E-ISSN:2456-3110

Research Article

Vartaku Gutika

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 9 October
Publisherwww.maharshicharaka.in

Comparative clinical study to evaluate the efficacy of Vartaku Gutika and Chitrakadi Vati in the management of Grahani Roga (Irritable Bowel Syndrome)

Chande A.1*, Acharya G S.2, Madhavi.3
DOI: http://dx.doi.org/10.21760/jaims.7.9.1

1* Aarti Chande, Post Graduate Scholar, Department of Kayachikitsa, Muniyal Institute of Ayurveda Medical Sciences, Manipal, Karnataka, India.

2 Shripathi Acharya G, Director Academic and WHO collaborator, HOD, Department of Kayachikitsa, Muniyal Institute of Ayurveda Medical Sciences, Manipal, Karnataka, India.

3 Madhavi, Assistant Professor, Department of Kayachikitsa, Muniyal Institute of Ayurveda Medical Sciences, Manipal, Karnataka, India.

Background: Grahani is a disease of great clinical relevance in modern era because of it’s directly link with improper food habits and stressful lifestyle. Agnimandhya is root cause of Amadosha and it is crucial factor for Grahani and causes Pakwa Apakwa Mala Pravritti. It can be correlated to irritable bowel syndrome. About 15% of the general populations have symptoms that justify diagnosis of IBS. As in the Grahani Agnimandhya is important factor in Samprapti, so it should be treated with Agnivardhan Yogas. Vartaku Gutika which is described in Chakradatta as reseach drug and Chitrakadi Vati mentioned in Charak Samhita for control group. Objectives: To evaluate the effect of Vartaku Gutika and to compare the effect Vartaku Gutika and Chitrakadi Vati in the management of Grahani. Methods: 40 enrolled subjects completed the course of intervention. Randomly they were divided into two groups, group A was given Chitrakadi Vati and group B Vartaku Gutika abd they were adviced 500 mg of tablet two times after food with Ushna Jala, and were adviced to follow Pathya Aahara. Statistical analysis with paired t test, Wilcoxon signed rank test, Mann Whitney test, Mc Nemar test and Chi square test was performed for numerical, ordinal and nominal data respectively. Results: Statistically significant reduction of Lakshana of Grahani in both the group was observed. Overall Vartaku Gutika has more improvement in compared to Chitrakadi Vati. Conclusion: Both Vartaku Gutika and Chitrakadi Vati breaking the pathology of Grahani, but in this study Vartaku Gutika is more effective than compared to Chitrakadi Vati.

Keywords: Vartaku Gutika, Chitrakadi Vati, Grahani, IBS

Corresponding Author How to Cite this Article To Browse
Aarti Chande, Post Graduate Scholar, Department of Kayachikitsa, Muniyal Institute of Ayurveda Medical Sciences, Manipal, Karnataka, India.
Email: 		Aarti Chande, Shripathi Acharya G, Madhavi, Comparative clinical study to evaluate the efficacy of Vartaku Gutika and Chitrakadi Vati in the management of Grahani Roga (Irritable Bowel Syndrome). J Ayu Int Med Sci. 2022;7(9):1-12.
Available From
https://www.jaims.in/jaims/article/view/2012

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-08-29 2022-08-31 2022-09-07 2022-09-14 2022-09-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2022by Aarti Chande, Shripathi Acharya G, Madhaviand 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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Chande A et al: Efficacy of Vartaku Gutika and Chitrakadi Vati of Grahani Roga

Introduction

Today’s world has been adapted to a system of consumption of food which has several adverse effects on human health. Lifestyle changes has compelled us so much that one has so little time to really think what we are eating is a healthy diet!

Grahani is a disease of great clinical relevance in modern era because of its direct link with improper food habits and stressful lifestyle. Mandagni brings about partial digestion of food, and then enters the circulation, which may move either in an upward or downward direction. When this Pakva-Apakva Mala moves downward in gastrointestinal tract it produces a disorder known as Grahani Gada.[1]

It can be probably correlated to Irritable Bowel Syndrome. IBS remains a clinical challenge in the 21st century. It is a functional gastrointestinal disorder having high population prevalence characterized by abdominal pain or discomfort and altered bowel habits in the absence of detectable structural abnormalities.[2] Based on more recent scientific knowledge that proposes the interaction of multifactorial pathophysiological factors involved in the generation of functional GI disorders, a revised definition was created: Disorder of gut brain interaction (DGBI) to help clarify its meaning.[3] These disorders classified by GI symptoms related to any combination of motility disturbance, visceral hypersensitivity, altered mucosal and immune function, gut micro biota, and /or central nervous system processing. Prevalence of IBS in India varies from 4.2-7.5%, prevalence varied substantially between individual countries, and this variability persisted even when the same diagnostic criteria were applied and identical methodology was used in studies.[4]

At present, the drugs available for the treatment of IBS have only a modest effect on symptom improvement there is no universal algorithm currently exists. Current management of IBS includes stool bulking agents, laxatives, anti-spasmodic, antacids and antidepressants etc. Despite recent advancements in the management of IBS in conventional medicine are merely symptomatic, but the symptomatic management of any disorder is incomplete as it cannot break the chain of pathogenesis. Due to the high prevalence, high healthcare costs and significant negative impact of this disorder on patients’ quality of

life, the treatment of IBS deserves increased attention. The burden of IBS on society is large, although there is no mortality associated with IBS but it has got poor quality of life and job-related problems.

In Ayurveda, Grahani Roga is well explained. This detailed study will help to understand the Samprapti and Samprapti Vighatana by Ayurvedic interventions.

As in the Grahani Agnimandhya is important factor in the Samprapti, so it should be treated with Agnivardhan Yogas. I have chosen the drug Vartaku Gutika[5] which is described in Chakradatta as the research drug and Chitrakadi Vati mentioned in Charak Samhita for the control group. Hence here an attempt has been made to evaluate the comparative clinical study of Vartaku Gutika and Chitrakadi Vati in the management of Grahani.[6]

Objectives of the Study

1. To study the literary review of Grahani.

2. To evaluate the effect of Vartaku Gutika in Grahani.

3. To compare the effect of Vartaku Gutika and Chitrakadi Vati in the management of Grahani.

Materials and Methods

Hypothesis

H0 - There is no effect of Varataku Gutika in the management of Grahani Roga

H1 - Vartaku Gutika is equally effective as Chitrakadi Vati in the management of Grahani Roga.

Source of data

Literary source: The literary data were collected from central library as well as Kaya Chikitsa department library of Muniyal Institute of Ayurveda Medical Science, Manipal also from journals, periodicals, other published works and internet sources.

Drug source: Medicines required for the treatment were prepared in MIAMS Manipal Pharmacy.

Clinical source: Patient diagnosed with Grahani who fulfil the inclusion criteria will be randomly selected from OPD and IPD of MIAMS, Manipal and also from the medical camps and referrals.


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Chande A et al: Efficacy of Vartaku Gutika and Chitrakadi Vati of Grahani Roga

Sample source: Patients were selected from OPD and IPD of PG studies in Kayachikitsa in MIAMS hospital, Manipal, Medical Camps and other referrals.

Methods of collection of data

Inclusion criteria

  • Patients between age group of 18-60 years were selected for the study
  • Patients irrespective of sex, religion, occupation were selected for the study
  • Patients having classical signs and symptoms of Grahani Roga like Muhur Badda and Drava Mala Pravritti, Aruchi, Alasya, Klama, Mukha Vairasya, Trishna, Tikta Amlodgara, Praseka, Antra Kunjana.

Exclusion criteria

  • Patients of Asadhya Lakshna and Updrava of Grahani were excluded
  • Patients suffering with other systemic disease which interfere with the course of the treatment
  • Vulnerable group - pregnant and breast-feeding women

Diagnostic criteria: By signs and symptoms of Grahani

  • Muhur Badda Muhur Shithilita Mala Pravritti
  • Anaddhordata
  • Arochaka
  • Balakshaya
  • Alasya
  • Klama
  • Trishna
  • Mukha Vairsaya
  • Tikta Amlodgara
  • Praseka
  • Antra Kunjana
  • Abhyavaran Shakti
  • Jarana Shakti

Rome 3 diagnostic criteria: Recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months associated with 2 or more following:

  • Improvement with defecation
  • Onset associated with a change in frequency of stool
  • Onset associated with a change in form of stool

Subjective criteria

Symptoms Scoring

Symptoms Scoring
Badda Mala
Normal once daily B0
Alternative days B1
Once in two days B2
Once in three days B3
Once in four days B4
Muhur Drava Mala Pravritti
Normal once daily D0
Twice daily D1
2-4 times daily D2
4-6 times daily D3
>6 times daily D4
Muhur Muhur Mala Pravritti
Normal once daily M0
Twice daily M1
2-4 times daily M2
4-6 times daily M3
>6 times daily M4
Udarshoola or discomfort  
No abdominal pain P0
Ocassional/rarely abdominal pain P1
Intermittent lower abdominal pain, relived by passage of stools & flatus P2
Continuous pain not relieved by passage of stools and flatus P3
Amayukta Mala
No visible mucous in stool A0
Visible mucous stickled to the stool A1
Passage of mucous with frequent stool A2
Passage of large amount of mucous in stool A3
Gas or flatulence
No abnormal gas/ flatulence G0
Occasional abdominal distension G1
Frequently abdominal distension with Increased flatulence & belching G2
Rumbling/ Gargling sound present in abdomen G3

Objective parameters
Hb%
Stool examination

Study design: The study was open lable, comparative clinical on 40 subjects of Grahani selected using the convenience sampling techniques.


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Plan of study
Intervention

Group A

Sample size 20
Intervention drug Chitrakadi Vati
Dose 500mg twice daily after food
Treatment duration 30 days
Anupana Ushna Jala

Group B

Sample size 20
Intervention drug Vartaku Gutika
Dose 500mg twice daily after food
Treatment duration 30 days
Anupana Ushna Jala

Statistical Method: Demographic data and other relevant information was analysed with descriptive statistics. Numerical data was analysed using paired t test, Nominal data was analysed with Mc-Nemar & chi square test and ordinal data analysed with Wilcoxon signed rank test, friedman’s test and Mann-whitney test.

The changes with P value <0.005 were considered statistically significant.

Observations and Results

Table 1: Showing Age wise distribution

Age Group A Percent Group B Percent Total %
20-30 9 45.0 9 45.0 18 45.0
30-40 5 25.0 3 15.0 8 20.0
40-50 3 15.0 5 25.0 8 20.0
50-60 3 15.0 3 15.0 6 15.0
Total 20 100.0 20 100 40 100

During the clinical study on Grahani, Maximum number of study subject i.e., 18(45%) subjects were 20-30yr age, 08 subjects (20%) were between 30-40yr and 08 subjects (20%) were also in 40-50yr, 06 subjects (15%) were between 50-60yr.

Table 2: Distribution of 40 patients of Grahani according to diet.

Diet Group A % Group B % Total %
Veg 08 40.00 09 45.00 17 42.5
Mixed 12 60.00 11 55.00 23 57.5
Total 20 100 20 100 40 100

Among the 40 patients of Grahani, (57.5%) of patients were having both Veg and Non veg food, followed by (42.5%) patients were having pure vegetarian food.

Table 3: Distribution of 40 patients of Grahani according to Agni.

Agni Group A % Group B % Total %
Vishamagni 10 50.00 11 55.00 21 52.5
Tikshagni 02 10.00 03 25.00 05 12.5
Mandagni 07 35.00 05 15.00 12 30.0
Samagni 01 5.00 01 5.00 02 5.00
Total 20 100 20 100 40 100

Among the 40 patients of Grahani, (52.5%) of patients were having Vishamagni, followed by (30%) patients of Mandagni, (12.5%) with Tikshnagni and (5%) with Mandagni.

Table 4: Distribution of 40 patients of Grahani according to Koshta.

Koshta Group A % Group B % Total %
Mrudu 03 15.00 03 15.00 06 15.00
Madhyam 10 50.00 08 40.00 18 45.00
Krur 07 35.00 09 45.00 16 40.00
Total 20 100 20 100 40 100

Among 40 patients of Grahani, (45%) of patients had Madhyam Koshta, followed by (40%) and (15%) had Mrudu Koshta.

Table 5: Distribution of 40 patients of Grahani according to Satwa.

Sara Group A Percent Group B Percent Total %
Pravar 00 0.00 00 0.00 00 0.00
Madhyam 06 30.00 08 40.00 14 35.00
Avar 14 70.00 12 60.00 26 65.00
Total 20 100 20 100 40 100

Among 40 subjects of Grahani, majority of the subjects were having (65%) Avar Satwa, followed by (35%) Madhyam Satwa.

Results

Subjective parameters: Between the group

Table 6: showing the effect of treatment on Badda Mala between the groups with Mann-Whitney U test.

Badda mala N Mean Rank Sum of Ranks U value Z value P value Remarks
Group A Group B Group A Group B
BT 20 23.38 17.63 467.50 352.50 142.50 -2.510 0.012 S
AT 20 23.95 17.05 479.00 341.00 131.00 -2.127 0.033 S
AF 20 21.10 18.90 442.00 378.00 168.00 -1.114 0.265 NS

Between the group analysis of before and after treatment (at the mean rank of the subordinate level of significance) Mean score of Group A was 23.95 and Group B was 17.05, which showed significant reduction of Badda Mala (P-0.033)


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At follow up Mean score of group A was 21.05 and group B was 18.90 and value shows non-significant reduction (P-0.265)

Table 7: showing the effect of treatment on Muhur Drava Mala Pravritti between the groups with Mann-Whitney U test.

Muhur Drava Mala N Mean Rank Sum of Ranks U value Z value P value Remarks
Group A Group B Group A Group B
BT 20 21.35 19.65 427.00 393.00 183.00 -0.546 0.659 NS
AT 20 22.95 18.05 459.00 361.00 151.00 -1.497 0.192 NS
AF 20   21.68 19.33 433.50 386.50 176.50 -0.743 0.529 NS

Between the group analysis of before and after treatment (at the Mean rank of the subordinate level of significance) Mean score of group A was 22.95 and group B was 18.05, which shows non-significant reduction (P-0.192)

After follow up Mean score of group A was 21.68 and group B was 19.33, which shows non-significant reduction (P- 0.529)

Table 8: Showing the effect of treatment on Muhur Muhur Mala Pravritti between the groups with Mann- Whitney U test.

Muhur Muhur Mala N Mean Rank Sum of Ranks U value Z value P value Remarks
Group A Group B Group A Group B
BT 20 20.48 20.53 409.50 410.50 199.50 -0.16 0.989 NS
AT 20 23.75 17.25 475.00 345.00 135.00 -2.083 0.081 NS
AF 20 23.90 17.10 478.00 342.00 132.00 -2.115 0.068 NS

Between the group analysis of before and after treatment (at the Mean rank of the subordinate level of significance) Mean score of group A was 23.75 and group B was 17.25, which shows non-significant reduction (P-0.081)

After follow up Mean score of group A was 23.90 and group B was 17.10, which shows non-significant reduction (P- 0.068)

Table 9: Showing the effect of treatment on Udarshoola between the groups with Mann-Whitney U test.

Udarshoola N Mean Rank Sum of Ranks U value Z value P value Remarks
Group A Group B Group A Group B
BT 20 19.05 21.95 381.00 439.00 171.00 -0.923 0.445 NS
AT 20 21.93 19.08 438.50 381.50 171.50 -0.940 0.445 NS
AF 20 24.20 16.80 484.00 336.00 126.00 -2.300 0.046 S

Between the group analysis of before and after treatment (at the Mean rank of the subordinate level of significance) Mean score of group A

was 21.93 and group B was 19.08, which shows non-significant reduction (P-0.445)

After follow up Mean score of group A was 24.20 and group B was 16.80, which shows significant reduction (P- 0.046)

Table 10: Showing the effect of treatment on Amayukta Mala Pravritti between the groups with Mann-Whitney U test.

Ama Yukta Mala N Mean Rank Sum of Ranks U value Z value P value Remarks
Group A Group B Group A Group B
BT 20 19.05 21.050 390.00 430.00 180.00 -0.673 0.602 NS
AT 20 24.10 16.90 482.00 338.00 128.00 -2.306 0.052 S
AF 20 24.50 16.50 490.00 330.00 120.00 -2.726 0.030 S

Between the group analysis of before and after treatment (at the Mean rank of the subordinate level of significance) Mean score of group A was 24.10 and group B was 19.60, which shows significant reduction (P- 0.052)

After follow up Mean score of group A was 24.50 and group B was 16.50, which shows significant reduction (P- 0.030)

Table 11: Showing the effect of treatment on Flatulence between the groups with Mann-Whitney U test.

Flatulence N Mean Rank Sum of Ranks U value Z value P value Remarks
Group A Group B Group A Group B
BT 20 20.85 20.15 417.00 403.00 193.00 -0.232 0.817 NS
AT 20 22.40 18.60 448.00 372.00 162.00 -1.171 0.241 NS
AF 20 22.50 18.50 450.00 370.00 160.00 -1.363 0.173 NS

Between the group analysis of before and after treatment (at the Mean rank of the subordinate level of significance) Mean score of group A was 22.40 and group B was 18.60, which shows non-significant reduction (P-0.241)

After follow up Mean score of group A was 22.50 and group B was 18.50, which shows non- significant reduction (P- 0.173)

Objective parameters: between the groups

Table 12: Showing the effect of treatment on Ova in stool between the groups with Chi- square test.

Groups BT AT Chi - square P value
Present Absent Present Absent
Group A 05 15 00 20 0.143 0.705
Group B 04 16 00 20
Total 09 31 00 40

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Between the group analysis of before and after treatment in group A, before treatment was present in 05 subjects and absent in 15, and after treatment was absent in all the subjects. In group B before treatment was present 04 subjects and absent in 16 subjects and after treatment was absent in all the subjects.

Table 13: Showing the effect of treatment on cyst in stool between the groups with Chi-square test.

Groups BT AT Chi - square P value
Present Absent Present Absent
Group A 03 17 00 20 0.229 0.633
Group B 02 18 00 20
Total 05 35 00 40

Between the group analysis of before and after treatment in group A, before treatment was present in 03 subjects and absent in 17, and after treatment was absent in all the subjects. In group B before treatment was present 02 subjects and absent in 18 subjects and after treatment was absent in all the subjects.

Table 14: Showing the effect of treatment on pus cells in stool between the groups with Chi- square test.

Groups BT AT Chi - square P value
Present Absent Present Absent
Group A 08 12 00 20 0.102 0.749
Group B 09 11 00 20
Total 17 23 00 40

Between the group analysis of before and after treatment in group A, before treatment was present in 08 subjects and absent in 12, and after treatment was absent in all the subjects.

In group B before treatment was present 09 subjects and absent in 11 subjects and after treatment was absent in all the subjects.

Table 15: Showing the effect of treatment on RBC cells in stool between the groups with Chi-square test.

Groups BT AT Chi - square P value
Present Absent Present Absent
Group A 00 20 00 20   2.105   0.147
Group B 02 18 00 20
Total 02 38 00 40

Between the group analysis of before and after treatment in group A,

before treatment was not present in any subjects, In group B before treatment was present 02 subjects and absent in 18 subjects and after treatment was absent in all the subjects.

Table 16: Showing overall effect of treatment on parameters of group A and group B after treatment.

Parameters Mean Score
Goup A Group B
BT AT % BT AT %
Badda Mala 2.05 0.90 56% 1.75 0.45 74.28%
Muhur Drava Mala 1.8 0.8 55.5% 1.7 0.45 74.2%
Muhur Muhur Mala 2.25 1.3 42.2% 2.3 0.9 60.86%
Udarshoola 1.55 0.85 45.16% 1.75 0.70 60%
Amayukta Mala 1.10 0.6 45.45% 1.2 0.20 83.33%
Flatulence 1.30 0.6 53.84% 1.25 0.40 68%

Discussion

Discussion on observations

Age: Among the 40 patients of Grahani, it was found that highest no. of patients i.e., 45% were between the age group of 20 to 30 years. IBS occurs in all age group. However, worldwide 50% of the patients with IBS report having first had symptoms before the age of 35 years.[7]

In this age group, people usually do Adhyashana, Vishamashana, Ratrijagrana and Diwaswapna, which leads to Tridosha Dushti - mainly Samana Vayu, Pachak Pitta, Kledaka Kapha and tension, anxiety is much seen in this age group, which leads to Agni Dushti and finally, it leads to Agni Dushti, finally leads to Amavastha of Grahani Roga.


Dietary Habits: Maximum patients 57.5% were mixed diet while 42.5% were vegetarian. Probably Guru, Snigdha and Abhishyandi Ahara may cause indigestion leading to formation of Ama and resulting in Grahani. There are studies that indicates a possibility that symptoms of some IBS patients could be eased by changing into vegetarian diet often means increasing the intake of FODMAP’s (Fermentable Oligo-Di-Mono-saccharides and Polyols) which present in for example onions, wheat, fruits and milk; intake of such diet worsen the symptoms.[8]

Agni: Among 40 subjects of Grahani, (52.5%) were having Vishamagni, followed by (30%) of Mandagni


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and (12.5%) with Tikshagni. This may indicate predominance of Vata Dosha in Lakshnas among the subjects.

Koshta: In the study, 45% of subjects were having Madhyam Koshta, followed by 40% of Krur Koshta and 15% subjects with Mrudu Koshta.

Satwa: Among 40 subjects of Grahani 65% had the Avara Satwa, which can signify the relation between gut brain axis in IBS.

Discussion on Results

Baddha Mala: In statistical analysis effect of intervention on Badda Mala before and after treatment in Group A with Wilcoxon signed rank test (Z value -2.714 P value 0.007) showed significant reduction in all 20 subjects.

In Group B with Wilcoxon signed rank test (Z value -1.633 P value 0.025) showed significant reduction in all 20 subjects.

Between the groups after treatment Mean was reduced to 0.90 in Group A and 0.45 in Group B

Group B (74.28%) showed more percentage of improvement in Badda Mala than group A (56%)

Although action of medicine on the individual symptoms cannot be explained, its action on the Samprapti, Dosha and Dushya can be assessed. Vartaku has more significant effect on Badda Mala probably because of the Dravyas like Snuhi, Arka and Lavanas which can do the action of Bhedana and Ushna Virya and Katu, Tikta Rasa which can control the Vata.

Muhur Drava Mala Pravritti: In statistical analysis effect of intervention on Muhur Drava Mala before and after treatment in Group A with Wilcoxon signed rank test (Z value-3.127 P value<0.001) showed significant reduction in all 20 subjects.

In Group B with Wilcoxon signed rank test (Z value-3.963 P value<0.001) showed significant reduction in all 20 subjects.

Between the groups after treatment Mean was reduced to 0.8 in Group A and 0.45 in Group B.

Group B (74.2%) showed more percentage of improvement in Muhur Drava Mala Pravritti than Group A (55.5%)

Katu, Tikta Rasa predominance

medicine with Deepana and Pachana property does Ama Pachana and Mala Roopi Kapha Shoshana, which in turn reduces Drava Mala Lakshna.

Muhur Muhur Mala Pravritti: In statistical analysis effect of intervention on Muhur Muhur Mala Pravritti before and after treatment Group A with Wilcoxon signed rank test (Z value-3.316 P value<0.001) showed significant reduction in all 20 subjects.

In Group B with Wilcoxon signed rank test (Z value-3.938 P value0.001) showed significant reduction in all 20 subjects.

Group B (60.86%) showed more percentage of improvement in Muhur Muhur Mala Pravriti than Group A (42.2%).

Udarashoola: In statistical analysis effect of intervention on Udarashoola before and after treatment in Group A with Wilcoxon signed rank test (Z value-3.500 P value<0.001) showed significant reduction in all 20 subjects.

In Group B with wilcoxon signed rank test (Z value-4.739 P value<0.001) showed significant reduction in all 20 subjects.

Between the groups after treatment Mean was reduced to 0.85 in group A and 0.70 in group B.

Group B (60%) showed more percentage of improvement in Udarashoola than group A (45.16%)

Although both the medicine contain Katu, Tikta Rasa, Ushna Virya and Vatahara property drugs, but Kshara Guna of Vartaku Gutika, it contains alkaloids (Kwonet al.,2007) Vohora et al., 1984 tested the effect of crude alkaloidal fraction isolated of Solanum melongena on the central nervous system. It exhibited significant analgesic effect (Vohora et al., 1984).

Amayukta Mala: In statistical analysis effect of intervention on Amayukta Mala before and after treatment in group A with Wilcoxon signed rank test (Z value-2.673 P value0.008) showed dignificant reduction in all 20 subjects.

In group B with Wilcoxon signed rank test (Z value-3.879 P value<0.001) showed significant reduction in all 20 subjects.

Between the groups after treatment Mean was reduced to 0.6 in group A and 0.2 in group B.


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Group B (45.4%) showed more percentage of improvement in Amayukta Mala than group A (83.33%)

Katu, Tikta Rasa, Laghu, Kshara Guna of medicine does the Ama Pachana and correct the deranged Kledaka Kapha in Samprapti of Grahani which in turn reduces the Amayukta Mala Lakshna.

Flatulence: In statistical analysis effect of intervention on flatulence before and after treatment Group A with Wilcoxon signed rank test (Z value-3.500 P value <0.001) showed significant reduction in all 20 subjects.

In group B with Wilcoxon signed rank test (Z value-3.532 P value<0.001) showed significant reduction in all 20 subjects.

Between the groups after treatment Mean was reduced to 0.6 in group A and 0.4 in group B.

Group B (68%) showed more percentage of improvement in flatulence than group A (53.84%).

Discussion on objective parameters

Non-significant improvement in Group A and Group B was seen. As at baseline lab parameters were in almost normal ranges and they remained almost same after completion of the study.

Discussion on probable mode of action of drugs

Probable mode of action of Vartaku Gutika at different levels

At the level of Dosha

In Grahani Roga, Saman Vayu, Pachaka Pitta, Kledaka Kapha these are the main culprits. Because of its Laghu, Tikshna, Ruksha Gunas and Katu, Tikta Rasa (dominant with Agni, Vayu and Akash Mahabhuta) it subsides the aggrevated Kapha.

While, by Ushna Virya and Tikshna, Snigdha Guna it counteracts Vata. Due to Madhura Rasa, Snigdha Guna, Madhura Vipaka its balances the Pitta.

At the level of Dushya

From the Samprapti of Grahani Roga, it is cleared that the main Dushya involved is Rasa Dhatu, most of the drugs from this formulation Tikta and Katu Rasa which improves the digestion and made first Dhatu in proper form, so the combination will act on the Rasa Dhatu.

Probable action on Srotas

The disease exhibits three types of Sroto Dushti (Sanga, Vimarga-Gamana, Atipravitti)

The combination by the virtue of Deepana, Pachana, Anulomana property, Laghu, Snigdha, Sukshma Guna, Tikta Rasa, Ushna Virya relieves Sanga type of Dushti.

Anulomana property relieve from Vimarga Gamana type of Dushti.

Deepana, Pachana and Grahi property and Ruksha Guna decreases Srotogata Ama and relives Atipravritti.

Probable action on Agni and Ama level

By virtue of its Deepana, Pachana and Rochana property, Katu Tikta Rasa, Ushna Virya it stimulates the Jatharagni which is the main culprit in Grahani. This in turn stops the further Ama production and helps into break the basic pathology.

This Ama Pachana causes Srotomukh Shodhana, Drugs like Chitraka, Snuhi etc. proved as best Ama Pachaka, so the Yoga will act as the Amapachana and Agni Deepana.

Table 17: Showing Research articles related to each ingredient of Vartaku Gutika.

Drugs Research Studies
Chitraka Analgesic, Anticancer, Anti-inflammatory, Anti-oxidant, Anti-ulcer, Anti-bacterial[9]
Snuhi Laxative, Improves appetite, Digestive, Antispasmodic[10]
Arka Anti-inflammatory, Antioxidant, Antidiarrheal, Anticancer, Hepatoprotective, Antipyretic[11]
Saidhava Lavna Antacid, Anti-flatulent, Carminative, Digestive stimulant[12]
Suvarcha Lavna Laxative and used in Digestive aid[13]
Vida Lavna Systemic acidifier, maintain pH and exerts a mild diuretic effect
Vartaku Antioxidant, Analgesic, CNS depressant, the beneficial effects on health of chlorogenic acid and related compounds present in minor quantities in eggplants are numerous, and apart from their potent antioxidant activity, they also include free radical scavenging and anti tumoral activities (sawa et al.,1998. Triantis et al.,2005)

Conclusion

Grahani Roga represents a group of digestive disorder.


Journal of Ayurveda and Integrated Medical Sciences 2022;7(9)8
Chande A et al: Efficacy of Vartaku Gutika and Chitrakadi Vati of Grahani Roga

It is closely linked with Agnimandhya, Koshtha Gata Vata and Atisara. Impaired Agni and Samana Vata are the most predominant factors in the pathogenesis of Grahani. Prana Vata and Apana Vata also have a significant role in Grahani. Samana Vata Dushti explained in Ayurvedic literatures in Grahani can be correlated and understood with the abnormal gut motor activity in IBS, similarly the Agni Dushti with that of abnormal gut sensory activity. Central nervous system deregulation can be understood with impaired function of Prana Vata with respect to “Deha Indriya Chitta Drik.” Increased colonic motor activity in IBS due to various factors is similar to the involvement of Apana Vata in Grahani. Hence total physiologic disturbances mentioned in IBS are similar to Vata Pitta Dushti in Grahani and involvement of luminal factors in IBS can be explained with the Kala Hani in Grahani. Diagnostic criteria of IBS i.e., Rome III criteria is same as the Pratyatmaka Lakshanas of Grahani. Both Vartaku Gutika and Chitrakadi Vati breaking the pathology of Grahani, but in this study Vartaku Gutika is more effective than compared to Chitrakadi Vati. Null hypothesis is rejected here. Both interventions were well tolerated in the present study and there were no any adverse events reported during study.

Reference

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7. Maxwell PR, Mendall MA, Kumar D. Irritable bowel syndrome. Lancet. 1997;350(9092):1691–1695

8. Buscail C, Sabate JM, Bouchocha M et al. Association between self-reported vegetarian diet and the irritable bowel syndrome in the French NutriNet cohort. PLoS One.2017;12:e0183039

9. K. Madhava Chetty et al, Pharmaceutical Studies and Therapeutic Uses of Plumbago Zeylanica L. Roots (Chitraka, Chitramulamu), Ethnobotanical Leaflets 10: 294-304. 20

10. Nishigandha Pradip Jagtap, Nilima Wadnewar. A pharmacological perspective of Ayurvedic Upvisha-Snuhi (Euphorbia Nerifolia Linn.) International Ayurvedic Medical Journal, September,2009

11. https://www.ayurtimes.com/rock-salt- sendha-namak-halite-benefits-uses/ (accessed on March,2022)

12. http://www.livemint.com/r/LiveMint/ Period1/oldpdf/52d367ae-f4a8-463f- aec4 5ad563f1257f.pdf

13. McEvoy, G.K. (Ed.). American Hospital Formulary Service. AHFS Drug Information. American Society of Health-System Pharmacists, Bethesda, MD. 2006., p. 2585


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