Ayurveda for management of migraine: A narrative review of clinical evidence.

Migraine is a primary headache disorder characterized by recurrent attacks. The economic and societal burden of migraine is substantial, affecting patients' quality of life in terms of work, social activities, and family life. This article attempts to review the available literature for clinical evidence of Ayurveda in the management of migraines. We performed a literature search from January 2000 to July 2020 on popular search engines such as Pub Med, Google Scholar, and AYUSH Research Portal using the keywords "Complementary and Alternative Medicine (CAM) and Migraine", "Ayurveda and Migraine" and "Panchakarma and Migraine". The selection criteria involved published clinical trials, including pilot studies, whereas review articles, concept papers, letters to the editor, and studies published in languages other than English were excluded. Out of 77 studies that were screened, 12 articles that satisfied the selection criteria consisted of six Randomized controlled Trials (RCTs), five non-RCTs, and one pilot study. Among them, ten studies used polyherbal and Herbo mineral formulations, two studies contained no oral medications, three trials utilized external therapies, and ten studies used panchakarma procedures. Eleven studies found Ayurveda to be clinically beneficial as monotherapy, while one study demonstrated the usefulness of Ayurveda as an add-on to conventional management. This review reveals the beneficial role of Ayurveda in the management of migraines without many side effects. Yet several limitations exist, like small sample size, short follow up, and lack of better outcome measures for pre and post-assessments. Future research should overcome these limitations and follow a robust methodology so that definitive conclusions can be drawn.

Effect of Ayurveda Management on Liver Cirrhosis with Ascites-A Retrospective Cohort Study.

Liver cirrhosis with ascites is a challenging medical condition. Ayurveda Clinical experiences suggest of a favourable role but lacks evidence. In a Retrospective cohort study, hospital records of patients with liver cirrhosis and ascites diagnosed though medical ultrasonography, treated at in patient division, department of Kayachikitsa, Medical Research Facility of KLE Ayurveda Hospital Belagavi were screened. Records with Nityavirechana procedure, minimum of 7 days of admission, proper documentation and meeting the other inclusion and exclusion criteria were selected for the study. Assessment were abdominal girth measurements at umbilicus, Xiphisternum to umbilicus measurement, Umbilicus to pubic symphysis measurement, weight, clinical global impression (CGI) scales (Severity, improvement and efficacy index), hemoglobin, liver function tests, Prothrombin time, INR and renal function tests. Fifty five case records met the methodological criteria of the study. Patients were suffering from stage 3, decompensated cirrhosis and Child-Turcotte-Pugh Score was in class C. Analysis of 15 days of interventions was carried out. Assessments were carried out at base line, 7th, 9th, 11th and 15th day of treatment. Interventions included nitya virechana, oral medicaments, diet, salt and fluid restrictions. Ayurveda interventions resulted in significant improvement (p<0.001) at all time points in various parameters of abdominal measurements, weight, CGI scales, hemoglobin, liver function tests, prothrombin time, INR and renal function tests. Study showed complex Ayurveda interventions through nitya virechana, oral medications, diet, fluid and salt restrictions improve the clinical profile, liver function, renal function, prothrombin time, INR parameters in patients of ascites with decompensated cirrhosis and warrants further studies.

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.

Efficacy of Virechana, Triphaladi decoction with processed Guggulu in the management of ovarian cyst - A pilot study.

Background: Ovarian cyst is an emerging problem among the women of reproductive age group. Most of the ovarian cyst (80%-85%) are benign, and two-thirds of these occur in women between 20 and 44 years of age. They may be identified in asymptomatic women during routine pelvic examination or may produce symptoms. Management of the ovarian cyst through surgery is available to meet urgent need of the patient, but to establish a satisfactory conservatory medical treatment is the need of the hour. According to Ayurveda, ovarian cysts can be managed on the line of Kaphaja Granthi (nodular/glandular swellings by Kapha Dosha) and Vidradhi (abscess). Aim: The aim of this study was to evaluate the clinical efficacy of Virechana (therapeutic purgation), Triphaladi Kashaya (decoction) with processed Guggulu (Commiphora mukul Engl.) in the management of ovarian cyst. Materials and methods: 16 patients were included in this clinical study and among them, 15 patients completed the treatment and one patient was dropped out from the trial. Patients were given Virechana followed by Triphaladi Kashaya (50 ml) with processed Guggulu (1 g) orally twice a day before meal for 60 days. The patients were followed up till 1 month. The assessment was carried out on subjective parameters such as lower abdominal pain, backache, and dysmenorrhea as well as objective parameters such as ovarian cyst size and volume by four-dimensional gray scale and color doppler sonography. Cancer antigen 125 was also assessed before and after treatment. Results were statistically analyzed using Wilcoxon signed-rank test and Student's t-test by sigma statistical tool (version 3.5, Systat Software Inc., United States). Results: Significant results were observed in subjective parameters such as lower abdominal pain (93.11%), backache (81.81) and dysmenorrhea (90.90%) as well as objective parameters such as reduction in size of the cyst (60%) and complete resolution of the cyst (26.66%). Conclusion: Triphaladi Kashaya with processed Guggulu is more effective in hemorrhagic cyst and simple cyst rather than other cyst, due to Shothahara properties which may have effectively curtailed the progress of ovarian cyst.

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.

Thuvaraka rasayana regimen in Psoriasis vulgaris - A case report.

Psoriasis is one among the wide-spreading, chronic, frequently recurring diseases of the skin. Its world prevalence varies between 0.09% and 11.4% in 2013 which reported in 2006 as in between 0.5% and 4.6%. In Ayurveda, the description of Kushta-roga viz. Vata-Kaphaja kushta finds similarity with psoriasis. The common sites of occurrence of psoriasis are scalp, elbow, knee, earlobes and sole which are also considered as the location of Vata and Kapha. The science of Ayurveda has anecdotal accounts of success in the management of psoriasis in the actual clinical practice even though it lacks the evidence-based medical dermatology research data. It observed that the physicians adopt several treatment protocols for the cure of this disease in clinical practice, which was not rigorously evaluating in research settings. This paper/report is one of on the 'Thuvaraka rasayana' is one such component that could improve treatment outcomes in Psoriasis. A pre and post test case report selected of a 36-year-old lady patient who diagnosed as having stable psoriasis vulgaris for last seven years. She was administered with internal and external therapies along with Shodhana therapies (bio-cleansing procedures) and then followed by intake of Thuvaraka rasayana. The total duration of the treatment was 43 days, and the Study subject assessed before treatment, after treatment and on follow-up for improvement using PASI scoring, and histo-pathological study. All the symptoms observed in the beginning were found considerably reduced, and the severity also found mild. On the follow-up, it concluded that the lesions disappeared completely and the skin set back to its normal texture. Even though psoriasis is an autoimmune disease where recurrence rate found more Shodhana therapy and Thuvaraka rasayana have a definite role.

Panchakarma in autoimmune pancreatitis: A single-case study.

Autoimmune pancreatitis (AIP) is the pancreatic manifestation of a systemic fibro-inflammatory disorder. AIP is a unique form of pancreatitis in which autoimmune mechanisms are suspected to be involved in the pathogenesis. AIP is a rare disorder, its exact cause is unknown, but it is thought to be caused by the body's immune system attacking the pancreas and it responds to steroid therapy only. In Ayurveda, although there is no synonym for AIP, but has a resemblance in clinical features of Grahani Dosha (derangement of duodenum and intestine). The cause of Grahani Dosha is Mandagni (hypofunctioning of Agni) and Panchakarma therapy increases Agni. As per Charaka Samhita, treatment for Grahani Dosha amongst the Panchakarma therapy is Virechana (therapeutic purgation) and Basti (medicated enema). The present case report is of a 30-year-old female, diagnosed as case of AIP with multisystem involvement with increased level of immunoglobulin G (IgG), glycosylated heamoglobin (HbA1c), cholesterol, triglycerides, low-density lipoprotein (LDL) and body mass index (BMI). The patient was on anticholinergic agents, antacids, levothyroxine, multivitamin along with iron and antihistamine drugs since 1 year, but with not much relief. Patient was treated with classical Virechana and Madhutailika Basti. It was observed after the completion of therapy, that there was decrease in IgG, HbA1c, S. cholesterol, S. triglyceride, low density lipoprotein (LDL) and body mass index (BMI). This shows that Virechana and Basti play a significant role in patient with AIP associated with other disorders.

A clinical study on Virechana Karma (therapeutic purgation) over the gut flora with special reference to obesity.

BACKGROUND: Altered gut flora is associated with the pathogenesis of both intestinal and extra­intestinal disorders. Aetiology of obesity is associated with mechanisms such as short chain fatty acid production, stimulation of hormones, chronic low­grade inflammation, lipoprotein and bile acid metabolism and increased endocannabinoid. Receptor system tone have been suggested to explain the role of gut microbiota of obesity. The Panchakarma (Ayurvedic purification methods) claims the management of metabolic disorders hence this work provides the target specific evidence for the clinical studies. The proposed project is aimed to explore the particular molecular mechanism and, to make this therapy more evidence based. Hence, it was hypothesized that Panchakarma­based intervention such as Virechana Karma (therapeutic purgation) may influence microbiota and help in the management of the obesity. MATERIALS AND METHODS: The study was conducted to explore the effect of Virechana Karma over the gut flora; therefore, total of 19 patients with Madhyama Koshtha diagnosed with obesity were included and received the intervention. Before and after Virechana, a stool sample was collected and processed for the enterobacterial repetitive intergenic consensus ­polymerase chain reaction to find the changes over the facultative aerobic bacteria. RESULTS: It was found that Virechana is effective in the management of the obesity as it helps to reduce colonization of aerobic bacteria. After Virechana and after follow­up also, it showed the correction of the gut flora dysbiosis, thus initiated the weight loss mechanism in the body, resulting in diminution in the signs and symptoms of obesity. CONCLUSION: Virechana is effective in the management of the obesity due to reduction in the Escherichia coli colonization and is effective over the gut flora dysbiosis.

Comparative study of Anuvasana Basti with constant and escalating dose as an alternative to Snehapana in Purvakarma of Vamana and Virechana.

BACKGROUND: Snehapana is the essential step prior to Vamana and Virechana (therapeutic vomiting and purgation). But it was found that 10-15% patients are reluctant towards Snehapana hence may deprive the benefits of Shodhana. These inconveniences made us think about effective alternative to counter drawbacks of Snehapana. On the basis of literature review and pilot study, it was confirmed that, Anuvasana Basti can be administered as an alternative for Snehapana. OBJECTIVE: To evaluate samyak snigdha lakshana achieved by administration of Anuvasana Basti and to evaluate outcomes of Vamana and Virechana. MATERIALS AND METHODS: Specially designed basti pouches were used according to doses. In group A, constant dose of processed sesame oil (120 ml) and rock salt (500 mg) was used. In group B, the dose was escalating started with 120 ml and 500 mg with 25 ml and 100 mg increase in sesame oil and rock salt respectively for maximum seven days. RESULTS: Patients from group B showed better results than group A i.e. 29 patients showed symptoms of proper oleation. Mridu koshtha required minimum dose and duration for getting proper symptoms of oleation. Outcome of Vamana and Virechana were also very promising. CONCLUSIONS: Hence it can be concluded that Anuvasana Basti in escalating dose can be used as an alternative for Snehapana.

Antiphospholipid antibody syndrome - A case report.

Anti-phospholipid antibody (APLA) syndrome is defined by the presence of thrombo-embolic complications and pregnancy morbidity in the presence of persistently increased titers of APLA syndrome. Its clinical presentation can be diverse and any organ can be involved with a current impact in the most surgical and medical specialties. Here, the case of a 34-year-old young lady with APLA syndrome presented with the cerebral venous thrombosis and subsequently deep vein thrombosis of the left leg veins. Three classes of APLAs (IgG, IgM and activated protein C) were elevated. There were no clinical or laboratory evidence for other autoimmune or systemic illnesses. The patient is under treatment of Ruksha Tikshna Virechana (purgation) with Haritaki (Terminalia chebula Retz.) and Goarka (extract of cow's urine) with the concept of Kaphaja Shotha (nonpitting edema) and got significant result in both subjective and objective parameters.

A single-case study of management of Jalodara (ascites).

Most common manifestation of liver dysfunction is ascites and most common cause of ascites is liver disease. Ascites is the accumulation of fluid in the peritoneum. Inspite of advanced medical facilities, still, there is no sure treatment which cures a patient of ascites totally. The modern treatments only provide provisional relief with time dependent recurrence but, the fluid gets collected in the abdominal cavity repeatedly. In such case, Ayurvedic treatment gives relief without any side effect, in such cases and can be correlated with Jalodara (ascites) which mentioned in Ayurveda medical science. Diet restriction, medicinal treatment and surgical procedure are mentioned in Samhita. Diet restriction is an important feature of the management of this condition. A 46-year-old female came to outpatient department with anorexia, abdominal distension, vomiting after meal, respiratory distress etc. She was given Nitya Virechana (daily therapeutic purgation) with Abhayadi Modaka, cow's urine, SharapunkhaSwarasa, PunarnavaKwatha, etc. and restricted diet plan for 3 months. After 3 months, a significant improvement was noted in all the symptoms of the patient. Hb% was also increased from 7.5% to 11.2% and erythrocyte sedimentation rate and serum creatinine were decreased from 35 mm/h to 10 mm/h and 1.2 mg/dl to 0.9 mg/dl respectively. Ultrasonographic findings also showed improvement in comparison with previous report. Hence, it was concluded that Ayurvedic management gives relief in ascites.

Role of Virechana and Ashwatha Phala Churna in the management of Ksheena Shukra (oligozoospermia): A pilot study.

BACKGROUND: Infertility is the inability of a sexually active, noncontracepting couple to achieve spontaneous pregnancy in 1 year. Low sperm count (oligozoospermia) is one of the main causes of male infertility and is correlated with Ksheena Shukra (oligozoospermia). Shodhana procedures are to be performed before the administration of Vajikarana drugs, especially Virechana Karma has been indicated in the cases of Shukra Dushti. The fruit of Ashwatha (Ficus religiosa Linn.) has been indicated in premature ejaculation and low sperm count. AIM: This study aimed to evaluate the effect of Virechana and Ashwatha Phala Churna in the management of Ksheena Shukra (oligozoospermia). MATERIALS AND METHODS: Eligible male participants between the age of 21 and 50 years, with sperm count <15 million/ml, received Ashwatha Phala Churna for 60 days in the dose of 3 g, after undergoing Virechana Karma. The primary outcomes measured were percentage changes in the seminal parameters and associated symptoms of Ksheena Shukra in comparison to baseline. RESULTS: The Ashwatha Phala Churna administered after Virechana provided 59.78% increase in sperm count, 36.81% increase in semen volume, and 16.18% decrease in abnormal form of sperm and 91.34% of increase was reported in total sperm count after Virechana Karma which was also statistically significant. CONCLUSION: Overall assessment of the therapy showed that administration of Ashwatha Phala Churna after performing Virechana provided statistically significant improvement on seminal parameters, especially total sperm count.

A standard controlled clinical study on Virechana Karma and Lekhana Basti in the management of dyslipidemia (Medoroga).

BACKGROUND: Dyslipidemia, a major risk factor of coronary heart disease, is the leading single cause of death in the world. Currently available hypolipidemic agents have been associated with a large number of side effects. The radical Ayurveda Samshodhana Chikitsa as a treatment protocol can provide better effect. Therefore, the present study was designed to evaluate the effect of Virechana Karma and Lekhana Basti in dyslipidemia. OBJECTIVES: To evaluate the effect of Virechana Karma and Lekhana Basti in the management of dyslipidemia (Medoroga). MATERIALS AND METHODS: Ninety patients of either sex in the age group of 20-60 years, fulfilling the study criteria were included in the study. The patients were randomly divided into three groups (thirty patients each). Virechana Karma was administered to patients in group A, Lekhana Basti was administered in group B and tablet Atorvastatin in group C. The effect of treatment was assessed by analyzing the complete lipid profile after completion of treatment and after the follow up in comparison to base line score. RESULTS: All the three groups showed statistically highly significant result in the lipid profile after the treatment and after the follow up. CONCLUSION: Virechana Karma is effective in reducing triglycerides level, where as Lekhana Basti is effective in reducing the cholesterol level in particular.

Analysis of Virechana karma with Danti avaleha: A retrospective study.

Virechana (therapeutic purgation) is a common procedure that is widely practiced among the panchakarma treatments (pentad treatments). Various Virechaka dravyas (purgative drugs) have been described for Virechana. Even after critical analysis of Virechaka dravyas in the literature, still there is difficulty in the fixation of dose. Hence, the retrospective analysis of varied outcomes of Virechana with Danti (Baliospermum montanum) avaleha (linctus) is discussed in this paper. The study included twenty-seven case reports of patients who were administered Virechana with Danti avaleha. These case reports are of patients suffering from various ailments such as irregular menstrual cycles, polycystic ovarian syndrome, primary and secondary infertility, and psoriasis. Danti avaleha was administered at dose of 10 g and 5 g in the Krura (~strong) and Madhyama (~moderate/normal) Koshta (~GI tract) patients, respectively. Among seven Krura koshta patients, three of them resulted with Pravara (excellent) Shuddhi and other four resulted with Madhyama (medium) Shuddhi. In twenty Madhyama koshta patients, sixteen of them resulted with avara (minimum) Shuddhi and remaining four patients resulted with Madhyama shuddhi. Complications like Udara shoola (spasmodic pain of abdomen) and Vamana (emesis) were observed during Virechana. Majority of the patients suffered with Udara shoola were of Madhyama koshta. Vamana was seen in both Krura and Madhyama koshta patients. Irrespective of the type of Shuddhi and complications, all the patients resulted with Samyak Kaphaantiki Virikta lakshana (signs of perfect purgation with end expulsion of Kapha). The study concluded that the Krura koshta patients were tolerable for dose of 10 g and are expected to attain Pravara Shuddhi. Whereas Madhyama koshta patients were intolerable even to mild dose of 5 g, producing Avara shuddhi.

Efficacy of Virechana and Basti Karma with Shamana therapy in the management of essential hypertension: A comparative study.

Considering high prevalence and the need to look for alternative medicine, essential hypertension was screened in light of Vata-Pitta Pradhana Rakta Pradoshaja Vikara as mentioned by Acharya Charaka. Comparing the etiological factors, symptomatology, and complications with Rakta Pradoshaja Vikara with that of essential hypertension, a striking similarity was revealed. To prove the practical approach of management of Vata-Pitta Pradhana Rakta Pradoshaja Vikara, a randomized open clinical trial on 33 uncomplicated subjects of essential hypertension was conducted. The subjects were allotted in two groups, viz. (Group A) Virechana group having 16 cases who underwent Virechana Karma by Trivrita, Aragvadha, Eranda Taila, and Draksha Kwatha as Sahapana; and (Group B) Basti group consisting of 17 cases who were administered Dashmoola Kala Basti in which Niruha with Dashmoola Kwatha and Anuvasana with Dashmoola Taila was done. Patients of both the groups were followed by Shamana Chikitsa (Arjunadi Ghanavati). The overall effect of the therapies on systolic and diastolic blood pressure showed that Virechana proved better relief (43.75%) as compared to Basti (29.41%). The response was encouraging and has created scope for further studies.

Comparative study of Vamana and Virechanakarma in controlling blood sugar levels in diabetes mellitus.

Diabetes mellitus (DM) with its devastating consequences is a global health problem of this era. Presently India is having the largest diabetic population of 50.8 million. The characteristic features of DM have close resemblance with Prameha (obstinate urinary disorders including diabetes) in Ayurveda. Madhumeha is a Vatika subtype of Prameha that is most close to DM. One variety of this Madhumeha (DM) is Aavaranjanya (due to occlusion) in which Vayu aggravates due to occlusion by Pitta or Kapha. This type of Madhumeha (DM) can be managed if Samshodhana (bio-cleansing) is used in early stages of disease followed by palliative treatment. Vamana (emetic therapy) and Virechana (purgation therapy) are the Samsodhana Karma (bio-cleansing therapies) that are compatible to overcome this Aavarana (occlusion). A comparative study was planned to compare their efficacy in controlling blood sugar levels in patients with DM. Although none of them were completely able to control blood sugar in the long-term but the study yields some very interesting results in reducing the blood sugar levels which could be useful in the future studies related to DM.

Physiological and biochemical changes with Vamana procedure.

Vamana Karma (therapeutic emesis) primarily a Samshodhana Karma (purification procedure) is one of the five Pradhana Karmas (chief procedures) of Panchakarma. It is mentioned in Ayurvedic texts that a person after Samyak Vamana (proper Vamana) experiences lightness of the body, Hrit (precordium), Kantha (throat/voice), and Shirah (head) and weakness. This procedure is effectively used in healthy and ailing persons for purification of body and extraction of Doshas (especially Kapha) in Ayurvedic system. It has been found worth to observe the physiological and biochemical changes during Vamana and after the procedure to understand the effect/safety margins of the procedure in healthy volunteers.

Role of Virechana Karma in cure and prevention of recurrence of Vicharchika (Eczema).

Mandip and Chandola reported that administration of Rasayana (Guduchi and Bhringaraja) after Koshtha Shuddhi with Aragvadha Hima and simultaneous giving of Shirishadi decoction orally and applying of Snuhyadi Lepa externally provided complete remission to 22.6% patients of Vicharchika (Eczema) and checked the recurrences of the disease in the 89.5% patients. As in this group, cure rate was not up to the expectation; therefore, it was thought desirable to see whether performing of Virechana Karma instead of Koshtha Shuddhi prior to the administration of the above drugs enhances the cure rate for the Vicharchika (Eczema) patients. For the present study, 39 patients of Vicharchika (Eczema) were registered, of which 32 patients completed the full course of the treatment. These patients were given Virechana after preparing with the proper internal Snehana, Abhyanga, and Svedana as per classical method. After the Samsarjana Krama, they were administered the Shirishadi decoction and Guduchi-Bhringraja Rasayana powder orally with simultaneous local application of Snuhyadi Lepa on the eczematous lesions. The results of this study showed that when Virechana Karma was performed prior to the administration of Guduchi-Bhringaraja Rasayana and Shirishadi decoction orally and SnuhyadiLepa externally, it not only increased the cure rate to 81.3% in the patients of Vicharchika (Eczema) but also checked the recurrences to great extent as only negligible number of the patients reported the recurrence.

Clinical efficacy of Shodhana Karma and Shamana Karma in Mandala Kushtha (Psoriasis).

In India an estimated 0.8% of the population is suffering from Psoriasis. It is a papulo-squamous disorder of the skin, characterized by sharply defined erythemato-squamous lesions. It is chronic and is well known for its course of remissions and exacerbations. The exact etiology is still unknown. This condition is comparable with Mandala Kushtha in Ayurvedic system of medicine. Shodhana procedures are reliable to control the disease. Forty patients, fulfilling the inclusion criteria, were selected and randomly divided into four groups with 10 patients in each group. In Group A, Vamana and Virechana was administered once during the trial period. In Group B, Vamana and Virechana followed by Dermo-care in the dose of 5 g twice a day for the period of 2 months. In Group C, only Dermo-care was administered. In Group D, Tab. Neotrexate (Methotrexate) 7.5 mg/week was given under the supervision of dermatologist. Marked improvement was observed in 10% of the patients in Group B. Moderate improvement was observed in 20% of the patients in Group A, 90% in Group B, and 80% in Group D. Mild improvement was observed in 80% of the patients in Group A, 100% in Group C, and 20% in Group D.

Clinical effect of Virechana and Shamana Chikitsa in Tamaka Shwasa (Bronchial Asthma).

To evaluate comparative efficacy of Samshodhana and Samshamana Chikitsa, the current study is planned in 24 patients of Tamaka Shwasa. Thirteen patients (Group A) were treated with Samshodhana, particularly with Virechana Karma. The patients of this group received Abhyantara Snehana with Tila Taila followed by Bahya Snehana with Tila Taila and Saindhava Lavana. After observations of proper signs of Snehana; Virechana Karma was performed with Aragvadha Phala Majja. Samsarjana Krama was followed for five days. Subsequently all the patients were given the trial drug (powder of Badara). The patients of group B, were treated only with the powder of dried ripe fruits of Badara. In both groups, the dose of Badara powder was 5 g, twice a day, with luke warm water, for a period of 60 days. In group A, maximum number of patients (61.45 %) showed good response, while in group B, 45.45 % patients showed good response. No side effects were observed during the clinical trial. Based on the observations, it was concluded that, group A is more effective than group B.