E-ISSN:2456-3110

Case Report

Garbhini Chardi

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 9 September
Publisherwww.maharshicharaka.in

A case study on the management of Garbhini Chardi w.s.r. to Emesis Gravidarum

Sahil1*, Panda J2, Tanwar S3
DOI:10.21760/jaims.8.9.32

1* Sahil, Post Graduate Scholar, Department Of Prasuti Tantra Stri Roga, Shri Krishna Govt Ayurvedic College Hospital, Kurukshetra, Haryana, India.

2 Jitesh Kumar Panda, Professor HOD, Department of Prasuti Tantra Stri Roga, Shri Krishna Govt Ayurvedic College Hospital, Kurukshetra, Haryana, India.

3 Suniti Tanwar, Associate Professor, Department of Prasuti Tantra Stri Roga, Shri Krishna Govt Ayurvedic College Hospital, Kurukshetra, Haryana, India.

Pregnancy is regarded as the most delicate time in a women life. Maternal physiology is under continuous adaption throughout the pregnancy. One such bothersome side effect of such physiological changes occurring during pregnancy is Emesis Gravidarum which has significant impact on pregnant women life, including everyday functioning and general wellbeing. As Chardi is considered a Vyakta Garbha Lakshana it is not associated with much harm to growing fetus or mother and is therefore considered a physiological disorder; however, when it occurs frequently it develops into Hyperemesis Gravidarum, a pathological condition that require early intervention to prevent symptoms such as extreme dehydration, exhaustion weight loss, congenital problems in fetus and early labor etc. that could harm the developing fetus. In this study effort have been undertaken to evaluate the efficacy of Eladi Choorna in Garbhini Chardi.

Keywords: Garbhini Chardi, Emesis Gravidarum, Physiological changes, Eladi Choorna, PUQE form

Corresponding Author How to Cite this Article To Browse
Sahil, Post Graduate Scholar, Department Of Prasuti Tantra Stri Roga, Shri Krishna Govt Ayurvedic College Hospital, Kurukshetra, Haryana, India.
Email: 		Sahil, Panda J, Tanwar S, A case study on the management of Garbhini Chardi w.s.r. to Emesis Gravidarum. J Ayu Int Med Sci. 2023;8(9):191-195.
Available From
https://jaims.in/jaims/article/view/2777

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-07-16 2023-07-24 2023-08-02 2023-08-12 2023-08-27
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 19.63

© 2023by S, Panda J, Tanwar Sand 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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Sahil et al. A case study on the management of Garbhini Chardi w.s.r. to Emesis Gravidarum

Introduction

Pregnancy is the most important and sensitive part of every woman’s life it is important to have healthy status for getting healthy progeny. But during this complete span of nine month, the women might have to experience a number of annoying problems that are not dangerous but may need some attention. Emesis Gravidarum is worldwide obstetrical problem seen in 1st trimester of pregnancy in about 50% of pregnant women. According to Ayurveda Garbhini Chardi is considered to be a Vyakta Garbha Lakshana which bears a similar resemblance to Emesis Gravidarum.[1] Acharya Charka has compared pregnant women with Taila Poorna Patra which can be spill off even by slight oscillation, hence we should carefully treat the Garbhini or Garbhini Roga.[2] Nausea and vomiting are common complaint during first half of pregnancy i.e., Emesis Gravidarum. These vary in severity and usually commence between the first and second missed menstrual period and continue until 14 to 16 weeks gestation. Although nausea and vomiting tend to be worse in the morning thus termed morning sickness - both symptoms frequently continue throughout the day.[3] The onset of the symptoms is thought to be caused by altered hormonal and immunological conditions, which are likely made worse by neurogenic variables.[4] If sufficient care is not provided for such physiological changes, it may result in problems such as severe dehydration, fatigue, weight loss, electrolyte imbalance, etc., which may affect the mother and developing foetus. Therefore, it is important to treat this illness as soon as possible in order to avoid complications. Garbhni Avastha is most considered as most sensitive state so in this condition the measures taken should be very pleasant, satisfying and easily palatable. Shamna Chikitsa is preferred instead of Shodana Chilkitsa. Eladi Choorna will be taken here as a trial in the management of Garbhini Chardi as most of the drug in this formulation have Madhura, Kashaya Rasa, Sthambhaka Guna which helps in pacifying the Chardi, Srotoshodaka and Aampachak.[5] As per Acharya Kasyapa Jwaradi Vikara in Garbhini can occurs in same manner as in others.[6]

Case Report

A 28- years old pregnant patient with amenorrhea of 3 months came to OPD no.-15 of Prasuti Tantra evam Stree Roga

, SKGAC&H, Kurukshetra with C/O nausea and 2-3 episodes of vomiting since 15 days with increased frequency and quantilty of 3-4 episodes of vomiting, Weakness and aversion toward food since 5 days.

Personal History

Dietary habits revealed that she was taking Vegetarian diet and her appetite was reduced since 15 days, Urine frequency was 2/times per day (Dark coloured, decreased), Bowel was constipated (since 5 days), Sleep was sounds.

Obstetric history: G1P0A0L0D0

Dashavidha Pareeksha

  • Prakruti: Vata Kapha
  • Vikruti: Vatapitta, Hetu: Asatyma and Ahittakara Ahara and Dauhruda Avastha
  • Sara: Meda
  • Satmya: Mishrarasa Satmya
  • Pramana: Bhara: 62.2 kg
  • Darighya: 148cm
  • Satva:Madhyama
  • Ahara Sakti: Avara
  • VyayamaSakti: Avara
  • Vaya: Madhyam

Astha Sthana Pareeksha

  • Nadi: Pitta Pradhana
  • Pulse: 74 bpm
  • Mala: Badha
  • Mutra: 2 times a day, dark coloured
  • Jiwha: Lipta
  • Shabda: Utpatti-+
  • Grahana - +
  • Sparsha: Anushna Sheeta
  • Drik: Prakruta
  • Akruti: Madhyama

Investigations

HB% - 12.8 gm%, WBC -7400 cell/Cumm, Platlet count - 3.4 lakh/cum, Urine R/M- Normal.

USG

A single intrauterine pregnancy corresponding to 13weeks 1 day.


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FHR - 153 beats/min, NTT - 1.8 mm appears normal for GA

Preparation of Drug

Raw drug was procured from the good authentic source and identified and approved by Department of Dravyaguna and Choorna was prepared in pharmacy of Rasa Shastra and Bhisjaya Kalpana of Shri Krishna Govt. Ayurvedic College and Hospital, Kurukshetra.

Patient was given Eladi Choorna orally 3gm BD after meal with Sharkara and Madu as Anupana.[7]

Assessment Criteria

Subjective parameters

1. Aruchi (Anorexia)
2. Hrillasa (Nausea)
3. Daurbalya (Weakness)
4. Shrama (Fatigue)
5. Vibandha (Constipation)
6. Shirashoola (Headache)

Objective Parameters

1. Frequency of vomiting
2. PUQE Form.

Objective Parameters: PUQE FORM

SNGrading12345
1.In the last 24 hours, for how long you felt nauseated or sick your stomach?Not at all1 hour or less2-3 hours4-6 hoursMore then 6 hours
2.In the last 24 hours have you vomited or thrown up?I did not throw up.1-2 times3-4 times5-6 times7 or more times
3.In the last 24 hours how, many times have you had retching or dry heaves without bringing anything up?No times1-2 times3-4 times5-6 times7 or more times

Total score (Sum of 1, 2 and 3): Mild NVP<6; Moderate NVP<7-12; Severe NVP>13

Quality of life question:

On the scale of 0 to 10, how would you rate your wellbeing…………?

0 (worst possible)-10 (the best you felt before pregnancy)

Observations and Results

SNParameterBTDTATFU
1.AruchiPresentPresentAbsentAbsent
2.HrillasaPresentPresentAbsentAbsent
3.DaurbalyaPresentPresentPresentAbsent
4.ShramaPresentPresentAbsentAbsent
5.VibandhaPresentAbsentAbsentAbsent
6.ShirashoolaPresentPresentAbsentAbsent
7.Chardi vega4 Vega2 Vega 1 Vega1 Vega
8.PUQE FORM10633

Discussion

Eladi Choorna is an Ayurvedic formulation mentioned in Bhaisjya Ratnavali in Chardi Roga Chikitsa. The ingredients of Eladi Choorna are Ela, Lavang, Nagkesra, Lajja, Kolamajja, Musta, Priyangu, Chandana and Pippali.[5] Most of the medication in this formulation have Kashaya rasa and Madhura Rasa. The two Adhobhagaharasa that predominate in Madhura Rasa are Prithvi and Ap Mahabhoota.[8] Madhura Rasa act as a Brumhana and Tarpana and helps in reducing symptoms like tiredness and giddiness which is most commonly associated symptoms in Garbhini Chardi thus helps in Dhatu Poshana. Kashaya Rasa possess Ropana Karma and Sthambana. In the Chikitsa Sutra of Chardi Acharya Sushrutha has cited to use Kashaya Rasa Pradhan Dravya[9] and the quality of Langhana and Srotoshodana are present in Laghu Guna, Ruksha Guna possess the quality like Stambhana and Soshana thereby it does Aama Pachana.[10] Most of the drug like Ela, Lavanga, Priyangu, Musta, Chandana have Sheeta Virya and medicines with Sheeta Virya does the action of Prahladana, Stambhana and Balya by virtue of Virya which pacify Trishna, Murcha and Daha which all connected to Chardi. With the Anupana like Madhu and Sita it becomes easily palatable. Glucose and fructose in it help to reduce carbohydrate starvation, breaking the cycle of vomiting and preventing further episodes.

Probable mode of action

Ela contain Borneol, Camphene, p-cymene, heptadene etc. Borneol shows to be effective antagonist of acetylcholine and perhaps this compound imbusese cardamom with its antiemetic property. Eugenol, which is contained in Lavanga, has anti-ulcer properties because it can encourage the production of mucus. Nagakesara


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is having antiulcerogenic, antispasmodic helps in prevention of complications of vomiting. Badara also shows properties anti-ulcer properties it contains proanthocyanidins that act on serotonion. Essential oil present in Ela, Lavang and Chandana has action at the molecular, psychological and physical level. The treatment with Manaso Anuguna Gandha of this drug may be considered. Lajja and Piper longum contain ferulic acid, which has a serotonin antagonistic action. Cyperus rotundus Gastroprotective properties are related to endogenous and suppression of Gastric motility. Furthermore, Lajja will serve as main source of energy because it contains starch. Lajja is Agroaushadi for Chardi as per Acharya Charka,[11] while Badara is included in Chardighana Dashamani in Charka Sutra Stana.[12] Honey contains glucose, fructose, maltose, sucrose, water, proteins, organic acids, amino acids, vitamins, flavonoids, and acetylcholine. Glucose and fructose in honey help reduce gastric emptying time and smooth muscle contraction, preventing vomiting. Glucose also aids in water absorption and rehydration, reducing symptoms like dehydration, tiredness, and lethargy in Emesis gravidarum.

Conclusion

In the management of Garbhini Chardi w.s.r. to Emesis Gravidarum, Eladi Choorna is highly effective. Both during and after the treatment, there was no adverse effect reported. Treatment has produced noticeable progress in nausea and amount of vomiting has decreased and frequency from three to four times daily to once daily others symptoms of Garbhini Chardi like Aruchi, Hrillasa, Daurbalya, Shrama, Vibandha and Shiroshoola has reduced to nil.

References

1. Shastri K, Chaturvedi G. Charak Samhita. Varanasi: Chaukhamba Prakashan. 2017. Part I Sharira sthana chapter 4 verse 16. Page no.874

2. Shastri K. Chaturvedi G. Charka Samhita. Varanasi: Chaukambha Prakashan. 2017. Part I Sharirasthana chapter 8 Verse 22. Page no.930

3. Cunningham F, Leveno K. Dashe J. Hoffman B, Spong C, Casey B. Williams obstetrics. Mc Graw Hill; 2022. Edition 26th, Chapter 10. Page no. 191.

4. Dutta DC, Hiralal K. DC Dutta's Textbook of

Obstetrics including Perinatology & Contraception. Jaypee Brothers Medical Publishers; 2023. Edition X chapter 15. Page no.149

5. Shastri R. Bhisjaya Ratnawali. Varanasi: Chaukambha Sanskrit Sansthan; chapter 19 verse 21. Page No.348.

6. Sharma H, Bhisagacharya S. Kasyapa Samhita. Varanasi: Chaukamba Prakashan. 2018. Khila sthana chapter 10 verse 182,183.

7. Tripathi B. Sarangadhara Samhita. Varanasi: Chaukambha Surbharti Prakashan; 2017. Madhyamkhanda. chapter .6 verse 147/148.

8. Acharya Agnivesha, Caraka Samhita, Ayurveda Deepika Commentary of Chakrapani, Edited By Vaidya Yadvji Trikamji Acharya, Chaukambha Krishnadas Academy, Varanasi. Reprint:2019 Sutra Stana, Chapter 26, Verse-40, Page No-143

9. Srikantha Murthy K.R, English translation on Susrutha Samhitha, Uttarastana, Chardi Pradisheda, chp.49, ver-6, Varanasi, Chaukhamba Orientalia, 2012, pp327.

10. Shastri JLN. Dravyaguna Vignana. Reprint 2006, Varanasi, Chaukhambha Orientalia. Reprint 2006. Vol-1, Pp54

11. Acharya Agnivesha, Caraka Samhita, Ayurveda Deepika Commentary of Chakrapani, Edited By Vaidya Yadvji Trikamji Acharya, Chaukambha Krishnadas Academy, Varanasi. Reprint:2019 Sutra Stana, Chapter 25, Verse-40

12. Acharya Agnivesha, Caraka Samhita, Ayurveda Deepika Commentary of Chakrapani, Edited By Vaidya Yadvji Trikamji Acharya, Chaukambha Krishnadas Academy, Varanasi. Reprint: 2019 Sutra Stana, Chapter 4, Verse-28


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