 6 types, called as Aru Suvai (6 taste)

Those are

1. Inippu - Sweet

2. Pulippu - Sour

3. Uppu - Salt

4. Kaippu - Bitter

5. Kaarppu - Pungent

6. Thuvarppu - Astringent

All 6 tastes are formed by the combination of two boothams from

pancha bootham, these are

Inippu = Prithivi + Appu

Pulippu = Prithivi + Theyu

Uppu = Appu + Theyu

Kaippu = Vayu + Aahaayam

Kaarpu = Vayu + Theyu

Thuvarppu = Prithivi + Vayu

Like that in Mukkutra, Except Azhal, the other two kutra (Vali, Iyam)

has the combination of two boothams. Azhal is formed by one bootha that is

Vali = Vayu + Aahaayam

Azhal = Thee or Theyu

Iyam = Appu + Prithivi

From this, we know that the knowledge about the combination of

boothas in the formation of suvai and mukkutra is very helpful to know that

which taste has increased or neutralized the mukkutra and to give treatment

depending upon this.

For example, in case of pitha diseases the taste, sour will become

increased. So that to neutralize pitham we have to give the opposite tastes.

Tastes that increase the pitha

!! “ HtqKui<!uqR<Sr<gxq!bix<H,iqg<Gl<!uikl<!

!! ytq!Bui<jgh<!Ohxqz<!hqk<kl<!sQXl<!gqtqolipqOb!

!! gii<h<hqeqh<H!uqR<sqx<!ghl<uqR<S!R<sm<cvks<!

!! Osvh<!H{i<!Ofib[giOk”!

- Kannu Samiyam

According to this verse, bitter and salt tastes increase the pitha

Tastes that neutralize the pitha

“hqk<klkq!giqh<hqe<!OhSl<hiqgivl<!

Sk<kk<!KuoviM!osiz<zqeqh<Hs<!!.!sk<kiGl<! !

jgh<Hs<!SjuOb!gVKuke<!uQX!

wb<h<hjmB!ole<Xjvk<ki!iqr<G” !- Kannu Samiyam

According to this verse the tastes which neutralize the pitham are

sweet astringent and bitter.

Three phases ‘PRAPAKAM’ metabolism

Prabakam metabolism Thodam Taste Function

Inippu Kabham Sweet Moistering the food

Pulippu Pitham Sour Conversion of food into an absorbable form

Kaarpu Vatham Pungent Absorption and separation of food

ALTERATIONS OF PITHA

The three humours are affected either themselves or with udal

thaathukkal, pathologically.

The types of alteration of pitha

Thannilai Valarchi

Definition : A Kutram which is provoked in its own location is called

Thannilai valarchi

Limitation : Hatefullness of the things which are causing Thannilai

valarchi and likeness of the things which are getting

opposite properties are the limitations of Thannilai valarchi.

Period : Pitha gets thannilai valarchi during Kaar Kaalam -

Aavani and purattasi.

II. Vetrunilai Valarchi

Definition : A kurtram which is provoked to other locations is called

Vetrunilai valarchi.

Limitation : Signs and Symptoms of the affected kutram and the

pathological conditions of the udal thaathukkal give the

details of the limitations.

Period : Pitham gets Vetrunilai valarchi during koothir kaalam

Iyppasi and Kaarthigai.

III. Thannilai Adiadhal

Definition : A provoked kutram, which is neutralized in its own

location is called Thannilai Adaidhal.

Period : The provoked pitha neutralizes during Mun Pani Kaalam

Margazhi and Thai.

Types of pitham

The siddha classical texts divide pitham into five subsidiary forms that

differ from other by their localization in the body (Anatomical and by their

particular functions (Physiological).

They are

� Anal pitham.

� Eranjaga Pitham.

� Saadhaga Pitham.

� Aalosga Pitham.

� Prasaga Pitham.

Anal pitham

� It gives appetite and helps in digestion.

� It has the character of thee or fire.

� It lies between abdomen and scrotum. Pitham dries the liquid form

things and digests the food we take.

Eranjaga Pitham:

� Which colours the blood.

� It increases the quality of blood.

� It lives in intestine and gives red colour to the essence which seperate

from the food we take.

Saadhaga Pitham:

� It controls the whole body.

� It has the ccomplishing property.

� It lies in heart and accomplish the work, via knowledge, mind and

desire.

Aalosaga Pitham:

� It brightens the eyes.

� It shows the things to eyes.

� It lies in eyes and shows the shape of all things.

Prasaga Pitham:

� It gives complexion to the skin.

� It lies in skin and brightens the skin.

Classificatin of Pitha diseases

According to Yugi Vaidhya Chinthamani- 800 Pitha diseases are

classified into 42 types . According to this classification, the symptoms of

VATHA PITHAM gives us a picture more or less similar to Hypertension.

Classification

“fim<cOee<!hqk<kk<kqe<!ohbjvk<kiEl<!

! ! fix<hk<kqv{<mie!G{iG{r<gt<!

! Nm<cOeeiUV!hqk<kf<ke<OeiM!

! ! Nlzhqk<k!lkOeiMe<lik!hqk<kf<!!

! kim<cOee<!klf<k!hqk<kl<!uik!hqkkf<!

! ! keqk<Okii<!he<eqhqk<kR<!sqOzm<l!hqk<kf<!

! K~m<cOee<!SOvi{qk!hqk<kf<!uqgiv!hqk<kf<!

! ! Kcbie!uqv{!hqk<kf<!okijgjbg<!OgOt”!

!!!!“okijgbie!Uvk<khqk<k!lqvk<k!hqk<kR<!

! ! Spqgish<!hqk<koliP!Suish<!hqkkl<!

! ujgbie!sqOzm<l!hqk<kr<!gVl<hqk<kf<kie<!

! ! ligvh<hie<!hqk<kk<Okim!sQv{!hqk<kl<!

! njgbie!uVsqhqk<k!oliqhqk<kf<kie<!

! ! npz<uqk<kf<!Kch<hqk<kl<!uq]h<hqk<kf<kie<!

! Ljgbie!nkqsivh<!hqk<kf<kiEl<!

! ! &zh<hqk<k!Lkqi<uqk<k!LjxjlbiOl!

! Ljxjlbir<!g{<m!hqk<kOliM!hqk<kl<!

! ! &Mhqk<k!fMg<Gh<!hqk<kr<!ghizhqk<kl<!

! kqxjlbiR<!si<k<kq!hqk<kf<kigh<!hqk<kf<!

! ! kVg<gie!uqg<gz<!hqk<kl<!!]bhqk<kf<kie<!

! kqxjlbif<!kqlqi<hqk<kl<!uzqhqk<kOliM!

! ! sQkhqk<kr<!gqVlqhqk<kl!sik<b!hqk<kl<!

! lxjlbil<!lii<g<g!hqk<klVk<kQM!hqk<kl<!

! ! ujgbK!fix<hk<kqv{<M!lgqp<f<K!hiOv/” !

- Yugi Vaidhya Chinthamani- 800

According to this verse, pitha diseases are classified into 42 types

� Aavuru pitham

� Amalaga pitham

� Unmadha pitham

� Thamandha pitham

� Vatha pitham

� Vanni pitham

� Silathma pitham

� Suronitha pitham

� Vigara pitham

� Virana pitham

� Uraththa pitham

� Raththa pitham

� Kaasa pitham

� Swasa pitham

� Semipitham

� Karum pitham

� Karappan pitham

� Aseerana pitham

� Aroosi pitham

� Eri pitham

� Azhal pitham

� Thudi pitham

� Athisaara pitham

� Moola pitham

� Vida pitham

� Muthir pitham

� Kanda pitham

� Oodu pitham

� Moodu pitham

� Naaduku pitham

� Kabaala pitham

� Sarthi pitham

� Thaga pitham

� Vikkal pitham

� Shaya pitham (Kaya pitham)

� Thimir pitham

� Vali pitham

� Seetha pitham

� Kirumi pihtam

� Asathiya pitham

� Markkap pitham

� Marumdeedu pitham

According to Pararasa Sekaram

The pitha diseases are classified into 40 types in Pararasekaram

“ux<xqMr<!gis!hqk<k!Olikqb!uikhqk<kl<!

osix<xqMl<!uxm<sq!hqk<kf<!KbVX!Spx<X!hqk<kl<!

osx<xqMR<!sk<kq!hqk<kR<!Osx<he!hqk<kf<!Okgl<!

ux<xqM!Lzi<k<K!hqk<kl<!uslxh<!hqkx<Xl<!hqk<kl<!

hqk<kli!obMg<Gl<!hqk<kl<!Okqk<K!fMg<Gl<!hqk<kl<!

sk<kli!lUe!hqk<kr<!KbVx!OuiMl<!hqk<kl<!

sk<klii<!gcb!hqk<kR<!six<xqb!uiBh<!hqk<kl<!

sqk<kli!Bxr<Gl<!hqk<kl<!osl<hqk<kR<!sQk!hqk<kl<!

sQklib<!lbg<Gl<!hqk<kR<!osh<hqb!uOgiv!hqk<kl<!

Ohkli!bzm<Ml<!hqk<kl<!ohVk<K!uiB,Xl<!hqk<kl<!

Wkli!ObXl<!hqk<k!bqzr<Gf<!kvk<kqx<!hqk<kl<!

ghizlii<!H,khqk<kl<!hVl<hqk<k!LOvig!hqkkl<!

nhiblii<!vkqg!hqk<k!lMl<hqk<k!lOvisq!hqk<kl<!

Ghiblii<!oghik!hqk<kr<!%XLm<!h{Olii<!hqk<kl<!

yVkeq!uqmik!hqk<k!OlikqMl<!uqsiqe<!hqk<kl<!

kVl!uqgib!hqk<kR<!sii<sbqk<kq!bk<kqe<!hqk<kl<!

DVlqG!lf<khqk<k!Olikqe!lqeqOl!zqh<hiz<!

uVlkqe<!G{LR<!osb<b!uGk<kqM!lVf<KR<!osiz<uil<”!

!! ! ! ! .!Pararasasekaram

� According to the Therayar, the pitha diseases are classfied into 21

types in Therayar Vaagadam

� According to Dhanvandhiri, in the book Dhanvandhiri Vaidhyam

pitha diseases are classified into 40 types including vatha pitham.

VATHA PITHAM

Definition

It is one of the 42 Pitha diseases as mentioned in Yugi Vaidhya

Chinthamani - 800. The disease is caused by pitham having symptoms like

Giddiness, Fatigue, Headache, Blurring of vision.

uikhqk<kl<!

! kiqh<hie!g{<kjeOb!lqg!ljxg<Gf<!

! ! kiqbik!lqguqjvs<sz<!Hjgs<s!Z{<mi!

! lqiqh<hie!g{<lqe<!lqeqbib<!Spe<X!

! ! lqg<gfQI!kKl<hqOb!gzr<gq!fqx<Gl<!

! uiqh<hie!lqe<Eml<H!uqbi<ju!hiG!

! ! lbg<golim!kqbg<glib<!uif<kq!biGu<!

! Gxqh<hie!ogil<OhPl<!ne<el<!Ou{<mir<!

! ! %xqOeil<!uikhqk<k!ogit<jg!kiOe!

- b,gq!juk<kqb!sqf<kil{q!

g{<Hjgs<sz<?! wiqs<sjzB{<mig<gqg<! g{<j{! ljxg<Gl<!

g{<lqe<lqeqh<! H,s<sqjbh<! Ohiz! Spzs<! osb<K! g{<{QI! ucBl<?!

g{<gzr<Gl<?! dml<hqz<! uqbi<ju?! lbg<gl<?! kbg<gl<?! uif<kq?! d{U!

Ou{<mijl!wEl<!GxqG{r<jgtg<!gim<Ml</!

!

� Excessive sweating.

� Giddiness.

� Fatigue.

� Vomitting.

� Loss of appetite.

� Blurring of vision.

According to Thanvanthiri Vaidhyam – I higl<?!!

Symptoms of Vatha pitham are !

!! “osizx<giq!kieOleq!Svr<Gtqi<!KbvL{<mil<!

!! ! uqbg<giq!kie!ue<el<!ouXk<kqMl<!nVsqB{<mil<!

!! szqk<Km!zbi<f<K!ofif<K!kti<s<sqbib<!!dkvf<!ke<je!

!! ! uzqk<kpe<!oxiqk<Kg<!gif<kq!uikk<kqx<!hqk<kliOl!”

(himz<!w{<!;!29!*!!

)hg<g!w{<!;!78*!

!! dmzqz<! Gtqi<Svl<! Oukje! -jugT{<miGl</! ! Ngikvk<jkk<!

kt<Tl</! nVsq! Wx<hMl</! dmz<! uim<ml<! njmBl<?! ! ubqx<xqz<! uzq?!

wiqs<sz<!LkziejugTl<!d{<miGl</!-ju!uikhqk<kg<!GxqgtiGl</! !

� Fever.

� Loss of appetite.

� Tiredness.

� Abdominal pain.

According to Pararasasekaram, Vathapitham is mentioned as

“ohiVlqMl<!siQvLx<Xl<!OhikofR<!sqck<Kk<!okib<uib<!

!! -VlqM!LgLl<!uQr<G!Olklib<g<!gMg<GOleq!

lVuqMl<!hsqBlqe<xq!lzg<gqM!fMg<g!L{<mil<”!

!! ohVgqM!uik!hqk<kR<!osb<G{l<!OhSr<giOz!

)hvvisOsgvl<!hg<g!w{<!;!8*!

� Body pain.

� Cough.

� Swelling of face.

� Loss of appetite.

AETIOLOGY

According to Yugi Vaidhya Chinthamani - 800

lgqp<f<KOl!hqk<kf<kie<!uVGl<!uiX!

! lsOkui<!kjlh<h{qb!lim<mi!kii<g<Gl<!

lgqpf<KOl!GVucjb!u{r<gi!kig<Gl<!

! likiuqe<!lelgqpi!lii<g<gk<!kii<g<Gl<!

lgqp<f<KOl!kf<jkjb!uR<sqk<k!Ohi<g<Gl<!

!! lkizbr<gt<!!okiPkqmi!lii<g<gk<!kii<g<Gl<!

lgqp<f<K!squ!kqvuqbk<jk!bhgiqk<!Okii<g<Gl<!

! lihi!kgi<g<G!uf<K!lVUl<!hiOv!

!

lVUOl!Htqh<H!djvh<!Hzh<H!lqR<sz<!

!! lekqOz!Kg<gr<gtjmk!ziZ!

ofVUOl!ofVh<H!oub<bqz<!Ogihf<!ke<eqz<!

!! fqk<kqjv!kieqz<zieiz<!uqVk<kq!Vg<gqz<!

nVUOl!ng<gqeqbqx<!ohisqg<g!uqm<hiz<!

! nkqglib<h<!oh{<Ohig!lEhuqk<k!

fVUOl!ficg<Gl<!OlOz!fqe<X!

! ficOb!g{<mlm<mibq!Vg<Gl<!hiOv!

.!B,gq!Leq!

From this verse, the Aetiological factors which cause pitha diseases

including vatha pitham are

� Persons do not pay respect to good,

� Persons who do not give due respect to guru,

� Persons who do not make their mother happy,

� Persons who cheated their father,

� Persons who do not go to temple,

� Persons who steal “Siva diraviyam”

� High in take of sour and salt foods,

� Having feelings in mind,

� Walking in sunlight and heat,

� Loss of sleep,

� Excessive indulgence in sex.

According to Pararasasekaram,!

hqk<kOki]lkqgiqk<kx<G!WK!

!

“oub<bqzq!emg<jg!biZl<!oul<hsq!lqGk<k!ziZl<!

Kb<bOkiz<!vZofb<!bie<hiz<!Kb<k<kjz!uqMk<k!ziZl<!

jfbOu!uVr<Ogi!hk<jk!f{<j{bix<!gsh<jh!fiTl<!

jgBx!d{<{!ziZr<!gkqk<kqMl<!hqk<k!Oki]l<”!

!

“hqk<kk<jk!uqjtg<G!ole<X!Ohsqb!U{ju!fiTl<!

olk<kOu!bVf<k!ziZ!lqGf<kqMl<!Kbvk<!!kiZl<!

fqk<kqjv!bqzijl!biZ!fqjeUg{<!lqGk<k!ziZl<!

lx<Xt!OuK!uiZl<!ui<k<kqg<Gl<!hqk<k!Oki]l<”!

.!hvvisOsgvl<!

!

This verse, says the aetiological factors that, lead to pitha diseases.

These are

� Walking in sunlight.

� Excessive appetite.

� Avoiding in take of milk and ghee.

� Increasing anger.

� Excessive intake of sour foods.

� High intake of food which increase pitham.

� Increased sorrow.

� Loss of sleep.

� Vedhu- Excessive use of steam bath.

According to Danvandhiri vaidhiyam,

“ngiz!fqk<kqjvbqeiZl<!nkqsr<g!Oligk<kiZg<!

! kgik!oul<!hsqbqeiZf<!kVuqm!Olx<jgbiZl<!

! hgikue<!gqOzsk<kiZl<!hbqk<kqb!hkii<k<kk<kiZl<!

! sqgv!kir<!gz<jgbiZf<k!Osi<f<kqMl<!hqk<kf<kiOe”!!

“-Vlz!lmg<!jgbiZl<!oliVlz!lqjpg<jgbiZl<!

uVl<!oubqz<!ohVg<jgbiZ!leLX!Ogihk<kiZR<!

SvlK!kiqg<jgbiZR<!SMhq{!fix<xk<kiZf<!

kqvuqbr<!ogMjgbiZf<!Osi<f<kqMl<!hqk<kk<!kiOe” !! ! ! ! ! ! ! ! ! !

This verse, says

� Irregular sleeping habit.

� Increased appetite.

� Lust on women.

� Excessive in take of foods that increase Pitham.

� Improper disposal of waste by the body.

� By the ill effects of sun’s rays.

� Angry.

� Fever.

� Smell of the decaying dead body.

� Spoil of Diraviyam. !

“ fqk<kqjv!kuqi<kziZl<!ofMOfvl<!fqx<jgbiZl<!

!Gk<kqv!uqkk<kqeiZr<!ogil<heii<!lVf<kQm<miZl<!

!Sk<kqbqz<!ziOk!ogi{<m!nUuqk!Okiuqk<kiZl<!

!hqk<kOl!hqvOgihqk<Kh<!ohVf<Kbi<!osb<Br<giO{”!!

! ! ! ! ! .!Dhanvandhiri vaidhyamm

According to this verse, the aetiological factors which cause pitha

diseases ae sleeplessness standing, for a long time in a place, and consuming

drugs which contain unpurified raw drugs.

PATHOLOGY (Mukkutra Verupaadugal)

“dx<xOkii<!dmzqe<!%X!

! dXh<Hme<!uqvuq!fqe<X!

! Lx<Xl<l!Ofib<gt<!wz<zil<!

! LgzkqeqOz!Okie<Xl<!OhiK!!

! hx<XOl!uikhqk<kl<!

!! sqOzx<hef<kef<ke<eqz<!ye<jxh<!

! hx<xqOb!Okie<X!ole<X”!

! !! ! ! ! .Agathiyar Gurunaadi

In Siddha sysem of medicine, disease have been classified in the basis

of mukkutram. Vatha pitham Noi is one of the pitha dominent disease. In

this disease the azhal kutram is elevatd from its normal plane. The elevation

of pitha from its normal unit and therby increase the heat of the body, Then

the normal function of Dhasavayu have been affected. Due to increased

azhal and the elevated function of vayu the disease arise. Though the prime

causative factor is azhal kutram, the other two humour vatha and kaba are

also affected simultaneiously. Because of that only the disease is classfied on

the basis of 3 dhosas.

The three thosa theory has a strong hold on the study of Guna.

1. Sattuva

It is the illuminating pure and good quality.

2. Rajo

It is the quality of mobility of activity. It makes a person active and

energetic tense and willful.

3. Thamo

It is the dark and restraining quality.

Of these three gunas the Rajo Guna is of pitha type. A man in whom

Rajo Guna predominates has inner thrist and affectionate.

As he is passionate and covetous, he hurts others. He is unsteady,

fickle, easily distracted as well as ambition and acuisitive, He shrinks from

unpleasant things and clings to plasant ones. His speech is sour and his

stomach greedy. These are the normal qualities are Roja Guna individuals.

All the human beings are affected by these Guna factor. Unless the bad

qualities of Gunas are controlled disease like Vatha Pitham Noi will occur

due to humoral changes in the body as a stress factor.

Naadi Pathology:

!!!!“ohiVtie!uikk<kqz<!hqk<kR<!Osi<f<K!

! ! ohiVf<K!G{r<gtiL]<{uiB!sk<kq!

! osiqbijl!Htqk<Okh<hl<!ohiVlz<!fQiqx<!

! ! squh<H!lzl<hqck<kZVf<!kiK!fm<ml<!

! gVuie!OkglkqZjts<sz<!Osil<hz<!

! ! jg!giz<!kxqh<H!fig<gsg<G!le<el<!

! hiquie!U,{<!Gjxkz<!Vsq!Ogmikz<!

! ! hz!OfiBl<!uVk<kq!jug<Gl<!hir<GkiOe”!

! ! ! ! ! ! .!skgfic/!

!!!!“dXkqBt<t!hqk<klK!Okie<xqz<!ouh<H!

! ! d]<{uiBux<xq!Svlkq!sivr<gt<!

! lxkqBme<!gqXgqXh<H!hbqk<kqb!Ovigl<!

! ! uti<!OsijgbpoziqU!gif<kz<!jgh<H!

! -Vkbk<kqz<!gzg<glK!lxh<H!kigl<!

! ! wPr<gtU!Olb!jeU!lbg<g!&Is<js!

! sqxqK!ohVl<hiM!vk<kl<!hqvOlgr<gt<!

! ! Osi<f<K!lqG!hq{q!hzUR<!sqxg<Gf<kiOe”!

! ! ! ! ! ! .!skgfic!

! !

!!!!“hqk<kk<kqz<!hqk<kligqz<!hqkx<xqMr<!gqXgqXg<Gl<!

! sk<kqBlkqgliGR<!siQvk<kqjeh<!H{<miGl<!

nk<kqbiBzVOleq!bigLl<!OuxkiGl</!

ux<xqOb!ouTk<Kg<!gibl<!ux{<M!hqe<!uQg<gL{<mil<”!

! ! ! ! .!ngk<kqbi<!fic

In Vatham, Pranan, Abanan, Viyanan, Uthanan, Samanan, Nagan,

Kirukaran and Devathathan are affected.

Altered Pranan causes dyspnoea.

Altered Abanan causes oliguria, constipation.

Altered Viyanan causes malaise, neuralgic pain, fatigue.

Altered Uthanan causes nausea, vomitting.

Altered Samanan causes loss of appetite, taste disturbances.

Altered Koorman causes altererd sensorium, horipliatation,

blurring of vision.

Altered Kirukaran causes cough, sneezing.

Altered Devathathan causes malaise, fatigue, sleeplessness, anxiety.

In Pitham

Altered Analam causes loss of appetite.

Altered Ranjagam causes pallor of nailbed, conjuctiva and

reduced Hb.

Altered Sathagam causes mental confusion, difficulty in

concentration.

Altered Alosagam causes difficulty in differentiating colour,

blurring of vision.

Altered prasagam causes pallor of skin.

In Kabam

Altered Avalambagam causes derangement of other kabas

Altered Kiletham causes loss of appetite

Altered Santhigam causes joint pain

Complication of Vatha Pitham

According to “Agasthiyar Gunavagadam”

“ Ogtmi!-Vkbk<kqz<!Kch<!H{<miGl<!

! ! ogcbie!&s<SLm<mz<!Okie<X!lh<hi!

! fQtmi!Ouglib<!fmg<g!ouim<mi!

! ! fqslie!-mKhg<g!-vk<ki!sbk<kqz<!

! uitmi!OukjeBl<!d{i<s<sq!Ge<xq!

! ! utlie!sqvsqeqz<kie<!uzqBl<!gim<Ml<!

! Oktmi!ncg<gckie<!lbg<gl<!d{<mil<!

! ! oktquie!-Vkbk<kqz<!giK!juk<Kg<!OgOt/!

! giKjuk<Kg<!Ogm<mig<giz<!-Vk!bk<kqe<!

! ! gelie!sk<kr<gt<!Ogm<c!miK!

! fqkqbib<g<!jgjbjuk<Kh<!hiIk<ki!bieiz<!

! ! fqs<sblib<!-Vkbk<kqe<!Kch<H!nh<Ohi!

! Oukjebib<h<!hzlig!ncg<Gl<!hiV!

! ! ouGK~vl<!hvuqbK!uqjvuib<h<!OhiGl<!

! Osikqk<k!sqgqs<jsjbfie<!osiz<Oue<!hiV!

! ! Sglig<g!ujgbxqbs<!osiz<Oue<!hiOv”!

! ! ! ! ! ! ! .!Agathiyar Gunavagadam!!

� Palpitation.

� Breathlessness.

� Difficulty in walking.

� Pain in the left sided chest.

� Head ache.

� Fainting

� Muffled heart-sounds on auscultation.

� Heaving apical impulse on palpation.

!

According to Pararasa Sekaram,! !

hqk<klkqgiqk<kziz<!hqxg<Gl<!OuX!Ofib<gt<!

!! “hqk<kOl!bkqg!iqk<kix<!ohVk<kqMr<!gsLr<!gisl<!

!! !! olk<kOu!uQg<gf<!Okie<X!lqGk<kqM!Lzi<f<K!S,jz!

!! yk<kOki!fqvk<k!Ge<l!Olicb!Gmz<ui!kr<gt<!

!!!!!!! wb<k<kqM!osr<g{<!liiq!bqe<eL!lOeg!Ofib<gt</”

� Pulmonary disease.

� Oedema.

� Peripheral neuritis.

� Persistent gastric ulcer.

DIFFERENTIAL DIAGNOSIS:

sQkhqk<kl<!

! ue<jlbi!Bml<ohr<Gl<!ucBf<!k{<{QI!

! ! lbg<gli!!Bmz<gek<Kh<!hivliGl<!

! H{<jlbib<h<!hqmiqkeq?!zqsqU{<!hiGl<!

! ! ohiVlqOb!ubqXh<!hqsf<kieiGl<!

! kq{<jlbi!Bmz<gek<Ks<!osig<G!OhiziR<!

! ! sQxqOb!lqg!uqVlqs<!sqf<jk!OgmiR<!

! os{<jlbib<!uib<fQIkie<!dh<H!jxg<Gf<!

! ! sqXfQVR<!sqgh<hiGf<!sQkhqk<kl<!

! ! ! ! ! ! ! )B,gq!sqf<kil{q*!

! dmzqz<!uqbi<juk<!k{<{QI!lqGkqbigg<!ogim<Ml<!lbg<gl<?!dmz<!

gek<kz<?! hTuibqVk<kz<?! Hxr<gPk<kqz<! -sqU?! ubqX! ohiVlq!Dkz<?!

hzlq<e<jl?! -Vlz<?! ofR<S! H{<{ikz<! Lkzqb! GxqG{r<gjt!

gim<MuOkiM?! uib<fQI! dh<Hgiqk<kz<?! sqXfQI! squf<K! -pqkzigqb!

GxqG{r<gjtBl<!d{<mig<Gl</!

According to Yugi Vaidhya Chinthamani - 800 the clinical features

of seetha pitham are

� Excess sweating.

� Giddiness

� Pain in the neck.

� Abdominal distention.

� Tiredness.

� Cough.

� Redness of urine.

Eventhough, the symptoms of seetha pitham are related to vatha

pitham. Cough, redness of urine, pain in the neck are not present in vatha

pitham.

According to Theraiyar Vagadam, Thalaichuzhal Pitham belongs

to Pitha disease.

kjzs<$pz<!hqk<kl<;!

“npz<!hqk<k!Lml<!ohz<zi!lezib<!uQSl<!nkqglkib<!kigL!!!

lqgU{<miGl<!

!!Spz<!hqk<kl<!fmg<jgbqOz!gqX!gqXoue<X!!

!!Sx<xquqPg<!gim<Mole!lVuXg<Gl<”!

. Okjvbi<!uigml</!himz<!w{<!37:/!)h/w{<;87*!

The above symptoms are after the complications of diabetes mellitus

i.e. diabetic neuropathy.

According to Yugi muni, Uraktha pitham belongs to pitha diseases,

“&Ig<glir<!OgihlK!lqgU{<!miG!

! ! Ljebig!ucgcg<Gs<!s{<jm!ogit<Tl<!

! NIg<glibg<!%uqOb!uqjvs<s!ziG!

! ! likie!hikitl<!Ohkq!biGl<!

! fiIg<glib<!fe<jlKe<jl!Okie<xi!lx<xie<!

! ! fzg<glig!g{<squg<Gf<!K~g<g!lqz<jz! !

! DIg<gli!Bmp<K~!zqg<G!Lh<H!

! ! Lvk<khqk<k!uikk<kq!Z{<jl!kiOe”!

! ! ! ! ! ! ! .!B,gq!juk<kqb!sqf<kil{q!

� Frequent angerness.

� Aggressive behaviour.

� Speaking in high-pitched voice.

� Frequent diarrhoea.

� Inability to differentiate good- things

� Redness of the eyes.

� Insomnia.

� Obesity.

The same features are mentioned under Uraktha pitham in

Sarabendra Vaidhya Muraigal also which more or less correlate with

hypertension.

“kjzuzq!Spx<sq!uqpqgt<!lbr<gz<!

! utqLkz<!&e<Xl<!lQxq!fqx<xz<!

! fvl<Hgt<!okxqk<kz<!lbg<gf<!Okie<xz<!

! dml<hqjtk<!kqMkz<!dvepqf<!kqMkz<!

! GjzOfi!BXkz<!GVkq!osxqkz<!

! gVg<gt<!hqxU!olzqf<K!kti<kz<!

! GVkq!ogikqh<hqe<!lVuqM!ole<h”!

Frequent diarrhoea, Insomnia, Obesity are not present in vatha pitham.

Piniyari muraimai (Diagnosis)

Diagnosis is the very important thing for a physician by which he

deals the disease by finding its cause and is helpful to undertake a correct

line of treatemnt and also prognosis. The diagnosis is based on

� Poriyalarithal (Inspection).

� Pulanalarithal (Palpation).

� Vinathal (Interrogation) and

� Envagai thervugal.

1. Poriyal arithal

Porigal are the five organs of perception. They are nose, tongue, eyes,

skin and ears.

Poriyalarithal is examining the pori of the patient by pori of the

physician.

2. Pulanal arithal

Pulangal are the five object of senses namely smell, taste, sight,

sensation and sound.

3. Vinathal (Interrogation):

By vinathal, the physician knows about the patient’s name, age,

occupation, native place (thinai), family history, socio economic status,

dietary habits, complaints, history of past illness, relevant history of

treatment and habits etc.,

Envagai thervugal:

It is the basis diagnostic principle and the unique speciality of the

siddha system of medicine. The following verse’s reveals this as follows

“fich<hiqsl<!fi!fqxl<!olipq!uqpq!

!lzl<!&k<kqvlqju!lVk<KuviBkl<” ! ! .!Okjvbi<!

Envagai thervugal are

� Naadi (pulse).

� Sparisam (palpation).

� Naa (tongue).

� Niram (colour of the skin).

� Mozhi (speech).

� Vizhi (eyes).

� Malam (motion).

� Moothiram (urine).

Envagai thervugal gives a definite idea to diagnose Vatha pitham. This

is explained as follows.

1.Naadi

In the Noi Nadal Noi Mudhal Nadal text it is defined as follows,

dmzqz<!dbqi<!kiqk<kqVh<hkx<Gg<!giv{lie!sQu!sg<kq!wKOui!

! nKOu!kiK!nz<zK!fic!weh<hMl<!

Genesis of Naadi:

The three thathukkal are formed by the combination of three naadies

with three vayus.

Idakalai + Abanan = Vatham

Pinkalai + Piranan = Pitham

Suzhumunai + Samanan = Kabham

These can be felt one inch above the wrist on the radial side by means

of palpation with the tips of index, middle and ring finger corresponding to

vatham, pitham and kabham respectively

!!!!“giqLgecjb!uip<k<kqg<!jgkeqz<fic!hii<g<gqz<!

! ohVuqvzr<Gzkk<qz<!hqck<kc!fMOu!okim<miz<!

! yV!uqvOzicz<!uikLbi<!fMuqvzqx<!hqk<kl<!!

! kqVuqvz<!&e<xqOzicz<!Osk<Kl!fickiOe”!

!! ! ! ! ! ! ! .! juk<kqbsivsr<gqvgl<!

According to Thirumoolar’s Naadi Nool

“kiKLjxOgt<!keqk<!kGkqs<!sf<OkiM!

! YKXgilqb!Lf<kq!ofMlii<H!

! giK!OfM&g<Gg<!g{<ml<!gvl<HVul<!

! OhiKXLs<sqHgp<!hk<Kl<!hii<k<kqOm”!

� Inner aspect of the ankle joint.

� Genital organs.

� Abdomen.

� Thorax.

� Ear.

� Nose.

� Neck.

� Hands.

� Eye-brows.

� Vertex are the sites for pulse reading.

Among them, the pulses read from hands are considered to be the best

for diagnosing diseases.

2. Sparisam (palpation) :

By sparisam, the temperature of skin (heat or cold), smoothness, sweat,

dryness, hard patches, swelling, abnormal growth, tenderness, ulcers,

enlargements, nourishment can be noted.

3.Naa (Tongue) :

In the examination of tongue, it's colour, coating, dryness, deviation and

movement, variations in taste and the conditions of teeth and gums can be

noted.

4. Niram (colour) :

By examining the niram, the type of udal (body) whether vatham (black),

pitham (red or yellow) and kabam (white) or mixed, cyanosis and pallor of

the body can be noted.

5. Mozhi (speech or voice) :

In the examination of mozhi, high or low pitched voice, slurring and

incoherant speech, nasal or crying, hoarseness of voice can be noted .

6. Vizhi (Eye) :

In the examination of vizhi, the change in the colour of the eye such as

redness, yellowishness, pallor etc may be noted. With these dryness,

lacrimation, sharpness of vision, response of the pupil, falling of hair in eye-

lashes, inflammations and ulcerations may also be noted.

7. Malam (stools) :

In the examination of malam, it's nature (whether it is solid, semisolid

or liquid), its colour, it's quantity (increased or decreased) can be noted.

Other examinations like diarrhoea, presence of blood, mucus, undigested

matter in the stools and odour should be studied .

8. Moothiram (urine) :-

In the examination of urine, the colour, odour, quantity of urine, the

presence of froath, deposits, blood, pus, small stones, abnormal constituents

such as sugar, proteins etc and the frequency of urination can be noted.

Neerkuri and Neikuri are the two methods used to diagnose the

disease. They are discussed below.

Neerkuri :

According to this verse, the general features of urine, i.e niram, edai,

manam, nurai and enjal are analysed.

� Niram indicates the colour of the urine voided.

� Edai indicates the specific gravity of the urine voided

� Manam indicates the smell of the urine voided.

� Nurai indicates the frothy nature of the urine voided.

� Enjal indicates the quantity (increased or decreased) of the urine

voided.

Neikuri :

For this examination, urine is collected in the early morning in a pure

glass vessel. The patient should be prepared specially for this before a day in

a manner of not taking excessive diet in irregular timing etc.

A drop of gingelly oil is dropped on a wide vessel containing the

urine to be tested and placed in the sunlight in a calm place. The

derangement of the three thathuvas and the disease can be diagnosed by

the behaviour of gingelly oil on the surface of the urine.

Seven Udal kattugal:

1. Saram :

This is the product which assimilate in the digestive process- It

strengthens the body and mind.

2. Senneer :

The rasam after absorption is converted into senneer. It is responsible

for knowledge, strength, boldness and healthy complexion.

3. Oon :

It gives a structure to the body and is responsible for the movement of

the body.

4. Kozhuppu :

When the organs of the body do their works this. Thathu helps for

lubrication and facilitates their functions.

5. Enbu :

It gives shape to the body and is responsible for protection of vital

organs.

6. Moolai :

It is present in the core of the bone which strengthens and maintains

the normal condition of the bones.

7. Sukkilam/Suronitham:

It is responsible for reproduction.

When the seven udal thathukkal increases or decreases from the

normal level, the normal functioning of the body is affected.

Thingal or nilam

Thinai or Nilam is classified into five types

They are

� Kurinji - Mountain and its surroundings

� Mullai - Forest and its surroundings

� Marutham - Field and its surroundings

� Neithal - Sea and its surroundings

� Paalai - Desert and its surroundings

1. Kurinji

“GxqR<sq!uV!fqzk<kqx<!ogix<xL{<c!vk<kl<!

dxqr<sq!uV!SvL!L{<mil<!.!!nxqRjvg<!!

jgbOl!kr<Gk!vk<kijl!uz<jz!Br<gkqg<Gl<!

JbOl!kr<G!lxq”!

- Pathartha guna chinthamani

According to this verse, in Kurinji, kabha diseases, fever which cause

anaemia tumour in stomach (Aamai katti) are common.

2. Mullai

!!!!“Lz<jz!fqzk<kjlb!Lf<fqjv!OluqElu<!

ouz<jz!fqjzk<k!hqk<k!olb<Kxr<gi{<!.!nz<zoueqe<!

uikolipq!bikkE{<!le<E!lju!upqOfib<h<!!

Ohkolipq!bikjxbh<!hqe<H”!

- Pathartha guna chinthamani

According to this verse, in Mullai, pitha diseases, liver diseases and

vatha diseases commonly occur.

3. Marutham

“lVkfqz!fe<eQi<!utolie<jxg<!ogi{<Om!

! ohiV!kfqz!likqbOfib<!Ohig<Gr<!!.!gVkfqzk<!

! kixqmkR<!S,p!uVf<Kuove<!xix<!hq{qobz<!

! WxqvkR<!S,p<uqg<G!lqz<”!!

- Pathartha guna chinthamani

According to this verse, in Marutham, Vatha, Pitham and Kabha

diseases all get cured. It is the best place to live.

4. Neithal

“ofb<keqz!OlZui<h<jh!fQr<gi!KxqElK!!

! oub<keqz!Olkr<G!uQmiGl<!.!ofib<kQe<!

! lVr<G!mjz!Lg<gig<gq!uz<ZXh<jh!uQg<Gr<!

! gV!r<Gmjzg<!gQpqxg<Gr<!gi{<”!!

According to this verse, in Neithal, pitha vayu, filariasis and Hernia

occur commonly.

5. Paalai

“ hijz!fqzl<Ohix<!hmjvh<!hqxh<hqg<g!

! Oljzfqz!lQbiK!uqiqk<kx<G!.!!Oujzfqz!

! Lh<hq{qg<G!lqz<zil<!LjxOb!bux<xzil<!

wh<hq{qg<G!!lqz<zi!lg<oke<”!!

According to this verse, in paalai, vatham, pithtam and kabham get

deranged and lead to various diseases.

GxqR<sq!fqzOl!uiklir<!gi[l<!hijz!hqk<kliR<!

! osxqf<k!lVkR<!sqOzk<llir<!sqOzk<luik!Lz<jzbkil<!

! fqjxf<k!ofb<kz<!uikhqk<kl<!fqzr<gtkje!lbg<gi!

! Zjxf<k!uqbikq!gzf<kqVg<G!Lhiblxqf<K!osb<uQOv!

- Padhinen Siddhar naadi saasthiram

According to this verse, the diseases that develop in each land in as

follows

Kuringi - Vatha diseases

Mullai - Kabha vatha diseases

Marutham - Kabha diseases

Neithal - Vatha pitha disease

Palali - Pitha diseases

Paruva Kaalangal

A year is classified into six seasons eachy consitutes two months ,

they are

Season Months Kaarkaalam Aavani and Purattasi

Koodhir kaalam Iyppasi and Kaarththigai Munpani Kaalam Maargazhi and thai Pin pani kaalam Maasi and panguni Elavenir Kaalam Chiththirai and Vaigaasi

Muthu venir kaalam Aani and Aadi

Udal Vanmai

It means the strength and vitality of the body and is classified into

three types

1. Iyrarkai vanmai

It is formed naturally from mukkunam. These are sathuva, rajotha and

thamo gunaas.

2. Kaala vanmai

It is due to year (Age) and the paruva kalangal.

3. Seyarkai vanmai

It secure the body which is formed through the mukkunam by proper

day to day diet according to that ‘gunam’ and by drug intake without

disturbing the vitality of the body.

Prognosis:

If the patient had good B.P control, then the prognosis will be a good

one. But if the level of blood pressure is fluctuated it will end in lots of

complication.

Line of treatment:

In siddha system, the treatment is based on the deranged three doshas.

“uqOvsek<kiz<!uikf<kiPl<!

! ! ulek<kiz<!hqk<kl<!kiPl<!

! ! fsqb!nR<sek<kiz<!ghl<!kiPl<” /!

! Pitha disease can be brought down by “vamanam” with the emetic

drugs. This emetic drugs are given according to the disease and patient’s

tolerance to drug.

The line of treatment of Vatha Pitham noi is as follows:

1. Internal medicines - To bring down the vitiated Pitham

2. Diet - To maintain Tridoshas.

3. Yoga therapy - To maintain Dhasavayukal and to improve

mental and body health

4. Prevention methods - To relieve anxiety and stress.

Administration of internal medicines to normalize pitham:

For the treatment of Vatha Pitham noi, several remedies are suggested

in ancient siddha literatures. Among these remedies,

Iruveli Kiyalam – 90ml B.D was given before meals.

2. DIET:

Siddhars advice the diet regimen for pitha patients and they are

explained below:

Diet to be added:

� -VLjx!uck<k!OsiX!)Double boiled rice).

� gR<sq)Rice water).

� nk<kqh<hqR<S)Ficus glomavata)

� nujvh<hqR<S)Dolichos lab-lab)

� l{k<kg<gitq!gQjv!)Solanum rubrum)

� ohie<eir<gi{q!)Alternanthera sessilis)

� sqXgQjv!(Amaranthus gangeticus)

� hsjzg<gQjv!)Portulaca quadrifolia)

� Htqbijv!)Oxalis korniculatus).

� Sg<gie<gQjv!(Rumex vesicarius).

Diet restriction :

Siddhars advice to avoid sour, salty and pungent food for Vatha

Pitham noi. Nowadays all the patient were advised to take low sodium diet

(less than 5mg per day) and to take low fatty diet (especially oils containing

mono-unsaturated fatty acids (MUFA).

Yoga therapy:

Yogasanam is one of the part of Astanga Yogam. It controls mind and

body by various mechanisms. So it has been applied to control various

stress-related diseases nowadays as an adjuvant therapy.

Mechanism:

Every asanas require the spine to be kept erect and to keep riched

blood supply to the pelvic region. This stimulates kundalini, which controls

the mind and body.

In modern study, it seems to stimulation of psycho-neuro hormonal

axis which controls the sympathetic overactivity. This in turn eliminates free

radicals, catecholamines and secrets endorphins and encephalins which is a

natural steroidal hormone which helps to maintain the body and mind active

and releive the stress.

Asanas beneficial in hypertension:

� Padmasanam

� Pranayamam

� Vajrasanam

� Savasanam.

Relaxation Therapy:

It is particularly useful for anxiety disorders, psychosomatic disorders

(e.g hypertension) and in other conditions where anxiety is associated (e.g.

smoking, sexual disturbances, sleeplessness). It is usually done in a calm

room with a relaxed mind in the lying down posture with palms facing

upwards for about 15 to 20 minutes twice daily. The underlying principle is

the counterproductive nature of relaxation towards anxiety. So the cycle

(anxiety leading to muscle tension which in turn aggravates anxiety) is

broken by this approach.

In schulz method, relaxation is done through concentration on certain

thoughts by autogenous training. In the commonly used Jacobson’s method,

the client is taught to relax one group of muscles at a particular time (by

alternate contraction and relaxation) which progresses slowly from head to

foot until the whole body is relaxed.

The person also knows the adverse, effect of muscle contraction. For

example, the relaxation of head muscles will often correct tension headache.

So it is a simple and highly useful technique.

Transcendental Meditation:

It is an unusual state of consciousness taking qualities of both sleep

and wakefulness with a profound state of rest. It decreases the oxygen

consumption, heart rate, respiratory rate and sympathetic overactivity. So it

reduces tension and anxiety. It improves interpersonal relationships and

concentration power.

There are number of meditative processes like attending to a mental

repetation of a sound or mantra etc.

In our programme, the patient was asked to repeat a word (as he likes)

silently for about 20 minutes twice daily in a relaxed, calm, comfortable

position with eyes closed, It removes the inner conflicts, anxiety and mental

stress very effectively. So a sense of well-being and mental relaxation with

good sleep was observed in patients who do this mediation regularly.

Prevention:

� Relieving the tension or the stress and stain of life by reducing

unnecessary burden and responsibilities.

� Transforming the attitudes and belief systems so as to reduce

anxiety and excitement.

� Good sleep.

� Low sodium chloride intake (less than 5gm per day).

� Totally avoiding intake of tabacco.

� Stopping alcohol consumption or reducing it considerable.

� Overcoming obesity.

� Avoiding constipation.

� Light regular exercise (avoid undue physical strain and exertion).

� Practice of relaxation and positive thinking.

Modern Aspect

MODERN ASPECTS

BLOOD PRESSURE

Anatomy of Hypertension:

The effects of hypertension are widespread no organ in the body is

spared.

In the heart, there is gradual concentric hypertrophy of the left

ventricle.

Degenerative lesions develop in both the heart and arteries and lead to

the lethal consequences, of hypertension. The coronary arteries develop

atheromatous lesions which aggregate the development of Ischaemic heart

disease or even frank myocardial Infarction.

Hypertension is an important risk factor for the development of

aneurysm of aorta especially dissecting aneurysm of aorta

Arterioles called as the resistant vessels of the bdoy. So deposition of

a hyaline material, thickness of the vessel wall, medial and intimal

hypertrophy, reduplication of elastical lamina and intimal proliferation.

Hypertension is implicated in the aneurysmal dilatation of small

arteries in the brain (CHARCOT BOUCHARD ANEURYSM) which

precipitate haemorrhagic stroke)

History of Blood pressure:

The first determination of arterial Blood Pressure was done in 1733 by

Rev Stephen Hales by inserting brass cannula into the central end of the

femoral artery of a horse.

Definition:

Blood pressure means the lateral force exerted by the blood column

against any unit area of the vessel wall which is expressed in mm of Hg.

It is expressed as systolic and diastolic pressure.Palpatory method of BP

recording is always precede the auscultatory method.

Systolic blood pressure:

It is defined as the maximal pressure exerted during systole. The

normal range is 89 – 100 mm Hg.

Significance:

It reflects the distensibility characteristic of the arterial system as it

receives blood from the left ventricle. It can be altered by the stress and

strain of day-to-day life.

Diastolic blood pressure:

It is defined as the minimum pressure exerted during diastole. The

normal range is 70 – 89 mm Hg.

Blood Pressure must be recorded in lying, sitting and standing

positions especially when postural hypotension is suspected. When there is

fall in systolic pressure of > 20mm Hg after standing for 3 minutes from

lying posture the patient is said to have postural hypotension.

Significance :

It represents the state of the peripheral vessels and determines the

filling of the coronary vessels.

Pulse pressure :

It is defined as the difference between systolic and diastolic pressure.

Normal range = 30 – 60mmHg

Significance :

It is caused by the ejection of blood into the aorta during systole.

A rise in systolic or fall in diastolic will increase the pulse pressure.

Mean arterial pressure :

It is the product of cardiac output and total peripheral resistance.

MAP = Diastolic blood pressure + 1/3 of pulse pressure

Normal -100mm Hg.

Significance :

It determines the tissue perfusion pressure.

To confirm the presence of hypertension, multi Blood Pressure

recordings should be taken with a mercurial mmetre on several occasions.

Home monitoring, ambulatory monitoring are preferable.

Classification of Hypertension

(The seventh report of the joint national committee on preventic detection,

evaluation and treatment of high blood pressure)

Category Systolic pressure Diastolic pressure

Normal <120 mmHg <80 mmHg

Pre – hypertension 120 – 139 mmHg 80 – 89 mmHg

Hypertension

a) Stage 1 140 – 159 mmHg 90 – 99 mmHg

b) Stage 2 > 160 mmHg > 100 mmHg

Definition and classification of blood pressure levels (WHO)

Category Systolic pressure Diastolic pressure

Optimal <120 mmHg <80 mmHg

Normal <130 mmHg < 85 mmHg

High Normal 130 – 139 mmHg 85 – 89 mmHg

ANOTHER CLASSIFICATION

Category Systolic pressure Diastolic pressure

Grade / Stage I / Mild 140 – 159 mmHg 90 – 99 mmHg

Grade / Stage II / Moderate

160 – 179 mmHg 100 – 109 mmHg

Grade / Stage III / Severe

≥ 180 mmHg ≥ 110 mmHg

When the diastolic pressure is below 90 mm Hg, a

� Systolic pressure below 140 mm Hg indicates normal blood

pressure

� between 140-149 mm Hg indicates borderline isolated systolic

hypertension

� 140 mm Hg or higher indicates isolated systolic hypertension.

When there is an elevation of systolic pressure > 30 mm Hg and a

diastolic pressure of > 20 mmHg from the basal original level, it indicates

presence of hypertension.

Factors maintaining arterial blood pressure:

� Cardiac output.

� Peripheral resistance.

� Elasticity of arterial walls.

� Blood volume.

� Capacity of vascular bed.

CARDIAC CYCLE

Among these, cardiac output and peripheral resistance are considered

to be more important . So blood pressure is the product of cardiac output

and peripheral resistance.

B.P = CO * PR

Cardiac output :

It depends upon venous return, blood volume, heart rate and force of

heart beat. If cardiac output increases it rises, Blood Pressure and if it

decreases, it reduces Blood Pressure.

As per Frank sterlings law, force of contraction of heart is directly

proportional to initial length of muscle fibres.

Peripheral resistance :

The peripheral resistance depends on viscosity of blood, size of the

lumen of the blood vessel and viscosity of blood flow.

If the peripheral resistance is increased due to high viscosity and

reduced blood vessel size, the blood pressure rises.

Venous return:

If venous return is more, increased in ventricular filling and cardiac

output, results in increased Blood Pressure.

Elasticity of the arterial walls :

The elastic recoil is responsible for the maintenance of peripheral

resistance. It is mainly concerned with the origin and maintenance of

diastolic pressure.

Blood volume :

Increase in blood volume increases both systolic and diastolic

pressures. It maintains Blood Pressure through venous return and cardiac

output.

Capacity of the vascular Bed :

When the arterioles and capillaries dilate, it increases the capacity of

vascular bed and it decreases B.P and vice-versa.

Regulation of B.P :

The regulation of blood pressure is necessary for the proper blood

supply to various organs according to the needs.

The regulation of B.P is controlled by four important mechanisms.

They are

1. Nervous mechanism.

2. Renal mechanism.

3. Endocrine mechanism.

4. Capillary fluid shift mechanism.

Nervous mechanism :

It rapidly re adjust the B.P in a few seconds. These are useful during

exercise, emotional states and change in posture. The desired effects are

due to

� Pressoreceptor sino aortic mechanism.

� Increased sympathetic activity and

� Central nervous system ischaemic response.

a. Sino aortic mechanism :

This mechanism works through the baroreceptor or pressoreceptor

mechanism. These receptors are spray-type nerve endings that lie in the

walls of the large arteries especially in the walls of the internal carotid artery,

carotid sinus and the wall of the aortic arch.

If these receptors stretches due to rise in pressure, it transmits signals

into the central nervous system, and “feedback” signals are then sent back

through the autonomic nervous system to reduce blood pressure normally.

Baroreceptors are not stimulated by pressures between

0 and 60mmHg. But above 60mm Hg they respond progressively more

rapidly and reach a maximum at about 180 mm Hg.

In Chronic hypertension, the baroreceptor reflex mechanism is ‘reset’

to maintain the high rather than a normal blood pressure.

b. Increased sympathetic activity :

This mechanism mainly works through adrenergic receptors namely α

and β receptors. These are present in post ganglionic sympathetic nerve

endings.

A receptors are further classified into α1 and α2. α1 receptors

present in the vascular smooth muscle leads to constriction. α2 receptors are

present in the human leucocytes and platelets and it helps to release renin

from the kidney.

Receptors are further classified into β1 and β2. β1 receptors present

in the heart, increases the force and rate of contraction. β2 receptor present

in the bronchus leads to relaxation of bronchus.

c. Ischaemic response of the C.N.S :

Ischaemic leads to sensitisation of vasomotor centre. When B.P falls

very low below 90mm, the Vaso Motor Centre produces vasocontriction of

vessels throughout the body. Thereby the B.P will be raised.

2. Renal Mechanism :

Kidneys regulate blood pressure various mechanisms. The important are

� Extracellular Fluid Volume theory.

� Salt retention theory.

� Renin Angiotensin theory and Renin Angiotensin-aldosterone theory.

� ECF volume Theory

b. Salt Retention Theory :

Increased salt intake

↓

Increased extra cellular volume

↓

Increased arterial pressure.

The hormones concerned in the regulation of B.P are

� Catecholamines, adrenaline and nor-adrenaline.

� Aldosterone

� Vasopressin

a. Catecholamines, adrenaline and nor-adrenaline :

These are excessively secreted during stress and strain which in turn

leads to stimulation of adrenergic receptors. It leads to increased Blood

Pressure.

b. Aldosterone :

It regulates the sodium content of ECF and ECF volume which in turn

influence Blood Pressure.

c. Vasopressin :

It promotes the retention of water.

4. The capillary fluid shift mechanism :

If the capillary hydrostatic pressure is increased, Blood Pressure is

rised and vice versa.

MEASUREMENT OF BLOOD PRESSURE :

Shortly after Riva-Rocci had invented the sphymomanometer, the

Russian surgeon Korotkoff suggested that by placing a stethoscope over the

brachial artery at the antecubital fossa distal to the Riva-Rocci cuff, sounds

could be heard. The origin of these sounds is still not clear. Vibratory and

flow phenomenon are probably responsible.

The phases are

Phase I :

The first appearance of faint clear tapping sounds (Thuds) which

gradually increase in intensity represents the systolic Blood Pressure.

Phase II :

The softening of the sounds, which may become swishing or blowing.

Phase III :

The return of sharper softer sounds, which become crisper, but never

fully regain the intensity of phase I sounds.

Neither phase II or phase III have any known clinical significance.

Phase IV :

Distinct abrubt muffling of sounds which become soft and blowing.

The fourth phase is 7 – 10mm Hg above the true diastolic pressure.

Phase V :

The point at which all sounds disappear completely.

Phase I is taken as systolic pressure and phase V as diastolic pressure.

For an adult, the standard cuff width is 12 cm.

Korotkoff Sounds

Korotkoff sounds should be examined preferably with bell of the

stethoscope. There are five phases of korotkoff sounds, i.e. the sounds

produced by the flow of blood as the constricting Blood Pressure cuff is

gradually released.

Diastolic pressure closely corresponds to phase V. However, in aortic

regurgitation, the disappearance point is extremely low, sometimes 0 mm Hg

and so phase IV is taken as diastolic Blood Pressure in adults as well as

children.

When Korotkoff sounds are not heard while recording Blood Pressure,

ask the patient to raise the cuffed upper limb and ask him to open and close

the fist of that hand repeatedly and then record the Blood Pressure.

The length of the bladder is approximately twice that of the width. The

average length of the rubber bag is 25 cm.

The air bag within the cuff should extend for at least 2/3rd of the arm

length and circumference.

The midportion of the rubber bag within the cuff should lie over the

brachial artery.

After inflation, the cuff should be deflated at a rate of 2-3 mm Hg per

second.

Auscultatory Gap

Occasionally, after the initial appearance of the Korotkoff sounds,

indicating the systolic pressure, the sounds disappear for sometime, to re-

appear again and finally disappear at the diastolic pressure.

This phenomenon of a silent gap is found in certain patients with

hypertension. It overestimates the diastolic pressure and underestimates the

systolic pressure thereby necessitating the palpatory method of Blood

Pressure recording to always precede the auscultatory method.

Auscultatory gap occurs when there is venous distension or reduced

velocity of arterial flow in the arm.

Various Cuff Sizes for Blood Pressure Measurement

Age in Years Width of the bladder of the cuff < 1 yr 2.5cm

1 – 5 yrs 5cm 6 -10 years 10cm

Normal adult 12.5cm Obese adult 14cm

Thigh 20 – 25 cm

Apparatus :

1. Mercury Sphygmomanometer:

Here the pressure changes are reflected by a rise of mercury. It is an

accurate method of taking Blood pressure. However, the instrument is bulky

and heavy.

2. Aneroid meter :

Here the pressure changes are reflected by a change in the needle

which is connected to the spring. Though the instrument is small and non-

bulky, it has to be frequency reset to ensure accuracy.

3. Electronic Blood Pressure meter :

Here the pressure changes are measured electronically. They are not

very accurate.

Technique :

1. Clothing should be removed from the arm. If it cannot be removed, it

is better to leave it as it is, rather than fold the clothing into tight

constricting bands.

2. The cuff should be encircled around the arm. If the bladder does not

encircle the arm completely, the centre of the bladder should be over

the brachial artery. The rubber tubes from the bladder are usually

placed inferiorly at the site of the brachial artery, but it would be better

to place it superiorly or posteriorly so that the antecubital fossa is

easily for auscultation.

3. The bell gives better sound reproduction but a diaphragm is easier to

secure with the finger of one’s hand and covers a large area.

4. To measure Blood Pressure in the legs a thigh cuff containing large

bladder (18*24 cms) for adults should be wrapped around the thigh of

the prone patient and the korotkoff sounds auscultated in the popliteal

fossa in the usual way. Blood Pressure in the legs is equal to that in

the arms provided the bladder is adequate in size.

5. For children, pediatric size cuff should be used.

Precautions :

1. Explain the procedure to the patient to allay anxiety.

2. Avoid exertion, meals or smoking for 30 minutes before Blood

Pressure is measured. The patient must be allowed to rest for 5

minutes before Blood Pressure is measured. He should not have

consumed coffee, tea for the preceding one hour or smoked for the

preceding 15 minutes. He should no bladder distension.

3. The room should be warm and quiet.

4. High Blood Pressure may be erroneously recorded in an obese person

because the inflatable rubber bladder may be too short for the obese

arm (recommended dimensions are 12 * 35 cms). When the bladder

does not completely encircle the arm the centre of the bladder must be

placed directly over the brachial artery.

5. The arm must be supported to the heart level. In the supine position

the arm is usually at the heart level. In sitting and standing positions

the arm must be horizontal with fourth intercostal space at the heart

level. Some antihypertensive agents cause postural hypotension and

when this is expected, Blood Pressure must be measured in both lying

and standing positions.

6. It is desirable to record the Blood Pressure in both the arms as the

differences in systolic pressure exceeding 10 mm Hg between the two

arms when measured simultaneously or in rapid sequence suggest

obstructive lesions of aorta, innominate or subclavian arteries.

7. In vertebrobasilar insufficiency, a difference in pressure between the

arms may signify that a subclavian steal is responsible for

cerebrovascular symptoms.

8. Normally systolic pressure in the legs is up to 20 mm Hg higher than

in the arms, but diastolic Blood Pressure is the same.When systolic

pressure in the popliteal artery exceeds that in brachial artery by > 20

mm Hg (Hill's sign), AR is usually present.

9. Measuring lower limb Blood Pressure is useful in detecting

coarctation of aorta or obstructive disease of the aorta or its immediate

branches..

10. The Blood Pressure may be higher in right arm by 2-10 mm Hg. Most

pressures in practice are measured on the right arm. However if the

Blood Pressure is higher by 10 mm Hg in one arm further

measurements should be made in that arm.

11. The cuff should be snugly fitted to the arm. A cuff which is too tight

may give a false lower blood pressure and a loose cuff may give a

false higher Blood Pressure.

12. Repeated inflation of the cuff may cause venous congestion of the

limb and elevate both systolic and diastolic Blood Pressure. To avoid

this the cuff should be inflated as rapidly as possible and deflated

completely between successive readings. At least 15 seconds should

be allowed between successive measurements.

Postural or Orthostatic Hypotension

Blood Pressure must be recorded in lying, sitting and standing

positions especially when postural hypotension is suspected.

When there is a fall in systolic pressure of > 20 mm Hg after standing

for 3 minutes, from the lying posture, the patient is said to have postural

hypotension

Causes

� Hypovolaemia (blood or fluid loss).

� Autonomic neuropathy (diabetes mellitus, old age).

� Drugs (ganglion blocking agents, centrally acting anti-hypertensives).

� Myocardial pump failure.

� Secondary hypertension (pheochromocytoma).

In atrial fibrillation, an average of three Blood Pressure recordings in

the same limb must be taken.

HYPERTENSION

An elevated arterial pressure is probably the most important public

health problem in developed countries, being common, asymptomatic,

readily detectable, usually easily treatable and often leading to lethal

complications if left untreated.

Definition :

Since there is no dividing line between normal and high blood

pressure, arbitrary levels have been established to define those who have an

increased risk of developing a morbid cardio-vascular event and / or will

clearly benefit from medical therapy. This definition should consider not

only the level of diastolic pressure but also systolic pressure, age, sex and

race.

Hypertension is thus not a disease or abnormality but if it

progresses it leads to end organ damages.

Incidence:

It is present in 10-15% of the individuals in the Indian population.

The prevalence of individuals prone to have hypertension are more in Asian

migrants especially Indians due to the presence of increased Lipo-protein (a)

in their blood.

Aetiology :

The causes of elevated arterial pressure is unknown in most cases.

The prevalence of various forms of secondary hypertension depends on the

nature of the population studied and how extensive the evaluation is. There

are no available data to define the frequency of secondary hypertension in

the general population.

Classification :

Arterial hypertension may be classified into

1. Primary or idiopathic or essential hypertension.

2. Secondary hypertension.

Essential hypertension :

Patients with arterial hypertension and with no definable cause are

said to have primary or essential or idiopathic hypertension. Moreover

individuals who may have generalised or functional abnormalities causing

the hypertension are defined as having essential hypertension.

Factors influencing the development of essential hypertension :

1. Genetic and Familial.

2. Socio – economic

3. Dietary factors :

• Obesity.

• High salt intake.

• High alcohol, caffeine.

4. Hormonal factors.

• High renin.

• Reduced nitric oxide etc.

5. Neurotransmitters

• Acetyl choline.

• Nor-adrenaline.

• Substance-p.

• Serotonin.

• Dopamine etc.

Factors modifying the course of essential hypertension :

• Age.

• Race.

• Sex.

• Smoking.

• Excessive salt intake.

• Serum Cholesterol.

• Glucose intolerance.

• Weight.

• Renin activity.

Aetiology :

Common causes of hypertension

� Essential or primary hypertension 94%

� Secondary hypertesion 6%

1. Renal 4%

2. Endocrine 1%

3. Misselaneous 1%

About 95% of the causes have no specific underlying causes. In most of

the cases, the causes are multifactorial.

Pathogenesis :

It is not clearly understood. However it is known that the underlying

defect is an increasing peripheral vascular resistance. This is due to an

increase in sympathetic nervous activity or a fundamental defect in the

vascular smooth muscle.

PATHOPHYSIOLOGY OF HYPERTENSION

Pathophysiology:

In larger arteries (> 1mm diameter) the internal elastic lamina is

thickened, smooth muscle hypertrophied, fibrous tissue deposited. So the

vessels dilate and become tortuous and their walls become less compliant.

Atheroma is perpetuated.

In smaller arteries (< 1 mm diameter) hyaline arterio-sclerosis occurs

in the wall, the lumen narrows and aneurysms may develop. These structural

changes lead to an increase in peripheral vascular resistances, a further rise

in blood pressure and acceleration of atheroma within the vessel walls.

Classification :

Essential hypertension may be classified into

I Clinically :

• Isolated systolic hypertension.

• Accelerated hypertension.

• Benign hypertension.

• Malignant hypertension.

• Hyper tensive urgency

• Hypertensive emergency

• White coat hypertesnion

• Pseudohypertension

• Transistent hypertension

• Episodic or Paroxysmal hypertension.

• Labile Hypertension

• Paradoxical Hypertension

1. Isolated Systolic Hypertension

This is said to be present when systolic blood pressure is > 140 mm

Hg and diastolic blood pressure is < 90 mr Hg. It is commonly seen in old

age (above 65 years).

2. Accelerated Hypertension

A Significant recent increase in blood pressure over previous

hypertensive levels, associated with evidence vascular damage on

fundoscopic examination, but without papilloedema.

3.Benign Hypertension

Hypertension remains fairly stable over many years. It is compatible

with long life.

4. Malignant Hypertension

A triad of blood pressure of > 200/140 mm Hg, grade retinopathy

(papilloedema) and renal dysfunction.

5. Hypertensive Urgency

This is a situation in which the Blood Pressure is markedly elevated,

but without any evidence of end organ damage. In this condition, the control

of the elevated Blood Pressure can be done gradually.

6. Hypertensive Emergency

This is a situation in which the Blood Pressure is markedly elevated,

but with evidence of some end organ damage. In this condition, the control

of the elevated Blood Pressure has to be done immediately in order to

prevent further end organ damage.

7. White Coat Hypertension

A transient increase in blood pressure in normal individuals, when

Blood Pressure is recorded in a physician's consulting room, or in a hospital.

8. Pseudohypertension

A false increase in blood pressure recording due to stiff and

noncompliant vessels (Osier's sign), occurring in old age. In these

individuals, actual intra-arterial Blood Pressure is lower than the Blood

Pressure measured by a sphygmomanometer.

9. Transient Hypertension

This may be seen in

• Acute cerebrovascular accidents

• Acute myocardial infarction

• Acute glomerulonephritis

• Pregnancy

• Acute intermittent porphyria.

It is systemic hypertension seen for a transient phase of the time when

the patient is under stress or when he is having a disorder with a transient

hypertensive phase, may occur in the above-mentioned conditions.

10. Episodic or Paroxysmal Hypertension

This seen in pheochromocytoma. However, a patient with

pheochromocytoma may be normotensive, hypotensive or hypertensive.

11. Labile Hypertension

Patients, who sometimes, but not always have arterial pressure within

the hypertensive range, are classified as having labile hypertension.

12. Paradoxical Hypertension

In this form of hypertension, patients paradoxically show an increase

in Blood Pressure, even when on antihypertensive drugs.

Examples

1. Patients with DM and HTN, on β blockers, on developing hypoglycaemia

show a paradoxical rise over previously well-controlled Blood Pressure.

This is because the excess adrenaline released secondary to hypo-

glycaemia, acts unopposed on the α1 receptors and thereby raises the

Blood Pressure.

2. With high doses of clonidine, the peripheral α 1 receptors are stimulated,

apart from its central action, thereby raising the Blood Pressure.

3. ln patients with bilateral renal artery stenosis,administration of ACE

inhibitors, results in a para doxical rise in Blood Pressure.

4. Administration of β blockers in patients with pheochromocytoma leads to

uninhibited α receptor stimulation by epinephrine leading to paradoxical

rise in Blood Pressure

II According to the severity :

• Mild hypertension.

• Moderate hypertension.

• Severe hypertension.

In adults, a diastolic pressure below 85mmHg is considered to be

normal;

• between 85 to 89 mm Hg is high normal,

• 90-104mmHg mild hypertensive;

• 105 to 114mmHg; moderate hypertensive

• 115mmHg or greater to severe hypertensive.

When the diastolic pressure is below 90mmHg,

• a systolic pressure below 140mmHg indicates normal blood pressure,

• between 140 to 159mmHg is border-line isolated systolic

hypertension;

• 160mmHg or higher is isolated systolic hypertension.

Clinical features :

Symptoms :

Most of the patients are asymptomatic

• Occipital headache usually in the early morning.

• Easy fatigability.

• Giddiness.

• Lack of concentration.

• Loss of memory.

• Insomnia.

• Palpitation.

• Breathlessness.

• Flashes of light before the eyes.

• Epistaxis.

Signs :

Most of the patients have no abnormal physical signs apart from the

hypertension.

• Apical heave (left ventricular hypertrophy).

• Accentuation of aortic component of second heart sound

(loud or ringing A2).

• Fourth heart sound (S4).

• Pulse-high bounding pulse.

Complications :

Central nervous system complications :

• Transient ischaemic attacks.

• Cerebro-vascular accidents due to cerebral thrombosis or

haemorrihage.

• Sub-arachnoid haemorrhage.

• Hypertensive encephalopathy.

It is characterized by very high Blood Pressure, neuralgic

manifestations including transient disturbances in speech and vision,

paraesthesiae, fits, disorientation, loss of consciousness and papilloedema.

The neuralgic deficits are easily reversible with control of blood pressure.

Cardio-vascular complications :

• Coronary artery disease (Angina, myocardial infarction).

• Left ventricular failure.

• Aortic aneurysm.

• Aortic dissection.

Renal complications :

• Proteinuria.

• Progressive renal failure.

Maligant hypertension :

Sometimes hypertensive renal damage results in an increased release

of renin which in turn accelerates hypertension. There is worsening of renal

failure and very severe hypertension.

Opthalmic complications :

• Hypertensive retinopathy.

• It is charaterized by thickening of the walls of the retinal arterioles and

it can cause visual field defects and blindness.

• Granding of hypertensive retinopathy according to KEITH-

WAGENER-BARKER classification

Stage I : Arteriolar narrowing and vessel irregularity.

Stage II : AV nipping.

Stage III : Flame shaped haemorrhages, hard exudates, cotton wool spots.

Stage IV : Papilloedema.

Prognosis :

Factors indicating an adverse, prognosis in hypertension :

• Black race.

• Youth.

• Male.

• Persistent diastolic pressure > 115 mmHg.

• Smoking.

• Diabetes mellitus.

• Obesity.

• Evidence of end organ damage.

A. Cardiac :

• Cardiac enlargement.

• ECG changes of ischaemic or left ventricular strain.

• Myocardial infarction.

• Congestive heart failure.

B. Eyes :

• Retinal exudates and hemorrhages.

• Papilloedema.

C. Renal :

Impaired renal function.

D. Nervous system :

Cerebrovascular accident.

HYPERTENSIVE CRISIS

Hypertensive emergency :

It is an acute clinical condition and it should be controlled within

minutes. If not, it leads to end organ damage.

Causes :

• Abrupt drug withdrawal.

• Renal problems (eg.Acute Glomerula Nephritis).

• Catecholamine excess (pheochromocytoma).

• Drugs (steroids, sympathomimetics).

• Events involving CNS (eg. Cerebro Vascular Accident).

• After coronary bye-pass surgery.

Hypertensive urgency :

This is also an acute clinical condition and the B.P should be

controlled within hours. There is no end organ damage.

Causes :

• Accelerated / malignant hypertension.

• Brain infarct.

• Surgical (post operative, renal transplant, severe body burns).

• Sudden withdrawal of treatment.

• Eclampsia.

Hypertensive States

These are situations in which there is a marked increase in both

systolic and diastolic Blood Pressure, occurring in normal individuals, as

during sexual intercourse or on diving into cold water.

Measurement of Blood Pressure may be useful in detecting

• Pulsus paradoxus

• Pulsus alternans.

Pulsus Paradoxus

Inflate the Blood Pressure cuff to suprasystolic level and deflate

slowly at a rate of 2 mm Hg per heart beat. The peak systolic pressure during

expiration is noted. The cuff is then deflated even more slowly, and the

pressure is again noted when Korotkoff sound becomes audible throughout

the respiratory cycle. Normally the difference between the two pressures

should not exceed 10 mm Hg during quiet respiration. If it is more than 10

mm Hg, pulsus paradoxus is said to be present."

Pulsus Alternans

Inflate the Blood Pressure cuff to suprasystolic level and deflate

slowly. Pulsus alternans is present if there is an alterlation in the intensity of

Korotkoff sound.

Investigations :

Since essential hypertension has no obvious cause, the causes for

secondary hypertension must be ruled out.

Basic investigations :

• Urine analysis for blood, protein and glucose.

• Blood urea and creatinine (to assess renal fuction).

• Serum electrolytes (for hypokalaemia and alkalosis in

hyperaldosteronism).

• Fasting and post-prandial blood glucose (for hyperglycaemia).

• Serum cholesterol and tri-glycerides (to rule out atherosclerosis).

• Serum calcium and uric acid.

• Electrocardiogram and ECHO to rule out cardiac pathology.

• Chest – radiograph (for cardiac size, failure and aortic dilatation).

Secondary studies :

• Plasma catecholamine levels and 24 hours urinary Vanillylmandalic

acid.

o Pheochromocytoma.

• Plasma cortisol levels, 24 hours urinary cortisol and dexamethasone

suppression test

o Cushing’s syndrome.

• Intra-venous urogram, renal angiogram, ultrasonagraphy

o Renal artery stenosis, polycystic renal disease.

• Hypokalaemia, high aldosterone levels, low plasma renin

o Primary aldosteronism.

• Growth Harmone levels and x-ray of the skull

o Acromegaly.

• T3, T4, TSH levels

o Primary hypothyroidism.

• Chest radiography for rib notching and catheterization

o Coarctation of aorta.

Materials and Methods

MATERIALS AND METHODS

The disease vatha pitham noi has been described in Yugi Vaidhya

Chinthamani - 800. Approach towards the patient were made according to

the signs and symptoms mentioned in the verse Vathapitham as well as the

Blood Pressure levels.

Selection of the patients:

20 patients were admitted in the inpatient ward

20 patients were treated in outpatient ward.

• Both sexes were selected.

• Patients with the age group between 35 – 75 were selected.

• Patients mostly with mild to moderate hypertension were selected.

Patients with secondary hypertension ( Renal, hormonal, pregnancy

and drug induced) were excluded.

• Only essential hypertension patients were selected for the study.

For this purpose, a case sheet was prepared based on both siddha and

modern aspects and was maintained separately for all the patients.

Iruveli kiyalam is the drug selected for the research work. The

medicine was prepared by the author in the post-graduate Gunapadam

practical hall with the knowledge and guidelines of staff of the post-graduate

department. The preparation of these drugs are mentioned below.

PREPARATION OF DRUG

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Ingredients

• Roots of Iruveli (Coleus Forskholii)

• Adhimadhuram (Glycyrhyza Glabra)

• Ingi (Zingiber Officinale)

All the above drugs are taken in equal parts

Preparation:

The drugs Adhimadhuram and Ingi were bought from the pharmacy

raw drug store Government Siddha Medical College and Hospital they are

cleaned and dried under shade. The roots of Iruveli are purchased from the

field. The raw drugs are authenticated by medical botanist of Govt. Siddha

Medical College Palayamkottai.

200gm of each items are ground into small pieces. Mixed well. 5gms

of mixture was taken in 720 ml of water. It is boiled in a reduced flame to

the final volume of 1/8th measure i.e 90ml and filtered.

Dosage :

90ml twice a day

Indications:

Vatha pitham (Hypertension), Sobai, Pandu

Life Span:

3 hours

Reference:

Agathiyar Vaithya Pooranam - 205 (Pg. No. 154)

Administration of drug:

The trial drug, Iruveli Kiyalam 90ml was given twice daily before

meals for minimum 40 days.

Patients were advised to consume restricted diet including minimum

salt and fat intake.

Evaluation of the drugs:

The herbal drugs selected for dissertation work were subjected to

pharmacological, Bio-chemical and Toxicological analysis. These analysis

were made in the Pharmacology department and Bio-Chemistry department,

Govt. Siddha medical college, Palayamkottai.

Parameters of Assessment:

During the trial studies, the parameters adopted for the assessment of

the role of Iruveli Kiyalam in the management of vatha pitham are described

below.

1. Subjective improvement:

Here the patient’s sense of well being was noted.

2. Patterns of changes in systolic and diastolic B.P:

The B.P of all the patients were recorded twice daily regularly.

Clinical improvement:

Here reduction of patient’s symptoms like sleep pattern, emotional

disturbances, giddiness, headache, fatigue has been noted.

Investigations :

The signs and symptoms of vatha pitham almost correlates with

hypertension in modern medicine. Siddha parameters like Envagaithervugal,

Poriyalarithal, Pulanalarithal, 7 Udal thathukkal and Vinathal were applied.

Investigations meant for hypertension in modern medicine were sought for

Vatha pitham also.

Lab investigations:

Lab investigations were done in the Government Siddha Medical

College and Hospital which include routine blood investigations like T.C,

D.C, ESR, HB, Blood Sugar, Blood Urea, Uric acid and Serum Cholesterol.

Other investigations include X- ray - Chest P.A view.

Diagnosis:

Siddha methods of diagnosis were employed based on the Tridhosa

theory, Envagai thervugal and Seven udal kattugal.

Modern method of diagnosis were employed on the basis of daily

recordings of Blood Pressure by sphygmomanometer, blood, urine and

radiological investigations.

Results and Observation

RESULTS AND OBSERVATIONS

Results were observed with respect to the following criteria

1. Sex Distribution

2. Age Distribution

3. Thegi

4. Kaalam Distribution

5. Religion Distribution

6. Thinai Distribution

7. Paruva Kaalam Distribution

8. Sirupoludhu Distribution

9. Occupation Distribution

10. Socio-economic status

11. Risk factors

12. Clinical features

13. Duration of Illness

14. Other System involvement

15. Family history

16. Diet factor

17. Habitual History

18. Gnanendhiriyam (Imporigal)

19. Kanmendhiriyam

20. Kosam

21. Mukkutram a)Vadham b)Pitham c) Kabam

22. Ezhu Udal Kattugal

23. Envagai Thervugal

24. Neerkuri

25. Neikuri

26. Clinical Assessment

27. Effect on Blood Pressure

28. Laboratory Analysis and ECG

29. Echo Report

30. Gradation of Results

For this study 20 In-patients and 20 Out-patients were selected.

1. SEX DISTRIBUTION

Table 1 illustrates the distribution of Sex.

In-patients Out Patients S.No Sex

No. of Cases Percentage (%) No. of Cases Percentage (%)

1. Male 6 30 11 55

2. Female 14 70 9 45

From the table, it is observed that Vathapitham occured in both sex

population.

2. AGE DISTRIBUTION

Table 2 illustrates the distribution of Age.

In-patients Out Patients

S.No Age in

Years No. of

Cases

Percentage

(%)

No. of

Cases

Percentage

(%)

1. 35- 40 - - - -

2. 41- 45 1 5 2 10

3. 46 – 50 1 5 3 15

4. 51 – 55 2 10 1 5

5. 56 – 60 2 10 5 25

6. 61 – 65 4 20 1 5

7. 66 – 70 6 30 6 30

8. 71 – 75 4 20 2 10

From the table, it is observed that the highest incidence of Vathapitham was

around the age group of 50– 70yrs.

3. DISTRIBUTION OF THEGI

Table 3 illustrates the distribution of Thegi.

In-patients Out Patients

S.No Thegi No. of

Cases

Percentage

(%)

No. of

Cases

Percentage

(%)

1. Vatha Thegi 2 10 4 20

2. Pitha Thegi 14 70 14 70

3. Kabha Thegi 4 20 2 10

From the table, it is observed that the highest incidence of vatha pitham was

pitha thegi.

4. KAALAM DISTRIBUTION

Table 3 illustrates the distribution of Kaalam

In-patients Out Patients

S.No Kaalam No. of

Cases

Percentage

(%)

No. of

Cases

Percentage

(%)

1. Vadha Kaalam

1 – 33 years - - - -

2. Pitha Kaalam

34 – 66 years 10 50 17 85

3. Kaba Kaalam

67 – 100 years 10 50 3 15

The table showed that, the highest incidence of Vathapitham in Pitha

Kaalam.

5. RELIGION DISTRIBUTION

Table 4 illustrates the distribution of Religion among the patients.

In-patients Out Patients

S.No Religion No. of

Cases

Percentage

(%)

No. of

Cases

Percentage

(%)

1. Hindus 17 85 17 85

2. Christians 1 5 1 5

3. Muslims 2 10 2 10

From the table it is obsrved that, Vathapitham occured more among in

Hindus.

6. THINAI DISTRIBUTION

Table 5 illustrates the distribution of the disease among Thinai.

In-patients Out Patients

S.No Thinai No. of

Cases

Percentage

(%)

No. of

Cases

Percentage

(%)

1. Kurinchi - - - -

2. Mullai - - - -

3. Marutham 20 100 20 100

4. Neithal - - - -

5. Palai - - - -

The table indicated that, Marutham was the place of incidence of the

disease.

7. PARUVAKAALAM DISTRIBUTION

Table 6 illustrates the distribution of the disease among the Paruva Kaalam.

In-patients Out Patients

S.No Paruvakaalam No. of

Cases

Percentage

(%)

No. of

Cases

Percentage

(%)

1. Kaarkaalam 7 35 4 20

2. Koothirkaalam 3 15

3. Munpanikaalam

4. Pinpani Kaalam

5. Elavenil kaalam

6. Mudhuvenilkaalam 10 50 16 80

The table showed the prevalence of disease under Mudhuvenilkaalam and

then Kaar kaalam.

8. SIRUPOLUDHU DISTRIBUTION

Table 7 illustrates the distribution of the disease among the Sirupoludhu.

In-patients Out Patients

S.No Siru Poludhu No. of

Cases

Percentage

(%)

No. of

Cases

Percentage

(%)

1. Vaigarai 16 80 15 75

2. Pagal - - - -

3. Nan pagal - - - -

4. Pirpagal - - - -

5. Maalai 4 20 5 25

6. Yamam - - - -

The table showed that, the prevalance of disease during vaigarai poludhu.

9. OCCUPATION

Table 8 illustrates the distribution of Occupation among the patients.

In-patients Out Patients S.No Occupation No. of

Cases Percentage

(%) No. of Cases

Percentage (%)

1. Coolie 14 70 8 40

2. Housewives 3 15 6 30

3. Farmer 2 10 2 10

4. Teacher - - 1 5

5. Driver - - 1 5

6. Tailor 1 5 1 5

7. Businessman - - 1 5

The table indicated increased incidence of the disease in Coolie’s.

10. SOCIO - ECONOMIC STATUS

Table 9 illustrates the Socio - Economic Status of the patients.

In-patients Out Patients

S.No Socio Economic

Status No. of

Cases

Percentage

(%)

No. of

Cases

Percentage

(%)

1. Rich - - - -

2. Middle Class 4 20 5 25

3. Poor 16 80 15 75

From the table it is observed that, the disease occured more among poor.

11. RISK FACTORS

Table 11 illustrates the Risk Factor for the disease.

In-patients Out Patients

S.No Risk Factors No. of

Cases

Percentage

(%)

No. of

Cases

Percentage

(%)

1. Smoking 6 30 11 55

2. Alcohol 2 10 10 50

3. Obesity 6 30 6 30

4. Hyperlipedimia 8 40 6 30

The above table showed that, smoke was the main aetiological factor among

the patients.

12. CLINICAL FEATURES

Table 12 illustrates the distribution of Clinical Features.

Table - 12

In-patients Out Patients

S.No Clinical Features No. of

Cases

Percentage

(%)

No. of

Cases

Percentage

(%)

1. Giddiness 16 80 16 80

2. Fatigue 18 90 17 85

3. Occipital headache 15 75 17 85

4. Sleeplessness 16 80 15 75

5. Weakness 10 50 8 40

6. Palpitation 15 75 12 60

7. Visual changes 4 20 5 25

8. Emotional stress 15 75 17 85

9. Fear and anxiety 12 60 15 75

10. Heamaturia - - - -

11. Polyuria - - - -

12. Polydipsia - - - -

13. Nausea - - - -

14. Vomitting - - - -

15. Fainting - - - -

16. Epistaxis - - - -

17. Chest pain - - - -

18. Dyspnoea - - - -

19. Loss of apetite 10 50 12 60

The table shows that, most of the patients had giddiness, sleeplessness,

headache, fatigue.

13. DURATION OF ILLNESS

Table 13 illustrates the distribution of Duration of Illness

In-patients Out Patients

S.No Duration of illness No. of

Cases

Percentage

(%)

No. of

Cases

Percentage

(%)

1. below 3 months - - - -

2. 3 – 6 months 3 15 4 20

3. 6 months - 1 year 2 10 2 10

4. 1 – 2 years 6 30 9 45

5. 2 – 3 years 9 45 5 25

6. 3 – 6 years - - - -

Among the patients, the highest incidence for the duration is 2 – 3 years

& 1 – 2 years.

14. OTHER SYSTEM INVOLVEMENT

Table 14 illustrates the distribution of co- existing symptoms involving others system.

In-patients Out Patients

S.No System

Involvement No. of

Cases

Percentage

(%)

No. of

Cases

Percentage

(%)

1. Cardio vascular system - - - -

2. Gastro Intestinal

system - - - -

3. Musculo skeletal

system 15 75 16 80

4. Central nervous system - - - -

The table showed that, musculo skeletal system was affected more than

other system.

15. FAMILY HISTORY

Table15 illustrates the distribution of Family History

In-patients Out Patients S.No Family History No. of

Cases Percentage

(%) No. of Cases

Percentage (%)

1. Positive 4 20 2 10

2. Positive previous history

6 30 4 20

3. Miscellaneous

10 50 14 70

The table showed that, most of the Inpatients and Out patient had

miscellaneous history.

16. DIET FACTORS

Table 16 illustrates the distribution of diet factors among the patients

In-patients Out Patients S.No Diet No. of

Cases Percentage

(%) No. of Cases

Percentage (%)

1. Vegetarian 1 5 1 5

2. Mixed diet 19 95 19 95

The table showed that, the highest incidence of the disease for the patients

with Mixed diet.

17. HABITUAL HISTORY

Table 17 illustrates the distribution of habitual history.

In-patients Out Patients S.No Habit No. of

Cases Percentage

(%) No. of Cases

Percentage (%)

1. Smoker 6 30 11 55

2. Tobacco chewer 2 10 1 5

3. Betelnut chewer 5 25 5 25

4. Alcoholic 6 30 6 30

5. No such habits 5 25 4 20

The table showed that, the highest incidence of the disease are the Smokers

and Alcoholic.

18. IMPORIGAL (GNANENDHIRIYAM)

Table 18 illustrates the distribution of disease with Imporigal.

In-patients Out Patients

S.No Imporigal

(Gnanendhiriyam) No. of

Cases

Percentage

(%)

No. of

Cases

Percentage

(%)

1. Mei - - - -

2. Vai - - - -

3. Kann 4 20 5 25

4. Mookku - - - -

5. Sevi - - - -

The table showed that, Kann was affected in most of the patients.

19 . KANMENDHIRIYAM

Table 19 illustrates the distribution of disease with Kanmendhiriyam.

In-patients Out Patients

S.No Kanmendhiriyam No. of

Cases

Percentage

(%)

No. of

Cases

Percentage

(%)

1. Kai 5 25 4 20

2. Kaal 10 50 12 60

3. Vaai - - - -

4. Eruvaai 5 25 5 25

5. Karuvaai - - - -

The table showed that, Kaal was affected in most of the patients.

20. KOSAM

Table 20 illustrates the distribution of Kosam.

In-patients Out Patients S.No Kosam No. of

Cases Percentage

(%) No. of Cases

Percentage (%)

1. Annamayakosam 10 50 12 60

2. Pranamayakosam - - - -

3. Maromayakosam - - - -

4. Vingyanamayakosam - - - -

5. Anandhamayakosam - - - -

In all the In-patients and Out-patients Annamayakosam was affected.

21. MUKKUTRAM a.VADHAM b.PITHAM c.KABAM

21.a. VADHAM

In-patients Out Patients S.No Types of Vadham No. of

Cases Percentage

(%) No. of Cases

Percentage (%)

1. Pranan 10 50 12 60

2. Abanan 5 25 5 25

3. Viyanan 15 75 16 80

4. Udhanan 2 10 3 15

5. Samanan 20 100 20 100

6. Nagan - - - -

7. Koorman 4 20 5 25

8. Kirugaran 4 20 5 25

9. Devathathan 15 75 12 60

10. Dhananjeyan - - - -

In all the In-patients and Out-patients Viyanan, Samanan, Pranan,

Devathathan were affected.

21.b. PITHAM

Table 21.b illustrates the distribution of Pitha in the disease

In-patients Out Patients

S.No Pitham No. of

Cases

Percentage

(%)

No. of

Cases

Percentage

(%)

1. Anal pitham 10 50 12 60

2. Ranjagapitham 2 10 3 15

3. Sadhagapitham 20 100 20 100

4. Aalosagapitham 4 20 5 25

5. Prasagapitham 2 10 3 15

The table shows most of the patients affected with Sadhagapitham and

Anal pitham

21. c. KABAM

Table 21.C illustrates the distribution of Kabam in the disease.

In-patients Out Patients

S.No Types of Kabam No. of

Cases

Percentage

(%)

No. of

Cases

Percentage

(%)

1. Avalambagam 15 75 16 80

2. Kilethagam 10 50 12 60

3. Pothagam - - - -

4. Tharpagam - - - -

5. Sandhigam 15 75 16 80

The table showed that the Avalambagam and Sandhigam were affected in

all the patients in this disease.

22. EZHU UDAL KATTUGAL

Table 22 illustrates the distribution of derangement of Udal Kattugal in the disease.

In-patients Out Patients

S.No Ezhu Udal Kattugal No. of

Cases

Percentage

(%)

No. of

Cases

Percentage

(%)

1. Saaram 20 100 20 100

2. Senneer 20 100 20 100

3. Oon - - - -

4. Kozhuppu 6 30 6 30

5. Enbu 15 75 16 80

6. Moolai - - - -

7. Sukkilam / Suronitham - - - -

The table showed that, Saaram & Seneer were affected in most of the

patients in this disease.

23. EN VAGAI THERVUGAL

Table 23 illustrates the distribution of En Vagai Thervugal in the disease.

In-patients Out Patients

S.No Envagai Thervugal No. of

Cases

Percentage

(%)

No. of

Cases

Percentage

(%)

1. Naadi

a) Vadha pitham 10 50 12 60

b) Pitha vadham 10 50 8 40

Sparisam - - - -

Naa 2 10 3 15

Niram 2 10 3 15

Mozhi - - - -

Vizhi 4 20 5 25

Malam 5 25 5 25

Moothiram - - - -

The table showed that Mozhi, Sparisam and Moothiram were not affected

in all the patients in the disease. In Naadi Vadhapitham naadi showed higher

frequency than the others

24. NEER KURI

Table 24 illustrates the distribution of Neer Kuri in the disease.

In-patients Out Patients

S.No Neerkuri No. of

Cases

Percentage

(%)

No. of

Cases

Percentage

(%)

1. Niram - - - -

2. Manam - - - -

3. Edai - - - -

4. Nurai - - - -

5. Enjal - - - -

The table showed that Niram, Manam, Edai, Nurai, Enjal were not affected.

25. NEIKURI

Table 25 illustrates the distribution of Neikuri in the disease.

In-patients Out Patients

S.No Neikuri No. of

Cases

Percentage

(%)

No. of

Cases

Percentage

(%)

1. Vadha neer 1 5 - -

2. Pitha neer 19 95 20 100

3. Kaba neer - - - -

The table showed that, Kabha neer was found in most of the cases.

30

70

55

45

0

10

20

30

40

50

60

70

Per

cent

age

(%)

Inpatients Outpatients

Sex Distribution

Male

Female

-

0 0

50

85

50

15

0102030405060708090

Per

cent

age

(%)

Vadha Kaalam(1 – 33 years)

Pitha Kaalam(34 – 66 years)

Kaba Kaalam(67 – 100

years)

Kaalam Distribution

In patients Out patients

0 0

5

10

5

15

10

5

10

25

20

5

0

5

10

15

20

25

Per

cent

age

(%)

35 - 40 41 - 45 46 - 50 51 - 55 56 - 60 61 - 65

Age Distrubution

In patients Out patients

35

15

0 0 0

50

20

0 0 0 0

80

0

10

20

30

40

50

60

70

80P

erce

ntag

e (%

)

In patients Out patients

Paruvakaalam

Kaarkaalam

Koothirkaalam

Munpanikaalam

Pinpani Kaalam

Elavenil kaalam

Mudhuvenilkaalam

70

15

10

0 05

0

5 5 5 5 5

40

30

105

5 5 5

0

15 15

10

5

0

10

20

30

40

50

60

70

Inpatients Outpatients

Occupation

Coolie

Housewife

Farmer

Teacher

Driver

Tailor

Businessman

Carpenter

Tailor

Conductor

Cotton mill worker

Electrician

40

90

10

50

30 30

40

30

0

10

20

30

40

50

60

70

80

90

Per

cent

age

(%)

Smoking Alcohol Obesity Hyperlipedimia

Aetiological Factors

Inpatients Outpatients

30

55

105

25 2530 30

2520

0

10

20

30

4050

60P

erce

ntag

e (%

)

Smoker Tobaccochewer

Betelnutchewer

Alcoholic No suchhabits

HABITS

In patients Out Patients

60

65

4035

0 0

0

10

20

30

40

50

60

70

Per

cent

age

(%)

Good Fair Poor

RESULT

In Patients Out Patients

IP - Remarks

Good60%

Poor10%

Fair30%

OP - Remarks

Good65%

Poor10%

Fair25%

27. EFFECT ON BLOOD PRESSURE

S.No I.P.No IP BP (in mmhg) at 10am

BP (in mmhg) at 12 noon

BP (in mmhg) at 3 pm

BP (in mmhg) at 4 pm

At the time of discharge BP in (mmhg)

1. 1475 Mr.Iyyasamy 150/90 140/90 140/90 130/90 130/80

2. 1476 Mr.Mohamed Ali 150/90 150/90 150/90 150/90 150/90

3. 1477 Mr.Shajahan 150/100 140/100 140/100 140/100 120/80

4. 1478 Mr.Swaminathan 150/100 140/100 140/90 140/90 130/80

5. 1479 Mrs. Seevalamangai 150/90 140/90 140/90 130/90 120/80

6. 1641 Mrs. Gomathi 160/100 150/100 150/100 140/90 120/80

7. 1692 Mrs. Chendu 160/100 150/100 150/100 150/90 150/90

8. 1751 Mrs. Velammal 160/90 150/90 150/90 140/90 130/80

9. 1802 Mr. Chellavadivu 170/110 160/110 160/110 160/100 150/90

10. 1812 Mrs. Santha 180/100 180/100 180/100 180/100 180/100

11. 1843 Mrs.Rajammal 160/100 150/100 150/90 150/90 150/90

12. 1973 Mrs. Thamayanthi 150/90 140/90 140/90 130/90 130/80

13. 1975 Mrs. Sivapackiam 150/100 140/100 140/100 140/90 130/80

14. 1992 Mr.Natarajan 170/100 160/100 160/100 150/100 140/80

15. 2175 Mrs.Bagavathy 190/90 180/90 180/90 170/90 170/90

16. 2361 Mrs. Petchiammal 170/100 160/100 160/100 160/100 160/90

17. 2803 Mrs. Ganapathiammal

150/90 150/90 140/90 140/90 130/80

18. 2853 Mrs.Rajammal 160/90 150/90 150/90 140/90 130/80

19. 2930 Mrs. Kaliammal 160/90 150/90 150/90 150/90 150/90

20. 3046 Mrs. Santhanam 150/90 140/90 140/90 130/90 130/80

The table shows that,most of the patients had reduction of blood pressure

Table 28.a Illustrate In patients Results.

Blood Pressure No. of Days Treated Before

Treatment After Treatment

S.No I.P. No

Name Age Sex Date of

Admision Date of

Discharge Duration of illness As In-

patients days

As OP follow

up days

Total days

SBP DBP SBP DBP

Xray Chest

PA View Result

1. 1475 Mr.Iyyasamy 65 M 10.07.11 25.07.11 4 months 15 34 49 150 90 130 80 Normal Good 2. 1476 Mr.Mohamed Ali 65 M 10.07.11 23.09.11 5 months 73 - 73 150 90 150 90 Normal poor 3. 1477 Mr.Shajahan 53 M 10.07.11 25.08.11 3 months 45 - 45 150 100 120 80 Normal Good 4. 1478 Mr.Swaminathan 60 M 10.07.11 18.09.11 7 months 50 - 50 150 100 130 80 Normal Good 5. 1479 Mrs. Seevalamangai 45 F 10.07.11 13.09.11 1 Year 50 - 50 150 90 120 80 Normal Good 6. 1641 Mrs. Gomathi 60 F 27.07.11 07.09.11 2 Year 41 9 50 160 100 120 80 Normal Good 7. 1692 Mrs. Chendu 68 F 01.08.11 21.08.11 1 Year 21 40 61 160 100 150 90 Normal Fair 8. 1751 Mrs. Velammal 70 F 08.08.11 04.09.11 1 Year 27 26 53 160 90 130 80 Normal Good 9. 1802 Mr. Chellavadivu 66 M 13.08.11 11.09.11 1 Year 29 24 53 170 110 150 90 Normal Fair 10. 1812 Mrs. Santha 75 F 15.08.11 04.09.11 2 Year 20 28 48 180 100 180 100 Normal poor 11. 1843 Mrs.Rajammal 70 F 18.08.11 01.09.11 1 Year 14 35 49 160 100 150 90 Normal Fair 12. 1973 Mrs. Thamayanthi 72 F 30.08.11 16.09.11 3 Year 18 30 48 150 90 130 80 Normal Good 13. 1975 Mrs. Sivapackiam 70 F 30.08.11 07.10.11 3 Year 39 17 56 150 100 130 80 Normal Good 14. 1992 Mr.Natarajan 66 M 31.08.11 16.09.11 3 Year 17 31 48 170 100 140 80 Normal Good 15. 2175 Mrs.Bagavathy 67 F 17.09.11 05.10.11 3 Year 18 37 55 190 90 170 90 Normal Fair 16. 2361 Mrs. Petchiammal 65 F 03.10.11 25.10.11 3 Year 12 36 48 170 100 160 90 Normal Fair 17. 2803 Mrs. Ganapathiammal 65 F 06.11.11 23.11.11 3 Year 17 31 48 150 90 130 80 Normal Good 18. 2853 Mrs.Rajammal 50 F 10.11.11 21.11.11 3 Year 11 37 48 160 90 130 80 Normal Good 19. 2930 Mrs. Kaliammal 67 F 16.11.11 12.12.11 3 Year 26 22 48 160 90 150 90 Normal Fair 20. 3046 Mrs. Santhanam 53 F 24.11.11 03.12.11 3 Year 9 39 48 150 90 130 80 Normal Good

SBP - Systolic Blood Pressure DBP - Diastolic Blood Pressure

Table 28.b Illustrate Out patients Results.

Blood Pressure Before

Treatment After

Treatment S.No O.P. No

Name Age Sex Occupation Date of

Admision Date of

Discharge Duration of

illness

No. of Days

Treated SBP DBP SBP DBP

Xray Chest

PA View Result

1. 37549 Mr.Thangalakshmi 50 F Coolie 09.07.11 16.11.11 4 Months 131 150 90 130 80 Normal Good 2. 37630 Mrs. Pitchammal 58 F Coolie 09.07.11 21.09.11 3 Months 75 150 90 130 80 Normal Good 3. 38166 Mr.Abdul kader 45 M Driver 13.08.11 17.10.11 3 Months 66 150 90 130 80 Normal Good 4. 38654 Mr.Arumugam 67 M Tailor 15.07.11 17.10.11 4 Months 95 150 100 130 80 Normal Good 5. 38660 Mrs. Gomathi 57 F Coolie 15.07.11 20.10.11 6 Months 98 150 90 120 80 Normal Good 6. 39216 Mrs. Krishnammal 58 F Housewife 18.07.11 17.10.11 2 Year 92 150 100 130 80 Normal Good 7. 39646 Mr. Bramanayagam 70 M Coolie 20.07.11 12.11.11 8 Months 116 180 90 160 90 Normal Fair 8. 39843 Mrs. Muthammal 70 F Housewife 21.07.11 24.10.11 2 Year 96 180 90 180 90 Normal Poor 9. 40183 Mr. Santhanam 75 F Housewife 22.07.11 20.10.11 2 Year 91 170 100 150 90 Normal Fair 10. 40186 Mr.Srinivasan 70 M Coolie 13.08.11 20.10.11 2 Year 69 180 100 180 100 Normal Poor 11. 40409 Mr.Subramanian 60 M Coolie 23.07.11 15.10.11 3 Years 85 150 90 130 80 Normal Good 12. 40416 Mr. Arumugam 60 M Farmer 23.07.11 10.10.11 2 Year 80 170 100 150 90 Normal Fair 13. 40425 Mr.Arumugam 64 M Coolie 23.07.11 20.10.11 2 Year 90 150 100 130 80 Normal Good 14. 40579 Mr. Balu 55 M Businessman 25.08.11 10.11.11 3 Years 78 150 100 130 80 Normal Good 15. 40686 Mrs. Chendu 68 F Housewife 25.07.11 20.10.11 2 Year 88 160 90 130 80 Normal Good 16. 44722 Mr.Arumugam 74 M Coolie 13.08.11 26.10.11 3 Years 75 160 80 140 80 Normal Good 17. 44760 Mr.Aruna 50 F Housewife 13.08.11 20.10.11 2 Year 69 150 90 130 80 Normal Good 18. 46079 Mr.Palani 45 M Farmer 20.08.11 16.11.11 3 Years 89 150 90 130 80 Normal Good 19. 49574 Mr.Rahamath 48 F Housewife 08.09.11 09.11.11 3 Years 63 150 100 140 90 Normal Fair 20. 53211 Mr.Jebamani 67 M Teacher 24.09.11 30.11.11 2 Year 68 180 100 160 90 Normal Fair

SBP - Systolic Blood Pressure DBP - Diastolic Blood Pressure

Table 28.c Illustrate Lab Investigation.

BLOOD INVESTIGATION Before Treatment After Treatment

DC DC BT AT URINE ANALYSIS MOTION

BLT (Minutes)

CLT (Minutes)

ESR/MM Hrs

ESR/MM Hrs BT AT BT AT

S.No I.P .N o.

BT AT BT AT

Total Cells / cumm P L E

Hb% Total cells / cumm P L E

Hb%

½ 1 ½ 1 Alb Sug Dep Alb Sug Dep Ova Cyst Ova Cyst 1 1475 2 2 3 3 7800 56 41 3 12 8000 60 36 4 12.1 5 15 5 10 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil 2 1476 2 2 3 3 8000 63 30 7 12.2 8300 64 35 1 12.6 8 16 4 9 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil 3 1477 3 3 2 2 8400 52 42 6 12 8600 59 39 2 12.2 8 19 2 5 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil 4 1478 2 2 3 3 8000 58 37 5 12.2 8700 56 38 6 12.4 3 7 6 14 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil

5 1479 3 3 3 3

8300 56 40 4 12 8400 64 35 1 12.5 10 22 8 18 Nil Nil 1-2 epi Nil Nil NAD

Nil Nil Nil Nil

6 1641 3 3 2 2 8600 55 39 6 9.6 9800 65 32 3 9.8 4 8 4 9 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil 7 1692 3 3 3 3 7000 51 46 3 13 7100 62 37 1 13.1 2 5 4 9 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil 8 1751 2 2 3 3 9300 57 39 4 9.8 9200 86 13 1 10.1 3 7 3 6 Nil Nil NAD Nil Nil NAD Nil Nil Nil NIL

9 1802 2 2 3 3

8500 68 30 2 12.8 8600 63 36 1 13 3 5 3 5 Nil Nil 1-2 epi Nil Nil NAD

Nil Nil Nil Nil

10 1812 3 3 3 3

8200 58 40 2 9.4 8000 63 36 1 10.4 10 18 7 16 Nil Nil 1-2 epi Nil Nil NAD

Nil Nil Nil Nil

11 1843 3 3 3 3 8200 58 38 4 9.6 8100 62 36 2 10.2 10 20 4 8 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil 12 1973 2 2 2 2 8900 68 30 2 12.2 9000 65 34 1 12.5 5 10 2 4 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil 13 1975 2 2 3 3 8900 63 34 3 13..2 9000 60 39 1 13.4 8 18 6 14 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil 14 1992 3 3 3 3 8200 57 38 5 13.2 8300 62 37 1 13.2 4 10 4 8 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil 15 2175 3 3 3 3 8500 65 32 3 12.5 8700 65 33 2 13.2 4 9 4 8 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil

16 2361 2 2 2 2

8700 58 40 2 12.5 8500 66 33 1 12.5 15 30 10 18 Nil Nil 1-3 epi Nil Nil NAD

Nil Nil Nil Nil

17 2803 2 2 4 4 8300 60 35 5 12.8 8000 59 39 2 12.8 8 17 8 15 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil

18 2853 2 2 3 3

10000 65 30 5 12.8 10100 60 39 1 13.1 11 22 10 20 Nil Nil 1-3 epi Nil Nil NAD Nil Nil Nil Nil

19 2930 3 3 3 3

8600 56 38 6 12.6 8500 64 34 2 12.8 12 22 10 18 Nil Nil 1-2 epi Nil Nil NAD

Nil Nil Nil Nil

20 3046 2 2 3 3 8200 65 30 5 13.2 8400 60 38 2 13.5 12 18 10 15 Nil Nil NAD Nil Nil NAD Nil Nil Nil Ni l

BLT – Bleeding Time CLT – Clotting Time DC - Differntial Count P- Polymorphs L- Lymphocytes E – Eosinophill Hb – Haemoglobin ESR - Erythrocyte Sedimentation Rate BT – Before Treatment AT – After Treatment

Table 28.d Illustrate Lab Investigation. BLOOD INVESTIGATION

Before Treatment After Treatment DC DC BT AT

URINE ANALYSIS MOTION BLT(Mints) CLT(Mints)

ESR MMHrs ESR MMHrs BT AT BT AT S.No OP

.No.

BT AT BT AT

Total Cells / cumm P L E

Hb% Total cells / cumm P L E

Hb% ½ 1 ½ 1 Alb Sug Dep Alb Sug Dep Ova Cyst Ova Cyst

1. 37549 2 2 3 2 9500 58 28 4 12.4 9600 62 35 3 13.5 6 12 5 10 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil 2. 37630 2 2 3 2 8700 63 35 2 9.8 8900 55 33 2 10.2 10 22 6 18 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil

3. 38166 3 3 2 3 8900 55 40 5 13 9000 67 29 4 13.1 2 4 2 4 Nil Nil 1-2 pus

Nil Nil NAD Nil Nil Nil Nil

4. 38654 2 2 3 2 9000 68 30 2 12.8 9100 69 30 1 13.1 3 7 3 6 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil 5. 38660 3 3 3 3 7800 65 31 4 8.5 7900 67 30 3 9.4 10 22 8 16 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil 6. 39216 3 3 2 3 9400 62 35 3 13 9200 67 31 2 13.4 3 6 3 5 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil 7. 39646 3 3 3 3 9400 65 28 7 13 9500 66 30 4 13.2 7 16 7 15 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil 8. 39843 2 2 3 2 7800 58 36 6 12 8000 70 27 3 12.2 5 12 5 10 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil 9. 40183 2 2 3 2 9000 72 23 5 12.5 9200 70 27 3 13.2 20 40 18 32 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil 10. 40186 3 3 3 3 9100 60 34 6 12.5 9200 68 30 4 12.6 6 12 5 10 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil

11. 40409 3 3 3 3 8500 58 39 3 12.4 8500 64 34 2 12.5 1 3 1 3 Nil Nil 1-2 pus

Nil Nil NAD Nil Nil Nil Nil

12. 40416 2 2 2 2 8000 55 39 6 12.1 8200 68 29 3 12.1 4 8 4 8 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil 13. 40425 2 2 3 2 8000 55 39 6 12.1 8100 65 31 4 12.1 4 8 4 7 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil 14. 40579 3 3 3 3 7800 57 38 5 12.8 8000 68 28 4 13 2 4 2 4 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil

15. 40686 3 3 3 3 9400 65 30 5 9.5 9400 70 27 3 10.1 2 4 2 4 Nil Nil 1-2 EPI

Nil Nil NAD Nil Nil Nil Nil

16. 44722 2 2 2 2 8700 64 32 4 13 8500 69 28 3 13 4 8 3 7 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil 17. 44760 2 2 4 2 8900 66 31 3 12.6 8800 69 29 2 12.8 2 5 2 4 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil

18. 46079 2 2 3 2 9000 63 35 2 12.5 8900 66 32 2 12.6 4 8 4 8 Nil Nil 1-2 EPI

Nil Nil NAD Nil Nil Nil Nil

19. 49574 3 3 3 3 10000 69 28 3 9.5 10100 65 33 2 9.7 6 12 5 10 Nil Nil 1-2 PUS Nil Nil NAD Nil Nil Nil Nil

20. 53211 2 2 3 2 8900 67 29 4 12.5 8900 72 26 2 12.4 4 9 4 8 Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil

BLT – Bleeding Time CLT – Clotting Time DC - Differntial Count P- Polymorphs L- Lymphocytes E – Eosinophill Hb – Haemoglobin ESR - Erythrocyte Sedimentation Rate BT – Before Treatment AT – After Treatment

Table 28.e Illustate Lab Investigation.

Blood Sugar

(R) mg %

Blood

urea

mg%

Blood Uric

acid

mgs

S.Creatinine

mgs

S.Cholesterol

mgs S.No IP.No Name Age Sex Occupation

BT AT BT AT BT AT BT AT BT AT

1. 1475 Mr.Iyyasamy 65 M Coolie 137 130 17 16 5.5 5.3 1.2 0.9 184 182

2. 1476 Mr.Mohamed Ali 65 M Coolie 94 90 34 25 6 5.7 1 1 180 164

3. 1477 Mr.Shajahan 53 M Farmer 123 122 26 25 5.8 5.6 1.2 1 177 169

4. 1478 Mr.Swaminathan 60 M Coolie 140 134 28 28 6 5.8 1.1 1 210 208

5. 1479 Mrs. Seevalamangai 45 F Housewife 100 100 26 25 5.3 4.9 0.9 0.8 220 215

6. 1641 Mrs. Gomathi 60 F Coolie 103 100 31 30 6.2 5.8 1.1 1 220 210

7. 1692 Mrs. Chendu 68 F Housewife 119 82 30 28 5.8 5.6 1.1 1 248 230

8. 1751 Mrs. Velammal 70 F Coolie 123 112 33 30 5.9 5.5 0.9 0.9 230 215

9. 1802 Mr.Chellavadivu 66 M Farmer 136 122 24 22 4.8 4.5 0.9 0.9 210 205

10. 1812 Mrs.Santha 75 F Housewife 131 118 32 30 6.1 5.8 0.9 0.8 192 161

11. 1843 Mrs.Rajammal 70 F Coolie 91 88 21 21 4.5 4.2 1 0.9 257 244

12. 1973 Mrs. Thamayanthi 72 F Coolie 140 130 32 30 5.8 5.6 1 1 196 160

13. 1975 Mrs.Sivapackiyam 70 F Coolie 98 90 25 24 4.9 4.4 1.2 1 150 144

14. 1992 Mr.Natarajan 66 M Tailor 141 135 17 17 4 3.8 1.1 1 167 164

15. 2175 Mrs. Bagavathi 67 F Coolie 121 111 25 24 4.9 4.7 0.9 0.8 261 230

16. 2361 Mrs.Petchiammal 65 F Coolie 60 60 30 28 5.5 5.1 1 0.9 193 151

17. 2803 Mrs.Ganapathiammal 65 F Coolie 113 112 35 32 6 5.8 0.9 0.8 139 130

18. 2853 Mrs.Rajammal 50 F Coolie 147 140 28 26 4.8 4.6 0.9 0.8 197 178

19. 2930 Mrs.Kaliammal 67 F Coolie 136 130 34 30 6.2 5.9 0.9 0.8 185 171

20. 3046 Mrs.Santhanam 53 F Coolie 125 110 28 25 5.1 5 0.9 0.9 196 192

BT – Before Treatment AT – After Treatment

Table 28.f Illustrate Out Patient Lab Investigation.

Blood Sugar (R)

mg %

Blood

urea

mg%

Blood Uric

acid

(mgs)

S. Creatinine

(mgs)

S.Cholesterol

(mgs) S.No OP.No Name Age Sex

BT AT BT AT BT AT BT AT BT AT

1. 37549 Mr.Thangalakshmi 50 F 110 108 21 20 4.3 4.2 1 0.9 260 258

2. 37630 Mrs. Pitchammal 58 F 126 160 23 23 4.6 4.4 0.9 0.8 254 244

3. 38166 Mr.Abdul kader 45 M 71 71 14 14 3.5 3.4 0.9 0.8 249 230

4. 38654 Mr.Arumugam 67 M 118 110 28 26 4.9 4.7 1.1 1 168 158

5. 38660 Mrs. Gomathi 57 F 85 82 28 26 4.8 4.3 1 1 174 168

6. 39216 Mrs. Krishnammal 58 F 104 103 32 30 5.9 5.7 1 1 150 140

7. 39646 Mr. Bramanayagam 70 M 105 103 16 16 3.9 3.8 0.9 0.8 186 179

8. 39843 Mrs. Muthammal 70 F 81 80 17 17 3.9 3.8 1.1 1 205 198

9. 40183 Mr. Santhanam 75 F 140 128 20 19 4.1 4.0 0.9 0.9 190 178

10. 40186 Mr.Srinivasan 70 M 138 130 37 35 6.3 6.0 1.2 0.9 173 161

11. 40409 Mr.Subramanian 60 M 115 112 18 17 3.8 3.8 1.1 1 186 179

12. 40416 Mr. Arumugam 60 M 85 83 25 24 4.8 4.6 0.9 0.9 144 135

13. 40425 Mr.Arumugam 64 M 85 82 20 20 3.9 3.7 1 1 144 139

14. 40579 Mr. Balu 55 M 81 80 39 34 5.8 5.2 1.1 1 180 159

15. 40686 Mrs. Chendu 68 F 100 97 35 33 4.9 4.7 1.2 1 200 183

16. 44722 Mr.Arumugam 74 M 115 111 23 22 4.4 4.2 1.2 1 173 160

17. 44760 Mr.Aruna 50 F 116 110 21 20 4.2 4 0.9 0.9 187 160

18. 46079 Mr.Palani 45 M 108 105 25 24 4.5 4.3 1 1 219 210

19. 49574 Mr.Rahamath 48 F 116 110 21 21 4.3 4.2 0.9 0.8 246 236

20. 53211 Mr.Jebamani 67 M 80 78 28 27 4.6 4.5 0.9 0.8 196 180

BT – Before Treatment AT – After Treatment

Table 28.g Illustrate Lipid Profile.

Before Treatment After Treatment

S.No I.P. No

Name Age Sex

HDL LDL VLDL Trigly cyrides

HDL C

Ratio HDL LDL VLDL

Trigly cyrides

HDL C

Ratio 1. 1478 Mr.Swaminathan 60 M 51 154 36 180 5.8 48 138 30 162 5.4 2. 1479 Mrs. Seevalamangai 45 F 50 150 30 150 5.5 38 140 28 148 5.1 3. 1641 Mrs. Gomathi 60 F 52 152 32 188 5.4 48 148 27 184 5.2 4. 1692 Mrs. Chendu 68 F 49 146 31 198 5.3 47 144 26 179 5.2 5. 1751 Mrs. Velammal 70 F 38 132 27 219 5.1 36 130 25 206 5 6. 1802 Mr. Chellavadivu 66 M 48 152 32 210 5.4 40 140 30 156 5.2 7. 1843 Mrs.Rajammal 70 F 55 145 31 225 5.8 48 132 29 204 5.4 8. 2175 Mrs.Bagavathy 67 F 58 142 35 245 5.4 49 131 33 216 5.2

Before Treatment After Treatment

S.No O.P. No

Name Age Sex

HDL LDL VLDL Trigly cyrides

HDL C

Ratio HDL LDL VLDL

Trigly cyrides

HDL C

Ratio 1. 37549 Mrs.Thangalakshmi 50 F 55 160 35 189 5.7 52 148 31 185 5.5 2. 37630 Mrs.Pitchammal 58 F 52 152 32 188 5.4 48 148 27 184 5.2 3. 38166 Mr.Abdul Kadher 45 M 40 160 33 178 5.9 38 142 30 174 5.6 4. 39843 Mrs.Muthammal 70 F 51 149 32 175 5.6 45 135 30 170 5.4 5. 46079 Mr.Palani 45 M 60 140 36 170 5.8 51 139 33 166 5.6 6. 49574 Mrs.Rahamath 48 F 59 140 35 166 5.4 55 137 30 165 5

HDL – High Density Lipo protein LDL - Low density Lipo protein VLDL – Very Low Density Lipo protein

Table 28.h

ECG Reports were found to be normal axis in all the 100% of in patients and outpatients

Table 29 Echo Cardiogram Done at Arul Diagnostic Centre.Tirunelveli.

S.No Op.No Name Age / Sex Impression

1. 44760 Mrs. Aruna 50/F • RA, RV, LA, LV – Normal dimension • Normal pulmonary and Tricuspid valves • No Obvious regional wall motion abnormality • Normal LV systolic function (EF : 71.2%)

Table 29.a Echo Cardiogram Done at Arul Diagnostic Centre.Tirunelveli.

S.No Ip.No Name Age / Sex Impression 1. 2175 Mrs. Bagavathy 67/F • Good LV, RV, RA, LA function

• Normal Pulmonary and Tricupid valves • No vegetarian, No clot or Pericardial effusion.

140

GRADATION OF RESULTS Table 30

In-patients Out Patients S.No Result

No. of Cases Percentage (%) No. of Cases Percentage (%) 1. Good 12 60 13 65 2. Fair 6 30 5 25 3. Poor 2 10 2 10

This table showed that In Ip 60% of the patient had Good result,30% had Fair result,10% had Poor result.In Op,65% of the patient had

Good result,25% had Fair result and 10%had Poor result.

Assessment of result

GOOD : Complete dissaperance of giddiness, restoration of normal Blood Pressure. FAIR : Moderate disapperance of giddness, moderate control of

Blood Pressure.

POOR : Uncontrlled Blood Pressure.

141

Table 26

CLINICAL ASSESSMENT

In-patients Out Patients S.No Result

No. of Cases Percentage (%) No. of Cases Percentage (%)

1. Mild 5 25 8 40

2. Moderate 15 75 12 60

3. Severe - - - -

This table showed that, most of the patient were mode

142

117

118

119

Discussion

120

DISCUSSION

Vatha Pitham as said in Yugi Vaidhya Chinthamani – 800 more or

less clinically correlate with Hypertension.

Hypertension is evolving high mortality especially as cardio-vascular

and cerebro-vascular diseases. Nowadays most of this problems are due to

increased stress and strain, lack of exercise, irregular dietary habits,

sedantary life etc.

As per recent studies, both systolic and diastolic pressures are equally

important and treated carefully.

The present study is a preliminary study. 20 patients of both sex were

admitted in the In-patient and 20 patients of both sex were treated in Out

patient in Post Graduate department of Govt. Siddha Medical college,

Palayamkottai and they were given the trial drug.

1.Sex distribution :

In IP, Out of 20 cases, 30% belong to Male and 70% belong to female.

In OP, Out of 20 cases, 55% belongs to male and 45% belongs to

female. It indicates that Vatha Pitham was common in both sex.

2.Age distribution :

In IP out of 20 cases, 5% cases were in the age between 41-45yrs,

5% between 46-50yrs, 10% between 51-55yrs and 10% between 56-60yrs,

and 20% between 61-65yrs, 30% between 66-70yrs and 20% between 71 –

75 years.

In OP out of 20 cases, 10% cases were in the age between 41-45yrs,

15% between 46-50yrs, 5% between 51-55yrs and 25% between 56-60yrs,

and 5% between 61-65yrs,30% between 66-70yrs and 10% between

71 – 75 years.

So the incidence of this disease was common in the elderly people age

group 50 – 70 years.

121

3. Constitution of body :

In IP out of 20 cases 10% of the patients were Vadha theki,

70% Pitha theki and 20% Kaba theki.

In OP out of 20 cases 20% of the patients were Vadha theki,

70% Pitha theki and 10% Kaba theki.So most of the patients wee pitha thegi.

4.Mukutra Kaalagal :

In IP Among 20 cases, 50% were found in the Pitha Kaalam and 50% in

the Kaba Kaalam.

In OP Among 20 cases, 85% were found in the Pitha Kaalam and 15% in

the Kaba Kaalam

So the disease was predominantly found in Pitha Kaalam.

5. Religious distribution :

In OP and IP 85% were Hindus, 10% Muslims and 5% were

Christians.

So Vatha pitham was commonly affected in Hindus.

6.Thinai :

In OP and IP 100% cases belonged to Marutham. So most of the cases

were found Marutham.

7.Paruva Kaalam :

In IP out of 20 cases, 35% were admitted in the Kaar Kaalam and

15% in the Koothir Kaalam, 50% were admitted in Muduvenil Kaalam

In OP out of 20 cases, 20% were admitted in the Kaar Kaalam,

80% were admitted in Muduvenil Kaalam

So most of the cases were admitted in the Mudhuvenil Kaalam.

8. Sirupozhuthu:

In IP out of 20 cases, 80% of the patients showed the prevalence of

disease during vaigarai pozhuthu, 20% of the patients shouwed the

prevalence of disease during malai pozhuthu.

In OP out of 20 cases, 75% of the patients showed the prevalence of

disease during vaigarai pozhuthu, 25% of the patients shouwed the

prevalence of disease during malai pozhuthu.

122

So the prevalence of disease during vaigarai poluthu.

9.Occupational Status:

In IP Out of 20 cases, 70% belonged to coolies, 15% house-wives,

10% farmer and 5% tailor.

In OP Out of 20 cases, 40% belonged to coolies, 30% house-wives,

5% driver, 10% farmer, 5% tailor, 5% teacher and 5% businessman.

So Vatha pitham was found increased incidence in coolies

10.Socio-economic status :

In IP 20% belonged to middle class and 80% belonged to poor class.

In OP 25% belonged to middle class and 75% belonged to poor class.

So this disease can occur in poor class of the society.

11. Risk factors:

In IP 40% of the cases were smokers, 10% Alcoholic, 30% Obese,

40% hyper lipedimic.

In OP 90% of the cases were smokers, 50% Alcoholic, 35% Obese,

30% hyper lipedimic.

So Smoking was the main risk factor among the patients.

12. Clinical features:

In IP 80% had giddiness, 90% had fatigue, 75% had Occipital

headache, 80% had sleeplessness, 50% had weakness, 75% had palpitation,

20% had visual defects, 75% had emotional stress, 60% had fear& anxiety

and 50% had loss of appetite.

In OP 80% had giddiness, 85% had fatigue, 85% had Occipital

headache, 75% had sleeplessness, 40% had weakness, 60% had palpitation,

25% had visual defects, 85% had emotional stress, 75% had fear& anxiety

and 60% had loss of appetite.

So Vatha Pitham can be presented as a spectrum of symptoms but

commonly giddiness, fatigue and sleeplessness.

123

13. Duration of illness

In IP Out of 20 cases, 15% of patients have the incidence for the

duration of 3- 6 months, 10% of the patient have the incidence for the

duration of 6 months to 1 year, 30% of the patients have the incidence for

the duration of 1-2 years, 45% of the patients have the incidence for the

duration of 2 – 3 years.

In OP Out of 20 case, 20% of patients have the incidence for the

duration of 3- 6 months, 10% of the patient have the incidence for the

duration of 6 months to 1 year, 45% of the patients have the incidence for

the duration of 1-2 years, 25% of the patients have the incidence for the

duration of 2 – 3 years.

So among the patients, the highest incidence of the disease is from 1-

2yrs & 2-3yrs.

14. Other systems involved :

In IP out of 20 cases 75% of cases co-existed with musculo skeletal

system involvement.

In OP out of 20 cases 80% of cases co-existed with musculo skeletal

system involvement.

15. Family History:

In IP out of 20 cases, 20% of the cases had positive family history,

30% of cases had positive previous history, 50% of the cases had

miscellaneous history

In OP 10% of the patients had positive family history, 20% of patients

had positive previous history, 70% of the patients had miscellaneious

history.So most of the patient had miscellaneous history.

16. Diet factors:

In OP and IP 95% were mixed diet. and 5% vegetarian. So most of

the cases were mixed diet.

124

17.Habitual history:

In IP out of 20 cases, 30% were smoker, 10% were tobaco chewer,

25% were betel nut chewer, 30% were alchoholic, 25% were no such a

habit.

In OP out of 20 cases, 55% were smoker, 5% were tobaco chewer,

25% were betel nut chewer, 30% were alchoholic, 20% were no such a

habit.So the highest incidence is smoker and alcoholic.

18. Imporigal (Gnanenthirium)

In IP out of 20 cases, 20% of the patient affected with Kann.

In OP out of 20 cases, 25% of the patient affected with Kann.

So Kann was affected in most of the patients.

19.Kanmenthriam:

In IP out of 20 cases, 25% patients were affected with kai, 50% of the

patients were affected with kaal, 25% of the patients were affected with

eruvai.

In OP out of 20 cases, 20% patients were affected with kai, 60% of

the patients were affected with kaal, 20% of the patients were affected with

eruvai.

So Kaal was affected in most of the patients.

20. Kosam:

In IP out of 20 cases, 50% of patients were affected with

annamayakosam, In OP 60% of cases were affected with annamayakosam.

So annamayakosam was affected in most of the patients.

21. Tridhosa theory:

a. Disturbances in vatham :

In IP 50% cases had derangement in Pranan, 25% Abanan, 75% Viyanan

100% Samanan, 10% Udanan, 20% Koorman, 20% Kirukaran and 75%

Devathathan.

125

In OP 60% cases had derangement in Pranan, 25% Abanan, 80%

Viyanan, 15% Udanan, 100% Samanan, 25% Koorman, 25% Kirukaran and

60% Devathathan.

• Affected Pranan can produced loss of appetite.

• Affected Abanan can produced constipation.

• Affected Viyanan can produced malaise, fatigue, neuralgic pain etc.

• Affected Uthanan can produced nausea and vomiting.

• Affected Samanan can produced loss of appetite and taste

disturbances.

• Affected Koorman can produced altered sensorium, horipliation and

blurring of vision.

• Affected Kirukaran produced body pain and tiredness.

• Affected Devathathan can produced malaise, fatigue, sleeplessness

and anxiety.

B. Disturbances in pitham :

In IP 50% had derangement in Anal pitham, 10% Ranjagam, 100%

Sathagam, 20% Alosagam and 10% Prasagam.

In OP 60% had derangement in Anal pitham, 15% Ranjagam, 100%

Sathagam, 25% Alosagam and 15% Prasagam.

• Affected Anal pitham can producesdloss of appetite.

• Affected Ranjaga pitham can produced pallor of nailbed, skin and

conjunctiva, reduced haemoglobin.

• Affected Sathaga pitham can produced mental confusion and difficulty

in concentration.

• Affected Alosaga pitham can produced blurring of vision.

• Affected Prasaga pitham can produced pallor of skin.

126

c. Disturbances in Kabam :

In IP 75% had derangement in Avalambagam, 50% Kilethagam, 75%

Santhigam

In OP 80% had derangement in Avalambagam, 60% Kilethagam, 80%

Santhigam

• Affected Avalambagam can produced derangement of other kabhas

• Affected Santhigam can produced difficulty in joint movements.

• Affected Kilethagam can produced loss of apetite.

22. Seven udal kattugal :

In IP Out of 20 cases, 100% had disturbances in saaram and senneer,

30% kozhuppu, 75% enbu.

In OP Out of 20 cases, 100% had disturbances in saaram and senneer,

30% kozhuppu, 80% enbu.

• Affected saaram can produced weakness of the body and mind, fear

and anxiety.

• Affected senneer can produced derangements in pitham.

• Affected kozhuppu can produced obesity, hypercholesteraemia.

• Affected Enbu can produced difficulty in range of movements, joint

pain.

23. Envagai thervugal :

In IP 50% of the cases had pitha vatha nadi, 50% had vatha pitha

nadi, 10% naa and niram, 20% vizhi and 25% malam were affected.

In OP 40% of the cases had pitha vatha nadi, 60% had vatha pitha

nadi, 15% naa and niram, 25% vizhi and 25% malam were affected.

• Affected naa and niram can produced paleness.

• Affected vizhi can produced blurring of vision, redness of eyes.

• Affected malam can produced constipation.

127

24. Neerkuri

In neerkuri, miram, manam, edai, nurai and enjal were not affected in

all the patients.

25. Neikuri

In IP neikuri, 95% had pitha neer and 5% had vatha neer.

In OP 100% had pitha neer.

26. Clinical Assessment

In IP out of 20 cases 25% mild blood pressure, 75% Moderate blood

pressure

In OP out of 20 cases 40% mild and 60% Moderate blood pressure.

27. Effect of blood pressure:

From the table 27,In Ip and Op, it is observed that,all the patients had

marked reduction of blood pressure at the time of discharge

28. Lab investigation and ECG report:

From the table 28a to 28h illustrate lab investigation.

29. ECHO:

From the table 29,it is observed that normal impression in the Echo-

cardiogram

30. Gradation of results:

In IP 60% of the patients had good results, 30% of the patients had fair

and 10% of the patients had poor results.

In OP 65% of the patients had good results, 25% of the patients had

fair and 10% of the patients had poor results.

Investigations :

Routine investigation of blood and urine were done during the time

of admission and discharge for all cases.

128

Urine examination in Ip & Op showed,Nil aibumin. 30% of patients

had deposits in before treatment. After treatment there was NAD(Nothing

Abnormal Deposits).

Blood investigation showed that, 30% raised Blood Urea and Serum

cholesterol before treatment.

After treatment, blood investigation showed that, moderate reduction

in Blood urea and mild reduction in Serum cholesterol .

Radiological investigation :

X-ray chest P.A. view was done for 80% of patients. For remaining

20% of the patients, X-ray was not taken due to inevitable conditions.No

abnormal findings can find out in all Chest X-Rays.

Modern Medicine comparision :

The signs and symptoms of Vatha Pitham as said in Yugi vaidhya

chindhamani-800 are closely matched with hypertension.

According to modern medicine literature survey, the causes of primary

hypertension may be smoking, alcohol, high fatty diet, altered life-style,

increased stress and strain both physically and mentally, Type-A personality

etc.

In siddha literature survey also the above causes are mentioned in the

Vatha pitham.

Management :

All the selected patients were administered to take the trial medicine

Iruveli Kiyalam 90 ml was given internally twice a day before food daily, till

discharge.

Clinically,My drug has proven, no side effects and no adverse effects

were observed.

129

Summary

130

SUMMARY

Vatha Pitham (Hypertension) is very common and its prevalence is

very much increased now. Most of the cases are not yet diagnosed. Most of

the cases present their symptoms in the later stage only. Vatha Pitham as

compared with Hypertension in Modern, should be properly screened,

diagnosed and treated as early as possible. If neglected, it produces

urgencies and emergencies.

So the author had worked on this subject very thoroughly and more

enthuciastically to help the suffering society.

Iruveli Kiyalam was taken as a trial drug for this clinical study.

The Aetiology, pathology, patho-physiology, classification, clinical

features, complication, prognosis, diagnosis, treatment and prevention of the

disease were collected from various literatures from Siddha system and

Modern system of Medicine.

In this study, 20 patients of both sex of varying age groups were

selected as In-patients and 20 patients as Out-patients.

From the observations and results, we were clear that, the disease was

common in the following aspects.

Age incidence was commonly found in 50-70yrs and it occurs in all

classes of people and mostly in mixed diet.

Hindus were affected more than the other religions. All the cases were

belong to marutha nilam. The patients suffered from giddiness, head ache,

fatiguability and sleeplessness.

In Uyir thathukal,

• Vatham had deranged. Vyanan was affected in all the patients.

• Pitham had deranged especially Analam, Ranjagam, Sathagam and

Alosagam.

131

• Kabam had deranged especially Avalambagam, Kiletham and

Santhigam.

In Seven udal kattugal, most of the cases had disturbances in saaram,

senneer and kozhuppu.

Signs and symptoms as mentioned in the case sheets was dealt in the

discussion.

Siddha diagnosis were made with the help of Envagai thervugal,

Neerkuri and Neikuri had showed derangement in Tri-dhosas. Naadi had

showed pitha vatham and vatha pitham.

The efficacy of the test drug, iruveli kiyalam was observed during the

period of study.

Iruveli kiyalam – 90ml twice daily before meals.

� Majority of the cases had shown marked reduction of blood pressure

and symptoms.

� The results of this clinical trial were found to be very encouraging in

almost every cases and there was marked improvement.

� All the In patients were instructed to follow up the treatment in the

Out patient.

� No recurrence occur during the treatment schedule.

� No side effects and adverse effects were noted during this period of

study.

� The trial drugs were found to play the major role to correct the

deranged three humours therby correcting Pranan, Abanan, Udhanan,

Vyanan, Samanan, Koorman, Kirugaran and Devathathan vayus and

Pitham such as Analam, Ranjagam, Sathagam, Aalosagam and

kabham such as Avalambagam, Kiletham and Santhigam is restored to

the normal.

� All the patient were advised to follows strict diet restrictions and

adviced to practice yoga and meditation therapy

132

� No cases had evidence of secondary hypertension clinically.

In modern views, routine B.P readings were taken regularly to assess

the improvement. Moreover routine blood, urine investigations were done.

Serum cholesterol, Blood urea, Blood sugar, Serum creatinine were also

done. ECG was taken in some patients. In radiological investigations, x-ray

chest P-A view.

Pharmacological evalution showed that the drug has got significant

diuretic action and there is no toxic effect in acute toxicity study.

Biochemical analysis showed the presence of starch, iron in ferrous

form, unsaturated compounds, reducing sugar amino-acids, calcium,

sulphate and chloride.

133

Conclusion

134

CONCLUSION

60% of In patient showed good results in this trial, 30% showed fair

results and the remaining 10% showed poor results. Among the out patients,

which are under this trail 65% of the subjects showed good results 25%

showed fair results and the remaining 10% showed poor results. The trial

drugs,

1. Iruveli Kiyalam has got the taste of Inippu and Kaarpu suvaigal.

2. Iruveli Kiyalam has got Thanmai - Thatpam

3. Iruveli Kiyalam has got Inippu pirivu.

The identification of suvai, thanmai and pirivu are on the basis of

individual ingredients of these preparations.

According to the basic principles of Siddha medicines as described by

the ancient sage Siddhars.

The taste, vital humours, the universal Pancha Boothas are closely

ralated to each other.

In this trial, the drug has got Inippu and Kaarpu suvaigal.

The Inippu suvai which decrease the excess of vatham & pitham.

‘gizpz<!fs<Sr<!!gckgx<Xl<”!

- sqk<k!lVk<Kuir<g!SVg<gl</!

The kaarpu suvai has got the principle to dilate the blood vessels and

prevent the obstruction in the blood vessel and to regulates the blood

circulation.

“ogiPh<jhBl<!yPg<gQcz<!upuPk<kqms<!osb<!

!ofb<h<jhBl<!ypqk<kqMl<!Jb!uqgivl<!

!npqk<kqMl<!fic!fit!njmh<hqjeg<!

!gpx<xqOb!kml<ohx!uqbx<Xr<!giIhiR<!

!Sjukjeg<!g{g<Ogi!M{<{qz<!

!fjubqjz!fzlil<!fzqbqjz!flg<Og”!

- sqk<k!lVk<Kuir<g!SVg<gl</!

135

Iruveli Kiyalam has got Thanmai Thatpam. The Thatpam has got the

action to decrease the excessive pitham those who are suffering from vitiated

pitham.

After the ingestion, these trial drug enter into gartric juice, it will

change into the vibagam. This in turn to change the taste into inippu and

kaarpu.

Inippu suvai which neutralize excessive vatha pitham.

Also Inipu suvai which neutralize excessive pitham.

‘gizpz<!fs<Sr<!gckgx<Xl<”!!

- sqk<k!lVk<Kuir<g!SVg<gl<!

!

The role of Thanmai veeriyam has got the action of antipitha effect.

In this trial the drugs present in Iruveli kiyalam has got significent

efficiency to treat vathapitham on the basis of their anti pitha prinicple.

I observed in many patients that, the blood pressure remained normal

even after 10 days of cessation of treatment. It shows the high bio-

availability of the kiyalam. So it can be used as one of the effective durgs to

treat high blood pressure in the siddha hospitals.

!

136

Annexure

Preparation and Properties

of The Trial Medicine

137

ANNEXURES - I

-VOuzq!gqbipl<!

! “wz<zif<!kie<!OhigouiV!gqbipR<osiz<Ou!

! ! eqVOuzq!lKvLmeqR<sq!!&e<Xf<!

! osiz<zilz<!ujgg<Gg<gix<!hzlib<k<K~g<gqs<!

! ! Sglig!uqVfipq!fQiqzqm<M!

! ouz<zOu!kQobiqk<K!obm<omie<xig<gq!

! ! uQxigh<!hk<Kfim<!ogit<uibieiz<!

! uz<zokiV!uikhqk<kR<!Osijghi{<M!

! ! uir<gquqMl<!nOvisqgLl<!uiviokie<Oe!”

- ngk<kqbi<!juk<kqb!H,v{l<!316!

Preparation of the trial drug:-

Ingredients:

Roots of Iruveli (Coleus Forskholii)

Adhimadhuram (Glycyrhiza Glabra)

Ingi (Zingiber officinale)

All the above drugs taken equal parts

Preparation:

The drugs Adhimadhuram and ingi were bought from the pharmacy

raw drug store GSMCH. They are cleaned and dried under shade. The roots

of Iruveli are purchased from the field. Raw drugs are authenticated by

medicinal botanist of Government Siddha Medical College, Palayamkottai.

200gm of each items are ground into small pieces. Mixed well. 5gms

of mixture was taken in 720ml of water. It is boiled in a reduced flame to

the final volume of 1/8th measure that is 90ml and filtered.

Dosage : 90ml – twice a day

Indications : Giddiness, Vatha pitham, obesity, anemia and arosigam.

Life span : 3 hours

Reference : Agathiayar Vaithia Poornam 205 (P.No:154).

138

Properties of the trial drug: -VOuzq!

! “-VOuzq!OhiqEm!bqbg<gr<!OgT!

! ! bqxqOhil!bxq!Ogsv///////!kqs<sqbliGl<!

! uVOuzq!uiegR<!szLliGl<!

! ! lgk<kie<!Ogsvl<!Heig!uqbiGl<!

! kqVOuzq!sQktf<!kQI<k<k!hqk<kR<!

! ! sqOv]<mi!Osx<hisg<!gvLliGl<!

! SVOuzq!Sv!gisei!seqBliGl<!

! ! Sbl<hie!bqVOuzqs<!$]liGl</”

-Bogar Nigandu!

Botanical Name : Coleus forskholii

Tamil Name : Iruveli

Family : Lamiaceae

Useful part : Roots

Suvai : Inippu

Thanmai : Seetham

Pirivu : Inippu.

Habitat : A perennial herb, branched, aromatic

Chemical constituents:

Major : Forskohlin – 10 to 18%

Diterpenoids like forskolin, coleonols, coleons, barbatusin,

cyclobutatusin, coleosol, coleol, coleonone, deoxycoleonol,

7-deacetylforskolin and 6-acety-7-deacetylforskolin.

Properties and activity:

Coleus has basic cardiovascular action and lower blood pressure due

to forskohlin’s cyclic AMP elevating ability, which results in relaxation of

arteries and increaed force of contraction of the heart muscle. If may be

beneficial in cerebro vascular insufficiency and in enhancing post storke

139

recovery, Platelet aggregation inhibitory effect also used in cardiovascular

disorders.

Forskohlin the alkaloid used extract from tuburous root of Coleus

Forskohlin are being as a drug for Hyper Tension, glaucoma, asthma,

hypothyroidism, weight loss, immune enhancement, congestive heart failure

an certain types of cancer.

It is spasmolytic, CNS active, hypothermic, diuretic and vasodilator

Pharmacology:

Forskohlin was found to be a direct cerbral vasodilator. It lowers

intraoccular pressure in rabbit and in normal volunteers free from eye

disease.

Uses:

Coleus has been used as a medical herb to treat heart and lung

diseases, intestinal spasms, insomnia and convulsions. It also lowers blood

pressure, antipasmodic, dilates the blood vessels. Uterine cramps as well as

painful urination. It accelerates the breakdown of existing fat stores.

-Quality standard of Indian Medicinal Plant Vol.4 P-107

-eqh<hqe<!G{l<;!

� dmx<gm<MgTg<G! ue<jlBl<?! dmZg<G! Dm<mk<jkBl<!

ytqjbBl<?!-f<kqiqb!hzk<jkBl<!kVl</!

� uikl<?!uikhqk<k!Okimr<gt<!ke<eqjz!uti<s<sqbjmbqe<!nux<jx!

ke<eqjzh<hMk<kUl<?! hqk<kl<?! uiB?! uq]l<! Ngqbux<jx! fQg<gUl<!

-kje!dhObigqg<gzil</!

ke<jl!uQiqb!okipqz<;!

! leg<gtqh<H?!NBt<!uqVk<kq!kl<hel<!Ngqbux<jx!osb<Bl<!vk<kl<?!

hqk<kl<!Ohig<Gl</!

hqiqU;!

!! -eqh<H.uikhqk<kk<jk!slh<hMk<Kl</!

140

nkqlKvl<!

!

Botanical Name : Glycyrrhiza glabra

Tamil Name : Adhimadhuram

Trade Name : Liquorice

Habitat : Perrenial herb

Family : Fabaceae

Usefullpart : Root

Suvai : Inippu

Thanmai : Seetham

Pirivu : Inippu

ohiKG{l<;!

!!!!“gk<kqbiq!Lh<hq{qbiz<!uVH{<!kigr<!

! g{<O{ib<de<!likl<uqg<gz<!uzqou{<!Gm<ml<!

! hqk<kolZl<!HVg<gq!gqiqs<svl<!Nui<k<k!

! hqk<klk!&Is<js!uqmhigl<!ouh<hf<!

! kk<kquV!uikOsi!{qkr<gi!lijz!

! sVuuqmr<!gilqbOfib<!kiK!fm<mr<!

! Gk<kqVlz<!Nsqbr<gl<!-kp<Ofib<!-f<K!

! Gbh<H{<[l<!Ohil<!lK~goleg<!%Xr<!giOz”!

! ! ! ! ! ! .!Okjvbi<!G{uigml<!h{<H;!2/ -K! Lh<hq{qbiz<! uVl<! H{<?! fQI! Oum<jg?! g{<Ofib<gt<?!

ouxqOfib<?!ouh<HOfib<gt<!Ohig<Gl</!

3/ kQg<Gx<xk<kqe<!ue<jljb!kips<!osb<Bl</!

Chemical constituents:

The dried roots and underground stems of this plant constitute the

drug. Liquorice roots consists of triterpenids and flavonoid, starch, glucose,

sucrose, asparagine, fat, resins, mannitol and bitter principles.

Chemistry-contain glycoside Glycerrhizin.

141

Properties and Action:

The liquorice roots are useful in medicine as well as flavour. It is

known as demulcent, expectorant, laxative and sweetener.

Various preparation of liquorice are administered in Gastric &

Duodenal ulcers, Cardiac asthma, Hypertension, Rheumatoid arthritis &

Dermititis.

. Hand book of medicinal plants (P.No: 171)

Prof. S.K.Bhattacharjee

Properties & Uses:

Refrigerent, Demulcent, Expectorant, Mild laxative, Tonic, Diuretic

-Drient longman

-Indian Medicinal plants-3 P.84

!

-eqh<hqe<!G{l<;!

! dmx<gm<MgTg<G! ue<jlBl<?! dmZg<G! Dm<mk<jkBl<!

ytqjbBl<?!-f<kqiqb!hzk<jkBl<!kVl</!

! uikl<?!uikhqk<k!Okimr<gt<!ke<eqjz!uti<s<sqbjmbqe<!nux<jx!

ke<eqjzh<hMk<kUl<?!hqk<kl<?!uiB?!uq]l<!Ngqbux<jx!fQg<gUl<!-kje!

dhObigqg<gzil</!

!

ke<jl!uQiqb!okipqz<;!

! leg<gtqh<H?!NBt<!uqVk<kq!kl<hel<!Ngqbux<jx!osb<Bl<!vk<kl<?!

hqk<kl<!Ohig<Gl</!!

hqiqU;!

!! -eqh<H!.!uikhqk<kk<jk!slh<hMk<Kl</!

!

142

-R<sq!

!

Botanical Name : Zingiber officinale

Family : Gingiberaceae.

Useful part : Rhizome

Suvai : Karppu

Thanmai : Veppam

Pirivu : Karppu.

ohiKG{l<;!

! -R<sqbqe<!G{Ol!oke<xqbz<!HmEjvg<gg<!OgtQI!

! nR<sqMl<!se<eqobz<zi!lge<xqMl<!hqk<kOkiml<!

! ofR<sqeq!zqVlx<!Ogijp!ofgqp<f<kqMl<!ghr<gt<!ke<jl!

! lqR<sqeq!uVoli!oue<X!uqtl<hqMl<!Oku!F~Oz/!

! ! ! ! ! ! .!WM/!&zqjg!uGh<H.!G{himl</!

h{<H;!

!! se<eq?!hqk<k!Okiml<!fQr<Gl</!

! -Vlz<!Ogijp?!ghg<gm<M!kQVl</!

! hqk<k!lbg<gk<kqx<G!-kje!keqbigUl<!upr<gzil</!

ZINGIBER

Constituents:

Indian ginger contains an aromatic acid, volatile oil, camphene,

phallendrene, zingiberine, cineol and borneol.

An oleo recin: Gingerin, active principle. Others resins and starch.

- Indian Materia Medica. (P.No:1310)

Action:

The raw zinger is acrid, thermogenic, appetiser, laxative, stomachic

and carminative.

143

Uses :

It is useful in anorexia, diarrhoea, vomitting, dyspepsia.

It removes obstruction in the vessels.

gii<h<hqe<!G{l<!;!

!

“ ////////////////////////!hVleil<!

ogiPh<jhBl<!yPg<gQcz<!uPuPk<kqms<!osb<!

ofb<h<jhBl<!ypqk<kqMl<!Jb!uqgivl<!

npqk<kqMl<!fic!fit!njmh<hqjeg<!

gpx<xqOb!kml<ohx!uqbx<Xr<!giIh<hiR<!

Sjukjeg<!g{g<Ogi!M{<{qz<!

fjubqjz!fzlil<!fzqbqjz!flg<Og”!

! ! ! ! ! ! .!lVk<Ku!keqh<himz<!

! !

!! dmZg<Gh<! hVljek<! kVl<! ogiPh<hqe<! osxqjuBl<?!

upuph<Ht<t! ofb<h<jhBl<! ypqk<KuqMl</! ! dmzqZt<t! ficgtqZl<!

GVkqfitl<! Lkzie! fitr<gtqZl<! lzqer<gt<! kr<gq! njugtqz<!

YmOu{<cb! fQIh<! ohiVm<gjt! Ymouim<milz<! njmk<Kg<!

ogi{<Mt<tjugjtBl<! njvk<K! nu<uqmlqVf<K! nh<hix<! osz<z!

-bx<xqBl<!fic!fvl<Hgtqz<!sk<Kgjt!uqsizqg<gUl<!osb<Bl</! !

!

144

COLEUS FORSKOHLI

145

INJI – Zingiber officinale

ATHIMATHURAM – Glycyrrhiza glabra

146

IRUVELI KIYALAM

IRUVELI KIYALA CHOORANAM

147

Bio-Chemical Analysis

148

ANNEXURE – II

A. BIO-CHEMICAL ANALYSIS OF IRUVELI KIYALAM

PREPARATION OF THE EXTRACT

5gms of the drug was weighed accurately and placed in a 250ml clean

beaker. The 50ml of distilled water is added and dissolved well. Then it is

boiled well for about 10 minutes. It is cooled and filtered in a 100ml

volumetric flask and then it is make up to 100ml with distilled water. This

fluid is taken for analysis.

QUALITATIVE ANALYSIS

S.NO. EXPERIMENT OBSERVATION INFERENC

E

1. TEST FOR CALCIUM

2ml of the above prepared extract is

taken in a clean test tube. To this add

2ml of 4% Ammonium oxalate solution

A white precipitate

is formed

Indicates the

presence of

calcium

2. TEST FOR SULPHATE:

2ml of the extract is added to 5%

barium chloride solution.

A white precipitate

is formed

Indicates the

presence of

sulphate

3. TEST FOR CHLORIDE

The extract is treated with silver nitrate

solution

A white precipitate

is formed

Indicates the

presence of

chloride

4. TEST FOR CARBONATE

The substance is treated with

concentrated Hcl.

No brisk

effervessence is

formed

Absence of

Carbonate

5. TEST FOR STARCH

The extract is added with weak iodine

solution.

Blue colour is

formed

Indicates the

presence of

Starch

149

6 TEST FOR IRON FERRIC

The extract is acidified with Glacial

acetic acid and potassium ferro cyanide.

No blue colour is

formed

Absence of

ferric Iron

7. TEST OF IRON FERROUS

The extract is treated with concentrated

Nitric acid and ammonium thio cynate

solution

Blood red colour

is formed

Indicates the

presence of

ferrous Iron

8. TEST FOR PHOSPHATE

The extract is treated with ammonium

Molybdate and concentrated nitric acid.

Yellow precepitate

is formed

Indicates the

presence of

phosphate

9. TEST FOR ALBUMIN

The extract is treated with Esbach’s

reagent

No yellow

precipitate is

formed

Absence of

Albumin

10. TEST FOR TANNIC ACID

The extract is treated with ferric

choloride.

No blue black

precipitate is

formed

Absence of

Tannic acid

11. TEST FOR UNSATURATION

Potassium permanganate solution is

added to the extract

It gets

decolourised

Indicates the

presence of

unsaturated

compound

12. TEST FOR THE REDUCING

SUGAR

5ml of Benedict’s qualitative solution is

taken in a test tube and allowed to boil

for 2 mts and added 8-10 drops of the

extract and again boil it for 2 mts.

Colour change

occurs

Indicates the

presence of

reducing

sugar

150

13. TEST FOR AMINO ACID

One or two drops of the extract is placed

on a filter paper and dried it well. After

drying, 1% Ninnydrin is sprayed over

the same and dried it well.

Violet colour is

formed

Indicates the

presence of

Amino acid

14. TEST FOR ZINC:

The extract is treated with potassium

Ferrocyanide

No white

precepitate is

formed

Absence of

Zinc

Inference :

The trial drug of Iruveli Kiyalam contains calcium, sulphate, chloride,

Starch, ferrous Iron, phosphate, unsaturated compound, reducing sugar and

amino acid.

151

Pharmacological Analysis

152

B. PHARMACOLOGICAL ANALAYSIS

EVALUATION OF DIURETIC EFFECT OF IRUVELI KIYALAM

Aim:

To study the diuretic effect of Iruveli Kiyalam in albino rats.

Preparation of the test drug:

Iruveli Kiyalam:

5 gms of Iruveli Kiyala Chooranam was boiled in a reduced flame in

100ml of water and reduced to 50ml.

Procedure :

Two groups of rats each weighing 100-150 gms were taken. Each

group contain 3 rats. They were kept deprived of food and water for an

overnight period.

In the first group, each animal received 5ml of distilled water orally.

They were kept in a metabolic cage and taken as control group.

In the second group, each animal received 5ml of the test drug orally.

They were kept in another metabolic cage.

For both the groups, urine was collected in a pure glass vessel

separately and the quantity was measured after 1 ½hrs , 3 hrs and 4 ½ hrs

The readings were Sl.No. Time in hours Control group in ml Test drug group

in ml 1. 1 ½ 7 8 2. 3 11 15 3. 4 ½ 15 27

Then the urine electrolytes were measured. The measurement was done

Krishna Computerised Clinical Laboratory, Palayamkottai.

153

Table showing Urine Electrolytes Measurement

Sl.No. Electrolytes Control (meq/1)

Test drug (meq/1)

1. Sodium 31 80 2. Potassium 37.6 58 3. Chloride 40 80

Inference:

From the above study there was increased quantity of urine output noted in test drug group. In electrolytes measurements showed that the increaed excretion of sodium, chloride and pottasium confirm the signficant diuretic effects.

154

Toxicological Study

155

ACUTE TOXICITY STUDIES

Toxicity study:

The toxicity evaluation of IRUVELI KIYALA CHOORANAM is

carried out in phase.

Phase I - Acute toxicity study

Animal:

Wistar albino rat bred in the animal house attached to the

Post Graduate, Pharmacology Department, Government Siddha Medical

College, palayamkottai were used.

Sex:

Animals of both sexes were used.

Weight:

Animals weighing between 80-120 gms were selected.

Feeding of the animals:

The animals were randomly selected and kept in their cages.

Conventional laboratory diet was used with unlimited supply of drinking

water.

Separation of animals into groups:

30 rats were divided into 6 groups, each group consists of 5 rats. One

group is kept as control, by giving water alone.

156

Dose levels of the drug:

Since it is difficult to proceed the toxicity study with Iruveli Kiyalam

basis, it is better to study with Iruveli Kiyala Chooranam basis. The Iruveli

Kiyala chooranam contained in the Iruveli Kiyalam having the following

ascending dose levels were fixed by presuming a range of atleast toxic to

high toxic doses.

I Group - Control

II Group - 200mg / 100gm body weight of animal

III Group - 400mg / 100gm body weight of animal

IV Group - 800mg / 100gm body weight of animal

V Group - 1600mg / 100gm body weight of animal

VI Group - 3200mg / body weight of animal

Route of administration:

Oral administration.

Drug preparation:

The drug was weighted and taken and suspended in water, which is

heated and melted, as a suspending agent. The mixture was ground well

before the administration. The preparation owas done in such a way that 1ml

of suspension contains dose ranging from 200mg to 3200mg of IRUVELI

KIYALA CHOORANAM which is given to the respective groups, as

classified above in the dose level. The drug was administered in morning and

observed.

Observation:

The following details are recorded.

I. Stimulation:

• Hyperactivity

• Pyloerection

157

• Twitching

• Rigidity

• Irritability

• Jumping

• Clonic convulsion

• Tonic convulsion

II. Depression:

Ptosis

Sedation

Sleep

Loss of Pinna reflex

Ataxia

Loss of muscle tone

Analgesia.

III. Autonomic effect :

Straub tail

Laboured Respiration

Cyanosis

Blanching

Reddening

158

IV. Number of animals dead:

At the end of 24 hours, the number of animals live or dead in each

group was noted and approximate ED50 is tried to determine. The tabular

column was made and the results was analysed.

Result:

The said parameters in acute toxicity study were observed on various

6 groups (Group I, II, III, IV, V and VI) Group I – is the control and Group

II-VI were treated with the drug such as 200mg, 400mg, 800mg, 1600mg

and 3200mg / 100gm body weight of the animal respectively. The results

were tabulated in Table I to VI.

From the table I-VI it is being found that the drug IRUVELI

KIYALA CHOORANAM did not produce any mortality even upto the

dose level of 3200mg/ 100gm body weight of the animal. The same

procedure in acute toxicity study was done for 7 days and after the study

period it is found that the drung did not reduce any mortality. and

abnormalities in behavioural pattern Since it is practically difficult to give morethan 3200mg/ 100gmbody

weight of the animal in this small species (wistar albino rats) it is unable to

calculate the lethal dose in this preliminary acute toxicity study. So it is

inferred that the drug is safe upto 3200 mg/ 100gm body weight of the

animal.

159

Case sheet Proforma

160

GOVERNMENT SIDDHA MEDICAL COLLEGE AND HOSPITAL

PALAYAMKOTTAI

POST- GRADUATE DEPARTMENT OF POTHU MARUTHUVAM

AN OPEN CLINICAL TRIAL FOR THE DISEASE VATHA PITHAM USING THE SIDHA DRUG “IRUVELI KIYALAM” INTERNAL

FORM I –SCREENING FORM

1. OP/ IP No: 2. BED No: 3. Sl. No:

4. NAME: 5. AGE: 6. GENDER:

7. OCCUPATION: 8. SOCIO ECONOMIC STATUS

9. DATE OF ADMISSION: 10. DATE OF DISCHARGE:

11. POSTAL ADDRESS:

------------------------------------------------------------------------------------------------------------

II. EXCLUSION CRITERIA:

� Renal hypertension

� Hormonal hypertension

� Pregnancy induced

hypertension

� Drug induced hypertension.

� Left ventricular failure.

� Cerebro vascular accident.

� Pulmonary Hypertension

� Sanni naadi nilai.

� Kaba vatha dhontham

� Asathiya neikuri.

� Patients with infective

diseases.

I. INCLUSION CRITERIA:

� Age : 35 – 75 Yrs

� Sex : Both Male and Female

� Patients having symptoms of

giddiness, headache, palpitation

sleeplessness, fatiguability

� Mild Moderate and Accelerated

hypertensive patients

134

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135

GOVERNMENT SIDDHA MEDICAL COLLEGE AND HOSPITAL

PALAYAMKOTTAI

POST- GRADUATE DEPARTMENT OF POTHU MARUTHUVAM

AN OPEN CLINICAL TRIAL FOR THE DISEASE VATHA PITHAM USING THE SIDHA DRUG “IRUVELI KIYALAM” INTERNAL

Form: II CONSENT FORM

CERTIFICATE BY INVESTIGATOR

I certify that I have disclosed all the details about the study in the terms readily understood by

the patient.

Signature…………………. Date……… Name…………………… CONSENT BY PATIENT

I have been informed to my satisfaction, by the attending physician, the purpose of

the clinical trial, and the nature of drug treatment and follow-up including the laboratory

investigations to be performed to monitor and safeguard my body functions.

I am aware of my right to opt out of the trial at any time during the course of the trial

without having to give the reasons for doing so.

I, exercising my free power of choice, hereby give my consent to be included as a

subject in the clinical trial of ‘Iruveli Kiyalam’ (Internal drug) for the treatment of ‘Vatha

Pitham’

Signature………………… Name……………………..

Date…………………..

136

GOVERNMENT SIDDHA MEDICAL COLLEGE AND HOSPITAL

PALAYAMKOTTAI

POST- GRADUATE DEPARTMENT OF POTHU MARUTHUVAM

AN OPEN CLINICAL TRIAL FOR THE DISEASE VATHA PITHAM USING THE SIDHA DRUG “IRUVELI KIYALAM” INTERNAL

FORM III – CASE PROFORMA (IP/OP)

1. OP/ IP No: 2. BED No: 3. Sl. No:

4. NAME: 5. AGE: 6. GENDER:

7. OCCUPATION: 8. SOCIO ECONOMIC STATUS

9. DATE OF ADMISSION: 10. DATE OF DISCHARGE:

11. POSTAL ADDRESS: Prognosis : Good / Fair / Poor

------------------------------------------------------------------------------------------------------------

12. COMPLAINTS & DURATION:

13. HISTORY OF PRESENT ILLNESS:

14. PAST HISTORY:

15. FAMILY HISTORY:

16. MENSTRUAL HISTORY (If applicable):

Lecturer HOD

137

17. HABITS:

Yes No 1. Smoker

2. Alcoholic

3. Betel nut chewer

4. Non-Vegetarian/Vegetarian

5. Drug addiction

18. GENERAL EXAMINATION:

1. Consciousness :

2. Orientation :

3. Body weight [Kg] :

4. Height [cm] :

5. Body Temperature [oF] :

6. Blood Pressure (mmHg) :

7. Pulse Rate /min. :

8. Heart Rate /min. :

9. Respiratory Rate /min. :

Yes No

10. Pallor :

11. Jaundice :

12. Clubbing :

13. Cyanosis :

14. Pedal Oedema :

15. Lymphadenopathy :

16. Jugular venous pulsation :

138

SYSTEMIC EXAMINATION: CARDIO VASCULAR SYSTEM Inspection:

1. Precordium : a. Bulging : b. Flattened :

2. Apex impulse : 3. Other pulsations :

a. Suprasternal : b. Carotid :

4. Dilated veins : 5. J.V.P. : 6. Scars and Sinuses :

Palpation: 1. Apex beat : 2. Left Parasternal heave : 3. Thrills : 4. Other pulsations :

a. Epigastric b. Suprasternal

Percussion: Upper border : Lower border : Right border : Left border : Auscultation:

1. Mitral area : 2. Tricuspid area : 3. Pulmonary area : 4. Aortic area :

EXAMINATION OF OTHER SYSTEMS: 1. Respiratory system : 2. Gastro intestinal system : 3. Central nervous system : 4. Musculo skeletal system :

139

SIDDHA ASPECTS

1 . NILAM:

1. Kurinji 2. Mullai 3. Marutham 4. Neithal 5. Paalai

2 . KAALAM:

1. Kaar Kaalam 2. Koothir Kaalam 3. Munpani Kaalam

4. Pinpani Kaalam 5. Ilavenir Kaalam 6. Muduvenir Kaalam

3. YAAKKAI:

1. Vatham 2. Pitham 3. Kabam

4. Vathapitham 5. Pithavatham 6. Kabavatham

7. Vathakabam 8. Pithakabam 9. Kabapitham

4. GUNAM:

1. Sathuvam 2. Rasatham 3. Thamasam

5. IYMPORIGAL:

Normal Affected

1. Mei …………………………………………..

2. Vaai …………………………………………...

3. Kan ……………………………………………

4. Mookku ……………………………………………

5. Sevi ……………………………………………

6. KANMENDHIRIUM / KANMAVIDAYAM:

Normal Affected

1. Kai …………………………………………...

2. Kaal …………………………………………...

3. Vaai …………………………………………..

4. Eruvaai …………………………………………..

5. Karuvaai …………………………………………..

140

7. UYIR THATHUKKAL:

I. VATHAM: Normal Affected

1. Piraanan …………………………………………

2. Abaanan …………………………………………

3. Viyaanan …………………………………………

4. Uthaanan …………………………………………

5. Samaanan ………………………………………….

6. Naagan ………………………………………….

7. Koorman ………………………………………….

8. Kirukaran …………………………………………

9. Devathathan …………………………………………

10. Dhananjeyan …………………………………………

II. PITHAM : Normal Affected

1. Analam ………………………………………….

2. Ranjagam ………………………………………….

3. Saathagam …………………………………………..

4. Aalosagam ………………………………………….

5. Prasagam ………………………………………….

III. KABAM: Normal Affected

1. Avalambagam ……………………………………………

2. Kilethagam ……………………………………………

3. Pothagam ……………………………………………

4. Tharpagam ……………………………….…………...

5. Santhigam ……………………………………………

8. UDAL THAATHUKKAL: Normal Affected

1. Saaram …………………………………..

2. Senneer …………………………………..

3. Oon …………………………………..

4. Kozhuppu …………………………………..

5. Enbu …………………………………...

6. Moolai .…………………………………..

7. Sukkilam/Suronitham …………………………………...

141

9. ENVAGAI THERVUGAL:

1 . Naadi …………………………………………………….

Normal Affected

2. Sparisam ……………………………..

3. Naa ……………………………..

4. Niram ……………………………..

5. Mozhi ……………………………..

6. Vizhi ……………………………..

7. Malam

Normal Affected

a. Niram ……………………………..

b. Nurai ……………………………..

c. Kirumi .……………………………..

d. Thanmai:

i. Irugal ii. Ilagal

8. Moothiram:

I. NEERKKURI:

Normal Affected

a. Niram ……………………………..

b . Manam … ……………………………..

c. Edai ……………………………..

d. Nurai ……………………………..

e. Enjal ……………………………..

II. NEIKKURI: ……………………………………….

Vatha Neer Pitha Neer Kaba Neer

142

GOVERNMENT SIDDHA MEDICAL COLLEGE & HOSPITAL PALAYAMKOTTAI.

POST-GRADUATE DEPARTMENT OF ‘POTHU MARUTHUVAM’ AN OPEN CLINICAL TRIAL FOR THE DISEASE “VATHA PITHAM” (HYPER TENSION) USING THE SIDDHA DRUG

“IRUVELI KIYALAM” Internal FORM – IV (OP/IP)

MEDICAL UNIT : POST GRADUATE

OP/IP No :

BED NO :

Sl No :

NAME :

AGE :

GENDER :

OCCUPATION :

SOCIAL STATUS

POSTAL ADDRESS :

After Treatment S.No Symptoms Before

Treatment Duration 7th day

14th day

28th day

35th day

48th day

1. Giddiness / Dizziness

Fatigue

Headache

Sleeplessness

Weakness

Palpitations

Visual Changes

Blurring of vision

Chest pain

Tightness

NATIONALITY :

RELIGION :

DATE OF ADMISSION :

DATE OF DISCHARGE :

NO. OF DAYS TREATED:

RESULT : GOOD / FAIR / POOR

DIAGNOSIS : VATHAPITHAM

MEDICAL OFFICER :

143

Heaviness or chest

Oedema

Peripheral

Lumbosacral

Generalised

Pitting / Non

Pitting

Nausea

Frequent

Occasional

Associated with

vomiting

Vomitting

Frequent

Occasional

Stained with blood

Haematuria

Polyuria

Polydipsia

Fainting

Epistaxis

Dyspnoea

On Exertion

Rest

Loss of apetite

Emotional stress

Fear / Anxiety

144

GOVERNMENT SIDDHA MEDICAL COLLEGE & HOSPITAL PALAYAMKOTTAI.

POST-GRADUATE DEPARTMENT OF ‘POTHU MARUTHUVAM’ AN OPEN CLINICAL TRIAL FOR THE DISEASE “VATHA PITHAM” (HYPER TENSION) USING THE SIDDHA DRUG

“IRUVELI KIYALAM” Internal) FORM – V (IP/OP)

MEDICAL UNIT : POST GRADUATE

OP/IP No :

BED NO :

Sl No :

NAME :

AGE :

GENDER :

OCCUPATION :

SOCIAL STATUS

POSTAL ADDRESS :

LAB INVESTIGATION

Before Treatment After Treatment

Blood

TC:

P:

L: DC:

E:

½ Hr

ESR

1 Hr

BT

NATIONALITY :

RELIGION :

DATE OF ADMISSION :

DATE OF DISCHARGE :

NO. OF DAYS TREATED:

RESULT : GOOD / FAIR / POOR

DIAGNOSIS : VATHAPITHAM

MEDICAL OFFICER :

145

CT

HB

BLOOD SUGAR

BLOOD UREA

URIC ACID

S.CREATININE

SERUM

CHOLESTEROL

URINE

Albumin

Sugar

Deposit

Epithelial cells

Pus cells

Redblood cells

Casts / Crystals

MOTION

Ova

Cyst

Occult Blood

OTHER INVESTIGATIONS:

LIPID PROFILE

� LDL

� HDL

� VLDL

� Triglycerides

146

X-ray Chest PA View

ECG

Fundus Examination

USG -Abdomen

Case Summary

Treatment Medicine Dosage

Iruveli kiyalam 90ml (bd)

Diet and Advice

Date Prognosis Treatment

Iruveli Kiyalam 90ml

bd before meals

147

GOVERNMENT SIDDHA MEDICAL COLLEGE AND

HOSPITAL PALAYAMKOTTAI

POST- GRADUATE DEPARTMENT OF POTHU MARUTHUVAM AN OPEN CLINICAL TRIAL OF IRUVELI KIYALAM FOR VATHA PITHAM

FORM - VI PATIENT WITHDRAWAL FORM (OP/IP) 1. OP / IP No …………… 2. S.No. …………… 3. Date: ……………

4. Name …………… 5. Age …………… 6. Gender …………

7. Postal address:

------------------------------------------------------------------------------------------------------------

Complaints and Duration:

Irregular treatment:

Other causes:

148

Bibliography

149

BIBLIOGRAPHY

1. Yugi vaidhya chinthamani. - R.Thiyagarajan. 2. Siddha Maruthuvam.

- K.M. Kuppuswamy Mudhaliar. HPIM. 3. Agathiyar Vaithiya Rathina Churukkam

- K.B.Thiyagarajan 4. Agathiyar Vaithiya Kaviyam - 1500

- S.P.Ramachandran 5. Agathiyar Naadi Sasthiram

- S.P. Ramachandran 6. Theraiyar Vaithyam - 1000 1st part

- S.P.Ramachandran 7. Theraiyar Vagadam

- S.P.Ramachandran 8. Theraiyar Neerkuri and Neikuri Nool

- S.P.Ramachandran 9. Thanvandhiri Vaidhayam

- S.P.Ramachandran 10. Agathiyar Gunavagadam

11. Pararasasekaram - Ponnaiyapillai

12. Pathinen Siddhar Naadi Sasthiram

13. Thirukkural - Thiruvalluvar

14. Agathiyar paripooranam - 1200 - S.P.Ramachandran

15. Noi Naadal Noi mudhal Naadal Thirattu. - I & II volume. - Dr. M. Shanmugavelu. HPIM. 16. Uyir Kakkum siddha maruthuvam @ Athma Ratchamirtham.

- S.P.Ramachandran.

17. T.V.Sambasivampillai Tamil & English Dictionary

18. Siddha maruthuvanga churukkam. - Dr.C.S.Uthamarayan. 19. Thotrakirama Araichium Siddha Maruthuva varalarum. - Dr.C.S.Uthamarayan. 20. Gunapadam - mooligai vaguppu.

- Dr.S.Murugesa mudhaliyar.

150

21. Siddha Maruthuvam sirappu. - Dr.R.Thiyagarajan C.I.M.

22. Maruthuva Thavara Iyal. - Dr.Somasundaram .

23. Sikicha Rathna Dheepam @ vaidhya chinthamani – I & II volume.

- C.Kannusamy pillai.

24. Thanvandhiri Vaidhyam- I volume.- Dr.S.Venkatarajan.

25. Angiosperms Vagaipadu. - Dr.S.Soma sundaram

26. Padhartha Guna Vilakkam. - C. Kannusamy Pillai.

Modern Books:

27. Indian Materia Medica-Vol I & II - Dr.K.M. Natkarni.

28. Quality standard Indian Medicinal Plants ICMR 2003

29. Materia Medica of India and their therapeutics.

30. Ross and Wilson’s Anatomy and Physiology.

31. Essential of Medical Physiology.

- Dr.K.Sembulingam and Prema Sembulingam. Ph.D.,

32. Robbinson’s Pathologic Basis of Disease.

33. Medicinal plants in India - T. Pullaiah

34. Indian Medicinal Plants Vol. I & II - Orient Longmann.no

35. Davidson’s Principle and Practice of Medicine.

36. Manual of Practical Medicine.

- Dr. R. Alagappan

37. Hutchison’s Clinical Methods.

38. Pharmacology and Pharmacotherapeutics

- K.D.Tripathi

39. www. icmr.nic.in

40. www.openmed.nic.in

41. www.wikipedia.org