vishamajwaram kc029 gdg

Evaluation of the efficacy of

THE BHARANGYADI GHANAVATI IN VISHAMAJWARA WITH

SPECIAL REFERENCE TO MALARIAL FEVER

By

MANGALAVVA .B. PATIL

Dissertation submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fulfillment of the degree of

Ayurveda Vachaspati M.D.In

KayachikitsaUnder the Guidance of

Dr. V. Varada CharyuluM.D. (Ayu) (Osm)

Dr. R.V.ShettarM.D. (Ayu)

Department of Kayachikitsa

Post Graduate Studies & Research CenterD.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG

2002-2005

Ayurmitra

TAyComprehended

D.G.M.AYURVEDIC MEDICAL COLLEGE

POST GRADUATE STUDIES AND RESEARCH CENTERGADAG, 582 103

This is to certify that the dissertation entitled “EVALUATION OF THE EFFICACY OF

THE BHARANGYADI GHANAVATI IN VISHAMAJWARA WITH SPECIAL REFERENCE

TO MALARIAL FEVER” is a bonafide research work done by “MANGALAVVA .B. PATIL”

in partial fulfillment of the requirement for the post graduation degree of “Ayurveda

Vachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi University of Health Sciences,

Bangalore, Karnataka.

Dr. V. VARADA CHARYULU

M.D. (Ayu) (Osm)Guide

Professor & HOD

Dept. of Kayachikitsa

PGS&RC

Date:

Place: Gadag

Dr. R V SHETTAR

M.D. (Ayu)Co- Guide

LECTURER IN KAYACHIKITSA

DGMAMC, PGS&RC, Gadag

Date:

Place: Gadag

J.S.V.V. SAMSTHE’S

D.G.M.AYURVEDIC MEDICAL COLLEGE

POST GRADUATE STUDIES AND RESEARCH CENTERGADAG, 582 103

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

This is to certify that the dissertation entitled “EVALUATION OF THE EFFICACY OF

THE BHARANGYADI GHANAVATI IN VISHAMAJWARA WITH SPECIAL REFERENCE

TO MALARIAL FEVER” is a bonafide research work done by “MANGALAVVA .B. PATIL”

under the guidance of Dr. V. VARADA CHARYULU, M.D. (Ayu) (Osm), Professor & HOD

and Dr. R V SHETTAR, M.D. (Ayu), in partial fulfillment of the requirement for the post

graduation degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi

University of Health Sciences, Bangalore, Karnataka.

.

(Dr. G. B. Patil)Principal,

DGM Ayurvedic Medical College,Gadag

Date:Place:

(Dr. V. Varada charyulu)Professor & HOD

Dept. of KayachikitsaPGS&RC

Date:Place: Gadag

Declaration by the candidate

I here by declare that this dissertation / thesis entitled “EVALUATION OF THE

EFFICACY OF THE BHARANGYADI GHANAVATI IN VISHAMAJWARA WITH SPECIAL

REFERENCE TO MALARIAL FEVER” is a bonafide and genuine research work carried out

by me under the guidance of Dr.V.Varada Charyulu M.D.(Ayu) and Dr. R.V.Shettar, M.D.

(Ayu), lecturer in Kayachikitsa, DGMAMC, PGS&RC, Gadag.

Date

Place


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


© Rajiv Gandhi University of Health Sciences, Karnataka

Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 1

I express my deep gratitude to my guide Dr. V. Varadacharyulu M.D.(Ayu), Professor and

H.O.D., for his timely advises and encouragement in every step of my success.

I express my gratefulness to my co-guide Dr R. V. Shettar, M.D (Ayu) lecturer in

Kayachikitsa, for his time to time help and critical suggestions associated with expert guidance at the

completion of this dissertation.

I express my thankfulness to beloved principal Dr. G. B. Patil, Principal for his

encouragement as well as providing all necessary facilities for this research work.

I express my profound sense of acknowledgement to various departments H.O.D.s, teachers

and colleagues of sister concern departments along with the ministerial and sub staff of the D.G.M.

Ayurvedic Medical College, Gadag.

I express my sincere thanks to Dr. K. Shiva Rama Prasad, Dr. Shashidar. H. Doddamani, Dr.

Kuber Sankh, Dr. P. Shivaramudu, Dr. M.C. Patil, Dr. Santhosh Belavadi, Dr. Mulkipatil and Dr

Kona. I express my sincere thanks to Mr. Nandakumar for his help in statistical analysis of results. A

special thanks on this regard to Dr. Danappagoudar for his valuable support at the preparation of the

drug.

I express my deepest gratitude to my beloved parents, Sri B.H.Patil and smt G.B. Patil, and

my husband Sri Shivkumargouda S.Patil, who supported me all the time. I express my sincere thanks

to one and all of my relatives and well wishers Dr. D.M.Patil, Dr. Meenakshi, Dr. Shankargouda,

Dr. Chetan, Dr. Joshi. D.P, All my colleagues and Harun Kowshik, Smt Valli Shree for their co-

operation at all times.

At first my sincere thanks to the subjects who co-operated at my dissertation, with out of

them it would have been not a success.

Place:

Date:Dr. MANGALAVVA .B. PATIL


Abstract

Vishamajwara vis-à-vis Malaria or a disease resembling malaria has been noted

for more than 4,000 years. Vishamajwara characterised by visamarambha (irregular

onset). Dalhana consider bhutas (Keetanu – Parasites) responsible to produce

Vishamajwara. Cough may be a presenting feature of malaria with severe anaemia can

be a presenting feature of malaria.

In Vishamajwara the Doshas are not only localised in Rasa Dhatu like in other

jwara, they spread through Rasa, Rakta, Mansa, Meda, Asthi and Majja to get the

different Vishamajwara such as Satata jwara, Santata jwara, Anyedushka jwara,

Triteeyak jwara, Chaturthak jwara and Chaturthak jwara.

In this trail drug Bharangyadi Ghana Vati, the prime herbs are – Bharangi and

Kirata Tikta. Panduhara, Jwarahara, Mootrakruchrahara, Hrudrogahara, Tridoshahara,

Deepaka, Sangrahi, Rasayana, Panduhara, Kamalahara, Chardihara and Amahara

Dravyas are used in the Bharangyadi Ghana Vati.

Present study registers 30 patients, out of 68 approached patients. The remaining

26 patients of Vishamajwara viz. Malaria, fulfilling the criteria of diagnosis and inclusive

criteria were included in the study.

The observation of the jwramukta Lakshana shows that the effect of the

Bharangyadi Ghana Vati over Vishamajwara vis-à-vis Malaria is admissible.All the

parameters except Yakrut Vruddhi and Pleeha Vruddhi show high significance..

Evaluation of the efficacy of the BharangyadiGhana Vati in Vishamajwara with special

reference to malarial fever

Dr. MANGALAVVA .B. PATIL


Table of contents

Heading Page number

Chapter - 1 Introduction 1 to 6

Chapter –2 Objectives 7 to 8

Chapter –3 Review of literature 9 to 87

Chapter –4 Methodology 88 to 107

Chapter –5 Results 108 to 139

Chapter –6 Discussion 140 to 157

Chapter –7 Conclusion 158 to 163

Chapter –8 Summary 164 to 164

Bibliographic References I to X

Annex – Case sheet 1 to 6


List of figures

Sno Figures heading Page

1 Photograph of Parvateeya Mashaka 10

2 Geographical distribution of the Malaria 13

3 Postal Stamp released by Government of India on the occasion of

Malaria control

24

4 Life cycle schematic diagram 37

5 Sporogonic and Erythrocytic cycles of Malaria 38

6 Exogenous and Endogenous Phases of Malaria 39

7 Ingredients of Bharangyadi Ghana Vati 68

8 Laboratory diagnosis of malaria fever 98

9 Finished Product of Bharangyadi Ghana Vati 108

List of Flow charts

Sno Flow charts heading Page

1 Classification of aetiology of Vishamajwara 46

2 Schematic diagram of Vishamajwara Samprapti 59


List of graphs

Sno Graph heading Page1 Distribution of patients by Age 109

2 Distribution of patients by Age- gender 111

3 Distribution of patients by Gender 112

4 Distribution of patients by Religion 113

5 Distribution of patients by Occupation 115

6 Economic status distribution Vs Vishamajwara vis-à-vis Malaria 116

7 Distribution of patients by Economic status 117

8 Distribution of patients by Hygienic Condition 119

9 Distribution of patients by Diet 120

10 Distribution of patients by presenting complaints 121

11 Distribution of patients by Associated features 123

12 Distribution of patients by type of Jwara 124

13 Distribution of patients by Pranavaha sroto dusti Lakshana 125

14 Distribution of patients by Rasavaha sroto dusti Lakshana 126

15 Distribution of patients by Annavaha sroto dusti Lakshana 127

16 Distribution of patients by Swedavaha sroto dusti Lakshana 128

17 Distribution of patients by Nidana 130

18 Distribution of patients by Poorva Roopa 131

19 Distribution of patients by Jwaramukta Lakshana 132

20 Aniyamita Jwara (mean) in Vishamajwara 133

21 Graph the temperatures (mean) in Vishamajwara 135

22 Distribution of patients by Result in Vishamajwara 137


List of tablesSno Table Heading Page1 Showing the Dosha pradhanyata in Malaria 55

2 Duration and vega in different jwaras 58

3 Showing the Vishamajwara vishista Lakshana 60

4 Distribution of patients by Age 109

5 Distribution of patients by Age- gender 110

6 Distribution of patients by Gender 112

7 Distribution of patients by Religion 113

8 Distribution of patients by Occupation 114

9 Distribution of patients by Economic status 117

10 Distribution of patients by Hygienic Condition 118

11 Distribution of patients by Diet 119

12 Distribution of patients by presenting complaints 121

13 Distribution of patients by Associated features 122

14 Distribution of patients by type of Jwara 123

15 Distribution of patients by Pranavaha sroto dusti Lakshana 125

16 Distribution of patients by Rasavaha sroto dusti Lakshana 126

17 Distribution of patients by Annavaha sroto dusti Lakshana 127

18 Distribution of patients by Swedavaha sroto dusti Lakshana 128

19 Distribution of patients by Nidana 129

20 Distribution of patients by Poorva Roopa 130

21 Distribution of patients by Jwaramukta Lakshana 132

22 Evaluation of Subjective Parameters 133

23 Evaluation of objective Parameters 134

24 Showing the temperatures (mean) in Vishamajwara 135

25 Distribution of patients by Result in Vishamajwara 136

26 Statistical analysis of the clinical parameters at the end of treatment (21days)

137

27 Statistical analysis of the objective parameters at the end of treatment(21 days)

138

28 Statistical analysis of the clinical parameters at the end of follow-up (36days)

138

29 Describing the pharmacological properties of Bharangyadi Ghana Vati 145

30 Describing the Chemical constituents and Indications of individualcomponents of Bharangyadi Ghana Vati

146


Chapter –1

Introduction

“ osquito makes man Eunuch”, is popular dialogue of the film actor.

Fact is that the mosquito really conquers the eco-symphony of the earth and disturbed much

and more of human life. Now a day an average spending of human on mosquito repellents

are sufficient to maintain a family. Asian, African, etc, tropical countries are badly effected

by this small tiny untidy creature and Governments are fallen because of the same.

Vishamajwara, a most popular Ayurvedic term in turn of modern medical

terminology co-related to malarial fever, is a protozoan disease caused by genus

plasmodium and transmitted to man by certain species of infected female anopheles

mosquito. India's geographic position and climatic conditions are favourable for the

transmission of malaria. Frequently people living in the endemic areas are prone for this

infection. Out of 300-500 million clinical cases around 100 countries and one million deaths

due to malarial malady are noticed globally.

The 38th world health assembly in 1985 recommended that, malaria control should

be developed as an integral part of the national primary health care systems. 1-2-3

Vishamajwara is irregular (inconsistent) in it's arambha (nature of onset

commitment), kriya (action production of symptoms) and kala (time of appearance) and

possesses anushanga (persistence for long periods) 4-5-6. As on today, the malarial parasite

has developed resistance to chloroquine compounds, which are used vividly for the past

three decades.

The emergence of multiple-drug resistant strains of malaria, which has accompanied


each new class of anti-malarial drugs, is one of most significant threat to the health of people

in tropical countries. While there is widespread agreement that a fresh approach to the

prevention and treatment of malaria is urgently needed, solutions have tended to focus on

the development of new classes of drugs. More recently, there has been an emphasis on

promoting combination therapy of existing drugs as a means of preventing resistance.

Historically, however, local communities in tropical regions have used local flora as

a means of preventing and treating malaria (Kirby, 1997). It can be argued that these

traditional medicines, based on the use of whole plants with multiple ingredients or of

complex mixtures of plant materials, constitute combination therapies that may well combat

the development of resistance to anti-malarial therapy.

Resistance, synergism and traditional medicines

Medical science is beginning to recognise aspects of synergy, complexity and

potentiation in malaria therapy. At the same time, little significance is as yet being given to

the obvious point that all of the major anti-malarial have been derived from plants, often

based on traditional knowledge about the effects of the plants against fever, or specifically,

malaria. The call to combine anti-malarials overlooks the fact that combination existed in

the traditional formulations before the process of extraction took place. In view of this, it

must be asked whether any pre-existing synergism, and hence challenge to the development

of resistance, may have been lost in the process of extraction, isolation and synthesis of new

molecules.

For instance, the artemisinin drugs (artesunate, artemehter, dihydroartemisinin) are

derived from artemisia annua, used in traditional Chinese medicine as an antipyretic. An

examination of traditional Chinese medical knowledge and practice would reveal that it was


usual for this plant to be used in combination with others in the treatment of fevers. In the

development of the new artemisinin drugs, not only has this been overlooked, but the

complex of alkaloids in the plant itself have been sacrificed for the purpose of isolation of a

so-called single active ingredient. Indeed, flavinoids in Artemisia annua, which are

structurally unrelated to the anti-malarial drug artemisinin, enhance the in vitro

antiplasmodial activity of artemisinin 7.

Elsewhere, synergism has been observed between the alkaloids of the anti-malarial

plant Ancistrocladus peltatum. A total alkaloid extract of this plant had far greater anti-

parasitic activity than any of the six alkaloids isolated subsequently. In studies on anti-

malarial plants from Madagsacar, the alkaloids bisbenzylisoquinoline , novel pavine and

benzyl tetrahydroisoquinolines all were found to potentiate the anti-parasitic activity of

chloroquine in vitro and, in some case, in vivo. Preparations of these plants are currently

being tested as adjutants to chloroquine therapy in Madagascar (Kirby, 1997). In Uganda,

there is data from clinical case reports that a traditional Ugandan herbal remedy is effective

against malaria. (Bitawha et. al., 1997)

Utilisation of traditional medicine is widespread in developing countries and the

efficacious of many traditional treatments have been well documented, including in skin

disease, malaria and other disorders. Despite growing policy interest in traditional medicine,

and the seminal 1997 Dakar meetings on malaria recommending research into herbal anti-

malarial, there has been almost no research into the clinical effectiveness of herbal remedies

as they are used in real life.


The research initiative for traditional anti-malarial methods (RITAM)

To redress this situation, a partnership was established in December 1999 between

the Global Initiative For Traditional Systems (GIFTS) of Health, the Tropical Disease

Research Programme of WHO and individual scientists, traditional health practitioners and

others to investigate evaluate and, where appropriate, develop traditional herbal medicines to

combat malaria. It is the Research Initiative for Traditional Anti-malarial Methods (RITAM)

Many people live in malarious regions, traditional herbal medicines may be the only

course of treatment available. Therefore, research into, promoting and increasing the

understanding of the nature of crude plant derived medicines are key research priorities.

Plants are usually identified for study on the basis of a traditional reputation for

effectiveness, usually for treating or preventing malaria and other fever related conditions.

In designing new treatments, drugs and public health programmes in developing

countries, it can be considered unscientific to cast aside traditional knowledge and wisdom

after cursory review, on the assumption that modern methods of analysis and explanation are

superior.

RITAM members have developed four specialist groups to implement a research

strategy designed to make a significant contribution to malaria control programmes:

1. Policy, advocacy and funding

2. Pre-clinical studies

3. Clinical development

4. Repellence and Vector Control 8

The Indian Systems of Medicine & Homoeopathy is popular in a large number of

States in the country. There are separate Directorates of ISM&H in 18 States. Ayurveda,


Homeopathy, Unani, Yoga & Naturopathy and Siddha systems together called as Indian

Systems of Medicine. These systems have become part of the culture and traditions of our

country 9.

Drug resistance to chloroquine in P. falciparum was reported in India for the first

time from Assam in 1973. Since then the foci of resistance have spread to many more states

all over India. The situation has further deteriorated in the recent past due to parasite

becoming resistant to other available drugs in addition to chloroquine. Sulphadoxine-

pyrimethamine, a second line drugs for P. falciparum is not effective for P. vivax malaria.

Quinine is still effective but as oral monotherapy it has limited role in mild malaria because

of 7-day regimen. Mefloquine and artemisinin have specific indications. Therefore, new

drugs and treatment strategies need to be developed as a priority.

Development of new drugs involves extensive pre clinical and toxicological studies

followed by well-planned clinical trials. At MRC, a number of new drugs have been

screened in clinical trials for evaluation of safety and efficacy. Based on these data, the

drugs have been registered with Drugs Controller General of India for commercial

marketing and also for use in national programme under

A y u s h - 6 4

Ayush-64 is a combination of four plants namely Alstonia scholaris (aqueous extract

of bark–1 part) Picrorhiza kurroa Royle (aqueous extract of rhizome–1 part), Swertia chirata

(aqueous extract of whole plant–1 part) and Caesalpinia crista Linn (fine powder of seed

pulp–3 parts).

The drug was patented by the Central Council of Ayurveda and Siddha and to

confirm the efficacy in well designed scientific trial, open prospective, non-crossover,


randomised clinical trial was conducted in P. vivax malaria patients at the Centre in

collaboration with NAMP 10. Results showed that with Ayush-64 cure rate on Day 28 was

48.9% at a dose of 1 g three times a day for 5–7 days as against 100% with chloroquine

1500 mg over three days 11.

Ayurvedic herbs have an important role in the treatment of malarial fever. Even the

chloroquine is a derivative of herbal origin. In the treatment of Vishamajwara many yogas

have been explained in Ayurveda. The composition of Bharangyadi Yoga is easily available,

low-priced and has no proved adverse effects 12 against malarial fever.

Thus the present study has been under taken as “Evaluation of the efficacy of the

Bharangyadi Ghanavati in Vishamajwara with special reference to malarial fever”. A few

numbers of clinical trials have been conducted in different Ayurvedic institutes in India,

regarding Vishamajwara. These are as follows -

Year / scholarname

Title Institute

1980 M.V. Chari Clinical and experimental study of medicinalplants in the treatment of malaria.

Gujrat Ayurvedauniversity, jamnagar.

1981 M.V. Chari A double blind clinical trial with ayush. 64 anAyurvedic drug in P. vivax malaria.

Do

1981 K.D. Sharma Clinical trial of ayush 64 in case of malaria C.C.R.A.&S. Newdelhi

1982 Kanaka rai dal A study of management of Vishamajwara G.A.U. Jamnagar

1982 Jagabandhudas

Clinical study of panchatikta ghaanabati onVishamajwara

G.A.M. Puri. (orissa)

1985 Kishore panda “therapeutic evaluation of Kiratatikta ghanabation Vishamajwara”

Do

1994 B. Baliarsingh “clinical trial on ajajiguda yoga inVishamajwara vis-à-vis malaria

Do

1991 Deshmukh 54 Anaetiopathological study on the managementof vishama jwara with bnuranggadi kwata

Kerala universitytrivendrum

1983 mahantdhaneshwar

Ushna jwara GovernmentAyurvedic collegehyderabad


Chapter -2

Objectivesresent study bears the following objectives -

1. To evaluate the efficacy of the Bharangyadi Ghanavati in

Vishamajwara (Malarial fever)

2. To evaluate the antipyretic properties of Bharangyadi Ghanavati in


3. To evaluate the anti-malarial properties of Bharangyadi Ghanavati in


Detailed discussion of above mentioned objectives are as under –

1. To evaluate the efficacy of the Bharangyadi Ghana Vati in Vishamajwara (Malarial

fever)

Many herbal compounds and herbo-mineral compounds are listed in Ayurveda to

pacify the Jwara, especially Vishamajwara. Ayurveda offers more importance to that of the

rise of temperature, which is a protective and also pathological identity of the any ailment


present in the body. The jwara called as fever may not be a big problem from the

contemporary but as par Ayurveda it is a primary symptom and a disease also some times a

complication. This particular condition needs through emphasis and management. In this

process a laboratory identified malarial parasite expression as fever i.e. Vishamajwara is

extensively studied and the efficacy of the Bharangyadi Ghana Vati in Vishamajwara is

emphasized.

2. To evaluate the antipyretic properties of Bharangyadi Ghana Vati in Vishamajwara

(Malarial fever)

The main aim of the study is to see the antipyretic effect of the selected drug,

Bharangyadi Ghana Vati in Vishamajwara. The fever is rise in body temperature. This

primary symptom which give the inconvenience is to be forbidden at the earliest to provide

comfort to the patient. Thus the antipyretic effect is specially studies under the guide lines of

Ayurveda in comparison with that of the contemporary medicine.

3. To evaluate the anti-malarial properties of Bharangyadi Ghana Vati in


The chosen drug Bharangyadi Ghana Vati is assumed as a best medicament at the

relieving the jwara i.e. fever by all means. Its antipyretic effects also a sure thing. But many

a times a doubt is raised is whether any Ayurvedic drug acts as anti-microbial, anti-viral or

anti-malarial? To achieve the answer for the above raised question and to strengthen the

Ayurvedic glory to establish Ayurvedic scientific grounds the evaluation of the anti-malarial

properties were under taken as one of the objectives of the study.


Chapter -3

Literary review

yurveda is a perfect science of life and consists of a body of most

remarkable knowledge on the internal mechanism of human health and longevity, on

medicinal herbs and therapeutic roots, on the efficacious treatment of human ills by

eradicating from the human system the very sources of their causation. This great medical

science and humanity’s most ancient and finest preventive school of practical medicine,

which has been practised in India, century after century for over four thousand years, by

expert Vaidyas. To those who claim to have a knowledge of this ancient medicinal science

enriched by the happy results of the researches and advancement made by eminent Vaidyas

in succeeding ages, its superior merits over the Western systems of medicine, and its

immense value, do not need any delineation. Such names of the great pioneers who added to

the development of the science of Ayurveda, as Vagbhata, Madhava, Jivaka and Bhava

Mishra of Banaras are well known.

Ayurveda has a significant name. It is the knowledge of the science, which ensures

health and longevity. It is in no way inferior to other systems. The Ayurvedic doctors had

very great influence in the field of medicine. Charaka, Sushruta, Vagbhata, Madhava Nidhan

are the well-known scientific books on Indian Medicine. This glorious system of medicine

fell into disease owing to lack of State support and facilities for proper study, training and

research.

Susruta, while classifying different insects expands the mosquitoes as five varieties.

They are Samudra Mashaka, Parimandala Mashaka, Hasti Mashaka, Krishna Mashaka and


Parvateeya Mashaka. Out of these the last Parvateeya Mashaka are more toxic and fatal in

nature. The symptoms of this type resemble with the malarial fever of present discussion 13.

Figure –1Photograph of Parvateeya Mashaka

Malaria is a protozoal disease transmitted by the Anopheles mosquito, caused by

minute parasitic protozoa of the genus Plasmodium, which infect human and insect hosts

alternatively. It is a very old disease and prehistoric man is thought to have suffered from

malaria. It probably originated in Africa and accompanied human migration to the

Mediterranean shores, India and South East Asia. In the past it used to be common in the

marshy areas around Rome and the name is derived from the Italian, (mal-aria) or "bad air";

it was also known as Roman fever. Today some 500 million people in Africa, India, South

East Asia and South America are exposed to endemic malaria and it is estimated to cause

two and a half million deaths annually, one million of which are children.

Fishermen and traders, long before British colonisation, probably introduced the

disease into northern Australia and in the past malaria were not uncommon in the northern

parts of the country. In Western Australia an explosive outbreak of falciparum malaria

occurred at Fitzroy Crossing in 1934 which at first was mistaken for influenza and resulted


in 165 deaths. WHO declared Australia free of malaria in 1981, however since that time 9

patients have contracted locally acquired malaria.

The so called "airport malaria" has become a problem in recent years. A publican

working in an establishment close to London's Heathrow Airport became acutely ill and was

found to be suffering from falciparum malaria, he had never been out of the country. A lady

driving her car past the same airport became ill with malaria although she too had never

been out of the country. Four workers unloading a cargo plane at Amsterdam airport became

infected with malaria. It is assumed that infected mosquitoes were carried on planes from

Africa and released at the destination airport.

While it was recognised that the Anopheles mosquito played a key role in the

transmission of the disease it was not until 1948 that all the stages in its life cycle were

identified. The parasite undergoes a development stage in the mosquito and the female of the

species requires a blood meal to mature her eggs. She bites a human and injects material

from her salivary glands, which contains primitive malarial parasites called sporozoites,

before feeding. These sporozoites circulate in the blood for a short time and then settle in the

liver where they enter the parenchymal cells and multiply; this stage is known as pre-

erythrocytic schizogony. After about 12 days there may be many thousands of young

parasites known as merozoites in one liver cell the cell ruptures and the free merozoites

enter red blood cells. The blood stages of the four species of malaria can be seen in the

section on diagnosis. In the case of P. vivax, and P.ovale the liver cycle continues and

requires a course of primaquine to eliminate it. P.falciparum on the other hand does not have

a continuing liver cycle.


In the red blood cells the parasites develop into two forms, a sexual and an asexual

cycle. The sexual cycle produces male and female gametocytes, which circulate in the blood

and are taken up by a female mosquito when taking a blood meal. The male and female

gametocytes fuse in the mosquito's stomach and form oöcysts in the wall of the stomach.

These oöcysts develop over a period of days and contain large numbers of sporozoites,

which move to the salivary glands and are ready to be injected into man when the mosquito

next takes a meal. In the asexual cycle the developing parasites form schizonts in the red

blood cells which contain many merozoites, the infected red cells rupture and release a batch

of young parasites, merozoites, which invade new red cells. In P.vivax, P.ovale and probably

P.malariae, all stages of development subsequent to the liver cycle can be observed in the

peripheral blood. However, in the case of P.falciparum only ring forms and gametocytes are

usually present in the peripheral blood. Developing forms appear to stick in the blood

vessels of the large organs such as the brain and restrict the blood flow with serious

consequences.

While all four species have a haemolytic component i.e. when a new brood of

parasites break out of the red blood cell this is usually of little consequence. The exception is

falciparum malaria where the parasites multiply very rapidly and may occupy 30% or more

of the red blood cells causing a very significant level of haemolysis. One reason for this is

that P.falciparum invades red cells of all ages whereas P.vivax and P.ovale prefer younger

red cells, while P.malariae seeks mature red cells.


Figure –2Geographical distribution of the Malaria

History of malaria

Malaria or a disease resembling malaria has been noted for more than 4,000 years.

From the Italian for "bad air," malaria has probably influenced to a great extent human

populations and human history.

Ancient History (2700 BCE-340 CE)

The symptoms of malaria were described in ancient Chinese medical writings. In

2700 BC, several characteristic symptoms of what would later be named malaria were

described in the Nei Ching, (The Canon of Medicine. Nei Ching was edited by Emperor

Huang Ti). Malaria became widely recognised in Greece by the 4th century BCE, and it was

responsible for the decline of many of the city-state populations. Hippocrates noted the

principal symptoms. By the age of Pericles, there were extensive references to malaria in the

literature and depopulation of rural areas was recorded. In the Susruta, a Sanskrit medical


treatise, the symptoms of malarial fever were described and attributed to the bites of certain

insects. A number of Roman writers attributed malarial diseases to the swamps.

In China, during the second century BCE, the Qinghao plant (Artemisia annua L)

was described in the medical treatise, 52 Remedies, found in the Mawangdui Tomb. In 340

CE, the anti-fever properties of Qinghao were first described by Ge Hong of the East Yin

Dynasty. Chinese scientists isolated the active ingredient of Qinghao in 1971. Known as

artemisinin, it is today a very potent and effective anti-malarial drug, especially in

combination with other medicines.

Quinine (Early 17th Century)

Following their arrival in the New World, the Spanish learned of a medicine used for

the treatment of fevers. Spanish Jesuit missionaries in South America learned of a medicinal

bark from indigenous Indian tribes. With this bark, the Countess of Chinchón, the wife of

the Viceroy of Peru, was cured of her fever. The bark from the tree was then called Peruvian

bark and the tree was named Cinchona after the countess. The medicine from the bark is

now known as the antimalarial, quinine. Along with artemisinin, quinine is one of the most

effective antimalarial drugs available today.

Discovery of the Malaria Parasite (1880)

Charles Louis Alphonse Laveran, a French army surgeon stationed in Constantine,

Algeria, was the first to notice parasites in the blood of a patient suffering from malaria.

This occurred on the 6th of November 1880. For his discovery, Laveran was awarded the

Nobel Prize in 1907.


Differentiation of Species of Malaria (1886)

Camillo Golgi, an Italian neurophysiologist, established that there were at least two

forms of the disease, one with tertian periodicity (fever every other day) and one with

quartan periodicity (fever every third day). He also observed that the forms produced

differing numbers of merozoites (new parasites) upon maturity and that fever coincided with

the rupture and release of merozoites into the blood stream. He was awarded a Nobel Prize

in Medicine for his discoveries in neurophysiology in 1906.

Naming of Human Malaria Parasites (1890,1897)

The Italian investigators Giovanni Batista Grassi and Raimondo Filetti first

introduced the names Plasmodium vivax and P. malariae for two of the malaria parasites

that affect humans in 1890. Laveran had believed that there was only one species, Oscillaria

malariae. An American, William H. Welch, reviewed the subject and, in 1897, he named the

malignant tertian malaria parasite, P. falciparum. There were many arguments against the

use of this name, however, the use was so extensive in the literature that a change back to

the name given by Laveran was no longer thought possible. In 1922, John William Watson

Stephens described the fourth human malaria parasite, P. ovale.

Discovery That Mosquitoes Transmit Malaria Parasites (1897-1898)

On August 20th, 1897, Ronald Ross, a British officer in the Indian Medical Service,

was the first to demonstrate that malaria parasites could be transmitted from infected

patients to mosquitoes. In further work with bird malaria, Ross showed that mosquitoes

could transmit malaria parasites from bird to bird. This necessitated a sporogonic cycle (the

time interval during which the parasite developed in the mosquito). Thus, the problem of


malaria transmission was solved. For his discovery, Ross was awarded the Nobel Prize in

1902.

Discovery of the Transmission of the Human Malaria Parasites (1898-1899)

Led by Giovanni Batista Grassi, a team of Italian investigators, which included

Amico Bignami and Giuseppe Bastianelli, collected Anopheles claviger mosquitoes and fed

them on malarial patients. The complete sporogonic cycle of Plasmodium falciparum, P.

vivax, and P. malariae was demonstrated. In 1899, mosquitoes infected by feeding on a

patient in Rome were sent to London where they fed on two volunteers, both of whom

developed benign tertian malaria.

The Panama Canal (1905-1910)

The construction of the Panama Canal was made possible only after yellow fever and

malaria were controlled in the area. These two diseases were a major cause of death and

disease among workers in the area. In 1906, there were over 26,000 employees working on

the Canal. Of these, over 21,000 were hospitalised for malaria at some time during their

work. By 1912, there were over 50,000 employees, and the number of hospitalised workers

had decreased to approximately 5,600. Through the leadership and efforts of William

Crawford Gorgas, Joseph Augustin Le Prince, and Samuel Taylor Darling, yellow fever was

eliminated and malaria incidence markedly reduced through an integrated program of insect

and malaria control.

The U.S. Public Health Service (USPHS) and Malaria (1914-1942)

During the U.S. military occupation of Cuba and the construction of the Panama

Canal at the turn of the 20th century, U.S. officials made great strides in the control of

malaria and yellow fever. In 1914 Henry Rose Carter and Rudolph H. von Ezdorf of the


USPHS requested and received funds from the U.S. Congress to control malaria in the

United States. Various activities to investigate and combat malaria in the United States

followed from this initial request and reduced the number of malaria cases in the United

States. The USPHS established malaria control activities around military bases in the

malarious regions of the southern United States to allow soldiers to train year round.

The U.S. Tennessee Valley Authority (TVA) - The Integration of Malaria Control with

Economic Development (1933)

U.S. President Franklin D. Roosevelt signed a bill that created the TVA on May 18,

1933. The law gave the federal government a centralised body to control the Tennessee

river's potential for hydroelectric power and improve the land and waterways for

development of the region. An organised and effective malaria control program stemmed

from this new authority in the Tennessee River valley. Malaria affected 30 percent of the

population in the region when the TVA was incorporated in 1933. The Public Health Service

played a vital role in the research and control operations and 1947 essentially eliminated the

disease. Controlling water levels and insecticide applications reduced Mosquito breeding

sites.

Chloroquine (1934, 1946)

A German, Hans Andersag discovered chloroquine, in 1934 at Bayer I.G.

Farbenindustrie A.G. laboratories in Eberfeld, Germany. He named his compound resochin.

Through a series of lapses and confusion brought about during the war, chloroquine was

finally recognised and established as an effective and safe anti-malarial in 1946 by British

and U.S. scientists.


Dichloro-diphenyl-trichloroethane (DDT) (1939)

A German chemistry student, Othmer Zeidler, synthesized DDT in 1874, for his

thesis. Paul Müller in Switzerland did not discover the insecticidal property of DDT until

1939. Various militaries in WWII utilised the new insecticide initially for louse-borne

typhus. DDT was used for malaria control at the end of WWII after it had proven effective

against malaria-carrying mosquitoes by British, Italian, and American scientists. Müller won

the Nobel Prize for Medicine in 1948.

Malaria Control in War Areas (MCWA) (1942-1945)

MCWA was established to control malaria around military training bases in the

southern United States and its territories, where malaria was still problematic. Many of the

bases were established in areas where mosquitoes were abundant. MCWA aimed to prevent

reintroduction of malaria into the civilian population by mosquitoes that would have fed on

malaria-infected soldiers, in training or returning from endemic areas. During these

activities, MCWA also trained state and local health department officials in malaria control

techniques and strategies.

CDC and Malaria (1946-present)

CDC's mission to combat malaria began at its inception on July 1, 1946. The

Communicable Disease Centre, as CDC was first known, stemmed from MCWA. Thus,

much of the early work done by CDC was concentrated on the control and eradication of

malaria in the United States. With the successful reduction of malaria in the United States,

the CDC switched its malaria focus from eradication efforts to prevention, surveillance, and

technical support both domestically and internationally. This is still the focus of CDC's

Malaria Branch today.


Eradication of Malaria in the United States (1947-1951)

The National Malaria Eradication Program, a co-operative undertaking by state and

local health agencies of 13 Southeastern states and the CDC, originally proposed by Louis

Laval Williams, commenced operations on July 1, 1947. By the end of 1949, over 4,650,000

house-spray applications had been made. In 1947, 15,000 malaria cases were reported. By

1950, only 2,000 cases were reported. By 1951, malaria was considered eradicated from the

United States.

Eradication Efforts Worldwide: Success and Failure (1955-1978)

With the success of DDT, the advent of less toxic, more effective synthetic anti-

malarials, and the enthusiastic and urgent belief that time and money were of the essence,

the World Health Organisation (WHO) submitted at the World Health Assembly in 1955 an

ambitious proposal for the eradication of malaria world wide. Eradication efforts began and

focused on house spraying with residual insecticides, anti-malarial drug treatment, and

surveillance, and would be carried out in 4 successive steps: preparation, attack,

consolidation, and maintenance. Successes included eradication in nations with temperate

climates and seasonal malaria transmission. Some countries such as India and Sri Lanka had

sharp reductions in the number of cases, followed by increases to substantial levels after

efforts ceased. Other nations had negligible progress (such as Indonesia, Afghanistan, Haiti,

and Nicaragua). Some nations were excluded completely from the eradication campaign

(most of sub-Saharan Africa). The emergence of drug resistance, widespread resistance to

available insecticides, wars and massive population movements, difficulties in obtaining

sustained funding from donor countries and lack of community participation made the long-


term maintenance of the effort untenable. Completion of the eradication campaign was

eventually abandoned to one of control.

Fall of Roman Empire because of Malaria

Could ancient children's burial ground contain clues about how one of the world's

greatest empires came to an end? Andrew Thompson explores the theory that malaria was

the silent killer responsible for the fall of Rome.

A British scientist proved conclusively that the most dangerous type of malaria was a

killer in imperial Rome. The scientist relied on the latest DNA techniques that are

revolutionising the understanding of the role of disease in ancient times. The malarial DNA

from a Roman site, dating from around AD 450, is the oldest definite evidence of malaria in

history. The finding of malaria was a remarkable and complicated piece of detective work,

which spanned the last ten years.

At its height, the Roman Empire stretched from Scotland in the Northern

Hemisphere to the deserts of Africa in the south. The empire lasted for over 500 years,

although its eastern part, the Byzantine Empire, lasted for several more centuries. When the

empire collapsed, hordes of barbarian armies, including the infamous Vandal pirates invaded

Italy throughout the fifth century AD. Rome was transformed from a bustling city of

millions to a provincial town of a few thousand, surrounded by swamps. The anarchy of the

Dark Ages had begun.

Although there has been no shortage of theories, it has never been clear why Rome

became so vulnerable to foreign invaders at this time. Political instability, the collapse of

food supplies to Rome, and even the infamous lead in the water supplies have all been


implicated. Historians have generally agreed that Rome's downfall was due to a combination

of many factors 14.

Past and present of Malaria

Mosquitoes probably originated in Africa (along with mankind), and fossils of

mosquitoes up to 30 million years old, show that the malaria vector, the malaria mosquito,

was present well before the earliest history. Hippocrates, a physician born in ancient Greece,

today regarded as the "Father of Medicine", was the first to describe the manifestations of

the disease, and relate them to the time of year and to where the patients lived. Before this,

the supernatural was blamed. The association with stagnant waters (breeding grounds for the

Anopheles mosquito) led the Romans to begin drainage programs, the first intervention

against malaria.

The first recorded treatment dates back to 1600, when the bitter bark of the Cinchona

tree in Peru was used by the native Peruvian Indians. By 1649, the bark was available in

England, as "Jesuits powder," so that those suffering from "agues" might benefit from the

chemical substance quinine, which it contained. Not until 1889 was the protozoal (single

celled parasite) cause of malaria discovered by Alphonse Laveran working in Algeria, and

only in 1897 was the Anopheles mosquito demonstrated to be the vector for the disease by

Ronald Ross 15.

It was the army surgeon, Ronald Ross, who undertook the experimental testing of the

mosquito-theory, proposed by both Laveran and the investigator, Patrick Manson. The

solution came from India, while Ross was commissioned in the Indian Medical Service, and

in the late 1890s the mosquito hypothesis could be established.


Malaria Control Operation

The discovery of the insecticide DDT in 1942, by Paul Müller the Nobel Prize

Laureate in Physiology or Medicine, 1948, and its first use in Italy in 1944, made the idea of

global eradication of malaria seem possible. Subsequently, widespread systematic control

measures such as spraying with DDT, coating marshes with paraffin (to kill Anopheles

mosquito larvae), draining stagnant water, and the widespread use of nets and cheap,

effective drugs such as chloroquine were implemented - with impressive results. Despite

initial success, there was a complete failure to eradicate malaria in many countries due to a

number of factors. Although technical difficulties such as mosquito and parasite drug

resistance have played a part, the main failure to reduce the disease is probably due to social

and political factors preventing efficient application of control measures.

Despite the setbacks, up until 1969, when the global eradication policy was finally

abandoned, the following European countries had managed to completely eradicate endemic

malaria by interrupting transmission: Hungary, Bulgaria, Romania, Yugoslavia, Spain,

Poland, Italy, Netherlands and Portugal.

From the early 1970s, the malaria situation has slowly and progressively deteriorated

and reduced control measures between 1972 and 1976, due to financial constraints, led to a

massive 2-3 fold increases in cases globally. Spraying never truly eradicated the mosquitoes

anywhere, and the reduction in the more persistent P. vivax infections were much less than

for P. falciparum - though the latter returned in much greater strength as control measures

waned. The growing interchange of populations between countries where malaria is

prevalent and malaria free countries is responsible for the continuous increase in the number

of imported malaria cases in European countries, and causes serious concern because of


possible epidemic focal resurgence in receptive areas such as the Mediterranean. Since

1976, several new pockets of malaria transmission have evolved, and a WHO 1980 report

recommended that countries, which had become non-malarious should maintain at least one

malaria vigilance unit.

The World Health Organization (WHO) warned about increased risk of vector-

borne diseases such as malaria and dengue fever across tsunami-affected areas in Southeast

Asia. Nearly four weeks after the disaster struck the region on 26 December, the

organization is strengthening its disease surveillance, as stagnant water conditions create

conditions for mosquito vectors to multiply to sufficient levels to potentially cause severe

public health problems.

Most affected countries in the region are endemic for dengue fever and malaria

except the Maldives, which has no malaria cases but does have dengue cases. With the onset

of the rainy season, particularly in Indonesia and Sri Lanka, a rise in the cases can be

expected at this time of the year 16.

According to the World Health Organisation, the following statistics reveal the

spread of malaria in the world. Africa: Ninety-seven million cases of malaria a year. The

tropical region’s leading killer of children claims five percent under five. Latin America:

One million cases a year. The settlement of people in mosquito-infested rain forests in Brazil

has exposed millions to the disease. Asia: Nine million cases a year. New, hard-to-treat

strains are rapidly gaining ground 17.

Malaria control – philately

It is fantasising for a researcher to observe in various angles, the topic chosen. The

Malaria, a disease caused by an insect placed it self in the philately because of its


importance. No other country other than India releases a stamp on a Mosquito. The Malaria

eradication programme is to be recollected and on the occasion 4 Annas (25 Paise) stamp is

released by the Indian Postal Department is shown below.

Figure – 3Postal Stamp released by Government of India on the occasion of Malaria control

Epidemiology

Malaria is primarily a disease of the tropics and subtropics and is widespread in hot

humid regions of Africa, Asia and South and Central America. The disease was also

common in many temperate areas including the USA, Europe and northern Eurasia and

Asia, but has been eradicated. In many areas, which previously had malaria under control,

are experiencing resurgence 18. The four human malarial species exhibit an overlapping

geographical distribution (Box). P. vivax and P. falciparum are the most commonly

encountered species with P. vivax being the most wisespread geographically. Mixed

infections are common in endemic areas. "Everything about malaria is so moulded by local

conditions that it becomes a thousand epidemiological puzzles." Hackett (1937)

The above quote emphasises the complexity of malaria and the many facets the

disease exhibits. Different communities will experience different malaria and consequently


different control and treatment strategies may be necessary. The intricate interactions

between host, parasite, and vector are the major factors in this epidemiological complexity.

The fundamental problem of developing drugs for tropical diseases are too expensive

for widespread use of poor countries. Ayurveda may contribute a lot for the utilisation of our

own resources. The Ayurvedic method of treatment in Vishamajwara has been claimed

effective either in single/compound drug therapy. Sudarsana Churna has been used for the

treatment of Vishamajwara since Sarangadhara period (1400 A.D). Even the contemporary

Ayurvedic practices the same is considered as very effective and potent treatment modality

in Vishamajwara of “all types”. It also claimed to be effective any kind of jwara including

malarial fever as diagnosed by modern clinical-parasitology.

Vishamajwara, literally meaning irregular fever, is very vast. It may be remittent

type or intermittent type as keetanu (micro-organisms) have been incriminated as one of the

causes of Vishamajwara. The major cardinal symptoms of Vishamajwara i.e. Fever with

chill and rigor have been observed to be present in other disease including Malaria, which is

a protozoal disease caused by plasmodia group of organism and transmitted to man

primarily by certain species of infected female anopheles mosquitoes 19.

Jwara (fever) and Vishamajwara (Malaria)

Ayurveda mentioned jwara as the synonym of the disease or a febrile condition.

“From among all disorders fever deserves to be described fist, it being the foremost of all

somatic diseases”. Charaka mentioned jwara afflicts body, mind and sense organs, regulates

the well being of life. Chakrapani described jwara as “jwarayati santapayati” i.e. disease

associated with burning manifestation is known as jwara 20-21.


The disease Vishamajwara is included under the jwara roga in Ayurveda. Jwara is a

broad term, which has versatile meaning. If we analyse the etymological derivation of the

term we see that the word jwara is derived from the “jr” or “jya”. The jr. indicates vayohani

or loss of life span. It indicates the state of cellular destruction produces more temperature.

Vishamajwara characterised by visamarambha (irregular onset) 22 visama kriya

(alternative feeling of hot and cold) and visamakala (irregular duration of sufferings) 23 of

jwara. Susruta believed this to be caused by agantuka Karana or parahetu (external factor) 24.

This parahetu is more cleared by commentator Dalhana as bhutabhisanga. Bhutabhisanga 25

can be correlated with parasitic infection as discussed in modern medicine.

History and background of Vishamajwara

VAIDAIC PERIOD:

Jwara is the term originated by the anger of Rudra. Rudra is known as god of

destruction in Hindu mythology. Jwara is the king of all diseases and known by different

terms in various animals also i.e. Pakala for the jwara of elephants and abhitapan for horses’

etc. Vishamajwara is the varieties of jwara, which can be identified by its peculiarity of

visamata (irregularity) 26.

The description of Vishamajwara was known from ancient era. In “UPANISHAD”

(400B.C) visamajwara is described as “TAKMAN”. It is described that the jwara having

dahana and shosana properties, which attacks like fire (Agni) and they’re by the patient runs

like a mad. For it’s relief chanting of mantras has been described to pray God 27.

Atharva Veda has also described Vishamajwara causes that in the body like Agni (fire)

patients feels very much uneasiness and sometime comes in the state of pralapa (delirium)

and die. The attack of triteeyaka and santatajwara follows in sarat (autumn), varsa (rainy


season) and grishma kala (summer season) or in the state of sheeta and ruksha. Atharva

Veda described the following types of Vishamajwara 28. These are -

1. Triteeyaka

2. Chaturthaka

3. Satataka

4. Sharada

5. Grishmika

6. Varsakalika

Atharva-Veda is also described that takman is a periodic fever manifested with rigor,

trembling and pain particularly in head. It is accompanied by debility and cough and ends in

pallor or yellow-ness. It is endemic in particular places like Manjavan, Mahavrsa, Gandhara,

Anga and Magadha 29.

It is a clear picture of Vishamajwara of malarial origin. Sayana calls it sitajwara.,

sitajanka (chill fever) 30 and kricchra jivanakrit (making life troubled). Whitney translates it

as ‘fever’31.

Synonyms in Vedas

The synonyms of jwara are tapah, shushmi, Shoka, abhishoka, rudraha, papma,

amarthya vigadh, vyangah, sheersha, parbheta and sochi etc. mentioned in the Veda are said

to be developed due to rudrakopa 32.

Samhita & Sangraha kala

Wide description of Vishamajwara is found in Samhita granthas like, Charaka,

sushrut, bhela, harita, kashyapa, Madhava, sarangadhara, bhavaprakash, yogaratnaka etc.

Kashyapa considered that in the Vishamajwara specific properties of jwara are found in a


irregularity manner. He enumerated the Vishamajwara as follows santataka, satataka,

anyeduska, triteeyaka and chaturthaka considering the days of its onset. According to

Kashyapa the aetiology lies as - if one takes exercise, heavy meal, unsuitable diet, excess

drinking of water or milk, blackgram preparation, recent curd, paste of tila, village animal

flesh, virudhahara (incompatible food), day sleeping and takes much food before the

digestion during the period of jwara temperature goes on rising and attains the stage of

Vishamajwara. He also described not to take Kashaya during the Amavastha or

Tarunavastha of jwara etc. which may leads to Vishamajwara 33. Bhaluki considered that the

jwara that comes with cold or hot stage with temperature rise or low is uncertain in

Vishamajwara 34.

Charaka described that all the Vishamajwara are tridoshaja 35 in origin. Susruta

considered that the Vishamajwara occurs due to Tridosha but Vata is the dominant Dosha.

He considered the Agantuka Karana (external cause) of which bhutabhishanga constitute

one of the variety in the main aetiology for Vishamajwara 36.

Vagbhata defined Vishamajwara, as the jwara is irregular in respect to its onset,

suffering and symptoms. The mandagni during adanakala is one of the important causes of

Vishamajwara. He also advocated if an emaciated patient who takes irregular diet during

convalescent period in spite of residual of small quantity of Dosha may causes

Vishamajwara 37.

According to Hareeta 38 the Vishamajwara is five types such as vataja, ekaikajwara,

dwahieka jwara, triahika jwara, chaturthakjwara. Chakrapani opinions, the poisonous insects

may be considered under the word bhuta. Dalhana consider bhutas responsible to produce

Vishamajwara. Madhavkara 39 views as bhuta plays an important role for Vishamajwara too.


In Amarkosh the bhuta means keetanu. Jejjata considered Vishamajwara as

tridoshaja in origin. Most of the authors considered five types of Vishamajwara.

Bhavamishra and Madhavakara have included pralepaka jwara also in the group of

Vishamajwara.

Clinical Features of Malaria

Fever is the commonest reason for hospital attendance in rural India. In recent past,

Malaria was the main reason for fever. Even today, probably malaria may rank first.

Outbreaks of fever are regularly reported from health workers and health institutions. Now-

a-days after malaria, dengue fever has become important cause of fever outbreaks 40.

Malaria is a febrile illness characterised by fever and related symptoms. However it

is very important to remember that malaria is not a simple disease of fever, chills and rigors.

In fact, in a malarious area, it can present with such varied and dramatic manifestations that

malaria may have to be considered as a differential diagnosis for almost all the clinical

problems! Malaria is a great imitator and trickster, particularly in areas where it is endemic.

All the clinical features of malaria are caused by the erythrocytic schizogony in the

blood. The growing parasite progressively consumes and degrades intracellular proteins,

principally haemoglobin, resulting in formation of the 'malarial pigment' and hemolysis of

the infected red cell. This also alters the transport properties of the red cell membrane, and

the red cell becomes more spherical and less deformable. The rupture of red blood cells by

merozoites releases certain factors and toxins (such as red cell membrane lipid, glycosyl

phosphatidyl inositol anchor of a parasite membrane protein), which could directly induce

the release of cytokines such as TNF and interleukin-1 from macrophages, resulting in chills

and high grade fever. This occurs once in 48 hours, corresponding to the erythrocytic cycle.


In the initial stages of the illness, this classical pattern may not be seen because there could

be multiple groups (broods) of the parasite developing at different times, and as the disease

progresses, these broods synchronise and the classical pattern of alternate day fever is

established. It has been observed that in primary attack of malaria, the symptoms may

appear with lesser degree of parasitemia or even with sub-microscopic parasitemia.

However, in subsequent attacks and relapses, a much higher degree of parasitemia is needed

for onset of symptoms. Further, there may be great individual variations with regard to the

degree of parasitemia required to induce the symptoms.

The first symptoms of malaria after the pre-patent period (period between

inoculation and symptoms, the time when the sporozoites undergo schizogony in the liver)

are called the primary attack. It is usually atypical and may resemble any febrile illness. As

the disease gets established, the patient starts getting relapse of symptoms at regular

intervals of 48-72 hours. The primary attack may spontaneously abort in some patients and

the patient may suffer from relapses of the clinical illness periodically after 8-10 days owing

to the persisting blood forms of the parasite. These are called as short term relapses

(recrudescences). Some patients will get long term relapses after a gap of 20-60 days or

more and these are due to the reactivation of the hypnozoites in the liver in case of vivax and

ovale malaria. In falciparum and malariae infections, recrudescences can occur due to

persistent infection in the blood.

Atypical features

In an endemic area, malaria often presents with atypical manifestations.

Atypical features are more common in the following situations:

• Falciparum malaria


• Early infection

• Patients at extremes of age

• Patients who are immune-compromised (extremes of age, malnourished, AIDS,

tuberculosis, cancers, on immunosuppressive therapy etc.)

• Patients on chemoprophylaxis for malaria

• Patients who have had recurrent attacks of malaria

• Patients with end stage organ failure

• Last but not the least, pregnancy.

Atypical fever:

In an endemic area, it is rather unusual to find cases with typical fever pattern. Some

patients may not have fever at all and may present with other symptoms listed below. Many

present with fever of various patterns - low grade to high grade, with or without chills,

intermittent to continuous, or even as cases of prolonged fever. In the initial stages of the

illness, fever may be quotidian, with more than one spike per day and this is due to the

development of multiple broods of the parasite. As the disease progresses, these broods get

synchronised and the fever tends to be more uniform. However in cases of P. falciparum

malaria and mixed infections, this pattern of multiple spikes may continue.

Headache:

Headache may be a presenting feature of malaria, with or without fever. It can be

unilateral or bilateral. Some times the headache could be so intense that it may mimic intra-

cranial infections or intra-cranial space occupying lesions. It may also mimic migraine,

sinusitis etc. Presence of projectile vomiting, papilloedema, neck stiffness and focal

neurological signs would suggest other possibilities.


Body ache, backache and joint pains:

These symptoms are fairly common in malaria. These can occur even during the

prodromal period and at that stage these are generally ignored and diagnosis of malaria is

impossible owing to lack of peripheral parasitemia. They are also common accompaniments

of the malaria paroxysm. Sometimes, malaria may present only with these symptoms,

particularly in cases of recurrent malaria.

Dizziness, vertigo:

Some patients may present with dizziness or vertigo, with or without fever. They

may also have associated vomiting and/or diarrhoea. This may mimic labyrinthitis,

Menniere's disease, vertebro-basilar insufficiency etc. Rarely patients may present with

swaying and cerebellar signs. Drugs like chloroquine, quinine, mefloquine and halofantrine

can also cause dizziness, vertigo, and tinnitus.

Altered behaviour, acute psychosis:

Patients may present with altered behaviour, mood changes, hallucinosis or even

acute psychosis, with or without fever. Malaria may be detected accidentally in such cases

and they improve completely with anti malarial therapy. Altered behaviour may also be due

to high grade fever or drugs. Antimalarial drugs like chloroquine, quinine, mefloquine and

halofantrine can cause restlessness, hallucinations, confusion, delirium or even frank

psychosis.

Altered sensorium:

Patients with P. falciparum malaria may present with altered sensorium due to severe

infection, hypoglycemia, electrolyte imbalance due to vomiting or diarrhoea (particularly the

elderly), hyperpyrexia, subclinical convulsions etc. Differential diagnosis will include acute


encephalitis, meningitis, metabolic encephalopathy etc. As a rule of the thumb, malaria

should be considered a possibility in all cases of acute neuropsychiatric syndromes and in

cases of proven malaria, other possibilities should be considered in the presence of

papilloedema, increasesd ICT, neck stiffness and focal deficits.

Convulsions, coma:

Patients with cerebral malaria present with generalised seizures and deep

unarousable coma. Sometimes one single fit can precipitate deep, unarousable coma. These

could also be due to hypoglycemia and all patients presenting with these manifestations

should be administered 25-50% dextrose immediately. Drugs like chloroquine, quinine,

mefloquine and halofantrine may also trigger convulsions.

Cough:

Cough may be a presenting feature of malaria, particularly P. falciparum infection.

Patient may have pharyngeal congestion and features of mild bronchitis. Patients who have

persistent cough and/or fever even after clearance of parasitemia should be evaluated for

secondary bacterial pneumonias/ bronchopneumonia and bronchitis.

Breathlessness:

In severe falciparum malaria, patients may present with history of breathlessness,

due to either severe anemia or non-cardiogenic pulmonary oedema. Secondary respiratory

tract infections and lactic acidosis are other rarer causes for tachypnoea and/or

breathlessness in these patients. Patients with pre-existing cardio-vascular or pulmonary

compromise may deteriorate or even die if they suffer from severe malaria.


Chest pain:

Acute retrosternal or precordial pain may be presenting feature of malaria. It may

radiate to the left or right shoulder tips or arms. It is due to rapid increase in the splenic size

and perisplenitis. This pain may mimic acute myocardial infarction, pleurisy, neuralgia etc.

Coupled with breathlessness, sweating and hypotension (algid malaria), the picture will very

closely resemble that of acute MI.

Acute abdomen:

Patients can present with acute abdominal pain, guarding and rigidity, mimicking

bowel perforation, acute appendicitis, acute cholecystitis, ureteric colic etc.

Weakness:

Sometimes patients may present with history of weakness, malaise and prostration.

On examination they may have significant pallor, hypotension, dehydration etc. Algid

malaria may present like this and the patient may not have fever at all. Chloroquine is also

known to cause profound muscular weakness and a new disease called macrophagic

myofaciitis has been described in patients receiving chloroquine.

Vomiting and diarrhoea:

Malaria can present as a case of acute gastroenteritis with profuse vomiting and

watery diarrhoea (Choleraic form). Vomiting is very common in malaria and is due to high

grade fever, the disease itself or even drugs. Vomiting may pose problems in administering

antimalarial treatment. These could also be due to drugs like chloroquine and due to

secondary bacterial or amebic colitis.


Jaundice:

Patients may present with history of yellowish discoloration of eyes and urine. Mild

jaundice is fairly common in malaria and may be seen in 20-40% of the cases. Deeper

jaundice with serum bilirubin of more than 3 mg/dL is seen in severe P. falciparum malaria

and is associated with anemia, hyperparasitemia and malarial hepatitis with elevated serum

enzymes. Malaria must be considered as a differential diagnosis for all cases of jaundice in a

malarious area.

Pallor:

Severe anemia can be a presenting feature of malaria. It is usually normocytic

normochromic. It may pose special problems in pregnancy and in children. Pre-existing

nutritional anemia may be aggravated by malaria.

Puffiness of lids:

Occasionally patients may present with puffiness of lids, with or without renal

dysfunction.

Secondary infections:

Malaria produces significant immune suppression and this can result in secondary

infections. Common among them are pneumonia, aspiration bronchopneumonia (in the

elderly), urinary tract infection, colitis etc. Meningitis and enteric fever have also been

reported. In falciparum malaria, severe infection can lead to septicaemic shock (algid

malaria). Persistence of fever, neutrophilic leucocytosis and focal signs of infection should

always alert the clinician to this possibility of secondary infections.


Hepatosplenomegaly:

Patients can present with enlargement of liver and/or spleen, tender or non-tender,

with or without fever. Rapid enlargement of spleen or liver in malaria can cause acute pain

in the abdomen or chest. Generally, organomegaly is noticed in the second week of malarial

illness. However, in cases of relapse or recrudescence, it may be present earlier. Also, in

immune compromised patients splenomegaly may be absent. In pregnancy, particularly

second half, splenomegaly may be smaller or an enlarged spleen may regress in size due to

immune suppression. Although splenomegaly is a cardinal sign of malaria, absence of

splenomegaly does not rule out the possibility of malaria.

Combinations of the above:

Patients can frequently present with various combinations of the above mentioned

symptoms and signs, further confusing the picture.

This list is not exhaustive and malaria may present in many other ways. In all the

above listed situations, patients may not have associated fever, thus confusing the picture. In

some, fever may follow these symptoms. Therefore, one should not wait for the typical

symptoms of malaria to get a blood test done; it is always better to do a smear whenever

reasonable doubt exists.

Pathophysiology of Malaria:

The bite of an infected mosquito introduces asexual forms of the parasite, called

sporozoites, into the bloodstream. Sporozoites enter the hepatocytes and form schizonts,

which are also asexual forms. Schizonts undergo a process of maturation and multiplication

known as preerythrocytic or hepatic schizogony. In Plasmodium vivax and Plasmodium


ovale infection, some sporozoites convert to dormant forms called hypnozoites, which can

cause disease after months or years.

Preerythrocytic schizogony takes 6-16 days, and results in the host cell bursting and

releasing thousands of merozoites into the blood. Merozoites enter the erythrocytes and

initiate another asexual reproductive cycle, known as erythrocytic schizogony. The parasite

passes successively through the stages of trophozoite and schizont, ultimately giving rise to

several merozoites. On maturation of these merozoites, the erythrocyte ruptures, releasing

the merozoites and multiple antigenic and pyrogenic substances into the bloodstream. These

merozoites again infect new erythrocytes. After a few cycles of this erythrocytic schizogony,

some merozoites differentiate into the sexual forms: the male and female gametocytes. A

mosquito that takes a blood meal from a patient with gametocytemia acquires these sexual

forms and plays host to the sexual stage of the plasmodial life cycle.

Figure – 4

Life cycle schematic diagram


Figure –5

Sporogonic and Erythrocytic cycles of Malaria

Rupture of a large number of erythrocytes at the same time releases a large amount

of pyrogens, which causes the paroxysms of malarial fever. The periodicity of malarial fever

depends on the time required for the erythrocytic cycle and is definite for each species.

Plasmodium malariae needs 72 hours for each cycle, leading to the name quatrain malaria.

The other 3 species each take 48 hours for one cycle and cause fever on alternate days

(tertian malaria). However, this periodicity requires all the parasites to be developing and

releasing simultaneously; if this synchronization is absent, periodicity is not observed 41.


Figure – 6

Exogenous and Endogenous Phases of Malaria

Life cycle of Malaria

The life cycle of all human malaria species consists of two phases a sexual phase

(sporogony), with development and multiplication in certain female anopheline mosquitoes

and an asexual phase (schizogony) with multiplication in man.

The asexual phase in man has two parts, schizogony in the cells of liver

(preerythrocytic schizogony or tissue phase) and schizogony in the red cells (erythrocytic

schizogony or erythrocytic phase).


Asexual phase in human host

Tissue phase

Sporozoites are inoculated by infected mosquito into the host and disappear from

circulation within half an hour. Some enter the parenchymal cells of liver where they

undergo development and multipication, known as pre-erythrocytic schozogony.

The tissue schizont which develops from the sporozoite enlarges and the nucleus and

cytoplasm divide to form many thousands of merozoites which after 6-16 days rupture the

liver cells and invade the circulation, where they enter the red cells by a process of

invagination. The prepatent period is the time from infection until the appearance of

parasites in the blood and varies with the species of parasite (P. vivax 6-8 days, P. malariae

2-16 days, P. ovale 9 days. P. falciparum 51/2 –7 days).

Exoerythrocytic schizogony

In P. vivax and the P. ovale malaria some of exacoythrocytic trphozortes orginating

from sporozoites lie dormant and are known as hypnozoites. After a period of up to 250 days

they they become active and mature, allowing merozoites to infect red cells and give rise to

an erythrocytic phase. This is the mechanism responsible for delayed prepatent periods and

relapses in P. vivax and P. ovale malaria.

Erythrocytic phase

To enter the red cell the merozoite binds to glycophorin, the major erythrocytic

glycoprotein, which is psecific for a particular species of parasite. The apex of merozoite

releases a substance which forms a deep pit in surface of red cells and, maintaining contact

bya contact ring, the merozoites are enveloped by the red cell in a vacuole (parasitophorous

vacuole) in which it is enclosed. In the red cell the merozoites develop into ringforms which


grow in size to trophozoites absorbing haemoglogin leaving a pigment (haematin or

haemazoin) – a combination of haemoglobin with protein which can be seen as dark

granules. The trophozoite multiplies by schizogony dividing into a number of small

merozoites varying with species to form mature schizont. The merozoites are released by

rupture of red cell membrane and enter new red cells, particularlyyoung red cells. The

erythrocytic phase called schizogonic periodicity, which differs according to the species of

parasite, is responsible for the febrile paroxysms. In the early stages of infection there may

be several broods of parasites developing at different times so that there is no regular

periodicity, but with development of immunity the periodicity settle down and becomes

regular.

Gametogony

After a period some merozoites give rise to two sexually differentiated forms of

gametocytes male (microgamete) and female (macrogamete) which differ in morphology in

the different species of parasite. These gametocytes are taken up by female anopheline

mosquitoes and they undergo development.

Sexual phase in anopheline mosquitoes

In the stomach of mosquito the female gametocyte forms a macrogamete and the

male a microgamete. The male gamete nucleus divides and forms a number of long slender,

thread like structure or flagellae (exflagellation). These enter the female gamete and fuse to

form a zygote, which becoming mobile as an olkinete and penetrating between the epithelial

cells leaving the stomach, comes to rest on the outer surface of the stomach wall to form an

oocyst, of which there may be several hundreds in one stomach. In the oocyst a large

number of slender sporozoites form which burst out into the body cavity and enter the


salivary glands ready to be inoculated into a new host at the next blood meal. The duration

of cycle in the mosquito is known as the extrinsic incubation period. It varies according to

the temperature being 8-10 days at 28°C, 16 days at 20°C and cannot be completed under

15°C.

Frequency:

• Internationally: Malaria is a major health problem in Africa, Asia, Central America,

Oceania, and South America. About 40% of the world's population live in areas

where malaria is common. Approximately 300-500 million cases of malaria occur

every year, and 1-2 million deaths occur, most of them in young children.

• In the US: Approximately 1000 cases are diagnosed every year, most of them

acquired outside the country. Only about 1% of patients acquires the infection in the

United States. Usually fewer than 10 deaths are reported in the United States

annually.

Mortality/Morbidity:

• Cerebral malaria: Most of the mortality of malaria is due to this complication of

Plasmodium falciparum malaria, an acute illness that is mostly observed in children

aged 6 months to 3 years. Early diagnosis and prompt treatment with a drug to which

the parasite is susceptible is important to save the life of the child.

• Anaemia: Anaemia is so common in malaria that it is considered almost a part of the

disease. The degree of anaemia is much greater than can be explained by destruction

of parasitized erythrocytes. Malarial anaemia can be quite severe, sometimes causing

death.


• Repeated frequent seizures: Even without cerebral malaria, a child can experience

prolonged, frequent convulsions, which can lead to prostration and death.

Race: People of all races are affected, with some exceptions. People of West African origin

who do not have the Duffy blood group are not susceptible to P vivax malaria.

Sex: Malaria affects females and males equally.

Age: Children of all ages living in non-malarious areas are equally susceptible to malaria. In

endemic areas, younger children are repeatedly have and often serious attacks of malaria.

The survivors develop partial immunity. Thus, older children and adults often have

asymptomatic parasitemia, i.e., and presence of plasmodia in the bloodstream without

clinical manifestations of malaria. Most deaths resulting from malaria occur in children

younger than 5 years 42.

DIFFERENTIAL DIAGNOSIS

There are many other conditions that may mimic malaria fever. A careful history and

examination with the aid of the laboratory, when necessary, will often resolve the difficulty.

a. Malaria — This may be mistaken for typhoid in countries where both are endemic. A

history of previous attacks, the more rapid onset in malaria, the shivering and sweating, the

high early pyrexia, the relative infrequency of abdominal symptoms and signs, and a

positive blood slide all point to a diagnosis of malaria.

b. Influenza — Influenza may also be confused with typhoid, but is usually of much more

rapid onset with high temperature, severe sore throat, cough, and the absence of a palpable

spleen and rose spots.

c. Bacillary dysentery — This disease seldom causes much difficulty in diagnosis. The

onset is usually acute, with severe blood diarrhoea, although in mild cases the blood may be


absent. Diarrhoea with blood is rare in early typhoid. The signs and symptoms in dysentery

are usually abdominal and remain so, the mental state and chest being clear.

d. Typhus and other rickettsial infections — These conditions should be considered

important when considering the differential diagnosis. This is because both typhus and

typhoid can cause a febrile illness with delirium, chest signs, and abdominal discomfort. In

typhus, however, the onset is acute, and the temperature high at an early stage. Shivering

attacks are common at the onset, and prostration is rapid.

The rash is quite different (brownish red in colour, and much more profuse). It does

not fade on pressure, as does the rose spot in typhoid. There is a leucocytosis and the Weil-

Felix test becomes significantly positive at about the tenth day.

e. Pulmonary tuberculosis and atypical abdominal tuberculosis — These are probably

the most difficult diagnoses to differentiate from typhoid in economically poor countries.

The pyrexia and vague symptoms and signs may be very similar. A chest X-ray, or

laboratory confirmation of typhoid, may be the only sure method of diagnosis.

f. Brucellosis — This may cause difficulty, but the onset tends to be more insidious. The

patient is also alert, and a painful joint is frequently present.

g. Trypanosomiasis — This condition in endemic areas should also be considered in the

differential diagnosis.

h. There are numerous other diseases — Some other diseases could enter into the

differential diagnosis category and some of these are illustrated. Suffice to say that there are

few conditions that cannot mimic, or be mimicked by, typhoid fever.


Nidana of Jwara: (Aetiology)

The causative factor may be sarnikristha Nidana (immediate cause) and/or

viprakristha Nidana (distant cause). So these two factors are responsible for vyadhijanaktva

as well as Vyadhi bodhakatva. On the basis of the above all the factors like Bahya (external)

as jeevanu, mithya Ahara vihara etc. and the internal factor is vitiated Dosha and dushya.

Gananath Sen described the external cause like abhighata (trauma). Jeevanu (parasite or

microbes) and mithya Ahara-vihara (defective food and habits) are causes for

Vishamajwara.

Role of Ahara and Vihara 43

Unsuitable food and drinks are provocative of Vata. Pitta and Kapha and ultimately

may cause the development of Vishamajwara. According to Vagbhata if Shodhana is given

in Nava-Jwara cases when there is Indigestion State, aggravated Dosha becomes the cause

of Vishamajwara. According to Yadvji Trikamji emaciated and weak patients if take ahita

Ahara-vihara in course of time it produces Vishamajwara. So aetiology of Vishamajwara is

discussed under following heads.

Factors relating to Ahara -

1. Kasaya Dravya sevana

2. Ruksha Dravya sevana

3. Ushna drvya sevana

4. Shitambu pana

5. Santarpan Dravya sevana

6. Anupamansa bhakshana

7. Pinaka bhojana


8. Asatmya Dravya bhojana

9. Virudha Padartha bhojana (antagonist food)

10. Ahita Ahara sevan

Factors relating to vihara

1. Visa ausadhi gandha sevan

2. Divaswapna (day sleeping)

3. Mithya vihar (the habits which is not good for health)

4. Sorrowfulness

Others –

1. Aupasargika Karana

2. Rutuparivartana

3. Kroda

4. Bhaya

Flow chart -1Classification of aetiology of Vishamajwara

Abhichara Abhishanga Abhighata Abhishapa

Ahara

Vihara

Dosha Bhutabhishanga Mahabhishanga

Kala

Prakruti Keetanu

Drushya Adrushya(Macroscopic) (Microscopic)

Nija (Internal) Agantuja (External)


Role of bhuta (Keetanu) in Vishamajwara

Susruta believed that Vishamajwara takes place due to agantuka Karana (external

cause). Agantuka is divided into 4 types i.e., abhighata, abhichara, abhishapa and abhisanga.

Dalhana considered abhisanga as bhutavisanga. Chakrapani stated poisonous insects may be

considered as bhuta. According Amarkosha it is keetanu. Therefore the keetanu introduced

the body by its corresponding portan entry and aggravates the doses. The time taken from

the entry to manifestation of disease is known as sanchaya kala (incubation period). After

sanchaya the doshas follow their normal pathway to travel for manifestation of diseases. But

in this instance which Dosha is principal may be considered on the type of keetanu and the

strain of keetanu 44. Regarding the vectors, Charaka mentions countries which abound

mashaka (mosquitoes), mooshaka (rats) and makshika (flies) as unhealthy 45. In Charaka, it

is stated that “unsanitary winds, unsanitary water, unsanitary countries and unsanitary

seasons are cause of catastrophes. Water is considered to be more important than wind, and

country more important than water and season yet more important than country by virtue of

their degree of indispensability 46. In this statement one can see the rudimentary concept of

germ theory and epidemiology.

Relation of Dosha in Vishamajwara

Ayurvedic doctrine based on the Tridosha theory. The three Doshas are responsible

for all diseases when they are deranged. The vitiated Dosha after localising in Dhatus of the

body are responsible to produce diseases. Through it is described in all classical texts that

Vishamajwara is tridoshaja but Vata plays an important role. Charaka described that

Vishamajwara is developed due to vitiation of Tridosha, but according to predominance of

Dosha different features of its varieties may be noticed 47.


According to Susruta Vishamajwara is due to predominance of Vata and Kapha,

because patient feels chill and rigor during first stage. Vagbhata described due to vitiation of

three Doshas, five types of Vishamajwara occur. Jejjata described Vata plays an important

role in Vishamajwara where as Pitta and Kapha remain quiescent stage. According to

Hareeta predominance of Vata, Pitta and Kapha Dosha causes Vatolbana, Pittolbana and

Kaholbana Vishamajwaras in 14th, 18th and 22nd days respectively. According to Ayurvedic

scholars the seat of jwara is stated to Amashaya. The three doshas (samana vayu, pachahaka

Pitta, Kledakakapha remain in Amashaya in jwara the Pitta is mainly involved with

Samanavata and Kledakakapha. Jwara occurs in whole body by the circulation of blood with

the help of Vyanavata. Besides all the factors Pitta plays an important role for producing

jwara. So description of Pitta may not be out of place. Tapa (temperature) and daha (burning

sensation) are due to Pitta. Pitta regulates the normal body temperature along with other

functions also.

Role of dushya in Vishamajwara

In Vishamajwara the Doshas are not only localised in Rasa Dhatu like other jwara.

But Rakta, mamsa, meda asthi and majja Dhatu are also involved subsequently as stated by

Charaka, Susruta and Vagbhata in the following manner as regard its seat in particular

Dhatu.

1. Rasa Dhatu – Santata jwara

2. Rakta Dhatu- Satata jwara

3. Mansa Dhatu – Anyedushka jwara

4. Meda Dhatu – Triteeyak jwara

5. Asthi Dhatu – Chaturthak jwara

6. Majja Dhatu – Chaturthak jwara


Relation of vega in Vishamajwara 48

As a seed lies dominantin the soil and grows up in favourable time, Doshas stay in

Dhatus and get vitiated in opportune time. The Dosha having attained exacerbation and

timely strength due to weakening of the contracting factor gives to the tertian as well as the

quatrain fever. After the paroxysm, the Doshas being weakened stay in their respective

places and being reinforced in their opportune times again give rise to fever.

Role of Prakruti

Prakruti plays pivotal role in occurrence and prognosis of diseases. According to

deha Prakruti the Dosha kalpana is also considered. The Vishamajwara due to Kapha is

difficult to cure in Kapha Prakruti because in this disease the Vata and Pitta are less

powerful. Similarly Pittolbana is difficult to cure in Pitta Prakruti and Vatolbana is difficult

to cure in Vata Prakruti. 49

Role of kala in Vishamajwara

The rise of temperature at the end of the day, end of the night is due to Vata dosha,

the same rises in the mid-day and mid night due to Pitta Dosha. The rise is during morning

and evening hours due to Kapha Dosha respectively. Besides these, same disease is

produced in particular season. According to the principles of Ayurveda Vata is aggravated in

varsa, Pitta in sharat and Kapha in vasanta. If a person takes “mithya ahar-vihar” in a

particular season the particular Dosha of that season is provacated. The aggravated doshas

interact Rasa and other Dhatu and ultimately produces Vishamajwara.

Samprapti (pathogenesis)

Jwara is defined as “santapo deha manasa” i.e., body and mind equally disturb in

fever along with derangement of Agni, Ama, srotaes and rogamargas etc.


Role of Agni in Vishamajwara

Among the thirteen types of Agni, the Jataragni is most important 50. It digests the

food and controls all other pittas. The Pachakapitta remains in Grahani and stimulates

dhatwagni. If a person adopts mithya Ahara and vihara for a long time then the imbalance

Dosha localised in Amashaya, disturb the functions of the same and displace Agni.

Therefore, activity of Agni becomes impaired in Amashaya but enhances in Dhatu.

Ultimately there is formation, of Ama Rasa and obstruction of Rasavaha and swedavaha

srota giving rice to different clinical features known as jwara roga.

Role of Ama in Vishamajwara

Ama is defined as undigested food particles, which subjected to less amount of Agni

as desired. This Ama is produced in Amashaya as a result of aharapaka. Ama may be

grouped into two parts (1) local and (2) systemic. The systemic effects of Ama (Amarasa)

which sticky in nature obstruct the fine channels of swedavaha strotas as a result there is

elevation of body temperature. On the other hand in bhutabhisanga Vishamajwara, person

having Bhatubaisamya, Swabhava (immunity) and the Keetanu directly involved the Dhatu

and produces agantuka Vishamajwara. 51

Role of Srotas in Vishamajwara

In Ayurveda all diseases are produced by srotovaigunya. Jwara is due to Annavaha

srotavaigunya in general. But in Vishamajwara there is no clear description about particular

srotavaigunya. According to signs, symptoms and site of Dhatus it may be concluded that

udakavaha, swedavaha, rasavaha, raktavaha, mansavaha, medavaha, asthivaha, majja vaha

and manavaha Srotas are involved.


Role of rogamarga in Vishamajwara

Ayurveda described the three rogamarga (pathway of disease) for the manifestation

of diseases. The seat of jwara is Amashaya and is one of the organs of kostha (thoraco-

abdmino-pelvic cavity). Therefore, jwara is considered as abhyantara rogamargaja Vyadhi.

Samprapti is classified in two parts.

1. Samanya Samprapti (general pathogenesis)

2. Visista Samprapti (specific pathogenesis)

Samanya Samprapti of Vishamajwara

It means six stages of development of disease according to Susruta 52

Sanchaya (stage of accumulation) – in this stage vitiated doshas are localised in

their principal site. On the other hand when a keetanu invade the host then it cannot produce

disease. Instantaneously this period may be compared with incubation period of modern

medical science.

Prakopa (stage of provocation) – due to lack of proper treatment in the previous

stages the Dosha leads this stage. The Pachakapitta being “unmarga gami” tries to migrate to

Rasa and swedavaha Srotas.

Prasara (stage of circulation) – after circulating throughout body by Vata, this

prakopita doshas accumulated depend on the “khavaigunya” only. Therefore production of

disease is possible only where the disorder of Srotas occurs.

Sthana sansraya (stage of localisation) – the vitiated Dosha become localised in

rasavaha and swedavaha Srotas owing to previous factors. The premonitory symptoms like

arati, shrama, vairasya are found.


Vyakta – (manifestation of diseases) – during this stage the vitiated Pachakapitta

causes Ushna (hot) stage and Sheeta (cold) stage in the body associated with Vata Dosha

and Sheeta Guna of Kapha Dosha.

Bheda (stage of classification) – Santata etc, five type of jwara are manifested

owing to involvement of rasadi Dhatu and Kapha sthana.

Classification of Vishamajwara according to different Acharyas -

There are various opinions regarding the type of Vishamajwara. Primarily it can be

divided into two groups, viz. 53

(I) Arambhat visama – The Vishamajwara which is started as irregular

fever from the very onset ;

(II) Krita visamajwara – The Vishamajwara which occurs due to

apathya sebana (untous dietetics and regimens) of previous jwara. So

it is usually considered as relapsing fever.

There are mainly five types of Vishamajwara accepted now 54. But there are various

views on these types of Vishamajwara illustrated below.

1. Charaka described five types according to its vega and agamankala i.e., santata, satata,

anyeduska, triteeyak and chaturthaka 55

2. According to Vagbhata santataka, satata, triteeyaka, anyeduska, chaturthaka, and

chaturthaka viparyaya. Here be classified the viparjaya as vatadhikya, pittadhikya and

kaphadhikya. 56

3. Susruta advocates as santataka, satata, anyeduska, triteeyaka, chaturthaka, pralepaka

and also due to predominance of doshas (anupathyaka jwara madhya samudbhavan) and

Vata valasaka.57


4. Harita describe as kahika, dwahika, trayahika chaturthaka 58

5. According to Gananath Sen it is four types such as vatabalasaka, Sleepadika, kalajwara,

upadravikjwara.59

6. Kharanada described as viparita tikhanata santatajwara, anyeduska, triteeyak and

chaturthaka

7. Kashyapa described it as viparita tikshanata santatajwara, anyeduska, triteeyak and

chaturthaka.

8. Drudhabala described two types such as triteeyaka and chaturthaka

9. Madhavakara viewed that santata, satataka, anyeduska, triteeyaka, chaturthaka. Here

triteeyaka is again divided into three types according to predominance of Dosha like

kaphapitta. Vatakapha, vatapitta chaturthaka, two types as slesmika and anila. Besides

this he described another three types known as chaturthaka, viparjava, vatavalasaka and

pralepaka.60

Visista Samprapti of Vishamajwara 61

If the mithya Ahara Vihara taken in case of residual fever or during convalescent

period of jwara it causes Vishamajwara being localised in one or more Dhatu. On the other

hand keetanu may aggravate Dosha in according to balam kalamcha prapya (dependent on

the host strength and climate). But according to Susruta as well as supported by

Madhavakara about the pathogenesis of disease stated that if a weak person just after fever

adopts unsuitable food and drink, his residual doshas aggravated being afflicted by Vata

localised in kaphasthana (shira, kantha, hridaya, amasaya) to produce different of

Vishamajwara. The five types of Vishamajwara manifested after invading of Rasa, Rakta,


mansa, meda, asthi and majja dhatu and loges at shira, kantha, hridaya, amasaya and

rasavaha Srotas, as a result of which the following types of Vishamajwara are produced.

1. Santata – continuous fever – Rasa Dhatu – wall of Amashaya

2. Satata – double quotidian fever – Rakta Dhatu – Amashaya

3. Anyeduska – quotidian fever – mamsa and meda – Hrudaya

4. Triteeyaka – tertian fever – asthidhatu – kantha

5. Chaturthaka – quartan fever – majja Dhatu – shira

1) Samprapti of Santatajwara

The word santataja jwara means fever in continuos nature. Now it is under

controversy before the modern Ayurvedic scholar’s deviates from the definition of

Vishamajwara. But to overcome the controversy Charaka classified that the

“muktanubandhitvam visamatvam”, which means fever with relapsing nature. Then Dosha

circulating in body through rasavaha Srotas with the help of Vata and gets localised in the

Kapha sthana. The period of localisation may vary according to kala prakriti and

predominance of doshas. They also affect dhatus and malas to manifest the diseases. The

site of santatajwara is rasadhatu and its period is 7 days, 10 days, 12 days according to

predominant of Vata Pitta and Kapha respectively. During this period the jwara may either

subside or kill the patient without appropriate therapeutics intervention 62.

According to Harita the period of subsidence of jwara is 14, 18, 22 days in

Vatolbana, Pittolbana and Kapholbana respectively. During the period the fever may subside

or kill the patients.


Dosha pradhanyata – 63

The doshapradhanyata in the Santata jwara is tabulated as below.

Table –1

Showing the Dosha pradhanyata in Malaria

Kala (Rutu) Dushya Prakruti Dosha

Vasanta Medas Kapha Kapha

Sharad Rakta Pitta Pitta

Varsha Asti Vata Vata

2) Samprapti of satatajwara

The satatajwara is said to be dwikalika (two times) in an ahoratra (24hr). The vitiated

doshas are localised in raktavaha Srotas and aggravated in a day and night. According to

kashyap this types of aggravation and remission depends upon the kala, Dosha and dushyas.

Dalhana considered jwara be twice in day. Once in a night, because the seat of satatajwara is

raktadhatu. Raktavaha Srotas is comparatively minute and more distant than rasavaha

Srotas. So Dosha gets longer time to enter in Srotas causing Vishamajwara. When doshas

more from rasavaha to raktavaha during this phase there will no be only febrile attack.

According to Vagbhata onset of jwara in Vata dosha is at early aparanha (afternoon)

and pratyusha (morning and last part of night). Pitta dosha aggravates in midday and

midnight and Kapha Dosha in purbanha (evening hours)

Vruddhi Kshayatmaka of satatajwara 64

The heavy Doshas spread all over the body through the channels carrying Rasa and

stiffened and give rise to santata jwara (remittent fever). Being unbearable and quick –

acting it gets subsides or kills the patients by the period of seven, ten or twelve days. Dosha

equal in respect of time, dushya, (affected tissue) and constituents and having no counter


acting factor causes the remitted fever and as such in quite unbearable. In remittent fever, as

a rule, Vata etc. also affect in urine and faeces simultaneously as the Dhatus. This fever gets

subsides or becomes fatal in periods of a week etc. according to the conditions whether Rasa

etc. have been purified completely or not. When they are not purified completely or entirely

the remitted fever gets lodged in the twelve entities (seven Dhatus, three Doshas, urine and

faeces). Thus even after remission on Twelfth Day, it continues hidden for a long time

without responding to any treatment. Considering all this, the physician should treat the case

of fever. Mostly in such management de-saturating remedy is administered at first.

3) Samprapti of Anyeduska jwara

Jwara vega occurs once in a whole day or night is called anyeduska jwara. Kashyapa

named it as anusargee and in Veda it is known as “anyeduha”. Vagbhatta considered that

manasvaha Srotas are very smaller (minute) than raktavaha Srotas. Therefore delay occurs

because of doshas have to reach a longer distance. This doshas circulated all over the body

slowly and ultimately reach mansavaha Srotas once in a whole day or night.

4) Samprapti of Triteeyak jwara

The jwara vega occurs once in every third day. Vagbhata considered that the sites of

vitiated doshas are medhadhtu and medavaha Srotas. Dosha gets longer time to enter

medavaha Srotas from rasavaha Srotas. So the paroxysm of fever is on every third day.

Doshanusara bheda – trika grahi – prusta grahi – shirograhi 65

Triteeyak jwara (Tertian fever) is of three types-

1. Due to Kapha and Pitta stating from trika (sacral region)

2. Due to Vata and Kapha starting from the back

3. Due to Vata and Pitta starting from head.


Likewise, the quatrain fever has also two type of characters- one caused by Kapha

and starting from legs and other caused Vata and starting from head.

5) Samprapti of Chaturthaka jwara 66

Jwara comes on every fourth day having two days interval between the onset of

every attack. The site of Dosha in this jwara is said to be majja-Dhatu which is deeper than

other discussed above. So vitiated Dosha takes a longer period to reach there. Therefore

paroxysm of fever is an every fourth day.

According to Kasyapa the Dosha which have been localised in shirasthana moves

towards kanthas than in one day from kanthasthana to Hrudaya on next day and from

Hrudaya to rasadhatu or Amashaya to manifest the jwara on the fourth day. Dosha located in

shira and majja Dhatu being provocateur by kala prakriti. Dushya enters into amasaya and

produce Agnimandya. The produced Ama causes srotarodha and responsible for

vimargagamana of Jataragni.

According to predominance

Dosha it has been classified in two types.

1. Kaphadhikya chaturthak jwara

2. Vatadhikya chaturthaka jwara

Kaphadhikya chaturthakjwara originates from jangha pradesh and spread all over the

body and vatadhikya chaturbakajwara originates from shira and spread through out the body.

Viparijya jwara

If the fever comes in its remission period discussed above then it can be regarded as

viparjayajwara. The word viparjaya means virudhata/veniyama or parivartana (reverse).

Susruta considered it as viparjaya. Charaka and Vagbhata considered for chaturthaka as


“viparyaya jwara” are mainly according to the predominant of Doshas in the particular site

of vitiation. Here it is noted that the vitiated Doshas has no definite place to be localised in

any of the five Kapha sthana in Santatajwara, there is no viparyaya because the Dosha

remains in all five kaphasthanas. But in case of Anyeduskajwara, if it is comes in remission

period than it is known as Anyeduska viparyaya, in Chaturthaka viparyaya jwara vega

occurs continuously for three days and subside as fourth day. Also the similar process takes

place in Treetiyaka jwara.

Duration and vega in different jwaras

Table –2Name of jwara No. of vega Period

Santata Nirantara(whole time) 7,10 or 12 days

Satata Twice In ahoratra (24hr)

Anyeduska Once In ahoratra (24hr)

Triteeyaka Once An alternate day

Chaturthaka Once On every 4th day

Chaturthaka viparjaya Twice In between two days leaving

1st and 4th day

Purvarupa (premonitary symptoms)

Any specific premonitory symptoms of Vishamajwara are not found or described in

any Ayurvedic literature. As per the general principle the initial appearance of some of the

features of Vishamajwara is considered as its purvarupa.


Flow chart –2Schematic diagram of Vishamajwara Samprapti

Nidan –nija

Agantuka (keetanu)

Dosha vaisamya

Agni mandya

Production of Ama

Tridosha being provocateur and mixed with

Ama first appeared in Amashaya

Srotorodha in Amashaya

Localisation of Pachakapitta

Circulating in Rasa and Rakta Dhatu

Localisation in Rasa and swedavaha Srotas

Development of Vishamajwara

Santata Satata Anyeduska Triteeyaka Chaturthaka


Table –3Showing the Vishamajwara vishista Lakshana

Lakshana Charaka SusrutaSitilathat (lethergy) + +Gurutha (heavyness) + +Udveg (excitement) + +Dinata (weakness) + +Gamana (movement) + +Jrumbha (yawning) +Angamarda (malaise) +Sa

ntat

a Jw

ara

Aruchi (anorexia) +Daha (burning sensation) + +Bhrama (vertigo) + +Pralapa (delirum) + +Pidika (pedicles) +Sthivana (spitting) + +Sveda pravriti (sweating) + +Sa

tata

Jw

ara

Vamana (vomiting) +Pindikidwevasthan (pedicles) +Murati pravriti (urination) +Angavisesa (myelgia) +Sweadadhikya (sweating) +Vamana (vomiting) +Aruchi (anorexia) +Glani (sorrow fullness) + +Pralapa (delirum) +Antardaha (internal burning) +A

nyed

yush

ka J

war

a

Malati pravruti (diarrhoea) +Atisara (diarrhoea) +Vedamntapida (pain) +Anga vikshepa (myelgia) +Abhyantara daha (internal burning) +Murcha (fainting) +Swedhikya (excessive sweating) +Pralapa (delirium) +Glani (sorrow fullness) +Dourgandha (foul smell) +Swasa (dyspnoea) +Kasa (cough) +

Tru

teey

aka

Jwar

a

Vamana (vomting) + +Vamana (vomting) + +Vedantaka pida (pedicles) + +Angavishada (malaise) + +Swasa (dyspnoea) + +Hikka (hie-cough) +Abhyathara daha (internal burning) +Asthi sankoch +C

hatu

rdha

kaJw

ara

Agnimanda (dyspepsia) + +


Sadhya sadhyata (prognosis)

Sadhya-sadhyata is very important to assess the prognosis of disease before starting

treatment. In a person who is strong, vitiation of Dosha is mild without any complication of

jwara is said to be sadhya.

If the jwara developed by strong positive factors which all the sign and symptoms

are present, function of indriya (sense organ) are derranged, the disease is considered to be

asadhya. If the jwaravega is antarvega, it is said to be kruchhara sadhya (curable with

difficulties) and vaheervega it is sukhasadhya. When the jwara associated with Bhrama,

durbala indriya, tikshna jwaravega, durbalata, prabahani, aruchi and function of Indriyas

become feeble then the jwara is said to be asadhya.

The santata jwara if one or two doshas are involved then it is curable but if more two

than kill the patient. The anyedushka, satata. Triteeyak are curable as the doshas lies in

superficial as in Rakta, mansa and meda Dhatu. Chaturthaka is difficult to cure because the

doshas lies in deeper dhatus like asthi, majja leaving to development of other diseases.

The bhutavisanga Vishamajwara depends upon baya, bala, Agni, prakriti and the

invovement of dhatus. The symptoms like swash, murcha, chharoli trishna, Atisara,

vatagraha hicca, kasha, angaveda are detected than it is said to be asadhya.

Management of Vishamajwara in Ayurveda

In Ayurveda removal of positive factors as well as measures adopted for the

maintenance of Doshic equilibrium is called as Chikitsa. There are 3 types of Chikitsa i.e.,

1. Daiva vyapasraya

2. Yukti vyapasraya and

3. Satwavajaya


Yuktivyapasraya joins its popularity now days because of its application of therapeutics

dilemmas in particular ailments. Again this is divided into three parts i.e.,

1. Antahparimarjan (internal purification)

2. Bahirparimarjan (external purification and

3. Sastra pranidhana (surgical measures)

For each one of those five fevers different kashayas (decoctions) are prescribed.

Though bitter drug is prescribed in any kind of fever, in the treatment of Vishamajwara

more emphasis is laid on biter drugs like kirata, guduchi, bharangi, nimba etc. The emphasis

on bitter medicine is due to the vitiated Dosha (Pitta) though other two Doshas also play

some important role. For Pitta shamana drugs, which are astringent, bitter and sweet are

useful. In high temperature and extreme burning sensation of the body, application of water

and milk externally are recommended for immediate relies. Some lauha preparations like

vishamajwarantaka lauha. Sarbajvarahar lauha chandanadilauha etc. will be highly useful in

case of anemia after malaria attack.

Perusal of various texts of Ayurvedic classics will indicate the following main mode

of treatment in Vishamajwara.

1. Kasaya (decoction) (Panchakashaya) 67

2. Ghritams (medicated ghee)

3. Suportive therapy like rasuna yoga

4. Anjana

5. Dhupana

The drug mentioned in the treatment of Vishamajwara can be classified as those.

1. Acting on doshas mainly on Pitta and Kapha (Dosha pratyaneek)


2. Acting on Dhatu and including organ like liver, spleen, etc.

3. Acting on the disease (Vyadhi pratyaneeka)

The drugs having Kashaya and Tikta Rasa by and large from jwaraghna Dravyas like

guduchi (tinospora cordifolia) nimba (azadirachta indica), chandana (santalumalbum),

murva (sansvieria roxburghiana), kiratatikta etc. full under the doshagna group.

Role of langhana

The treatment of ordinary fever, langhana (fasting) swedana (diaphoretics), kala

(time factor), yavagu (liquid diet) and tiktarasa (bitter medicines) are indicated. In

Vishamajwara, langhana and swedana are not recommended.

Preventive countermeasures in contemporary practice

Preventive countermeasures are divided into three sections:

1. Personal Protective Measures,

2. Chemo-prophylaxis, and

3. Management.

1) Personal Protective Measures

This section presents measures that prevent mosquitoes from biting and transmitting

malaria. Applications of personal protective measures are effective against a wide range of

disease vectors, not solely for prevention of malaria. In many military operations, they will

be the only means of protection against biting arthropods. They are the first line of defense,

are simple to teach and perform, and enable personnel to remain in endemic areas while

maintaining their operational capabilities. The major drawback of personal protective

measures is dependence on service member compliance. Persuasion by medical personnel,

and enforcement by NCOs and commanders is necessary for their continuous proper


application. Medical personnel must circulate among units teaching, examining, and

improving personal protective measure practice, and also reporting their findings to those in

charge. Commanders and NCOs must ensure compliance and lead via personal example.

DEET

Topical repellents are natural or synthetic compounds that repel arthropods. The use

of vapor-active skin repellents by U.S. Armed Forces has a long history. It began with the

use of oil of citronella in 1910, continued with the discovery of dimethyl phthalate during

WW II, and led to the development of diethyl toluamide or “DEET” in 1957. The duration

of a repellent’s effectiveness decreases with activity, heat, and humidity. Since Anopheles

mosquitoes inhabit warm tropical environments, military personnel need to re-apply

repellent frequently to prevent biting. These products were selected based on their

effectiveness. Contrary to public opinion, Avon Skin So Soft R and flea collars are not

effective.

Protective Clothing and Netting

The basic utility or camouflage uniform treated with permethrin and worn with

sleeves down, collars closed and trousers bloused over boots offers excellent protection from

mosquitoes. Other types of protective clothing and netting are also available.

2) Chemoprophylaxis

Choice of regimen is determined by two factors:

• Drug resistance in specific locations.

• Any allergic or other reaction to the anti-malarial drug of choice, or restriction by job

(mefloquine is not authorised for prophylaxis in aviators and divers).


Excellent primary sources of information on malaria drug resistance are the Medical

Environmental Disease Intelligence and Counter-Measures (“MEDIC”) compact disc, and

the Navy Environmental and Preventive Medicine Unit responsible for that area of the

world.

Prophylactics

Four regimens are set out below. The choice depends on the countries, which are to

be visited and possible drug sensitivity of the traveller

• Chloroquine can still be used in some regions but is of limited value in many parts of

the world. Treatment should be started one week before travelling to, and continued

for four weeks after leaving, a malaria endemic area. (Adult dose 300mg weekly

taken with a meal, at the same time and on the same day each week). It will suppress

but not cure an infection with P. vivax and symptoms may not appear for weeks or

months after the traveller has returned home. For children the dose is 5mg/kg base

given once a week on the same day each week. Since liquid suspensions for children

are no longer available, a tablet has to be divided to provide the appropriate dose.

Chloroquine has a bitter taste and should be given to children crushed in a strong

flavoured (sweet) drink. Prophylactic drugs in children should not be given without

advice from a medical practitioner, preferably one practising from a health travel

medical centre. 68

Chloroquine is considered a safe drug for pregnant and lactating women and

also for children. However, it is wise to discourage women who are pregnant from

travelling to areas where malaria is present because of the difficulties associated with

treatment and the risk to the mother and foetus should they get malaria.


• Doxycycline is a suitable prophylactic anti-malarial agent to use in high risk areas

such as South East Asia. It must not be used in children under 8 years of age nor in

pregnant or breast-feeding women. Doxycycline may cause contraceptive pills to be

less effective so additional precautions should be taken. It may cause thrush in some

women but usually only when taken for long periods. It may cause severe skin

photosensitivity in some individuals. Doxycycline - Adult dose 100mg daily. Start 1-

2 days before travelling to a malarious area and continue for 2-4 weeks after leaving.

To ensure that the patient is not sensitive to doxycycline it is worthwhile starting

treatment 7 days before travelling. It is recommended that it is not taken for longer

than three months without a medical review.

• Mefloquine (Lariam) is still a widely used prophylactic. It has a long half life and the

convenience of a once weekly dose. For adults (more than 45 kg bodyweight) the

dose is 250mg base weekly, starting one week before arrival in a malarious area.

Side effects have been reported which are generally mild (e.g. Sleep disturbances,

gastrointestinal disturbances, dizziness or disturbed sense of balance). A rare but

important adverse reaction is acute brain syndrome which occurs in, one in 5,000-

20,000 of those taking the drug. It is not recommended for aircraft pilots or drivers of

public transport.

• MalaroneTM. This is a combination of atovaquone and proguanil and recent studies

have found it a safe and effective prophylactic agent with few side affects.

Unfortunately it is expensive and has to be taken daily. It is not suitable for those

sensitive to atovaquone or proguanil . Treatment should be started 2 days before


travel and continued for at least 7 days after a period of potential exposure to

malaria.

• Other possible regimens include daily azithromycin, daily high-dose primaquine and

short course tafenoquine.

Deterrence/Prevention:

• Avoid endemic regions.

• Take the proper prophylactic drugs at proper intervals if traveling to endemic

regions.

• Use topical insect repellent (30-35% diethyltoluamide [DEET]), especially from

dusk to dawn.

• Wear long-sleeved permethrin-coated clothing if not allergic to permethrin; spray

under beds, chairs, tables, and along walls.

• Sleep under fine-nylon netting impregnated with permethrin.

• Avoid wearing perfumes and colognes.

• Seek out medical attention immediately upon contracting any tropical fever or flulike

illness.

• Chemoprophylaxis is available in many different forms.

• The drug of choice is determined by the destination of the traveler and any

medical conditions the traveler may have that contraindicate the use of a

specific drug.

• Before traveling, people should consult their physician or call the CDC's

Malaria Hotline to determine the most appropriate chemoprophylaxis.


3) Management

Blood schizonticides are the first-line drugs for the treatment of malaria and must be

started as soon as the diagnosis is made or even suspected. They act on the asexual forms in

the erythrocytes and interrupt clinical attacks. Delay in treatment of P falciparum malaria

can lead to development of severe malaria, which has a poorer prognosis than

uncomplicated malaria. Chloroquine, quinine, quinidine, mefloquine, halofantrine, and

artemisinin compounds are the rapidly acting drugs that can terminate an acute malaria

attack. While chloroquine acts rapidly, resistance is widespread and an accurate travel

history should be obtained before choosing the anti-malarial drug.

P vivax and P ovale have dormant stages (hypnozoites) in the liver, and the treatment

of an episode of malaria requires eradication of these forms also. The classic treatment is a

3-day course of chloroquine, followed by a 14-day course of primaquine. A shorter course

of 5 days of primaquine, started with chloroquine, has been described but is associated with

higher relapse rates.

Detailed Drug review

All the components of the Bharangyadi Ghanavati are explained as under.

1) BHARANGI – Clerodendrum Serratum 69-70

PLANT PART USED:

Roots and leaves.

DESCRIPTION:

A shrub 0.9-2.4 m high, slightly woody, not very branched, stems bluntly

quadrangular, young parts usually glabrous. It has pink white flower, numerous and striking.


PHYTOACTIVE :

A sterolglucoside has been isolated. The root bark yields a glycosidic material,

phenolic in nature 71. D-mannitol was isolated from the root bark with a yield of 10.9%

72.The powdered stem contains D-mannitol, b-D glucoside of b-sitosterol,b-sitosterol and

cetyl alcohol 73. From the bark the sapogenin mixture contains three major triterpenoid

constituents-olconolic acid,queretaroic acid and serratagenic acid.

DIRECTIONS FOR USE :

An aqueous extract produced a graded block of the responses to histamine on

isolated guinea pig ileum. It blocked the histamine-induced contractions of the guinea pig

tracheal chain preparations without affecting the response to acetylcholine 74. The saponin

isolated from the root bark caused a release of histamine from rat lung tissue 75. Continuous

daily administration of the plant extract in the sensitised guinea pig causes a gradually

developing protection against anaphylaxis. The anticholinestrase activity of the saponin was

confirmed by acetylcholine responses on guinea pig tracheal chain preparation, isolated rat

ileum and frog rectus muscles 76. The saponin also disrupted the rat peritoneal mast cells and

blocked the effect of horse serum antigen 77.

A decoction of roots is used in asthma and bronchitis. The leaves are applied in the

form of poultice in skin suppurations. The drug is used in fever 78. It is also used in sinusitis.

It is recommended in inflammations of the eye.

CONTRAINDICATION :

In the doses used, no adverse reactions have been reported in man.

Larger doses are reactive.

FORMULATION AND DOSAGE : Churna : 0.5 - 1.5 gm


2) MUSTA - Cyperus rotundus Linn 79-86

PLANT PART USED :

Bulbous root.

DESCRIPTION :

The plant is a common weed represented by several types growing in India. The

blackish rhizomes are slightly fragrant and in Asia the essential oil they yield is used as a

perfume and to repel insects. The branches are long and with three edges. The flowers are

tiny.

PHYTOACTIVE :

The essential oil from C. rotundus contains at least 27 components comprising

sesquiterpene hydrocarbons,epoxides,ketones, monoterpene and aliphatic alcohols and some

unindentified constituents. (+) copadiene and (+) epoxyquaine have been detected. The

various characteristics of the essential oil obtained from the tubers have been studied

chromatographically and by spectroscopic methods.


The petroleum ether extract of the roots showed anti-inflammatory activity against

carrageenin-induced oedema in albino rats. The active fraction was identified as a

triterpenoid. The antipyretic activity was demonstrated on pyrexia induced by Brewers yeast

in albino rats. A fraction tested on aconitine-induced writhing in mice showed mild

analgesic activity.Antihistaminic and antiemetic activities were shown in experimental

studies on dogs. Smooth muscle relaxant activity was demonstrated on rabbit ileum. Extracts

of rhizomes were inhibitory to the growth of fungi depending on species. Antibacterial

activities of oil and its fractions have been demonstrated against a number of organisms'.


Clinical trials have shown efficacy of 2'1, solution of aqueous extract of C. rotundus

in 26 patients with conjunctivitis. Traditionally it has been used in the treatment of chronic

diarrhoea'. It is found useful in diarrhoea with mucus. It is commonly given in fever. It acts

as an antiperspirant and deodorant.

CONTRAINDICATION :

Safety: In the commonly used dose no adverse reactions have been reported. M

albino mice, no toxic effects of the plant were observed.

FORMULATION AND DOSAGE :

1. Mushtadi churna : 1 to 3 gms. b.i.d.

2. Mushtadi kwath : 30 - 60 ml. b.i.d.

3. Mushta kwath : 30 to 60 ml. b.i.d.

4. Mushta oil : topical use.

Medicinal Applications 87

Action

Alterative, anthelmintic, anti-fungal, anti-parasitic, anti-rheumatic, antispasmodic,

aphrodisiac, astringent, carminative, demulcent, diaphoretic, diuretic, emmenagogue,

galactagogue, refrigerant, stimulant, stomachic, tonic

Uses

(high) blood pressure

bloody stool, urine, and

vomiting blood

breast tumors

candida

colds and flu

colic

Fevers

gastritis

indigestion

mal-absorption

mental health (moodiness, and depression)

menstrual disorders (pain, cramps, and PMS)

menopause


convulsions

diarrhoea

dysentery

dysmenorrhea

palpitation

parasites

vomiting

The decoction of the roots and tubers are excellent antidote to all poisons. A paste of

the fresh tubers applied to the breasts acts as an effective galactagogue. The root is often

used for developing high memory. This herb also harmonizes the liver, spleen, and pancreas.

3) PARPATAKA - Fumaria officinalis Linn 88-95

PLANT PART USED : Whole plant

DESCRIPTION :

The plant is of a greyish yellow colour. Leaves greenish, thick and narrow, stems

greyish yellow, one or two inches long, furrowed and rather quadrangular. Fruit capsules are

very small greyish green, slightly compressed and with a transverse ridge scar to the apex.

Flowers are irregular, asymmetrical and either violet or white, seeds small and consist of

fleshy albumin'.

PHYTOACTIVE :

The plant contains fumaric acid and fumarine. Fumarine exists in irregular 6-sided

crystals or in monocionic prisms, insoluble in alcohol, chloroform, benzol and amyl alcohol

sparingly soluble in water and soluble in ether'. Seven alkaloids have been isolated from the

alcoholic extract of whole plant.


The water-soluble portion of 90% ethanolic extract of stem and leaves of F

officinalis produced a marked relaxant effect on the isolated rabbit ileum, dog's intestine in


situ and on spontaneously contracting isolated uteri of rat, and- guinea pig. It had non-

specific spasmolytic action on isolated rat arid guinea pig uterus and dog's tracheal chain.

Protopine (5 mglkg iv) the major alkaloid of the plant produced marked relaxation of

intestine in situ of anaesthetized dog without producing any effect on the blood pressure. A

rise in biliary flow occurred in the anaesthetised dog4. It is often used in common cold and.

fever and also in certain skin disorders. With black pepper it is given in jaundice. It is given

to relieve vomiting and thirst in febrile conditions.

Remedies For: Diuretic, laxative, alterative, hepatic.

Fumitory has long been used in the treatment of skin problems such as eczema and

acne. Its action is probably due to a general cleansing mediated via the kidneys and liver.

Fumitory may also be used as an eyewash to ease conjunctivitis.

CONTRAINDICATION :

LD,0 is 1.95 gm/kg in the mouse and 1.28 gm/kg in the rat. When given orally for 3

months, it has no effect on the vital organs and produced no haematological disturbances. It

stimulated respiration in both the cat and dog".


Fumitory are often combined with Burdock, Cleavers or Figwort.

1. Parpatadikwath : 5 ml. b.i.d.

2. Parpatadyarishta : 5 ml. b.i.d.

3. Parpatachurna : 1 to 2 gms. t.i.d.

4. YAVASA (DANVAYAVASA) 96

Fagoina arabia

Fagoina arabia is amongst the widely used medicinal plants in Pakistan. It is known

by common names "Azghakhi" or "Damiya" in the rural areas of NWFP. Fagoina arabica


belongs to the family Zygophyllaceae (Hooker, 1882). Generally the plant is found on dry

calcareous rocks distributed throughout the Mediterranean region to South Africa,

Afghanistan, India, Pakistan especially Sindh, Punjab and NWFP (Rizvi et al., 1996). It is

the chief and popular fever remedial source of people in the hilly areas. Its infusion is

effective in sore mouth and for cooling mouth in stomatitis and also purifies the blood and

acts as a deobstruent (Said, 1996).

People of NWFP specially used it for skin diseases, small pox and for endothermic

reaction in the body (Watt, 1972). The twigs of the plant are used as remedy to snakebite

and also applied externally as paste on tumours and for the swellings of neck.

5) SHUNTI - Zingiber officinale 97-115

Other Names:

Ginger; Ardrakam; Shunthi; Adrak; Sunth; black ginger; race ginger; African ginger; sheng jiang;

PLANT PART USED : Rhizome

DESCRIPTION :

A herbaceous rhizornatous perennial, upto 90 cm in height when fully grown. The

herb develops several lateral shoots in clumps. Leazies are 15-30 cm long and 2-3 cm broad,

with sheathiiig bases, the blade gradually tapering to a point. The rhizomes are aromatic,

thick lobed pale yellow, bearing simple alternate (listichotis narrow, oblong lanceolate

leaves.

PHYTOACTIVE:

Ginger contains 1-2% volatile oil and 5-8% resinous matter, starch and iiiucilage.

The oil of ginger is a mixture of over 24 constituents, consisting of monoterpenes

(phellandrene,'(+) carnphene, cineolc,, citral and borneol) and sesquiterpenes etc

(zingiberine, and hisabolene). The pungent component is gingerol formed in the plant from


phenylalaanine, nialoiiate and hexanoate. Minor constituents of an extract are gingreniols,

methylgingediol, gingeryldiacetates and methyl gingediacetates.


Anti-inflammatory activity in carrageenin-induced rat paw oedema has been shown'.

The active principles - gingerol, and dehydrogingerdione and gingerdione were shown to be

potent inhibitors of prostaglandin synthesis'- confirming the mechanism of anti-

inflammatory effect. The antirheumatic effects were further confirmed by other inves-

tigators. Antihistaminic activity has also been shown in vitroll. The plant inhibits the virion

toxic factor production in infected chorioallantoin membrane and also inhibits the growth of

W.M. - 25d malignant cell-line. Cardiac inotropic activity has been shown in, Dogs and

guinea pigs. Ginger was shown to have significant antiemetic and antivertigo effects like

dramamine". It has been lised effectively along with Piper nigrum and Piper longum in viral

hepatitis". Ginger forms an important constituent of many Ayurvedic formulations. It is

chiefy used as a home remedy for nausea and dyspepsia.

Remedies For:

For over 2,500 years, ginger has been an important herb in Asian medicine.

Traditionally it has been used to promote cleansing of the body through perspiration, to calm

nausea

Action: Aromatic, carminative, stimulant to the gastrointestinal tract, diaphoretic,

expectorant, antiemetic, and stomachic, also sialagogue and digestive; Externally, a local

stimulant and rubefacient.

Ginger is used for:

Atherosclerosis, heart diseaseChemotherapy support

ConstipationIncontinence


Migraine headachesMorning sicknessMotion sicknessNausea and vomiting following surgeryRheumatoid arthritisBelchingLaryngitisVomiting

FlatulenceColicSpasmsFeverEye diseasesAsthmaColdsCough

Digestive System Actions:

Ginger is a classic tonic for the digestive tract. Classified as an aromatic bitter, it

stimulates digestion. It also keeps the intestinal muscles toned.

This action eases the transport of substances through the digestive tract, lessening

irritation to the intestinal walls. Ginger may protect the stomach from the damaging effect of

alcohol and non steroidal anti-inflammatory drugs (such as ibuprofen) and may help prevent

ulcers.

Allergies and asthma:

Dried ginger can help in the management of allergies and asthma by offsetting the

effect of the platelet-activating factor (PAP). PAP initiates inflammatory processes in

allergy and asthma. It was found to become more active after changes in blood chemistry

that occur in a high-fat diet.

Atherosclerosis and high cholesterol:

Arthritis, bursitis, fibrocystic breasts, lymphedema, and pain. Ginger inhibits the

production of immune-system components called cytokines. These chemicals are believed to

create a long-term tendency toward inflammation.

Ginger also stimulates blood circulation. These effects of ginger are taken advantage

of in treating a number of disorders marked by swelling and pain, such as arthritis.


Studies have also shown that ginger can relieve pain without the side effects

typically found when using nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids.

Anti-nausea/Anti-vomiting Actions:

Research is inconclusive as to how ginger acts to alleviate nausea. Ginger may act

directly on the gastrointestinal system or it may affect the part of the central nervous system

that causes nausea. It may be that ginger exerts a dual effect in reducing nausea and

vomiting.

Parasitic infection

Ginger contains a chemical called zingibain that dissolves parasites and their eggs. In

laboratory trials, ginger extracts have been shown to kill the anisakid worm (a parasite

occasionally found in raw fish) within sixteen hours. Ginger tea is useful as a supplement in

treating schistosomiasis, a parasitic disease.

Seizure disorders

Ginger protects the body from the hepatotoxic effects of valproic acid (Depakene), a

common treatment for seizure disorders. Ginger, when used on a daily basis, was found to

improve the elevated levels of the liver enzymes alanine aminotransferase (ALT) and

aspartate aminotransferase (AST).

Action and Uses in Ayurveda and Siddha

Ginger is an important herb used in Ayurveda. Ayurveda takes advantage of the

following medicinal properties for ginger: Analgesic, anti-emetic, aromatic, aphrodisiac,

carminative, diaphorelic, digestive, expectorant, nervine, sialagogue, stimulant.

Ayurvedic practitioners consider ginger to be a truly a wonder drug, having so many

healing properties. It was called the universal medicine. Taken with rock salt it reduces


vayu; with rock candy it reduces Pitta; with honey it reduces Kapha. Thus it can be used to

influence all tridoshas.

Ginger is used in the following ayurvedic remedies: katu rasam, ushna veeryam,

vata-kapha-haram, katu- vipaka, lagu, snigdam, pachanam, ruchyam, vrishyam, swaryam,

vibhanda haram, in grahani agnimanthyam. amavatham, chardhi, swasam, soolam, arsas,

anaham, hrith-rogam, udhara rogam. It is used externally in kapha, swellings, headache.

CONTRAINDICATION :

With the recommended doses and the use as spice, side- effects are hardly reported.

With large doses of some of the active principles CNS depression has been noted in

animals".


1. Adrakkhand : 1

2. Soubhagyasunthipak : 6 - 12 gm b.i.d.

3. Rhizome powder : 0.15 - 1.5 gm b.i.d. / t.i.d.

4. Ginger juice : 2 - 4 ml b.i.d. / t.i.d.

5. Panchasamachurna : 0.75 gm b.i.d. / t.i.d.

6. Samasharkarchurna : 250 - 750 mg t.i.d.

6. KIRATATIKTA (BHUNIBHA) Swertia chirata – 116

PLANT PART USED :

The whole plant is used medicinally, but the root is said to be the most powerful part.

DESCRIPTION :

The plants is an erect herb, stems are robust 0.6-1.5 m, branching leaves are

opposite, broadly lanceolate, acute, lower leaf often much larger, sometimes petioled. Calyx

and corolla are four-lobed. Corolla green-yellow and tinged with purple 117.


PHYTOACTIVE:

The main chemical constituents of this plant are ophelic acid and chiratin. The plant

also contains resins, tannin, gum, carbonates, phosphates and 4 to 6 per cent ash 118-119. A

number of workers have shown that the drug contains bitter glycosidal components, chiratin

and amarogentin, swerchirin, phytosterol, also a number of acids and phenolic compounds

120-122.


Anti-inflammatory activity of Swertia chirata has been shown 123. Islam et al also

noted such activity against acute inflammation, in rat hind paw 124. Chirata is much prized in

India as a powerful bitter tonic. Unlike most other medicines of this class it does not

constipate the bowels, but tends to produce a mild laxative affect. It promotes the flow of

bile. It is used as a tonic. In gastrointestinal disorders, like dyspepsia/anorexia it is used as

digestive, febrifuge and laxative. It is particularly useful in fever as a tonic and mild

febrifuge125. It is used to prevent malaria.

Medicinal Uses Bitter tonic, stomachic, febrifuge and anthelmintic, appetizer, laxative,

alterative, antidiarrhoeic and antiperiodic.

Action & Uses in Ayurveda

Tikta-rasam, metha veeryam, lagu, ruksham. In sannipatham, swasam, kasam,

raktadosham,

CONTRAINDICATION :

With the doses used no adverse reactions have been reported. No toxic effects in

animals are shown with reasonable doses126.



1. Infusion : 10 - 15 ml b.i.d.

2. Root powder : 3 - 5 gms b.i.d.

3. Mahasudarshan Churna : 2 gms b.i.d.

4. Sudarshan ghanavati : 2 gms b.i.d.

7) KUSTA Saussurea lappa 127

PLANT PART USED : Roots.

DESCRIPTION :

It is a tall, stout herb with annual stem and perennial roots. The leaves are large and

heart shaped. Roots are used in medicine, which are dug up in autumn. The roots have a

pungent taste and a characteristic fragrant aromatic odour 128.

PHYTOACTIVE :

The root of .S. lappa contains essential oils, resins, inulin, tannins, potassium nitrate

and an alkaloid, which has been named 'saussurine'. From the etheral extract of the roots, a

liquid fraction named Kushtin has been isolated 129.


The essential oil has antiprotozoal effect in vitro (1 in 10,000 dilution). It also has

antibacterial effects against streptococei and staphylococci. On the isolated heart of the

rabbit, the essential oil produces positive inotropic and chronotropic effects. The alkaloid

saussurine has a smooth muscle relaxant activity. On rabbit ileum in vitro, Saussurine

antagonized the contractions produced by histamine and acetylcholine. On peripheral vessels

(perfused car vessels of rabbit) the alkaloid produced initial dilatation followed by

subsequent constriction. The alkaloid did not block the effects of adrenaline and histamine


on the vessels. On guinea-pig tracheal chain, it did relax the broncho-constriction produced

by histamine in this preparation.

On systemic administration, under experimental conditions, saussurine has a positive

inotropic action on the myocardium. It is. Used as a bronchodilator and antispasmodic, and

also in skin diseases.

Medicinal Properties: Action

alterative, anthelmintic, antiseptic, antispasmodic, aphrodisiac, aromatic, astringent,

carminative, diuretic, expectorant, insecticidal, prophylactic, stimulant, tonic

Uses

Bronchial asthma

cholera

cough

dyspepsia

edema

gas

jaundice

leprosy

phlegm

rheumatism

skin diseases

hiccup

As an ointment it is applied externally to wounds, severe ulcerations, skin diseases,

and tumours.

CONTRAINDICATION :

Maximum tolerated doses were found to be 100 mg/kg in white mice and rats

respectively 130. Clinically, gastric irritation and dizziness are occasional side effects seen

only with large doses.


As an infusion of the dried root : 20 - 30 ml b.i.d.

Agnimukha churna : 5 - 10 gms b.i.d.

Root paste : Topical use.


8) PIPPALI - Piper longum Linn. 131

PLANT PART USED :

Fruit, root and stem.

DESCRIPTION :

The erect shrub has a thick, jointed and branched rootstock. Leaves are numerous,

6.3 to 9.0 cm, broadly ovate or oblong-oval, dark green and shining above, pale and dull

beneath. Fruits are present in a solitary, pedunculate, fleshy spike 2.5 to 3.5 cm long, 5 mm

thick, ovoid, oblong, erect, blunt, blackish green in colour and shining. Odour is aromatic

and the taste is pungent. 132

PHYTOACTIVE :

The fruits contain 1% volatile oil, resin, alkaloids piperine and piperlonguminine, a

waxy alkaloid N-isobutyldeca-trans-2-trans-4-dienamide and a terpenoid substance. Roots

corain piperine, piperiongumine or piplartine. Dihydrostigmasterol has been isolated 133.


Antiallergic activity of the fruit has been studied 134. It effectively reduced passive

cutaneous anaphylaxis in rats and protected guinea pigs against antigen-induced

bronchospasm; a 30% protection of mast cells was observed in an in-vitro study. Both

alcoholic extract and piplartine extracted from the stems showed significant inhibition of

ciliary movements of oesophagus of frog 135. Neogi et al studied the pharmacology of

piperine.Piperine decreased the rate and amplitude of respiration and showed nonspecific

blockade of acetylcholine,histamine and 5-hydroxytryptamine induced spasm on isolated

guinea pig and rabbit intestine 136. The oil of fruit has been found to possess significant

paralytic action on the nerve-muscle preparation of A. lumbricoides 137. The hepato-


protective effect has been shown in carbon tetrachloride-induced liver damage in rats138. A

common use of the fruit is in the prevention of recurrent attacks of bronchial asthma 139.

Another important indication is in chronic malaria 140. In a study of 240 children with a long

term use of fruit 58.3% had decreased severity of attacks 141. In another study 20 children

were studied for one year with the same treatment. Eleven had no recurrence. All patients

had strongly positive skin test which became negative in 6 and decreased significantly in 12

after five weeks of treatment 142. Along with Piper nigrum and C. officinale it has been

useful in viral hepatitis 143.

Uses

Abdominal tumoursAsthmaBronchitisColdsCoughsDigestionEpilepsy

FlatulenceGoutLaryngitisParalysisRheumatic painSciaticaWorms

Medicinal Applications - Action

Analgesic, anthelmintic, aphrodisiac, carminative and expectorant.

Seed used in cough and throat pain. Root used in paralysis, epilepsy, and stiff joints.

Both seeds and root are used for cough, rheumatism, leprosy, and consumption. The herb is

also believed to improve vitality.

CONTRAINDICATION :

Piper longum is in widespread use for many centuries. The standard doses are well

tolerated. No mortality was observed with the powder of the fruit boiled in milk and water

administered orally to albino rats in a dose of 1 gm/kg;. Acute toxicity studies with piperine,

piperlongumine and piperlonguminine were carried out in mice, rat and dog with oral and


intraperitoneal route. In mice, oral LD (50) was 56.2 + 8.0, 110.1 + 7.8 and 115.3 + 9.5 mg/kg

with piperine, piper- lonigumine and piperlonguminine respectively144


1. Fruit powder : 250 mg. to 500 mg. t.i.d.

2. Pippalyasava : 20 ml. b.i.d.

3. Chousastha Pippali : 125 - 500 mg b.i.d.

9) BRUHATI - Solanum Indicum Linn 145

PLANT PART USED :

Root, fruits, seeds.

DESCRIPTION :

A much branched shrub 0.3-1.5 m high, with large prickles. Stem stout,often

purple.Branches covered with minute stellate hairs. Leaves 5-15 by 2.5-7.5 cm ovate in

outline,acute,clothed with simple hairs. Flowers in racemose extra axillary cymes,purple

coloured,clothed with darker purple coloured hairs. Fruit berry 8 mm diameter globose, dark

yellow, when ripe. Seeds minutely pitted 146.

PHYTOACTIVE :

Fruit and root contain wax,fattyacids,and alkaloids solanine and solanidine 147


Few drops of water extract of the whole plant are administered through nasal route

especially on 'Pushya Nakshatra' Prostaglandin content of the endometrium from ten women

was examined before and after 3 months of the drug administration. A significant increase in

prostaglandin E and F was observed. 17-oxysteroids in the urine of women patients also

increased on exposure to a nasal spray of the drug 148.


It is described as useful in asthma, dry cough, and chronic febrile afflictions and also

in dysuria. The fruit is useful in leueoderma, pruritus and bronchitis. Juice of the leaves with

fresh juice of ginger is taken to stop nausea and vomiting.

CONTRAINDICATION :

In routine doses no untoward effect is found.


1. Bruhatyadikwatha : 15 - 30 ml b.i.d.

2. Dashamulakwatha : 15 - 30 ml b.i.d.

10) GUDUCHI - Tinospora cordifolia 149

PLANT PART USED :

Root, stem, leaves, and satwa (starch).

DESCRIPTION :

This plant is a glabrous, succulent, climbing shrub, often growing very tall. It sends

down long aerial roots, which resemble roots except for nodal swellings. The bark is creamy

white to grey, deeply cleft spirally, the space in between being spotted with large rosette like

lenticels.150

PHYTOACTIVE:

Different constituents reported include a glucoside, alkaloids, bitter principles,

crystalline components etc 151-152-153-154. The glycoside-giloin, and a non-glucoside-gilenin

and gilosterol have been found 155. The bitter principles have been identified as columbin,

chasmanthin and palmarin'. The alkaloid tinosporin 156, tinosporic acid, and tinosporol have

been identified in leaves, which are rich in proteins, calcium and phosphorus. Protoberberine

alkaloids are found as trace components in many plants of Tinospora spp.



Studies on induced oedema and arthritis, and on human arthritis proved the anti-

inflammatory potency of the water extract of this plant 157. Phase I and Phase II of adjutant

induced arthritis were also inhibited. The anti-inflammatory activity of this plant resembles

that of nonsteroidal anti-inflammatory agents 158-159. It also has weak antipyretc action and is

a morphine potentiatorg. It also shows we diuretic action 160. The hypoglycaemic potential

of this plant has been studied, extensively. Administration of the aqueous extract to alloxan

induced hyper- glycaemic rats and rabbits in a dose of 400 mg/kg body weight induced

reduction in blood sugar". Reduction in blood sugar levels has been reported in adrenaline

induced hyperglycaemia in rates 161, as also a favourable glucose tolerance in this rodent

species on exposure to an aqueous extract of T. cordifolia 162-163-164. The aqueous extract of

the stem antagonises the effects of agonists such as 5-hydroxytryptamine, histamine,

bradyklnin, and prostaglandins El and E2, on the rabbit smooth muscle. This drug relaxes

the intestinal, uterine smooth muscle and inhibits the constrictor response of histamine and

acetylcholine on smooth muscle 165. Intravenous exposure, to aqueous extract of T.

cordifolia in doses of 5.0, 10.0 and 15.0 mg/kg body weight produces a temporary but

marked fall in blood pressure and bradycardia in anaesthetised dogs. Blood urea levels in

uraemic dogs and human subjects were also decreased by this drug 166. The hepato-

protective effect of T. cordifolia extract has been studied in carbon tetrachloride induced

liver damage in rats. While acute damage was enhanced by prior exposure to the drug, it

proved effective in the prevention of fibrosis, and in stimulating regeneration in hepatic

tissue 167. Clinically, this drug has been tried as a therapeutic modality in rheumatoid


arthritis 168-169-17-171, jaundice 172-173 and in diabetes 174. Used in compound formulations for

treatment of jaundice, rheumatoid arthritis and diabetes.

Medicinal Properties - Action

Alterative, antiperiodic, bitter tonic, diuretic, febrifuge

Uses

This herb is used in seminal weakness and urinary affections. It is also a valuable

tonic. Other applications of this herb include: fever, gout, jaundice, torpidity of the liver,

skin diseases, secondary syphilis, rheumatism, constipation, tuberculosis, and leprosy. It is a

blood purifier and may be useful in AIDS and other immune diseases also. It is also being

proposed for cancer patients before and after chemotherapy.

CONTRAINDICATION :

Found to he nontoxic in acute toxicity studies.


1. Giloy satva : 5 - 15 rati (625-1875 mg)

2. Guduchyadi tailam : Topical use.

3. Guduchyadi kashaya : 60 - 100 ml b.i.d. / t.i.d.

4. Guduchyadi churna : 1 1/2 - 3 gm b.i.d. / t.i.d.

Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) 88

Chapter –4

Methodology

“ ishamajwara in term of modern medical terminology co-related to

malarial fever, is a protozoan disease caused by genus plasmodium and transmitted to man

by certain species of infected female anopheles mosquito. India's geographic position and

climatic conditions are favorable for the transmission of malaria. Frequently people living in

the endemic areas are prone for this infection. Out of 300-500 million clinical cases around

100 countries and one million deaths due to malarial malady are noticed globally. The 38th

world health assembly in 1985 recommended that, malaria control should be developed as

an integral part of the national primary health care systems 175-176-177.

Vishamajwara is irregular (inconsistent) in it's arambha (nature of onset

commitment), kriya (action production of symptoms) and kala (time of appearance) and

possesses anushanga (persistence for long periods) 178-179-180. As on today, the malarial

parasite has developed resistance to chloroquine compounds, which are used vividly for the

past three decades.





Vishamajwara is a type of fever, which is described in all Ayurvedic texts. Charaka


mentioned Vishamajwara and Chakrapani have commented on Vishamajwara as

bhutanubanda 182. Susruta affirmed that Aagantuchhanubhandohi praysho Vishamajware183.

Madhavakara has also recognised Vishamajwara as Bhutabhishangajanya (infected by

microorganism) 184. Hence infected female anopheline mosquito bite can be considered as

causative factor for Vishamajwara along with other etiological factors.


Bharangyadi Ghanavati in Vishamajwara with special reference to malarial fever”. The

Ayurvedic practitioners use Bharangyadi Ghanavati in the management of Vishamajwara,

which is explained in Sahasrayoga in Kashaya kalpana.

Bharangyadi Ghanavati is a combination of Jwarahara and Krimihara drugs.

Bharangi, Kiratatikta are proved as anti malarial drugs. Guduchi, Parpataka and Brahati are

having antipyretic properties. Shunti, Pippali are the best drugs for the Amapachana. So the

combination of Bharangyadi yoga shows the Vishamajwarahara properties. Thus this

combination is chosen for the present study.

Materials and Methods

Method of Collection of data

1) Patients:

Patients suffering from Vishamajwara will be selected from department of

Kayachikitsa Post Graduation studies and Research OPD of D G Melmalgi

Ayurvedic medical college and Hospital by preset inclusion and exclusion criteria.

2) Literary:

Literary aspect of study will be collected from classical Ayurvedic and modern texts.


3) Study design:

Prospective clinical study

4) Sample size:

A minimum of 30 patients

5) Exclusion Criteria –

v Patient below 15 years and above 65 years of the age

v Patient with complication like severe anaemia

v Renal failure

v Pulmonary oedema,

v Jaundice

v Spleenic rupture

v Pregnant women

v Cerebral Malaria

6) Inclusion criteria –

v Age of the patients between 15 to 65 years.

v Uncomplicated malarial fever

v Peripheral smear test for M P must be positive

7) Criteria of Diagnosis

1) The symptomatalogy of Vishamajwara mentioned in ayurvedic text will be

the basic diagnostic criteria.

2) Peripheral smear for MP is taken as diagnostic criteria


8) Posology-

Internal - 3 gms in divided doses

1 vati =500 mg, 2 tab thrice a day with Ushna jala

9) Study Duration:

21 days and Follow up for 15 days

10) Assessment of Result

Subjective and objective parameters are taken for the assessment of result.

11) Subjective parameters

As designated in the classical texts.

12) Objective Parameters

1. Thick and thin blood film for malaria.

2. Peripheral smear test for MP

3. Erythrocyte Sedimentation Rate (ESR)

4. Haemoglobin (Hb %)

5. Temperature chart

13) Investigations -Diagnostic and Exclusion

1. Thick and thin blood film for Malaria.

2. Peripheral smear

3. Haemoglobin (Hb %)

4. Total Count (TC)

5. Differential Count (DC)

6. Erythrocyte sedimentation rate (E S R)

7. Widal test


14) Examination of a Vishamajwara Patient vis-à-vis Malaria

History: Most patients live in or recently have travelled to an endemic area; however, a few

cases are reported each year with no history of such travel.

• Determine the patient's immune status, age, allergies, other medical conditions, other

medications, and pregnancy status.

• The patient usually remains asymptomatic for a week or more after the infecting

mosquito bite.

• Clinical symptoms include the following:

• Cough

• Fatigue

• Malaise

• Shaking chills

• Arthralgia

• Myalgia

• Paroxysm of fever, shaking chills, and sweats

• The classic paroxysm begins with a period of shivering and chills, which lasts for

approximately 1-2 hours, and is followed by a high fever. Finally, the patient

experiences excessive diaphoresis, and the body temperature of the patient drops to

normal or below normal.

• Many patients, particularly early in infection, do not present the classic paroxysm but

may have several small fever spikes a day.

• Maintain a high index of suspicion for malaria in any patient exhibiting any malarial

symptoms and having a history of travel to endemic areas.


• Less common symptoms include the following:

• Anorexia and lethargy

• Nausea and vomiting

• Diarrhoea

• Headache

Physical examination:

• Physical symptoms that may be noted with malaria include the following:

• Tachycardia

• Fever

• Hypotension

• Signs of anaemia

• Splenomegaly

Causes of Malaria tested:

There are four species of the genus plasmodium responsible for the malarial parasite

infections that commonly infect man, P.falciparum, P.vivax, P.malariae and P.ovale. The

most important of these is P.falciparum because it can be rapidly fatal and is responsible for

the majority of malaria related deaths.

Malaria occurs in most tropical regions of the world with P.falciparum

predominating in Africa, New Guinea and Haiti. P.vivax is more common on the Indian sub-

continent and Central America with the prevalence of these two infections roughly equal in

Asia, Oceania and South America. P. malariae is found in most endemic areas especially

sub-Saharan Africa but much less frequently. P. ovale is relatively unusual outside Africa

although some cases are now being identified in other regions (eg. Southern States of India).


It is also important to recognise that with the relative ease and speed of modern travel and

migration, "imported" cases of malaria may present in any country. Additionally so called

"airport malaria" (see History section) has now been identified in a number of countries

including the USA, UK, Belgium, and Switzerland. Airport malaria is particularly dangerous

since Clinicians may have little reason to suspect it, if the patient has had no recent travel to

areas where malaria is endemic. This may result in a delay before the correct diagnosis is

made and which may lead to death before appropriate treatment can be initiated. Small

outbreaks of malaria may occur in countries considered free of the disease, such outbreaks

are most likely the result of an infected person entering the country asymptomatic and where

suitable mosquito vectors are present.

• Malaria most often is caused by the bite of a female Anopheles species mosquito that

is infected with 1 of the 4 species of the protozoan genus Plasmodium.

• P vivax: If this kind of infection goes untreated, it usually lasts for 2-3

months with diminishing frequency and intensity of paroxysms. Of patients

infected with P vivax, 50% experience a relapse in a few weeks to 5 years

after the initial illness.

• P ovale: These infections are similar to P vivax infections, although they are

usually less severe. A P ovale infection often resolves without treatment.

• P malariae: Those infected with this species of Plasmodium remain

asymptomatic for a much longer period of time than those infected with P

vivax or P ovale. Recrudescence is common in those infected with P

malariae. It often is associated with a nephrotic syndrome, possibly resulting

from deposition of antibody-antigen complex upon the glomeruli.


• P falciparum: The most malignant form of malaria is caused by this species.

Infection with P falciparum is not limited to RBCs of a particular age and,

hence, represents the highest level of parasitemia among the 4 Plasmodium

species. This species also causes vascular obstruction due to its ability to

adhere to endothelial cell walls. This property leads to most complications of

P falciparum infection. P falciparum can cause cerebral malaria, pulmonary

edema, rapidly developing anemia, and renal problems.

• Other less common routes of infection are through blood transfusion and maternal-

foetal transmission.

Dipstick tests

In recent years a number of new techniques based on the "dipstick" format, have

become available for the diagnosis of malaria. These include the ICT-Malaria Pf, OptiMALr

and the Kat-Quick kits. The methods are based on the principle of the detection of

plasmodial histidine rich protein-2 (HRP-2) or parasite-specific lactate dehydrogenase

(pLDH) which is present in P.falciparum infections. A number of reports claim sensitivities

and specificities approaching 100% while other reports have claimed up to 6% cross

reactivity with sera positive for rheumatoid factor. Some of these "dipstick" methods have

been extended to include screening for other forms of malaria but to date results have not

been quite so impressive.

Dipstick tests have the potential of enhancing the speed and also the accuracy of

diagnosing P. falciparum, particularly in non specialised laboratories where inexperienced

or junior staff may be involved, since very little training is required for these techniques. In

this laboratory we have found the dipstick kits to be very useful screening or confirmatory


tests, especially when there is difficulty in identifying scanty ring forms in blood films. They

have proved to be particularly useful out of hours when junior, less experienced staffs have

been on duty. However dipstick methods are unable to indicate parasite load and in some

countries the cost may be prohibitive. A potential problem with these methods is that the

circulating antigen may be detected for many days (up to 2 weeks in our laboratory) after the

elimination of viable parasites from the circulation. It must therefore be remembered that a

positive test may not always be due to an active infection. We would like to emphasise, that

we regard these dipstick methods as useful additional tests to the long established method of

examining thick and thin blood films (outlined below), which is still regarded as the "gold

standard", NOT as replacement methods. The highest density of malaria occurs in countries

least able to afford sophisticated and expensive diagnostic tools.

Antibodies to malaria can be detected using enzymatic immunoassays or

immunofluorescence techniques. The antibodies to the asexual blood stages appear days to

weeks after the infection and may persist for months. Although useful in survey work or for

screening blood donors and reducing wastage, they are of little value in the "acute" malaria

situation. 185

Other methods include the QBC II System, Becton-Dickinson's Quantitative Buffy

Coat (QBC) method. This involves centrifuging the patient's blood in special capillary tubes

precoated with Acridine Orange (AO) in which parasite DNA is stained with AO. A small

precision moulded plastic float presses the parasitised red cells (which occupy the upper

most part of the red cell column) against the wall of the tube, where they can be viewed by

ultra violet light microscopy. The sensitivity of this method is claimed to be very high with

experienced users, although some reports suggest that young trophozoites of P. falciparum


and P. vivax, could not be distinguished with any degree of certainty and that confirmatory

blood films should always examined. Additionally special equipment is required, which may

preclude the method from being used in smaller centres. 186

Another relatively new method is the polymerase chain reaction (PCR) which uses a

non-isotopically labelled probe following PCR amplification. It is possible to detect <10

parasites per 10uL of blood and PCR may yet prove to be a valuable addition to the

examination of blood films for the diagnosis and specification of malaria 187. Once again the

special equipment required precludes all but the larger centres. Some researchers have

claimed that PCR (and Elisa) techniques are as sensitive as blood films, however they are

infinitely more expensive, require specialised equipment and take a longer time to complete.

Examination of a thick blood film should be the first step since this has the

advantage of concentrating the parasites by 20 fold in comparison to a thin film, although

the parasites may appear distorted making species identification difficult. If parasites are

seen then the species should be confirmed by the examination of a thin film. Ideally blood

should be collected when the patient's temperature is rising.

Preparation of thick and thin blood films: -

Thick films:- place a drop of blood in the middle of a clean microscope slide and with the

corner of a second slide spread the drop until it is about 10-15mm in diameter. The thickness

should be such that it is just possible to see news print through it. Thin films are made in the

standard manner. Allow the films to dry, do not leave on the bench in a laboratory which is

not fly proofed otherwise the film will be eaten.

When the films are dry, fix and stain the thin films in the conventional manner but be

careful about the pH of the stain, a slightly alkaline stain is recommended (pH 7.2) as an


acid stain may fail to show the parasites. When only a few thick films are to be stained it is

best to use dilute Giemsa stain (1/20), using a staining jar so that the film is in an upright

position, this will allow any debris to fall to the bottom of the jar. Do not fix the sample

prior to staining. Stains for about 30 minutes, wash gently with clean water and allowed

drying. If available use a positive control. When a large number of thick films require

staining, Field's stain is preferred because it is very quick. Field's stain comprises two

solutions; a polychrome methylene blue (A) and eosin (B). The solutions are kept in covered

staining jars.

1. Dip the dry but unfixed film into solution A for 1 or 2 seconds.

2. Remove from solution A and immediately rinse in clean water ( a 250ml beaker with

water gently flowing into it is suitable)

3. Dip the film into solution B for 1 or 2 seconds.

4. Rinse in clean water for a few seconds.

5. Place in a vertical position to dry.

If films are old or too thick the red cells may not lyse completely in the brief staining

time. If this is likely dip the film in clean water for a few seconds or until the haemoglobin

has dispersed before staining. Instructions for preparing Field's stain can be found in many

laboratory textbooks.

Under the microscope examine the thick film first, using an oil immersion or high

dry lens to determine if parasites are present. Be aware of the patient's platelet and leucocyte

counts. Malaria is usually associated with a normal or reduced leucocyte numbers. A

leucocytosis is only found in terminal cases. Platelet numbers are moderately or markedly


reduced in some 80% of patients with malaria. Parasites may appear distorted if the patient

has been treated or has had inadequate or ineffective prophylaxis.

Diagnostic points of P. falciparum:-

1. Red Cells are not enlarged.

2. Rings appear fine and delicate and there may be several in one cell.

3. Some rings may have two chromatin dots.

4. Presence of marginal or applique forms.

5. It is unusual to see developing forms in peripheral blood films.

6. Gametocytes have a characteristic crescent shape appearance.

However, they do not usually appear in the blood for the first four weeks of

infection.

7. Maurer's dots may be present.

Diagnostic points P vivax:

1. Red cells containing parasites are usually enlarged.

2. Schuffner's dots are frequently present in the red cells as shown above.

3. The mature ring forms tend to be large and coarse.

4. Developing forms are frequently present.

Diagnostic points P. Malariae:-

1. Ring forms may have a squarish appearance.

2. Band forms are a characteristic of this species.

3. Mature schizonts may have a typical daisy head appearance with up to ten

merozoites.

4. Red cells are not enlarged.

Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)100

5. Chromatin dot may be on the inner surface of the ring.

Diagnostic points P ovale:

1. Red cells enlarged.

2. Comet forms common (top right)

3. Rings large and coarse.

4. Schuffner's dots, when present, may be prominent.

5. Mature schizonts similar to those of P. malariae but larger and more coarse.

Lab Studies:

• Helpful studies include a CBC, electrolyte panel, renal function tests, pregnancy test,

urinalysis, urine and blood cultures, and thick and thin blood smears.

• Laboratory diagnosis in the ED may be limited in hospitals that do not have

personnel who are well acquainted with malaria or special tests for rapid detection of

the disease.

Imaging Studies:

• A chest x-ray may be helpful if respiratory symptoms are present.

• If CNS symptoms are present, a CT scan of the head may be ordered once the patient

is stable.

Other Tests:

• Microhematocrit centrifugation

• Using this method with the CBC tube is a more sensitive method of detection

of malaria infection.


• However, microhematocrit centrifugation does not allow the identification of

the species of Plasmodium. To determine that species, a peripheral blood

smear must be examined.

• Giemsa-stained thick and thin peripheral blood smears

• These smears are the criterion standard for malaria detection and should be

sent to the laboratory immediately, since malaria is a potentially life-

threatening infection.

• When reading the smear, 200-300 oil-immersion fields should be examined

(more if the patient recently has taken prophylactic medication, because this

temporarily may decrease parasitemia).

• One negative smear does not exclude malaria as a diagnosis; several more

smears should be examined over a 36-hour period.

• Fluorescent dyes: Several different dyes allow laboratory results to be obtained more

quickly. These methods require the use of a fluorescent microscope.

• Polymerase chain reaction

• Polymerase chain reaction (PCR) is a very specific and sensitive test for

determining if the species of Plasmodium are present in the blood of an

infected individual.

• PCR is also very effective at detecting the Plasmodium species present in-

patients with parasitemias as low as 10 parasites/ml of blood.

• ParaSight F (dipstick test)


• This test is useful in detecting only P falciparum infections. It is based on

antibody recognition of the HRP-2 antigen of P falciparum and, in most

cases, it has been found to be as specific as microscopy studies.

• It often is able to detect P falciparum in parasitemias that are below the

threshold of reliable microscopic species identification.

• The dipstick test is not as effective when parasite levels are below 100

parasites/ml of blood, and the test rarely is negative in those with high

parasitemias. For these reasons, always confirm ParaSight F test results with

a second type of screening test.

Special Concerns:

• Pregnancy

• Pregnant women, especially primigravid women, are up to 10 times more

likely to contract malaria than nongravid women. Gravid women who

contract malaria also have a greater tendency to develop severe malaria.

• Unlike malarial infection in nongravid individuals, pregnant women with P

vivax are at high risk for severe malaria, and those with P falciparum have a

greatly increased predisposition for severe malaria as well.

• For these reasons, it is important that nonimmune pregnant women in

endemic areas use the proper prophylaxis.

• If a pregnant woman becomes infected, she should know that many of the

antimalarial and antiprotozoal drugs used to treat malaria are safe for use

during pregnancy for both the mother and the foetus. Therefore, they should


be used, since the benefits of these drugs much outweigh the risks associated

with leaving the infection untreated.

• To obtain the latest CDC recommendations for malaria prophylaxis and

treatment, call the local Anti-malarial squad.

• Paediatrics

• In children, malaria has a shorter course, often rapidly progressing to severe

malaria.

• Children are more likely to present with hypoglycaemia, seizures, severe

anaemia, and sudden death, but they are much less likely to develop renal

failure, pulmonary oedema, or jaundice.

• Cerebral malaria results in neurologic sequelae in 9-26% of children, but of

these sequelae, approximately one half completely resolve with time.

• Most anti-malarial drugs are very effective and safe in children, provided that

the proper dosage is administered. Children commonly recover from malaria,

even severe malaria, much faster than adults.

Complications:

• Most complications are caused by P falciparum, and they may include the following:

• Coma (cerebral malaria)

• Defined as coma, altered mental status, or multiple seizures with P

falciparum in the blood, cerebral malaria is the most common cause

of death in malaria patients. If untreated, this complication is lethal.

• Even with treatment, 15% of children and 20% of adults who develop

cerebral malaria die.


• The symptoms of cerebral malaria are similar to those of toxic

encephalopathy.

• Seizures

• Renal failure: As many as 30% of nonimmune adults infected with P

falciparum suffer acute renal failure.

• Haemoglobinuria (blackwater fever)

• Blackwater fever is the passage of dark, Madeira-colored urine.

• Haemolysis, haemoglobinemia, and the subsequent haemoglobinuria

and hemozoinuria cause this condition.

• Noncardiogenic pulmonary oedema: This affliction is most common in

pregnant women and results in death in 80% of patients.

• Profound hypoglycaemia: Hypoglycaemia often occurs in young children and

pregnant women. It often is difficult to diagnose since adrenergic signs are

not always present and since stupor already may have occurred in the patient.

• Lactic acidosis: This occurs when the microvasculature becomes clogged

with P falciparum. If the venous lactate level reaches 45 mg/dl, a poor

prognosis is very likely.

• Haemolysis resulting in severe anaemia and jaundice

• Bleeding (coagulopathy)

Consultations:

It is recommended that the emergency physician contact an infectious disease

clinician or the pathologist when confronted with a possible case of malaria based upon

history and physical examination to ensure proper identification and diagnosis.


• To aid in identification of the species of Plasmodium, also notify the pathologist of

patient information, including the following:

• Determine where the patient has travelled and when the patient returned

home.

• Determine if the patient has been diagnosed with malaria ever before. If so,

find out which species of Plasmodium caused the previous infection.

• Determine what medication or prophylaxis the patient has taken, and find out

when the last dose was administered.

• Determine if the patient has a history of blood transfusion or of non-sterile

needle usage.

• Identify the date and time that the patient's blood sample was drawn and

determine what condition the patient was in at that time (eg, patient was

symptomatic, any periodicity of symptoms).

Prognosis:

• Most patients with uncomplicated malaria exhibit marked improvement within 48

hours after the initiation of treatment and are fever-free after 96 hours.

• Only P falciparum infection carries a poor prognosis with a high mortality rate if

untreated. However, if diagnosed early and treated appropriately, the prognosis is

excellent.

Uncomplicated malaria

The presentation of uncomplicated P. falciparum malaria is very variable and

mimics that of many other diseases. Although fever is common, it is absent in some cases.

The fever is initially persistent rather than tertian (spikes of fever on alternate days, Fig. 2).


The expectation that P. falciparum malaria should have a tertian fever pattern may lead to

the diagnosis of malaria being missed with a consequent delay in treatment. The fever may

or may not be accompanied by rigors. True rigors are relatively unusual in acute falciparum

malaria.

Severe malaria (Severe falciparum malaria)

Severe malaria is caused by Plasmodium falciparum infection and usually occurs as

a result of delay in treating an uncomplicated attack of falciparum malaria. Sometimes,

however, especially in children, severe malaria may develop very rapidly. Recognizing and

promptly treating uncomplicated P. falciparum malaria is therefore of vital importance.

A patient with severe falciparum malaria may present with confusion or drowsiness with

extreme weakness (prostration). In addition, the following may develop:

• Cerebral malaria defined as unrousable coma not attributable to any other cause in a

patient with falciparum malaria.

• Generalised convulsions.

• Severe normocytic anaemia.

• Hypoglycaemia.

• Metabolic acidosis with respiratory distress.

• Fluid and electrolyte disturbances.

• Acute renal failure.

• Acute pulmonary oedema and adult respiratory distress syndrome (ARDS).

• Circulatory collapse, shock, septicaemia ("algid malaria").

• Abnormal bleeding.

• Jaundice.


• Haemoglobinuria.

• High fever.

• Hyperparasitaemia.

15) Trail Drug:

The combination and proportion of Bharangyadi Ghanavati is as follows.

1. Bharangi Clerodendrum serratum 1 Part

2. Musta Cyprerus rotundus 1 Part

3. Parpatak Fumaria officinalis 1 Part

4. Yavasa (danvayavasa) Fagonia arabica 1 Part

5. Shunti Zingeber officinale roscoe 1 Part

6. Kiratatikta (Bhunibha) Swertia chirata 2 Part

7. Kusta Saussurea lappa 1 Part

8. Pippali Piper longum 1 Part

9. Bruhati Solanum indicum 1 Part

10. Guduchi Tinospora cardifolia 1 Part

15) Preparation of Yoga

All the drugs will be identified and collected from local areas. Good manufacturing

practice will be followed for the preparation of Bharangyadi Ghana Vati. All the ingredients

are pondered and powered well to powder. Powder is tabulated and preserved in bottles till

to usage.

Drug Course powder is boiled with 16 parts of water over mild fire, till the liquid is

reduced to solid part of the quantity. 188-189


Chapter-5

Resultsresent study registers 30 patients, out of 68 approached patients.

Out this, 4 patients were discontinued hence their data has not been included in the

assessment. The remaining 26 patients of Vishamajwara viz. Malaria, fulfilling the criteria

of diagnosis and inclusive criteria were included in the study.

All the patients were examined before and after the trail, according to the case sheet

format given in the annex. Both the subjective and objective criteria were recorded. The data

recorded are presented under the following headings.

A. Demographic data

B. Evaluating disease Data

C. Result of the Bharangyadi Ghanavati in Vishamajwara viz. Malaria and

D. Statistical analysis of the clinical and objective parameters

A) Demographic data:

The details of Age, Gender, Religion, and Occupation etc. of the 30 patients is as

follows.

A1) distribution of patients by Age

Age – gender distributions Observation and Results:

An interval of 10 has considered from the ages 15 to 65 as discussed in the methods.

In the study it is revealed that malarial fever is common from the ages of 15 onwards and as

age advances the samples are settled. At the older age group of 45-65 no patients are

reported. Where in 15-25 and 25-35 age groups reported with maximum number of patients,

i.e. 14 (46.7%) and 10 (33.3%) respectively. The tabulations are depicted as under.


Table- 4

Distribution of patients by Age

AgeC

ured

%

Res

pond

ed

% Not

Res

pond

ed

%

Dis

cont

inue

d

%

Tot

alpa

tient

s %

15 –25 10 33.3 0 0 3 10 1 3.33 14 46.7

25-35 5 16.7 1 3.33 2 6.67 2 6.67 10 33.3

35-45 4 13.3 0 0 1 3.33 1 3.33 6 20

45-55 0 0 0 0 0 0 0 0 0 0

55-65 0 0 0 0 0 0 0 0 0 0

Total 19 63.3 1 3.33 6 20 4 13.3 30 100

Graph – 1


DISTRIBUTION OF PATIENTS BY AGE

55-650.00%

15 –2546.67%

35-4520.00%

25-3533.33%

45-550.00%


Out of the 15-25 category we found that, 10 (33.3%) cured patients, 3 (10 %) not

responded patients and 1 (3.33%) patient discontinued. At the 25-35 category we found that,

5 (16.7%) cured patients, 1 (3.33 %) responded patient, 2 (6.67%) not responded patients

and 2 (6.67%) patients discontinued. In the 35-45 age group it is observed that 4 (13.3%)

cured patients, 1 (3.33%) not responded and 1 (3.33%) patient discontinued. No other

groups are reported in the study.

Another observation regarding the age and gender is made in the study. It is found

that the distributions of the ages in the genders are also gender dependent. Male gender is

predominant in the study and reveals that it is 24 (80%) and the rest females are only 6

(20%). Much of the categories that are subjected to the atmosphere with out time relevance

are exposed to the Vishamajwara vis-à-vis Malaria. The tabulations are depicted as under.

Table- 5

Distribution of patients by Age- gender

Male patients Female patients Total patientsAge

Number Percentage Number Percentage Number Percentage15-25 10 33.33 4 13.33 14 46.67

25-35 10 33.33 0 0 10 33.33

35-45 4 13.34 2 6.67 6 20

45-55 0 0 0 0 0 0

55-65 0 0 0 0 0 0

Total 24 80 6 20 30 100

At the male gender 10 (33.33%) patients are of 15-25 ages, 10 (33.33%) patients

belongs to 25-35 ages and the rest of 4 (13.34%) patients are in 35-45 age category of

Vishamajwara vis-à-vis Malaria.


On the other hand the female populations are well protected and are in total only

20% in the study of Vishamajwara vis-à-vis Malaria. Out of 6 patients reported 4(13.33%)

patients are of 15-25 age group and the rest 2 (6.67%) patients are in 35-45 age group. No

patients are reported from the 45-55 and 55-65 age groups of either category.

Graph –2


A2) Distribution of patients by Gender

The male female ratio in the study is 4:1 patients. The percentage of the distribution

does not show any gender differentiation to get this protozoan-related disease. The

observations are 24 Patients i.e. (80%) male and 6 patients i.e. (20%) were female.

As the results observed, out of 24 (80%) males, 15 (50%) patients cured, 1 (3.33%)

patient responded, 4 (13.3%) patients not-responded and 4 (13.3%) patients are discontinued

from the study. On the other hand out of 6 (20%) female, 4 (13.3%) patients’ cured and 2


4

0

2

0

0

0

10

4

10

0

0 2 4 6 8 10 12

15-25

25-35

35-45

45-55

55-65Female

Male


(6.67%) patients not-responded in the study of Vishamajwara vis-à-vis Malaria. The

tabulations and depictions are as under.

Table- 6

Distribution of patients by Gender

Gender

Cur

ed

%R

espo

nded

% Not

Res

pond

ed

%

Dis

cont

inue

d

%

Tot

alpa

tient

s %

Male 15 50 1 3.33 4 13.3 4 13.3 24 80

Female 4 13.3 0 0 2 6.67 0 0 6 20

Total 19 63.3 1 3.33 6 20 4 13.3 30 100

Graph - 3


DISTRIBUTION OF PATIENTS BY GENDER

Male80%

Female20%


A3) distribution of patients by Religion

Table- 7

Distribution of patients by Religion

Religion

Cur

ed

%

Res

pond

ed

% Not

Res

pond

ed

%

Dis

cont

inue

d

%

Tot

alpa

tient

s %

Hindu 14 46.67 1 3.33 6 20 4 13.3 25 83.33

Muslim 4 13.34 0 0 0 0 0 0 4 13.34

Christian 1 3.3 0 0 0 0 0 0 1 3.3

Others 0 0 0 0 0 0 0 0 0 0

Total 19 63.3 1 3.33 6 20 4 13.3 30 100

Graph- 4



Christian 3.33%

Hindu83.33%

Muslim13.33%

Others0.00%


At the results observed 25 (83.33%) Hindus, 4 (13.33%) Muslims and 1 (3.33%)

Christians are observed in the study. Out of 25 (83.33%) of Hindu patients, 14 (46.66%)

patients are cured, 1 (24%) patient responded, 6 (20%) patients not-responded and 4 (13.3%)

patients are discontinued.

On the other hand the results observed at Muslim community are, out of 4 (13.33%)

all 4 (13.33%) patients are cured. 1 (3.3%) patient of Christian is also cured in the study of

Vishamajwara vis-à-vis Malaria.

A4) Distribution of patients by Occupation

Table- 8

Distribution of patients by Occupation

Occ

upat

ion

Cur

ed

%

Res

pond

ed

% Not

Res

pond

ed

%

Dis

cont

inue

d%

Tot

alpa

tient

s %

Labour 9 30 0 0 5 16.7 3 10 17 56.7

Agriculturist

2 6.67 1 3.33 0 0 0 0 3 10

Service 0 0 0 0 1 3.33 0 0 1 3.33

Student4 13.33 0 0 0 0 0 0 4 13.33

Business2 6.67 0 0 0 0 1 3.33 3 10

Housewife

2 6.67 0 0 0 0 0 0 2 6.6

Total 19 63.3 1 3.33 6 20 4 13.3 30 100

Occupations are divided in to six groups basically. They are Labour, Agriculture,

student, Service, Business and Housewives. More of the patients reported are of labour


group, as they are not well protected and also expose to the unhygienic environment. The

observations on the basis of occupation are 17 (56.7%) labour, 3 (10%) Agriculture, 4

(13.33%) Students, 1 (3.33) Service candidates, 3 (10%) Business people and 2 (6.6%)

Housewives as tabulated above.

The results of the individual groups are as follows. The major group of labourers out

of 17 patients reported, 9 (30%) cured, 5 (16.7%) responded and 3 (10%) discontinued in the

study. Out of 3 reported Agriculturists 2 (6.67%) cured and 1 (3.33%) responded. At the 4

(13.33%) of students are cured and 1 (3.33%) service candidate is not responded to the

treatment. 2 (6.67%) patients of reported Business people are cured and 1 (3.33%)

discontinued. 2 (6.67%) Housewives reported are cured. The graphical representation is as

follows.

Graph - 5


DISTRIBUTION OF PATIENTS BY OCCUPATION

Student13.33%

House wife 6.67%

Service3.33%

Labour56.67%

Agriculturist10.00%

Business10.00%


A5) Distribution of patients by Economic Status

The economical condition is a key for the evaluation and prognosis. At the study it

is found that distributions are falling from the very poor to rich class people. As the

economical status is permitting to have more protection the incidences are smaller and

minimal. The observations are 15 (50%) very poor, 6 (20%) poor, 5 (16.7%) Lower Middle

class, 3 (10%) higher middle class and 1 (3.33%) of rich class. The tabulation is as under.

Graph - 6

Economic status distribution Vs Vishamajwara vis-à-vis Malaria

The results based on economical status are as under. Out of the 15 very poor patients,

8 (26.7%) cured, 5 (16.7%) responded and 2 (6.7%) discontinued. At the 6 reported poor

patients, 5 (16.7%) cured and 1 (3.33%) discontinued. At the 5 Lower middle class patients,

3 (10%) cured, 1(3.33%) not responded and 1 (3.33%) discontinued. Out of 3 Upper middle

class Vishamajwara patients 2 (6.67%) cured and 1 (3.33%) not responded. One (3.33%)

Economic status distribution Vs Vishamajwara vis-à-vis Malaria

15

0

13

5

6

-4

-2

0

2

4

6

8

10

12

14

16

Very Poor Poor LowerMiddle

UpperMiddle

Rich Aristocrat


patient reported from rich class is cured. The graph depicting the victims of Vishamajwara

vis-à-vis Malaria at the economical groups is as under.

Table -9Distribution of patients by Economic status

Eco

nom

ical

stat

us

Cur

ed

%

Res

pond

ed

% Not

Res

pond

ed

%

Dis

cont

inue

d

%

Tot

alpa

tient

s %

VeryPoor

8 26.7 0 0 5 16.7 2 6.7 15 50

Poor 5 16.7 0 0 0 0 1 3.33 6 20

LowerMiddle

3 10 1 3.33 0 0 1 3.33 5 16.7

UpperMiddle

2 6.7 0 0 1 3.33 0 0 3 10

Rich 1 3.33 0 0 0 0 0 0 1 3.33

Total 19 63.3 1 3.33 6 20 4 13.3 30 100

Graph-7

Distribution of patients by Economic status

Distribution of patients by Economic status

Rich 3.33%

Lower Middle16.67%

Very Poor50.00%

Poor20.00%

Upper Middle10.00%


A6) Distribution of patients by Hygienic Condition

Hygiene is a very important factor to protect health from external invaders. The

hygiene is categorised as Good, moderate and Mild. At the study it is observed that more

people are under mild category (23 patients – 76.7%). Moderate (6 patients – 20%) and

Good (1 patient – 3.33%) hygiene’s are recorded in addition to above. The tabulation is as

under.

Table –10

Distribution of patients by Hygienic Condition

Hyg

ieni

cC

ondi

tion

Cur

ed

%

Res

pond

ed

% Not

Res

pond

ed

%

Dis

cont

inue

d

%

Tot

alpa

tient

s %

Poor 14 46.7 0 0 6 20 3 10 23 76.7

Moderate 4 13.3 1 3.33 0 0 1 3.33 6 20

Good 1 3.33 0 0 0 0 0 0 1 3.33

Total 19 63.3 1 3.33 6 20 4 13.3 30 100

As the observations reveals that out of the 23 poor hygiene people attended the

study, 14 (46.7%) cured, 6 (20%) responded and 3 (10%) patients are discontinued. At the

moderate hygiene patients we found that 4 (13.3%) cured and 1 (3.33%) responded and 1

(3.33%) discontinued. The patient from the category of good hygienic conditions maintained

reported to (3.33%) cured in the study of Vishamajwara vis-à-vis Malaria. The graphical

representation is as follows.


Graph-8


A7) Distribution of patients by Diet

Table -11

Die

t

Cur

ed

%

Res

pond

ed

% Not

Res

pond

ed

%

Dis

cont

inue

d

%T

otal

patie

nts

%

Vegetarian 3 10 0 0 2 6.67 2 6.67 7 23.3

Mixed diet 16 53.3 1 3.33 4 13.3 2 6.67 23 76.7

Total 19 63.3 1 3.33 6 20 4 13.34 30 100

Diet is an important factor of Dosha provocation and their involvement with the

subjects is to be evaluated. At the present study is noticed that maximum subjects are mixed

food i.e. 23 (76.7%) and the vegetarians are only 7 (23.3%) patients. As we observe out of 7


Good3.33%

Poor76.67%

Moderate20.00%


vegetarians, 3 (10%) cured 2 (6.67%) not-responded and 2 (6.67%) patients discontinued.

On the other hand of mixed food consumers 16 (53.3%) patients are cured and 1 (3.33%)

responded. 4 reported not-responded and 2 (6.67%) discontinued from the same category.

The graphical representation is as follows.

Graph-9

Distribution of patients by Diet

B) Data related to the disease.

B1) Distribution of patients by presenting complaints

Many subjective parameters in the form of presenting complaints collected in the

study. They are listed in the following table. Out of the complaints it is found that a

Pratyatma Niyata Lakshana, Aniyamita Jwara (100%) is present along with Shira shoola

(100%) and Aruchi (100%) for the all patients.

Distribution of patients by Diet

3

16

0

1

2

4

2

2

7

23

0 5 10 15 20 25

Vegetarian

Mixed diet

discotinued

Not-Reson

Responded

Cured

Total


Table-12Distribution of patients by presenting complaints

Presenting complaints Total no of patients Percentage

Aniyamita Jwara 30 100

Vepana 28 93.33

Chardi 24 80

Shira shoola 30 100

Aruchi 30 100

Parshwa shoola 6 20

Tandra 5 16.7

Swasa 4 13.33

Anidra 20 66.7

Yakrut Vruddhi 2 6.67

Pleeha Vruddhi 4 13.33

Graph –10Distribution of patients by presenting complaints

Distribution by Presenting Complaints

30

28

24

30

30

6

5

4

20

2

4

0 5 10 15 20 25 30 35

Aniyamita Jwara

Vepana

Chardi

Shira shoola

Aruchi

Parshwa shoola

Tandra

Swasa

Anidra

Yakrut Vruddhi

Pleeha Vruddhi


28 (93.33%) patients reported with Vepana (Shivering), 24 (80%) patients with

Chardi, 6 (20%) parshwashoola, 5 (16.7%) Tandra, 4 (13.33%) Swasa, 4 (13.33%) Pleeha

Vruddhi and 2 (6.67%) of Yakrut Vruddhi in the study of Vishamajwara vis-à-vis Malaria.

The tabulation of the above is depicted as under.

B2) Distribution of patients by Associated features

Table-13

Associated features Total no of patients Percentage

Trushna19 63.33

Pralapa2 6.67

Anga Gourava24 80

Glani7 23.33

Asahishnuta1 3.33

Dravamala Pravrutti0 0

The associated features of the Vishamajwara vis-à-vis Malaria are Trushna, Pralapa,

Anaga gowrava, Glani., Asahishnuta and Drava mala Pravrutti. Out of these features in

Vishamajwara vis-à-vis Malaria, it was found that the Anga Gowrava is more in 24 (80%) of

patients. The next best complaint seen is Trushna with 19 (63.33%) patients. In further 7

(23.335) Glani, 2 (6.67%) Pralapa and 1 (3.33%) Asahishnuta were found. No patient

reported with the Drava Mala Pravrutti in the study of Vishamajwara vis-à-vis Malaria. The

tabulations are shown above and the graphical representation is as below.


Graph –11

Distribution of patients by Associated features

B3) Distribution of patients by type of Jwara

Table-14

Distribution of patients by type of Jwara

Type of Jwara Total no of patients Percentage

Santata (continues)4 13.33

Satata (Twice in day)17 56.67

Anyedyushka (Once in day)6 20

Truteeyaka (Alternative day)3 10

Chaturthaka (on every 4th day)0 0

Viparyaya (Truteeyaka/Chaturthaka)0 0

Total30 100

Distribution by Associated features

19

2

24

7

1

0

0 5 10 15 20 25 30

Trushna

Pralapa

Anga Gourava

Glani

Asahishnuta

DravamalaPravrutti


The Vishamajwara is one of the Jwaras mentioned from the texts. Various Acharyas

classify the Vishamajwara vis-à-vis Malaria as different. The appearance of the Vishama

Arambhata, Vaga and Kala are noted here and classified. The divisional expression is as

below. In this study of Vishamajwara vis-à-vis Malaria many (17 patients –56.67%) are

under the Satata Variety. It was found in the study as – 6 (20%) Anyedushka, 4 (13.33%)

Santata and 3 (10%) of Truteeyaka Vishamajwara vis-à-vis Malaria. No Chaturthaka and

Viparyaya patients were reported. The graphical representation is as follows.

Graph –12


B4) Distribution of patients by Pranavaha sroto dusti Lakshana

In the study of Vishamajwara vis-à-vis Malaria various Srotas are involved. One by

one Srotas involvement is explored in the study of Vishamajwara vis-à-vis Malaria. At

present the Pranavaha Srotas bears the symptoms of – Kasa, Swasa, Swasa bheda, Chardi,


Chaturdhaka (on every 4th

day)0.00%

Viparyaya (Truteeyaka/Chaturdhaka)

0.00%

Anyedyushka (Once in day)

20.00%

Santata (continues)

13.33%

Satata (Twice in day)56.67%

Truteeyaka (Alternative

day)10.00%


Urah Shoola and Rakta steevana. As many as 24 (80%) patients reported with chardi in

association with Kasa (4 patients – 13.33%) and Swasa (4 patients – 13.33%). No patients

are observed with the Urah shoola, Swasa bheda and Rakta steevana. The tabulation and

graph is as follows.

Table-15Distribution of patients by Pranavaha sroto dusti Lakshana

Pranavaha sroto dusti Lakshana Total no of patients Percentage

Kasa4 13.33

Swasa4 13.33

Chardi24 80

Urah shoola0 0

Swasa bheda0 0

Rakta Shteevana0 0

Graph –13

Distribution of patients by Pranavaha sroto dusti Lakshana

Distribution of patients by Pranavaha sroto dusti Lakshana

0

0

24

4

4

0

0 5 10 15 20 25 30

Kasa

Swasa

Chardi

Urah shoola

Swasa bheda

Rakta Shteevana


B5) Distribution of patients by Rasavaha sroto dusti Lakshana

Table-16

Distribution of patients by Rasavaha sroto dusti Lakshana

Rasavaha sroto dusti Lakshana Total no of patients Percentage

Aruchi30 100

Hrullasa12 40

Shareera Gourava24 80

Anidra20 66.66

Jwara30 100

Tandra6 20

Graph –14



30

6

24

30

12

20

0

5

10

15

20

25

30

35

Aruchi Hrullasa ShareeraGourava

Anidra Jwara Tandra


In the Rasavaha Srotas Jwara and Aruchi are the major complaints found in the study

by all 30 patients. 24 (80%) of patients expressed that they possess the Shareera Gowrava

and 20 patients (66.66%) Anidra. 12 (40%) patients expressed Hrullasa and 6 (20%) patients

with Tandra. The tabulations and graph is shown as above.

B6) Distribution of patients by Annavaha sroto dusti Lakshana

Table-17Distribution of patients by Annavaha sroto dusti Lakshana

Annavaha sroto dusti Lakshana Total no of patients Percentage

Aruchi30 100

Chardi24 80

Anannabhilasha0 0

Annadwesha0 0

Shoola0 0

Graph –15Distribution of patients by Annavaha sroto dusti Lakshana

30

240

0

0

0 5 10 15 20 25 30

Aruchi

Chardi

Anannabhilasha

Annadwesha

Shoola

Distribution of patients by Annavaha sroto dusti Lakshana


Annavaha Srotas is one more major Srotas involved in Vishamajwara vis-à-vis

Malaria. All patients (100%) show the Aruchi and 24 patients (80%) Chardi as Lakshana in

Vishamajwara vis-à-vis Malaria. No other categories are recorded in the study. The table

and graph is as above.

B7) Distribution of patients by Swedavaha sroto dusti Lakshana

Table-18

Distribution of patients by Swedavaha sroto dusti Lakshana

Swedavaha sroto dusti Lakshana Total no of patients Percentage

Asweda30 100

Atisweda0 0

Daha20 66.67

Romaharsha22 73.33

Graph –16



20

30

0

22

0

5

10

15

20

25

30

35

Asweda Atisweda Daha Romaharsha


In Jwara or in Vishamajwara vis-à-vis Malaria, with out involvement of the sweda

vaha Srotas the jwara doesn’t appear. The sroto dusti Lakshana dictated in Samhitas are

observed here. In this study Vishamajwara vis-à-vis Malaria, all patients (100%) reported

with Atisweda and 20 (66.66%) patients even with the Daha. 22 (73.33%) patients expressed

with Romaharsha. The tabulation and pictorial expression is shown above.

B8) Distribution of patients by Nidana

The evaluation of the disease should and must be with the Pancha Lakshana Nidana.

Out of the first one is Nidana i.e. etiological factors. The aetiology explained is as under in

the table. Out of those 26 (86.67%) Ahita Bhojana, 24 (80%) Akala Bhojana and 18 (60%)

Dustajalapana are observed, which are of dietetic in origin. 16 (53.33%) Rutu Parivartana

and 11 (36.67%) Aupasargika Karana are expressed in the study Vishamajwara vis-à-vis

Malaria. Apart from the above 19 (63.33%) Krodha and 20 (66.33%) Bhaya also

enumerated as aetiology in the study. The tabulation and graph is as follows.

Table-19

Distribution of patients by Nidana

Nidana Total no of patients Percentage

Akala Bhojana24 80

Ahita Bhojana26 86.67

Dushita jalapana18 60

Aoupasargika Karana11 36.67

Rutu parivartana16 53.33

Krodha19 63.33

Bhaya20 66.67


Graph –17


B9) Distribution of patients by Poorva Roopa

Table-20

Distribution of patients by Poorva Roopa

Poorva Roopa Total no of patients Percentage

Jrumbha13 43.33

Aruchi30 100

Romaharsha24 80

Sahreera Guruta23 76.67

Ashrupoorna netra10 33.33

The poorvaroopa is prodromal syndrome of the disease Vishamajwara vis-à-vis

Malaria. In this common jwara conditions are observed. All (100%) show the Aruchi in the


20

16

19

18

24

26

11

0 5 10 15 20 25 30

Akala Bhojana

Ahita Bhojana

Dushita jalapana

Aoupasargika Karana

Rutu parivartana

Krodha

Bhaya


study. Apart from 24 (80%) Romaharsha, 23 (76.67%) Shareera Gowrava, 13 (43.33%)

Jrumbha and 10 (33.33%) of Ashrupoorva netrata are found in the Vishamajwara vis-à-vis

Malaria study. The graph is as follows.

Graph –18


C) Result of the Bharangyadi Ghanavati in Vishamajwara viz. Malaria

C1) Distribution of patients by Jwaramukta Lakshana

The assessment of the Vishamajwara vis-à-vis Malaria with Bharangyadi Ghana Vati

is done by the subjective and objective parameter assessment. But in Ayurveda

jwaramuktata is an important assessment. The jwaramukta Lakshana are enumerated in the

study of Vishamajwara vis-à-vis Malaria. It is noticed that 20 (66.67%) patients show the

Sweda pravrutti and Shareera Laghavata. 16 (53.33%) patients expressed Kshudha and 4

(13.33%) with Shira kandu, a specific Lakshana of jwara muktata. 2 (6.67%) patients show

mukhapaka and 3 (10%) with the Trushna. The observation of the jwramukta Lakshana


10

24

13

30

23

0 5 10 15 20 25 30 35

Jrumbha

Aruchi

Romaharsha

Sahreera Guruta

Ashrupoorna netra


shows that the effect of the Bharangyadi Ghana Vati over Vishamajwara vis-à-vis Malaria is

admissible. The table and graph is as follows.

Table-21

Distribution of patients by Jwaramukta Lakshana

Jwaramukta Lakshana Total no of patients Percentage

Sweda pravrutti20 66.67

Shareera Laghavata20 66.67

Shirah Kandu4 13.33

Mukhapaka2 6.67

Trushna3 10

Kshudha16 53.33

Graph –19



3

16

4

20

20

2

0 5 10 15 20 25

Sweda pravrutti

ShareeraLaghavata

Shirah Kandu

Mukhapaka

Trushna

Kshudha


C2) Evaluation of Subjective Parameters (Bharangyadi Ghanavati in Vishamajwara)

The following symptoms of the Vishamajwara are considered for the evaluation of

the cumulative effect of the Bharangyadi Ghana Vati in Vishamajwara vis-à-vis Malaria.

Their mean grading values are drawn periodically to assess the effect is self explanatory.

Table -22Subjective parameter Before

Treatment7th day 14th day 21stday Follow Up

Aniyamita Jwara 2.84 1.61 0.53 0.30 0.19

Vepana 0.88 0.61 0.34 0.15 0.03

Chardi 1.38 1.07 0.57 0.26 0.11

Shira shoola 1.92 1.38 0.88 0.26 0.15

Aruchi 1.0 1.0 0.7 0.46 0.11

Parshwa shoola 0.19 0.07 0.07 0 0

Tandra 0.19 0.07 0.03 0 0

Swasa 0.34 0.19 0.07 0.07 0

Anidra 1.30 0.80 0.23 0.19 0

Yakrut Vruddhi 0.03 0.03 0.03 0.03 0.03

Pleeha Vruddhi 0.11 0.11 0.11 0.07 0.03

Graph –20Aniyamita Jwara (mean) in Vishamajwara

Evaluation of Aniyamita Jwara (Mean)

0.19

0.53

2.84

1.61

0.3

-1

-0.5

0

0.5

1

1.5

2

2.5

3

3.5

BeforeTreatment

7th day 14th day 21stday Follow Up


As the trend-line drawn to the Aniyamita Jwara (mean values) show that the effect of

the Bharangyadi Ghana Vati for a period of stipulated usage has given relief effectively and

as follow up period is advanced fall to a minimal of 0.19 expected to reach absolute

normalcy with in a short while of the follow-up.

C3) Evaluation of Objective Parameters (Bharangyadi Ghanavati in Vishamajwara)

The following objective parameters of the Vishamajwara are considered for the

evaluation of the cumulative effect of the Bharangyadi Ghana Vati in Vishamajwara vis-à-

vis Malaria. Their mean grading values are drawn periodically to assess the effect.

Table -23Objectiveparameters

Before Treatment After Treatment Difference

MP smear (Positive) 26 7 19

Haemoglobin % 9.195385 9.513077 0.317692

E.S.R 15.65385 11.11538 4.53847

Total Count 6239.038 6080.192 158.846

Neutrofils 54.92308 60.57692 5.65384

Lymphocytes 38.34615 31.5 6.84615

Eosinophil 5.653846 5.769231 0.115385

Monocytes 1.461538 1.192308 0.26923

At the above tabulation various parameters are expressed with their mean values of

baseline data to that of final data. The most important parameter Malarial Parasite smear test

is positive for the all patients those are included in the study. Out of them 19 patients

(73.07%) are MP negative at the end of the treatment. Disease prognostic factors such as

ESR and Total counts are dropped their vales to normalcy. More over the haemoglobin


percentage is improved by 0.317692 mean value. At the differential count of blood

Neutrophills and Eosinophills show marginal increase and lymphocytes and Monocytes

show marginal decrease. The mean vale table is as above.

C4) Mean temperature variances

The mean temperature variances at the intervals of 7 days are depicted here under in

the form of table and graph.

Table –24

Showing the temperatures (mean) in Vishamajwara

0th day 7th day 14th day 21st day 36th day102.3346 100.7231 99.28462 98.94615 98.86154

Graph –21

Graph the temperatures (mean) in Vishamajwara

Patients were showed significant reduction in fever on 14th day. Nearly half the

number of patients came to normal temperature and remaining patient are at grade 1 on 21st

day cure rate was attained and much changes are not observed during fallow up period.

Evaluation of Temperature in (Mean)

98.6 98.6 98.6 98.6 98.6 98.698.94615

100.7231

102.3346

99.28462

98.86154

97

98

99

100

101

102

103

0th day 7th day 14th day 21st day 36th day


During the fallow up period there was no recurrence also. Linear and slow regression of

temperature were noted

C5) Distribution of patients by Result

Table-25

Distribution of patients by Result in Vishamajwara

Result Total no of patients Percentage

Cured19 63.33

Responded1 3.33

Not Responded6 20

Discontinued4 13.34

Total30 100

The results of Bharangyadi Ghana Vati over Vishamajwara vis-à-vis Malaria are

declared after through assessment of the subjective objective parameters. The results for the

sake of convenience classified as Cured, Responded, Not Responded and Discontinued. Out

of these the discontinued patients are the dropouts in the study. The cured are fulfilling the

satisfactory subjective and objective criteria and must be malarial parasite smear test

negative at the end of the schedule. The responded are satisfactory at the subjective

parameters and feel comfort by all means but their MP is still positive. The Not-Responded

patients are of either of the subjective or objective criteria non-fulfilled. Based on this the

results are 19 (63.33%) Cured, 1 (3.33%) responded 6 (20%) Not-Responded and 4

(13.34%) discontinued. The picturesque is drawn is as below.


Graph –22

Distribution of patients by Result in Vishamajwara

D) Statistical analysis of the clinical and objective parameters

D1) Statistical analysis of the clinical parameters at the end of treatment (21 days)Table -26

SN

SubjectiveParameter

Mean SD SE t-Value p-Value Remarks

1 Jwara 2.423 0.702 0.137 17.686 <0.001 HS

2 Vepana 0.563 0.485 0.095 5.926 <0.001 HS

3 Chardi 1.115 0.993 0.194 5.747 <0.001 HS

4 Sjhira shoola 1.576 1.0265 0.201 7.840 <0.001 HS

5 Aruchi 0.538 0.508 0.099 5.434 <0.001 HS

6 Parshwa shoola 0.231 0.514 0.1 2.31 <0.05 HS

7 Tandra 0.192 0.401 0.078 2.461 <0.05 HS

8 Swasa 0.269 0.666 0.131 2.053 >0.05 NS

9 Anidra 1.153 0.924 0.181 6.37 <0.001 HS

10 Pleeha Vruddhi 0.038 0.196 0.038 1.0 >0.05 NS

Distribution of patients by Result

Not Responded

20.00%

Cured63.33%

Responded3.33%

Discontinued13.33%


Al the parameters except Pleeha Vruddhi after 21 days of treatment show highly

significant. The parameter jwara shows more highly significant with high mean net effect.

The shira shoola shows more variations. (By comparing t value, p-value and SD).

D2) Statistical analysis of the objective parameters at the end of treatment (21 days)

Table -27S

N

Objective

Parameter

Mean SD SE t-Value p-Value Remarks

1 Haemoglobin % 0.313 0.293 0.057 5.49 <0.001 HS

2 Total Count 399.615 393.64 77.2 5.176 <0.001 HS

3 Neutrofils 6.346 3.52 0.69 9.197 <0.001 HS

4 Lymphocytes 6.461 3.022 0.592 10.913 <0.001 HS

5 Eosinophills 0.346 0.628 0.123 2.813 <0.05 HS

6 Monocytes 0.346 0.485 0.0951 3.638 <0.01 HS

7 ESR 4.192 2.953 0.579 7.24 <0.001 HS

D3) Statistical analysis of the clinical parameters at the end of follow-up (36 days)Table -28

SN

Parameter Mean SD SE t-Value p-Value Remarks

1 Jwara 2.461 0.646 0.126 19.53 <0.001 HS

2 Vepana 0.653 0.481 0.095 6.873 <0.001 HS

3 Chardi 1.115 0.993 0.194 5.747 <0.001 HS

4 Sjhira shoola 1.576 1.0265 0.201 7.84 <0.001 HS

5 Aruchi 0.538 0.508 0.099 5.434 <0.001 HS

6 Parshwa shoola 0.230 0.514 0.1 2.3 <0.05 HS

7 Tandra 0.192 0.401 0.078 2.461 <0.05 HS

8 Swasa 0.192 0.567 0.111 1.729 >0.05 NS

9 Anidra 1.153 0.924 0.181 6.37 <0.001 HS

10 Pleeha Vruddhi 0.038 0.196 0.038 1.0 >0.05 NS


All the parameters except Yakrut Vruddhi and Pleeha Vruddhi show high

significance. Assume that the drug is not responsible in curing the disease, to test the

hypothesis we use paired “t” test {as p <0.05). The parameter Aniyamita Jwara shows more

significance than the others. The mean net effect of Aniyamita Jwara in subjective

parameters is more and the Yakrut Vruddhi is less in mean net effect.

The parameter Aruchi shows units mean net effect with zero variations i.e. response

in all patients of before to after study. The parameters Aruchi after the treatment have zero

variations. The parameter Chardi, have more net variation but kampa have less net effect.

The mean effect of the subjective parameters of Vishamajwara is more after the

treatment but aruchi, Yakrut Vruddhi have same variations, where as Aruchi having uniform

effect (by comparing mean SD and coefficient of variations) for the to know the effect of

drug after the 7 days of treatment. The Aniyamita Jwara again shows high significance with

more net mean effect.

The aruchi shows no significance with net less variation and with less net mean

effect as shown in the above table.

Among the objective parameters ESR shows high significance than the others, but

there is a least variation in haemoglobin percentage. Among the DC, lymphocytes show

more (high) significance than the others. The nets mean effect in Nutrophils is more with

more variation. But the Eosinophils and Monocytes have equal mean net effect with

difference in the variations (by comparing the “t” and “p” values).


Chapter –6

Discussion“ ever is unwanted rise in body temperature either because of disturbed

internal environment or invasion of exogenous origins. Vishamajwara, a most popular

Ayurvedic term in turn of modern medical terminology co-related to malarial fever, is a

protozoan disease caused by genus plasmodium and transmitted to man by certain species of

infected female anopheles mosquito. India's geographic position and climatic conditions are

favourable for the transmission of malaria.

The emergence of multiple-drug resistant strains of malaria, which has accompanied

each new class of anti-malarial drugs, is one of most significant threat to the health of people

in tropical countries.

Resistance, synergism and traditional medicines

Medical science is beginning to recognise aspects of synergy, complexity and

potentiation in malaria therapy. At the same time, little significance is as yet being given to

the obvious point that all of the major anti-malarial have been derived from plants, often

based on traditional knowledge about the effects of the plants against fever, or specifically,

malaria.

Elsewhere, synergism has been observed between the alkaloids of the anti-malarial

plant Ancistrocladus peltatum. A total alkaloid extract of this plant had far greater anti-

parasitic activity than any of the six alkaloids isolated subsequently. In Uganda, there is data

from clinical case reports that a traditional Ugandan herbal remedy is effective against

malaria.


Utilisation of traditional medicine is widespread in developing countries and the

efficacious of many traditional treatments have been well documented, including in skin

disease, malaria and other disorders.

The research initiative for traditional anti-malarial methods (RITAM)

It is the Research Initiative for Traditional Anti-malarial Methods (RITAM). Many

people live in malarious regions, traditional herbal medicines may be the only course of

treatment available. Plants are usually identified for study on the basis of a traditional

reputation for effectiveness, usually for treating or preventing malaria and other fever related

conditions.

Clinical development in Indian Systems of Medicine & Homoeopathy

The Indian Systems of Medicine & Homoeopathy is popular in a large number of

States in the country. Ayurveda, Homeopathy, Unani, Yoga & Naturopathy and Siddha

systems together called as Indian Systems of Medicine.

Drug resistance to chloroquine in P. falciparum was reported in India for the first

time from Assam in 1973. Sulphadoxine-pyrimethamine, a second line drugs for P.

falciparum is not effective for P. vivax malaria. Development of new drugs involves

extensive pre clinical and toxicological studies followed by well-planned clinical trials.

Ayush-64 is a combination of four plants namely Alstonia scholaris (aqueous extract of

bark–1 part) Picrorhiza kurroa Royle (aqueous extract of rhizome–1 part), Swertia chirata

(aqueous extract of whole plant–1 part) and Caesalpinia crista Linn (fine powder of seed

pulp–3 parts).

Many herbal compounds and herbo-mineral compounds are listed in Ayurveda to

pacify the Jwara, especially Vishamajwara. The jwara called as fever may not be a big


problem from the contemporary but as par Ayurveda it is a primary symptom and a disease

also some times a complication. Ayurvedic herbs have an important role in the treatment of

malarial fever. In the treatment of Vishamajwara many yogas have been explained in

Ayurveda.

Vishamajwara vis-à-vis Malaria

Ayurveda has a significant name. The symptoms of this type resemble with the

malarial fever of present discussion. Malaria is a protozoal disease transmitted by the

Anopheles mosquito, caused by minute parasitic protozoa of the genus Plasmodium, which

infect human and insect hosts alternatively. It is a very old disease and prehistoric man is

thought to have suffered from malaria. WHO declared Australia free of malaria in 1981,

however since that time 9 patients have contracted locally acquired malaria. The exception

is falciparum malaria where the parasites multiply very rapidly and may occupy 30% or

more of the red blood cells causing a very significant level of haemolysis.

Malaria or a disease resembling malaria has been noted for more than 4,000 years.

The symptoms of malaria were described in ancient Chinese medical writings. A number of

Roman writers attributed malarial diseases to the swamps. Vedic literature possesses many

more references of this condition as Vishamajwara. Discovery of the Malaria Parasite in

1880 by Charles Louis Alphonse Laveran, a French army surgeon stationed in Constantine,

Algeria, was the first to notice parasites in the blood of a patient suffering from malaria. An

American, William H. Welch, reviewed the subject and, in 1897, he named the malignant

tertian malaria parasite, P. falciparum. In 1922, John William Watson Stephens described

the fourth human malaria parasite, P. ovale. On August 20th, 1897, Ronald Ross, a British

officer in the Indian Medical Service, was the first to demonstrate that malaria parasites


could be transmitted from infected patients to mosquitoes. In further work with bird malaria,

Ross showed that mosquitoes could transmit malaria parasites from bird to bird. This

necessitated a sporogonic cycle (the time interval during which the parasite developed in the

mosquito). Thus, the problem of malaria transmission was solved.

Vishamajwara

The disease Vishamajwara is included under the jwara roga in Ayurveda.

Vishamajwara characterised by visamarambha (irregular onset).

Atharva Veda described the following types of Vishamajwara. It is a clear picture of

Vishamajwara of malarial origin. Susruta considered that the Vishamajwara occurs due to

Tridosha but Vata is the dominant Dosha. Vagbhata defined Vishamajwara, as the jwara is

irregular in respect to its onset, suffering and symptoms. According to Hareeta the

Vishamajwara is five types such as vataja, ekaikajwara, dwahieka jwara, triahika jwara,

chaturthakjwara. Dalhana consider bhutas responsible to produce Vishamajwara. Jejjata

considered Vishamajwara as tridoshaja in origin.

Malaria Control program

An organised and effective malaria control program stemmed from this new

authority in the Tennessee River valley. Controlling water levels and insecticide applications

reduced Mosquito breeding sites. DDT was used for malaria control at the end of WWII

after it had proven effective against malaria-carrying mosquitoes by British, Italian, and

American scientists.

Atypical fever - Malaria

Some patients may not have fever at all and may present with other symptoms listed

below. Many present with fever of various patterns - low grade to high grade, with or


without chills, intermittent to continuous, or even as cases of prolonged fever. As the disease

progresses, these broods get synchronised and the fever tends to be more uniform. However

in cases of P. falciparum malaria and mixed infections, this pattern of multiple spikes may

continue. The other symptoms are

Headache, dizziness or vertigo, with or without fever, may present with altered

behaviour, mood changes, hallucinosis or even acute psychosis. Due to severe infection,

hypoglycaemia, electrolyte imbalance - due to vomiting or diarrhoea (particularly the

elderly), subclinical convulsions etc. are also found in malarial fever. Cough may be a

presenting feature of malaria with severe anaemia can be a presenting feature of malaria.

Secondary infections:

Malaria produces significant immune suppression and this can result in secondary

infections. Splenomegaly is a cardinal sign of malaria, absence of splenomegaly does not

rule out the possibility of malaria.

Vishamajwara and Ayurveda

The vitiated Dosha after localising in Dhatus of the body are responsible to produce

diseases. Besides all the factors Pitta plays an important role for producing jwara. In

Vishamajwara the Doshas are not only localised in Rasa Dhatu like in other jwara, they

spread through Rasa, Rakta, Mansa, Meda, Asthi and Majja to get the different

Vishamajwara such as Santata jwara, Satata jwara, Anyedushka jwara, Triteeyak jwara,

Chaturthak jwara and Chaturthakviparyaya jwara. The Vishamajwara due to Kapha is

difficult to cure in Kapha Prakruti because in this disease the Vata and Pitta are less

powerful. The aggravated doshas interacts Rasa and other Dhatu and ultimately produces

Vishamajwara. The heavy Doshas spread all over the body through the channels carrying


Rasa and stiffened and give rise to santata jwara (remittent fever). Considering all this, the

physician should treat the case of fever.

Drug discussion

The combination of the compound drug “Bharangyadi Ghana Vati” is discussed in

the literature. The collective properties of the Bharangyadi Ghana Vati with its probable

mode of action are discussed here. The following table describes the pharmacological

properties of the individual components.

Table –29

Describing the pharmacological properties of Bharangyadi Ghana Vati

Name of the

ingredient

Rasa Guna Veerya Vipaka Prabhava

1) Bharangi190-195

Tikta, KatuKashaya

Laghuruksha

Ushna Katu JwaraharaPeenasaharaKasaswasaharaShodhaghna

2) Musta196-201

Tikta, KatuKashaya

Laghuruksha

Sheeta Katu JwaraharaKrumiharaDeepanapachaka

3) Parpatak202-207

Tikta Laghusangrahi

Sheeta Katu JwaraharaRaktadoshaharaBhramaharaTrushnahara

4) Yavasa208-213

Tikta, Kashaya,Madhura

Laghu Sheeta Katu JwaraharaChardiharaBhramaharaTrushnahara

5) Shunti214- 219

Katu Guru,rooksha,tikshna

Ushna Katu Kapha haraAmavataharaHrudrogaharaGrahiPanduhara


Name of theingredient

Rasa Guna Veerya Vipaka Prabhava

6) Kiratatikta220- 225

Tikta Laghu,Rooksha

Ushna Katu JwaraharaVranaharaKrumighnaRaktadoshaharaTrushnaghanaSwasaghnaKasaghnasannipatajwarahar

7) Kusta226- 231

Tikta, Katu,Madhura

Laghu,rooksha,Teekshna

Ushna Katu RaktadoshaharaKustaghnaKasaghna

8) Pippali232- 237

Katu Laghu,Snigdha,tiksshna

Anushnasheeta

Madhura VatakaphaharaYogavahiDeepanaPachanaRechanaUdarahara

9) Bruhati238- 243

Katu, Tikta Laghu,Rooksha,teekshna

Ushna Katu JwaraharaKasaswasaharaAgnimandyaharaKustaghna

10) Guduchi244- 249

Tikta, Kashaya,Katu, Madhura

Guru,Snigdha

Ushna Madhura JwaraharaMootrakruchraharaHrudrogaharaTridoshaharaDeepakaSangrahiRasayanaPanduharaKamalaharaChardiharaAmahara

Table –30

Describing the Chemical constituents and Indications of individual components of

Bharangyadi Ghana Vati

Name of theingredient

Chemical constituents Indications Preparations

1. Bharangi Hispidulin 7.0 gluco-caronides, Scutellarrin,uncinatone, pctolinarigenin

Jwara, Swasa, kasa,shotha, krini, daha,peenasa

Bharangyadikwatha,bharangyadi guda


2. Musta Cineol +, copadiene,copaene, cyperen I & II,cypernone, isopathoulenone,cypertoperotundone, etc

Jwara, krimi, trushna,Atiusara, kandu, kasa,nidra nasha, Raktavikara etc

Musta rishta,mustadi kasaya,mustadi vati,shadungapaneeya

3. Parpataka Adlumidiceine (-)- adlumine,(+) bisculline, cocharinecoptisine, cryptopine,fumaromine, laharmine,parfemdine etc

Jwara, trushna, Bhrama,mada, Rakta Pitta,Atisara, charadi etc

Sadanga paneeyaparpatadyarista

4. Yavasa Galacto, catechin+catechin(-), epigallocatechin, andleucodelphnidin, B –phenethylamine etc

Jwara, kase, Raktapitta,trishna, medaroga,chardi brama, kusta etc

Agasthyavaleha,khatiradigutika,yasa sarkara,vasagrita,kalasyadi grutha

5. Shunti Dry Ness 80.9, protein 2.6,fat 0.9, fibre 2.4,carbohydrate 12.3, metals1.2%, calcium 20,phosphorus 60, iron 2.6 mg,each 100 gm other then theseiodine chlorine are alsopresent vitamin A,B,C arealso present

Jwara, Hrudourbaya,hrutshoola, shlipadha,shotha, amavata ,sheethaPitta, pandu, Atisara,kasa Swasa, Agnimamdhya etc

Ardrakakhand,panchasamaChurna,samasharkaraChurna, rasnadikwatha,soubhagyashunthi , shunthisura

6. Kiratatikta Amarogentin, gentiopicrin,isobellicifolin, decussatin,chiratol, swerchirin, 7-0methyl swertianin mangiferin, swertianin, kairatinolswertanone etc

Sanepata jwara, RaktaPitta, arsas, krimi, kusta,vruna, shotha, trishna,daha etc

Kiratadi kwata,sudharsanaChurna,kiratitiktadiChurna,kiratarista etc

7. Kusta Essential oil, castol ,taraxasterol, dehydrocostuhactone, sistosterol, ar-cuscumene, isodihydrocostuslactone costus– lactone etc

Jwara, kusta, hikka,kasa, prasava shoola,hrudroga, visarpa,kandu, Vata Rakta

Kustadi taila,kustadi curna,kusta rasayanam

8. Pippali Volatile oil – 0.8%Piperine – 4-5%Pipalatine and sesamine andpiplasterol- 0.15- 0.18% andpipalartin-0.13-0.20% piperlanguminon, steroid,glycoside

Hrudhadourbalya,pandu, raktavikara, kasa,Swasa, aruchi, Agnimandhya, kshata, jwara.

Guda pippali,pippali khada,pippalyasava,yakartlihari loha,yakrt pippaladiyoga.


9. Brahati Glycoside, alkaloid, solanine,dulcunarin, carotene,carpesterol, solonocurpone,disogenin, solasodine, vit – Cetc

Jwara, Swasa, hrdroga,shoola, chardi, kushta,kandu, krimi etc

Brihatyadikasaya,pipapalyadi leha,dashamoolarista

10. Guduchi Tinosporide, cardifalide,tnosparidine, B- sitosterol,cardifol heptacosanol,octacasanol, magnoflarine,palmatine.

Jwara, trishna,Vatarakta, pandu,kamala, chardi, krimi,kandu, kasa, bhrama,jwaravyadhi

GuduchadiChurna,Guduchadikwata,amritarista,amrithadi,chandraprabhavati,PanchaTiktaGuggu grutametc

From the above tabulations, it is clear that the individual components of the

Bharangyadi Ghana Vati are effective antipyretic and also acts efficiently over the areas of

co-morbidity.

As all ingredients are “Jwaraghna” in its property, there is no discussion of doubt

about the embedded active principles of the individual components. Still it is a bound duty

to discuss its mode of action with regard in this concern.

Cumulative action of Bharangyadi Ghana Vati based on Rasa

The component of the Bharangyadi Ghana Vati bears mainly the Tikta Rasa in

association with that of Katu Rasa. The other two Rasa dominant in the compound are

Kashaya and Madhura.

If the composition is to be brought in the form of formula it can be stated as - Tikta 8

Katu 7 Kashaya 4 Madhura 3. The main functions of the Tikta Rasa are – Soshaka,

Kantashodhaka and Prahladanakara. As the fundamental components are of Vayu and


Pruthvi Mahabhuta it possesses the Ruksha, Sheeta and laghu Guna, there by acts as Pitta

shamaka and Kapha shamaka.

Here in this topic of discussion it is very much needed as the disease basically a Pitta

dominant. The Rasavahasrotas and Rasa Dhatu, which are, predominant dushyas in

Vishamajwara subjects for the soshana (drying) under the influence of the Tikta Rasa. Thus

the importance of the Tikta Rasa in association with the other Rasa in the pacification of the

Vishamajwara is substantiated.

Cumulative action of Bharangyadi Ghana Vati based on Veerya

The components are with the Ushna Veerya in 60% and Sheeta in 30% and anushna

Sheeta in 10%. It is said as the Ahara Dravyas are of Rasa pradhana and the Aushadha

Dravyas are of Veerya pradhana.

Apart form the prabhava, which is a most important factor of the medicine, the

Veerya needs the discussion. The Bharangyadi Ghana Vati, with the 60% Ushna Veerya in

it, in a disease which is predominant with the Pitta Dosha (Agneya tatwa) is a pint of

discussion.

Here the Ushna Veerya Dravyas are specifically sweda janaka pravartakas by nature.

The swedavarodhata is the pratyatma niyata Lakshana of the jwara. Thus the

swedavarodhata is passified by the Ushna veeraya Dravyas and there by facilitates the

thermal regulations in the body.

As the thermo regulatory functions withstands the normal functions of the Pitta are

resumed. There by the deeptagni, Ama pachana etc, are visualised in the body.


Cumulative action of Bharangyadi Ghana Vati based on Prabhava

Any compound action is difficult to assess with out noting the individual prabhava of

the Dravya. At the same time out of any compound medicine few are of prime and rest as

supportive.

In this trail drug Bharangyadi Ghana Vati, the prime herbs are – Bharangi and Kirata

tikta. The rest of the components are also have the Jwarahara prabhava. Thus the cumulative

action is a perfect Jwaraghna with the Bharangyadi Ghana Vati is witnessed.

As we see the prime drug – Bharangi, on which the name of the medicine is named

Bharangyadi Ghana Vati, has the specific Jwarahara (Anti-pyretic) Property in association

with the upper respiratory tract pacifying principles such as Peenasahara, Kasahara,

Swasahara and Shothahara. These are the relative areas of the disease predisposing and the

regulating the air hunger at the time of temperature rise makes the Pitta pacification along

with the Kapha.

The malarial parasite lies at the blood. They’re by the Rakta, as dooshya in the

Vishamajwara needs pacification through medication. The Parpataka and Kusta are such

herbs embedded with the Raktadoshahara property. Parpataka in association is a

Bhramahara and Trushnahara. In the jwara trushna appears because of the water evaporation

due to BMI rise or the temperature rise.

This is nullifies by the parpataka. The second herb is Kusta, which is a Kasa and

Kusta hara. Kusta is a Rakta vikara, and any invasions over Rakta are capable of vitiating

Rakta. Apart from these the main function which is impaired at the Jwara is temperature rise

is a factor associated with the Twacha i.e. skin and it is a adhistana of the Kusta. Thus the

action over Twak is substantiated here. Bruhati is another herb, which is acting over the


skin area as kustaghna. Yavasa is chardihara, there by it pacifies the nausea of

Vishamajwara.

Shunti is Kapha hara, Amavatahara, Hrudrogahara, Grahi and Panduhara. Guduchi

is Jwarahara, Mootrakruchrahara, Hrudrogahara, Tridoshahara, Deepaka, Sangrahi,

Rasayana, Panduhara, Kamalahara, Chardihara and Amahara. Out of these herbs the

common of common is panduharatwatam. In Vishamajwara it is observed that the Rakta

Dhatu is vitiated and the destruction of the Rakta is witnessed. The destruction of the Rakta

leads to pandu in Vishamajwara and there by hepato-speenomegale is appeared. To rule out

the organomegale the Guduchi and sunti are used.

A Dravya, which is a Yogavahi in the composition (Pippali) makes the bio-

availability of the drug to deep tissues faster and faster. Thus the association of the Pippali

makes that the drug acts faster in Vishamajwara and by its Rechaka property pacifies the

Pitta, which is a dominant Dosha in the pathogenesis of the Vishamajwara. Apart from the

Pippalai is Deppana and Pachaka Dravya thus the rectification of the Agni takes place.

Another important property of Guduchi is Rasayana along with Jwarahara,

Mootrakruchrahara, Hrudrogahara, Tridoshahara, Deepaka, Sangrahi, Panduhara,

Kamalahara, Chardihara and Amahara properties. The disease penetrates in to the deep

tissues as it takes the different shapes of Vishamajwara. The Rasayana property of the

Amruta in association with the anti-pyretic property makes the sense at the management of

the Vishamajwara.

Krimiharatwa of Bharangyadi Ghana Vati based

In this combination we found Musta and Kiratatikta, as the Krimihara. The

probability of the action of these over the invaded malarial parasite is to be studied at


laboratory in vitro. Apart from Krimihara property Musta is even deepana and pachana

Dravya, there by it acts over Annavahasrotas and Agni. Kiratatikta is such a wonderful drug,

it has Jwarahara, Vranahara, Krumighna, Raktadoshahara, Trushnaghana, Swasaghna,

Kasaghna and sannipatajwaraharatwa as specific.

Cumulative action of Bharangyadi Ghana Vati based on chemical composition

v The antipyretic activity of Musta was demonstrated on pyrexia induced by

Brewers' yeast in albino rats'.

v Antibacterial activities of Musta oil and its fractions have been demonstrated

against a number of organisms'.

v People of NWFP specially used Yavasa for skin diseases, small pox and for

endothermic reaction in the body.

v Sunti was shown to have significant antiemetic and antivertigo effects like

dramamine". It has been listed effectively along with Piper nigrum and Piper

longum in viral hepatitis". Ginger forms an important constituent of many

Ayurvedic formulations. It is chiefy used as a home remedy for nausea and

dyspepsia.

v The hepato-protective effect of pippali has been shown in carbon tetrachloride-

induced liver damage in rats. A common use of the fruit is in the prevention of

recurrent attacks of bronchial asthma. Another important indication is in chronic

malaria.

v The hepato-protective effect of Guduchi extract has been studied in carbon

tetrachloride induced liver damage in rats.


v Sunti contains a chemical called zingibain that dissolves parasites and their eggs.

In laboratory trials, ginger extracts have been shown to kill the anisakid worm (a

parasite occasionally found in raw fish) within sixteen hours. Ginger tea is useful

as a supplement in treating schistosomiasis, a parasitic disease.

v The essential oil of Kusta has antiprotozoal effect in vitro (1 in 10,000 dilution).

It also has antibacterial effects against streptococei and staphylococci.

Observation of Bharangyadi Ghana Vati in Vishamajwara vis-à-vis Malaria

Present study registers 30 patients, out of 68 approached patients. Out this, 4 patients

were discontinued hence their data has not been included in the assessment. The remaining

26 patients of Vishamajwara viz. Malaria, fulfilling the criteria of diagnosis and inclusive

criteria were included in the study.

Demographic data of Bharangyadi Ghana Vati in Vishamajwara vis-à-vis Malaria

v The male female ratio in the study is 4:1 patients. The percentage of the

distribution does not show any gender differentiation to get this protozoan-

related disease.

v More of the patients reported are of labour group, as they are not well protected

and also expose to the unhygienic environment.

v The economical condition is a key for the evaluation and prognosis. At the study

it is found that distributions are falling from the very poor to rich class people.

As the economical status is permitting to have more protection the incidences are

smaller and minimal.


v At the study it is observed that more people are under mild category (23 patients

– 76.7%). Moderate (6 patients – 20%) and Good (1 patient – 3.33%) hygiene’s

are recorded in addition to above.

v At the present study is noticed that maximum subjects are mixed food i.e. 23

(76.7%) and the vegetarians are only 7 (23.3%) patients.

Subjective analysis of Bharangyadi Ghana Vati in Vishamajwara vis-à-vis Malaria

v The appearance of the Vishama Arambhata, Vaga and Kala are noted here and

classified. In this study of Vishamajwara vis-à-vis Malaria many (17 patients –

56.67%) are under the Satata Variety.

v Out of the complaints it is found that a Pratyatma Niyata Lakshana, Aniyamita

Jwara (100%) is present along with Shira shoola (100%) and Aruchi (100%) for

the all patients.

v Out of associative features in Vishamajwara vis-à-vis Malaria, it was found that

the Anga Gowrava is more in 24 (80%) of patients. The next best complaint seen

is Trushna with 19 (63.33%) patients. In further 7 (23.335) Glani, 2 (6.67%)

Pralapa and 1 (3.33%) Asahishnuta were found.

v As many as 24 (80%) patients reported with chardi in association with Kasa (4

patients – 13.33%) and Swasa (4 patients – 13.33%).

v In the Rasavaha Srotas Jwara and Aruchi are the major complaints found in the

study by all 30 patients and 24 (80%) of patients expressed that they possess the

Shareera Gowrava.

v In this study Vishamajwara vis-à-vis Malaria, all patients (100%) reported with

Atisweda and 20 (66.66%) patients even with the Daha.


v It is noticed that 20 (66.67%) patients show the Sweda pravrutti and Shareera

Laghavata as Jwaramukta Lakshana. The observation of the jwramukta Lakshana

shows that the effect of the Bharangyadi Ghana Vati over Vishamajwara vis-à-

vis Malaria is admissible.

v As the trend-line drawn to the Aniyamita Jwara (mean values) show that the

effect of the Bharangyadi Ghana Vati for a period of stipulated usage has given

relief effectively and as follow up period is advanced fall to a minimal of 0.19

expected to reach absolute normalcy with in a short while of the follow-up.

Objective analysis of Bharangyadi Ghana Vati in Vishamajwara vis-à-vis Malaria

v At the above tabulation various parameters are expressed with their mean values

of baseline data to that of final data. The most important parameter Malarial

Parasite smear test is positive for the all patients those are included in the study.

Out of them 19 patients (73.07%) are MP negative at the end of the treatment.

Disease prognostic factors such as ESR and Total counts are dropped their vales

to normalcy. More over the haemoglobin percentage is improved by 0.317692

mean value. At the differential count of blood Neutrophills and Eosinophills

show marginal increase and lymphocytes and Monocytes show marginal

decrease. The mean vale table is as above.

v Patients were showed significant reduction in fever on 14th day. Nearly half the

number of patients came to normal temperature and remaining patient are at

grade 1. On 21st day cure rate was attained and much changes are not observed

during fallow up period. During the fallow up period there was no recurrence

also. Linear and slow regression of temperature were noted.


Result of Bharangyadi Ghana Vati in Vishamajwara vis-à-vis Malaria

v The results of Bharangyadi Ghana Vati over Vishamajwara vis-à-vis Malaria are

declared after through assessment of the subjective objective parameters. The

results for the sake of convenience classified as Cured, Responded, Not

Responded and Discontinued. Out of these the discontinued patients are the

dropouts in the study. The cured are fulfilling the satisfactory subjective and

objective criteria and must be malarial parasite smear test negative at the end of

the schedule. The responded are satisfactory at the subjective parameters and feel

comfort by all means but their MP is still positive. The Not-Responded patients

are of either of the subjective or objective criteria non-fulfilled. Based on this the

results are 19 (63.33%) Cured, 1 (3.33%) responded 6 (20%) Not-Responded and

4 (13.34%) discontinued respectively.

Mean effect of Bharangyadi Ghana Vati in Vishamajwara vis-à-vis Malaria

v All the parameters except Yakrut Vruddhi and Pleeha Vruddhi show high

significance. Assume that the drug is not responsible in curing the disease, to test

the hypothesis we use paired “t” test {as p <0.05). The parameter Aniyamita

Jwara shows more significance than the others. The mean net effect of Aniyamita

Jwara in subjective parameters is more and the Yakrut Vruddhi is less in mean

net effect.

v The parameter Aruchi shows units mean net effect with zero variations i.e.

response in all patients of before to after study. The parameters Aruchi after the

treatment have zero variations. The parameter Chardi, have more net variation

but kampa have less net effect.


v The mean effect of the subjective parameters of Vishamajwara is more after the

treatment but aruchi, Yakrut Vruddhi have same variations, where as Aruchi

having uniform effect (by comparing mean SD and coefficient of variations) for

the to know the effect of drug after the 7 days of treatment. The Aniyamita Jwara

again shows high significance with more net mean effect.

v The aruchi shows no significance with net less variation and with less net mean

effect as shown in the above table.

v Among the objective parameters ESR shows high significance than the others,

but there is a least variation in haemoglobin percentage. Among the DC,

lymphocytes show more (high) significance than the others.

v The nets mean effect in Nutrophils is more with more variation. But the

Eosinophils and Monocytes have equal mean net effect with difference in the

variations (by comparing the “t” and “p” values).


Chapter – 7

Conclusion

v Utilisation of traditional medicine is widespread in developing countries and the

efficacious of many traditional treatments have been well documented, including

in skin disease, malaria and other disorders.

v Many herbal compounds and herbo-mineral compounds are listed in Ayurveda to

pacify the Jwara, especially Vishamajwara. Ayurvedic herbs have an important

role in the treatment of malarial fever.

v Malaria or a disease resembling malaria has been noted for more than 4,000 years.

The symptoms of malaria were described in ancient Chinese medical writings.

v In 1922, John William Watson Stephens described the fourth human malaria

parasite, P. ovale. In further work with bird malaria, Ross showed that mosquitoes

could transmit malaria parasites from bird to bird.

v The disease Vishamajwara is included under the jwara roga in Ayurveda.

Vishamajwara characterised by visamarambha (irregular onset).

v It is a clear picture of Vishamajwara of malarial origin. Dalhana consider bhutas

(Keetanu – Parasites) responsible to produce Vishamajwara.

v Jejjata considered the Vishamajwara is as tridoshaja in origin.

v Cough may be a presenting feature of malaria with severe anaemia can be a

presenting feature of malaria.

v Malaria produces significant immune suppression and this can result in secondary

infections.

v Splenomegaly is a cardinal sign of malaria, absence of splenomegaly does not rule

out the possibility of malaria.


v In Vishamajwara the Doshas are not only localised in Rasa Dhatu like in other



Triteeyak jwara, Chaturthak jwara and Chaturthak jwara. The aggravated doshas

interact Rasa and other Dhatu and ultimately produces Vishamajwara.

v The component of the Bharangyadi Ghana Vati bears mainly the Tikta Rasa in

association with that of Katu Rasa.

v Present study registers 30 patients, out of 68 approached patients. The remaining

26 patients of Vishamajwara viz. Malaria, fulfilling the criteria of diagnosis and

inclusive criteria were included in the study.

v In this trail drug Bharangyadi Ghana Vati, the prime herbs are – Bharangi and

Kirata Tikta. The rest of the components are also have the Jwarahara prabhava.

Thus the cumulative action is a perfect Jwaraghna with the Bharangyadi Ghana

Vati is witnessed.

v Panduhara, Jwarahara, Mootrakruchrahara, Hrudrogahara, Tridoshahara, Deepaka,

Sangrahi, Rasayana, Panduhara, Kamalahara, Chardihara and Amahara Dravyas

are used in the Bharangyadi Ghana Vati.

v The malarial parasite lies at the blood. They’re by the Rakta, as dooshya in the

Vishamajwara needs pacification through medication.

v The destruction of the Rakta leads to pandu in Vishamajwara and there by hepato-

speenomegale is appeared. To rule out the organomegaly the Guduchi and sunti

are used.

v A Dravya, which is a Yogavahi in the composition (Pippali) makes the bio-

availability of the drug to deep tissues faster and faster. Thus the association of the

Pippali makes that the drug acts faster in Vishamajwara and by its Rechaka


property pacifies the Pitta, which is a dominant Dosha in the pathogenesis of the

Vishamajwara.

v Apart from all Deppana and Pachaka Dravyas are used for the rectification of

Agni.

v In this combination we found Musta and Kiratatikta, as the Krimihara. The

probability of the action of these over the invaded malarial parasite is to be studied

at laboratory in vitro.

v The antipyretic activity of Musta was demonstrated on pyrexia induced by

Brewers' yeast in albino rats'.Antibacterial activities of Musta oil and its fractions

have been demonstrated against a number of organisms'.

v Sunti was shown to have significant antiemetic and antivertigo effects like

dramamine". It has been listed effectively along with Piper nigrum and Piper

longum in viral hepatitis". Ginger forms an important constituent of many

Ayurvedic formulations. It is chiefy used as a home remedy for nausea and

dyspepsia.

v The hepato-protective effect of pippali has been shown in carbon tetrachloride-

induced liver damage in rats. A common use of the fruit is in the prevention of

recurrent attacks of bronchial asthma. Another important indication is in chronic

malaria. The hepato-protective effect of Guduchi extract has been studied in

carbon tetrachloride induced liver damage in rats.

v Sunti contains a chemical called zingibain that dissolves parasites and their eggs.

In laboratory trials, ginger extracts have been shown to kill the anisakid worm (a

parasite occasionally found in raw fish) within sixteen hours. Ginger tea is useful

as a supplement in treating schistosomiasis, a parasitic disease.


v The essential oil of Kusta has antiprotozoal effect in vitro (1 in 10,000 dilution). It

also has antibacterial effects against streptococci and staphylococci.

v The male female ratio in the study is 4:1 patients. The percentage of the

distribution does not show any gender differentiation to get this protozoan-related

disease.

v More of the patients reported are of labour group, as they are not well protected

and also expose to the unhygienic environment.

v The economical condition is a key for the evaluation and prognosis. At the study

it is found that distributions are falling from the very poor to rich class people. As

the economical status is permitting to have more protection the incidences are

smaller and minimal.

v At the study it is observed that more people are under mild category (23 patients –

76.7%). Moderate (6 patients – 20%) and Good (1 patient – 3.33%) hygiene’s are

recorded in addition to above.

v At the present study is noticed that maximum subjects are mixed food i.e. 23

(76.7%) and the vegetarians are only 7 (23.3%) patients.

v The appearance of the Vishama Arambhata, Vaga and Kala are noted here and

classified. In this study of Vishamajwara vis-à-vis Malaria many (17 patients –

56.67%) are under the Satata Variety.

v Out of the complaints it is found that a Pratyatma Niyata Lakshana, Aniyamita

Jwara (100%) is present along with Shira shoola (100%) and Aruchi (100%) for

the all patients.

v Out of associative features in Vishamajwara vis-à-vis Malaria, it was found that

the Anga Gowrava is more in 24 (80%) of patients. The next best complaint seen


is Trushna with 19 (63.33%) patients. In further 7 (23.335) Glani, 2 (6.67%)

Pralapa and 1 (3.33%) Asahishnuta were found.

v As many as 24 (80%) patients reported with chardi in association with Kasa (4

patients – 13.33%) and Swasa (4 patients – 13.33%).

v In the Rasavaha Srotas Jwara and Aruchi are the major complaints found in the

study by all 30 patients and 24 (80%) of patients expressed that they possess the

Shareera Gowrava.

v In this study Vishamajwara vis-à-vis Malaria, all patients (100%) reported with

Atisweda and 20 (66.66%) patients even with the Daha.

v It is noticed that 20 (66.67%) patients show the Sweda pravrutti and Shareera

Laghavata as Jwaramukta Lakshana. The observation of the jwramukta Lakshana

shows that the effect of the Bharangyadi Ghana Vati over Vishamajwara vis-à-vis

Malaria is admissible.

v As the trend-line drawn to the Aniyamita Jwara (mean values) show that the effect

of the Bharangyadi Ghana Vati for a period of stipulated usage has given relief

effectively and as follow up period is advanced fall to a minimal of 0.19 expected

to reach absolute normalcy with in a short while of the follow-up.

v At the above tabulation various parameters are expressed with their mean values

of baseline data to that of final data. The most important parameter Malarial

Parasite smear test is positive for the all patients those are included in the study.

Out of them 19 patients (73.07%) are MP negative at the end of the treatment.

Disease prognostic factors such as ESR and Total counts are dropped their vales

to normalcy. More over the haemoglobin percentage is improved by 0.317692

mean value. At the differential count of blood Neutrophills and Eosinophills show


marginal increase and lymphocytes and Monocytes show marginal decrease. The

mean vale table is as above.

v Patients were showed significant reduction in fever on 14th day. Nearly half the

number of patients came to normal temperature and remaining patient are at grade

1. On 21st day cure rate was attained and much changes are not observed during

fallow up period. During the fallow up period there was no recurrence also.

Linear and slow regression of temperature were noted

v The results of Bharangyadi Ghana Vati over Vishamajwara vis-à-vis Malaria are

declared after through assessment of the subjective objective parameters. The

results for the sake of convenience classified as Cured, Responded, Not responded

and Discontinued. Out of these the discontinued patients are the dropouts in the

study. The cured are fulfilling the satisfactory subjective and objective criteria and

must be malarial parasite smear test negative at the end of the schedule. The

responded are satisfactory at the subjective parameters and feel comfort by all

means but their MP is still positive. The Not-Responded patients are of either of

the subjective or objective criteria non-fulfilled. Based on this the results are 19

(63.33%) Cured, 1 (3.33%) responded 6 (20%) Not-Responded and 4 (13.34%)

discontinued.

v All the parameters except Yakrut Vruddhi and Pleeha Vruddhi show high

significance. Among the objective parameters ESR shows high significance than

the others, but there is a least variation in haemoglobin percentage. Among the

DC, lymphocytes show more (high) significance than the others. (by comparing

the “t” and “p” values).


Chapter -8

Summary1. Malaria or a disease resembling malaria has been noted for more than 4,000 years.

2. The disease Vishamajwara is included under the jwara roga in Ayurveda.

3. Vishamajwara is characterised by visamarambha (irregular onset).

4. Dalhana consider bhutas (Keetanu – Parasites) responsible to produce

Vishamajwara.

5. Cough may be a presenting feature of malaria with severe anaemia.

6. In Vishamajwara the Doshas are not only localised in Rasa Dhatu like in other



Triteeyak jwara, Chaturthak jwara and Chaturthak jwara.

7. Present study registers 30 patients, out of 68 approached patients. The remaining

26 patients of Vishamajwara viz. Malaria, fulfilling the criteria of diagnosis and

inclusive criteria were included in the study.

8. In this trail drug Bharangyadi Ghana Vati, the prime herbs are – Bharangi and

Kirata Tikta.

9. It is noticed that the Sweda pravrutti and Shareera Laghavata as Jwaramukta

Lakshana are observed shows that the effect of the Bharangyadi Ghana Vati over

Vishamajwara vis-à-vis Malaria is admissible.

10. All the parameters except Yakrut Vruddhi and Pleeha Vruddhi show high

significance.

11. Thus it is concluded that the Bharangyadi Ghana Vati in Vishamajwara vis-à-vis

Malaria is established.

Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) I

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185) Vox Sanguinis. 73(3):143-8, 1997. Clin & Exp Immunol. 54(1):127-34, 1983186) J Trop Med & Hygene. 96(4):245-8, 1993-Aug187) Am J Trop Med & Hyg. 65(4):355-363. 2001-Oct188) K.R. Srikantaha Murthy (Translator), Sharagdhara Samhita, madhyama khanda, 1st ed,

1984, Chowkhambha Orientalia, Varanasi, chapter 2 sloka 1-2189) Ibid, chapter 8 sloka 1190) Dr. K M Nadakarni, Indian Materia Medica Volume I, 3rd Edition 1982, Popular

Prakashan Pvt. Ltd, Bombay, p 354191) Bhavamishra, Bhava Prakasha Nighantu edited by Dr K C Chunekar And G S Panday,

7th Edition 1984, chaumkhamba Bharati Academy varasnasi, P 102192) Priyavat sharma (editor), Dhanavantari Nighantu, 1st Ed. 1982, Jaykrishana Ayurvedic

Series No 40, Chaukhmaba Orientalia Varanasi, p28

Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)VIII

193) Priyavat sharma and Guruprashad Sharma (editors), Kayyadeva Nighantu, 1st ed., 1979,Chaukhmaba Orientalia Varanasi, p210

194) P.V. Sharma, Drvyaguna vijnan, Vol-2, 1993, Chaukhambha Bharati Academy,Varanasi, p 298

195) J.L.N. Shastri, Dravyaguna Vijnan, vol-2, first ed., Chaukhambha Orientalia, 2004,Varanasi,, p 421

196) Dr. K M Nadakarni, Indian Materia Medica Volume I, 3rd Edition 1982, PopularPrakashan Pvt. Ltd, Bombay, p248

197) Bhavamishra, Bhava Prakasha Nighantu edited by Dr K C Chunekar And G S Panday,7th Edition 1984, chaumkhamba Bharati Academy varasnasi, P 243

198) Priyavat sharma (editor), Dhanavantari Nighantu, 1st Ed. 1982, Jaykrishana AyurvedicSeries No 40, Chaukhmaba Orientalia Varanasi, p23

















Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) IX























Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) X





241) Priyavat sharma and Guruprashad Sharma (editors), Kayyadeva Nighantu, 1st ed., 1979,Chaukhmaba Orientalia Varanasi, p12-13







248) P.V. Sharma, Drvyaguna vijnan, Vol-2, 1993, Chaukhambha Bharati Academy,Varanasi, p 761-763

249) J.L.N. Shastri, Dravyaguna Vijnan, vol-2, first ed., Chaukhambha Orientalia, 2004,Varanasi,, p 33,37,39


DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA D.G.M.A.M.C.GADAG

SPECIAL CASE SHEET FOR EVALUATION OF THE EFFICACY OF

THE BHARANGYADI GHANAVATI IN VISHAMAJWARA WITH SPECIAL REFERENCE TO MALARIAL FEVER

Guide: Dr. V. VaradaCharyulu, M.D (Ayu),

Professor & H.O.D. Kayachikitsa

Co-guide: Dr. R.V. shettar, M.D (Ayu),

1) Name of the Patient Sl.No

2) Gender Male Female OPD No

3) Age Years IPD No

4) Religion Hindu Muslim Christian Other

Student Service House wife5) Occupation

Labour Agriculturist Business

6) Economical status Very

Poor

Poor Lower-

Middle

Upper

Middle

Rich

7) Address

Pin

8) Birth data Place of Birth

AMDate Month Year Time

Hours Minutes PM

9) Hygienic stautus Poor Moderate Good

10) Selection Included Excluded

11) Schedule Initiation Date Completion Date

Cured Responded12) Result

Not responded Discontinued

13) INFORMED CONSENT

I Son/Daughter/Wife of am

exercising my force power of choice here by giving my consent to be included as a subject in this study.

I have been informed to my satisfaction, by the attending physician the clinical trail and nature of the

drug treatment and its follow-up. I am also aware of rights to quit out the trail at any time during the

course of total without giving reasons.

Patient's Signature

Scholar: Dr. Manga;a B. Patil

Annexure


14) Pradhana Vedana

DurationNo Complaints

Fresh < 3 days < 5 days > 5 days

1 Aniyamita Jwara2 Vepana (shivering)3 Agnimandya4 Chardi5 Shira shoola6 Aruchi7 Parshwa shoola8 Tandra9 Swasa10 Anidra

15) Anubandha Vedana

Before treatmentNo ComplaintsFresh < 3 days < 5 days > 5days

Aftertreatment

1 Trushna2 Pralapa3 Dravamala Pravrutti4 Anga Gowrava5 Glani6 Asahishnuta

16) Poorva Vyadhi Vruttanta

17) Chikitsa Vruttanta

18) Vayaktika Vruttanta

a) Ahara Vegetarian Mixed foodb) Vihara Adhika Vyayama Diwaswapnac) Nidra Normal Disturbed Excessd) Vyasana Tobacco Pan-chewing Smoking Alcohole) Vyayama shakti Heena Madhyama Uttama

Regular Constipated Dravamala pravruttif) Mala pravrittiColour Frequency

g) Mutra pravrutti Normal BurningColour Odour Frequency

h) Raja Pravrutti Regular Irregular AmenorrhoeaPainful Menopause

i) Mental State


19) Astastana PareekshaNadi Dosha Pravrutti

Gati VarnaPurnata GandhaSpandanaKathinya

Mutra

Jihwa Ardra Sushka Sama NiramaLepa Nirlepa

Mala

Shabda Sparsha Sheeta Ushna

Ast

asth

ana

Drik Akruti

20) Sroto pareekshaSrotas PareekshanaPranavaha sroto dusti Lakshana

KasaSwasaChardi

Urah shoolaSwasa bheda

Rakta ShteevanaRasavaha sroto dusti Lakshana

AruchiHrullasa

Shareera GouravaAnidraJwara

TandraAnnavaha sroto dusti Lakshana

AruchiChardi

AnannabhilashaAnnadwesha

ShoolaSwedavaha sroto dusti Lakshana

AswedaAtisweda

DahaRomaharsha

21) General examination

Pulse /min Temp °F Respiration rate /min

Weight /kgs Height heart rate /min


22) Systemic examination

Srotas Darshana Sparshana Sravana Akotana

Prana (RS)

Rasa (CVS)

Anna (GIT)

Any other

23) Examination of Organomegale

Day 0 Day 7 Day 14 Day 21 Day F1 Day F21. Palpable in

finger2. Tenderness3. Edge/ Border4. Nodularity5. Sharpens6. RoundedY

akru

t (L

iver

)

7. Leafy1. Palpable2. Tenderness3. Enlargement4. Mild5. Moderate6. Massive7. Surface8. Smooth

Ple

eha

(Spl

een)

9. Hard24) Nidana evaluated

Akala Bhojan Rutu ParivartanaAhita Bhojana KrodhaDooshita jalapana BhayaAupasargika Karana25) Poorva Roopa

Jrumbha Shareera GurutaAruchi Ashrupurna netraRomaharsha26) Roopa (Lakshana) of Vishamajwara

Aniyamita Jwara ChardiAgnimandya Parshwashoola


Aruchi Shiroshoola27) Samprapti ghatakaDosha Sroto dusti prakaraDooshaya UdbhavastanaAgni Sanchara stanaSrotas Vyakta stana28) Jwaramukta LakshanaSweda pravrutti Mukha pakaShareera laghuta TrushnaShira kandu Kshudha29) Assessment

Day 0 Day 7 Day 14 Day 21 Day F1 Day F2Aniyamita JwaraVepana (shivering)AgnimandyaChardiShira GowravaAruchiParshwa shoolaTandraSwasaSu

bjec

tive

par

amet

ers

AnidraHaemoglobin %Total countDifferential count

LymphocytesNutrophils

EosioniphilsBasophils

MonocytesErythrocytesedimentationRateO

bjec

tive

par

amet

ers

Peripheral smear(MP)

30) Investigator’s note:

Guide signature Scholar signature

Co-Guide signature


Tem

pera

ture

and

Blo

od P

ress

ure

char

t

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1.Name of the candidate and

address

: MANGALAVVA .B. PATIL

M. B. PATIL W/O S.S. PATIL

4TH CROSS PANCHAKSHARI NAGAR,

GADAG -582 101

2. Name of the institution : Post Graduate Studies and Research center,

Dept of Kayachikitsa,

D.G.M. Ayurvedic Medical College, Gadag.

3.Course of study and

Subject

: Ayurveda Vachaspathi M D (Kayachikitsa)

4. Date of Admission : September 2002

5. Title of the Topic : EVALUATION OF THE EFFICACY OF THE

BHARANGYADI GHANAVATI IN

VISHAMAJWARA WITH SPECIAL REFERENCE

TO MALARIAL FEVER

6. Brief Review of Intended Work

6.1 Need for the Study.

Vishamajwara in term of modern medical terminology co-related to malarial fever, is a

protozoan disease caused by genus plasmodium and transmitted to man by certain species

of infected female anopheles mosquito. India's geographic position and climatic conditions

are favorable for the transmission of malaria. Frequently people living in the endemic areas

are prone for this infection. Out of 300-500 million clinical cases around 100 countries and

one million deaths due to malarial malady are noticed globally. The 38th world health

assembly in 1985 recommended that, malaria control should be developed as an integral

part of the national primary health care systems 1.

Vishamajwara is irregular (inconsistent) in it's arambha (nature of onset commitment),

kriya (action production of symptoms) and kala (time of appearance) and possesses

anushanga (persistence for long periods) 2-3-4. As on today, the malarial parasite has

developed resistance to chloroquine compounds, which are used vividly for the past three

decades.






Bharangyadi Ghanavati in Vishamajwara with special reference to malarial fever”.

6.2 Review of Literature

Vishamajwara is a type of fever, which is described in all Ayurvedic texts. Charaka

mentioned Vishamajwara and Chakrapani have commented on Vishamajwara as

bhutanubanda6. Susruta affirmed that Aagantuchhanubhandohi praysho Vishamajware7.

Madhavakara has also recognised Vishamajwara as Bhutabhishangajanya (infected by

microorganism) 8. Hence infected female anopheline mosquito bite can be considered as

causative factor for Vishamajwara along with other etiological factors.

The Ayurvedic practitioners use Bharangyadi Ghanavati in the management of

Vishamajwara, which is explained in Sahasrayoga in Kashaya kalpana.

Bharangyadi Ghanavati is a combination of Jwarahara and Krimihara drugs.

Bharangi, Kiratatikta are proved as anti malarial drugs. Guduchi, Parpataka and Brahati are

having antipyretic properties. Shunti, Pippali are the best drugs for the Amapachana. So the

combination of Bharangyadi yoga shows the Vishamajwarahara properties. Thus this

combination is chosen for the present study.

6.3 Objectives of the study

1. To evaluate the efficacy of the Bharangyadi Ghanavati in Vishamajwara

2. To evaluate the antipyretic properties of Bharangyadi Ghanavati in Vishamajwara.

3. To evaluate the antimalarial properties of Bharangyadi Ghanavati in Vishamajwara

(Malarial fever).

7) Materials and Methods

7.1 Source of data.

a) Patients:

Patients suffering from Vishamajwara will be selected from department of

Kayachikitsa Post Graduation studies and Research OPD of D G Melmalgi Ayurvedic

medical college and Hospital by preset inclusion and exclusion criteria.

b) Literary:

Literary aspect of study will be collected from classical Ayurvedic and modern texts.

c) Trail Drug:

The combination and proportion of Bharangyadi Ghanavati is as follows 9 -10-11.

1. Bharangi Clerodendrum serratum 1 Part








9. Brahati Solanum indicum 1 Part


d) Preparation of Yoga

All the drugs will be identified and collected from local areas. Good manufacturing

practice will be followed for the preparation.

7.2 Method of Collection of data

a) Study design:

Prospective clinical study

b) Sample size:

A minimum of 30 patients

c) Exclusion Criteria –

v Patient below 15 years and above 65 years of the age

v Patient with complication like severe anemia

v Renal failure

v Pulmonary oedema,

v Jaundice

v Spleenic rupture

v Pregnant women

v Cerebral Malaria

d) Inclusion criteria –

v Age of the patients between 15 to 65 years.

v Uncomplicated malarial fever

v Peripheral smear test for M P must be positive

e) Criteria of Diagnosis

1) The symptomatalogy of Vishamajwara mentioned in ayurvedic text will be the basic

diagnostic criteria.

2) Peripheral smear for MP is taken as diagnostic criteria

e) Posology-

Internal - 3 gms in divided doses

1 vati =500 mg, 2 tab thrice a day

Anupanam- ushnajala

f) Study Duration:

21 days and Follow up for 15 days

g) Assessment of Result

Subjective and objective parameters are taken for the assessment of result.

h) Subjective parameters

As designated in the classical texts.

i) Objective Parameters

1. Thick and thin blood film for malaria.

2. Peripheral smear test for MP

3. Erythrocyte Sedimentation Rate (ESR)

4. Hemoglobin (Hb %)

5. Temperature chart

7.3 Investigations

Diagnostic and Exclusion

1. Thick and thin blood film for Malaria.

2. Peripheral smear

3. Hemoglobin (Hb %)

4. Total Count (TC)

5. Differential Count (DC)

6. Erythrocyte sedimentation rate (E S R)

7. Widal test

7.4 ETHICAL CLEARANCE : Obtained

8 List of Reference

1. a) Park’s Text book of Preventive and social medicine, Page no 189 Published by M/s

Banarasidas Bhanot ,16th Edition, Nov 2000.

b) Davidson’s principles and practice of medicine, Page no 148-153, Edited by

Haslett,chilvers,Hunters,boon, Published By Churchill lingstone international 18th Edition

1999.

c) Harrison’s principles of internal medicine, 14th Edition 1998 Volume 1, Page 1180

2. Astanga Hridayam Nidan stana 3rd chapter slk no 69, Krishnadas Ayurveda series no 27,

Published by Krishnadas Academy Varanasi, 2nd edition 1995.

3. Yogaratnakar with Vaidyprabhahindu commentary Vishamajwara prakaran slk No 1

krishnadas Ayurveda series no 54, Published by Krishnadas academy, 1st edition 1998.

4. Bhavprakash By Bhavmishra uttararda Vishamajwara prakaran slk No. 722, shri Kashi

Sanskriti series 130,published by chaukhamba Sanskrit sanstan Varanasi 5th edition

1980.

5. Sahasrayoga – Kashaya Prakarana, Page 6,edited by Ramnivas Sharma and Surendra

sharma, pakshini prakashan Hyderabad,2nd edition oct 1990

6. Charaka Samhita Chikitsa stana 3rd Chapter slk no 74, Chakrapanidatta Ayurveda Deepika

shri Kashi Sanskrit series no 194,edited by Dr.Gangasahaya pandeya, published by

chaukhambha Sanskrit sanstan varanasi.

7. Sushruta Samhita Uttara Tantra Dalhanacharya commentary chapter 39 slk no 56,

Jaikrishnadas Ayurveda series no34, edited by Vaidya Jadavi Trikanji Acharya Narayan

Ram,Acharya Kavytirtha,published by Chaukhmba Orientalia Varanasi,4th edition 1980.

8. Madhava Nidana Madhukosha commentary, Jwara Nidana 2 Chapter Slk no.26,36,kashi

sanskrit series no 158, edited by Yadunandana upadhyaya, published by chaukhambha

Sanskrit sanstan varanasi 26th edition 1996.

9. Indian Materia Medica Volume I – Dr. K M Nadakarni, published by popular Prakashan Pvt.

Ltd Bombay 3rd Edition 1982, page no’s 354,428,560,533,1308

1184,1108,965,1149,1120.

10. Bhava Prakasha Nighantu edited by Dr K C Chunekar And G S Panday, published by

chaumkhamba Bharati Academy varasnasi, 7th Edition 1984, page no’s 102, 243, 223,

411,13,72,91,15,288,269.

11. Dhanavantari nighantu, Jaykrishana Ayurvedic Series No 40,edited by priyavrut sharma ,

published by Chaukhmaba Orientalia Varanasi 1st Edition 1982 Page no’s

25,23,24,20,85,22,99,83,32,16.

9 Signature of the candidate

(M B Patil)

10 Remarks of guide

The Medicament Bharangyadi Ghanavati for the proposed study, Evaluation of

efficacy of the Bharangyadi Ghanavati in Vishamajwara with special reference to malarial

fever will be very useful because of its availability, efficacy and economical in nature. Hence

it is recommended.

11. Name and Designation

11.1 Guide: Dr V VARADACHARYULU

M. D (Ayu)

PROFESSOR AND H.O.D. D G M A M C

PGS&RC, DGMAMC, GADAG

12.2 Signature

12.3 Co Guide: Dr R V SHETTAR

M.D (Ayu)

11.4 Signature

11.5 Head of the Department Dr V VARADACHARYULU

M D (Ayu)

PROFESSOR AND HOD D G M A M C

PGS&RC, DGMAMC, GADAG.

11.6 Signature

12. Remarks of Chairman & Principal:

12.1 Signature : Dr. G.B.Patil (Principal/C.M.O.)

“Evaluation of the efficacy of

THE BHARANGYADI GHANAVATI IN

VISHAMAJWARA WITH SPECIAL

REFERENCE TO MALARIAL FEVER”

Mangalavva.B.Patil. By

Dissertation submitted to the RajivGandhi University of

Health Sciences,Bangalore, In partial

fulfillment of Regulations for the

award of the Degree

Department of Kayachikitsa Postgraduate Studies and Research

D.G. Melmalagi Ayurvedic Medical CollegeGadag - 582 103

GuideDr. Vangipuram Varadacharyulu

Co-GuideDr. R.V.Shettar

Introduction• Mosquito makes man Eunuch.

• Vishamajwara, a most popular Ayurvedic term in turn of modern medical terminology co-related to malarial fever, is a protozoan disease caused by genus plasmodium and transmitted to man by certain species of infected female anopheles mosquito.

• India's geographic position and climatic conditions are favourable for the transmission of malaria.

Objectives of the study: -• To evaluate the efficacy of the Bharangyadi

Ghanavati in Vishamajwara (Malarial fever)

• To evaluate the antipyretic properties of Bharangyadi Ghanavati in Vishamajwara(Malarial fever)

• To evaluate the anti-malarial properties of Bharangyadi Ghanavati in Vishamajwara(Malarial fever)

Life cycle

• "

Role of bhuta in Vishamajwara• Susruta believed that Vishamajwara takes place due to agantuka karana (external cause).

• Agantuka is divedid in to four types

Abhighata

Abhichara

Abhishapa

Abisanga

• Dalhana considered Abhisanga as bhutavisanga

• Chakrapani stated that poisones insects may be cosidered as Bhuta .

• According to Amarkosha it is Keetanu.

Composition of the trail drug “BHARANGYADI GHANAVATI”

1. BharangiClerodendrum serratum 1 Part








9. Bruhati Solanum indicum 1 Part


Chemical Composition of Bharangyadi Ghana Vati

Name of the

ingredient

Chemical constituents

Indications Preparations

1.Bharangi Hispidulin 7.0 glucocaronides,scutellrrin,uncinatone,

pctolinarigenin

Jwara,Swasa,kasa, shotha,krimi,daha,peenasa.

Bharangyadi kwatha,

Bharangyadi guda.

2.Musta Cineol+,copadiene,

Copaene,cyperen I&II,cypernone,isopathoulenone,cypertoperotundone,etc

Jwara,krimi,trushna,Atiusara,kandu,kasa,nidra nasha,rakta vikara

Musta rishta, mustadi kasaya,mustadi vati.shadungapaneeya

3.Prapataka Adlumidiceine(-)-adlumine,(+)bisculline,cocharine coptisine,cryptopine,fumaromine,laharmine,parfemdine etc

Jwara,trushna,Bhramamada,Rakta pitta,Atisara,charadi etc

Sadanga paneeya parpatadyarista

4.Yavasa Galacto,catechin+catechin(-),epigallocatechin,andleucodelphnidin,B-phenethylamine etc

Jwara,kase,Raktapitta,trishna,medaroga,chardi brama,kusta etc

Agasthyavaleha,khatiradigutika,yasa sarkara,vasagrita,kalasyadi grutha

5.Shunti Dryness 80.9,protein 2.6,fat 0.9,fibre 2.4,carbohydrate 12.3,metals1.2%,calcium 20, phosphorus 60,iron 2.6mg,each 100gm other than these iodine chlorine are also present vitamin A,B,C also present.

Jwara,Hrudourbaya,hrutshoola,shilpadha,shotha,amavata,sheetha,pitta,pandu,atisara,kasaswasa, agni mamdhya etc

Ardrakakhand,panchaasama churna,samashrkara churna,rasnadi kwatha,soubhagya shunthi,shunthisura.

6.Kiratatikta Amarogentin,gentiopicrin,isobellicifolin,decussatin,chiratol,swerchirin,7-0methyl swertianian,kairatinol swertanone etc

Sanepata jwara, Rakta pitta, arsas krimi, kusta. Vruna, shotha, trishna.daha etc

Kiritadi kwata,sudharsana churna,kiratitiktadi churna,kiritarista etc

7.Kusta Essential oil,castol,taraxasterol,dehydrocostuslactone,sistosterol, arcuscumene,iso dihydrocostuslactone costus-lactone etc

Jwara,kusta,hikka, kasa,prasava shoola,hrudroga,visarpa,kanduvata rakta.

Kustadi taila,kustadi curna,kusta rasayanam

8.pippali Volatile oil-0.8%,piperine-4.5%,pipalatine and sesamine andpipalsterol-0.15-0.18% and pipalartin 0.13-0.20%,piper languminon,steroid,glycoside

Hrudhadourbalya,pandu,raktavikara,kasa,swasa,aruchi,agni mandhya,kshata, jwara

Guda pippali,pippali khada,pippalayasava,yakartlihari loha,yakrt pippaladi yoga.

9.Brahati Glycoside,alkaloid,solanine,dulcunarin,carotene,carpesterol,solonocurpone,disogenin,solasodine,vit-C etc

Jwara,swasa,hrdroga,shoola,chardi,kushta,kandu, krimi etc

Brihatyadi kasaya, pipapalyadi leha,dashamoolarista

10.Guduchi Tinosporide,cardifalide,tnosparidine,B-sistosterol,cardifol heptacosanol,octacasonol,magnoflarine,palmatine.

Jwara, trishna,vatarakta,pandu, kamala,chardi,krimi,kandu,kasa,bhrama,jwaravyadhi

Guduchadi churna,Guduchadi kwata,amritarista , amrithadi chandra prabhavati, pancha tikta , Guggu grutam etc

MATERIAL AND METHODSSource of data Post graduation and research center

of Sri D.G.M. Ayurvedic medical college and hospital, Gadag.

Sample size 30 patientsResearch Design simple Random clinical Trail Duration 21 daysFollow-up 15 daysPosology Internal - 3 gms in divided doses

1 vati =500 mg, 2 tab thrice a day

Anupanam- ushnajala

Inclusion criteria

Inclusion criteria –

• Age of the patients between 15 to 65 years.

• Uncomplicated malarial fever

• Peripheral smear test for M P must be positive

Exclusion criteria

• Exclusion Criteria –• Patient below 15 years and above 65 years of the • Patient with complication like severe anemia• Renal failure • Pulmonary oedema,• Jaundice• Spleenic rupture• Pregnant women• Cerebral Malaria

Criteria for withdrawals

• Deterioration of condition, which needs hospitalization

• Subsequent diagnosis of associated diseases

• Indulgence in concomitant therapy

Special instruction/advice given to patients

• To stop smoking, alcohol and other habits

• Not to indulge in strenuous exercise• Not to take any other medication except

the trial medication.• Not to indulge in sex• To take regulated food and not to have

food out side the house.

• As designated in the classical texts.

Objective parameters

• Thick and thin blood film for malaria.

• Peripheral smear test for MP

• Erythrocyte Sedimentation Rate (ESR)

• Hemoglobin (Hb %)

• Temperature chart

Assessment criteria

• Subjective and objective parameters are taken for the

assessment of result.


DISTRIBUTION OF PATIENTS BY AGE

55-650.00%

15 –2546.67%

35-4520.00%

25-3533.33%

45-550.00%


DISTRIBUTION OF PATIENTS BY GENDER

Male80%

Female20%


DISTRIBUTION OF PATIENTS BY OCCUPATION

House wife 6.67%

Service16.67%

Labour56.67%

Agriculturist10.00%

Business10.00%



Christian 3.33%

Hindu86.67%

Muslim10.00%

Others0.00%

Data related to presenting complaints

Presenting complaints Total no of patients Percentage

Aniyamita Jwara 30 100

Vepana 28 93.33

Chardi 24 80

Shira shoola 30 100

Aruchi 30 100

Parshwa shoola 6 20

Tandra 5 16.7

Swasa 4 13.33

Anidra 20 66.7

Yakrut Vruddhi 2 6.67

Pleeha Vruddhi 4 13.33

Evaluation of Subjective Parameters(Bharangyadi Ghanavati in Vishamajwara )

Parameter Before 7th day 14th day 21stday Follow Up

Aniyamita Jwara 2.84 1.61 0.53 0.30 0.19

Vepana 0.88 0.61 0.34 0.15 0.03

Chardi 1.38 1.07 0.57 0.26 0.11

Shira shoola 1.92 1.38 0.88 0.26 0.15

Aruchi 1.0 1.0 0.7 0.46 0.11

Parshwa shoola 0.19 0.07 0.07 0 0

Tandra 0.19 0.07 0.03 0 0

Swasa 0.34 0.19 0.07 0.07 0

Anidra 1.30 0.80 0.23 0.19 0

Yakrut Vruddhi 0.03 0.03 0.03 0.03 0.03

Pleeha Vruddhi 0.11 0.11 0.11 0.07 0.03

Aniyamita Jwara (mean )

Evaluation of Aniyamita Jwara (Mean)

0.190.53

2.84

1.61

0.3

-1

-0.5

0

0.5

1

1.5

2

2.5

3

3.5

BeforeTreatment

7th day 14th day 21stday Follow Up

Evaluation of Subjective Parameters

(Bharangyadi Ghanavati in Vishamajwara)

parameters Before Treatment

After Treatment Difference

MP smear (Positive) 26 7 19

Haemoglobin % 9.195385 9.513077 0.317692

E.S.R 15.65385 11.11538 4.53847

Total Count 6239.038 6080.192 158.846

Neutrofils 54.92308 60.57692 5.65384

Lymphocytes 38.34615 31.5 6.84615

Eosinophil 5.653846 5.769231 0.115385

Monocytes 1.461538 1.192308 0.26923

RESULTS

Distribution of patients by Result

Not Responded

20.00%

Cured63.33%

Responded3.33%

Discontinued13.33%

Statistical analysis of the clinical parameters at the end of treatment (21 days)

S/n subjective parameter

Mean SD SE t-value P-value Remarks

1 Jwara 2.423 0.702 0.137 17.686 <0.001 HS

2 Vepana 0.563 0.485 0.095 5.926 <0.001 HS

3 Chardi 1.115 0.993 0.194 5.747 <0.001 HS

4 Sjhira shoola 1.576 1.0265 0.201 7.840 <0.001 HS

5 Aruchi 0.538 0.508 0.099 5.434 <0.001 HS

6 pasrswashoola 0.231 0.514 0.1 2.31 <0.05 HS

7 Tandra 0.192 0.401 0.078 2.461 <0.05 HS

8 Swasa 0.269 0.666 0.131 2.053 >0.05 NS

9 Anidra 1.153 0.924 0.181 6.37 <0.001 HS

10 Pleeha vruddhi 0.038 0.196 0.038 1.0 >0.05 NS

Discussion• The fever is unwanted rise in body temperature

either because of disturbed internal environment or invasion of exogenous origins.

• Vishamajwara, a most popular Ayurvedic term in turn of modern medical terminology co-related to malarial fever.

• Vishamajwara vis-à-vis Malaria

• Vishamajwara and Ayurveda

Effect of Bhrangyadi Ghanavati on Vishamajwara

• Cumulative action of Bharangyadi Ghana vati based on Rasa.

• Cumulative action of Bharangyadi Ghana vati based on Veerya.

• Cumulative action of Bharangyadi Ghana vati based on Prabhava.

• Krimiharatwa of Bharangyadi Ghana vati based

• Cumulative action of Bharangyadi Ghana vati based on chemical compositions

• Observation of Bharangyadi Ghana vati in Vishamajwara vis-à-vis Malaria.

• Demographic data of Bharangyadi Ghana vati in Vishamajwara vis-à-vis Malaria.

• Subjective analysis of Bharangyadi Ghana vati in Vishamajwara vis-à-vis Malaria.

• Objective analysis of Bharangyadi Ghana vati in Vishamajwara vis-à-vis Malaria.

• Result of Bharangyadi Ghana vati in Vishamajwara vis-à-vis Malaria.

• Mean effect of Bharangyadi Ghana vati in Vishamajwara vis-à-vis Malaria.

Recommendations for further study

• Same yoga can be repeated by taking a large number of samples with randomized control groups.

• The effect of Bharangyadi Ghanavati can be studied along with Shodhana therapy.

• The effect of Bharangyadi Ghanavati can be studied on long duration to avoid the reoccurrence of Vishamajwara.

Limitations of the study

• Sample size is small to generalize the result.

• Samples are selected incidentally. • As chosen drug is a compound form it is

difficult to specify the action of any individual herb and or to cumulative mode of action.

Conclusion

• Vishamajwara is the condition, which is almost, resembles the disease Malaria

• The etiology of Vishamajwara and Malaria are similar.

Conclusion

• The Bharangyadi Ghanavati found effective in Vishamajwara.

• Bharangyadi Ghanavati Highly effective on P.Falciparum and P.vivax

• Bharangyadi Ghanavati is effective in chronic cases of Vishamajwara and more effective in fresh reported cases.

Thank you sir

vishamajwaram kc029 gdg

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