“a comparative clinical study to evaluate the …
TRANSCRIPT
“A COMPARATIVE CLINICAL STUDY TO EVALUATE THE EFFICACY OF
BHARANGYADI KALKA AND SHUDDHA HINGU IN THE MANAGEMENT
OF SUTIKA MAKKALLAW.R.T PUERPERAL AFTER PAINS”
BY
DR. BORADEVI HUNGUND B.A.M.S
DISSERTATION SUBMITTED TO
THE RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,
BENGALURU
IN THE PARTIAL FULFILMENT FOR THE DEGREE OF
AYURVEDA DHANVANTARI
M.S. (PRASUTI TANTRA EVUM STREE ROGA)
Under the guidance of
DR. SHOBHA B. NADAGOUDA M.S (AYU)
Professor & HOD
Dept. of PG Studies in PTSR, S.V.M.A.M.C, IIkal
Department of Post Graduate studies in PTSR
Shri. VijayMahanteshAyurvedicMedicalCollege
IIKal -587125
2016-2018
RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BENGALURU
ABBREVATIONS
A.H. AshtangaHridaya
A.S.: AshtangaSangraha
Bhe.Sa: BhelaSamhita
Bha.Pr: Bhavaprakasha
B.R. BhaisajyaRatnavali
Cha.Sa: CharakaSamhita
C.D. Chakradatta
Chi : ChikitsaSthana
Dal : Dalhana
Ha.Sa. : HaritaSamhita
Ka.Sa: KashyapaSamhita
Ma.Kh : Madhyamakhanda
Ma. Ni: MadhavaNidana
Ni : NidanaSthana
Pu.kh PoorvaKhanda
Ut.Kh: Uttarakhanda
Sha.Sa : SharangdharaSamhita
Sha : ShareeraSthana
Su: Sutra Shthana
YR : Yogaratnakara
List of Tables
Table
No
Topic of the table Page No
1 Haematological Values in puerperium 27
2 Composition of colostrums and breast milk 32
3 Drugs of Bharangyadikalka 53
4 Drugs of ShuddhaHingu 53
5 Bharangyadi Kalka 60
6 Age distrubution in two groups studied 66
7 Eductiondistrubution in two groups studied 67
8 Occuptiondistrubution in two groups studied 68
9 Scoial status distrubution in two groups studied 69
10 Religion distrubution in two groups studied 70
11 Obstetric History distrubution in two groups studied 71
12 Diet distrubution in two groups studied 72
13 Prakrutidistrubution in two groups studied 73
14 UDARA SHOOLA. Assement in different time points of
patients in two groups studied
74
15 UDARA SHOOLA. Assement in different time points of
patients in two groups studied
76
16 STANYA PRAVARTANA. Assement in different time points
of patients in two groups studied
77
17 STANYA PRAVARTANA. Assement in different time points
of patients in two groups studied
79
18 INVOLUTION OF UTERUS Assement in different time points
of patients in two groups studied
80
19 INVOLUTION OF UTERUS Assement in different time points
of patients in two groups studied
82
20 LOCHIA. Assement in different time points of patients in two
groups studied
83
21 LOCHIA. Assement in different time points of patients in two
groups studied
85
List of Graphs
Table
No
Topic of the Graphs Page No
1 Age distrubution in two groups studied 66
2 Eductiondistrubution in two groups studied 67
3 Occuptiondistrubution in two groups studied 68
4 Scoial status distrubution in two groups studied 69
5 Religion distrubution in two groups studied 70
6 Obstetric History distrubution in two groups studied 71
7 Diet distrubution in two groups studied 72
8 Prakrutidistrubution in two groups studied 73
9 UDARA SHOOLA. Assement in different time points of
patients in two groups studied
75
10 UDARA SHOOLA. Assement in different time points of
patients in two groups studied
76
11 STANYA PRAVARTANA. Assement in different time points
of patients in two groups studied
78
12 STANYA PRAVARTANA. Assement in different time points
of patients in two groups studied
79
13 INVOLUTION OF UTERUS Assement in different time points
of patients in two groups studied
81
14 INVOLUTION OF UTERUS Assement in different time points
of patients in two groups studied
82
15 LOCHIA. Assement in different time points of patients in two
groups studied
84
16 LOCHIA. Assement in different time points of patients in two
groups studied
85
Abstract
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha hingu in the management of Sutika Makkalla w.r.t puerperal after pains
ABSTRACT
Title:-“A Comparative clinical study to evaluate the efficacy of Bharangyadi Kalka
And Shuddha Hingu in the management of Sutika Makkalla W.R.T Puerperal After
Pains”
Sutika Makkalla, the post delivery complication frequently occurring in
women, is assocatied with accumulation of blood in the uterus due to various reasons.
The drugs Bharangyadi Kalka and Shuddha Hingu is used for the treatment of this
condition.The drugs Bharangyadi Kalka and Shuddha Hingu are having properties
like garbhashaya shodhaka, sula prasamana, rakta shodhaka, vatakapha hara, vedana
sthapana, anulomanan, deepana, pacana, stanya shodhaka, shotha hara etc. The same
are the desired effects of the study .
INTRODUCTION
Post delivery complication of Sutika Makkalla have been described in Sushrut Sharir
Adhyay 10(1).
After delivery the blood doesnot flow out but returns due to dhatukshinata,
vayu prakropa, dryness of the body or due to non availability of drugs required for
shodhan done after delivery or retains in the uterus after delivery due to obstructed
pathway.
This results in uterus getting streched due to haematoma causing, severe,
discomfort, pain below umbilical and bladder region, abdomen and cardiac region. At
times the pain is so severe that a pricking sensation with possibility of tearing of
bowel or its perforation. These are associated with flatulence and retention of urine.
This condition is generally referred to as the Makkalla, some times this accumulated
blood gets infected with virus and abscess can also formed.
Treatment of Sutika Makkalla by use of Bharangyadi Kalka and Shudha
Hingu is described in Ashtanga Samgraha 3 chapter 34-35 and in yogaratnakar
Sutikaroaga adhikara Makkalla Chikitsa Sholka No. 8 respectively.
Ayurveda describes these drugs used having Vedanastapana Garbhashaya
Shodhana, Sulaparsama, Rakta shodhna, Vatahara Anulomana etc., due to these
properties the drugs are used in this study
Abstract
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha hingu in the management of Sutika Makkalla w.r.t puerperal after pains
MATERIALS & METHODS
The dry powders of Bharangi, Nagara, Devadaru was collected from local
markets whereas Hingu was collected from local area.
Prepartion of Kalka
All the drugs in dry powder were sieved through cotton cloth and fine powder
was obtained and Kalka was prepared as per classics freshly and given to the patient
whereas Hingu was made into powder form after frying it in ghee and was
administered to the patient with warm water.
SELECTION OF PATIENT
30 patient of Makkalla was selected for study from among the IPD of PTSR,
patient having undergone normal deliveries was considered for the trial with different
age groups, parity avoiding the patient with C.Section, assisted deliveries,
hypertension, D.M, PPH etc.,
Selected patient were divided into 2 groups of 15 patient each. Group A
patients were given Bharangyadi Kallka 6 grams bd for 5 days on empty stomach and
15 patients were administered shudha Hingu with ghee 125 mg X 5 days
RESULTS AND DISSCUCION
The given drugs in both groups showed good result in the pain parameter with
Shuddha Hingu showing better results as compared to Bharangyadi Kalka.
There was no significant results in the other parameter included in the study
but also no undue complications was seen in the study period.
Both the drug groups showed good improvement in increasing the bala of the
sutika thus favoured other parameters as may be physiological and can be advised in
sutika for the said parameter.
Key words : Sutika, Makkalla, Bharanagaydi kalka, shudha Hingu, After pains
Introduction
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 1
INTRODUCTION
Ayurveda the science of life which exists since the creation of life has also
given due consideration about the specific epochs of women life. The phase of
pregnancy and child birth is not as simple and easy as it seems. The different
avastha like garibhini avastha, sutika avastha etc., have been clearly mentioned in
our classics by our acharyas.
In Ayurveda the women after delivery is called as Sutika6. The sutika avastha
(puerperium) has got certain time period which varies accordingly to different
authors, Sutika Paricharya and diseases which occur in sutika and its management
have been mentioned in our Ayurvedic texts12
.Pathya apathya aahara taken during
puerperium ends up with many complications, one among them is sutika makkalla.
and it is well explained in our classics.
If the women whose body becomes dry after delivery and is not treated with
teekshna dravya, the vata in the uterus obstructs the flow of blood causing makkalla.
Sutika avastha in Ayurveda can be compared to puerperium in Modern science
is the period of reverting back the pregnant state to non-pregnant state8.
According to modern science, puerperium after pains is the infrequent
spasmodic pain felt in the lower abdomen after delivery for a variable period of 4-5
days. Presence of blood clots or bits of the after birth leads to hypertonic contraction
of the uterus in an attempt to expel it out8.Prevalance rate – 40 to 50% of normal
delivery.
After pains are those pians when the body works hard to get recovered by the
presence of uterine contractions serve the important functions of clamping of open
blood vessels at the placenta site, minimizing the loss of blood after birth.
To overcome the frequent post partum morbidity and its association and
adverse perinatal out come and also to promote a healthy puerperium i.e. maternal
health so as to resume her normal activities as soon as possible, so the management
of sutika is essential to avoid causalties, occurrence of infections and various
disorders prone to in the period.
Introduction
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 2
In such painful condition, even after giving analgesics and antispasmodics,
the pain may not subside. So to see the effect of the mentioned drugs, as those drugs
are cost effective. With this view the clinical study entitled
“A CLINICAL STUDY TO EVALUATE THE EFFICACY OF
BHARANGYADI KALKA AND SHUDDHA HINGU IN SUTIKA
MAKKALLA.”
Objectives
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 3
OBJECTIVES OF STUDY
1] To study and understand Sutika makkalla sula in detail with Ayurvedic and
modern references.
2] To evaluate the efficacy of Bharangyadi kalka in sutika makkalla.
3] To evaluate the efficacy of Shuddha Hingu in sutika makkalla.
4] To study comparative efficacy of Bharangyadi kalka and
Shuddha Hingu in sutika makkalla.
Review of Literature
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 4
HISTORICAL REVIEW
The ancient medical system of India which dates back has explored all branches
of present existing medical science in the form of Astangas.
First documentation regarding Sutika was seen in the Samhita Kala
Vedic period
Entire vedic literature is full of ideas and facts relating to prasoothi tantra and
stree roga which guided the development of the subjects in post vedic era.
Samhita Kala
First and foremost complete documentation regarding sutika was seen in
Samhita Kala. Description regarding Suthika paribhasha, Kala, Paricharya and vyadhi
is available in all the Grantha of Bruhatrayee and laghutrayee.
Sushruta Samhita 1
Explanation regarding the Nidana, Lakshana and chikitsa of sutika Makkalla is
dealt in Sharira Sthana 10th
chapter
Charaka Samhita 62
An elaborate explanation of Suthikagara, Sutika Kala, Parichaya, Nidana,
Kricha Sadhyatwa of suthika roga is available in sharira sthana.
Astanga Sangraha 2
In sharira stana, 3rd chapter the symptoms of Makkalla sula and chikitsa is
described
Madhava Nidana of Madhavkara 4
There is mention of Nidana and Lakshana of Makkalla Sula .
Bhavprakash 9
In chikitsa sthana chapter 70 there is mention about Nidana, Samprati and
lakshana of Makkalla sula .
Review of Literature
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 5
Yogaratnakar10
In stree Roga Adhikar chikitsa sthana, the chikitsa of Makkalla sula with
shuddha Hingu is mentioned, and description regarding sutika is available
Kashyapa samhita 12
Elaborate explanation of Sutika paricharya according to desha and jaati is
found, a list of suthika vyadhi are also explained with treatment
History of puerperium
In olden days the power of women was considered in the form of Goddess and
lady was considered as Bearer or nurturer.
In the middle ages however the child was given paramount importance. Thus
in threatening condition the life of the child was favoured, which led to high rate of
maternal mortality
The only disease condition explained in detail was the puerperial fever which
was much talked about during the end of 18th
century
Puerperial care and after pains were mentioned in all the recent obstetric text
books.
Review of Literature
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 6
Review of Previous work :-
1] Dr. Sachan [Mrs.] Mamta – Role of Yavashara in sutika Makkalla .
Banaras Hindu University
(BHU) Varanasi.1990.
2] Dr.Surekha J. Dewaikar – Prevention of Sutika Makkalla by oral administration of Katu
Nimba Kwatha, Govt. Ayurved College,Nanded.India-2004
3] Dr.Vijaylaxmi G.Inamdar– A Comparative Clinical Study of Yavashara and
Shuddha Hingu in Sutika Makkalla.
Shri Kalabyreshwara Ayurvedic Medical College &
Research Centre, Bangalore- 2014.
Review of Literature
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 7
SUTIKA
Nirukthi 24,25
* - -
- -
-
A womenwho has been just/recently delivered .
Paribhasha
- ११/६
The word soothika is coined to a woman, who has just given birth to a baby and after
apara patana. The process of Labour is said to be completed only after the expulsion
of placenta.26
- १
Vagbhata also has explained suthika paricharya only to be started after the expulsion
of garbha and apara20.
Hence after the delivery of child till the placenta is not expelled
the lady cannot be called as suthika.
Review of Literature
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 8
Suthika Kala
All acharyas, except charaka have given a definite duration for period of
suthika.
- १०/१६
- ( १/१००,१०१)
Accoding to sushruta 19
and vagbhata 20
time period of soothika is said to be
one and half month or until the reappearance of her menstrual cycle.
Four months period of soothika kala is explained for soothika after the
extraction of mudha garbha (obstructed labour).21
-( ११)
Acharya kashyapa26,
Bhavaprakasha 30
and yogarathnakara 64
have explained
one month period of specific dietic management and still kashyapa specially confirms
that suthika kala is for 6 months.
Sutika roga
The woman become deprived by the increase demand on her by growing fetus
and placenta all the dhatus are in sluggish condition due to stress and strain of
pregnancy and delivery and due to rakta and kleda nisruti. Also there is agni dhatu
Review of Literature
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 9
and bala ksahya hence the disease developing during sutika are said to be asadhya or
krichrasadhya.28
Kashyapa has described sutika rogas at two places 35 diseases in dushprajata
chikitsa adhyaya and 64 diseases in sootikopakramaniya adhyaya. Among 99
diseases, 25 diseases have been enumerated at both the places thus in total 74
different varities of sutika rogas have been mentioned.
Diseases mentioned in dushprajata chikitsa adhyaya27
Asragdhara Manyasthamb Vicharchika Vataasthila
Moha Sula Sotha Ardhasiroruja
Kitibh Dadru Yonidosha Yonibheda
Visphota Pama Prastashool Yonisopha
Hrud rog Plihodara Katisula Yoni vedana
Kamala Sakhavata Hrutsula Visarpa
Jwara Hanugraha Adhmana Chardi
Atisara Akshiroga Mutrarodha
Pravahika Vatagulma Kampa.
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A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 10
Diseases mentioned in suthikopakramaniya adhyaya26
Yonibhramsa Yoniksata Yonisrava Yoniprasupata
Parswashoola Visuchika Mahodara Makkala
Angamarda Praksepaka Apatanaka Vidradi
Pralapa Mutrasanga Unmada Daurbalya
Bhrama Karsya Bhaktadwsha Avipaka
Trsna Hikka Swasa Kasa
Pandu Raktagulma Anaha Mukharog
Yonibheda Yonispoha Yonivedana Prshtasula
Katisula Hridshoola Plihodara Shaakhavata
Haugraha Mayastamba Shopha Kamala
Jwara Atisara Visarpa Chardi
Pravahika Adhmana Mutrarodha Malarodha
Akshirog Kampa Vatashitla Vatagulma
Vicarchika Pratishyaya Galagraha Rajayakshma
Ardita Karnasrava Prajagarana Usnavata
Grahabadha Stanarog Rohini Raktapitta
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A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 11
Diseases mentioned at both places :29
Yonivedana Yonishopa Yonibheda
Prastaula Katisula Hridusla
Plihodara Sakhavata Hanugraha
Manyastambha Sotha Kamala
Jwara Atisarav Visarpa
Chardi Pravahika Adhmana
Mutrarodha Malarodha Akshiroga
Kampa Vaatasthila Vaatagulma
Vicharchika.
Apart from all these disease, Acharya Susruta and Vagbhata, given a detailed
description regarding makkalla shula which is commonly seen during sutika avastha
caused by vitiation of vata and retained blood in the uterine cavity. Also the
commonly seen sutika rogas are angamarda, prusta shula, yoni shula, gurugatrata etc
Causes of sutika roga27
Roaming out at night, terror, sudden fall from height, jealousy, grief, fear,
anger, day sleeping, suppression of various natural urges, excess eating before the
digestion of previous food and even in indigestion etc are some of the main causes of
all the sutika roga.
Review of Literature
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 12
Line of treatment in sutika roga :30,31
Aggravated vata is the main culprit for causing disease, Hence the measure to
subside the vata are to be undertaken and also advised to take bala vardhak dravyas to
over come the tiredness which is due to labour process.
The best line of treatment is to avoid nidana ie nidana parivarjana. She should
be advised to use jeevaniya, brumhaniya, madhura and vatahara dravyas for the
purpose of abhyanga, parisheka, avagaha, utsadana etc in the form of ghrita, taila or
kwatha .
SUTHIKA PARICHARYA
Birth which is a natural process represents the utmost important event that
makes a lady responsible for producing offsprings. The physiologic transition from
pregnancy to motherhood heralds an enormous change in each woman physically and
mentally. This fabulous phase of pregnancy and delivery is strenuous and tedious to
the lady. Inspite of that post delivery period itself needs adjustment of lady not only to
the infant needs but also to her own physiological and psychological variations.
The Suthika avastha is described in Ayurveda with a particular mode of life
for a stipulated period.
प्राप्ते प्रसव काले च भयमतु्पाध्यते यत: ।
अस्ममन्नेक: स्मथत: पादो भवदन्यो यमक्षये: ॥ - का.सं.स्ि.११/२
एव ंस्ह गभभवसृ्ि क्षस्पत स्िस्थल सवभ िरीर धात ुप्रवाहण वेदना
क्लेद रक्त स्नसतृ स्विषे िनू्य िरीराच्च पनुनभवी भवस्त ॥ - अ.सं.िा.३/३९
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A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 13
GENERAL INDICATIONS AND CONTRA INDICATIONS –
प्रसतूा स्हतमाहारं स्वहारं च समाचरेत ्।
व्यायाम ंमथैनुं क्रोधं िीतसेवां स्ववजभयेत ्।
सवभत: पररििुा मयाद ्स्मनग्ध पथ्या अल्पभोजनात ्।
मवदेाभ्यङ्गपरा स्नत्यं भवने्मासमतस्न्िता ॥
- भा.प्र.प.ू४
The prasutha stree should use hitakara ahara and vihara, avoid vyayama,
vyavaya, sheeta maruta sevana and krodha. When she becomes parishudha, continue
with snigdha, pathya alpa bhojana, abhyanga and sweda every day. 63
The Panchakarma procedures like Asthapana Basti, Nasya, Virechana, Sira
vyadhana, teekshna Sweda are also contraindicated in suthika.
IMPORTANCE OF DOING SUTHIKA PARICHARYA 19
स्मथ्याचारात ्ससू्तकाया यो व्यास्धरुपजायते ।
स कृछ्रसाध्यो असाध्यो वा भवदे ्अत्यपतपभणात ्॥
- स.ुिा.१०/१९
For proper naveekarana of suthika.the paricharya explained by our acharyas is must to
follow. Other wise improper regime in the form of excessive nourishing or more of
apatarpana procedures will make suthika easily suceptable for diseases. Kashyapa has
described nearly Thirtyfive types 27
and Sixtyfour types 26
of suthika rogas.
Twentyfive diseases are common29
at both the places, most of these are difficult to
treat or incurable. Suthika if she does ratri nirgamana, divaswapna, having earsha,
bhaya, shoka etc, manasika abhitapa, ajeerna, adhyashana etc is prone to get alt sort of
vikara27
. So Suthika paricharya is a part and parcel of every prasava.
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A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 14
SUTIKA MAKKALLA
प्रजातायाश्च नायाभ रूक्षिरीरायामतीक्ष्णरैस्विोस्धतं रकं्त वायनुा तद्दिेगतेनास्तसंरुिं
नाभरेध:पार्श्भयोर्भमतौ र्स्मतस्िरस्स वा ग्रस्न्थं करोस्त; ततश्च नास्भर्मत्यदुरिलूास्न
भवस्न्त, ससू्चस्भररव स्नमतुद्यते स्भद्यत ेदीयभत इव च पक्वािय:, समन्तादाध्मानमदुरे
मतू्रसङ्गश्च भवतीस्त मक्कल्ल - लक्षणम ्॥ - स.ुसं.िा १०/२२
Unexcreated or unpurified blood inspite of use of pungent drugs by puerperal
women having dry body gets localized by vayu in uterus or the excreted blood is
retained by vayu in uterus. This retained blood produces a glandular structure in any
site amongst infraumbilical region, flanks, bladder, bladder neck (hypogastric region).
Due to this there is severe pain in umbilical and bladder region, abdomen and cardiac
region as well as headache. In pakwashaya region there is severe pain as if needles are
being torn or perforated, flautence and retention of urine also occur1.
प्रजाताया ंचेद्वस्मतमधूोदरेष ुिलंू मक्कलाख्यं मयात्तत्र यवक्षारचणू ंसस्पभषा
सिुोष्णोदकेन वा स्परे्त् । वरणास्द ंवा सपञ्चकोलमलेाप्रतीवापम ्॥३४॥ - अ.सं.िा ३
If after delivery the women develops pain in the region of head of the bladder
and abdomen which is known as Makkalla, she should take any one of the above
combination of drugs,i.e. paste of bharngi, nagara, devadaru mixed with hot water2.
मक्कल्लारप्ये स्िरोर्स्मतकोष्ठिलेू........... - अ.रृ.िा.१/९२
According to Ashtang Hridaya pain in shira, basti and koshta is makkalla sula3.
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A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 15
वाय:ु प्रकुस्पत: कुयाभत्संरुध्य रुस्धरं च्यतुम ्।
सतूाया रृस्च्छरोर्स्मतिलंू मक्कल्लसंस्ितम ्॥२॥ - मा.स्न.६४
According to madhava Nidana, says that the accumulated blood causes pain
in Heart, Head, Bladder in prasuta stree is called Makkalla4.
वस्नताया: प्रसतूाया वातो रूक्षेण वस्िभत: ।
तीक्ष्णोष्णिोस्षतं रकं्त रुदध््वा ग्रस्न्थ ंकरोस्त स्ह ॥१३६॥
नाभ्यध:पार्श्भयोवभमतौ र्स्मतमधू्दभस्न चास्प वा ।
ततश्च नाभौ र्मतौ च भवचे्छूलं तथोदरे ॥१३७॥
भवते्पक्वाियाध्मानं मतू्रसङ्गश्च जायत े।
एतस्भ्दषस्ग्भरुस्दतं मक्कल्लामयलक्षणम ्॥१२८॥ - भा.म.७०
The vayu of prasuta vitiated due to ruksha dravyas and by intake of ushna,
tikshna dravyas the rakta which gets shoshna and unexcreted produces a glandular
structure below umbilicus, flanks, bladder, neck of bladder which produces pain in
umbilicus, abdomen bladder & flatulence and retention of urine also occur 9
.
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PUERPERIUM
From latin language "Puerperium" word got originated or derived, which
means to bring forth (pario) a child (puer).32
It is the period of adjustment after child
birth when anatomical and physiological changes of conception are reversed to an
almost prepregnancy level 8.The pelvic organs returns to the non-gravid state, the
metabolic changes of pregnancy are reversed and lactation is established. This
postpartum period lasts from delivery of the placenta until 6 weeks after delivery. Of
course all maternal adaptations during pregnancy do not necessarily subside
completely by 6 weeks postpartum.38
Diseases stated specific to pregnancy and the
puerperium may occassionaly be life threatening. It is therefore necessary to consider
the interaction of the anatomical and physiological changes of the puerperium with
preexisting medical and surgical complication of the pregnancy.
For the purpose of proper management this period can be divided into an 33,8
1. Immediate Puerperium
2. Early Puerperium
3. Remote Puerperium
Immediate Puerperium - It includes the first 24 hours after delivery, the stage of
acute post partum period.
Early Puerperium - It is the period of first week after delivery.
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Remote Puerperium - It starts from second week to six weeks post-delivery.
Following delivery, when the endocrine influences of the placenta are removed, the
physiological changes of pregnancy are reversed and the body tissues, especially
pelvic organs, return to their previous state.
POSTPARTUM CHANGES8,34,35,36,37
Changes in Uterus
Involution of the Uterus
Immediately after delivery the uterus is hard, very much reduced in size &
fundus is generally felt 10-12 cm above symphsis pubis. During puerperium, the
uterus gradually decreases in size & by the 10-12 days it can no longer felt by
abdominal palpation. This process is known as "Involution’.
The uterus increased markedly in size & wt. during pregnancy, but involutes
rapidly after delivery. Estrogen, Progesterone & the chronic stretching of muscles
induced by enlarging fetus exert synergistic effect on the synthesis of actomyosin &
collagen. Soon after the delivery the involution process is started. Involution is the
rapid reduction in the size of the uterus and its return to a condition similar to its
prepregnant state. Involution of the uterus begins immediately after the expulsion of
the placenta. Three physiologic processes are involved in uterine involution, Uterine
contractions, Autolysis and Regeneration.
Progesterone as a result of the delivery autolysis triggers the release of
proteolytic enzymes and the migration of macrophages in to the endometrium this
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action causes the protein to be broken into components that are excreted in the urine.
Autolysis represents a reduction of cell size rather than cell number. Following
delivery, the epithelium must regenerate and replace the uterine lining.
Immediately following delivery the uterus weighs about 1 kg & its size
approximately that of 20 weeks. At the end of the 1st week it normally will decrease to
the size of 12 weeks to be just palpable at the symphysis pubic. Myometrial
contractions or after pains assist in involution.These contractions occur during the
first 2-3 days of post partum and produce more discomfort in multiparous than in
primi. Such pains are accentuated during the nursing as a result of oxytocin release
from posterior pituitary, during 1st 12 hrs of post partum uterine contraction are
regular, strong and coordinated the intensity frequency and regularity of
contraction decrease after the 1st postpartum day as involution changes proceed uterus
involution is nearly completed by 6weks at which time the organ weighs less than 100
gms. The increase in number of cells are permanent to some degree so as the uterus is
following delivery of placenta there is immediate contraction of the placental size to a
size less than ½ the diameter of the original placenta. This contraction causes
constriction and permits occlusion of underlying blood vessels. It also accomplishes
haemostasis and presumably leads to endometrial necrosis. Initially placental site is
elevated and somewhat ragged and friable in appearance. Involution occurs by means
of the extension and down growth of marginal endometrium & by endometrial
regeneration is completed by the end of the post partum week, except at the placental
site, where the regeneration is usually complete uptill 6 wks.
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Assessment of involution of uterus
Involution is assessed by daily measurement of the fundal height in relation to
the pubic symphsis. It is measured carefully at same time daily by the same person the
bladder is emptied beforehand & preferably the bowel too the uterus is to be
centralized. It is measured in two ways which are as follows.
1. Height from the symphsis pubis measured in cms
Just after delivery,the fundus lies above 13.5cms from the symphasis pubis.
The level remains same for 24hrs thereafter, there is steady decrease in height by
1.25cms in 24 hrs.so that by the end of second week ,the uterus become a pelvic organ
.the rate of involution thereafter slows down until by 6 weeks,the uterus becomes
almost normal in size.
2. From umbilicus, downwards in finger breadth.
1-2 days after delivery fundus is at the level of umbilicus.
3rd
day- 1- 2 finger below the umbilicus.
4th
day-2-3 finger below the umbilicus.
5th
day- midway between the umbilicus and superior margin of the symphysis pubis.
6th
day-1 finger below the fifth day
7th
day-3 finger above the symphysis pubis.
8th
day- 2 finger above the symphisis pubis.
10th
-12th
day-below the superior margin of symphysis pubis.
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Abnormalities of involution
The normal process of involution may be affected adversely by many factor.
Two such abnormalities are,
1 sub involution
2 super involution
Sub involution:
When the involution is impaired or retarded, it is called subinvolution.
Causes;
Predisposing factors- Grand multipara
Anaemia and malnutrition
Uterine fibroid
Prolapse of the uterus
Retroversion of the uterus
Maternal ill health
Mismanagement of the third stage of labour
Aggravating factors 1. Retained product of conception.
2. Uterine sepsis.
Symptoms;
1. Abnormal lochial discharge either excessive or prolonged.
2. Irregular cramp like pain.
3. Rise of temperature.
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Signs;
1. The uterine height is greater than the normal for the particular day on
Puerperium.
2. It feels boggy and softer.
3. Presence of features responsible for subinvolution may be evident.
Management
Appropriate therapy is to be instituted only when subinvolution is found to be
mere sign of some local pathology.
1. Antibiotics in sepsis.
2. Exploration of uterus in retained products.
3. Pessary in prolapsed or retroversion.
2. Super-involution;
The involution of uterus may be prolonged in women who are lactating, it is
called superinvolution. The uterus, however returns to normal size if the lactation is
withheld
Lochia 8,36,38
It is the discharge, which escapes from the genital tract during the first 3 to 4
weeks of puerperium. It is the discharge that originates from the uterine, cervix &
vagina.
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It consists of sloughed decidua.Odour & reaction- healthy lochia has got
sweetish odour, and some explains that ,it has peculiar offensive fishy smell. It is
alkaline tending to become acid towards the end.
Lochia Rubra: This occurs for 1 to 4 days. It is red in colour and consists of blood,
fetal membranes, deciduas, vernix caseosa, epithelial cells, bacteria and meconium.
Lochia Serosa: It is yellowish initially, then brownish in colour and lasts for next 5 to
9 days. It consists of fewer RBCs more leucocytes, wound exudates, mucus from the
cervix and micro organisms (anerobic streptococci and staphylococci), the presence of
bacteria is not pathogenic unless associated with clinical signs.
Lochia Alba: This is white in colour and lasts for 10 to 15 days after lochia serosa
has disappeared. It consists of plenty of decidual cells, leucocytes, mucus, cholestrin
crystals, granular epithelial cells and micro organisms.
During the first 5 to 6 days the amount secreted is 250 ml, It is excessive in
deliveries following multiple gestation, hydramnios and big babies. It is scanty in
preterm deliveries.
Changes in The Cervix -36,38
After delivery, the cervical epithelium becomes very flaccid and thinner in the
first 4 days, the outer cervical margin, which corresponds to the external os, is usually
lacerated, especially laterally. The cervical opening contracts slowly, and for a few
days immediately after labour it readily admits two fingers. By the end of the first
week it has narrowed, hence the cervix thickens and the canal reforms.
At the completion of involution, however, the external os does not resume its
prepregnant appearance completely. It remains wider, with bilateral depressions at the
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site of lacerations and remains as permanent changes that characterize the parous
cervix. The cervical epithelium undergoes considerable remodeling; this complete re-
epithelisation takes 6- 12 weeks.
Vagina-38
The over distended vagina, slowly returns to its prepartum shape around 3 rd
week. The reverting process is completed within 4-8 weeks. The tone of the vagina
never returns back to virginal state. The increased venous congestion makes the
mucosa delicate in this period. Even the vaginal rugasities reappear partially, introitus
remains permanently larger than virginal state. The lacerated, fibrosed healing hymen
represents in the form of carunculae myrtiformes.
Fallopian Tubes and Ovarian Functions 38
After delivery the low level of estrogen and progesterone will effect the
increased number of tall nonciliated cells in the fallopian tubes. Their nuclei will
extrude out, thickness of the cellular layer decreases, inflammatory changes are also
seen.
Elevated prolactin levels are the basis of anovulation in lactating mothers. As
the ovarian activity is suppressed, the resumption of menstruation may be delayed for
many months. Other wise in non-lactating mother, ovulation can occur as early as 70-
75 days postpartum with the resumption of menstrual period after 7-9 weeks.
Pelvic Changes8,37,38
For easy passage of the fetus, even pelvic cavity increases in its width, the
widening of the symphysis pubis and sacro-iliac joints are well observed. After
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delivery the voluntary muscles of the pelvis and other pelvic supports slowly regain
their tone. Involution of muscles takes up-to 6-7 weeks, hence exercises should be
postponed till these stretched muscles come to their original state.
Systemic Changes –
Cardio Vascular System- 37,38,39
Just after parturition, plasma volume decreases due to bleeding. Hematocrit
values increases by 5% and cardiac out put increases by 50%. Pulse rate is increased
on the lsiday. On the 3
rd day post delivery there is a shift from extracellular fluid into
the vascular compartment causing 900 to 1,200ml increase in intravascular volume.
There is also slight increase in blood pressure in the first 5 days of puerperium.
Ventricular hypertrophy of pregnancy resolves in about one year.
Within 8 weeks after delivery the red cells volume returns to normal. The
rapid loss of blood during delivery stimulates reticulocytosis (which is maximum at
the 4th
postpartum day) and a moderate increase in the erythropoitin level during the
first week after delivery. There is hyper activity of bone marrow during puerperium,
prolactin also stimulates bone marrow. Due to stress of labour there is marked
leucocytosis, consisting especially of granulocytes.
Respiratory System -38
The oxygen consumption is increased during pregnancy and even in 7- 14
days after delivery. The delivery of child has decreased the uterine size hence the
diaphragm comes down. The volume of lungs will increase which reduces the
respiratory alkylosis and metabolic acidosis. The hypoapnea will also reduce.
Decreasing level of Progesterone is also responsible for the increased PCO2 in first
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week postpartum. The oxygen saturation is increased to 95% during day one after
delivery.
Urinary System36,37,38,39
During labour, the sustained trauma to the nerve plexus will make the bladder
insensitive to raised intravesicular pressure. The changes which occur in urinary tract
during pregnancy disappear in a similar manner as the involutional changes. The
bladder mucosa become oedematus. enlarged with increased capacity of urine. The
over distended bladder with incomplete emptying leads to significant amount of
residual urine. Within 2-3 weeks the hydroureter and caliceal dilation of pregnancy is
much less evident.
Diuresis occurs to get rid of excess of extracellular fluid accumulated during
pregnancy. Even there is mild proteinuria in immediate postpartum period which is
normal. And Pregnancy induced glycosuria disappears. Increased Glomerular
Filtration Rate comes to normal by 8 weeks of puerperium and there is 25% increase
in renal plasma flow.
Metabolic Changes38
Fatty acids (Total and non esterified) return to the prepregnancy level on the
second post partum day. Plasma Triglyceride levels slowly fall to normal by 6-7
weeks. Lactation does not affect the fatty acid levels. Blood sugar level falls below
the pregnancy level on the 2nd
and 3rd
day after delivery due to an elevated renal
threshold. Free plasma amino acids increase post-partum on 2nd
or 3rd
day.
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Hemodynamic Re-adjustment36,38
Delivery leads to obliteration or low resistence of uteroplacental circulation
and result in 10-15% reduction in the size of the maternal vascular bed. Loss of
placental endocrine function also removes a stimulus to vaso dilatation. This
reduction of blood volume and venous tone which becomes normal with a significant
decrease in deep vein size and increase in uterine vascular resistance. There is
increase in venous blood flow velocity in lower limbs.
A declining in blood volume with a rise in hematocrit is usually seen with in
3-5 days after delivery. Hemoconcentration occurs if the loss of red cells is less than
the reduction in vascular capacity. Hemodilution takes place in woman who loses
20% or more of their circulatory blood volume at delivery.
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Table No -1 Hematological Values in Puerperium
Total Blood Volume
Decreases immediately Post Partum due
to blood loss at delivery
Plasma volume
Decreases immediately Post Partum due
to blood loss at delivery
Increases 3 days Post Partum due to shift
of extra cellular fluid into vessels
RBCs
RBC production returns to normal levels
RBC count returns to normal by 8 weeks
PP
Hb & Hct
Immediate decrease in Hb immediately
PP due
to blood loss at delivery
Hb levels stabilize by 2-3 days
HCT remains relatively stable
immediateiy after delivery
Hct returns to non-pregnant levels 4-6
weeks
WBCs
Decrease to 6- 10,000 after high of 25-
30,000 during intrapartum and immediate
postpartum returns to normal 4-7 days
Platelets
Increases at 3-4 days
Gradually returns to non-pregnant levels
Coagulation factors Increase in fibrolytic activity in first few
hours
Slow decrease to non-pregnant levels by
1-4 weeks
Slow decrease in coagulation factors by
1-4 weeks
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Coagulation Mechanism 36,37
A sudden reduction in the platelet count is seen immediately after the placenta
has separated, but a secondary raise can occur later with an increase in their
adhesiveness.
During the 1st day after delivery the plasma fibrinogen concentration starts
decreasing and the lowest level is reached. After that a secondary increase in its level
occurs which is maintained till the second week after parturition, after which a down
ward trend again starts for the next 7 to 10 days.
These changes make the delivered women susceptible to thrombosis during
the puerperium. How ever a sharp return of normal fibrinolytic activity after delivery
does prevent this complication.
The clotting factors increased during pregnancy are used to provide a reserve
to compensate for their rapid utilization during delivery and also to achieve
haemostasis after delivery. A large deposition of fibrin occurs in the placental bed
after the delivery of the placenta. Thus there is a continous release of fibrin
breakdown products from the placental site.
Weight Loss8,36,38
Approximately 10-13 kg weight is gained during pregnancy. There is an
immediate loss of about 5-6 kg due to delivery of the infant, placenta, amniotic fluid
and blood loss. At the end of 6 weeks most of the mothers have lost of excess 4-5 kg
weight due to excretion of fluids and electrolytes.At least 2 liters of fluid is lost within
the first week and 1.5 liters in next 5 weeks after delivery.
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Factors that influence increased puerperial weight loss includes weight gain
during pregnancy, primi parity, early return to work. Of course breast feeding or
maternal age won't affect weight loss.
Hormonal Changes38
Placental hormone levels decline very fast following delivery.
Human Placental Lactogen (HPL)
This has a half life of 20 min. No HPL can be seen in the maternal blood on
the lst day after delivery.
Human Chorionic Gonadotrophin (hCG)
This has a half life of 9 hrs. 48 to 96 hrs after delivery the levels are below
1000 mu/ml and 7 day post partum they are less than 100 mu/ml. It virtually
disappears by the 11 - 16th
day after delivery.
Plasma 17 B Estradiol
The level falls to 10% of pregnancy value within 3 hours of the 3rd
stage of
labour. By one week after delivery its lower level is achieved. Follicular phase level
(>50 pg/ml) is reached earliest by 19 to 21 days after parturition in non-lactating
women and by 60 to 80 days in lactating women. In latter, during the period of
lactational amenorrhoea the estrogen levels are less than lOpg/ml. Breast
engorgement that occurs 3-4 day after delivery is due to low estrogen levels (because
high estrogen levels suppress lactation)
Progesterone
This has very short half life (in minutes) hence by 3rd
post partum day, the
levels are far less than 1 ng/ml (luteal phase level).
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Prolactin (PRL)
During pregnancy prolactin level rises up to 200ng/ml or more. The levels
rises in breast feeding mothers. With each suckling episode the level of prolactin
raises up to lOOng/ml. Therefore the frequency of breast feeding has an important
role in maintaining the prolactin level.
Serum FSH and LH
These levels during first 10-12 days after delivery are very low, irrespective of
the status of lactation. After 12 days their levels increase, by the 3rd
week their
concentration is same as in follicular phase. Low level of FSH and LH in early
puerperium is due to a reduced GnRH during pregnancy and the early post partum
period.
There is also reduction in the secretion of GnRH, Growth Hormone, Insulin,
Thyroid Hormones and even the secretion of ACTH. There is relative normal or high
level of these hormones during pregnancy, which reduces soon after parturition.
Again all these levels are stabilized by 6-8 weeks of postpartum period.
Lactation36,38
The major physiological event of the puerperium is the establishment of
Lactation. The humoral and neural mechanisms involved in lactation are complex.
Progesterone, estrogen, cortisol, placental lactogen as well as prolactin appear to act
in concert to stimulate the milk secreting apparatus. 8,37
Mainly prolactin helps in milk production and oxytocin helps in ejection of
milk. Release of prolactin acts upon the glandular cells of the breast to stimulate milk
secretion and the second induces the release of oxytocin which acts upon the
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myoepithelial cells of the breast to induce the milk ejection reflex. This milk ejection
reflex is mediated by the release of oxytocin from the posterior pituitary gland. It is
readily inhibited by the emotional stress, maternal anxiety etc which frequently leads
to a failure of lactation.
Both estrogen and progesterone are necessary for mammary development in
pregnancy but prolactin, growth hormone and adrenal steroids may also be involved.
During pregnancy only minimal amounts of milk is formed in the breast despite high
levels of the Placental lactogenic hormones and even prolactin. This is because the
actions of these lactogenic hormones are inhibited by the secretion of high levels of
oestrogen and progesterone from the placenta and it is not until after delivery that
copious milk production is inhibited.
The composition of breast milk varies according to the age of the baby and
from the beginning to end of the feed. Colostrum is the breast secretion of the mother
in the first few days after delivery. It is a deep yellow coloured thick serous secretion
having high specific gravity and alkaline reaction, contains high protein, vitamin A,
sodium and chloride. More of antibodies (IgA, IgG, IgM), white blood cells and other
anti infective proteins in colostrum provides immunological defence to the new born.
This colostrum also has a mild purgative effect, which helps to clear the baby's gut of
meconium. This clears bilirubin from the gut and thus helps to prevent jaundice.8
The milk secreted later is having more fat and lactose but less protein. The
long chain poly unsaturated fatty acids present are important for neuro developmental
consequences for the baby, ie, it helps in myelination of central nervous
system.Facilitates absorption of calcium. The ammo acids like taurine and cystein
which are important neurotransmitters. Breast feeding protects the infant against
infection ie, prevents gastrointestinal illness (diarrhea), respiratory tract infections etc.
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The protective factors like IgA, Macrophages, lymphocytes, Complements and
interferon etc. present are very much important in this aspect.8
Table No - 2 Composition of colostrum and Breast milk8
Protein
Fat
Carbohydrates
Water
Colostrum
8.6%
2.3%
3.2%
86%
Breast milk
1.2%
3.2%
7.5%
87%
. The proteins present are lactalbumin, lacto globulins, lactoferrin and casein.
. Among carbohydrates mainly lactose along with glucose and
galactose.
. Mainly triglycerides (olein, palmitin, stearin) in fats.
. Vitamins like B.C.D with abundance of Vitamin A and exception of Vitamin K.
There is no doubt that breast milk is the ideal nutrition for the New born baby.
Highly nourishing, easily digestible and immunizing contents in mothers milk
necessitates the exclusive breast feeding during first 6 months of neonatal life. A
healthy mother will produce about 500 - 800m] of breast milk a day to feed her infant
with about 500kcal/day. In well established lactation, it is possible to sustain a baby
on breast milk alone for 4-6 months. This requires about 600 k cal / day for the
mother which must be made up from the mothers diet or from her body store. For this
purpose a store of about 5 kg of fat during pregnancy is essential to make up any
nutritional deficit during lactation.
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Breast feeding accelerates the process of uterine involution in mother.40
reducing the chances of post partum hemorrhage, Improves post partum weight loss39
,
In exclusively breast fed mothers it provides 98% protection against pregnancy for
first 6 months. It also lowers the risk of breast cancer and ovarian cancer. Lactation or
breast feeding or nursing the child - What ever the terminology it strengthens the
psychological bonding between mother and the baby.
Care of Puerperium8,36,37,38
The care of a pregnant woman does not end with the delivery of the child and
the conclusion of the 3rd
stage of labour. Even pregnancy should be considered as a
natural, physiological event, Management and care of the delivered lady is a must.
So the main objectives of puerperial management are –
To monitor the physiological changes of puerperium.
To diagnose and treat any postnatal complications.
To establish infant feeding.
To give the mother emotional support.
To advise about contraception and other measures, will contribute in
continuing her health.
Immediately following delivery, lady may be given a drink or something to eat if
she is hungry. Close monitoring of general health (BP, Pulse, Temperature, vaginal
bleeding, P/A size of the uterus etc) of the lady and adequate bed rest is must.
Rooming in, ie, keeping the infant with the mother, is very important, it builds up the
parent-infant bonding.
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New mother is made ease by proper care of vulva, episiotomy wound, breast
and nipple care. Proper feeding methods, care of bowel and bladder are advised. The
lady is moved out of bed with in 48hrs of post partum. By early ambulation, she feels
stronger and better, Bladder complications leading to catheterization and even
complaints of constipation are less frequent. Adequate fluid intake, liberalization of
nourishing and fiber rich diet is necessary to prevent constipation. Bladder is to be
emptied by the patient as frequently as possible.
Proper aseptic care, perineal wound dressing, observing the involution of
uterus and lochial discharge is a part and parcel of the puerperial management. For all
these necessary care and advice a minimum of 3-5 days of Hospital stay is needed.
Correction of anaemia in puerperial women is done by supplementation of iron
therapy ie, ferrous sulphate 200mg daily and also with a supplementation of calcium 1
SQOmgdaily, for 4-6 weeks.8 'After pains' in puerperium may need the help of
analgesics.40
Post Natal Exercises -8,38,39
Post natal postures and exercises must be taught for better puerperial
rehabilitation. Softness of elastic ligaments and collagenous connective tissue persists
for 4-5 months after delivery. The abdominal muscles are stretched and elongated
during pregnancy. Hence entire abdominal wall is weakened.
If the back is not properly held (incorrect postures during lifting weight) it is
vulnerable to injuries. The pelvic floor is also weakened during pregnancy due
continuous support of the gravid uterus, stretching and trauma during delivery. The
perineum is stretched and sometimes may have tears or episiotomy. Hemorrhoids may
cause severe pain; legs may be painful or swollen.
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The management starts with breathing exercises and free hand movements of
the body parts. Deep breathing is helpful for relaxation and improving circulation.
Movement of the foot, ankle and leg also improve circulation. Proper Postures,
lactating methods are important in prevention of future back ache etc. Correct
postures itself will tone up the back muscles.
Pelvic floor exercises are must and to be started as early as possible. Repeated
contraction and relaxation of the pelvic floor muscles will help in regaining the tone
and elasticity. Abdominal muscle exercises are essential to regain the size of over
stretched muscles and to prevent divarication of recti. For this lady should be in dorsal
position, with knee flexed, abdominal muscles are contracted and relaxed
alternatively. Again she should lie on her face, then head and shoulders are slowly
moved up and down. The procedure is to be repeated 3-4 times a day. These Exercises
should be continued for at least 3 months.
The main advantages of these exercises are –
It minimise the risk of puerperial venous thrombosis by promoting arterial
circulation and preventing venous stasis.
It prevents back ache.
It prevents genital prolapse and stress incontinence of urine.
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PUEPERAL AFTER PAINS
*Definitions of after pains by medical dictionary.
After Pains- painful cramplike contractions of the uterus occurring after
childbirth.46.1
After Pains- cramp like pains following the birth of a child due to uterine
contractions.46.2
After Pains- cramps or pains following child birth, caused by contraction of the
uterus.46.3
After Pains- a popular term for lower abdominal cramping and uterine contractions
that typically occur after vaginal delivery of the baby.46.4
After Pains- painful cramp like contraction of the uterus occurring after child
birth.46.5
AFTER PAINS
After pain is the pain resulted from the rapid and intermittent contractions of
the uterus,after the exit of placenta and membranes52
.It is felt in lower abdomen and
lower back similar to delivery pain53
.The severity is similar to that of menstrual
cramps with severe discomfort,and is sometimes worse than delivery pain52,53
.It
usually continues for 3-4 days and rarely last one week after delivery54
.Hold Croft
reported that more than 80% of women experienced after pains and this pain could
continue for one week after discharge from hospital55.
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Any Factor which causes a delay in the process of uterus contractions and
interrupts appropriate restoring to the pre-pregnanacy status is effective in increasing
after pains.After pains is influenced by many factors which are as follows.
Multiparity56
, over distended uterus due to big baby, multiple gestation56
,
polyhydraminous56
, breastfeeding53
, assited delivery with tools56
, administration of
medications during and after delivery to facilitate the delivery or prevent PPH,
analgesia during delivery53
, the placenta removed by hand56
, mothers physical nad
psychological disorders53
, consumption of magnesium sulphate during pregnancy,
history of nacrotics use and chronic pain, full bladder56
, mothers delivery
position.cultural factors such as mothers race, religion and knowledge.
In primi paras, the puerperal uterus tends to remain tonically contracted unless
blood clots, fragments of placentas or other foreign bodies are retained in its cavity,
causing hypertonic contractions in an effort to expel them.
In multiparas especially the uterus often contracts giving rise to painful
sensation that are known as after pains and that occasionally are sufficiently severe to
require an analgesic, in some patients they may last for days.
After pains are particularly noticeable when the child is put to the breasts
presumably because of release of oxytocin ordinarily however they decrease in
intensity and become quite mild after the 48 Hours immediately following delivery.
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AFTER PAINS
The cramps known as afterbirth pains or simple afterpains, are caused by
contraction of the uterus as it returns to its prepregnancy size after the birth of the
baby-this process is called involution43
.
Afterpains are typically mild for first time moms and don’t last long. But they
can be quiet uncomfortable after a second delivery and usually get worsen with each
successive delivery. That’s because first time moms tends to have better uterine
muscle tone, which means the uterus can contract and stay contracted rather than
relaxing and contracting intermittently43
.
Cramping will be most intense for first day or two after giving birth, but it
should taper off around third day, though it can take six weeks or longer for the uterus
to return to its normal size43
.
Breast feeding can bring on after pains or make them more intense because the
baby’s sucking triggers the release of the hormone oxytocin,which in turn causes
contractions.This is actually a good thing ,the cramps brought on by breast feeding
helps the uterus shrink to normal size more quickly, reducing the risk of postpartum
anaemia from blood loss43
.
Post partum cramps are uncomfortable pains which signals that the body is
getting back to its non pregnant state.They remain for few days after child birth and
vary in their frequency44
.
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# How long do Afterpains last (in weeks)
It takes about six to eight weeks for the uterus to return to its pre-pregnant size and
severe pain last only for one or two days post delivery.
# Causes of pains and cramps
While pressure and strain on the body post delivery are the main causes of pain,there
are other reasons as well.
1) During pregnancy, the uterus expands up to 25 times its normal and it as large as
the basket ball.It then shrinks to a size of a tiny pear.This shrink causes after birth
pains and cramps or involution.
2) Breast feeding is another cause for pains ans cramps after pregnancy.The babys
sucking stimulates the production of oxytocin which leads to contraction and thus
pain.
3) If there was C-Section then there will abdominal pain along with pulling sensation
that last for a long period.
Few tips to minimize the discomfort.
. Try to pee often,even if ther is no urge to go.A full bladder displaces the uterus so it
cant contract completely.
. Lie face down with a pillow under your abdomen.
. Lie face down with a warm heating pad under your belly.
. Gently massage the lower belly.
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Home remedies for relieving after birth pains.
1) Hot Water Compress;
Hot water treatment is the best way to cure unpleasant abdomen tenderness
and suffering as it loosens contracted uterus and improves blood circulation
thereby relieving lower abdomen and uterus pain.
2) Rice Water
Cook rice with extra water and drink the strained water twice a day this water
soothens the stomach region,improves digestion and prevents constipation.
3) Ginger Tea
Ginger is anti inflammatory and an excellent astringent.and antiseptic which
prevents pains and cramping after birthby relieving abdominal and hip pains.
Make ginger tea by adding grated ginger to a cup of boiling water,you can also
add 10 parseley leaves and them together for sometime,add honey to taste and
have it twice a day.
4) Fennel Tea
Fennel seeds also have anti inflammatory and analgesic properties that work
on relieving post pregnancy pain.
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5) Warm Water Bath
Bathing in warm water will alleviate hip and uterus pains.You can soak in a
bath tub for about 30 mins but ensure that temperature is not so hot.
6) Oil Massage
Gently massage the abdomen with oil mix.To make oil mix take 5 drops of
lavender oil,10 drops of cypress oil,15 drops of peppermint oil and one ounce
carrier oil(Jojoba,Olive,Sweet almond or coconut oil).To massage place hand
on navel and move in circular motion,as it will stimulate contractions and
make uterus firm.
AFTER PAINS, PAINS AFTER LABOUR/DELIVERY45
After labour and birth you may have pains or soreness in your whole body.It
happens because of laboring in different position and pushing. Body undergoes
tremendous changes throughout the nine months of pregnancy and in just 6 weeks
afterwards organs return to their normal or previous state during this process few
transformation may cause some or more discomfort to the body.
After pains are those pains when body works hard to get recovered by the
presence of uterine contractions after childbirth these contractions serve the important
function of clamping off open blood vessels at the placental site, minimizing the loss
of blood after birth.
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If the uterus does not contract appropriate medications and massage must be
given as mentioned in the puerperium care.The first time moms do not usually find
the after pains or postpartum uterine contraction as painful as in females who have
given birth second time.
If the lady has given birth before, the afterpains may be very painful. An
ocassionally first time moms find the afterpains much painful. One should be aware of
that persistent severe cramps or uterine tenderness could be the sign of infection. To
get ameliorated from pains try spending time lying on the abdomen, if the pains are
especially uncomfortable one can apply heating pads to the abdomen along with
medications.
Calicum consumption as supplements 500mg twice a day,during 3rd trimester of
pregnancy and postpartum period can prevent afterpains57
.Also consumption of
magnesium supplementation for treatment of leg cramps, premature uterine
contractions or pregnancy hypertension reduces the incidence of after pain and
decreases postpartum analgesic consumption.
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DRUG REVIEW
With the art and skill of formulation a poisonous drug could be transmuted in to a
safe and effective drug.A simple drug could be converted in to a most potent one.
Dravya which is one of the chikitsa chatushpada, usage of it in particular diseases
depends upon the yukti of vaidya, as there is no drug which cannot be used as
medicine
Bharangyadi Kalka
In classicsa reference regarding Bharangyadi kalka that is bharangi, nagara and
devadaru in makkalla sula is available
प्रजातायां चेद्वस्मतमधूोदरेष ुिलंू मक्कल्लाख्यं.......
...........भाङ्भगीनागरदवेदारुकल्कं वोष्णाम्भसा ।
- अ.सं ३/३४-३५
Here descripton of the drugs are mentioned.
BHARANGI
Botanical Name :- Clerodendrum serratum
Naturalorder:- Verbenaceas
Classical name:-Padam, Bhramani Bharangi , Bharagvi Bhargi, Phanji, Hanjika
Bharamanyashtika etc.,
Vernacular Name :- Sanskrit- Bharngi, Kharasakah
Hindi - Bharangi
Kannada – Gantabarangi
Malayam –Cerutekku
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Tamil – Sirutekku
Telgu – Gantubarangi
Description :- A slightly woody shrub with bluntly quadrangular stems and branches,
leaves usually three at a node, sometimes opposites ablong or elliptic, coarsely and
sharply serrate.
Flowers:- Blue, many in long cylindrical thyrsus with a pair of acute bracts at each
branching and a flower in the fork
Fruit:- 4-lobed purple durpe, somewhat succulent with one pyrene in each lobe.
Habitate:-Throughout India, in forest upto 1,500 m elevation
Propagation :- By seeds and vegetative method
Parts used– Roots, leaves
Chemical constituents :- Serrtagenic acid, queretaroic acid, phytoserols saponins,
two iridoid glycosides etc.,
Uses :- The roots are bitter, acrid, thermogenic anti-inflammatory, digestive,
carminative stomachic, anthelmintic, depurative, expectorant, sudorific,
antispasmodic, stimulant and febrifuge, and are useful in vitiated conditions of kapha
and vata, inflammation, dyspepsia anorexia, colic, flatulence, helminthiasis cough,
asthma, bronchitis, hicough , tumours, tubercular glands, dropsy, consumption,
chronic nastitis skin disease, leucoderma, leprosy and fevers.
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Ayurvedic Properties
Rasa– Tikta, Katu, Kashaya
Guna-Ruksha, Laghu
Veerya- Ushna
Vipaka– Katu
Doshaghnata– Kaphavatashamaka
Rogaghnata– Gandamala, Vrana, Visarpa, Agnimandya shotha, Nashtartava, Kasa,
Raktavikara Gulma etc.
Karma– Shothahara, Vranapachana, Deepana Pachana, Anulomana, Raktashodhaka
Pharmacological Activities
Spermicidal, CNS depressant, anti histaminic, hypotensive,antiasthmatic, antibiotic,
antifertility, stomachic, antiallergic etc.
NAGARA
Botanical Name :-Zingiber officinale
Family :-Zingiberaceae
Classical name
Vernacular NameEnglish – Ginger
Hindi –Adarak
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Kannada- Haisunti, Ardraka
Malayam – Inci, Erukkilannu
Sankrit –Ardrakam
Tamil – Inci
Telgu –Allamu Ardrakamu
Description :-A slender, perennial rhizomatous herb,
Leaves:-Linear, Sessile , glabrous
Flowers:-Yellowish green in oblong,cylindrical spikes ensheathed in few scarious,
glabrous bracts
Fruits:-oblong capsules
The rhizomes are white to yellowish brown in colour, irregularly branched, some
what annualated and laterally flattened. The growing tips are covered over by a few
scales. The surface of rhizomes is smooth and if broken a fewfibrous elements of the
vascular bundles project out from the cut ends.
Habitate:- cultivate throughout India run wild in some place in western ghats
Propagation: - By rhizomes
Parts used: - Rhizomes (raw as well dry)
Chemical constituents - ∞ curcumene
β D- curcumene
∞ -bergamotene
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β – bourborenene
β- camphene
d- bornealand its acetate calamine
car -3- ene
∞ - cedrol
citral
citronellol
Uses: - The raw ginger is acrid thermogenic carminative laxative and digestive, it is
useful in anorexia, vitiated conditions of vata and kapha, dyspepsia, pharyngopathy
and inflammation.
The dry ginger is acrid, thermogeic, emollient appetizer, laxative, stomachic,
stimulant rubefacient anodyne, aphrodisiac, expectorant anthelmintic and carminative.
It is useful in dropsy, otalgia, cephalagia, asthma, cough, colic, diarrhea, flatulence,
anorexia, vitiated condition of vata and kapha, dyspepsia, cardiopathy,
pharyngopathy, cholera nausea, vomiting, elephantiasis and inflammation.
Ayurvedic Properties
Rasa– katu
Guna- Laghu, snigdha, Guru, Tikshna
Veerya- Ushna
Vipaka – Madhura
Doshaghnata – Vatakaphashamaka
Rogaghnata – Amvate, Sandhishotha, Udarashoola, Anaha, Vibandha, Vatavyadhi,
Katishool, Gulma, Adhmana , Prasavottara daurbalya etc.,
Karma – Vedanasthapana, Vatashamaka, Rochana Deepana, shoolaprashamanna,
Vatanulomana shothahara etc.,
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Pharmacological Activities :- Anti inflammatory, hypolipidaemic,
antiemetic,antipyretic antioxidant, analgesic, anti bacterial, anti fungal etc,.
DEVADARU
Botanical Name–Cedrus Deodara
Classical Name:- Devadru, Darubhadra, Daru, Indradaru, Mastdaru, Drukilima,
Surbhuruha.
Vernacular Name :- Sankrit -Devadru
English- Doedar, Himalayan Cedar, True Cedar
Hindi- Debdar , Deyodar
Kannada –Devadaru
Malayam –Devataram
Tamil –Tevataram, Tevatazu
Telgu –Devadau
Description :- A large handsome evergreen conifer tree reaching up to 85 meter in
high with almost rough, black, furrowed bar and spreading branches
Shoots- Dimorphic
Leaves:- Needle like triquetors, sharp pointed, Male cones - solitary, cylindrical at
ends of the branches. Female cones- solitary at the ends of the branchlets composed
of imbricating thin woody placental scales.
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Seeds :- Pale brown, wings longer than seeds
Habitate :- Himalayas in areas of elevation from 1,050 to 3600 mtrs
Propagation:- By seeds
Parts used :- leaves, heart wood, oil, bark, resin
Chemical constituents:- It is contains himachalol, allohimachalol, himadarol
centdarol, Isocentdarol, Dewarene, Dewarol, dewardiol, taxifolin, cedeodarin,
dihydromyricetin, cedrin, cedrinoside, dihydrodehyadrodiconiferyl alcohol.
Uses:- The leaves are bitter, acrid and thermogenic an are useful in inflammations and
tubercular glands.
The heart wood:- Is bitter, acrid, thermogenic emollient, anodyne, anthelmintic,
digestive, carminative, cardiotonic, galacto purifier, anti-inflammatory, diuretic,
expectorant diaphoretic, antiseptic, laxative and febrifuge and is useful in
inflammation, dyspepsia, cephalagia, haemorrhodis, insomnia, epilepsy, hiccough,
bronchitis, tubercular glands diabtes, urethrorrhea, renal and vesical calculii
elephantiases, fever, cardiac disorders, leucoderma skin disorders proctoptosis and
vitiated conditions of vata and kapha
The oil is antiseptic, diaphoretic, depurative diuretic and is useful in leprosy syphilis,
skin disease, wounds, and ulcers, fever and strangury
Ayurvedic Properties
Rasa– Tikta
Guna- Laghu, Snigdha
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Veerya- Ushna
Vipaka – Katu
Doshaghnata– Kaphavata Shamaka
Rogaghnata – Vedana, Sandhivata, Shotha, Adhamana karnashoola, Shirashoola,
Sutika roga etc.,
Karma– Shothahara, Vedanasthapana, Kushthagna, Garbhashaya
shodhana,Stanyashodhana, Deepana Pachana, Anulomna
Pharmacological Activities :- Spasmolytic, anti inflammatory antibacterial, anti
fertility, anti fungal, anti viral, antiseptic, anlegsic etc.,
Here the description along with reference of Hingu is mentioned.
स्हङ्ग ुििंु ससस्पभष्कं भकंु्त मक्कल्लिलूनतु ्॥
- यो.म.८
Here Shuddha hingu is advised along with ghrita in sutika makkalla.
HINGU
Botanical Name :- Ferula asafetida
Family:- Apiaceae, Umbelliferae
Classical name :- Hingu, Bahlika, Ramatha
Vernacular Name :- Sankrit – Hingu
English – Asafoetida
Hindi – Himg
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Kannada – Hingu
Malayam – K.Yam,Karikk.yam,perunk. yam
Telgu –Ingwya
Description :- A herbaceous pernennial with fleshy, massive, carrot shaped root with
one or more forks
Stem:- 1.8 – 3 m high, solid, clothed with memberanous leaf sheaths .
Leaves:- Radical 45 cm long, shiny, coriaceous with pinnatifid segments and
channeled petiode.
Flowers :-10-20 in the main and 5-6 in the partial umbels
Fruits:-Flat, thin, reddish brown
Habitate:- wild in Punjab, Kashmir, Iran Afghanisthan .
Propgation:- By seeds and vegetitave method
Parts Used :-Resionous exudates of the root, oleo-gum-resin, leaf, stem, root
Chemical Constitutent :- The gum resin contains the coumarins 5- hydroxy-
umbelliprenin, 8-hydroxyum- belliprenin, 9- hydroxy umbellipernin,8- acetoxy 5-
hydroxyumbel- lipernin, assofoetdin , ferocolici, asacoumarin A and B,farnesiferol
A-B and C and the disulphides asadisulphide and sec-butylpropenyl disulphide.
Uses :- The oleo resin is bitter acrid, carminative antispasmodic, expectorant,
anthelmintic,diuretic, laxative, nervine tonic, digestive sedative and emmenagogue. It
is used in flatulent colic, dyspepsia asthma, hysteria, constipation , chronic
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bronchitis, whooping cough, epilepsy, pyschopathy, hepatopathy, splenopathy and
viatiated conditions of kapha and vata.
Ayurvedic Properties
Rasa – Katu
Guna- Laghu,Snigdha, Tikshna
Veerya- Katu
Vipaka – Ushna
Doshaghnata –Kaphavatashamaka, Pittavardharaka
Rogaghnata– Udarshoola, Hridyashool, Pakshaghata, Ardita, Agnimandya,
Garbhadosha, Shirashoola, Mootraghata, Bastishoola, Vibandha etc.
Karma – Vedanasthapana, Vataharaya, Shoolprashamana, Anulomana, Rochna
Pachana, Artavajnana
Pharmacological Activities :- Plant was reported to have antispasmodic
abortfacitent, anti implantation, emmenagogue antibacterial, pungent,
Anticarcinogenic, Hypotensive activities
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Ghrita - It is used as anupana with hingu.
Qualities – It does pitta and vata shaman
It does not increases the kapha
It provides the bala
It is beneficial for the skin
It does shodhana of yoni marga.
Ghrita is sheeta virya and with ushna jala it spreads all the minute
channels of the body and shows its karya.
Drug
Latin name
Rasa
Guna
Veerya
Vipaka
Karma
Bharangi Clordendrum
Serratum
Tikta
Katu
Laghu
Ruksha
Ushna Katu Kaphavatahara
Nagara Zingiber
officinale
Katu Guru
Ruksha
Tikshna
Ushna Madhura Vatakaphahara
Dipaniya
Bhedaniya
shoolprashamana
Devadara Cedrus
deodara
Tikta
Katu
Kashya
Ruksha
Laghu
Ushna Katu Kaphavatahara
Dipaniya kashara
Table No.4 Drug of Shuddha Hingu
Hingu Ferula
asafetida
Katu Laghu
Snigdha
Tikshna
Ushna Katu Kaphavatahara,
Sulahara
Anulomana
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Preparation of the kalka.
Dry raw drugs is powdered and filtered through thin cloth then this is
trichurated in khalwa with addition of little water to form a fine paste
The dose of kalka as mentioned in texts is 1tola or 1 karsha,i.e.12
gms.Therefore here 6 gms BD is the selected dose of Bharangyadi
kalka.
Hingu shodhana is done by frying it in ghee and then powered and
used for administered.By doing so the teekshanata of hingu is
reduced.
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THE DRUGS OF BHARANGYADI KALKA
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HINGU
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PREPARED BHARANGYADI KALKA
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HINGU POWDER
Methodology
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 59
“A COMPARATIVE CLINICAL STUDY TO EVALUATE THE EFFICACY
OF BHARANGYADI KALKA AND SHUDDHA HINGU IN THE
MANAGEMENT OF SUTIKA MAKKALLA W.R.T PUERPERAL AFTER
PAINS”
AIM AND OBJECTIVES :-
To study the sutika makkalla sula in detail
To study the efficacy of Bharangyadi Kalka in sutika makkalla.
To study the efficacy of Shuddha hingu in sutika makkalla.
To compare effect of Bharangyadi Kalka and Shuddha hingu in sutika makkalla.
HYPOTHESIS
H0 - There is neither effect of Bharangyadi Kalka nor shuddha Hingu in Sutika makkalla.
H1 - There is significant effect of Bharangyadi Kalka than shuddha Hingu in makkalla.
H2 - There is significant effect of shuddha Hingu than Bharangyadi Kalka in Sutika
Makkalla
MATERIAL AND METHODS :-
SOURCE OF DATA
a) Subjects :-
Patients were selected from OPD and IPD of Dept. of Streeroga- Prasuti Tantra, RPK
Ayurvedic Hospital Ilkal.
Methodology
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b) Literary :-
Literary aspect of study is collected from classical ayurvedic and modern texts in details
and internet and journals.
c) SELECTION OF DRUG :-
* Bharangyadi kalka2 reference is from Ashtanga Sangraha Sharira Sthana.
* Shuddha Hingu10
reference is from Yogaratnakar Streeroga Adhikar Chikitsa.
d) Collection of drug :-
The trial drugs required for the preparation of medicine were collected from local
areas and market.
e) PREPARATION OF MEDICINE :-
Raw Materials were collected from market and kalka was prepared freshly in front
of the patent at the time of the administration.
द्रव्यमार्द ंशिलाशिष्ट ंिषु्कै वा सजलं भवते ्॥ - िा.सं.५/१
Talble No, 5 A. Bharangyadi kalka :
Drugs Latin name Quantity
Bharangi moola
Choorna
Clerodendrum Indicum 2 gms
Nagara Zingiber Officinale 2 gms
Devadaru twak Cedrus deodara 2 gms
Methodology
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 61
Procedure : 17
Above drugs are taken and kalka will be prepared as per classical
reference.
B. Shuddha Hingu :
The shodhana of hingu is done by frying in ghrita and then used for administration18
according to the dose decided.
METHODS OF COLLECTION OF DATA :- OPD and IPD Patients from PTSR
Department of RPK Ayurvedic Hospital, Ilkal were taken for study.
a) Study Design :-
A Randamized comparative clinical study – where 30 patients screened of sutika
makkalla were selected.
b) Sample Size :-
30 patients will be included
Group –A :- 15 diagnosed patients of Sutika Makkalla were treated with
Bharangyadi Kalka 6 gms twice orally before food for five days.
Group –B :- 15 diagnosed patients with sutika makkalla were treated with Shuddha
Hingu 125 mg twice orally before food for five days.
c) Diagnostic Criteria :-
- Udara shoola
- Nabhi shoola
- Basti shoola
- Suchivat vedana in pakwashaya
- Mootrasanga
- Adhmana
Methodology
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 62
SELECTION CRITERIA :-
d) Inclusion Criteria :-
* Women who have undergone vaginal delivery.
* Sutika having classical signs and symptoms of makkalla sula.
* Preterm and postdated vaginal delivery
* Sutika complaining of makkalla shoola from the time of delivery upto 5 days.
e) Exclusion Criteria :-
* Sutika having undergone L.S.C.S Assisted delivery (vacuum, forceps delivery)
*Sutika with severe anaemia (less than 8 gm %)
*Sutika with HTN, DM, APH, PPH, prolonged labour.
*Sutika undergone any lower abdominal surgeries in past.
*Sutika having any ovarian or uterine pathology.
* Retained or manual removal of placenta
f) ASSESSMENT CRITERIA
Statistical analysis done after accessing the pre and post medication data of subjective and
objective parameters.
SUBJECTIVE PARAMETERS :-
► Pain abdomen
►Stanya pravartana
Methodology
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 63
OBJECTIVE PARAMETERS
► P/A uterine involution
► Lochia
g) INTERVENTION:-
Group – A
Drug - Bharangyadi kalka
Dose - 6 gram twice daily before food (pragbhakta)
Duration – 5 days
Route – Oral
Anupana – Ushna Jala
Follow up period – On 6th
day of treatment
On 15th
day of treatment
On 30th
day of treatment
Total duration - 30 days
Group – B
Drug - Shuddha Hingu
Dose - 125 mg. twice daily before food (pragbhakta)
Duration – 5 days
Route – Oral
Anupan – Ghrita
Follow up period – On 6th
day of treatment
On 15th
day of treatment
On 30th
day of treatment
Total duration – 30 days
Methodology
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 64
STATISCTICAL ANALYSIS : Chi –Square/Fisher Exact test has been used to find the
significnance of study parameters on categorical scale between two or more grpous, Non-
parametric setting for Qualitative date analysis. Mann Whitney U test as Non-parametric U
test has been used to find the significance of score of study variables in two groups.
GRADINGS OF SUBJECTIVE PARAMATERS
Udara Shoola
Grade – 0 – No pain
1- Mild pain (Pain while walking )
2- Moderate pain (Pain in sitting standing)
3- Severe Pain (Pain on lying on bed rest)s
Stanya Pravartana
Grade- 0 –Absent
1- Inadequate
2- Adequate
3- Excessive
Methodology
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 65
GRADINGS OF OBJECTIVE PARAMETERS:-
Involution of uterus :-
Grade-0- No involution (Fundus at the level of umbilicus)
1- 0- 1.25 cm of involution (below umbilicus)
2- 1.25-5 cm of involution (below umbilicus)
3- 5-10 cm of involution (below umbilicus)
4-10-13.5 cm of involution (below umbilicus)
5- Completely involuted (Not Palpable)
LOCHIA
Grade – 0 absent
1- Mild (1-2 pads / day)
2- Normal (2-3pads / day)
3- Moderate (3-4 pads / day)
4- excessive (more than 4 pads / day)
Observations and Results
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 66
OBSERVATIONS
Table 6: Age distribution of patients studied
Age in years Group A Group B Total
18-20 8(53.3%) 0(0%) 8(26.7%)
21-25 5(33.3%) 8(53.3%) 13(43.3%)
26-30 2(13.3%) 7(46.7%) 9(30%)
Total 15(100%) 15(100%) 30(100%)
Mean ± SD 21.33±2.72 25.20±2.78 23.27±3.34
P=0.001**, Significant, Student t test
Graph No. 1 Age distribution in two groups patients studied
Among the 30 patients included in this study 26.7% of the patients were in the age
group of 18-20 years, 43.3% of the patients were in the age group of 21-25 years,
30% of the patients were in the age group of 26-30 years
Observations and Results
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 67
Table 7: Education distribution in two groups of patients studied
Education Group A Group B Total
Illiterate 5(33.3%) 2(13.3%) 7(23.3%)
SSLC 5(33.3%) 6(40%) 11(36.7%)
PUC 4(26.7%) 4(26.7%) 8(26.7%)
Graduate 1(6.7%) 3(20%) 4(13.3%)
Total 15(100%) 15(100%) 30(100%)
P=0.519, Not Significant, Fisher Exact Test
Graph No.2 Education distribution in two groups patients studied
Among the 30 patients included in this study 23.3 % of the patients were illiterate,
36.7% of the patients were studied SSLC, 26.7% of the patients were studed PUC,
13.3% of the patients of were graduate.
Observations and Results
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 68
Table 8: Occupation distribution in two groups of patients studied
Occupation Group A Group B Total
Housewife 15(100%) 14(93.3%) 29(96.7%)
Office Job 0(0%) 1(6.7%) 1(3.3%)
Total 15(100%) 15(100%) 30(100%)
P=1.000, Not Significant, Fisher Exact Test
Graph No.3 Occupation distribution in two groups patients studied
Among the 30 patients included in this study 96.7% of the patients were housewifes,
3.3% of the patients were job goers
Observations and Results
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 69
Table 9: Social Status distribution in two groups of patients studied
Social Status Group A Group B Total
Lower 7(46.7%) 4(26.7%) 11(36.7%)
Middle 7(46.7%) 7(46.7%) 14(46.7%)
High Class 1(6.7%) 4(26.7%) 5(16.7%)
Total 15(100%) 15(100%) 30(100%)
P=0.314, Not Significant, Fisher Exact Test
Graph No.4 Social status distribution in two groups patients studied
Among the 30 patients included in this study 36.7% of the patients were of lower
class, 46.7% of the patients were of middle class, 16.7% of the patients were of high
class.
Table 10: Religion distribution in two groups of patients studied
Observations and Results
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 70
Religion Group A Group B Total
Hindu 11(73.3%) 14(93.3%) 25(83.3%)
Muslim 4(26.7%) 1(6.7%) 5(16.7%)
Total 15(100%) 15(100%) 30(100%)
P=0.330, Not Significant, Fisher Exact Test
Graph No.5 Religion distribution in two groups patients studied
Among the 30 patients included in this study 83.3% of the patients were Hindu,
16.7% of the patients were Muslims
Table 11: Obstetric History distribution in two groups of patients studied
Observations and Results
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 71
Obstetric
History Group A Group B Total
Primi 9(60%) 6(40%) 15(50%)
Multi 6(40%) 9(60%) 15(50%)
Total 15(100%) 15(100%) 30(100%)
P=0.273, Not Significant, Chi-Square Test
Graph No.6 Obstetric History distribution in two groups patients studied
Among the 30 patients included in this study 50% of the patients were primipara,
50% of the patients were Multipara.
Table 12: Diet distribution in two groups of patients studied
Observations and Results
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 72
Diet Group A Group B Total
Mixed 10(66.7%) 8(53.3%) 18(60%)
Veg 5(33.3%) 7(46.7%) 12(40%)
Total 15(100%) 15(100%) 30(100%)
P=0.456, Not Significant, Chi-Square Test
Graph No.7 Diet distribution in two groups patients studied
Among the 30 patients included in this study 60% of the patients were taking mixed
diet, 40% of the patients were vegetarians.
Table 13: Prakruthi distribution in two groups of patients studied
Observations and Results
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 73
Prakruthi Group A Group B Total
Vata pitta 9(60%) 3(20%) 12(40%)
Vatta 1(6.7%) 8(53.3%) 9(30%)
Vata kapha 4(26.7%) 1(6.7%) 5(16.7%)
Pitta 1(6.7%) 3(20%) 4(13.3%)
Total 15(100%) 15(100%) 30(100%)
P=0.006**, Significant, Fisher Exact Test
Graph No.8 Prakruthi distribution in two groups patients studied
Among the 30 patients included in this study 40% of patients were VP prakruti, 30%
of the patients were V prakruti, 16.7% of the patients were of VK prakruti, 13.3% of
the patients were of the P prakruti.
RESULTS
Table No.14 : UDARA SHOOLA-Assessment of study outcome in different study
points
Observations and Results
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 74
Udara shoola D1 D2 D3 D4 D5 D6 D15 D30 %
difference
Group A
(n=15)
0 0(0%) 0(0%) 0(0%) 1(6.7%) 1(6.7%) 1(6.7%) 4(26.7%) 6(40%) 40.0%
1 4(26.7%) 4(26.7%) 7(46.7%) 9(60%) 10(66.7%) 10(66.7%) 9(60%) 9(60%) 33.3%
2 7(46.7%) 7(46.7%) 6(40%) 4(26.7%) 4(26.7%) 4(26.7%) 2(13.3%) 0(0%) -46.7%
3 4(26.7%) 4(26.7%) 2(13.3%) 1(6.7%) 0(0%) 0(0%) 0(0%) 0(0%) -26.7%
Group B (n=15)
0 0(0%) 0(0%) 0(0%) 2(13.3%) 4(26.7%) 5(33.3%) 10(66.7%) 11(73.3%) 73.3%
1 5(33.3%) 6(40%) 7(46.7%) 10(66.7%) 9(60%) 7(46.7%) 4(26.7%) 4(26.7%) -6.6%
2 7(46.7%) 6(40%) 7(46.7%) 3(20%) 2(13.3%) 3(20%) 1(6.7%) 0(0%) -46.7%
3 3(20%) 3(20%) 1(6.7%) 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) -20.0%
P value 0.006** 0.805 1.000 1.000 0.339 0.280 0.101 0.139 -
Chi-Square/Fisher Exact Test
Group A - On stastically analyzing the effect of treatment on Udara shoola it was
noted that there was statistically significant change. The mean score of udara shola of
which was 40% in No pain grade, 33.3% were in Mild pain grade,-46.7% were in
Moderate pain grade,-26.7% were in severe pain grade.
Group B - On stastically analyzing the effect of treatment on Udara shoola it was
noted that there was statistically significant change. The mean score of which was
73.3% in No pain grade,-6.6% were in Mild pain grade,-46.7% were in Moderate pain
grade,-20.0% were in severe pain grade.
Graph No.09 : UDARA SHOOLA-Assessment of study outcome in different
study points
Observations and Results
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 75
Table 15: UDARA SHOOLA- Comparative assessment at different time points
in two groups studied
Observations and Results
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 76
Udara shoola Group A Group B Total P value
D1 2.00±0.76 1.87±0.74 1.93±0.74 0.623
D2 2.00±0.76 1.80±0.77 1.90±0.76 0.463
D3 1.67±0.72 1.60±0.63 1.63±0.67 0.854
D4 1.33±0.72 1.07±0.59 1.20±0.66 0.321
D5 1.20±0.56 0.87±0.64 1.03±0.61 0.140
D6 1.20±0.56 0.87±0.74 1.03±0.67 0.178
D15 0.87±0.64 0.40±0.63 0.63±0.67 0.041*
D30 0.60±0.51 0.27±0.46 0.43±0.50 0.070+
Mann whitney U test- a non-parametric test
Graph No. 10 UDARA SHOOLA- Comparative assessment at different time
points in two groups studied
The mean difference of udara shoola in Group A was reduced from 2.00 ± 0.76 to
0.60 ± 0.51 on D30. And in Group B it was reduced from1.87 ± 0.74 to 0.27 ± 0.46 on
D30.
The difference in the mean values of the two groups shows that it is statistically
significant (P=0.070+).
Table 16: STANYA PRAVARTANA-Assessment of study outcome in different
study points
Observations and Results
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 77
Stanya
pravart
ana
D1 D2 D3 D4 D5 D6 D15 D30
%
differe
nce
Group A
(n=15)
0 5(33.3
%)
4(26.
7%)
1(6.7
%) 0(0%) 0(0%) 0(0%) 0(0%) 0(0%)
-
33.3%
1 9(60%
)
9(60
%)
5(33.
3%)
3(20%
)
2(13.3
%)
1(6.7
%)
1(6.7
%) 0(0%)
-
60.0%
2 1(6.7
%)
2(13.
3%)
9(60
%)
12(80
%)
13(86.
7%)
14(93.
3%)
14(93.
3%)
15(10
0%) 93.3%
3 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) 0.0%
Group B
(n=15)
0 5(33.3
%)
5(33.
3%)
1(6.7
%) 0(0%) 0(0%) 0(0%) 0(0%) 0(0%)
-
33.3%
1 10(66.
7%)
5(33.
3%)
6(40
%)
4(26.7
%)
1(6.7
%) 0(0%) 0(0%) 0(0%)
-
66.7%
2 0(0%) 3(20
%)
6(40
%)
10(66.
7%)
12(80
%)
15(100
%)
15(100
%)
15(10
0%)
100.0
%
3 0(0%) 2(13.
3%)
2(13.
3%)
1(6.7
%)
2(13.3
%) 0(0%) 0(0%) 0(0%) 0.0%
P value 1.000 0.406 0.608 0.682 0.598 1.000 1.000 1.000 -
Chi-Square/Fisher Exact Test
Group A - On statistically analyzing the effect on treatment on Stanya
pravartana it was noted that there was no significant change.The mean score of stanya
pravartana of which was-33.3% in absent grade, -60% in inadequate grade, 93.3% in
adequate grade, 0.0% in excessive grade.
Group B -On statistically analyzing the effect of treatment on stanya
pravartana it was noted that there was no significant change.The mean score of which
was -33.3% in absent grade, -66.7% in inadequate grade, 100% in adequate, 0.0% in
excessive,grade.
Observations and Results
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 78
Graph No. 11 STANYA PRAVARTANA - Comparative assessment at different
time points in two groups studied
Observations and Results
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 79
Table 17: STANYA PRAVARTANA-Comparative assessment at different time
points in two groups studied
Stanya
pravartana Group A Group B Total P value
D1 0.73±0.59 0.67±0.49 0.70±0.53 0.806
D2 0.87±0.64 1.13±1.06 1.00±0.87 0.593
D3 1.53±0.64 1.60±0.83 1.57±0.73 0.927
D4 1.80±0.41 1.80±0.56 1.80±0.48 0.936
D5 1.87±0.35 2.07±0.46 1.97±0.41 0.190
D6 1.93±0.26 2.00±0.00 1.97±0.18 0.317
D15 1.93±0.26 2.00±0.00 1.97±0.18 0.317
D30 2.00±0.00 2.00±0.00 2.00±0.00 1.000
Mann whitney U test- a non-parametric test
Graph No.12 STANYA PRAVARTANA-Comparative assessment at different
time points in two groups studied
The mean difference of stanya pravartana in group A was increased from 0.73±0.59 to
2.00±0.00 on D30. And in group B it was increased from 0.67±0.49 to 2.00±0.00 on
D30. There is not a statistically significant difference between the input groups
(P=1.000).
Observations and Results
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 80
Table 18: INVOLUTION OF UTERUS-Assessment of study outcome in different
study points
Involution of
uterus D1 D2 D3 D4 D5 D6 D15 D30
%
difference
Group I (n=15)
0 14(93.3%) 9(60%) 1(6.7%) 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) -93.3%
1 1(6.7%) 2(13.3%) 2(13.3%) 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) -6.7%
2 0(0%) 4(26.7%) 12(80%) 15(100%) 13(86.7%) 0(0%) 0(0%) 0(0%) 0.0%
3 0(0%) 0(0%) 0(0%) 0(0%) 2(13.3%) 15(100%) 5(33.3%) 0(0%) 0.0%
4 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) 10(66.7%) 0(0%) 0.0%
5 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) 15(100%) 100.0%
Group II (n=15)
0 15(100%) 9(60%) 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) -100.0%
1 0(0%) 2(13.3%) 1(6.7%) 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) 0.0%
2 0(0%) 4(26.7%) 14(93.3%) 15(100%) 10(66.7%) 0(0%) 0(0%) 0(0%) 0.0%
3 0(0%) 0(0%) 0(0%) 0(0%) 5(33.3%) 15(100%) 8(53.3%) 0(0%) 0.0%
4 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) 7(46.7%) 0(0%) 0.0%
5 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) 15(100%) 100.0%
P value 1.000 1.000 0.598 1.000 0.390 1.000 0.462 1.000 -
Chi-Square/Fisher Exact Test
Group A-On statistically analyzing the effect of treatment on involution of uterus it
was noted that there was no statistically significant change.The mean score of
involution of uterus which was -99.3% in No involution grade, -6.7% in 0-1.25 cms
involution grade, 0.0% in 1.25-5 cms involution grade,0.0% in 5-10 cms involution
grade,0.0% in 10-13.5 cms involution grade, 100% in completelety involuted grade.
Group B- On statistically analyzing the effect of treatment on involution of uterus it
was noted that there was no statistically significant change. The mean score of
involution of uterus which was -100% in No involution grade, 0.0% in 0-1.25 cms
involution grade, 0.0% in1.25-5 cms involution grade, 0.0% in 5-10 cms involution
grade, 0.0% in 10-13.5 cms involution grade, 100% in completely involuted grade.
Observations and Results
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 81
Graph No.13 : INVOLUTION OF UTERUS - Comparative assessment at
different time points in two groups studied
Observations and Results
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 82
Table 19: INVOLUTION OF UTERUS-Comparative assessment at different
time points in two groups studied
Involution of
uterus Group A Group B Total P value
D1 0.07±0.26 0.00±0.00 0.03±0.18 0.317
D2 0.67±0.90 0.67±0.90 0.67±0.88 1.000
D3 1.73±0.59 1.93±0.26 1.83±0.46 0.276
D4 2.00±0.00 2.00±0.00 2.00±0.00 1.000
D5 2.13±0.35 2.33±0.49 2.23±0.43 0.203
D6 3.00±0.00 3.00±0.00 3.00±0.00 1.000
D15 3.67±0.49 3.47±0.52 3.57±0.50 0.277
D30 5.00±000 5.00±000 5.00±000 1.000
Mann whitney U test- a non-parametric test
Graph No. 14 INVOLUTION OF UTERUS-Comparative assessment at different
time points in two groups studied
The difference in the mean values in group A was increased from 0.07 ± 0.26 to 5.00
± 000 on D30. And in group B it was increased from 0.67 ± 0.90 to 5.00 ± 000 on
D30.
There is not a statistically significant difference between the input groups (P=1.000).
Observations and Results
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 83
Table 20: LOCHIA-Assessment of study outcome in different study points
LOCHIA D1 D2 D3 D4 D5 D6 D15 D30 %
difference
Group A
(n=15)
0 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) 10(66.7%) 66.7%
1 0(0%) 0(0%) 1(6.7%) 0(0%) 1(6.7%) 0(0%) 0(0%) 0(0%) 0.0%
2 0(0%) 0(0%) 1(6.7%) 3(20%) 6(40%) 11(73.3%) 13(86.7%) 5(33.3%) 33.3%
3 9(60%) 9(60%) 12(80%) 10(66.7%) 6(40%) 4(26.7%) 2(13.3%) 0(0%) -60.0%
4 6(40%) 6(40%) 1(6.7%) 2(13.3%) 2(13.3%) 0(0%) 0(0%) 0(0%) -40.0%
Group B (n=15)
1 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) 7(46.7%) 46.7%
2 0(0%) 0(0%) 1(6.7%) 0(0%) 0(0%) 0(0%) 0(0%) 0(0%) 0.0%
3 0(0%) 0(0%) 1(6.7%) 5(33.3%) 5(33.3%) 8(53.3%) 10(66.7%) 6(40%) 40.0%
4 10(66.7%) 10(66.7%) 9(60%) 9(60%) 8(53.3%) 5(33.3%) 4(26.7%) 1(6.7%) -60.0%
5 5(33.3%) 5(33.3%) 4(26.7%) 1(6.7%) 2(13.3%) 2(13.3%) 1(6.7%) 1(6.7%) -26.6%
P value 1.000 1.000 0.636 0.750 0.877 0.386 0.390 0.566 -
Chi-Square/Fisher Exact Test
Group A- On statistically analyzing the effect of treatment on lochial bleeding it was
noted that there was no statistically significant change .The mean score of lochia
which was 66.7% in Absent grade, 0.0% in Mild bleeding grade, 33.3% in Normal
bleeding grade, -60.0% in Moderate bleeding grade, -40.0% in Excessive bleeding
grade.
Group B- On statistically analyzing the effect of treatment on lochial bleeding it was
noted that there was no statistically significant change. The mean score of lochia
which was 46.7% in Absent grade, 0.0% in Mild bleeding grade, 40.0% in Normal
bleeding grade, -60.0% in Moderate bleeding grade, -26.6% in Excessive bleeding
grade.
Observations and Results
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 84
Graph No.15 : LOCHIA - Comparative assessment at different time points in two
groups studied
Observations and Results
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 85
Table 21: LOCHIA-Comparative assessment at different time points in two groups
studied
LOCHIA Group A Group B Total P value
D1 3.40±0.51 3.33±0.49 3.37±0.49 0.710
D2 3.40±0.51 3.33±0.49 3.37±0.49 0.710
D3 2.87±0.64 3.07±0.80 2.97±0.72 0.317
D4 2.93±0.59 2.73±0.59 2.83±0.59 0.355
D5 2.60±0.83 2.80±0.68 2.70±0.75 0.485
D6 2.27±0.46 2.60±0.74 2.43±0.63 0.195
D15 2.13±0.35 2.40±0.63 2.27±0.52 0.185
D30 0.67±0.98 1.27±1.33 0.97±1.19 0.194
Mann whitney U test- a non-parametric test
Graph No.16 : LOCHIA - Comparative assessment at different time points in
two groups studied
The mean difference of Lochia in Group A was decreased from 3.40±0.51 to 0.67±0.98
on D30. And in Group B it was decreased from 3.33±0.49 to 1.27±1.33.
There is not a statistically significant difference between the input groups (P=0.194)
Observations and Results
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 86
Discussion
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 86
DISCUSSION
DISCUSSION ON CONCEPTUAL STUDY
Mortality and morbidity of the mother the most challenging problem of our
country.Yet postpartum and postnatal period receives less attention from health care
providers than pregnancy and childbirth.In day to day life we come across the females
patient complaining of various ailments such as pain abdomen, back ache, anaemia,
joints pains and prone to infection if not taken care in the puerperial period.
Frequent postpartum morbidity and its association with perinatal outcome
suggest the need for postpartum care in developing countries for both the mother and
the child.
Post natal care is the attention given to the general mental and physical
welfare of the mother and the infant. Care should be directed towards prevention and
early detection and treatment of the sutika roga and its complications.Among the most
common and distressing complications the puerperial period are “After Pain” in multi
as well in primi paras and painful breast engorgement usually in primipara.
Sutika Makkalla one of the sutika roga is well documented in our classics
since the ancient time by our acharyas.The main causative factor of sutika makkalla is
the viatiation of the vata dosha.The Prakupita vayu localizes the unexcreated blood
and retains this blood in the uterus inspite the use of ushna teekshna dravyas,this
retained blood produces various complication and leads to Makkalla and if left
untreated can cause abcess.
Discussion
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The vata dosha is the main reason for the diseases occurring in the sutika
avastha,hence all possible measures to balance the vata dosha is been done in the
study.
The paricharya mentioned in sutika is atmost important for preventing various
diseases in this period and maintain the health of the sutika so as she can take care of
herself and the baby.
Ayurveda describes the condition of sutika avastha and its various
vyadhis.The most happiest stage in the womens life.Here various paricharya
explained to sutika i.e prasavottara kala like dinacharya rutucharya has been explained
for the betterment of the health.
During the various stages of womens life as in garbha avastha, prasava
avastha,etc the chala doshas,kledha,rakta nisruthi,dhatu kshinata and shareera
shunyata after the prasava makes the sutika abala more prone to disorders caused due
to the viatiation of vata. Also due to strenuous work of the body during the various
stages of labour makes the stree abala with reduced agni because of shunyata of the
body therefore the sutika should be given the energetic and potent medications.
As the body of the sutika has undergone wear and tear she should be
administered ghrita pana as it is pittaanila hara,nourishes all the dhatus, its ojas
kara,medhya, swara varna prasadana,daha shamaka, does bala vriddhi and is vayah
sthapana.Thus sneha pana is advised in the paricharya,this sneha is good provider of
cell wall removes the wear and tear and tissue builder.It is considered as yoga vahi
which provides many essential fatty acids such as omega 6 which provides anti
inflammatory properties. Ghrta which includes 17 amino acid is essential for good
Discussion
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health. It contains 3% linoleic acid, an antioxidant.It also contains Vitamin A, D, C
K.41
As the puerperial women is prone to infection such as urinary tract infection
she was advised to take plenty of liquids in form of water peya vilepi etc and
evacuation of bladder time to time.
Sutika was also advised to follow the diet and regimes according to their
culture which has been running in tradition since the olden times. Apart from the
internal medication external treatment described in classics as abhyanga, parisheka,
avagha etc all help in the mitigation of the vata dosha. All the massage therapies can
be sthanika or sarvadiahika has lot of advantages such as –It is jara hara, pushti kara,
shrama hara, vata hara, klesha sahatwa, abhighata sahatwa, dhadyakrith67
,i.e it will
definitely strengthen the sutika to tolerate the after effects of labour.it gives good
sleep and also ayush kara.
The swedana given to the stree should be according to her bala, as abala stree
should not be teeskshana sweda infact mrudu sweda in form of pariskeha and avagha
are benefical. This su ushna medicated jala dhara or immersing the body into this jala
droni is kapha vata hara does maintaining of pitta, effective in reducing the vedana
vega, does agni deepti, twak prasannata, removes muscle cramps stiffness in the
joints, heavinees of the body.This type of sweda is effective in arsha, ashmari, and
shula. This procedures act as vedana sthapana in the sutika .
The benefits of abhyanga, parisheka etc reduces and stabilizes the increased
heart rate and blood pressure, improves circulation and endo phins , cause
vasodilatation and relaxes the muscles.The Endophins are the body’s natural pain
killers. Massage improves the circulation and nervous stimulation and also exert
Discussion
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 89
smoothening effect on the body. The sudation is also a good reliever of muscular pain,
and various pain experienced by the women in puerperial period. The blood vessels
dilate as a result of heat due to sudation and increases circulation resulting in more
oxygen supply to all parts of body. This will thus help in relieving the pain local as
well as generalized pains.
As mentioned in classics the different types of sweda ,advise given to sutika to
sit on the chair of ushna charmavan filled with oil is for the purpose of yoni
prasadana. Laxiety of perineum as a result of excessive stretching during the process
of labour this ushna oil helps in regaining the pelvic floor strength. Also Nubja
shayana, udara vesthana, abhyanga not only does vayu shaman but prevents vayu
vikruthi occurring due to hollow space formed in the uterus and abdomen due the
delivery of the fetus.The sutika snana followed by dhupana, and vishranti are vata
hara and shramahara.
After the process of delivery the the sutika is prone to infections especially the
genital tract due to dilated tract. So it was advised for yoni dhupana which acts as
antibacterial, maintaines the hygiene of perineum, keeps episotomy healthy along
with hastening in the healing process. The drugs used for the purpose having
jantugna, kandugna, sthohara, vedana sthapana, vrana shodhana and ropana
properties. Due to all the above measures advised to the sutika helped her regain her
lost strength, healing of wound, reduction of perineal tenderness.
Researches show that sudation helps in relieving pain and speed up the healing
process.Fumigation with Agaru acts as pain reliever of the wounds and ulcers,
Guggulu acts as a anti infective.The essential oils of the roots of Kustha and the
Discussion
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 90
glycosides are pharmacologically active bodies which has carminative , antiseptic and
disinfectant thus having destructive effect against the streptococcus and
staphylococcus bacteria.
No shodhana procedures are advised in sutika avastha since there is no
bahudosha avastha in lady after giving birth.Only by following the samanya sutika
paricharya will get back her the qualities of swastha28
.
Puerperium is the period following birth of the child during which all the body
tissues revert back approximately to the pre-pregnant state. The International
Conference on Population and Development 1994 defines reproductive health as the
state of complete physical , mental, and social well being and not merely the absence
of disease or infirmity in all matters relating to reproductive system and to its
functions and process.
It is well known that certain psycho-somatic changes takes place during the
sutika kala such as weigth loss, loss of body fluids, lacerated genital tract, pain lower
abdomen, back pain, constipation, mental stress etc. Most of the changes leads to
apatarpana of the stree 65
and this causes vata vriddhi which is responsible for
different types of health problems such as puerperial sepsis, anaemia, prolapse of
uterus. This disorders are difficuilt to treat and some become incurable. The risk
factors could be partially be reduced by facilitating early recovery process. So the
management of sutika and its vyadhis is essential to ,promote recovery of maternal
health so that the mother may become able to resume her normal activities as early as
possible.
Discussion
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Ayurveda emphasis much importance of the care of women especially in the
prenatal and postnatal period, Sutika is the state of women immediately after delivery
extends till the time she continues breast feeding. Sutika refers to women after
expulsion of placenta .The sound puthramsutte brings back the jeeva i.e the life in the
parturient women, but this is possible if her health is taken care during the postnatal
period. The period after prasava is called as sutika avastha .Puerperium begin as soon
as the placenta is expelled and last for approximately 6 week when the uterus
becomes regressed to non pregnant state. The women becomes emaciated and have
shunya shareera because of garbha vriddhi, shithila sarva shareera dhatu, pravahana
vedhana, kledha rakta nisruti,agni mandya will lead to dhatushaya hence extra care to
be given to prevent the 74 types of diseases which can happen in this period if not
managed properly.
Our Acharyas Charaka, Sushruta, both Vaghbhata said what so ever disease
afflict the sutika are difficuilt to cure or become incurable, Ayurveda has advises a
specific diet and life style regime called sutika paricharya to prevent the
complications and to restore the health of the mother.
The paricharya described in our classics is very essential for the sutika to
regain her bala which has been followed since ancient times.
1] Abhyanga
It can be sthanika (udara, yoni),sarvadaihika with help of ghrta and tailas mentioned
in text are beneficial. It is having list of advantages:
It is jara hara, pushti kara - gives bala to dhatu.
Discussion
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Shrama hara-reduces the stress and strain of the muscles due to excessive stretching
during labour,weigth bearing and uterine contractions.
Vata hara,klesha sahatwa, abhigata sahatwa, dhadyakritha67
i.e helps strengthen the
sutika to tolerate the effects strenuous labour.
Abhyanga of lower back help for proper drainage lochia. Yoni abhyanga tones up
the vagina and perineum and prevents laxity and prolapse, alleviates pains , heals
vaginal and perineal wounds42
2] Parisheka and Avagaha20
Parisheka is pouring hot water in a stream , it is vatakapha hara, vedana hara, does
agni dipti, twak prasadana, sroto nirmalata so that the abnormal blood clots
accumulated in the uterine cavity after delivery is excreated properly and vata dosha
subsides.
3] Udara veshtana (Pattabandhana)
It prevents vitiation of vata dosha by compressing the hollow space produced after
expulsion of the fetus.Abdomen should be tightly wrapped with long cotton cloth
after bath.It provides support to the back and abdomen.It mainly helps the uterus to
shrink back to its normal size.
4] Yonidhupana
Vaginal defence is lowered due to hypoestrogenic state and patient is prone to
infection.Dhupana will maintain the hygiene of the perineum.It keeps the episiotomy
wound healthy and hastens its healing process.The drugs having jantugna , kandugna ,
vrana ropana and shodhana properties are been used for the purpose.
Discussion
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In the same way puerperial after pains can be relieved off by following the
above paricharya and some home remedies such as Ginger tea, Fennel tea, rice water,
warm water bath and oil massage along with the given medications.
DISCUSION ON THE DRUGS
Almost all the drugs in the group have ushna veerya, katu vipak,laghu ruksha
teekshna gunas and kaphavata hara properties.
Probable mode of action of the drugs
After pains is predominant feature of vata dosha,the sutika having taken the
Bharangyadi kalka and shuddha hingu having ingriedients which have vata hara,sula
hara, shoths hara,vedanasthapana properties.
Katu rasa, laghu ruksha,teekshna guna and ushna veerya of Bharangi etc drugs
will help improve the metabolic rate thereby increasing the agni which helps the
sutika to take congenial diet which will provide the necessary nutrients to all organs
of the body.The drugs having anti oxidant properties by which the puerperial women
regains her strength thus have proper sthanya utpatti and vriddhi as it is also having
sthanya shodhaka properties.As the women regains her bala ,she will have better
threshold of pain.
The karma like shotha hara, vedanasthapana, garbhashaya shodhana, rakta
shodhana,sthanya shodana,anulomana soola hara of bharangi etc rugs relives the
spasmodic contaction establishes good uterine contraction and retraction which
favors proper involution of uterus and normalizes the lochial discharge,therby
stabilizes or prevents the pains (After Pains).
Discussion
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Good Involution of the uterus and proper lochial discharge ensures the sroto
shuddhi which results in koshta shuddhi, Bharangyadi kalka helps in stimulating the
metabolism of the body and excreation of the waste products by its anulomana
properties, thus relieving the pain.
Bharangi, the drug having kaphavata shamaka, shotha hara, vranapacana, rakta
shodhana, anulomana will help in the healing process of episiotomy wound, helps
excreation of lochial discharge by anuloma & rakta shodhaka activity as a result the
pain is relieved.Bharangi-Clerodendrum serratum is having serratogenic acid,
phytoserols,saponins etc acts as anti bacterial, anti allergic stomachic48
hence reduces
the infection of puerperial women.
It has been observed that the Nagara one among the ingriedients of
Bharangyadi Kalka is not having anti inflammatory, hypolipidaemia, antibacterial,
analgesia but also have anti oxidant along with anti thrombolytic activity50
,
thrombosis of leg is commonly seen in post delivered ladies hence this ailment
isprevented by the presence of the drug Nagara.
Nagara-Ginger-The gingerols present in dried ginger has a very powerful anti
inflammatory properties which helps in decreasing the level of pain, also having
thermogenic activity which helps lower the body temperature and treats the cold and
flu and gets rid of toxins in sutika who is prone to such ailments in puerperial period.
Devadaru having the properties of vedana sthapana, shotha hara, garbhashaya
shodhaka, anuloma49
etc helps in relieving the pain ailment and also promotes good
uterine activity by cleansing the uterus of its unwanted contents therby good lochial
discharge and involution of uterus is possible with this drug.
Discussion
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Devadaru-Cedrus Deodar is having the activities such as anti
inflammatory,anti bacterial,anti septic and analgesia51
by which the ailments is
subsided along with regaining good health of the puerperial women as she will be
protected against the infection prone during the post partum period.
Hingu-having the katu rasa, laghu teekshna guna, ushna veerya is useful in
flatulent colic vitiated conditions of vata kapha dosha having vedana sthapana, sula
hara,vata hara anulomana47
helping in relieving the pain(Makkalla). As Hingu is
having all these qualities, so it is advised to administer with ghrita only to make it
palatable and to reduce its teekshnata.
Hingu-Ferula Asafetida was reported to have anti spasmodic, abortifacient
emmmanagogue, anti bacterial etc activities useful in conditons of udara shoola,
hridya shoola, agnimandya, basti shoola etc which are the predominant complaints of
the sutika makalla.
भषैज्यं ििगणुऽेपाने भोजनाग्रे प्रशस्यते ।
- शा.सं.पिूव
Here the drug is given before i.e. pragbhakta because as there is vitiation of
Apanavata.
DISCUSSION ON THE PATIENTS
All the patients had attended complete follow ups and there were no dropouts in
the study.
The study has been carried out in 30 delivered ladies, considering the most
common ailments seen after delivery that the lady experiences.The clinical study or
the medications prescribed will be considered effective only if the lady gets relief
Discussion
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from the complaints.With this view the present study was selected which showed
improvements in both the groups.
Drugs were selected on the basis of their properties and actions to treat the
ailments described.To evaluate the efficacy and to compare the effect of the drugs i.e
Bharangyadi Kalka and Shuddha Hingu,the 30 patients were divided into 2 groups of
15 patients each,Group A was given the drug Bharangyadi Kalka in the dose of 6
gms bd before food for 5 days and Group B was given Shuddha Hingu in the dose of
125 mg bd before food for 5 days and the groups were followed up on day 6,15 and
30 of the treatment.
DISSCUSION ON OBSERVATION SEEN IN PATIENTS
AGE-Among the 30 patients included in the study, 26.7% were in the age group of
18-20 yrs, 43.3% of the patients were in the age group of 21-25 yrs, 30% of the
patients were in the age group of 26-30 yrs.The age group between 20-35 is the
average child bearing period for primi as well as for multi.The age group between 18-
25 is considered for marriage and conceiving soon after.
EDUCATION- Among the 30 patients included in the study 23.3% of the patients
were illiterate, 36.7% of the patients studied SSLC, 26.7% of the patients were
studied PUC,13.3% of the patients were graduate, this shows that majority of the
patients were literate as far as education is concerned.
OCCUPATION- Among the 30 patients included in study 96 % of the patients were
housewife, 3.3% of the patients were office goers, this shows that the majority of the
patients were housewife doing their daily household works.
Discussion
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SOCIAL STATUS- Among the 30 patients included in the study 36.7% of the
patients were of lower class, 46.7% of the patients were of middle class,16.7% of the
patients were of high class. The status of the patients shows that they were aware of
the need of hospital delivery and its managements of conditions.
RELIGION- Among the 30 patients included in the study 83.3% of the patients were
Hindu, 16.7% of the patients were Muslims.This shows that area of study was more
Hindu dominating population.
OBSTETRIC HISTORY- Among the 30 patients include in the study 50% of the
patients were primi, whereas 50% of the patients were multi.
DIET-Among the 30 patients included in the study 60% of the patients were
habituated to take mixed diet, 40% of the patients were vegetarians.It can be stated as
the patients in the area were habituated to take mixed diet.
PRAKRUTI- Among the 30 patients included in the study 40%of the patients were
of VP Prakruti, 30%of the patients were of V Prakruti,16.7% of the patients were VK
prakruti and 13.3% of the patients were of P prakruti.
Discussion
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DISCUSSION ON THE EFFECT OF TREATMENT
UDAARA SHOOLA
Group A-On stastically analyzing the effect of treatment on Udara shoola it was
noted that there was statistically significant change.The mean score of udara shola of
which was 40% in No pain grade,33.3% were in Mild pian grade,-46.7% were in
Moderate pain grade,-26.7% were in Severe pain grade.
Group B- On stastically analyzing the effect of treatment on Udara shoola it was
noted that there was statistically significant change.The mean score of which was
73.3% in No pain grade,-6.6% were in Mild pain grade,-46.7% were in Moderate pain
grade,-20.0% were in Severe pain grade.
It was observed that there was significant difference (P=0.006) between group
B(73.3%) and group A(40%) which shows that the drug Shuddha Hingu may be
having vata hara property,thus this statement is also justified by Dr.Gyan Kamat et al
saying that Hingu acts as anti spasmodic.This could be due to the properties of hingu
as anulomana, shoola hara, vedana sthapana which helped in relieving the pain.
The mean difference of udara shoola in Group A was reduced from 2.00 ± 0.76 to
0.60 ± 0.51 on D30. And in Group B it was reduced from 1.87 ± 0.74 to 0.27 ± 0.46
on D30.
The difference in the mean values of the two groups shows that it is statistically
significant (P=0.070+).
Incidence of lower abdominal pain in women after delivery is one of the most
common problem today. After labour and birth there may be pain or soreness in the
Discussion
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whole body. It happens because of laboring in different positions and pushing. Body
undergoes tremendous changes throughout the nine months of pregnancy and in just
six week afterwards organs return to their normal or previous state, during this
process a few transformation may cause discomfort to the body. In this study the said
parameter is considered and the desired effect has been shown in both the groups. The
drugs of study groups having properties like shula prasamana, vedana sthapana, vata
hara, shotha hara, garbhashaya shodhana etc, have shown results in reducing the pain
parameter, the drug Hingu has showed better results than the Bharangyadi Kalka .
STANYA PRAVARTANA
Group A- On statistically analyzing the effect on treatment on Stanya pravartana it
was noted that there was no significant change.The mean score of stanya pravartana
of which was-33.3% in absent grade, -60% in inadequate grade, 93.3% in adequate
grade, 0.0% in excessive grade.
Group B-On statistically analyzing the effect of treatment on stanya pravartana it was
noted that there was no significant change.The mean score of which was -33.3% in
absent grade, -66.7% in inadequate grade, 100% in adequate, 0.0% in excessive grade.
The mean difference of stanya pravartana in group A was increased from0.73 ± 0.59
to2.00 ± 0.00 on D30 And in group B it was increased from 0.67 ± 0.49 to2.00 ± 0.00
on D30.
There is not a statistically significant difference between the input groups(P=1.000).It
can be stated that the drugs of treatment groups may not be acting on stanya
pravartana thus it can be stated that it is one of physiology change in peuerperium.
Discussion
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Establishment of lactation is one of the important measures in the management of the
puerperiumThe sthanya uttpatti and vriddhi depends on the nutrition of the sutika as
also mentioned in classics about the aahara etc paricharya to be followed in this
period for proper nourishment of the dhatus.Formation of proper rasa dhatu by means
of aahara favours the formation of breast milk which the updhatu of rasa dhatu.The
study of drugs having deepana pacana activity will help to increase the agni thus the
mother takes nutritious diet will improve the general condition of the mother,thus will
have proper lactation.In the study there was no undue complications like breast
engorgement, mastitis, abcess etc. Desired results were not statistically significant in
both the groups in lactation parameter.
INVOLUTION OF UTERUS
Group A- On statistically analyzing the effect of treatment on involution of uterus it
was noted that there was no statistically significant change.The mean score of
involution of uterus which was -99.3% in No involution grade, -6.7% in 0-1.25 cms
involution grade, 0.0% in 1.25-5 cms involution grade,0.0% in 5-10 cms involution
grade,0.0% in 10-13.5 cms involution grade,100% in completelety involuted grade.
Group B-On On statistically analyzing the effect of treatment on involution of uterus
it was noted that there was no statistically significant change. The mean score of
involution of uterus which was -100% in No involution grade, 0.0% in 0-1.25 cms
involution grade, 0.0% in1.25-5 cms involution grade, 0.0% in 5-10 cms involution
grade,0.0% in 10-13.5 cms involution grade, 100% in completely involuted grade.
The difference in the mean values in group A was increased from 0.07 ± 0.26 to 5.00
± 0.00 on D30 and in group B it was increased from 0.67 ± 0.90 to 5.00 ± 0.00 on
D30.
Discussion
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 101
There is not a statistically significant difference between the input groups (P=1.000).
Good contractions of the uterus after delivery as it returns to its pre-pregnant size, the
process called as involution is the significant change in the lady who has given
birth.Process of involution is affected by many factors such as multiparity,
overdistended uterus due to big baby, polyhydraminous etc which may take some
more time than the normal to revert back to its original size. Also retained products of
after births may have adverse effect on the general condition of the mother leading to
infection or PPH where the puerperial lady is prone to during this period of
postpartum.Here the process of involution has occurred in normal pace in both the
groups. The drugs in Bharangyadi Kalka having ushna, teekshna, garbhashaya
shodhaka, rakta shodhaka, stanyashodhaka helped relieved the spasmodic contractions
and established good uterine retraction and contractions have favoured proper
involution but not significant.
LOCHIA
Group A-On statistically analyzing the effect of treatment on lochial bleeding it was
noted that there was no statistically significant change .The mean score of lochia
which was 66.7% in Absent grade, 0.0% in Mild bleeding grade, 33.3% in Normal
bleeding grade, -60.0% in Moderate bleeding grade, -40.0% in Excessive bleeding
grade.
Group B- On statistically analyzing the effect of treatment on lochial bleeding it was
noted that there was no statistically significant change. The mean score of lochia
which was 46.7% in Absent grade, 0.0% in Mild bleeding grade, 40.0% in Normal
Discussion
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 102
bleeding grade, -60.0% in Moderate bleeding grade, -26.6% in Excessive bleeding
grade.
The mean difference of Lochia in Group A was decreased from 3.40 ± 0.51 to 0.67 ±
0.98 on D30 and in Group B it was decreased from 3.33 ± 0.49 to 1.27 ± 1.33.
There is not a statistically significant difference between the input groups(P=0.194).
Early in puerperium, sloughing of decidual tissue results in a vaginal
discharge of variable quantity, is termed as lochia . Conventional obstetrical wisdom
shas for many years taught that lochia lasts for approx. 2 weeks after delivery. Recent
studies, however have indicated that lochia persists for upto 4 weeks and may stop
and resume up to 56 days after delivery. Both the groups showed no results in
normalizing the lochial discharge . The lochial discharge result was not significant
though the drugs having teekshna, ushna guna, katurasa ushna virya, vatanuloma,
garbhashaya shodhaka properties of drugs used.
OTHER OBSERVATIONS SEEN DURING TRIALS
One patient in group A had gap in episiotomy wound during the follow up
period. On examination it was found that the patient had unhygienic condition.
On history taking it was noted that patient had constipation due to which there
was straining during defecation which resulted in the gap in the wound. The
wound was healed by daily dressing only. Though th drug has no effect on
episiotomy.
Abdominal girth : It was observed that there was decrease in the abdominal
girth from the day of trial to the follow up. In some it was observed that there
Discussion
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 103
was increase in the abdominal girth during the follow up periods. This could
be due to fat accumulation during the time of sutika paricharya.
Conclusion
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 104
CONCLUSION
Since After pains can lead to the pain in nervous hormonal stress responses
which prohibit the mother from performing daily tasks and due to fact that pregnancy
and puerperium period is verey important in fetal, maternal, and infant
health,suppertive care should be developed for this period to improve the relationship
between the mother and the infant and to reduce the side effects.Therefore mothers
support and follow up during this period is essential.Cosidering the importance of
health promotion,protection of women,the high incidence and prevalence of after
pains and the need to investigate the related factor,hoping that the results of this study
trigger the conduction of high quality clinical and non-invasive services and
encourage taking a step towards improving the health and satisfaction of the women
in the society.
The study has shown good results over relieving the pain ,healing the
episotomy wound,giving strength to the lady by increasing the appetite,clearing the
bowels etc,therby having proper lactation,involution of the uterus and shedding of
lochia.
As the drug Hingu showed better results which was administered in group B than
Bharangyadi kalka which was administered in group A, hence the hypothesis H2 can
be accepted i.e.
H2 : There is significant effect of Shuddha Hingu than Bharangyadi kalka in Sutika
Makkalla.
Conclusion
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 105
Considering that longer duration of breast feeding and ambulation in early postpartum
period could decrease after pains,it is suggested to encourage postpartum mothers to
begin breast feeding and ambulation as soon as possible after the birth of the child.
Scope for further research
Further studies in the same topic can be carried out in large sample for better results,
since the sample here is too small.
Further scope of research in the following topic can be carried out by taking more
factors and studying each factor to see the results with larger samples.
The dose of the drug Hingu taken was very less i.e. 125 mg BD. This dose is taken in
the view that it should not interfere in the normal lactation. As this dose did not affect
lactation, so further study can be taken with a larger dose.
The dose of the drug bharangyadi kalka to be reduced as the dose taken here is 6 gms
BD where there was difficulty for the patients to take and also by making it in
palatable form.
Summary
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 106
SUMMARY
The dissertation entitled “A COMPARATIVE CLINICAL STUDY OF
BHARANGYADI AND SHUDHA HINGU IN SUTIKA MAKKALLA WITH
RESPECTIVE TO PUERPERAL AFTER PAINS” is been discussed under
headings namely review of literature, Methodology, observation, Results , discussion
and conclusion.
Introduction
Now days the post partum and post natal period receives less attention apart
from pregnancy and child birth as a result of which the Sutika complaints of various
aliment such as low abdominal pain, backache weakness, body ache and even
psychological instability is seen. To fulfill her responsibilities she needs to be free
from aliments, in order to promote healthy puerperium that is maternal health so as to
resume her normal activities as soon as possible, hence the present study has been
selected.
Review of Literature
Historical review : Has been dealt with the origin and reference of Sutika and
Sutika Vyadhi from beginning of Vedic Period.
Sutika Paricharaya, Sutika vyadhi : Ayurvedic review Sutika and its vyadhis
has been understood according to different Acharays, the suitka paribhasha,
paricharya, Kala and sutika vyadhi have been dealt
Summary
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 107
Puerperium after pains : Modern review of puerperium with different stages,
hormonal and systemic changes taking place in puerperial period and management of
puerperal after pains have been dealt with.
Drug Review :- The drugs selected for the study have been discussed in detail
according to ayurvedic and modern composition, properties, the action of drugs has
been hypothetically concluded due to laghu, Ruksha, Tikshna gunas, katu, tikta rasa
with a deepana, Pacana, vatanulomana, Vedanasthapna etc., properties doing
garbhashaya shodhan, Rakta Shodhan improving her lochial discharge with good
uterine involution of uterus.
Methodology :
This explains about the method of data collection, inclusion, exclusion criteria
and assessment criteria i.e the study design
Observation:
The observation noted throughout the study process has been included under
this dissertation work done.
Results :
Statistically significance of the study has been incorporated here in one of the
parameter.Study has been found effective in relieving the symptons of pain which was
the most important parameter in this study than the other parameters.It has been seen
that there was improvement in the general condition of the sutika thus proper
involution, lactation, lochial shedding was possible.
Summary
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 108
Discussion:
Here along with treatment, the sutika wasadvised the paricharya was
analysed.The mode of action of the Brangyadi Kalka and Shuddha Hingu in the
selected parameters and also discussion on the observation and effect of the treatment
on the patients has been disscussed.
Conclusion:
Conclusion drawn from various section of the work are given in this part of
dissertation. i.e Shuddha Hingu showed better results than Bharangyadi Kalka in the
parametrs of assessment,hence can be advised in Sutika Makkalla.
Bibliography
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 109
BIBLIOGRPHY
1. Kaviraja Dr. Ambikadatta Shastri, Sushruta Samhita, published by Chaukhamha
Sanskrit Sansthan, Varanasi, Edition Reprint 2009, Sharira Sthana 10th
Chapter, 2nd
and 24-25th
Shloka, ,Pg. No. 104.
2. Kaviraja Atrideva Gupta, Ashtang Samgraha, published by Chaukhamha Krishnas
Academy, Varanasi – 2011, Sharira Sthana, 3rd
Chapter, 35 Shloka, Page No.287.
3. Acharya Vagbhata, Ashtanga Hridaya, edited with Vidhyotini Hindi Commentary
by Kaviraj Atridev Gupta, published by Chaukhamha Prakashan, Varanasi,
Edition Reprint–2009, Sharira Sthana, 1st Chapter, 92
nd Shloka, Pg. No.241.
4. Madavakara, Sudarsena Shastri Madhava Nidana Madhukosha Sanskrit
commentary by Shri. Vijayrakistha and Srikantha Dutta, revised edited by
Yadunandara Upadhaya Part-II, published by Chaukambha Sanskrit Sansthan Reprint
Edition-2004, Pg. No.372.
5. Agnivesha Caraka, Dridhabala Charaka Samhita Sharira Sthana Vol.1 Introduction
by Vaidya Samrata- Sri. Satya Narayan Sastri Padmabhushana elaborated Vidyohni
Hindi Commentary by Pt. Kasinath Sastri and Dr. Gorakhanatha Chaturvedi,
published by Chaukumbha Bharati Academy reprint year–03, Pg No.652-653.
6. P.V. Tewari – Ayurvedic Prasuti Tantra Striroga Vol. 1 Published by Chaukumbha
Orientalia, Varanasi, 2nd
Edition 1999, Reprint -2003, Page No. 573-576
7. J.L.N. Shastry Dravya Guna Vol. II forwarded by Prof. K.C. Chunukar, published
by Chaukumbha Orientalia, Varanasi, Reprint Edition -2010, Page No. 507, 871, 922
8. D.C. Dutta Text Book of obstetrics, New Central, Book Agency (P) Ltd., Kolkatta,
6th
Edition-2004, Page No.151-152, 145,146,147,149-150,,160,154,,436-437.
Bibliography
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 110
9. Shri. Bhavamishra, Bhavaprakash, Edited with Vidyotini Hindi commentary by
Bhisagratha, Pandit Shri. Bhramashankar Mishr Shastri, Published by Chaukhabha
Sanskrit Sansthan, 5th
Edition 1993, Chikitsa Sthana, 70th
Chapter, Shloka 136-139,
Page No. 789-790.
10. Vaidya Laxhmipati Shastri Yogratnakar Streerog Adhikar with Vidyotini Hindi
commentary, edited by Bhisagratra Bhrama Sanskar Sastri Published by Chaukhabha
Sanskrit Sansthana, 5th
Edition -1993, Page No. 426 - 427.
11. Dr. Gayatridevi Prasuti Tantra made easy published by Chaukhabha Sanskrit
Pratishthan Delhi, 1st Edition -2008, Orientalia Published And Distributors, Page No.
283 - 284.
12. Vrddha Jivaka, Kashyapa Samhita, Sansthan introduction by Nepal Rajaguru
Pandit Hemaraja Sarma with Vidyotini Hindi commentary and Hindi translation of
Sanskrit commentary by Sri. Satyapala Bhisagachorya, published by Chaukhabha
Sanskrit Sansthan, Varanasi, Khilasthana 11th
Chapter, Shloka No. 7th
– 13th
Page
No. 305.
13. Bapalal G. Vaidya, Nighantu Adarsha (Uttaradha) published by Chaukhambha
Bharati Academy Publisher and Distributors of Monumental Treatises of the East
Varanasi (India) 1st Edition -1985, Page No. 255, 256, 542, 568.
14. Cakradatta Chikitsa Samagraha Grantha compiled by Mahamahopadyaya Caraka
Chaturanana Sri. Mahachakrapanidatta with Tahracandrika Explanation with
Annotation of Sri. Swidas Sen publisher Chaukhambha Orientalia, Varanasi, 1st
Edition - 1993, Page No. 736.
Bibliography
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 111
15. Kaviraja Shri. Ambitadatta Shastri Bhaisayyatraiavali – Vidyatini Hindi
commentary published by Chaukhambha Sanskrit Sansthan Varanasi Edition -2002,
Page No. 73.
16. Willams Pritchard MacDonald Obstetrics COD – 1976 by Appleton Century
Crofts Newyork 15th
Chapter, Page – 379.
17. Acharya Sharangadhar, Sharangadhar Samhita by Dr Smt Shailaja Srivastav,
published by Chaukhambha orientalia, Reprint edition 2009, 5th
chapter, 1st shloka,
page no 168.
18. Dr Shobha Hiremath, Bhaishajya Kalpana (Indian Pharmacuetics), Published by
H.K.L Adiga for IBH, Bangalore, 3rd
reprint 2006, page no 77.
19. Sushruta:Sushrutha samhita:Acharya Jadhavji Trikamji, Chaukhamb
Orientaila,8thEdition,2005,Varanasi.Page-389.
20. Vaghbhatacharya:Ashtanga Hridaya,Shastri Kashinath,Chaukhabha orientalia,9th
Edition,2005,Varanasi Page-383.
21. Sushruta:Sushrutha samhita:Acharya Jadhavji Trikamji,Chaukhamba,
Orientaila,8thEdition,2005,Varanasi.Page-463.
22. Harita:Harita samhita,Ramavalamba Shastri,Prachya Prakashana,1st Edition
1985,Vranasi,Page-407.
23. Maharshi Bhela:Bhela samhita,K.H.Krishnamurthy, Chaukhambha
Vishwabharati,Edition 2000,Vranasi,Page-545.
24. Ayurvedacharaya,Venimadhava shastri,Ayurvediya Shabda Sangraha,Page-923.
25. Kaviraj Umeshchandra Gupta,Vaidyaka Sabdha Sindhu,Chaukhabha
Orientalia,1999,Varanasi,Page-1145.
26. Kashyapa:Kashyapa Samhita.Pandit Hemaraja Sharma,Chaukhambha Sansrit
Samsthana,10th Edition 2005,Varanasi Page-305,308.
Bibliography
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 112
27. Kashyapa:Kashyapa Samhita.Pandit Hemaraja Sharma,Chaukhambha Sanskrit
Samsthana,10th Edition 2005,Varanasi Page-97.
28. Agnivesha:Charaka Samhita,Acharya Jadhavji Trikamji,Chaukhabha
Orientalia,5th Edition 2001,Varanasi,Page-349.
29. Professor:Premavati Tewari,Ayurvedia Prasooti tantra and Streeroga,
Chaukhambha Orientalia,2nd Edition1999,Varanasi,Page-559.
30. Bhavmishra,Bhavprakash Uttara Khanda,Shri Bramhashankar Mishra,Sri
RupalaljiVaishya,Chaukhambha Orientalia2005,Varanasi,Page-790.and 2009,Edition
11th
,Page-792.
31. Harita:Harita samhita,Ramavalamba Shastri,Prachya Prakashana,1st Edition
1985,Vranasi,Page-405,406.
32. Stedman’s Medical Dictionary,New Delhi,S.Chand and company Ltd,23rd
Edition,Page-1170.
33. RALPHA C. BENSON-Current Obstetric and Gynaecology Diagnosis and
Treatment,Edition1976,California,Page-697-720.
34. Current Obstetrics and Gyaecology Diagnosis and Treatment,By-
Alan.H.Decherney,Lavern Nathan,Page-234-241.
35. A Practice of Obstetric and Gynaecology-By Geoffery Chamberlain,
J.Friend,PeBowen-Simpkins,Page-105.
36. Gray Cunningham,Norman,Kenneth,Larry.C.Gilstrap,John C.Hauth,Katherine
D.Wenstrom-Willams Obstetrics,Mc GRAW-HILL,Medical Publishing
Division,Library of Congress Cataloging in Publication Data,21st Edition 2001,Page-
404,406,407,415-419.
Bibliography
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 113
37. D.Keith,Edmonds-Dewhurst’s Textbook of Obstetrics and Gyaecology for post
graudates-Black Well Science Ltd,6th Edition 1999,Reprinted 2000,Page-342-353.
38. Sudha Salhan,Textbook of Obstetrics,Jaypee Brothers,Medical Publishers (P)
LTD,1ST Edition 2007,Page-597-599.600,601,602,603,604-611,612-623.
39. Mudaliar and Menon,Clinical Obstetrics,Madras Orient Longman,9th Edition
1990,Page-123.
40. V.Ruth,Benneth,Linda K Brown,Myles,Textbook of Midwives,Churchill Living
Stone,13th Edition 2001,Page-598.
41. Livestrong.Com(Home page on internet)Santa MonicaCA 90404,Healthy Living
for prevention of Diseases Inc, C Available from Http://www.livestrong.com/:2013.
42. http:/www.allthingshealing.com/Martial Arts/Abhyanga-Ayurveda Massage
and Postnatal Care/12173#.
43. http/www.babycentre.com/o-postpartum-cramps-afterpains 11723.bc
44. http://www.momjunction.com/articles/tips to reduce your postpartum cramps-
00120670/
45. googleweblight.com/https://hpathy.com/cause-symptom-
treatment/afterpains,pains after labour/delivery
46. https://medical-dictionary.thefreedictionary.com/afterpains
46.1] Cite-Farlex Partner Medical Dictionary c Farlex 2012
46.2] Cite-Dorlands Medical Dictionary for Health Consumers c 2007
by Saunders,an imprint of Elsevier,Inc.
46.3] Cite-The American Heritage R Medical Dictionary copyright c 2007,2004 by
Houghton Mifflin Company.Published by Houghton Mifflin Company.
46.4] Cite-Segen’s Medical Dictionary c 2012 Farlex.
46.5] Cite-Medical Dictionary for Health Profeesion and Nursing c Farlex 2012.
Bibliography
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 114
47. Datbase on Medicinal Plants used in Ayuveda & Siddha,By Professor
G.S.Levekar.Assited By R.Koditkar, A.Hole ,V.Shinde, M.V.Sathe and
G.Deshmukh.Vol-8.2007.
48. Datbase on Medicinal Plants used in Ayuveda,Vol-1 P.C.Sharma,
M.B.Yelne,T.J.Dennis.AssitedbyArunJoshi,Y.S.Prabhune,G.B.Borkar,D.P.Sharma,P.
B.Singh.2000.Published by Central Council For Research In Ayurveda
&Siddha,Jawahar Lal Nehru Bharatiya Chikitsa Avum Homoepathy Anusandhan
Bhawan.61-65,Institutional Area,Janakpuri,New Delhi-110058.
49. Datbase on Medicinal Plants used in Ayuveda & Siddha, Vol-7
50. Datbase on Medicinal Plants used in Ayuveda & Siddha,Vol-5
51. A Handbook of Medicinal Plants. Prajapati /Purohit /Sharma / Kumar. Published
By Agrobis India,Agro House,Behind Nasrani Cinema Chopasani Road,Jodhpur.
52. Cunningham FG,Leveno KJ,Bloom SL,Haut JC,Rouse D,Spong CY.Willams
Obstetrics 22nd Edition,New York;Mc Graw HILL 2012.
53. Hold Croft A.Postpartum Lower abdomen pain.1999;Available at
URL:http://link.springer.com/journal/11916/3/2/page/1.
54. Murray SS.Mckinney ES,Gorrie TM.Foudation of maternal new born nursing,
3rd Edition,Philedelphia:W.b,Saunders company.2003,page 426.
55 Specialised Visual Culture,women childbirth and midwifery,
Translators:Ahmadi M,Azgoli.G,et al Tehran:Publication of light 2003s.
56. CollenN. Physiologic consideration 2005,Available
at;URL:http://www.nursingcell.com.
57. Hold Croft A.Postpartum pain, Department of Anaesthesia and Intensive
care,Imperial college London,UK.
Bibliography
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 115
58. Priyavat Sharma History of Medicine in India,New Delhi,Indian National Science
Academy,First Print 1992,Page no-70,72,77,96,98,99,429,438.
59. Vaghbhata,Ashtang Sangraha,Volume 1.Krishnadas Academy,Varanasi
1993,Page no-288
60. Shrangadhara,Sharangadhara Samhita,Pandit Parashurama Shastri Vidyasagar,
Chaukhambha Orientalia,Vranasi 2005,Page no-149
61. Bhavmishra,Bhavprakash,Brahmasankara Mishra,Rupalalji Vaishya,1st and 2
nd
part,Chaukhambha University,Varanasi 2004,Page-vol1-30.31.32.vol2-791.
62. Agnivesha, Charak Samhita,Acharya Priyavat Sharma,Chaukhanbha Orientalia
Delhi,Edition 2007,Shareera Sthana Chapter 8,Jatisutriya adhaya,Sholka no-33-
35,Page-788-789.
63. Bhavmishra, Bhavprakash Purva Khanda,Shri Bramhashankar Mishra,Sri
RupalaljiVaishya,Chaukhambha Orientalia2007, Edition 11th
Varanasi,Page-96
64. Yogaratnakar,Vaidya Laxmipati Shastri,Chaukhambha Sanskrit
Samasthana,Varanasi,Uttaradha,Page-426.
65. Kaviraj Ambikadutta Shastri,Sushruta Samhita,Chaukhambha Sanskrit
Sansthana,Varanasi, Reprint edition 2005,Sharira Sthana 10th
Chapter,Sholka no-
21,Page-77
66. Sushruta Samhita by Yadavji Trikamji,5th
Editon,Chaukhambha Orientalia
1992,Page-389.
67. Vagbhatacharya, Ashtang Sangraha,Krishna Shastri Narve,
Chaukhambha Orientalia, 9TH
Edition 2005,Varanasi,Page-26.
Annexure
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains.
Patient’s consent
I am fully educated with the disease and treatment procedure thereby I got satisfied. I
accept for medical trial on me happily.
Date : Signature of Patient
Annexure
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 116
Mahantesh Ayurvedic Medical College, Ilkal
Affliated of RGUHS, Karnataka, Bangalore.
Department of Post Graduate Studies in PTSR
A Comparative Clinical Study to evaluate the efficacy of
Bharangyadi Kalka and Shuddha Hingu in Management of Sutika
Makkalla w.r.t Puerperal After Pains
Guide – Dr.S.B.Nadagouda (M.S Ayu) Scholar- Dr. Boradevi Hungund
Professor Dept. of PTSR
CASE SHEET PERFORMA
Name: Case:
Husband / Father Name: IPD:
Address: OPD:
Age:
Sex: Female DOA:
Education: Illiterate/SSLC/PUC/Graduation. DOD:
Occupation: Student/HW/Off Job/ Business.
Religion : Hindu/ Muslim / Christian.
Socioecomic Status: Lower/ Middle/Highclass.
Email/Phone No:
Date of Commencement of Treatment:
Date of Completion:
Result:
Patient’s consent
I am fully educated with the disease and treatment procedure thereby I got satisfied. I
accept for medical trial on me happily.
Date : Signature of Patient
Annexure
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 117
1] Pradhana Vedana [chief complaints with duration] :
2] Poorva Vyadhi Vrittanta [h/o. Past illness/surgery] :
3] Kula Vrittanta [family History] :
4] Vaiyaktika Vrittanta :
Appetite : good/ moderate/ poor
Diet : Veg/ Mixed
Sleep : Normal/ Disturbed
Bowel : Regular/Irregular
Micturation : Regular/ Irregular
Habits :
5] Rajo – Vrittanta :
Age of Menarche :
Menstrual Cycle : Regular / Irregular
LMP :
EDD :
Annexure
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 118
6] Poorva Prasava Vrittanta [Obstetric history] :
No. Yrs Date Pregnancy
event
Labour
event
Method of
Delivery
Puerperium Baby
7] Prasava Vrittanta (Delivery Notes) :
8] Pareeksha [Examination] :
A] Samanya Pareeksha [General Examination] :
1] Dasavidha Pareeksha :
1. Prakriti : V/P/K/VP/VK/PK/VPK.
2. Vikriti : V/P/K
3. Sara : P/M/A
4. Samhanana : P/M/A
5. Pramana : Heena/Madhyama/ Uttam
6. Satmya : Ekarasa/ Sarvarasa
7. Satva : Pravara/ Madhyama/ Avara
8. Ahara Shakti : P/M/A
9. Vyayama Shakti : P/M/A
10. Vayah : Baala/ Madhyam/Vruddha
2] Ashtavidha Pareeksha :
Nadi : Shadha:
Mala : Sparsha:
Mutra : Drika:
Jihwa : Akruti:
Annexure
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 119
3] Vital Signs :
Pulse : Blood Pressure:
Temperature : Height:
Respiration Rate : Weight:
B] Samsthanika Pareekhsa ( Systemic Examination) :
1. R.S :
2. C.V.S :
3. C.N.S :
C] Sthanika Pareeksha ( Local Examination) :
P/A :
9] Prayogika Pareksha :
CBC :
HIV :
HBsAg :
RBS :
VDRL :
Annexure
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 120
10] Assessment Criteria :
Subjective Parameter
Pain abdomen ( Gradings)
Grade BT AT (6th
day) AT (15th
day) AT (30th
day)
0 – No pain
1 – Mild pain
2 – Mod pain
3 – Severe pain
Objective Parameter
P/A Uteine Inrvolution
Fundal ht
in cms
Day 1 Day 2 Day 3 Day 4 Day 5
Follow up
Fundal ht
in cms
Day 6 Day 15 Day 30
Effect of Drug on P/V Bleeding
P/V
Bleeding
Day 1 Day 2 Day 3 Day 4 Day 5
Follow up
P/V
Bleeding
Day 6 Day 15 Day 30
Annexure
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 121
Effect of Drug on Stanya
Stanya
Day 1 Day 2 Day 3 Day 4 Day 5
Follow up
Stanya
Day 6 Day 15 Day 30
11] Chikista :
Date of Treatment schedule initiation –
Date of Completion of Treatment –
Group A Bharangyadi Kalka
Days Time Dose Any Complication Observation
1st day
2nd
day
3rd
day
4th
day
5th
day
Date of Treatment schedule initiation – Date of Completion of Treatment –
Group B Shuddha Hingu
Days Time Dose Any Complication
Observation
1st day
2nd day
3rd day
4th day
5th day
Annexure
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 122
12] Follow up
6th
day :
15th
day :
30th
day :
13] Result : 1) Cured
2) Improved
3) Unchanged
14] Conclusion
Signature of Guide Signature of Researcher
(Dr. S. B. Nadagouda) (Dr. Boradevi. B. Hungund)
Review of Literature
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 55
THE DRUGS OF BHARANGYADI KALKA
Review of Literature
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 56
HINGU
Review of Literature
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 57
PREPARED BHARANGYADI KALKA
Review of Literature
A comparative clinical study to evaluate the efficacy of Bharangyadi kalka and Shuddha Hingu in the management of Sutika Makkalla w.r.t Puerperal after pains. Page 58
HINGU POWDER