!!"# $%&'()*+,-./ %0405.6)*01)7*%()7,.8(91)7,

Transcription

1 !!"# $%&'()*+,-./ %0405.6)*01)7*%()7,.8(91)7,

2 RESEARCH ARTICLE Global Impact Factor (GIF) (2013) EFFICACY OF GOKSHURA (Tribulus terrestris) AND SHATAVARI (Asparagus racemosus) IN PITTAJ MUTRAKRUCHRA Parag Narayan Deshmukhe, 1* Rashtrapal N. Ukey, 2 Swapnil Sabgonda Patil, 3 Rajesh Sawai 4 1. * Associate Professor, Dept. of Kayachikista, Hon. Shree Annasaheb Dange Ayurvedic Mahavidyalaya Ashta, Tal: - Walawa, Dist: - Sangli., Mobile No , ID:- pdeshmukhe@yahoo.co.in 2. Assistant Professor, Dept. of Agadatantra, Government Ayurveda College, Nanded , dr.rashtrpal@gmail.com 3. Assistant Professor, Dept. of Rognidan and Vikruti Vigyan, Hon. Shree Annasaheb Dange Ayurvedic Mahavidyalaya Ashta, Tal: - Walawa, Dist: - Sangli. 4. Associate Professor, Dept. of Samhita-Siddahant, Government Ayurved College, Wazirabad, Nanded. Article Received on - 25 th June 2014 Article Revised on - 22 nd July 2014 Article Revised on - 22 nd Aug 2014 Article Accepted on - 23 rd Aug 2014 All articles published in IJAAM are peer-reviewed and can be downloaded, printed and distributed freely for non commercial purpose (see copyright notice below). (Full Text Page IJAAM This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( which permits unrestricted non commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

3 RESEARCH ARTICLE EFFICACY OF GOKSHURA (Tribulus terrestris) AND SHATAVARI (Asparagus racemosus) IN PITTAJ MUTRAKRUCHRA *Corresponding Author Parag Narayan Deshmukhe Sai Prasad, Plot No.47, Z.P. Colony, Agashiv nagar, Malkapur, Tal.- Karad, Dist.:- Satara. Mobile No , ID :- QR Code IJAAM ABSTRACT: Urinary tract infection is one the most serious health problem affecting million of people each year. The moolsthanam of Mutravaha Strotas are Basti, Medhra and Vankshana. Understanding of Urinary diseases may not coincide with the Modern views, but the detailed description in all aspects given in these texts leaves no doubt that they managed these patients. In present clinical study of Gokshura [Tribulus terrestris] and Shatavari [Asparagus racemosus] on Pittaj Mutrakruchra found encouraging results and drugs are economical. For convenience of patients drug is prepared in tablet form as it is easy to consume. This clinical study shows the effectiveness of present drug in Pittaj Mutrakruchra. Key Words: Pittaj Mutrakruchra, Painful Micturation, Burning Micturation, Gokshura [Tribulus terrestris], Shatavari [Asparagus racemosus] INTRODUCTION Urinary disease is common infection in the body which is one the most serious health problem affecting million of people each year. Urinary tract infection is an infection of any part of urinary system i.e. kidneys, bladder, and urethra. Understanding of Urinary diseases in Ayurveda may not coincide with the Modern views. But the detailed description in all aspects given in these texts leaves no doubt that they managed these patients quite successfully. The Mul-sthanas of Mutravaha Strotas are Basti, Medhra and Vankshan. [1] The problem arising with these organs i.e. due to Dusthi [Infection] of this strotas is very common, and can give rise progressive damage of this strotas leads to permanent changes resulting in renal failure which is usually a fatal condition. In Pittaj Mutrakruchra Sashool [painful], Sadaha [burning], Alpa-alpa Mutrapravrutti [frequent urination], Alp Udarshool [flank pain], Manda Jwara [Mild fever] symptoms are present and hampers routine life [2]. These all symptoms resembles as urinary tract infection mentioned in modern era. Management of Urinary tract infection occupies an important place in all classics of Ayurveda. After pilot study and clearance of Institutional ethical committee Clinical trials of Gokshura [Tribulus terrestris] and Shatavari [Asparagus racemosus] on Pittaj Mutrakruchra found encouraging results and decided to study The efficacy of Gokshura [Tribulus terrestris] and Shatavari [Asparagus racemosus] in Pittaj Mutrakruchra. To convenient take drug in tablet form so preparation of tablet was done. These two drugs have been selected in Pittaj Mutrakruchra based on the references of these two drugs in Pittaj Mutrakruchra mentioned in Ayurvedic samhitas. The idea behind the selection of Tablet of Gokshura [Tribulus terrestris] and Shatavari [Asparagus racemosus] was as follows: 1) Easy to administration of drug 2) Treatment should be economical. 3) This Ayurvedic drug should prove acceptable in our fight against this common condition i.e. Mutravaha Strotas Dusthi [Urinary Tract Infection]. AIM: To study the effect of an Ayurvedic herbal compound i.e. Tablet of Gokshura [Tribulus terrestris] and Shatavari[Asparagus racemosus] in patients having Pittaj Mutrakruchra. OBJECTIVES: 1) To study the distribution of clinical signs and laboratory findings. 2) To study the clinical efficacy of the Tab. Gokshura [Tribulus terrestris] and Shatavari [Asparagus racemosus] in Pittaj Mutrakruchra. Page68

4 Drug review: Table No.1: Drug Review Sr. no. Particular Gokshura [3] Shatavari [4] 1 Botanical name:- Tribulus terrestris Asparagus racemosus 2 Family:- Zygophyllaceae (Gokshura kula) Liliaceae. (Rasona Kula) i) Whole plant Part used : 3 ii) Fruits Rhizome iii) Root Fruits contain a substance having an aromatic smell. It contains:- An alkaloid in traces The fresh rhizome contains. Water :- 9% Water soluble contents :- 52.5% Glucose :- 7% (Included in soluble content) A fixed oil 3.5% consisting mainly of Insoluble content :- 70% unsaturated acids. Main content:- 70% Chemical constitutions 4 i) An essential oil in very small quantities Four Steroidal (Shatavarin, I, II, III, IV) ii) Resins Saponins were isolated from the root. iii) Fair amounts of Nitrates. Root has cooling, tonic, diuretic and appetizing activity. It has a nutritive, antidiarrhoeal, antispasmodic and galactogogue activities. It tones up hormonal control in female. Guna : Guru, Snigdha Guna : Guru, Snigdha Rasa : Madhur Rasa : Madhur, Tikta Properties Vipaka : Madhur Vipaka : Madhur 5 Veerya : Sheet Veerya : Sheeta Prabhav : Ashmarighna, Mehanashak & Vrushya. Prabhav: Rasayani, Shukra- Stanya Vardhka, Shothanashak 6 Karma:- a)action on Doshas Vat : Vata shamak Pitta : Pittashamak Kapha: Kaphakar b)action on Dhatus Vrushya : Shukra vardhaka Mansa : Dhatu Balyakaraka c) Action on Mala Mutra Mutral action Mutrakrucha and ashmari nashak. 1)Action on Doshas: Vat : Vat shamak Pitta : Pitta shamak Kapha: Alpa Kaphakar 2) Action on Dhatu: Rasa : Stanyavrudhikar Mansa: Mansavardhan Majja : Medhya Shukra : Vridhikar Sapta dhatu : Rasayana 3) Action on Mala:- Mutra : Mutrajanan Pureesha : Alp-Sangrahi MATERIALS AND METHODS: The present work deals with the study of patients suffering from Pittaj Mutrakruchra and its treatment with Gokshura Shatavari Vati. 4) Phimosis or Paraphimosis 5) Renal failure 6) Traumatic causes 7) Patient below 10 years and above 60 years. SELETION OF PATIENTS:- 30 patients were randomly selected who were suffering from Pittaj Mutrakruchra from OPD and IPD in Dr. M. N. Agashe Charitable Hospital, Satara. CRITERIA FOR SELECTION OF PATIENTS:- Inclusion criteria 1) Patients with clinical signs and symptoms of Pittaj Mutrakruchra described in Ayurvedic classics and modern medicine. 2) Patients belonging to age group between 10 to 60 years. 3) Patients from both sexes. Exclusion criteria 1) Pregnancy 2) Prostate enlargement. 3) Malignancy of any part of urinary tract Parameters:- Subjective Parameter a) Sashool Mutrapravrutti [Painful micturation] b) Sadaha Mutrapravrutti [Burning micturation ] c) Sarakth Mutrapravrutti [Hematuria] d) Alpa-alpa Mutrapravrutti [Frequent micturation] e) Alp Udarshool [Flank pain] f) Manda Jwara.[Low grade fever] Visual analog score was utilized to evaluate the severity for above symptoms viz. a, b & e. The gradation for Alpa-alpa Mutrapravrutti [Frequent micturation] as grade 1 -frequency less than 8, grade 2- frequency between 9-12 and grade 3- frequency more than 13. Manda Jwara [Low grade fever] is graded as grade 1 [mild] temp. up to 99 0 Page69

5 F, grade 2 [moderate] temp. between F to F and grade 3 [severe] temp. above F. Sarakth Mutrapravrutti [Hematuria] considered on the basis of presence of RBC in urine. Objective Parameter:- 1) Presence of Albumin in urine 2) Presence of pus cells in microscopic examination up to 50/- hpf. Drugs: - Tablet of Gokshura and Shatavari. Dose: - 2 Tablets of Gokshura - Shatavari 3 times a day (i.e. 2 tablets in the morning, 2 tablets in the afternoon and 2 tablets in evening) Anupana: - Jal pan. (Tap water) Duration of treatment: - For 7 days. PREPARATION OF TABLET: For present study first of all the raw material required for tablet formation i.e. Gokshura [Tribulus terrestris] Phala and Shatawari [Asparagus racemosus] is procured from local Ayurvedic herbal venders. They were positively identified by experts from the department of Dravyaguna of the institute. Gokshura [Tribulus terrestris] Phala and Shatavari [Asparagus racemosus] taken in equal quantity and finely prepared in powder form. The dreg part of the churna was used for kwath [decoction] preparation, which was used for bhawana to the churna. All the two ingredients, which were given the Bhawana of the kwath [decoction] were taken together and mixed well. In the above mixture sugar and gum acacia with starch in paste form were added and granules were made from this mixture. These granules are transferred in rotator tableting machine to form tablets. The disintegration time of tablet is 30 minutes. The tablet weighing equal to 500 mg was prepared. Table No.2: SHOWING DISTRIBUTION ACCORDING TO CONSTITUTION Group Constitution No. of Cases Percentage A Vataj 0 0% B Pittaj 0 0% C Kaphaj 0 0% D Vat-Pittaj 20 67% E Vat-Kaphaj 4 13% F Kapha-Pittaj 6 20% Table No.3: SHOWING DISTRIBUTION ACCORDING TO RITU Group Ritu No. of Cases Percentage A Shishira 1 3% B Vasant 4 13% C Greeshma 16 54% D Varsha 3 10% E Sharad 6 20% F Hemant 0 0% Table No.4: SHOWING NUMBER OF PATIENT RELIEVED FROM SIGN AND SYMPTOMS OF PITTAJ MUTRAKRUCHRA AFTER TREATMENT. Sr. No. Sign and Symptom of Pittaj Mutrakruchra Before Treatment After Treatment No. of patients relieved Percentage 1 Sashool Mutrapravrutti Sadaha Mutrapravrutti Sarakth Mutrapravrutti Alp-alp Mutrapravrutti Alp udarshool Manda Jwara Albumin Pus cells Table No.5: Table showing Significance of Ayurvedic therapy on sign & symptoms of Pittaj Mutrakruchra. Sr. Sign and Mean score No Symptoms Before T After T S.D. S.E. t value p value Symptoms of 1 Pittaj P < Mutrakruchra 2 Pus cells P < Page70

6 Graph No.1: SHOWING RESULT OF PROJECT A Complete Relief B No. Relief Table No.6: SHOWING RESULT OF TOTAL PROJECT WORK of Guru and Snigdha Guna, Madhur Rasa, Madhur Vipaka, Sheet Veerya and Ashmarighna, Mehanashak & Vrushya Prabhava. [3] Other drug i.e. Shatavari [Asparagus racemosus] is having properties of Guru and Snigdha Guna, Madhur and tikta Rasa, Madhur Vipaka, Sheet Veerya and Rasayani, Shukra- Stanya Vardhka, Shothanashak Prabhav. [4] Due to these Properties the sign and symptoms of Pittaj Mutrakruchra i.e. Sashool Mutrapravrutti [Painful Micturation], Sadaha Mutrapravrutti [Burning Micturation], Sarakth Mutrapravrutti [Hematuria], Alpa-alpa Mutrapravrutti [Frequent micturation], Alp Udarshool [Flank pain], and Manda Jwara [Low grade fever] might be reduced. Group Relief No. of Cases Percentage A Complete Relief 28 93% B No. Relief 02 7% DISCUSSION: Thirty cases of Pittaj Mutrakruchra attending O.P.D. and I.P.D. of Kayachikitsa were chosen for the present study. They were treated with Tab. Gokshura - Shatavari prepared for the study. In the light of the data presented above the following facts can be deduced. The incidence of the disease was more in Tarunyawastha [young age] due to dominance of pitta dosha. [5] It is 70% of the total number of patients. The incidence of the disease is observed 73% in Female because in female urethral opening is short. [6] The 73% incidence is observed in married patients because of regular coitus with partner. Prakritiwise (constitutional) distribution of the patients has shown 67% incidence of the disease in Vat-Pittaj. In Ayurveda this type of prakruti is hina prakruti. [7]. 54% of the disease is observed in Greeshma Ritu, due to predominance of katu rasa with vayu and Agni mahabhuta and dryness of elements in the body. [8] The 57% incidence of disease was observed in housewives. Maximum signs and symptoms of Pittaj Mutrakruchra are diminished by 93 % % after treatment. Hence it shows that drug is highly significant in Pittaj Mutrakruchra. After studying clinical sign and symptoms of Pittaj Mutrakruchra before and after treatment with Tab. Gokshura -Shatavari, it is observed that efficacy of these two drug evaluated with the help of paired t test. The calculated t value was 15.1 and respectively (table no. 5) is greater than t table value at level of significance 0.05 and and hence the drug efficacy in Pittaj Mutrakruchra is highly significant. Probable Action of Drug: The drug Gokshura [Tribulus terrestris] used for the treatment of Pittaj Mutrakrucha having properties The study conducted by N. Jagannath et.al shows that the administration of ethanolic extract of shatavari [A. racemosus] significantly decreased the development of urolithiasis in rats. [9] Some recent studies also shows the efficacy of Goksura in Urolethesis. [10][11][12][13][14][15] CONCLUSION: Urinary infection is one of the common health problems, which impairs day to day life. In Ayurveda many remedies are available easily and economically for management of Pittaj Mutrakruchra. The compound preparation of Tablet contains Gokshura [Tribulus terrestris] and Shatavari [Asparagus racemosus] with Jal pana (Tap water) is useful in management of Pittaj Mutrakruchra. The drug is also very cost effective & useful to treat Pittaj Mutrakruchra without any complication. REFRENCES: 1. Sushrut Samhita of Sushruta editor Ambika Dattashastri, Sharir Sthana Chapter 9 th,verse No.12,Chaukhamba Sanskrit Sansthan,Varanasi,Reprint 2005, p The Charak-Samhita of Agnivesha, Elaborated by Charak and Drudhabala with Ayurved Dipika Commentary of Chakrapanidatta. Vaidya Yadavji Trikamji Acharya,Chikitsa Sthana,Chapter No.26, VerseNo.34, Chaukhambha Surbharti Prakashan,Varanasi, Reprint 2005,p Dravya Guna vigyan Volume II,editor Prof.P.V.Sharma,Chapter No.268, chaukhmbha Bharti Academy,Varanasi,Reprint 1999,p.632,633, Dravya Guna vigyan study of dravya- material medica, Editor Prof. D.S Lucas, Chapter No.119, Chaukhmbha Visvabharti, Varanasi, Reprint 2012, p Ashtanga Sangrah vol-1 sarvangsundari commentary Pt. Lalchand Shastri Vaidya Chapter1,Verse No.25 Baidyanath Ayurved Bhavan ltd Reprint 1996, P Principals of Anatomy and Physiology, Editor by Tortora, Bryan Derrickson 11th edition John Wiley & sons, Inc, Chapter no. 26, p Sarth Vagbhat Sutrasthan by Dr. G. K. Garde Chapter-1, Verse No.10 Anamol Prakashan Pune-2,Reprint Jan 2006, p.2 8. The Charak-Samhita of Agnivesha, Elaborated by Charak and Drudhabala with Ayurved Dipika Commentary of Chakrapanidatta. Vaidya Yadavji Trikamji Acharya,Chikitsa Page71

7 Sthana,Chapter No.26, VerseNo.53, Chaukhambha Surbharti Prakashan,Varanasi, Reprint 2005,p Jagannath N, Chikkannasetty SS, Govindadas D, Devasankaraiah G. Study of antiurolithiatic activity of Asparagus racemosus on albino rats. Indian J Pharmacol [serial online] 2012 [cited 2014 Aug 22]; 44: Available from: Al-Ali M, Wahbi S, Twaij H, Al-Badr A. Tribulus terrestris: Preliminary study of its diuretic and contractile effects and comparison with Zeamays. J Ethnopharmacol 2003; 85: Chhatre S, Nesari T, Somani G, Kenjale R, Sathaye S. Comparative Evaluation of Diuretic Activity of Different Extracts of Tribulus terrestris Fruits in Experimental Animals. Int J Res Phytochem Pharmacol 2012;3: Anand R, Patnaik GK, Kulshreshtha DK, Dhawan BN Activity of certain fractions of Tribulus terrestris fruits against experimentally induced urolithiasis in rats. Indian J Exp Biol 1994; 32: Aggarwal A, Tandon S, Singla SK, Tandon C. A novel antilithiatic protein from Tribulus terrestris having cytoprotective potency. Protein Pept Lett 2012; 19: Sangeeta D, Sidhu H, Thind SK, Nath R. Effect of Tribulus terrestris on oxalate metabolism in rats. J Ethnopharmacol 1994; 44: Shirfule AL, Sangamwar AT, Khobragade CN. Exploring glycolate oxidase (GOX) as an antiurolithic drug target: Molecular modeling and in vitro inhibitor study. Int J Biol Macromol 2011;49:62-70 CITE THIS ARTICLE AS Deshmukhe P.N. et.al., Efficacy of Gokshura (Tribulus Terrestris) and Shatavari (Asparagus Racemosus) in Pittaj Mutrakruchra, Int. J. Ayu. Source of Support Nil Conflict of Interest None Declared Page72

8 #401/8-A, 4 th Floor, Shiv Shrishti Apt. Nardas Nagar, TP Rd., Bhandup (W), Mumbai E:mail-editorijaam@gmail.com, Web-