Clinical StudyA Clinical Evaluation of Rasnadi Guggulu &Katibasti In

Katishool (w.s.r. to Lumbo-Sacral Disorders)

*Dr. Radhey Shyam Sharma, **Dr. Bharti Bandil

Abstract

Katishool or pain around Lumbo-sacral region is the most Challenging problem arising due toadaptation of modern life style and a majority of people are suffering from this Palliative disease with noproper treatment found in modern medicine except for analgesics and Surgery. Ayurvedic System of medicineis a time tested therapy with a good hold on this particular disease. Here is a detail study of a clinical Trialdone on 30 patients of Katishool treated with Ayurvedic oral medicine (Rasnadi Guggulu) as well asPanchakarma therapy (snehana, swedana and Katibasti with Dashmool oil), conducted at PG department ofPanchakarma NIA Jaipur. In this clinical trial 10 Pts. of group A (Rasnadi Guggulu) have got 47.89% relief,10 Pts. of group B (Katibasti) have got 47.3 % relief and 10 Pts. of group C (Rasnadi Guggulu + katibasti)have got 84.05% relief, showing the importance of combined therapy i.e. oral + Panchakarma, on Katishool.

Key words:Katishool, Lumbo-sacral disorder, Low Back ache, Rasna, Guggulu, Dashmool, Panchakarma, Snehana,

Swedana, Katibasti, Vata Vyadhi, Scatica, Lumber spondylosis etc.

CflfC:~(1 "lJTCfi"R: ~ *" 3Wl crm 1Wn ~ "CfTffT~ :m~ ~ ~ *" CflRUT ~ m fl ~~ ~ ~ I ~§dl~d if ffiTT ~ ~ "WT "it ~ -qrit ~ W ~ I :m~ f-q fCflffl I ~ if ~ 0!lTf~ *"fulit ~{'iI!?ICfl c:crr3TI ~ ~ f-q fCflffl I *" ~ ~ ~ ~ ~ ~ ~ I 3119)':tf~Cfl f-q FCflffl I ~ if ~0!lTf~ CflT >i"~ ~ "B~ ~ I ~ Cfi"R: ~ *" ~o :mgU 'R fc8?t ~ ~ f-qfCflffll,I1Cfl 31'U:f<R CflT ffi~ ~ WI ~ ~ 3119)'~f~Cfl ~ f-q fCflffl I ~ ~ f-q fCflffl I -m'il CflT >r<WT ~ l"fm ~ I ~ f-qFCflffll,I1Cfl

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*Associate Professor & Head, P.G. Dept. of Panchakarma, N.l.A. Jaipur (Raj.) **Ph.D. Scholar, P.G. Dept. ofPanchakarma, N.l.A. Jaipur (Raj.)

50

Clinical StudyA Clinical Evaluation of Rasnadi Guggulu &Katibasti In

Katishool (w.s.r. to Lumbo-Sacral Disorders)

Dr. Radhey Shyam Sharma, Dr. Bharti Bandil

Introduction

The lower back is a well designedconstruction of bone, muscle and ligament. Ourbackbone (vertebral column) is actually a stack ofmore than 31 small bones called vertebrae.Together, they create a bony canal that surroundsand protects our spinal cord. Small nerves enterand exit the spinal canal through spaces in ourvertebrae called the foramen. The vertebral rootsi.e. the lumbo-sacral roots emerges below theirrespective vertebrae, hence a disc lesion maydamage a root anywhere b/w its origin from the cordand its exit foramen and cause various types oflumbo-sacral disorders.

The Lumbo-Sacral Disorders means thedisorders, generated due to the lesion in the lumberand sacral spine i.e.L1-Ss (mostly b/w L4-LS or LS-Sr) Vertebrae which effects the normal activity orworking of a person and creates a number ofproblems such as low backache, referred pain tolower limb region, sciatica, foot drop, numbness,tingling sensation, pain on walking or even at restetc. These disorders may even cause paraparesis &paraplegia.

The causes are mainly cold air, accidentalinjuries,pressure due to pelvic tumor, Inter vertebraldisc prolapse, Lumber spondylosis, or any othercause which may cause spinal nerve compression,may responsible for Lumbo - sacral disorders.

In Ayurveda the lumbo-sacral disorders canbe considered under katishool which is a vatikdisorder and mainly caused by Vitiated Vata, whichis due to vata prakopak Aahar-vihar and Aaghatajvata prakopa. The main places of vat a are Basti(urinary bladder ), purishadhanam (large intestine),Kati (pelvic region or lower back), sakthini(thigh),pada(legs) & ashthi(bones). Pakvashaya is the mainplace of vata (ch. Suo 20/7). Sparshendriya(Skin)

being also given as a Sthana of Vata. (As. Hri. Su12/1) is responsible for all the sensation of touch.Any structural or functional deformity in thesestructures may lead to all kinds of pain, numbness,tingling sensations, paresthesias, convulsions andtwitching sensation in the lumbo-sacral region i.e.Kati Pradesh.

Katishool may be found in Gradhrasi,Katigriha, trikashool, Amavata, sandhivata,Asthikshaya, disorders of Uterus, Bladder andRectum etc.

Treatment - In modern medicine the treatmentinvolves -

1. Heat therapy - useful for back spasms or otherconditions.

2. Medications - muscle relaxants, narcotics, non-steroidal anti-inflammatory drugs etc.

3. Exercises - effective for chronic back pain, butnot for acute pain.

4. Massage therapy- Acupressure or pressurepoint massage.

5. Acupuncture has a small benefit for chronicback pain.

6. Education and attitude adjustment to focuson psychological or emotional causes.

7. Postural factors such as improper liftingtechnique, poor posture or poor support from theirbed or office chair etc.

8. Surgery- In significant neurological deficit or infailure of non-surgical therapies.

9. Injections, such as epidural steroid injections,facet joint injections, etc.

10. Cold compression therapy in chronic back

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Journal of Ayurveda

pain, after strenuous exercise such as golf, gardeningor lifting.

11. Bed rest when necessary is usually limited to oneor two days.

Ayurvedic chikitsa - The basic principalinvolved in the treatment are-

1. Vata shaman (Ch. Chi.28/183).

2. Repeated use of Ushna and Anushna chikista isindicated.( Ch.Chi.28/219).

3. In Panchakarma Snehan, Swedan, Snigdha MriduVirechan, Basti, Vatanuloman, use of Vrishya,Vatshamak Aushadh, Aahara and Vihara isindicated. (Yog Rat.)

4. Repeated use of Snehana and Swedana.( Ch.Chi.28/82).

5. Indication of Vaman, Virechana, Basti, Katibasti,Raktamokshana, Dahakarma, Anuvasana basti,Snigdha nasya & Snigdha MriduVirechana.t Ch.Chi.a.S/vz.Sg).

6. In weak patient in place of Virechana, Niroohabasti is indicated. (Ch. Chi.28/86).

In a clinical trial we have done a comparativestudy of the effect of both Shaman and Shodhanatherapy on three different groups of patients.

Aims & Objectives-

1. To evaluate the effect of Rasnadi Guggulu (oraltherapy) in Katishool on various scientific andbiological parameters.

2. To evaluate the effect of Katibasti (Shodhantherapy) in the management of Katishool.

3. To evaluate the effect of combined therapy i.e.Rasnadi Guggulu and katibasti both(shaman+shodhan therapy) in the management ofKatishool.

4. To treat the patient of Lumbo-Sacral disorderswith Indigenous medicine.

S. To provide safe, cheapest, non surgical treatmentwithout any side effect.

6. To provide a better life to the patients ofKatishool (Lumbo-Sacral disorders).

Vol.2 No.2 Apr-Jun 2008

Material and Methods

1. Selection of cases-

The Patients were selected with consent fromthe OPD/IPD of NIA Hospital, Jaipur and wereexamined thoroughly as per the case sheets speciallyprepared for this purpose.

The study was conducted on 30 clinicallydiagnosed and confirmed cases of Lumbo-SacralDisorders at the P.G. Department of Panchakarma,NIA, Jaipur(Raj.).

2. Criteria of Selection-

Criteria of Inclusion-

o Age between 17 - 65 yrs.

o Duration of disease not more than 10 yrs.

o Sex - either sex.

o All non surgical cases of Lumbo-sacral disorders.

o All cases of lumbo-sacral disorders of noncongenital origin.

Criteria of Exclusion -

o All the cases below 17yrs. And above 65 yrs.Age.

o All the cases of more than 10 yrs diseaseduration.

o All the congenital cases of Lumbo-sacraldisorders.

o All the cases with serious accidental injuriesinvolving structural deformity.

o All the cases with chronic infective diseases ofbone. For e.g. Bone Tuberculosis, Pyogenicinfection etc.

o All the post operative cases involving foreignmaterial implantation.

3. Grouping of patients - For clinical trialSelected 30 patients were categorized in three groupsof 10 each:

o Group A - Rasnadi Guggulu orally for 3 weeks.

o Group B - Kati Basti (with Dashmool oil) for 3weeks.

52

Vol.2 No.2 Apr-Jun 2008

o Group C - Both Oral therapy and Kati Basti for3 weeks.

Local Abhyang (with dash moo I oil) andswedan ( dashmool washpa) was done prior to Katibasti daily. Along with snehana- swedana andKatibasti, Lumbar Traction was also given whereverrequired.

5. Drug, Dose, Duration, Schedule andVehicle-

Drug : Oral Medicine-

Rasnadi Guggulu =This is a yoga of YogaRatnaker, described in chapter Vata vyadhi Chikitsaand is specially given in case of Gradhrasi. Itcontains Rasna(leaves of Pluchea lanceoiata ofCornpositae family) 1 pala and Guggulu (Oleo gumresin of Balsamodendron mukul or Commiphoramukul of Burseraceae family) 5 karsha i.e. Rasna 4parts and Guggulu 5 parts, both are mixed togetherwith the help of Gau ghrita and Pills are made.

Both are the chief drugs among theVatashamak Dravyas. Both are shreshthavedanasthapana, Shool prashamana, shothahar, Vatakapha shamak, deepan, Amapachana, vishaghna,Rechana, vatanulomana, nadi balya, Rasayana andvrishya dravya. Hence the medicine prepared fromthe above drugs i.e. Rasna and Guggulu is also veryeffective in vatik disorders, specially it acts very wellon pain and nadi janya vikaras, like Gradhrasi. Herewe have used this Rasnadi guggulu in pain aroundLumbo-sacral region and the result came out, werebeyond our expectations.

Medicines used for External Application(Abhyang, swedana & Katibasti)

Dashmool Oil which was used in Abhyang andKatibasti contains Dashmool dravyas, Nirgundi andOil of mustard. All are vatashamak andvedanasthapana, shothahar and has good effect onLumbo-sacral disorders and pain around Lumbo-sacral region. Swedana was done with Dashmoolwashpa, which is again vatashamak andvedanasthapana, shothahar and has good effect onLumbo-sacral disorders and pain around Lumbo-sacral region.

Dose-

• Kati Basti -

[ournai of Avurveda- ,

• Dashmool oil.Dose -about 300 ml daily, for 3weeks.

• Oral Medication -• Rasnadi Guggulu -Dose - 500 mg twice a day orally for 3 weeks.

Duration-

.:. The whole therapy was given for 3 weeks.

Schedule-

• The oral medicine was given as a B.LD. dose.

• Kati Basti was done only once a day.

Vehicle-

o Rasnadi Guggulu was given with an anupanaof Dashmol Quath( 20 ml/ dose) mixed with 10 ml ofErenda sneha. This anupana is described in Vatavyadhi Chikitsa of Yoga Ratnaker and is speciallydescribed with reference to the disease Katishool.

Dashmool qwath contains dashmool dravyaswhich are vatahara, vedanasthapana and shothahara,the eranda oil mixed is also vatahara, vatanulomana,rechana hence very useful in Katishool or painaround Lumbo-sacral region.

6. Criteria of Assessment & Follow up study-

• A history sheet specially prepared for thepatients of Lumbo-sacral disorder was filled torecord the important information regarding eachpatient and his disease.

• The patients were restricted on a diet comprisingof daliya, chapati, skimmed milk, greenvegetables and moong dal, in fruits Papaya,chiku, apple etc were given. Oily or heavy foodcontaining fat, junk food, sour substances, curd,banana etc. was strictly prohibited.

• A weekly symptomatic progress assessment wasdone for consecutive three weeks and in pts. withkatibasti prescribed, were followed up daily,

During the trial and follow up study thepatients were assessed on following parameters: -

• Subjective improvement- increase in thefeeling of well being, physical and mental fitnessand relief in pain and stiffness.

• Clinical evaluation-done on the basis ofvarious symptoms of back pain studied.

• Hematological assessment-Routine

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Journal of Ayurveda

Haemogram (Hb.gm%, TLC, DLC, ESR) &Biochemistry(CRP, RA Factor, S.uric acid) torule out metabolic & inflammatory causes.

• Radiological Assessment- done on the basisof-

1. X-Ray of effected joints.

2. Computed tomography scan (CT or CATscan)

3. Magnetic resonance imaging (MRI)

Grading of the Symptoms - done on thefollowing criteria-

1. Alpa (1+) - symptoms found occasionally.

2. Mridu (2+) - symptoms found in mild form.

3. Madhya (3+) - symptoms found in moderateform.

4. Teevra (4+) - symptoms found in severe form.

Assessment of the result - done on thefollowing criteria-

Uttam labh (Good response) - 76% ormore relief In clinical symptomatology andpathological feature.

Madhayam labh(fair response)-51% -75% relief in clinical symptomatology andpathological feature.

Alpa labh (poor response) - 26% - 50%relief in clinical symptomatology and pathologicalfeature.

Alabh (No response) -below 26% relief inclinical symptomatology and pathological feature.

Clinical Study-

Observation and Discussion-

Table -1 showing the distribution of casesaccording to the Age and Sex group

S. No. Age group Male Female Total %

1. 17-32 2 1 3 10%

2. 33-50 4 8 12 40%

3· 50-65 6 9 15 50%

Total 12 18 30 100%

Vol.2 No.2 Apr-Jun 2008

Shows that Katishool is found predominantlyin middle age and in elderly persons and in bothgender.

Table -2 Showing the Distribution of casesaccording to Prakruti

S.No Prakruti No.of Patients. %

1. Vatakaphaj 12 40%

2. Vatapaittika 6 20%

3· Kaphapaittika 9 30%

4· Sannipatika 3 10%

Total 30 100%

Shows that Katishool is found in all Prakruties

Table -3 Showing the Distribution ofcases according to Chronicity

S.No Chronicity No.of Patients %

1. Up to 1 yr. 6 20%

2. 1 - 5 yr. 15 50%

3· 5 - 10 yr. 9 30%

Total 30 100%

Maximum Pts. were suffering from theKatishool from more than 1 yr.

Table -4 Showing the Distribution of casesaccording to Radiological findings

S. Radiological findings No.of %No. Patients.

1. Osteophytic changes 9 30%

2. Reduced joint space 6 20%

3· Degenerative changes 6 20%

4· Prolapse of Disc 3 10%

5· Herniation of Disc 3 10%

6. Normal 3 10%

Total 30 100%

Maximum no. of cases were havingOsteophytic and Degenerative changes

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Vol.2 No.2 Apr-Jun 2008

Table -5 Showing Distribution of cases according to the symptoms studied

Journal of Ayurveda

S.No. Symptoms No. of cases %

1 Pain 30 100%2 Stiffness 30 100%3 Referred pain 26 86.6%4 Restriction in movement 29 96.6%5 Muscle spasm & cramping 30 100%6 Weakness of lower part of body/ Paraparesis 25 83·3%7 Weakness with loss of bladder/ bowel control 11 36.6%8 Numbness 30 100 %9 Tingling / burning sensations 29 96.6%10 Pins and needles like sensations 29 96.6%11 Fasciculation or atrophy of muscles 20 66.6%12 Paraplegia 7 23·3%13 Anorexia 27 90%14 Fatigue / malaise 30 100%15 Indigestion 27 90%16 Diffuse musculoskeletal pain 30 100%

Table-6 showing relief in the severity of symptoms in group A i.e Patients treated withRasnadi Guggulu only

S.No. Symptoms mean BT mean AT mean relief % Relief

1 Pain 3·1 1.7 1.4 45·1%2 Stiffness 3·6 1.8 1.8 50%3 Referred pain 2-4 1.1 1.3 54%4 Restriction in movement 2·9 1.6 1.3 44.8%5 Muscle spasm & cramping 3·2 1.3 1.9 59·3%6 Weakness of lower part of body/ Paraparesis 1.9 1.3 0.6 31.5%

7 Weakness with loss of bladder/ bowel control 0·9 0·7 0.2 22.2%8 Numbness 3·1 1.4 1.7 54·8%9 Tingling / burning sensations 2.2 0·9 1.3 59%10 Pins and needles like sensations 1.8 0.8 1.0 55·5%11 Fasciculation or atrophy of muscles 1.3 0·9 0·4 30·7%12 Paraplegia 0.6 0·5 0.1 16.6%13 Anorexia 2·7 1.6 1.1 40·7%14 Fatigue / malaise 2.6 1.3 1.3 50%15 Indigestion 2·7 1.7 1.0 37%16 Diffuse musculoskeletal pain 3·6 1.9 1.7 47·2%

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Journal of Ayurveda Vol.2 No.2 Apr-Jun 2008

Table-7 showing Relief in the severity of Symptoms in group B i.e Patients treated withKatibasti only

S.No. Symptoms mean BT mean AT mean relief % Relief

1 Pain 3·0 1.6 1.4 46.6%2 Stiffness 3·3 1.9 1.4 42-4%3 Referred pain 2·5 0·9 1.6 64%4 Restriction in movement 2·3 1.1 1.2 52.1%5 Muscle spasm & cramping 2·5 1.2 1.3 52%6 Weakness of lower part of body; Paraparesis 1.5 0.8 0·7 46.6%7 Weakness with loss of bladder/bowel control 0·7 0.6 0.1 14·2%8 Numbness 2.6 0·9 1.7 65·3%9 Tingling ; burning sensations 2.2 0·7 1.5 68.1%10 Pins and needles like sensations 2.1 0.8 1.3 61.9%11 Fasciculation or atrophy of muscles 1.1 0·9 0.2 18.1%12 Paraplegia 0·5 0·4 0.1 20%13 Anorexia 2·7 1.7 1.0 37%14 Fatigue ; malaise 2·9 1.8 1.1 37·9%15 Indigestion 3.2 2·4 0.8 25%16 Diffuse musculoskeletal pain 2·9 1.5 1.4 48.2%

Table-8 showing Relief in the severity of Symptoms in group A i.e Patients treated withRasnadi Guggulu & Katibasti both

S.No. Symptoms mean BT mean AT mean relief % Relief

1 Pain 3·6 0·9 2·7 73%2 Stiffness 3·5 0·7 2.8 80%3 Referred pain 2-4 1.0 2·3 95·8%4 Restriction in movement 3-4 0·5 2·9 85·3%5 Muscle spasm & cramping 3·5 0.6 2·9 82.8%6 Weakness of lower part of body/ Paraparesis 2.2 0-4 1.8 81.8%7 Weakness with loss of bladder; bowel control 1.4 0·5 0·9 64·2%8 Numbness 2·9 0.1 2.8 96·5%9 Tingling ; burning sensations 1.9 0.0 1.9 100%10 Pins and needles like sensations 1.5 0.0 1.5 100%11 Fasciculation or atrophy of muscles 1.4 0·3 1.1 78·5%12 Paraplegia 1.0 0·4 0.6 60%13 Anorexia 2·5 0·5 2.0 80%14 Fatigue ; malaise 3·1 0·7 2-4 77·7%15 Indigestion 2.6 0.6 2.0 76·9%16 Diffuse musculoskeletal pain 3·0 0·7 2·3 76.6%

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\'01.2 No.2 Apr-Jun 2008

S.No. mean BT

Table-q Showing Relief in the severity of Symptoms in Different Groups

Journal of Ayurveda

Group mean AT mean relief % Relief

1. Group A

Group B

Group C

2. 2.25

3· 2-49

1.28 1.13

1.2 43·7%1.05

1.99 81.8%

Table Showing Relief in Patients in Different Groups

S.No. Group mean BT mean AT mean relief % Relief

1. Group A 3·9 2.05 1.86 47.89%

2. Group B 3.67 1.9 1. 77 47·3%

3· Group C 3·99 0.68 3.31 84·05%

Table-10 Showing Relief in severity of Symptoms in terms of the Response of thetherapy in different Groups

S.No Group Good Response Fair Response Poor response NoResponse(>76%) (51-75%) (26-50%) «25%)

1. GroupA 0 5 9 2

2. GroupB 0 6 6 4

3· GroupC 13 3 0 0

Table-a r Showing Relief in Cases in terms of the Response of the therapy InDifferent Groups

S.No Group Good Response Fair Response Poor response NoResponse(>76%) (51-75%) (26-50%) «25%)

1. GroupA 0 4 6 0

2. GroupB 0 3 7 0

3· GroupC 8 2 0 0

Discussion and Results

;. Clinically after three days of starting the therapythe pain, stiffness, referred, muscle cramp/spasm, restriction in movement, numbness,tingling/ burning sensation and diffusedmusculoskeletal pain starting decreasing.

~ As the treatment proceeds a marked reductionin the severity of almost all of symptoms wasfound within a week.

~ The percentage relief in the severity of thesymptoms as well as the relief in the patients ofgroup C( combined therapy)was comparativelyquite high as compare to that of Group A(Oraltherapy) & B(Katibasti).

~ The mean relief in the severity of the symptomsin group A, B, C were 43.6%, 43.7 % and 81.8%respectively, while the mean relief found in thepatients of Group A, B, C were 47.89%, 47.3% and

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journal of Ayurveda

84.05% respectively.

~ Response wise- in group A & B good responsewas not found in neither symptoms nor in patientwise study but in case of group C out of 16symptoms studied good response was found in13 and fair in 3 symptoms and out of 10 pts.Studied good response was found in 8 cases andfair response in rest of the two cases.

~ Hematologically there was a marked decrease inthe E.S.R. and an increase in the Hb% level wasfound in almost all of the patients kept on oralmedication (Probably due to Guggulu).

~ Radiologically the intervertebral spacing wasfound to be increased in cases of reducedIVspace, after the therapy which was due to theapplication of snehana, swedana, katibasti as wellas lumber traction along with the oral therapy.

~ In degenerative cases the condition was foundbetter than before.

~ In case of Osteophytic changes no radiologicalchanges were found after the therapy butPatients shows a very good symptomatologicalrecovery.

~ In case of systemic symptoms such asindigestion, Insomnia and anorexia, a clinicalrelief was found as a result of the therapy anddue to relief from the distressing Pain.

Conclusion

In the last it can be concluded that, the drugRasnadi Guggulu(along with anupana of Dashmoolquath mixed with Eranda sneha) is an effectivemedicine in Katishool, but when accompanied withauthentic Panchakarma techniques speciallysnehana, swedana and katibasti, gives very goodresults with least expenditure and no harmful effector complication, as seen practically in this clinicaltrial.

VoL2 No.2 Apr-jun 2008

References -

1 . Caraka Samhita ofCakrapaoidatta byPrakashan Varanasi.

Agnivesa Elaborated byChaukhambha Surabharati

Edition-2000

2. Susruta Samhita of Suuruta of tJri Dalhanacharyaby Choukhambha Orientalia Varanasi.Bth edition2008.

3. AstafigahvdayamSarvangasundaraof Hemadri.

byof

VagbhataAruoadatta

commentaries ofAyurvedarasayana

4. Astafiga Sam??graha with Iodu bakhya published byKendriya Ayurveda and Siddha Anfisam PdhanaParisada Newfrelhi.j co S

5. Kasper DL, Braunwald E etc. Harrison's Principles ofInternal Medicine roth edition 2005.

6. Lawrence MT, Stephen JM, etc. Current medicaldiagnosis and treatment forty-third edition 2004.

7. Davidson's Principles and Practice of Medicine Edi- -17th International Edi. 1995-96.

8. Yogaratnakara -Yd.Chaukhambha SanskritSeventh Edition, 1999.

LakshmipattaSansthana,

Shastri,Varanasi,

9. Kasture HS, Ayurvediya Panchakarma Vigyan 6th

Edi; Vaidyanath Ayurveda Bhawan Ltd.

10. Sharma PV, Dravya guna Vigyan part 2, 14th Edi;Chaukhambha Bhartiya Academy, 1993.

1 1. Mahajan BK, Methods in Bio- statistics 6th Edition.

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