Original Research Role of Vachadi Vati in the Management of Epilepsy (Apasmara) Usha K 1 and Gurdip Singh 2

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1 Journal of Ayurveda Physicians & Surgeons (Peer Review International Journal, EISSN ) Original Research Role of Vachadi Vati in the Management of Epilepsy (Apasmara) Usha K 1 and Gurdip Singh 2 1 Associate Professor Ayurveda Medical College Bangalore, 2 Director, PG & Ph D Studies, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, BM Road, Thanniruhalla, Hassan , Karnataka *Corresponding author: address: dr.ushaks@gmail.com Mobile phone: Access this article on online: Published by International Academy of Ayurveda-Physicians (IAAP), 7HB, Gandhinagar, Jamangar Date of submission: ; Date of Revision: ; Date of Acceptance: Abstract: Sutaria and Gurdipsingh (1989, 2017) treated the patients of epilepsy with Smriti-Sagara Rasa along with multiple Rasayana drugs and reported that it significantly reduced the severity of the disease (58.5 %) and provided complete remission to 41.7% patients, marked improvement to 41.7% and mild improvement to 16.7% patients. But the drug multiple drug administration was very inconvenience to the patients. Hence in the present study a single Vachadi Vati was prepared comprising of all those drugs to ascertain its effect on the patients of epilepsy. The results of this study showed that it provided marked improvement to 33.3% patients and improvement to 41.7% patients but 25% patients remained unchanged. Key Words: Epilepsy, Apasmara, epilepsy, Vachadi Vati Introduction: Charaka mentions that Apasmara (epilepsy) is a chronic and difficult to cure disease and for such conditions the use of Rasayana drugs is advised. For this purpose the Rasayana drugs such as Lashuna (Allium sativum), Shatavari (Asparagus racemosus), Vacha (Acorus calamus), Kushtha (Saussuria lappa) and Mandukaparni (Hydrocotyle asiatica) are mentioned (Caraka Chikitsa 10:64). On this basis Sutaria and Gurdipsingh (1989, 2017) carried out a clinical study and in which multiple drugs such as Smriti Sagara Rasa, Vachadi Churna, Brahmi Ghrita Nasya, Shatavari powder at bed time and Lashuna paste with sesame oil in the morning were given simultaneously and reported that the treatment provided complete remission to 41.7% patients, marked improvement also to Aim: To evaluate the role of Vachadi Vati in the management of epilepsy (Apasmara) Patients and Methods 12 patients of epilepsy who were registered irrespective of their age, sex, religion etc, from the OPD of Kaya Chikitsa Department, 41.7% patients and mild improvement to 16.7% patients. Obviously the above multiple drug schedules administered at different time were inconvenient to the patients. Hence it was thought that if a pill comprising all those drugs is prepared, then, it might be more convenient for the patients. So from all those drugs, a compound termed as Vachadi Tablet was prepared. It comprises of equal parts of Vacha (Acorus calamus), Kushtha (Saussurea lappa), Shatavari (Asparagus racemosus), Shankhapushpi (Convolvulus pluricaulis), Lashuna (Allium sativum) and Mandukaparni (Hydrocotyle asiatica). As mentioned above all these Rasayana drugs have also been advised to manage the chronic stage of the disease in the chapter of Apasmara (Charaka Chiki.10: 64-65). IPGT&RA, Gujarat Ayurved University, Jamnagar Criteria of Diagnosis: The main criterion for diagnosis was the clinical presentation of the disease but it was confirmed by E.E.G. in doubtful cases. 22

2 Exclusion Criteria: Patients with diabetes mellitus, hypertension, and congenital abnormalities and in whom the interval between the two seizures was more than two months with normal E.E.G. were excluded from the study. Laboratory Investigations: Routine hematological investigations like R.B.C. Count, TLC, DLC, Hb.%, ESR and urine Drug and Doses: Vachadi Vati comprising equal part of Vacha (Acorus calamus), Kushtha (Saussurea lappa), Shatavari (Asparagus racemosus), Shankhapushpi (Convolvulus pluricaulis), Lashuna (Allium sativum) and Mandukaparni (Hydrocotyle asiatica) was formulated, as all these Rasayana drugs have been advised to prescribe in the chronic stage of the disease in the chapter of Apasmara (Charaka Chiki.10: 64-65). Vachadi Vati was given in the dose of 3 gm, three times a day with lukewarm water for two months. Diet: The patients were asked to continue their routine light diet and the routine hospital diet was given to the I.P.D. patients. Duration of treatment: The treatment was continued for two months. Follow-up Study: After the completion of the treatment, the follow-up study was done weekly for two months to note the recovery of attacks or otherwise and the investigations were repeated to see any obvious effect of the drugs under trial. Criteria for Assessment: The symptoms were assigned suitable scores to give objectivity so that statical analysis of the data may be done. Results The effect of Vachadi Vati administered for two months on the pre-ictal signs and symptoms of the epilepsy patients are shown in Table-1, on ictal signs and symptoms in Table-2 and on post-ictal signs and symptoms in Table-3. All the symptoms of pre-ictal, and stool examinations were carried out in all the patients. Biochemical investigations like serum cholesterol, total protein, albumin, A:G ratio, blood urea, serum creatinine, serum sodium, serum potassium, serum calcium were also under taken in doubtful patients to exclude other pathologies as well as to assess the initial condition of the patients. Criteria for the Overall Effect of the Therapy: To assess the total effect of the therapy, the following criteria were fixed: Complete remission: 100% relief in signs and symptoms. No attack of Apasmara during and after the treatment upto two months of follow-up. Markedly Improved: More than 50% relief in signs and symptoms during the attack as well as 50% decrease in the frequency of attack. Improved: 25% to 50% relief in the signs and symptoms during the attack with the frequency of attack reduced to 25% of the initial frequency. Unchanged: Less than 25% relief in signs and symptoms during the attack with no change in the frequency. Observations: In the series the patients were between the age of 10 years and 60 years with the maximum patients (76.5%) were between the age of 11 and 30 years. 58.8% patients were male, 64.8% patients were having Vata-Kapha Prakriti (Table-3) and 47.1% patients each were having the chronicity of 6 to 10 years and 11 to 20 years. ictal and post ictal were statistically analyzed separately to show the nutshell effects of the therapy on these symptoms and the results are shown in Table-4. The effect of on frequency, duration and severity of the seizures are presented in Table-5. Last Table-6 shows the overall effect of the Vachadi Vati therapy. 23

3 Table-1 Effect of Vachadi Vati on Signs and Symptoms (Pre-Ictal) of Epilepsy Patients Signs & Symptoms Mean Score % of SD (±) SE T P BT AT change (±) Bhru Vyudasa >0.05 Aksnoho Vaikrtam >0.05 Asabda Sravana >0.05 Anannabhilasa >0.05 Avipaka >0.05 Daurbalyata <0.01 Asthi-Bheda >0.05 Angamarda <0.01 Tamaso Darsana >0.05 Bhrama <0.05 Sunyata <0.01 Sveda >0.05 Dhyana <0.05 Nidra Nasa <0.05 Table-2 Effect of Vachadi Vati on Signs and Symptoms (Ictal) of Epilepsy Patients Signs & Symptoms Mean Score % of SD (±) SE T P BT AT change (±) Unconsciousness <0.01 Falling Down >0.05 Convulsion >0.05 Foaming from Mouth <0.01 Teeth Locking <0.01 Lala Srava <0.05 Phena Vamana <0.001 Danta Khadana <0.01 Jihva Prasphurana <0.01 Aksi Prasphurana >0.01 Bhru Prasphurana <0.01 Hasta Viksipana >0.05 Pada Viksipana >0.05 Vivrtaksa <0.01 Kujana <0.01 Tongue bite <0.05 Incontinence of urine <0.001 Incontinence of Stool >

4 Table-3 Effect of Vachadi Vati on Post Icteral Signs and Symptoms of Epilepsy Patients Signs & Symptoms Mean Score % of SD (±) SE t P BT AT change (±) Gestural automatism >0.05 Headache <0.001 Amnesia <0.01 Drowsiness <0.01 Paresis >0.05 Table-4 Total Effect of Vachadi Vati on Pre-ictal, Ictal and Post Ictal Signs and Symptoms of Epilepsy Patients Signs & Symptoms Mean Score % of SD (±) SE t P BT AT change (±) Pre ictal <0.001 Ictal <0.001 Post ictal <0.05 Table-5 Effect of Vachadi Vati on the Seizures of Epilepsy Patients Seizure s Mean Score % of SD (±) SE (±) t P BT AT change Duration >0.05 Frequency >0.01 Severity <0.01 Table-13 Overall Effect of Vachadi Vati on the 12 Patients of Epilepsy Patients Overall effect No. of Patients Percentage Complete remission Markedly improved Improved Unchanged Discussion 12 patients of Apasmara (epilepsy) were treated with Vacadi Vati administered for two months. It provided significant relief in the ictal features of incontinence of urine (74%), froth from mouth (68.4%) and grinding of teeth (52%). Significant relief was also found in the preictal features of insomnia and feeling of hollowness (79.1%), non-relishing of food (77.3%), unawareness (75.2%), weakness (69.8%), disliking for food (67%), diminished digestion (60.9%) and skew of eyeball (43.1%). It significantly reduced the frequency of the epilepsy attack by 16.2%, duration of attack by 29.3% and severity of attack by 24.9%. 25

5 It provided significant relief in signs and symptoms of pre-ictal (67.5%), ictal (43.2%) and post-ictal (55.6%) symptoms. The drug significantly reduced the frequency of the seizure by 16.2%, duration of attack by 29.3% and severity of the seizer by 24.9%. Consideration of overall effect of this drug showed that it provided marked improvement in 33.3% patients, improvement in 41.7% patients and no improvement in 25% patients. The results of follow up of the patients observed up to 2 months after stopping the treatment showed that 25% patients of this group had no attack of epilepsy. The frequency of the seizure was reduced to 50% in 25% patients. It was reduced to25% in other 33% patients. No change in the frequency was observed in the remaining16.7% patients. No deterioration in the level of duration of the attack achieved by the treatment was noticed. Neither any increase nor decrease in the severity of the attacks was noticed during this follow up study, which showed somewhat stable effect of the drug. Comparison of the results of previous study (Sutaria and Gurdipsingh 2017) wherein the patients of epilepsy were treated with Smriti- Sagara Rasa along with multiple Rasayana drugs and reported that it provided complete remission to 41.7% patients, while in present study none of the patient got complete remission. The reason may be that in that study Smriti Sagara Rasa was also be given. Further individual drugs such as Shatavari, Lashuna etc were given in higher doses and Brahmi was given in form of Brwahmi Ghrita nasya. While in present study their dose in combination form was comparatively very less, hence the relief was also proportionally less. To compensate, it is suggested to use Vachadi Vati along with Smriti Sagara Rasa. Conclusions Two months treatment with Vacadi Vati provided significant relief in all most all the signs and symptoms of the disease. It provided significant relief in signs and symptoms of pre ictal, ictal and post ictal stages. It significantly reduced the duration, frequency and severity of the seizer. Vachadi Vati provided marked improvement in 33.3% patients, improvement in 41.7% patients and no improvement in 25% patients. Bibliography Charaka Samhita with Chakrapani Commentary. Published by Nirnnaya Sagar Press, Bombay. Sutria, Bharti N., Singh, Gurdip and Chandola H.M. (1989): A Clinical Study on the Role of Rasayana Drugs in the Management of Apasmara. M.D. (Ayu) Thesis, Gujarat Ayurved University, Jamnagar Usha K. Satyanarayana and Singh Gurdip (2001): A Clinical Study on Apasmara (Epilepsy) and its Management with Mahapanchagavya Ghrita. M.D.(Ayu) Thesis, Gujarat Ayurved University, Jamnagar Yogaratnakara: Yogaratnakara, Published by Chaukhmba Publication, Varanasi. Nagarajan, (1991): Apasmara and its management-a critical study M.D. (Ayu) KC &PK Thesis, Govt. Ayurvedic College, Thiruvananthapuram. Jadhava Ranjit (1999): A comparative phytochemical and Psychoneuropharmacological study of Vaca and Suvarna Vaca Pandya M. B. (1962): Apasmara-A treatise on epilepsy by Department of Stress as a risk factor for seizures among adults with epilepsy Epilepsia 1984;25:

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