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   Table of Contents - Current issue
Coverpage
July-September 2021
Volume 15 | Issue 3
Page Nos. 153-244

Online since Saturday, September 25, 2021

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EDITORIAL  

Medical profession and soft skills Highly accessed article p. 153
Sanjeev Sharma
DOI:10.4103/joa.joa_281_21  
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PRE - CLINICAL STUDY: ORIGINAL ARTICLE Top

Evaluation of polyherbal formulation for antihypertensive activity in albino rats Highly accessed article p. 155
Pratibha , Gaurav Sharma, Sudipta Kumar Rath
DOI:10.4103/joa.joa_317_20  
Background: Hypertension (HTN) is a multifactorial clinical condition and therefore can be managed in multiple pathways. Long time period use of modern antihypertensive drugs is associated with a spectrum of toxic and side effects. Modern antihypertensive drugs are not ideally effective owing to dependence, side effects, and cost. However, therapeutic interventions using herbal drugs for HTN have gained widespread attention worldwide. Aim: The aim of the study is to evaluate the antihypertensive activity of polyherbal formulation (NIA/DG/2015/01) as an adjuvant with modern antihypertensive drug or as a stand-alone drug in cadmium chloride (CdCl2)-induced hypertensive albino rat model. Methods: The polyherbal formulation (NIA/DG/2015/01) comprises the bark of Terminalia arjuna (Roxb.) W and A, the root of Withania somnifera (Linn.), the rhizome of Nardostachys jatamansi DC., the root of Boerhaavia diffusa (Linn.), and whole plant of Convolvulus pluricaulis Choisy. All the herbs were separately extracted in aqueous medium. Polyherbal formulation (90 mg/kg., p.o.), was evaluated using the CdCl2-induced hypertensive rat model using the Verapamil as a standard reference drug. HTN was induced in albino rats by intraperitoneal administration of CdCl2 (0.1% CdCl2 solution) 1 mg/kg/day for 15 days. After 15 days, intervention was started for 28 days, and blood pressure (B.P.) was measured in every 7th day. Results: Polyherbal formulation significantly reduced (P < 0.001, one-way analysis of variance followed by Tukey's multiple comparison test and Dunnett's multiple comparison test) systolic and diastolic B.P. in CdCl2-induced HTN model when compared with Verapamil. Conclusion: Polyherbal formulation (NIA/DG/2015/01) possesses significant antihypertensive activity.
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CLINICAL STUDY: ORIGINAL ARTICLES Top

An open-labelled randomized clinical trial for the evaluation of Balaharidradi Lepa with and without Khadira Twaka Kwath in Vyanga (Melasma) p. 163
Sukha Ram, Mita Kotecha, Krutika Jitendra Chaudhary
DOI:10.4103/joa.joa_29_21  
Introduction: Vyanga (Melasma) is a common disorder appearing on the face, causing skin discoloration. Niruja (painless), Tanu (thin), Shyava Varnayukta (hyperpigmentation), and Mandala (circular patches) are the peculiar diagnostic features of the disease. It is categorized as a Kshudra Roga (minor disease) in Ayurveda. Lepa (pack) and Kwath (decoction) are well-known medicines for Vyanga (Melasma). Balaharidradi Lepa and Khadira Twaka Kwath are defined as Vyangahara Dravyas in Ayurvedic Samhitas as they are having Vyangahara, Kushthaghna, Varnya, Krimighna, and Kantikara activity. This study aims to evaluate the effect of Balaharidradi Lepa with and without Khadira Twaka Kwath in Vyanga (Melasma). Materials and Methods: (i) Design: Open-labelled randomized clinical trial of thirty patients of either sex. (ii) Intervention: Group A (15 patients) was given Balaharidradi Lepa and Khadira Twaka Kwath, while Group B (15 patients) treated with Balaharidradi Lepa. (iii) Duration: 2 months. (iv) Outcome measures: photography. Results: All the two groups were compared by Kandu and Von luschan's color scale statistically significant results were observed in both Groups A and Group B. Conclusion: The present study supports the use of Balaharidradi Lepa and Khadira Twaka Kwath in treating Vyanga with the good acceptance by all treated patients.
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Study of pattern of morbidity in children under 5 years and effect of Swarnaprashan on morbidity status p. 170
Nitu Sinha, Nisha Kumari Ojha
DOI:10.4103/joa.joa_105_20  
Background: Infant and child mortality and morbidity remain a challenge especially in the developing world. More than half of the children (53.7%) are suffering from some form of illness. Recurrent respiratory infection, recurrent diarrhea, recurrent fever, etc. are the most common causes of morbidity in immune-compromised children. In India, 15% of death occurs during infancy and 1-5 years of age are due to respiratory infections. Diarrhea constitutes the most important cause of chronic morbidity followed by malnutrition. The objective of this research was to study the effect of swarnaprashan on morbidity status of the children under five years of age. Methods: A randomized, open-label study was conducted on 60 children of 06 months to 5 years of age and were randomly divided into two groups (30 in each). In Group A, trial drug (Swarnaprashan) was given and in Group B, there was regarded as 'No treatment concurrent control'. Results: In group A where trial drug (Swarnaprashan) was given, improvement in morbidity features were found whereas in group B which was 'No treatment concurrent control', 'not significant' results were obtained. Conclusion: Present research reveals that swarnaprashan works as an immune-modulator which decreased the morbidity rate and therefore can be a simple remedy to bring down the morbidity rate in children.
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SURVEY STUDY: ORIGINAL ARTICLE Top

A preliminary study on correlation between stress and Satva sara among students of ayurveda college p. 181
Resmy A Raj, M Abhilash, Chitra M Gawande, Jeevan Jagadeesh Kulkarni
DOI:10.4103/joa.joa_32_20  
Introduction: Stress is a physical, mental, or emotional factor that causes physical or psychological tension. Various researches conducted in the field of stress revealed that stress is the common inhibitor on academic performances and students in professional colleges exposes to higher levels of stressors than their peers. In addition to stressors of everyday life, the medical students must deal with stressors such as examinations, chances of failure, lack of leisure time, workload, relationships with peers, etc. Therefore, early detection and estimation of stress and its intervention is very much essential to prevent or minimize the effects of distress on the students in future. Methods: 200 students of 1st and 2nd year BAMS were selected for the study. Their stress as evaluated with perceived stress scale-10. Satva sara was evaluated with a validated Satvasara assessment tool. Statistical tests were employed to find out the prevalence of stress and correlational studies were conducted to find out the relationship between stress and Satvasarata. Results and Conclusion: About 80% of Ayurveda College students were recorded as having moderate stress, 6% has mild and remaining 14% suffer from high perceived stress. A significant negative correlation is found in between stress and Satvasara with a spearman's correlation coefficient of - 0.332 and P < 0.001. Implementing methods to enhance the Satvasara of subjects with behavioral therapies like chanting mantra, yoga, meditation, pranayama could be more useful and effective in controlling stress among medical students.
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ANALYTICAL STUDY: ORIGINAL ARTICLES Top

Assessment of effect of Murchana in Ark Taila on the basis of physiochemical parameters p. 189
Suman Purohit, Shweta Shukla, Yadevendra Yadav, Khemchand Sharma
DOI:10.4103/joa.joa_229_20  
Background: Murchana is a specific procedure mentioned in classical texts to remove Ama Dosha increase therapeutic properties and shelf life of Taila. The effect of Murchana Sanskara was studied by preparing two samples of Ark Taila one with Murchana Sanskara and other without Murchana Sanskara. Material and Methods: Pharmaceutical preparation of two samples of Taila, Murchita Ark Taila samples was prepared as mentioned in Bhaishajya Ratnavali and two samples were subjected for physico-chemical parameters- specific gravity, saponification value, iodine value, acid value, viscosity, etc. Result & Conclusion: Murchana process imparts changes in good colour, odour in Taila. After Murchana Sanskara there were increase in saponification value and decrease in viscosity, acid, iodine and peroxide value. Murchana Sanskara enhanced the properties and stability of Ark Taila.
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Pharmacological evaluation of processed Cannabis leaves as a non sedative analgesic: The novel approach p. 193
Swagata Dilip Tavhare, Mukesh B Nariya, Rabinarayan Acharya
DOI:10.4103/joa.joa_330_20  
Background: Ayurvedic pharmacopoeia records vivid indications of Cannabis (Bhanga) including its analgesic, sedative and intoxicant actions. For inhibition of intoxication, Ayurveda recommends certain processing (Shodhana) techniques for Cannabis. The present study is planned to evaluate the analgesic potential and sedative effects of water washed (Jalaprakshalana)–processed Cannabis sativa leaves through pharmacological experimentation. Methods: Wistar strain albino rats weighing 200 ± 20 g and Swiss albino mice (25–35 g) of either sex were used in the study. Pharmacologically validated models were used to evaluate the analgesic effects (by formalin test and tail flick method) and neuromuscular coordination by rotarod experiment. water-washed–processed Cannabis leaves powder (test drug [TD]) was administered at dose of 22.5 and 45 mg/kg for rat and mouse, respectively, against reference standard morphine sulfate (MS) 5 mg/kg and the results were evaluated statistically. Results: TD at 22.5 and 45 mg/kg showed significant decrease in paw licking response at early phase in formalin test. TD at 22.5 mg/kg showed significant increase in tail flick latency after 3 h, and in 45 mg/kg dose, it was significant up to 4 h. In rotarod experiment, TD did not show any decrease in latency of fall-off time after 1 and 3 h. Conclusion: Water-washed processed Cannabis leaves powder possesses significant analgesic effect at 22.5 mg/kg (250 mg human dose) and 45 mg/kg (500 mg human dose) comparable to MS 5 mg while nonsignificant effect in neuromuscular in-coordination, thus devoid of sedative effect.
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REVIEW ARTICLES Top

Compilation of herbal drug substitutes suggested in selected classical ayurvedic texts p. 198
C N Shanti Vasudevan, Ima Neerakkal
DOI:10.4103/joa.joa_169_20  
Introduction: Ayurvedic literature suggests the use of readily available substitute drugs (Abhava Pratinidhi Dravya) with similar properties (rasa, guna, and veerya) for genuine drugs in its scarcity or absence (Abhava Dravya). Data Source: Ayurvedic texts – Yogaratnakara, Bhavaprakasha, Bhaishajya Ratnavali, and Vaidya Chintamani. Review Methods: The present review focuses on enlisting such alternative substitute plants or plant parts suggested in ayurvedic texts – Yogaratnakara, Bhavaprakasha, Bhaishajya Ratnavali, and Vaidya Chintamani. The International Plant Names Index and the Plant List were referred for citing the latest scientific names. Results: The compiled list of original substitute drug pairs includes Sanskrit name, scientific name, family, and their habit. Two of the pairs were found repeated in all the four texts while five pairs were found in three texts. Fourteen pairs were found repeated in two texts. Some of the plants for whom substitutes are being suggested come under, Ashtavarga Rare Medicinal Plants. Conclusion: This concept needs to be scientifically analyzed for identifying genuine substitutes. Comparative scientific studies on original and substitutes suggested can help to avoid adulteration in medicinal plants and can also act as a conservation strategy to protect rare medicinal plants.
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Rasayana herbs for longevity: An ayurvedic and contemporary appraisal p. 208
Vishal Kumar, Tanuja Manoj Nesari, Shivani Ghildiyal, Rahul Sherkhane
DOI:10.4103/joa.joa_115_20  
Objective: To explore Rasayana herbs ascribed in Ayurveda classics and their contemporary appraisal for Rasayana potential. Data Source: Classical Ayurvedic review of Rasayana herbs were done from three distinguished Ayurveda classics (Charaka Samhita, Sushruta Samhita and Ashtang Hridaya) known as Brithattrayi. The contemporary review of those classical herbs was done from PubMed and other reputed databases. Review Methods: The classical Ayurveda review was done manually from Charaka Samhita, Sushruta Samhita and Ashtanga Hridaya. The single herbs mentioned in specifically dedicated Rasayana chapters of these classics (Charaka Chikitsa 1, Sushruta Chikitsa 27, 28, Ashtanga Hridaya Uttarsthana 39) were gathered. The botanical identity of the herbs were taken from “The plant list.org”. The contemporary review of those classical herbs mentioned as Rasayana in Ayurveda classics were done from PubMed and other databases. The searching key was Latin name of drug/herb+Rasayana activity. Results: Total 39 herbs were enumerated in Brihattrayi, among them 21 are in Charaka Samhita, 12 in Sushruta Samhita and 21 are from Ashtanga Hridaya, few of them are Bhallataka, Mandukaparni, Guduchi, Varahikanda, Soma, Tuvaraka, Vacha and Bhringaraja. Most of the herbs mentioned as Rasayana are evaluated scientifically for their antioxidant, immunomodulatory and nootropic potential. These reported activities of herbs support their Rasayana property. Conclusion: These studies indicate that daily damage of cells leads to early ageing and occurrence of many diseases. Rasayana herbs through their anti-oxidant, immunomodulatory and nootropic potential protect the damage which contribute towards health and longevity.
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Indukanta ghritam – An ayurvedic formulation for acid peptic disorder and longevity: A review p. 215
Punam Aggarwal, R Galib, PK Prajapati, Pramod R Yadav
DOI:10.4103/joa.joa_149_20  
Introduction: Acid peptic disorders are common conditions reported in daily clinical practice in India. Epidemiological study of 30,216 patients inferred 7.8% prevalence of peptic ulcer in India, while prevalence of gastroesophageal reflux is reported to be around 28% in South West India. Repeated gastric ulcers, perforation, or hemorrhage can cause intestinal fibrosis or cancer which can lead to death. As the disease occurs mostly in Madhyama vayas (16-70 yrs of age) and if this age is affected, longevity also be affected. Based on the clinical features, such manifestations can be compared with Amlapitta and Parinama shula. These diseases are preventable and, if not addressed at the right time, may burden the scenario hampering the quality of life of the individuals. Objective: To screen the activities of individual ingredients of Indukanta ghritam and to propose possible mode of action in APDs and longevity. Data Source: Charaka Samhita, Sushruta Samhita, Ashtanga Hridaya, Sahasra yoga, Sharangadhara Samhita and online data bases. Review Methods: The classical text books were reviewed manually and review was also done by referring various scientific journals and other databases. Results: The formulation is a combination of several drugs, i.e., Dashamoola and Panchakola etc. They are referred to be useful in Amlapitta, Parinama shula etc. conditions and latest researches have established activities like gastroprotective, antioxidant, immuno-modulation etc. inferring the use of the formulation the therapeutics of APDs, as well as a rejuvenating drug. Conclusion: Indukanta ghritam can prevent as well as cure the disease and can improve the quality of life. The herbal formulation can minimize the disease burden and possibly can play an important role as a classical rejuvenating drug.
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“Milk as a food” – A boon or curse, think before use p. 224
Ritu Kaushik, AS Baghel, HA Vyas, SB Kamble, Pankaj Kaushik
DOI:10.4103/joa.joa_177_20  
Objective: To evaluate whether the milk is compatible as daily routine beverage or not. Data Source: Ayurvedic classics with available commentaries, material available online have been thoroughly screened, analyzed and presented in a systematic manner. Review Methods: literary review deals with eight types of milk which are commonly used in the community described by different Samhita. It is mentioned under Ksheera Varga that comes under Drava Varga of Ahara. Being part of Ahara its intake amount depends upon Agni, Desha, Kala, Vaya and Prakriti. Results: Persons living in Sadharandesha with Samagni should take Go-dughda (cow's milk) and Aja-dughda (goat milk). In Varsha Ritu, individual's having Mandagni and living in Aanupadesha buffalo's milk is contraindicated although it is beneficial in Tikshnagni individuals and in Hemanta Ritu. Its use is prohibited with the Haritkayadi varga, Amla Varga, and Lavana Varga. Milk is more beneficial in Vata and Pitta dominant constitution. Conclusion: Milk can be considered as boon if taken according to Desha (geographical region), Kala (season), Prakriti or Agni (digestive capacity) and also can be a curse if not taken appropriately.
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CASE REPORTS Top

Hirayama disease: An ayurvedic approach p. 228
Sukumar Ningappa Nandigoudar, Swarda Ravindra Uppin, Anita Dalawai, Namrata Bhagaje
DOI:10.4103/joa.joa_196_20  
Introduction: Hirayama disease, also known as Monomelic amyotrophy or benign focal amyotrophy, is a rare motor neuron disease. It is reported to primarily affect males of southeast Asia, particularly India and Japan. Clinical findings and Intervention: A 27 years male patient approached Ayurveda OPD with a known case of Hirayama Disease from last 9 years. Considering this condition, the treatment was planned according to Ayurvedic Medicinal system which included courses of Nasya karma, Basti karma and Shamana aushadi. Outcome: Post treatment, the patient showed considerable clinical improvement, and arrest in disease progression was observed. Conclusion: The present condition is understood under the spectrum of Vata vyadhi and was diagnosed as a case of Viswachi. The treatment was focused upon pacifying vata Dosha and restoring strength and functional capacity.
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Integrative management of recurrent anterior shoulder dislocation p. 232
Dasari Sri Lakshmi
DOI:10.4103/joa.joa_208_20  
Introduction: Shoulder joint is the most mobile ball and socket joint. It allows movement along three planes due to its bony configuration and loose joint capsule. Stability of shoulder joint mainly depends on muscle strength supporting the joint. Shoulder dislocation is common injury; anterior dislocation being most common. Main Clinical Findings and Diagnosis: 38 year male patient with a history of fourth recurrent anterior shoulder dislocation (RASD) reduced under anaesthesia was immobilized in sling for 6 weeks. After immobilization, active assisted flexion and abduction was restricted to 90° associated with pain and feeling of instability. Interventions: Integrative treatments of Ayurveda and Physiotherapy were given in three divided sessions, 7 days in each session for a total of 21 treatment days. Ayurveda treatments included Sthanika abhyanga (SA) and Shashtika shali pinda sweda (SSPS). Physiotherapy treatments included interferential therapy (IFT) and exercises. Outcome: Nourishing external treatments enhanced muscle strength and joint mobility. Conclusion: There was appreciable improvement in shoulder muscle strength, active range of motion (AROM) and no incidence of recurrence since past 2 years. The patient is able to carry out unhindered daily activities with full and free AROM.
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Safe and effective management of COVID-19 through ayurveda intervention: A case series p. 237
Santosh Kumar Bhatted, Kavita Kumari, Nishant Malhotra, Tanuja Nesari
DOI:10.4103/joa.joa_308_20  
Introduction: COVID-19/SARS-CoV-2 has become a major concern for whole humanity, it is rising rapidly and the condition is worsening. With a huge transmission rate, it has become an important requirement of this times to hatch out a safe and effective treatment for COVID-19. Main clinical findings–All the 5 cases of Doctors pursuing MD education in Ayurveda at All India Institute of Ayurveda were having varied variety of symptoms fever, sore throat, fatigue being common along with rest others like dyspnea, hemoptysis, cough, palpitations, pain in abdomen and calf muscles. Diagnosis: All the cases were diagnosed as COVID-19 positive. Intervention: All of the cases were given Ayurveda treatment chiefly comprising of SamshamniVati, AYUSH Kwatha, Chyawanprash along with Steam Inhalation with Ajwain (Tachyspermumammi) and nasal application of Anu Taila along with a specific daily (Dinacharya) and dietary (Ahara ) regimen. Outcome: All the patients recovered completely without any post-complications assessed after a follow-up period of 1 month. Conclusion: It was found that Ayurveda is a safe and effective treatment for mild to moderate COVID-19 patients. A lead can be taken from these cases and Ayurveda can be conjugated with the main stream modern medical treatment modalities for curing this pandemic with an integrated approach.
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