E-ISSN:2456-3110

Research Article

Kiratatikta syrup

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 7 August
Publisherwww.maharshicharaka.in

A randomized controlled comparative clinical trial on Jwarahara effect of Mukkaamukkatukaadi Syrup with Kiratatikta Syrup in Febrile Children

Suja K.1*, Puranik P.2, Sharashchandra R.3, Kumar Shetty S.4
DOI: http://dx.doi.org/10.21760/jaims.7.7.6

1* K Suja, Final Year PG Scholar, Department of Kaumarabhrithya, Shri Dharmasthala Manjunatheshwar College of Ayurveda, Udupi, Karnataka, India.

2 Prathviraj Puranik, Professor & HOD, Department of Kaumarabhrithya, Shri Dharmasthala Manjunatheshwar College of Ayurveda, Udupi, Karnataka, India.

3 R Sharashchandra, Associate Professor, Department of Kaumarabhrithya, Shri Dharmasthala Manjunatheshwar College of Ayurveda, Udupi, Karnataka, India.

4 Sandesh Kumar Shetty, Associate Professor, Department of Swasthavritta, Shri Dharmasthala Manjunatheshwar College of Ayurveda, Udupi, Karnataka, India.

Ayurvedic classics have described many diseases amongst which Jwara stands first because of its uniqueness to make everyone suffer, since birth to death. Jwara being one of the commonest symptoms which accompanies almost all constitutional diseases has been coined with term Rogadhipathi. Fever is defined as temperature in rectum more than 100.4°F (38°C), in oral cavity above 99.5°F (37.5°C) or in axilla above 99°F (37. 2°C). If we don’t treat fever in its earlier stage, there will be more chances of hyperpyrexia which may cause febrile convulsions which leads to brain damage. Therefore, it is necessary to control fever at its earlier stage. One such Jwarahara formulation is Mukkaamukkatukaadi Gulika and Kiratatikta which is converted into syrup form to overcome palatability issues. A sample size of 30 patients was selected by simple random sampling method and 15 patients were allotted in two groups. It was planned to compare the result between Mukkaamukkatukaadi syrup in Group A study group for STG and LTG and Kiratatikta syrup in Group B control group for STG and LTG. On STG comparison, the difference in mean in Group A and Group B were 0.49,0.44 before treatment changed to 0.96 and 0.98 after treatment respectively. On LTG comparison, difference in mean in Group A and Group B were 0.49, 0.44 before treatment changed to 2.02 and 1.96 after follow up respectively. This depicts both formulations effective when consumed for longer duration. From the results and observations it can be concluded that Group A and Group B are equally effective and equally significant on reducing the temperature in both STG and LTG. No adverse drug reaction was found during the study.

Keywords: Mukkaamukkatukaadi syrup, Kiratatikta syrup, Jwara, Fever

Corresponding Author How to Cite this Article To Browse
K Suja, Final Year PG Scholar, Department of Kaumarabhrithya, Shri Dharmasthala Manjunatheshwar College of Ayurveda, Udupi, Karnataka, India.
Email: 		K Suja, Prathviraj Puranik, R Sharashchandra, Sandesh Kumar Shetty, A randomized controlled comparative clinical trial on Jwarahara effect of Mukkaamukkatukaadi Syrup with Kiratatikta Syrup in Febrile Children. J Ayu Int Med Sci. 2022;7(7):40-46.
Available From
https://jaims.in/jaims/article/view/1934

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-06-27 2022-06-28 2022-07-05 2022-07-12 2022-07-19
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Yes Yes 16%

© 2022by K Suja, Prathviraj Puranik, R Sharashchandra, Sandesh Kumar Shettyand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

Jwara is considered to be the king of all diseases. Jwara induces Santapa, Aruchi, Trushna, Angamarda and Hridivyadha. Jwara is mentioned under Nidanarthakara Rogas. If not treated in time, it will lead to complications like Rakta Pitta and Sosha in children. If neglected it will even lead to death of the child. Children are more prone to infections due to immature immune system in which fever is one of the commonest symptoms. Fever is defined as temperature in rectum more than 100.4°F (38°C), in oral cavity above 99.5°F ( 37.5°C) or in axilla above 99°F (37. 2°C).[1] If we don’t treat fever in its earlier stage, there will be more chances of hyperpyrexia which may cause febrile convulsions which leads to brain damage. Therefore, it is necessary to control fever at its earlier stage.

The formulation selected for present study is Mukkaamukkatukaadi Gulika which is converted into syrup form considering the palatability. Most of the ingredients are Katu and Tikta Rasa Pradhana. They are predominantly Kaphapittashamak. This drug is compared to Kiratatikta syrup which is proved as antipyretic drug.[2]

Objectives of the Study

1. To evaluate the Jwarahara effect of Mukkamukkatukaadi syrup in febrile children.

2. To evaluate the Jwarahara effect of Kiratatikta syrup in febrile children.

3. To compare the Jwarahara effect of Mukkamukkatukaadi syrup with Kiratatikta syrup in febrile children.

Materials and Methods

Method of preparation: The dried drugs were collected, with a quantity 15﮳72g each. The drugs were soaked in water overnight, next day Kwatha of drugs was prepared by adding 48 litres of water, boiled and reduced to ¼ part and filtered, remnant is 12 litres and filtered, to this 3﮳6 kgs of sugar were added & boiled on mild flame till it is reduced to 6 litres﮳ Total quantity of suspension obtained was 6 litres which is cooled down and bottled, into 200ml each﮳ They were packed in plastic containers which were then sealed﮳ Then the containers were labelled and made ready for distribution.

Ingredients of Mukkamukkatukaadi Syrup

Table 1: The trial drug contains the following ingredients

Ingredients Botanical Name Part used Quantity
Haritaki Terminalia chebula Fruit pulp 1 part
Vibhitaki Terminalia bellerica Fruit pulp 1 part
Amalaki Emblica officinalis Fruit pulp 1 part
Shunthi Zingeber officinale Rhizome 1 part
Pippali Piper longum Fruit 1 part
Maricha Piper nigrum Fruit 1 part
Kiratatikta Swertia chirata Plant 1 part
Jiraka Cuminum cyminum Seed 1 part
Krishna jiraka Nigella sativa Seed 1 part
Vacha Acorus calamus Root 1 part
Jatiphala Myristica fragrans Seed 1 part
Kanyasara Aloe Barbedensis Extract 1 part
Saindhava Rock salt ___ 1 part
Hingu Ferula asafoetida Resin 1 part
Lavanga Syzigium aromaticum Flower bud 1 part
Kusta Saussurea costus Root 1 part
Karpura Cinnamomum camphora Resin 1 part
Tvak Cinnamomum veram Bark 1 part
Kankola Piper cubeba Seed 1 part
Lasuna Alium sativum Seed 1 part
Ajamoda Trychospermum roxburghianum Seed 1 part
Nirgundi Vitex nirgundo Whole plant 1 part
Sharkara Saccharum officinarum Crystals 1part

Table 2: Ingredients of Kiratatikta Syrup

Kiratatikta Swertia chirata Plant 1 part
Sharkara Saccharum officinarum crystals 1 part

Source of data: The study was approved by Institutional Ethics Committee (Ref: SDMCAU/ACA -49/ECH45/19-20). 30 patients, diagnosed cases of Jwara were selected from the  Kaumarabhrithya OPD and IPD of SDMCA&H, Udupi using permuted block randomization. Detailed history was taken based on the Special proforma made for the history taking, examination and assessment.

Inclusion criteria

1. Children whose temperature is more than 99.5°F to 102°F (axillary).

2. Children between age group of 1-3 years.

Exclusion criteria

1. Children requiring conventional medicine

2. Severely dehydrated patients.

3. Sick child requiring aggressive management.


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4. Previous history of convulsions with high-grade fever.

5. Fever with rash and bacterial infection.

Grouping

Group A:  Short term - 15 subjects were given with Mukkaamukkatukaadi syrup as a single dose. Then temperature was recorded at half an hour interval for 6 hrs. The other symptoms were recorded before treatment and at 6th hour.

Long term - The medicine was given 6th hourly. The temperature and other symptoms were recorded before treatment and every 6th hourly for 5 days.

Group B: Short term - 15 subjects were given with Kiratatikta syrup as a single dose. Then temperature was recorded at half an hour interval for 6 hrs. The other symptoms were recorded before treatment and at 6th hour.

Long term

The medicine was given 6th hourly. The temperature and other symptoms were recorded before treatment and every 6th hourly for 5 days.

Plan of intervention

Dosage form (Kalpana): Sharkara (Syrup)

Dose: 1 year - 2.5ml 6th hourly, 2 year - 5ml 6th hourly, 3year - 7ml 6th hourly.

Duration of Study

Short term - 6hrs

Long term - 5 days

Follow-Up: Follow up was done after 7days of completion of the treatment.

Lab investigations

Routine blood investigations like Hb%, TC, DC, ESR, CRP if necessary.

Assessment criteria

Assessment of treatment quality of Syrup of Mukkamukkatukaadi drugs in the management of Jwara was done according to signs and symptoms of Jwara which were evaluated based on subjective and objective parameters. All these were assessed on the basis of gratings designed according to severity of signs and symptoms.


Subjective parameters

1. Trushna (Thirst)

2. Aruchi (Anorexia)

3. Swedavarodha

4. Activity

Objective parameters

1. Axillary temperature in Fahrenheit.

Observations and Results

In the present study among 30 subjects, 9 (30%) subjects belonged to the age group of 1-2 yrs and 21 (70%) subjects belonged to the age group of 2-3years. Although prevalence of Jwara is more at any age but it is more common between the age group of 3 -10yrs as per different texts but 6months to 5yrs are more prone for febrile convulsions.[3] The school going children gets exposed to other sick children in the classroom and develops fever because of overcrowding and weak immunity against infectious diseases. Majority of the subjects 18 (60%) had Mandagni, 3 (10%) subjects had Samagni and 9 (30%) subjects had Vishamagni. Mandagni leading to formation of Ama stage, responsible for occurrence of Jwara.[4]

All of subjects had complaints of Santapa irrespective of other associated complaints (Figure 1). Acharyas has considered Santapa to be one of the cardinal feature for the disease Jwara.[5] 22 (73.3%) of subjects had complaints of Aruchi. It may be due to Ama and Mandagni which causes less secretion of digestive enzymes and obstruction in the channel.[6] 19 (63.3%) of subjects had complaints of Trushna. Trushna is one among the common character seen relating to Udakavaha Srotodushti. Reduction in extracellular fluid releases enzyme Renin which acts on Angiotensinogen and convert it into Angiotensin I and Angiotensin II which causes vasoconstriction and increase in blood pressure and also inhibits Renin release to maintain sodium and water balance in the body.[7] 22 (73.3%) of subjects had complaints of Swedavarodha. Due to Mandagni, Amotpatti takes place. The Snigdha, Picchila properties of Ama obstruct the Swedavaha Srotas. 26 subjects (86.6%) had complaints of activity. Ama has the tendency to vitiate Kapha quickly due to similarity in nature, hence subjects showed decrease in activity.


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jaims_1934_01.JPG

Figure 1: Showing distribution based on Santapa

Effect of therapy

In STG, there was 0.95% of improvement in Group A (Table no. 3) and 0.9% of improvement in Group B (Table no. 5) in temperature after 6hrs.

On comparison, the difference in mean in Group A and Group B were 0.49, 0.44 before treatment changed to 0.96 and 0.98 after treatment respectively (Table no. 7).

Both Group A and Group B are equally effective and was statistically significant with p value <0.05.

In LTG, there was 2.01% of improvement in Group A (Table no. 4) and 1.95% of improvement in Group B (Table no. 6) after follow up.

The improvement before treatment and after treatment in Group A and Group B was statistically highly significant with p value 0.00 within the groups.

On comparison, the difference in mean in Group A and Group B were 0.49, 0.44 before treatment changed to 2.02 and 1.96 after follow up respectively (Table no. 8).

This depicts both the formulations equally effective when consumed for longer duration.

Kiratatikta and Mukkaamukkatukaadi syrup was not effective in Aruchi and Trushna in STG. But in LTG, Kiratatikta syrup was more effective in reducing Trushna and Aruchi.

Kiratatikta syrup and Mukkaamukkatukaadi syrup are equally effective in reducing Swedavarodha.


Mukkaamukkatukaadi syrup was more effective in increasing daily routine activities in STG and LTG.

Table 3: Showing short term effect of Axillary temperature within Group A.

Mean score N S.D. S.E.M. M.D. % T P Interpretation
BT 1H 15 1.47 0.37 0.49 0.48 1.49 0.15 NS
100.41 99.92
BT 2H 15 1.14 0.29 0.10 0.09 0.43 0.66 NS
100.41 100.30
BT 3H 15 1.12 0.29 0.16 0.15 0.56 0.58 NS
100.41 100.24
BT 4H 15 1.51 0.39 0.54 0.53 1.36 0.19 NS
100.41 99.87
BT 5H 15 1.46  0.37 0.84 0.83 2.24 0.04 S
100.41 99.56
BT 6H 15 1.49 0.38 0.96 0.95 2.66 0.02 S
100.41 99.44

Table 4: Showing long term effect of Axillary temperature within Group A.

Mean score N S.D. S.E.M. M.D. % T P Interpretation
BT D1 15 1.49 0.38 0.96 0.95 2.66 0.02 S
100.4 99.44
BT D2 15 1.49 0.38 1.42 1.41 3.33 0.005 S
100.4 98.9
BT D3 15 1.12 0.28 2.44 2.43 8.09 .00 HS
100.4 97.96
BT D4 15 0.69 0.17 2.28 2.27 10.40 .00 HS
100.4 98.12
BT D5 15 0.38 0.09 2.04 2.03 13.97 .00 HS
100.4 97.9
BT FU 15 0.24 0.06 2.02 2.01 11.67 .00 HS
100.4 98.3

Table 5: Showing short term effect of Axillary temperature within Group B.

Mean score N S.D. S.E.M. M.D. % T P Interpretation
BT 1H 15 1.41 0.36 0.44 0.43 1.49 0.15 NS
100.28 99.83
BT 2H 15 1.49 0.38 0.87 0.86 2.43 0.02 S
100.28 99.40
BT 3H 15 2.00 0.51 1.11 1.10 2.32 0.03 S
100.28 99.16
BT 4H 15 1.81 0.46 0.73 0.72 1.62 0.12 NS
100.28 99.5
BT 5H 15 1.74 0.45 0.98 0.97 2.44 0.02 S
100.28 99.2
BT 6H 15 1.40 0.36 0.98 0.97 2.76 0.01 S
100.28 99.3

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Table 6: Showing long term effect of Axillary temperature within Group B.

Mean score N S.D. S.E.M. M.D. % T P Interpretation
BT D1 15 2.76 0.01 0.98 0.97 2.76 0.01 S
100.28 99.36
BT D2 15 2.95 0.01 1.22 1.21 2.95 0.01 S
100.28 99.06
BT D3 15 5.05 .00 1.79 1.78 5.01 0.00 HS
100.28 98.48
BT D4 15 4.23 0.001 1.42 1.41 4.23 0.001 HS
100.28 98.85
BT D5 15 10.59 .00 2.38 2.37 10.59 0.00 HS
100.28 97.90
BT FU 15 11.50 .00 1.96 1.95 11.50 0.00 HS
100.28 98.32

Table 7: Showing short term effect of Axillary temperature between the groups

Axillary temperature Group N M.D. S.D. S.E.M. T P Interpretation
BT-1H A 15 0.49 1.27 0.32 -0.10 0.91 NS
B 15 0.44 1.15 0.29 NS
BT-2H A 15 0.10 0.94 0.24 1.77 0.08 NS
B 15 0.87 1.38 0.35 NS
BT-3H A 15 0.16 1.14 0.29 1.68 0.10 NS
B 15 1.11 1.85 0.47 NS
BT-4H A 15 0.54 1.53 0.39 0.32 0.75 NS
B 15 0.73 1.75 0.45 NS
BT-5H A 15 0.84 1.46 0.37 0.25 0.80 NS
B 15 0.98 1.56 0.40 NS
BT-6H A 15 0.96 1.43 0.37 0.26 0.97 NS
B 15 0.98 1.37 0.35 NS

Table 8: Showing long term effect of Axillary temperature between the groups

Axillary temperature Group N M.D. S.D. S.E.M. T P Interpretation
BT-D1 A 15 0.88 1.45 0.37 0.19 0.84 NS
B 15 0.98 1.37 0.35 NS
BT-D2 A 15 1.42 1.65 0.42 -0.34 0.73 NS
B 15 1.22 1.59 0.41 NS
BT-D3 A 15 2.44 1.17 0.30 -1.39 0.17 NS
B 15 1.79 1.38 0.35 NS
BT-D4 A 15 2.28 0.85 0.21 -2.13 0.41 NS
B 15 1.42 1.30 0.33 NS
BT-D5 A 15 2.04 0.56 0.14 1.26 0.21 NS
B 15 2.38 0.87 0.22     NS
BT-FU A 15 2.02 0.67 0.17 -0.27 0.78 NS
B 15 1.96 0.65 0.17 NS


Discussion

Probable mode of action

Jwara is considered to be Sarvarogagraja. It brings miseries to the body none of the other diseases are so serious, so complicated and so difficult to cure as Jwara. Drug selected for the present study is Mukkaamukkatukaadi syrup and Kiratatikta syrup.

Mukkaamukkatukaadi syrup is having Jwaragna, Deepana, Pachana properties. Mukkaamukatukaadi syrup is having Katu, Tikta Rasa Pradhana Dravyas. Katu, Tikta Rasa increases Agni and treats Mandagni (Su.Su.35) and Agnimandya is always present in any types of Jwara. So ultimately it dissolves Ama and increase Kshudha. In Mukkamukkatukaadi syrup, Triphala does Vatanulomana by which there will be correction of Agni in Amashaya leading to Amapachana and acts as Jwarahara.

Trikatu, Jeeraka Dvaya, Vacha, Jatiphala, Ajamoda, Twak, Lavanga, Hingu, Kankola, Kusta & Karpoora are some of the best Amapachaka and Agnideepaka Dravyas helping in curing the Jwara. Pippali has antibacterial and anti-oxidant activity. Pippali is a good catalyst agent that enhances the absorption and assimilation of drug (S. Chhajed et al. 1990). Alcoholic extract of Maricha has antipyretic activity; the underlying mechanism may be inhibition of prostaglandin synthesis within the hypothalamus. Lashuna acts as Deepaka and Pachaka and it also has Rasayana property and ginger are effective antibacterial activity. A study on Vacha suggested that the active constituents have enough potential to be used as an analgesic, antipyretic.[8] Studies have proved that the various phytoconstituents of Lavanga like eugenol exhibit antipyretic, antimicrobial, analgesic effects. Kusta drug has immunomodulatory, anticonvulsant, hepatoprotective, antiviral activity.

Kiratatikta syrup is having Jwaragna, Swedajanana, Anulomana and Dahaprashamana properties. Kiratatikta syrup with its Tikta Rasa pacifies the Pitta predominanace of Jwara as well as initiates Amapachana and increase the appetite.

Ushna Veerya of drugs of both groups imparts Swedana and Vilayana properties to Ama, thereby hindering chances of Srotorodha. It becomes more effective with the Laghu, Ruksha, Teekshna Guna and Katu Vipaka which enhances


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the Agni Deepana and Amapachana. These properties remove obstruction from Rasa and Swedavaha Srotas and decrease temperature.

Kiratatikta is one of the best Jwaragna Dravya. Methanolic extract of Kiratatikta possess significant antipyretic effect against elevated rectal temperature induced by yeast suspension in rats, at the dose 200mg/kg at 4hrs and compared to standard drug paracetamol. The presence of alkaloids and flavonoids are responsible for the antipyretic activity.[9]

Jwara is manifested due to Rasavahasrotoavarodha and needs a Deepana, Pachana, Srotosodhana qualities for its relief. Both the formulations are having Deepana, Pachana drugs which potentiates the Agni thereby facilitating the Aharapaka as well as Dhatupaka at Jataragni and Dhatwagni levels. Deepana Dravya increases the Agni and Pachana property improves the digestive action.

Conclusion

Fever in children is one of the most common manifestations of illness, which makes the parents to seek medical attention early. Children between ages of 6 months to 5yrs are at increased risk of benign febrile seizures and irreversible brain damage.

Kiratatikta syrup and Mukkaamukkatukaadi syrup are equally effective in reducing temperature in LTG and STG.

Reference

1. Paul Vinod, Bagga Arvind. Ghai Essential Paediatrics. 7th Ed. New Delhi: CBS Publishers & Distributors Pvt Ltd; chap 9 ,2009. p. 181.

2. Patil J.Pravin, Comparison of Jvarahara (Anti pyretic) Effect of Amrita and Kiratatikta in Jwara in children, 2008, Rajiv Gandhi University of Health Sciences, Karnataka.

3. L Aruchamy. Clinical Paediatrics (4th ed.), Disorders of Central Nervous System: Chapter 11, Wolters Kluwer (India) Pvt.Ltd, New Delhi;2019.

4. Prof. Yadundana Upadhyay: Madhava Nidana; The Madhukosha Sanskrit Commentary, Varanasi, Part 1 Chaukhambha Prakashana: 2013 (Chapter 25/1-5) Page No. 509.

5. Acharya Y.T. (ed). Sushruta Samhita of Susrutha, Uttarasthana; Jwarapratishedha Adhyaya: Chapter 39, Varanasi: Chaukhamba Surbharati Prakashan; 2012. p. 675.

6. D.Y.Patil, Importance of Agni in the management of Grahani disease with special reference to Lavanabhaskarachurna in Grahaniroga, Navi, Mumbai,2013.

7. Guyton, Arthur C., Hall John. Textbook of Medical Physiology. 11th ed. Philadelphia: Elsevier Saunders; 2006.p 807

8. A. Akhila Retnam., Keerthi V. R, and Reenu Mathew. “A Critical Review of Herbo-Mineral Formulations in Jwara Chikitsa.” International Journal of Health Sciences and Research 11.7 (2021): 394–406.

9. https://www.researchgate.net/publication/340526840_Pharmacognostical_Tlc_Fingerprinting_of_Kiratatikta.


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