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1.  A comparative clinical study of Snuhi Ksheera Sutra, Tilanala Kshara Sutra and Apamarga Kshara Sutra in Bhagandara (Fistula in Ano) 
Ayu  2012;33(1):85-91.
Bhagandara (Fistula in Ano) at modern parlance is a common anorectal condition prevalent in the populations worldwide and its prevalence is second highest after Arsha (hemorrhoids). Kshara Sutra (K.S.) is one of the chief modality in the treatment of Bhagandara in Ayurvedic science. Exploration of the new plants for the preparation of Kshara as a better substitute to Apamarga Kshara is the need of the hour. To find out an effective alternative to Apamarga K.S. in view of easy processing, a Snuhi Ksheera Sutra without any Kshara and the Tilanala K.S. were opted for their clinical evaluation. Total 33 cases of Bhagandara were divided randomly into 3 groups, having 11 patients in each group. In Group A, Snuhi Ksheera Sutra; in Group B, Tilanala K.S. and in Group C, Apamarga K.S. were used. Assessment was done on objective (Unit Cutting Time - UCT) and subjective parameters. Statistically insignificant difference was observed in the efficacy of treatment by subjective parameters like pain, discharge, etc. between the three groups. It was found that Tilanala K.S. showed higher UCT (9.76 days) while lower in Snuhi Ksheera Sutra (7.42 days) as compared to Apamarga K.S. (8.82 days). Thus Tilanala K.S. can be used as a substitute for Apamarga K.S. and Snuhi Ksheera Sutra can be employed in the recurrent fibrosed cases of Bhagandara.
doi:10.4103/0974-8520.100319
PMCID: PMC3456871  PMID: 23049190
Apamarga; Bhagandara; fistula in ano; Snuhi Ksheera Sutra; Tilanala Kshara Sutra; Unit Cutting Time
2.  Comparative clinical evaluation of Kshara Sutra ligation and hemorrhoidectomy in Arsha (hemorrhoids) 
Ayu  2011;32(2):225-229.
Arsha (hemorrhoids) is engorgement of the hemorrhoidal venous plexus, characterized by bleeding per rectum, constipation, pain, prolapse and discharge. It is manifested due to improper diet, prolonged standing and faulty habits of defecation causing derangement of tridosha, mainly vata dosha. Vitiated dosha localizes in guda vali, pradhana dhamani and mansdhara kala and vitiates twak, mansa, meda and rakta, resulting in the annavaha sroto dushti. Modern management of arsha needs, mainly, a surgical approach, i.e. hemorrhoidectomy, wherein the result was found to be less satisfactory. In this regard, to determine a solution for satisfactory cure, the kshara sutra ligation method in arsha was studied in comparison with hemarrhoidectomy. Kshara sutra ligation in arsha was employed in 35 patients, and 26 patients were dealt with hemorrhoidectomy. The study revealed a better result of the kshara sutra ligation-treated group in comparison with hemorrhoidectomy. The observations revealed that maximum advantages like minimum hospital stay, no bleeding during or after operation, no post-operative anal stenosis, a low cost-effective and more acceptable to different categories of people, etc. were recorded in the kshara sutra-treated group. Statistically, kshara sutra ligation for arsha was found to be highly significant and effective management. No adverse effects were noted during the follow-up period.
doi:10.4103/0974-8520.92591
PMCID: PMC3296345  PMID: 22408307
Arsha; hemorrhoidectomy; hemorrhoids; kshara sutra ligation
3.  Clinical study of Manjishthadi Ghrita in vrana ropana 
Ayu  2011;32(1):95-99.
Healing of vrana (wound) is either primary or secondary by nature. Secondary healing requires more attention than primary healing. Basically, two things, shodhana (making free from undesirable healing factors) and ropana (closure of wound), are desirable for proper healing. Many drugs have been described in classics for healing, but none of them is capable of healing the wound individually. Hence, to fulfill the aim, manjishthadi ghrita was prepared with the help of 7 drugs having vrana ropana effects and was evaluated clinically for its healing properties in this study. It was used topically in postoperative wounds, mostly of ano-rectal cases, twice a day, for 21 days. The follow-up period was 1 month to observe the healing as well as vaikritapaham (reduced deformity) properties and any untoward effects of the drug. A randomized control clinical trial was done. Out of 45 patients, 24 patients in group A were treated with “Manjishthadi Ghrita” (treated group), while 21 patients in group B (standard group) treated with povidine iodine ointment. Better result was observed in the treated group in comparison to the standard group. No adverse effect was observed in any patient. Manjishthadi ghrita can be prescribed as a local healing agent for common wound.
doi:10.4103/0974-8520.85738
PMCID: PMC3215426  PMID: 22131765
Manjishthadi ghrita; ropana; shodhana; vaikritapaham; vrana; wound healing
4.  Effect of Mahayavanala Roma Kshara and Dhanyaka Gokshura Ghrita in benign prostatic hyperplasia 
Ayu  2010;31(3):332-337.
Vatastheela is a disease of Mutravahasrotasa, one among the 12 types of Mutraghata disorders elaborated by Sushruta in his seminal work, the Sushruta Samhita. Vatastheela, as described in Ayurveda, closely resembles benign prostatic hyperplasia (BPH) of modern medicine in its signs and symptoms. It is a senile disorder and chiefly affects individuals above the age of 40 years. The symptoms are those of bladder outflow obstruction, with increased frequency of micturition, dribbling, hesitancy, and the features of chronic urinary retention. Surgical management has been accepted as the standard management but is associated with many disadvantages as well as complications, which may not be acceptable at this age. Conservative management with modern medicines is also not free from side effects. So, in this age-group, there is a need for much safer alternative method of management. In this regard, many works have been carried out and shown that the Ayurvedic approach, using natural medicines, is a far better approach. We carried out a comparative study of Mahayavanala Roma Kshara (MRK) and Dhanyaka Gokshura Ghrita (DGG), which are the compounds prescribed for Mutraghata in Ayurvedic literature. The patients were randomly selected from the OPD and IPD of IPGT and RA hospital, Jamnagar, Gujarat, and divided into two groups. In first group, one (500 mg) capsule of MRK was given twice a day with lukewarm water for 45 days; in second group, 10 gm of DGG was given orally twice a day with lukewarm water for 45 days. DGG showed significantly greater relief in the subjective parameters as per International Prostate Symptoms Score (IPSS) than MRK. However, reduction in the size of the prostate and in the volume of the post-void residual urine was found much better in the MRK group.
doi:10.4103/0974-8520.77168
PMCID: PMC3221067  PMID: 22131735
Benign prostatic hyperplasia; Dhanyaka Gokshura Ghrita; Kshara; Mahayavanala Roma Mutraghata; Mutravahasrotasa; Vatastheela
5.  The role of Apamarga Kshara in the treatment of Arsha 
Ayu  2010;31(2):232-235.
As per the available treatment modalities of Arsha, the Kshara karma modality is the best one, taking into the consideration its convenience, easy adoptability, cost-effectiveness and curative results. Under this parasurgical procedure, various forms of external kshara application are used in treating the Arsha. These are Ksharasutra Ligation (KSL), ksharpatan, etc. KSL is a surgical procedure, while ksharapatan vidhi is local application and seems to be effective with an easy procedure. Several studies of ksharapatan had been conducted; so the time has come to specify the study of ksharapatan, e.g., according to degree of pile mass and different symptoms and signs. In this present study, apamarga (Achyranthus aspera Linn.) kshara, one among the best qualitative ksharas, was locally applied directly on the different sizes, shapes and degrees of Arsha, to find out its effectiveness with or without any untoward effect. A total of 30 patients were treated by local application of Apamarga kshara. The ksharapatan was done every day, for 7 days in 3 g dose, and the result was assessed thoroughly on the basis of observation according to the specially designed proforma. Apamarga kshara was prepared as per the standard method described in Ayurvedic texts. Patients suffering from Arsha were selected by simple random sampling method, with the complaints of bleeding per rectum, Vedana, Srava, kandu and prolapse. Lastly, it was concluded that ksharapatan had shown significant improvement in 1st and 2nd degree of pile masses without any side effect.
doi:10.4103/0974-8520.72406
PMCID: PMC3215370  PMID: 22131716
Apamarga; Arsha; hemorrhoids; kshara; ksharapatan; Ksharasutra Ligation (KSL); parasurgical; pratisaraniya.
6.  A comparative study of Agni karma with Lauha, Tamra and Panchadhatu Shalakas in Gridhrasi (Sciatica) 
Ayu  2010;31(2):240-244.
Sushruta has mentioned different methods of management of diseases, such as Bheshaja karma, Kshara Karma, Agni karma, Shastrakarma and Raktamokshana. The approach of Agni karma has been mentioned in the context of diseases like Arsha, Arbuda, Bhagandar, Sira, Snayu, Asthi, Sandhigata Vata Vikaras and Gridhrasi. Gridhrasi is seen as a panic condition in the society as it is one of the burning problems, especially in the life of daily laborers. It is characterized by distinct pain starting from Sphik Pradesha (gluteal region) and goes down toward the Parshni Pratyanguli (foot region) of the affected side of leg. On the basis of symptomatology, Gridhrasi may be simulated with the disease sciatica in modern parlance. In modern medicine, the disease sciatica is managed only with potent analgesics or some sort of surgical interventions which have their own limitations and adverse effects, whereas in Ayurveda, various treatment modalities like Siravedha, Agni karma, Basti Chikitsa and palliative medicines are used successfully. Among these, Agni karma procedure seems to be more effective by providing timely relief. Shalakas for Agni karma, made up of different Dhatus like gold, silver, copper, iron, etc. for different stages of the disease conditions, have been proposed. In the present work, a comparative study of Agni karma by using iron, copper and previously studied Panchadhatu Shalaka in Gridhrashi has been conducted. A total of 22 patients were treated in three groups. Result of the entire study showed that Agni karma by Panchadhatu Shalaka provided better result in combating the symptoms, especially Ruka and Tandra, while Lauhadhatu Shalaka gave better results in combating symptoms of Spanadana and Gaurava. In the meantime, Tamradhatu Shalaka provided better effect in controlling symptoms like Toda, Stambha and Aruchi. Fifty percent patients in Panchadhatu Shalaka (Group A) were completely relieved. In Lauhadhatu Shalaka (Group B), the success rate was 00.00%, and in Tamradhatu Shalaka (Group C), the percentage of success rate was 14.28%. After analyzing the data, Tamradhatu Shalaka was found to be more effective than Lauha and Panchadhatu Shalakas.
doi:10.4103/0974-8520.72408
PMCID: PMC3215372  PMID: 22131718
Agni karma; Gridhrasi; Panchadhatu Shalaka; Parshni Pratyanguli; Sciatica

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