|Year : 2011 | Volume
| Issue : 3 | Page : 370-374
Clinical effect of Kukkutanda Twak Bhasma in the management of Swetapradara
Gatikrushna Panda1, KB Mohapatra2
1 Assistant Professor, Department of Prasuti Tantra and Streeroga, M.S.M. Institute of Ayurveda, B.P.S. Mahilla University, Sonipat, Haryana, India
2 Professor and Head, Gopabandhu Ayurveda Mahavidyalaya, Puri, Orissa, India
|Date of Web Publication||17-Mar-2012|
Assistant Professor, Department of Prasuti Tantra and Streeroga, M. S. M. Institute of Ayurveda, B. P. S. Mahilla University, Khanpur Kalan, Sonipat, Haryana 131 305
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Swetapradara is an important gynecological disorder nowadays. Most women in the reproductive age group complain about white discharge. Due to white discharge, they are prone to so many other symptoms, such as backache, itching in vulva, and burning micturition. According to Ayurveda, swetapradara is caused by the vitiation of Kapha and Vata dosha. Kukkutanda twak is also said to be Kapha Vata shamaka and swetapradara shamaka. In Ayurveda so many drugs are mentioned in the treatment of swetapradara. Among them Kukkutanda twak bhasma is a good medicine. In this clinical study Kukkutanda twak bhasma has shown statistically significant improvement in white discharge, backache, itching, anemia, weakness, and urinary tract infection.
Keywords: Bhasma, Kukkutanda twak, leucorrhoea, Swetapradara
|How to cite this article:|
Panda G, Mohapatra K B. Clinical effect of Kukkutanda Twak Bhasma in the management of Swetapradara. AYU 2011;32:370-4
| Introduction|| |
Swetapradara , one of the most common manifestations of gynecological disorders, is an important psychosomatic disorder affecting the psychology of women irrespective of socioeconomical status, occupation, and others. It occurs not only by the dysfunction of reproductive organs but also due to abnormality in general health factors. Although it seems to be a negligible symptom initially, if not treated in time leads to many major complications. The symptoms of swetapradara either physiological or pathological results into great discomfort and deep agony in the individuals. 
The treatment of this manifestation, although virtually depends on its etiopathology, invites immediate measures. The modern treatment involves systemic and local antibiotics and surgical methods, which will create a number of inconveniences during their usage.  Ayurveda provides many alternatives and can prove a boon to the ailing humanity not only by curing the disease, but also by preventing their recurrences. Keeping this in view, it becomes necessary to explore some curative, safe, and economical remedy, which can help the poor. 
According to Ayurveda swetapradara is caused by the vitiation of Kapha and Vata dosha in the body. Kukkutanda twak is also said to be Kapha Vata shamaka and swetapradara shamaka. Hence an attempt has been made to establish the efficacy of Kukkutanda twak bhasma in the management of Swetapradara. 
Evaluate the efficacy of Kukkutanda Twak Bhasma on swetapradara (nonspecific leukorrhea).
| Materials and Methods|| |
For the present study 30 patients were selected from inpatient and outpatient departments of Gopabandhu Ayurveda Mahavidyalaya, Puri, during the period of June 2002 to June 2003.
Criteria for selection
- The selection was done on the basis of chief complaints of swetapradara, such as vaginal discharge, itching of the vulva associated with backache and general weakness.
- In pathological point of view vaginal smear, blood, stool and urine examination was carried out during the course of the treatment. 
The following cases were excluded from the study.
- Positive history of venereal diseases
- Positive Pap smear More Details
- Diabetic cases
- Genital prolapse
- Anemic conditions
- Uterine tumor and other growths. 
Kukkutanda Twak Bhasma.
Preparation of the trial drug
Prior to the incineration process, the Kukkutanda twak was subjected to Shodhana by Swedana process in Kanji through Dola yantra for 12 h. Thereafter the twak was washed thoroughly with lukewarm water and dried in sun rays.
After drying it was made into coarse powder and triturated with lime juice for 2 days and subjected to two Gaja putas. The reduced powder was again triturated with pulp of Kumari for 2 days and subjected to three gaja putas. Finally the Kukkutanda twak Bhasma was collected from the saravasamputa and preserved in air tight containers.
Kukkutanda twak bhasma was administered at the dose of 500 mg. twice daily orally for 3 months.
To administer the Bhasma, a suitable liquid media (anupana) is necessary. Among different anupanas, Madhu was selected in the present study, as it is said to be yogavahi, has effect over Kapha, Rasa is Kashaya and Madhura with Ruksha, Guru, and Sheeta guna, having Chhedana, Lekhana, Ropana, and Sandhana karma and also acts as Brimhana.
All the patients were advised to avoid the usage of food substances and other acts, which exacerbate Kapha and Vata. The patients were also advised for follow-ups at regular intervals. 
The cases were assessed by subjective and objective parameters, before and after treatment. The parameters are Amount of Discharge, Consistency, odor, pH, Pus cells, Epithelial cells, Backache, Itching, Hb%, and so on.
The following pattern of scale was prepared and used for the estimation of the severity of the disease and to record the clinical outcome.
Clinical assessment criteria
- Amount of Vaginal Discharge:
G 0 - No discharge
G 1 - Use of 1-2 pads a day.
G 2 - Use of 3-4 pads a day.
G 3 - Use of 5 or more pads a day.
G 0 - No discharge.
G 1 - Mucoid discharge.
G 2 - Watery discharge.
G 3 - Curdy discharge.
G 0 - Absent. G 1 - Present.
- Vaginal pH:
G 0 - 4 to <5
G 1 - 5 to <6
G 2 - 6 to 7
G 3 - More than 7
- Pus cells:
G 0 - Not found.
G 1 - Occasionally found under HP field.
G 2 - 1-3 cells found under HP field.
G 3 - >4 cells found under HP field.
- Epithelial cells:
G 0 - Not found.
G 1 - Occasionally found under HP field.
G 2 - 1-3 cells found under HP field.
G 3 - >4 cells found under high power field.
- Back ache:
G 0 - No pain.
G 1 - Pain without the disturbance of work
G 2 - Pain with partial disturbance of routine.
G 3 - Pain with disturbance of work and sleep.
G 0 - No itching.
G 1 - Occasional itching.
G 2 - Itching with partial disturbance in work.
G 3 - Itching disturbs daily routine and sleep.
G 0 - >11 gm%.
G 1 - 9-11 gm%.
G 2 - 7-9 gm%.
G 3 - <7 gm%.
The clinical assessment was done on the basis of the following criteria:
Cure: 100% free from the chief and associated complaints.
Maximum improvement: 75% to <100% free from the chief and associated complaints.
Moderate improvement: 50% to <75% free from the chief and associated complaints.
Mild improvement: 25% to <50% free from the chief and associated complaints.
No improvement: <25% free from the chief and associated complaints.
All these observations are subjected to paired t test to evaluate the significance of the treatment and the effectiveness was assessed through P value.
- While considering the prakriti, the incidence of Vata-Pitta (64.46%) and Pitta-Kapha (33.88%) had found more in this series.
- In the chapter of Yonivyapada, it is mentioned that "na hi vatadrite yonirvnitanam pradushati0" (A.S. Ut.39/52) means this disorder does not occur without vitiation of vata. And Yonitah Srava is found in many Yonivyapada those are described in disease review. Vitiated Apana Vayu produces swetapradara because its main Karma is Pravartna of Adhomargagata Malas. So, Pravartna of Yonisrava is also one of the Karma of Apana Vayu. In this way, Apana Vayu plays an important role in the manifestation of swetapradara.
- Vitiated Kapha also plays a major role in Samprapti Ghataka by producing Ama in the body, which is also described in Samprapti. "na paakah pittadrite" (Su.Su.17/7) means onset of suppuration and formation of pus occur due to Pitta Prakopa. So, Pitta is one of the responsible factor for producing vaginal discharge in the cause of vaginitis, cervicitis, and others. So, it is justified that women of Vata-Pitta and Pitta-Kapha Prakriti are prone to swetapradara.
Sara, samhanana, pramana, satmya, satva
- The observations through the enrolled patients revealed that, 80% - 90% have Rajasika Prakriti.
- The Rajadosha patients are well known for their negligency towards body care and other activities. So, they are not so much aware about their personal hygiene, which may create swetapradara.
- In the present study, maximum number of patients (73.55%) are having Madhyama sara, Madhyama samhanana (69.42%), Madhyama pramana (66.94%), Mishra Rasa Satmya (94.21%), and Madhyama Satva (80.16%).
- The data suggest that this disease, is prevalent among those who are not in the peak of their health. Here, it is also reflected that the people who have, for example, Madhyama Sara, take more stress and strain and they mostly suffer from either psychological or somatic disorders. Moreover, Atichintana, Krodha, and others are found moderately in these people. And all these factors are important cause of psychosomatic disorders, including swetapradara.
- Further the data also denote the predominance of Madhyama Satva and others among general population of today's fast life style.
- In the present study, the incidence was found highest in Yuvavastha of Stri (89.26%).
- It is already discussed in age-related data that during this Avastha (16-40 years), active sexual life, reproduction, hormonal imbalances, take place, which may lead to shwetapradara.
Vyayama Shakti and Ahara Shakti
- The data show that majority of the patients (95.87%) were from Jangala Desha. The location of the hospital is in Jamnagar, which comes under the criteria of Jangala Desha, therefore all the patients were from Jangala Desha. Although, no definite inference can be drawn, yet we can say that the Vata Pradhana nature of Jangala Desha can be one of the causative factors of this disease.
- In the present study, maximum number of patients (67.77%) had Madhyama Vyayama Shakti, Madhyama Abhyavaharana Shakti (66.11%), and Madhyama Jarana Shakti (63.63%). It is very difficult to establish the relationship between the disease and the obtained findings.
- The data show that maximum numbers of patients (57.02%) were having Vishamagni followed by 28.10% were having Mandagni.
Due to Vishamagni or Mandagni, Ahara is not properly digested and Ama is produced. Ama itself is a causative factor for manifestation of all kinds of diseases in general and shwetapradara in particular.
The improvement found in white discharge with the treatment of 1 month, 2 months and 3 months was found to be 83.33%, 93.33% and 96.66% respectively [Table 1].
|Table 1: The percentage of the patients attained improvement after treatment with reference to different signs and symptoms|
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In consistency of discharge improvement was found 43.33%, 56.67% and 86.67% with the treatment of 1 month, 2 months and 3 months respectively [Table 1].
Improvement in back-ache was found to be 60% and 70% with the treatment of 1 and 3 months respectively [Table 1].
Itching in vulva was reduced to 41.17%, 82.35%, 94.11% respectively with the treatment of 1 month, 2 months and 3 months [Table 1].
The vaginal pH was found to be restored at the end of the treatment in most of the registered cases (90%).
Pus cells and Epithelial cells were also found to be reduced at the end of the treatment, while the hemoglobin percentage was increased in 83.33% of cases [Table 1].
[Table 2] shows the average percentage of improvement of different signs and symptoms and laboratory findings after 1, 2, 3 months of treatment. The improvement of various signs and symptoms, such as the amount of discharge were 56.66%, 68.88%, and 79.99%; consistency were 34.44%, 47.77%, and 70.55%; odor 40%, 80%, and 80%; pH 23.33%, 43.33%, and 73.33%; pus cells were 27.2%, 36.10%, and 66.10%; epithelial cells were 26.10%, 43.32%, and 65.54%; backache 30%, 40%, and 60%; itching were 23.52%, 38.23%, and 76.47%; and Hb% 17.24%, 37.93%, and 63.79%, respectively.
|Table 2: The average percentage of improvement of sign and symptoms after treatment|
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The result of the present study was assessed as cure, maximum improvement, moderate improvement, mild improvement, and unsatisfactory. The improvement was assessed after 1, 2, and 3 months of treatment.
It was observed that after 1 month of treatment no patients was cured and no patients were in maximum improvement. There were 6 (20%) cases in moderate improvement, 15 (50%) patients in mild improvement, and in 9 (30%) patients the improvement was unsatisfactory.
After 2 months of treatment it was observed that no patients were cured and no patients had maximum improvement. There were 16 (53.33%) patients in moderate improvement, 11 (36.67%) patients in mild improvement, and 3 (10%) patients were unsatisfactory.
But after 3 months of treatment it was observed that 9 (30%) patients were cured, 8 (26.67%) patients were on maximum improvement, 6 (20%) patients were in moderate improvement, and 7 (23.33%) patients were in mild improvement [Table 3].
| Results|| |
Statistical analysis suggests that the administration of Kukkutanda twak bhasma is highly significant in treating almost all the major symptoms of swetapradara (ie, discharge, itching, consistency, pH, pus cells). In all these cases the P value was found as <0.001 at the end of the treatment.
Improved levels of Hb% were found in anemic cases also. The P value found in this case was <0.001. This improvement may be due to the presence of high concentrations of calcium, magnesium, and calcium carbonate in the trial drug, which stimulates the hemopoieses.
The treatment was found less significant in controlling symptoms, such as backache and bad odor. The P value in these cases were <0.005 and <0.05, respectively. pH value in most of the cases came to normal. Laboratory findings also supported all these findings.
The overall result of the clinical study shows that 9 (30%) patients were totally cured from the symptoms. Eight cases (26.7%) showed maximum improvement, 6 cases (20%) moderately improved, and mild improvement was observed in the remaining 7 cases (23.3%) at the end of the treatment [Table 4].
| Discussion|| |
In Ayurveda almost all the gynecological disorders are described under a broad heading "Yonivyapad." Direct references of swetapradara are not available in Samhitas. However, some references of white discharge from vagina are available under the heading of yonivyapad. According to the signs and symptoms and etiologic factors mentioned in Ayurvedic text, swetapradara is a condition where vitiation of Kapha and Vata are predominant. As regards, incidence, ill health and undernutrition is the highest, that is, 25.4% and 20.6% patients are of psychologic origin. 
Kukkutanda twak have the Kapha Vata Shamaka properties, which can subside the vitiation of Kapha and Vata in swetapradara.
Kukkutanda twak bhasma has also been indicated in Rakta pradara, Prameha, Mutraroga, Vatavikara, and Mansik Daurbala. It also has the properties of rasayana, balya, and shakti vardhaka. The Bhasma was administered with Madhu as anupana. 
The clinical study of Kukkutanda twak bhasma is done on 30 selected swetapradara patients. The patients are selected from outpatient department and in the dose of 500 mg twice daily with honey for 3 months. In the present study it is observed that active reproductive age group and house wives are more prone to the disease due to lack of conscious effort in maintaining their normal hygiene, carelessness regarding their own wellbeing and irregular diet habit.
It is revealed from the present study that maximum number of patients 83.33% belong to average and poor nutritional status, which indicates that nutritional factor has a key role in causing of nonspecific leukorrhea. At the end of the treatment, it was observed that, there was a decrease in the amount of white discharge to 79.99% (P value <0.001). In the present study, although the total number of patients of the trial group is very small the result was encouraging. Kukkutanda twak bhasma can be administrated safely in cases of nonspecific leukorrhea without having any unwanted effects. No toxic effects were noted in a single case during the trial. The Kukkutanda twak bhasma can also be used to improve the Hb% in cases of anemia.
Mode of action of the drug
Kashaya Rasa is predominant in kukkutandtwak bhasma. It drives off kleda by virtue of sangrahi, soshana, stambhna, and shleshma prashamana properties of kashaya rasa (ch. An. 29/42)
Kashya rasa is mainly formed by conjugation of vayu and prithvi mahabhuta. Both have opposite qualities of Dravya Guna. So this helps in decrease of srava.
- Kukkutandtwak bhasma is mainly having ruksha guna. Ruksha guna by virtue of its shoshana action restrain srava.
- Kukkutandtwak bhasma is sheeta virya. A drug by virtue of its virya mainly acts in srotasa. Sheeta virya drugs act in srotasa and cause stambhana. By this way trial drug restrain srava by stambhana action in srotasa.
- This bhasma is a Rasa preparation, so may act quickly and enter into the srotas by tikashana guna. During bhasma preparation it may implant the yogavahi guna to the Bhasma. So the bhasma may act quickly and in smaller dose.
| Conclusion|| |
The people who are in active reproductive age group, who fall under low economic status, who observe poor sanitation, and individuals with poor nutrition, inadequate, irregular diets are more prone to this disease. Psychologic disturbances are the main exacerbating factors. The oral administration of Kukkutanda twak bhasma gives effective results in this pathologic manifestation. It had no side effects and is a potent, effective, economical, easily available compound. In cases of anemia also this drug will provide satisfactory results.
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[Table 1], [Table 2], [Table 3], [Table 4]