Role of Ayurveda in end-of-life care Mandip Goyal AYU (An international quarterly journal of research in Ayurveda) 2019 40(1):1-2

Dashavidha Parikshya Bhava (tenfold of investigation) according to Acharya Charaka – An ancient method of research Vinay Ankush Pawar AYU (An international quarterly journal of research in Ayurveda) 2019 40(1):3-7 Research follows a scientific way of establishing facts. All those methods which are used by the researcher during the course of studying the research problem are termed as research methods. The scientific method implies an objective, logical, and systematic method. Research is an organized endeavor. Like any other organized work, research requires proper planning, that systematizes the research work. It eliminates aimless intellectual wandering. Database of knowledge creation and its classification gives a definite structure to any literature. However, it needs a proper research methodology, without which the structure is incomplete. Ayurveda experts have followed certain research methods and methodology. The traditionally established truths need to be validated in scientific manner. Validation of ancient methods of investigation or research will ultimately lead to establishment of Ayurveda as a science which will contribute to broad domain of Indian research methodology. The critical scientific approach of Ayurveda is evident from various ancient methods. Proper planning before performance of any task is always advised by authoritative persons. Acharya Charaka has given Dashavidha Parikshya Bhava, i.e. tenfold of investigation which are necessary for accomplishment of task without intellectual wandering. The desired objectives can be achieved if proper planning is done beforehand. This study is an attempt to establish the applicability of Dashavidha Parikshya Bhava, i.e. tenfold of investigation in planning of research mentioned in Charaka Samhita.

Effect of Ayurveda intervention, lifestyle modification and Yoga in prediabetic and type 2 diabetes under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)–AYUSH integration project Ramavtar Sharma, Vinod Kumar Shahi, Shruti Khanduri, Arun Goyal, Suhas Chaudhary, Rakesh Kumar Rana, Richa Singhal, Narayanam Srikanth, Kartar Singh Dhiman AYU (An international quarterly journal of research in Ayurveda) 2019 40(1):8-15 Background: Type 2 diabetes is a lifestyle-related disorder that affects around 422 million individuals in India. Integration of AYUSH (Ayurveda) with the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) was conceived on pilot basis at Gaya, Bihar, to provide integrative treatment for non-communicable disease patients and to manage the burden of non-communicable diseases in India. Objectives: The objective of this study was to analyze the effect of Ayurveda intervention, lifestyle modification and Yoga in the management of type 2 diabetes under NPCDCS-AYUSH integration project. Materials and Methods: A multi-centric, open-labeled, prospective, comparative clinical study was conducted at 17 community health centers and 1 district hospital. Population over 30 years of age was screened and prediabetic or type 2 diabetic individuals were enrolled in two cohorts, i.e., pre-diabetic (Cohort A) and type 2 diabetic (Cohort B). Each cohort was further divided into two groups: Group A1 was advised for lifestyle modification and Yoga and group A2 was given Ayurveda medication in addition to lifestyle modification and Yoga. Similarly, group B1 was advised for lifestyle modification and Yoga along with allopathic medication and group B2 was given Ayurveda medication, i.e., Mamajjaka, Amalaki and Guduchi powder in addition to lifestyle modification and Yoga along with allopathic medication. Treatment was given for 6 months. Data were analyzed through paired t-test. Results: A significant reduction was observed in fasting blood sugar level in groups A2 and B2 (P = 0.001) and also in the postprandial blood sugar level in Groups A2 and B2 (P = 0.001). Further, improvement in subjective symptoms such as polyuria, polydipsia, polyphagia, blurred vision and weakness was found in all the groups, while non-healing ulcer does not show any improvement. Conclusion: The study reveals that Ayurveda intervention, i.e., Mamajjaka Churna (1 g), Amalaki Churna (3 g) and Guduchi Churna (3 g) two times a day effectively controls blood sugar level in pre-diabetic and type 2 diabetic patients and improves the disease management with lifestyle modification and Yogasana as well as with allopathic treatment.

An open-label, prospective, multicenter, clinical study to evaluate efficacy of Ayuartis capsules in patients suffering from osteoarthritis of the knee(s) Narendra B Mundhe, Sanjay Motilal Tamoli, Shishir Purushottam Pande, Savita Ambadas Kulkarni, Vishal G Patil, Swapnali B Mahadik AYU (An international quarterly journal of research in Ayurveda) 2019 40(1):16-22 Background: The management of chronic degenerative joint disorders such as osteoarthritis (OA) with ayurvedic medicines provides a safe and effective alternative. Ayurvedic medicines possess analgesic, anti-inflammatory, anti-oxidant and immunomodulator activities. Aims: The main aim of the study was to assess the efficacy of Ayuartis capsule in patients suffering from OA of the knee(s). Materials and Methods: Thirty-one patients suffering from OA knee(s) were recruited after evaluating them as per inclusion/exclusion criteria. Patients were advised to take two Ayuartis capsules twice daily orally for 90 days. Knee joint(s) pain was assessed on the Visual Analog Scale. Patients' joint pain, stiffness, and physical functions were assessed on the Western Ontario McMaster University Osteoarthritis (WOMAC) index. Quality of life (QOL) and the time required to walk 50 feet was evaluated. Patients were called for follow-up visits on every 15th day till 90 days. Adverse events and vitals were recorded at every visit. Safety laboratory investigations were done before and after the completion of trial. Statistical Analysis: Data describing quantitative measures are expressed as mean ± standard deviation. The comparison of variables representing categorical data was performed using pair t-test. Results: The mean joint pain reduced significantly by 53.82% on day 90. The mean WOMAC combined score, pain score, stiffness score and difficulty score reduced significantly by 50.88%, 54.96%, 58.76% and 49.02%, respectively on day 90. A significant improvement was observed in mean QOL of patients. A significant reduction in mean time required to walk 50 feet was observed. Majority of the patients had shown good overall improvement and excellent tolerability to the trial drug. Conclusion: Ayuartis capsule is a safe and effective medicine for the treatment of OA of the knee(s).

Efficacy of Ocimum sanctum, Aloe vera and chlorhexidine mouthwash on gingivitis: A randomized controlled comparative clinical study Gautami S Penmetsa, Sudha Rani Pitta AYU (An international quarterly journal of research in Ayurveda) 2019 40(1):23-26 Background: The medicinal plants are widely used for curing various diseases in day-to-day practice. Ocimum sanctum (Tulsi) is one such popular herb in Ayurvedic medicine, which is widely used in the treatment of several systemic diseases because of its antimicrobial property. Aloe vera is also widely known for its medicinal uses in wound healing and its anti-inflammatory properties. However, studies documenting the effect of O. sanctum and A. vera in treating gingivitis are rare. Aim: The aim of this study was to assess the effectiveness of two herbal mouthwashes in comparison with chlorhexidine mouthwash on gingivitis. Materials and Methods: A double-blind randomized placebo-controlled clinical trial, wherein sixty patients were randomly allocated into three study groups. (1) O. sanctum mouthwash (n = 20) (2) A. vera mouthwash (n = 20) and (3) Chlorhexidine mouthwash (n = 20). All groups were treated with scaling and asked to rinse with respective mouthwashes twice daily for 1 month. Clinical parameters such as plaque index (PI), gingival index (GI), and sulcus bleeding index (BI) were recorded at baseline, after 15 days and after 30 days, respectively. Results: Results of the study showed that O. sanctum, A. vera and chlorhexidine are equally effective in reducing plaque, gingival, and bleeding indices at 30-day interval. However, no significant reductions in PI, GI and BI in 15-day interval in group 1 and group 2 when compared with chlorhexidine were evident. Conclusion: The results in the present study indicate that O. sanctum and A. vera may prove to be as effective as chlorhexidine mouthwash in its ability in reducing all the three indices by reducing plaque accumulation, gingival inflammation and bleeding when used in the long-term follow-up.

Efficacy of Virechana (therapeutic purgation) followed by Go-Ghrita (cow ghee) in the management of Ksheena Shukra (oligozoospermia): A clinical study Jitendra Nathabhai Varsakiya, Mandip Goyal, Anup Thakar, Shilpa Donga, Divyarani Kathad AYU (An international quarterly journal of research in Ayurveda) 2019 40(1):27-33 Background: Fertility is affected by many different cultural, environmental and socioeconomic factors, especially in developing countries where poverty and infections are common place. Infertility is the inability of a sexually active, noncontracepting couple to achieve spontaneous pregnancy in 1 year. Shodhana (biopurificatory) procedures are indicated before the administration of Vajikarana (aphrodisiac) drugs, especially Virechana Karma (therapeutic purgation) is indicated in the cases of vitiation of Shukra (seminal parameters). Go-Ghrita(cow ghee) is a rejuvenator and aphrodisiac. Maximum preparations for the diseases of Shukra and reproductive system are prepared in Go-Ghrita and reported to be useful in the management of infertility. Aim: The present clinical study aimed to evaluate the clinical efficacy of Go-Ghrita administered after performing Virechana Karma in the management of Ksheena Shukra (oligozoospermia). Materials and Methods: Eligible male participants from the age group of 21 to 40 years, with sperm count of <15 million/ml, received cow ghee for 8 weeks in the dose of 10 g, after undergoing Virechana Karma with Haritakyadi Yoga. Percentage changes in the semen parameters and associated symptoms of Ksheena Shukra in comparison to baseline were the primary outcomes measured. Results: Go-Ghrita administered after Virechana provided 80.92% increase in total sperm count, 41.78% increase in sperm motility, 12.58% increase in normal form of sperm, 41.69% decrease in abnormal forms, and increase in semen volume by 45.22%. Conclusion: Overall assessment of the therapy showed that administration of cow ghee after performing Virechana provided statistically highly significant improvement on seminal parameters.

Management of chronic pain with Jalaprakshalana (water-wash) Shodhita (processed) Bhanga (Cannabis sativa L.) in cancer patients with deprived quality of life: An open-label single arm clinical trial Swagata Dilip Tavhare, Rabinarayan Acharya, R Govind Reddy, Kartar Singh Dhiman AYU (An international quarterly journal of research in Ayurveda) 2019 40(1):34-43 Introduction: Pain is a common and complex symptom of cancer having physical, social, spiritual and psychological aspects. Approximately 70%–80% of cancer patients experiences pain, as reported in India. Ayurveda recommends use of Shodhita (Processed) Bhanga (Cannabis) for the management of pain but no research yet carried out on its clinical effectiveness. Objective: To assess the analgesic potential of Jala-Prakshalana (Water-wash) processed Cannabis sativa L. leaves powder in cancer patients with deprived quality of life (QOL) through openlabel single arm clinical trial. Materials and Methods: Waterwash processed Cannabis leaves powder filled in capsule, was administered in 24 cancer patients with deprived QOL presenting complaints of pain, anxiety or depression; for a period of 4 weeks; in a dose of 250 mg thrice a day; along with 50 ml of cow's milk and 4 g of crystal sugar. Primary outcome i.e. pain was measured by Wong-Bakers FACES Pain Scale (FACES), Objective Pain Assessment (OPA) scale and Neuropathic Pain Scale (NPS). Secondary outcome namely anxiety was quantified by Hospital Anxiety and Depression Scale (HADS), QOL by FACT-G scale, performance score by Eastern Cooperative Oncology Group (ECOG) and Karnofsky score. Results: Significant reduction in pain was found on FACES Pain Scale (P < 0.05), OPA (P < 0.05), NPS (P < 0.001), HADS (P < 0.001), FACT-G scale (P < 0.001), performance status score like ECOG (P < 0.05) and Karnofsky score (P < 0.01). Conclusion: Jalaprakshalana Shodhita Bhanga powder in a dose of 250 mg thrice per day; relieves cancerinduced pain, anxiety and depression significantly and does not cause any major adverse effect and withdrawal symptoms during trial period.

Ayurvedic management of necrozoospermia - A case report Shashidhar H Doddamani, MN Shubhashree, SK Giri, Raghavendra Naik, BK Bharali AYU (An international quarterly journal of research in Ayurveda) 2019 40(1):44-47 Male factors are responsible for more than forty percent of the infertility cases. Necrozoospermia is one among the main cause for infertility in male. Necrospermia i.e. 100% immotile and 0% viable spermatozoa in ejaculate, is a rare and poorly documented cause of male infertility. A 56-year-old man was referred for reproductive counseling with secondary infertility and diagnosed as necrozoospermia (Shukra Dosha). He presented with complaints of having no issues since 7 years of married life with his second wife. The patient has a son from divorced first wife. After the thorough clinical examination and laboratory investigations, diagnosis was confirmed as necrozoospermia. The patient was administered Koshtha-Shuddhi (purgation) with Eranda Taila (castor oil) as per the guidelines of Ayurvedic treatment. After the proper purificatory procedures depending on dominance of deranged Dosha, the patient was given Arogyavardhini Vati, Chandraprabha Vati, Shilapravanga and Phala Ghrita (medicated ghee) as Sneha (internal oleation). At the end of 3½ month, semen analysis showed marked improvement in sperm count and increase in the sperm motility. The present finding and the effective management of necrozoospermia with Ayurvedic formulations with no adverse effect highlight the promising scope of traditional medicine in male infertility disorders.

A case study on the management of dry gangrene by Kaishore Guggulu, Sanjivani Vati and Dashanga Lepa Prem Lal Bharati, Prateek Agrawal, Om Prakash AYU (An international quarterly journal of research in Ayurveda) 2019 40(1):48-52 Gangrene is a type of tissue death caused by lack of blood supply. Symptoms may include a change in skin color red or black, numbness, swelling, pain, ulceration and detachment of local skin. The feet and hands are most commonly affected. This condition may arise because of an injury, infection or other health conditions, majorly diabetes. Gangrene and its associated amputations are clinically challenging, but Ayurveda offers therapy options. In Ayurveda, gangrene can be considered as Kotha under Dushta Vrana due to Margavarana and Dhatu Kshaya. This case study aims to investigate whether Ayurvedic intervention can manage Kotha (gangrene) without amputation of the gangrenous part. A 45-year old woman came to the outpatient department (OPD) of Regional Ayurveda Research Institute for Drug Development, Gwalior, with clinical features indicative of dry gangrene. She was examined and diagnosis was confirmed by previous reports of X-ray and arterial color doppler. This case of dry gangrene was managed by Ayurvedic intervention of Kaishore Guggulu 1 g twice a day and Sanjivani Vati 250 mg thrice a day and Dashanga Lepa local application as a Lepa twice a day with lukewarm cow Ghrita for 2 months at OPD level. The response to the treatment was found highly effective. At the end of the treatment period of 2 months as compared with baseline, a highly significant change was observed. Kaishore Guggulu, Sanjivani Vati and Dashanga Lepa in the above-mentioned dose were found very effective and safe in a patient of dry gangrene.

Triphala: A phytomedicine for local drug delivery – A strategic intervention BM Shivaprasad, Padmavati Patil, Sruthi K Nair, Navnita Singh, Shilpa Shivan, Ume Sameera AYU (An international quarterly journal of research in Ayurveda) 2019 40(1):53-57 Background: In the Indian system of medicine (ISM) Triphala is one of the oldest and longest used natural herbal remedy which consist of mixture of equal parts of the Embilica officinalis Gaertn. (Family- Euphorbiaceae), Terminalia Chebula Retz. (Family- Combretaceae) and Terminalia beleria [Gaertn.] Roxb. (Family- Combretaceae). Currently, Triphala is being extensively researched for its various therapeutic effects including its anti-caries, antioxidant, anti-collagenase and anti-microbial activities. This fruit extract is used in various forms in the treatment of periodontitis. Aim: The aim of the present study was to compare the clinical and microbiological benefits of routine scaling and root planing (SRP) with adjunctive use of Triphala (Hiora GA) as local drug delivery agent in the management of periodontitis. Materials and Methods: Thirteen patients diagnosed with chronic periodontitis were included in the present study. The control sites received SRP alone and the test sites received SRP with locally delivered Triphala (Hiora GA). The clinical parameters were evaluated at baseline, 15 days and 1 month. The plaque samples were cultured anaerobically for the keystone-periodontal pathogen Porphyromonas gingivalis, Fusobacterium nucleatum and Prevotella intermedia. The Mann–Whitney U-test and Wilcoxon signed-rank tests were performed to compare the results between the test and control groups. Results: Statistically significant improvement was observed in both groups. Intergroup comparison of prevalence of microorganisms also revealed a statistically significant difference (P = 0.0007) at 15 days and 1 month. Conclusion: Subgingivally delivered Triphala (Hiora GA) as an adjunct to SRP in the treatment of chronic periodontitis has shown anticipative results revealing slow and constant releasing property of Triphala.