A CLINICAL STUDY TO ASSESS THE EFFECT OF GUDUCHI SADHITA KSHEERA BASTI AND ANUBHUTA YOGA IN THE MANAGEMENT OF ASTHI-MAJJA KSHAYA W.S.R TO POST-MENOPAUSAL OSTEOPOROSIS

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BENGALURU, KARNATAKA

RGUHS Update: RGUHS Emblem Explained

 COMPLETED PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

 â€œA CLINICAL STUDY TO ASSESS THE EFFECT OF GUDUCHI SADHITA KSHEERA BASTI AND ANUBHUTA YOGA IN THE MANAGEMENT OF ASTHI-MAJJA KSHAYA W.S.R TO POSTMENOPAUSAL OSTEOPOROSIS.”

 BY

DR. ANJANA V S

PG SCHOLAR

DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SAMHITA AND SIDDHANTA

AYURVEDA MAHAVIDYALAYA, HUBBALLI- 580 024

  GUIDE

DR. SANDEEP DESAI  M.D.(Ayu), (Ph.D)

DYS yoga, M.A Sanskrit, Jyotish Acharya

ASSOCIATE PROFESSOR,

DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SAMHITA AND SIDDHANTA

AYURVEDA MAHAVIDYALAYA, HUBBALLI- 580 024

    2022-2023

AYURVEDA MAHAVIDYALAYA

HUBBALLI- 580024

 From,

DR. ANJANA V S

P.G Scholar,

Department of Post Graduate Studies in Ayurveda Samhita and Siddhanta

Ayurveda Mahavidyalaya

Hubballi – 580024

 TO,

THE REGISTRAR,

Rajiv Gandhi University of Health sciences

Bengaluru,Karnataka.

 Through,

The PRINCIPAL and

The HEAD OF THE DEPARTMENT of Post Graduate Studies in Ayurveda Samhita and Siddhanta.

Ayurveda Mahavidyalaya, Hubballi- 580024.

 Respected sir,

Sub: Submission of Completed Proforma for Registration of subject for Dissertation.

                    I request you to kindly Register the below mentioned subjects against my name for the submission of dissertation to the Rajiv Gandhi University of Health Sciences, Bengaluru for partial fulfilment of M.D(Ayu) in Ayurveda Samhita and Siddhanta.

  TITLE OF DISSERTATION:

 â€œA CLINICAL STUDY TO ASSESS THE EFFECT OF GUDUCHI SADHITA KSHEERA BASTI AND ANUBHUTA YOGA IN THE MANAGEMENT OF ASTHI-MAJJA KSHAYA w.s.r TO POSTMENOPAUSAL OSTEOPOROSIS.”

Here I am enclosing a completed proforma for registration of subject for dissertation.

Thanking you,

Place: Hubballi                                                                                Yours faithfully

Date:                                                                                               Dr. ANJANA V S

   RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BENGALURU, KARNATAKA

 COMPLETED PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

 1.   NAME OF THE CANDIDATE:                      DR. ANJANA V S

AND ADDRESS                                        1st Year P.G. Scholar

DEPARTMENT OF POST GRADUATE  STUDIES

IN AYURVEDA SAMHITA AND SIDDHANTA,

AYURVEDA MAHAVIDYALAYA,

HUBBALLI, KARNATAKA-580024

 PERMANENT ADDRESS:                        DR. ANJANA V S

D/O  VEERESH D SAJJANAR,

#36, SHREEGANDHA,

MADANI COLONY,

PADMARAJ NAGAR

GOKUL ROAD,HUBBALLI, KA - 580030

 2.   NAME OF THE INSTITUTION:                  AYURVEDA MAHAVIDYALAYA,

HUBBALLI - 580024

 3.   COURSE OF STUDY:                                DOCTORS OF MEDICINE (AYURVEDA) IN

AYURVEDA SAMHITA AND SIDDHANTA

 4.   DATE OF ADMISSION OF COURSE:        25/03/2023

 5.   TITLE OF TOPIC:“ A CLINICAL STUDY TO ASSESS THE EFFECT OF GUDUCHI SADHITA KSHEERA BASTI AND ANUBHUTA YOGA IN THE MANAGEMENT OF ASTHI-MAJJA KSHAYA w.s.r TO POSTMENOPAUSAL OSTEOPOROSIS.”

                                                                                       6. BRIEF RESUME OF THE INTENDED WORK

6.1 NEED FOR THE STUDY:

       Ayurveda explains Shareera as the composition of dosha, dhatu, and mala 1. These entities are responsible for proper functioning of the body, their poshana is done by Aahara Rasa after its paka by Jatharagni. Dhatu poshana is influenced by the function of respective Dhatvagni. The samasthiti of these entities is considered as Aarogya and imbalance in them as Vyadhi 2.

Among many factors that contribute to vaishamyata in dosha; kala and swabhava3 are the one which can’t be controlled but have to be experienced by every being. In accordance with that, the shareerika changes that a woman undergoes during puberty, reproductive, menopausal and postmenopausal phase has an impact on manas as well and all this makes her more vulnerable towards different vyadhi utpatti. Among all these, postmenopausal changes in shareera is a more evident and challenging problem that most women face in today’s time.

Rajonivritti is a condition that can be considered under Swabhavika avastha attained due to kala and swabhava. It’s made up of two words ’Rajah’ and ’Nivritti’ which means cessation of Arthava pravritti. Various symptoms can be seen in this phase due to imbalance of Tridoshas. One of the major symptoms seen due to Vata vaishamyata and its effects on Asthi dhatu due to ashraya and ashrayi sambhanda4, are such as: Asthi toda, asthi soushirya, parva-bheda, kesha patana, shrama, tamodarshana, etc which are told in the lakshanas of asthi-majja kshaya. These symptoms are similar to a condition called ’Osteoporosis’.

Osteoporosis is a disease that is characterised by low bone mass, deterioration of bone tissue, and disruption of bone microarchitecture: it can lead to compromised bone strength and an increase in the risk of fractures. It is more prevalent among postmenopausal women5. It also occurs in men and women with underlying conditions or major risk factors associated with bone demineralization. According to statistics given by the World Health Organization (WHO), 30% of postmenopausal women suffer from osteoporosis. It has been reported that 61 million people in India have osteoporosis and, out of these, 80% are women6.

Osteoporosis in postmenopausal women can have wide-ranging effects on individuals and society, including physical, emotional, economic, and health care-related impacts. Recognizing the importance of prevention, early detection, and effective management of osteoporosis is crucial to mitigate these effects and improve the overall well-being of postmenopausal women in society. Thus, it is of prime importance to manage in the initial stage rather than leaving it to attain chronic state. As precisely said in our classics -’swasthasya swasthya rakshanam’ 7.

In Ayurveda, Basti is considered as ardha chikitsa8 by our Acharyas due to its effectiveness in correction of vitiated doshas. The principle of management of Asthi kshaya is said to be tikta, ghrita samyukta ksheera basti 9,10. Therefore, Guduchi sadhita ksheera basti is chosen in the present study. The Anubhuta yoga (Ashwagandha11, Amalaki12, Asthi Shrinkhala13, Eranda14, Guggulu15,Yastimadhu16) given after basti may act as bone strengthening, pain relieving and Rasayana.

Contemporary medicine offers a range of medications for osteoporosis, which are known to cause many side effects and carry potential risks. Studying Guduchi Sadhita Ksheera Basti and Anubhuta yoga treatment in postmenopausal osteoporosis is essential to assess its efficacy, safety, and potential benefits, ultimately contributing to improved patient care and treatment options. So, the present study titled “A Clinical Study to assess the effect of Guduchi Sadhita Ksheera Basti and Anubhuta yoga in the management of Asthi-Majja Kshaya w.s.r to Postmenopausal Osteoporosis” has been undertaken".

      6.2 REVIEW OF THE LITERATURE:

●     Review on asthi and majja dhatus - vruddhi 17,18,19, kshaya 20,21,22,23 and respective dhatu pradoshaja vikaras 24,25,26 as per Ayurvedic classics.

●     Review on Osteoporosis, Postmenopausal Osteoporosis 27,28 in detail.

●     Review on Guduchi sadhita ksheera Basti and Anubhuta yoga and its effectiveness in Asthi-Majja kshaya w.s.r to Postmenopausal Osteoporosis.

 PREVIOUS WORK DONE:

 â—     M. G. Bhatt – Concept of Dhatu and Dhatvagni  w.s.r. to Asthi dhatu and Asthyagni. IPGT & RA, Jamnagar,GAU, 1995.

●     Dr.Jasmine- A Clinical Study on the Role of Shatavari in Minimising the Risk of Post-Menopausal Osteoporosis. IPGT&RA, GAU Jamnagar, 2006.

●     Sanjay M Kadlimatti - Clinical Evaluation Of Asthi Kshaya Vis--Vis Osteoporosis And Its Management Through Ksheera Basti And Tab.Calcipral. Kayachikitsa . Ayurveda Mahavidyalaya, Hubli . 2006

●     Dr Rajya Lakshmi K - A Study on the effect of Katutrayadi Vati and Matra Basti in the management of Asthisoushirya (Osteoporosis). Dr BRKR Govt. Ayurvedic College,  Hyderabad. 2009

●     Dr Ajay Kumar Gupta R - Effect Of Majja basti and Asthishrinkala in the management of Osteoporosis w.s.r to Asthi-Majja kshaya- A clinical study. IPGT&RA, GAU, Jamnagar, 2010.

●     Dr.Soumendra Mohapatra- A Comparative Clinical study to Evaluate the Efficacy of Adityapaka guggulu and Abha guggulu in the management of Asthikshaya w.s.r to Osteoporosis. Shri D G Melmalagi Ayurvedic Medical College & Hospital, Gadag, RGUHS, Bangalore, 2014.

●     Dr.Deepa.S.Patil- A Randomised clinical study-Minimising the risk of Asthikshaya in Post-Menopause through Shodhana and Rasayana. Ayurveda Mahavidyalaya, Hubballi. RGUHS, Bangalore, 2020.

    6.3 AIMS OF THE STUDY:

To evaluate the efficacy of Guduchi Sadhita Ksheera Basti and Anubhuta yoga in the management of Asthi-Majja Kshaya w.s.r to Postmenopausal Osteoporosis.

 6.4 OBJECTIVES OF THE STUDY:

●     To study the concept of Asthi-Majja kshaya and their vikaras in detail.

●     To study in detail about Postmenopausal Osteoporosis.

●     To study and evaluate the efficacy of Guduchi sadhita ksheera basti and Anubhuta yoga in Asthi-Majja kshaya w.s.r to Postmenopausal Osteoporosis.

 6.4 HYPOTHESIS:

●     H0

• Guduchi sadhita Ksheera basti and Anubhuta yoga are not statistically significant in Asthi-Majja kshaya w.s.r to Postmenopausal Osteoporosis.

●     H1

• Guduchi sadhita Ksheera basti and Anubhuta yoga are statistically significant in Asthi-Majja kshaya w.s.r to Postmenopausal Osteoporosis.

  7. MATERIALS AND METHODS:

The present study entitled “A CLINICAL STUDY TO ASSESS THE EFFECT OF GUDUCHI SADHITA KSHEERA BASTI AND ANUBHUTA YOGA THE MANAGEMENT OF ASTHI-MAJJA KSHAYA w.s.r TO POSTMENOPAUSAL OSTEOPOROSIS.” is a literary and clinical research.

  7.1 SOURCE OF DATA:

The literary source of present study will be obtained from Ayurvedic Samhitas and textbooks of contemporary science, from the Departmental library of Postgraduate studies in Moulika Siddhanta in Ayurveda Mahavidyalaya Hubballi and Internet publications available in authentic websites.

In the present study the research scholar proposes to take the subjects attending the OPD and IPD of HASS’s Ayurveda Mahavidyalaya Hospital.

 7.2 METHOD OF COLLECTION OF DATA:

●     Literary Data: It will be collected from Post Graduate Library Department of Moulika siddhanta and Central library of Ayurveda Mahavidyalaya & Hospital Hubli, Authentic Research Journals, Websites and Digital Publications.

●     Clinical Data: Subjects attending the OPD and IPD of Ayurveda Mahavidyalaya & Hospital, Hubli will be taken and Subjects fulfilling the criteria of diagnosis as per the proforma will be selected for the study.

●     A clinical evaluation of Subjects will be done by collection of data through information obtained by history, physical examination and laboratory tests.

●     Statistical test: The data which are obtained by the clinical trial will be statistically analysed by applying Student’s paired ’t’ test.

●     The drug required for the clinical study will be procured and prepared in the Post Graduate Department of Rasa Shastra and Bhaishajya kalpana, Ayurveda Mahavidyalaya, Hubli.

 DIAGNOSTIC CRITERIA:

●     Subjects with classical signs and symptoms of Asthi-Majja kshaya: Asthi toda/shoola,Parvanam bheda, Sandhi shaithilya, Shrama, Kesha patana and Bone Mineral Density (BMD Score < -2.5) in postmenopausal women.

 INCLUSION CRITERIA:

●     Female subjects aged between 50-65 years (attained menopause).

●     Subjects fulfilling diagnostic criteria.

●     Subjects fit for basti karma.

 EXCLUSION CRITERIA:

●     Subjects with known cases of severe metabolic disorders and Cardiovascular disorders will be excluded.

●     Subjects who are on Hormonal therapy and known cases of Fracture, Avascular necrosis, Carcinoma will be excluded.

●     Subjects not fit for basti karma.

 7.2 (A) PARAMETERS OF STUDY:

 SUBJECTIVE PARAMETERS:

●     Asthi toda/shoola

●     Parvanam bheda

●     Sandhi shaithilya

●     Shrama

●     Kesha patana

 OBJECTIVE PARAMETERS:

●     Bone Mineral Density Test

GRADATION OF PARAMETERS:

SUBJECTIVE PARAMETERS:

1. Asthi Toda/Shoola

 

Grade - 0

No pain

|Grade - 1

Mild - Pain only on movement

|Grade - 2

Moderate - Pain without any movement, at rest

|Grade - 3

Severe - persistent pain

  

2. Parvanam Bheda

 

Grade - 0

No pain

|Grade - 1

Mild pain and Involvement of 2 joints

|Grade - 2

Moderate pain and Involvement of all joints

|Grade - 3

Severe pain and Involvement of all joints

  

3. Sandhi Shaithilya

 

Grade - 0

No Laxity

|Grade - 1

Laxity but can perform activities

|Grade - 2

More laxity and difficult to perform activities

|Grade - 3

Excessive laxity and cannot perform activities

  

4. Shrama

 

Grade - 0

No Fatigue

|Grade - 1

Mild - Occasionally not able to perform Strenuous activities

|Grade - 2

Moderate - Not able to perform routine activities

|Grade - 3

Severe - Fatigue even without doing work

5. Kesha patana

 

Grade - 0

Absent (0-100 Hair fall per day)

|Grade - 1

Mild (100- 400 Hair fall per day)

|Grade - 2

Moderate (400 - 700 Hair fall per day)

|Grade - 3

Severe - ( More than 750 Hair fall per day)

 OBJECTIVE PARAMETERS:

●     BMD TEST (T-score)

 

Normal

-1 and Above

|Osteopenia

-1 to -2.5

|Osteoporosis

-2.5 and Below

 STUDY DESIGN:

It’s a single group of literary and clinical study where 30 patients of Asthi-Majja kshaya fulfilling the inclusion criteria will be taken from the O.P.D, I.P.D and Medical camps conducted by A.M.V & H Hubli. The parameters of signs and symptoms will be graded on the basis of the standard method of Statistical analysis - Student’s paired ’t’ test.

 SAMPLE SIZE:

A minimum of 30 subjects will be selected randomly who have attained menopause.

  ASSESSMENT CRITERIA:

The data which are obtained by the clinical trial will be statistically analysed by applying Students paired “t” test.

 Reduction in subjective and objective parameters before and after the treatment will be assessed and the result will be recorded as:

 Results****Response of the patient

Marked reduced in parameters                 76%- 100% reduce of signs and symptoms

Moderately reduced in parameters            51%- 75% reduce of signs and symptoms

Mild reduce in parameters                         26%- 50% reduce of signs and symptoms

No reduction in parameter                          0% - 25% reduce of signs and symptoms

 7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so please describe briefly.

YES

 INVESTIGATIONS:

●     BMD test

●     Serum Calcium

●     RBS

 INTERVENTIONS:

A minimum of 30 subjects diagnosed as Asthi-Majja kshaya and attained menopause will be selected and are analysed.

  âž¢    Shodhana**:**

â—‹     Ama Pachana: Shunti churna

â–      3-5g thrice before food with ushna jala (till nirama lakshana is attained).

 âž¢    Procedure: Guduchi Sadhita Ksheera Basti

â—‹      Duration: Kala Basti

 âž¢    Shamanoushadi:

â—‹     Anubhuta Yoga in vati form (Guggulu kalpana).

â–      1 karsha is appropriated to 500 mg with milk thrice daily before food, for 30 days.

 âž¢    Follow up:      Once in 15 days.

 âž¢    Total duration of the study:    60 days.

      7.4 Has ethical clearance been obtained from your institution in case of 7.3?

YES

Ethical clearance has been obtained by the Ethical committee constituted by AYURVEDA MAHAVIDYALAYA, HUBBALLI  and Written consent will be taken from each individual patient on a printed consent form.

 8. LIST OF REFERENCES:

1. Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastry Navre, Edited by Pt.Hari Sastry, Astanga Hridaya of Vagbhata, with the commentaries: Sarvanga Sundara of Arunadatta and Ayurveda rasayana of Hemadri, Sutra Sthana of 11th Chapter, Verse 1. Chaukhamba Sanskrit Sansthan, Varanasi, Reprint 2015, Page No. 182.
2. Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastry Navre, Edited by Pt.Hari Sastry, Astanga Hridaya of Vagbhata, with the commentaries: Sarvanga Sundara of Arunadatta and Ayurveda rasayana of Hemadri, Sutra Sthana of 1st Chapter, Verse 20. Chaukhamba Sanskrit Sansthan, Varanasi, Reprint 2015, Page No. 14.
3. Vd Yadavji Trikamaji Acharya, Agnivesha, Charaka Samhita with Ayurveda Dipika commentary by Chakrapani, Sharira Sthana 6th chapter, Verse No. 12, Chaukhambha Publications, Varanasi, Reprint 2016, Page No. 332.
4. Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastry Navre, Edited by Pt.Hari Sastry, Astanga Hridaya of Vagbhata, with the commentaries: Sarvanga Sundara of Arunadatta and Ayurveda rasayana of Hemadri, Sutra Sthana of 11th Chapter, Verse 26-29. Chaukhamba Sanskrit Sansthan, Varanasi, Reprint 2015: Page No. 186.
5. Tümay Sözen,Lale Özışık,and Nursel Çalık Başaran, An overview and management of osteoporosis, Eur J Rheumatol. 2017 Mar; 4(1): 46–56. Published online 2016 Dec 30. doi: 10.5152/eurjrheum.2016.048

PMCID: PMC 5335887 PMID: 28293453

6. Rubanpal Khinda,1 Srishti Valecha,1 Nitin Kumar,1 J. P. S. Walia,2 Kuldeep Singh,3 Sudhir Sethi,4 Avtar Singh,5 Monica Singh,1 Puneetpal Singh,1,* and Sarabjit Mastana6,* Paul B. Tchounwou, Academic Editor, Prevalence and Predictors of Osteoporosis and Osteopenia in Postmenopausal Women of Punjab, India, Int J Environ Res Public Health. 2022 Mar; 19(5): 2999. Published online 2022 Mar 4. doi: 10.3390/ijerph19052999 PMCID: PMC8910053 PMID: 35270692
7. Vd Yadavji Trikamaji Acharya, Agnivesha, Charaka Samhita with Ayurveda Dipika commentary by Chakrapani, Sutra Sthana 30th chapter, Verse No. 26, Chaukhambha Publications, Varanasi, Reprint 2016, Page No. 187.
8. Vd Yadavji Trikamaji Acharya, Agnivesha, Charaka Samhita with Ayurveda Dipika commentary by Chakrapani, Siddhi Sthana 1st chapter, Verse No. 40, Chaukhambha Publications, Varanasi, Reprint 2016, Page No. 683.
9. Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastry Navre, Edited by Pt.Hari Sastry, Astanga Hridaya of Vagbhata, with the commentaries: Sarvanga Sundara of Arunadatta and Ayurveda rasayana of Hemadri, Sutra Sthana of 11th Chapter, Verse 31. Chaukhamba Sanskrit Sansthan, Varanasi, Reprint 2015, Page No. 187.
10. Vd Yadavji Trikamaji Acharya, Agnivesha, Charaka Samhita with Ayurveda Dipika commentary by Chakrapani, Sutra Sthana 28th chapter, Verse No. 27, Chaukhambha Publications, Varanasi, Reprint 2016, Page No. 180.
11. Dr Prakash L Hegde, Dr Harini A, A text book of Dravyaguna Vijnana, Vol-2, Chaukhamba Sanskrit Sansthan,  Varanasi,  Reprint 2016, Page no. 93.
12. Dr Prakash L Hegde, Dr Harini A, A text book of Dravyaguna Vijnana, Vol-2, Chaukhamba Sanskrit Sansthan,  Varanasi,  Reprint 2016, Page no. 31.
13. Prof. P V Sharma, Dravyaguna Vijnana, Vol-2, Chaukhamba Bharati Academy,  Varanasi,  Reprint 2006, Page no. 927.
14. Dr Prakash L Hegde, Dr Harini A, A text book of Dravyaguna Vijnana, Vol-2, Chaukhamba Sanskrit Sansthan,  Varanasi,  Reprint 2016, Page no. 281.
15. Dr Prakash L Hegde, Dr Harini A, A text book of Dravyaguna Vijnana, Vol-2, Chaukhamba Sanskrit Sansthan,  Varanasi,  Reprint 2016, Page no. 319.
16. Dr Prakash L Hegde, Dr Harini A, A text book of Dravyaguna Vijnana, Vol-2, Chaukhamba Sanskrit Sansthan,  Varanasi,  Reprint 2016, Page no. 903.
17. Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastry Navre, Edited by Pt.Hari Sastry, Astanga Hridaya of Vagbhata, with the commentaries: Sarvanga Sundara of Arunadatta and Ayurveda rasayana of Hemadri, Sutra Sthana of 11th Chapter, Verse 11-12. Chaukhamba Sanskrit Sansthan, Varanasi, Reprint 2015, Page No. 184.
18. Dr Keval Krishna Takral, Sushruta Samhita with commentaries: Nibanda Sangraha of Dalhana and Nyaya Chandrika of Gayadas,  Sutra sthana, 15th chapter, Verse No. 14. Chaukhamba Orientalia, Varanasi,  Reprint 2016, Page No. 166.
19. Sri Pt. Lalchandra Shastry Vaidya, Astanga Sangraha with Sarvanga Sundari commentary,  Sutra sthana, 19th chapter,  Verse No. 7. Shree Bhaidyanath Ayurved Bhavan lit. Nagpur, Reprint 1996, Page no. 590.
20. Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastry Navre, Edited by Pt.Hari Sastry, Astanga Hridaya of Vagbhata, with the commentaries: Sarvanga Sundara of Arunadatta and Ayurveda rasayana of Hemadri, Sutra Sthana of 11th Chapter, Verse 19. Chaukhamba Sanskrit Sansthan, Varanasi, Reprint 2015, Page No. 185.
21. Dr Keval Krishna Takral, Sushruta Samhita with commentaries: Nibanda Sangraha of Dalhana and Nyaya Chandrika of Gayadas,  Sutra sthana, 15th chapter, Verse No. 9. Chaukhamba Orientalia, Varanasi,  Reprint 2016, Page No. 162.
22. Sri Pt. Lalchandra Shastry Vaidya, Astanga Sangraha with Sarvanga Sundari commentary,  Sutra sthana, 19th chapter,  Verse No. 10. Shree Bhaidyanath Ayurved Bhavan lit. Nagpur, Reprint 1996, Page no. 592.
23. Vd Yadavji Trikamaji Acharya, Agnivesha, Charaka Samhita with Ayurveda Dipika commentary by Chakrapani, Sutra Sthana 17th chapter, Verse No. 67-68, Chaukhambha Publications, Varanasi, Reprint 2016, Page No. 103.
24. Vd Yadavji Trikamaji Acharya, Agnivesha, Charaka Samhita with Ayurveda Dipika commentary by Chakrapani, Sutra Sthana 28th chapter, Verse No. 16-17, Chaukhambha Publications, Varanasi, Reprint 2016, Page No. 179.
25. Sri Abhay Katyayan, Bhela Samhita edited with Hindi Commentary Notes and Appendices, Sutra Sthana,  11th Chapter, Verse No.  11-12. Chaukhamba Surbharati Prakashan, Varanasi,  Reprint 2009, Page No. 67.
26. Dr Keval Krishna Takral, Sushruta Samhita with commentaries: Nibanda Sangraha of Dalhana and Nyaya Chandrika of Gayadas,  Sutra sthana, 24th chapter, Verse No. 9. Chaukhamba Orientalia, Varanasi,  Reprint 2016, Page No. 284.
27. Dennis L. Kasper, Harrison’s Principle of Internal Medicine,  19th Edition, Chapter - 425, Page no. 2488.
28. Sir Stanley Davidson. Davidson’s Principles and practice of medicine, edited by Nicki R. colledge, Brian R.Walker, Stuart H. Ralston, 20th edition. Elsevier Limited: 2010. Pn

            9. SIGNATURE OF CANDIDATE:

   10. REMARKS OF GUIDE:    Trial will be conducted under my direct               Supervision. The synopsis of the dissertation is forwarded for needful action.

  11. NAME AND DESIGNATION OF:

11.1 Guide :                           DR. SANDEEP DESAI  M.D.(Ayu), (Ph.D)

DYS yoga, M.A Sanskrit, Jyotish Acharya

ASSOCIATE PROFESSOR,

DEPT. OF POSTGRADUATE STUDIES

IN AYURVEDA SAMHITA AND SIDDHANTA

AYURVEDA MAHAVIDYALAYA,HUBLI.

  11.2 Signature :

                                                                                                                                                    11.5 Head of the Department:            DR.J.R. JOSHI    MD (AYU)

PROFESSOR AND H.O.D

DEPT. OF POSTGRADUATE STUDIES

IN AYURVEDA SAMHITA AND SIDDHANTA

AYURVEDA MAHAVIDYALAYA,HUBLI

   11.6 Signature :

      12. REMARKS OF THE PRINCIPAL:        Forwarded for needful action

                 12.1 Principal :                           DR.PRASHANTH

M.D(AYU) Ph.D

PRINCIPAL

AYURVEDA MAHAVIDYALAYA,

HUBLI-580024

                           12.2 Signature :