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CLINICAL RESEARCH
Year : 2013  |  Volume : 34  |  Issue : 3  |  Page : 254-258  

Clinical study on the effect of decoction of Pavetta indica Linn. in treatment of Purishaja Krimi with special reference to Enterobius vermicularis infestation


1 Professor, Department of Nidana Chikithsa, Institute of Indigenous Medicine, University of Colombo, Rajagiriya, Sri Lanka
2 Professor, Department of Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Sri Lanka
3 Medical Officer, Department of Ayurveda, Sri Lanka

Date of Web Publication17-Dec-2013

Correspondence Address:
E. R. H. S. S. Ediriweera
Professor Department of Nidana Chikithsa, Institute of Indigenous Medicine, University of Colombo, Rajagiriya
Sri Lanka
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-8520.123110

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   Abstract 

Pavetta indica Linn. (Family: Rubiaceae; Sanskrit name: Papata) is 2-5 m tall, shrub or small tree with opposite branches and grows in the Asia - Pacific region including Sri Lanka. Purishaja Krimi is one of the worm infestations described in Ayurveda. Enterobius vermicularis is among the most common of worms affecting children and adults. E. vermicularis is considered as one type of Purishaja Krimi. Sri Lankan traditional and ayurvedic physicians use P. indica to treat different ailments including Purishaja Krimi (E. vermicularis) infestations successfully. Since no scientific studies have been undertaken to study these effects so far, the present clinical study was carried out to evaluate the effect of P. indica in treatment of E. vermicularis infestation. Fifty patients between age of 5 and 12 years (Group A and B) and 50 patients between 13 and 65 years (Group C and D) with symptoms of E. vermicularis infestations such as itching in the anal region, impaired appetite, abdominal pain, eructation, diarrhea or constipation and presence of ova in stools were selected. Two decoction of the trail drug with different concentration was prepared. Group A and Group B were treated with 60 ml of decoction 1 and 60 ml of placebo respectively, twice daily for 14 days. Group C and Group D were treated with 120 ml of decoction 2 and 120 ml of placebo respectively, twice daily for 14 days. Groups A and C showed complete or partial reduction of symptoms, that is; itching in the anal region, impaired appetite, abdominal pain, eructation, diarrhea and also ova of E. vermicularis were absent in stools after treatment with P. indica. Decoction of P. indica can be recommended as an effective treatment for Purishaja Krimi (E. vermicularis infestation).

Keywords: Enterobius vermicularis, Pavetta indica, Purishaja Krimi, thread worm


How to cite this article:
Ediriweera E, Rajapaksha R, Rathnayaka R, Premakeerthi W, Premathilaka S. Clinical study on the effect of decoction of Pavetta indica Linn. in treatment of Purishaja Krimi with special reference to Enterobius vermicularis infestation. AYU 2013;34:254-8

How to cite this URL:
Ediriweera E, Rajapaksha R, Rathnayaka R, Premakeerthi W, Premathilaka S. Clinical study on the effect of decoction of Pavetta indica Linn. in treatment of Purishaja Krimi with special reference to Enterobius vermicularis infestation. AYU [serial online] 2013 [cited 2020 Jan 26];34:254-8. Available from: http://www.ayujournal.org/text.asp?2013/34/3/254/123110


   Introduction Top


Krimi Roga (worm infestation) is one of the diseases mentioned in ancient ayurvedic and Sri Lankan traditional medical books. A vast description is given in those books on different types of worms, etiology, clinical features of worm infestation and their management. Purishaja Krimi is one type of worms described in Ayurveda. The signs and symptoms of Purishaja Krimi Roga are eructation, impaired appetite, pain in the abdomen and itching in the anal region, emaciation and diarrhea. [1] Purishaja Krimi Roga can be correlated with Enterobius vermicularis infestation.

E. vermicularis, commonly referred to as the thread worm or pinworm is a nematode with the largest geographical distribution of any helminthes. Humans are the only known host and about 209 million persons world-wide are infected. More than 30% of children world-wide; most commonly those of school age, are infected. Some people may have an infestation without having any symptoms. When symptoms are present, the most common one is that of itching around the rectum. This itching is usually worse at night and is caused by worms migrating to the area around the rectum to lay their eggs. When a person scratches the itchy area, eczema or a bacterial infection around the rectum can result. In females, thread worm infestation can spread to the vagina and cause a vaginal discharge. [2]

Pavetta indica L. (Family: Rubiaceae; Sanskrit name: Papata; Sinhala name: Pawatta) is nearly a smooth or somewhat hairy shrub growing 2-5 m or more in height. It is widely distributed from India and the North-Western Himalayas, Sri Lanka, Andaman Islands to Southern China and southwards throughout Malaysia to Northern Australia. [3],[4] It is commonly used in treatment of cough, hematemesis, hemorrhoids and worm infestation by Sri Lankan traditional and ayurveda physicians but no known scientific studies have been carried out so far. The present study was carried out to scientifically evaluate the efficacy of decoction of P. indica in Purishaja Krimi (E. vermicularis infestation).


   Materials and Methods Top


Selection of patients

Patients between 05 and 65 years of age, from both sexes, suffering from Purishaja Krimi (infestation of E. vermicularis) were selected from those who attended the mobile clinic, Lollupitiya, Ratnapura conducted by Ayurveda Hospital, Ratnapura, Sri Lanka. The patients having such symptoms as Udgara (eructation); Agnimandya (impaired appetite); Shoola (pain in abdomen); Agnisadana (poor digestion); Gudakandu (itching in the anal region); Vidbheda (loose stool); Vishtambha (constipation); Nihshwasa Vidgandha (bad breath having fecal odor); Parushya (dryness of the skin); Pandutha (whitish-yellow discoloration of the skin); Karshya (emaciation) were selected. Detailed examination of the patients was carried out. In adults, the patients who are over 65 years and those who are suffering from recurrent attacks of bronchial asthma, anemia, hypertension and diabetes mellitus were excluded from this research. In children, the patients who are below 5 years, underweight, suffering from eczema and cough, were excluded from this study.

Clinical study

Selected patients were divided into two groups according to their age; that is, children between 05 and 12 years and patients above 13-65 years. Each group of patients was again randomly divided into two sub groups as trial and control. They were then named as Group: A, B, C, D and were treated in the following manner.

Group A consisted of 25 patients between 05 and 12 years and were treated with 60 ml of decoction 1 (decoction of P. indica prepared for children) twice a day after meals for 7 days. Group B consisted of 5 patients between 05 and 12 years and treated with 60 ml of placebo, twice a day after meals for 7 days. Group C consisted of 25 patients between 13-65 years and treated with 120 ml of decoction 2 (decoction of P. indica for adults), twice a day after meals for 7 days. Group D consisted of 25 patients between 13-65 years and was treated with 120 ml of placebo, twice a day after meals for 7 days. Stools test for ova was carried out pre- and post-treatment.The patients in all four groups continued the treatment as prescribed without drop outs

Patients of all the groups were advised to keep the finger nails short and clean, avoid scratching the infected area around the anus, wash hands before meals and after using the toilet, to keep hands and fingers away from the nose and mouth unless they are freshly washed, to wash all bed linen and clothing daily during the treatment period.

Preparation of decoction 1 (decoction of P. indica for children between 05 and 12 years)

The 60 g of fresh leaves of P. indica was taken and cut into small pieces, then 960 ml of water was added and boiled down to 120 ml.

Preparation of decoction 2 (decoction of P. indica for adults)

The 120 g of fresh leaves of P. indica was taken and cut into small pieces, then 1920 ml of water was added and boiled down to 240 ml.

Preparation of placebo (children and adults)

The placebo was prepared by adding brown, permitted food coloring to boiled and cooled water.

Clinical assessment and statistical analysis

The therapeutic effect was evaluated through symptomatic relief of the patients using a scoring pattern and statistical comparisons were made using Mann-Whitney U test using the statistical package Minitab 12.1 for windows. P <0.05 was considered as a significant effect.


   Observations and Results Top


In the present study, it was observed that most of patients suffering from Purishaja Krimi (E. vermicularis infestation) had the symptoms such as itching in the anal region (80%), impaired appetite (75%), abdominal pain (60%), eructations (40%), diarrhea (38%) or constipation (20%), bad breath having fecal odor (20%) dryness (30%) and discoloration of the skin (30%). The therapeutic effect was evaluated through symptomatic relief and the results obtained in children are given in [Table 1] and [Table 2] and in adults are given in [Table 3] and [Table 4]. Laboratory investigations showed ova of E. vermicularis were present in the stools in the all the groups prior to the treatment. In Groups A and C ova were absent in stools, after treating with decoction of P. indica for 7 days.
Table 1: Percentages of symptomatic relief during treatment, with decoction 1 (decoction of Pavetta indica for children) and placebo in children (05‑12 years)

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Table 2: Statistical results on Symptomatic relief during treatment, with decoction 1 (decoction of Pavetta indica for children) and placebo in children (05‑12 years) (mean±SEM)

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Table 3: Percentages of symptomatic relief during treatment, with decoction 2 (decoction of Pavetta indica for adults) and placebo in adults

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Table 4: Statistical results on Symptomatic relief during treatment, with decoction 2 (decoction of Pavetta indica for adults) and placebo in adults (mean±SEM)

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   Discussion Top


P. indica is used in treatment of cough, hemorrhoids, worm infestations and hematemesis by Sri Lankan traditional physicians. P. indica has the properties of Rasa: Tikta, Kashayarasa, Laghu, Ruksha and Tikshnaguna, Katuvipaka and Sheetaveerya. Due to these properties P. indica acts as a Kaphaghnadravya (ingredient which reduces Kapha Dosha). According to principals of Ayurveda, predominance of Kapha Dosha, supports a favorable environment for the reproduction, growth and propagation of worms in the human body. Any ingredient that reduces Kapha Dosha, makes the environment unfriendly for the survival of worms. This will cause the worms to die out. This action will lead to reduction of the symptoms of E. vermicularis infestation and to make stools free of ova. Based on this chain of actions, it can be proposed that P. indica acts as a reducer of Kapha Dosha which in turn reduces the growth and reproduction of worms including E. vermicularis.


   Conclusion Top


Most patients who were treated with decoction of P. indica had complete or partial relief from the symptoms which occur in thread worm infestation; especially itching in the anal region, impaired appetite and pain in the abdomen. According to this study, ova in stools disappear after the treatment of decoction of P. indica. It is concluded that decoction of P. indica is a traditional decoction, which can be very successfully used in treatment of Purishaja Krimi (E. vermicularis infestation) in children and adults.

 
   References Top

1.Madhavakara, Madhava Nidana. Adhyaya 7/13, 14. Edited and translated by Murthy KR. 1 st ed. Varanasi, India: Chaukhambha Orientalia; 1986. p. 34.  Back to cited text no. 1
    
2.Sachdev EN. Medical Parasitology and General Bacteriology. Delhi, India: Jayapee Brothers Medical Publishers; 1985. p. 97-8.  Back to cited text no. 2
    
3.Jayweera D. Medicinal Plants. Part IV. Colombo, Sri Lanka: National Science Foundation of Sri Lanka; 1982. p. 299.  Back to cited text no. 3
    
4.Anonymous. Ayurveda Pharmacopoeia. Vol. 1, Part 2. Colombo, Sri Lanka: Department of Ayurveda; 1979. p. 78.  Back to cited text no. 4
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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