Ambily.VN BAMS

“A COMPARATIVE CLINICAL STUDY ON THE

EFFECT OF ELADI GUTIKA AND MATULUNGA

AVALEHA IN GARBHINI CHARDI”

By

Ambily.V.N B.A.M.S.

Dissertation submitted to the Rajiv Gandhi University of Health

Sciences, Bangalore, for the partial fulfillment of the Degree

Of

Master of Surgery

(AYURVEDA DHANVANTARI)

in

PRASOOTI TANTRA EVAM STREE ROGA

Under the Guidance of

Dr. Sunita Siddesh M.D (Ayu)

Professor & H.O.D

And

Co-guidance of

Dr. Jayasudha G.C. M.S (Ayu)

Lecturer

Department of Prasooti Tantra Evam Stree Roga

S K A M C H and R C, Bangalore

DEPARTMENT OF POST GRADUATE STUDIES IN PRASOOTI TANTRA EVAM STREE

ROGA

SRI KALABYRAVESHWARA SWAMY AYURVEDIC MEDICAL COLLEGE, HOSPITAL &

RESEARCH CENTRE,

VIJAYANAGAR, BANGALORE - 560104.

2011- 2014

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,

KARNATAKA

I hereby declare that this dissertation entitled “A COMPARATIVE CLINICAL

STUDY ON THE EFFECT OF ELADI GUTIKA AND MATULUNGA

AVALEHA IN GARBHINI CHARDI” is a bonafide and genuine research work

carried out by me under the guidance of Dr.Sunita Siddesh, Professor & H.O.D, and

co-guidance of Dr.Jayasudha G.C, Department of P.G Studies in Prasooti Tantra

Evam Stree Roga, S K A M C H & R C, Bangalore.

Date: Signature of the Candidate

Place: Ambily.V.N

DECLARATION BY THE CANDIDATE

SRI KALABYRAVESHWARA SWAMY AYURVEDIC MEDICAL

COLLEGE, HOSPITAL & RESEARCH CENTRE,


CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “A COMPARATIVE CLINICAL


AVALEHA IN GARBHINI CHARDI” is a bonafide research work by

Ambily.V.N in partial fulfillment of the requirement for the degree of Ayurveda

Dhanvantari - MS (Prasooti Tantra Evam Stree Roga) of the Rajiv Gandhi

University of Health Sciences, Bangalore.

Guide

Dr.Sunita Siddesh

Date: Professor & H.O.D

Place: S K A M C H & R C

Bangalore.




CERTIFICATE BY THE CO- GUIDE



AVALEHA IN GARBHINI CHARDI” is a bonafide research work by

Ambily.V.N in partial fulfillment of the requirement for the degree of Ayurveda

Dhanvantari - MS (Prasooti Tantra Evam Stree Roga) of the Rajiv Gandhi

University of Health Sciences, Bangalore.

Co-Guide

Dr.Jayasudha G.C

Date: Lecturer

Place: S K A M C H & R C

Bangalore.




ENDORSEMENT BY THE H.O.D AND PRINCIPAL



AVALEHA IN GARBHINI CHARDI” is a bonafide research work done by

Ambily V.N under the guidance of Dr. Sunita Siddesh, Professor & H.O.D,

Department of P.G Studies in Prasooti Tantra Evam Stree Roga, S K A M C H & R C,

Bangalore.

Dr. Sunita Siddesh Dr.Kiran. M. Goud

Professor & H.O.D. Principal

Dept. of P.G. Studies in PT & SR S K A M C H & R C

S K A M C H & R C Bangalore.

Bangalore.

Date: Date:

Place: Place:

COPYRIGHT

I hereby declare that the Rajiv Gandhi University of Health

Sciences, Karnataka shall have the rights to preserve, use and

disseminate this dissertation in print or electronic format for

Academic/ Research purpose.

Date: Signature of the Candidate

Place: (Ambily.V.N)

Dedicated to my

Loving husband

Mr.Krishnan K.C

and my sweet

Little daughter

Malavika Krishnan

Acknowledgement

A COMPARATIVE CLINICAL STUDY ON THE EFFECT OF ELADI GUTIKA AND

MATULUNGA AVALEHA IN GARBHINI CHARDI Page I

ACKNOWLEDGEMENT

With bowed head before Almighty and

Joined hands before my parents and teachers.

At the moment of the completion of my thesis work I prostrate at the feet of

Almighty for providing this opportunity and easy completion of this work.

I am indebted to Late Paramapoojya Jadguru Padmabhushana Sri Sri Sri

Dr.Balagangadharanatha MahaSwamiji, who is founder of many Educational and

Health institutions of Adichunchanagini Shikshana Trust including our own

institution. On the first day of our PG studies, he showered us with his blessings,

which gave us strength to overcome all the hurdles and complete our works with

success. Parama Poojya Swamiji dedicated his life to serve humanity and his social

deeds have inspired us to follow the path of service and charity.

I bow my head at the lotus feet of Sri Sri Sri Nirmalanandanatha Swamiji and seek

his blessings.We are elevated by his dynamic nature.

I also bow my head at the holy feet of Paramapoojya Sri Sri Sowmyanatha Swamiji

who is the mentor of our institution. Swamiji has been of utmost support for us as

students at each and every step of our works

I am indebted to my parents V.V.Nethran Namboodiripad and N.Vijayakumari

whose affection and care has helped me to build up my career. I take this

opportunity to remember the physical and mental support and prayers of my

mother without whom I would never be able to accomplish this work.

I also express my sincere gratitude to my better half and soul mate

Mr.KrishnanK.C for his inspiration and never ending support and for making me

believe in my capabilities.

My love filled thanks to my daughter Baby Malavika Krishnan who supported me

throughout my studies even though she missed my presence in many of her

important events.

Acknowledgement


MATULUNGA AVALEHA IN GARBHINI CHARDI Page II

I also express my sincere thanks to my sister Sreedevi.V.N who supported and

helped in all my works.

My sincere gratitude to my in-laws Mr.K.C.K Chithrabhanu and Mrs.A.Savithri for

their care, love and support.

I express my thanks to my sisters, sister in law and all my family members for their

support.

It is a matter of great pleasure and honour to express my gratitude to our Respected

Principal, Dr. Kiran M Goud whose profound knowledge and constant monitoring

have helped us throughout our study.

I would like to impress my immense gratitude to the Dean of PG studies

Dr.N.Anjaneya Murthy for his valuable guidance at each step of our study.

My sincere thanks to the Medical superintendent Dr.Venkatshamiah for his support

throughout my study.

I am obliged to Dr.M.Ramesh who has always been with us in all our difficult

situations and supported us throughout our work.

It is my privilege to express my respect and gratitude to my Guide and HOD of our

department Dr.Sunita Siddesh for her guidance, constant support and invaluable

help throughout this study. The mental and physical support extended by her

encouraged me for successful completion for this work.

I extend my sincere gratitude to my Co-Guide Dr.Jayasudha.G.C whose inspection

and support have helped me throughout my PG studies.

I am grateful to my teacher Dr.Anupama for her guidance and mental support

throughout my work.

I wholeheartedly thank my teacher Dr.Padmasarita who has guided me for the

successful completion of this work.

I am extremely thankful to my teacher Dr.Usha Kiran who has supported me in my

study.

Acknowledgement


MATULUNGA AVALEHA IN GARBHINI CHARDI Page III

I extend my sincere thanks to Dr.Abdul Khader, who has always extended a helping

hand in all my obscure situations.

I am grateful to my teachers Dr.Gopal, Dr.Bhrahmanand and Dr.Sunitha G.S for

their guidance and support for the preparation of my drug.

I would like to extend a heartfelt thanks to my teachers Dr.Byresh, Dr.Satish,

Dr.Amarnath, Dr.Mahesh, Dr.Vinay Kumar, Dr.Nayan, Dr.Sharada, Dr.Swati,

Dr.Neeta, Dr.Keerthi, Dr. Dr.Shubha Hegde, Dr.Sujatamma, Dr.Shailaja for their

helping hand whenever I approached them for help.

I also thank Dr.Vanajakshi, Dr.Kumaraswamy and Dr.Lalita for their help in my

studies.

I extend my warm thanks to my batch mates and friends especially Dr.Divya,

Dr.Jyothi, Dr.Megha Dr.Rakesh, Dr.Sindhu, Dr.Sunanda. Dr.muneeb, Dr.Rohit and

Dr.Varun for being always a support for me.

My sincere thanks to my seniors Dr.Reshma, Dr.Chetana, Dr.Priya, Dr.Swetha and

Dr.Shubha for their support and timely advice.

My affectionate thanks to my juniors Dr.Sarang, Dr.Shivakumar, Dr.Amruta,

Dr.Shridevi and Dr.Shriniwas for their help.

I also am indebted to Mr.Lancy’D Souza and Mr. Nanda Kumar for their guidance

in my statistical work. I also thank our librarian Mr.Satish for his help.

I also extend my gratitude to all teaching and non-teaching staff for their support.

Finally I would like to thank all my patients for being so co-operative and having

faith in me.

I acknowledge my sincere thanks to all who helped me directly or indirectly during

the course of my study.

Place

Acknowledgement


MATULUNGA AVALEHA IN GARBHINI CHARDI Page IV

Date Dr.Ambily .V.N

Abbreviations

Page IV

LIST OF ABBREVIATIONS

HCG Human chorionic gonadotropin

CS Charaka Samhita

SS Sushruta Samhita

AS Ashtanga Samgraha

AH Ashtanga Hrudaya

BP BhavaPrakasha

MN MadhavaNidana

YR Yogaratnakara

KS Kashyapa Samhita

GIT Gastro-intestinal tract

CTZ Chemoreceptor trigger zone

LES Lower oesophageal sphincter

USO Upper oesophageal sphincter

PR Prithvi

sAP Aapa

TJ Teja

VY Vayu

AK Akasha

OPD Out patient department

IPD In patient department

Hb% Haemoglobin percentage

RBS Random blood sugar

USG Ultra sound sonography

Kg Kilogram

Gm % Gram percentage.

Abbreviations

Page V

PE Primary Education

SE Secondary Education

HS Higher secondary

GR Graduate

LMC Lower middle class

MC Middle class

UMC Upper middle class

VP Vata pitta

VK Vata kapha

PK Pitta kapha

BT Before treatment

AT After treatment

AT1 Follow up after treatment.

HS Highly significant

SS Statistically significant

NS Non significant

SD Standard deviation

SE Standard error

PSE Pooled standard error

Abstract

Page VII

ABSTRACT

Pregnancy and mother hood is an exclusive privilege for women. The

transformation of motherhood is the only instance in the world when both

pleasure and pain work in unison. Acharyas have explained chardi as one of

the vyakta lakshanas of garbhini.

Vomiting is a symptom seen in the first trimester of pregnancy. It usually

commences in the early part of the day. Sometimes, it may persist longer and

may occur at other times of the day. About 50% of the pregnant women

complain of vomiting which is considered as a physiological condition.

Emesis Gravidarum or Vomiting needs to be treated as it causes physical and

psychological impact on mother’s health which in turn affects the health of the

foetus. So this study was done to find a safe and effective remedy for emesis

gravidarum.

Material and methods

A minimum of 40 pregnant women in their 1st trimester of pregnancy who

were willing to take part in the study and fulfilling the inclusion criteria were

selected randomly from OPD and IPD of Prasooti Tantra Evam Stree Roga

Department of S.K.A.M.C, H and R.C, Bangalore.

Study design: A comparative clinical study with pre test and post test

design was conducted on 40 pregnant patients in 1st

trimester. 40 patients

complaining of Chardi in 1st trimester were randomly divided into the

following two groups, each comprising of 20 patients.

Group A: Eladi Gutika was given for 2 weeks.

Dose: 2 tablets thrice daily (each 500mg) with Honey.

Group B: Matulunga Avaleha with Eladi Gutika was given for 2 weeks.

Dose:Matulunga Avaleha 24gms in divided dose of 6gms 4 times

daily followed by Water.

Eladi gutika: : 2 tablets thrice daily (each 500mg) with Honey .

Abstract

Page VIII

Investigations: Investigations done were urine pregnancy test, Hb%,

RBS and USG.

Assessment criteria: The parameters assessed before and after treatment

were Frequency of vomiting, Contents of vomitus, Nausea, Salivation,

Increase in weight and Increase in Hb%.

Results: Group A consisting of Eladi Gutika and Group B consisting of Eladi

Gutika and Matulunga Avaleha showed highly significant result in all

parameters of the assessment criteria. The Group B patients had comparatively

more significant result in the parameters like nausea and salivation and also in

improvement of weight.

Conclusion: Overall improvement was more in Group B as compared to

Group A.

Key Words: Emesis Gravidarum, Eladi Gutika, Matulunga Avaleha.

Contents

Page IX

TABLE OF CONTENTS

Ch. No:

CHAPTERS Pg. No:

1

INTRODUCTION 1-2

2

OBJECTIVES 3

3 REVIEW OF LITERATURE

3a)HISTORICAL REVIEW

3b)DISEASE REVIEW

3c)DRUG REVIEW

4-5

6-26

27-44

4

METHODOLOGY 45-49

5

OBSERVATIONS 50-68

6

RESULTS 69-86

7

DISCUSSION 87-102

8

CONCLUSION 103-104

9 SUMMARY

105-106

10 BIBLIOGRAPHY

107-120

11 ANNEXURE

121-131

Tables

Page X

LIST OF TABLES

Sl.No. CONTENTS OF THE TABLES Page No. 1. Features of Shadbhavas.

6-7

2. Vyakta garbha lakshanas according to different

Acharyas.

9-10

3. Nidana of chardi according to different Acharyas.

12

4. Vishishta nidana of chardi.

13

5. Purva roopa of chardi according to different Acharyas.

13

6. Classification of chardi.

14

7. Pathya of Chardi.

18

8. Apathya of Chardi.

19

9. Garbhopakhatakara bhavas.

19-20

10. Panchabhautikata composition of ingredients of

Matulunga Avaleha.

35

11. Panchabhautikata component of ingredients of Eladi

gutika.

44

Observations

Distribution of patients based on Age.

50 12.

13. Distribution of patients based on Religion.

51

14. Distribution of patients based on Occupation.

52

Tables

Page XI

15. Distribution of patients based on Education.

53

16. Distribution of patients based on Socio-economic status.

54

17. Distribution of patients based on Habitation.

55

18. Distribution of patients based on Gravidity.

56

19. Distribution of patients based on Dietary Habits.

57

20. Distribution of patients based on Appetite.

58

21. Distribution of patients based on Dominant rasa

consumed.

59

22. Distribution of patients based on Prakruti.

60

23. Distribution of patients based on Abhyavarana Shakti.

61

24. Distribution of patients based on Jarana Shakti.

62

25. Distribution of patients based on Bowel Habits.

63

26. Distribution of patients based on Duration of Vomiting.

64

27. Distribution of patients based on Time of Vomiting.

65

28. Distribution of patients based on Contents of Vomiting.

66

29. Distribution of patients based on Associated Complaints.

67

Results

Effect of treatment on frequency of vomiting in Group A.

69 30.

31. Effect of treatment on frequency of vomiting in Group B.

69

32. Comparative effect in frequency of vomiting as compared

between groups

70

33. Effect of treatment on contents of vomitus in Group A. 72

Tables

Page XII

34. Effect of treatment on contents of vomitus in Group B.

72

35. Comparative effect in contents of vomitus as compared

between groups.

73

36. Effect of treatment on nausea in Group A.

75

37. Effect of treatment on nausea in Group B.

75

38. Comparative effect on nausea as compared between

groups.

76

39. Effect of treatment on salivation in Group A.

78

40. Effect of treatment on salivation in Group B.

78

41. Comparative effect on salivation as compared between

groups.

79

42. Effect of treatment on improvement of weight in Group A.

81

43. Effect of treatment on improvement of weight in Group B.

81

44. Comparative effect on improvement of weight as

compared between groups.

82

45. Effect of treatment on improvement in Hb% in Group A.

84

46. Effect of treatment on improvement in Hb% in Group B.

84

47. Comparative effect on improvement in Hb% as compared

between groups.

85

48. Pharmacodynamics of ingredients of Eladi Gutika

92

49. Pharmacodynamics of ingredients of Matulunga

Avaleha.

93

50. Mode of action of drugs according to chemical

constituents.

94

Graphs

Page XIII

LIST OF GRAPHS

Sl No. TITLE

Page No.

Observations

Distribution of patients based on Age.

50 1.

2. Distribution of patients based on Religion.

51

3. Distribution of patients based on Occupation.

52

4. Distribution of patients based on Education.

53

5. Distribution of patients based on Socio-economic

status.

54

6. Distribution of patients based on Habitation.

55

7. Distribution of patients based on Gravidity.

56

8. Distribution of patients based on Dietary Habits.

57

9. Distribution of patients based on Appetite.

58

10. Distribution of patients based on Dominant rasa

consumed.

59

11. Distribution of patients based on Prakruti.

60

12. Distribution of patients based on Abhyavarana

Shakti.

61

13. Distribution of patients based on Jarana Shakti.

62

14. Distribution of patients based on Bowel Habits.

63

Graphs

Page XIV

15. Distribution of patients based on Duration of

Vomiting.

64

16. Distribution of patients based on Time of Vomiting.

65

17. Distribution of patients based on Contents of

Vomiting.

66

18. Distribution of patients based on Associated

Complaints.

67

Results

Comparative effect in frequency of vomiting as

compared between groups

71

19.

20. Comparative effect in contents of vomitus as


74

21. Comparative effect on nausea as compared between

groups.

77

22. Comparative effect on salivation as compared

between groups.

80

23. Comparative effect on improvement of weight as


83

24. Comparative effect on improvement in Hb% as


86

Flow charts

Page XV

LIST OF FLOW CHARTS

Sl.No: TITLE

Page No.

1. Samprapti of chardi

16

2. Physiology of vomiting

22

3. Act of vomiting

23

4. Involvement of dosha dushti in garbhini chardi

91

Plates

Page XVI

LIST OF PLATES

Sl.No:

Contents

Pg.No

1

Matulunga

28

2

Kola

29

3

Laja

30

4

Sharkara

30

5

Daruharidra

31

6

Dadima

32

7

Kshoudra

33

8

Preparation of Avaleha

34

9

Ela

37

10

Patra

38

11

Twak

39

12

Mridvika

40

13

Pippali

41

14

Madhuka

42

15

Kharjura

43

Introduction

A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi Page 1

INTRODUCTION

God has bestowed many precious things on human beings of which women are

endowed with the unique gift of the power of giving birth to an offspring.

Acharya Charaka highlights greatness of women by saying that virtue, wealth

affluence and creation depend on women. Pregnancy and motherhood is a

unique experience of every woman. The growing foetus depends entirely on

the body of the mother for all its needs. So the pregnant mother should remain

always healthy and well-nourished to have a healthy baby.

Acharya Charka has given specific importance to pregnant lady and given the

comparison of a pot filled with oil because slight oscillation may cause spilling

of oil. Many physiological and psychological changes happen in the body of a

woman during pregnancy. The body of the mother adjusts to these changes and

results in many symptoms of pregnancy.

Garbhini Chardi is mentioned as a vyakta garbha lakshana which is due to the

presence of garbha and due to vata vaigunya. Almost 50% of the women

suffer from emesis gravidarum in the first trimester of pregnancy. It is also

called as morning sickness because most of the time, vomiting occurs in the

early morning hours and associated with nausea and salivation. Even though it

is physiological, it is a common symptom in obstetric practise. It is better to

treat these conditions in early stage and prevent complications like Hyper

emesis gravidarum. Emesis gravidarum is due to the presence of hormones

like hCG and progesterone.

Many yogas are told in classics for the treatment of garbhini chardi. In the

present study Eladi gutika and Matulunga Avaleha are selected and given for

15 days in diagnosed patients of garbhini chardi.

Eladi gutika is deepana, pachana and ruchya and thus helps in reducing the

agnimandya which is mostly present in the first trimester of pregnancy. The

drugs are aromatic in nature and help the mother to have better palatability.

Since it is in the tablet form, it can be easily taken by the patients. So Eladi

gutika was selected for this study.

Introduction


Leha is one among four types of food items having good palatability because

of the sweetening agents. The metabolism and absorption of medicine starts

from the mouth itself because of the presence of enzyme ptyalin in the salivary

secretion. Vomiting in pregnancy is seen mainly due to carbohydrate

starvation. As honey and sugar is seen more in leha preparation along with

other ingredients, it helps in supplementing carbohydrates. Matulunga, the

main ingredient of avaleha is amla in rasa and amla rasa is better liked by the

pregnant woman. It also contains the chemical constituent Limonene which is

used as a flavouring agent and will have better palatability. So Matulunga

avaleha was selected for this study.

Objectives


OBJECTIVES OF THE STUDY

To evaluate the effect of Eladi Gutika in Garbhini Chardi.

To evaluate the effect of Matulunga Avaleha with Eladi Gutika in Garbhini

Chardi.

To compare the effect of both Eladi Gutika and Matulunga Avaleha with Eladi

Gutika in Garbhini Chardi

Historical review


. HISTORICAL REVIEW

VEDIC PERIOD

Description of Kola as chardi nigrahana dravya has been told.

VISHNU PURANA

In Vishnu Purana description regarding chardi has been told.

SAMHITA PERIOD. (1000BC-500AD)

Charaka Samhita (1000 BC)

Acharya Charaka has described five types of chardi and its chikitsa in detail.1

He has also explained chardi as one of the vyakta lakshana of garbha.2

Susruta Samhita (600BC-400BC)

Acharya Susrutha has given detailed description of nidana, types of chardi and its chikitsa in

detail.3 In the nidana of chardi, Acharya Susruta has given one nidana aryaascha

aapanna satwa4 and Dalhana in hiscommentary explains aapanna satwa as garbhini.

5

In the types of chardi,Acharya Susruta considers the fifth type as caused by Dauhrida.6

Dalhanaacharya has explained in commentary that dauhrida is due to garbha.7

Astanga Samgraha (5TH

CENTURY)

Acharya Vagbhata has mentioned chardi as one of the vyakta lakshanas of garbha.8

Astanga Hrudaya (5TH

CENTURY)

Acharya Vagbhata has also considered chardi as one of the vyakta lakshanas of garbha.9

Historical review


SANGRAHA KALA (500AD-1700AD)

Madhava Nidana (7TH

CENTURY)

Acharya Madhava also have mentioned about chardi and chikitsa in detail. He has explained

one nidana as garbhini.10

Bhavaprakasha (16TH

CENTURY)

Bhavamisra has mentioned nidana and chikitsa of chardi.11

Kasyapasamhita

Kasyapa has mentioned garbhini vyadhis in detail and explained different types of chardi and

its chikitsa separately.12

Hareeta samhita

Hareeta has explained chardi as one of the upadravas in garbhini.13

Historical review


BIBLOGRAPHY

1 Agnivesha, Charaka Samhita, Ayurvedadipika Commentary by Chakrapanidatta, edited by;

Vaidya Yadavji Trikramji Acharya, Chaukhamba Surbharati Prakashan, Varanasi, reprint-

2011,Chikitsa Sthana 20th

Chapter, Verse-4-5, pp- 738, pg -555.



2011,Shareera Sthana 4th

Chapter, Verse-16, pp- 738, pg -320.

3 Sushruta, Sushruta Samhita, Nibandha Samgraha commentary of Sri Dalhanacharya edited

by Acharya Yadavji Trikamji, Choukhamba Surabharati Prakashan Varanasi 2008, Uttara

tantra 49th Chapter Verse-4 teeka pp-824, pg – 754.

Historical review


4 Sushruta, Sushruta Samhita, Nibandha Samgraha commentary of Sri Dalhanacharya edited



5 Sushruta, Sushruta Samhita, Nibandha Samgraha commentary of Sri Dalhanacharya, edited


tantra 49th Chapter Verse-3-5 teeka pp-824, pg – 754.



tantra 49th Chapter Verse-12 pp-824, pg – 755.




8 Vagbhata, Ashtanga Samgraha ,Sasilekha commentary of Indu Prologue in Sanskrit by

Prof.Jyotir Mitra, Edited by Shivprasad Sharma, Chaukhambha Sanskrit Series, Reprinted

2008, Choukhamba Krishnadas Academy,Varansi, Sharira Sthana 2/8, pp-965,P-276.

9 Vagbhata, Astanga Hrudaya, SarvangaSundara Commentary of Arunadatta and Ayurveda

Rasayana Commentary of Hemadri, edited by; Pandit Hari Sadasiva Sastri Paradakara

Bhisagacharya, Chaukhamba Surbharati Prakashan, Varanasi, reprint-2010, Shareera sthana

1st


10 Acharya Madhava, Madhava Nidana,Madhukosha Commentary, Hindi trasalation by

Acharya Narendranath Shastry, Motilal Banaraseedas, Delhi, reprint- 2009, Chardi

nidana,Verse 2-4,pp-, pg316.

11

Acharya Bhavamishra, Bhavaprakasha, Vidyotini teeka of Pandit Brahma Sankara Misra,

Chaukhambha Sanskrit Bhavan, Varanasi, 11th

edition 2010,17th

Chapter, Verse 1-4, pp-

836,pg- 172.

12 Vruddha Jeevaka, Revised Vatsya Kashyapa samhita with Vidyotini hindi commentary by

Ayurvedalankara SriSatyapala Bhishagachayara, Chaukhamba press Varanasi, reprint –

1998,Khila Sthana 10th

Chapter, Verse 182 pp-364, pg -300

Historical review


13 Hareeta Samhita, Pandit HariharaprasadTripathi, Chaukhamba Krishnadas Academy,

Varanasi, reprint 2005, Chapter No: 51, Verse-1-2, pp-524, pg-456.

Disease review


DISEASE REVIEW

GARBHA

Garbha is derived from the word Garbha which means the womb (or) the belly.14

According

to Medini Kosha “Garbhe bhroone arbhake kukshou”.It means that the smallest 'Bhruna'

which stays in Kukshi is called as 'Garbha'.

DEFINITION

“Shukra shonitam garbhashayastham aatma prakruti vikaara sammoorchitam garbha

ityuchyate.”15

“Shukra shonitajeevasamyoge tu khalu kukshi gate garbha samgjya bhavati.”16

The union of shukra, shonitha, aatma, ashta vidha prakruti and shodasha vikaaras in the

Garbhashaya is termed as Garbha.

SHADBHAVAS

Along with the five factors (Panchamahabhootas), another six more factors have been

described by Acharyas. They are Matrija, Pitrija, Atmaja, Satmyaja, Rasaja and Satvaja

bhavas. Garbha is formed and developed by the combination of these bhavas.

TABLE NO: 1 FEATURES OF SHADBHAVAS

BHAVA FEATURES

1. Matrija Twak, Rakta, Mamsa, Meda, Majja,

Nabhi, Hridayam, Kloma, Yakrit,

Pleeha,Vrikka,Vasti,Purishadhanam

Amasaya, Pakvasaya, Antra, Uttara

Guda, Adhara Guda, Kshudrantra,

Sthulantra,VapaVapavahanam,

Garbhasaya and all Mridu Angas.

Disease review


2. Pitrija Shukra, Kesha, Smasru, Nakha,

Loma, Danta, Asthi, Sira, Snayu,

Dhamani and all Sthira Angas

3. Atmaja Taasu Taasu Yonishu Utpatti (Birth

in specific species), Ayu (lifespan),

Atmagnanam Vignanam, Prerana of

Prana and Apana, Swara, Sukha,

Dukha,Ichcha,Dvesha,Chetana,

Dhriti, Buddhi, Smriti, Ahankara,

Prayatna, Kama, Krodha, Lobha,

Bhaya, Harsha,

Dharmadharmaseelata,Mana,

Indriyas, Akriti, Varna.

4 Satmyaja

Arogyam, Analasyam,

Alolupatvam, Indriya

Prasadanam,Svara Varna Beeja

Sampat, Praharsha, Veeryam,

Balam,Medha, Ayu, Ojas, Prabha,

Uthanam, Santosham.

5 Rasaja Sarirasya Abhinivritti, Sarirasya

Abhivriddhi, Prananubandhata,

Tripti, Pushti, Utsaham, Balam,

Varnam, Sthiti Hani, Aloulyam,

Buddhi, Vritti

6 Satvaja BhaktiSeelam, Saucham, Dvesham,

Smriti, Moham, Tyagam,

Matsaryam, Souryam, Bhayam,

Krodham, Tandra, Utsaham,

Taikshnyam, Mardavam,

Gambhiryam, Anavasthitatvam

The mentioned Matrija, Pitrija and Atmaja bhavas cannot be changed as they come from the

parents and Poorvajanma Samskaras respectively. The other three bhavas viz. Satmyaja,

Disease review


Rasaja and Satvaja bhavas can be changed by proper medication and proper Ahara and

Vihara.

SATMYAJA BHAVA

Those are called as Satmya substances which stabilize the health in a healthy person and

which help in alleviation of the disease or vitiated doshas in an unhealthy person. This Satmya

depends upon many factors like Desa, Kala, Jati, Ritu, Roga, Vyayama, Udaka etc. Satmya, in

this context, refers to the Ahara Rasa which is favourable to mother and foetus. The Satmyaja

food when taken by the mother provides proper nutrition to her and foetus. When the same

Ahara which is taken by the mother is not suitable to herself and foetus, it will result in poor

nutrition of the both. It may also lead to improper organogenesis of foetus, disproportion in

various organs of foetus, small for gestation age babies etc. In severe conditions, Garbha

Srava and Garbha Pata are also likely to occur.

RASAJA BHAVA

Definition

“Rasyate aaswaadyate rasanena iti rasah”17

Rasa is that substance which flows continuously and which is tasted by tongue and felt by

mind. In this context, Rasa refers to balanced Ahara Rasa. The balanced Ahara Rasa which is

taken by the pregnant woman helps in formation of Sapta Dhatus in required amount in the

foetus. Rasa Dhatu of the mother performs three functions. (1) Matru Pushti (2) Garbha Pushti

(3)Stana/Stanya Pushti.18

GARBHINI

Garbhini is considered as a woman walking with a filled pot in her head.19

There is always a

need of gentle care for her as any slight changes can cause problem to the foetus.

GARBHINI LAKSHANAS

(Physiological changes in mother during pregnancy)

During pregnancy, there are progressive anatomical and physiological changes not only

confined to the genital organs but also to all systems of the body. This is principally a

phenomenon of maternal adaptation to the increasing demands of the growing foetus.

Disease review


Charaka and Chakrapani have said that after Dauhrida's Abhivyakti, Grihita (Vyakta) Garbha

Lakshanas start. According to Vagbhata-II, Dauhridavastha starts in the 2nd month. Probably,

because of this reason, Vagbhata-II has explained the Vyakta Garbha Lakshanas in 2nd

month, whereas, Charaka in 3rd month. Sushruta and Vagbhata I have not specified the period

of Vyakta Garbha Lakshanas.

The signs and symptoms of Vyakta Garbha Lakshanas are tabulated below

TABLE NO: 2 VYAKTA GARBHA LAKSHANAS ACCORDING TO DIFFERENT

ACHARYAS

No

Sign/Symptom CS20

SS21

AS22

AH23

1 Artava

Adarsanam

+ + + _

2 Asya

Samsravanam

- - _ -

3 Praseka _ - + +

4 Anannabhilasha - + +

5 Chardi + + + +

6 Arochaka + - + +

7 Amla Kamata + - + +

8 Uchchavacheshu

Bhaveshu

Sraddha

+ - + +

9 Gurugatrata + - _ -

10 Chakshushor

Glani

+ - + -

11 Stanayoh

Stanyapravritti

+ - _ +

12 Oushtha, Stana

Mandala

Krishnata

+ + _ +

Disease review


13 Padayoh

Svayathu

+ - + +

14 Roma

Rajyudgamah

+ + _ +

15 Yonyascha

Atalatvam

+ - - +

16 Subhagandhat

Udvejanam

_ - - +

17 Sadanam - - - +

18 Kukshi

Gauravam

- - + +

19 Akshi Pakshma

Sammilanam

- + + -

20 Swara Kshamata - - + -

21 Nidradhikyata - - + -

22 Jrimbha - - + +

23 Moorcha - - + +

24 Kshamata - - - +

25 Stana Peenata - - - +

26 Vidaha - - - +

GARBHINI CHARDI

Garbhini chardi is a common complaint in obstetric practice. Pregnancy is a condition in

which many physiological changes happen in the body of a woman. These changes can lead

to many symptoms in her body. One of these includes Garbhini Chardi. Chardi is mentioned

as one of the vyakta lakshanas of Garbha in all Ayurvedic classics.

In Charaka samhita, there is a detailed description of classification of chardi and its

chikitsa.24

Susruta samhita also mentions about chardi in detail.25

In the nidana of chardi,

Acharya Susruta has given one nidana as naryaascha aapanna satwa and Dalhana in his

commentary explains aapanna satwa as garbhini.26

He has explained douhrudaja as nidana for

Disease review


agantuja chardi, and Dalhana commentary explains douhrudaja as caused by garbha.27

Acharya Vagbhata also explains types of chardi and has mentioned dwishtardhaja as one

classification of chardi and explained dauhrida as a cause of chardi. Acharya Hareeta has

explained chardi as one of the upadravas of garbha.28

There is no separate chapter explaining about garbhini chardi in classics. Acharya Kashyapa

have explained that there is no difference of the physical and psychological disorders of a

pregnant woman from any other individual.29

The diseases manifested in her will also be like

other persons. So the nidana panchakas of chardi can be considered for garbhini chardi also.

But the principles of treatment differ because it should be aimed at the proper development of

garbha and the pregnant lady.

NIRUKTI OF CHARDI

The word “chardi” is a stree linga pada.30

The word chardi is derived from two words “chad” dhatu and “inn” pratyaya.31

The word chard is with two words “chad” meaning to fill and “ardh” means with discomfort.

PARYAYA OF CHARDI32

Vamanam Vamathu Vamah

Vanthi Chardanam Prachardika

PARIBHASHA OF CHARDI.

Chardi is so called as the vitiated doshas comes out of mouth with forceful impulses covering

the mouth and producing discomfort to the whole body.33

Disease review


NIDANA

There is no direct reference regarding garbhini chardi. So the nidana of chardi is considered in

detail.

TABLE NO: 3 NIDANA OF CHARDI ACCORDING TO DIFFERENT ACHARYAS

SS34

MN35

YR36

BP37

Atidrava + + + +

Atisnigdha + + + +

Ahrudya + + + +

Atilavana + + + +

Akalabhojna + + + +

Atimatra + + + +

Asatmya

Bhojana

+ + + +

Shrama + + + _

Kshaya + + + _

Udvega + + _ +

Ajeerna + + _ +

Krimi + + + +

Apannasatwa + + + +

Atidruta

Mashnata

+ + _ +

Ama + + + +

Disease review


Acharya Charaka has explained vishishta nidanas for chardi.

TABLE NO: 4 VISHISTA NIDANA OF CHARDI38

TYPE OF CHARDI NIDANA

VATAJA Vyayama,teekshanaoushadha,shoka,bhaya,upavasa.

PITTAJA Ajeerna,katu,amla,vidahi ahara

KAPHAJA Snigdha,atiguru ,vidahi ahara,atinidra

SANNIPATAJA Sarvarasa aharasevana,amadosha,rituviparyayaahara.

DWISHTARTHAJA Ashuchi,pooti,amedhya,beebhatsa

PURVARUPA

Prodromal symptoms are nausea with uneasy feeling in chest region, excessive salivation and

aversions of food.

TABLE NO: 5 PURVA RUPA OF CHARDI ACCORDING TO DIFFERENT

ACHARYAS.

CS39

SS40

MN41

BP42

Hridayotklesha + + _ +

Kapha praseka + + + +

Annadwesha + _ + +

Bhaktasya

anabhinanadanam

_ + _ _

Hrullaasa _ _ + +

Udgararodha _ _ + +

Disease review


CLASSIFICATION OF CHARDI.

TABLE NO: 6TABLE SHOWING CLASSIFICATION OF CHARDI

CS

43

SS

44

AH45

AS

46

MN

47

BP

48

VATAJA + + + + + +

PITTAJA + + + + + +

KAPHAJA + + + + + +

SANNIPAT

AJA

+ + + + + +

DWISHTAR

THAJA

+ + + + + +

ROOPA

Vataja chardi: In vatika chardi,the person experiences hrid parswa peeda, mukhasosha,

moordha nabhi vedana, kasa, swarabheda, prabala udgara shabda. The chardi is saphena,

vichinna, krushna, tanu and with kashaya rasa. The vomitus is alpa, but with forceful vegas.49

Pittaja Chardi: In pittaja chardi the patient experiences moorcha, pipaasa, mukhasosha,

moordha talu akshi santaapa, tama and bhrama. The vomitus is peeta or harita and ushna and

tikta and takes place with daha.50

Kaphaja Chardi: In kaphaja, the chardi is with roma harsha and asya madhurya. There will

be kapha praseka, nidra, aruchi, and shareera gourava.51

Sannipatika Chardi: The chardi in which all the above features are found should be known

as caused by all the doshas.52

Dwishtarthaja chardi: No specific roopa is mentioned .

Disease review


SAMPRAPTI Nidanas will lead to the vitiation of kapha dosha and pitta dosha which inturn vitiates vata

which forces the doshas to move upward leading to chardi.53

During pregnancy, nidana like garbha peedana together with lack of proper garbhini

paricharya will cause agnimandya. Manasika karanaas like douhrida avamana can lead to vata

vrudhi and may also lead to kapha dushti. The kapha dushti together with the pitta dushti will

lead utklishtata of dosha or aamasanchaya. These utklishta doshas can cause avarodha to the

gati of vata which inturns brings about kshobha to amashaya. The utklishta doshas are

expelled out through the mouth by the action of udana and vyana vata resulting in chardi.

SAMPRAPTI GHATAKAS

Dosha –Tridosha

Dooshya-Rasa

Srotas-Annavaha and Rasavaha

Agni-Jatharaagni,rasadhatwagni

Adhishtana-Amashaya

Vyakta Sthana-Mukha

Srotodushti-Vimargagamana

Roga marga-Abhyantara

Saadhyasadhyata-Sadhya

Disease review


SAMPRAPTI

FLOW CHART NO: 1 SHOWING THE SAMPRAPTI OF CHARDI

PEEDANA DUE TO GARBHA VRUDHI IMPROPER GARBHINI PARICHARYA

DOUHRUDA AVAMANA

AGNIMANDYA

KAPHA DUSHTI IN AMASHAYA + PITTA DUSHTI+VATAVRUDHI

UTKLISHTATA OF DOSHA OR AMA SANCHAYA

CAUSE AVARODHA TO VATA GATI

CAUSE KSHOBHA IN AMASHAYA

VILOMA GATI OF UTKLISHTA DOSHAS BY VYANA AND UDANA VATA

MUKHA POORANA

CHARDI

Disease review


The pathogenesis clarifies three types of causes for garbhini chardi.54

1) VATA-VAIGUNYA

Vata denotes nervous system including psychology of individual. Abnormality of this factor

may produce reflux and psychogenic factors.

2) DAUHRUDA (Avamana or non-fulfilment of Dauhruda)

Normally the woman desires for the substances when she is deficient. Non fulfilment of these

may produce certain deficiency and this may initiate vomiting.

3) GARBHANIMITTA (Due to foetus)

Presence of Garbha itself is a nidana for chardi.

UPADRAVA55

Kasa

Swasa

Jwara

Hikka

Trushna

Vaichintya

Hrudroga

CHIKITSA

SAMANYA CHIKITSA

Chikitsa for garbhini chardi is explained in Yogaratnakara and Bhavaprakasha.

1) Use of pestled bhoonimba with equal quantity of sugar.

2) Shunti vilwa kashaya with yava saktu.

3) Paste of dhanyaka with rice water and sugar.

4) Vilva phala majja with lajambu

VISHESHA CHIKITSA

Acharya Kasyapa has mentioned doshanusara chikitsa for chardi.

Disease review


CHIKITSA IN VAJAJA GARBHINI CHARDI 56

Leha of matulunga rasa, laaja, kolamajja, daadimasara, rasanjana, sarkara and madhu.

Pakva rasa of amla dadima without salt.

Samskaarita mahisha mamsa rasa.

CHIKITSA IN PITTAJA GARBHINI CHARDI 57

Rice water with Laaja choorna , sarkara and madhu mixed with chaturjata kalka and with

pushpa to make hrudya.

Peya of laja with sita and kshoudra.

Jangala mamsa rasa with sarkara.

CHIKITSA IN KAPHAJA GARBHINI CHARDI58

Kwatha of jambu pallava and amra pallava mixed with kshoudra.

Yoosha of mudga and dadima mixed with salt and sneha.

CHIKITSA IN SANNIPATAJA GARBHINI CHARDI59

Combination of all above treatments.

PATHYA

TABLE N0: 7 PATHYA OF CHARDI60

AHARA VIHARA

Laja manda Narikela Sugandha lepana

Purana shali

Dhatri Manoanukoola roopa,rasa

gandha,sparsa

Mudga Nagakesara Mano anukoola pushpa,phala

darsana

Godhooma Draksha

Jangalamamsa Kola

Hareetaki Nimbu

Disease review


APATHYA

TABLE NO: 8 SHOWING APATHYA OF CHARDI61

AHARA VIHARA

Bimbiphala Chinta

Teekshna ushna ahara Shoka

Akala bhojana Bhaya

Bheebhatsya darshana

Aarohana

Bharodwahana.

GARBHOPAKHATAKARA BHAVAS.

Garbhopakhatakara bhavas are considered as apathyas in pregnancy. All acharyas have

mentioned about garbhopakhatakara bhavas.

TABLE NO: 9 SHOWING GARBHOPAKHATAKARA BHAVAS

CS62

SS63

AS64

AH65

KS66

Uccha

bhashana

Maithuna Yana Apriya

avalokana

Looking at

declining sun

and moon

Avarohana Vyayama Ajeerna Apriya

sravana

Exposed to

solar and

lunar eclipse

Kupa

avalokana

Ati-

tarpana

Krodha Bharavah

ana

Excessive

laughing

Rakta

vasana

dharana

Ati-

karshana

Shoka Guru

pravarana

Wearing tight

garments

Snehadi

kriya

Diva-

swapna

Bhaya Uttana

shayana

Staying in

erect or

flexed

posture in

Disease review


long

intervals.

Vyayama Rathri

jagarana

Trasa Shodhana Viewing the

filled pots,

garlands,

pot filled

with gruta or

dadhi.

Vyavaya Kukkuta

Asana

Upavasa

Udvartana Excitement

Disease review


VOMITING.

Vomiting is considered as one of the symptom of many diseases especially of gastro intestinal

tract rather than a separate entity. It is present as a cardinal symptom in many diseases which

helps in diagnosis. Nausea and vomiting are seen together in many diseases or conditions

among which pregnancy is one such condition where with history of amenorrhea and presence

of nausea and vomiting it can be diagnosed that woman is pregnant. It is present in most

mammals except rodents, a species that lacks the vomiting centre.

The word nausea is derived from the Greek “naus” meaning “ship”67

and thus originally

carried the idea of sickness from sea travel.

Definition:-

It can be defined as a reflux which serves to relieve the upper G.I tract by forcible expulsion

of gastric contents through the mouth68

. The strongest stimuli include unpleasant sights and

dizziness or irritation and distension of the stomach.

Causes of vomiting:-

Indulgence of foods which are very fatty, unpleasant, very watery and salty

Taking meals at odd times, in excess of quantity

Infection by worms

Pregnancy

Sight of terrific, fearsome, ugly and unpleasant things

Ingestion of toxins i.e. food poisoning

Gastritis, peptic ulcer with or without pyloric stenosis, dyspepsia, intestinal obstruction etc

Raised intra cranial tension, meningial irritation, motion sickness, encephalitis, labrynthitis

and migraine

Acute hepatitis

Psychogenic vomiting

Drugs which produce gastritis, over dose of digitalis etc

PHYSIOLOGY OF VOMITING69

The act of vomiting is accompanied by a complex of movements which are controlled by the

vomiting centre in the dorsal portion of the lateral reticular formation. The efferent and

afferent pathways which bring about vomiting are caused by vagus and symphathetic nerves.

Disease review


A major sensory relay station in the afferent vomiting pathway is the chemoreceptor trigger

zone (CTZ) situated in the lateral border of the area postrema of the medulla oblongata. It is

in direct contact with the circulating blood and is outside the blood brain barrier. CTZ being a

purely sensory relay station is incapable of initiating vomiting in the absence of vomiting

centre while direct chemical stimulation of the latter can evoke vomiting irrespective of the

CTZ. Vomiting is usually preceded by the sensation of nausea and increased secretion of

saliva, bronchial fluid and sweat. The muscles involved in the act of coughing take part in the

act of vomiting and the vagal vomiting and cough centre have a close functional relationship.

FLOW CHART NO: 2 SHOWING PHYSIOLOGY OF VOMITING

CORTEX

VOMITING CENTRE

GIT

G.I.IRRITATION,

INFECTION,

DRUGS,

RADIATION

CEREBELLUM

INNER EAR

CTZ

SMELL, PAIN, SIGHT

STIMULI

VEGAL

STIMULATION

MOTION

SICKNESS

Disease review


ACT OF VOMITING

The vomiting act encompasses three types of outputs initiated by CTZ

Increased salivation to protect the enamel from the gastric acid.

Retro peristalsis movement which starts from the middle of the small intestine and moves

upward sweeping all the contents into the stomach through the relaxed pyloric stenosis.

A lowering of intra thoracic pressure, coupled with an increase in abdominal pressure making

abdominal muscles to contract and propels stomach contents into oesophagus as the

oesophageal sphincter relaxes causing vomiting which is followed by retching.

FLOW CHART NO: 3 SHOWING ACT OF VOMITING70

Taking a deep breathe

Raising the hyoid bone and larynx to pull the USO open

Closing of the glottis-prevents aspiration in the trachea

Soft palate lifted to close the posterior nares

Subsequently strong downward contraction of diaphragm

Simultaneous contraction of abdominal wall muscles

Squeeze stomach to build up high intra gastric pressure

Finally LES relaxes allowing expulsion of gastric contents upward.

Disease review


CHANGES IN ALIMENTARY SYSTEM DURING PREGNANCY:

The gums become congested and spongy and may bleed to touch71

. A focal, highly vascular

swelling of the gums develops called as epulis of pregnancy develops occasionally but

regresses after delivery.As pregnancy progresses, the stomach and intestines are displaced by

the enlarging uterus . The appendix is usually displaced upward and somewhat laterally as the

uterus enlarges and at times it may reach the right flank.72

There is diminished gastric secretion and delayed emptying time of the stomach. Muscle tone

and motility of the entire gastrointestinal tract are diminished due to high progesterone level.73

Decreased levels of motilin, a hormonal peptide is known to have smooth –muscle stimulating

effect74.

This can lead to conditions like vomiting, nausea and gastric irritation. Cardiac

sphincter is relaxed and regurgitation of acid gastric content into the oesophagus may produce

chemical oesophagitis and heart burn. The altered position of the stomach probably

contributes to its frequent occurrence.75

However lower oesophageal sphincter tone is also

reduced. Intra oesophageal pressures are reduced and intra gastric pressures are greater in

pregnant woman. At the same time oesophageal peristalsis has lower wave speed and lower

amplitude. Atonicity of the gut leads to constipation, while diminished peristalsis facilities

more absorption of food materials.76

Vomiting in pregnancy can be classified as 77

1. Physiological Vomiting (Simple Vomiting).

2. Pathological Vomiting (Hyperemesis Gravidarum).

1) SIMPLE VOMITING (EMESIS GRAVIDARUM)78

In simple vomiting, the patients have nausea and occasional sickness on rising in the morning.

Slight vomiting is common in early pregnancy (about50%) that is considered as a symptom of

pregnancy. It may however occur at other times of the day. The vomit is small and clear or

bile stained. It does not produce any impairment of health or restrict the normal activities of

the women. The feature disappears with or without treatment by 12-14th

week of pregnancy.

High level of serum human chorionic gonadotrophin, oestrogen and altered immunological

states are considered responsible for initiation of the manifestation which is probably

aggravated by the neurogenic factor.

Disease review


2) HYPEREMESIS GRAVIDARUM79

Hyperemesis gravidarum is a severe type of vomiting which has got a deleterious effect on the

health of mother and incapacitates in her day to day activities.

ETIOLOGY

The aetiology of emesis gravidarum is obscure.

THEORIES SUPPORTING EMESIS GRAVIDARUM

1) Hormonal 80

HUMAN CHORIONIC GONADOTROPIN

Excess of chorionic gonadotropin will stimulate the vomiting centres of brain. An increase in

HCG also causes nausea. The reason can be because of the HCG stimulates the maternal

ovaries to secrete oestrogen in turn causes nausea.

PROGESTERONE

Excess of progesterone will lead to relaxation of the cardiac sphincter and simultaneous

retention of gastric fluids due to impaired motility.

OESTROGEN

High level of oestrogen will lead to more vomiting in pregnancy.

2) Psychogenic causes81

Psychogenic factors probably aggravate nausea and vomiting.

3) Dietetic causes82

Probably the low carbohydrate reserve, starvation may lead to excessive vomiting.

4) Allergic or immunological83

5) Decreased gastric motility can lead to nausea in pregnancy.

Disease review


6) An increase in salivation during the first trimester, that is often bitter tasting Ptyalin is

ingested during the mother’s sleep. This can upset the stomach enough to cause the morning

nausea.84

Whatever may be the cause of initiation of vomiting, it is probably aggravated by neurogenic

element. Unless it is rectified, features of dehydration and carbohydrate starvation supervene

and a vicious cycle of vomiting appears.85

Vomiting

Carbohydrate starvation

Keto-acidosis

Vomiting

MANAGEMENT 86

The principles in the management of vomiting are

1) To control vomiting.

2) To correct electrolyte and fluid imbalance

3) To correct metabolic disturbances.

4) To prevent the complications of severe vomiting.

Disease review


BIBLIOGRAPHY

14

Amarakosha, Kannada Transalation by Vidwan Raghavendra Sharma, Kavyalaya

Prakashana Jayanagar Mysore, Triteeya khanda, 3rd

chapter, pp-472, pg-269.

15 Sushruta, Sushruta Samhita, Nibandhasangraha Commentary of Sri

DalhanaAcharya,editedbyVaidya Yadavji Trikamji Acharya, Choukhamba Surabharati

Prakashan Varanasi,reprint 2010,Shareera sthana 5th

Chapter,Verse 3, pp-824, pg-363





17

Prof. Dr.A.P.Deshpande &Prof.Dr.Subhash Ranade, Dravyaguna vijnana, Anmol

Prakashan,Pune,First edition 2004,pp-954, pg-54





Disease review





Chapter, Verse-16, pp- 738, pg -320





21 Sushruta, Sushruta Samhita, Nibandhasangraha Commentary of Sri DalhanaAcharya,

editedbyVaidya Yadavji Trikamji Acharya, Choukhamba Surabharati Prakashan

Varanasi,reprint 2010,Shareera sthana 3rd

Chapter,Verse 14-15, pp-824, pg-352.

22 Vruddha Vagbhata, Astanga samgraha, Sashilekha commentary of Indu, Edited by

Shivprasad Sharma,Chowkhanba Sanskrit Series Office, Varanasi,reprint 2008, Shareera

sthana 2nd

Chapter,Verse 8, pp-965, pg-276.




1st








Prakashan Varanasi,reprint 2010,Uttara tantra 49th

Chapter,Verse 3-5, pp-824, pg-754

26 Sushruta, SushrutaSamhita, Nibandhasangraha Commentary of Sri DalhanaAcharya,edited

byVaidya Yadavj Trikamji Acharya, Choukhamba Surabharati Prakashan Varanasi,reprint

2010, Uttara tantra 49th

Chapter,Verse 3-5 Dalhana acharya teeka, pp-824, pg-754.

Disease review


27 Sushruta, Sushruta Samhita, Nibandhasangraha Commentary of Sri DalhanaAcharya,edited

byVaidya Yadavji Trikamji Acharya, Choukhamba Surabharati Prakashan Varanasi,reprint


Chapter,Verse 12 Dalhana acharya teeka, pp-824, pg-755.

28 Hareeta Samhita, Pandit HariharaprasadTripathi, Chaukhamba Krishnadas Academy,

Varanasi, reprint 2005, Chapter No:51, Verse-1-2, pp-524, pg-456.




Chapter, Verse 182 pp-364, pg -304.

30

Raja Kantha deva, Sabdakalpa druma, Dwiteeya kanda, Reprint 1988, pp-937, pg-486.

31 Raja Kantha deva, Sabdakalpa druma, Dwiteeya kanda, Reprint 1988, pp-937, pg-486.

32Sir Monier Monier Williams, English Sanskrit Dictionery, Munshiram Manoharlal Publishers Pvt Ltd,

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2010,Uttara tantra 49th

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2010,Uttara tantra 49th


35

Acharya Madhava, Madhava Nidana,Madhukosha Commentary, Hindi trasalation by


nidana,Verse 2-4,pp-616, pg-316.

36

Yogaratnakara, Vidyotini Hindi Commentary by Vaidya Lakshmipati Sastri, Edited by

Bhishagratna Brahmasankar Sastri, Chaukhambha Sanskrit Sansthan, Varanasi, 7th

edition

1999, Chardi nidana, Verse1-3, pp-508, pg-447.

Disease review


37



edition 2010,Chikitsa prakarana 17th

Chapter,

Verse 1-4, pp-836, pg- 172.




Chapter, Verse-5, pp- 738, pg -555-556.

39

Agnivesha, Charaka Samhita, Ayurvedadipika Commentary by Chakrapanidatta, edited by;






2010,Uttara sthana 49th


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Verse 4, pp-836, pg- 173.






DalhanaAcharya,edited byVaidya Yadavji Trikamji Acharya, Choukhamba Surabharati

Prakashan Varanasi,reprint 2010,Uttara sthana 49th


45 Vagbhata, Astanga Hrudaya, SarvangaSundara Commentary of Arunadatta and

Ayurveda Rasayana Commentary of Hemadri, edited by; Pandit Hari Sadasiva Sastri

Paradakara Bhisagacharya, Chaukhamba Surbharati Prakashan, Varanasi, reprint-

2010, Nidana sthana sthana 5th


Disease review



Shivprasad Sharma,Chowkhanba Sanskrit Series Office, Varanasi, reprint 2008,

Nidana sthana 5th


47




48Acharya Bhavamishra, Bhavaprakasha, Vidyotini teeka of Pandit Brahma Sankara Misra,



Chapter,

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49 Agnivesha, Charaka Samhita, Ayurvedadipika Commentary by Chakrapanidatta, edited

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reprint- 2011,Chikitsa Sthana 20th










52Agnivesha, Charaka Samhita, Ayurvedadipika Commentary by Chakrapanidatta, edited by;





DalhanaAcharya,edited byVaidya Yadavji Trikamji Acharya, Choukhamba Surabharati

Prakashan Varanasi,reprint 2010,Chikitsa sthana 49th


54 Premavathy Tewari, Ayurvedeeya Prasootitantra evum Streeroga,Choukhambha

Orientalia, reprint 2009,6th

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Disease review


55







Chapter, Verse 118-119, pp-364, pg -300.









59Vruddha Jeevaka, Revised Vatsya Kashyapa samhita with Vidyotini hindi commentary by



Chapter, Verse 125, pp-364, pg -300.

60 Sree Govindadasa, Bhaishajyaratnavali edited and translated by SreeLalchandraji

Vaidya, Motilal Banarasidas Publication,NewDelhi 8th

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832, pg -300.

61 Bhaishajya ratnaavali Sree Govindadasa, Bhaishajyaratnavali edited and translated

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Edition 1997,

Chardiadhikaara; Verse – 34-35, pp-832, pg 300.



2011,Shareera Sthana4th


Disease review




Prakashan Varanasi,reprint 2010,Shareera sthana 3rd



Shivprasad Sharma,Chowkhanba Sanskrit Series Office, Varanasi,reprint 2008,

Shareera sthana 2nd





1st




1998,Shareera Sthana, Jatisootreeya Adhyaya, Verse 16-20, pp-364, pg -84.

67

www.etymonline.com/index.php?term=nausea

68 Chandi Charan Chatterjee, Human Physiology Volume 1, Medical Allied Agency Kolkata,

reprint 2003, pp-760, pg-488.

69 R.S. Satoskar, S.D.Bhandarkar, S.S.Ainapure, Pharmacology and Phamacotherapeutics Volume II,Popular

Prakashan Private Limited, 14th

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Arthur C.Guyton, Text book of Medical Physiology 8th

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1014, pg-740.

71 D.C.Dutta-Text Book of Obstetrics edited by Hiralal Konar 5th

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book Agency (p) Ltd. London, pp- 705, pg -57.

72 F.GaryCunningham, Williams Obstetrics 21

st edition 2001, Mc GrawHill Medical

Publishing Division, pp-1668, pg-190

73 D.C.Dutta-Text Book of Obstetrics edited by Hiralal Konar 5

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Disease review


74

F.GaryCunningham, Williams Obstetrics 21st edition 2001, Mc GrawHill Medical Publishing Division,

pp-1668, pg-190

75 F.GaryCunningham, Williams Obstetrics 21

st edition 2001, Mc GrawHill Medical Publishing Division, pp-

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D.C.Dutta-Text Book of Obstetrics edited by Hiralal Konar 5th

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84 www http://en.wikipedia.org/wiki/Morning_sickness







http://en.wikipedia.org/wiki/Morning_sickness

Drug review


DRUG REVIEW

The two medicines used in the present study are Matulunga Avaleha and Eladi

Gutika.

Group A - Eladi gutika.

Group B - Eladi Gutika and Matulunga Avaleha .

MATULUNGA AVALEHA87

अथ चछरदिचिकितसा त परोचयमसनसा ननबोधत/

मसतलनगरो लसजसाःिोलमजजस तथस अनजनम//

तथस दसडिमसरशि शिि रस कषौदरमव ि/

एष वसतसततमिसा छरदि हतनत लहोववशषताः//(िस.ा.स.१०/११५)

Drug review


MATULUNGA88

Botanical Name – Citrus medica

Family Name – Rutaceae

PHOTO PLATE NO: 1 MATULUNGA

Vernacular Names –

English – Citron

Hindi – Barenimbu

Kannada – Madala

Malayalam – Ganapathy Narakam

Synonyms – Beejapooraka,Ruchaka,Madiphala

Chemical Constituents: Abscisic acid, AbscisinII, Limonin, Limonene,

Limocitrol, Rutin

RASAPANCHAKA

Rasa Amla

Anurasa Madhura

Guna Laghu snigdha

Veerya Ushna

Vipaka Amla

Karma VataKapha hara

Drug review


KOLA89

Botanical Name – Ziziphus jujuba

Family Name – Rhamnaceae

PHOTO PLATE NO: 2 KOLA


English – Indian Jujube

Hindi – Beri

Kannada – Bore

Malayalam – Lantappazham

Synonyms – Badara,Ajapriya

Parts used: - Fruit

Chemical constituents: Jujubosides A&B (seeds), Zizogenin, Zeatin,

Frangufoline, Saponin, etc.

RASAPANCHAKA

Rasa Madhura

Anurasa Amla

Guna Guru snigdha

Veerya Sheeta

Vipaka Madhura

Karma Vata Pitta hara

Drug review


LAAJA

PHOTO PLATE NO: 3 LAAJA

RASAPANCHAKA

Rasa Madhura Kashaya

Guna Laghu

Veerya Seetha

Vipaka Madhura

Karma VataPitta hara.

SHARKARA

PHOTO PLATE NO: 4 SHARKARA

RASAPANCHAKA

Rasa Madhura

Guna Laghu snigdha

Veerya Sheeta

Vipaka Madhura

Karma Tridosha hara

Drug review


DARUHARIDRA90

Botanical Name – Berberis aristata

Family Name – Menispermaceae

PHOTO PLATE NO: 4 DARUHARIDRA


English – Tree turmeric

Hindi – Jha-i-haldi

Kannada – Maradarsina.

Synonyms – Darunisa, Pitadaru, Darvi

Parts used: - Stem

Chemical constituents: Karachine, Taxilamine, Berberine, Palmatine,

Oxycathine

RASAPANCHAKA

Rasa Tikta Kashaya

Guna Laghu Ruksha

Veerya Ushna

Vipaka Katu

Karma Kapha Pittahara

Drug review


DAADIMA91

Botanical Name – Punica granatum

Family Name – Punicacae

PHOTO PLATE NO: 5 DAADIMA

Vernacular Names

Eng – Pomegranate

Hindi – Anar

Kannada – Dalimbe

Malayalam – Matalanaraka

Synonyms – Raktabija, Karaka, Raktapushpa

Parts used: Fruit

Chemical constituents: Estrone, Punicic acid

RASAPANCHAKA

Rasa Madhura Amla

Anurasa Kashaya

Guna Laghu snigdha

Veerya Ushna

Vipaka Madhura

Karma Tridosha hara

Drug review


KSHOUDRA

PHOTO PLATE NO: 6 KSHOUDRA

RASAPANCHAKA


Guna Laghu rooksha

Veerya Sheeta

Vipaka Madhura

Karma Tridosha hara

PREPARATION OF AVALEHA92

One part of swarasa was mixed with 16 parts of sarkara and heated on

mandagni till the tantumat paka was obtained and 1 part of choorna was added.

When it was cooled sufficient quantity of honey and ghee was added.

Avaleha paaka lakshana93

Tantumatvam

Apsumajjati

Kharatvam

Pidite mudra

Gandhavarnarasobhavata

Dose of Avaleha94

1 pala (48gms)

Drug review


PREPARATION OF AVALEHA

PHOTO PLATE NO: 7 PREPARATION OF AVALEHA

Drug review


TABLE NO: 10 SHOWING PANCHABHAUTIKA COMPOSITION OF

INGREDIENTS OF MATULUNGA AVALEHA95

Drug Ras

a

PR AP TJ VY AK

Matulunga Amla

madhura

+ ++ + - -

Kola Madhura

Amla

+ ++ + - -

Laaja Madhura

++ + - + -

Dadima Amla

Madhura

++ ++ + + -

Sarkara Madhura

+ + - - -

Rasanjana Tikta

+ - - - -

Madhu Madhura

Kashaya

++ + - + -

Drug review


ELADI GUTIKA

एलसपतरतविो अधसिकषसाःवपपपलयसधि पला तथस/

सतसमधि खजजिर सिदवीिसाशि पलोतनमतसाः//

ािजरणयि मधनस यकतस गरििसाःिसरयत सिषि/

अकषमसतरसाततशििसा िकषयत न रदनरदन//

िसा सवसा जवरा रहकिसा चछरदि मजचछसि मदा भरमा/

रकतननषिीवनातरषसा पसशविशजलमरोििा

शोथपलीहसढयवसतसमशशि सवरिदा कषतकषया/

गरििस तपि ी वरषयस रकतवपतता ि नसशयत// 96

Drug review


ELA97

Botanical Name – Eletteria cardamomum

Family Name – Zingiberacae

PHOTO PLATE NO: 8 ELA


Hindi – Choti Elaychi

English – Lesser Cardamom

Malayalam – Elam

Kannada – Elakki

Synonyms – Korangi, Dravidi, Tuttha, Triputa

Parts used: - Seeds

Major chemical constituents:Bornneol, Camphene, P-cymene, Heptane, D-

limonene, Linalool, Menthone, Sitosterol etc.

RASAPANCHAKA

Rasa Katu Madhura

Guna Laghu Ruksha

Veerya Sheeta

Vipaka Katu

Karma Kapha Vata hara

Drug review


PATRA98

Botanical Name – Cinnamomum tamale

Family Name – Lauraceae

PHOTO PLATE NO: 9 PATRA

Vernacular Names:

Hindi – Tejapatra

Telugu – Lavanga Patri

Synonyms – Patra,Dala

Parts used:-Leaf

Major chemical constituents: Eugenol,Cinnamic Aldehyde, d-phelladrene

RASAPANCHAKA

Rasa Katu Madhura

Guna Laghu Ruksha

Veerya Sheeta

Vipaka Katu

Karma Kapha Vata hara

Drug review


TWAK99

Botanical Name – Cinnamomum zeylanicum

Family Name – Lauraceae

PHOTO PLATE NO: 10 TWAK

Vernacular Names

Hindi – Dalchini

English – Cinnamon

Telungu – Lavange Patta

Synonyms – Utkada, Tanutwak, Ramapriya

Parts used: - Barks

Chemical constituents: Cinnamaldehyde, Eugenol, Cumic Aldehyde,

Caryophyllene, Methyl Eugenol, Borneol, Cinnamyl Alcohol, Cinnzeylanin

etc

RASAPANCHAKA

Rasa Katu Tikta Madhura

Guna Laghu Ruksha Teekshna

Veerya Ushna

Vipaka Katu


Drug review


MRIDVIKA100

Botanical Name – Vitis vinifera

Family Name – Vitaceae

PHOTO PLATE NO: 11 MRIDVIKA

Vernacular Names

English – Common grape vine

Malayalam – Munthiri

Telugu – Draksha

Tamil – Kolumuntiri,

Synonyms - Mridwika,Gostani.

Parts used:-Ripe Fruits (dried).

Chemical constituents: Catechin, Epicatechin, B-sitosterol, Jasmonic acid.

RASAPANCHAKA

Rasa Madhura

Guna Guru snigdha

Veerya Sheeta

Vipaka Madhura


Drug review


PIPPALI101

Botanical Name – Piper longum

Family Name – Piperaceae

PHOTO PLATE NO: 12 PIPPALI

Vernacular Names:

Hindi – Pipala

English – Long Pepper

Malayalam – Tippali

Syn – Magadhi,Krishna

Chemical constituents: Essential oil, caryophhyllene mainly Piperine,

Piplartine, Piperlongumine, Pipernonaline, Piperundecalidine, Pipercide,

Sesamin.

Parts used-Fruit

RASAPANCHAKA

Rasa Katu

Guna Laghu Snigdha

Veerya Ushna

Vipaka Madhura

Karma Vata Kapha hara

Drug review


MADHUKA102

Botanical Name – Madhuca longifolia

Family Name – Sapotacae

PHOTO PLATE NO: 13 MADHUKA

Vernacular Names.

Hindi – Mahua

English – Butter tree

Kannada – Hippe

Synonyms – Guda Puspa

Parts used: - Twaksara

Chemical constituents: Saponins, Myricetin, Quercetin

RASAPANCHAKA


Guna GuruSnigdha

Veerya Sheeta

Vipaka Madhura


Drug review


KHARJURA103

Botanical Name – Phoenix sylvestris

Family Name – Arecaceae

PHOTO PLATE NO: 14 KHARJURA

Vernacular names

Hindi – Kharjur

English – Dates palm

Synonyms – Skandha phala, Bhumikharjurika

Parts used: - Fruit

RASAPANCHAKA

Rasa Madhura

Guna GuruSnigdha

Veerya Sheeta

Vipaka Madhura


Drug review


PREPARATION OF GUTIKA104

All the ingredients are made into fine powder and the gutika is prepared by

mixing with two parts of honey and it is dried in shade.

Dose of Gutika.105

1 tola.

According to Ayurveda Pharmacopia the dose of Eladi Gutika is given as 2

tablets each of 500 gms to be given thrice daily with Honey.106

The same dose

was used in this study.

TABLE NO: 11SHOWING PANCHABHAUTIKA COMPOSITION OF

INGREDIENTS OF ELADI GUTIKA107

Drug

Rasa PR AP TJ VY AK

Ela Katu

madhura

+ + + + -

Patra Madhura,

katu

+ + + + -

Twak Katu.tikta.

madhura

++ + + + -

Mridvika

Madhura + + - - -

Pippali

Katu - - - - +

Madhuka Madhura,

kashaya

++ + - - -

Kharjura Madhura,

kashaya

++ + - - -

Drug review


BIBLIOGRAPHY

87 Vruddha Jeevaka, Revised Vatsya Kashyapa samhita with Vidyotini hindi commentary

by Ayurvedalankara SriSatyapala Bhishagachayara, Chaukhamba press Varanasi, reprint –

1998,Khilasthana Chapter10, Verse -115- 116 pp-364, pg -300

88 Dr.J.L.N.Sastry, Foreword by K.C.Chunekar, Chaukhambha Orientalia Varanasi,

Edition-2004, pp-, pg 650.


Edition-2004, pp-, pg 669.


Edition-2004, pp-, pg 54, 55.


Edition-2004, pp-, pg 232-235.

92

Acharya Sarangadhara, Sarangadhara samhita, Jiwanprada hindi commentary by

Dr.Shailaja Srivastava, Chaukhambha orientalia Varanasi,Second edition 1998, pp-578,pg-

208.

93 Acharya Sarangadhara, Sarangadhara samhita, Jiwanprada hindi commentary by


208.

94 Sarangadhara samhita, Acharya Sarangadhara, Sarangadhara samhita, Jiwanprada hindi

commentary by Dr.Shailaja Srivastava, Chaukhambha orientalia Varanasi,Second edition

1998, pp-578,pg-208.

95 Vagbhata, Astanga Hrudaya, SarvangaSundara Commentary of Arunadatta

and Ayurveda Rasayana Commentary of Hemadri, edited by; Pandit Hari

Sadasiva Sastri Paradakara Bhisagacharya, Chaukhamba Surbharati

Prakashan, Varanasi, reprint-2010, Sutra sthana 10th

Chapter, Verse-1,

pp- 956, pg -174.

Drug review




Edition 1997,

Raktapittaadhikaara; Verse - 32-35, pp-832, pg -236.


Edition-2004, pp-, pg 527-529.


Edition-2004, pp-, pg 918-919.


Edition-2004, pp-, pg 464-466.


Edition-2004, pp-, pg 673-674.


Edition-2004, pp-, pg 452-454.


Edition-2004, pp-, pg 824-825.


Edition-2004, pp-, pg 1014-1015.

104Acharya Sarangadhara, Sarangadhara samhita, Jiwanprada hindi commentary by


195.



Edition 1997,

Raktapittaadhikaara; Verse - 32-35, pp-832, pg -236.

106 The Ayurvedic Formulary of India-Part1, Government of India, Ministry of Health

and Family Welfare 2003 Department of Indian Systems of Medicine and

Homeopathy, Revised English Edition, Published by The Controller of Publications,

Civil lines, Delhi,pp:488, pg -181-182.

Drug review


107 Vagbhata, Astanga Hrudaya, SarvangaSundara Commentary of Arunadatta

and Ayurveda Rasayana Commentary of Hemadri, edited by; Pandit Hari

Sadasiva Sastri Paradakara Bhisagacharya, Chaukhamba Surbharati

Prakashan, Varanasi, reprint-2010, Sutra sthana 10th

Chapter, Verse-1,

pp- 956, pg -174.

Methodology


METHODOLOGY

This clinical study entitled “A COMPARATIVE CLINICAL STUDY ON THE EFFECT

OF ELADI GUTIKA AND MATULUNGA AVALEHA IN GARBHINI CHARDI” was

carried out on 40 patients who attended the OPD and IPD sections of Prasooti Tantra and

Stree Roga Department, SKAMCH & RC, Bangalore.

OBJECTIVES OF THE STUDY

To evaluate the effect of Eladi Gutika in Garbhini Chardi.

To evaluate the effect of Matulunga Avaleha with Eladi Gutika in Garbhini Chardi.

To compare the effect of both Eladi Gutika and Matulunga Avaleha with Eladi Gutika

in Garbhini Chardi.

Source of Data:

40 patients diagnosed with Garbhini Chardi were selected from O.P.D and I.P.D of SKAMC

H& RC, Bangalore and randomly divided into two groups.

Methods of Collection of Data

It was an open comparative clinical study with a pre- test and post-test design and the

patients were randomly assigned into two groups.

A case proforma was specially designed with all points of history taking, physical

signs and symptoms, and necessary laboratory investigations.

The parameters of signs and symptoms were scored using a special case proforma.

Following statistical methods were employed to analyse data collected – descriptive

statistics and t test (paired and unpaired) using SPSS for windows software.(version

21 for windows 7)

Methodology


Diagnostic Criteria

Patients were diagnosed as per diagnostic criteria of Garbhini chardi which includes:

Pregnant women in their 1st trimester.

Pregnant women with Chardi (Vomiting)

Pregnant women with Praseka (Salivation)

Pregnant women with Hrullasa(Nausea)

Pregnant women with Aruchi (Anorexia)

Inclusion criteria

Pregnant women in between 18 to 40 years of age.

Pregnant women with Chardi in 1st trimester.

Both primi and multi gravida.

Exclusion criteria

Pregnant women with Hyperemesis Gravidarum.

Patient with Twin pregnancy.

Patient with Molar pregnancy.

Patient with history of Diabetes Mellitus.

Assessment criteria

Signs and symptoms were assessed using the following objective and

subjective parameters:

Frequency of vomiting.

Contents of vomitus.

Nausea.

Salivation.

Increase in weight.

Increase in Hb%

Methodology


Laboratory investigations

Blood investigations: Hb%, RBS.

Urine examination: Pregnancy test

USG: OBG

Study design

A comparative clinical study with pre- test and post- test analysis was conducted on 40

randomly assigned patients with signs and symptoms of Garbhini Chardi.

Intervention

40 patients complaining of Chardi in 1st trimester were randomly divided into the following

two groups, each comprising of 20 patients.

1) Group A: Eladi Gutika was given for 2 weeks.

Dose: 2 tablets thrice daily (each 500mg) with Honey.

2) Group B: Matulunga Avaleha with Eladi Gutika was given for 2 weeks.

Dose: Matulunga Avaleha 24gms in divided dose of 6gms 4 times daily

followed by Water .

Eladi gutika: 2 tablets thrice daily (each 500mg) with Honey

Duration of the study

The study was done for a period of 30 days which included the first follow-up on 14th

day and second follow-up on 28th

day.

Methodology


Assessment Criteria

The results of the treatment were assessed on the following scoring patterns

1) FREQUENCY OF VOMITING No Vomiting Grade 0

Less than 2 times Grade 1

2-5 times Grade 2

>5times Grade 3

2) CONTENTS OF THE VOMITUS No vomiting and salivation Grade 0

Only saliva Grade 1

Saliva with gastric juice Grade 2

Saliva with gastric juice and food Grade 3

3) NAUSEA No nausea Grade 0

Nausea only in the morning Grade 1

Nausea only in the morning Grade 2

&evening

Nausea throughout the day Grade 3

4) SALIVATION No salivation Grade 0

Salivation only in the morning Grade 1

Salivation throughout the day Grade 2

Salivation persisting to hamper Grade 3

day to day activities

5) IMPROVEMENT IN WEIGHT More than 1kg Grade 0

½ to 1 kg Grade 1

Up to ½ kg Grade 2

No improvement Grade 3

Methodology


6) IMPROVEMENT IN THE Hb% >0.5 gm% Grade 0

0.25 – 0.5 gm% Grade 1

Up to 0.25 gm % Grade 2

No change Grade 3

Observations


OBSERVATIONS

The data recorded are presented under the following headings:

Demographic Data

Data related to Disease

Data related to Clinical Trial

DEMOGRAPHIC DATA

TABLE NO: 12 DISTRIBUTIONS OF PATIENTS BASED ON AGE IN YEARS

GRAPH NO: 1

Group A-8 patients were in the age group of 18-22 years, 9 patients in the age group of 23 to 27

yrs and 3 patients were in the age group of 28-32 years.

Group B-8 patients were in the age group of 18-22 years, 9 patients in the age group of 23 to

27 yrs and 3 patients were in the age group of 28-32 years.

Among 40 patients included in the study, 16(40%) were in the age group of 18 to 22 yrs, 18

(45%) in the age group of 23 to 27 yrs and 6 (15%) were of age group 28-32 yrs.

Age in years Group A Group B Total %

18-22 8 8 16 40

23-27 9 9 18 45

28-32 3 3 6 15

Total 20 20 40 100

0

2

4

6

8

10

18-22 23-27 28-32

8 9

3

8 9

3

Age in years

Group A

Group B

Observations


TABLE NO: 13 DISTRIBUTIONS OF PATIENTS BASED ON RELIGION

GRAPH NO: 2

Group A-13 patients were of Muslim community and 7 patients were belonging to Hindu

community.

Group B-15 patients were of Muslim community and 5 patients were belonging to Hindu

community.

Among 40 patients in the study, 28(70%) were Muslims and 12(30%) were Hindus.

0

2

4

6

8

10

12

14

16

GROUP A GROUP B

7

5

13

15

Religion

HINDUS

MUSLIMS

Group A Group B Total %

Hindus 7 5 12 30

Muslims 13 15 28 70

Total 20 20 40 100

Observations


TABLE NO: 14 DISTRIBUTIONS OF PATIENTS BASED ON OCCUPATION

GRAPH NO: 3

Group A-In group A, 18 patients were home makers, and 2 patients were working.

Group B-In group B, 17 patients were home makers, and 3 patients were working.

In the study, majority of the women that is 35 (87.5%) were home-makers, 3(7.5%)

were private employees and 2(5%) were teachers.

0

2

4

6

8

10

12

14

16

18

homemakers teachers employee

18

1 1

17

1

2

Occupation

Group A

Group B

Occupation Group

A

Group B Total %

Homemaker 18 17 35 87.5

Teacher 1 1 2 5

Employee 1 2 3 7.5

Total 20 20 40 100

Observations


TABLE NO: 15 DISTRIBUTIONS OF PATIENTS BASED ON EDUCATION

GRAPH NO: 4

Group A- In Group A, 6 patients were with primary education, 9 patients were with

secondary education, 4 patients were with higher secondary education and 1 patient was a

graduate.

Group B- In Group B, 7 patients were with primary education, 6 patients were with

secondary education, 3 patients were with higher secondary education and 4 patients were

graduates.

Among 40 patients in the study, 13(32.5%) were primary educated, 15(37.5%) had got

secondary education, 7(17.5%) had higher secondary education and 5 (12.5 %) were

Graduates.

0

2

4

6

8

10

PE SE HS GR

6

9

4

1

7

6

3

4

Education

Group A

Group B

Education Group A Group B Total %

PE 6 7 13 32.5

SE 9 6 15 37.5

HS 4 3 7 17.5

GR 1 4 5 12.5

Total 20 20 40 100

Observations


TABLE NO: 16 DISTRIBUTIONS OF PATIENTS BASED ON SOCIO ECONOMIC

STATUS

GRAPH NO: 5

Group A- In Group A, 2 patients were from lower middle class, 15 patients were from middle

class, and 3 patients were from upper middle class.

Group B- In Group B, 4 patients are from lower middle class, 13 patients are from middle

class, and 3 patients were from upper middle class.

Among 40 patients included in the study, 6 (15%) were from lower middle class, 28(70%)

were from middle class, and 6 (15%) were from upper middle class.

Socio Economic Status Group A Group B Total %

LM 2 4 6 15

M 15 13 28 70

UM 3 3 6 15

Total 20 20 40 100

0

2

4

6

8

10

12

14

16

LM MC UMC

2

15

3 4

13

3

Socio economic status

Group A

Group B

Observations


TABLE NO: 17 DISTRIBUTIONS OF PATIENTS BASED ON HABITATION

GRAPH NO: 6

Group A- In Group A, all patients were from the urban habitation.

Group B- In Group B, all patients were from the urban habitation.

Among 40 patients included in the study, all patients (100%) were from the urban habitation.

Habitation Group A Group B Total %

Urban 20 20 40 100

Suburban 0 0 0 0

Rural 0 0 0 0

Total 20 20 40 100

0

2

4

6

8

10

12

14

16

18

20

URBAN SUBURBAN RURAL

20

0 0

20

0 0

Habitation

Group A

Group B

Observations


TABLE NO: 18 DISTRIBUTIONS OF PATIENTS ACCORDING TO GRAVIDITY

GRAPH NO: 7

Group A- In Group A, 12 patients were primi gravida and 4 patients were second gravida, 4

patients were third gravida and 1 patient was 4th

gravida.

Group B- In Group B, 11 patients were primi gravida and 3 patients were second gravida, 4

patients were third gravida and 1 patient was 4th

gravida.

Among 40 patients, 23 (57.5 %) were primi gravida and 7 patients were second gravid, 8

patients were third gravid and 1 patient was 4th

gravida.

0

2

4

6

8

10

12

G1 G2 G3 G4

12

4 4

1

11

3 4

1

Gravidity

Group A

Group B


G1 12 11 23 57.5

G2 3 4 7 17.5

G3 4 4 8 20

G4 1 1 2 5

Total 20 20 40 100

Observations


TABLE NO: 19 DISTRIBUTION OF PATIENTS BASED ON DIETARY HABITS

GRAPH NO: 8

Group A- In Group A, 13 patients were of mixed diet and 7 were vegetarians.

Group B- In Group B, 15 patients were of mixed diet and 5 were vegetarians.

Among 40 patients, 28 (70%) patients had mixed diet, whereas 12 (30%) were vegetarians.

0

2

4

6

8

10

12

14

16

Group A Group B

7

5

13

15

Dietery Habits

veg

mixed


Vegetarian 7 5 12 30

Mixed 13 15 28 70

Total 20 20 40 100

Observations


TABLE NO: 20 DISTRIBUTION OF PATIENTS BASED ON APPETITE

GRAPH NO: 9

Group A: In Group A, 3 patients had normal appetite and 17 patients had decreased appetite.

Group B: In Group B, 4 patients had normal appetite, 15 patients had decreased appetite and

1 patient had poor appetite.

Among 40 patients, 7 (17.5%) patients had a normal appetite, 32(80%) had decreased appetite

and 1(2.5%) patient had poor appetite.

0

2

4

6

8

10

12

14

16

18

normal decreased Poor

3

17

0

4

15

1

Appetite

Group A

Group B

Appetite Group A Group B Total %

Normal 3 4 7 12.5

Decreased 17 15 23 85

Poor 0 1 1 2.5

Total 20 20 40 100

Observations


TABLE NO: 21DISTRIBUTION OF PATIENTS BASED ON DOMINANT RASA

CONSUMED

GRAPH NO: 10

Group A: In Group A, 15 patients were consuming more amla katu rasa, 2 were consuming

more madhura lavana rasa,2 were consuming more amla lavana katu rasa and 1 was

consuming sarva rasa ahara.

Group B: In Group A, 12 were consuming more amla katu rasa, 1 was consuming more

madhura lavana rasa,2 were consuming more amla lavana katu rasa,2 were consuming more

madhura katu rasa and 3 were consuming sarva rasa ahara. Among 40 patients, 27(67.5 %)

patients were mainly consuming amla katu rasa, 3(7.5%) were mainly consuming Madhura

Lavana rasa, 4(10%) patients were mainly consuming Amla Lavana Katu and 2(5%) patients

were mainly consuming Madhura Katu rasa and 4(10%)were mainly consuming sarva rasa.

0

2

4

6

8

10

12

14

16

AK ML ALK MK SR

15

2 2

0 1

12

1 2 2

3

Main Rasa Consumed

Group A

Group B


Amla Katu 15 12 27 67.5

Madura Lavana 2 1 3 7.5

Amla Lavana Katu 2 2 4 10

Madhura Katu 0 2 2 5

Sarva Rasa 1 3 4 10

Total 20 20 40 100

Observations


TABLE NO: 22 DISTRIBUTION OF PATIENTS BASED ON PRAKRUTI

GRAPH NO: 11

Group A: In Group A 6 patients were of vata pitta prakruti, 14 patients were of vata kapha

prakruti .

Group B: In Group B, 4patients were of vata pitta prakruti, 12 patients were of vata kapha

prakruti and 4 were of pitta kapha prakruti.

Among 40 patients, 10(25%) patients were of vata pitta prakruti, 26(65%) patients were of

vata kapha prakruti, 4(10%) were of pitta kapha prakruti.

.

0

2

4

6

8

10

12

14

VP VK PK

6

14

0

4

12

4

Prakruti

Group A

Group B

Prakruti Group A Group B Total %

VP 6 4 10 25

VK 14 12 26 65

PK 0 4 4 10

Total 20 20 40 100

Observations


TABLE NO: 23 DISTRIBUTIONS OF PATIENTS BASED ON ABHYAVARANA

SHAKTI

GRAPH NO: 12

Group A: In Group A, 14patients had avara abhyavaharana shakti and 6 patients had madhyama

abhyavarana shakti.

GroupB: In Group B, 12patients had avara abhyavaharana shakti and 8 patients had madhyama

abhyavarana shakti.

Among 40 patients, 26 (65%) patients had avara abhyavarana shakti while 14 (10%) patients were

having madhyama abhyavarana shakti.

0

2

4

6

8

10

12

14

Avara Madhyama pravara

14

6

0

12

8

0

Abhyavarana shakti

Group A

Group B


Avara 14 12 26 65

Madhyama 6 8 14 35

Pravara 0 0 0 0

Total 20 20 40 100

Observations


TABLE NO: 24 DISTRIBUTIONS OF PATIENTS BASED ON JARANA SHAKTI


Avara 14 12 26 65

Madhyama 6 8 14 35

Pravara 0 0 0 0

Total 20 20 40 100

GRAPH NO: 13

Group A: In Group A, 14patients had avara jarana shakti and 6 patients had madhyama

jarana shakti.

GroupB: In Group B, 12patients had avara jarana shakti and 8 patients had madhyama jarana

shakti.

Among 40 patients, 26 (65%) patients had avara abhyavarana shakti while 14 (10%) patients

were having madhyama abhyavarana shakti.

0

2

4

6

8

10

12

14

Avara Madhyama pravara

14

6

0

12

8

0

Jarana shakti

Group A

Group B

Observations


TABLE NO: 25 DISTRIBUTIONS OF PATIENTS BASED ON BOWEL HABITS


Regular 20 16 36 90

Constipated 0 4 4 10

Total 20 20 40 100

GRAPH NO: 14

Group A: In Group A,all patients had regular bowel habits.

GroupB: In Group B, 16 patients had regular bowel habits and 4 patients had constipated

bowel habits.

Among 40 patients, 36 (90%) patients had regular bowels while 4(10%) patients were said to

have constipated bowels.

0

5

10

15

20

Regular Constipated

20

0

16

4

Bowel Habits

Group A

Group B

Observations


DATA RELATED TO DISEASE.

TABLE NO: 26 DISTRIBUTIONS OF PATIENTS BASED ON THE DURATION OF

VOMITING.

GRAPH NO: 15

Group A: In Group A, 16 patients had duration of vomiting of 0-15 days and 4 patients had

duration of 16-30days.

Group B: In Group B, 13 patients had duration of vomiting of 0-15 days,5 patients had

duration of 16-30 days and 2 patients had duration of 31-45 days.

Among the patients selected for the study, 29 patients (72.5%) were having vomiting of 0-15

days, 9 patients (22.5%) were having vomiting of 16-30 days and 2 patients were suffering

with vomiting of 31-45 days.

0

2

4

6

8

10

12

14

16

0-15 days 16-30 days 31-45 days

16

4

0

13

5

2

Duration of vomiting

Group A

Group B

Duration of vomiting Group A Group B Total %

0-15 days 16 13 29 72.5

16-30 days 4 5 9 22.5

31-45 days 0 2 2 7.5

20 20 40 100

Observations


TABLE NO: 27 DISTRIBUTIONS OF PATIENTS BASED ON TIME OF VOMITING.

Time of vomiting Group A Group B Total %

Morning only 10 7 17 42.5

Morning and evening 5 4 9 22.5

Through out the day 5 9 14 35

Total 20 20 40 100

GRAPH NO:16

Group A: In Group A, 10 patients had vomiting in the morning time, 5 patients had vomiting

in morning and night times and 5 patients had vomiting throughout the day.

Group B: In Group B, 7 patients had vomiting in the morning time, 4 patients had vomiting

in morning and night times and 9 patients had vomiting throughout the day.

Among the patients selected for the study, 17 patients (42.5%) were having vomiting more in

the morning time. 9 patients (22.5%) were having vomiting in the morning and night time and

14 patients were having vomiting throughout the day.

0

1

2

3

4

5

6

7

8

9

10

morning only morning and evening throughout the day

10

5 5

7

4

9

Time of vomiting

Group A

Group B

Observations


TABLE NO: 28 DISTRIBUTIONS OF PATIENTS BASED ON THE CONTENTS OF

VOMITING.

GRAPH NO:17

Group A: In Group A, 11patients had watery type of vomiting and 9 patients had vomiting of

whole food.

Group B: In Group B, 8patients had watery type of vomiting and 12 patients had vomiting of

whole food.

Among the patients selected for the study, 19 patients (47.5%) were having watery type of

vomiting and 21patients (52.5%) were having vomiting of the whole food.

0

2

4

6

8

10

12

Watery Whole food

11

9

8

12

Contents of vomiting

Group A

Group B


Watery 11 8 19 47.5

Whole food 9 12 21 52.5

20 20 40 100

Observations


TABLE NO: 29 DISTRIBUTIONS OF PATIENTS BASED ON ASSOCIATED

COMPLAINTS

Signs and Symptoms Group A Group B Total %

Anannabhilasha 11 5 16 40

Dourbalya 19 17 36 90

Bhrama 12 9 21 52.5

Aversion to smell 3 2 5 12.5

Udarashoola 5 0 5 12.5

Malabadhata 0 4 4 10

Sweta pradara 1 0 1 2.5

Kateeshoola 1 0 1 2.5

Deha shoola 1 0 1 2.5

GRAPH NO: 18

0

2

4

6

8

10

12

14

16

18

20

5

17

9

3

0 0 0 0 0

11

19

12

2

5 4

1 1 1

Associated Complaints

Group A

Group B

Observations


Among 40 patients, 16 (40%) had anannabhilasha, 36(90%) had dourbalya, 21 (52.5%) had

bhrama,5(10%) had aversion to smell, 5(10%) had udarashoola, 3 (7.5%) had malabadhata, 1

patient (2.5%) had sweta pradara,1 patient(2.5%)had kateeshoola and 1 patient (2.5%) had

dehashoola.

Results

A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi.. Page 69

RESULTS

FREQUENCY OF VOMITING

TABLE NO: 30

Effect of treatment on frequency of vomiting in group A

TABLENO: 31

Effect of treatment on frequency of vomiting in group B

Mean S.D S.E t value p value Remarks

BT-AT 1.05

0.76 0.17 6.09 <0.001 HS

BT-AT1 1.45

0.83 0.19 7.73 <0.001 HS

Mean SD SE t value p value Remarks

BT-AT 1.10

0.55 0.13 8.8 <0.001 HS

BT-AT1 1.55 0.69 0.16 9.9 <0.001 HS

Results


TABLENO: 32

COMPARATIVE EFFECT IN FREQUENCY OF VOMITING AS

COMPARED BETWEEN GROUPS

Mean

SD

SE

PSE

t value

p value

Remarks

BT

Group A

1.95

0.60

0.14

0.22

0

------

-------

Group B

1.95

0.76

0.17

AT

Group A

0.9

0.72

0.16

0.26

0.19

>0.05

NS

Group B

0.85

0.93

0.21

AT1

Group A

0.5

0.69

0.16

0.235

0.43

>0.05

NS

Group B

0.4

0.75

0.17

Results


GRAPH NO:19

The effect of treatment on patients in Group A is statistically highly significant

with p value <0.001 after treatment and in the follow up respectively.

The effect of treatment on patients in Group B is statistically highly significant


Comparing the effect of treatment in between the two groups, it is shown that

the t values in Group A are 6.09 and 7.73 after treatment and in follow up

respectively whereas the t values in Group B are 8.8 and 9.9 after treatment

and in follow up respectively. Since Group B is having a higher t value, Group

B has a better result as compared to Group A, but statistically it is showing a

non-significant result with p value >0.05.

1.95

0.9

0.5

1.95

0.85

0.4

0

0.5

1

1.5

2

2.5

BT AT AT1

FREQUENCY OF VOMITING

GROUP A GROUP B

Results


CONTENTS OF VOMITUS

TABLE NO: 33

Effect of treatment on contents of vomiting on group A

TABLE NO: 34

Effect of treatment on contents of vomiting on group B

Mean

S.D S.E t value p value Remarks

BT-AT 1.3

0.73 0.17 7.81 <0.001 HS

BT-AT1 1.85

0.81 0.18 10.02 <0.001 HS


BT-AT 1.65

0.93 0.21 7.8 <0.001 HS

BT-AT1 2.2

7.8 0.20 10.8 <0.001 HS

Results


TABLE NO: 35

COMPARATIVE EFFECT IN CONTENTS OF VOMITUS AS


BT

Mean

SD

SE

PSE

t value

p value

Remarks

BT

Group A

2.3

0.57

0.13

0.214

1.4

>0.05

NS

Group B

2.6

0.75

0.17

AT

Group A

1

0.79

0.18

0.3

0.167

>0.05

NS

Group B

0.95

1.65

0.24

AT1

Group A

0.45

0.69

0.16

0.236

0.212

>0.05

NS

Group B

0.40

0.75

0.17

Results


GRAPH NO:20

The effect of treatment on patients in Group A is statistically highly

significant with p value <0.001 after treatment and in the follow up

respectively.



Comparing the effect of treatment in between the two groups, it is shown that

the t values in Group A are 7.81 and 10.02 after treatment and in follow up

respectively whereas the t values in Group B are 7.8 and 10.8 after treatment

and in follow up respectively. Since Group B is having a higher t value, the

effect of treatment is better in Group B, but statistically it is showing a non-

significant result.

2.3

1

0.45

2.6

0.95

0.4

0

0.5

1

1.5

2

2.5

3

BT AT AT1

CONTENTS OF VOMITING

GROUP A GROUP B

Results


NAUSEA

TABLE NO: 36

Effect of treatment on nausea on group A

Mean S.D S.E t value p value

Remarks

BT-AT 0.55

0.51 0.12 4.74 <0.001 HS

BT-AT1 0.85

0.49 0.11 7.64 <0.001 HS

TABLE NO: 37

Effect of treatment on nausea in group B

Mean


BT-AT 1.05

0.22 0.05 20.7 <0.001 HS

BT-AT1 1.55

0.51 0.12 13.4 <0.001 HS

Results


TABLE NO: 38

COMPARATIVE EFFECT ON NAUSEA AS COMPARED

BETWEEN GROUPS

BT

Mean

SD

SE

PSE

t value

p value

Remarks

BT

Group A

1.8

0.41

0.09

0.166

0

-----

------

Group B

1.8

0.62

0.14

AT

Group A

1.25

0.55

0.13

0.139

3.571

<0.01

HS

Group B

0.75

0.64

0.15

AT1

Group A

0.95

0.39

0.09

0.135

5.185

<0.001

HS

Group B

0.25

0.44

0.1

Results


GRAPH NO :21




with p value <0.001 after treatment and in follow up respectively.

Comparing the efficacy of treatment in between the two groups, it can be

observed that the t values in Group A are 4.74 and 7.64 after treatment and in

follow up respectively whereas the t values in Group B are 20.7 and 13.4 after

treatment and in follow up respectively. So the higher t values seen in Group B

signify better outcome to treatment in this group. The treatment shows

statistically also highly significant result with p value <0.001.

1.8

1.25

0.95

1.8

0.75

0.44

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

BT AT AT1

NAUSEA

GROUP A GROUP B

Results


SALIVATION.

TABLE NO: 39

Effect of treatment on salivation in group A

TABLE NO: 40

Effect of treatment on salivation in group B

Mean


BT-AT 1.05

0.22 0.05 20.7 <0.001 HS

BT-AT1 1.55

0.51 0.12 13.4 <0.001 HS

Mean


BT-AT

0.55

0.51

0.12

4.74

<0.001

HS

BT-AT1

0.9

0.55

0.13

7.17

<0.001

HS

Results


TABLE NO: 41

COMPARATIVE EFFECT ON SALIVATION AS


BT

Mean

SD

SE

PSE

t value

p value

Remarks

BT

Group A

1.8

0.41

0.09

1.48

0

-------

---------- Group B

1.8

0.62

0.14

AT

Group A

1.25

0.55

0.13

0.139

3.571

<0.001

HS

Group B

0.75

0.64

0.15

AT1

Group A

0.9

0.05

0.1

0.141

4.60

<0.001

HS

Group B

0.25

0.44

0.10

Results


GRAPH NO:22




with p value of <0.001 after treatment and in follow up respectively.






statistically highly significant result with p value <0.001.

1.8

1.25

0.9

1.8

0.75

0.25

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

BT AT AT1

SALIVATION

GROUP A GROUP B

Results


IMPROVEMENT IN WEIGHT

TABLE NO: 42

Effect of treatment on improvement in weight on group A


BT-AT

0.025

0.50

0.11

0.22

>0.05

NS

BT-AT1

0.475

0.88

0.20

2.37

<0.05

SS

TABLE NO: 43

Effect of treatment on improvement in weight in group B


BT-AT

0.25

0.44

0.10

2.5

<0.05

S

BT-AT1

0.60

0.50

0.11

5.3

<0.001

HS

Results


TABLENO: 44

COMPARATIVE EFFECT IN INCREASE IN WEIGHT AS


BT Mean SD SE PSE t value p value Remarks

BT Group A

49.9

8.05

1.83

3.05

2.23

<0.05

SS

Group B

57

10.75

2.44

AT Group A 49.93

8.09 1.84

3.09

2.27

<0.05

SS

Group B

56.95

10.93

2.48

AT1 Group A

50.38

8.18

1.86

3.08

2.25

<0.05

SS

Group B

57.3

10.77

2.45

Results


GRAPH NO: 23

The effect of treatment on patients in Group A is statistically non-significant

with p value >0.05 after treatment and is statistically significant with p value

<0.05 in the follow up respectively

The effect of treatment on patients in Group B is statistically significant with p

value<0.05 and statistically very highly significant with p value <0.001 in

follow up respectively.






statistically significant result with p value <0.05.

49.9 49.93 50.38

57 56.95 57.3

0

10

20

30

40

50

60

BT AT AT1

IMPROVEMENT IN WEIGHT

GROUP A GROUP B

Results


INCREASE IN Hb%

TABLE NO: 45

Effect of treatment on improvement in Hb% in group A


BT-AT 0

0 0 0 ------ -------

BT-AT1 0.04

0.13 0.03 1.14 >0.05 NS

TABLE NO: 46

Effect of treatment on improvement in Hb% in group B


BT-AT 0.03

0.08 0.02 1.4 >0.05 NS

BT-AT1 0.10

0.22 0.05 2 <0.05 SS

Results


TABLE NO: 47

COMPARATIVE EFFECT IN INCREASE IN Hb% AS

COMPARED BETWEEN GROUPS BT Mean Std

Dev

Std

Error

PSE t value p value Remarks

BT

Group A

9.97

0.56

1.3

2.9

0.131

>0.05

NS

Group B

9.59

1.16

2.6

AT

Group A

9.965

0.56

0.13

0.29

0.948

>0.05

NS

Group B

9.61

1.15

0.26

AT1

Group A

10

0.58

0.13

0.29

1.07

>0.05

NS

Group B

9.69

1.13

0.26

Results


GRAPH NO: 24

The effect of treatment on patients in Group A after treatment cannot be

elicited and it is statistically non-significant with p value >0.05 in the follow

up treatment.

The effect of treatment on patients in Group B is statistically non- significant

with p value >0.05 after treatment and statistically significant with p value

<0.05 in the follow up respectively.


observed that the t values in Group A are 0 and 1.14 after treatment and in

follow up respectively whereas the t values in Group B are 1.4 and 2 after


signify better outcome to treatment in this group. But the treatment shows

statistically non-significant result with p value >0.05.

9.97 9.97 10 9.59 9.61 9.69

0

2

4

6

8

10

12

BT AT AT1

IMPROVEMENT IN Hb%

GROUP A GROUP B

Discussion

A comparative clinical study on the effect of eladi gutika and matulunga avaleha in garbhini chardi . Page 87

DISCUSSION

Discussion is considered to be the heart of any clinical study. The purpose of discussion is to

state our interpretations and opinion and explain the implication of our findings. It is

important for the proper understanding of the disease and its probable causes, mechanism of

the action of drugs and the treatments. With the help of discussion on various aspects of the

disease together with the statistical calculations, a clear conclusion for the study can be

achieved.

Discussion can be done under the following headings.

1) Discussion on selection of Disease.

2) Discussion on Disease Review.

3) Discussion on Selected drugs.

4) Discussion on probable Mode of action of drugs.

5) Discussion on Observations and Results.

1) DISCUSSION ON SELECTION OF THE DISEASE.

Many physiological and psychological changes occur in the life of a woman from menarche

to menopause. The physiological changes occurring in pregnancy is unique because it helps

in the creation of a new life. The changes are body’s own adaptation for an environment

needed for the growing baby. 50% of the women suffer from emesis gravidarum.

There is rapid cell division in embryo and formation of vital organs takes place in the first

trimester. Nutritional deficiencies can interfere with the proper development of the foetus. So

prevention of emesis gravidarum is important for the normal development of all the vital

organs.

It is a known fact that pregnancy is most of the time associated with vomiting but the quality

of the life of a woman is hampered. These can also lead to Hyperemesis gravidarum during

pregnancy if not treated. Hence emesis gravidarum should be treated, to improve the quality

of the day to day life of a woman.

2) DISCUSSION ON DISEASE REVIEW

Chardi is one of the vyakta garbha lakshanas mentioned by all the acharyas. Acharya Hareeta

has mentioned chardi as one of the ashta upadravas. As chardi is described as an upadrava, it

clearly emphasises the importance of treating the chardi in garbhini. The vyakta garbha

Discussion


lakshana told by Acharyas can be probably correlated as Emesis Gravidarum and the

upadrava told by Acharya Hareeta can be considered as Hyperemesis Gravidarum.

Emesis gravidarum is due to the physiological changes in pregnancy like relaxation of cardiac

sphincter and decreased peristalsis leading to stasis of food. These changes are happening due

to the increased secretion of the hormone progesterone. It is needed for the relaxation of

uterine muscles so that the foreign paternal genes are accepted and does not lead to first

trimester abortions. The same effect of relaxation of smooth muscles over the gastro intestinal

tract leads to emesis gravidarum in first trimester. So the treatment should be given in

improving the intestinal motility thereby improving the nausea and vomiting of pregnancy.

According to classics, the role of panchamahabhoota is told as “vayur vibhajati.108

” Vata is

helping in the normal organogenesis of the embryo.109

Normalcy of vata is important in the

first trimester of pregnancy to prevent defective organogenesis and abortions. Vatavaigunya is

one of the reasons for Garbhini Chardi. So Garbhini Chardi should be treated with deepana

and pachana drugs which can regularise vata vaigunya and thereby regularising the normal

peristalsis.

Discussion on nidana.

Acharyas have mentioned nidanas for Garbhini Chardi as Apanna satwa ,Dauhrida Avamana

and Vata Vaigunya.

Apanna Satwa.

Acharya Sushruta has considered apanna satwa as one of the nidana of chardi.110

In the

NibandhaSamgraha teeka,Acharya Dalhana mentions “Apanna satwa” as Garbhini.111

So

garbhini can be considered as with changing psychological status. This can be correlated to

psychological causes of vomiting. This can be considered as to seek attention from other

family members.

The garbha can cause peedana to the mother which may be the reason for vata prakopa.

According to modern science, pregnancy is considered as an immune suppressed condition

where in the pregnancy specific proteins suppresses the immune system so that the paternal

genes are not expelled out by the body of the mother.112

Further, progesterone together with

hCG and desidual cortisol inhibits T-lymphocyte mediated tissue rejection and protects the

conceptus.113

Due to action of progesterone, there is relaxation of the smooth muscles. This

leads to the relaxation of cardiac sphincter and delayed emptying of gastric contents leading

to emesis gravidarum in the first trimester of pregnancy.114

Discussion


Dauhrida Avamana.

During the Garbha avastha, the lady may develop desire for certain foods. These desires can

be considerd as the ways to achieve the needs of the body. Amlakamata is one of the vyakta

garbha lakshana.115

It can be considered as Rakta kshaya lakshana also116

. Amla rasa is

necessary for the proper assimilation of the iron by which the rakta kshaya can be

compensated. Pregnant woman may also develop desire for chalk, mud etc. These can be due

to Calcium deficiency which has to be corrected for the proper development of the foetus. If

the desires are not fulfilled, it can lead to manasika peeda which can cause vata vrudhi. The

vata vrudhi can lead to chardi.

Acharya Vagbhata 117

and Acharya Charaka have told about the development of sarva indriya

and chetasi at the 3rd

month. They also explained that by 3rd

month the hrudaya of mother will

be attached to the hrudaya of baby by the rasavahini nadi and the lady is considered as

dauhridini.118

In Indu teeka it is also mentioned that other Acharyas have consider mother as

dauhridini from any time from 45 days of conception to the 4th

month.119

From this, it can be

considered that the mother can develop dauhrida any time from 45 days to the 4th

month of

pregnancy. So dauhrida avamana at any time during this period can lead to the vatavrudhi

causing chardi. The desires expressed by the mother are the desires of the foetus. If it is not

fulfilled it can lead to the defective organogenesis leading to the vairoopya or vinasha of

garbha.120

According to modern science also, foetal heart develops at the 5th

week and from that time

the desires of the mother may be according to the needs of the baby. It should be satisfied

without causing harm to the foetus.

Vata-Vaigunya.

The vata-vaigunya can be attributed to ahara, vihara and vichara of garbhini. Katu and

rooksha ahara can cause vataprakopa.121

Improper garbhini paricharya also can lead to vata

vrudhi.Viharas like nishajagarana and vegadharana can cause vata prakopa122

. In

vichara,Udwega which is told as a nidana for chardi123

can cause vata prakopa.

According to modern parlance, it may be probably correlated that carbohydrate starvation can

lead to vomiting in pregnancy as it happens after a night without food124

. It is also told that

spicy and fatty foods can increase nausea and vomiting in pregnancy.125

Psychogenic causes

also play a major role in emesis gravidarum.126

It is evident from the fact that emesis

Discussion


gravidarum gets subsided after shifting the patient from the home surroundings. Anxiety also

plays a role in vomiting as it is more in primi gravida and also in unplanned pregnancies.127

Discussion on purva roopa

Poorva roopa includes Hrullasa, Annadwesha and Praseka. Hrullasa, Praseka and

Annadwesha can be considered as rasavrudhi lakshanas. This may be due to

rasadhatwagnimandya leading to rakta dhatu kshaya which is seen in garbhini avastha. These

can be further understood as ama lakshanas due to the dourbalya of jatharagni.

Discussion on Roopa.

The lakshanas of chardi based on dosha predominance are as follows:

Vata Dosha Predominant

If vata is the predominant dosha the chardi will be alpa with forceful vegas. It is tanu, krushna

and with kashaya rasa. In this study, many of the patients were having watery and less

quantity of vomitus which may be correlated to predominance of vata dosha.

Pitta Dosha Predominant

In chardi, if pitta is the predominant dosha, it is peeta, tikta and associated with daha and

bhrama. In this study, some of the patients were having bhrama and watery vomiting which

was yellow in colour and this may be correlated to the predominance of pitta dosha.

Kapha Dosha Predominant

If kapha is predominant, chardi is with romaharsha and asya madhurya and associated with

shareera gaurava. In this study, many patients had vomiting of the whole food and this may be

correlated to agnimandya and the predominance of kapha dosha.

Discussion on Samprapti

During pregnancy, sudden physiological changes happen in the body of mother. These sudden

physiological changes will lead to kapha dushti in amashaya causing agnimandya. The

agnimandya will lead to pittavikruti and causing amasanchaya. Later,improper garbhini

paricharya and indulgence in garbhopakhatakara bhavas will lead to the dushti of samana

vata and apanavata. This avarodha of vata causes kshobha to amashaya. Garbha peedana also

will lead to vyana vataprakopa. By the action of prakupita vata the utkishta doshas are

expelled out through the mouth resulting in chardi.

Discussion


FLOW CHART NO: 4 INVOLVEMENT OF DOSHA DUSHTI IN GARBHINI

CHARDI

Kapha dushti

Agnimandya

Pitta dushti (Improper garbhini paricharya+Garbha peedana+

Indulgence in garbhopakhatakara bhavas)

Vata prakopa

Mukha poorana resulting in chardi

This can be explained in correlation to the contemporary science. During pregnancy, excess of

progesterone will lead to relaxation of the cardiac sphincter and simultaneous retention of

gastric fluids due to impaired motility. This can lead to kapha dushti. There is diminished

gastric secretion and delayed emptying time of the stomach which may cause pitta and vata

dushti. Further dietary causes and psychogenic causes can lead to vata prakopa. Relaxation of

cardiac sphincter together with delayed emptying of gastric contents, together with other

reasons like psychological, dietetic causes and immunosuppressed state of mother will result

in the nausea and vomiting of pregnancy.

Retention of food and gastric fluids due to impaired motility and leading to vomiting can be

probably correlated to the rasasesha ajeerna. This also implies the importance of pachana in

the treatment of Garbhini Chardi.

3) DISCUSSION ON SELECTED DRUGS

The drugs selected for the present study were Eladi Gutika and Matulunga Avaleha. The

ingredients of Eladi Gutika are Ela, Patra, Twak, Pippali, Madhuka, Kharjura, Mridvika, Sita

Discussion


and Madhu. Ela, Patra and Twak are katu madhura in rasa, Madhuka,Kharjura ,Sita ,Madhu

and Mridvika are madhura rasa, and pippali is katu rasa. The ingredients of Matulunga

Avaleha are Matulunga, Kola, Laaja, Dadima, Sarkara, Daruharidra and Kshoudra.

Matulunga,Kola, Dadima are Madhura Amla in rasa, Laja and Sarkara are madhura in rasa.

4) DISCUSSION ON PROBABLE MODE OF ACTION OF DRUGS.

TABLE NO: 48

PHARMACODYNAMICS OF INGREDIENTS OF ELADI GUTIKA

Rasa Guna Veerya Vipaka Karma

Ela Katu

Madhura

Laghu Rooksha Seeta Katu Kapha

vata hara

Patra Madhura

Katu

Laghu Ushna Katu Kapha

vata hara

Twak Katu

Tikta

Madhura

Laghu Rooksha Ushna Katu Kapha

vata hara

Pippali Katu Laghu Snigdha Ushna Katu Vata

kapha

hara

Madhuka Madhura,

Kashaya

Snigdha,Guru Seeta Madhura Vata

hara

Kharjoora Madhura,

Kashaya

Snigdha,Guru Seeta Madhura Vatapitta

hara

Mridvika Madhura Snigdha,Guru Seeta Madhura Vatapitta

hara

Most of the drugs are having katu as pradhana rasa and madhura as anurasa. The drugs

possessing katu rasa have laghu rooksha guna, ushna veerya and katu vipaka. Due to ushna

veerya and katu vipaka, it is vatapitta hara. The Katu rasa helps in the deepana and pachana of

ahara128

which causes proper digestion as agnimandya is a one reason for chardi in Garbhini.

Madhura rasa is preenana and vatashamaka129

and the medicines for garbhini should be

palatable to have better effect. In Indu commentary ,preenena is told as tushtikara. Most of the

Discussion


important drugs like ela,patra and twak are kapha vata hara and chardi nigrahana in action..

Drugs like twak, patra and ela are aromatic drugs. Medicines for garbhini will be better

palatable because of the use of these aromatic drugs. By these actions, eladi gutika helps in

reducing chardi.

TABLE NO: 49

PHARMACODYNAMICS OF INGREDIENTS OF MATULUNGA AVALEHA

Most of the drugs are hrudya and belong to chardi nigrahana gana which directly implies that

these medicines will help in reducing the chardi. Matulunga,kola and dadima are amla in rasa

and madhura in anurasa. Amla rasa helps in deepana, pachana, and rochana of ahara. It is also

vatashamana and vatanulomana in nature.130

Deepana and pachana property helps in reducing

agnimandya and imparting ruchi to ahara. Kashaya rasa helps in the kleda soshana 131

and

tiktha rasa helps in kandha vishodhana132

thereby helps to reduce hrullasa and praseka. The

amla dravyas are liked in pregnancy as “Amleshtata” is told as a vyakta garbha lakshana. The

drugs like laaja,sarkara which are vatashamaka help in reducing chardi.

Ingredients Rasa Guna Veerya Vipaka Karma Gana

Matulunga Amla Laghu

Snigdha

Ushna Amla Vata

Kapha

hara

Chardi

Nigrahana

Kola Madhura,

Amla

Guru

Snigdha

Seeta Madhura,

Amla

Vata

pittahara

Chardi

Nigrahana

Laaja Madhura,

Kashaya

Laghu Seeta Madhura Vata

pittahara

Chardi

Nigrahana

Daru

haridra

Tikta

,Kashaya

Laghu Ushna Katu Kapha

pittahara

Haridradi

Dadima Madhura,

Amla

Laghu

Snigdha

Ushna Madhura,

Amla

Tridosha

hara

Chardi

Nigrahana

Sarkara Madhura Guru Seeta Madhura Vata hara Ikshu

varga

Madhu Madhura

,Kashaya

Laghu Seeta Katu Tridosha

hara

Madhu

varga

Discussion


The “Amleshtata” can be considered as a rakta kshaya lakshana which is seen in

garbhavastha. This also implies the presence of rasa dhatwagnimandya in this stage. The

medicines can help in the deepana and pachana, thereby helps to correct the rasa dhatu. Rasa

dhatu is helping the mother in three ways –for the proper nourishment of garbha, nourishment

of garbhini and also for the utpatti of stanya.133

According to Contemporary science, Anaemia is a common sign in pregnancy. It is due to the

haemodilution because of the increase level of plasma which is a physiological change

happening in pregnancy. The drugs of Matulunga avaleha helps to correct the agni by

correcting the jarana shakti and increase in abhyavaharana shakti can help in correcting dhatu

kshaya. The drugs of Matulunga avaleha like dadima are rich source of iron which can help in

correcting the anaemia. Madhura rasa dravyas are dhatu vardhaka which may also helps for

the same. The brumhana guna may help in the proper development of the foetus and also

helps to improve the health of the mother. Even though there will be a slight decrease in the

weight of the mother in the first trimester, in the present study there was an increase in weight

of the mother. This may be due to the brumhana guna of the drugs in the Matulunga avaleha.

TABLE NO:50

MODE OF ACTION OF DRUGS ACCORDING TO CHEMICAL CONSTITUENTS.

Piperine134

Pippali Stimulate digestive

enzymes.

Increases digestion.

Tannin135

Daruharidra,

Dadima

Astringent Decreases salivation

Limonene136

Matulunga Flavouring agent.Relieve

gastro-oesophageal reflux

disease.

Improves taste.

Decreases heart burn

Eugenol,

Cinnamyl

aldehyde,

Catechine

Twak,Patra,Ela Aromatic Improves taste

and digestion,

Ela, Patra, Twak improves digestion and helps to combat nausea. Ela is digestive and

stomachic. Ela is a good supply of minerals like potassium. The balancing of electrolytes may

also helps to reduce vomiting. They have chemical constituents like eugenol, cinnamyl

Discussion


aldehyde, catechine which are aromatic in nature and palatable to pregnant woman and there

by reduces vomiting. Kharjoora help in improving bowel movements and is good for

digestive system. It is also a rich supplier of iron. Piperine which is present in pippali

stimulates the digestive enzymes and increases the digestive capacity.

Matulunga contains limonene which is used to relieve gastro oesophageal reflux diseases and

heart burn. It is used as a flavouring agent to mask the bitter taste of alkaloids. Hence, it may

help in flavouring the avaleha and may probably mask the tikta rasa of rasanjana. The

astringent property of rasanjana controls the secretion of mucous and thereby reduces

salivation. Dadima helps to prevent smooth muscle dysfunction and helps in curing digestive

problems. Dadima extract supplies iron to blood and helps to prevent anaemic symptoms.

5) DISCUSSION ON OBSERVATIONS AND RESULTS.

DISCUSSION ON OBSERVATIONS

Age

In the study, majority of the patients ( 45% ) were in age group 23-27 years and 40% patients

were from age group 18-22 years and only 15% patients were from age group 27 -32 years.

This correlates with the view that young girls are more suffering with emesis gravidarum. It

may be probably due to the increased anxiety which is more in young age leading to nausea

and vomiting in pregnancy. (This correlates to the findings of Klebanoff MA, Koslowe PA,

Kaslow R, et al 1985)137

Religion

Among the 40 patients, 70% were Muslims and the rest belongs to the Hindu religion. It may

be because of the dominance of the Muslim population in and around the institution.

Occupation

Majority of the women (87.5%) in the study were home makers. There was a smaller

percentage of 12.5% of women who were employed. Research works have shown that

homemakers are most prone to vomiting in pregnancy. There was a similar finding in this

study also. This can be probably correlated to the environmental changes of a working woman

because if the change in environment happens, it can decrease emesis gravidarum.

Discussion


Education

Majority of the women were having primary education (32.5%) and secondary education

(37.5%). This can be probably due the marriage of girls at a younger age in the particular, by

which they don’t have proper awareness about pregnancy and associated changes in the body.

This also correlates with the other studies that women with lesser education are prone to

pregnancy induced vomiting. (This correlates to the findings of Klebanoff MA, Koslowe PA,

Kaslow R, et al 1985)138

Socio-economic status

In the study, majority of the people (70%) were from middle class. This shows that the area

around the institution have more population belonging to the middle class. It may also be

considered that the women of this economic status may be deprived of proper nutrition which

can be a reason for pregnancy induced vomiting.

Parity

A larger percentage of the women (57.5%) were primigravida in the study. It is seen that

primigravidas are more prone to pregnancy induced vomiting or Emesis gravidarum. This can

be probably due to the psychological factor as pregnancy is first experience for her and

anxiety may lead to emesis gravidarum. According to classics also, udwega is told as a reason

for chardi. (This correlates to the findings of Klebanoff MA, Koslowe PA, Kaslow R, et al

1985)139

Dietary habits

Most of the pregnant women (70%) in the study were having a mixed diet. Carbohydrate

starvation is a reason for Emesis Gravidarum and intake of carbohydrate rich diet is advised

as a treatment. The intake of more of fatty foods can probably be a reason for increased

vomiting in these patients. (This correlates to the findings of Klebanoff MA, Koslowe PA,

Kaslow R, et al 1985,)140

Appetite

Majority of the patients (80%) in the study were having decreased appetite which clearly

shows agnimandya is found in pregnant women in their first trimester. Hence the treatment

should be deepana and pachana which can reduce agnimandya and reduce vomiting. It is also

Discussion


explained that excess of the hormone progesterone will lead to relaxation of cardiac sphincter

and simultaneous retention of gastric fluids due to impaired motility. This may be leading to

decrease in appetite.

Predominant rasa consumed.

In the study, a large group (67.5%) were in the habit of consuming more of Amla Katu rasa

ahara. This correlates with the classical reference of “amleshtata” as a vyakta garbha

lakshana. Even the intake of more of amla katu ahara can cause pitta and vata dushti leading

to increased vomiting. Even contemporary science explains that spicy foods can increase

emesis gravidarum.

Prakruti

Most of the women (65%) in the study were of vata kapha prakruti. It can be considered that

vata kapha predominant prakruti people will be suffering more with Garbhini Chardi. It may

be because of the reason that in vata kapha prakruti, there is increased chance of agnimandya.

It may also correlated like vata kapha prakruti people can have increased incidence of

vomiting of whole food and the agnimandya can happen more in kapha predominant prakruti.

It may also be considered that the watery type of vomiting was more in vatapitta predominant

persons and the colour of vomitus was peeta which shows the involvement of pitta.

Bowel habits.

Majority of the patients (90%) were having a regular bowel habit. Even though the women

were of vata predominant prakruti, the regular bowel habits can be attributed to the increased

liquid and fruit diet followed by them in their first trimester.

DISCUSSION ON THE COMPLAINTS.

Duration of vomiting

A larger group of patients (72.5%) were having vomiting for a period of 0-15 days. This can

be discussed like that the patients approach the doctors even at early stages of the vomiting.

This emphasises that the women are worried if the vomiting may cause harm or even growth

retardation for their babies. So they will be following the proper ante natal care even from the

first trimester of pregnancy.

Discussion


Time of vomiting

Most of the women (42.5%) in the study were having vomiting in the morning hours. Emesis

Gravidarum is also referred to as Morning sickness. It may be because of the low

carbohydrate reserve after a night starvation without food. According to our classics, it can be

considered as chardi occurring more in Kapha kala as we have a classical reference for the

same.

Contents of vomitus

There were an almost equal percentage of the patients regarding the contents of the vomitus.

While52.5% of women were vomiting the whole food, 47.5% of women were having a watery

type of vomiting. The vomiting of whole food may be probably due to the hampered agni

which was seen in majority of the patients. The watery type of vomiting may be suffered by

the patients who did not have much of the agnimandya. It may also be correlated as that the

vata kapha prakruti persons were having more of the vomiting of the whole food. The vata

pitta prakruti persons were having more of watery type of vomiting.

DISCUSSION ON RESULTS.

Frequency of vomiting

Effect of treatment in frequency of vomiting in Group A: The effect of treatment in

Group A was statistically highly significant with p value <0.001after treatment and in the

follow up respectively. As drugs of eladi gutika are deepaka,pachaka and ruchya, and have

the property of vatashamaka, it helped in reducing the chardi vega. The main ingredient of

Eladi gutika, Ela belongs to Chardi nigrahana gana. The drug contain constituents like

piperine have digestive property which helps to reduce agnimandya and thus reduce vomiting.

Effect of treatment in frequency of vomiting in Group B: The effect of treatment in

Group B also was highly significant with p value <0.001after treatment and in the follow up

treatment respectively. The ingredients of matulunga avaleha also are deepaka,pachaka and

ruchya, and have the property of vatashamaka thus helped in reducing the chardi vega. Some

of the drugs like kola,laja,ela belongs to chardinigrahana gana. The constituent limonene

helps to relieve gastro oesophageal reflux and reduces vomiting. Moreover, dadima and

khajoor helps in digestive problems.

Discussion


Comparison between the groups: The comparison between the groups showed statistically

non-significant result with p value>0.05 which means that both the groups were having highly

significant result and there was no marked difference in the frequency of vomiting in between

the groups.

Contents of vomitus

Effect of treatment in contents of vomitus in Group A: The effect of treatment in

Group A was statistically highly significant with p value <0.001 after treatment and in the

follow up respectively. The effect of the treatment on the contents of vomitus may be

probably due to the deepana and pachana effect of the drugs which may be helping to reduce

the agnimandya. Piperine present in the helps to stimulate digestive enzymes and thus reduces

agnimandya.

Effect of treatment in contents of vomitus in Group B: The effect of treatment in

Group B was statistically highly significant with p value <0.001 after treatment and in the

follow up respectively. The effect of treatment may be due to deepana and pachana properties

of matulunaga avaleha and eladi gutika.

Comparison between the groups: The comparison between the groups showed statistically

non-significant result with p value>0.05 which means that both the groups were having highly

significant result and there was no marked difference in the contents of vomitus in between

the groups.

Nausea

Effect of treatment in nausea in Group A: The effect of treatment in Group A was

statistically highly significant with p value <0.001 after treatment and in the follow up

respectively. The drugs of eladi gutika are hrudya and vatanulomana which is helping in

reducing the nausea.

Effect of treatment in nausea in Group B: The effect of treatment in Group B was


respectively. The drugs of matulunga avaleha are also hrudya and vatanulomana which is

helping in reducing the nausea.

Comparison between the groups: The comparison between the groups also showed

statistically highly significant result with p value<0.001 by which can conclude that group B

were having a more significant result in reducing nausea.The drugs of both eladi gutika and

Discussion


matulunga avaleha are hrudya and vatanulomana which is helping in reducing the nausea.

Even though both groups are giving highly significant result, Group B showed statistically

significant result on comparison. The drugs in matulunga avaleha is mostly from the phala

vargas and amla rasa is more hrudya and vatanulomana, thus giving a better result in Group

B. More over the property of avaleha is lehana which also brings down the nausea. According

to classics the bheshaja kala in chardi is muhurmuhu and when the avaleha was given in

divided doses it gave better result in nausea and vomiting.

The contents like limonene, P-cymene,eugenol cinnamyl aldehyde are natural aromatic

compounds and helps to reduce vomiting. Moreover the astringent property of the drugs helps

to reduce the secretion of the mucous and thus reduce nausea as hrullasa is defined as

“Tuthkaranam hrullasam”

Salivation

Effect of treatment in salivation in Group A: The effect of treatment in Group A was


respectively. The drugs of eladi gutika are hrudya and vatanulomana which is helping in

reducing the salivation.

Effect of treatment in salivation in Group B: The effect of treatment in Group B was


respectively. The drugs of matulunga avaleha are also hrudya and vatanulomana which is

helping in reducing the salivation.


statistically highly significant result with p value<0.001 by which can conclude that group B

were having a more significant result in reducing salivation.The drugs of both eladi gutika

and matulunga avaleha are hrudya and vatanulomana which is helping in reducing the nausea.

Some of the drugs in matulunga avaleha are of kashaya rasa and kashaya rasa helps in the

kleda soshana which would have helped to reduce the excessive salivation. The rasayana also

have tikta rasa drug which may help in the asya sodhana which may also reduce the

salivation. The astringent property of berberine helps in reducing the secretion of mucous and

thus reduces salivation.

Improvement in weight

Discussion


Effect of treatment in improvement in weight in Group A: The effect of treatment in

Group A was statistically non- significant with p value >0.05 after treatment and statistically

significant with p value <0.05 in the follow up respectively. The drugs of eladi gutika like

Kharjoora,mridvika are hrudya, balya and brumhana. So it may helped in the mild increase in

the weight of the patient.

Effect of treatment in improvement in weight in Group B: The effect of treatment in

Group B was statistically significant with p value <0.05 after treatment and statistically highly

significant with p value <0.001 in the follow up respectively. The drugs of matulunga avaleha

are hrudya, balya and brumhana which helped in increase in weight of the patients.


statistically significant result with p value<0.05 after treatment and in follow up by which can

conclude that group B were having a more significant result in increasing the weight. The

drugs of matulunga avaleha and eladi gutika are hrudya, balya and brumhana. So it can help

in the increase in the weight of the patient. Since the avaleha is more hrudya, it helps in

reducing the salivation and nausea as it is evident from the statistical results. This can

probably help in proper intake of food by the patients and thereby increase in the body weight.

Matulunga avaleha also contains ghruta and madhu. Most of the avalehas have the action of

rasayana also. By these gunas the avaleha probably helped to increase the weight of patients

in Group B.

Improvement in Hb%

Effect of treatment in improvement in Hb% in Group A: The effect of treatment in Group

A was statistically non- significant with p value >0.05.

Effect of treatment in improvement in weight in Group B: The effect of treatment in

Group B was statistically non-significant with p value >0.05 after treatment and statistically

significant with p value <0.05 in the follow up respectively.


statistically non-significant result with p value >0.05 after treatment and in follow up by

which can conclude that none of the groups were having an effect on the increase in Hb%.

The drugs of matulunga avaleha have drugs like dadima which is a rich supplier of iron and

helps to decrease anaemic symptoms and help in increasing the Hb%. But the formation of

RBC takes 4 days and the medicine was given only for a short duration which may not be

sufficient to have an increase in Hb%. Even though the t value shows significant result in

Discussion


increasing the Hb% in Group B in the follow up treatment, the result is statistically non-

significant. So the study has to be done in a larger sample and also for a longer duration to

draw a proper conclusion regarding the effect of the drugs in the increase of Hb%. Also we

can supplement some panduhara drugs which is not contraindicated in pregnancy for the

improvement in Hb%.

OVERALL EFFECT OF THERAPY

At the end of the trial, all 20 patients in Group A and Group B showed marked response in all

subjective parameters. Group B showed a better result in parameters like nausea and

salivation. In objective parameters like increase in weight also, the Group B showed a better

result over group A. There was no significant result in increase in Hb% in both Groups.

Overall improvement was more in Group B as compared to Group A.

Discussion




Prakashan Varanasi,reprint 2010,Shareera sthana 5th Chapter,Verse 3, pp-824, pg-363.



1998,Shareera sthana 3rd

Chapter, Verse 4, pp-364, pg -73.




Chapter,Verse 3-5, pp-824, pg-754

111 Sushruta, SushrutaSamhita, Nibandhasangraha Commentary of Sri DalhanaAcharya,edited

byVaidya Yadavj Trikamji Acharya, Choukhamba Surabharati Prakashan Varanasi,reprint


Chapter,Verse 3-5 Dalhana acharya teeka, pp-824, pg-754.

112




113




Discussion


114







1st



Shivprasad Sharma,Chowkhanba Sanskrit Series Office, Varanasi,reprint 2008, Sutra sthana

19th Chapter,Verse 9, pp-965, pg-150.



sthana 2nd

Chapter,Verse 15 teeka, pp-965, pg-278.



sthana 2nd




sthana 2nd

Chapter,Verse 17 teeka, pp-965, pg-278.



sthana 2nd


121Vagbhata, Astanga Hrudaya, SarvangaSundara Commentary of Arunadatta and Ayurveda


Bhisagacharya, Chaukhamba Surbharati Prakashan, Varanasi, reprint-2010, Nidana sthana

1st




Discussion


Bhisagacharya, Chaukhamba Surbharati Prakashan, Varanasi, reprint-2010, Nidana sthana

1st







th edition 2001, New Central













Bhisagacharya, Chaukhamba Surbharati Prakashan, Varanasi, reprint-2010, Sutra sthana

10th


129Vruddha Vagbhata, Astanga samgraha, Sashilekha commentary of Indu, Edited by


18th




18th


Discussion




18th


132

Vruddha Vagbhata, Astanga samgraha, Sashilekha commentary of Indu, Edited by


18th






134

www.ncbi.nib.gov/pubmed/17987447 Black pepper and its pungent principle- piperine-

A Review of diverse physiological effects.

135

en.wikipedia.org/wiki/tannin

136

en.wikipedia.org/wiki/limonene.

137 www.ncbi.nib.gov/pubmed/3903578 Epidemology of vomiting in early pregnancy.

138

www.ncbi.nib.gov/pubmed/3903578 Epidemology of vomiting in early pregnancy.

139

www.ncbi.nib.gov/pubmed/3903578 Epidemology of vomiting in early pregnancy.

140 www.ncbi.nib.gov/pubmed/3903578 Epidemology of vomiting in early pregnancy.

http://www.ncbi.nib.gov/pubmed/17987447





Conclusion


CONCLUSION

Conclusion is the extract of the work done in the study. In this study 40

patients of Garbhini Chardi were divided into 2 groups Group A and Group B

each comprising of 20 patients. Group A patients were given Eladi Gutika 2

tablets thrice daily for 2 weeks. Group B patients were given Eladi Gutika 2

tablets thrice daily for 2 weeks and Matulunga Avaleha 1 tsp, four times daily

for 2 weeks. The assessment of the treatment was done on 15th

day and 30th

day of the treatment. The effect of the treatment were statistically analysed

within the group and in between the groups.

The following conclusions were made from the study.

Emesis Gravidarum is a condition which is affecting 50% of the pregnant

women.

The condition is more prevalent in primigravida than in multiparous women.

It generally affects the patients in the early morning hours.

Eladi Gutika showed a highly significant result in treating vomiting, nausea

and salivation but was not giving any increase in weight or Hb%.

As it was in the tablet form, the medicine was appreciated by the patients for

easy consumption.

The combination of Eladi Gutika and Matulunga Avaleha showed highly

significant results in all parameters. It helped in decreasing vomiting, nausea

and salivation and also helped in increasing the body weight. The medicines

also helped in mild increase of Hb% .

The difference between the results of two groups is due to the effect of

Matulunga Avaleha used in the second group.

Avaleha form was not much appreciated by the patients for its consistency and

smell.

Matulunga avaleha also helped in correcting associated complaints like

constipation.

There were no side effects seen in patients of both the Groups.

Overall effect of the treatment was more significant in Group B than in Group

A.

Conclusion


SUGGESTIONS FOR FURTHER STUDY

The study should be done in a larger group and for a larger duration to know

the effect of the treatment especially in the increase of Hb% .

Ambily.VN BAMS

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