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1 ORIGINAL RESEARCH ARTICLE EVALUATION OF PURGATION ACTIVITY OF CASSIA FISTULA IN SKIN DISEASES DUE TO VITIATED PITTA DOSHA Manojkumar V. Chaudhari Ass. Pressor, Ashtang Ayurved College, Pune (Maharashtra University Health Sciences, Nashik Corresponding author address: Access this article online : Published by Atreya Ayurveda Publications, Ilkal (India) All rights reserved. Received on: 25/6/2, Revised on: 29/6/2, Accepted on: /7/2 Abstract Background: It has been reported from various studies in the general population and primary care that around 5-2% people are suffering from various skin diseases. Due to pathogenic materials skin disorders as described in charaka samhita, 8 types skin disorders appear. Aims and objectives: To evaluate the efficacy Cassiaa Fistula in skin diseases due to vitiated pitta dosha. Methods and materials: Fifty subjects suffering from skin disease due to vitiated pitta dosha were studied. Total duration for trial was 2 days. The were administered with internal oleation, external oleation and fomentation. Later they were given purgation with decoction fruit Cassia fistula. Results: It is observed that, the p values were almost highly significant (p <.) in all the parameters. Hence, it can be concluded thatt the purgation therapy by Cassia Fistula decoction is more effective in Skin disease due to vitiated pitta dosha. The results are encouraging and support the classical claim that Cassia Fistula is effective in reducing the symptoms skin disease due to vitiated pitta dosha and can be used extensively in the. Conclusion: On the basis the results this study it may be concluded that, the Cassia Fistula is having significant effect in ameliorating the skin diseases due to pitta origin and is safe drug choice for Purgation therapy. Key Words: Cassia Fistula, Aragvadha, purgation therapy, Virechana, skin disease Key Messages: Purgation with Cassia Fistula is safe and effective in ameliorating the skin diseases due to pitta origin. Introduction: drink, sleep regularly in day, sexual activities It has been reported from various studies in the after intake food - are not rare things. Using general population and primary care that around cold & hot edibles successively, indulging in 5-2% people are suffering from various fasting & goring, taking diet with violating the skin diseases. In those days intake food & proper sequence, afflicted with excessive drink made up incompatible ingredients, as perspiration, or toil, or terror, quickly indulge in also food & drink thatt are liquid, oily & heavy cold water are also habitual things. Eating are very common things. Suppressing the natural food during indigestion and when previously urges, ndulging in physical exercises and food is not digested, use contraindicated items exposing themselves to the extreme heat after like cakes, raw sugar, milk, and use rice that having overloaded the stomach with food & is new, curd, fish, salt and things that are sour

2 are very common. These causes vitiate tridosha. They affect skin, blood, muscle, kleda (~ watery content body). These are pathogenic materials skin disorders. Due to which 8 types skin disorders appear according to charaka samhita. These are kapala, audumbara, mandala, rushyajivha, pundarika, sidhma, kakanaka, eka kushtha, charma, kitibha, vipadika, alasaka, dadru, charmadala, pama, visphotaka, shataru & vicharchika 2. Symptoms skin disease due to vitiated pitta dosha according to dominance vitiated dosha Charaka are: severe burning sensation, redness, discharge, visphotaka (pimples), itching. Out these 8 types audumbara, rushyajihva, pundarikaa from sapta maha kushtha & pama, shataru, visphota, dadru, charmadala are due to vitiated dominance pitta and association pitta are having very common occurrence. Alll these 8 types show common symptoms such as redness, burning sensation, pain, itching and pimples 4. Considering all thesee quotations, commonly occurring symptoms like redness, pimples, discharge, burning sensation & itching are included for study. In case skin diseases due to dominance pitta dosha, the purgation therapy is recommended as the first choice by charaka 5. Purgation therapy is the major proceduree included under panchakarma therapy (~ purification therapy). Purgation therapy expels out the vitiated dosha from lower GIT throughh the anus 6. Aacharya charaka has described skin diseases as the first indication for purgation therapy. It may be pointed out that Vamana is stressful processs but purgation therapy 7 is a comparatively easy proceduree for both doctor & patient. Cassia Fistula is described as phalini (fruit is useful part these herbs) purgative drug 8, mentioned in herb group useful for purgation 9 in charak samhita. He has described cassia Fistula for external application in skin diseases, specially the name that chapter as Aragvadhiya itself indicates the efficacy Cassia Fistula as drug most choice for skin diseases. Cassia Fistula is mild, sweet, cold and is particularly beneficial for those suffering from fever, heart disease, gout, hiccough, etc. Cassia Fistula is particularly used in children, old, wounded, wasted and delicate persons. Precisely, we can say that it is safe for all. Along with these qualities bhavprakashaa had mentioned its anti skin disease property. And dhanavantari nighantu, madhav nidan, nighantu ratnakar, kaiyadev nighantu also recommends Cassia Fistula as purgation therapy herb. Aims and objectives: To evaluate the efficacy Cassia Fistula in skin diseases due to vitiated pitta dosha. Materials and methods: Study design: Open labeled randomized uncontrolled clinical trial. Selection : Subjects suffering from skin disease due to vitiated pitta dosha aged between -6 years, irrespective sex, cast, religion, socioeconomic strata were selected. Study Population: Pune Municipal Corporation Area Sampling: Simple random sampling technique using lottery method. Sample size: 5 Study setting: The study was carried out at Ashtang Ayurved College s Hospital, 262, Sadashiv Peth, Pune 4, from date to Ethical considerations: 2

3 Ethical clearance was obtained from the institutional ethics committee (IEC) EC No. /26 dated Informed consent obtained from all subjects. Inclusionn criteria. Subjects suffering from Skin diseases having symptoms- redness, pimples, discharge, burning sensation, itching. 2. Subjects aged between -6 years, irrespective sex, cast, religion, socioeconomic strata. Exclusion criteria 2. The subjects which are contraindicated for Purgation therapy such as weakness, acute fever, low digestive power, dehydration, childhood, anal injury, rectal prolapse, anal prolapse, ulcerative colitis, hemorrhoids, alcoholism, operated emaciating, chest disease, pregnant, postpartum period. 2. Subjects suffering from serious diseases like cancer, tuberculosis, diabetes, a history stroke, myocardial infarction, coronary artery disease, cardiac failure, angina, life- threatening arrhythmia.. Below the age years and above 6 years. 4. Subjects with major psychiatric disorders. 5. Subject not ready to sign the consent & unable to comply with the protocol. Withdrawal Criteria - Subjects meeting any the following criteria were to be withdrawn from the study:. Earnest request the subject assigning a reason for the same. 2. Serious adverse events wheree continuationn study possess serious risk to the subject.. Subject consumes any other medicines used for the skin disease. d. Sample size- Number planned: 5 completed cases. e. Safety - Monitoring adverse events & Clinical examination. Interventions: Drug: for Snehana- sesame oil; for purgation- decoction fruit pulp Cassia Fistula Dose: 5 ml decoction Duration: 2 days Follow up: follow up visit after 7 days purgation therapy Procedure: After recruitment, subjects were put on 5 days wash-out period for Allopathic medicine & 7 days for Ayurveda medicines; & before being administered the investigational product. On baseline visit (Day ), medical history and physical examination weree performed, an inclusion criterion was assessed and the trial, i.e. purgation therapy by Cassia Fistula decoction was explained. Patients were administered with internal oleation till optimum signss oleation and then subjected massage and fomentation for days. On the next day morning about 8 A.M. empty stomach Cassia Fistula Decoction (prepared as described in SOP) was administered orally & subject was observed throughout the Main procedure for inadequate form, adequate form, excessive form or complications. After completing Main procedure subject was advised for post Panchakarma behavior regimen & diet regimen.. Assessment criteria: Symptoms- redness, pimples, itching. discharge, burning sensation, Dataa analysis: Statistical evaluation the data obtained was done using means, standard deviation, percentage, mean difference Data analysis was done by using SPSS 7. statistical stware. We have used Wilcoxon sign rank test

4 to find out the significance before study & after study. Results: It is observed that in the study, P-value <.5, hence considered as significant. Observations are made under following points: Gender In this research study, the gender proportion subjects was 48% females & 52 % males. Average age subjectss was 4.2% with standard deviation % (See Table ). Number Percent Male Female Total 5. Table : Gender subjects Skin diseases Types Out 5 number subjects; Subjects with audumbara type skin diseases was 22 %, rushyajivha -8%, shataru 6% %, pundarika - 4%, dadru 2 % & pama, visphotaka & charmadalaa was each 6% (See Table 2). Type Kushtha Number Percentage (%) Audumbara Rushyajihva Shataru Pundarika Dadru Pama Visphotaka Charmadala Table 2 : Kushtha Types Proper oleation symptoms Out total 8 symptoms described by Charaka samhita, oleation external body was occurred in 92%, increase in digestive power was in 9%, nausea for oily substance was in 9%, Samyak Snehana Symptoms Gatra Snigdhata Agni Deepti Snehodvega Gatra Mardavaa Vatanulomam smoothness in body was in 86%, smooth passage gases was in 82% %, oiliness in stool was in 8% & non uniform faecal material was 46%. The symptom lightness in body was 2% (See Table ). Number Percentage (%)

5 Purish Snighata Asamhat Malaa Pravrutti Angalaghava Table : Symptoms Adequate Oleation Proper fomentation symptoms Out total 5 symptoms, sweating was observed in % subjects, dis-appearance coldness - 94%, dis-appearance rigidity) 7%, pain in the body is reduced - 68% & heaviness is reduced was in 66% subjects (See Table 4). Samyak Swadana Symptoms Number Percentage (%) Sweda Pradurbhava Sheeta Uparama Stambha Nigraha Shoola Uparama Gaurahava Nigraha Table 4 : Symptoms Proper Sudation Yoga after purgation therapy (~ form/ stages purgation therapy) In this research recorded for 2% subjects & excess form was observed in 2%. Safety Cassia Fistula study, total 78% subjects were having drug as a choice for purgation therapy can be adequate form, which explains the properr proved by % complications in this study effect purgation therapy by Cassia Fistula (see table 5) decoction. Inadequate form was also Ayoga Samyak Yoga Atiyoga Vyapadaa Total Assessment purgation therapy In this study 78% subjectss was madhya shuddhi (moderate purification), 2% was avaraa Number 9 5 Table 5 : Outcome Purgation Percent shuddhi (least purification) & 2 % was pravara shuddhi (superior purification) (See Table 6). 5

6 Grade Purification Superior Moderate Least Total Table 6 : Grade Purgation Effect on Redness Symptom P-value <.5 therefore there is significant differencee was 58% (n = 29) grade after. About this symptom negativee rank between pre- & post-t was in 4 subjects, positive rank was in symptom. Out 5 subjects 58% (n=29) grade 2 was in pre-, which after subject & ties were in 7 subjects (See Table 7).Test used Wilcoxon Sign Test. Grade 2 Grade Before (2%) 4 (8%) 29 (58%) 6 (2%) Table 7 : Effect on Rednesss Symptom Effect on Pimple Symptom - P-value <.5 therefore there is significant differencee. Present research study had shown that before the pimple symptom between pre- & post-t Negative rank was in 8 subjects, positive symptom. Out 5 subjects 6% (n=) grade 2 was in pre-, which after was 44% (n =22) grade after rank was in subject & ties were in subjects (See Table 8). Test used- Wilcoxon Sign Test Before (2%) 4 (8%) 2 (6%) 5 (%) After (22%) 29 (58%) 9 (8%) (2%) After 22 (44%) 8 (6%) 9 (8) (2%) Number Negativee Positive Ties Negativee Positive Ties Table 8 : Effect on Pimple Symptom 9 5 Number Number Percent P-value <. P-value <. 6

7 Effect on Discharge Symptom- P-value <.5 therefore there is significant difference between pre- & post- symptom. Out 5 subjects 6% (n =8) grade 2 was in pre-, which after t was 5% (n = 25) grade after. This study had Grade 2 Table 9 : Effect on Discharge Symptomm Effect on Burning Sensation - P-value <.5 = 4) grade after. In present study, therefore there is significant difference between this symptom s negative rank was in 45 subjects, pre- & post- 2% (n =6) grade 5 was in subjects (See Table ). Test used- Wilcoxon pre-, which after was 8% (n Sign Test. symptom. Out positive rank was in subjects & ties were in 5 5 subjects Before After Grade Treatment (2%) 6 5 (%) 7 8 (6%) 8 (2%) 9 9 (8%) Before 9 (8%) 4 (28%) 8 (6%) 9 (8%) (2%) 9 (8%) (2%) After 25 (5%) 2 (42%) 4 (8%) 4 (8%) 9 (8%) 8 (6%) 4 (8%) 5 (%) (2%) Table : Effect on Burning Sensation Symptom shown that beforee the discharge symptom Negative rank was in subjects, positive rank was in subjects & ties weree in 9 subjects (See Table 9). Test used- Wilcoxon Sign Test. Negative Positive Ties Negative Positive Ties Number 45 5 Number 9 P-value <. P-value <. 7

8 Effect on Itching Symptom - P-value <.5 therefore there is significant difference between pre- & post- 22% (n =) grade was in pre-, which after was 24% (n = 2) grade 2 after. This research Before After symptom. Out 5 subjects Grade Treatment (2%) 2 (2%) 2 (24%) (8%) 6 7 (4%) 7 (22%) 8 (22%) 9 5 (%) (22%) 8 (6%) 9 (8%) 7 (4%) (6%) (2%) study had shown that before the itching symptomm negative rank was in 48 subjects, Positive was in subjects & Ties was in 2 subjects (See Table ). Test used- Wilcoxon Sign Test. Negativee Positive Ties Number Table : Effect on Itching Symptomm Discussion: Toxicity potentials fruits as laxative with Comparative data analysis revealed that the p reference to Senna was studied. LD5 the value in all the symptoms (redness, pimples, drug is 66mg/kg without any pathological discharge, burning sensation & itching) was effects on the organs examined highly significant. From the data the objectivee microscopically. features, the p values were almost highly significant (p <.) in all the parameters. Hence, it can be concluded that the Purgation therapy by Cassia Fistula decoction is more effective in Skin disease due to vitiated pitta dosha. The results are encouragingg and support The pharmacological and toxicological studies the aqueous infusions the pods the plant weree studied in rodents. The aim the study was to estimate medium lethal dose after oral administration. Results showed that the extract pods possesss significant dose dependent the classical claim effective in reducing that Cassiaa Fistula is the symptoms Skin laxative activity between and 5 mg/kg, in rats 4. disease due to vitiated pitta dosha and can be Probable mode action the Cassia Fistula in used extensively in the. skin disease due to vitiated pitta dosha: All types Skin diseasess are due to vitiated tridosha, 48 2 P-value <. 8

9 hence one should treat the patient according to dominance vitiated Dosha. The vitiated dosha which is more dominant that should be treated first. As per these guidelines Charak, instead going in details 8 types skin disease, this study is about Skin disease due to vitiated pitta dosha. Charaka has recommendedd Shodhanaa in Skin disease due to vitiated pitta dosha & has given more emphasis on Purgation therapy to balance the vitiated Pitta Dosha. Many drugs have been described for purgation therapy in classical texts. Out these, for the present study Cassiaa Fistula was selected. Charaka has considered it as the best purgation therapy drug. Cassia Fistula is sweet & bitter in taste; heavy, st, unctuous by property; cool by virya (~ potency) and sweet vipaka 5. Hence, the drug is useful in pitta vitiation. In ashtangaa hridaya, Cassia Fistula is described as Virechanaa drug and in sushruta samhita, Cassiaa Fistula has been described as the adhobhagaharaa drug. As per charaka samhita, Cassia Fistula is the best mild purgative drug. Therefore, it helps in kapha nirharana along with vatanulomana. Thus, the drug helps in breaking dosha - dushya complex in the skin diseases due to vitiated pitta dosha. Conclusion: On the basis the results this study it may be concludedd that, the Cassia Fistula is having significant effect in ameliorating the skin diseases due to pitta origin and is safe drug choice for Purgation therapy. References:. Yadavaji Trikamji, Editor, Charaka Samhita Agnivesha, Sutra sthana, chapter 5, verse no. 7. Prakashan, 28; p Yadavaji Trikamji, editor, Charaka Samhita Agnivesha, Sutrasthana, chapter, verse no. 8. 5th ed, Varanasi: Prakashan, 28; p.2.. Yadavaji Trikamji, editor, Charaka Samhita Agnivesha, Sutrasthana, chapter, verse no.. Prakashan, 28; p Yadavaji Trikamji, editor, Charaka Samhita Agnivesha, Nidanasthana, chapter 5, versee no. 5 ed, 5 Varanasi: Prakashan, 28; p Yadavaji Trikamji, editor, Charaka Samhita Agnivesha, Chikitsasthana, chapter 7, verse no. 9. Prakashan, 28; p Yadavaji Trikamji, editor, Charaka Samhita Agnivesha, Sutrasthana, chapter 5, verse no.7. Prakashan, 28; p.95, Yadavaji Trikamji, editor, Charaka Samhita Agnivesha, Chikitsasthana, chapter 5, verse no. 5. Prakashan, 28; p Yadavaji Trikamji, editor, Charaka Samhita Agnivesha, Sutrasthana, chapter 4, verse no. 4. Prakashan, 28; p.. 9. Yadavaji Trikamji, editor, Charaka Samhita Agnivesha, Sutrasthana, chapter 2, verse no.. Prakashan, 28; p.24.. Yadavaji Trikamji, editor, Charaka Samhita Agnivesha, Sutrasthana, chapter, verse no.. Prakashan, 28; p.27.. Yadavaji Trikamji, editor, Charaka Samhita Agnivesha, Kalpasthana, chapter 8, verse no. 5. Prakashan, 28; p Yadavaji Trikamji, editor, Charaka Samhita Agnivesha, Siddhisthana, chapter 2, verse no., 2. Prakashan, 28; p

10 . Akanmu M.A et.al., Toxicity potentials Cassiaa fistula fruits as laxative with reference to Senna. African Journal Biomedical Research.24; 7: Akanmu M.A et.al., Toxicity potentials Cassiaa fistula fruits as laxative with reference to Senna. African Journal Biomedical Research.24; 7: Yadavaji Trikamji, editor, Charaka Samhita Agnivesha, Kalpasthana, chapter 8, verse no. 4. Prakashan, 28; p.666. Cite this article as: Manojkumar v Chaudhari. Evaluation purgation activity cassia fistula in skin diseases due to vitiated pitta Dosha. Journal Ayurveda and Holistic Medicine 2;(4): - Source support: Nil, Conflict interest: None Declared