A Randomized Clinical Trial to compare the effect of Kokilaksha Kashayam and Kokilakshadi Kashayam in hyperuricemia.

Hyperuricemia is a metabolic disorder commonly seen in gout, caused by increased serum uric acid levels due to reduced renal excretion. It is defined as serum uric acid levels greater than 6.8 mg/dL in males and greater than 5.7 mg/dL in females. Risk factors include high intake of purine-rich foods, alcohol use, certain drugs, hypertension, hypothyroidism, and obesity.Uric acid is the final product of purine metabolism in humans. Purines are broken down mainly in the liver by xanthine oxidase, converting hypoxanthine to xanthine and then to uric acid. Uric acid circulates in plasma and is excreted mainly by the kidneys. When serum levels exceed about 7 mg/dL, monosodium urate crystals may form and deposit in joints, triggering inflammation with pain, swelling, tenderness, and stiffness.From an Ayurvedic perspective, hyperuricemia can be explained by Dhatvagni Mandya, leading to Ama Utpatti and Mala Sanchaya, resulting in Pitta Prakopa and Rakta Dushti. The vitiated Rakta produces Paittika lakshanas such as osha, chosha, paridaha, and dhumayana. The associated Avarana of Vata localizes at Asthi and Sandhi sites of khavaigunya, producing features resembling Pittadhika Vatarakta like ruk, raga, shotha, sparshasahatva, and sandhivikriti.Kokilakshadi Kashaya, described in Bhaishajya Ratnavali and Chakradatta under Vatarakta Chikitsa, contains Guduchi and Kokilaksha, with Pippali as anupana. Ashtanga Hridaya also mentions Kokilaksha as a single-drug formulation for Vatarakta. Guduchi has proven hypouricemic, anti-inflammatory, anti-arthritic and immunomodulatory actions, supporting its classical indication.