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| CLINICAL RESEARCH |
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| Year : 2011 | Volume
: 32
| Issue : 2 | Page : 187-191 |
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A clinical study of Devadarvyadi-Vati on Grahani Dosha in children
Rutu V Patel1, VK Kori2, KS Patel3
1 M.D.(Ayu) Speciality: Kaumarabhritya, Department of Kaumarabhritya, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India
2 Assistant Professor, Department of Kaumarabhritya, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India
3 Associate Professor, Department of Kaumarabhritya, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India
| Date of Web Publication | 2-Feb-2012 |
Correspondence Address:
Rutu V Patel
7, 'Shree', Hariom Society, Old Dumaral Road, Nadiad, Gujarat
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0974-8520.92568
 Abstract | | |
Childhood period is considered as the period of rapid growth and development, as it is the crucial stage of establishing future. Gastro-intestinal disorders show high prevalence in pediatric practice. These conditions generally produce chronic illness. Grahani Dosha is a disease related with Agnidushti. This condition is seen more in childhood period due to faulty dietary habit and changing lifestyle. The present paper deals with study on etiopathogenesis of Grahani Dosha and evaluates the efficacy of Deavadarvyadi-Vati. The etiological factors and symptoms were observed carefully to make clear etiopathogenesis. Total 32 patients (3-12 years) were registered and randomly divided into two groups. In Group A Devadarvyadi-Vati (treated group) and in Group B Bhunimbadi-Vati (control group) given for 4 weeks with Koshna Jala. In Group A (Devadarvyadi-Vati), marked improvement was observed in 21.43% of the patients, moderate improvement was observed in 57.14% of patients and mild improvement was observed in 21.43% of patients. Keywords: Bhunimbadivati , Devadarvyadivati, Grahani Dosha
How to cite this article:
Patel RV, Kori V K, Patel K S. A clinical study of Devadarvyadi-Vati on Grahani Dosha in children. AYU 2011;32:187-91 |
| Introduction | |  |
Children are always put in a special category and they require more attention. In children, the diagnosis as well as prognosis based on strength of the clinical features should be made at the earliest possible, so that the management could be fixed soon. [1]
Diseases of digestive system constitute a major problem in India. It is certain that socioeconomic and environmental factors are responsible for a much greater prevalence of digestive disorders. Digestive diseases commonly affect the persons at the prime period of their life i.e., in the young - most productive part of the life and the children during the crucial stage of growth and development. Most of the digestive diseases are chronic or recurrent and lead to more disability than acute transient illness. Grahani Dosha is a disease related with gastrointestinal disorders. This condition is seen more in childhood period due to irregular dietary habit like over-eating; more ingestion of cool, heavy, dry, fried and dehydrated food. A wide variety of gastrointestinal symptoms like loss of appetite, abdominal pain, nausea, vomiting, constipation, etc., have been reported in children. Gastrointestinal disorders show high prevalence in pediatric practice. But in today's era, this condition mostly goes unnoticed under the burden of antibiotics or at times is either not reported by the child or is not taken up seriously by the parents. These conditions generally hamper growth and development of the child and produce chronic illness. Proper care of digestive diseases in children will help in "Adding life to years…as well as years to life."
The formulation having the property of Deepana-Pachana has been selected for present study in the form of Devadarvyadi-Vati as treated group mentioned by Acharya Charaka in Chikitsa Sthana Grahani Dosha Chikitsa Adhyaya 15/99. It contains six herbs: Devadaru [Cedrus deodara (Roxb.) Loud], Vacha (Acorus calamus Linn.), Musta (Cyperus rotundus Linn.), Sunthi (Zingiber officinale Rosc.), Ativisha (Aconitum heterophyllum Wall. ex Royle) and Haritaki (Terminalia chebula Retz.).
Bhunimbadi-Vati has been selected as control group mentioned in Charaka Samhita Chikitsa Sthana. [2] It consists nine drugs: Bhunimba (Swertia chirayata Roxb. Ex Flem.), Katuki (Picrorhiza kurroa Royle ex Benth), Shunthi (Zingiber officinale Rosc.), Maricha (Piper nigrum Linn.), Pippali (Piper longum Linn.), Musta (Cyperus rotundus Linn.), Chitraka (Plumbago zeylanica Linn), Kutaja [Holarrhena antidysenterica (Roxb.ex.Flem) Wall] and Indrayava [Holarrhena antidysenterica (Roxb.ex.Flem) Wall]. The collected drugs were authenticated in the pharmacognosy laboratory of IPGT and RA, Jamnagar.
Aims and objectives
- To study the etiopathogenesis of Grahani Dosha in children.
- To evaluate the clinical efficacy of Devadarvyadi-Vati in comparison to Bhunimbadi-Vati in the management of Grahani Dosha in children.
| Materials and Methods | | |
Selection of the patients: Patients (3-12 yrs), having signs and symptoms of Grahani Dosha have been selected from O.P.D. of Kaumarabhritya Dept., I.P.G.T. and R.A., G.A.U., Jamnagar hospital after excluding conditions like congenital disease, hereditary disease, worm infestation and infectious disease. A special research proforma was prepared for study based on Ayurvedic literature.
Sampling method: Simple random sampling method.
| Grouping | | |
Group A: Devadarvyadi-Vati (treated group)
Group B: Bhunimbadi-Vati (control group)
Dose: 3.5-12.5 gm according to age. (SharangadharaSamhita) in three divided doses.
Anupana: KoshnaJala.
Duration: 4 weeks
Follow up: 2 months
| Criteria for Assessment | | |
Assessment has been done based on the improvement in signs and symptoms and investigations. The scoring pattern adopted for the assessment of clinical features is as follows:
Laboratory investigations
- Routine and microscopic examination of stool.
- Routine and microscopic examination of urine.
- pH value of stool.
- Mala parikshana by ayurvedic method.
Habits (Regular/Irregular), Number of motions, Akriti (Appearance) of the stool (Cylindrical/Not define), Samhatatva-consistency (Semisolid/Hard), Varna, Gandha and Jala Parikshana (Flots/Sinks in water) of stool was assessed.
Dietary restrictions
The patients were strictly advised to follow the restrictions regarding food habits and life style and to avoid the possible causative factors for Agnimandya like Vishamashana, Sheeta Jala Sevana, etc.
Assessment of total effect of therapy
No improvement - 0 %
Mild improvement - 0-25%
Moderate improvement - >25-50%
Markedly improvement - >50-75%
Complete remission - 100%
Paired 't' test was carried out to evaluate the statistical significance of the results obtained at the end of the therapy.
Clinical study
Total 32 patients were registered and randomly divided into two groups . Out of 32 patients of Grahani Dosha, 24 had completed the course of treatment. In Group A (Devadarvyadi-Vati) 14 patients had completed the course of treatment and 4 patients were discontinued. In Group B (Bhunimbadi-Vati) 10 patients had completed the course of treatment and 4 patients were discontinued.
| Observation and Results | | |
Observations of 32 patients are as presented below:
Maximum numbers of patients were in the age group of 3-5 years (40.62%), male (62.50%), Hindu (87.50%), middle class (50%) and mothers are housewives (96.87%). Majority of the patients were Vata-Pitta Prakriti (53.12%), Avara Sara (65.62%), Avara Samhanana (81.25%), Avara Vyayama Shakti (87.50%), Avara Abhyavarana Shakti (87.50%) and Avara Jarana Shakti (84.38%).
Majority of patients (59.37%) were having past history of Grahani Dosha followed by 37.50% of patients been having past history of Atisara. Vishamashana (93.75%), Divaswapna (46.87%) and Krodha (56.25%) was observed in maximum numbers of the patients.
Vatakapha Pradhana Rupa was observed in i.e., 59.37% of the patients. As chief complaints Muhurbaddha-Muhurshithila Mala Pravritti (100%), Anaddhodarata (84.37%), Arochaka (93.75%), Balakshaya (90.62%), Aalasya (87.50%), Klama (59.37%), Trishna (62.50%), MukhaVairasya and TiktaAmlodgara (09.37%), Praseka (37.50%), Antrakujanam (96.87%) were observed. Chronicity (6-12 months) was observed in 56.25% of the patients.
Nirama mala pravritti was observed in 50% of patients treated in Group A, which is statistically highly significant. Only 20% effect on this symptom was found in Group B, which statistically insignificant. In trial group, increase in pH of stool was observed (27%), while in control group; it was 11.67%. Both results are statistically highly significant.
Overall effect of therapy
In Group A, marked improvement was observed in 21.43% of the patients, moderate improvement was observed in 57.14% of patients and mild improvement was observed in 21.43% of patients. Not any patient was observed as complete cured and unchanged [Table 1]. In Group B, moderate improvement was observed in 40% patients and mild improvement was observed in 60% patients [Table 2].
| Discussion | | |
Bruhattrayee as well as Laghuttrayee have explained Grahani Dosha in detail along with management. According to Kashyapa Samhita the children whose Grahani is vitiated and often eat too much, they suffer from Phakka (Vyadhija). [4]Agnimandhya predominantly causes the disease Grahani Dosha. When Dosha Dushti occurs, the disease is manifested and Apakva food is invariably voided (unchanged). In Purvarupavastha both Ama and Pakva food products come out through the stool, the condition is described as Grahani Dosha. When only Apakva food is invariably voided, the condition is described as Grahaniroga. [5]Grahaniroga is considered as the advanced stage of Grahani Dosha.
According to Acharya Charaka, the action of the drug depends upon either its Rasa, Guna, Virya, Vipaka or Prabhava. [6] To break the Samprapti of the disease, an ideal drug should have Deepana, Pachana properties predominantly. Devadarvyadi-Vati contains Katu Rasa, Laghu Guna, Ushna Veerya, Katu Vipaka, Vatakapha Doshaghnata predominantly and in Bhunimbadi-Vati most of the drugs have Tikta and Katu Rasa, Laghu and Ruksha Guna, Sheeta Virya, Katu Vipaka and Kaphapittashamaka Doshaghnata. Due to these properties of the both groups help in Amapachana and Agnidipti.
Maximum numbers of the patients belonging to the age group of 3-5 years. Digestive diseases can affect at any age, but incidence seems to be higher in small aged children. The beginning of Annada Avastha period and the characteristics of Balyavastha are described as Aparipakva Dhatu, Asampurna Balam, Shleshmadhatuprayam, Aniyata Agni, etc. During this period, any mild etiological factor can impairs Agni easily and disturbs the digestive system.
Most of the mothers were housewives. As a housewife, the mother is in the home whole day with children, she thinks that her children eat nothing and she forces her children to eat more and more. "Atimatra Ashanam Amapradosha Hetunam0" and "Ajeerna Adhyashanam Grahani Dushananam" [7] over-eating, is one of the factors for creation of Ama. [8] Most of the patients were having past history of Grahani Dosha and Atisara. It suggests that Grahani Dosha is a recurrent condition. Atisara is described as Nidanarthakara Roga. [9]
Majority of the patients were taking biscuits, chocolates, kurkure, sweets, ice cream, wafers, curd, tea and bakery items frequently in their whole day diet. Vishamashana was observed as Aharajanidana, Divaswapana was observed as Viharajanidana and Chinta was observed as Manasikanidana predominantly. These all are responsible for Agni Vaishamya. Majority of the patients were having chronicity of 6-12 months. The observation suggests it comes under chronic condition. Proper treatment and Pathyapathya is needed for cure the disease. Muhurbaddha-Muhurdrava Mala Pravritti was found in all of patients, frequency of stool was observed 3-4 times in a day. The observation shows that due to vitiation of Agni, it does not digest even light food and Anna becomes Vidagdha, it moves downward with Pakva and ApakvaAvastha.
The effect of trial drug Devadarvyadi-Vati showed better result on Muhurbaddha Muhurshithila Mala Pravritti, Anaddhodarata, Arochaka, Balakshaya, Aalasya, Klama, Trishnaand Antrakujanam due to its Kaphavatashamaka properties predominantly, while the control drug Bhunimbadi-Vati showed better result on Mukha Vairasya and Tikta Amlodgaradue to its Kaphapittashamaka properties predominantly. Both groups showed similar effect on Praseka.
The results on Muhurbaddha Muhurshithila Mala Pravritti, Anaddhodarata, Arochaka, Trishana and Antrakujanam Lakshanas, increase in Abhyavarana Shakti and Jarana Shakti were statistically highly significant in both groups. While result on Balakshaya, Klama and Tikta Amlodgara were insignificant in both groups. Treated group Devadarvyadi-Vati showed highly significant effect on Aalasya and Praseka. Control group Bhunimbadi-Vati showed highly significant effect on Mukha Vairasya and significant effect on Praseka.
Regarding scoring pattern, uniformity should be maintained andregarding overall effect of therapy, assessment should be done at different interval; it will become more specific for conclusion.
| Conclusion | | |
Grahani Dosha is due to functional derangement of Grahani. Grahaniroga is considered as the advance stage. Faulty dietary habit and changing in the life style are main etiological factors responsible for Doshadushti resulting in Agnimandhya. In Balyavastha Agni is stated as Aniyata Avastha, even a mild etiological factor may become responsible for Agnidushti. Grahani and Agni are interdependent; therefore, all etiological factors of Agni Dushti are the direct cause of Grahani Dosha. It comes under chronic diseases. If the proper care is not taken, it will hamper child's growth and development. It is mostly seen as recurrent condition. Devadarvyadi-Vati-showed better relief on Anaddhodarata, Arochaka, Balakshaya, Aalasya, Klama, Trishna and Antrakujanam. Bhunimbadi-Vati-showed better relief on Mukha Vairasya and Tikta Amlodgara. After completion of treatment, both the groups showed similar effect on Praseka and nearly similar effect on Muhurbaddha Muhurshithila Mala Pravritti. Pathyapathya plays an important role in the treatment of Grahani Dosha. No any adverse effect of drug observed in this study.
| References | | |
| 1. | Vriddhajeevaka. KashyapaSamhita. Text with English Translation and Commentary. IndriyaSthana 36. TewariPV, editor.Varanasi:ChaukhambhaVishvabharati; 2008. p.157. 
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| 2. | Agnivesha, Charaka, Dridhabala, CharakaSamhita, ChikitsaSthana 15/132.Chakrapanidatta Commentary.VaidyaJadavajiTrikamajiAcharya, editor. Varanasi:ChaukhambhaPrakashana; 2007. p.521.
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| 3. | Madhavakar, Madhava Nidanam, Agnimandhyadhi Nidanam 6/24.Madhukosha Vyakhya. Shri Yadunandanopadhyaya, editor. Varanasi: Chaukhambha Prakashana; 1992. p.237.
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| 4. | Kashyapa, Vriddhajeevaka, KashyapaSamhita.ChikitsaSthanaPhakkaChikitsa 19. Text with English Translation and Commentary.Tewari PV, eidtor. Varanasi:ChaukhambhaVishvabharati;2002. p.243.
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| 5. | Agnivesha, Charaka, Dridhabala.CharakaSamhita, ChikitsaSthana 15/57.Vol. 4. Chakrapanidatta Commentary. Sharma RK, Bhagwandash. Varanasi:ChaukhambhaSanskrita Series Office;2006. p. 29.
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| 6. | Ibidem Charak Samhita, Sutra Sthana 26/71-2.Vol 1, 2006. p.478.
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| 7. | Ibidem Charak Samhita, Sutra Sthana 25/40.Vol 1, 2006. p.426.
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| 8. | Ibidem Charak Samhita, ChikitsaSthana 15/41-2.Vol 4, 2006. p.23.
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| 9. | Sushruta. SushrutaSamhita.Uttaratantra40/167. with the Nibandhasandraha Commentary of ShriDalhanacharya.JadavajiTrikamajiAcharya, editor. Varanasi:ChaukhambhaSanskritaSamsthana;2009. p.709
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[Table 1], [Table 2]
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