Ayush [Indian System of Medicines] Prophylaxis Against COVID-19: A Living Systematic Review and Meta-Analysis (Second Update).

Background: Ayush (Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy) system of medicine has been extensively used in India for the prevention and management of coronavirus disease 2019 (COVID-19). The present report is the second update of a living systematic review and meta-analysis and has been intended to assess the preventive potential and safety of Ayush drugs against COVID-19. Methods: A search of databases such as PubMed, the Cochrane central register of controlled trials, the World Health Organization (WHO) COVID-19 database, the clinical trial registry-India, the AYUSH research portal, and preprint repositories was performed till March 1, 2023. Randomized controlled trials or analytical observational studies were included. Incidences of COVID-19 infections and mortality were taken as primary outcome measures; and symptomatic severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) infection, incidences of hospital admissions, and adverse events were taken as secondary outcomes. The risk of bias was evaluated by version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB-2) and the Risk of Bias in Non-Randomized Studies-of Interventions (ROBINS-I) tool. Data were synthesized through the RevMan 5.4 tool, and the certainty of the evidence was ranked through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: Out of 2350 articles, 15 studies were included in the review. The pooled estimate of Guduchi [Tinospora cordifolia (Thunb.) Miers], Chyawanprasha, and Ayuraksha kit was obtained. Meta-analysis of the data suggested that Guduchi may reduce the incidences of COVID-19 infections (risk ratio [RR]: 0.67 [95% confidence interval, CI: 0.48-0.95]) and the symptom development among the infected (RR: 0.88 [95% CI: 0.73-1.08]), however, no change was observed in hospital admissions (RR: 0.96 [95% CI: 0.20-4.53]). It is uncertain that Chyawanprasha reduces the incidence of COVID-19 infection (RR: 0.28; [95% CI: 0.07-1.08]). Ayuraksha kit as chemoprophylaxis may reduce the incidences of COVID-19 infections (RR: 0.49; [95% CI: 0.32-0.77]). The certainty of the evidence was low to moderate mainly due to the serious risk of bias. Conclusion: Prophylactic use of Ayush medicines for populations at risk may help to prevent COVID-19 infection by reducing incidence and severity. However, considering the certainty and fewer studies, high-quality studies are still desired to confirm the efficacy and safety of Ayush chemoprophylaxis for COVID-19. Nevertheless, this update will serve as a torchbearer for policymakers, physicians, and other stakeholders for their decision-making through evidence-based medicine.

Ayurvedic management of idiopathic small fibre neuropathy- A case report.

Small fibre neuropathy (SFN) is a subgroup of peripheral neuropathy which is characterized by a disorder of the thin myelinated A-δ and unmyelinated C-fibres. With a prevalence of 52.95 per 100,000 population per year, the reported etiology of SFN has remained unclear in 23-93% of investigated patients and hence termed idiopathic small fibre neuropathy (iSFN). Pain is the most common symptom which is often described as burning. Conventional pain management is the only treatment option for iSFN, which is only modestly effective and associated with adverse events which lead to reduced drug compliance. It also affects the overall quality of life. This case report discusses the effect of Ayurvedic interventions in the management of iSFN. The patient was a 37-year-old male, who presented with severe pain, burning, and tingling sensation of B/L lower limbs and hands with decreased sleep for 5 years (visual analogue scale (VAS) was 10 and neuropathic pain scale (NPS) score was 39). Considering the signs and symptoms, the disease was diagnosed under the Vata Vyadhi (disease/syndrome caused by Vata Dosha) spectrum. The treatment included an initial OPD-based Shamana (treatment that pacifies the aggravated doshas) treatment with Drakshadi Kwatha, Sundibaladwaya Ksheera Kwatha, Kalyanaka Gritha, and Ashwagandhadi Churna. As the symptoms persisted, Shodhana (treatment in which aggravated doshas are expelled from the body) treatment was adopted which included Mridu (mild) Shodhana, Nasya (medicine administered through nasal route) and Basti (administration of medicine through the procto-colonic route). The intervention resulted in significant clinical improvement as evidenced by the reduction in VAS and NPS scores to zero and five respectively. The patient's quality of life also showed significant improvement. This case report signifies the pivotal role of Ayurvedic intervention in the management of iSFN and encourages further research in this area. Integrative therapeutic approaches can be developed which may offer a promising strategy for managing iSFN and improving patient outcomes.

AYUSH (Indian System of Medicines) Therapeutics for COVID-19: A Living Systematic Review and Meta-Analysis (First Update).

Background: In India, alternative and complementary therapies (Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy [AYUSH] medicines) are extensively utilized in COVID-19 management, and some were investigated clinically. This study assessed the effectiveness of AYUSH therapeutic on COVID-19 through a living systematic review and meta-analysis approach. Methods: Databases like PubMed; the Cochrane central register of controlled trials; WHO COVID-19 database; the central trial registry-India; Digital Helpline for Ayurveda Research Articles and AYUSH research portal, and preprint repositories were searched till August 1, 2021. Randomized controlled trials or analytical observational studies were included only. Primary outcomes selected were clinical improvement, WHO ordinal scale, viral clearance, and mortality, whereas secondary outcomes were the use of O2 therapy or mechanical ventilator, admission to high dependency unit or emergency unit, duration of hospitalization, the time to symptom resolution, and adverse events. The risk of bias was evaluated by Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB-2) and Risk of Bias in Nonrandomized Studies-of Interventions (ROBINS-I) tools; data were synthesized through RevMan 5.4 tool, and the certainty of the evidence was ranked through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: Of 3609 studies retrieved, 17 were included in the systematic review, and 3 AYUSH therapeutics were meta-analyzed. Meta-analysis suggested that add-on AYUSH-64 likely provides therapeutic benefits by reducing time to symptom resolution (mean difference [MD] 2.35 days lower [95% confidence interval, CI; 4.05 lower to 0.65 lower]) and hastening clinical improvement (365 more per 1000 [95% CI; 4 more to 1000 more]) in mild-to-moderate COVID-19 patients. Kabasura Kudineer adjuvant to standard care is likely to reduce symptom resolution (MD; 1.93 days lower [95% CI; 2.28 lower to 1.58 lower]) and hospital stay (MD; 4.2 days lower [95% CI; 4.97 lower to 3.43 lower]) in mild-to-moderate COVID-19 patients. Co-administration of Guduchi (Tinospora cordifolia [Willd.] Miers.) to standard care may reduce the duration of hospitalization (MD; 3.93 days, lower [95% CI; 8.83 lower to 0.97 higher]) in mild-to-moderate COVID-19 patients. Furthermore, all three agents seemed safe in adjunct usage to standard care. The certainty of evidence for most outcomes was moderate to low, primarily due to the high risk of bias or imprecision owing to the small sample size. Conclusion: Rational use of integrated or standalone AYUSH interventions in mild-to-moderate COVID-19 patients is safe and may provide therapeutic benefits. The effect estimates may be changed with additional evidence in upcoming updates.

Impact of AYUSH 64 as an adjunctive to standard of care in mild COVID 19 - An open-label randomized controlled pilot study.

Background: Ayurveda herbal formulation AYUSH-64, proven to treat malaria and influenza-like illness in india was repurposed for COVID-19 patients considering preliminary evidances, however, scientific data was not available. Aim: To evaluate the preliminary efficacy and safety of AYUSH 64 as an add-on to standard of care in mild COVID19 patients. Materials and methods: A single centre, randomized, open-labeled, controlled, pilot study were conducted on mild COVID 19 confirmed patients. Patients allotted in interventional group (n = 41) recieved AYUSH 64, 3 gm per day in three divided dose for 14 days as an adjuvant to standard of care (SOC) whereas control group received SOC (n = 39) alone. Outcomes were reduction in WHO ordinal scale for clinical improvement, all-cause mortality, incidence of COVID19 symptoms among asymptomatic patients at baseline, use for oxygen therapy, use for a mechanical ventilator, the total duration of symptomatic phase and adverse events. Results: Mean score of WHO ordinal scale was reduced as time lapse in both the groups (f (1) = 20.5, p < 0.001) indicating clinical improvement among groups. There was no statistically significant difference in mean WHO ordinal scale between groups (f (1) = 0.98, p = 0.32). The proportion of asymptomatic patients progressing to the symptomatic stage is lower in AYUSH 64 group [OR, 0.68 (CI, 0.17-2.66)]. Mean days for the total duration of the symptomatic phase was also short in AYUSH 64 group (4.68 ± 3.29 days) compared to SOC group (5.81 ± 3.5 days). No incidence of the requirement of a mechanical ventilator, adverse drug reaction and death were observed in either of the groups. Conclusion: The findings of this pilot study show that an integrated approach of AYUSH 64 with SOC provide early trends of benefit by reduction in disease progression and in total symptom duration. However, its effects remains inconclusive on outcomes such as all cause mortality, use of oxygen therapy, invasive ventilator due to sparse outcomes.

Guduchi Ghanavati (Ayurveda medication) improves the perceived immunity in individuals at risk of SARS-CoV-2: A Multicentred, controlled, before-and-after study.

Introduction During the COVID-19 pandemic in India, Ayurvedic medication (Guduchi Ghanavati, GG) was prescribed by Ayurveda physicians for prevention and management. This study aimed to evaluate the prophylactic effect of GG in individuals with moderate to very high risk of SARS-CoV-2. Methods A multicenter, controlled, quasi-experimental, before-and-after study was conducted on individuals at moderate to very high risk of SARS-COV-2 exposure. In the intervention group (n = 15,992), participants received GG 1 g daily for 28 days in conjunction with standard preventive guidelines (SPG), while in the control group (n = 4953), participants were asked to follow SPG only. Outcomes were the incidence of COVID-19, perceived immune status, quality of life, and safety. The perceived immune status was assessed using a brief Likert-scale questionnaire having common immune-related complaints. Results Of the 20,945 enrolled, 20,574 completed the trial (intervention: 15,729, control: 4845). The percentage of participants who reported the incidence of COVID-19 was marginally lower in the GG+SPG group (41, 0.26%) than in the SPG group (16, 0.33%), leading to 21% (95% CI, -40% to 55%) efficacy of GG. However, the decrease in incidence percentage was statistically insignificant due to the trivial incidences reported. The scores of perceived immune status quality of life improved significantly from baseline in the GG+SPG group (p < 0.001) compared to the SPG group. Conclusion GG is safe and improves perception of immune status in individuals at risk of developing SRAS-CoV-2. However, these findings are inadequate to establish that GG lowers the incidence of COVID-19 necessitating to conduct RCTs in high-risk populations. Clinical Trial Registration CTRI/2020/06/025,525.

Efficacy of Kantakari Avaleha and its modified dosage form of Kantakari Avaleha granules in the management of bronchial asthma - An open-label randomized controlled clinical trial.

Background: Bronchial asthma is a common chronic episodic respiratory disease that resemblance to Tamaka Shwasa in Ayurveda. Kantakari Avaleha is one of the primarily recommended formulations for the management of Shwasa (bronchial asthma), Kasa (cough), and Hikka (hiccup). Although Avaleha dosage forms are better medicaments, granules have an added advantage over them such as palatability, less moisture content, and easy handling. For this purpose, Kantakari Avaleha was modified into Kantakari Avaleha granules by modifying the operational procedures of Kantakari Avaleha. Aims: To evaluate and compare the efficacy of Kantakari Avaleha and Kantakari Avaleha granules in the management of bronchial asthma. Materials and method: A total of 69 patients with mild to moderate bronchial asthma were selected randomly and divided into groups A and B. Patients of groups A were treated with Kantakari Avaleha, whereas patients of groups B received Kantakari Avaleha granules. These dosage forms of Kantakari were given in the dose of six grams with lukewarm water before breakfast and dinner for 60 days and followed up for the next 30 days. Assessments were done before and after treatment as per the scoring patterns of international asthma guidelines of the Global Initiative for Asthma (GINA), Asthma Control Questionnaire (ACQ), Asthma Control Test (ACT), and Respiratory Rate (RR), Breath-Holding Time (BHT), Peak Expiratory Flow Volume (PEFV), and laboratory investigations such as complete blood count, liver and kidney function tests, and urine routine examination were also carried out. Paired t-test and Wilcoxon signed-rank test were applied to evaluate the effect of therapy in the individual group for the above-mentioned criteria. While the comparison of results between the groups was done by applying the coefficient of variation (CV). Results: Group A showed better results in most of the cardinal symptoms, ACT, and ACQ, except for BHT, RR, and GINA control in terms of CV. In both the groups, statistically, highly significant improvement was found as per the overall assessment of bronchial asthma such as ACQ, ACT, and number of episodes and the difference between the groups was statistically insignificant. Conclusion: Both dosage forms of Kantkari were found to be effective treatments for bronchial asthma with significant relieving capacity as internal use for over 2 months. Hence, Kantakari Avaleha granules could be substituted for Kantakari Avaleha.

Role of Ayurveda treatment in the management of hepatitis B (Ubhayapatha Ashrita Swatantra Kamala)- A case report.

Hepatitis B is one of the most common causes of liver disease, and due to unawareness of the safety measures, more prone to spread. As per the World Health Organization, for the South East Asia region, its prevalence is 2%. Yellowish discoloration of the eyes, body, and urine, abdominal discomfort, and vomiting is its cardinal symptoms. In Ayurveda, this set of symptoms is known as Kamala. This case report illustrates the effectiveness of the Ayurveda treatment modality in a patient with a viral load of 3705.71 IU/ml, and the values of AST (aspartate aminotransferase) and alanine transaminase (ALT) were 140 IU/ml and 173 IU/ml, respectively. A 40-year-old female patient with a complaint of yellowish discoloration of urine, eyes, and skin with fatigue and irritability was diagnosed with Ubhayapatha Ashrita Swatantra Kamala. The patient was treated with Ayurveda drugs and Virechana Karma (therapeutic purgation). After the treatment for 13 months, the disease was cured. Improvement was observed based on hepatitis B virus deoxyribonucleic acid (DNA) polymerase chain reaction (PCR) (hepatitis B DNA PCR) (decreased from 3705.71 IU/ml to <50.0 IU/ml) and the values of AST (decreased from 140 IU/ml to 19.0 IU/ml) and ALT (decreased from 173 IU/ml to 28 IU/ml). The patient was stable and asymptomatic during the follow-up period of 4 months.

Add-on Ayurveda Treatment for Early Stage COVID-19: A Single Center Retrospective Cohort Study From Gujarat, India.

The retrospective cohort study aimed to evaluate the clinical outcomes of Ayurveda treatment exposure as an add-on to conventional care in early stage COVID-19 patients admitted at Samaras COVID care center, Ahmedabad, India. Conventional care included Vitamin-c, Azithromycin, and Paracetamol. Ayurveda formulations used as add-on were Dashamula and Pathyadi decoctions along with Trikatu powder, Sanshamani tablet, AYUSH-64 tablet AND Yastimadhu Ghana tablet for oral administration. Considering Add-on Ayurveda medicines as exposure of interest, patients who received Add-on Ayurveda medicines at least for 7 days were included in the exposed group while those who received only conventional care in unexposed group. Data was collected through record review and telephonic interviews. The outcomes of interest were the development of symptoms, duration of symptomatic phase in those progressing to symptomatic stage and mortality. Total 762 participants were included-[541 (71%) in the exposed group and 221 (29%) in the unexposed. Progression to symptomatic phase did not differ significantly between groups [27.6% in exposed, 24.6% in unexposed, adjusted RR 0.85; 95% CI 0.6-1.2]. The total duration of symptomatic phase among those progressing to the symptomatic stage was significantly decreased in the exposed group (x¯ = 3.66 ± 1.55 days in exposed (n = 133); x¯ = 5.34 ± 3.35 days in unexposed (n = 61), p < 0.001). No mortality was observed in either of the groups. Ayurveda Treatment as adjunctive to conventional care reduced the duration of symptomatic phase in early stage COVID-19 as compared to standalone conventional care. Add-on Ayurveda treatment has promising potential for management of early stage COVID-19.

Impact of AYUSH interventions on COVID-19: a protocol for a living systematic review and meta-analysis.

Background: The coronavirus disease 2019 (COVID-19) pandemic has created a great burden on governments and the medical fraternity globally. Many clinical studies from the Indian system of Traditional Medicines [Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy (AYUSH)] have been carried out to find appropriate solutions. Through a living systematic review and meta-analysis, this study aims to determine the effectiveness of the Traditional System of Indian Medicine (AYUSH system) in lowering the incidence, duration, and severity of COVID-19. Methods: We will search the following databases: Pubmed; the Cochrane central register of controlled trials (CENTRAL); the Clinical Trials Registry - India (CTRI); Digital Helpline for Ayurveda Research Articles (DHARA); AYUSH research portal; Google scholar and World Health Organization (WHO) COVID-19 database. Clinical improvement, WHO ordinal scale, viral clearance, incidences of COVID-19 infection, and mortality will be considered as primary outcomes. Secondary outcomes will be use of O2 therapy or mechanical ventilator, admission to high dependency unit or emergency unit, duration of hospitalization, the time to symptom resolution, and adverse events. Data will be synthesized, with RevMan 5.4 tool and the risk of bias will be assessed with RoB 2 (for RCTs) and ROBINS I (for NRSIs). Certainty of evidence will be assessed through the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) tool. The review will be updated bi-monthly with two updates. Conclusion: This living systematic review will be the first to address AYUSH interventions in COVID-19, synthesizing the full spectrum of Indian Traditional System of Medicine against COVID-19. It will facilitate professionals, guideline developers, and authorities with up to date synthesis on interventions periodically to make health-care decisions on AYUSH therapies in the management of COVID-19.

Role of Laksha Churna and Madhu Pratisarana after ultrasonic scaling in the management of Dantasharkara (dental calculus): An open-label, standard controlled randomized clinical trial.

Background: Dental calculus is one of the major problems in dentistry, which is characterized by calcified mass that forms on and adheres to the surface of teeth resulting in bad breath, receding gums and chronically inflamed gingiva. It can be correlated with Dantasharkara (dental calculus), which is characterized by the collection of hardened accumulation of Mala (tartar) at the junction of teeth and gums. Ultrasonic scalars are used for the removal of dental calculus for convenience. In texts, Laksha Churna (powder of Laccifer lacca Kerr) has been mentioned as Vranaropaka (wound healing) and indicated for the eliminating plaque through cleaning and polishing tooth surfaces. Aim: This study was aimed to evaluate the clinical efficacy of local application of Laksha Churna and Madhu (honey) Pratisarana after Dantasharkara Nirharana (scaling of dental calculus) in the management of Dantasharkara (dental calculus). Materials and methods: Patients having calculus deposition, fulfilling the inclusion criteria were selected. In group A, Pratisarana with Laksha Churna (powder) 1 g and Madhu as per requirement was given, whereas in group B, chlor-hexidine gluconate 0.2% for gargling was given for 2 weeks. Ultrasonic scaling was done in both groups before given trial drugs. The outcomes were calculated on the base on changes in score of the subjective parameters like pain, inflammation of gum, bleeding gums, halitosis as well as objective parameters like oral hygiene index, debris index, calculus index, gingival index, and periodontal index. For analysing the effect of the result, Wilcoxon signed-rank test for nonparametric paired data and paired t-test for quantitative parametric paired data was applied. Results: After analysing the data, it was found that Ultrasonic scaling of dental calculus followed by Pratisarana of honey with Laksha Churna provided statistically significant improvement in calculus index (97.77%) in debris index (84.44%), in oral hygiene index(96.66%), in gingival index (83.33%)and showed 96.15% improvement in periodontal index, whereas Ultrasonic scaling of dental calculus followed by gargling with chlorhexidine gluconate 0.2% provided 80% improvement in calculus index, 70% in debris index, 90% in oral hygiene index, in gingival index by 73.06%, and 93.75% improvement periodontal index which was statistically significant. Conclusion: The present study indicates Dantasharkara Nirharana followed by Pratisarana of Laksha Churna and Madhu is comparatively more effective than conventional standard treatment protocol (ultrasonic scaling and chlorhexidine gluconate mouth wash) in the management of dental calculus.

Efficacy of Sharapunkhadi powder (a polyherbal formulation) and lifestyle modification in the management of nonalcoholic fatty liver disease-A randomized placebo-controlled clinical trial.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is an expanding health problem, which varies in prevalence among ethnic groups, occurring with an estimated global prevalence of 25%. In high-risk populations, the prevalence of NAFLD may be as high as 70%-90%. No established pharmacological treatment is available for NAFLD in modern medicine and hence, there is a search for alternative treatment modalities in other systems of medicine, which is safe and cost-effective. AIM: The aim is to evaluate the efficacy of Sharapunkhadi powder and lifestyle modification in the management of NAFLD. MATERIALS AND METHODS: Patients suffering from any of the components of metabolic syndrome, i.e. hypertension, diabetes mellitus, hypertriglyceridemia, elevated body mass index (>25 kg/m2), truncal obesity, or presenting with the symptoms of indigestion, abdominal discomfort, flatulence. were screened with liver function tests and ultrasonography (USG) of the abdomen. A total of 93 patients confirmed with fatty liver Grade 1-3 were selected for the present trial and were randomly divided into two groups. After Mridu Virechana (mild purgation) with Haritaki powder (6-8 g) according to Koshtha, in group A (n = 46), 2 capsules (500 mg each) filled with Sharapunkhadi powder thrice a day before food with warm water along with lifestyle modification were administered for 8 weeks. In group B (n = 47), capsules filled with roasted Sooji powder in the same dose as mentioned for group A was given along with lifestyle modification and were maintained as a placebo. Relief in subjective parameters such as indigestion, abdominal discomfort, and flatulence and improvement in the grades of fatty liver evident from USG was considered for the overall assessment of the therapy in both the groups. SigmaStat 3.1 software was used for statistical calculation. Wilcoxon signed-rank test for subjective criteria and Student's paired t-test for objective criteria were applied to check the level of significance in a single group before and after treatment, while Student's unpaired t-test for objective criteria was applied to assess the level of significance of difference observed between two groups. RESULTS: After 8 weeks of treatment, it was found from USG findings that there was a statistically significant improvement by about 39.25% in group A and 31.82% in group B, in the grade of fatty liver. The combination of Sharapunkhadi powder along with lifestyle modification provided comparatively better relief in subjective and objective parameters over the placebo control group. CONCLUSION: Sharapunkhadi powder is a promising herbal preparation for the management of NAFLD and the combination of Sharapunkhadi powder along with lifestyle modification can yield more significant results in the management of NAFLD than lifestyle modification alone.

Effect of Opuntia elatior Mill. (Nagaphani) in the management of Pandu Roga w. s. r to iron deficiency anemia; an open labeled randomized standard controlled clinical trial.

BACKGROUND: Pandu Roga described in Ayurveda bears resemblance to the clinical features of anemia. The fruits of Nagaphani (Opuntia elatior Mill.) of family cactaceae, are consumed by the inhabitants of Gujarat as a hematinic agent to treat general debility and anemia. AIM AND OBJECTIVE: To evaluate the efficacy of the O. elatior fruit juice in Pandu Roga with special reference to iron deficiency anemia. MATERIALS AND METHOD: Present clinical study was an open labeled, randomized trial, in which 105 patients of Pandu Roga (iron deficiency anemia), were divided into two groups using the coin method of randomization. Group A received Opuntia elatior fruit juice, 20 ml twice a day with lukewarm water before meal. Group B received Punarnava Mandura (standard control), well accepted after this a herbo-mineral fromulation, two tablets of 500 mg each, twice a day with Takra (butter milk) before meal. Duration of intervention was 2 months in both groups and a follow-up of 1 month. The assessment was done based on the clinical signs and symptoms and hematological parameters such as Hb% (hemoglobin %), total red blood cell (TRBC), serum iron, serum ferritin and total iron-binding capacity (TIBC), before and after completion of the treatment. The data were subjected to statistical tests (Wilcoxon signed-rank test and paired t-tests, co-efficient of variance (CV)), and analyzed. RESULTS: Both trial drug and the standard drug produced a statistically significant increase in Hb%, TRBC and serum Iron. The standard drug provided statistically significant increase (P < 0.05) in TIBC, whereas a statistically insignificant (P > 0.05) effect was observed in the trial group. Both trial and standard drug provided statistically significant (P < 0.001) relief in Panduta (pallor), Daurbalya (general weakness), Akshikutashotha (periorbital edema) and Pindikodveshthana (calf muscle cramps). When compared between the groups, the standard drug was found to be more effective than the trial drug. CONCLUSION: Fruit juice of Opuntia elatior is effective in iron deficiency anemia as it increases the hemoglobin, TRBC levels in blood along with providing relief in Panduta (pallor), Daurbalya (general weakness) Akshikutashotha (periorbital edema).

Efficacy of Virechana (therapeutic purgation) followed by Go-Ghrita (cow ghee) in the management of Ksheena Shukra (oligozoospermia): A clinical study.

BACKGROUND: Fertility is affected by many different cultural, environmental and socioeconomic factors, especially in developing countries where poverty and infections are common place. Infertility is the inability of a sexually active, noncontracepting couple to achieve spontaneous pregnancy in 1 year. Shodhana (biopurificatory) procedures are indicated before the administration of Vajikarana (aphrodisiac) drugs, especially Virechana Karma (therapeutic purgation) is indicated in the cases of vitiation of Shukra (seminal parameters). Go-Ghrita (cow ghee) is a rejuvenator and aphrodisiac. Maximum preparations for the diseases of Shukra and reproductive system are prepared in Go-Ghrita and reported to be useful in the management of infertility. AIM: The present clinical study aimed to evaluate the clinical efficacy of Go-Ghrita administered after performing Virechana Karma in the management of Ksheena Shukra (oligozoospermia). MATERIALS AND METHODS: Eligible male participants from the age group of 21 to 40 years, with sperm count of <15 million/ml, received cow ghee for 8 weeks in the dose of 10 g, after undergoing Virechana Karma with Haritakyadi Yoga. Percentage changes in the semen parameters and associated symptoms of Ksheena Shukra in comparison to baseline were the primary outcomes measured. RESULTS: Go-Ghrita administered after Virechana provided 80.92% increase in total sperm count, 41.78% increase in sperm motility, 12.58% increase in normal form of sperm, 41.69% decrease in abnormal forms, and increase in semen volume by 45.22%. CONCLUSION: Overall assessment of the therapy showed that administration of cow ghee after performing Virechana provided statistically highly significant improvement on seminal parameters.