Introduction:
Pravahika is a disease described in the Ayurvedic texts which can be compared with the diarrhoeas and dysenteries of the present day medical literature. It was described in the shleshmika atisaara.(1) (Sushruta Samhita, Uttara Sthana 40/ 138-160). It is described with various synonyms like Purisha kshaya, Nischaraka or Nissaaraka, Bhimbhisi etc. it occurs because of the Excessive consumption of the heavily digested, oily or dry, very hot, liquid and sticky foods, incompatible foods, excessive eating and irregular food habits are the causative factors of the disease. It also occurs as a complication of the panchakarma. Psychological causes like fear, etc. consumption of the contaminated water and excessive consumption of the alcoholic beverages and allergic foods also play a major role. Suppression of the vega (natural urges) and infections (krimi) are also the commenest causes of Pravahika.
It expressed by the symptoms of pain in the chest, abdomen and anal canal, gatraavasaada (tiredness), anilasannirodha (flatulence), vitsangha (constipation), adhmaana (bloating) and avipaaka (indigestion). The main feature of the disease is the painful and forceful elimination less or more quantity of the sticky (picchila) stool. The other features of Pravahika are abdominal and anorectal pain due to vaata, burning pain due to pitta, kapha mixed sticky stools due to kapha and blood mixed stool due to raktha involvement (1).
The disease is compared with amoebic and other forms of dysenteries of the modern medical literature.
Amoebiasis is the next major cause of death, next to Malaria, in the developing countries. It occurs because of the poor sanitation. It is cause by the Infection of the Protozoan Entamoeba histolytica. The parasite was first described by Losch (1875) in Russia.
The life cycle of E. histolytica consists of two stages: an infective cyst and an invasive trophozoite. The trophozoites measure 10–50 mm in diameter and contain a single nucleus with a central karyosome. The cysts measure 10–15 mm in diameter and typically contain four nuclei.
E. histolytica cysts are resistant to acidification, chlorination and desiccation. They are capable of surviving in a moist environment for several weeks and are spread via the ingestion of faecally contaminated food or water. After ingestion of the cysts by a human host, excystation occurs within the lumen of the small intestine. During excystation, nuclear division is followed by cytoplasmic division, giving rise to eight trophozoites. The trophozoites then reside in the lumen of the caecum and large intestine, where they adhere to the colonic mucus and epithelial layers; re-encystation of the trophozoites occurs within the lumen of the colon, resulting in the excretion of cysts in the faeces and continuation of the life cycle.
E. histolytica can spread in the bloodstream (haematogenously) after it has penetrated the colonic epithelium and can establish persistent extraintestinal infections (most commonly amoebic liver abscess).
The clinical forms of intestinal Amoebiasis may be
1. Asymptomatic cyst carriers - It consists of colicky lower abdominal pain and increased frequency of bowel movements with loose watery diarrhea.
2. Symptomatic. The symptomatic intestinal Amoebiasis can progress from mild diarrhoea (non-dysenteric colitis with intermittent diarrhea, mucus, abdominal pain, flatulence and weight loss) to severe haemorrhagic dysentery (acute amoebic dysentery with presence of blood and mucus in the stool, accompanied by abdominal pain, tenderness, tender Hepatomegaley and rectal tenesmus) with or without complications.
Laboratory diagnosis can be done by:
• Direct examination of colonic exudates obtained at sigmoidoscopy or of freshly passed stool as a saline wet mount.
• Sigmoidoscopy and
• Barium enema examination
• The Amoebic Flourescent Anti-Body Titre (FAT)
Treatment:
The treatment for this condition is
aimed at administering the drugs which have the properties of langhana, deepana,
paachana and graahi. After the infection reduces sthambhana dravyas can
be administered.
Rationale in
the selection of the drug:
Many internal medications are mentioned in
Ayurvedic texts for the treatment of Pravahika.
Daruharidra Rasakriya is selected for the present study as it has the
properties of deepana, paacana, grahi etc which are more suitable for
the control of Pravahika.
Daruharidra (Berberis aristata, Berberidaceae) is one
of the important medicinal plants used by the Ayurvedic physicians since ages
for various ailments. It is also known by the synonyms Peetadru (stems are yellow in colour), Kaleyaka (It removes
doshas out of the body), Daarvi (It washes out doshas), Pacham pachca (Increases
digestive power), Parjani (It prevents the diseases), Katamkateri (It removes
the doshas, which cause obstruction to the srotos) etc. (2)
It is said to be used in diseases like Prameha, Kusta,
Rajayakshma, Unmaada, Apasmaara, Kshatha, Kshaya, Swayathu, Arshas, Grahani,
Paandu, Visarpa, Visha, Vrana, Vaataraktha, Mukha roga, Hikka, Shwaas,
Yonivyapath, Netra roga and Atisaara. (2,3)
The chief chemical content in it is Berberine (C20H17NO4). Berberine has been proved to have wide range of pharmacological activites like antimicrobial activity against a variety of intestinal parasites like Entamoeba histolytica, bacteria, fungi, protozoans, helminths, chlamydia, and viruses. It is also useful in ocular trachomal infections, cardio-vascular diseases like tachyarrythmias etc. (4)
Mode of
preparation of Rasakriya(3):
Rasakriya is the form of preparation of the acqueous extract of the plant materials used by the Ayurvedic physicians. In this the 1 part of the drug(s) are made into coarse powder and boiled with 16 parts of water till only 4 parts of the water remains. Then it is filtered and the filtrate is again heated on a low flame till it becomes semi-solid. This semisolid mixture is again dried in shade or drier to get a solid mass of extract. This is called as Rasakriya. This is a dosage form mentioned in Ayurvedic classics which is palatable and less in dosage (approximately 1/10th of the powder). This can be given in a dose of 300mg TID.
By considering the above mentioned the present clinical study is conducted to know the efficacy of the Rasakriya of Daruharidra (Berberis aristata, Berberidaceae) in the cases of Pravahika (Amoebiasis).
Aims and
objectives:
The aim of the study is to study the effect of the Daruharidra (Berberis aristata, Berberidaceae) Rasakriya in the cases of Amoebiasis.
Materials and
methods:
Selection of
the patient:
30 patients who are diagnosed to have the symptoms of acute amoebic infection and positive microscopic stool examination for Entamoeba histolytica were taken for the study from Government Ayurvedic Hospital, Hyderabad.
Patients with other forms of diarrhoeas are not considered for this study.
Method of
study: Open clinical study.
Inclusion
criteria:
- Patients with positive microscopic stool examination for Entamoeba histolytica cysts and having the symptoms of Amoebiasis.
- Patients without the symptoms of severe dehydration.
- Patients with age group between 20 and 60 years were selected for the study.
Exclusion
criteria:
- Severe dehydration
- Patients below 20 years of age.
- Pregnant and lactating women.
- Elderly patients.
- Patients having arrhythmias.
- Patients having complications of the disease.
Assessment:
- Based on the relief in the symptoms.
- Stool examination for the presence of cysts.
Symptoms and
grading of the symptoms:
Diarrhoea:
• 1-2 motions a day – 0
• 3-4 motions a day – 1
• 4 -5 motions a day – 2
•
Above 5 motions a day – 3
Precipitate
stool
• Absent – 0
• Present at certain times a day – 1
• Present all through the day – 2
Melena
• Absent – 0
• Few blood stains in stool – 1
• Bloody stools – 2
Abdominal
cramps
• Absent – 0
• Mild not affecting daily activity – 1
• Affecting daily activity – 2
Flatulence
• Absent – 0
• Mild without bloating and constipation – 1
• With bloating and constipation – 2
Epigastric
distress
• Absent – 0
• Mild burning sensation – 1
• Burning with sour belchings – 2
• Burning with vomitings – 3
Fatigue
• No Fatigue - 0.
• Fatigue not affecting his daily activities - 1
• Fatigue affecting his daily activities - 2
• Activities reduced due to weakness - 3
Stool
examination:
• No cysts – 0
• Positive for the cysts – 1
Total efficacy of therapy:
Classification
of results:
• No response: if the efficacy is below 50%.
• Poor response: If the efficacy is between 51 to 60%.
• Fair response: If the efficacy is between 61-75%.
• Good response: if the efficacy is between 76-100%.
Drugs:
Daruharidra bark was procured from Jaipur market and was tested for its microscopic identity in the Department of Dravyaguna, Government Ayurvedic College, Hyderabad. The bark is then made into course powder and Rasakriya is prepared as per the procedure mentioned for the Rasakriya by the Ayurvedic texts. The Rasakriya thus obtained is made into 300mg pills (Figure 1-3).
Dose: 300mg TID before meals with warm water.
Route of Administration: Oral route.
Duration of the Treatment: 10 Days.
Clinical assessment
The study is based on the randomized clinical trial conducted at Govt Ayurvedic hospital, Hyderabad during the period 2002 to 2003.
Both the subjective and objective parameters are recorded before and after the treatment and analyzed statistically.
Observation
and results:
Totally 30 patients were taken for the study. The patients are classified according to the age, sex, diet and place of residence. The tables showing the distribution of the patients in the above groups are as follows:
TABLE
1: SHOWING AGE WISE DISTRIBUTION OF THE PATIENTS
|
Age (in years) |
Number of patients |
Percentage of patients |
|
21-30 |
11 |
36.67 |
|
31-40 |
8 |
26.67 |
|
41-50 |
6 |
20 |
|
50-60 |
5 |
16.67 |
|
Total |
30 |
100 |
AGE
WISE DISTRIBUTION OF THE PATIENTS
TABLE
2: SHOWING SEX WISE DISTRIBUTION OF
PATIENTS
|
Sex |
Number of patients |
Percentage of patients |
|
Male |
20 |
66.67 |
|
Female |
10 |
33.33 |
|
Total |
30 |
100 |
SEX
WISE DISTRIBUTION OF PATIENTS
TABLE
3: SHOWING DIET WISE DISTRIBUTION OF THE
PATIENTS
|
Diet |
Number of patients |
Percentage of patients |
|
Veg |
14 |
46.67 |
|
Non-veg |
16 |
53.33 |
|
Total |
30 |
100 |
DIET
WISE DISTRIBUTION OF THE PATIENTS
TABLE
4: SHOWING HABITAT WISE DISTRIBUTION OF
THE PATIENTS
|
Habit |
Number of patients |
Percentage of patients |
|
Urban |
10 |
33.33 |
|
Sub-urban |
15 |
50 |
|
Rural |
5 |
16.67 |
|
Total |
30 |
100 |
HABITAT
WISE DISTRIBUTION OF THE PATIENTS
