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   Table of Contents - Current issue
Coverpage
January-March 2020
Volume 41 | Issue 1
Page Nos. 1-67

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EDITORIAL  

Is integration of various systems of medicine need of today? p. 1
Mandip Goyal
DOI:10.4103/ayu.ayu_38_21  
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ORIGINAL ARTICLES - REVIEW STUDY Top

Review of health-care services for older population in India and possibility of incorporating AYUSH in public health system for geriatric care p. 3
Pallavi Suresh Mundada, Sakshi Sharma, Bharti Gupta, MM Padhi, Aparajit B Dey, KS Dhiman
DOI:10.4103/ayu.ayu_172_16  
Background: In a developing country like India, which has 10.11% population of >60 years age and a projection of rise of the same by 300% in 2050, health care of elderly is an enormous challenge. The developed world has evolved many models for elderly care, for example, nursing home care, health insurance, etc. Indian Government has also taken multiple measures in this direction by initiating National Policy on Older Persons, 1999, the Maintenance and Welfare of Parents and Senior Citizens Act, 2007, the Old Age Pension Scheme, Rashtriya Vayoshri Yojana 2017, etc. However, there is a necessity that, India must rapidly adapt to the complex health related, social and economic challenges caused by these demographic changes. This may be an opportunity for innovation in the health system by developing a perspective for healthy and active aging, though it is a major challenge. Health care of the older people cannot be achieved unless total health, i.e., physical, social, economic, psychological, and spiritual aspects are addressed. Objective: The objective is to study current policies regarding geriatric health care in India and to propose the possibility to develop a model to provide comprehensive and dedicated health-care services to the older population by integrating conventional and indigenous systems of medicine dwelling in the country. Materials and methods: Electronic search in various scientific journals for research and review articles; electronic along with hand searching of conference proceedings, brochures, government policy documents, press releases, Ayurveda classical texts, etc., regarding geriatric health care in India and model health-care facilities in other countries and regarding of AYUSH systems in geriatric health care in India. Results: There is an urgent need of adaptation and modification in the National Health System to cater the actual requirements of the elderly with plans and strategies dedicated to face their health-related challenges. Adoption of inclusive health-care interventions, can improve health outcomes by making it more acceptable, accessible, and affordable. Conclusion: Integration of AYUSH at various levels of health-care delivery system can potentially contribute to provide unique newer dimensions to the field of geriatric care in India.
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A compendious review of Chitraka Haritaki Avaleha – A polyherbal Ayurveda formulation for bronchial asthma p. 12
Sagar Mahendrabhai Bhinde, Sonam Sagar Bhinde, Virendra K Kori, Kalpana S Patel
DOI:10.4103/ayu.AYU_340_20  
Introduction: Avaleha (confection) is an unique dosage form of Ayurvedic pharmaceutics, which is frequently prescribed in various disorders and especially in respiratory disorders. Chitraka Haritaki Avaleha (CHA) is one such formulation being used extensively by Ayurveda physicians for bronchial asthma, despite its classical use in various other disorders too. CHA was first time described by Vrindamadhava in the 9th century and had been amended for many times till today. Because of its demand, many pharmaceutical companies are also manufacturing it, and is freely available in the market. Aim: The aim is to screen and compile references pertaining to composition, method of preparation, therapeutic uses, organoleptic, and physico-chemical parameters of CHA from different classics and original research articles. Materials and methods: Description of CHA was extensively reviewed from Vrindamadhava, Chakradatta, Vangasena, Gadanigraha, Yogatarangini, Bhaishjya Ratnavali and Yogaratnakara. Synonyms, Rasapanchaka (Ayurveda principles of drug action), and Dosha Karma (therapeutic attributes) of ingredients were compiled from Bhavaprakasha Nighantu. Organoleptic and physicochemical parameters were compiled from original research articles, searched from PubMed, Google Scholar, and Research Gate. Results: Variations in formulation name, ingredients, method of preparation, therapeutic indications and Anupana (adjuvant) was observed in the classical texts. Value of water-soluble extracts and pH of analytical study was found different than Ayurveda Pharmacopeia of India standards. Conclusion: Screening through various texts revealed that CHA has been mentioned in seven classical treatises and two gazetted texts with amendments which indicate its high demand and clinical efficacy in bronchial asthma along with other diseases. Disparity found in analytical parameters indicates the need of standardization of pharmaceutical process.
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ORIGINAL ARTICLES - CLINICAL RESEARCH Top

Impact of chronic wound on quality of life among diabetic foot ulcer patients in a selected hospital of Guwahati, Assam, India p. 19
Muthu Srinivasan Jayalakshmi, P Thenmozhi, R Vijayaragavan
DOI:10.4103/ayu.AYU_33_20  
Background: Diabetic foot ulcer (DFU) is an important mortality factor among diabetes mellitus (DM) patients and has a massive impact on the quality of life (QoL) of patients. The non-heal foot ulcer needs extra care and need special attention in maintaining wound hygiene. Dressing on wound is done in four stages such as cleanse the wound, debridement of wound, fashioning of edges and final dressing. The important stage of cleanse the wound was done with solution extracted from neem leaves which has medicinal value and anti-biotic properties and was used instead of normal saline or water solution, which do not carry medicinal value. Other medicinal solutions are of high cost as well as not easily available such as octanedione dihydrochloride or hypochlorous acid etc. Aims: This study was aimed to investigate the impact of DFU on QoL among patients suffering from chronic wounds. Materials and methods: A cross-sectional, descriptive study was conducted at foot care clinic in a private hospital situated at Guwahati, Assam. Data were collected using a pro forma consisting of sociodemographic variables, Wagner ulcer classification and Cardiff wound impact questionnaire. Analysis of data was done using the descriptive and inferential statistical methods. Results: A total of 118 DFU patients of type 1 and 2 DM were studied. Out of which, 81.4% were male and 18.6% were female. About 66 participants (55.9%) were in grade 2 and 38 (32.2%) were in grade 3 of Wagner ulcer classification. Overall mean score for QoL was 6.27, whereas overall mean score for satisfaction on QoL was 7.01. Patients had the highest score in the well-being domain and lowest in the social life stress. Computation of correlation matrix and factor analysis showed a positive correlation between QoL and satisfaction and negative correlation between QoL and satisfaction with stressful experience of social life and physical symptoms experience (P < 0.05, 0.01). Multiple regression analysis reveals that satisfaction had a significant impact on QoL (P < 0.001) with r2 = 62.59%. Factor analysis of correlation matrix showed that physical symptoms and daily living experiences and social experiences as well as stress dominated factor 1 followed by satisfaction led QoL in factor 2 and social life stress was the leading force in factor 3. Conclusion: QoL of patients with DFUs can be improved by educating the diabetic patients on the prevention and early detection of foot ulcers, other diabetic complications, and availing benefits of prevailing health-care facility in early stages.
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ORIGINAL ARTICLES - PHARMACEUTICAL STUDIES Top

Shodhana (processing) of Rakta-Snuhi (Euphorbia caducifolia Haines.) latex with Chincha-patra Swarasa (Tamarindus indica L. leaf juice): A pharmaceutical analysis. p. 24
Shashi Gupta, Rabinarayan Acharya, Vinay J Shukla
DOI:10.4103/ayu.AYU_90_17  
Background: Latex of Euphorbia caducifolia Haines. (Euphorbiaceae), botanical source of Rakta Snuhi, a caustic irritant, is being used in different Ayurvedic therapeutics, after proper processing (Shodhana) in some specific media. Shodhana of Snuhi latex with Chincha-Patra Swarasa (juice of tamarind leaves) using Raudra Yantra (instrument/pot kept under sunlight for drying) has been recommended in Ayurveda texts. Snuhi is one of the Upavisha (sub toxic group of herbal drugs) and a well-known plant in the Indian system of medicine. It is used in pharmaceutical procedures like preparation and processing of drugs. Aim: The aim of the study was to carry out Shodhana of E. caducifolia latex with Chincha-Patra Swarasa. Material and methods: Fresh latex of Snuhi was collected from the Sapada area of Jamnagar, Gujarat and fresh leaves of Tamarindus indica L. were collected from the herbal garden of the university and Swarasa was extracted by traditional expression technique. Shodhana of Snuhi Kshira was done under sunlight dried and shade dried method by mixing it with leaf juice of Tamarindus indica L. in a glass bowl in different ratio i.e. Kshira: leaf juice was 8:4, 8:2, 8:1 respectively. Results: This study reveals certain changes in physico-chemical parameters (pH) and organoleptic characters of processed E. caducifolia latex by Tamarind leaf juice both in shade-dried and sunlight-dried samples. Under HPTLC, Shodhana of E. caducifolia latex with Tamarind leaf juice alters the number of spots both sunlight-dried and shade-dried samples. In sun-dried sample, the number of spots increased when the concentration of Tamarind leaf juice is decreased in HPTLC study. The study reveals that in case of shade-dried Shodhita (processed) Snuhi latex sample, the concentration of lupeol increases with the increasing quantity of Tamarind leaf juice. Conclusion: Shodhana with Tamarind leaf juice changes both qualitative and quantitative property of Snuhi latex.
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Evaluation of nutritional value and antioxidant activity of root and leaf of Samarakhai (Byttneria herbacea Roxb.): An extra pharmacopoeial herb p. 29
Tarun Sharma, Rabinarayan Acharya
DOI:10.4103/ayu.AYU_270_18  
Background: Samarakhai (Byttneria herbacea Roxb.), family Sterculiaceae, is one of the reputed folklore medicinal herbs, found in many parts of India. Although consumed as a vegetable since long time, its root and leaves are not yet reported for its nutritive value and antioxidant activities. Aim: The aim of this study was to evaluate nutritional value and antioxidant potential of root and leaf of B. herbacea Roxb. Materials and methods: Nutritional parameters such as carbohydrate, fat, protein, energy value, calcium, iron, zinc, manganese, phosphorus and vitamin C were evaluated. Antioxidant activity was evaluated through three test methods, i.e., 1,1-diphenyl-2-picrylhydrazyl, ferric-reducing antioxidant power (FRAP) and phosphomolybdenum assay. Results: B. herbacea roots and leaves showed the presence of total carbohydrate 46.39 g/100 g and 40.12 g/100 g, total fat 0.63 g/100 g and 1.20 g/100 g, true protein 11.46 g/100 g and 10.49 g/100 g, energy content 237.07 kcal/100 g and 213.24 kcal/100 g, iron 821.10 ppm and 889.64 ppm, zinc 9.2 ppm and 47.98 ppm, manganese 329.86 ppm and 474.59 ppm, phosphorus 0.40 ppm and 0.10 ppm and calcium 4856.84 ppm and 14964.49 ppm, respectively. The half-maximal inhibitory concentration values of the methanol extract of root, leaf and ascorbic acid were found to be 217.25 μg/ml, 131.42 μg/ml and 178.88 μg/ml, respectively. In FRAP assay, antioxidant activity of methanol extract of leaf (129.15 μM) was found to be more than root (73.13 μM). Conclusion: B. herbacea root contains high amount of true protein, carbohydrate and energy value, while micronutrients such as iron, zinc, manganese and calcium are more in its leaf. Both roots and leaves exhibited potent antioxidant activity where the leaves possess more values than the roots.
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ORIGINAL ARTICLES - PHARMACOLOGICAL STUDIES Top

Chronic toxicity study of Sameera Pannaga Rasa in Charle's foster albino rats p. 36
Madhvi Sharma, Biswajyoti Patgiri, Mukesh B Nariya, Shrirang Jamadagni, Prashant Bedarkar
DOI:10.4103/ayu.AYU_49_20  
Introduction: Sameera Pannaga Rasa (SPR) is a Kupi Pakwa Rasayana (a mercurial–arsenical formulation of Ayurveda prepared by specific pharmaceutical-controlled, indirect heat treatment [sand bath] in glass bottle) that contains Shodhita Parada (processed mercury), Shodhita Gandhaka (processed sulfur), Shodhita Haratala (processed arsenic trisulfide), Shodhita Somala (processed arsenic oxide) and Shodhita Manahshila (process arsenic disulfide) in equal quantity as ingredients. Parada, Haratala, Manahshila and Somala are highly potent minerals which are included in the Drug and Cosmetic Act 1940 under Schedule E1 because of their toxic nature in crude form. Materials and methods: In the present study, SPR was evaluated for safety profile through its chronic toxicity study in Charle's foster albino rats. The test drug was made into suspension in vehicle (4 ml honey and 7 ml distilled water). The test drug was administered orally once a day for 90 consecutive days in the dose of 11.25 (therapeutic dose [TED]), 56.25 (5 times TED) and 112.25 mg/kg (10 times TED). Animals were sacrificed on 91st day and animals of recovery group were sacrificed on 121st day. Parameters such as hematological, serum biochemical, and histopathology of various organs were studied. Results: Test drug at a higher dose level and recovery study showed no toxic effect in albino rats during chronic toxicity study. Conclusion: SPR is found to have no toxic effect in albino rats during the repeated dose, oral, chronic toxicity study of 90 days, even at 10 times therapeutic equivalent dose (112.25 mg/kg) and even during recovery period of 1 month. It may be safety used at TED level.
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Effects of Chlorophytum borivilianum Sant. F against gamma radiation-induced testicular injuries in Swiss albino mice p. 45
Ruchi Vyas, Garima Sharma, Devki Sain, Rashmi Sisodia
DOI:10.4103/ayu.AYU_82_20  
Background: Radiation therapy is considered as an important tool in cancer treatment. Despite its impressive role in treating cancer, severe side effects in organs have been reported. To address these therapeutic side effects, several combination methods have been identified to minimize adverse effects caused by radiation therapy. Aims and Objectives: Based on higher radioactive sensitivity of testicular tissues, administration of Chlorophytum borivilianum (CB) Sant. F extracts was evaluated for its protective effects against radiation in testis. Materials and methods: Two forms of CB extracts (CB alone and CB-silver nanoparticles [AgNPs]) were administered at a dose of 50 mg/kg body weight in Swiss albino male mice for 7 consecutive days. Following 6 Gy gamma radiation, animals were observed for 30 days in four phases. Sperm counts, body weight, testicular weight and stereological and histological evaluation of testis were evaluated. Results: Following irradiation, a significant decline in body weight (P = 0.008) and testicular weight (P = 0.001) was noted when compared with control. Ununiformed type A and B spermatogonia, partially filled tubules, inter-tubular vacuoles, and disrupted epithelium were the main types of damages caused by irradiation. Reorganization and resumption of histological features emerged from the 15th day postirradiation in CB extract (CBE)-treated animals. Conclusion: Testicular response was observed against radiation in animals treated with CB extracts, while CB-AgNPs indicated better toleration when compared to CB extract alone.
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ORIGINAL ARTICLES - SHORT COMMUNICATION Top

Efficacy of Triphala Ghrita and Goghrita Manda Tarpana in the management of Shushkakshipaka w.s.r. to dry eye syndrome: An open labelled randomized comparative clinical trial p. 52
Gangadhar M Timmapur, Shamsa Fiaz
DOI:10.4103/ayu.AYU_108_18  
Background: Shalakya Tantra is one of the eight branches of Ayurveda, which also includes ophthalmology. Shushkakshipaka (dry eye syndrome) is one of the diseases, involving all parts of eye (Sarvagata Netra Roga) characterized by Gharsha (gritty feeling), Toda (pricking type of pain), Kunita (photophobia), Avila Darshana (blurred vision), Daha (burning sensation) and Raktaraji (congestion in the eye). All these symptoms are similar to the symptoms of dry eye syndrome. Aims and objective: The objective of the present study was to evaluate and compare the effect of Triphala Ghrita and Goghrita Manda (supernant liquid part of cow ghee) Tarpana (therapeutic procedure done on the eye) in the management of Shushkakshipaka. Materials and methods: Thirty patients fulfilling the inclusion criteria of Shushkakshipaka were selected from the outpatient department and inpatient department of Shalakya Tantra, Sri Dharmasthala Manjunatheshwara College of Ayurveda, Hassan. Clinical signs and symptoms were given suitable scores according to their severity, and assessment was based on the relief in these symptoms after the treatment. Patients of dry eye syndrome were allocated alternatively in two groups for Tarpana, namely Triphala Ghrita Tarpana (TGT) group and Goghrita Manda Tarpana (GMT) group and Tarpana was given for 7 consecutive days in afternoon with follow up after 15 days for 2 months. Results: Moderate relief (50%–75% relief) was seen in 73.3% of the patients in both the groups, while marked relief (>75% but <100% relief) was seen in 26.7 patients in both the groups. Relief in symptoms like Gharsha (74%), Avila Darshana (65%), Upadeha (80%), Daha (72%), Kunita (78%), Toda (59%) and Raktaraji (83%) was obtained. Conclusion: The effect of Goghrita Manda Tarpana (GMT) on Garsha, Toda and Daha was better in immediately after treatment than Triphala Ghrita Tarpana (TGT).
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Understanding the etiopathogenesis and diagnosis of malignancy in the framework of Ayurveda: A review based on experience of working in an institute of oncology p. 58
BV Kumaraswamy
DOI:10.4103/ayu.AYU_45_18  
Background: The etiopathogenesis and diagnosis of cancer has intrigued modern oncology researchers for decades, and it is still a rapidly growing area in medicine. Cancer is not a single disease, but rather a collection of related diseases which is diagnosed on the basis of aberrant cellular changes. Since this is established by the modern medical science, it becomes important to understand it from the perspective of Ayurveda. Despite the fact that there are a few endeavors in this area, there is no common agreement among the experts. The current article is an effort to fulfill this knowledge gap. Aims and objectives: To understand the cancer systematically in the frame work of Ayurveda and propose its probable Samprapti (pathogenic process) based on clinical observations. Materials and methods: It is based on the clinical observation and detailed examination of 400 cancer patients, following modern and Ayurvedic methods in an institution dedicated to oncology. Results: After careful study of each type of cases of cancer at its all stages to understand the natural history and clinical behavior, Ayurvedic pathogenesis, diagnosis with possible etiologic association has been arrived at. Three main conditions, namely Udara (enlargement of abdomen), Gulma (lump in abdomen) and Vidradhi (abscess) can be equated with cancer. Conclusion: Modern diagnosis of cancer cannot be equated with any single disease entity mentioned in the Ayurvedic literature. Udara-Gulma-Vidradhi is the abdominal tumors present as benign and possess cancerous potential.
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LETTER TO EDITOR Top

Need to safeguard insensible wastage of Ayurvedic medicines p. 66
Mahesh Kumar, Jitendra N Varsakiya
DOI:10.4103/ayu.AYU_56_20  
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