OPEN LABEL COMPARATIVE CLINICAL TRIAL OF DVIPANCHAMOOLADI TAILA AND KSHEERABALA TAILA MATRA VASTI IN THE MANAGEMENT OF LOW BACK ACHE

Low back pain is a leading cause of disability, interferes with quality of life and work performance, and is the most common reason for medical consultations. Few cases of back pain are due to specific causes; most cases are non-specific. The most common presentation is acute back pain and is usually self-limiting, lasting less than three months regardless of treatment. Chronic back pain is a more difficult problem, which often has strong pathological and psychological overlay like work dissatisfaction, boredom, and a generous compensation system contribute to it. Among the diagnoses lumbar spondylosis is blamed. No single treatment is superior to others; even surgery is seldom successful at alleviating it. Hence a clinical study was conducted on 30 patients with classical sign and symptoms of Katigraha (LBA) with an aim to find out the effectiveness of Dvipanchamooladi taila Matra basti (oil enemata of an indigenous compound). The patients were randomly divided in to two groups 15 patients in each. Group I (Trial) administered with Dvipanchamooladi taila matra basti and Group II (Control) – Ksheerabala taila Matra basti (enemata prepared by processing Sida Cordifolia root with milk and sesame oil) for a total period of nine days. The trial drug being potentiated by its inherent properties like anti-inflammatory, anodyne etc. exhibited favorable result with an effectiveness of 87.30% to reduce the sign and symptom of low back ache & the effect of the trial therapy were statistically highly significant with a p-value of > 0.01 in the management of Low back ache

Ayurvedic perspective of water, its pollution and purification

According to Ayurveda water is considered as one among the Panchamahabhootas and Prana/life of the entire universe. The 5000 year old classics, of India like Sushruta Samhita and Charaka Samhita have analyzed the issues related to water its pollution, causes, effects, its impacts on the body and universe, and the measures to purify the polluted water and also the prevention of water pollution. Even several thousands of years before, the great sages of India had envisaged the issue of water pollution, its hazardous effect on health, community and environment and the measures to purify them. A lion share of these organic methods of purification still remains virgin to the field of researches. A combination of one or more of these measures when applied in a systematic manner can sometimes be more effective than the most advanced chemical methods of purification. For that this holistic science and its treasures are to be explored and unveiled to its best

A Rare Malignant Triton Tumor

Malignant peripheral nerve sheath tumor with rhabdomyoblastic differentiation, malignant triton tumor, has a rare incidence. We report such a case in a 40-year-old male who presented with a mass over the buttock. He was a previously diagnosed case of neurofibroma in the same area. Histomorphology supported by immunostaining with S-100 protein confirmed the diagnosis. Malignant triton tumor has a poor prognosis owing to its aggressive biological behavior. The fact that the presence of this tumor in the buttock region is extremely rare has prompted the authors to report this case

Effect of Acacia catechu and alum hot sitzbath on post-operative pain in patients treated with herbal seton

Background: Post-operative pain is the major consequence of Kṣārasūtra, Seton technique employed in Ayurvedic management of Low anal fistula. Surgeons are forced to prescribe Opioids and NSAIDs with pronounced untoward effects. Non pharmacological measures like Balneotherapy are used to improve circulation and relieve spasm in contemporary sciences. Aim: To compare the efficacy of Khadira (Acacia catechu) and Sphaṭika (Potash alum) hot sitzbath with plain hot sitzbath in patients of low anal fistula treated with Kṣārasūtra. Method: The study was single blind, double armed; prospective, randomized control clinical trial in which 30 patients were randomly allocated into two groups of 15 each on the basis of inclusion and exclusion criteria. Group A received hot sitzbath using Acacia catechu and alum infusion twice daily for 21 days. Group B received hot sitzbath using warm water for 21 days. The assessments were made on pain, post-surgical satisfaction burning sensation, tenderness, discharge, constipation, itching and incontinence. Result: The disease was prevalent in the 4th decade of life, more in males (86.67%) involved in sedentary work (53.33%) residing in urban domicile, consuming mixed diet (100%). Both groups showed statistically significant improvement in outcome measures like pain, burning sensation, tenderness, discharge, constipation and itching. Conclusion: On comparative analysis Acacia and Alum hot sitzbath was more effective in outcomes like pain, surgical satisfaction, burning sensation and discharge. There was no difference in the effect of both interventions with respect to outcome measures like constipation, itching and incontinence. Resumo: Justificativa: A dor pós-operatória é a principal consequência da técnica que utiliza seton de Kṣārasūtra no tratamento ayurvédico de fístula anal baixa. Os cirurgiões são impelidos a prescrever opiáceos e AINEs que possuem efeitos indesejáveis pronunciados. Medidas não farmacológicas como a balneoterapia são usadas nas ciências contemporâneas para melhorar a circulação e aliviar o espasmo. Objetivo: Comparar a eficácia do banho quente de assento com Khadira (Acacia catechu) e Sphaṭika (Potash alum) com apenas banho de assento em pacientes com fístula anal baixa tratados com Kṣārasūtra. Método: Estudo clínico prospectivo, cego e controlado de dois braços randomizados, no qual 30 pacientes foram alocados aleatoriamente em dois grupos de 15 pacientes cada com base nos critérios de inclusão e exclusão. O Grupo A recebeu banho de assento com Acacia catechu e infusão de alume duas vezes ao dia por 21 dias. O Grupo B recebeu banho de assento com água morna por 21 dias. Os desfechos avaliados foram dor, satisfação pós-cirúrgica, sensação de queimação, sensibilidade, corrimento, constipação, prurido e incontinência. Resultado: A doença foi prevalente na 4ª década de vida, mais frequente no sexo masculino (86,67%), nos envolvidos em trabalho sedentário (53,33%), nos residentes em domicílios urbanos e nos que consumiam dieta mista (100%). Ambos os grupos apresentaram melhora estatisticamente significativa na avaliação dos resultados, tais como dor, sensação de queimação, sensibilidade, corrimento, constipação e prurido. Conclusão: Na análise comparativa, o banho quente de assento com acácia e alume foi mais eficaz nos desfechos de dor, satisfação cirúrgica, sensação de queimação e corrimento. Não houve diferença em relação ao efeito de ambas as intervenções sobre os desfechos de constipação, prurido e incontinência

Physico-chemical analysis of Commiphora wightii and borax coated herbal seton

Background: Herbal seton (Kṣārasūtra) is a cost effective para-surgical technique employed in the management of anorectal conditions like fistula and hemorrhoids without causing much complications. Perennial non-availability raw materials, severe pain and allergic reactions are the major demerits of standard Kṣārasūtra demanding for its better options. Guggulu (Commiphora wightii) and Tankana (Borax) coated Kṣārasūtra (GTK) a modified variant of the standard is being used in the Anorectal Clinic under the Department of Shalyatantra (Surgery), Amrita School of Ayurveda since last 6 years. It has been observed for good patient tolerance, cutting and healing properties. Methods: The physico-chemical evaluation of GTK was conducted in the Quality Control (QC) lab of Amrita School of Ayurveda. The parameters assessed were length, weight, thickness, tensile strength, loss on drying, water soluble extractive, sulphated ash, pH and macroscopic appearance following the methodology elaborated in Ayurvedic Pharmacopoeia of India (API). Those were compared with the corresponding values of standard Kṣārasūtra prescribed by Indian Council for Medical Research (ICMR). Results: The final results on each parameters were length – 39.44 cm, weight – 0.19934 g, thickness – 0.7147 mm, tensile strength – not less than 6.25 kg, loss on drying – 18.73%, water soluble extractive – 39.79%, sulphated ash – 12.89%, pH – 7.94 and macroscopic appearance – blackish brown. Conclusion: GTK was found less alkaline, higher in tensile strength, more in moisture content and less brittle in nature suggesting it as a safe choice in anorectal practice compared to the ICMR standard. Resumo: Fundamento: O seton à base de plantas (Kṣārasūtra) é uma técnica para-cirúrgica custo-efetiva, empregada no tratamento de doenças anorretais, como fístula e hemorroidas, sem causar muitas complicações. Matérias-primas perenes indisponíveis, dor grave e reações alérgicas são os principais deméritos do Kṣārasūtra padrão, exigindo melhores opções. Guggulu (Commiphora wightii) e Kṣārasūtra revestido com Tankana (Bórax) (GTK), uma variante modificada do padrão, tem sido utilizada na Clínica Anorretal do Departamento de Shalyatantra (Cirurgia) da Amrita School of Ayurveda nos últimos 6 anos. Foram observadas boa tolerância dos pacientes, propriedades de corte e cicatrização. Métodos: A avaliação físico-química do GTK foi realizada no laboratório de Controle de Qualidade (QC) da Amrita School of Ayurveda. Os parâmetros avaliados foram comprimento, peso, espessura, resistência à tração, perda por secagem, extrato solúvel em água, cinza sulfatada, pH e aparência macroscópica seguindo a metodologia elaborada na Ayurvedic Pharmacopoeia of India (API). Esses foram comparados com os valores correspondentes do Kṣārasūtra padrão prescrito pelo Conselho Indiano para Pesquisa Médica (ICMR, Indian Council for Medical Research). Resultados: Os resultados finais em cada parâmetro foram comprimento – 39,44 cm, peso – 0,19934 g, espessura – 0,7147 mm, resistência à tração – não inferior a 6,25 kg, perda na secagem – 18,73%, extrato solúvel em água – 39,79%, cinza sulfatada – 12,89%, pH – 7,94, e aparência macroscópica - marrom escuro. Conclusão: Foi verificado que o GTK é menos alcalino, possui maior resistência à tração, mais teor de umidade e é menos frágil na natureza, sugerindo uma escolha segura na prática anorretal em comparação com o padrão do ICMR

Taila Dāha (Cauterization with Oil) an innovative approach in pilonidal sinus

Pilonidal sinus is a chronic inflammatory track in mid gluteal cleft usually associated with hairs with an incidence rate of twenty six per one lakh population. It is more prevalently seen in the natal cleft of hairy middle aged obese, males. Such type of non-healing tracts may be considered as Nāḍivraṇa (Sinuses) and can either be treated by the conventional Kṣārasūtra (medicated seton) therapy or contemporary treatment methods. Irrespective of whatsoever management protocol adopted, it inevitably needs long term hospitalisation and is associated with complications. A case of a 28 year old male patient, presenting with pain (within tolerable limits) in the natal cleft and frequent occurrence of a pustule which burst out spontaneously on and off, diagnosed as pilonidal sinus (nāḍi vraṇa) was treated with excision of tract and Tailadāha (thermal cauterization with hot oil) with a combination of yaṣṭimadhu taila and powdered Copper Sulphate (CuSO4). Good haemostasis and uneventful wound healing with a minimally invasive and cost effective treatment was the outcome of study. This study represents an innovative treatment modality in pilonidal sinus