E-ISSN:2456-3110

Research Article

Kavala Dharana

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 10 October
Publisherwww.maharshicharaka.in

Comparative study on efficacy of Kavala Dharana with Godugdha and Goghrita in management of Mukhapaka

Patil M1*, Nagur K2
DOI:10.21760/jaims.8.10.4

1* Manjula Patil, Post Graduate Scholar, Dept Of Swasthavritta, Dr Bnm Rural Ayurvedic Medical College, Vijayapur, Karnataka, India.

2 KB Nagur, HOD, Dept of Swasthavritta, Dr BNM Rural Ayurvedic Medical College, Vijayapur, Karnataka, India.

Mukhapaka is affected to particular age, socioeconomic status, improper food habits and life style. Here control over Pittadosha is the very first step. There is a need to find out a simple, cost effective, economical, reliable and most suitable therapy by which one can give good results on disease. Godugdha & Gogritha is best Vranaropaka and due to its Guna, it cures Mukhapaka. In present era people are interested towards Ayurveda, which is most effective and reliable. Hence the present work was undertaken “Comparative study on efficacy Kavala Dharana with Godugdha and Goghrita in management of Mukhapaka”. Objectives: To compare the efficacy of Godugdha and Goghruta Kavala Dharana in the management of Mukhapaka. Conclusion: Goghrita Kavala has shown better effect than Godugha during subsequent fallow up with very minimal recurrence rate was found.

Keywords: Dinacharya, Kavala, Mukhapaka, Godugdha, Goghrita

Corresponding Author How to Cite this Article To Browse
Manjula Patil, Post Graduate Scholar, Dept Of Swasthavritta, Dr Bnm Rural Ayurvedic Medical College, Vijayapur, Karnataka, India.
Email: 		Patil M, Nagur K, Comparative study on efficacy of Kavala Dharana with Godugdha and Goghrita in management of Mukhapaka. J Ayu Int Med Sci. 2023;8(10):28-33.
Available From
https://jaims.in/jaims/article/view/2817

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-08-11 2023-08-22 2023-09-01 2023-09-11 2023-09-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 23.56

© 2023by Patil M, Nagur Kand 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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Manjula Patil et al. Efficacy of Kavala Dharana with Godugdha and Goghrita in Mukhapaka

Introduction

Ayurveda is an ancient science derived from “Vedas”. Ayurveda is given by Bramha to mankind to teach them properly the manner of living in world by preventing & curing disease. The ancient science is said to be ‘Divya’. Anadi, Nitya, Shashwat etc. because of its own unchanged principles Ayurveda is a holistic healing science. It comprises of both practical & scientific information. On various subjects beneficial to mankind like health, philosophy, astrology & engineering. Ayurveda is science dealing not only with treatment of disease but is also a complete way of life. The aim of Ayurveda is to give complete health & not just getting free from physical disease. Ayurveda treatments don’t suppress the main symptom & create new ones as side effects of the main treatment. It is to remove the root cause & give permanent relief. The treatment mainly comprises of powders, tablets, decoctions, medicated oils etc. prepared from natural herbs, plants & minerals. We are thousands year away from the time when Ayurveda was practiced uniquely. The Siddhanta’s of this science then & now are the same. These Siddhanta’s are too revised in the context of modern lifestyle. To maintain the health of healthy person is main the main goal of Swasthavritta. The branch parallel to Swasthavritta is ‘Preventive & Social Medicine (PSM) which is now considered to be one of the important branches in the modern medicine. Swasthavritta mainly emphasizes on following a proper routine regime as well as seasonal regime. Daily regime stresses on day-to-day instructions like morning, routine, basic cleanliness, natural urges, evening routine etc. There are some principles which are mentioned in old classical, texts are ‘Dincharya’ Upakrama. By following rules of Dinacharya. We can take care of Indriya i.e., Sensory organs & keep them clean, so they can do their function normally Dantadhavan, Nasya, Gandoosha, Kavala[1] and Anjana are some of the Upakrama’s described in Dinacharya.[2] Now a days as life style are changed everyone is trying to live western style. In today modern & fastmoving hectic life style common man has no time to take care of his health. Many bad habits are developed in human being. Some of them alcohol, smoking, gutkha chewing, soft drink etc. Due to busy & hectic schedule oral hygiene is neglected ultimately leads to Mukhapaka.[3] To maintain oral hygiene

Ayurveda describe Kavala & Gandoosh Upkrama in Dincharya.

Kavala is defined as holding medicated decoction or Semisolids in the mouth in such a quantity so that it could be moving in the mouth.[4] Advantages of Godugdha and Goghrita are described in old text Bhavaprakasha Nighatu. Due to oral hygiene neglected so many people are approaching from treatment for complaining Mukhapaka[5] recurrently. Ayurveda Acharyas mentioned various Dravyas which are effective as well as affordable for patients. As Godugdha[6] and Goghruta[7] are easily available any were and also it is having Ropana quality. So, this topic was selected to evaluate the efficacy of Godugdha and Goghrita kavaladhrana in Mukhapaka.

Objective of the study

1. To study the Kavala, Mukhapaka in detail.
2. To study the effect of Godugdha & Goghrutha Kavala Dharana in detail.
3. To compare the efficacy of Godugdha and Goghruta Kavala Dharana in the management of Mukhapaka.

Materials and Methods

Source of data

Literary Source from Classical books of Ayurveda and Modern Science. Articles from Periodicals, Journals, Dissertation and other Published and Unpublished works. Related Sources of the data from the website.

Clinical Sources

Mukhapaka patients were selected by Random sampling method from OPD, IPD and Camps conducted in College and Hospital.

Materials

Godugdha & Goghritha was selected for Kavala as mentioned in Sushruta Samhita[8]

Drugs: 1. Godugdha 2. Goghrita

Composition of drug: Only Godugdha & Goghrita was used for present study.

Dose: 30ml

Time: Morning (after Dantadhavana)

Procedure:


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Poorvakarma: The individual was made to sit comfortably in a room devoid of breeze and dust. Mild massage and fomentation was given to the shoulder neck, throat and forehead.

Pradhankarma: Individual was asked to keep his face slightly lifted up and advised to hold Godugdha or Goghrita allowing movements of Dravya inside the mouth till the secretion occur in mouth, nose and eyes.

Paschatkarma: After spitting out the contents, mouth was cleaned with lukewarm water.

Methods of collection of data: Diagnosed patients of Mukhapaka will be selected with respective of age above 5 years. Irrespective of sex, occupation, socio economic status from OPD and Camps conducted in college and hospital. The sample size will be 30 (minimum) excluding dropouts.

Study design

The sample of 30 patients of Mukhapaka will be randomly divided into the following two groups.

Group A: 15patients of this group will be advised for Godugdha Kavala Dharana in the morning.

Group B: 15 patients of this group will be advised for Goghrita Kavala Dharana in the morning.

Study duration: Total duration: 30 days.

Treatment duration: Treatment will be performed for 15 days.

Follow up study: 1st follow up: On the last day of treatment i.e., on 15 days.

2nd follow up: After 15 days of treatment i.e., on 30th day.

Parameters of the study

Subjective parameters

1. Daha
2. Ruja
3. Spotha

Objective Parameters

Spotha (numbers of ulcers)

Inclusive Criteria

1. Patients with Lakshanas

of Mukhapaka were selected.
2. Patients of age above 5 yrs were selected.[12]
3. Patients of both genders were included irrespective of their religion & caste.
4. Patients fit for Kavaladharana were selected.

Exclusive Criteria

1. Patients of below 5 years of age were excluded.
2. Patients suffering from any systemic disorders were excluded.
3. Patients suffering from CA of oral cavity, toothache were excluded.
4. Patients unfit for Kavala dharana were excluded.

Assessment Criteria

1. Daha
2. Ruja
3. Sphota

Symptoms are taken as parameters for the assessment & gradation. The observations were noted from time to time of every user in research as well as group A and group B. This categorized information is prepared & presented statistically to subject to the critical analysis. After analyzing the information, we are going to make an effort to draw better conclusions regarding the facts mentioned above in the aims & objectives of this clinical study. All the symptoms were assesses using scoring pattern.

Score grading

0 : No Symptom

1 : Mild degree

2 : Moderate degree

3 : Sever degree

Assessment Variables

Clinical assessment was made for the severity of the disease and for clinical improvement. Grading for the severity of individual symptoms was framed as variables on the basis of guidelines of 3 the management. The grading of 4 variables is given along with clinical proforma specially designed for the study on Mukhapaka. The severity of each variables ranging from Normal (1), Mild (2), Moderate (3) and Severe (4).

Assessment of clinical improvement

Clinical improvement of the disease was based


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on the improvement in, reduction in severity of the symptoms & overall severity of disease.

Statistical Analysis

The data were collected from both Groups. Before, in between the treatment, after treatment and post follow up. They are statistically analyzed by using unpaired student’s ‘t’ test in consultation with Biostatistician.

Observations and Results

In the present study 30 patients suffering from Mukhapaka, fulfilling inclusion criteria were taken for clinical study. Patients were randomly categorized under following groups.

Group A - Godugdha - 15 patients.

Group B - Goghrita - 15 patients.

Table 1: Showing the different degree of assessment criteria after follow-up.

SNAssessment CriteriaGroup- A
NRG1%MLDG2%MDRG3%SVRG4%
1.Ruja213.33853.33----
2.Daha0426.66426.66----
3.Sphota0746.660213.33----

Table 2: Showing the different degree of assessment criteria after follow-up:

SNAssessment CriteriaGroup- B
NRG1%MLDG2%MDRG3%SVRG4%
1.Ruja0533.330853.33----
2.Daha0213.330213.33----
3.Sphota03200320----

Statistical analysis of Group A

ParametersBT Mean±SEFollow upAT Mean±SEDft- value%p-valueRemarks
Ruja1.93±0.12AT1.00±0.141414.000048.27<0.0001HS
AF0.53±0.1310.692772.41<0.0001HS
Daha1.07±0.23AT0.73±0.15142.645831.25=0.0192SS
AF0.27±0.124.582675=0.0004HS
Sphota0.93±0.18AT0.60±0.13142.645835.71=0.0192SS
AF0.13±0.094.582685.71=0.0004HS

Statistical analysis of Group B

ParametersBT Mean±SEFollow upAT Mean±SEDft- value%p-valueRemarks
Ruja1.80±0.17AT1.07±0.12146.204840.74<0.0001HS
AF0.53±0.135.551370.37<0.0001HS
Daha1.27±0.21AT0.47±0.13144.000063.15=0.0013HS
AF0.13±0.095.905978.94<0.0001HS
Sphota0.93±0.18AT0.47±0.13142.824350=0.0135SS
AF0.20±0.114.035985.71=0.0012HS

In between Group - A v/s Group - B

ParametersTreatmentGroup AMean±SEGroup BMean±SEDft- valuep-valueRemarks
RujaAT1.00±0.141.07±0.12280.7165=0.1051NS
AF0.53±0.130.53±0.13280.0000=1.0000NS
DahaAT0.73±0.150.47±0.13281.3127=0.2000NS
AF0.27±0.120.13±0.09280.8944=0.3787NS
SphotaAT0.60±0.130.47±0.13280.7135=0.4814NS
AF0.13±0.090.20±0.11280.4752=0.6383NS

Overall result of Group A

ParametersBTMean±SEATMean±SEdft- value%p-valueRemarks
Overall Parameters3.93±0.443.27±0.52142.869716.94=0.0124SS

Overall result of Group B

ParametersBTMean±SEATMean±SEdft- value%p-valueRemarks
Overall Parameters4.00±0.452.87±0.46142.915528.33=0.0113SS

Discussion

Kavala is among the Ayurvedic theories explained in Dinacharya which has been attributed not only as promoter of oral hygiene but also taken as an Upakrama in the management of Mukhagata Rogas.[8]


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Regular practice of Kavala will exert cleansing action and promotes the defense mechanism in oral cavity thus prevents oral disorders. It is true fact that if a person does not follow the rules of oral hygiene has an important role in the maintenance of body health. It is believed that the nature provides both the disease and the drug together and gave concept of protection, restoration and regeneration of health. Ayurveda being a nature remedy gave concept of Kavala in the Mukhapaka Roga for protection restoration and regeneration of oral health. So, efficacy of Kavala has been taken for clinical study. Mukhapaka is the Sarvasaramukhagataroga which is due to the vitiation of Vata, Pitta, Kapha and Rakta. The Sarvasara manifested by the vitiation of Pitta and Rakta is known as Mukhapaka having the symptoms of Daha, Alparuja and yellow or red Sphota in the Mukha.[9] Acharya Vagbhata explained that the vitiated Vatadosha in the Mukha leads to the Vrana all over the Mukha,[10] these Vrana and Ruksha, are red in color called as Mukhapaka. There is great necessity to find an effective and economical mode of treatment method. So, to see the effect of these procedures Kavala Dharana in disease Mukhapaka which is the most common problem caused by improper food habits, the study was undertaken with title entitled Comparative study on efficacy of Kavala Dharana with Godudhga and Goghrita in the management of Mukhapaka.

Kavala is one of Kriya Kalpa procedure explained in classics. It is explained under the context of daily regimen as well as part of treatment. Kavala is routine process of filling the mouth with liquid which helps to maintain the oral health. It is also an Upakrama for Mukhapaka for Mukharoga. So, it is having preventive and curative effect. From the definition of Kavala it reveals that Kavala the process of holding any medicated liquid like Kwath, Swarasa, Madhu, Ghrita, Taila, Gomutra, Ushnodaka etc. in mouth fill half and do movement until tears and nasal watering starts and then asked to split out. The classification of Kavala is mainly based on its Karma i.e., Snaihika, Shamana, Shodhana and Ropana Kavala which is useful in Vataja Mukharoga, Pittaja Mukharoga, Kaphaja Mukharoga and Mukhagata Vrana respectively.

General mode of action of Kavala

Even though Kavala is Sthanika Chikitsa its action can be understood as both

1. Local action
2. Systemic action

Local action[11]

Kavala has many actions locally they are as follows. Increase local defense mechanism. Enhancing both mechanical and chemical digestion of food that starts in Mouth. Removing of metabolic waste (urea and uric acid), Soothing effect strengthening of muscles of oral cavity. The action of Kavala exerts increased mechanical pressure inside the oral cavity. So, this increased stimulate pressoreceptor (stretch reflex) that are present in mouth. Once the pressoreceptor is stimulated they send signals to salivary nuclei in the brain stem (pons and medulla). As a result, para sympathetic nervous system activity increases and motor fiber in facial (VII) and glossopharyngial (IX) nerve trigger dramatically increased output of saliva chemical constituent present in the drug also stimulate chemoreceptor present in mouth, which in turn increases salivary secretions. An enzyme called lysosome present in saliva is bacteriostatic in action. It will not allow for growth of pathogenic microorganisms in the oral cavity, Antibody IgA present in saliva also provide protection against microorganisms. Thus, Kavala increases local defense mechanism. The enzyme salivary amylase present in saliva and lingual lipase secreted by the lingual gland present at the dorsum of togue initiates digestion of carbohydrate and fats respectively. Kavala increases secretions of the enzymes. Excessive salivary secretion, which predominantly contains water, removes metabolic wastes present in oral cavity. Some of Dravyas used for Kavala like Panchavalkala produces soothing effect on lesions like ulcers thus prevents ulcers from physical and chemical injury. The act of Kavala and Gandusha gives proper exercise to the muscles of cheeks tongue, lips and soft palate there by increasing the motor functions of these muscles

Systematic action[12]

Mucosal layer inferior to tongue (sublingual) is thin and highly vascular enough to permit the rapid absorption of lipid soluble drugs into systematic circulation. Some of drugs irritates the oral mucosa (by their chemical nature) and increase cellular permeability. Thus, an active principle of Dravya gets absorption in systematic circulation. Most of the Dravas (Kwatha) given for Gandusha


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thereby enhancing systematic absorption of and are warm (Sukhoshna) so raised temperature causes the increased vascular permeability there by enhancing systematic absorption of drugs.

Conclusion

Kavala is one among the Dinacharya which has been attributed not only as promoter of oral hygiene but also taken as an Upakrama in the management of Mukhapaka. The disease Mukhapaka can be correlated with disease stomatitis. Nidana Parivarjana plays a vital role in preventing the disease Mukhapaka. Godugdha Kavala has shown significant result in management of Mukhapaka. Goghrita Kavala has shown significant results in management of Mukhapaka. Goghrita Kavala has shown better effect than Godugha during subsequent follow up with very minimal recurrence rate was found.

References

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4. Vriddavagbhata. Astanga Sangraha. Edited by Shivaprasad Sharma. Varanasi: Chowkambha Sanskrit Series; 2006. Chapter 30, Verse 43, p. 41.

5. Astanga Hridayam Sutrasthana by K.R. Srikntmurthy, Chaukhamba Sanskrit Sansthana, Varanasi. Reprint 2004.

6. Bhavaprakasha. Bhavamishra. Translated by Prof. K.R. Shrikantamurthy. Varanasi: Krisnadas Academy; 2000. Chapter 6, Verse 18, p. 472.

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8. Susrata Samhita chikitsasthana edited by Kaviraj Ambikadutta Shastri part-2, Chaukhamba Sanskrit Sansthana, Varanasi. Reprint 2004.

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10. Sarangadhara Samhita. Editor – Sri Dayas Ankara Pandeya. Chaukhamba Amarabharati Prakashan, Varanasi. 7th Edition, 1988.

11. Human Anatomy – Volume Three by B.D. Chaurasia. 2nd Edition, 1993. Publisher: S.K. Jain, Delhi.

12. A Manual of Clinical Surgery by Dr. Somen Das. 4th Edition, 1996. Publisher: Dr. S. Das.

13. Vriddavagbhata. Astanga Sangraha. Edited by Dr. Shivaprasad Sharma. Varanasi: Chowkambha Sanskrit Series; 2006. Chapter 6, Verse 43, p. 41.


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