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Evaluation of Efficacy of Plaksha Twak Churna in the Management of Shweta Pradara A Comparative Clinical Study By Dr. Kalavati. D. Petlur Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore In partial fulfillment of the degree of Ayurveda Vachaspati M.D. In Dravya Guna Under the Guidance of Dr. Kuber Sankh M.D. (Ayu) and Co-guidance of Dr. Shashikant Nidagundi M.D. (Ayu) Department of Dravya Guna Post Graduate Studies & Research Centre D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG 2006-2009

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Evaluation of Efficacy of Plaksha Twak Churna in the Management of Shweta Pradara A Comparative Clinical Study - Dr. Kalavati. D. Petlur, Department of Dravya Guna, Post Graduate Studies & Research Centre, D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE,GADAG

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Evaluation of Efficacy of Plaksha Twak Churna in the Management of Shweta Pradara

A Comparative Clinical Study

By

Dr. Kalavati. D. Petlur

Dissertation submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fulfillment of the degree of

Ayurveda Vachaspati M.D.

In Dravya Guna

Under the Guidance of Dr. Kuber Sankh

M.D. (Ayu) and Co-guidance of

Dr. Shashikant Nidagundi

M.D. (Ayu)

Department of Dravya Guna Post Graduate Studies & Research Centre

D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG 2006-2009

Ayurmitra
TAyComprehended
Page 2: Shweta pradara#dg16 gdg

D.G.M.AYURVEDIC MEDICAL COLLEGE

POST GRADUATE STUDIES AND RESEARCH CENTRE

GADAG - 582 103

This is to certify that the dissertation entitled “Evaluation of Efficacy of Plaksha

Twak Churna in the Management of Shweta Pradara A Comparative Clinical Study” is a

bonafide research work done by Dr. Kalavati. D. Petlur in partial fulfillment of the

requirement for the post graduation degree of “Ayurveda Vachaspati M.D. (Dravya Guna)”

Under Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka.

Dr. Kuber Sankh

M.D. (Ayu) Guide

Asst.Professor

Dept. of Dravya Guna

DGMAMC, PGS&RC, GADAG

Date:

Place: Gadag

Dr. Shashikanth Nidagundi

M.D. (Ayu) Co- Guide

Lecturer in Dravya Guna

DGMAMC, PGS&RC, GADAG

Date:

Place: Gadag

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J.S.V.V. SAMSTHE’S

D.G.M.AYURVEDIC MEDICAL COLLEGE

POST GRADUATE STUDIES AND RESEARCH CENTRE

GADAG, 582 103

Endorsement by the H.O.D, Principal/ head of the institution

This is to certify that the dissertation entitled “Evaluation of Efficacy of Plaksha

Twak Churna in the Management of Shweta Pradara A Comparative Clinical

Study” is a bonafide research work done by Dr. Kalavati. D. Petlur under the guidance

of Dr. Kuber Sankh , M.D. (Ayu), Asst. Professor and Dr. Shashikanth Nidagundi,

M.D. (Ayu), in partial fulfillment of the requirement for the post graduation degree of

“Ayurveda Vachaspati M.D. (Dravya Guna)” Under Rajiv Gandhi University of

Health Sciences, Bangalore, Karnataka.

.

(Dr. G. B. Patil) Principal,

DGM Ayurvedic Medical College, Gadag

Date: Place: Gadag

(Dr. G. V. Mulagund) Professor & HOD

Dept. of Dravya Guna PGS&RC

Date: Place: Gadag

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Declaration by the candidate

I here by declare that this dissertation / thesis entitled “Evaluation

of Efficacy of Plaksha Twak Churna in the Management of Shweta

Pradara A Comparative Clinical Study” is a bonafide and genuine

research work carried out by me under the guidance of Dr. Kuber Sankh

M.D.(Ayu) Professor and Dr. Shashikanth Nidagundi M.D.(Ayu),

Lecturer in Dravya Guna, DGMAMC, PGS&RC, Gadag.

Date :

Place : Gadag

(DR. KALAVATI. D. PETLUR)

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© Copy right

Declaration by the candidate

I here by declare that the Rajiv Gandhi University of Health

Sciences, Karnataka shall have the rights to preserve, use and disseminate

this dissertation/ thesis in print or electronic format for the academic /

research purpose.

Date :

Place : Gadag

(DR. KALAVATI. D. PETLUR) © Rajiv Gandhi University of Health Sciences, Karnataka

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I

ACKNOWLEDGEMENT

This is a moment of great pleasure and Contentment for me as writing

Acknowledgment is the last phase in completion of this research work.

At the onset my devotional pranamas to Shri Sainath, Shiradi Math and Holiness

Sri. Jagadguru Abhinava Shivanada Swamiji, Shivananda math, Gadag.

I take this glorious opportunity to acknowledge with deep sense of gratitude to Dr.

G.V. Mulagund, professor, Head of the Dept, Department of post graduate studies

research (Dravyaguna) D.G.M.A.M.C,Gadag for his valuable guidance and close

supervision during the entire phase of the study.

I take this opportunity to acknowledge with the deep sense and gratitude to my

guide Dr. Kuber Sankh. Asst. Professor, Department of post graduate studies and

Research (Dravyaguna) D.G.M.A.M.C,.Gadag for their valuable guidance and close

supervision during the entire phase of the study.

My profound gratitude to my co- guide Dr. Shashikanth Nidagundi, lecturer,

Department of Post graduate studies and Research (Dravyaguna) D.G.M.A.M.C, Gadag

for their good and valuable guidance through out this dissertation work.

With profound sense A gratitude I express my sincere thanks to Dr. G.B. Patil,

beloved Principal , D.G.M.A.M.C. Gadag, I thank Sri. S.B. Saunshi, Chairman and all the

committee members for their constant encouragement, facilities provided and moral

support during my post graduate study.

I wish to add my warmest thanks to my PG teaching faculty, Dr. K.S. Paraddi, Dr.

G.S. Hiremath, Dr. M.C. Patil, Dr. K. Shivaram Prasad, Dr. Shashidhar Doddamani, Dr.

Santosh Belavadi, Dr. Jagadish Mitti, Dr. Raghavendra Shettar, Dr. Girish

Danappagoudar, Dr. Veena Kori, Dr. Ashok Patil for their valuable suggestions and

timely help made me to complete this dissertation work successfully,

I thank Dr. G.B. Mulugund, Prof and H.O.D, Department of P.G studies in

Dravyaguna GAMC, Bangalore. For their constructive suggestions and encouragement in

preparing this dissertation.

I sincerely thank P.M. Nandakumar statistician, Sri. V.M. Mundinamani,

Librarian, Sri. Lakkundi, Photographer, Sadguru Computers for their timely help during

my study.

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II

I express my sincere thanks to Dr. Chandrakant. S. Hiremath, Principal Shri

Raghavendra Ayurvedic Medical College, Malladahalli for their kind support.

I extend my greatfulness to my colleague Dr. G.S. Kulkarni who helped me

during my dissertation work. I extend my gratefulness and sincere heart felt gratitude to

my colleagues Dr.Kavita Mittalkod, Dr. R.A. Malwad, Dr. Jaya Malgoudar, Smt. P.K.

Belavadi and other office staff for their timely support and encouragement got during the

course. I am very thankful to my friends Dr. Mukta, Dr. Savita, Dr. Jaya, Dr.

Sarvamangala, Dr. Veena, for their help and co-operation during the study.

I wish to thank Principals of Rajeev Gandhi D.Ed. College, Anglo Urdu D.Ed.

College of Gadag R.M.O and all the physicians and other staff of the hospital and all my

patients and their assistants for their co-operation during my clinical study. And I express

my deepest gratitude to my beloved Parents Devendrappa, Smt. Laxamavva and my

beloved Husband Rachappa and my lovely daughter Sunanda, my brother Mr & Mrs.

Mahantesh, Udayavani, and family members, my aunty Shanta who have inspired me to

continue my PG study with their constant moral support.

I wish to thank G.B. Mamdapur, Chairman and all the committee members of

S.VP.R.A.M.C. Badami for their economical support.

Place: Gadag

Date: (K. D. Petlur)

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III

ABBREVIATION

A.H. Astanga Hridaya

A.P.I. Ayurvedic Pharmacopoeia of India

A.S. Astanga sangraha

B.P. Bhavaprakasha

B.R. Bhaishajya Ratnavali

BP.N. Bhavaprakasha Nighantu

C.Chi Charaka Samhita Chikitsa Sthana

C.S. Charaka samhita

D.N. Dhanwantari Nighantu

PVS Dravyaguna Vijnana By Priyavrat Sharma

VMG Dravyaguna vijnana By V.M. Gogte

D.G Dravyaguan vijnana.

I.M.M. Indian Materia Medica

I.M.P. Indian Medicinal Plants

K.N. Kaiyadeva Nighantu

M.D. Madhava Dravyaguna

M.N. Madanapala Nighantu

N.A. Nighantu Adarsha

R.N. Raja Nighantu

R.R.S Rasa Ratna Samucchaya

R.S.S Rasendra Sara Sangraha

S.S Sushruta Samhita

S.N Shaligrama Nighantu

Sha.Sam Sharangadhara Samhita

Y.R. Yoga Ratnakar

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IV

ABSTRACT

Shweta pradara is one of the commonest problems of women. Women suffer from

leucorrhoea at least once in a while during their lifetime. Recurrence also is a common

phenomenon and it occurs mainly due to infections by bacteri, fungi and protozoa.

Usually it occurs in unhygienic conditions, but can also occur after some surgical

procedures and at the time of delivery. This condition is described in ayurvedic classics

by the term shwetapradara as a symptom in various vaginal related diseases (yonivyapat).

Though there are different modes of treatment for yonivyapat, the significant one is local

therapy. Hence this study was conducted to find out some suitable drug for this procedure

and Plaksh (Ficus lcaor) was selected. Here study is aimed to evaluate the effect of

Plaksha twak churna in Shweta pradara.

OBJECTIVES

1. Pharmacognoistical evaluation of Plaksha, Preliminary phyto chemical study,

Macroscopical evaluation, Standardization and validation.

2. To Evaluate the efficacy of Plaksha twak churna in the management of Shewta

pradara.

3. To evaluate the Plaksha twak kashaya as a trans vaginal douche in the

management of Shweta pradara.

4. To evaluate the comparative effect of Plaksha twak churna orally and kashaya as

trans vaginal douche in the management of Shweta pradara.

METHOD

In this prospective comparative clinical study, 30 patients randomly selected and

Grouped as A and B receiving Plaksha twak churna with Madhu and Plaksha twak churna

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V

kashaya as trans vaginal douche respectively for the study duration of 21 days from the

day of initiation of medication with dose of 4 gms with honey BD. The patients are asked

for the reporting every 7th, 14th and 21st days efficacy was assessed by the difference of

before and after the treatment from the subjective and objective parameters.

RESULTS

Individually all the 2 groups showed highly significant in subjective as well as

objective parameters comparatively group A shows more significant then the group B.

INTERPRETATION & CONCLUSION

The statistical analysis is done by using student’s paired t-test, by assuming that

the drug is not responsible for changes in the readings before and after treatment. From

the analysis all parameters shows highly significant (as p<0.05). The parameters

Excessive Vaginal Discharge, Vaginal ph, Vaginal Smear and Extensive prurtis shows

more highly significant than the other parameters ( as p<0.001). and the parameters

Persistent vulval moistness and General weakness shows less highly significant (as

p>0.001).

The percentage of improvement in the parameters is Excessive Vaginal Discharge

with 96.66667, Persistent vulval moistness with 91.42857 %, Extensive pruritis with

91.11111%, General weakness with 93.47826%, Pain in lumbar region with 87.5%,

Vaginal ph with 26.89394 % and Vaginal Smear with 100% from the study.

KEY WORDS

Plaksha (Ficus lacor), Madhu (Honey)

Leucorrhoea; Methods; Clinical study; Results;

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VI

CONTENTS

Page No.

1. Introduction 1-2

2. Objectives 3-3

3. Review of literature 4-60

a) Drug Review 4-32

b) Disease Review 33-60

4. Methodology 61-74

5. Results 75-105

6. Discussion 106-118

7. Conclusion 119-120

8. Summary 121-121

9.Bibliography 122-131

10.Annexure

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LIST OF TABLES

DRUG REVIEW

TABLE 1 PLAKSHA

Page No.

Table 1.1 – Showing Gana and Varga according to different

classics

7

Table 1.2 – Showing Prayaya according to different authors. 8-10

Table 1.3 – Showing Guna according to different authors 20

Table 1.4 – Showing Karma according to different authors 21

Table 1.5 – Showing Prayojya anga according to different authors 22

Table 1.6 – Showing Prayoga according to different authors. 23

Table 1.7 – Showing the Matra according to different authors. 24

Table 1.8 – Showing the use of Plaksha in different yogas. 25

Table 1.9 – Showing Pharmacological action of Madhu 30

TABLE. 2. DISEASE REVIEW

Page No.

Table 2.1 – Showing the Swaroopa of Shuddha Artava 40

Table 2.2 – Showing the Nidana of Shweta pradara. 40

Table 2.3 – Showing the Yoni rogas in which Shwetasrava is

considered as a symptom

42

Table 2.4 – Showing the Sthanika lakshanas of Shweta pradara 43

Table 2.5 – Showing the Pathyapathya in Shweta pradara. 46

Table 2.6 – Showing the Incidence of cause of Leucorrhoea 55

TABLE. 3. OBSERVATIONS AND RESULTS Page No.

Table 3 a) Showing the Physical constants & found values of Bark

powder of Plaksha.

74

Table 3 b) Showing the Thin layer Chromatography analysis of

Aqueous extract.

74

Table 3 c) Showing the Phytochemical components and found

values of bark powder of Plaksha.

75

Table 3.1 Showing the incidence of Menstrual history 77

Table 3.2 Showing the incidence of Age 78

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Table 3.3 Showing the incidence of Socio-economic status 79

Table 3.4 Showing the classification of Patients based on their

Prakruti

80

Table 3.5 Showing the incidence of Dietic pattern 80

Table 3.6 Showing the incidence of Nidhana 81

Table 3.7 Showing the result by religion in Shweta pradara with

Plaksh twak churna.

82

Table 3.8 Showing the result by occupation in Shweta pradara

with Plaksh twak churna.

83

Table 3.9 Showing the Economic status in Shweta pradara with

Plaksh twak churna.

83

Table 4.0 Showing the result by Diet in Shweta pradara with

Plaksh twak churna.

84

Table 4.1 Showing the percentage by presenting complaints. 84

Table 4.2 Showing the percentage of distribution of patients by

Associated complaints.

84

Table 4.3 Showing the percentage of Ahara Nidana observed in

the study

84

Table 4.4 Showing the percentage of Vihara Nidana observed in

the study

84

Table 4.5 Showing the percentage of Manasika Nidana observed

in the study

85

Table 4.6 Showing the Chronisity of Leucorrhoea observed in the

study

85

Table 4.7 Results of Plaksha twak churna in Swetapradara 85

Table 4.8 Showing the grades of Excessive vaginal discharge

Before treatment in Group A & B.

85

Table 4.9 Showing the grades of Excessive vaginal discharge

After treatment in Group A & B.

86

Table 5.0 Showing grades of Persistent vulval moistness Before

treatment in Group A & B.

86

Table 5.1 Showing grades of Persistent vulval moistness After

treatment in Group A & B

86

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Table 5.2 Showing grades of Extensive pruritis before treatment

in Group A & B

87

Table 5.3 Showing grades of Extensive purities after treatment in

Group A & B

87

Table 5.4 Showing grades of General weakness before treatment

in Group A & B

87

Table 5.5 Showing grades of General weakness after treatment in

group A & B.

87

Table 5.6 Showing grades of pain in lumbar region before

treatment in Group A&B

88

Table 5.7 Showing grades of pain in lumbar region after

treatment in Group A&B

88

Table 5.8 Showing the grades of Draging sensation before

treatment in Group A & B.

89

Table 5.9 Showing grades of Draging sensation after treatment in

Group A & B.

89

Table 6.0 Showing the distribution of Patient by Degree of

vaginal pH before and after treatment

89

Table 6.1 Showing the distribution of Patient by Degree of

vaginal smear before and after treatment

89

Table 6.2 Showing the Statistical Analysis of both the groups,

Before and after treatment and Percentage of

improvement with respect to excessive vaginal

discharge.

90

Table 6.3 Showing the Statistical Analysis of both the groups,

Before and after treatment and Percentage of

improvement with respect to Vulval moistrness.

91

Table 6.4 Showing the Statistical Analysis of both the groups,

Before and after treatment and Percentage of

improvement with respect to Extensive Pruritis.

91

Table 6.5 Showing the Statistical Analysis of both the groups,

Before and after treatment and Percentage of

improvement with respect to General weakness.

92

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Table 6.6 Showing the Statistical Analysis of both the groups,

Before and after treatment and Percentage of

improvement with respect to Pain in Lumbar region.

93

Table 6.7 Showing the Statistical Analysis of both the groups,

Before and after treatment and Percentage of

improvement with respect to Vaginal pH.

93

Table 6.8 Showing the Statistical Analysis of both the groups,

Before and after treatment and Percentage of

improvement with respect to Vaginal Smear.

94

Table 6.9 Analysis table by using student t- test 95

Graph No.

LIST OF GRAPHS

Page No.

1 Showing the incidence of Menstrual history 77

2. Showing the incidence of Age 78

3. Showing the incidence of Socio-economic status 79

4. Showing the classification of Patients based on their

Prakruti.

80

5. Showing the incidence of Dietic pattern 80

6. Showing the incidence of Nidhana 82

7. Showing the incidence of Religion 82

8. Showing the distribution of patient by occupation 83

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LIST OF PHOTOGRAPHS

Plate No 1 Plant Plaksha (Ficus lacor)

Fig. 1 Plaksha twak (Ficus lacor)

Fig. 2 Plaksha twak churna (fine)

Fig. 3 Madhu

Fig. 4 Plaksha twak churna (course)

Fig. 5 Plaksha twak kashaya

Fig. 6 Vaginal douche

Plate No 2 T.S. of Bark stem

Fig.10 Microscopic view of Powder (Plaksha)

Plate No 3 TLC of Plaksha twak churna

Fig. 11 Dragendroff

Fig. 12 UV

LIST OF MASTER CHARTS Page No

Master Chart 1 Assessment of subjective parameters in Group –A 96

Master Chart 2

Assessment of objective parameters in Group –A

98

Master Chart 3

Assessment of subjective parameters in Group –B

99

Master Chart 4

Assessment of objective parameters in Group –B

100

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Introduction

Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara-

A Clinical study.

1

INTRODUCTION

In present era abnormal vaginal discharge is quite frequent complaint of women

in gynaecologic clinic1. Shweta pradara troubles more than 75% of women during their

life. Most of the women are working, due to change in life style, food, habit, work load,

faces lots of stress and strain. Women are subject to large number of complaints and

connected with genital organs. Gender differences play a role in manifestation of disease

and health out comes.

The disease Shweta pradara based on theoretical and clinical symptoms can be

compared to Leucorrhoea. The pathogens like Trichomonas vaginalis 94.5%), N

genorrhoeae (2.7%) and C albicans (6.7%) were exclusively present in leucorrhoea2.

Gynaecological complaints includes leucorrhoea, disfunction uterine bleeding, pelvic

inflammatory disease etc, among them leucorrhoea is more prevalent. The external

genitalia with long tubular content is susceptible to the infectious conditions from puberty

till menopause, either because of unhygienic conditions or coital and even

physiologically.

Wide variety of reasons are encountered in its causation, commonly fungal,

parasitic, bacterial and sexually transmitted diseases. Most secretions are regarding life

cycle physiological and warrant no medical interventions. But it is significant if it is

blood stained, profuse, foul smelling or changes in its colour. If not treated infection may

continue for months even years and may spread to other areas of genital tract3.

Though there is an established line of treatment for leucorrhoea in the allopathic

system of medicine, most of the drugs fail to cure the disease completely and recurrence

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Introduction

Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara-

A Clinical study.

2

is common. Many ayurvedic formulations have been evaluated clinically, and Plaksha is

one of the new drug taken up for the trial in this study.

Ayurveda is the safest curative system. There are many drugs described in

ayurvedic literature for Shweta pradara among them plaksha4 (Ficus lacor) is one of the

most potent drug for Shweta pradara. On the basis of authentic classical references the

easy availability of a drug and cost effectiveness developed interest in selecting this drug

for Shweta pradara.

An effective remedy for shweta pradara is Plaksha twak. (Ficus lacor) comes

under the kashaya skandha and is one among panchavalkala. Due to its kashaya rasa it

acts as rakta stambhaka and grahi. Due to its sheeta veerya and laghu ruksha qualities acts

as vranashodhana and vrana ropana5-9, so these actions are extremely beneficial in curing

shweta pradara. A warm vaginal douche of plaksha twak churna kashaya is beneficial to

general cleansing and elimination of purulent discharge. Plaksha twak churna have many

means to kill fungus, bacteria, parasite as its acts as krimighna.

In present study is aimed to evaluate the efficacy of Plaksha twak churna in the

management of Shweta pradara with the view to find out therapeutically efficacious,

safer, cost effective and easily available drug.

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Objectives

Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara-

A Clinical study.

3

OBJECTIVES

1. Pharmacognoistical evaluation of Plaksha.

a. Macroscopical evaluation

b. Microscopical evaluation

c. Standardization and Validation.

2. Preliminary phyto chemical analysis of Plaksha.

3. TLC of Plaksha.

4. To Evaluate the efficacy of Plaksha twak churna in the management of Shewta

pradara.

5. To evaluate the Plaksha twak kashaya as a trans vaginal douche in the

management of Shweta pradara.

6. To evaluate the comparative effect of Plaksha twak churna orally and kashaya as

trans vaginal douche in the management of Shweta pradara.

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Drug Review

Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara-

A Clinical study.

4

DRUG REVIEW

Historical aspect of the Drug

Plaksa is one of the ficus species and is member of group vanaspatya chatustaya

along with aswattha, udumbara, nyagrodha. The plant is mentioned in vedic samhitas.

Brahmanas and kalpa sutras10.

Plaksha is used in the Indian system of medicine since antiquity and it has been

mentioned in Yajurveda, Charaka samhita, sushruta samhita, Astanga hridayam, Bhav-

Prakasha and in various Nighantus like Dhanwantari Madanapala and texts of Ayurveda

and Yunani, Panini, the great grammarian of Sanskrit refers the principal tree of North

India including Plaksha in his Astadhyas of Panini “(Agarwal, 1952)11.

Madanapal described described the drug Plaksha as visarpajit i.e it cures

erysepalas. Plaksha is extensiovely used ion the treatment of ulcers along with the four

ingredients in the groups panchavalkala. The four drugs are the root barks of ficus

glomerata, Ficus religiosa, Ficus bengalensis and Azardirachta indica. The healing takes

place properly when oils and ointments containing Plaksha are used.

It’s fruits have been described in charaka samhita (su 27, 164) and shushruta

samhita (su. 46,165) along with other ficus fruits.

It is also mentioned in visnu (1,22,9) and Bhagawata (5,20,2) puranas and

raghuvamsha (8,93).

Charaka: described it as mutra sangrahaniya while susruta and vagbhata have mentioned

it under Nyagrodhadi gana. It is considered as one of the ksiri vrksas or pancha valkalas

by Bhavamisra.

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Drug Review

Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara-

A Clinical study.

5

Shatapathabrahmanha: gives reference pertaining to plaksha. One among vanaspatis

and beneficial in the Yajna (Homage) Plaksha, Kashmarya, Ashvattha, Udumbara,

Pitudaru, bilwa are shrestha, vetasa is Nikrastha.

Etareya brahmanha: We come across the reference about these vanaspatis. Pranou vai

vanaspati (E.Br. 2/4,20) 5/23, 7/32) Chatusta vanaspatis are Plaksha, Nyagrodha,

Udumbara, Asvattha. (E.Br. 6/16)

Kalpasutra: Gives the reference about the usage explained like Plakshodumbara.

Panini: Mentioning of the vanaspatyadi gana (6/2/140) Plakshodumbara.

Vattikakar: Description regarding vanaspatis (1/4/12)

Bhattoji: Give the reference with an examples as “Plakshanyagrodhou”

Taittiriya samhita: The references as Plakshanyayagrodhakhadirpalasha (6/3/20/2)

Usage of “Praksha” word. One among Kshirivruksha In the unmada roga havan by

plaksha is told. Fruits of this tree are edible. In the yajna usage of plakshakha explained.

Darila: We come across the reference of Plakshodumbar “Pipariti” is supreme.

In Yajurveda: Reference as Plaksha is one among vanaspatis.

Patanjala: Reference as that “Plakshodumbara”

Sushruta Samhita: Reference regarding Kshirivruksha such as plaksha, Nygrodha,

Udumbara, Ashwattha these four vanspatis included in the “Vishnu sahasranam” even pet

names of God Vishnu. Specific references are available regarding ‘plaksha’

cÉiÉÑhÉÉï ¤ÉÏUÏuÉפÉÉhÉÉqÉç (xÉÑ. 1/4)

¤ÉÏUÏuÉפÉMüwÉÉrÉ (zÉÑ.ÍcÉ. 16/13; 46/433)

iÉcÉÈ ÌmɹuÉ ¤ÉÏËUhÉÉqÉç (xÉÑ.ÍcÉ. 20/34) Told

ÌuÉSìÍkÉ ÍcÉÌMüixÉÉ WåûiÉÑ (ÍcÉ.16, /13)

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¤ÉÏUÏuÉÑ¤É MüwÉÉrÉ Told.

In the context of “Nyagrodhaadi gana” explaination regarding plaksha, kapitana,

Nyagrodha, Udumbara, Ashwatha. Shushruta clearly mentioned Panchakashaya

prayojana in detail12.

uÉÉiÉeÉ MühÉïzÉÔsÉ – MühÉïmÉë¤ÉÉsÉlÉ and MühÉïmÉÔUhÉ by mÉlcÉMüwÉÉrÉ YuÉÉjÉ, cÉÑhÉï. (xÉÑ.E. 11/42)

SÒaÉÉïÎlSiÉ ÌmÉÎcNûiÉ rÉÉåÌlÉ – mÉlcÉMüwÉÉrÉ cÉÔhÉï – mÉÔUhÉ, mÉlcÉMüwÉÉrÉ YuÉjÉ – kÉÉuÉlÉ (xÉÑ.E. 36/25)

Charaka Samhita: In Charaka samhita specification of Panchavalkala (Ch. 22/14),

Panchakshirivruksha (Chi. 11/44) Nyygrodhadhaischturbi (Si. 10/37) told

mÉlcÉuÉsMüsÉ, mÉlcÉMüwÉÉrÉ – irÉaÉëÉåkÉ, AμÉijÉ, ESÒqoÉU, msɤÉ, uÉåiÉxÉ explained. (Ch. 15/41)

Astanga Hradaya: In the context of chikitsa Shofanirvanartha, nygrodhadi

panchavalkala explained. (Ch. 15/41)

Vagbhat: Vagbhat attributed the same opinion as that of charaka, Shofa nirvapana hetu

(chi. 15/16) Nayagrodhadi four drugs with vetasa valkala told chandanadi ghrita (chi

10/42)

Brahatrayi: Especially the manifold actions of the drugs mentioned are highlighted by

the synonyms, Kshiri vruksha kashaya, valkala, specifically Nyagrodha, Udumbara,

Ashvattha, Plaksha known as Panchavalkala and panchakshiri. Different opinions

regarding these five drugs.

Chakrapani: Reference regarding “Panchavalkala kashaya” In this context vetasa told.

In the chapter on “dviruniya” Shofanirpanha hetu (Chi. 25/46) these 4 drugs vetasa

valkala ghruta mishrita pralepa told. Visarpa chikitsa hetu (Chi. 12/84) 4 drugs with

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vetasa, pallava, valkala kalka gruta mishrita- pralepa In panchaksheeravruksha prasanga

with 4 drugs + kapitana told.

Dalhana: In this (Vi.Chi) references regarding Nyagrodha, Udumbar, ashvatta, plaksha

gardabhanda told. Anupana vivechana (Su. 46/433) and vranashodhana hetu prayukta

‘kashayanam’ hetu (chi. 20/16) (Chi. 2/66) ‘Kshiri’ i.e kshudraroga chikitsa. Dalhana told

twachaha pishtava kshireenam and vatadi pancha kshirini vruksha twacha told.

Utpatti13: msɤÉÉå qÉåkÉålÉ – iÉæ 7/4/12/1

iÉxrÉ (SæuÉæUÉsÉprÉqÉÉlÉxrÉ mÉzÉÉåÈ) AuÉÉQÒû qÉåkÉÈ mÉmÉÉiÉ |

xÉ LuÉ uÉlÉxmÉÌiÉUeÉÉrÉiÉ | iÉÇ SåuÉÉÈ mÉëÉmÉzrÉlÉç |

iÉxqÉÉiÉçç mÉëZrÉÈ| mÉëZÄrÉÉå Wû uÉæ lÉÉqÉæiÉSè, rÉiÉç msÉ¤É CÌiÉ’- zÉ0 3/8/12)

Table No-1.1 Ganas and vargas according to different classics

Charaka samhita Mutra sangrahniya kasaya skandha

Sushruta samhita Nyagrodhadi

Phala varga

Astanga hridaya Nyagrodhadi

Bhavaprakasha Nighantu (Kshirivriksha) vatadi varga panchavalkala

Nighantu Adarsha Vatadi varga

Kaiyadev Nighantu Oushadhi varga

Raj Nighantu Amradi varga

Dhanvantari Nighantu Amaradi varga

Madanapala Nighantu Vatadi varga

Shaligram Nighantu Vatadi varga

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Abhidana Ratnamal Kashaya dravya skandha

Madhav dravya guna Vividoushadi varga

Amara kosha Vanoushadi varga

Table No-1.2 Paryayas according to different authors

Synonyms CS14 SS15 AH16 BN17 KN18 RN19 MN20 NA21 Ab

R22

AK23 SN24 SKD25

Plaksha + + + + + + + + + + + +

Jathi + + + + + +

Parkari + +

Parkati + + + + + +

Pippari +

Shrungika +

Vathi + + + +

Pugamunda +

Gardabhanda + + + + + +

Kamandalu + + + +

Plava + + +

Gandhamunda +

Charudaru +

Suparshva + + + + + +

Charudarshana + + +

Mundika +

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Ashwath patra + +

Kapitana + +

Ksiri + + + + +

Shrangi + +

Varohashakhi + +

Kapitaka +

Drada praroha + + +

Plavaka + +

Plavanga + +

Mahabala + +

Hrsva plaksha + +

Sushita +

Shitaviryaka +

Pundra + +

Mahavaroha + +

Hrsva parna + +

Pimpari + +

Bhidura + +

Mangalacchaya +

Charuvrksha +

Garbha

bhandaka

+

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Pippari + +

Yupa +

Pippalapadapa + +

Kapotana +

Pitana +

Ashwatthi +

Karpari +

Plavaksha +

Shungi +

Avarohashakha +

Ploksha +

Sukshma +

Sushouta +

Shoutavarnyak +

Bhitura +

Paryayas and its meanings26

1) msÉ¤É - mÉë¤ÉUÌiÉ CÌiÉ msɤÉÈ |

Spreading much more

2) msɤÉÌiÉ: AkÉÉå aÉcNûÌiÉ msÉ¤É = mÉëÌiÉ AkÉÉå aÉcNûÌiÉ qÉÔsÉÉæ CÌiÉ |

By its Jatha rupa root facing towards down.

3) eÉPûÏ : eÉOûÉ xÉÉÎliÉ AxrÉ CÌiÉ eÉOûÏ | (N.A)

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Here Jata found

4) eÉOûÌiÉ – xÉÇbÉÉiÉÏ pÉuÉiÉÏÌiÉ | ‘eÉOû xÉÇbÉÉiÉå’ (N.A)

It founds as Jata all at one

5) mÉMïüOûÏ : mÉMïüOûÉZrÉÇ TüsÉqÉxrÉ mÉMïüOûÏ |

rÉSè uÉÉcÉxmÉÉÌiÉ: = TüsÉÇ iuÉålÉxrÉmÉMïüOûqÉç |

mÉ×crÉiÉå xÉqrÉMçü xÉÇoÉkrÉiÉå uÉëhÉÉÌSwÉÑ CÌiÉ | (N.A)

Best remedy in Ulcers

6) ÌmÉmmÉsÉmÉÉSmÉ: A synonym told by ¤ÉÏUxuÉÉqÉÏ

7) Suparshwa – Few branches and many adventitious roots growing down word

8) Kamadalu – Probably indicates the habitat near fresh water or it may also refer to

shape of fruit.

MODERN REVIEW OF THE DRUG PLAKSHA

Botanical Name27: Ficus lacor

Ficus = From an original Arabic word meaning fig

Lacor = or thespasia populuca = divine.

VERNACULAR NAMES28

Latin Name : Ficus lacor

Sanskrit : Ashvatthi, charudarshani, Dradapraroha, Gardabhanda, Jati,

Kamandalrohataru

Hindi : Kahimal, Kaim, Pakar, Pakri, Khabar

Marathi : Bassari, Lendwa, Pakari

Gujarati : Pepri

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Telgu : Badijuwi, Jati, Juvvi

Kannada : Basarigida, Juvvi, Hasuri, Karibasari, Kadubasari, Jeevibasari, Basa

Bengal : Pakar, Pakur

English : Wave leaved fig tree

Tamil : Jovi, Kallal, Kurugatti, Kurugu

Malayalam : Bakri, Chakkila, Chela, Itti, Jathi

Bengal : Pakar, Pakur

Bombay : Bassari, kaim, pakri, pipli

Kolami : Baswesa

Konkani : Killah

Kurku : Pepere, pepre

Lambadi : Katipipri

Nepal : Safed kabra

North-west provinces: Pakur

Punjab : Batbar, Jangli pipli

Sindhalese : Kalha, Kiripella

Tulu : Basari goli

Thana : Kel

Urdu : Pakhari

Uriya : Pakodo, Rushorchona

Can : Juvi, kari

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CLASSIFICATION OF PLAKSHA

Plaksha has been mentioned in various Ganas due to its manifold actions by

different authors. They have been listed below.

Botanical Classification29

Kingdom – Plantae

Division – Magnoliophyta

Class – Magnoliopsida

Sub class – Rosidae

Order – Rosales

Family – Moraceae

Genus – Ficus

Species – Ficus

Diagnostic features of Family Moraceae

Plant usually trees and shrubs with stipulate leaves; latex present, Inflorescence

cymes of small male and female flowers, perianth usually 4 gamo-or polyphyllous,

persistent, stamens 4 opposite to tepals; gynoecium bicarpellary, synacarpous, superior,

unilocular, fruit nut or drupe.

Distribution30

It is commonly called Mulberry family and consists of 53 genera and 1400

species. It is distributed in warm temperate, tropical and substropical countries of the

world. In India the family represented by about 104 species belonging to 15 genera.

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Vegetative characters:

Habit – Mostly trees (Morus, Ficus), shrubs or climbers rarely herbs (Dorstenia), mostly

with lates.

Root – Tap root, branched, produce adventitious aerial roots (Ficus sp)

Stem – Aerial, erect or climbing, cylindrical solid, branched, woody, gum may be exuded

from the surface.

Leaf – Alternate usually simple, cauline, ramal, in some, stipulate stipules large and

leafy, caduceus, entire or deeply lobed, or serrate, glabrous or glaucous, reticulate-

unicostate or multicostate.

Floral Characters

Inflorescence – catkin (Morus) or hypathodium (Ficus) or globose heads

(Plecospermum).

Flower – Small, inconspicuous, bacteate, or ebracteate, incomplete usually unisexual,

monoecious (Ficus, Morus) or dioecious, actinomorphic, hypogynous, clclic. In Ficus

five types of Flowers viz.

1. Male with pistillode, 2. Female flower, 3. Male without pistillode, 4. Female with short

style, 5. Sterile flowers.

2. Perianth – 2 to 6, two in Ficus carica, four in Morus, six in other Ficus spp. Free or

united, inferiou, usually green, persistent, valvate or imbricate in bud; sometimes absent.

Male flowers

Perianth – As above.

Androecium – 1 to 6 in various specied of Ficus, 4 in Morus, bent or straight opposite to

perianth leaves, introrse, bithecous, basifixed or dorsifixed.

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Gynoecium – Represented by pistillode.

Female Flower

Perianth – As above

Androecium – Absent

Gynoecium – Bicarpellary, syncarpous, superior, unilocular, ovule solitary or two, erect

or pendulous, style simple or bifid, stigma 1 or 2, linear of filiform.

Fruit – Sorosis (Morus), syconus (Ficus) etaerio of achenes or drupes (Maclura), berry

(Cudrania).

Seed – Endosperimic or non-endospermic.

Pollination – Entomophilous or anemophilous

Ficus exhibits extraordinary way of pollination. The insects enter the hypanthodium

through apical opening to lay eggs in the ovaries of sterile flowers (or gall flowers). The

insects cannot lay eggs in the ovaries of fertile female flowers as they are covered by

hairs. The bodies of insects get dusted with pollen from the male flowers, then they enter

another hypanthodium and so come in contact with the papillose long styles of the fertile

female flowers, in this way cross pollination is ensured.

Flower formulae:

Male flower – 0 P2-6 or (4) A1-6 or 3-8 G0 or pistillode.

Female flower – 0 P2-6 or (4) or zero A0 G(2).

Botanical Description

Ficus lacor - A large spreading deciduous fast growing tree, all parts glabrous; bark

grey, smooth, scaly.

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Leaves – membranous, 9-12.5 by 5-6.3cm. ovate or ovate-oblong, shortly and rather

abruptly acuminate, with entire, subundulate margins.

Base – Usually rounded, slightly cordate, or sometimes narrowed or acute, 3-nerved;

lateral main nerves 5-7 not very prominent.

Petioles – 3.8 – 5.7 cm. long, some times indistinctly jointed with the blade;

Stipules – about 13mm long, broadly ovate, acute, pubescent.

Receptacles – axillary in pairs, sessile, globose, 6mm diam, whitish, flushed with red and

dotted, when ripe; basal bracts, ovate- round, minute.

Male flowers - few, bracte sessile near the mouth of the receptacles.

Stamen1; another broadly ovate; Filament short. Sepals 4 or 5, Gall and fertile flowers;

perianth as in the Male. Style of fertile female flowers long, of the gall folwers short;

stigma elongate.

Distribution: Plains and lower hills of India, Ceylon- Malaya.

Pharmacognosy of Plaksha (Stem Bark)31

a) Macroscopic – Bark rough, occurring in flat to curved, quilled pieces, measuring

0.4-0.7 cm in thickness; external surface ash or whitish-grey; numerous

transversely arranged lenticels; ranging from 0.1 cm – 1.3 cm in length, lip-

shaped and exfoliating; internal surface rough, fibrous, longitudinally striated,

reddish-brown; fracture, fibrous.

b) Microscopic – Shows 5-8 layered cork consisting of thin-walled, rectangular

cells, a few external layers exfoliating; secondary cortex very wide consisting of

compactly arranged, rectangular, thick-walled, pitted cells, patches of circular to

elongated, lignified, elliptical stone cells with radiating canals, a few with

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concentric striations; a few prismatic crystals of calcium oxalate and reddish-

brown contents found scattered throughout the secondary cortex; secondary

phloem very wide consisting of mostly stratified layers of collapsed cells forming

ceratenchyma, groups of fibres, phloem parenchyma, laticiferous cells, traversed

by 2-5 seriate phloem rays; phloem fibres lingnified with wide lumen and pointed

tips; thin-walled, rectangular, a few phloem parenchyma containing prismatic

crystals of calcium oxalate.

c) Powder – Reddish-brown; shows thick-walled parenchyma with simple pits;

stone cells in groups and singles, prismatic crystals of calcium oxalate, elongated

phloem fibres with wide lumen and pointed tips.

Identity, Purity and Strength

Foreign matter - Not more than 1 percent

Total ash - Not more than 10 percent

Acid-insoluble ash - Not more than 1.5 percent

Alcohol-soluble extractive- Not more than 5 percent

Water-soluble extractive - Not more than 6 percent

Pharmacognosy of Plaksa (Fruit)32

a) Macroscopic: Fruit is a syconus, 0.5 to 1.0 in dia, attached with pedicel; sub-

globose, wrinkled, glabrous, having three basal bracts; grayish- borown to

yellowish-brown; taste, astringent.

b) Microscopic: Fruits shows single layered, thin-walled epidermis followed by a

narrow zone of 2 to 5 layers, of round, oval, rectangular, lignified stone cells with

wide lumen; rest of mesocarp very wide consisting of oval to polygonal,

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collenchymatous cells containing brownish contents; a few vascular traces found

scattered in this zone; inner zone consisting of stone cells similar in shape and

size to these found scattered in outer zone; male and female flower attached to

inner of mesocarp.

c) Powder – Dark grayish-brown; shows fragments of epidermal cells; single, or

groups of lignified stone cells; collenchymatous cells; a few debris of male and

female flowers present.

Identity Purity and Strength

Foreign matter - Not more than 2 percent

Total ash - Not more than 9 percent

Acid-insoluble ash - Not more than 1 percent

Alcohol-soluble extractive - Not more than 5 percent

Water-soluble extractive - Not more than 15 percent

TLC

TLC of alcoholic extract on Silica Gel ‘G’ using n-Butanol: Acetic Acid: Water

(4:1:5) shows in visible light three spots at Rf. 0.27, 0.63 (both grey) and 0.97 (yellowish

green). Under UV (366 nm) six fluorescent zones are visible at Rf. 0.53, 0.63, 0.84, 0.91,

(all blue) and 0.97 (pink). On exposure to Iodine vapour twelve spots appear at Rf. 0.12,

0.16, 0.22, 0.27, 0.50, 0.63, 0.73, 0.84, 0.91, 0.94 and 0.97 (all yellow). On spraying with

Ninhydrin reagent a single spot appears at Rf. 0.97 (brick red).

Constituents – Amino Acids

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VARIETIES OF PLAKSHA:

According to Bhavaprakasha Nighantu33

1. Jangala

2. Gramya

According to P.V. Sharma34

Three varieties – 1) Var, infectoria

2) Var, lambertiana

3) Var, weightiana

4) Ficus lacor,

Other species35 - 1) Ficus arnottiana

2) Ficus rumphii, Blume

3) Ficus talboti. G

4) Ficus retusa, Ficus microcrapa syn, Firetusa acuct

5) Ficus tsiela Roxb

6) Ficus tsjakela Burm f.

Table No. 1.3 GUNAS (PROPERTIES) ACCORDING TO DIFFERENT

AUTHORS.

Properties BN36 DN37 MN38 RN39 KN40 NA41 SN42 P.V. Sharma43

Rasa Kashaya + + + + + + + Katu - + + - + + - Guna Sheeta + + + + + + + - Guru - - - - - - - + Ruksha - - - - - - - + Veerya Sheeta + + + + + + + Vipaka

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Katu + + + + + + + Doshaghnata Kaphahara + - + - + + - + Pittahara + + + + + + + +

Phytochemistry: Stem bark44 – contains methyl ricinolate, caffeic acid, bergenin,

lanosteral and B- sita sterol, sterols, sugar, Tannin, Alkaloid and saponin.

(Carbohydrates, glycosides, Proteins, amino acids)

Leaves – contain the flavonoids, scrbifolin -6-0- (arabinopyranosy 1- (1-2) – B-D

glucopyranoside) [(C27 H30O15, mp 340-420) and scutellarein 6-0B-glucoside.

Fruit – Amino Acids

Tannins45 – They have been known as astringents substances, having capacity to

combine with tissue proteins and precipitate them. They are used as antiseptics, in the

treatment of diarrhea, to check small haemorrhages.

Tannin detoxifies the fungal infections, acts as tonic. They are agents which

contract muscular fibers and control the abnormal secretions of mucous membranes.

Tannins are soluable in water.

Table No. 1.4 KARMAS ACCORDING TO DIFFERENT AUTHORS

Karmas CS46 SS47 AH48 BP49 DN50 RN51 KN52 NA53 DG. 54

HMK

M

N55

P.V.56

Sharma

Vrana ropaka + + + + + + +

Yonigata roga + + + + + + +

Rakta vikara + + + + + + +

Grahi + + +

Shotahara + + + + +

Vrana

prakshalana

+ + +

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Medahara +

Visarpa + +

Murcha + +

Bhrma + +

Pralapa + +

Shamaka +

Sthambhana + + +

Mutrasangrah

aniya

+ + +

Sangrahaka + +

Vistambakara

ka

+

Kaphapitta

Nashaka

+ + + + +

Daha

Prashanana

Rakta

shodhana

Stanya +

Shonita

stapana

+

Varnya +

Garbhashaya

shothahara

+

Mukha

rogahara

+

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Table No. 1.5 PRAYOJYA ANGA

Parts used P.V.57

Sharma

RN58 BN59 NA60 Indian

material61

D.G.V

M.G62

Bark + + + + + +

Leaves - - - + + -

Fruit - + - - - -

Table No. 1.6 PRAYOGA ACCORDING TO DIFFERENT AUTHORS

Prayoga CS63 SS64 AH65 B

P

N66

K

N67

R

N68

M

N69

D

N70

N

A71

D.G

P.V.S72

D.G.

J.L.

N73

D.G74

V.M.G

Shotha + + - + + + +

Vrana + + + + + + +

Rakta vikara + + + + +

Visarpa + + + + +

Raktapitta + + + + + +

Raktapradara + + +

Shwetapradara + +

Prameha + +

Atisara blood + + + +

Pravahika + +

Yonisrava + +

Yoniroga + + +

Daha + + + + + +

Astanya +

Stomatitis +

Jvara

Vidradi

+ +

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Prayoga75: All parts are acrid, pungent, cooling; useful in diseases of the blood and the

vagina, ulcers, burning sensations, biliousness, “kapha” inflammations, leprosy,

hallucinations, loss of consciousness.

The fruit is sour; the seeds are useful in bronchitis, biliousness, scabies, boils,

inflammation.

The bark of this, along with the barks of other four species of ficus and of melia

azadirachta, pass by the name of panchavalkala. They are used in combination. A

decoction is much employed as a gargle in salivation, as a wash for ulcers, and as an

injection in leucorrhoea.

Nighantu describes this tree as cooling, pungent astringent and curative of Rakta

dosha, moorcha srama and pralapa.

Bark enters the composition of Panchavalkala decoction of the bark is used as

gargle in salivation; as a wash for ulcers and also as an injection in leucorrhoea. This also

cures yonidosha charaka prescribes a varti or suppository made with the pulversised bark

to be inserted into the vagina in case of yoni-srava. As a vegetable, the leaves can be

eaten as they are, by those who suffers from Raktapitta.

Table No. 1.7 Matra (Posology)

D.G.

P.V.S76

D.G.

HMK77

D.G.

V.M. Gogte78

Indian

material79

Charak80

Powder - 3-5 gm -

Decoction 50-100 ml 40-50 ml 50-100 ml

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Therapeutic uses81

Charaka – Erysipelas – cold paste of the tender leaves and bark mixed with profuse ghee

should be applied (cs.ci. 21.85)

Charaka – Meno metrorrhagia – Lump of powdered bark of plaksha mixed with honey

should be kept in lubricated vagina. (cs.chi. 30,119)

Charaka – Inflammation – paste of bark of above drugs mixed with ghee form an

excellent anti-inflammatory agent (cs.ci. 25, 46)

Sushrut – Diarrhoea with blood – Barks of plash sallaki and tinisa are pounded with

milk, mixed with honey and then taken (ss.u. 40.119)

Bhavaprakasha – Intrinsic haemorrhage tender leaves of Plaksha vetasa etc and

tanduliya etc are wholesome as vegetable (B.P. Ci. 9,18)

Uses in othersystem of medicine In Chinese medicine bark diaphoretic

Table No.1.8. USE OF PLAKSHA IN DIFFERENT YOGAS

S.L.No Yoga Indication Reference

1 Changeri ghrita Raktarsha Bhel,sa 16/39/401

2 Vranashodhana kashaya Vrana Bhel, sa 27/10/467-468

3 Nyagrodhadhya ghrita Pradara, shweta, rakta,

Krishna, shrava,

yonishrava

Bhai. R 93/2036-2037

4 Vatadi lepa Shotha C.S.Chi. 25/46/705

5 Nyagrodhadi lepa Vrana C.S. Chi 25/63/707

6 Panchavalkala churna Vrana C.S. Chi. 25/67/705

7 Vrana shodhaka kashaya Vrana prakshalana C.S. Chi. 25/84/710

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8 Nyagrodhadi ropanha kwatha Vrana ropanartha C.S.Chi 25/87/720

9 Nyagrodhadi kashaya Vrana C.S. Chi. 30/84/851

10 Nygrodhadi pralepa Vrana C.S.Chi. 30/46/8

11 Panchavalkalamr lepa Abhighataja

mutrakricchra, vataja

mutrakrucchra

Y.R.U 6/163/164

12 Shatadhouta ghrita Raktaja vrana shotha

lepartha

Y.R. Chi 6/163/164

13 Nyagrodhadi kwatha Vrana shotha Y.R. Chi. 8/176

14 Panchavalkaladi yoga Puya vrana Y.R. 10/176

15 Gouradhya ghrita Vrana, sahaja, purana

nadi, vishama vrana

Y.R Chi. 1-4/183

16 Baladi taila Sadhya vrana ropana S.S. Chi 2/53/19

17 Decoction of plaksha bark Stomatitis, Ulcer I.M.M. P 551

18 Inj of Plakshatwak kashaya Leucorrhoea yonidosha I.M.M. P551

19 Varti of pulversed plaksha

bark

Yoni srava I.M.M 551

20 Vaginal suppository of

plaksha bark powder

Menorrhagia

leucorrhoea

A.Ph. logy P.659

21 Vaginal douche of plaksha

kashaya

Menorrhagia

leucorrhoea

A.Phology P 659

22 Plaksha twak churna Yonisrava C. S. Chi 36/116

23 Plaksha twak kwatha Vranaropanartha C. S. Chi. 13/85

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24 Nyagrodhadi lepa Shotha Vr. Ma IInd vol 44/7 P-

573

25 Preprn of ile & aintment Ulcers A.D. plant sources P-

377

26 Usirasava Ulcers A.D. plant sources P-

377

27 Gandhatailam Ulcers A.D. plant sources P-

377

28 Nalpamaradi tailm Ulcers A.D. plant sources P-

377

29 Dinesavalyadi Kulambu Ulcers A.D. plant sources P-

377

30 Parantyadi taila Ulcers A.D. plant sources P-

377

31 Valiya marma gulika Ulcers A.D. plant sources P-

377

Research Profile82

1) Plaksha as anti inflammatory- Ficus lacor was studied experimentally for anti-

inflammatory activity in caraginin induced paw edema. This showed a good result.

However, in the classics it used or external application alone. Only two formulations

have reference for this drug to be one of the ingredients keeping this in mind another

study was carried out though topical application of Plaksha kashaya in ear edema in rats

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induced by croton seed oil. This method of application of this was 5 minutes parisheka

(pouring in thin a stream of kashaya) in 1 hour and repetition of the same in every hour

for four hours. This was sufficient to produce significant anti-inflammatory effect. This

study proved the drug to be having highly significant effect both as internal and topical

application.

2) The caloric values and ash content in the leaves at different growth stages of five Ficus

species (Ficus religiosa, F elastica, F. lacor, F. Microcarpa cv Golden-leaves, F

microcarpa) were studied. The results showed that the ash content increased with the

growth of the leaves, the relatively high ash contents of old leaves were not the lowest,

which indicates that the leaves have a mechanism to maintain the balance of nutritious

elements. The young leaves have relatively higher gross caloric value than mature and

old leaves, gross caloric value in the leaves at different development stages vary with

species. The gross caloric values in the leaves at different development stages have

distinct liner correlation with ash contents. The ash-free caloric values in the leaves at the

different development stages also vary with species.

3) Tanin stimulates the uterus. In prolonged and frequent uterine bleeding is suggested in

all cases of uterine bleeding. It is reported to have stimulant effects on the endometrium

and ovarian tissue, and useful in menorrhagia.

4) Reported as even infected with trichomanas vaginalis were also cured. Cervical

erosion cases showed healing of erosions.

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ANUPANA

Madhu83,84

UeÉlÉÏcÉÔhÉïqÉkÉÑMüqÉç kÉȨ́ÉTüsÉUxÉlÉiÉÑ

cÉiÉÑmÉëMüÉU mÉëSUqÉç lÉzÉrÉåiÉ lÉ xÉÇzÉrÉÈ |

Harudra powder, madhu (honey), amalaki, swarasa are supposed to be best

vehicles or anupanas for pradara roga.

The role of Mahdu:

MüwÉÉrÉlÉÑUxÉÇ Ã¤É zÉÏiÉsÉÇ qÉkÉÑU qÉkÉÑ |

SÏmÉlÉÇ sÉåZÉlÉÇ oÉsrÉ uÉëzÉÉåkÉlÉUÉåmÉhÉqÉç |

xÉÇkÉÉlÉÇ sÉbÉÑ cɤÉÑwrÉ xuÉjÉïqÉç ¾û±Ç ̧ÉSÉåwÉlÉÑiÉç ||

Madhu is astringent in anurasa, unctuous cooling, sweet, digestive stimulant,

lekhana and strength promoting. It cleans and heals ulcers and helps in joining of

fractured bones, It is light promoter of eye sight and good voice, cardiac tonic and

alleviant of all the doshas.

Synonyms: Madhu Makshika, Madhvika, Kshaudra, Saragh, Makshikavanta,

Varativanta, Bringa vanta, Pushpa, Rasobhava.

Vernacular Name:

Kannada : Jenu tuppa

English : Honey

Hindi : Shahad

Marathi : Madhu

Tamil : Teni

Bangali : Madhu

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Gujarathi : Madhu

Pharmacological Properties:

Rasa : Madhura, Kashaya

Guna : Guru, Ruksha

Veerya : Sheeta

Vipaka : Madhura

Prabhava : Yogavahi

Doshagnata : Tridosha

Physical Properties:

Honey is thick, Semitranslucent liquid of yellowish brown clour of aromatic

odour. After some times it becomes opaque and crystalline.

Chemical Composition :

The sugars in honey, fructose, glucose and maltose followed by lower

concentration of sucrose and maltose. The average composition of honey is as follows.

Moisture - 17.1% Calcium - 5mg

Protein - 0.2% Phosphorous - 16mg

Minerals - 0.2% Iron - 0.9mg

Carbohydrates - 74% Vitamin C - 4mg

Nava Madhu:

Navamadhu i.e freshly collected madhu is nourishing. It does not alleviate kapha

in excess.

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Purana Madhu:

Bhava mishra says, purana means after one year (Samvastra) Madhu becomes

purana i.e old.

Purana Madhu in general, cures meda and sthaulya. It is grahi, Ruksha and

exceedingly depleting one.

Table No.1.9. SHOWING PHARMACOLOGICAL ACTION OF MADHU

S.L.No Pharmacological

action

Ch.s Sus. V. B.P R.N D.N P.N

1. Balya - + - - + + +

2 Chedana + - + - - - -

3 Chakshyashya - + + + - + +

4 Deepana - - - + - + +

5 Hridya - - - + - + -

6 Lekhana - - - + - + +

7 Medo hara - + - - + - +

8 Ropona - + + + - + +

9 Sandhana - + + - + + -

10 Swarya - - - + + + -

11 Srotashodhaka - + - + - - -

12 Sangrahi - + - + - + -

13 Varnya - + - + - - -

14 Vajeekar - - - + - - -

15 Medhya - - - + - - -

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MODERN PHARMACOGNOSY OF HONEY85

Synonyms – Madhu, honey, purified, mel

Biological surce – Honey is a sugar secretion deposited in honey comb by the bees, Apis

mellifera, Apis dorsata, belonging to family Apidae, order Hymenoptera.

Geographical source – Honey is produced in Africa, Australia, New zeland, California

and India.

Preparation for market – Honey is extracted from the comb by centrifugation. It must be

free from foreign bodies Honey is liable to fermentation, unless it is suitable processed.

Honey is heated to 800C before it sent to the market cooled rapidly. Filtered through

flannel.

Description – Colour – Pale yellow to yellowish brown

Odour – Characteristic, pleasant

Taste – Sweet and faintly acid.

Standards – Weight per ml – 1.35 to 1.35g

Specific rotation - +300 to - 100

Total ash – 0.1 to 0.8% It is syrupy thick liquid, translucent when fresh on

keeping it becomes opadue and glanular due to the crystallization of glucose.

Chemical constituents –

Gulcose 35% ( 3%)

Fructose 45% ( 5%)

Sucrose 25%

Uther constituent maltose, gum, traces of succinic acid, acetic acid, dextrin,

formic acid, enzymes, vitamins Adulteration – Artificial invert sugar, an adulterant of

honey contains furfural – detected by fiechel’s test gives instant red colour with

resorcinol in hydrocholoric acid.

Uses – 1) Used as demulcent and sweeting agent

2) Good nutrient to patients.

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3) It is antiseptic and applied to wounds.

Exploration – 1) India is only exploited 10% of its honey potential.

2) India is producing 11000 tones of honey per annum

3) Per capital consumption of honey in India only 8.0gms while in

Germany is 1800gms.

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DISEASE REVIEW

Historical Review

This Indian system of medicine has got a vast history based on veda, upaveda,

purana etc which are dealt as under.

Veda kala (2500 BC – 100 BC)

Samhita kala (1000BC – 100AD)

Sangraha kala (800AD – 1600AD)

Adhunika kala (1600AD –onward)

Atharva veda is regarded to be the authentic source of Ayurveda, given few

references pertaining to pradara but no reference available regarding shvetapradara. In

veda there is a mentioning of krimis, which cause the injury to uterus through vagina.

The word “Asrava” has been mentioned which mean to flow, to flow, to move, in veda

there is a mentioning of Krimis, which (A.V. 44.3) cause the injury to uterus through

vagina.

SAMHITA PERIOD

Samhita period is said to be the scientific era of medicine in India.

CHARAKA SAMHITA (400BC-500BC): Indetail description of yoni vyapat is

described in chikitsasthana 30th chapter. In the context of chikitsa he mentioned

about pandure-asragdare (C.Ci. 30/119)86

SUSHRUTA SAMHITA (800BC-700BC): He explained the yoni rogas in chapter

yonivyapatpratishedhadhyaya. No specific reference are available regarding

shevetapradara (SU.U. 38 chapter)87

ASTANGA SANGRAHA (400AD): He explained the yonirogas in chapter

guhyarogavignaniyadhyaya specific reference of shwetapradara is mentioned but

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in chikitsa he mentioned about “site shukle asrakdhare” is shwetapradara (A.S.U.

39/123)88

ASTANGA HURDAYA (500AD): He explained yonirogas in Guhyaroga

vignaniya adhyaya. No specific reference of shwetapradara available, but he

mentioned pandu srava for yoni in kaphaja yoni Lakshana. (A.H.U. 33/44)89

MADHAVA NIDANA (800AD): He mentioned the Pandu srava in kaphaja

asragdara lakshana, no specific reference is available regarding shweta pradara.

(M.N. II 61/3)90

CHAKRAPANI (1100AD); Chakrapani clearly mentioned the Lakshana and

chikitsa of shwetapradara. He mentioned pandusrava from yoni is shwetapradara

and in chikitsa kashaya dravyas are used. (Chakrapani coments on C.Ci. 30/119)91

SHARANGADHARA SAMHITA (1300AD): Specific reference are not available

but he mentioned the yoni rogas and shwetapradara chikitsa. (Sr.S.P.K. 7/177 and

M.K. 2/110&114)92

BHAVAPRAKASHA (500AD): There is a detail explanation of pradara under

streerogaadhikara and pandu srava is mentioned in kaphaja pradara and chikitsa

of shweta pradara along with all types of pradara is also explained.

(B.P.M.K.streerogadhikara)93

YOGARATNAKARA (1600 AD): Detail explaination of pradar, in that pandu

srava is mentoned in kaphaja pradara. In chikitsa also he indicated shweta

pradara chikitsa while explaining all types of pradara chikitsa.

(Y.R.Streerogadhikara)94

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BHAISHAJYARATNAVALI (1600 AD): The author explained the shweta

pradara chikitsa in detail. (B.R.Pradararoga chikitsa prakarana)95.

NIRUKTHI AND PRATHIBHASHA: The term “SHWETA PRADARA” is

formed by union of two words, shweta and pradara. They can be derived in

following way.

Shwitt+Acch

The word shweta is formed by ‘shwit’ dhatu.

Shwetate iti / Rupyaml

Shweta is the varna resembles to Roupya

Shwetate its / shwita shouklo + pachadach/shukla

Shweta is varna which resembles shukla varna and also kshira, Dadhi, Roupya

are different substances which resembles the shweta varna. (S.K.D)96

Shweta-white (San-eng dictionary)

PRADARA

Pra + Dru Vidarane + Rudaram (S.K.D)97

This term pradara is formed by “pradhatu and indicates vidarana.

Vidarana (Samskrit-kan-dictionary)

The term vidara means srava

Tannamaka srouraktadisravaroge |

Rajaha pradeeryate yasmat Pradarastena sa smratana. |

Pradara is a roga in which raktadi srava is occur and depending upon the srava the

name comes along with pradara.

Narou Rugbhedah iti medinou ||

It is a rogabeda of nari (women)

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Asya Namantaram asragadara ||

Tattu phalitayonya Raktadidhatu ksharanam ||

The raktadi dhatu ksharana from yoni is pradara (S.K.D)98

Pradara: Rending, Tearing, A kind of disease of women | (San-eng dictionary)

Rajah pradeeryate yasmat pradarastena sa smrutah || (C.Chi. 30/209)99

Due to Pradirana (excessive excretion of raja, it is named as pradara.

SHWETA PRADARA:

The word shwetapradara is not mentioned as an independent disease in great

yonirogas, specially kaphaja yoni rogas as “yonigata shweta picchila srava”.

………….. MüTüÉåÅÍpÉwrÉÇÌSÍpÉuÉ×kkÉÈ

………….. xÉÑMÑüjÉïiÉç ÌmÉΊsÉ zÉÏiÉsÉÉ MühQÒûaÉëxiÉÅsmÉuÉåSlÉÉqÉç

………….. mÉÉÇQÒûuÉhÉï iÉjÉÉ mÉÉhQÒûÌmÉÎcNûsÉÉiÉïuÉuÉÉÌWûlÉÏqÉç || (cÉ.ÍcÉ. 30/13)100

Commenting on this chakrapani quotes that

mÉëSU ÌuÉÍzɹ AjÉÉåï pÉuÉÌiÉ

mÉÉÇhQÒûUå mÉëSUÍqÉÌiÉ μÉåiÉmÉëSU | cÉ.ÍcÉ. 30/223101

Here pradara referes to both asrugdhara and kaphajasrava. But chakrapani in his

commentary has used the term shwetapradara for pandura ashrugdhara.

In the same chapter at 116 shloka charaka quotes

UÉåÌWûiÉMüÉiqÉÔsÉMüsMÇü mÉÉÇhQÒûUåÅxÉ×akÉUå ÌmÉoÉåiÉç || (cÉ.ÍcÉ. 30/116)102

Where pandura ashrugdhara refers to shweta pradara Sharangadhara, bhavaprakasha,

Yogaratnakara have used the word shwetapradara for white vaginal discharge.

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Like this shwetapradara is described as cordinal symptom in so many yonirogas.

Some times this symptom is so severe that it over shadows the symptom of actual disease

and woman come for the treatment of only this shwetapradara. Probably due to this

reasons charaka, vagbhata etc have not mentioned shweta pradara as disease but have

prescribed only symptomatic treatment. Hence a consolidated aspect of other yonirogas

should be taken into consideration to study the Nidana roopa, samprapti etc.

Among the yonirogas slesmala yonivyapat sannipataja yonivyapat, vipluta yoniyapad

aticharana yonivyapad and acharana yonivyapad represents shwetapradara with their

specific features.

Other reasons to consider the shwetapradara under yonirogas is,

CjjÉæiÉæsÉï¤hÉæÈ mÉëÉå£üÉ ÌuÉÇzÉÉÌiÉjÉæÌlÉeÉÉaÉSÉÈ

iÉzÉÑ¢ükÉÉUcÉirÉÉåÍpÉSÉæwÉærÉÉåÌlÉÃmÉSìuÉiÉÉ |

aÉÑsqÉ AÉzÉï mÉëSUÉSÉïYcÉ uÉÉiÉÉkÉæYcÉÉÌiÉmÉÏQûlÉqÉç || 103

While explaining the upadrvas of yonirogas pradara is one among them.

Another reason is in the same chapter at the end of the yonivyapath rogas,

UÉåÌWûiÉMüÉiqÉÔsÉYsÉMÇü mÉÉhQÒûUåÅxÉ×akÉUå ÌmÉoÉåiÉç || 104

Shwetapradara is related to arthavaha srothas, susrutha quotes that,

AÉiÉïuÉhWåû ²å iÉrÉÉåqÉÔïsÉÇ aÉpÉÉïzÉrÉ AÉiÉïuÉuÉÉÌWûlrÉ

Arthava vahini is two in number having roots in garbhashaya and arthavavaha

srothas. Injury to these srotas leads to vandhyathva,maithuna asahishnutha and

arthavanasha. This reveals anatomical stucters and physiological importance of

arthavaha srotas. The main root of arthavavahaa srotas is garbhashaya which refers to

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uterine cavity, and atrthavavahini refers to to yoni,fallopian tubes and ovarian gland.

Hence detail knowledge about these structures is necessary to know the disease

shwetapradara.

YONI

Derivation:

The word yoni is derived from the Sanskrit root YU (Amarakosh) YU means join

or unite, which is suffixed with NI to form the word yoni. Thus the literal meaning of the

word yoni is a place of contact or union.

Synonyms of Yoni

Bhagam, Varangam, Upasthah, samara mandiram, madanalayah, rati kuharum,

rati graham, rati, mandiram, janma vartanum, adharam, prakritih, apatham, samara kupah,

ratyanga, pushpa pathah.

Utpatti sthana, pushpin, samsarmargaka, samsar, marga, guhyam, adhah.

The dictionary meaning of yoni is wombs, uterus, vulva, the female organs of

generation any place of birth or origin, generating cause, spring.

Vagbhata while describing the specific muscles of woman used the word yoni to

denotes the entire reproductive system. Maharshi sushruta and vagbhat while giving the

reasons for conception occurring only during rtu kala have used the word yoni to donote

uterus and cervical canal.

ûrÉÉåÌlÉxiÉÑ zÉUuÉlÉÉprÉÉM×üÌiÉUrÉÉxiÉÉuÉiÉÉï |

iÉxrÉ iÉ×iÉÏrÉ AÉuÉiÉåï ÌmɨÉmÉYuÉzÉÉrÉÉ UÉåÌWûiÉqÉixrÉqÉÑZÉMüÉUÉ

aÉpÉÉïzÉÉrÉrÉÉ iÉxrÉ zÉÑ¢üÉiÉïuÉmÉëuÉåzÉÏlrÉÉx§ÉÏx§É mÉåzÉrÉ || A.xÉÇ.AÉ 5/116105

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The shape of yoni resembles shankha nabhi is hallow portion of conch shell and

has three avruthas. The garbhashaya is attached to third avrutha. In yoni, there are thre

nadis- samirana, chandramasi and gowri. At clitoris is mainly samirana shukra falling on

it becomes fertile. The woman having mainly chandramasi is easily satisfied with clitoris

and delivers female children sexual satisfaction to women possessing gowri nadi in

upasthagrabha (deepen part of vaginal cannel is attached with difficulty and she delivers

usually male children. The word yoni in ayurveda classics refers to whole reproductive

system of woman starting from the valva to the ovaries as well as supporting strugtures.

2. Garbhashaya:

Garbhashaya as the word is combination of two words.

Garbha+Ashaya, Garbha resides in this ashaya so it is called as Garbhashaya

women possess one extra ashaya known as Garbhashaya. Which is situated in the third

avarta of the yoni, in between pittasaya and pakwashaya, behind the bladder.

x§ÉÏhÉÉÇ aÉpÉïzÉrÉÉåŹÍqÉÌiÉ ÌmɨÉmÉMüuÉÉzÉrÉÉåqÉïkcÉå aÉpÉïzÉrrÉÉ rÉ§É aÉpÉÉïÎxiɹÌiÉ || xÉÑ.zÉÉ. 5/32106

rÉjÉÉ UÉåÌWûiÉqÉxirÉ qÉÑZÉÇ pÉuÉÌiÉ ÃmÉiÉÈ || xÉÑ.zÉÉ. 5/44107

In shape it resembles the mouth of rohita fish.

Acharya kashayapa has described it is in between the vipula kundala of srotas

(multiple coils of intestine) covered with jarayu (peritoneum) It resembles to the mouth

of the rohita a fish Acharya Dalhana explains that the resembalance to the mouth of

Rohita fish is to denote the internal structures of the uterus. Acharya Bhava mishra

explains identically to that of sushruta.

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3. Artava:

Derivation:

Artavam is derived from the root word Rutu.

“Rutuhu asya prapthah”

Who has got rutu i.e period, suffixed with Ann. Artava is formed, means stree beeja or

pushpa.

Defination:

The rakta gets collected inside the Garbhashaya and flows out for three days

every month, this is known as artava.

Artava, which is agneya, has characterstics of rakta, forms garbha and is essential

for life. The dominant mahabhoota is tejas. Its pramana is 4 anjalis. The period of about

12 days from the commencement of menstruation which is most suitable period for

conception is termed as rutukala.

Artava is slightly black. Is also called as Rajah, which is produced from the

Rasadhatu itself.

Table No-2.1. Swaroopa of Shudha Artava108

Swaroopa Cha.Sam Su. Sam As. S As. Hri Bha. Pra

Gunja phala varna + - - - -

Padma lakta + - - - -

Indra gopa + - - - -

Shasa asrak - + + + +

Laksha rasa - + + + -

Nishpicchila + - - - +

Na daha + - - - +

Na arthi + - - - +

Dautam cha - + + + -

Virajyayate + - - - -

Na ati bahu + - - - -

Na ati alpa + - - - -

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VRIDHI, KSHAYA, LAKSHAN OF ARTAVA:

1) Vridhi: Anga marda (Body ache) Artava ati pravriti (increased flow of artava)

Daurgandhya (Bad smell)

2) Kshaya: Yathochita kala adarshana (Tringular menstruation) Alpata (Scanty flow)

yonivedana (Pain in the vagina)

Table No-2.2. Showing the Nidana of Shweta pradara

Nidana Cha.S Su. S As. S As. Hri Bha. Pra MN Yog.r

Mithyachara

a) Mithyahara

b) Mithy vihara

+ + + + + + +

Artava Dusthi + + + + + + +

Beeja Dosha + + + + + + +

Daiva + + + + + + +

Pravridha

linga purusha

atisevana

- + + + - - -

Ruksha

Durbala Bala

- + + + - - -

Apadravya

Prayoga

- - + + - - -

Manasika - - + + - - -

Garavisha - - + + - - -

Specific shvetapradara nidana is not mentioned in classical literature. General pradara

nidana is mentioned as follows.

Lavana, Amla, Katurasa, Vidahi, Guru, Snigda

Mamsa of gramya, Oudaka, Medya

Krashara, Payasa, Dadhi, shukta, mastu, sura

Virudhahara, adhayashana, madhyapana

Garbhapata, Atimithuna, Yana, Ajirna, Adwa

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Bharavahana, Abhigata, Divashayana

Among the above nidana the aharajanya nidana will vitiates rakta, it’s amount will

increased and reach shleshmadhara kala of artavavaha srotas, vitiates stanika kapha and

vata, result in shvetapradara.

The viharajanya causes are vitiates vata and increases amount of rakta and result

in shvetapradara

Apadravya will vitiates sthanika vata & kapha result in shveta pradara.

Some other causative factors of shvetapradara are as follows:

Yoni adhavana Ativyavaya Abhigata

Unhygenic condition Chills Guru ahara

Raktalpata Oily substances Ati katu rasa sevana

Durbalata Ati ushna ahara Shalya

Krimi Malabaddhata Ati nidra

Garbhapata Nagnayoni Chinta

Ati prasava Malnutrition Krodha

Constant cold water bath specially during rutukala constant working in water or

wearing wet under garments, unsatisfied married life, contraceptives.

Table No. 2.3. The yoni rogas in which the shweta srava is considered as a symptom

S.No Name of Yoni vyapata Predominarncy of dosha

1. Shleshmala yoni vyapata Kaphaja

2. Tridoshaja yoni vyapata Tridoshaja

3. Acharana Yoni vyapata Vataja (Cha) Kaphaja (Su)

4. Atichurna Yoni vyapata Vataja (Cha) Kaphaja (Su)

5. Upapluta Yoni vyapata Vata, kapha (cha)

6. Vipluta Yoni vyapata Vataja (Su)

Purva Roopa

In Ayurvedic classics it is observed that purva roopa is explained as samanya i.e

which predicts the on coming disease but also specifies the doshic sub type of particular

on coming disease.

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In case of shweta pradara and yoni vyapata there is no reference regarding the

poorva roopa but according to the vagbhata quotation the avyakta or alpa lakshanaas are

considered under poorva roopa.

Roopa

Yonitach shweta srava

Samanya lakshanas are mentioned in charaka, Yogaratnakara as follows:

1) xÉ MÑürÉÉïiÉç ÌmÉÎcNûsÉÉ zÉÏiÉÉ MühQÕûaÉëxiÉÉsmÉ uÉåSlÉqÉç | cÉ.ÍcÉ. 30

2) zÉsÉåwqÉsÉÉ ÌmÉÎcNûsÉÉÇ rÉÉåÌlÉÈ MühQÒûaÉëxÉÉiÉÅÌiÉzÉÏiÉsÉÉ

---------------- zsÉåwqÉÉ _________ pÉuÉåiÉç || rÉÉå.U.E. 14109-110

excessive srava (shweta)

Angamarda

Vedana

The lakshanas are divided into slanika sarvadaihika lakshana

Table No. 2.4. Stanika lakshana:

Lakshana C.Chi C.D A.S.U A.N.U B.P.U V.R.U M.N.I

Pandu or shveta srava + + + +

Srava is like amarasa

(Apakwarasa)

+ + +

Srava is like sapicchila + + +

Srava is like pulakatoya

(rice or flesh washed

water)

+ + +

Picchila + + + +

Guru + + - -

Snigda + + - -

Shitalata + + + +

Alpavedana + + - -

Kandu + + + +

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SAMPRAPTI

Acharya charaka mentioned pradara samprapti as follows:

The lakshana of kaphaja pradara resembles to shvetapradara. So its samprapti can

be formed like this:

Due to excessive intake of gurvadi ahara and kaphavardhaka vihara (kleda, drava,

shita picchila guna), produce srotodusti in artavaha srotas, vitiates stanik kapha and vata

results in shwetapradara. Due to shweta srava it is named as pandure asragdare and

shweta pradara.

All yoni rogas are caused by vata vikruti (C.Ci 30/115)111 The vata vikriti nidanas

are not observed in aharajanya nidana, here vata vitiates due srotodusti, prarada is one of

symptom of apanavrata pitta (su.ni. 1/37)112 and disorder of rakta (C.Su. 28/11-12)113

Ahitakara Vihara

Saravadaihika (kapha) Sthanika

Vata vikruti (apanavata)

Agnimandya

Ama

Samarasadhatu

Artavaha srotus dushti

Sthana samshraya of dustha dosha in gabhashaya and yoni

Shwetasrava

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Samprapti ghataka:

Dosha : Kapha (Vatanubandhi)

Doshya : Rasa and Rakta

Agni : Jatharagni mandajanya ama

Srotas : Artavaha srotas

Srotodusti prakara: Sanga and atipravrutti are more suggestive, sanga occur due to ama

formation in artavaha srotas. Vitiates the vata and sthanika kapha

produce atipravrutti.

Adhisthana : Gabhashaya, Yoni

Sanchara stana : Artavaha srotas

Vyakta stana : Yoni

Ama : Jatharagni, Vikruti will produce ama. This cause sama rasa and

saamarakta

Vyadhi swabhava: It takes prolong duration from nidana sevana to lakshana

vyaktavasta. After vyaktavasta also the woman hegitate or neglects

to consult the physician. So it again prolongs the duration. Hence it

is chirakari

Sarvadaihika lakshana:

Dourbalya Supra pubic pain

Pulling sensation in jangha Heavyness in jangha

Alasya Aruchi

Ajirna Malabaddata

Shirashoola Shirobrama

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Katishoola Pschycological disturbance – samprapti

VYAVACHHEDAKA NIDANA

The vyava chhedaka nidana are as follows:

Upapluta

Sannipataja yoni vyapat

Upashaya and Anupashaya

Upashaya:

Specific upashaya is not mentioned in texts

Rukshopachara and Ushnopa chara

Japa kusuma

Tandulodak

Coconut water

Yoni prakashalana by kashaya rasa dravya like panchakshiri quatha or kankshi jala.

Anupashaya

Nidana

Constant cold water bath and wearing wet clothes.

SADHYASADHYATA : YAPY

The woman with continuous discharge, suffering from trushna, daha, durbala is

asadhya for chikitsa.

Hrutbhara, vedana, hrutipidana, cause swasakrusta, murchana later leads to

raktapradara

Treated in time is susadhya otherwise dusadhya.

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UPADRAVA

Dourbalya, Brama, Murcha, Tama, Trushna, Daha, Pralapa, Pandutwa, Tandra vata

vikara

Shopha is produced by pradara.

Table No. 2.5. PATHYA APATHYA

S.L.No Pathya Apathya

1. Diet with milk and mamsarasa Excessive katu rasa, shveta shali

2. Diet made with yavana usage of

Abhyarista, sidhu, tail, pippalichurna,

pathya and lohabhasma along with

madhu

Mamsa, Fish, Egg

3. Samashana Fried substance, excessive hot

substance

3. Vegetable fruits Guru ahara, Madhyapana

4. Nutricious food Onion, garlic, potato

5. Good hygiene Excessive srama, cold water bath and

wearing wet clothes chinta, krodha

6. Maintain dinacharya

7. Satvika vichara

Chikitsa sutra:

zÉsÉåwÉçqÉeÉÉxÉÑ cÉ Ã¤ÉÉåwhÉÉÇ MüqÉï MÑürÉÉïSÉÌuÉ cÉsɤÉhÉÈ|| cÉ.ÍcÉ. 30/42114

According to ayurvedic principles the first line of treatment is

“Nidana parivarjana” since it is kaphaja vyadhi, chikitsa should be done by

rooksha, ushna karmas this includes samshamana and samshodhana.

Samshamana: Systemic medication, local medication like pich, varti, kalka dharana with

kaphanashaka dravyas.

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Samshodhana: Uttaravasti, Yoni prakshalana with kwath prepared out of

kashayarasatmaka dravyas.

Abhyantara:

1. Rohitaka moola kalka should be taken with water. cha.chi. 30/116115

2. Juice of amalaki mixed with honey or sugar. A.S.

3. Paste of lohdra mixed with decoction of stem bark of nyagrodha should be taken.

Cha.Chi. 30/116116

4. Prepare the paste of amalaki beejakalka with water and add honey sugar give for

oral administration. Y.R.U 155P

5. Drinking of root of chakramarda pasted with rice water in morning hours cures

shwetapradara. Y.R.U. 156P

6. Use of nagakeshara with butter milk followed by diet on only cooked rice and

butter milk cures shwetapradara. Y.R.U. 156P

7. Badarabeeja choorna with honey and jaggery cures shwetapradara with in 3 days.

Cha.Chi. 30/118117

8. Use of darvyadi decoction cures shweta pradara. Sh.S.M.K. 2/113-116.118

9. Use of kashaya prepared with nyagrodha group of dravya is beneficial due to its

astringent properly.

Rasoushadhis:

Pradarantaka loham I & II

Pradarantaka rasha

Pradarari rasah (III)

Trivanga bhasma

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All these rasoushadhis contain vanga along with parada and gandhaka.

BHAHYA PRAYOGA: (STANIKA)

1. In case of excessive vaginal discharge a kshauma (flexon cloth) –vastra dipped

with decoction of stem-bark of only nyagrodha lodhra with vata should be placed

in vagina. (cha.chi. 30/173)119

2. Vaginal irrigation with kashaya of twak of lodra and vata should be done.

Cha.Chi. 30/72120

3. After snehana of vaginal canal kalka prepared with twak of plaksha mixed honey

should be placed. I.E. 39/73

4. Varti made with powder of lodhra priyangu and madhuka mixed with honey or

else of with kashaya drugs should be placed in snigdha yoni. Sh.S.M.K. 2/112)121

5. After snehana vaginal canal dhupana with sarala, guggulu and yava mixed with

plenty of grita or else katu matsyaka with oil should be done. Sh.S.M.K. 2/112122

6. Watery discharge per vaginum is cured by insufficient fine powders of khadira,

pathya, Jatiphala, nimba and puga triturated with soup of mudga and dried or else

powdered kahdhira, pathya, jatiphala puga and flowers of mudga. Sh.S.M.K. 116.

B.P. Ch. 70/47123,124

Anupana125:

UeÉlÉÏcÉÔhÉïqÉkÉÑMüqÉç kÉȨ́ÉTüsÉUxÉlÉiÉÑ

cÉiÉÑmÉëMüU mÉëSUqÉç iÉzÉcÉåiÉ lÉ xÉÇzÉÉrÉÈ |

Haridara powder, madhu, amalaki swarasa are supposed to be best vehicles or

anupanas for pradararoga.

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The role of madhu:

MüwÉÉrÉlÉÑUxÉÇ Ã¤ÉÇ zÉÏiÉsÉÇ qÉkÉÑU qÉkÉÑ |

SÏmÉlÉÇ sÉåZÉlÉÇ oÉsrÉÇ uÉëhÉzÉÉåkÉlÉUÉåmÉhÉqÉç

xÉÇbÉÉlÉÇ sÉbÉÑ cɤÉÑwrÉ xuÉrÉïqÉç QûkrÉÇ Ì§ÉSÉåwÉlÉÑiÉç ||

Madhu is astringent in anurasa, unctuous, cooling sweet, a digestive stimulant,

lekhana and strength promoting. It cleans and heals ulcers and helps in joining of

fractured bones. It is light promotes of eye sight and good voice, cardiac tonic and

alleviant of all the three doshas.

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MODERN CONCEPT “LEUCORRHOEA”126,127,128

Syn: Vaginal white discharge

The term leucorrhoea is strictly defined as an excessive vaginal discharge more

than normal. The term leucorrhoea should be restricted to those patients in whom the

normal vaginal secretion is increased in amount. In such patients there will be no excess

of leucocytes present when the discharge is examined under the microscope, and the

discharge is macroscopically and microscopically non-purlent. Purulent discharge is due

to specific infections such as gonorrhoea, trichomoniasis and moniliasis, to ulcerated

growths of the cervix and vagina. The symptom of excessive is a subjective one with

individual variation. To decide it to normal and not an infetive one requires clinical and

laboratory investigations. The term leucorehoea should fulfil the following criteria. The

excess secrtion is evident from persistent vulval moistness or staining of undergarments

(brownish yellow on drying) or need to wear a vulval pad. It is non-purulent, non-

offensive and non-irritant never causes prurities.

VAGINA

The Vagina of a healthy audult female is consist of white coagulated material

which contain squamous cells, Doderlein bacilli and coagulated secretion. Doerlein

bacilli are large gram positive organisms which are sugar fermenting. This ability to

convert glycogen in to latic acid is responsible for the high acidity of the normal healthy

audult vagina. The vaginal contents are mostly derived from the squamous cells of

vagina.

In healthy women the cervical secretion is small in amount and there is little

secretion from the endometrium of the body of uterus even during secretory phase of

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menstrual cycle. If the escape of endometrial serection is largely blocked by the plug of

mucous in the endocervix. The pathological conditions as erosions and ectropion of the

cervix are fromed, the mucus secrection is increased, so that patients may complain of a

mucous discharge at vaginal orifice.

The superficial cornified cells of the vaginal mucosa produce glycogen under

estrogen stimulation and are continuosly desquamated. As a result of breaking down of

the cells, glycogen is liberated and is ultimately converted into lactic acid.

In the new born before the appearance of Doderlein’s bacilli, glycogen is broken

down in to lactic acid and there is some evidence that the process is brought about by

enzyme action. After the appearance of Doderlin’s bacilli the production of lactic acid is

augmented by the action of the bacilli on simple sugars.

The amount of normal vaginal seretions varies with age in health and disease.

Pregnancy increase it, and just before the menstruation.

In healthy it is dependent on the vascular state of the genitalia and this itself is

largely oestrogen dependent. Congestive conditions of the genitalia and the adjacent

pelvic organs increase vaginal transudation apart from increased secretion that such

conditions themselves contribute to the vaginal contents.

The normal moistness of the vagina is sufficient to lubricate the vagina and labia

minora without staining the under clothes. Except at certain times when the secretion is

increased. These times are at ovulation, the immediate premenstrual phase, during

pregnancy and under the stimulus of sexual excitation.

A moderate increase in vaginal secretion is one in which the under clothes are wet

and require changing

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Vaginal acidity:

The vaginal acidity is due to lactic acid, which may be present as much as 0.6%.

The PH value is 5.7% in the newborn and reaches 6-7 in children, and falls to 4 at

puberty. During pregnancy the PH value is usually 4. After menopause the PH rises to 7.

the normal PH for healthy women during the child bearing period of life is about 4.5.

The deorlen’s bacillius is almost the only organism which will grow at a PH of 4-

4.5. as the acidiy of vagina falls and the PH rises, non-resident pathogens are able to

thrive.

Natural defence mechanism of the vagina against infection:

The skin of the vagina is a tough stratified squamous epithelium devoid of glands.

It presents a smooth unbroken surface to the attack of pathogenic organisms. The PH is

low and high acidity mitigates against bacterial growth. The thickeness of the squamous

the epithelium and the hostile PH depend upon oestrogen and therefore it is only in

extreme with before puberty. During the era of sexual activity and maxium oestrogen

production there are certain times at which the PH is raised.

During menstruation when the cervical and endometrial discharge which is

alkaline, tends to neutralize the vaginal acidity.

After abortion or labour when the alkaline lochia has a similar effect.

An excess cervical discharge has the same effect.

Apart from these excess cervical discharge has the same effect.

Apart from these exceptions, the vagina is naturally self sterilizing.

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Flora of the female genital tract:

In healthy women the fallopian tubes, the cavity of the uterus and the upper third

of the cervical canal are free of micro-organisms as does the vagina. In healthy vagina the

Doderlei’s bacillus is the only organism found in upper two thirds of the vagina, but in

the neighborhood of the vulva both saprophytic and paracitic organisms can usually be

demastrated.

Doderlein’s bacilli have been found in the vagina of the new born with in nine

hours after delivary, although the usualtime for them to appear is fifteen hours. The

vagina of the new born is probably inoculated during parturition.

During the puerperium the acidity of vagina is reduced and foreign organisms and

other pathogens can grow. During the climacteric and after menopause the number of

Doderein’s bacilli is reduced and sometimes this organism cannot be demonstrated in the

vagina.

The important of doderlein’s bacillis is that its presence is associated with the

production of lactic acid contained in the vagina and these acidy inhibits the growth of

organisms. In the multiparous woman when the vaginal orifies is patulous as a result of

lacerations during child birth, foreign organisms may be found in the lower part of

vagina, which by producing low grade vaginitis give rise to discharge.

AETIOLOGY

Physiological:

The physiological basis involved in normal vaginal secretion is dependent on the

endogenous oestrogen level. With the rising oestrogen level, there is abundant secretory

activity of the endocervical glands and superficial vaginal epithelium becomes rich in

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glycogen. The glycogen loaded epithelium sheds. The glycogen being converted in to

lactic acid by Doderlein bacilli. As a result the vaginal PH becomes acidic. The mucoid

secretion from cervical glands is normally small in amount. The carbohydrate radicle of

the glycoprotein mucin is split off and fermented in to lactic acid. If however the mucus

is secreted in excess, it pours out at the vulva.

Normal secretion from vulva, vagina, cervix show an increase in conditions when

the oestrogen level becomes high. Such conditions are.

1) New born:

Some newborn gets leucorrhoea for a week due to maternal oestrogen.

2) During puberty:

Increased levels of endogenous oestrogen lead to marked over growth of the

endocervical epithelium which may encroach on to the ectocervix producing

congenital erosion leads to increased secretion.

3) During Menstrual cycle:

Around ovulation – Peak rise of oestrogen leads to increase in secretory

activity of cervical glands.

Premenstrual pelvic congestion and increased mucous secretion from the

hypertrophoid endometrial glands.

4) Pregancy:

There is hyperoestrinism with increased vascularity. This leads to increased

vaginal transudate and cervical gland secretion.

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5) During sexual excitement:

When there is abundant secretion from bartholin’s glands. It is of tempaorary

duration and needs no treatment.

Non-Pathogenic leucorrhoea:

It is classified in to two:

1) Cervical leucorrhoea

2) Vaginal leucorrhoea

1) Cervical Leucorrhoea:

Non-infective cervical lesion may produce excessive secretion which pours out at

vulva. Such lesions are cervical erosion, chronic cervicitis mucous polyp and ectropion,

which is caused when the cervix has been badly lacerated during child birth so that the

cervix is partly everted to expose the cervical glands.

2) Vaginal Leucorrhoea:

This form of leucorrhoea is seen when the discharge originates in the vagina itself

asa transudation through the vaginal walls. It is now established that almost all the lactic

acid of the healthy vagina is formed from the glycogen contain in the keratinized cells of

vagina and the vaginal protion of the cervix. The cells are constantly being desquamated,

when that glycogen is liberated to be fermented by Doderlein’ bacilli, a process which

result in the production of lactic acid. This process is under the control of oestrogen, the

level of which determines the PH of the vaginal transudation.

Local congestive states of the pelvic organs such as pregnancy aquired

reroversion, prolapsed congested ovaries, chronic pelvic inflammatory diseases and

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chronic constipation with a sedentary occupation, pills ill health is also one of the

important cause of an excessive discharge.

Pathological:

This can be divided in to two

1. General health causes (One third)

2. Genital causes (Two third)

The important causes are ill health, Aneamia, colitis, vaginitis cervical erosion.

Table No. 2.6. Incidence of cause of Leucorrhoea

a) Ill health and malnutrition 25.4%

b) Dysfunctional 7.0%

General Health factor

c) Psychological 0.6%

Vulval growth and ulcer 1%

Vaginitis 19%

Cervical erosion -20%

Chronic cervicitis -7%

Uterine tumour (Polyptibroid) 1%

Genital prolapse 10%

Contraceptives 2%

Pelvic factors

Pregnancy 3%

Clinical features:

Excessive white discharge per vagina

Non irritant, non offensive, non purulent

No prurities

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DIGNOSIS:

1. HISTORY:

i. Age of the patient

Marriage

ii. Present illness: Character of leucorrhoea

Its duration

Timing with menstruation

Vulval irritation or any other symptoms

Use of contraceptives

iii. Menstrual History and obstetrical history

iv. Pastmedical and drug history

H/o tuberculosis, anaemia, dysentery, diabetes, antibiotic taken.

2. General health Examination: to detect ill health, anaemia etc.,

3. Gynacological examination:

P/v and P/s examination to detect the condition of valva, urethra, Bartholin glands,

vagina, cervix, uterus, foreign body and any growth.

Local Examination

A) Vulval inspection reveals

-The discharge looks white or creamy in colour.

- There is no evidence of Pruritis.

B) Bimanual including a speculum examination reveals

- The nature and amount of the discharge.

- The condition of the vaginal wall and cervix.

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- It reveals either a negative pathology.

- Associated pelvic lesion mentioned earlier causing vaginal

Leucorrhoea.

C) To exclude the infective nature,the discharge is subjected to

microscopic examination for detection of pus cells.

If pus calls are not found,then irrespective of any organism

present,it can be concluded that the discharge is true leucorrhoea and not due to

infection.

If pus cells are found,and unless an obvious cause such as

cancer or a foreign body is revealed,the nature of organisms present must then be

determined by the study of fresh preparations,stained smears and cultures.

4. Investigation:

To exclude infective nature, the discharge is subjected to microscopic

examination for detection of pus cells. If pus cells are not detected, it is considered as a

case of true leucovrhoea. If pus cells are detected further investigation are to be carried

out to identify the organism from the discharge.

Wet mount preparation of vaginal discharge for T.vaginalis and moniliasis.

Vaginal and cervical discharges should be examined by staining and culture for

the causative factor.

Cytological study from vagina and cervical scraping.

Treatment:

This should be conducted according to the determined cause.

Local hygiene should be maintained.

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A Clinical study.

60

Improvement of general health

Cervical factors may require surgical treatment

Pelvic lesion producing vaginal leucorrhoea require appropriate therapy Pill users

have to stop it.

Ill health leucorrhoea is treated by deworming,boiled water.

Correction of anemia.s

Pond bathing is prohibited.

Consolation to patient is done.

Vaginal irrigations – Betadine is the best antiseptic douche.

Introduction of pessaries like—

1) Estrogen to promote Keratinization.

2) Antibiotics.

3) Cortisone or Bacteriostatic drugs.

4) Fungicidal drugs.

Bactericidal cream like triple sulpha cream,betadine.

Phisiological leucorrhoea does not need any treatment. It subsides by itself and

the patient is to be repeatedly assured and convinced by making to understand that

it is purely physiological.

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59 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta

Pradara- A Clinical study.

METHODOLOGY

MATERIALS

Source of Data

Literary source

T.L.C.

Literary aspect of study is collected from Ayurvedic texts, modern texts, and

updated with recent medical journals and from internet search.

Drug

Plaksha (Ficus lacor) twak

Madhu (Honey) – As (anupana)

Collection of Raw Materials

Source of data:

1. Identification: Botanically identified plaksha twak is selected for the study.

2. Collection: The good quality plaksha twak is collected from the market of

Udupi.

3. Physical properties of plaksha twak:

The bark is rough in appearance, occurring in flat to curved, pieces, external

surface ash or whitish grey in colour.

Method of preparation

Source of the drug

Botanically identified freshly collected bark of plaksha (Ficus lacor) were

procured, cut into small pieces and dried. These dried pieces were powdered with

pulvaliser.

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Process of preparation of plaksha twak churna. (Course and fine)

1. The dried pieces weighting 5 kg were made into course powder.

2. The course powder was allowed to dry completely by keeping in drying

chambers.

3. Further among 5 kg course powder 2 kg course powder was made into fine

powder with the help of pulvaliser and sieved through 120 size mesh.

4. 3 kg of course powder and 2 kg of fine powder was collected and preserved in

separate airtight containers.

Place of preparation of medicine

The preparation of medicine was done in post Graduation Research studies

Department of Rasashastra D.G.M. Ayurvedic medical college Gadag.

Form of the medicine

The medicine was administered in the form of

1. Churna – orally

2. Kashaya – As vaginal douche.

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Pradara- A Clinical study.

METHODS

Material

The preparation of plaksha twak churna (fine) (sample A) and plaksha twak

churna (coarse) (sample B) are taken for study.

Methods

Objectives:

1. Pharmacognoistical evaluation of Plaksha.

a. Macroscopical evaluation

b. Microscopical evaluation

c. Standardization and Validation.

2. Preliminary phyto chemical analysis of Plaksha.

3. TLC of Plaksha.

4. To Evaluate the efficacy of Plaksha twak churna in the management of Shewta

pradara.

5. To evaluate the Plaksha twak kashaya as a trans vaginal douche in the

management of Shweta pradara.

6. To evaluate the comparative effect of Plaksha twak churna orally and kashaya

as trans vaginal douche in the management of Shweta pradara.

Criteria for selection of patients

a. Patients are diagnosed as shweta pradara as per the classics.

b. Respective of sex (only female patients are considered)

c. Patients in between the age group of 20-50 years.

2. Study Design

It is comparative clinical study of both churna and kashaya in

shwetapradara.

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Pradara- A Clinical study.

3. Source of Data

30 patients are selected from free check up health campus and also from

O.P.D department of Dravyaguna. Post Graduation studies and Research centre,

D.G.M.A.M.C and Hospital by present inclusion and exclusion criterial.

4. Sampling method

The patients are made into two groups Group A consists 15 patients and

Group B consists of 15 patients.

5. Inclusion criteria

1. All patients are between age group 20-50 years with complaint of

a. Shweta srava from Yoni

b. Shitalata

c. Kandu

d. Katishula

e. Dourbalya

f. Dragging sensation in abdomin.

2. The patients of shwetapradara are selected irrespective of their occupation,

socio-economical status, food habits etc.

3. Shweta pradara associated with trichomonas vaginals and candida

albicans.

6. Exclusion criteria

a. Pregnancy and lactation

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Pradara- A Clinical study.

b. Pelvic inflammatory disease

c. Abnormal papsmear

d. Abnormal uterine bleeding

e. Gynaecological causes like ovarian cyst, prolapse fibro myoma

polyps

f. Systemic diseases including severe anemia and HIV

g. Uses of hormones or intra uterine devices.

h. Classical veneral diseases like gonorrhoea and syphilis.

7. Diagnostic criteria

a. Patients having shweta srava from yoni with or without associated

symptoms are taken for study.

b. Vaginal pH is below 5.7 to 6.0

c. Microscopic study of vaginal smear shows clue cells is selected for

study

8. Intervention

Group A – Patients administered Plaksha twak churna 4 gm B.D with madhu

for 21 days before meals.

Group B – Patients administered Plaksha twak churna kashaya 50 ml as

vaginal douche in the morning before meals for 21 days.

9. Laboratory investigations

Investigations were done to diagnoses the disease, to exclude the patients

and to know the prognosis of the patients.

Haematological - a) Hb% (Haemoglobin%)

b) E.S.R. (Erythrocyte sedimentation rate)

c) T.C (Total count)

d) D.C. (Differential count)

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Vaginal smear

Vaginal pH

10. Assessment of clinical trial

a. The assessment of clinical trial is done by observing the severity of

symptomatology as well as Lab investigation.

b. The clinical assessment are done before treatment and after treatment,

observed after 1st week, after 2nd week, after 3rd week of treatment.

c. The Lab investigation is done before and after treatment and the

difference in values assessed and analyzed.

Grades for the subjective Parameters

1. Excessive vaginal discharge

0 – Normal

1 – Persistent moistness of vulva

2 – Need to change the under garments frequently

3 – Severe moistness

2. Persistent vulval moistness

0 – Normal

1 – Mild moistness

2 – Moderate moistness

3 – Severe moistness

3. Extensive pruritis

0 – Normal

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Pradara- A Clinical study.

1 – Occasionally pruritis

2 – Pruritis through out the day

3 – Increase particular time of day / Night

4. General weakness

0 – Normal

1 – Patient is able to involve in Physical activity

2 – Patient is slow to involve in Physical activity

3 – Patient feels exhausted to involve in physical activity

5. Pain in lumbar region

0 – Normal

1 – Particular time concerned with menstrual cycle

2 – Pain particular time of day relieves after rest

3 – Severe continuous pain more relief even after rest.

6. Dragging sensation in abdomen

0 – Normal

1 – Mild

2 – Moderate

3 – Severe before menstruation

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66 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta

Pradara- A Clinical study.

1. Pharmacognostic study of Plaksha

The Plaksha twak was taken for pharmacognostic study both in wet as well as

dry form. Its macroscopical and microscopical structures were studied in detail. Later

characteristics of the powder were also studied.

Materials for T.S. of Stem bark129

1) Napkin 2) Watch glass 3) Test tubes

4) Painting brush 5) Bunsen burner 6) A sharp razor blade

7) Micro slides 8) Cover slips 9) A beaker full of water

10) A dropper 11) filter paper /blotting paper 12) Stains

13) Drug sample 14) Forceps 15) Test tube holder

16) Test tube stand 17) Needle 18) Camel hair brushes

Methodology for T.S. of Stem bark (Micro preparation)

To study the anatomy of stem, a hand section is taken with the razor blade

sections are stained with saffren in and made semipermanent and observed under 10

X and 45 X magnification in light microscope. Photographs are taken through

binocular lens.

Methodology for the Microscopic powder

The powder drug was taken in the watch glass and few ml of chloralhydrate is

added and warmed, then removed chloral hydrate, then equal amount of Phloro

glucinol and HCL acid was added then wait for few minutes and mounted on the slaid

then one drop of glycerin is added, placed a cover slip and observed under microscop.

Photographs are taken through binocular lens.

2. IDENTIFICATION BY T.L.C

Drug: Extraction of sample (Aq & Alc) which is treated with 1:10ml solute; solvent

like ethyl alcohol with dilution method.

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Equipment: Silica gel, TLC kit, hot air oven, standard glass, wattaman glass plate,

beakers, sprayer.

Chemicals: Dragendroff’s reagent, Silica gel, ethyl alcohol.

Method: T.L.C. of the ethyl alcohol extract of the sample & Aqueous extract of the

sample was carried out as follows.

The silica gel powder mixed with water and made thin paste, then with the

help of glass slide, the silica gel was spread on glass plates uniformly, After some

times the air dried plate were kept in a hot oven at110-120 degree centigrade heay

was given continuously then the prepared sample is kept on a side of the plate then

immersed in solvents upto 30 minutes then Dragendroff’s solution is sprayed on the

plates.

A parameter called the Rf value is always used in TLC this is determined as

follows.

Rf = Distance traveled by the solute

__________________________

Distance traveled by the solvent

Aq extract = 12.6 Alc extract = 12.5

_____ = 0.96 _____ = 0.86

13 14.5

3. Preliminary Phytochemical analysis of Plaksh twak churna

Preliminary Phytochemical analysis of Plaksh twak churna was carried out at

Dr. Sandesh Kamat, Chief Executive, Bio Genics Research & training Institute in

Biotechnology, Unkal, Hubli.

4. Analysis of Plaksha twak churna for physical constants

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Pradara- A Clinical study.

Bark powder of Plaksha was analysed for physical constants at Dr. Sandesh

Kamat, Chief Executive, Bio Genics Research & training Institute in Biotechnology,

Unkal, Hubli.

I. Determination of moisture content

Material : Petriplates, physical balance, dessicator oven.

Method : 2 gms of the sample was taken in the previously weighed petriplates.

Petriplates were kept in the oven maintained at 1100c for drying. After 3 hours

petriplates were taken out and weight was noted down. This procedure was repeated

for 4-5 times until the constant weight is reached.

%Moisture = difference in weights X 100/ weights of the sample

II. Determination of ash content

Materials: Silica crusible, physical balance, dessicator, Bunsen burner.

Method : Weight of the empty crucible was noted down. 2 gms of the sample was

taken in the previously weighed crucible and was heated on a Bunsen burner until it

turned into ash. It was then cooled in a dessicator and weighed.

%Ash = difference in weights X 100/ weight of the sample

III. Determination of water insoluble ash

Materials : Silica crucible, hot H2O, ash less filter paper (whatmann No.42),

dessicator.

Method : The ash obtained from the above test was dissolved in H2O and filtered. The

water insoluble as collected on the filter paper was heated again on the Bunsen burner

until it turned into ash. The crucible was cooled in the dessicator and weighed.

%Water insoluble ash = difference in weights X 100 / weight of the sample

IV. Determination of acid insoluble ash

Materials : Silica crucible, 25% Hcl, ashless filter paper (whatmann no.42) dessicator.

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Method : The water insoluble ash obtained is dissolved in 15ml of 25% HCL and then

filtered. The acid insoluble ash collected on the filter paper was heated again. The

crucible was cooled in the dessicator and weighed.

%Acid insoluble ash = difference in weights X 100 / weight of the sample

V. Determination of water soluble extractive

Materials : Volumetric flask, distilled water, Chloroform, filter paper, evaporating

dishwater bath, ovan. Dessicator, physical balance.

Method : 5 gms of the powder was taken in the volumetric flask. Few drops of

chloroform were added to avoid the fungal attack. Subsequently 100 ml of distilled

water was added. It was kept for 24 hours, shaking frequently during the first six

hours. The solution was filtered the next day and 25 ml of this filtrate was evaporated

in a previously weighed evaporating dish on a water bath. Later it was dried in the

oven at 1100c to remove the traces of water. Weights were noted.

%Water soluble extractive = difference in weights X 100 / weight of the sample

VI. Determination of alcohol soluble extractive

Materials : 5 gms of the powder was taken in the volumetric flask. 100 ml of alcohol

was added to it, flask was kept for 24 hours, shaking frequently during the first six

hours. The solution was filtered the next day and 25 ml of this filtrate was evaporated

in a previously weighed evaporating dish on a water bath. Later it was dried in the

oven at 1100c to remove the traces of alcohol. Constant weights were noted down.

% Alcohol soluble extractive = difference in weights X 100 / weight of the sample.

Preliminary Phytochemical investigations of extracts130

Qualitative chemical tests were conducted for alcoholic and aqueous extracts of

Plaksh (Ficus lacor) to identify the various phyto constituents. The various tests

and reagent used are given below and observation are recorded.

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70 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta

Pradara- A Clinical study.

Material:

Drug: Aqueous & Alcoholic Extractive sample of Plaksh (Ficus lacor)

Equipments: Test tube, holder, stand, spirit lamp, pipette, glass rods, beakere 50 ml

to 250 ml, conical flask, water bath.

I. Test for alkaloids

a) Mayer’s test: The different reagents used are Mayer’s reagent (Potassium

mercuric iodide solution) giving cream coloured precipitate

1.Test solution with Mayer’s reagent

b) Test solution plus concentrated HNO3 plus 3% KOH in ethamol

c) Dragendorff’s reagent (Potassium bismuth iodide solution) giving reddish

brown precipitate

1.Test solution with Dragendorff’s reagent

d) Wagner’s reagent (Iodine, potassium iodide solution) Yielding reddish

brown

precipitate

1.Test solution with Wagner’s reagent

II. Test for Carbohydrates

a) Molish reagent : Ag or alcoholic solution of sub’s plus 10% alcoholic

solution of A Napthol Shake plus concentrated H2SO4 along the side of the tube

b) Benedict’s test : 5 ml of Benedict’s reagent plus 3 ml of sugar solution boil

for 2 minutes then allow to cool

c) Fehling’s test :2 ml of fehling’s solution

A + 2 ml of fehling solution

B + 2 ml of sugar solution then boil.

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d) Barfoed’s test :2 ml of test solution plus 2ml of barfoed’s reagent, boil on

water bath.

e) Seliwanoff’s test :3 ml of Seliwanoff’s reagent plus 1 ml of sugar solution,

boil for 2 minutes.

III. Test for Glycosides

a) Keller-kiliani test for digitoxose : The test consists of boiling about 1 gm

finally powdered digitalis with 10 ml 70% alcohol for 2-3 minutes. The extract

is filtered. To the filtrate is added, 5 ml water and 0.5 ml strong solution of lead

acetate. Shake well and separate the filtrate. The clear filtrate is treated with

equal volume of chloroform and evaporated to yield the extractive. The

extractive is dissolved in glacial acetic acid and after cooling, two drops ferric

chloride solution is added to it. These contents are transferred to a test tube

containing 2 ml concentrated sulphuric acid. A reddish brown layer acquiring

bluish-green colour after standing is observed due to the presence of giditoxose.

b) Baljet test : To a section of digitalis, sodium picrate solution is added. It

shows yellow to orange colour.

1. Foreign organic matter - Not more than 2%

2. Loss on drying - Not more than 5% W/W, by drying to

constant weight at 1050 C.

3. Acid – insoluble - Not more than 5%

c) Bornatrager’s test : Anthraquinone derivatives are generally detected by

Bornatrager’s test. In this test, the drug is powdered and further extracted with

ether or any water immiscible organic solvent. The filtered ethereal extract is

made

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Pradara- A Clinical study.

alkaline ether with caustic soda or ammonia, by which the aqueous layer shows,

after shaking, pink, red or violet colour. Bornatrager’s test is negative in case of

anthrenols (Reduced forms). Anthrones are detected with their fluorescence test.

IV. Test for Amino Acid

a) Ninhydrin test : 2 ml of Original solution plus 5 ml of Ninihydrin solution

boil for 2 minutes then allow to cool.

V. Test for Steroids

a) Salkowaski’s test : 2 ml of test solution in chloroform plus slowly add 2 ml

of concentrated H2 SO4 wait for 3 minutes.

b) L.B, : Libermann-Burchrdt’s test : 2 ml of test solution in chloroform

plus 10 drops of acetic anhydride plus 2 drops of concentrated H2 SO4.

VI. Test for Proteins

a) Biuret test : 2 ml of Original solution plus 2 ml of 10% NaOH solution plus

2-3 drops of 1 % CUSO4 solution mix.

VII. Test for Tannins

Test solution plus Ferric chloride (Fecl3) gives bluish black or brownish –

green colour

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73

OBSERVATION AND RESULTS

The observation and result of the present study are presented as under-

Pharmacognoistical and Preliminary Phyto chemical data pertaining to

the values of study, macroscopic evaluation, standardization and

validation of prepared drug.

Thin layer chromatography analysis of Aqueous extract.

Observations of the clinical study for the evaluation of effect of the

drug have been recorded.

Observation pertaining to the pharmacognostic study of Plaksh twak

a) Macroscopic – Bark rough, occurring in flat to curved, quilled pieces,

measuring 0.4-0.7 cm in thickness; external surface ash or whitish-grey;

numerous transversely arranged lenticels; ranging from 0.1 cm – 1.3 cm in

length, lip-shaped and exfoliating; internal surface rough, fibrous,

longitudinally striated, reddish-brown; fracture, fibrous.

b) Microscopic – Shows 5-8 layered cork consisting of thin-walled, rectangular

cells, a few external layers exfoliating; secondary cortex very wide consisting

of compactly arranged, rectangular, thick-walled, pitted cells, patches of

circular to elongated, lignified, elliptical stone cells with radiating canals, a

few with concentric striations; a few prismatic crystals of calcium oxalate and

reddish-brown contents found scattered throughout the secondary cortex;

secondary phloem very wide consisting of mostly stratified layers of collapsed

cells forming ceratenchyma, groups of fibres, phloem parenchyma, laticiferous

cells, traversed by 2-5 seriate phloem rays; phloem fibres lingnified with wide

lumen and pointed tips; thin-walled, rectangular, a few phloem parenchyma

containing prismatic crystals of calcium oxalate.

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74

Powder – Reddish-brown; shows thick-walled parenchyma with simple pits; stone

cells in groups and singles, prismatic crystals of calcium oxalate, elongated phloem

fibres with wide lumen and pointed tips.

Phytochemical study

The following observations were made in Plaksha with regard to-

Physical constants

Physico-chemical study

Table No. 3.a. Showing the Physical constants and found values of bark powder of Plaksha

Sl no Method adopted Plaksha (Ficus lacor)

1 Foreighn matter Not more than 1%

2 Total Ash Not more than10%

3 Acid insoluble Ash Not more than 1.5%

4 Water soluble extractive Not more than 6%

5 Alcohol soluble extractive Not more than 5%

Table No. 3.b. Showing the Thin layer Chromatography analysis of Aqueous extract

S.L.no Phyto constituents

TLC Plate

system

Detector Rf values

Spot colour Result

1 Alkaloid Silicagel G

Ultra violet 0.75 0.61

Fluorescent Green Fluorescent Green

Present Present

2. Alkoloid Silicagel G

Drangendroff’s reagent

0.75 0.61

Orange Orange

PresentPresent

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75

Table No. 3.c. Showing the Phytochemical components and found values of bark powder of Plaksha.

Test and reagents Observation Inference

Test for Carbohydrates (aqeous)

Molis Test: To the 2 ml of sample, aqueous 2 drops of alpha-napthol and mixed carefully rundown the concentrated H2SO4 along the walls of the tubes carefully

Test for Glycosides(aqeous)

To 1ml of test solution add 3 ml of anthrone reagent and mix well

Test for Polysaccharides (alcoholic)

To 1 ml of test solution, 2 drops of iodine solution was added

Test for Proteins (aqeous)

Test for free amino acids (aqueous)

To 1 ml of test sample add 5 drops of ninhydrin and boil for 2 min

Bradford’s test (aqeous)

To 0.5 ml of test sample add 2 ml of Bradford’s reagent

Test for alkaloids (aqeous)

To 1ml of test sample add 3ml of Drangendroff reagent, mix well, boil for 5 min.

Mayer’s test (aqeous)

To the 1 ml of test sample add 1 ml of mayer’s reagent, mix carefully

Test for Steriods

Liberman burchard test

To 2ml of sample (chloroform extract) add 10 drops of acetic acid and 2 drops of conc. H2SO4, mix.

Salkwoski test

2 ml of sample (chloroform

The purple violet ring at the junction of two layers

Green coloured complex formed

Blue coloured solution observed

Purple coloured solution observed

Observe the blue colour

Dark brown orange colour

White pale Yellow observed at the bottom of test tube

Initially red colour appears followed by blue and finally green colour development

Presence of carbohydrates

Presence of glycoside

Absencey of Polysaccharides

Presence of free amino acids

Presence of proteins

Presence of alkaloids

Alkaloids present

Steroids present

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76

extract) in a dry tube and add 2 ml of Conc. H2SO4, mix vigorously.

Test for Flavonoids(aqueous)

To 1ml of test sample, iodine solution was added drop wise

Test for Lipid(chloroform)

To 2ml of test sample, iodine solution was added drop wise

Test for Oils(chloroform)

The 1 drop of sample was placed on a filter paper and allowed to dry.

Test for saponins

Few drops of sample heated with alcoholic KOH and boiled for 1min and cooled. Acidified with 1 ml of conc. HCl. A portion of it was treated with 10 ml of water and 5% NaOH, added drop wise

Test for Tannins (aqueous)

Test solution plus Ferric chloride (Fecl3)

Steroid and H2SO4 layers separated and sample layer formws cherry red colour and acid layer forms green colour

Yellow colour formation

Original iodine colour disappears

Clear greasy spot observed

Clear soap was observed while shaking

Bluish black or brownish – green colour

Steroids present

Presence of Flavonoids

Lipids are present

Lipids are present

Saponins are absent

Tannins are present

Clinical observations

The present clinical study was meant for evaluation of Plaksha Twak Churna

in the Management of Shweta Pradara. Total 30 patients were taken randomly for the

above-mentioned study. All the patients under study were observed clinically during

the course of treatment and follow up. The patients were selected as per the study

design and evaluated through various subjective and objective parameters.

The demographic data pertained to age, Menstrual history, socio-economic

status, dietic pattern, habits and etiological factors have been tabulated and

percentages are represented through diagrams.

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The data pertaining to objective parameters like vaginal smear and Vaginal pH

have been recorded before and after treatment.

The data pertaining to subjective response of the patients are shown in

percentage through tables and finally compared between two groups.

Table 3.1 Showing the Incidence of Menstrual History

Menstrual

History

Group

A

Percentage Group

B

Percentage Total Percentage

Excessive 13 86.66% 10 66.66% 23 76.66%

Irregular 5 33.33% 2 13.33% 7 23.33%

Graph No 1 Showing the Incidence of Menstrual History.

0%

20%

40%

60%

80%

Percentage 77% 23%

Excessive Irregular

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Incidence of Age :

Incidence of age between 20-30 years, 30-40 years and 40-50 years was 80%

(12 patients) 20% (3 patients) respectively in group A. where as in group B the

incidence of age between 20-30 years, 30-40 years and 40-50 years was 66.66% (10

patients), 33.33% (5 patients) and 0% in both groups of (40-50) In total the incidence

of age between 20-30 Years , 30-40 Years, 40-50 Years was 73.33% (22 patients)

26.66% (8 patients) and 0% (40-50) age respectively.

Table 3.2 Showing the incidence of Age

Age Group A Percentage Group B Percentage Total Percentage

20-30 Yrs 12 80% 10 66.66% 22 73.33%

30-40 Yrs 03 20% 05 33.33% 08 26.66%

40-50 Yrs 0 0% 0 0% 0 0%

Total 15 100% 15 100% 30 100%

Graph No 2 Showing the incidence of Age

0%

20%

40%

60%

80%

Percentage 73% 27% 0%

20-30 30-40 40-50

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Incidence of socio economic status :

Incidence of the socio economic status is 80% (12 patients) 20% (3 patients)

and 0% (patients) belongs to Poor, Middle, Higher middle, Higher class respectively

in group A. where as in group B 13.33% (2 patients) 4.66% (7 patients), 40.6% (6

patients) 0% (patients) belongs to Poor, Middle, Higher middle, Higher class Socio

economic status respectively.

Table 3.3 Showing the incidence of Socio-economic status

Income Group A

Percentage Group B

Percentage Total Percentage

Poor 12 80 % 02 13.33 % 14 46.66 % Middle 03 20 % 07 46.66 % 10 33.33% Higher middle

0 0 % 06 40.66 % 06 20.10 %

Highers 0 0% 0 0% 0 0% Total 15 100 % 15 100 % 30 100 %

Graph No 3 Showing the incidence of Socio-economic status

46.66%

33.33%

20.10%

0%0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

Poor Middle Higher middl Higher

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Table No. 3.4. Showing the classification of Patients based on their Prakruti

Prakruti Group A Group B Total Percentage

Vata Kapha 03 06 09 30%

Kapha vata 09 06 15 50%

Kapha pitta 03 03 06 20%

Graph No. 4. Showing the classification of Patients based on their Prakruti

30.00%

50.00%

20.00%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

Vata kapha Kapha vata Kapha pitta

Incidence of dietic pattern

In the group A 60% (9 females) belongs to Mixed and 40% (5 females) belong

to vegetarian. Where as in group B 40% (6 females) belongs to mixed and 60% (9

females) belongs to vegetarian. In total the clinical study comprises 50% (15 females)

belongs to mixed and 50% (15 females) belongs to vegetarian food patterns.

Table 3.5 Showing the incidence of dietic pattern

Diet Group A Percentage Group B Percentage Total Percentage

Mixed 09 60% 6 40% 15 50%

Vegetarian 06 40% 09 60% 15 50%

Total 15 100% 15 100% 30 100%

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Graph No 5 Showing the incidence of dietic pattern

Mixed50%

Vegetarian50%

Mixed

Vegetarian

Incidence of etiological factors

In the group A 13.33% (2 females), 20.00% (3 females), 60.00% (9 females)

86.66% (13 females) 13.33% (2 females) 73.33% (11 females) were affected with

Abhishyandi ahara, Viruddha ahara, Lavana amla, katu, rasa, yoni, yoni aprakshalana,

atimaithuna, chinta, nidanas respectively. Where as in group B 20.00% (3 females)

13.33% (2 females) 40.00% (6 females) 66.66% (10 females), 06.66% (1 females),

73.33% (11 females) nidana’s respectively.

In total 16.66% (5 females), 16.66% (5 females), 50.00% (15 females),

76.66%, (23 females), 10.00% (3 females) affected with nidanas respectively.

Table 3.6. Showing the incidence of Nidana

Aetiological Factors

Group A

Percentage Group B

Percentage Total Percentage

Abhishyandi ahara

2 13.33% 3 20.00% 5 16.66%

Virudha ahara 3 20.00% 2 13.33% 5 16.66% Lavana amla

katu rasa pradhara

9 60.00% 6 40.00% 15 50.00%

Yoni aprakshalana

13 86.66% 10 66.66% 23 76.66%

Ati maithuna 2 13.33% 1 06.66% 03 10.00% Chinta 11 73.33% 11 73.33% 22 73.33%

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Graph No 6. Showing the incidence of Nidana

Table No. 3.7. Result by religious in shweta pradara with plaksh twak churna.

Religion Good response

Moderate Response

Poor Response

No Response

Total Percentage

Hindu 14 0 0 0 14 46.66% Muslim 9 0 0 0 9 30.00% Christian 0 3 0 0 3 10.00% Others 0 4 0 0 4 13.33% Total 23 7 0 0 30 100% Percentage 76.66% 23.33% 0% 0% 100% -

In the present study, 14 patients (46.66%) are Hindus, 9 patients (30%) are

Muslims, 3 patients (10%) are Christain, 4 patients (13.33%) are others.

Graph No. 7. Showing the incidence of Religion

16.66% 16.66%

50%

76.66%

10.00%

73.33% A B S Ahara

Virudahara

L A K ahara

Yoni aprakshalana

Ati maithuna

Chinta

46.66%

30.00%

10.00%

13.33%

HINDU

MUSLIM

CHRISTIAN

OTHERS

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Table No. 3.8. Results by occupation in Swetapradara with Plaksha twak churna.

Occupation Good response

Moderate Response

Poor Response

No Response

Total Percentage

Sendentory 8 0 0 0 8 26.66% Active 0 10 0 0 10 33.33% Labour 0 12 0 0 12 40% Total 8 10 12 0 30 100% Percentage 26.66% 33.33% 40.00% 0% 100% -

In the present study 8 patients (26.66%) are of Sedentary type, 10 patients

(33.33%) active, 12 patients (40%) Labour.

Graph No. 8. Showing the distribution of Pt.’s by Occupation.

27%

33%

40% Sedentary

Active

Labour

Table No.3.9. Results by Economic status in Swetapradara with Plaksha twak

churna.

Economic status

Good response

Moderate Response

Poor Response

No Response

Total Percentage

Poor 16 0 0 0 16 53.33% Middle 0 7 0 0 7 23.33% Higher middle

0 0 7 0 7 23.33%

Higher 0 0 0 0 0 0% Total 16 7 7 0 30 100% Percentage 53.33% 23.33% 23.33% 0 100 -

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Table No. 4.0. Results by Diet in Swetapradara with Plaksha twak churna.

Diet Good response

Moderate Response

Poor Response

No Response

Total Percentage

Vegetarian 12 0 0 0 12 40.0% Mixed diet 0 18 0 0 18 63.0% Total 12 18 0 0 30 100% Percentage 40.0% 63.0% 0% 0% 100% -

Table No. 4.1. Distribution of Patients by presenting complaints.

Presenting Complaints

Patients Percentage

Yoni srava 15 50.00% Kandu 6 20.00% Katishula 9 30.00%

Table No. 4.2 Distribution of Patients by Associated complaints.

Associated Complaints

Patients Percentage

Katishula 3 10.00% Jwara 5 16.66% Angamarda 6 20.00% Udarashoola 5 16.66% Dourbalya 5 16.66% Yonidaha 6 20.00%

Table No. 4.3. Ahara Nidana observed in the study

Ahara Nidana Patients Percentage Abhishyandi Ahara 5 16.66% Lavana amla katu 15 50.00% Viruddha ahara 9 30.00% Adhyashara 1 3.33%

Table No. 4.4. Vihara Nidana observed in the study

Vihara Nidana Patients Percentage Diwa swapna 5 16.66% Ayana 2 6.66% Yonia prakshalana 19 63.33% Atimaithuna 4 13.33%

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Table No. 4.5. Manasika Nidana observed in the study

Manasika Nidana Patients Percentage Chinta 25 83.33% Krodha 2 6.66% Anya Vegavarodha 3 10.00%

Table No. 4.6. Chronisity of Leucorrhoea observed in the cases

Chronisity of Swetapradara

Patients Percentage

10-20 days 6 20.00% 20-30 days 6 20.00% . 1 months 12 40.00% > 2 months 6 20.00%

Table No. 4.7. Results of Plaksha twak churna in Swetapradara.

Result No of Patients Percentage Well respond 25 83.33% Moderately 5 16.66% Responded 0 0% Not Responded 0 0% Total 30 100%

Section C - Data Related To Response To The Treatment

Response to treatment w.r.t Excessive Vaginal discharge

Table 4.8 Showing Grades of Vaginal discharge Before Treatment in Group A &

B

Grades No of

Patients

Group

3 % 2 % 1 % 0 %

15 A 4 26.66% 10 66.66% 1 7% 0 -

15 B 1 6% 10 67% 4 26.66% 0 -

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Table 4.9 Showing Grades of Excessive vaginal discharge After Treatment in

Group A & B

Grades No of Patients Group

0 % 1 % 2 % 3 %

15 A 13 87% 2 13.33% - - - -

15 B 15 100% - - - - - -

Gr-O No Discharge, Gr-1 Persistent moistness of Vulva, Gr-2 Need to change the

undergarments frequently, Gr-3 Need to use an extra cloth or pad

Table 5.0 Showing Grades of Persistent vulval moistness Before Treatment in

Group A & B

Grades No of Patients Group

3 % 2 % 1 % 0 %

15 A 1 7% 7 46.6% 7 47% - -

15 B - - 3 20% 5 33% 7 47%

Table 5.1 Showing Grades of Persistent vulval moistness After Treatment in

Group A & B

Grades No of Patients Group

0 % 1 % 2 % 3 %

15 A 12 80% 3 20% - - - -

15 B 15 100% - - - - - -

Gr-O No Moistness, Gr-1 Mild moistness, Gr-2 Moderate moistness ,

Gr-3 Severe moistness

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Table 5.2 Showing Grades of Extensive pruritis Before Treatment in

Group A & B

Grades No of

Patients Group

3 % 2 % 1 % 0 %

15 A 1 7% 8 53.3% 6 40% - -

15 B 3 20% 3 20% 6 40% 3 20%

Table 5.3 Showing Grades of Extensive pruritis After Treatment in

Group A & B

Grades No of Patients

Group 0 % 1 % 2 % 3 %

15 A 13 87% 2 13.3% - - - -

15 B 13 87% 2 13.3% - - - -

Gr-O No Pruritis, Gr-1 Occasionally pruritis, Gr-2 Pruritis through out the day, Gr-

3 Increases particular time of day/night

Table5. 4 Showing Grades of General weakness After Treatment in

Group A & B

Grades No of Patients

Group 3 % 2 % 1 % 0 %

15 A 7 46.6% 6 40% 2 13.3% - -

15 B - - 5 33% 1 7% 9 60%

Table 5.5 Showing Grades of General weakness After Treatment in

Group A & B

Grades No of Patients Group

0 % 1 % 2 % 3 %

15 A 12 80% 3 20% - - - -

15 B 15 100% - - - - - -

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Gr-O No Weakness, Gr-1 Patient is able to involve in routine activity

Gr-2 Patient is slow to involve in routine activity

Gr-3 Patient feels exhausted to involve in routine activity

Table 5.6 Showing Grades of Pain in lumbar region Before Treatment in

Group A & B

Grades No of

Patients Group

3 % 2 % 1 % 0 %

15 A 5 33% 8 53.3% 2 13.3% - -

15 B - - 3 20% 1 7% 11 73%

Table 5.7 Showing Grades of Pain in lumbar region After Treatment in

Group A & B

Grades No of Patients

Group 0 % 1 % 2 % 3 %

15 A 11 73% 4 26.6% - - - -

15 B 14 93.3% 1 7% - - - -

Gr-O No Pain, Gr-1 Mild , Gr-2 Moderate, Gr-3 Severe

Table 5.8 Showing Grades of Dragging sensation in abdomen Before Treatment in

Group A & B

Grades No of

Patients Group

3 % 2 % 1 % 0 %

15 A - - 5 33% 10 66.66% - -

15 B - - - - 2 13.3% 13 87%

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Table 5.9 Showing Grades of Dragging sensation in abdomen After Treatment in

Group A & B

Grades No of Patients

Group 0 % 1 % 2 % 3 %

15 A 14 93.3% 1 7% - - - -

15 B 15 100% 0 - - - - -

Gr-O Normal, Gr-1 Mild , Gr-2 Moderate, Gr-3 Severe

Objective Parameters

Table No.6.0. Showing the distribution of the patients by degree of Vaginal pH

before and after treatment.

SL.No Degree of Vaginal pH BT % AT % 1 3 - 4 0 0% 7 23.33% 2 4 - 5 6 20.00% 20 66.6% 3 5 - 6 11 36.66% 3 10.33% 4 6 - 7 10 33.33% 0 0% 5 7 - 8 3 10.00% 0 0

Vaginal Smear

Table No.6.1. Showing the distribution of the patients by degree of Vaginal

Smear before and after treatment.

SL.No Degree of Vaginal Smear

BT % AT %

1 Grade – 0 0 0% 30 100%2 Grade – 1 19 63.33% 0 0 3 Grade – 2 11 36.6% 0 0%

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OVERALL ASSESSMENT OF STATISTICAL DATA

Table No.6.2. Showing the Statistical Analysis of both the groups, Before and

after treatment and Percentage of improvement with respect to excessive vaginal

discharge.

Parameter Treatmen

t Group

Duration Mean±SD Mean±SE DF T-

Value

P-

Value

Rema

rks

BT 2.2 0.560 - - - - -

A AT 0.133 0.351 2.06 0.118 17.457 <0.001 HS

BT 1.8 0.56 - - - -

Excessive

Vaginal

discharge

B

AT 0.0 0.0 1.8 0.144

14

12.5 <0.001 HS

In order to assess the Excessive Vaginal discharge patients of each group

were examined according to the clinical findings and the results were analyses from

the statistical analysis.

The parameter Excessive Vaginal discharge in group A Mean ±SD before

was 2.2 ±0.56 and after the treatment it is reduced to 0.133 ±0.351, with Mean

difference 2.06 and standard of mean 0.118 and test shows more highly significant in

group A as P<0.001.

In group B Mean ±SD before was 1.8 ±0.56 and after the treatment it is

reduced to 0.0 ±0.0 with Mean difference 1.8 and standard of mean 0.144 and test

shows more highly significant in group B as P<0.001.

The parameter Excessive Vaginal discharge is having more effect in group A

than group B ( By Comparing t-values).

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Table No.6.3. Showing the Statistical Analysis of both the groups, Before and after treatment and Percentage of improvement with respect to Vulval moistrness.

Parameter Treatmet

Group

Duration Mean±SD Mean±SE DF T-

Value

P-

Value

Rem

arks

BT 1.6 0.632 - - - - -

A AT 0.2 0.414 1.466 0.133 11.02 <0.00

1

HS

BT 0.733 0.798 - - - - -

Persistent

Vulval

moistness

B

AT 0.0 0.0 0.733 0.206

14

3.55 <0.01 HS

The parameter Persistent Vulval moistrness in group A Mean ±SD before

was 1.6 ±0.632 and after the treatment it is reduced to 0.2 ±0.414, with Mean

difference 1.466 and standard of mean 0.133 and test shows more highly significant in

group A as P<0.001.

In group B Mean ±SD before was 0.733 ±0.798 and after the treatment it is

reduced to 0.0 ±0.0 with Mean difference 0.73 and standard of mean 0.206 and test

shows more highly significant in group B as P<0.01.

The parameter Persistent Vulval moistrness is having more effect in group A

than group B ( By Comparing t-values).

Table No.6.4. Showing the Statistical Analysis of both the groups, Before and after treatment and Percentage of improvement with respect to Extensive Pruritis.

Para-

meter

Treatment

Group

Duration Mean±SD Mean±SE DF T-

Value

P-

Value

Remar

-ks

BT 1.666 0.617 - - - - -

A AT 0.133 0.09 1.5

33

0.133 11.52 <0.001 HS

BT 1.33 0.975 - - - - -

Exten

sive

Prurit

is

B

AT 0.133 0.351 1.2 0.243

14

4.93 <0.001 HS

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The parameter Extensive Pruritis in group A Mean ±SD before was 1.666

±0.617 and after the treatment it is reduced to 0.133 ±0.09, with Mean difference

1.533 and standard of mean 0.133 and test shows more highly significant in group A

as P<0.001.

In group B Mean ±SD before was 1.33 ±0.975 and after the treatment it is

reduced to 0.133 ±0.351 with Mean difference 1.2 and standard of mean 0.243 and

test shows more highly significant in group B as P<0.001.

The parameter Extensive Pruritis is having more effect in group A than

group B ( By Comparing t-values).

Table No.6.5. Showing the Statistical Analysis of both the groups, Before and after treatment and Percentage of improvement with respect to General weakness.

Parameter Treatment

Group

Duration Mean±SD Mean±SE DF T-

Value

P-

Value

Rem

arks

BT 2.33 0.723 - - - - -

A AT 0.2 0.414 2.2 0.174 12.64 <0.001 HS

BT 0.733 0.961 - - - - -

General

weakness

B

AT 0.0 0.0 0.733 0.248

14

2.955 <0.05 HS

The parameter General weakness in group A Mean ±SD before was 2.33

±0.723 and after the treatment it is reduced to 0.2 ±0.414, with Mean difference 2.2

and standard of mean 0.174 and test shows more highly significant in group A as

P<0.001.

In group B Mean ±SD before was 0.733 ±0.961 and after the treatment it is

reduced to 0.0 ±0.0 with Mean difference 0.733 and standard of mean 0.248 and test

shows more highly significant in group B as P<0.05.

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The parameter General weakness is having more effect in group A than

group B ( By Comparing t-values).

Table No.6.6. Showing the Statistical Analysis of both the groups, Before and after treatment and Percentage of improvement with respect to Pain in Lumbar region.

Parameter Treatment

Group

Duration Mean±SD Mean±SE DF T-

Value

P-

Value

Rem

arks

BT 2.2 0.676 - - - - -

A AT 0.266 0.457 1.93 0.181 10.66 <0.001 HS

BT 0.466 0.833 - - - - -

Pain in

Lumbar

region

B

AT 0.066 0.258 0.4 0.19

14

2.10 >0.05 NS

The parameter Pain Lumba region in group A Mean ±SD before was 2.2

±0.676 and after the treatment it is reduced to 0.266 ±0.457, with Mean difference

1.93 and standard of mean 0.181 and test shows more highly significant in group A

as P<0.001.

In group B Mean ±SD before was 0.466 ±0.833 and after the treatment it is

reduced to 0.066 ±0.258 with Mean difference 0.4 and standard of mean 0.19 and test

shows non significant in group B as P>0.05.

The parameter Pain in Lumba region is having more effect in group A than

group B ( By Comparing t-values).

Table No.6.7. Showing the Statistical Analysis of both the groups, Before and after treatment and Percentage of improvement with respect to Vaginal pH.

Parameter Treatment Group

Duration Mean±SD Mean±SE DF T-Value

P-Value

Remarks

BT 6.1 1.22 - - - - - A AT 4.54 0.65 1.533 0.34 4.508 <0.001 HS

BT 6.22 1.116 - - - -

Vagnial pH

B AT 4.46 0.714 2.12 0.177

14

11.977 <0.001 HS

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The parameter Persistent Vaginal Ph in group A Mean ±SD before was 6.1

±1.22 and after the treatment it is reduced to 4.54 ±0.65, with Mean difference 1.533

and standard of mean 0.34 and test shows more highly significant in group A as

P<0.001.

In group B Mean ±SD before was 6.22 ±1.116 and after the treatment it is

reduced to 4.46 ±0.714 with Mean difference 2.12 and standard of mean 0.177 and

test shows more highly significant in group B as P<0.001.

The parameter vaginal Ph is having more effect in group B than group A ( By

Comparing t-values).

Table No.6.8. Showing the Statistical Analysis of both the groups, Before and after treatment and Percentage of improvement with respect to Vaginal Smear.

The parameter Vaginal smear in group A Mean ±SD before was 1.26

±0.457 and after the treatment it is reduced to 0.0 ±0.0, with Mean difference 1.266

and standard of mean 0.118 and test shows more highly significant in group A as

P<0.001.

In group B Mean ±SD before was 1.466 ±0.516 and after the treatment it is

reduced to 0.0 ±0.0 with Mean difference 1.466 and standard of mean 0.133 and test

shows more highly significant in group B as P<0.001.

The parameter Vaginal Smear is having more effect in group B than group A

( By Comparing t-values).

Overall the drug is having more effective in vaginal smear and Vaginal Ph in

group B and it is more highly significant in all other parameter in group A.

Parameter Treatment

Group

Duration Mean±SD Mean±SE DF T-

Value

P-

Value

Rema

rks

BT 1.266 0.457 - - - - -

A AT 0.0 0.0 1.266 0.118 10.72 <0.001 HS

BT 1.466 0.516 - - - - -

Vaginal

Smear

B

AT 0.0 0.0 1.466 0.133

14

11.022 <0.001 HS

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Table No. 6.9.Analysis table by using student t-test.

Parameter Mean SD SE t-value p-value Remarks Excessive Vaginal Discharge

1.933333

0.52083

0.095091

20.33148

<0.001 HS

Persistent vulval moistness

1.1

0.758856

0.138548

7.93948

<0.01 HS

Extensive pruritis

0.76489

0.13965

0.13965

9.786377

<0.001 HS

General weakness

1.466667

1.105888

0.201908

7.26405

<0.01 HS

Pain lumbar region

1.166667

1.053183

0.192285

6.067382

<0.01 HS

Vaginal ph 1.983333

0.769722

0.140532

14.11304

<0.001 HS

Vaginal Smear

1.366667

0.490133

0.089486

15.27241

<0.001 HS

% of imp 96.66667 91.42857 91.11111 93.47826 87.5 26.89394 100

Conclusion:

The statistical analysis is done by using student’s paired t-test, by assuming

that the drug is not responsible for changes in the readings before and after treatment.

From the analysis all parameters shows highly significant (as p<0.05). The

parameters Excessive Vaginal Discharge, Vaginal ph, Vaginal Smear and Extensive

pruritis shows more highly significant than the other parameters ( as p<0.001). and

the parameters Persistent vulval moistness and General weakness shows less highly

significant (as p>0.001).

The percentage of improvement in the parameters is Excessive Vaginal

Discharge with 96.66667, Persistent vulval moistness with 91.42857 %, Extensive

pruritis with 91.11111%, General weakness with 93.47826%, Pain lumba region with

87.5%, Vaginal ph with 26.89394 % and Vaginal Smear with 100%

from the study.

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Master chart 1

ASSMENT OF SUBJECTIVE PARAMETERS OF GROUP A

Excessive Vaginal discharge

Persistent Vulval moistness

Extensive Pruritis

General weakness

Pain in Lumba region

Draging sensation in abdomin

SLNo Gr A

OPD. No

BT AT Dif BT AT Dif BT AT Dif BT AT Dif BT AT Dif BT AT Dif1 9 2 0 2 3 1 2 2 0 2 3 1 2 2 0 2 2 1 1 2 10 3 0 3 2 0 2 2 0 2 2 0 2 3 0 3 1 0 1 3 34 2 0 2 2 0 2 1 0 1 3 0 3 3 1 2 1 0 1 4 18 2 0 2 1 0 1 1 0 1 3 0 3 2 0 2 1 0 1 5 35 3 1 2 2 1 1 1 0 1 3 0 3 3 0 3 1 0 1 6 56 3 1 2 2 0 2 2 0 2 2 1 1 2 0 2 2 0 2 7 55 1 0 1 2 0 2 2 1 1 3 1 2 2 0 2 1 0 1 8 37 2 0 2 1 0 1 1 0 1 1 0 1 2 1 1 1 0 1 9 3 2 0 2 1 0 1 1 0 1 2 0 2 1 0 1 1 0 1 10 5 2 0 2 1 0 1 3 1 2 2 0 2 1 0 1 2 0 2 11 61 2 0 2 2 1 2 2 0 2 2 0 2 2 1 1 1 0 1 12 1 2 0 2 1 0 1 2 0 2 3 0 3 2 0 2 2 0 2 13 25 2 0 2 1 0 1 2 0 2 2 0 2 3 1 2 1 0 1 14 29 2 0 2 1 0 1 2 0 2 1 0 2 2 0 2 2 0 2 15 37 3 0 3 2 0 2 1 0 1 3 0 3 3 0 3 1 0 1

BT= Before Treatment AT= After Treatment Dif = Difference

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Excessive vaginal discharge

Gr-O No Discharge, Gr-1 Persistent moistness of Vulva, Gr-2 Need to change the

undergarments frequently , Gr-3 Need to use an extra cloth or pad

Persistent vulval moistness

Gr-O No Moistness, Gr-1 Mild moistness, Gr-2 Moderate moistness , Gr-3 Severe

moistness

Extensive pruritis

Gr-O No Pruritis, Gr-1 Occasionally pruritis, Gr-2 Pruritis through out the day ,

Gr-3 Increases particular time of day/night

General weakness

Gr-O No Weakness, Gr-1 Patient is able to involve in routine activity , Gr-2 Patient is

slow to involve in routine activity, Gr-3 Patient feels exhausted to involve in routine

activity

Pain in lumbar region

Gr-O No Pain, Gr-1 Mild , Gr-2 Moderate, Gr-3 Severe

Dragging sensation in abdomen

Gr-O Normal, Gr-1 Mild , Gr-2 Moderate, Gr-3 Severe

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Master Chart

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Master Chart 2

ASSMENT OF OBJECTIVE PARAMETERS OF GROUP A

Vagnial pH Vaginal Smear S.L. No Gr.A

OPD BT AT Dif BT AT Dif

1 9 6.5 4.5 2 1 0 1 2 10 7.0 4.5 2.5 2 0 2 3 34 6.0 4.2 1.8 2 0 2 4 18 4.2 4.5 -0.3 2 0 2 5 35 8 5.0 3 1 0 1 6 56 4.1 6.0 -1.9 1 0 1 7 55 8.0 5.0 3 2 0 2 8 37 5.9 4.5 1.4 1 0 1 9 3 7.0 5.5 2.5 1 0 1 10 5 6.0 4.0 2.0 1 0 1 11 61 6.0 3.5 2.5 1 0 1 12 1 4.5 3.5 1 1 0 1 13 25 6.5 4.5 1 1 0 1 14 29 6.8 4.5 2.3 1 0 1 15 37 5.0 4.5 0.5 1 0 1

BT= Before Treatment AT= After Treatment

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Master Chart 3

ASSESSMENT OF SUBJECTIVE PARAMETERS OF GROUP B

BT= Before Treatment AT= After Treatment Dif = Difference

Excessive Vaginal discharge

Persistent Vulval moistness

Extensive Pruritis

General weakness

Pain in Lumba region

Draging sensation in abdomin

Sl NoGrB

OPD No

BT AT Dif BT AT Dif BT AT Dif BT AT Dif BT AT Dif BT AT Dif1 63 2 0 2 2 0 2 2 0 2 0 0 0 0 0 0 0 0 0 2 61 2 0 2 2 0 2 3 0 3 2 0 2 0 0 0 0 0 0 3 60 1 0 1 2 0 2 3 0 3 0 0 0 0 0 0 0 0 0 4 67 1 0 1 1 0 1 0 0 0 2 0 2 0 0 0 0 0 0 5 94 3 0 3 1 0 1 1 0 1 0 0 0 0 0 0 0 0 0 6 83 2 0 2 1 0 1 2 0 2 1 0 1 0 0 0 0 0 0 7 69 2 0 2 1 0 1 2 1 1 0 0 0 0 0 0 0 0 0 8 85 2 0 2 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 9 74 1 0 1 0 0 0 0 0 0 2 0 2 1 0 2 0 0 0 10 87 2 0 2 0 0 0 1 0 1 2 0 2 2 0 0 0 0 0 11 75 2 0 2 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 12 76 2 0 2 0 0 0 1 0 1 0 0 0 0 1 1 1 0 1 13 77 2 0 2 0 0 0 1 0 1 0 0 0 2 0 0 0 0 0 14 78 1 0 1 0 0 0 0 0 0 2 0 2 2 0 2 1 0 1 15 79 2 0 2 1 0 1 2 1 1 0 0 0 0 0 0 0 0 0

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Master Chart 4

ASSESSMENT OF OBJECTIVE PARAMETERS OF GROUP B

Vagnial pH Vaginal Smear Sl.NoGr.B

OPD BT AT Dif BT AT Dif

1 63 5.8 4.2 1.6 1 0 1 2 61 6.0 3.5 2.5 2 0 2 3 60 7.0 4.5 2.5 1 0 1 4 67 5.8 3.5 2.3 2 0 2 5 94 6.0 3.5 2.5 1 0 1 6 83 6.5 4.5 2 2 0 2 7 69 7.0 4.5 2.5 1 0 1 8 85 6.0 4.2 1.8 2 0 2 9 74 4.2 4.5 -0.3 2 0 2 10 87 8 5.0 3 2 0 2 11 75 4.1 6.0 -1.9 1 0 1 12 76 8.0 5.0 3 2 0 2 13 77 5.9 4.5 1.4 1 0 1 14 78 7.0 5.5 2.5 1 0 1 15 79 6.0 4.0 2.0 1 0 1

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DISCUSSION

In This study the Evaluation of efficacy of plaksha twak churna in the

management of Shweta pradara, A Clinical study is done.

1) Shweta pradara is a very common and irritating condition in women, Around 30-

40% of the patients attending the Gynecological OPD in routine practice are

suffering from this disease.

2) The disease Shweta pradara based on theoretical and clinical symptoms can be

compared to Leucorrhoea.

3) The pathogens like Trichomonas vaginalis (4.5%) N gonorrhoeae (2.7%) and C

albicans (6.7%) were exclusively present in leucorrhoea.

4) Charaka described plaksha under the Kashayakanda while shushruta and

Vagbhata have mentioned it under Nyagrodhadi gana. It is considered as one of

the ksirivraksas or pancha valkalas by Bhavamisra. Much beneficial in Yonigata

vikaras.

5) Tha plaksha twak, (Ficus lacor) is used in this study. It is having properties like

Kashaya rasa it acts as rakta stambhaka & grahi. Due to its sheeta veerya and

laghu, ruksha qualities acts as Vranashodhana and vrana ropana. So these actions

are extremely beneficial in curing Shweta pradara. A warm vaginal douche of

plaksha twak churna kashaya is beneficial to general cleansing and elimination of

purulent discharge. Plaksha twak churna have many means to kill fungus,

bacteria, parasite as it acts as krimighna. In shwetapradara there is mere

predominance of kapha dosha, here the rasadi dhatu get decreased due to vata

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dosa. So in order to cure the vitiated kapha, plaksha twak churna is implemented

in this clinical study as it is kaphagna.

Importance of madhu as anupana in this study:

Madhu as it is katu, tikta kashaya rasa pradhana and ushna virya ruksha guna

yukta so it does dosha bhedan and effect in kapha vitiated diseases and as shweta pradara

is one among kaphaja vyapat.

Dose – group A 4 gms of plaksha twak churna with madhu per day in divided dose was

advised. And madhu enhances the properties of plaksha twak churna.

Aushadhi sevana kala – Medicine should be taken before meals reason behind this is

the main cause for yoni vyapat especially apana vata vitiation plays an important role.

For the purpose of vata anulomana, agni deepana.

Group B- the patients of group B were treated with Plaksha twak churna kashaya every

day fresh kashaya was prepared as the saveeryata kalavadhi of kashaya is 24 hours.

Dose – 50gms powder to prepare kashaya. Sterilized vaginal douche was placed

approximately till it reaches to cervix carefully. Sterilization was maintained to avoid

infection. Douche was removed to avoid infection. After 5 to 10 minutes.

Pharmacognostic study

In order to standardize the identification of Plaksha, a detail pharmacognostic

study including microscopic and macroscopic characters of the twak and its powder was

carried out. The features observed are furnished in the related chapter and compared with

pharmacognostic study of Ficus lacor done at Ayurvedic Pharmacopia of India. Both the

study seemed similar thus proving the genuinity of the drug collected.

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Analytical study

The result of analytical study of Plaksha twak done at Bio Genics research &

training institute in Biotechonology, Unkal, Hubli was matched with analytical study

reports of previous research works and was found to be similar. The result of physical

constant in Plaksha twak churna also matched with the reports of previous works and

have been found to be similar.

Plan of Study:

In this study total 30 patients were taken for clinical trial in which two groups A

& B of each 15 patients were selected for study at D.G.M.A.M.C.P.G.R&S Gadag.

The disease shwetapradara is diagnosed on the basis of subjective parameters i.e

signs and symptoms as mentioned in our classics and objective parameters.

In present study overall 30 patients fall under age group of 20-50 years. Out of

which 73.33% (22 patients) between age between 30-40 years. The incidence is found

more in between age of 20-30 years due to in present study the minimal age criteria for

the study is 20 because the age for marriage for women is 18 and above and trans vaginal

douche can be advised only to married women.

Maximum is 50 years because the menopause stage starts at the age of 40 there is

hormonal changes. So the age is limited.

The incidence of Socio-economic status majorly concerned to shwetapradara. It

was found that 46.66% in poor state. 33.33% middle class families and where less as

20.10% in higher middle class families. Due to poor state malnutrition, unhygienic

condition. Mostly poor woman’s more prone to shweta pradara.

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The incidence of disease was found up to 50% Kapha vataja, and 30% vata kapha,

20% kapha pitta in the present study it can be preassumed that kapha vataja prakrati

person get affected more by shweta pradara compared to other prakrati person. Because

shweta pradara is due to vitiation of kapha and vata dosha.

The incidence of yoni aprakshalana 76.66% indicates the negligence towards

health and hygine more prone to words infection. It is a major cause for shweta pradara.

In the present study out of 30 patients 23 (76.67%) patients were having the

excessive menstruation, and 7 (23.33%) patients were having complaint of irregular

menstrual cycle. Which is also cause for artavadusti is also major cause for shweta

pradara.

It was evident from the present study the 40% of the patients were labour. More

prone towards the disease due to the unhygienic living standards.

In the present study out of 30 patients 10 (33.33%) were having the history of

abortions. It is also one of the cause for shweta pradara. It may be due to vitiated vata

dosha.

Subjective parameters like excessive vaginal discharge shows highly significant

in both groups due to control of kapha. Extensive purities was another major parameter

found more in both groups. It was also markedly reduced and shows highly significant. It

may be due to the kandugnata action of drug. And sthambaka action of the drug.

Associated with madhu act as kapha vata shamaka grahi guna present in madhu acts as

amapachaka & sthambak. The lekhana guna helps to destroy the sanga and act as

srotomukh vishodhaka with its yoga vahi guna.

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Duration

For all the two groups duration was fixed upto 21 days. As it is comparative study

based on duration of vaginal douche, the duration of plaksha twak churna along with

madhu was fixed up to 21 days.

Data collection

Data from each group was collected before treatment after treatment and at the

end of the follow up. The data was collected properly and documented and statistically

analyzed. To see the effect of plaksha twak churna along with madhu & plaksha twak

kashaya as trans vaginal douche.

Statistical analysis

The data collected was statistically analyzed under the guidance of statician. The

data was computed for mean, standard deviation standard error, t value and p value. P

value was obtained by using students paired ‘t’ test. Significance of the results was based

on the p value. The statistical values from each group were compared and analyzed to see

the significance of the treatment.

Other objective parameters are found to be improved after the treatment in both

groups.

1) Chemical compound tannic acid present in the drug helps to normalize pH value

of vagina.

2) The normal vaginal pH is acidic that is 4.5 alteration in this vaginal pH value

leads to growth of organism which cause white vaginal discharge.

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Vaginal secretion consist of tissue fluid, epithelial debris. Electrolytes, proteins

and lactic acid, so excessive vaginal discharge causes imbalance of all essential

component, individual feel general weakness, body ache, back ache.

3) The Objective parameter vaginal smear shows highly significant 100% result by

the study. Here the probable mode of action of the drug due to as it is krimighnna

have many means to kill fungus, bacteria, parasite. As it is of antiseptic destroy

invading organisms like (Trichomonas vaginalis) (Candida albicans) shofagna –

action helpful in the inflammatory conditions of the patients and improvement

shown in the results with highly significant. Astringent nature of kashaya rasa are

locally protein precipitants. They reduce the permeability of cell membranes.

These are used therapeutically reduce inflammation of mucous membranes

promote healing.

4) The laboratory investigations show Hb% more significantly improved observed

findings that 0.1gm – 0.2gm of haemoglobin increases in every individual. The

selected plaksha has the rasayanik sangatan like carbohydrates, amino acids,

polysaccharides, proteins, calcium oxalate, and tannic acid. Madhu has

rasayanaika sangathan phosphorus, barbohydrate and iron vitc, tannic acid, both

together helpful to fulfil deficiency in above criteria.

Probable mode of action of Trailed drugs

Probable mode of action of Plaksha twak churna with madhu.

1) Charaka described Plaksha under mootra sangrahaniya which indicates its action

on mootravaha srotovikara i.e a drug of choice for some uro-genital diseases and

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also been used in sukra vaha sroto vikaras. Shweta pradara is seen in anemia and

in artavaha srotovikaras

The artavaha srotos of female is homologus in function with shukra vaha

srotas of males. Hence the drugs acting on Sukravaha srotas may act as similarly on

artavaha srotas. Again Plaksha twak comes under kashaya sknda, nyagrodhadi gana

and one among panchavalklas so it is considered as much beneficial in yonigata

vikaras.

2) Plaksha twak churna, kapha vata shamaka, agini deepaka, ama pachaka,

sthambaka, sroto mukha vishodhaka, vrana shodhana, vrana roopana, grahi,

shotahara, yoni doshahara.

3) Kashaya rasa act as lekhana and stambhaka due to rooksha guna, sheeta veerya

and laghu paka aggravates vata subsides kapha have absorbing effects

(kledhahara). Hence it checks the ati pravruti of shweta srava as it is sheeta veerya

it helps to check the flow of discharge. Improves the tissues increases the bala

acts as dourbalya nashaka.

4) Katu vipaka act as Jatharagni deepaka, ama pachaka, plaksha twak churna with

madhu as it has been sroto mukha vishodhana due to chedana and lekhana

properties. It destroys the sangha of rasavaha srotas caused due to ama kapha.

Kashaya rasa makes dhatus free from impurities.

5) Presence of rich in alkaloids shows Haemostatic action. Which is beneficial in

shwetapradara including disfunction of uterine bleeding.

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Probable mode of action of Plaksha twak kashaya as vaginal douche.

Grahi, kaphagna, vrana ropaka, vedana sthapaka, shothahara, yoni dosha nasha,

kashaya rasa act as kapha shamaka. The grahi guna present in Plaksha twak act as sthanik

dhatwagni janya ama pachaka, and sthambaka which helps to check the yoni gata srava.

Due to vedana sthapaka property helps to cure yonigata vedana, sothahara property

relives yonigata sotha.

By all these properties it acts as yonidosha nashaka which indicates that in all

types of yoni vyapat, it can be advisable.

NIDANA

Avoiding the nidana itself is a first line of treatment so it seems very essential to

understand the nidana of the every vyadhi

1) Mithya achara

Mithya achara includes both mithya ahara and vihara

a) Mithya ahara

Ahara which are kapha vardak, are main etiological factors for shweta pradara

due to excess intake of guru, snigda, picchila, drava, sheeta, madhura, rasayukta ahara

which are predominant in prathivi and apa maha bhuta, due to their chirapaki guna. They

produce agni mandya, then produces ama further does the rasa vaha sroto dushti nad artw

vaha srotas dushti, leads to the shweta pradar.

Abhishendi ahara dravya produces the kleda in the dosha, dhatu, mala and srotas.

Due to this picchila and guru guna present in the abhishendi dravya act as sroto

avarodhak and simultaneously it increases the kapha doshas leads to shweta pradara.

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In the present study most of the patients were having the history of intake of

kapha vardaka and abhishendi ahara such as curds, milk, jaggery and chapatti etc.

b) Mithyavihara

It includes the vyavaya karma with the purush who has the pravradha linga,

ativayaya karma, who follows unhygienic procedure, that is yoni adhavana, repeated

grabha pata and D&C and adhik vyayam. These all are included in mithya viahara which

produces the sthanika uttejana in the yoni as well as external genitalia which ultimately

result in the vitiation of sthanika dosha particularly vata and kapha. And also the vega

dharana like mala, mutra leads to vitiation of apana vata, sthana samshraya of apana vata

takes place in artaw vaha srotas cause shweta pradar.

In present study most of the patients were having the history of ativyayama

karma, yoni adhavana, (unhygienic procedure) repeated abortions with Dilation and

Curatage, vega dharana like malavega etc.

c) Apadravya prayoga: Copper T,

d) Manasika

Manasika dosha and shareerika doshas are interlinked, due to the mental anxiety

and depression as well as desiring for sex etc will cause the vitiation of raja and tama

dosha which ultimately vitiate the vata and kapha dosha thus produces the shweta

pradara.

In present study most of the patients were having the history of manasika is

anxiety depression etc.

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2) Artava dusti

Here artava vruddhi, artava kshaya are considered and all hormonal imbalance

can be included.

In the present study patients were having the history of artava kshaya and vruddhi.

3) Beeja dosha

Abnormalities of shukra and stree beeja various chromosomal or genetic

abnormalities can be considered i.e kulaja vrattanta.

4) Daiva

Unknown or idiopathic factor come under this category, cause may be super

natural power or poorva janma kruta karma.

ROOPA

The complete vyakta lakshanas are considered as roopa.

In this vyadhi pratyatma lakshana is yoni gata shweta srava.

And in the present study all most all the patients were having the complaint of

yonigata, kandu, vedana, kati, shoola, sarvang marda, daurbalyata, so these can be

considered as anubandi vedana.

1) Yoni gata Shweta srava

Excessive yonitah shweta srava is the main complaint, swaroopa of srava differs

from jaliya, dadhi vata.

2) Yoni gata kandu

It is the main clinical symptom of shweta pradar. Due to excessive srava which is

kaphaia causes the kandu and also it may be due to unhygienic procedure.

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3) Yonigata vedana

This may be due to the effects of vata vitiation. Especially apana vata dushti. As

the functions of artaw vaha srotas are under the control of apanavata hence aggravated

apana vata may cause the yoni gata vedana.

4) Kati shoola

Kati shoola may be due to the vitiation of apana vata, particularly pain is at the

sacrum vitiated vata cause pain as vata and asthi dhatu are related with ashraya ashrayi

bhava.

5) Sarvanga marda

Sarvang marda is also due to the vitiation of the vata dosha.

6) Daurbalyata

Prakrat shleshma is considered as bala, in shweta pradara there is excessive

discharge of sama kapha which leads to bala kshaya according to modern the vaginal

discharge consist of electrolyte, proteins, epithelial cells which are essential elements,

when there is excessive discharge that leads to weakness.

7) Adho udara shoola

It indicates the shoth condition of the yoni because of the sthana samshraya of

dosha and dushya at trayavart yoni.

8) Vibanda

Aggravated vata dosha particularly apanavata dosh causes the vibanda

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UPASHAYA

Acharya charaka in nidana explains all the chikitsa as upashaya and it also called

as pathya in different contexts. Hence all the therapies that relieve shweta pradar can be

taken of upashaya.

ANUPASHAYA

All nidana explained for shweta pradar and apathya can be considered as

anupashaya.

CHIKITSA OF SHWETA PRADARA

1) Shamana – abhyantar

2) Sthanika

1) Shamana – By going through all the chikitsa dravya explained shamanaushadhi

we come to know that all dravyas contain kapha shamak, agni Deepak, grahi,

vrana prashamana, shothahar, krimigna, kandugna, amapachak, sroto mukha,

vishodaka, and vatanulomak properties, these all help in the samprapti vighatana.

2) Sthanika – Yoni dhawana, pichu dharana, kalka lepana, varti prayoga and

dhoopana etc sthanika chikitsa are advised.

Dravyas used for sthanika chikitsa are similar to with abhyantar chikitsa

As in shweta pradara vyadhi, kapha dosha is sthanantara gata dosha. Kapha

accumulates in vata Pradesh especially apana vata Pradesh, hence one should give

chikitsa for kapha dosha without harming the vata dosha.

In this clinical study both shamana as plaksha twak churna with madhu

and plaksha twak kashaya as transvaginal dush as a sthanika chikitsa was done.

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Pathya Apathya

Pathya:

All the pathya ahara explained in classics having Ushna, ruksha, laghu guna act as

agni Deepak, amapachaka, kapha vata shyamaka and vatanulomak.

In the present study Jawar roti, kulath, mudga, patola, lashuna, vrantaka, and

ushnodaka were advised these all help to stimulate agni and mitigate kapha vata dosha. In

vihara to avoid unhygienic procedure, remove copper T and abstinence from intercourse

up to treatment period.

Apathya:

All Nidanas of Shweta pradara are considered as apathya.

In the present study curd, Jaggery abhishyandi ahara, oral contraceptive pill were

advised.

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CONCLUSION

After a prompt theory and clinical study on evaluation of efficacy of Plaksha twak

churna in the management of Shwetapradara, A clinical study, following conclusion are

drawn.

1) Shweta pradara correlates with modern disease Leucorrhoea on the basis of

symptomatology.

2) Apart from the one of the symptom in yoni vyapat sweta pradara is considered as

a swatantra vyadhi as differentiated in the aspect of srava, varna and chikitsa.

3) Along with kapha vardaka aharajanya nidana, viharajanya nidanas like ativyavaya

repeated garbhapata and Dilate and Curatage, use of apadravya and yoni

adhawana etc are also major cause for shweta pradara.

4) Plaksha is identified as Ficus lacor and anupana madhu as honey. Have the effect

shwetapradara.

5) With the dose of 4gms/BD with madhu for 21 days to the first group and the 50ml

of the plaksha twak churna kashaya administered before the meals for 21 days, do

not cause any untoward effect in patients between the age group 20-50 yrs.

6) The percentage and result evaluated on the basis of subjective and objective

parameters for group A and B cumulatively and graphically.

7) Plaksha contains nutrients like protein carbohydrates, calcium oxalate, amino

acids and tannin which have specific action over shwetapradara and also anaemia.

8) Clinical study revealed that both groups are effective in the management of

swetapradara.

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9) Plaksha and madhu are economical effective drug in shwetapradara without any

side effects.

10) In the patients who complains of yonigata shweta srava with pain in lumbar

region, General weakness, yonigata kandu and less Hb% alone plaksha twak

churna with madhu is effective.

11) In the patients who complains of yonigata srava along with yonigata kandu, bahya

shotha alone plaksha twak kashaya as vaginal douch is effective.

12) In the result there is zero (0%) patients who does not respond, 25 (83.33%)

patients shown good response and moderately response in the schedule are 5

(16.66%)

Limitations of the Study

The sample size is very small to generalize the result.

Future Prospective

To achieve the aims and objectives of study the maximum work is to be done to

present this clinical study. Even though there is wider scope to study further.

In larger samples the study reveals the good sort of results.

Role of plaksha twak churna on female hormones like oestrogen, progesterone

etc.

Role of plaksha twak kashaya in maintanance of vagnial pH.

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SUMMARY

This study is performed to understand efficacy of plaksha twak churna in the

management of shweta pradara.

The aims and objectives of present study have been discussed.

The drugs plaksha and anupana madhu are reviewed, discussed elaborately and

explained from Ayurvedic and modern pharmacognosy and journals.

The definition history, etiology, samprapti, laxana and treatment of shwetapradara

according to all classics were reviewed in study.

The study was conducted on 30 patients which made into 2 equal groups each 15

patients in group A Plaksha twak churna 4gms BD Madhu. In group B plaksha

twak churna kashaya as Vaginal douche was administered in the dosage of 50ml

early in the morning, Before meals for 21 days duration to each group.

In this study incidence of socio economic status, sex, religion, constitution dietics

were highlighted in the observation.

Good response to symptoms of shweta pradara found in both groups.

Overall the drug is having more effective in vaginal smear and Vaginal Ph in

group B and it is highly significant in all other parameter in group A.

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122

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104. Ibid,30th Chapter,Shloka-117,pp-767.

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106. Ashtanga Samgraha of Vaghbhata,By Prof k.R.Srikantha Murthy,Vol 3 1st

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108. Ibid,5th Chapter,Shloka-44,pp-47.

109. Ibid,1st Chapter,Shloka-27,pp-7.

110. Charaka Samhita of Agnivesha of Chakrapani Datta,By Kashinath

Shastri(Part 2), 8th Edition 2004. Choukhamba Sanskrit Sansthan,Varnasi.

Chikitsa Sthana,30th, Chapter,Shloka-12.

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111. Yoga Ratnakar By Dr Indradev Tripathi,Krishnadas Academy,Varnasi,1st

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112. Charaka Samhita of Agnivesha of Chakrapani Datta,By Kashinath

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Chikitsa Sthana,30th , Chapter,Shloka-115,pp-767.

113. Sushruta Samhita,By kaviraj Ambika dutta shastri (Part 1) . Choukhamba

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114. Charaka Samhita of Agnivesha of Chakrapani Datta,By Kashinath

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115. Charaka Samhita of Agnivesha of Chakrapani Datta,By Kashinath

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Chikitsa Sthana,30th, Chapter,Shloka-42.

116. Ibid,Shloka-116,pp-767.

117. Ibid.

118. Ibid.

119. Sharangadhara Samhita,By Dr Brahmanand Tripati,1st Edition

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Chapter,Shloka-113- 116,pp-149.

120. Charaka Samhita of Agnivesha of Chakrapani Datta,By Kashinath

Shastri(Part 2), 8th Edition 2004. Choukhamba Sanskrit Sansthan,Varnasi.

Chikitsa Sthana,30th, Chapter,Shloka-173,PP-774.

121. Ibid,Shloka-72,pp-761.

122. Sharangadhara Samhita,By Dr Brahmanand Tripati,1st Edition

1990,Madhayama Kanda,Choukhamba Surabharati Prakashana,Varnasi.2nd

Chapter,Shloka-112,pp-149.

123. Ibid.

124. Ibid,Shloka-116,pp-150.

125. Bhavaprakash of Sri Bhava Mishra,By Sri Brahmashankar Mishra.

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Page 150: Shweta pradara#dg16 gdg

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“Management of Shweta Pradara with Plaksha Twak” 1

DEPARTMENT OF POST GRADUATE STUDIES IN DRAVYAGUNA D.G.M.A.M.C.GADAG

SPECIAL CASE SHEET FOR “MANAGEMENT OF SHWETA PRADARA WITH PLAKSHA TWAK”

Guide: Dr. Kuber Sankh, M.D (Ayu), Schoar: Dr. Kalavati. D. Petlur

Asst. Prof., P.G. Dept of Dravyaguna.

1) Name of the Patient

2)Father’s / Husband’s name

Sl.No

3) Sex Male Female OPD No

4) Age Years IPD No

5) Religion Hindu Muslim Christian Other

6) Occupation Sedentary Active Labour

7) Marital status Married Unmarried Widow

8) Economical status Poor Middle Higher middle Higher class

9) Address

Contact No: Pin

10) Selection Included Excluded

11) Schedule Initiation

Date

Completion

Date

Well responded Moderately responded 12) Result

Responded Not responded Discontinued

13) INFORMED CONSENT I Daughter/Wife of am

exercising my free will, to participate in above study as a subject. I have been informed to my satisfaction,

by the attending physician the purpose of the clinical evaluation and nature of the drug treatment. I am also

aware of my right to opt out of the treatment schedule, at any time during the course of the treatment.

EzÀÄ £Á£ÀÄ ²æ/²æªÀÄw ___________________________________________________ £À£Àß

¸ÀéEZÉѬÄAzÀ PÉÆqÀĪÀ aQvÁì ¸ÀªÀÄäw. ¥Àæ¸ÀÄÛvÀ £ÀqÉ¢gÀĪÀ aQvÁì ¥ÀzÀÞwAiÀÄ §UÉÎ £À£ÀUÉ aQvÀìPÀjAzÀ ¸ÀA¥ÀÇtð

ªÀiÁ»w zÉÆgÉwzÀÄÝ ªÀÄvÀÄÛ AiÀiÁªÁUÁzÀgÀÄ aQvÉì¬ÄAzÀ »AwgÀÄUÀ®Ä ¸ÁévÀAvÀæ÷å«zÉ JAzÀÄ w½¢gÀÄvÉÛ£É.

gÉÆVAiÀÄ gÀÄdÄ/Patient's Signature

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“Management of Shweta Pradara with Plaksha Twak” 2

14) Chief Complaints (Pradhana vedana) : Complaints - Lakshana Duration

1 Excessive vaginal discharge (White, Red tinged, Creamy)

2 Persistent vulval moistness 3 Extensive pruritis 4 General weakness 5 Pain in lumbar region 6 Dragging sensation in abdomen 7 Anya Laxanas

15) Associated Complaints (Anubandha vedana) :

Associated Complaints - Lakshana Duration 1 Katishoola (Back Pain) 2 Jwara (Fever) 3 Anga marda (Malaise) 4 Udara shoola (Abdominal pain) 5 Dourbalya (Weakness) 6 Yoni daha (Burning sensation)

16) Occupational History (if any) : 17) Personal History (Vaiktiyaka vrutanta) : Food habits Vegetarian Mixed diet Taste preferred Sweet Sour Salty Pungent Bitter Astringent Agni Sama Vishma Manda Teekshna Kosta Mrudu Mandhyama Krura Nidra Day Night Sound Distrubed Addictions Tobacco Alcohol Drugs Bowel habits Normal Loose Constipated Menstrual History Regular Irregular Amenorrhea Menopause Family history – Specify if any has the same disease

Other system medications Treatment history (if any) Obstetric history (if any)

Gynaecological History (if any)

History of past illness (if any)

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“Management of Shweta Pradara with Plaksha Twak” 3

18) Examination of Patients

a) Vitals:

1. Temp F 2. Pulse rate /min 3. Resp. Rate /min 4. B.P Mm of hg 5. Height M 6. Weight Kgs

b) Systemic:

System Findings G.I.T Respiratory system Cardio vascular system Central nervous system Genito urinary system

c) Ayurvedic methods of Examination:

Prakruti V P K VP VK PK VPK

Sara Pravara Avara Madhyama Samhanana Susamhita Asamhita Madhyma samhita Pramana Height in Cms Weight in Kgs Satmya Ekarasa Sarvarasa Ruksha Sneha Satwa Pravara Avara Madhyama Ahara Shakti Abhyavaharana Jarana Vyayam Shakti Pravara Avara Madhyama Vaya Balya Yauvana Vardhakya

Nadi Dosha Pravrutti

Gati Varna

Purnata Gandha

Spandana Kathinya

Mutra

Jihwa Ardra Sushka Sama Nirama Lepa Nirlepa

Mala

Shabda Sparsha Sheeta Ushna

A

stas

than

a

Drik Akruti

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“Management of Shweta Pradara with Plaksha Twak” 4

d. Local Examination (Yoni Pareeksha) :

( SzÉïlÉiÉÈ LuÉqÉç xmÉzÉïiÉÈ) 1. External genital organ - vulval (Bahya yoni)

a. Prakrata e. Vaivarnya

b. Vaikruta f. Shotha

c. Vruna g. Utseda

d. Pidaka h. Anya

2. Yoni Mukha

a. Samvruta d. Srava

b. Ragata e. Anya

c. Vivruta

3. Yoni Patha

a. Ragatha

b. Shotha

c. Anya

4. Grabhashaya Greeva (By speculum examination)

a. Tanu e. Vruna

b. Bahula f. Arsha

c. Mrudu g. Mamsankurani

d. Kathina h. Anya

5. Srava a. Pramana - Bahula, Natibahula, Alpa b. Gandha - Visra, Pooti, Knupa, Anya c. Varna - Sweta, Pandu, Raktabha Rakta shyava varna Anya 6. Guna - Picchita, Drava, Ghana, Tanu, Phenila, Pooya, Grathita

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“Management of Shweta Pradara with Plaksha Twak” 5

19) Nidana:

Ahara Vihara Anya Nidanarthakara

Vyadhi

Abhishyandi Ahara Diwaswapna Vegavarodha Ajeerna

Lavana amla katu Avyayama Manasika karana Agnimandya

Viruddha ahara Yoni

Aprakshana

Upapluta

Adhyashana Atimiathuna Acharana

Aticharana

Atyananda

20) Samprapti Ghatakas

a. Dosha e. Dooshya

b. Agni f. Ama

c. Srotas

d. Dusti Prakara

21) Investigations (Prayoga shala pareeksha krama)

1) Erythrocyte Sedimentation Rate

2) Hb%

3) Differential count - Lymphocytes

Neutrophils

Eosinophils

Basophils

Monocytes

4) Total count

5) Vaginal smear test

6) Vaginal Ph

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“Management of Shweta Pradara with Plaksha Twak” 6

22) Treatment Schedule (Plaksha twak kashaya – 50 ml as vaginal douch for 21 days)

Day Date Investigator’s Note

Day 1

Day 7

Day 14

Follow up

Day 21

23) Assessment

A) Disease Assessment

1) Subjective Parameters Before After Difference

BA

1 Excessive vaginal discharge

(White, Red tinged, Creamy)

2 Persistent vulval moistness

3 Extensive pruritis

4 General weakness

5 Pain in lumbar region

6 Dragging sensation in abdomen

7 Anya Laxanas

1 Vaginal PH 2 Vaginal Smear

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“Management of Shweta Pradara with Plaksha Twak” 7

Grades of assessment

1) Excessive vaginal discharge

Gr-O No Discharge

Gr-1 Persistent moistness of Vulva

Gr-2 Need to change the undergarments frequently

Gr-3 Need to use an extra cloth or pad

2) Persistent vulval moistness

Gr-O No Moistness

Gr-1 Mild moistness

Gr-2 Moderate moistness

Gr-3 Severe moistness

3) Extensive pruritis

Gr-O No Pruritis

Gr-1 Occasionally pruritis

Gr-2 Pruritis through out the day

Gr-3 Increases particular time of day/night

4) General weakness

Gr-O No Weakness

Gr-1 Patient is able to involve in routine

activity

Gr-2 Patient is slow to involve in routine

activity

Gr-3 Patient feels exhausted to involve in

routine activity

5) Pain in lumbar region

Gr-O No Pain

Gr-1 Mild

Gr-2 Moderate

Gr-3 Severe

6) Dragging sensation in abdomen

Gr-O Normal

Gr-1 Mild

Gr-2 Moderate

Gr-3 Severe

7) Vaginal Smear

Gr-O Negative (No abnormal findings)

Gr-1 Inflammatory smear

Gr-2 Inflammatory smear with organisim

Investigators Note

Signature of Guide:

(Dr. Kuber Sankh,) M.D (Ayu),

Signature of Scholar:

(Dr. Kalavati D. Petlur)