A Role of Udumbara Ksheer Sutra in Ano Rectal Fistula: An Ayurvedic Review

Acharya Sushrut has involved Bhagandara among the Ashtamahagad (8 dreadful diseases). At first it is present as Pidika (boil/abscess) in Apakwa (non-suppurated) state, become Bhagandara when it becomes Pakwa (suppurated). As defined in modern science, it is associated with fistula in ano. An anal fistula is an abnormal track having an external opening in the perianal region and internal opening in the anal canal and/or rectum. Ayurveda has a special approach to fistula management. All anal fistulas counter well to different forms of Kshar and Ksheer Sutra therapy. They are nothing but the medicated seton. The Ksheer sutra mechanical and chemical action of drugs coated on the thread work jointly to cut, cure, drain and clean the fistulous tract, thereby promoting track/wound healing. Though Bhrihattrayi, (chief three texts of Ayurveda) stated the use of Kshar Sutra, there is no proper description of their method of preparation. In eleventh century, Chakrapani Datta mentioned the preparation method of Ksheer sutra in his book Chakradatta for the first time which is indicated in Arsha and Bhagandara. Apamarga Kshar Sutra is the standard Kshar Sutra, and but it has some disadvantages. A variety of other Kshar Sutra, as well as Ksheer Sutra, have been prepared to resolve these inconveniences of Apamarga Kshar Sutra. One of them is Udumbara Ksheer Sutra which was founded by Prof. P.J Deshpande and M.K Jalan in 1984. Udumbara is one among the Nyagradhadi Gana Dravya mentioned by Acharya Sushrut. He described in Bhagandara Chikitsa that the Nyagradhadi Gana Dravyas are Bhagandaranashak.

Clinical Evaluation Of Apamarga Prati-sharaniya (teekshna) Kshara (local Application) Haritaki Churna In The Management Of Arsha (hemorrhoids)

Arsha (Hemorrhoids) is one of the most common conditions affecting peoples since time immemorial. The prevalence is equal in both sexes, peaks between the ages of 45 and 65 and declining thereafter. The main cause of hemorrhoids is constipation over a prolonged period of time and has to strain to pass stools, it can damage the lining of anal canal. Sushruta the Father of Surgery advocated four method of treatment of Arsha, which are Bheshaja, Kshara, Agni and Shastra. Under Sushrutas operative procedure local application of Pratisharaniya Kshara in the prolapse piles mass helps to reduce pile mass effectively (Ref.Su.Chi.6). It is safe, cheap, effective, simple, easily approachable procedure and ambulatory treatment and the patients acceptability is good to overcome such problem. Aims & Objective is to evaluate the clinical efficacy of Apamarga Pratisharaniya teekshna kshara in the management of Arsha. & to evaluate the safety of Apamarga Pratisharaniya teekshna kshara in the management of Arsha. Material and Methods: 30 patients were enrolled for the study within a period of one year and Teekshna pratisharaniya kshara was applied on piles mass intra anally under operative procedure with the help of a instrument proctoscope. Observation and result: Reduction in the piles mass evident by Inspection/ proctoscopy /Visual perception was observed remarkably.Bleeding and pain were also reduced remarkably in all the piles patient. 100% relief in bleeding, reduction of pile mass and total reduction in size of pile mass was recorded. Conclusion: Recently these Oldest technique advocated by Sushruta have been proven to be most effective and free from post-operative complications.

Preparation And Physicochemical Evaluation Of Mridu Apamarga Kshara

Ksharakalpana is one of the unique pharmaceutical preparation forms described in Ayurveda. Kshara is ashes of herbal drugs and is alkaline in nature. A detailed description of Kshara Kalpana preparation methods, types, properties and applications of different Kshara are available in Ayurvedic classics. Kshara is the substance having Ksharana and Kshanan properties. Various plants are mentioned as suitable for the preparation of Kshara viz., Apamarga, Arka (Calotropis gigantea Linn.), Mulaka (Raphanus sativus Linn.), Snuhi (Euphorbia nerifolia Linn.) etc. Among these Apamarga, Arka are the most common drugs used for the preparation of Kshara. In the present study whole plant of Apamarga (Achyranthes aspera Linn.) was used for the preparation of Kshara. Different opinions are there about the amount of water to be used, number of filtrations etc., while preparing the Kshara. Generally Apamarga kshara is prepared by decantation process in a single wash. In order to obtain increased yield and to reduce the loss during straining, in the present study it was prepared by the capillary action and three times washing. This method gave 49% more yield of Apamarga kshara and is far more when compared to traditional methods. Physicochemical evaluation of the prepared Kshara complied with the pharmacoepial standards.

Determination of betulinic acid, oleanolic acid and ursolic acid from Achyranthes aspera L. using RP-UFLC-DAD analysis and evaluation of various parameters for their optimum yield.

Achyranthes aspera L. is a well known herb commonly used in traditional system of Indian medicine to treat various disorders, such as cough, dysentery, gonorrhea, piles, kidney stone, pneumonia, renal dropsy, skin eruptions, snake bite, etc. Here, we used RP-UFLC-DAD method for determining triterpenoids betulinic acid (BA), oleanolic acid (OA) and ursolic acid (UA) from A. aspera. Optimum yield of these compounds were studied and evaluated using parameters viz., method of extraction, time of extraction, age of plant and plant parts (leaves, stem and roots). Linear relationships in RP-UFLC-DAD analysis were obtained in the range 0.05-100 µg/mL with 0.035, 0.042 and 0.033 µg/mL LOD for BA, OA and UA, respectively. Of the variables tested, extraction method and parts used significantly affected content yield. Continuous shaking extraction (CSE) at ambient temperature gave better extraction efficiency than exposure to ultra sonic extraction (USE) or microwave assisted extraction (MAE) methods. The highest content of BA, OA and UA were determined individually in leaf, stem and root extracts with CSE. Collective yield of these triterpenoids were higher in leaf part exposed to 15 min USE method. To best of our knowledge, the study newly reports UA from A. aspera and the same was confirmed using ATR-FT-IR studies. This study explains the distribution pattern of these major triterpenoids and optimum extraction parameters in detail.

Pharmaceutical standardization of Apamarga kshara.

Standardization of herbal drugs is essential to certify their quality and purity. Kshara (alkaline substance) of Apamarga (Achyranthes aspera Linn.) is an important constituent in many Ayurvedic formulations, but its standard manufacturing process (SMP) is not attempted till date. This study is aimed to establish SMP for Apamarga kshara. In pharmaceutical process; generally the sediments of ash obtained at the end of washes will be discarded. However, in the study, we attempted to wash the sediments repeatedly by adding water to extract more Kshara. Apamarga was collected from the local area and authenticated. Kshara was prepared by following standard methods and the preliminary physicochemical profile was developed. It is observed that the ash yields Kshara even in the consecutive washes. First wash yielded 21.23% w/w Kshara, while the second and third washes yielded 9.38% w/w and 4.76% w/w, respectively. Repeated washes yield more Kshara. Hence, it is advocated to wash the ashes repeatedly. As the findings are encouraging, similar experiments can be extended to all other Kshara preparations.

Clinical evaluation of the efficacy of kshara karma with Apamarga kshara and Jatyadi taila pichu in the Management of Cervical Erosion (Karnini Yonivyapada).

Cervical erosion is one of the commonest gynecological diseases which includes large section of women among her reproductive age group and needs medical attention and non surgical treatment In modern system its treatment done with diathermy and cryosurgery which has various side effect like cervical stenosis, accidental burns, etc. In Ayurveda science treatment of karnini yonivyapada by kaphahara chikitsa with Apamarga kshara which have property of lekhana, sodhana, ropana, stambhana, kaphghna and so many properties and Jatyadi taila which have property of vatashamak ,sheshmhara, mansapkarshana, shodhana and ropana . All these properties facilitate destruction of columnar epithelium and facilitate the re-epithelization of new healthy stratified squamous epithelium on ectocervix with this entire basis, this research work was done. karnini yonivyapada described in ayurvedic text books can be correlated with cervical erosion. Apamarga kshara ( Sushruta Samhita Sutrasthana-11/5) and Jatyadi taila ( Bhava Prakash Madhyama Khand.- 47/90-95) . Group I- this group 15 registered patients were administered with application of 'Apamarga kshara' on cervix and 'Jatyadi Taila' Pichu in the vagina for 7 sitting alternate day in a month Group II- In this group 15 registered patients of Cervical erosion were administered with 'Jatyadi Taila ' Pichu in the vagina daily for 14 days in a month. Treatment was done after bleeding phase of menstrual cycles over. Overall percentage relief was higher in group I 72.17% followed by group II i.e. 68.44% . Statistically the results were highly significant (p<0.001) in both groups. Combined use of kshara karma and Jatyadi taila pichu (Group I) is more effectively helps in managing the disease cervical erosion.