E-ISSN:2456-3110

Research Article

Management of Mukhapaka

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 10 October
Publisherwww.maharshicharaka.in

A clinical study to evaluate the efficacy of Triphala Kwatha with Madhu Mukha Dhavana in the management of Mukhapaka w.s.r. to Stomatitis

Chour S1*, Rehman Madni A2
DOI:10.21760/jaims.8.10.3

1* Sharanabasappa Chour, Assistant Professor, Department Of Shalakya Tantra, Dr Bnm Rural Ayurvedic Medical College And Hospital, Vijayapura, Karnataka, India.

2 Aneesur Rehman Madni, Associate Professor, Dept of Shalya Tantra, BLDEAs AVS Ayurveda Mahavidyalaya, Vijayapura, Karnataka, India.

Background: The Mukha (Oral cavity) is considered to be one of important part of the Urdhwajatru because it work as the reflector of the body health by acting as gateway of the alimentary canal. Sarvasara Mukha Rogas are named as “Mukha Paka” occur by spreading completely in the Mukha so only named as Sarvasara Mukha Rogas. Mukhapaka can be correlated to Stomatitis. Methodology: This is a single-arm clinical trial where 20 patients fulfilling the inclusion criteria of Mukhapaka were selected and evaluated to see the efficacy of Triphala Kwatha with Madhu Mukha Dhavana. Source of patients was O.P.D and I.P.D of Shalakya Tantra, SMVVS RKM Ayurvedic Medical College, Vijayapura. Results: Signs and symptoms were given with suitable scores according to their severity based on relief after treatment. The results having P value less than < 0.001 were considered as statistically significant in this study. Triphala Kwatha with Madhu Mukha Dhavana was effective and significant on parameters of Mukhapaka. Discussion: Triphala Kwatha with Madhu has very significant effect in the management of Mukhapaka. Marked reduction in clinical symptom was well appreciated within 7 days of treatment. Triphala Kwatha with Madhu is proved to be cost effective, adoptive, safe and better drug of choice in the management of Mukhapaka.

Keywords: Mukhapaka, Stomatitis, Triphala Kwatha, Madhu, Honey

Corresponding Author How to Cite this Article To Browse
Sharanabasappa Chour, Assistant Professor, Department Of Shalakya Tantra, Dr Bnm Rural Ayurvedic Medical College And Hospital, Vijayapura, Karnataka, India.
Email: 		Chour S, Rehman Madni A, A clinical study to evaluate the efficacy of Triphala Kwatha with Madhu Mukha Dhavana in the management of Mukhapaka w.s.r. to Stomatitis. J Ayu Int Med Sci. 2023;8(10):21-27.
Available From
https://jaims.in/jaims/article/view/2816

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-08-05 2023-08-12 2023-08-19 2023-08-26 2023-08-30
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 22.85

© 2023by Chour S, Rehman Madni Aand 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

Ayurveda is goldmine of traditional medicine. It is the holy ocean of Amrutha that can never be exploited and utilized fully, even with the strenuous and constant effort and research of any generation. Ayurveda is a gift of nature, which guides us to perfect living and its root can be searched in Vedic period are even early year it is rational and scientific. It is formulated after centuries of experiments and experiences. Ayurveda has its own concepts of Health and ill health. Ayurveda does not need any validation as it was already done very carefully long age, our problem is not validation but the standardization of drugs traditional practices should be modified to suit the changed Lifestyle. Ayurveda is so wide and it considers that each and every particle in the universe has some medicinal value.

Sarvasara Mukha Rogas are named as Mukhapaka as it occurs by spreading completely in the present Era word is looking at Ayurveda with the hope that it is going to provide good asset to the treatment of ailing humanity.

Stomatitis is diffused inflammation of oral mucosa nearly 20% of population is suffering with this problem.[1] It is characterized by superficial ulcers in the movable mucosa of the mouth with recurrent episodes which occur due to various causes like simple cut to the mouth eating very hot food items in proper cleaning of teeth, vitamin deficiencies general weaknesses, tobacco chewing, smoking etc. and complaints are inflammation of oral mucosa ulceration the mouth, Altered taste, pain, burning sensation, itching sensation, difficulty in mastication and discomfort.

According to Acharya Charaka, Mukhapaka is mentioned under 40 Pittaja Nanatmaja Vikara.[2] Dalhana in his commentary on Sushruta Samhita, mentions Mukhapaka as a Pittaja Vikara but Acharya Sushruta has classified Sarvasara Mukharogas (Mukhapaka) into 4 types, i.e., Vataja, Pittaja, Kaphaja and Raktaja.[3] The deteriorated Vatadi Doshas reaches the Mukha to produce Paka and Vrana.

Even through lot of research on the condition with different treatment modalities is undergoing in biomedical world considerable number of world population is suffering from this disease

without satisfactory relief. This arises the need to explore and effective line of management for this disorder.

Ayurveda Achayas mentioned various drugs which are effective as well as affordable for the patients. Among these Triphala Kwatha with Madhu[4] were selected for Mukhadhavan in the management of Mukhapaka.

Objectives of the study

To evaluate the efficacy of Triphala Kwatha with Madhu Mukha Dhavana in the management of Mukhapaka.

Materials and Methods

Source of data

The patients attending the OPD & IPD and patients from various medical camps conducted by Smt. Rajeshwari Karpurmath Ayurveda Medical College, Hospital & P.G. Research Centre, Vijayapura, Karnataka, India.

Criteria for selection of patients

Inclusion Criteria

1. The patients presenting with classical features of Mukhapaka will be selected irrespective of Gender, occupation, religion etc.
2. Patients who are willing to enroll for clinical trial.
3. Patients in the age between 16-70 years.

Exclusion Criteria

1. Patients suffering from any other systemic illness which interfere the duration of course of treatment.
2. Patients suffering from Non-healing ulcers of mouth, malignancy, syphilis, AIDS etc., will be excluded.

Research Design

This is a single-arm clinical trial where 20 patients fulfilling the inclusion criteria of Mukhapaka were selected and evaluated to see the efficacy of Triphala Kwatha with Madhu Mukha Dhavana.

Composition of drug formulation

Collection of drugs

All the raw materials required for the preparation of Triphala Kwatha were purchased from the


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department of Dravya Guna, R K M Ayurveda Medical College and Hospital, Vijayapura.

Preparation of medicine

All drugs were identified and collected. Preparation of medicine was done as per classical methods in the Dept of Rasa Shasthra and Bhaishajya Kalpana of SMVVS’s R.K.M. Ayurvedic Medical College, Hospital and PG Research Centre, Vijayapura, Karnataka.

Table 1: Triphala Kwatha with Madhu

SNDrugsQuantity
1.Triphala Churna1 part
2.Water8 parts
3.Madhu1/8 of Kwatha

Kwatha will be prepared by adding 8 parts of water to 1 part of Triphala Kwatha Churna and reducing to 1/4th by heating on Mandagni.

Posology: As required

Subjective Parameters

  • Pain
  • Burning sensation

Objective Parameters

  • Number of ulcers
  • Size of ulcer
  • Redness.

Gradation Index

Gradation of symptoms

Table 2: Ruja (pain)

No pain0
Mild pain during churning of food1
Moderate pain during talking and gets relief by topical anesthetics2
Several pain even during rest, No relief by topical anesthetics3

Table 3: Daha (burning sensation)

No Daha0
Mild tolerable, no need of cooling agents Like glycerin or cold juice1
Moderate intolerable, Gets relief by cooling agents2
Severe intolerable, no relief by cooling agents3

Table 4: Number of Vrana

No Vrana0
1-5 Vrana1
6-10 Vrana2
More than 103


Table 5: Size of the Vrana

Absence of the Vrana0
Size of the Vrana between 0-5 mm1
Size of the Vrana between 6-10 mm2
Size of the Vrana greater than 10mm3

Table 6: Rakta Varnata (Redness)

No redness0
Dull red or pink red1
Colour of magenta2
Bright red3

Follow up study

After completion of 7 days of course of Mukhadhavan the patient was asked to report for the follow-up once in 7 days for one month period.

Statistical Analysis

On the basis of scoring given to them, the data obtained was subjected to bio-statistical analysis using students ‘t’ test and final inferences were drawn.

Observations and Results

In the present clinical study, it was observed that 10 (50%) patients of Mukhapaka were in the age group of 16-30 years followed by 9 (45%) patients in the age group of 31-45 years and 1 (5%) patient in the age group of 45-60 years. In the present clinical study, it was observed that the 15 subjects (75%) were male and 5 subjects (25%) were female. In the present clinical study, it was observed that 18 (90%) of married patients were suffering from Mukhapaka and 2 (10%) of unmarried were also sufferers. In the present clinical study, it was observed that 17 (85%) of the patients were from the rural area and 3 (15%) of patients were from urban area. In the present clinical study, it was observed that patients belonging to lower class were 12 (60%), middle class were 5 (25%), and upper class were 3 (15%). In the present clinical study, it was observed that Labour and were affected more than other class with 15 (75%) patients.

In present study 14 (70%) patients were taking Ushna, Tikshna and Vidahi Ahara and Dugdha Sevana regularly as well as consuming excessive chilies and spices with about 14 (70%) of patients followed by 9 (45%) patients were taking Alpa, Pramita and Ruksha Ahara. In this series 9 patients


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i.e. (45%) had chewing habit of arecanut, tobacco and its related products while along with these 02 (10%) of patients had smoking habit. Maximum 16 (80%) patients had fewer intakes of fruits and green leafy vegetables in their diet as well as taking curd regularly in their diet. 5 (25%) patients were consuming Ikshuvikara, 2 (10%) were having Amamulaka as well as 2 (10%) Masha supa, while 1 (5%) patient was doing Matsya Sevana.

In 5 (25%) patient Danta Dhavana Dwesha was found. It was observed that 02 patients (7.5%) had the habit of smoking tobacco as shown in the below table. Maximum number of patients was addicted to Tea 17 (85%) patients, followed by addiction to Tobacco 8 (40%) patients & Chewing pan each in 01 (5%) of cases. 70% of the patients had bad oral hygiene. 95% of the patients were vegetarian. 65% patients had reported emotional stress.

Sleep wise distribution shows, maximum 12 (60%) patients were having disturbed sleep whereas 8 (40%) patients had sound sleep. Maximum 15 (75%) patients had regular bowel habit while 5 (25%) patients were having irregular bowel habit. Maximum 9 (45%) patients were having Mandagni, followed by 7 (35%) of patients having Vishamagni and 4 (20%) were having Samagni. Maximum patients had Mrudu Koshta with an incidence of 50% in the present study. Maximum patients i.e., 17 (85%) had Sama Jihva was noted and in rest there was Nirama Jihva.

It was observed in the clinical trial that 9 patients (45%) were Vata Pittaja Prakruthi and 8 patients (40%) were Kapha-Pitta Prakruthi.

Effect of therapy on Subjective Parameters of Mukhapaka

Table 7: Effect of Triphala Kwatha and Madhu Dhavana on Pain

SNDataMean%S.DS.ETP
BTAT
1.AT1.950.574.350.36570.135210.7214<0.001
2.AFU11.950.574.350.36570.135210.7214<0.001
3AFU21.950.669.230.34470.131210.2823<0.001
4AFU31.950.669.230.34470.131210.2823<0.001
5AFU41.950.669.230.34470.131210.2823<0.001

On analyzing the data it was found that the treatment provided 74.35% and 69.23% of relief after treatment (AT) and AFU respectively on the parameter Pain

On statistical analysis Triphala Kwatha and Madhu Dhavana proved to be highly significant (< 0.001) after treatment (AT) and AFU respectively on the parameter Pain

Table 8: Effect of Triphala Kwatha and Madhu Dhavana on Daha

SNDataMean%S.DS.ETP
BTAT
1.AT1.850.478.370.36570.135210.7214<0.001
2.AFU11.850.478.370.36570.135210.7214<0.001
3AFU21.850.4575.670.35780.133710.4653<0.001
4AFU31.850.572.970.34470.131210.2823<0.001
5AFU41.850.572.970.34470.131210.2823<0.001

On analyzing the data it was found that treatment provided 78.37% and 72.97% of relief after treatment (AT) and AFU respectively on the parameter Daha.

On statistical analysis Triphala Kwatha and Madhu Dhavana proved to be highly significant (< 0.001) after treatment (AT) and AFU on the parameter Daha.

Table 9: Effect of Triphala Kwatha and Madhu Dhavana on number of ulceration

SNDataMean%S.DS.ETP
BTAT
1.AT1.850.3581.080.47360.15399.7464< 0.001
2.AFU11.850.478.370.47100.15349.4478< 0.001
3.AFU21.850.4575.670.46310.15219.1995< 0.001
4.AFU31.850.4575.670.46310.15219.1995< 0.001
5.AFU41.850.4575.670.46310.15219.1995< 0.001

On analyzing the data it was found that treatment provided 81.08% and 75.67% of relief after treatment (AT) and AFU respectively on the parameter Number of ulceration.

On statistical analysis Triphala Kwatha and Madhu Dhavana proved to be highly significant (< 0.001) after treatment (AT) and AFU on the parameter Number of ulceration.

Table 10: Effect of Triphala Kwatha and Madhu Dhavana on Size of ulceration

SNData Mean%S.DS.ETP
BTAT
1.AT1.850.3580.550.47100.15349.4478< 0.001
2.AFU11.850.477.70.56840.16858.3041< 0.001
3.AFU21.850.45750.450.15008.9997< 0.001
4.AFU31.850.45750.450.15008.9997< 0.001
5.AFU41.850.45750.450.15008.9997< 0.001

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On analyzing the data, it was found that treatment provided 80.55% and 75% of relief after treatment (AT) and AFU respectively on the parameter Size of ulceration.

On statistical analysis Triphala Kwatha and Madhu Dhavana proved to be highly significant (< 0.001) after treatment (AT) and AFU on the parameter Size of ulceration.

Table 11: Effect of Triphala Kwatha and Madhu Dhavana on Colour of ulceration

SNDataMean%S.DS.ETP
BTAT
1.AT1.70.3579.410.450.15008.9997< 0.001
2.AFU11.70.3579.410.450.15008.9997< 0.001
3.AFU21.70.3579.410.450.15008.9997< 0.001
4.AFU31.70.476.470.43150.14698.8494< 0.001
5.AFU41.70.476.470.43150.14698.8494< 0.001

On analyzing the data, it was found that treatment provided 79.41% and 76.47% of relief after treatment (AT) and AFU respectively on the parameter Colour of ulceration.

On statistical analysis Triphala Kwatha and Madhu Dhavana proved to be highly significant (< 0.001) after treatment (AT) and AFU on the parameter Colour of ulceration.

Discussion

The study was carried out in the patients of Mukhapaka. Sample size of the study was 20. Patients were subjected to Triphala Kwath with Madhu Mukhadhavana for a duration of 7 days.

Discussion on Drug

As per Ashtanga Samgraha, Mukhapaka is mentioned as Pitta Dosha Roga and Susrutha Samhitha is mentioned as Pitta Kapha Dosha Vyadhi. Here both Triphala Kwatha and Madhu and Jati Patra Kwatha are basic formulated as Kwatha base. The drugs used are Vranahara in action.

Triphala Kwatha and Madhu is a combination widely used in treatment of Mukhapaka and it is acts as Tridoshaghna and Vrana Shodhana, Ropana. These drugs are used as a Shodhana as well as Shamana actions. Honey is having the property of Yogavahi so it takes the goodness of the medicine to the desired target organ. Jati Patra Kwatha is a combination used in Mukhapaka. It is having Tikta Kasaya Rasa, Kaphapitta Shamana, Vranahara property.

Discussion on observation

Data related to age incidence

In the present clinical study, it was observed that majority of the 10 patients of Mukhapaka were in the age group of 16-30 years with an incidence of 50% followed by 9 patients in the age group of 31-45 years with an incidence of 45%.

Data related to Gender present clinical study it was observed that the 15 subjects (75%) were male and 05 subjects (25%)

Data related to marital status

In the present clinical study it was observed that 90% of married patients were suffering from Mukhapaka and 10% of unmarried were also sufferers.

Data related to Habitat

In the present clinical study it was observed that 85% of the patients were from the rural area and 15% of patients were from urban area.

Data related to socio-economic status

In the present clinical study it was observed that patients belonging to lower class were 60%, middle class were 25% and upper class were 15%.

Data related to Occupation

In the present clinical study it was observed that Labour were affected more than other class with 75%

Incidence of Nidana

70% patients were taking Ushna, Tikshna and Vidahi Ahara and Dugdha Sevana regularly as well as consuming excessive chilies and spices with about 70% of patients followed by 45% was taking Alpa, Pramita and Ruksha Ahara.

In this series 45% patients had chewing habit of arecanut, tobacco and its related products while along with these 10% of patients had smoking habit.

Maximum 80% patient had fewer intakes of fruits and green leafy vegetables in their diet as well as taking curd regularly in their diet.

25% were having Ikshuvikara, 10% were having Amamulaka as well as 10% Masha supa while 5% were having Matsya Sevana. In 25% patient Danta Dhavana Dwesha was found.


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Data related to Addiction

In the present clinical study it was observed that 02 patients (7.5%) had the habit of smoking tobacco. Maximum number of patients was addicted to Tea (85%), followed by addiction to Tobacco (40%) & Chewing pan each in 5% of cases.

Oral Hygiene

Oral hygiene distribution shows that in maximum i.e., 70% patients’ oral hygiene was poor and in rest of the patients it was fair.

Data related to Diet

Regarding personal history it was observed that maximum patients were taking vegetarian diet i.e. 95%

Emotional stress wise

35% patient had no emotion stress while 65% patients had reported emotional stress.

Sleep wise

Maximum 60% patients were having disturbed sleep where as 40% patients had of sound sleep.

Bowel habits

Maximum 75 % patients had regular bowel habit while 25% patients were having irregular bowel habit

Agni Bala

Maximum 45% patients were having Mandagni, followed by 35% of patients having Vishamagni and 20% were having Samagni.

Data related to Koshta

It was observed in the clinical trial that maximum patients had Mrudu Koshta with an incidence of 50% in the present study.

Jihva wise

Maximum patients i.e., 85% Sama Jihva was noted and in rest there was Nirama jihva.

Data related to Prakruthi

It was observed in the clinical trial that 9 patients (45%) were Vata Pittaja Prakruthi and 8 patients (40%) were Kapha-Pitta Prakruthi.


Conclusion

Triphala Kwatha with Madhu Mukhadhavana shows decrease in the severity of symptoms of Mukhapaka. There might be fluctuation of results because of small sample size. Mukhadhavan is cost effective and can be practiced at OPD basis. The study can be conducted for large sample size to get accurate result.

References

1. Shulman JD. Prevalence of oral mucosal lesions in children and youths in the USA. Int J Paediatr Dent. 2005;15(2):89–97. https://doi.org/10.1111/j.1365-263X.2005.00632.x.

2. Pandey Kashinath, Chaturvedi Gorakhnath. Charaka Samhita with Vidyotini Hindi commentary. Vol.-1. Varanasi; Chaukhambha Bharati Academy; Reprint 2019. Sutrasthana 20/14. p.403.

3. Shastri Ambikadutt. Sushruta Samhita Edited with Ayurveda Tatva Sandipika Hindi commentary. Vol.-1. Varanasi; Chaukhambha Sanskrit Sansthan; Reprint 2019. Nidanasthana 16/66.p.391.

4. Gupta Atridev. Ashtangahridayam Edited with Vidyotini Hindi commentary. Varanasi; Chaukhambha Prakashan; Reprint 2019. Uttartantra 22/75. p.721.


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