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2 Indexing links of GJRMI GJRMI has been indexed in the Following International Databases Google Scholar, ProQuest, DOAJ - AYUSH RESEARCH PORTAL - Department of AYUSH, Ministry of Health & Family welfare, Govt. of India - Index Copernicus - NewJour - Ulrich s Periodicals Directory - This could be accessed only with a Login ID or through a Major academic Library at your place as it is a subscription datablase ScienceCentral - getcited - Geneva Foundation for Medical Education & Research - Catalog ebiblioteca - ageid=4 Ayurbhishak - Medicinal s (Dravya Guna) - RoMEO - Indianscience.in - Necker - Hong Kong University of Science and Technology Library - Chakradatta Ayurveda Chikitsalaya, Mysore. (Panchakarma & Netra Roga Chikitsa Kendra) Get treated through Ayurveda, at our Hospital. (Exclusive Panchakarma Therapy available with accommodation) Address: Beside Vikram Jyothi Hospital, Temple Road, V V Mohalla, Mysore 12, Karnataka, India. Contact: Mobile: , E- mail: raviamrita.kumar9@gmail.com Consultant Physician: Dr. Ravi Kumar. M. (Specialized in different types of Keraliya Ayurvedic treatments especially in ENT & Eye diseases) Special Ayurvedic Treatments in the following diseases: Special keraliya treatments in Myopia, Astigmatism, Macular degeneration, Cataract, Glaucoma, Diabetic Retinopathy, Retinal detachment, Retinal pigmentation, Obesity, Filariasis, Asthma, Stress, Anxiety, Insomnia, Depression, Loss of Memory & Concentration

3 An International, Peer Reviewed, Open access, Monthly E-Journal ISSN Editor-in-chief Dr Hari Venkatesh K Rajaraman Managing Editor Dr. Shwetha Hari Administrator & Associate Editor Miss. Shyamala Rupavahini Advisory Board Prof. Rabinarayan Acharya Dr. Dinesh Katoch Dr. S.N.Murthy Dr. Mathew Dan Mr. Tanay Bose Dr. Nagaraja T. M. Prof. Sanjaya. K. S. Dr. Narappa Reddy Editorial board Dr. Kumaraswamy Dr. Madhu.K.P Dr. Sushrutha.C.K Dr. Ashok B.K. Dr. Janardhana.V.Hebbar Dr. Vidhya Priya Dharshini. K. R. Mr. R. Giridharan Honorary Members - Editorial Board Dr Farhad Mirzaei Mr. Harshal Ashok Pawar

4 INDEX GJRMI, Vol.2, Iss. 1, January 2013 Medicinal s Research Natural Resource VARIATION OF ESSENTIAL OILS COMPOSITION OF PITURANTHOS SCOPARIUS IN ALGERIA Takia Lograda, Messaoud Ramdani, Abderazak Kiram, Pierre Chalard and Gilles Figueredo 1 9 Bio-Tech & Genetic Engineering MEDICINAL PLANTS USED BY KABIRAJ OF FOURTEEN VILLAGES IN JHENAIDAH DISTRICT, BANGLADESH Masum Gazi Z H, Sharkar Priyanka, Nayeem Md. Abu, Rahman M Mafizur, Rahman M Mizanur Indigenous medicine Ayurveda THE ROLE OF PANCHAKARMA THERAPY FOR MUSCULOSKELETAL DISORDERS WITH SPECIAL REFERENCE TO VATAVYADHI Dass Ranjip Kumar A CLINICAL STUDY TO COMPARE VIRECHANA AND JALAUKAVACHARANA PROCEDURES IN THE MANAGEMENT OF VICHARCHIKA Dass Ranjip Kumar, Nayak Annada Prasad A CLINICAL STUDY ON THE EFFECTIVENESS OF DM II HERBAL COMPOUND (KALPIT) IN THE MANAGEMENT OF OBESE DIABETICS Agarwal Vivek A COMPARATIVE CLINICAL EVALUATION OF THYROMAX POWDER AGAINST THYROXINE SODIUM IN THE MANAGEMENT OF HYPOTHYROIDISM Ujjaliya Nitin, Krishnankutty S V, Remadevi R RUDRAKHA: A REVIEW ON MYTHOLOGICAL, SPRITUAL AND MEDICINAL IMPORTANCE Kumar Naresh, Dubey Mukesh, Agarwal Vivek COVER PAGE PHOTOGRAPHY: DR. HARI VENKATESH K R, PLANT ID FLOWERS OF BARRINGTONIA RACEMOSA (L.) SPRENG. OF THE FAMILY LECYTHIDACEAE PLACE KOPPA, CHIKKAMAGALUR DISTRICT, KARNATAKA, INDIA

5 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January ISSN International, Peer reviewed, Open access, Monthly Online Journal Research article VARIATION OF ESSENTIAL OILS COMPOSITION OF PITURANTHOS SCOPARIUS IN ALGERIA Takia Lograda 1*, Messaoud Ramdani 2, Abderazak Kiram 3, Pierre Chalard 4 and Gilles Figueredo 5 1, 2, 3, 4, 5 Laboratory of Natural Resource Valorization, Sciences Faculty, Ferhat Abbas University, Setif, Algeria 4 Clermont Université, Université Blaise Pascal, BP 10448, F Clermont Ferrand 5 LEXVA Analytique, 460 rue du Montant, Beaumont, France *Corresponding author: - tlograda63@yahoo.fr ; Phone: (213) ; Fax: (213) ABSTRACT Received: 20/11/2012; Revised: 27/12/2012; Accepted: 31/12/2012 By means of gas chromatography and mass spectroscopy, was realized the analysis and identification of essential oils of four populations of Pituranthos scoparius, obtained by hydrodistillation. An average yield of 0.93% was obtained. From the leaf, essential oil of P. scoparius, 63 compounds were separated; 51 compounds in the oil of Boussâada population, representing 99.6% of the total essential oil mass, 40 compounds in Elkantra population, representing 75.9% of the oil, 47 compounds in the oil of T kout population, representing 98.5% of the total essential oil and 28 compounds were identified in Mechouneche population, representing 85.1% of the total essential oil. The major compound was sabinene ( %), other components present in appreciable contents were: α-pinene ( %), α-terpinene ( %) and β-pinene ( %). The comparison of our results with those of literatures allowed us to detect the presence of three chemotypes in this species. The limonene chemotype is located in the south (region of Ghardaia), the dill apiole chemotype is located in the North (Djelfa and Laghouat regions) and the sabinene chemotype is localized in the North East (region of Biskra and Batna). KEYWORDS: Pituranthos scoparius, Ombiliferes, essential oil, Chemotype, Algeria. Cite this article: Takia Lograda, Messaoud Ramdani, Abderazak Kiram, Pierre Chalard and Gilles Figueredo (2013), VARIATION OF ESSENTIAL OILS COMPOSITION OF PITURANTHOS SCOPARIUS IN ALGERIA, Global J Res. Med. Plants & Indigen. Med., Volume 2(1): 1 11

6 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January INTRODUCTION The genus Pituranthos (family Apiaceae) is represented by more than 20 species. This is characterized by stems in the form of rushes which are often much ramified, without leaves or nearly so, with small fruits of less than 3 mm. Four species are present in Algeria (Ozenda, 2004). The species studied in this work, Pituranthos scoparius (Coss. & Dur.) Schinz (Syn: Deverra scoparia Coss. & Dur.), is an endemic of North Africa and is widespread in Algeria, especially in the high plateau and in most parts of the Sahara. P. scoparius is an aphyllous perennial ; the upper leaves are reduced to their sheath. The stems are erect, cm high, and form dense clumps that send out laterally short rigid branches (Quézel et Santa, ). Pituranthos species are used in traditional medicine (Boukef et al., 1982; El Rhaffari et Zaid, 2002; Vérité et al., 2004; Hammiche and Maiza, 2006; Benmekhbi et al., 2008; Yangui et al., 2008; Sharaby et al., 2009; Krifa et al., 2011). Phytochemical studies have been carried out on P. scoparius (Hammiche and Maiza, 2006; Boutaghane et al., 2004; Haba et al., 2004; Dahia et al., 2009; Smaili et al., 2011; Gourine et al., 2011). The essential oil of populations of P. scoparius show that they are rich in α-pinene, β-pinene, limonene, myristicin, dill apiole and germacrene-d (table 1) (Hammiche and Maiza, 2006, Vérite et al., 2004; Smaili et al., 2011; Gourine et al., 2011). The aim of the present study is to carry out a large scale investigation on the essential oil composition and the determination of P. scoparius chemotypes in Algeria which involved different regions and search relationships between populations and ecology. MATERIALS & METHODS Plant material Pituranthos scoparius is collected from four localities in eastern Algeria, Boussâada (M sila), T Kout (Batna), ElKantra and Mechouneche (Biskra) (Figure 1). Aerial parts were collected during the flowering stage in October The air dried materials were subjected to hydro-distillation for 3 h using a clevenger apparatus type. Voucher specimens were deposited in the herbarium of the Department of Biology, Ferhat Abbas University, Algeria. Essential oil analysis The essential oils were analysed on a Hewlett-Packard gas chromatograph Model 5890, coupled to a Hewlett-Packard model 5971, equipped with a DB5 MS column (30 m X 0.25 mm; 0.25 μm), programming from 50 C (5 min) to 300 C at 5 C/min, with a 5 min hold. Helium was used as the carrier gas (1.0 ml/min); injection in split mode (1:30); injector and detector temperatures, 250 and 280 C, respectively. The mass spectrometer worked in EI mode at 70 ev; electron multiplier, 2500 V; ion source temperature, 180 C; MS data were acquired in the scan mode in the m/z range The identification of the components was based on comparison of their mass spectra with those of NIST mass spectral library (Masada, 1976; NIST, 2002) and those described by (Adams, 2001) as well as on comparison of their retention indices either with those of authentic compounds or with literature values (Adams, 2001). Statistical analysis Data were first subjected to Principal Components Analysis (PCA) to examine the relationships among the terpenes compounds and identify the possible structure of the population. Cluster analysis (UPGMA) was carried out on the original variables and on the Manhattan distance matrix to seek for hierarchical associations among the populations. The cluster analyses were carried out using STATISTICA 9 software. RESULTS The extract of the aerial parts of P. scoparius gave yellow-green oil with a characteristic odour and an average return

7 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January (1.16%) (v/w). The greater yield of essential oil was (2.29%) found in the population of Elkantra and the minimum (0.47%) in T kout population. The essential oils of P. scoparius were analyzed by GC and GC-MS. The compounds identified in these oils and their relative proportions are listed in order of their elution (Table 2). Table 1: Major components, in essential oil, of Pituranthos scoparius growing in different areas of Algeria Authors Smaili et al., 2011 Gourine et al., 2011 Localities M Sila Djelfa Laghouat Ghardaïa Populations compounds α-pinene Sabinene β-pinene Myrcene α-phellandrene Limonene β-phellandrene β-ocimene-z γ-terpinene Terpinene-4-ol p-cymen-8-ol Bornyle acetate Bicyclo-germacrene Myristicin Dill-apiole β-eudesmol Germacrene-D γ cadinene Methyl eugenol α-thujene β-ocimene-e Spathulenol 4.5 Camphene Δ 3 -carene Linalool γ cadinol t-muurolol β-caryophyllene 1.7 Bicyclo-elemene 1.1 Vérité et al., 2004

8 Boussaada T Kout Elkantra Mechouneche Boussaada T Kout Elkantra Mechouneche Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Table 2: Chemical composition of essential oils of Pituranthos scoparius Compounds KI Compounds KI Yield v/w Yield v/w Number of compounds Number of compounds Total % Total % α-thujene Phellandral α-pinene Bornyle acetate Thuja-2,4(10)-Diene Carvacrol Camphene α-cubebene Verbenene α-copaene Sabinene β-bourbonnene β-pinene β-cubebene Myrcene Methyl eugenol α-phellandrene β-caryophyllene α-terpinene β-copaene Para-cymene Sesquisabinene-A Limonene α-humulene β-phellandrene β-acoradiene β-ocimene-z γ-murolene β-ocimene-e Germacrene-D γ-terpinene β-selinene cis hydrate de sabinene α-farnesene Terpinolene Bicyclogermacrene methyl-2(2-methylbutenyl) furane Germacrene-A trans hydrate de sabinene Δ 3 -Cadinene Menthatriene, 1,3,8-Para Myristicin DB α-camphoaldehyde α-calacorene Trans-pinocarveol β-calacorene Sabinacetone (origan) Elemicin Pinocarvone Caryophyllene oxyde Terpinene-4-ol Spathulenol p-cymen-8-ol Salvial-4(14)-en-1-one Myrtenal ,5-epoxysalvial-4(14)-ene Estragole Humulene-1,2-Epoxyde Myrtenol Dill apiole Verbenone α-epi-muurolol Cuminaldehyde β-eudesmol

9 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Sixty four compounds were identified, showing high amounts in monoterpenes. Some samples are rich in oxygenated compounds such as dill apiole. Fifty-one compounds were identified in Boussâada population representing 99.6% of the total oil, 47 compounds were identified in T kout population representing 98.5%. 40 compounds were identified in Elkantra population; representing 75.9% and 28 compounds were identified in Mechouneche population, representing 85.1% of the total oil. The samples investigated present a large quantitative and qualitative variability. The main components identified are α-pinene ( %), sabinene ( %), α-terpinene ( %), limonene ( %), α-thujene ( %), p-cymene (1 3.2%), β-pinene ( %) and dill apiole ( %). The Boussaada population is individualized, compared to other populations, with high levels of caryophyllene epoxide (9.7%), α-farnesene (7.7%), α-humulene (4.7%), β-phellandrene (3.9), salvial-4(14)-en- 1-one (2.8%), sabinacetone (2%), β- bourbonnene (2%), β-eudesmol (1.4%) and a rate average of the α-pinene (16.4%) and sabinene (14.8%). The population of T'kout (Batna) is rich in α-pinene (23.3%), sabinene (18.6%), α-terpinene (7.7%), α-ocimene-(e) (7.6%), terpinolene (5.3%), β-pinene (5.1%), 3- methyl-2(2-methylbutenyl)-furan (2.3%), bicyclogermacrene (2.7%) and spathulenol (2%). The two populations of Biskra (Elkantra and Mechouneche) have the same major components with similar rates. In Elkantra population we noted the presence of compounds that are absent in Mechouneche population (α-phellandrene (0.6%), α-ocimene- (Z) (3.6%), estragole (0.5%), germacrene-d (0.9 %), myricticin (7.6%) and caryophyllene oxide (5%). The dill-apiole is present with a rate of 6.6% against 16.8% in the population of Mechouneche. In order to investigate the differences between the essential oils samples of the different regions, we have chosen the cluster analysis using the principal component analysis (PCA) performed on the correlations between the 43 variables presented three axes comprising 87.28% of the total variation present in the original data. This analysis clustered populations in tree groups, but the separation of the populations is not clear. The ordination of population s means obtained for the three vectors is shown in (figure 2). The result showed the existence of three groups. The first group consists of Ghardaïa populations, studied by (Hammiche and Maiza, 2006). This set is characterized by limonene, myristicin, α-phellandrene and germacrene-d. The second group, formed by the populations in northern sampling area, M sila, Djelfa, Laghouat and Ghardaia studied by (Smaili et al., 2011; Gourine et al., 2011). The group is very rich in α-pinene, myristicin. The third group formed by Batna and Biskra Populations, are characterized by the presence of the α-penene, sabinene, β-pinene, α-thujene and α-terpinene. It should be noted that this group has a high rate of sabinene, which is poorly represented in the rest of populations. We noted that the first group is well separated from the other groups, while the separation of groups (2 and 3) is less clear. All populations of this species have showed high α- pinene, β-pinene and dill apiole levels and low quantitative variations in all their components, the rest of the components present a quantitative and qualitative variability. The terpenoids variability reflects the heterogeneity of the genetic structure of Pituranthos scoparius. Genetic analyses were carried out using terpenoids including some compounds that have been shown in other species to be under the control of single locus with two alleles. The dendrogram based on UPGMA clustring (Manhattan distance), shows the presence of two group (figure 3), that confirms result obtained from ACP analyses. The first group (Group I) formed by populations of Ghardaia. This group is individualized by the presence of high levels of limonene ( %) and myristicin (0.4 to 31.1%). The rate of α-pinene closer to the

10 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January subgroup III located to the north of the study area and separates the subgroup II located in the southern part. We also note the presence of germacrene-d which approximates group III. The second group is divided into three subgroups. The first is formed by the populations of Boussaada, T'kout, ElKantra and Mechouneche, located to the north-east of the study area, are rich in α-pinene, sabinene, α- terpinene, β-pinene, dill-apiole and a low rate of limonene. The second subgroup formed by Djelfa and Laghouat populations, located in the middle of the transect study, is characterized by the presence of high levels of α-pinene (26.7 to 35.8%), β-pinene, dill-apiole and a low rate of limonene, myristicin and germacrene-d. the third subgroup. The third subgroup formed by the populations of M'sila and Djelfa, is characterized by an average rate of α-pinene, β- pinene, a high rate of α-phellandrene, β- ocimene-z, myristicin and germacrene-d. DISCUSSION Our results are in agreement with those of the bibliography (Smaili et al., 2011; Gourine et al., 2011) who investigated the yield of essential oil from P. scoparius from M Sila and Laghouar respectively. The compounds found in the Pituranthos scorparius populations generally resembled those previously reported to occur in Algeria (Hammiche and Maiza, 2006; Smaili et al., 2011; Gourine et al., 2011). In particular (α-pinene, sabinene, myrcene, α- phellandrene, limonene, myristicin, dill-apiole and germacrene-d), in the sampling areas, the compounds concentrations present a variability. Aggregation of P. scoparius populations into small groups is an indication of terpenoids variability in this population. The diversity of the terpenoids content reflects the existence of considerable genetic variability (Forrest, 1980; Raddi and Sümer, 1999). Figure 1: Populations of Pituranthos scoparius studied

11 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Figure 2: Ordination of the first three principal axes of P. scoparius populations. Factor 3: (9.57%) Djelfa 03 Ghardaia 03Ghardaia 07 Djelfa 02 Ghardaia 05 M'Sila Ghardaia 04 Laghouat 01 Djelfa 01 Ghardaia 01 Ghardaia Laghouat Ghardaia 02 Ghardaia 06 Elkantra Mechouneche Boussâada T kout Factor 2: (22.53%) Factor 1: (55.18%) Figure 3: Dendrogram based on Manhattan similarity distance.

12 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January The UPGMA analysis of terpene traits confirms this variability, and a clear conclusion can be transmitted between population s geographic distribution and a composition of the essential oil of this species. This later observation confirms the potential occurrence of chemotypes in these essential oils and could explain the variability of the results reported for the same essential oil of P. scorpius. The limonene is present in individuals of Ghardaia, it is poorly represented or even absent in other populations studied. The rate of α-pinene deteriorates from north to south. The α- phellandrene has a more or less homogeneous concentration. The diall-apiole in P. scoparius decrease from south to north, while germacrene-d is very low among populations of M'Sila, Batna and Biskra, its concentration increases from south to north. CONCLUSION Pituranthos scoparius is rich in α-pinene, limonene, sabinene, dill-apiole and β-pinene. Our study and previous studies decortications on this species, we were able to detect the presence of α-pinene-dill apiole chemotype, located in the north of the study area (M'sila Djelfa and Laghouat). The north-eastern part surveyed (M'sila, Batna and Biskra) contains α- pinene-sabinene chemotype. We note the decrease in the concentration of α-pinene from east to west. Finally Limonene chemotype is observed in the northern study area (Ghardaia). ACKNOWLEDGMENTS The works was supported by Algerian MESRS and Chemical Laboratory of carbohydrates Heterocyclic of Clermont Ferrant, France REFERENCES Adams R P (2001). Identification of essential oil components by gas chromatography and quadrupole mass spectrometry. Allured Publ. Corp., Carol Stream IL. Benmekhbi L, Kabouche A, Kabouche Z, Ait- Kaki B, Touzani R and Bruneau C (2008). Five glycosylated flavonoids from the antibacterial butanolic extract of Pituranthos scoparius. Chemistry of Natural Compounds. 44(5): Boukef K, Souissi H R and Ballansard G (1982). Contribution à l étude des es utilisées en médicine traditionnelle tunisienne. Plants. Med. Phyto. 16: Boutaghane N, Nacer A, Kabouche Z and Ait- Kaki B (2004). Comparative antibacterial activities of the essential oils of stems and seeds of Pituranthos scoparius frome Algerian septentrional Sahara. Chemistry of Natural Compounds. 40(6): Dahia Mostefa, Laura Siracusa, Hocine Laouer and Giuseppe Ruberto (2009). Constituents of the Polar Extracts from Algerian Pituranthos scoparius. Natural Product Communications. 4(12): El Rhaffari U et Zaid A (2002). Pratique de la phytothérapie dans le sud-est du Maroc (Tafilalet). Un savoir empirique pour une pharmacopée rénovée, Origine des pharmacopées traditionnelles et élaboration des pharmacopées savantes, Des sources du savoir aux médicaments du Futur, pp Forrest G I (1980). Seasonal and spatial variation in cortical monoterpene composition of Sitka spuce oleoresin. Can J. For. Res. 10: Gourine N, Merrad B, Yousfi M, Stocker P and Gaydou EM (2011). Chemical composition of the essential oil of Pituranthos scoparius. Nat Prod Commun. 6(8):

13 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Haba H, Benkhaled M, Massiot G, Long C and Lavaud C (2004). Alkylated Isocoumarins from Pituranthos scoparius. Nat. Prod. Res. 18(5): Hammiche Victoria and Khadra Maiza (2006). Traditional medicine in Central Sahara: Pharmacopoeia of Tassili N ajjer. Journal of Ethnopharmacology. 105: Krifa Mounira, Tahar Gharad, Rabiaa Haoualab (2011). Biological activities of essential oil, aqueous and organic extracts of Pituranthos tortuosus (Coss.) Maire. Scientia Horticulturae. 128: Masada Y. (1976). Analysis of Essential Oils by Gas Chromatography and Mass Spectrometry, Halsted, Nueva York, 334. NIST (2002). Mass Spectral Search Program for the NIST/EPA/NIH Mass Spectral Library, vers fiveash data, USA. Ozenda P (2004). Flore du Sahara, CNRS, Paris, 663 pp. Quézel P et Santa S ( ). Nouvelle flore de l Algérie et des régions désertiques méridionales. CNRS, Paris, 2 tomes. Source of Support: Nil Raddi S and Sümer S (1999). Genetic diversity in naturel Cupressus Sempervirens L. populations in Turkey. Biochem. Syst. Ecol. 27: Sharaby A, Abdel-Rahman H and Moawad S (2009). Biological effects of some natural and chemical compounds on the potato tuber moth, Phthorimaea operculella Zell. (Lepidoptera:Gelechiidae). Saudi Journal of Biological Sciences. 16: 1 9. Smaili Tahar, Zellagui Amar, Gherraf Noureddine, Flamini Guido and Cioni Pier Luigi (2011). Essential oil content of the flowers of Pituranthos scoparius in Algeria. International Journal of Phytomedicines and Related Industries. 3(2): Vérité P, Nacer A, Kabouche Z, Seguin E (2004). Composition of seeds and stems essential oils of Pituranthos scoparuis (Coss & Dur). Flavour Frag. J. 19: Yangui T, Bouaziz M, Dhouib A and Sayadi S (2008). Potential use of Tunisian Pituranthos chloranthus essential oils as a natural disinfectant. The Society for Applied Microbiology, Letters in Applied Microbiology. 48: Conflict of Interest: None Declared

14 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January ISSN International, Peer reviewed, Open access, Monthly Online Journal Research article MEDICINAL PLANTS USED BY KABIRAJ OF FOURTEEN VILLAGES IN JHENAIDAH DISTRICT, BANGLADESH Masum Gazi Z H 1, Sharkar Priyanka 2, Nayeem Md. Abu 3, Rahman M Mafizur 4, Rahman M Mizanur 5 * 1, 2, 3, 4, 5 Department of Biotechnology and Genetic Engineering, Islamic University, Kushtia-7003, Bangladesh. *Corresponding author: mmrahmanbtg79@hotmail.com; Phone: ext 2306; Fax: ; Cell: ABSTRACT Received: 06/12/2012; Revised: 05/01/2013; Accepted: 07/01/2013 Medicinal s use simple formulations of whole or parts from medicinal s for treatment of various ailments. The objectives of this study were to identify native medicinal s, their uses, type of conservation measures and evaluation of their contribution to income generation of participating farmers and Kabiraj. Data were collected from the beneficiaries local people and Kabiraj through direct interview, group discussion and visit to the gardens of medicinal s from 14 villages Jhenaidah district. A total of 121 medicinal species belonging to 64 families have been identified. The most frequently used families are Apocynaceae with 7 and Asteraceae with 6 species followed by Moraceae, and Solanaceae with 5 species. Among the selected species the maximum contribution was recorded for herbs with 48 species (40%) followed by the trees with 39 species (32%), shrubs with 25 species (21%) and the climbers with 9 species (7%). These species are utilized by local peoples against various a liver complaints, digestive problems, jaundice, asthma, bronchitis, anemia, piles, mental disorder, cancer, general weakness, diabetes, gonorrhoea, sexual disorders, syphilis, leprosy and insect-bites. It was noted that if proper marketing facility could be ensured, there would be greater scope of income generation and better chances of biodiversity conservation through regular cultivation of these native medicinal s. This survey signifies ethno-medicinal values of species that occur in Jhenaidah district. KEY WORDS: Medicinal s, Kavirajas, ethno-medicinal, Jhenaidah district. Cite this article: Masum Gazi Z H, Sharkar P, Nayeem Md. Abu, Rahman M, Rahman M. M (2013), Medicinal Plants Used by Kabiraj of Fourteen Villages in Jhenaidah District, Bangladesh, Global J Res. Med. Plants & Indigen. Med., Volume 2(1): 10 22

15 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January INTRODUCTION Medicinal s serve as important therapeutic agents as well as valuable raw materials for manufacturing numerous traditional and modern medicines. They offer alternative remedies with tremendous opportunities to generate income, employment and foreign exchange for developing countries (Rawat and Uniyal, 2004). Many traditional healing herbs and their parts have been shown to have medicinal value and can be used to prevent, alleviate or cure several human diseases (Dhar et al., 1999). It is estimated that 70 80% of people worldwide rely chiefly on traditional, largely herbal medicine to meet their primary healthcare needs (Farnsworth and Soejarto, 1991; Pei Shengji, 2001). It has further been observed that a number of modern pharmaceuticals have been derived from s used by indigenous people (Balick and Cox, 1996; Rahmatullah et al., 2010). Important modern drugs that have been derived from observations of traditional curing methods of indigenous people include aspirin, atropine, ephedrine, digoxin, morphine, quinine, reserpine and tubocurarine (Gilani and Rahman, 2005; Rahmatulla et al., 2010). Out of the 350,000 species identified so far, about 35,000 (some estimate up to 70,000) are used worldwide for medicinal purposes and less than about 0.5% of these have been chemically investigated (Comeran, 1996). In Bangladesh, medicinal s are found to grow naturally in the forest, bushes and marginal land along the canal and in other places and, a long tradition of indigenous herbal medicinal systems, based on the rich local diversity, are considered as very important component of the primary health care system. Bangladesh has over 5,000 floral species and many of them are in use by the Kabirajas in folk medicine. The previous ethnomedicinal studies conducted among folk and tribal medicinal practitioners of the country have noticed considerable variation between the medicinal s selected by different Kabirajas for treatment of a given ailment (Nawaz et al., 2009; Hasan et al., 2010; Hossan et al., 2010; Mollik et al., 2010a; Rahmatullah et al., 2010a; Jahan et al., 2011). These variations exist even between Kavirajas practicing in adjoining villages with identical flora. There are over 87,000 villages in Bangladesh and most villages have one or two practicing Kabirajas. The inescapable conclusion is that if one has to obtain a comprehensive picture of the medicinal s used by the folk medicinal practitioners, then as many Kavirajas as possible need to be interviewed to learn about the diseases treated, medicinal s used, and the formulations of their administration. Knowledge of medicinal used by the Kavirajas of Bangladesh can be a good source for further scientific studies in the quest for better drugs from the medicinal s used and with lesser side-effects (Rahmatulla et al., 2010). The objective of the present study was to conduct an ethnomedicinal survey among the Kavirajas of fourteen villages of Jhenaidah district, which lies in the South-western region of Bangladesh. METHODS AND MATERIALS Study Area The study was conducted in Jhenaidah district, the south-western part of Bangladesh. The study area is in Table 1 covers fourteen villages in Jhenaidah Sadar and Harinakundu upazilas. It was observed that Kavirajas of that area often collect their raw materials from these villages. Albeit this region is found to be a rich source of a variety of medicinal s, no systematic study conducted yet. Time and procedure of data collection Data for this study were collected through personal interview by the researchers themselves during 29 th April to 20 th June 2012 using questionnaires prepared earlier. The collection of data through interviews of Kavirajas and local people were conducted with the help of a semi-structured questionnaire and the guided field-walk method of Martin (1995) and Maundu (1995). Briefly, in this method, the Kavirajas and others took the interviewers on field-walks to Jhenaidah where

16 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January they usually collected their medicinal s, pointed out the s and described their uses. All provided information was double-checked with them in later evening sessions. Excellent cooperation was obtained from all the respondents during data collection. Identification of spices The medicinal s were identified with the help of National Herbarium, Mirpur, Dhaka- 1216, Bangladesh, where the voucher specimen has been deposited. Table 1 Studied area of different villages under Jhenaidah district SL No. Villages Unions Upazila 1 Rajapur Paglakanai JhenaidahSadar 2 Kulfadanga Mahajpur 3 Kisnopur Ganna 4 Rasnagar Kumabarai 5 Nagarpathan Kumabarai 6 Mohespur Kumabarai 7 Kusiarchar Kanchanpur 8 Kutirhat Kanchanpur 9 Charpara Raghunathpur Harinakunda 10 Porahati Raghunathpur 11 Tola Raghunathpur 12 Raghunathpur Raghunathpur 13 Mandera Raghunathpur 14 Horispur Bhayna RESULTS AND DISSCUSION Present status of medicinal species grown in study area A total of 121 medicinal s belonging to 62 families were documented from the study area. The documented medicinal s and their ethno-medicinal uses along with common name have been summarized (Table 2). Major families contributing species towards treatment of various diseases included, Apocynaceae, Combretaceae, Euphorbiaceae, Fabaceae, Moraceae, Piperaceae, and Poaceae families (Table 3). Among the selected species ethno-medicinally, the maximum contribution was recorded for herbs with 48 species (40%) followed by the trees with 39 species (32%), shrubs with 25 species (21%) and the climbers with 9 species 7% (Fig 1). Fig 1 Habit pattern of medicinal s in the study area 21% 7% 32% 40% Herb Tree Shrub Climber

17 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Serial No. Table 2 Medicinal s used for treatment of various ailments by Kavirajas of fourteen villages surveyed in Jhenaidha district, Bangladesh. Scientific Name Family Name Local Name Distri bution Part used Medicinal Uses 1 Aloe barbadensis Mill. Aloaceae Gheetokumari Herb Leaf Leaf pulp - lung disease, stomach disorders, skin burns. 2 Aegle marmelos L. Rutaceae Bel Tree Fruit Fruit pulp-diarrhoea, dysentery. 3 Acacia catechu (L. f.) Fabaceae, Khayar Tree Bark Bark powder -intestinal pain. Bark paste - skin diseases 4 Ageratum conyzoides L. Asteraceae Fulkuri Herb Whole Leaf - boils as a poultice. Leaf and stem - skin disease. Flower buds cure cancerous growth 5 Andrographis paniculata (Burm. F.) Acanthaceae Kalomegh Shrub Whole 6 Acacia nilotica L. Mimosaceae Babla Tree Whole Used in liver complaints, constipation, cholera, dysentery, diabetes. Bark-cough, bronchitis, gumsexual debility,leaf-eucoderma, gonorrhoea 7 Areca catechu L. Arecaceae Supari Tree Root Root paste-toothache. 8 Abutilon indicum L. Malvaceae Potari Shrub Whole Whole - fever, cough, piles, stones in bladder. 9 Averrhoa carambola L. Oxalidaceae Kamranga Tree Fruit Fruit pulp - Cold, cough, dandruff. 10 Artocarpus heterophyllus Moraceae Kathal Tree Gum Gum - dry cracked heels, Lam. hemorrhoids. 11 Asparagus racemosus Willd. Liliaceae Satamuli Herb Root Tuberous roots are used as aphrodisiac, alterative, tonic, and demulcent, diuretic. 12 Alstonia scholaris L. Apocynaceae Chatim Tree Bark Bark - swellings of mouth, scurvy, ulcer. 13 Anthocephalus chinensis (Lam.) Rubiaceae Kodom Tree Leaf Leaf juice - fever. 14 Azadirachta indica A. Juss Meliaceae Neem Tree Whole 15 Adhatoda vasica Nees. Acanthaceae Basak, Shrub Whole 16 Achyranthes aspera L. Amaranthaceae Apang Herb Whole Various parts of the are used in inflammation of gums, gingivitis, sores, fever, spleen complaints, tumors, smallpox. The root, bark and leaves are useful in cough, asthma. Whole used in coughs, pneumonia, piles, kidney stone and colic. 17 Abroma augusta L. f. Sterculiaceae Ulotkombol Tree Bark Bark -menstrual problems, urinary troubles. 18 Bacopa monnieri (L.) Pennel Scorphulariace Braham, Herb Whole 19 Boerhaavia diffusa L. Nyctaginaceae Punarnav, Gandhaprna Herb 20 Borassus flabellifer L. Arecaceae Tal Plam tree 21 Bambusa arundinacea (Retz.) Willd 22 Blumeala cera (Burn.f.) DC. Whole Fruit Poaceae Bans Tree Whole Asteraceae Shealmoti Herb Whole Plant juice is given orally as diuretic, cardiac tonic and memory enhancer. Root and leaf juice is effective as diuretic in anasarca and dropsy. Leaves and roots are also useful in jaundice, anaemia, ascites ophthalmia, gonorrhea. Fruit juice - coughs and pulmonary affection. stem-blood, leucoderma leafcough, cold, roots- joint pains Leaf juice-bleeding piles, bronchitis; Roots cholera. Rhizomes -dysentery

18 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Brassica nigra (L.) Koch. Brassicacee KaloSarisha Herb Seeds Seeds are emetic; powdered seeds are used as vesicant and rubefacient 24 Buettneria pilosa Roxb Sterculiaceae Harjora Climber Stem Paste of stem used in fractured bones. 25 Borreria articularis (L. F.) F. N. Will. Rubiaceae Madnabata Herb Whole Whole -inflammation of eye, diarrhoea, dysentery 26 Bombax ceiba L. Bombacaceae, Shimul Tree Root Root decoction is given as tonic, anti-dysenteric and in urinary troubles. 27 Catharanthus roseus (L.) G. Don Apocynaceae Noyontara Herb Leaf Leaf -Cancer, diabetes, fungal infection 28 Centella asiatica (L) Apiaceae, Thankoni Herb Whole 29 Calotropis gigantea (L) W.T Apocynaceae Akand, Shrub Whole 30 Canna indica L. Cannaceae Kalaboti. Herb Whole Plant-in skin diseases, leprosy, and mental disorder. Leaf juice - indigestion. Extracts of roots and leaves - abdominal tumors, boils, syphilis, leprosy, skin diseases, piles, wonds and insect-bites. Root-fevers, dropsy. Seed juice - relieves earaches. Rhizomeringworm. 31 Carica papaya L. Caricaceae Papa Shurb Latex Fever, blood dysentery. 32 Citrus limon (L.) Burm. f. Rutaceae, Labu Shurb Leaf Leaves are chewed to expel intestinal worms. 33 Capsicum frutescens L. Solanaceae KachaMorich Herb Fruit Fruit -gastric problems, ulcer. 34 Convolvulus obscurus L. Convolvulaceae Ban kalmi Climber Leaf Leaf juice - aphthous affection. 35 Coccini agrandis (L.) J. Voigt Cucurbitaceae Telakachu Climber Leaf Leaf juice -hypertension, diabetes, indigestion. 36 Carissa carandas L. Apocynaceae Koromcha Tree Fruit Fruit- Cold, cough 37 Cynodon dactylon (L.) Pers. Poaceae, Durba grass Climbers Whole Cissus ouadrangularis L. Vitaceae Harjod Shrub Whole Plant paste-cuts, wounds. Rootbleeding piles, indigestion. Plant juice-earache. Whole - bone fracture. Wound healing Cyperus rotundus L. Cyperaceae, Mutha gas Herb Tuber Tuber infusion, with sugar/salt is given orally in dysentery. 40 Dalbergia sissoo Roxb Fabaceae Shissu Tree Whole Bark and leaf juice -Diarrhoea, dysentery and gonorrhea. 41 Datura metel L. Solanaceae Dhutura Herb Whole Seeds, leaves and roots are used in insanity, fever with catarrh, diarrhoea, skin diseases and cerebra 42 Dillenia indica L. Dilleniaceae Chalta Tree Fruit Sex stimulant 43 Dendrophthoe alcata (L. f) Etting. 44 Diplazium esculentum (Retz.) Loranthaceae Manda Tree Bark Bark -Skin diseases, asthma, menstrual Problems Woodsiaceae Dhekishak shrub Leaf Fever. Leaves and stems are cooked and Eaten as vegetable. 45 Euphorbia tirucalli L. Euphorbiaceae Latadaona, Tree Stem Stem is useful in gonorrhoea, whooping cough, asthma, d, leprosy, enlarged spleen, dyspepsia.

19 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Zingiber officinale Roscoe Zingiberaceae Ada Herb Rhizome Cough, cold, fever, indigestion, and constipation, bronchial infections. 47 Eclipta prostrata L. Asteraceae Kesraj Herb Leaf Leaf juice - hair fall, bronchitis, itching, night blindness. 48 Eichhornia crassipes (M.)Solms Pontederiaceae Kochuripana Herb Whole Plant juice - fever, goiter. 49 Euphorbia antiquorum L. Euphorbiaceae Bojbaran, Shrub Latex Latex -rheumatism, toothache, nervine diseases, 50 Enhydra fluctuans Lour. Asteraceae Helencha, Herb Whole Whole -inflammation, biliousness; 51 Foeniculum vulgare Mill. Apiaceae Muhori, Herb Seeds Seed-cures eye diseases, amenorrhoea, cough and asthma. Seed oil- hook-worms 52 Ficus racemosa L. Moraceae Dumur Shrub Fruit Jaundice, diabetes. Fruits are cooked with mustard oil and taken as vegetable 53 Ficus rumphii Blume. Moraceae Ashok, Pakur Tree Bark Hematuria (passing of blood with urine).juice obtained from crushed bark is taken with honey. 54 Ficus hispida L.f. Moraceae Joggodumur Tree Fruit Fruits are taken for diabetes 55 Ficus benghalensis L. Moraceae Bot Tree Gum Kidney pain. 56 Flacourtia indica (Burm. f.) Merr. Flacourtiaceae Boichi, Tree Whole Fruits - jaundice and enlarged spleen. Bark -eczema. Root - nephritic colic. Gum - cholera 57 Foeniculum vulgare Mill. Apiaceae Pan Muhori Herb Seed Seed -diseases of the spleen, kidney, amenorrhoea, cough and asthma. 58 Gloriosa superba L. Liliaceae Karihari Climber Rhizome Rhizome paste ringworm, skin diseases. 59 Glycosmis arborea (R.) A. DC. Rutaceae Matmati Herb Whole Leaf juice ascaris, liver complaints.. Roots - low fever, 60 Gastrochilus longiflorua Wall. Zingiberaceae Shoti Herb Rhizome Rhizome - fore head to cure cataract. 61 Heliotropium indicum L. Boraginaceae Hatishur Herb Leaf Leaf juice-conjunctivitis. 62 Hemidesmus indicus (L.) R. Br. 63 Hedyotis corymbosa (L.) Link. Apocynaceae Anantamul, Shrub Root Root-leucoderma, paralysis, cough, asthma Rubiaceae Titkuipata Herb Whole Whole - jaundice, and liver complaints. 64 Hibiscus rosa sinensis L. Malvaceae Jaba Shurb Flower Flower juice - acute dysentery, hair fall. 65 Hyptis suaveolens (L.) Poit. Lamiaceae Tokma Herb Leaf Leaf paste - used in cancer and tumor 66 Ipomoea batatus (L.) Lamk. Convolvulaceae MistiAlu. Herb Whole 67 Ipomoea reptans Poir. Convolvulaceae KalmiShak. Herb Whole Whole -low fever, skin diseases. Root - strangury and diarrhoea Leaf juice -arsenic. Leaves and seeds cooling. Buds -ringworm. Flower - inflamed eyes as a drop. The root juice -diarrhoea. 68 Ixora cuneifolia Roxb. Rubiaceae Musea Shrub Leaf leaf is given in fevers 69 Ixora coccinea L. Rubiaceae Rangan Shurb Whole 70 Ipomoea mauritiana Jacq. Convolvulaceae Vuikumra Shrub Leaf Sexual disorders Root -fever, gonorrhoea, a dysentery; flower - bronchitis; leaf - diarrhoea 71 Justicia adhatoda L. Acanthaceae Asuro Shrub Leaf Leaf -treat asthma, cough. Juice of leaf is inhaled in bleeding nose.

20 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Kalanchoe pinnata (Lam.) Pers. 73 Kalanchoe pinnata (Lam.) Pers. 74 Lannea coromandelica (Houtt.) Merr. Crassulaceae Patharkuchi, Herb Leaf Leaf -bronchial affections, kidney stones, blood dysentery, gout and jaundice. Crassulaceae Heamkancha Herb Leaf Leaf juce-cold, polyuria (excessive urination), Abdominal pain. Anacardiaceae Jiga tree Bark Bark juice Diabetes. 75 Linumusi tatissimum L. Linaceae Tishi Herb seed Seed and seed oil - burns and boils. Seed poultice - rheumatic and swellings. 76 Lawsonia inermis L. Lythraceae Mehedi, Shrub Leaf The leaves are emetic, diuretic given in jaundice. 77 Leucas aspera (Willd.) Link. Lamiaceae Dulfi. Herb Whole Plants -snake insecticide. Leaf juice -psoriasis, chronic skin. 78 Lantana aculeata L. Verbenaceae Chotra Shrub Leaf Leaf juice - measles, malaria and tetanus. 79 Mimosa pudica L. Fabaceae, lajjaboti Herb Whole Leaf paste is applied on hydrocele. Leaf and root - piles. 80 Mimusop selengi L. Sapotaceae Bokul Tree Bark Coughs, toothache 81 Moringa oleifera Lam. Moringaceae Sajnagach Tree Leaf Leaf juice-diabetes, acidity, hypertension. 82 Musa sapientum L. Musaceae kola Herb Leaf Diarrhea, diabetes, blood purifier, coughs, dysentery, insect bite. 83 Menispermum cordifolium Willd. Menispermacea e Gulancha Climber Whole Whole - pimples, gonorrhoea, cough, fever, skin affections 84 Momordica charantia L. Cucurbitaceae Usta climbers Fruit Diabetes, cancer, headache, skin Disorder. 85 Mesua nagassarium (Burm. F.) Kosterm. Clusiaceae Nageshwar Herb Flower Fever. 86 Mangifera indica L. Anacardiaceae Aam Tree Leaf Diarrhea, headache 87 Nerium indicum Mill. Apocynaceae Korobi Shrub Whole Leaf - itch,.flowers- headache, scabies. Root and root barkcancer, ulcers, Roots and leaf-skin diseases and leprosy 88 Nicotiana tabacum Solanaceae Tamak, Tobacco. Herb Leaf Used for the treatment of rheumatic swellings, skin diseases. 89 Nigelia sativa L. Ranunculacee Kalojira, Herb Seeds Purgative drugs; good in cough, jaundice and piles. 90 Nyctanthes arbortristis L. Oleaceae Shefali Tree Whole Leaves - rheumatism. Bark -cures bronchitis. Flowers -lessen inflammation. Seeds -skin diseases. 91 Nymphaea nouchali. Burm. F. Nymphaeaceae Shapla Herb Whole 92 Ocimum tenuiflorum L. Lamiaceae. KaloTulsi Herb Whole 93 Opuntia elatior Mill. Cactaceae Phanimansa Shrub Whole 94 Oxalis corniculata L. Oxalidaceae Amrul Herb Whole 95 Piper betel L. Piperaceae Pan, Betel-leaf, 96 Phyllanthus acidus L. Euphorbiaceae Arboroi, Harbori,. Flower- cough, bile, vomiting, worms ; filament- pile; seed - cutaneous disease is given in fever, cough, cold, headache, nausea and skin diseases. Whole juice - whooping cough, ashma and gonorrhea Whole juice fever, anaemia. Climbers Leaf Leaf juce-sexual problems, indigestion, colic, diarrhea, headache. Tree Fruit Used in bronchitis, biliousness, urinary concretions and piles; useful in thirst, vomiting and constipation.

21 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Phyllanthus emblica L. Euphorbiaceae. Amaloki Tree Fruit Fruits decoction is given orally in shore throat and as tonic. 98 Physalis micrantha link. Solanaceae Phutka Herb Fruit Fruit -gonorrhea and spleen disorder 99 Phoenix sylvestris L. Arecaceae Khajur Palm Juice Juice gonorrhea, cough, fever. tree 100 Polygonum orientale L. Polygonaceae Bishkatali Herb Whole Whole - healing wounds. 101 Punicagra natum L. Lythraceae Dalim Shrub Bark Bark juice-dysentery. 102 Piper nigrum L. Piperaceae Golmorich Shrub Fruit Cold, jaundice, Rabies, gastric problems, ulcer, dysentery. 103 Psidium guyava L. Myrtaceae Peyara Tree Whole Fruits-diarrhea and dysentery, Young leaf extract -antibacterial and antifungal properties 104 Paederia foetida L. Rubiaceae Gondhovadal, Herb Leaf Indigestion, gout and Urinary stone. 105 Rauvolfia serpentina Benth.exKurz Apocynaceae, Sarpagandha Shrub Whole Reduce high blood pressure. Root infusion is given orally in intestinal disorders. Leaf - galactagogue, headache. Seeds paste- counter irritant. 106 Ricinus communis L. Euphorbiaceae Bherenda Shrub Whole 107 Santalum album L. Santalaceae Shetchondon Tree Stem Dysentery. Beauty 108 Shorea robusta C.F. Gaertn., Dipterocarpacea e, 109 Smilax zeylanica L. Smilacaceae Kumrakhata Climbers Whole Shal Tree Bark, Bark juice is used as eardrop in earache. Sexual problems 110 Solanum violaceum Orteg. Solanaceae Tit baegun Herb Fruit Snake bite, itches 111 Saccharum officinarum L. Poaceae Kushul, Aakh Herb Stem Indigestion. Jaundice 112 Syzygium cumini (L.) Skeels Myrtaceae Jam Tree Whole Bark, Leaf and seed powder is given orally to reduce sugar level in blood 113 Tamarindus indica L. Caesalpiniaceae Tetul, Tree Fruit Used in asthma, fever, and topically for loss of sensation in paralysis. 114 Terminalia arjuna (Roxb. ex DC.) Wight &Arn. Combretaceae Arjun Tree Bark Low sperm count, dysentery, heart Disease. 115 Terminalia belerica (Gaertn.) Roxb. 116 Terminalia chebula Retz. Combretaceae Bohera Tree Whole Combretaceae. Horitoki Tree Whole Bark juice-cut, wounds, and skin diseases. Fruits powder- cough, cold, respiratory problems. Bark - urinary problems. Fruits - cough, cold, respiratory troubles, fever. 117 Terminalia catappa L. Combretaceae. Kath badam Tree Leaf Leaf juice-skin disorder 118 Typhonium trilobatum (L.) Araceae Ghetkol Herb Whole Whole - stomach complaints Schott. 119 Vitex negundo L. Vitaceae, Nishindagach Shrub Leaf Leaf juice is given orally in cough, cold, sinusitis, fever, stomach problems. 120 Wedelia chinensis (O.) Merr. Asteraceae Kesraj Herb Leaf Leaf juice - orally in cough, cold; bark paste - applied on boils 121 Xanthium indicum Koenig. L. Asteraceae Ghagra Herb Whole Roots-cancer. Fruits cooling, demulcent. Seeds-swelling. Leaf - malaria

22 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Family Plants no Table 3: Family of the medicinal species Family Plants no Family Plants no Family Acanthaceae 3 Cactaceae 1 Linaceae 1 Polygonaceae 1 Aloaceae 1 Caricaceae 1 Lythraceae 2 Poaceae 3 Amaranthaceae 1 Combretaceae 4 Loranthaceae 1 Pontederiaceae 1 Anacardiaceae 2 Convolvulaceae 4 Malvaceae 2 Ranunculacee 1 Annonaceae 1 Crassulaceae 1 Menispermaceae 1 Rubiaceae 6 Apocynaceae 7 Cucurbitaceae 2 Meliaceae 1 Rutaceae 3 Araceae 2 Cyperaceae 1 Mimosaceae 1 Sapotaceae 1 Arecaceae 3 Clusiaceae 1 Moraceae 5 Scorphulariaceae 2 Apiaceae 2 Cannaceae 1 Moringaceae 1 Solanaceae 5 Vitaceae 2 Dilleniaceae 1 Musaceae 1 Sterculiaceae 1 Woodsiaceae 1 Dipterocarpaceae 1 Myrtaceae 2 Santalaceae 1 Asteraceae 6 Euphorbiaceae 5 Nymphaeaceae 1 Smilacaceae 1 Brassicaceae 1 Fabaceae 3 Nyctaginaceae 1 Verbenaceae 1 Bombacaceae 1 Flacourtiaceae 1 Oleaceae 1 Zingiberaceae 2 Boraginaceae 1 Lamiaceae 3 Oxalidaceae 2 Caesalpiniaceae 1 Liliaceae 2 Piperaceae 2 Plants no Sources of medicinal The study was reported in Table 4 that 58.6% of the respondents collected different medicinal s species from fallow land and road side. This is naturally grown. On the other hand, 20.7%, 13.8%, and 6.7% of the respondents collected medicinal s from local market, vesoj nursery sources and neighbor s house, respectively. Medicinal value of different species Among the selected species, parts used wise contribution was maximum for whole with 46 species (38%) followed by the leaf with 26 species (22%), fruit with 15 species (12%), bark with 10 species (8%), seeds with 5 species (4%), root and stem with 4 species (3%), rhizome with 3 species (2%), gum, latex and flower with 2 species (2%), juice and tuber with 1 species 1% respectively (Fig 2). Ornamental with 25 species (21%), fruit with 23 species (19%) and timber with 22 species (18%) were documented (Fig 3). Use of medicinal s against different diseases The medicinal s were reported to be effective against diarrhea, cough and cold, skin diseases, cuts and wounds, joint pain, headache, consumption, eye disorders, antidote for harmful insect bites, stomach disorders, urinary troubles, liver complaints, digestive problems, jaundice, asthma, bronchitis, inflammations, anemia, piles, mental disorder, abdominal pain, bone fracture, paralysis, impotency, indigestion, cancer, general weakness, skin burns, diabetes, fungal infection, gonorrhoea, gastric problems, sexual disorders, syphilis, leprosy, wounds and insectbites by the responding Kavirajas and local inhabitants. However, various parts from the same were observed to be used to treat different diseases. A single part also would be used for treatment of multiple diseases. For example, Seeds of Datura metel L. are used to treat skin rashes, ulcers, bronchitis, jaundice and diabetes (Khaton and Shaik, 2012).To cite one instance of each, the bark of Lannea coromandelica was used for treatment of diabetes. The barks of Mangifera indica were used for treatment of diarrhea, while young leaves of the same were used for treatment of headache. The leaves of Aloe barbadensis were used for treatment of two highly different ailments like dysuria and constipation. Paste of leaves of Glycosmis arborea with ginger is used in eczema and skin affections. Leaf juice of Nyctanthes arbortristis with honey the juice is given in chronic

23 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January fever. The anti-diabetic activities of whole s or parts of Catharanthus roseus, Ficus racemosa, Moringa oleifera, Musa sapientum, and Syzygium cumini have also been reported which goes very well with previous surveys conducted by Rasineni et al., 2010; Islam et al., 2009; Hafizur et al., 2011; Sangsuwan et al., 2004; Ahmed and Urooj, 2010; Jaiswal et al., 2009; Adewoye et al., 2009; Pandey and Khan, The scientific validation of medicinal usage by the Kavirajas that could be helpful to modern science for extensive investigation of the s used. Table 4 Sources of ing materials of medicinal species Sources Respondent Percentage (%) Rank No. Fallow land and road side Local market Vesojnursery Neighbors house Fig 2 Useable parts of medicinal in this area 3% 8% 3% 2% 4% 12% 2% 2% 2%1% 1% 22% 38% Whole Leaf Fruit Bark Seed Root Stem Rhizome Gum Latex Fig 3 Different medicinal species in this area

24 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January % 21% Ornamental Fruit Timber 19% Threatened medicinal species It is identified that 28 medicinal s which are under threat now in Bangladesh. In the study area, we found amloki, arjun, helencha, mander, shefali, lajjaboti, kathbadam hatishur and bel are likely to be threatened. CONCLUSIONS There were many important medicinal species available in the study area and these could be promising source of manufacturing modern medicine in Bangladesh and source of income generation to the rural households. The common people were found to encourage using medicinal s for ailments of common and frequently caused illnesses, especially for fever, cough, pain, catarrh etc. This was mainly because of awareness created among the farmers on the value of medicinal s for their livelihood and its impact on biodiversity conservation. Finally, it can be concluded that timely availability of native medicinal species, development of rural and community based resources could be useful for restoring the eco-biodiversity processes and for generating income for resource poor farmers and village practitioners. REFERENCES Adewoye EO, Taiwo VO, Olayioye FA (2009). Anti-oxidant and anti-hyperglycemic activities of Musa sapientum root extracts in alloxan-induced diabetic rats. Af. J. Medicine Med. Sci. 38: Ahmed F, Urooj A (2010). In vitro studies on the hypoglycemic potential of Ficus racemosa stem bark. J. Sci. Food Agri. 90: Balick JM, Cox PA (1996). Plants, People and Culture: the Science of Ethnobotany, Scientific American Library, New York. pp Comer M, Debus E (1996). A partnership: Biotechnology, biopharmaceuticals and biodiversity. In. Biodiversity. Science and development. (Di Castri, F. and Younnes, T. eds.), CAB International, Oxford, pp Dhar U, Rawal RS, Samant SS, Airi S, Upreti J (1999). People s participation in Himalayan biodiversity conservation: a practical approach. Current Sci. 76: Farnsworth NR, Soejarto DD (1991). Global importance of medicinal s. In The conservation of medicinal s (ed. O.

25 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Akerele, V. Heywood and H. Synge). Cambridge University Press, Cambridge, UK. pp Gilani AH, Rahman AU (2005).Trends in ethnopharmacology. J. Indian Medicinal Plants with active principles. Part-1 (A- K), CSIR, New Delhi, India. Hafizur RM, Kabir N, Chisti S (2011). Modulation of pancreatic _-cells in neonatally streptozotocininduced type 2 diabetic rats by the ethanolic extract of Momordica charantia fruit pulp. Natural Product Res. 25: Hasan MM, Annay MEA, Sintaha M, Khaleque HN, Noor FA, Nahar A, Seraj S, Jahan R, Chowdhury MH, Rahmatullah M (2010). A survey of medicinal usage by folk medicinal practitioners in seven villages of Ishwardi Upazilla, Pabna district, Bangladesh. Ame. Eur. J. Sust. Agri.. 4: Hossan MS, Hanif A, Agarwala B, Sarwar MS, Karim M, Rahman MT, Jahan R, Rahmatullah M (2010). Traditional use of medicinal s in Bangladesh to treat urinary tract infections and sexually transmitted diseases. Ethnobotany Res. Applications. 8: Islam MA, Akhtar MA, Khan MR, Hossain MS, Alam AH, Ibne-Wahed MI, Amran MS, Rahman BM, Ahmed M (2009). Oral glucose tolerance test (OGTT) in normal control and glucose induced hyperglycemic rats with Coccinia cordifolia L. and Catharanthus roseus L. Pak. J. Pharma. Sci. 22: Jahan FI, Hasan MRU, Jahan R, Seraj S, Chowdhury AR, Islam MT, Khatun Z, Rahmatullah M (2011). A Comparison of Medicinal Plant Usage by Folk Medicinal Practitioners of two Adjoining Villages in Lalmonirhat district, Bangladesh. Ame. Eur. J. Sust. Agri. 5(1): Jaiswal D, Kumar R, Kumar A, Mehta S, Watal G (2009). Effect of Moringa oleifera Lam. Leaves aqueous extract therapy on hyperglycemic rats. J. Ethnopharmacol. 123: Khaton M M and Shaik M M (2012). Review on Datura metel L.: A Potential Medicinal Plant. Global J Res. Med. Plants & Indigen. Med.1 (4): Martin GJ (1995). Ethnobotany: a People and Plants Conservation Manual, Chapman and Hall, London. pp: 268. Maundu P (1995). Methodology for collecting and sharing indigenous knowledge: a case study. Indigenous Knowledge and Development Monitor. 3: 3 5. Mollik MAH, Hassan AI, Paul TK, Sintaha M, Khaleque HN, Noor FA, Nahar A, Seraj S, Jahan R, Chowdhury MH, Rahmatullah M (2010b). A survey of medicinal usage by folk medicinal practitioners in two villages by the Rupsha River in Bagerhat district, Bangladesh. Ame. Eur. J. Sust. Agri. 4: Mollik MAH, Hossan MS, Paul AK, Rahman MT, Jahan R, Rahmatullah M (2010a). A comparative analysis of medicinal s used by folk medicinal healers in three districts of Bangladesh and inquiry as to mode of selection of medicinal s. Ethnobotany Res. Applications. 8: Nawaz AHMM, Hossain M, Karim M, Khan M, Jahan R, Rahmatullah M (2009).An ethnobotanical survey of Rajshahi district in Rajshahi division, Bangladesh. Ame. Eur. J. Sust. Agri. 3: Pandey M, Khan A (2002). Hypoglycaemic effect of defatted seeds and water soluble fibre from the seeds of Syzygium cumini (Linn.) Skeels in

26 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January alloxan diabetic rats. Ind. J. Experimental Biology. 40: Pei Shengji (2001). Ethnobotanical approaches of traditional medicine studies: some experiences from Asia. Pharma. Botany. 39: Rahmatullah M, Azam KNM, Mollik MAH, Hasan MM, Hassan AI, Jahan R, Jamal F, Nasrin D, Ahmed R, Rahman MM, Khatun A (2010). Medicinal s used by the Kavirajas of DaulatdiaGhat, Kushtia district, Bangladesh. Ame-Eur. J. Sust. Agri. 4: Rahmatullah M, Ferdausi D, Mollik MAH, Azam MNK, Rahman MT, Jahan R (2009a). Ethnomedicinal Survey of Bheramara Area in Kushtia District, Bangladesh. Ame. Eur. J. Sust. Agri. 3: Rahmatullah M, Ferdausi D, Mollik MAH, Jahan R, Chowdhury MH, Haque WM (2010a). A Survey of Medicinal Plants used by Kavirajas of Chalna area, Khulna District, Bangladesh. Afr. J. Trade.Complemen. Alternative Med. 7: Rahmatullah M, Khatun MA, Morshed N, Neogi PK, Khan SUA, Hossan MS, Mahal MJ, Jahan R (2010b). A randomized survey of medicinal s used by folk medicinal healers of Sylhet Division, Bangladesh. Advan. Natural Appl. Sci. 4: Rahmatullah M, Noman A, Hossan MS, Rashid MH, Rahman T, Chowdhury MH, Jahan R (2009b). A survey of medicinal s in two areas of Dinajpur district, Bangladesh including s which can be used as functional foods. Ame. Eur. J. Sust. Agri. 3: Rasineni K, Bellamkonda R, Singareddy SR, Desireddy S (2010). Antihyperglycemic activity of Catharanthus roseus leaf powder in streptozotocin-induced diabetic rats. Pharmacognosy Res. 2: Rawat RBS, Uniyal RC (2004). National Medicinal Plants Board, Committed for overall development of the sector. Agrobios.1: Sangsuwan C, Udompanthurak S, Vannasaeng S, Thamlikitkul V (2004). Randomized controlled trial of Tinospora crispa for additional therapy in patients with type 2 diabetes mellitus. J. Med. Association Thai. 87: Source of Support: Nil Conflict of Interest: None Declared

27 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January ISSN International, Peer reviewed, Open access, Monthly Online Journal Review article THE ROLE OF PANCHAKARMA THERAPY IN MUSCULOSKELETAL DISORDERS WITH SPECIAL REFERENCE TO VATAVYADHI Dass Ranjip Kumar 1 * 1 Assistant Professor, Dept. of Panchakarma, M.S.M. Institute of Ayurveda, B.P.S. Mahila Vishwavidyalaya, Khanpur Kalan, Sonipat (Haryana) *Corresponding Author: drranjipayu@yahoo.co.in ABSTRACT Received: 01/11/2012; Revised: 25/12/2012; Accepted: 31/12/2012 The collective meaning of Vatavyadhi indicates the specific disorders occurring due to the Vata Dosha. Due to various etiological factors, Whenever Vata Dosha (the humor called Vata in Ayurveda) gets vitiated it at first enters in all Srotases (the empty channels) of the body and then creates different types of Vata disorders described in classical Ayurvedic texts including Musculoskeletal disorders like Ardita (Facial Paralysis), Pakshaghata (Hemiplegia), Mansa Shosa/Kshaya (Muscular Dystrophy), Joint Disorders (SandhiVata, AmaVata, Vatarakta etc.), Asthi Shosa/Kshaya (Osteoporosis.), Myopathy etc. But when it is obstructed (Avrita) by various Dhatus, then mainly Mansa, Meda & Asthi Dhatus (various tissues) are affected as they are the main constituents of our body & the chief sites of Vata Dosha. As a result of these, Dhatu Kshaya (Degeneration of Skeletal & Muscle tissue) occurs, by which Nervous tissues supplying the affected parts lack proper nutrition & gets deactivated. This Pathophysiology leads to Musculoskeletal Disorders. The classical treatments in Musculoskeletal disorders, like various Panchakarma (five purification procedures in Ayurveda) therapies preceded by Snehana & Swedana which are used for relaxation as well as giving tone to the muscles & for promoting the blood circulation and Mriduvirechana with various Basti Karmas are very much beneficial which pacifies the provoked Vata Dosha, increases strength of the person, maintains health & longevity. An attempt has been made to review the treatment procedures in Ayurveda with reference to Vatavyadhi. KEY WORDS: Vatavyadhi, Musculoskeletal Disorders, Sanshodhana, Snehena, Swedana Cite this article Dass Ranjip Kumar (2013), THE ROLE OF PANCHAKARMA THERAPY IN MUSCULOSKELETAL DISORDERS WITH SPECIAL REFERENCE TO VATAVYADHI, Global J Res. Med. Plants & Indigen. Med., Volume 2(1): 23 29

28 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January INTRODUCTION Ayurveda is entitled as a Divine science due to its origin as well as its unimaginable potency in curing the diseases and protecting the health of a healthy person, physically and mentally. Even centuries after its golden period, Ayurveda continues to play a major role in maintaining the health status of majority of Indians and some sections of people of many other countries. The world is recognizing Ayurveda as a system which can become a universal health care system in treating a number of diseases which has minimal treatment options in the contemporary sciences. (Sudev C et al., 2012). The word Vatavyadhi has been composed from the different words Vata and Vyadhi. Vata is considered to be the most powerful and active amongst the three Doshas. As we know that Pitta Pangu Kapha Pangu Pangavo Mala Dhatavah Vayuna Yatra Niyante Tatra Gachhanti Meghavat (Sha.Pu.5/25) Vayu is the main element of body among 3 Doshas which give support to the body & controls all the activities of body. Pitta, Kapha, Mala & Dhatus are functionless without Vata. That means it motivates & controls all other Doshas, Dhatus & Malas. It has also predominant influence on the 3 principal routes of diseases namely as Sakha, Kostha & MarmAsthisandhi. Moreover Vayu is responsible for the formation, communication & spread of Sweda, Mala, Mutra, Kapha & other biological substances in the body. It increases the strength of muscles & maintains health and longevity. Although the entire body is the dwelling of three Dosha Vata, Pitta and Kapha, but the prime importance has been given to Vata due to its capacity to move in the entire body without help of other Doshas. To explore the supremacy of Vata, it has been mentioned that Vayu is life and vitality; Vayu is the supporter of all embodied beings; Vayu is verily the whole universe and Vayu is the lord of all. Thus is Vayu extolled (Charaka, 200 BC). By this reference, it is clear that Vayu is the main factor, which is responsible for the healthy and diseased status of the individual. Pitta and Kapha have also a capacity to disturb the normal state of the health, but they are crippling without the support of Vata. Due to the higher efficacy, Vata can produce eighty types of defects and derangements in the body. The word Vyadhi i.e. Disorder is suggestive of circumstances in which body and mind both are in distress. In this way the collective meaning of Vatavyadhi indicates the specific disorders occurring due to the Vata Dosha. While commenting on the word Vatavyadhi Chakrapani (the commentator on Charaka Samhita) has given two definitions of it. Vata Eva Vyadhi Vatavyadhih. Which means Vata, itself disordered and combined with particular Dushyas attains the form of generalized or localized affections and because of producing pain it is called as Vatavyadhi. Vataat Vyadhi Vatavyadhi. It means that Vata Dosha causes the disease by particular pathogenesis in which particular type of Dosha Dushya Sammurcchana (the pathological derangement of the 3 Humors & Tissue elements in the body) leads to the particular disease. To distinguish the Vatavyadhi from Samanya Vyadhi, it has been mentioned that though diseases like Jvara etc., are also caused by Vata, the role of Pitta and Kapha in causing Jvara can never be ruled out and hence it can not be called a Vata Vyadhi (Chakrapani, 12 th Cent. AD). Whereas Vatavyadhi cannot be manifestated until and unless Vata is involved and this type of diseases of Vata are known as Nanatmaja disorders of Vata (80 types). The exact meaning of the word Vatavyadhi is Vata Eva Vyadhi. It indicates that Vata itself is a disease (Vijayraksita on Madhav Nidnana, 11 th AD). Hence no one can be considered as healthy because Vayu has been called life and vitality (Charaka, 200 BC). The other definition Vatat Vyadhi Vatavyadhi, is also not suitable because according to this definition all the diseases in which Vata plays a major role as one of the causative factors may be included under the Vatavyadhi. Then there is no importance

29 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January remains of the separate description of Vatavyadhi. Vijayraksita has explained his own thought about the meaning of Vatavyadhi just after discussing on Chakrapani s definitions of Vatavyadhi. He explained that Vata Janito Asadharana Vyadhi Vatavyadhi, means specific diseases caused by vitiated Vata are known as Vatavyadhi. This definition seems to be correct because of its specificity and differentiality from other Samanya diseases of Vata (Vijayraksita on Madhav Nidan. Vata Vyadhi,11 th AD). Pathogenesis of Vatavyadhi Dehe Srotansi Riktani Purayitwa Anilo Bali Karoti Vividhan Vyadhin Sarvangaikanga Sansritan (Charaka, 200 BC) Due to Vata Prakopaka, Nidan Sevana, Whenever Vata Dosha vitiates it at first enters in all the empty channels (Srotas) of the body and then creates different types of Ekangagata (local) & Sarvangagata (general), a total 80 types of Vata disorders described by classics including Musculoskeletal disorders like Ardita (Facial Paralysis), Pakshaghata (Hemiplegia), Mansa Shosa/Kshaya (Muscular Dystrophy), Joint Disorders (SandhiVata, AmaVata, Vatarakta etc.), Asthi Shosa/Kshaya (Osteoporosis.), Myopathy etc. Pathogenesis of MSD When Vata Dosha is more provoked & obstructed (Avrita) by Rasa, Raktadi Dhatus, then mainly Mansa, Meda & Asthi Dhatus are affected as they are the main constituents of our body (As the body of human being is mainly supported by skeletons & muscles, which are the chief sites of Vata Dosha. As a result of this, Asthi, Meda & Mansa Dhatu Kshaya (Degeneration of Skeletal & Muscle tissue) occurs, by which Nervous tissues supplying to that affected parts lacks proper nutrition & gets deactivated. This Pathophysiology leads to Musculoskeletal Disorders. According to Modern Medical Science, disorders pertaining to both muscle & skeletal tissue are known as Musculoskeletal Disorders (Harrison, Principals of Internal Medicine, 2003). One should determine whether the Musculoskeletal complaint is (1) articular or nonarticular in origin, (2) inflammatory or noninflammatory in nature, (3) acute or chronic in duration, and (4) localized or widespread (systemic) in distribution. 1) Articular disorders may be characterized by deep or diffuse joint pain, limited range of motion on active and passive movement, swelling caused by synovial proliferation or effusion or bony enlargement, crepitation, instability, locking, or deformity. 2) By contrast, Non-articular disorders tend to be painful on active but not passive range of motion, demonstrate point or focal tenderness in regions distinct from articular structures, and have physical findings remote from the joint capsule. Moreover, Non-articular disorders seldom demonstrate crepitus, instability, deformity, or swelling. 3) Inflammatory disorders may be identified by the presence of some or all of the four cardinal signs of inflammation (erythema, warmth, pain &swelling), by systemic symptoms (Prolonged morning stiffness, fatigue, fever, weight loss) or by laboratory evidence of inflammation (Elevated ESR or C-reactive protein level, thrombocytosis, anemia of chronic disease, or hypoalbuminemia). 4) Non-inflammatory disorders may be related to trauma (rotator cuff tear), ineffective repair (osteoarthritis), cellular overgrowth (pigmented villo-nodular synovitis), or pain amplification (fibromyalgia). They are often characterized by pain without swelling or warmth, the absence of inflammatory or systemic features, little or no morning stiffness, and normal laboratory findings. In this way Individuals with Musculoskeletal complaints should be evaluated in a uniform, logical manner by means of a thorough history, a comprehensive physical examination, and if appropriate, laboratory testing. With such an approach and an understanding of the pathophysiologic

30 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January processes that underlie Musculoskeletal complaints, an adequate diagnosis can be made in the vast majority of individuals. However, some patients will not fit immediately into an established diagnostic category. Many Musculoskeletal Disorders resemble each other at the outset, and some take weeks or months to evolve into a readily recognizable diagnostic entity. This consideration should temper the desire always to establish a definitive diagnosis at the first encounter (Harrison, 2003). Panchakarma Therapy for Vatavyadhi w.s.r. to Musculo Skeletal Disorders The exposition of the line of treatment of the diseases due to the provocation of Vata has been given in all the major Ayurvedic texts. Ayurveda makes a unique approach to cure. The Ayurvedic Cure is a 2 fold strategy comprising of 1) Samsodhana (or Biopurification) by Pancha Karma & related measures and 2) Samsamana (or Palliation) of imbalances by appropriately planned diet, drug, & life style interventions. The Ayurvedic Classics describe the full range of therapeutics through Sadupakarmas (Six major treatment categories) consisting of Langhana Brimhana, Rukshana Snehana, Swedan - Stambhana. This classic scheme incorporates both Samsodhana & Samsamana and the popular Panchakarma Therapy is an offshoot of the same. But the diseases as prevalent today manifest themselves in such a complex manner that it becomes difficult to treat them by merely administering palliative treatment or Shamana therapy. It has been specially mentioned that the diseases/ Doshas controlled by Samsamana Therapy have the possibilities of re-provoking while there is no such probability in the eventuality of the control of Disease /Doshas treated by Samsodhana Therapy (Panchakarma Therapy) (Charaka, 200 BC). Here, the general line of treatment mentioned for Vata disorders in relation to Musculoskeletal disorders are being described, (According to Charaka & Astanga Hridaya), viz:- Snehana (Oleation Therapy) : Depending upon the application of Snehana, it can be divided into 2 types, viz: 1) Abhyantara Snehana (Internal Oleation) & 2) Bahya Snehana (External Oleation or Massage). If there is a simple provocation of Vata without any Upastambha or Avarana, it should be treated at first with oral administration of unctuous preparations such as Ghrta, Tailaa, Vasa and Majja. The person, when overstrained by the Snehana should be comforted and again Snehana should be done with milk. Further he should be treated with Oleated Yusas, meat juices of domestic, wet land and aquatic animals mixed with unctuous articles. Preparations of milk and Krisara may be given for eating. Patient should be administered with Anuvasana Basti having Amla and Lavana Rasa, Snigdha Nasyas and Tarpanas (Charaka, 200 BC). But when Vata Dosha is more provoked & obstructed (Avrita) by Rasa, Raktadi Dhatus, then in this case External Oleation or Massage therapy should be applied which is used for relaxation as well as giving tone to the muscles, for promoting the blood circulation & treating various musculoskeletal disorders. It improves the quality of skin, making it tender, delicate & strong. Again Massage therapy is of 14 types described in the classics at various places viz. 1) Abhyanga 2) Lepa 3) Udvartana 4) Mardana 5) Padaghata 6) Pariseka 7) Samvahana 8) Gandusha & Kavala Graha 9) Murdha Taila Shira Tarpana (Shiro-Abhyanga, Shirah Seka, Sirah Pichu & Shiro-Vasti) 10) Akshi Tarpana 11) Nasa Tarpana 12) Karna Purana 13) Mastikya 14) Snehavagahana (Oil Bath). For any types of Musculoskeletal Disorders Particularly Udvartana by Yava, Masa, Masura etc.coarse powder, Abhyanga (Massage) by Bala Taila, Dasamula Taila, Narayana Taila, Kshirabala Taila & Sahacharadi Taila, Lepa by Nirgundi (Vitex nigundo) Patra, Dhatura (Datura metel) Patra & Arka (Calotropis procera) Patra kalka (Paste), Mardana (Massage with pressure) by above oils (Which removes the fatigue of muscles, relieves myalgia & neuralgia), Snehavagahana (Tub

31 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Bath) by Bala taila, Pariseka by Taila, Milk or Mansa rasa etc., Siro-vasti & Sirodhara by Tila & Bala Taila, Siro Lepa by Amalaki Kalka are being practiced. Swedana (Sudation Therapy) after Snehana: When patient becomes well oleated with Snehana therapy he should be given Svedana treatment. After Abhyanga the patient may be subjected to the suitable type of Sveda like Nadi Sveda, Prastara Sveda, Samkara Sveda etc., in which unctuous articles should be mixed (Tripathi Brahmanand, Hindi commentary on Charaka Samhita, 1999). It relieves stiffness, heaviness & coldness of the body and liquefy the Snigdha vitiated Doshas (Brought about by Snehana Karma) which are spread throughout the body. As a result of this, the vitiated Doshas are made easily eradicable in the form of induction of sweating or with the help of Pradhana Karma such as Vamana, Virechana, Basti etc. Acharya Charaka has mentioned that Swedana therapy is the best treatment for vitiated Vata & Kapha dominant diseases (Charaka, 200BC). The Svedana procedures should be repeatedly administered in order that the disorders of Vata may not stay in the Kostha softened by Snehana procedure (Tripathi Brahmanand, Hindi commentary on Charaka Samhita, 1999). Various types of Swedan Karma like Nadi sweda, Baspa sweda by using the decoction of Dashamula (Roots of ten drugs), Balamula (Sida cordifolia) & Eranda (Ricinus communis) mula (Roots), Patrapinda sweda by using Nirgundi (Vitex nigundo) Patra (Leaves), Sastika Shali Pindasweda by using the decoction of Bala (Sida cordifolia) & Milk and Pizhichil are practiced for any types of Musculoskeletal disorders. Samsodhana (Panchakarma Therapy): - If due to excessive morbidity, the humors (i.e. Vata Dosha) do not subside with the above procedures, Samsodhana is to be given by mild drugs mixed with unctuous articles. Mriduvirechana (Mild Purgation):- For this purpose the patient may take the medicated Ghee prepared with Tilvaka or Saatala or he may take Eranda Taila mixed with milk, which are beneficial to expel the morbid humors (Tripathi Brahmanand, Hindi commentary on Charaka Samhita, 1999). By excessive use of Snigdha, Amla, Lavana and Usna etc. articles of diet, the Mala i.e. excretotary matter gets accumulated and by occluding the various Srotas, cause obstruction to the path of Vata; hence the Anulomana of Vata is essential to expel it out (Charaka, 200 BC) & it is possible by giving Virechana. Basti (Therapeutic Enemata):- The patient, who is debilitated and as a consequence, in whom Virechana is contraindicated, should be given Niruha Basti. He should be administered with the diet having Dipana and Pachana drugs (Tripathi Brahmanand, Hindi commentary on Charaka Samhita, 1999). Basti is considered as the most useful therapeutic procedures in which medicated oils, decoctions, decoctions with Milk, Mansa Rasa or paste of herbs or oils or ghee are introduced into the large intestines through rectum with the help of Basti Yantra (Enema Apparatus). Basti produces Sodhana of Doshas, Samsamana of the diseases, Mala Sangrahana, Increases Shukra in Shukrakshina patients and if the patient is Sthula (Obese), he will become Krisa (Weak) & vice versa after administration of Basti therapy. Basti increases strength of the persons in whom it is advocated, maintains health & longevity. Basti is the best chikitsa (treatment) for Vata Doshas, so also for Pitta, Kapha, Rakta in Sansarga & Sannipata Doshas. Thus Basti produces extensive benefits to each & every part of the body. Since the Basti has the capacity to eradicate most of diseases occurring in Sakha, Kostha & Marma Sthana, it is referred to as Half of the whole treatment and sometimes a Complete treatment (Charaka, 200BC).

32 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Basically Basti is of two types, viz. 1) Anuvasana Basti (By medicated oil) 2) Niruha Basti (By decoctions of drugs indicated). Both types of Bastis are indicated for many types of Vata disorders. Here Anuvasana Basti in the form of Sneha Basti (6 Pala), Anuvasana Basti (3 Pala) & Matra Basti (11/2 Pala) by Bala Taila is used for any types of Musculoskeletal disorders (Like SandhiVata, Gridhrasi, Katishula etc.). It can be administered daily without producing any complications in the body (Sushruta, 2000 BC). Various Niruha Bastis like different Yapana Bastis (Mustadi Yapana Basti, Baladi Yapana Basti, Dwitiya Baladi Yapana Basti & Tritiya Baladi Yapana Basti) for Mansa Shosa/Kshaya (Muscular Dystrophy), Madhutailaika Basti & Dasamula Niruha Basti for all types of Musculoskeletal disorders, Panchatikta Kshira Basti for Ankylosis Spondylosis & AmaVata, Vaitarana Basti for AmaVata & Dasamula Kshara Basti for AmaVata are commonly used in Panchakarma. In most of occasions, a combination of both these types of Bastis (Both Anuvasana & Niruha) is given in the form of Karma Basti (30 Number), Kala Basti (16 Number) & Yoga Basti (8 Number) except for fewer specific indications where single or continued use of one or the other type of these two Bastis is indicated. Some specific types of Basti like Kati Basti, Urah Basti, Janu Basti by Bala Taila, Mahavisagarbha Taila, Sahacharadi Taila, Kubja Prasarini Taila & Panchaguna Taila for Musculoskeletal complaints of specific part of the body are also practiced. In some cases of Musculoskeletal disorders like Ardita (Facial Paralysis), Pakshaghata (Hemiplegia), Ekangaghata (Monoplegia), Adharangaghata (Paraplegia) & Dhanustambha (Tetanus), Nasya Karma by different method like by medicated oil (Anu Taila, Brahmi Grhita etc.), by powder Katphal (Myrica esculenta), Haridra (Curcuma longa) etc.) & by Dhumapana, Shirodhara by medicated oil, Takra, Dhanyamla etc. and ShiroBasti by Bala oil, Jyotismati oil, Himasagar oil etc. are commonly used. In all these Panchakarma Therapy, Snehana & Swedana procedures are done repeatedly as Purvakarma (pre-operative procedures). DISCUSSIONS & CONCLUSIONS When Vata Dosha is get vitiated & obstructed by various Dhatus, then especially the skeletal and muscular tissues are more affected as these are the chief sites of Vata Dosha. As a result of this, Degeneration of Skeletal & Muscle tissue is occurred. This pathogenesis leads to deactivation of Nervous tissues supplied to those affected parts. In this way the Pathophysiology of Vatavyadhi leads to Musculo-skeletal Disorders according to Modern Medical Science. Now-a-days no any permenent solutions of these cases of Musculoskeletal disorders has invented yet in Modern Medical Science. But the Ayurvedic Classics describe the full range of therapeutics through various Panchakarma Therapies to eradicate these complaints like Snehana & Swedana which are used for relaxation as well as giving tone to the muscles & for promoting the blood circulation and Mriduvirechana with various Basti Karmas are very much beneficial which eradicates the provoked Vata Doshas, increases strength of the persons, maintains health & longevity. Various research work has also been done on Vatavyadhi with special reference to Muskulo-skeletal disorders in various research institution of India, where it can be concluded that Panchakarma Chikitsa has a major role to eradicate any types of Musculo-skeletal Disorder.

33 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January REFERENCES Charaka, (200 BC), Charaka Chandrika Hindi Commentary by Tripathi Brahmanand on Charaka Samhita, 6 th Edition, Chaukhambha Surbharati Prakashan; 1999, Varanasi, Vol.I & II.: Ch. Su. 14, 16; Ch. Si. 1; Ch.Chi. 28 Harrison: Principals of Internal Medicine, 15 th edition CD-ROM (International edition), 2003, Section-3, PP: 320 Sudev C, Suresh R D (2012), A clinical study on Gokshuradi churna in the management of Oligospermia, Global J Res. Med. s & Indigen. Med. 1(1):11 19 Sushrut, (2000 BC) Ayurveda-Tattva- Sandipika Hindi Commentary by Shastri Kaviraja Ambikadutta, Sushruta Samhita, 11 th Edition, Chaukhambha Sanskrit Sansthan; 1997, Varanasi,, Vol. I Su.Ch.35/18, PP: 154 Tripathi Brahmanand (1999), Charaka Chandrika Hindi Commentary on Charaka Samhita, 6 th Edition, Chaukhambha Surbharati Prakashan; 1999, Varanasi, Vol. II.: Ch.Chi.28 Source of Support: Nil Conflict of Interest: None Declared

34 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January ISSN International, Peer reviewed, Open access, Monthly Online Journal Research article A CLINICAL STUDY TO COMPARE VIRECHANA AND JALAUKAVACHARANA PROCEDURES IN THE MANAGEMENT OF VICHARCHIKA Dass Ranjip Kumar¹, Nayak Annada Prasad²* ¹ Assistant Professor, Dept. of Panchakarma, M.S.M. Institute of Ayurveda, B.P.S. Mahila Vishwa vidyalaya, Khanpur Kalan, Sonipat, Haryana, India ² Assistant Professor, Dept. of Kayachikitsa, M.S.M. Institute of Ayurveda, B.P.S. Mahila Vishwa vidyalaya, Khanpur Kalan, Sonipat, Haryana, India *Corresponding Author: vd_apnayak@rediffmail.com ABSTRACT Received: 10/12/2012; Revised: 27/12/2012; Accepted: 03/01/2013 Now-a-days, Vicharchika (one among 11 types of mild skin diseases as per Ayurveda) has become one of the prime skin diseases at general O.P.D. level due to offensive diet habits, fast life style, industrial and occupational hazard, repeated use of chemical additives etc. Ayurveda has a lot to offer in this regard since times immemorial. Virechana (Purgation) is the chiefly advocated, purificatory measure in this disease and so it was taken in the present study for treatment purpose. Considering Rakta dushti (vitiation of blood) in all types of skin diseases, Jalaukavacharana (bloodletting by Leech) provides excellent results by its ideal method to expel out the vitiated blood safely, quickly and effectively. In this study total 28 patients were randomly distributed into two groups, as Group A, where the patients were given Virechana (purgation) by classical method followed by Gandhaka Rasayana (an Ayurveda medicine prepared from purified Sulphur) for 1 month and Group B, where the patients were given four sittings of Jalaukavacharana for 1 month followed by Gandhaka Rasayana for 1 month. It was concluded that although Virechana (purgation) has provided significant relief in the symptoms of Vicharchika yet, Jalaukavacharana (bloodletting by Leech) has provided relatively better relief in most of the symptoms. KEY WORDS: Virechana (purgation), Jalaukavacharana Karma (bloodletting by Leech), Vicharchika (one among 11 types of mild skin diseases as per Ayurveda), Shamana drug (Palliation drugs) Cite this article: Dass Ranjip K, Nayak A P (2013), A CLINICAL STUDY TO COMPARE VIRECHANA AND JALAUKAVACHARANA PROCEDURES IN THE MANAGEMENT OF VICHARCHIKA, Global J Res. Med. Plants & Indigen. Med., Volume 2(1): 30 39

35 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January INTRODUCTION The skin is a highly complex organ which plays vital role in the body s general functioning. Skin is described as an ornament of the body in classics. The study of Indian medical classics reveals that all skin diseases were described under the broad heading of Kushtha (Skin diseases). According to Vagbhattaa(who wrote astanga hridaya), Kushtha (skin disease) (Vagbhatta, 4 th AD) is a disease which involves breakage in the charm of skin. Sushruta (who wrote Susruta sahmita) has described Vicharchika (one among 11 types of mild skin diseases as per Ayurveda) as one of the Kshudra Kustha (11 mild skin diseases) (Susruta, 2000 BC). The Vicharchika simulate with Eczema. It is one of the blazing problems in the society as accurate medicament is not available to treat the disease and to control its reappearance. The Shodhana (Purification) therapy and Shamana (palliative medicines) treatment forms the core of this reputed discipline of medicine. Because of preventive, promoting, prophylactic and rejuvenating properties as well as providing a radical cure; Panchakarma (five purification procedures) is a very unique therapeutic procedure, serving as a Shodhana (purification) therapy. Virechana (Purgation) procedure has been selected for the present study, is chiefly advocated for purification measure in Vicharchika (one among 11 types of mild skin diseases as per Ayurveda) (Charaka, 200 BC). Though the pathology of kustha (Skin diseases) establishes raktadusti (vitiation of blood), Jalaukavacharana (bloodletting by Leech) is being advocated here to expel out the vitiated blood safely. With this point of view, a study was undertaken to evaluate the effects of virechana (purgation) and Jalaukavacharana (bloodletting by Leech) in the management of Vicharchika. MATERIAL AND METHODS A. Selection of Patients Total 28 patients fulfilling the criteria for diagnosis (mentioned below) of the disease were registered for the present study irrespective of the age, sex, religion, etc. Among these, 8 patients left full course of the treatment before the completion of the therapy. All patients were selected from the O.P.D. and I.P.D. of the Department of Panchakarma (five purification procedures). Institutional ethics committee has approved the trial on with letter no. Inst. Ayu. /11/2447. B. Criteria for Diagnosis The patients were diagnosed on the basis of classical signs and symptoms (Kandu (itching), Pidaka (Eruption)), Shyavata (darkness of skin), Srava (secretion) etc.) of Vicharchika (one among 11 types of mild skin diseases as per Ayurveda) described in Ayurvedic classics. Inclusion criteria: Age more than 15 years and less than 70 years. Patients fulfilling the symptomatology of Vicharchika (one among 11 types of mild skin diseases as per Ayurveda), like Kandu (itching), Pidaka (Eruption), Shyavata (darkness of skin), Srava (secretion) etc. Exclusion criteria: Patients suffering from Diabetes Mellitus, Hypertension with hyperlipidemia, age less than 15 years and more than 70 years and patients having any other systemic disorders. Scoring criteria: Table -1, Kandu (Itching) Score Grade 1 Often mild type of itching (1 2 times in a day 2 Moderate itching along with mild itching episode (1 2 times in a day) 3 Moderate itching along with moderate itching episode (3 4 times in a day) 4 Severe itching episode (more than 5 times a day even)

36 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Table -2, Daha (Burning sensation) 0 No burning sensation even after rubbing 1 Mild type of burning sensation, sometime and not disturbing normal activity 2 After rubbing mild type of burning sensation 3 Severe burning sensation disturbing normal activity Table -3, Shrava (secretion) 0 No discharge 1 Moisture on the skin lesion 2 Weeping from the skin lesion 3 Weeping from the skin lesion followed by crusting Table -4, Rukshata (Dryness/Roughness) 0 No dryness (Snigdha) 1 Dryness with rough skin (Ruksha) 2 Dryness with scaling (Khara) 3 Dryness with cracking (Parushang) Table -5, Pidika (Eruption) 0 No eruption in the lesion 1 Scanty eruption in few lesion 2 Scanty eruption in at least half of the lesion 3 All the lesions full of eruption Table -6, Vaivarnya (De-pigmentation) 0 Nearly normal skin color 1 Brownish red discoloration 2 Blackish red discoloration 3 Blackish discoloration Table -7, Raji (Thickening Of Skin) 0 No thickening of the skin 1 Thickening of the skin but no criss-cross marking 2 Thickening of skin with criss-cross marking 3 Severe lichenification Grouping Pattern: The patients were randomly distributed in to 2 groups. Table -8, Distribution of 28 patients of Vicharchika (one among 11 types of mild skin diseases as per Ayurveda) in both groups Patients No. of Patients Total Group A Group B Completed LAMA Total

37 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Group-A (Virechana (purgation) + Shamana (Palliative) drugs): Method of Virechana (purgation) (Dwivedi Acharya Mukundilal, 2008): Virechana (Purgation) was carried out as per classical indications. Purva Karma (preparatory procedure): Abhyantara Snehapana (Internal oleation) was carried out by Shuddha Ghrita (pure ghee)in increasing dose starting from 30 ml then in multiplication for a maximum of 7 days as per the conditions of Agni (digestive capacity) and Koshtha (bowel habit) of patient till the occurrence of Samyak Snigdha Lakshana (symptoms of proper oleation). Sarvang Abhyanga (whole body massage) and Mrudu Vaspa Sweda (mild fomentation by steam) were performed after getting the Samyak Siddha Snehapana lakshanas (symptoms of proper oleation) for 3 days in morning and evening Pradhana Karma (main procedure) (Kasture H. S., (2004): After proper Snehana-Swedana (Oleation and fomentation), patients were given Virechaka Yoga (purgation drugs) on empty stomach. Virechana Yoga (medicines for purgation) (Charaka, 200 BC) was prepared by Triphala + Trivrita + Danti along with Eranda Taila and Icchabhedi Rasa (if needed). Pashchat Karma (post purification procedure): Samsarjana Krama (special dietary regimens after purgation) was given as per type of purification and in sequence mentioned by classics. Shamana (Palliative) drug: After completion of Virechana (purgation) process and Samsarjana Krama (special dietary regimens after purgation), the patients were given powder of Gandhaka Rasayana (Shastri Laxmipati, 2004) as a Shamana Yoga (Palliative formulation) in the dose of 5 gm/day in Capsule form into three divided doses for the duration of 30 days with water as Anupana (adjuvant during intake of medicine). Group-B (Jalaukavacharana (bloodletting by Leech) + Shamana (palliative) drug ): Jalaukavacharana (bloodletting by Leech): In this group one sitting of Jalaukavacharana (bloodletting by Leech) was carried out on every week for four weeks. Number of Jalaukas (leeches) used per sitting were decided depending upon the condition of affected lesion. Shamana (Palliative) drugs: After completion of four sittings of Jalaukavacharana (bloodletting by Leech) the patients were given powder of Gandhaka Rasayana as a Shamana Yoga (palliative formulation) in the dose of 5 gm/day in Capsule form into three divided doses for the duration of 30 days with water as Anupana (adjuvant during intake of medicine). Criteria for Overall Effect of Therapy The total effect of the therapy was assessed considering the following criteria. Cured: 100% relief in the sign and symptoms with plain skin surface and significant changes in color of the affected skin lesion towards normal were considered as cured. Complete remission: More than 75% relief in the signs and symptoms were recorded as complete remission with marked improvement in pigmentation and thickening of the skin. Marked Improvement: 51 75% relief in sign and symptoms were considered showing marked improved with moderate improvement in pigmentation and thickening of the skin. Improvement: Patients showing improvement in between 26 50% in sign and symptoms with slight improvement of pigmentation and thickening of the skin was taken as improvement. Unchanged: Below 25% relief in sign and symptoms was considered as unchanged.

38 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Statistical Analysis: The information gathered on the basis of classical symptomatology was subjected to statistical analysis in term of mean (X), standard deviation (SD) and standard error (SE). Paired t test was carried out at P < 0.10, P < 0.05, P < 0.01, P < significance level. The obtained results were interpreted as Insignificant - P > 0.05 Significant - P < 0.05 Highly significant - P < 0.01, P < DRUGS CONTRIVE: Snehapana (internal oleation): by Suddha Ghrita (pure ghee) 30ml/day increasing dose Abhyanga (oil massage): by Bala taila q.s. for twice 3 days Swedana (fomentation): by Baspa Sweda (steam bath) for 20 mins for twice 3 days Virechana Yoga (formulation for purgation) contains:- - Triphala Kwatha (decoction of three herbal fruit): 100 ml - Trivrita Churna (powder of Operculina turpethum): 50 gm - Danti Churna (powder Baliospermum Montanum): 25 gm - Eranda Taila (castor oil): 50 ml - Ichchabhedi Rasa (an Ayurvedic medicine): 2 Tab. (S.O.S.) Samsarjan karma (special dietary regimens after purgation): by Peya, Vilepee (recipe made from rice) etc as per texts. For Virechana (purgation), drug was attributed in accordance with Charaka (the author of Charaka Samhita) in which combination of Triphala, Trivrit, Danti, Eranda Taila was given after considered necessary Snehapana (internal oleation) by Suddha Ghrita (pure ghee). Here Combination of medicine taken for Virechana (purgation), act like: Triphala (fruit of Terminalia chebula, Terminalia bellirica, and Emblica officinalis) is mild laxative in action, Trivritta (Operculina turpethum) has property to liquefy the Mala (fecal matter) of Annarasa (chyle), Danti (Baliospermum Montanum) acts as strong Virechaka (purgative) which cleans Annavaha Srotas (alimentary canal) by removing sticking Mala also and Eranda Taila (castor oil) provides soothing effect to intestinal mucosal membranes to ease Virechana (purgation). Jalaukavacharana (bloodletting by Leech) (Charaka, 200 BC) is the safest and scientific method amongst Raktamokshana (bloodletting) procedures. Merely Panchakarma (five purification procedures) is not the complete treatment, but it is just a preparatory procedure for application of medicaments; hence Gandhaka Rasayana (Shastri Laxmipati, 2004) (an Ayurveda medicine prepared from purified Sulphur) in the dose of 5 gm/day for 30 days for both groups is chosen as a Shamana (palliative) drug after the completion of Shodhana (purification) procedure. RESULTS Observations Observations of Group-A: Samyaka Snehana (proper oleation) was found on 7 th day in 70.00% of patients. Total amount of Abhyantara Snehana (Internal oleation) was about 840 ml in 70.00% of cases % of the patients showed Madhyama Shuddhi (medium purification). Observations of Group-B: Maximum 40% patients were used nearly Jalauka (leech) during full course of treatment, whereas 30% patients were used number of jalauka (leech), 10% patients were used Jalauka (leech) and 20% patients were used jalauka (leech).. Maximum 55% of Jalauka (leech) have been sucked for 1 2 h. The effect of both therapies in various symptoms of the diseases can be highlighted as follows -

39 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Sr. No. Table no.-9, The Effect of Therapies on Individual Signs and Symptoms Symptoms % of Relief Group-A Group-B 1 Kandu (Itching) (>0.05) (<0.001) 2 Daha (Burning sensation) (<0.05) (<0.001) 3 Pidika (eruption) (<0.001) (<0.05) 4 Srava (Secretions) (<0.01) (<0.01) 5 Vaivarnya (De-pigmentation) (<0.01) (<0.001) 6 Shotha (Inflammation) (<0.01) (<0.001) 7 Rukshta (Dryness) (>0.05) (<0.01) 8 Raji (Thickening Of Skin) (<0.05) (<0.01) Graph No.-1, The Effect of Therapies on Individual Signs and Symptoms Table No.-10 : Overall effect on symptoms of Virechana Karma (Purgation) + Shamana Chikitsa (Palliative treatment) in Group-A Sr. Symptoms BT AT X % SD SE T P No. 1 Kandu(n=10) > Daha(n=10) < Pidika(n=6) < Srava(n=8) < Vaivarnya(n=10) < Sotha(n=10) < Rukshta(n=10) > Raji(n=9) <0.05

40 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Table No.-11 Overall effect on symptoms of Jalaukavacharana Karma (Leech therapy) + Shamana Chikitsa (Palliative treatment) in Group-B Sr. No. Symptoms BT AT _ X % SD SE t P 1 Kandu(n=10) < Daha(n=10) < Pidika(n=6) < Srava(n=8) < Vaivarnya(n=10) < Sotha(n=10) < Rukshta(n=10) < Raji(n=9) <0.01 It can be observed from the above mentioned table that although Virechana (Purgation) has provided significant relief in the symptoms of Vicharchika (one among 11 types of mild skin diseases as per Ayurveda), yet, Jalaukavacharana (bloodletting by Leech) has provided relatively better relief in most of the symptoms. Overall effect of therapy Complete remission was found in 30 % patient of Group-B, Marked improvement was noted in 40% patients of Group-A and only 10% patients of Group-B, Moderate improvement was observed in 30% patient in Group-A where 60% shows improved effective result in Group-B, Unchanged was noted in 30% patients of only in Group-A as shown on table no.13 and Graph no.2. The effect of all the therapies viz. Jalaukavacharana (Leech therapy) on the cardinal signs and symptoms of the disease was remarkable; however, Virechana (purgation) provided comparatively better relief. This showed that Jalaukavacharana Karma (Leech therapy) is more effective in curing the disease in comparison to Virechana (purgation). Table No.-13- Overall Effect of therapy in both groups Sr. No. Result Group-A % Group-B % 1 Complete remission Marked improvement Improvement Unchanged

41 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Graph No.-2, Total Effect of therapy in both groups Total Effect of Therapy in Both Groups Complete Remission Marked Improvement Improvement Unchanged Group-A Group-B DISCUSSION Commonest age of occurrence of Vicharchika has been reported between years. Cool atmosphere is much susceptible for eczematous patients. Vicharchika (one among 11 types of mild skin diseases as per Ayurveda) is Kaphapradhana Vyadhi. (Kapha dominant disease) (Charaka, 200 BC). So humid, cold, watery contacts may increases the symptoms of Vicharchika (one among 11 types of mild skin diseases as per Ayurveda). Excessive intake of Lavana (salty diet), Katu (pungent diet) and Madhura rasa (sweetening diet) are common causative factors for Vicharchika (one among 11 types of mild skin diseases as per Ayurveda). Viharaja Nidana (unlawful habit) like allergic factors and industrial pollutants can be considered as main causative factors behind the increasing incidence of Vicharchika. Same as Kushtha (skin disease), Vicharchika (one among 11 types of mild skin diseases as per Ayurveda) is also Tridhoshik (three basic constituent of body as vata, pitta and kapha) in which Kapha (one among three basic constituent) and Vata (one among three basic constituent) are dominant involved. Disturbed sleep is interesting symptoms of Vicharchika (one among 11 types of mild skin diseases as per Ayurveda), which leads Vata prakopa (vitiation of vata) and may further deteriorate the diseased condition. Hence, it becomes a vicious cycle. Leech saliva, contains Hirudin, which has property of anti coagulants. So it may be helpful in other skin diseases, obstructive blood disorders like Thrombosis, Hemangioma, and Gangrene etc. Probable Mode of Action of Virechana karma (Purgation): Snehapana (oleation) by virtue of its Doshotkleshana (vitiation of dosha) effects separates toxins accumulated in the patient s body by Nidanas (causes) like Viruddha ahara (food ingestion either in inappropriate way or quantity etc. and the separated Utklilshta Doshas (vitiated humours) are eliminated by Virechana (purgation). Virechana (purgation) might have removed the toxins from the cellular level, improving Jatharagni (Digestive fire) and Dhatvagni (hormones and enzymes), so that metabolism is normalized. Probable mode of action of Jalaukavacharana (bloodletting by Leech): Vicharchika (one among 11 types of mild skin diseases as per Ayurveda), is a type of Kushtha (Skin diseases) having Tridosha prakopa (vitiation of all the three doshas), pradhana Raktadushti (vitiation of blood dominantly) and Chirakari (chronic) manifestation. Sushruta (the author of Susruta Samhita) has given great emphasis to Jalaukavacharana (bloodletting by Leech) in the treatment of Raktapradoshaja Vyadhi (Blood originated disease), Tridosha Prakopajanya (vitiated all three body humours) and Chirakari (chronic) diseases. Jalaukavacharana (bloodletting by Leech) is

42 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January better for the superficial blood (Avagadha grathita Rakta). Vitiated Rakta (blood) may be washed-out by application of Leeches after slight scraping on the lesion of Kushtha (skin disease). Thus; it is well proved that Jalauka (leeches) gives better effect in Raktaja Roga (Blood originated disease), or Kushtha (skin disease) on the basis of classical references. Jalauka (leech) sucks the impure blood only with ideal example of Swan by Vagbhatta (the author of Astanga Hridaya). Leeches when applied to the skin, sucks the blood at superficial level might be from capillaries or extra-cellular so it may be more impure than other body channels, Jalauka (leech) (Vridha Vagbhatta, 4 th AD) can easily suck impure blood due to superficial distribution of veins. Leech application has counter irritant effect on the lesion, which creates new cellular division after removing dead cell layer, and result in reduction of local Swelling and Lichenification. Leech sucks blood from restricted area. When leech applied in only pathogenic area, then it can be said that leech expelled blood from where the pathological state is more. So ultimately blood of that area comparatively more vitiated than other area. Hence, it can be said that leeches give best effect in Vicharchika (one among 11 types of mild skin diseases as per Ayurveda) by expelling the morbid, vitiated Doshas (three basic constituent of body) and Dhatus (7 types of body tissues). The effect of therapy is not only by expelling the vitiated blood but also by leech that emits some enzymes in the wound. CONCLUSION It can be observed from the table number- 10 and 11 that although Virechana has provided significant relief in the symptoms of Vicharchika yet, Jalaukavacharana (bloodletting by leech) has provided relatively better relief in most of the symptoms. Most of the patients had reported in the chronic stage of Vicharchika. Negligence in early stage of eczema is common phenomenon observed in patients. Most of the affected sites for Vicharchika are lower feet, axilla and neck like skin folds regions. Relapsing nature of Vicharchika is most common, which suggest that, long term intensive therapy is necessary for eradication of the disease. Virechana (purgation) provides comparative better result in symptoms of Shushka Vicharchika (dry eczema) like, Shotha (oedema), Shyavata (secretion), Pidika (eruption), Raji (Thickening of Skin) etc. Jalaukavacharana (bloodletting by leech) is a choice of therapy for Sravi Vicharchika (wet eczema) symptoms like, Kandu (itching), Srava (secretion), Daha (burning) etc. Markedly improved was obtained in 40% of group-a, 10% of group-b. Improved was found in 30% in group-a, 60% in group-b. Only 30% of patients of group A remain unchanged. The effect of all the therapies viz. Jalaukavacharana on the cardinal signs and symptoms of the disease was remarkable; however the Virechana therapy was provided comparatively better relief. ACKNOWLEDEMENT We acknowledge gratitude to Prof. Vijay Kaushik, Dean and superintendent of M.S.M. Institute of Ayurveda & Hospital, Khanpur Kalan for his extensive support in providing all resources in the OPD & IPD of the hospital. We express our gratitude to Dr. K.V.Singh, H.O.D, M.S.M. Institute of Ayurveda & Hospital, Khanpur Kalan for his inspiring spirit and parental affection besides his subject knowledge and direction that helped in accomplishing this work. We owe our thanks to our friends, hospital staffs, laboratory staffs, library staffs of M.S.M. Institute of Ayurveda and patients for their sincere support in this clinical trial.

43 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January REFERENCES Charak, (200 BC), Charak Chandrika Hindi Byaksha, Tripathy Brahmananda, Charak Sahmita, 4 th edition, Chaukhamba Surabharati Prakasana, 1995, Varanasi, Vol-I & II, Sutra Sthan- 24; Chikitsa Sthan-7, Dwivedi Acharya Mukundilal, Sharma Tarachanda and Mishra Bhairava, (2008) Ayurvediya Panchakarma Chikitsa: Chaukhambha Sanskrit Pratishthan, Delhi. PP Kasture H. S., (2004), Ayurvediya Panchakarma Vijnan:, 8th edition, Shri Vaidyanath Ayurved Bhawan Limited, PP Shastri Laxmipati, (2004), Vidyotini Hindi Commentary, Shastri Brahmasankar, Yog Ratnakar, PP-501 Susruta, (2000 BC), Ayurveda Tatwa Sandeepika Hindi Commentary, Shastree Kaviraj Ambikadatta, Susruta Sahmita, 11 th edition, Chaukhamba Sanskrit Bhawan, 1997, Varanasi, Vol- I, Nidan Sthana.- 5/5, PP Vagbhatta, (4 th AD), Vidyotini Bhasa commentary, Gupt Kaviraj Atridev, Astanga Hridaya, twelfth edition, Chaukhamba Sanskrit Bhawan, 1997, Varanasi, Nidan Sthana, 14/3,PP 271 Vriddha Vagbhata, (4 th AD), Soroj Hindi commentary, Tripathy Ravidutta, Astanga sangraha, Chaukhamba Sanskrit pratisthana, 1996, Delhi, Sutra sthan-35/4, PP.600 Source of Support: Nil Conflict of Interest: None Declared

44 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January ISSN International, Peer reviewed, Open access, Monthly Online Journal Research article A CLINICAL STUDY ON THE EFFECTIVENESS OF DM II HERBAL COMPOUND (KALPIT) IN THE MANAGEMENT OF OBESE DIABETICS Agarwal Vivek 1 * 1 Assistant Professor, Department of Rog Nidan, MSM Institute of Ayurveda, BPS Women University Khanpur kalan, Distt. Sonipat, Haryana, Pin *Corresponding Author: - drvivek91@gmail.com; Phone ABSTRACT Received: 04/12/2012; Revised: 29/12/2012; Accepted: 02/01/2013 Diabetes is pandemic in both developed and developing countries. In 2000, there were an estimated 175 million people with diabetes worldwide and by 2030 the projected estimate of diabetic is 354 million. One out of 20 persons in new millennium will be diabetic. The study was planned to assess the effect of DM II Herbal compound in Sthula Pramehi (Obese diabetics i.e. NIDDM) on the basis of subjective and objective parameters. For the purpose of study ninety diagnosed Sthula Pramehi are randomly divided into three groups, thirty of each, Group A Participants were given modern medicine, Group B Participants were given modern medicine with DM II Herbal compound and Group C Participants were given DM II Herbal compound alone. Results were noted after two month drug trial. Group B showed more significant results than Group A and C. KEY WORDS: DM II Herbal compound, Sthula Pramehi, Non Insulin Dependent Diabetes Mellitus, Chala Sphiga Udara Stana (CSUS) Cite this article: Agarwal Vivek (2013), A CLINICAL STUDY ON THE EFFECTIVENESS OF DM II HERBAL COMPOUND (KALPIT) IN THE MANAGEMENT OF OBESE DIABETICS, Global J Res. Med. Plants & Indigen. Med., Volume 2(1): 40 51

45 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January INTRODUCTION Today is the era of modernization and fast life. Rapid urbanization and industrialization have produced advancement of the social and economic front in developing countries such as India. As a result, this dramatic life style changes lead to related diseases like NIDDM. The transition from a traditional to modern life style, consumption of diets rich in fat and calories combined with a high level of mental stress has compounded the problem further. Now days, it is concluded that the group of metabolic risk factors in one person which has given a name Metabolic syndrome or Syndrome X which usually includes Abdominal obesity, Atherogenic dyslipidemia, Hypertension, Diabetes mellitus. (Davidson, 2002). The predominant underlying risk factors for the metabolic syndrome appear to be abdominal obesity and insulin resistance. Other associated factors are physical activity, ageing, hormonal imbalance, atherogenic diet and insulin resistance which is an essential cause of the metabolic syndrome, predisposes to hyperglycemia and type 2 diabetes mellitus. Individuals who are insulin resistant may not be clinically obese, but they commonly have an abnormal fat distribution that is characterized by predominant upper body fat. Upper body obesity can occur either intraperitoneally (visceral fat) or subcutaneously, both of them are correlated strongly with insulin resistance and the metabolic syndrome. In present era, Sthaulyata is a burning problem which is a byproduct of urbanization. It is not only the root cause of major aliments like diabetes, heart problems, hypertension etc but it has also significant life running effect on the patient s quality of life. The quality of life measurements are increasingly being used in assessing the treatment outcomes in these conditions as they measure the missing dimensions of healthcare. Diabetes is a metabolic illness requiring regular medications and ability on the part of patient to monitor and modify diets and lifestyle (Niranjan Y et al., 2012). The etiological factors mentioned in context to Sthaulya and Prameha are almost the same, as both the diseases are considered as santarpanajanya-vyadhi in Ayurveda i.e. the disease caused by indulgence of madhurya (sweetness), snigdha (unctuousness), sita (coldness), guru (heaviness), picchila ahara (sliminess), meat of aquatic animals and decreased physical activities like divasvapna (sleep during day time), avyayama (lack of exercise) etc. (Charaka, 200 BC). According to the pathogenesis of these diseases, kapha plays important role which is aggravated first, then in turn aggravates the medo-dhatu (lipid) as their properties are similar in some extent. Now the aggravated or the dushit medo-dhatu (abnormal lipid) works as a dosha, causing atisthaulya and Prameha (Charaka, 200 BC). As per modern medical science, obesity is associated with carbohydrate intolerance, insulin resistance and hyper-insulinism, which are the features of Non-insulin dependent diabetes mellitus (Harsh Mohan, 2000). Hence a study was planned to assess the effect of DM II Herbal compound in Sthula Pramehi (Obese diabetics i.e. NIDDM) on the basis of subjective and objective parameters. MATERIAL AND METHODS (1) Selection of Participants - Participants for therapeutic drug trial were selected from the OPD and IPD of the MSM Institute of Ayurveda and Hospital, khanpur kalan Distt. Sonipat (Haryana) after screening as per Ayurvedic and Modern criteria for Sthula Pramehi. Selection had been carried out according to relevant history, sign, symptoms and Laboratory investigations including Body Mass Index for Sthula persons & the study carried out as per Institutional Ethical Committee clearance Reg.No.RAU/AK/Ph.D /184/ (a) Inclusion criteria Participants in the age group between 35 to 65 years irrespective of either sex. Diagnosed cases of NIDDM (as per subjective and objective parameters) with BMI > 25.

46 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January (b) Exclusion criteria Participants with major complications and requirement of emergency treatment. Participants taking drugs like corticosteroids, tricyclic antidepressant, cycloheptadine which leads to weight gain. IDDM Cases. Pregnant women (c) Diagnostic criteria All the Participants were diagnosed on the basis of following criteria i) Clinical signs and symptoms (Table 1) ii) Body Mass Index iii) Hip and waist circumference iv) Investigations- Hematological (Routine Test) - TLC, DLC, ESR, Hb% Bio-chemistry - FBS, PPBS, Blood Urea, Lipid Profile Urine examination - FUS, PMUS, Albumin, ph, Specific gravity etc. Table No. 1 -Symptoms observed in Participants for diagnosis S.No. Symptoms Explanation 1 Chala, sphiga, udara and stana Show movement of buttocks, abdomen and breast during activity 2 Ayathopachaya Disproportionate body 3 Prabhoot mootrata Polyurea 4 Aavil mootrata Turbidity in Urine 5 Pipasadhikya Polydipsea 6 Kshudhadhikya Polyphagia 7 Swedatipravritti Excessive sweating 8 Daurbalya Weakness 9 Aalasya Lassitude 10 Atinidra Excessive sleep 11 Vibandh Constipation 12 Malavritta Jihwa Coated tongue 13 Kar-paada daha Burning sensation in hand and foot 14 Mukhmadhurya Sweetness of mouth 15 Tandra Drowsiness 16 Krichvyavyata Sexual dysfunction 17 Sandhi shula Joint pain Scoring Criteria Feature Score No Symptom 0 Mild Symptom 1 Moderate Symptom 2 Severe Symptom 3

47 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January (2) General Observations a) Demographic Profile: The Participants registered under the present trial were closely interviewed according to the Performa of study. In incidence of their age, sex, socio-economic status, marital status, religion, habitat, dietary habits, nature of job and other relevant information s were worked out. b) Physical Measurement: All the measurement was made with the Participants in empty stomach i.e. before, during and after the treatment. (i) Height (ii) Weight (iii) Body Mass Index (iv) Waist Circumference It was measured in inches, when the Participants were in standing position, using a standard tape measure, over the unclothed abdomen of the patient at the midpoint between the costal margin and the iliac crest. (v) Hip Circumference It was measured to the nearest inches with the patient standing, using a standard tape measure at the level of the greater trochanters. Note Normal W/H ratio should be 0.8 in female and 1.0 in males. c). Determination of Prakriti (3) Clinical Observations Selection of drugs For the present study, selection of the drug combination DM II Herbal compound which was on the basis of various textual references. The drugs in this compound are easily available and having the high degree of clinical significance in Sthula Pramehi. Ingredients of DM II Herbal compound are as follows (Sharma P V, 2001) Chirabilwa bark (Holoptelea integrifolia), Daruharidra kanda (Berberis aristata), Aamrasthi majja (Mangifera indica), Jambu seeds (Syzygium cumini), Karvellaka fruit (Momordica charantia), Nimba (Azadirachta indica), Bilwa leaves (Aegle marmelos), Meshshringi leaves (Gymnema sylvestre), Haridra kanda (Curcuma longa), Danamethi seeds (Trigonella foenum-graecum), Triphala dried fruits (Phyllanthus emblica, Terminalia bellarica, Terminalia chebula). Preparation of drug Above mentioned all the eleven ingredients are taken in equal quantity and prepared in the form of churna (fine powder) in the pharmacy of MSM Institute of Ayurveda, Khanpur kalan (Sonepat, Haryana). Administration of drug Ninety clinically diagnosed Sthula Pramehi (obese diabetic) Participants were divided into three groups Group A 30 Participants were recommended allopathic medicine before 15 minutes of meal for two month as a control group. (Under supervision of allopathic physician) Group B - 30 Participants were recommended allopathic medicine along with DM II Herbal compound 5 gm twice a day with Luke warm water before 15 minutes of meal for two month. Group C - 30 Participants were recommended DM II Herbal compound 5gm twice a day with Luke warm water before 15 minutes of meal for two month. Follow up study Participants were followed up after 15 days up to two month. Laboratory investigations were repeated after the duration of trail. Improvement and other effects were noted. Note- Not any side effect and toxic effects of DM II Herbal compound was reported by any individual during trial.

48 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January OBSERVATIONS AND RESULTS Table No. 2 Distribution based on Family History of Obese Diabetics Participants S.N Family Number of Participants Total % o. History Group-A Group-B Group-C 1. Present Absent Total Table No. 3 Distribution based on the BMI of Participants S.No. BMI Number of Participants Total % (In Kg/m 2 ) Group-A Group-B Group-C > Total Table No. 4 Improvement in Symptoms in Group A Symptoms N Mean Dif. Improvement% SD SE t P BT AT CSUS <0.001 Ayathopachaya <0.001 Prabhoot mootrata <0.001 Aavil mootrata <0.001 Pipasadhikya <0.001 Kshudhadhikya <0.001 Swedatipravritti <0.001 Daurbalya <0.001 Aalasya <0.001 Ati nidra <0.001 Vibandh <0.001 Malavritta Jihwa <0.001 Karpada daha <0.001 Mukh Madhurya <0.001 Tandra <0.001 Krichvyavayata <0.001 Shula <0.001

49 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Table No. 5 Improvement in Symptoms in Group B Symptoms N Mean Dif. SD SE t P BT AT Impro vemen t% CSUS <0.001 Ayathopachaya <0.001 Prabhoot mootrata <0.001 Aavil mootrata <0.001 Pipasadhikya <0.001 Kshudhadhikya <0.001 Swedatipravritt <0.001 Daurbalya <0.001 Aalasya <0.001 Ati nidra <0.001 Vibandh <0.001 Malavritta Jihwa <0.001 Karpada daha <0.001 Mukh Madhurya <0.001 Tandra <0.001 Krichvyavayata <0.001 Shula <0.001 Table No. 6 Improvement in Symptoms in Group C Symptoms N Mean Dif. Impro SD SE t P BT AT vemen t% CSUS <0.001 Ayathopachaya <0.001 Prabhoot mootrata <0.001 Aavil mootrata <0.001 Pipasadhikya <0.001 Kshudhadhikya <0.001 Swedatipravritt <0.001 Daurbalya <0.001 Aalasya <0.001 Ati nidra <0.001 Vibandh <0.001 Malavritta Jihwa <0.001 Karpada daha <0.001 Mukh Madhurya <0.001 Tandra <0.001 Krichvyavayata <0.001 Shula <0.001

50 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Table No. 7 - Improvement in Objective Parameters in Group A Objective N Mean Dif. % SD SE t P Parameters BT AT Waist Circum <0.001 Hip Circum <0.001 Weight <0.001 BMI <0.001 Table No. 8 - Improvement in Objective Parameters in Group B Objective N Mean Dif. % SD SE t P Parameters BT AT Waist Circum <0.001 Hip Circum <0.001 Weight <0.001 BMI <0.001 Table No. 9 - Improvement in Objective Parameters in Group C Objective N Mean Dif. % SD SE t P Parameters BT AT Waist Circum <0.001 Hip Circum <0.001 Weight <0.001 BMI <0.001 Investigation N Mean B.T. Table No. 10 Improvement of Investigations in Group A Mean Mean A.T. Diff. % S.D. S.E. t Value p Value Hb% <0.001 TLC >0.01 Polymorph >0.01 Lymphocytes >0.01 ESR <0.001 Fasting Blood Sugar <0.001 Post Prandial Blood Sugar <0.001 Blood Urea >0.01 S.Cholesterol <0.01 S.Triglyceride >0.01 H.D.L >0.01 L.D.L <0.001 V.L.D.L >0.01 Fasting Urine Sugar <0.001 Post Meal Urine Sugar <0.001

51 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Investigation N Mean B.T. Table No. 11 Improvement of Investigations in Group B Mean Mean A.T. Diff. % S.D. S.E. t Value p Value Hb% <0.001 TLC >0.01 Polymorph >0.01 Lymphocytes <0.01 ESR <0.001 Fasting Blood Sugar <0.001 Post Prandial Blood Sugar <0.001 Blood Urea >0.01 S. Cholesterol <0.001 S. Triglyceride <0.001 High Density Lipoprotein <0.01 Low Density Lipoprotein <0.001 Very Low Density Lipo <0.001 Fasting Urine Sugar <0.001 Post Meal Urine Sugar <0.001 In Investigation N Mean B.T. Table No. 12 Improvement of Investigations in Group C Mean Mean A.T. Diff. % S.D. S.E. t Value p Value Hb% <0.01 TLC >0.01 Polymorph >0.01 Lymphocytes <0.01 ESR <0.001 Fasting Blood Sugar <0.001 Post Prandial Blood Sugar <0.001 Blood Urea >0.01 S.Cholesterol <0.001 S.Triglyceride <0.001 High Density Lipoprotein <0.01 Low Density Lipoprotein <0.001 Very Low Density Lipo <0.001 Fasting Urine Sugar <0.001 Post Meal Urine Sugar <0.001

52 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Table No. 13 Comparative improvement of Lipid Profile, Blood sugar & B.M.I. S.No. Parameters Group A Group B Group C 1. Lipid Profile 5.238% 19.08% 13.53% 2. Blood Sugar 22.01% 31.03% 20% 3. B.M.I. 2.38% 4.92% 3.48% Table No.14 Comparative improvement in percentage of Sthula Pramehi S.No. Observations Group A Group B Group C 1. Subjective 43.01% 53.46% 45.75% Improvement 2. Objective Improvement 3.005% 5.725% 4.607% 3. Investigation Improvement 19.31% 27.45% 23.94% OVER ALL GRAPHIC ASSESSMENT Group A 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Subjective Improvement Objective Improvement Investigation Improvement Group A Group B 60.00% 40.00% 20.00% 0.00% Subjective Improvement Objective Improvement Investigation Improvement Group B

53 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Group C 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Subjective Improvement Objective Improvement Investigation Improvement Group C DISCUSSION Discussion on Conceptual Study The Prameha is one among the eight troublesome diseases described by Ayurveda. So, it is difficult to treat with single drug therapy i.e. why a combination of drug is chosen for therapeutic study of Sthula Pramehi. The sthula (obese) pramehi have more strength as compared to krisha or asthenic Participants. But generally asthenics are preferred than obese, as the complications of obesity are more than compared with disadvantages of being asthenic. In Prameha the obese Participants have good prognosis than the asthenic Participants. (Charaka, 200 BC) All varieties of Prameha, if not treated in time, will ultimately become madhumeha which is incurable. One more thing, which has conceived through this study, is that the two types of madhumeha i.e. dhatukshayah janya and Aavaran janya can be called IDDM & NIDDM respectively. (Sushruta, 2000BC) Thus in the Ayurvedic texts the interrelationship is described, inference is that Prameha especially the madhumeha is strongly related to the Sthaulya (obesity). Discussion on Subjective Parameters Group A This group showed maximum percentage subsidence in Mukhmadhurya (56.25%), Prabhoot mootrata (51.47%), Aavil mootrata (51.28%), Pipasadhikya (51.02%), Kar-pada daha (50%), but over all study shows symptomatic improvement in Group A was 43.01%. Group B This group showed maximum percentage subsidence in Pipasadhikya (73.47%), Vibandh (68.09%) Swedatipravritti (67.74%), Prabhoot mootrata (65.71%), Atinidra (60.38%), Daurbalya (59.65%), Kar-pada daha (57.45%), but over all study shows symptomatic improvement in Group B was 53.46%. Group C This group showed maximum percentage subsidence in Mukhmadhurya (61.90%), Swedatipravritti (58.33%), Prabhoot mootrata (57.14%), Kar-pada daha (56%), Daurbalya (53.45%), Vibandh (52.37%) but over all study shows symptomatic improvement in Group C was 45.75%. Discussion on Objective Parameters Group A The percentage of change in Body weight (2.68%), Body mass index (2.38%), Waist circumference (4.65%) & in Hip circumference (4.05%). Over all percentage of improvement is 3.005%. Group B The percentage of change in Body weight (4.58%), Body mass index (4.92%), Waist circumference (7.14%) & in Hip circumference

54 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January (6.26%). Over all percentage of improvement is 5.725%. Group C The percentage of change in Body weight (3.39%), Body mass index (3.48%), Waist circumference (5.76%) & in Hip circumference (5.80%). Over all percentage of improvement is 4.607%. Discussion on Investigations In Routine investigations, Haemoglobin and ESR showed highly significant results but TLC & DLC showed statistically insignificant results in all the three groups. Blood Urea in all the three groups showed statistically insignificant results. Group A The reduction percentage of Blood sugar &Urine sugar after the treatment was 22.01% & 80.91%. Both parameters showed statistically highly significant improvement. The result percentage of Lipid Profile was 5.238%. In which cholesterol showed significant results but other parameters do not show such significant improvement. Over all percentage of improvement is 19.31%. Group B The reduction percentage of Blood sugar, Urine sugar and Lipid Profile after the treatment was 31.03%, 93.55% & 19.08%. All the above said parameters showed statistically highly significant improvement except HDL i.e. significant. Over all percentage of improvement is 27.45%. Group C The reduction percentage of Blood sugar, Urine sugar and Lipid Profile after the treatment was 20.00%, 85.98% & 13.53%. All the above said parameters showed statistically highly significant improvement except HDL i.e. significant. Over all percentage of improvement is 23.94%. CONCLUSION Declaration of diabetes mellitus as an epidemic by WHO signifies the gravity of disease. More incidences can be avoided by early education, early detection, and changing life style, food habit & proper exercise. Sthula Prameha (NIDDM) is personality damaging disease; it affects not only somatic level but also psychic level. As per observations & Results, maximum number of Participants having Rajasik dominant Manasik Prakriti. Sthaulya & Prameha both are dusit medoja vyadhi in which medodhatu acts an aetiological factor. Sthaulya (Medoroga) is a Nanatmaja kapha vyadhi and Prameha is predominant kaphaj, their pathogenesis is almost same. Prameha, Prameha pidika are considered as complications of the Medoroga, which explains their interrelationship. One should understand the fact that in diabetes the main culprit is not the sugar but fat. Diabetes mellitus is a metabolic syndrome where each cell of the body sufferers, characterized by chronic hyperglycemia with disturbances of carbohydrates. Fat & protein metabolism. Resulting from improper insulin secretion. From its complication it is clear that it is a ama vyadhi thus the line of treatment should address diabetes as a total and should include shodhana, ama-pachana (Anti-oxidants), rasayana along with specific anti-diabetics or hypoglycemic. The present research work showed that Medodusti in type-2 Diabetes mellitus (NIDDM) is more common in higher socio-economic society because of their sedentary and comfortable life style. The Traditional tribal combination used for prevention of Diabetes mellitus had shown almost full result so for. DM II Herbal Compound was very effective in reducing physical examination parameters, Blood and Urine sugar levels and some extent of Lipid Profile. Participants who were dependent on Ayurvedic drugs had better improvement than those on modern medicines. Group B showed better results of improvement than Group A and Group C on the basis of clinical parameters.

55 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January ACKNOWLEDGEMENT I would like to thank Prof. Loknath Sharma, Ex. HOD of Rog Nidan, National Institute of Ayurveda Jaipur, for his valuable guidance, precious support and priceless blessings showered on each and every step, right from the commencement. REFERENCES Charaka, (200 BC), Hindi commentary, Shastri Kashinath and Chaturvedi Gorakhnath, Charaka Samhita, Chaukhambha Bharti Academy, Reprint 1998,Varanasi, Vol.1 & II, Sutrasthana 21/17; Chikitsasthana 6/4-5 Davidson, (2002) Principles & Practice of Medicine, Churchill Livingstone Publication, 19 th Edition, New York. Page no.-655 Harsh Mohan, (2000), Text Book of Pathology, Jaypee Brothers, 4 th edition, New Delhi, Chap.24, page no.803 Source of Support: Nil Niranjan Y, Santwani M A, Baghel M S (2012), Quality of life consequences in diabetic polyneuropathy, Global J Res. Med. Plants & Indigen. Med. 1(7): Sharma P.V., (2001), Dravya Guna Vigyan, Chaukhambha Bharti Academy, 2 nd Edition, Reprint 2001, Varanasi, Vol. II Sushruta, (2000 BC) Ayurveda-Tattva- Sandipika Hindi Commentary, Shastri Kaviraja Ambikadutta, Sushruta Samhita, Chaukhambha Sanskrit Sansthan, 14 th Edition, 2003, Varanasi, Vol. I Su.Ni.6/30, page no. 255 Conflict of Interest: None Declared

56 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January ISSN International, Peer reviewed, Open access, Monthly Online Journal Research article A COMPARATIVE CLINICAL EVALUATION OF THYROMAX POWDER AGAINST THYROXINE SODIUM IN THE MANAGEMENT OF HYPOTHYROIDISM Ujjaliya Nitin 1 *, Krishnankutty S V 2, Remadevi R 3 1 Assistant Prof., Dept. of Dravyaguna Vijnana, Shri Dhanwantry Ayurvedic College & Dabur Dhanwantry Hospital, Chandigarh, India 2 Head, Department of Internal medicine, Maulana Hospital, Perinthalmanna, Kerala, India 3 Prof. & Head, Dept. of Dravyaguna Vijnana, V.P.S.V. Ayurveda College, Kottakkal, Kerala, India *Corresponding Author: drnujjaliya@gmail.com ABSTRACT Received: 06/12/2012; Revised: 01/01/2013; Accepted: 07/01/2013 The thyroid gland regulates metabolism of the body by virtue of its hormones. Insufficient levels of thyroid hormone causes signs and symptoms such as slower metabolic rate, weight gain, sleepiness, dry and cool skin, as well as others. This condition collectively can be called as Hypothyroidism. Of the different types, Primary Hypothyroidism is the commonest which occurs after destruction of thyroid follicles mainly because of autoimmunity. Hypothyroidism is most common in women than men. According to a study, it affects 3.9% people with 9.4% subclinical condition. The sole available treatment for this in conventional science is Hormone Replacement Therapy which is not always free from side effects and has to be taken lifelong. This study was aimed to search an option for Hypothyroidism in terms of herbs. Traditionally practiced drugs Guducī Satvam (Tinospora cordifolia Miers.) and Āmalakī cūrnam (Phyllanthus emblica Linn.) was taken in a combination named Thyromax powder which was standardized before commencing with clinical trial. A controlled clinical trial was planned with 20 newly diagnosed participants, which were not exposed to any medicament, with Thyroxine sodium in control group and Thyromax powder in study group for the duration of 3 month. Assessment was done on the basis of six subjective parameters and thyroid function test. Statistically, study drug showed a positive correlation on subjective parameters while control group showed significant result on T3 and T4 levels. Both the groups were found statistically insignificant on TSH level. KEY WORDS: Thyromax powder, Hypothyroidism, Standardization, controlled clinical trial. Cite this article: Ujjaliya Nitin, Krishnankutty S V, Remadevi R (2013), A COMPARATIVE CLINICAL EVALUATION OF THYROMAX POWDER AGAINST THYROXINE SODIUM IN THE MANAGEMENT OF HYPOTHYROIDISM, Global J Res. Med. Plants & Indigen. Med., Volume 2(1): 52 64

57 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January INTRODUCTION Endocrinology concerns the synthesis, secretion and action of hormones. Hormones are chemical messengers which have diverse molecular structures and are related to endocrine glands thereby coordinate the activities of different cells. Some endocrine disorders are common, particularly those of the thyroid gland. At present thyroid diseases form the second most common endocrine disorder in India next to Diabetes mellitus. (Sir Stanley Davidson, Davidson Principles & Practice of Medicine; 2006). According to the report of N. Kochupilli, thyroid disorders (5.4%) are the most common among all the endocrine diseases in India (N. Kochupillai et al., 1986). Unfortunately many people may have this disease and even not realize it. According to a study known as a Colorado thyroid disease prevalence study there may be as 13 million Americans with an undiagnosed thyroid condition (Gay J Canaris et al., 2000). In the state of Kerala, India, 9.4% people who suffer from hypothyroidism are asymptomatic (Unnikrishnan AG et al., 2011). Wickham Survey suggested that there is a high possibility of developing Hypothyroidism in the population with raised TSH and thyroid antibodies. In the after follow up study it was demonstrated to be much accurate. It was inferred that increasing values of serum TSH above 2mU/l increases the probability of developing hypothyroidism which was further increased in the presence of anti-thyroid antibodies (Vanderpump MP, 1995). According to a study anti-thyroid antibodies were found in 89.6% of the women between years of age and the overall prevalence of classical Hypothyroidism was found to be 10 times more than the men (K.P. Paulose, 2011). This made the medical society to consider it with a higher importance, as it may result in severe complications. The possibility of incidence of the disease also increases with a higher rate in old age. In Hypothyroidism, body function decreases and this leads to a slow heart rate, an increase in cholesterol level, mild anemia, pervasive fatigue, depression, low body temperature, cold intolerance, coarsening of skin, muscles and joint aches, constipation, weight gain, slow hair growth, loss of libido, infertility, increased risk of miscarriage and irregular menstrual cycle in women etc. In the most common case of Hypothyroidism, namely Primary Hypothyroidism resulting from an intrinsic disorder of thyroid gland, serum T3 and T4 is low and TSH elevated also called as classical Hypothyroidism, resulting above signs and symptoms. (Sir Stanley Davidson, Davidson Principles & Practice of Medicine; 2006). According to the signs and symptoms, it is concluded that Hypothyroidism is a resultant of Vāta-kapha-medo vikrti and Dhātvāgnimāndhya (Alsa mariyam kalathancheri, 2008 and Chanchal Gupta, 2003). Guducī and Āmalakī are known for Rasāyana property and have action on Dhātvāgni specially Rasa and Rakta. Both the drugs have been proven as immunomodulators and anti-oxidant effects. (Dikshit V et al., 2003 and Shukla V et al., 2009). Prevalence of autoimmune Hypothyroidism is much higher (K.P. Paulose, 2001). Considering rejuvenative effect of these herbs, they may rejuvenate destroyed follicles of thyroid gland which are responsible for production of thyroid hormones; of course it is questionable and needs further research. These are proved drugs for many diseases and found non toxic. These two drugs are not found to have any drug interactions. (Database on Medicinal Plants used in Ayurveda, 2005). Guducī Satvam (extract of Tinospora cordifolia Miers.) along with Āmalakī cūrnam (powder of fruit of Phyllanthus emblica Linn.) is used by the traditional vaidyas for Hypothyroidism in Madhya Pradesh and found effective. In modern medicine hormone supplement is the only management for this disease. Though it is thought to be a successful therapy but a long term hormone therapy is not always free from complications as well as side effects. Most often it is needed to continue throughout the life in adjusted doses.

58 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January This study was an effort to evaluate the effect of these two drugs in a combination which is named as Thyromax powder on the clinical symptoms and T3, T4 and TSH levels of Hypothyroidism. MATERIALS AND METHOD Study design The study design was a controlled clinical trial. Randomization was not done due to two different settings. Newly diagnosed participants were selected as per the inclusion and exclusion criteria. The control selected here was not a concurrent control. The control group was selected from an accessible population at Maulana Hospital, Perinthalmanna, Kerala, India. A detailed clinical examination was done before and after the study using a prepared case record form. Analysis of both the treatments was done by evaluating subjective and objective parameters. Sample collection and preparation of study drug The fresh Stem of Tinospora cordifolia were collected from nearby areas of Kottakkal, Kerala, India. The stem cuttings were properly identified in the department using external morphological and histological characters. Satvam was prepared as per the procedure given in the text. (Yogaratnākara Rājayaksamā Cikitsā; 328, Verse no /2) The fresh fruit of Phyllanthus emblica of similar size were bought from market. The fruits were identified in the department and well dried in shade. Powder was prepared in the size of microns. (The Ayurvedic Pharmacopoeia of India, 2001) Physicochemical Standardization of Thyromax powder In the present study the combination of Satvam of Tinospora cordifolia and fine powder of dried fruits of Phyllanthus emblica in the ratio of 1:3; given the name Thyromax powder were subjected to preliminary physicochemical screening for the standardization of drug and extraction of constituents. (Quality Standards of Indian medicinal Plants, and The Ayurvedic Pharmacopoeia of India, 2001). (Table no. 2-4) Phytochemical analysis Quantification of characteristic compounds The extracts obtained were subjected to qualitative tests for the identification of various constituents. (Quality Standards of Indian medicinal Plants, 2003 and The Ayurvedic Pharmacopoeia of India, 2001). (Table no. 5-7) Thin Layer Chromatography & HPTLC Selection of chromatographic layer Pre-coated TLC silica gel 60 F 254 (E. Merck) plates on aluminum sheet were used for chromatographic profile for individual drugs and for Thyromax powder. TLC of all successive solvent extractives of Thyromax powder was prepared. While HPTLC fingerprinting of methanolic extract of Guducī Satvam, Āmalakī cūrnam and Thyromax powder was prepared. Selection of mobile phase for TLC a] For Thyromax powder Before the application of the samples to the plates, an appropriate solvent system was selected. The solvent system was chosen by the trial and error method. The solvent systems used for the TLC analysis were different for different successive solvent extractives. For Petroleum ether extract n-hexane : ethyl acetate : formic acid (10:2:0.2) For Cyclohexane extractive Toluene : ethyl acetate : formic acid (8:2:0.2 ) For Acetone & Ethanol extract Toluene : ethyl acetate : formic acid (5:5:1) Selection of mobile phase for HPTLC a] For Guducī Satvam For methanolic extract toluene : ethyl acetate : formic acid (7:5:1)

59 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January b] For Āmalakī cūrnam For methanolic extract toluene : ethyl acetate : formic acid (7:5:1) c] For Thyromax powder For methanolic extract toluene : ethyl acetate : formic acid (7:5:1) Application of sample For the application of sample CAMAG Automatic TLC sampler IV were used and the concentration of sample extractives were between 0.2 to 0.6 micro liters. Pre-conditioning Saturated chamber by lining with filter paper for 30 minutes was prepared prior to development for getting better Rf values. For this CAMAG ADC-2 Automatic development chamber was used. Chromatographic development and drying After development, the plates were taken out and mobile phase was completely removed from the plate by drying in vacuum desiccators. Detection and visualization Detection under UV light is the first choice so plates were visualized in CAMAG TLC Visualizer and photographs were taken in UV 254 and 365 nm. wavelength. Since very dim spots were obtained in visible light, the TLC plates were then sprayed with Anasaldehyde sulphuric acid and dried in hot air oven at 110 o C. The colors of the spots were recorded and their positions were marked. The distance travelled by each band was measured and respective R f values were calculated. TLC analysis of Thyromax powder For TLC study of Thyromax powder, Petroleum ether, Cyclohexane, Acetone and Ethanol extractives were spotted in the solvent system given in the literature of TLC under heading selection of solvent system. Eluents were different for all extractives (common for Acetone and Ethanol) hence Rf values, TLC photographs are given separate. HPTLC analysis HPTLC profile was prepared for Guducī Satvam, Āmalakī cūrnam and for the combination Thyromax powder separately. The mobile phase and extracts were different for samples and has been mentioned earlier. For Methanolic extract of Guducī Satvam and Āmalakī cūrnam table of Rf value, TLC plate photos and HPTLC over view and area graphs are given separately. Clinical study In the present study randomization was not done hence comparison of demographic details and base line values of both the groups were done. Comparison of response to the treatment within both the groups was done. Total 20 participants were registered for the present study, each 10 in study and control group. All participants received full course of treatment and completed their course successfully without any interruption, hence there were no dropouts in the study. Data outcome were tabulated; mean deviation, standard deviation and percentage between the assessments were calculated. Student t test was applied to find out level of significance for all the parameters with in the treatment and control group. The data were statistically analyzed before and after intervention. RESULTS Organoleptic characters Detailed in (Table 1) Powder microscopy Guducī satvam Starch grains of Guducī showed deep blue color when mounted with Iodine solution. Every particle of Satvam was separated from each other. The shapes of Satvam particle was not similar and varies in size from other particles. Starch grains of Guducī were approximately µ in diameter and µ in length. (Fig. no. 1&2).

60 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Powder microscopy of Āmalakī cūrnam Powder showed hexagonal, thick, straightwalled epidermal cells in surface view embedded with small prismatic crystals of silica; isolated or groups of thin-walled pitted stone cells; fragments of thick walled fibers and sclereids; fragments of pitted vessels, tracheids and parenchyma, crystals of silica and simple oval to spherical starch grains scattered as such or embedded in the parenchymatous cells of the mesocarp. (Fig.no.3-6) (The Ayurvedic Pharmacopoeia of India). Table 1. Organoleptic Characters No. Characters Characteristics of Satvam Characteristics of Āmalakī cūrnam 1 Touch Fine and Smooth Rough 2 Color White Light grey 3 Taste Sweet Bitter, Sour and Sweet astringent 4 Odor Odorless Odorless 5 Consistency Fine powder Fine powder Fig. 1 2 Powder Microscopy of Guducī Satvam Fig. 3 6 Powder Microscopy of Āmalakī Cūrnam Table 2. Physicochemical standards of Thyromax powder Sr. No. Experiments Percentage 1. Total ash 3.05% 2. Water insoluble ash 2.23% 3. Acid insoluble ash 1.47% 4. Moisture content 11% 5. Volatile oil content 01% 6. Sugar content a. Total Sugar 13.1% b. Reducing sugar 7.23% 7. Fibre content 3.0%

61 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Table 3. Percentage of water soluble and alcohol soluble extractives No. Name of extract Percentage of extract Color / Consistency 1. Hot water soluble 80.75% Blackish brown / Dry 2. Cold alcohol soluble 27.40% Dark brown / Oily 3. Hot alcohol soluble 50.00% Dark brown / Oily Table 4. Successive solvent extractives No. Experiments Percentage Color /Consistency 1. Petroleum ether 1.63 % Light yellow / Oily 2. Cyclohexane 0.80 % Lemon yellow/oily 3. Acetone 12.0 % Dark brown / Oily 4. Ethanol 11.0 % Dark brown / Oily Table 5. Qualitative Phytochemical analysis of the extractives Solvent Steroid Alkaloids by Phenol Flavonoids Tannins Mayer s DDR Petroleum ether Cyclohexane Acetone Ethanol Water Cold alcohol Hot alcohol Table 6. R f values of different spots of Thyromax powder Petroleum ether Cyclohexane Acetone extract Ethanol extract extract extract 7 Spots 5 Spots 3 Spots 7 Spots Colour of R f Colour R f Colour of R f Colour of Spot R f Spot of Spot Spot Violet 0.24 Purple 0.40 Brown 0.12 Pale brown 0.07 Violet 0.31 Purple 0.48 Brown 0.34 Pale brown 0.13 Violet 0.36 Purple 0.66 Light 0.46 Pale brown 0.17 violet Violet 0.40 Violet Pale brown 0.24 Pale pink 0.61 Violet Brown 0.35 Violet Light green 0.41 Pale Violet Light violet 0.49

62 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January TLC of Thyromax powder (Fig. no. 7-18) Fig. no. 7-9: TLC plate of Petroleum ether extract of Thyromax powder Fig. no : TLC plate of Cyclohexane extract of Thyromax powder 7: 254 nm 8: Derivatized plate. 9: 366 nm. 10: 254 nm. 11: Derivatized plate. 12: 366 nm. Fig. no : TLC plates of Acetone extract of Thyromax powder Fig. no : TLC plates of Ethanolic extracts of Thyromax powder 13: 254 nm 14: Derivatized plate. 15: 366 nm. 16: 254 nm. 17: Derivatized plate. 18: 366 nm. Table 7. Rf value details of Methanolic extract of Guducī Satvam, Āmalakī cūrnam and Thyromax powder. Guducī Satvam Āmalakī cūrnam Thyromax powder Spots Spots Spots Color R f Color R f Color R f Light orange 0.80 Blue 0.18 Dark blue 0.18 Light orange 0.40 Blue 0.60 Light violet 0.70 Pink 0.70 Pink 0.80

63 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January TLC of Āmalakī curnam and Guducī satvam (Fig. no ) Fig. no : TLC plates of Methanolic extract Fig. no : TLC plates of Methanolic extract of Thyromax powder. 19: Āmalakī at 254nm 20: Āmalakī at 366nm 21: Guducī at 366nm. 22: 254 nm 23: 366nm HPTLC Over view graphs of study drugs (Fig. no ) Fig. no. 24: Over view graph of Methanolic extract of Āmalakī at 254nm Fig. no. 25: Area graph of Methanolic extract of Āmalakī at 254 nm. Fig. no. 26: Over view graph of Methanolic extract of Guducī Satvam at 254 nm Fig. no. 27: Area graph of Methanolic extract of Guducī Satvam at 254 nm

64 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Fig. no. 28: Over view graph of Methanolic extract of Thyromax powder at 254 nm Fig. no. 29: Area graph of Methanolic extract of Thyromax powder at 254 nm Fig. no. 30: Over view graph of Methanolic extract of Thyromax powder at 366 nm Fig. no. 31: Area graph of Methanolic extract of Thyromax powder at 366 nm Data related to response to the treatment Graph 1. Effect of the treatment on weight gain Effect of the treatment on weight gain Graph 2. Effect of the treatment on excessive sleep Effect of the treatment on excessive sleep BT AT Study Control BT 0.2 AT 1.6 Study Control

65 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Graph 3. Effect of the treatment on muscle cramp Effect of the treatment on muscle cramp BT 0.2 AT Study Control Graph 4. Effect of the treatment on edema Effect of the treatment on edema BT 0.4 AT 1.1 Study Control Graph 5. Effect of the treatment on dry skin Effect of the treatment on dry 2.0 skin BT AT Study Control Graph 6. Effect of the treatment on constipation Effect of the treatment on 2.8 constipation BT 0.0 AT Study Control Graph 7. Effect of the treatment on T3 parameter Effect of the treatment on T3 parameter Graph 8. Effect of the treatment on T4 parameter Effect of the treatment on T4 parameter BT AT Study Control BT AT Study Control

66 Global J Res. Med. Plants & Indigen. Med. Volume 2, Issue 1 January Graph 9. Effect of the treatment on TSH Effect of the treatment on TSH BT AT Study Control DISCUSSION Pharmacognostical study Moisture content of the shade dried drug determined by Dean & Starks apparatus was found to be 11%. Total ash of any drug is the residue obtained on its complete incineration in an electric Bunsen burner. This mainly represents the inorganic salts present in the drug, if the drug is pure and any impurities like sand, soil etc. adhering to the drug will also remain as ash, thus increasing the ash value several fold. Ash value is the general criterion to ascertain the purity of the drug. Total ash value of the drug was found to be 3.05%. Water insoluble ash mainly gives the percentage of organic matter present in the ash and this was found to be 2.23%. Acid insoluble ash, which mainly gives the percentage of the sand and impurities that remain insoluble in HCl and it was found to be 1.47%. Water soluble extracts of the drug mainly represents the percentage of organic constituents such as tannins, sugars, acids, mucilage and glycosides. Alcohol soluble extracts mainly represents the percentage of organic constituents such as alkaloids, phenols, flavanoids, steroids, sugars etc. present in the drug. Successive solvent extraction, which is the extraction of the drug with organic solvents of increasing polarity, was applied for the isolation of active constituents from the crude drug. The highest percentage of extract was obtained by the extraction with acetone (12.0 %) and least with the solvent cyclo-hexane 0.80 percent. The extracts obtained by exhausting crude drugs are indicative of approximate measure of their chemical constituents. Successive extraction showed scattered results because of the combination of two drugs. Due to Āmalakī cūrnam (Phyllanthus emblica) tannin present in all the extracts and steroids are present in all except cyclohexane extractive. While alkaloid (by Mayer s reagent) is present only in cyclohexane extract and alkaloid by Dragendroff s reagent present in all except water soluble extract. Phenol and flavonoids are present in all the extract except petroleum ether and cyclohexane extractives. Clinical study Student t test was applied to find out level of significance for all the parameters with in the treatment and control group. The data were statistically analyzed before and after intervention. Both the groups were not compared since only study group showed significant improvement on subjective parameters and only control group showed