A A M J Anveshana Ayurveda Medical Journal

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1 M J nveshana yurveda Medical Journal ISSN: Research rticle comparative clinical study on the effect of Triphala Guggulu & Kaiśora Guggulu with application of Jātyādi taila in Utkartana Sunita Siddesh 1 V N K Usha 2 b s t r a c t Ensuring healthy and safe motherhood with utmost care rendered to every women is the outright responsibility of an Obstetrician. Utkartana is a surgical incision of the perineum performed to widen the vaginal opening for the easy delivery of an infant [i]. It was rapidly adopted as a standard practice and has been widely used. Yoni Prasārana explained in our classics can be achieved through medicaments or surgical procedures like Utkartana Karma. The wound thus formed after an Utkartana is associated with immense pain and discomfort and seeks appropriate medical care and attention. If ignored, it may lead to various puerperal infections that are costly in terms of delayed mother infant interaction, lactation difficulties and prolonged hospital stay. Hence the present study was conducted to ensure faster and healthy healing of the Utkartana by giving Triphala Guggulu orally with Jātyādi taila application in one group, and Kaiśora Guggulu orally with application of Jātyādi taila in second group. The results were compared and analysed statistically with appropriate statistical test. Key words- Utkartana, Jātyādi taila, Kaiśora Guggulu, Triphala Guggulu, Utkartana karma 1 PhD Scholar, 2 Professor & Head, Department of PG Studies in Prasutitantra & Striroga, SDM College of yurveda, Udupi. CORRESPONDING UTHOR Dr. SUNIT SIDDESH PhD Scholar, Department of PG Studies in Prasutitantra & Striroga, SDM College of yurveda, Udupi, Karnataka. naveensirasangi@gmail.com MJ / Vol. 2 / Issue 3 / May June 2016

2 Sunita & Usha : comparative clinical study on the effect of Triphala Guggulu & Kaiśora Guggulu with application of Jātyādi taila in Utkartana INTRODUCTION Pregnancy is very important and very happy event in woman s life, but parturition is strenuous event. The complications of parturition are very severe and are difficult to cure. ncient Vaidyas were well convalescent with these complications. They were using tampons soaked in oil to put it into vagina in last month for softening of rigid perineum and vagina [ii]. Yoni snehana was done during labour for easy delivery [iii].our charyas have elaborated many measures to ensure Sukhaprasava. One such measure is Yoni Prasārana mentioned in cases of perineal insufficiency during prasava by charya Vagbhata. Yoni Prasārana can be achieved either by dilating with the fingers or by making an incision on the perineum. In Mūḍhagarbha chikitsa, Utkartana karma is mentioned as one of the shalya chikitsa. This can be compared to the episiotomy. Episiotomy is a surgically planned incision on the perineum and posterior vaginal wall, done during second stage of labour. In India the overall rate of episiotomy was 40.6% in 2003 [iv]. The episiotomy rate in Karnataka is very high. It is about 88% in women who are undergoing difficult labour. current medical literature documented that 60% of women with episiotomies reported severe postpartum pain, 25% experienced infection at the site and 20% had problems during intercourse for up to 3 months after child birth [v]. Hence it is evident that special care must be taken to prevent infection, hasten healing and reduce scar. fter Utkartana care starts immediately after suturing the wound in order to reduce pain and inflammation. Utkartana can be considered on the lines of Sadyo vrana and treated accordingly. Sushruta has mentioned the use of drugs possessing Kashaya, Madhura rasa and Snigdha properties for the immediate management in Sadhyovrana [vi]. Thus in the present study, an attempt is made to hasten the rate of Utkartana healing, by giving orally Triphala Guggulu with application of Jātyādi taila in and orally Kaiśora Guggulu with application of Jātyādi Taila in. OJECTIVES To compare the efficacy of - Triphala Guggulu [vii] with Jātyādi taila [viii] application Kaiśora Guggulu [ix] with Jātyādi taila application on Utkartana. Source of data 40 patients with sutured Utkartana following normal vaginal delivery, were randomly selected form IPD of Prasooti Tantra Evam Stree Roga Department of SKMCH and RC, angalore. Inclusion criteria ll Primi and Multi Gravida who underwent normal vaginal delivery with Utkartana. Exclusion criteria 3 rd or 4 th degree perineal tear. Perineal lacerations. Delivery complications like Post-Partum Haemorrhage and cervical tear. ny systemic diseases that interfere normal wound healing. Intervention 40 patients with sutured Utkartana following normal vaginal delivery, were randomly assigned into the following two groups each comprising of 20 patients. : Triphala Guggulu 1tablet twice daily with luke warm water after food given orally for 7days, and application of Jātyādi Taila twice daily for 7 days under all aseptic precautionary measures. Time of application- applied once in the morning and once in the evening. : Kaiśora Guggulu 1tablet twice daily with luke warm water after food given orally for 7 days, and pplication of Jātyādi Taila twice daily for 7 days under all aseptic precautionary measures. Time of application- applied once in the morning and once in the evening The wound healing was assessed on Post-test i.e. 7 th day Follow- Up: was done on the 14 th and the 21 st day. Total duration of study: 21days. ssessment criteria: Subjective Pain at stitches: Present / bsent Tenderness: Present / bsent Objective Oedema: Present / bsent Discharge: Present / bsent and Type of discharge whether serous or purulent was noted Dehiscence: Present / bsent. MJ / Vol. 2 / Issue 3 / May June

3 Sunita & Usha : comparative clinical study on the effect of Triphala Guggulu & Kaiśora Guggulu with application of Jātyādi taila in Utkartana Laboratory investigations: lood- Hb%, RS, CT, T, VDRL, HsG, HIV. OSERVTIONS Parity Table 1: Distribution of patients as per parity Total Primi Para Para Para Total Table 2: Distribution of patient based on type of episiotomy wound Type of episiotomy Wound Total R.M.L.E L.M.L.E Median Table 3: Distribution of patients based on size of Utkartana Size of Episiotomy wound(in cm) Total Table 5: Observations related to assessment criteria SSESSEMENT CRITE- RI Pain Oedema Tenderness Dehiscence Discharge RESULTS PRMETER Day 1 Day 7 Day 14 Day 21 No % Present bsent Present bsent Present bsent Present bsent bsent bsent Present bsent Present bsent bsent bsent No. of % of got relief GROUP X 2 value P Value Pain at stitches P<0.001 Tenderness P<0.001 Oedema P<0.001 Discharge P<0.001 Table 4: Distribution of patients based RS, T and CT GROUP RS T CT Hb% GROUP N Mean g% g PRMETER No of % of s X 2 value P Value Pain at stitches P<0.001 Tenderness P<0.001 Oedema P<0.001 Discharge P<0.001 MJ / Vol. 2 / Issue 3 / May June

4 Sunita & Usha : comparative clinical study on the effect of Triphala Guggulu & Kaiśora Guggulu with application of Jātyādi taila in Utkartana DISCUSSION Discussion on observations Distribution of patients according to parity, when considered in total, most number of patients i.e. 28 (70%) were primi-parous, 10 (25%) were second parous, and only 2 (5%) were third parous. Distribution according to type of Utkartana, when considered in total, most number of patients i.e 36(90%) were under gone with RMLE, this may be because RMLE is most convenient type of Utkartana and with less complications. Distribution of patients as per size of Utkartana when considered in total, most number of patients i.e 21(52.5%) were having Utkartana of size between 3.1-4cm. ll patients were having H%, RS, CT, T in normal range, and HIV, Hsg, and VDR were nonreactive for all patients. Discussion on probable mode of action of drug ll the drugs used in the study are directly told for treatment of vrana. Triphala is from Mustādi Gana of Sushruta which has property of curing diseases related to vagina, cervical canal, uterus (Tryāvarta Yoni) [x]. Triphala is anti-inflammatory [xi], antiviral antibacterial [xii] ; antioxidant improves circulation and possesses astringent [xiii] property. ccording to yurveda, it has krimighna (wormicidal) [xiv], and Vronaropana (wound healing) [xv] properties. Kaiśora Guggulu also contains Triphala and Guggulu along with other ingredients like trivrut, danti, vidanga etc. it is also having anti-inflammatory, antimicrobial property, and it has been told as a good blood purifier, as the most of the drugs in Kaiśora Guggulu are tikta Kashaya rasa pradhāna which helps for vrana Ropana and vrana Shodhana. Jātyādi taila is having Vrana Ropana properties, and it has been proved by many researchers in their research works, it mainly pacifies pitta and kapha and hence it is more effective in reducing inflammation of wound. Pain at stitches has been relieved as early as on 2 nd day in group, without using any analgesics which in turn minimizes expenditure and side effects. In group anti-inflammatory action of Triphala Guggulu was seen as early as on 2 nd day, whereas same was seen by 5 th day in group. This allows mother to sit comfortably and feed the baby. t the time application of Jātyādi taila helped for reducing local burning sensation and also helped for early wound healing. CONCLUSION On the basis of above results it is concluded that is very effective in controlling Pain at stitches and tenderness as compared to, while both the groups showed similar effect in reducing oedema and discharge from Utkartana. Overall the medicine of group was found more effective as compared to group. ΛΛΛΛ Discussion on results oth the groups have showed statistically highly significant effect (p< in both groups) When compared between the groups, group has showed more better results in reducing all the parameters i.e pain, tenderness, oedema, and discharge. MJ / Vol. 2 / Issue 3 / May June

5 Sunita & Usha : comparative clinical study on the effect of Triphala Guggulu & Kaiśora Guggulu with application of Jātyādi taila in Utkartana REFERENCES i. DR. C.S. Dawn Text book of Gynaecology, New Central ook gency, 2005, p 351 ii. charya Chakrapani - Charaka Samhita, Sharira Sthana 8/32, Edition 1 st, by Kashinath Pande & Gorakhnath Chaturvedi, Chaukhamba Publication, 2005, p 939 iii. charya Vagbhata - shtanga Sangraha with Indu commentary, edited by Shivprasad Sharma, Sharira Sthana 3/19, anaras yurved Series, 2005, p 287 iv. Inamdav M. Textbook of fundamental nursing. Mumbai: Vora Medical Publications; P. 184, v. Nancy Griffin. voiding an episiotomy. Mothering 2009 Dec ;(75): vi. charya Sushruta Nibandhasangraha Commentary by Yadavji Trikumji charya & Narayanji charya, Chikitsa Stahana 1/8, Edition 5 th, Chaukhamba Publication, 1992, p 397 vii. Sharngadhara, Sharngdhara Samhita, translated by 1998, Madhyama Khanda 7 th Chapter,Verse 82-83, Pp- 335, P-205 viii. Sharngadhara, Sharngdhara Samhita, translated by 1998, Madhyama Khanda 9 th Chapter,Verse , Pp-335, P-237 ix. Sharngadhara, Sharngdhara Samhita, translated by 1998, Madhyama Khanda 7 th Chapter,Verse 70-81, Pp- 335, P-204 x. charya Sushruta Nibandhasangraha Commentary by Yadavji Trikumji charya & Narayanji charya, Sutra Stahana 38/54-55, Edition 5 th, Chaukhamba Publication, 1992, p 168 xi. John nne merican Chronicle, Triphala and enefits of Triphala Herb 2007 ( accessed on ) xii. Yogesh S. iradar, Sheetal Jagatap, KR Khandelwal, and Smita S. shinghania Exploring of ntimicrobial activity of Triphala mashi an yurvedic formulation. Eved. ased compliment alternative medicine march 5 (1): published online 2007, p xiii. Mason TL, Wasserman P. Inactivation of red beet betaglucan synthase by native and oxidised phenolic compounds, phytochemistry, 1987, 26: xiv. charya Sushruta Nibandhasangraha Commentary by Yadavji Trikumji charya & Narayanji charya, Sutra Stahana 46/200, Edition 5 th, Chaukhamba Publication, 1992, p 229 xv. charya Vagbhata - shtanga Hridaya sarvanga Sundara Commentary of rundatta & yurved Rasayana of Hemadri, collated by Dr. nna Moreswar Kunte & Krishna Ramchanrdra Sastri Navre, Edited by Pandit Harisastri Paradkar Vaidya. Sutra Sthan 6/159,Chaukhamba Sanskrit Series, Edition 1 st, 1995, p 118 Source of Support: Nil. Conflict of Interest: None declared How to cite this article: Sunita & Usha : comparative clinical study on the effect of Triphala Guggulu & Kaiśora Guggulu with application of Jātyādi taila in Utkartana MJ 2016; 3: ΛΛΛΛ MJ / Vol. 2 / Issue 3 / May June