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   Table of Contents - Current issue
Coverpage
January-March 2018
Volume 39 | Issue 1
Page Nos. 1-60

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EDITORIAL  

Ayurveda research: The present status and prospects Highly accessed article p. 1
Anup Thakar
DOI:10.4103/ayu.AYU_269_18  
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ORIGINAL ARTICLES Top

Comparative clinical study of Guggulu-based Ksharasutra in Bhagandara (fistula-in-ano) with or without partial fistulectomy p. 2
Rakesh Kumar Meena, Tukaram Dudhamal, Sanjay Kumar Gupta, Vyasadeva Mahanta
DOI:10.4103/ayu.AYU_19_15  
Background: In Ayurveda, Bhagandara is considered as one of the grave disease by Sushruta due to more recurrence rate. Ksharasutra is para-surgical procedure which is found more effective in the management of fistula-in-ano. Ksharasutra is routinely prepared with Snuhi Ksheera (latex), Haridra powder and Apamarga Kshara. In conventional method collection of Snuhi latex is time consuming and laborious. Guggulu was selected as an alternative for preparation of Ksharasutra having similar binding property as Snuhi latex, and has antiseptic, anti-inflammatory and wound-healing properties. That is why, here, in this trial, the Snuhi latex was replaced by Guggulu. Aim: To evaluate the efficacy of Guggulu based Ksharasutra with and without partial fistulectomy in the management of Bhagandara. Materials and Methods: In this research study, 42 patients of Bhagandara (fistula-in-ano) were selected and randomly divided into two groups. In group-A (n = 22), patients were treated only with application of Guggulu-based Ksharasutra and in group-B (n = 20), partial fistulectomy was done and then Guggulu-based Ksharasutra was applied in remaining fistulous tract. After Ksharasutra application, patients were assessed for relief in symptoms such as pain, discharge, itching and swelling as subjective parameters and unit cutting time (UCT) as an objective parameter, on weekly follow-up basis and Ksharasutra was changed by railroad technique up to complete cut through of the tract. Results: In patients of group-A (plain Guggulu-based Ksharasutra), highly significant relief was seen in pain and discharge. The significant result was seen in itching while insignificant relief in swelling. In patients of group-B (partial fistulectomy with Guggulu-based Ksharasutra), relief in symptoms such as pain, discharge, and itching was statistically highly significant. The relief in swelling in this group was found statistically significant. The mean UCT was 8.85 days/cm in group-A, whereas the mean UCT was 8.19 days/cm in group-B. Conclusion: Partial fistulectomy with Guggulu-based Ksharasutra is better as compared to plain Guggulu-based Ksharasutra application in cases of Bhagandara (fistula-in-ano).
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Clinical evaluation of Trivṛta powder (Operculina turpethum Linn.) and Aragvadha Patra Lepa (paste of leaves of Cassia fistula Linn.) in the management of Vicharchika (eczema) p. 9
Manisha T Talekar, Sisir Kumar Mandal, Reetu R Sharma
DOI:10.4103/ayu.AYU_45_15  
Background: In Ayurveda, majority of skin diseases have been mentioned under the umbrella of Kushtha and in other words, it can be listed as “Ayurvedic dermatology.” Among them, Vicharchika (eczema) included under Kshudra Kushtha, has been mentioned as curable disease, but due to relapsing nature of the disease and hazardous side effects of the modern drugs, it is difficult to manage. Ayurveda classics described a number of formulations to combat Kushtha (skin diseases) which offers effective remedy for eczema. Therefore, the attempt was done to assess the effect of Nitya Virechana (regular purgation) along with local application in its management. Aim and Objective: The aim of this study is to compare the efficacy of Trivritta powder along with Aragvadha Patra Lepa (paste) and Aragvadha Patra Lepa (paste) alone as local application in the management of Vicharchika (eczema). Materials and Methods: A total of 63 patients of Vicharchika (eczema) were selected and allocated in 2 groups, out of which 60 patients (30 patients each) completed the trial treatment. Group A received Trivritta powder (Operculina turpethum Linn.) along with local application of paste of leaves of Aragvadha (Cassia fistula Linn.) and group B received local application of Aragvadha Patra Lepa (paste) for the duration of 4 weeks. Results: All calculations were calculated through ‘Graph Pad In Stat 3’ software. Nitya Virechana (regular purgation) by Trivritta along with Aragvadha Patra Lepa (group A) proved more effective to control itching, discharge, burning sensation, eruption, discoloration, pain and edema of cases of Vicharchika. Conclusion: Treatment with Trivritta (Operculina turpethum Linn.) along with local application of paste of Aragvadha Patra Lepa is effective in reducing the symptoms of Vicharchika Kushtha (eczema).
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CASE REPORT Top

Assessment of the outcome of Ayurvedic treatments for vertebral fracture with motor dysfunction p. 16
A. M. H. S. Attanayake, J. A. A. S. Jayaweera, WW Kubukgolla, U. M. G. D. De Silva
DOI:10.4103/ayu.AYU_226_16  
Assessment of outcome following Ayurveda treatment protocol was done in a complicated case of spinal fracture with motor dysfunction and having a past history of Pott's disease. A 52-year-old man was suffering from motor dysfunction after a spinal fracture at D5/D6 level. The patient sought Ayurveda treatments because he did not gained any significant improvement according to mainstream medical treatments what he underwent for several years. According to Ayurveda, the patient was treated following immobilization, external and internal application of herbal preparations followed by physiotherapy. The outcome of the treatments were monitored by motor function assessment, quality of life assessment and computed tomography scan. Initial signs of improvement were observed just after 1 month of commencing Ayurveda treatments. Continuously following the treatments for 24-month duration, the patient was reverted back to his normal life. This complicated case of spinal fracture was successfully cured using Ayurveda treatment. Therefore, the observations made here would be useful for organizing a future clinical trial.
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PHARMACOGNOSTICAL STUDY Top

Bioactivity-guided isolation of potent anxiolytic compounds from leaves of Citrus paradisi p. 21
Vikas Gupta, Ravinder Sharma, Parveen Bansal, Gunpreet Kaur
DOI:10.4103/ayu.AYU_173_17  
Context: Citrus fragrances have been attributed with mood-enhancing properties by aromatherapists. Leaves of this plant have been reported to exert anti-anxiety activity. Till date, no specific phytoconstituent responsible for this has been identified. Objective: Isolation of anxiolytic constituent of Citrus paradisi using bioactivity-guided fractionation. Materials and Methods: Leaf extracts of four varieties of C. paradisi in petroleum ether, chloroform, methanol and water were evaluated for anti-anxiety activity in mice using elevated plus-maze apparatus. Because of activity in methanol extract, it was used for safety evaluation/acute toxicity studies in animals. Bioactive fraction of methanol extract was subjected to column chromatography and structure of the isolated compound was elucidated by melting point, ultraviolet, infrared, nuclear mass reactor and mass spectroscopy. The isolated constituents were further evaluated for anti-anxiety activity using light/dark model and hole-board model of anxiety. Results: Results showed no mortality at a dose up to 2000 mg/kg body weight that indirectly reflects the safety profile of the leaf extracts. Fractionation of methanol extract led to the isolation of four flavonoids (rutin, quercetin, kaempferol and myricetin). The isolated compounds exhibited significant anxiolytic activity in different animal models. Conclusion: The study confirms the presence of four flavonoids responsible for anti-anxiety activity.
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PHARMACEUTICAL STUDIES Top

Pharmaceutico-analytical study of Samaguna, Dwiguna and Shadguna Balijarita Rasa Sindura p. 29
P Hrishikesh, NM Harsha
DOI:10.4103/ayu.AYU_110_16  
Introduction: Rasa Sindura is a Kupipakva Rasayana which is very popular and is widely used in therapeutics till date. Therapeutic property of Rasa Sindura varies with proportion of Gandhaka added to Parada. Aims and Objective: The present study was carried out to reevaluate and compare differences in the pharmaceutical analytical study of Rasa Sindura prepared with the changing proportion of Gandhaka. To prepare Samaguna (RS), Dwiguna (2RS) and Shadguna (6RS) Balijarita Rasa Sindura and to carry out X-ray diffraction study (XRD) and Fourier-Transform Infrared spectroscopy (FTIR) of the samples. Material and Methods: Samaguna, Dwiguna and Shadguna Balijarita Rasa Sindura were prepared as per classical reference and the samples were subjected to XRD and FTIR. Results: The duration of trituration for the preparation of Samaguna, Dwiguna and Shadguna Kajjali was 70, 40 and 24 h respectively. The duration of heating was 16, 16 and 19 h respectively. Average percentage yield of RS, 2RS and 6RS was 54%, 34.44% and 11.35%, respectively XRD showed increased crystallinity of the samples. FTIR spectrum revealed the decrease of unsaturated carbon and exchangeable proton as the proportion of sulfur increased in the preparation. Conclusion: XRD and FTIR suggested better stability of the crystals of 6RS than 2RS and RS.
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Establishment of quality function deployment with special reference to good manufacturing practice of Chandraprabha Vati p. 34
Abhay Jayprakash Gandhi, Vinay J Shukla
DOI:10.4103/ayu.AYU_44_18  
Context: Quality function deployment (QFD) is a powerful tool for the translation of vague, imprecise customer requirements into clear, measurable technical requirements. Aims: The objective of this article is twofold: (a) to propose a platform conceptual model for Chandraprabha Vati and (b) to present 10-step procedure to build QFD matrix. Materials and Methods: The method deals with, first, preparing two conceptual models for Chandraprabha Vati for the sake of manufacturing unit. The survey study was carried out for two products for the selection of customer requirement. Then, with the help of survey study QFD's house of quality matrix was prepared which contained two products, i.e., classical product prepared by pharmacy of university and marketed product. High performance thin layer chromatography study was also carried out. Statistical Analysis Used: Principal component analysis (PCA) was applied to the data using unscrambler software. Results: The results of QFD chart and PCA analysis were obtained from the two surveys. The first survey reveals that if proper care is taken during preparation on hardness and capping of Vati, then product goes toward zero defects. The second survey reveals that if proper care is taken during preparation on hardness, capping and sticking, then physically Vati goes toward zero defects. Conclusions: The 10-step procedure facilitates the process of reasoning and reduces the time spent for manufacturing with zero defect in product.
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PHARMACOLOGICAL STUDIES Top

Antidiarrheal activity of Clitorea ternatea Linn. (Fabaceae) ethanol leaf extract in rats p. 40
Ramdas Bhanudas Pandhare, Sangameswaran Balakrishnan, Gaurav Dnyandeo Bangar, Pramod Dnyandeo Dighe, Vinayak Kashinath Deshmukh
DOI:10.4103/ayu.AYU_19_17  
Background: Clitorea ternatea Linn. (Fabaceae) is a plant which is traditionally used for the treatment of wide range of pharmacological activities including antimicrobial, antipyretic, anti-inflammatory, analgesic, diuretic, local anesthetic, antidiabetic, insecticidal, blood platelet aggregation-inhibiting and diarrhea in India. However, scientific evidence does not exist in any literature to corroborate the claim of therapeutic success of the plant species in diarrhea. Aim of the Study: The core aim of the present study is to evaluate the antidiarrheal activity of C. ternatea ethanol extract (CTE). Materials and Methods: The antidiarrheal activity was evaluated using castor oil and magnesium sulfate (MgSO4)-induced diarrhea method. The effects of CTE on gastrointestinal motility, intestinal transit and enteropooling were also examined in rats. Results: CTE (100–400 mg/kg, p.o.) produced dose-dependent and significant (P < 0.05–0.01) protection of rats against castor oil and MgSO4-induced diarrhea, inhibited intestinal transit and delayed gastric emptying. CTE dose dependently and significantly delayed the onset of castor oil and MgSO4-induced diarrhea, decreased the frequency of defecation and reduced the severity of diarrhea in the rats compared with loperamide (10 mg/kg, p.o.). Conclusion: These findings confirm the ethno medicinal use of C. ternatea as a valuable natural remedy for the treatment, management and/or control of diarrhea.
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Assessment of Trisama, an ayurvedic formulation on intestinal transit time in swiss albino mice p. 46
Amit G Patel, Minuatee R Patel, Mukeshkumar B Nariya
DOI:10.4103/ayu.AYU_33_18  
Background: Trisama is an Ayurvedic formulation that can be prescribed for wide range of disorders, especially abdominal disorders such as indigestion, constipation and flatulence. Trisama is prepared by mixing an equal quantity of powder of Shunthi (Zingiber officinale Linn.), Haritaki (Terminalia chebula Retz.) and Guduchi (Tinospora cordifolia [Willd.] Miers.). As a single ingredient, Haritaki is an alternative to prokinetic drugs, Guduchi for intestinal motility and Shunthi for digestion-related problems. Materials and Methods: The present study aims to evaluate the effect of Trisama dosage forms on intestinal motility by adopting kaolin expulsion test in Swiss albino mice. Trisama powder (0.65 and 1.3 g/kg) and Trisama decoction (12.48 ml/kg) were administered and intestinal transit time of kaolin and latency of onset of kaolin expulsion in fecal matter was assessed. Results: Both the dosage forms of Trisama shortened the intestinal transit time of kaolin. However, the observed effects were statistically significant in Trisama powder at higher dose and Trisama decoction in comparison to control group. The behaviors of mice and consistency of fecal pellet were almost the same as observed in normal control group. Conclusion: From the present study, it is concluded that Trisama has significant intestinal motility-enhancing property in mice which may be useful in gastric problems without affecting the general physiology.
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SHORT COMMUNICATIONS Top

A clinical study to evaluate the role of Triphaladya Guggulu along with Punarnavadi Kashaya in the management of hypothyroidism p. 50
Karishma Singh, Anup B Thakar
DOI:10.4103/ayu.AYU_62_17  
Context: Hypothyroidism is one of the most common thyroid disorders in India, affecting one in ten adults. Although the diagnosis and treatment of hypothyroidism are often considered simple, there are large number of people with this condition who are suboptimally treated. Due to wide spectrum of the disease and high prevalence in the society, the current issue was opted for study and its management by means of Ayurvedic principles. Materials and Methods: Fifteen eligible hypothyroid patients with serum thyroid-stimulating hormone >4.5 μIU/ml and serum T3and T4 lower than their respective normal range were selected and treated with Triphladya Guggulu pills and Punarnavadi Kashayam (decoction) for 45 days. Patients were advised to discontinue any medicine they might be taking for the management of hypothyroidism to assess the unbiased effect of therapies. Results: Significant improvement was observed on subjective parameters, but the results on objective parameters were statistically insignificant (P > 0.05). Of the 15 enrolled patients, excellent improvement was observed in 33.33% of the patients, while marked improvement was reported by 53.33% of the patients, moderate improvement was found in 6.66% of the patients and same number of patients, that is, 6.66% showed mild improvement. Moreover, few interesting observations were noted 4 months after completion of the trial. Out of 15 patients registered, 86.66% had positive drug history for levothyroxine. After clinical trial, 6.66% of the patients continued their previous dosage of levothyroxine, while 80% of the patients had withdrawn their hormone replacement therapy. Conclusion: Triphladya Guggulu and Punarnavadi decoction are effective in the management of hypothyroidism.
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A pilot study on clinical efficacy of Agnikarma and Pathyadi decoction (an Ayurvedic formulation) in the management of Ardhavabhedaka (migraine) p. 56
Brinda Kanakhara, Varsha Chaudhari
DOI:10.4103/ayu.AYU_84_17  
Introduction: Ardhavabhedaka described under Shiroroga (disease of the head in Ayurveda) occurs due to vitiation of Tridosha (all of three biological humors). The signs and symptoms of migraine can be correlated with Ardhavabhedaka. Looking to the agony caused during acute episode of migraine and unavailability of specific management and only symptomatic management in conventional medicine this study was conducted. Agnikarma is indicated in severe pain and Pathyadi decoction is indicated in the management of Shiroroga. Aim and Objective: The aim of this study was to evaluate the efficacy of Agnikarma and Pathyadi decoction in the management of Ardhavabhedaka (migraine). Materials and Methods: A total of 15 patients were selected from outpatient department of Ayurveda College. Agnikarma was done on affected temporal side of face, dot type for 1 time, once in a week followed by application of honey–Ghee. Along with this, Pathyadi decoction 40 ml twice a day for 30 days was also given. Results: Statistically highly significant relief (P < 0.001) was noted in headache, photophobia and phonophobia and statistically significant (P < 0.05) relief was noted in vomiting, nausea and vertigo. Conclusion: Agnikarma along with Pathyadi decoction can be considered as an effective line of treatment to manage Ardhavabhedaka (migraine).
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