An exploratory single-arm open-label clinical study to evaluate the combined effect of Vamana and Sarasvata Churna in reducing excessive daytime sleepiness.

BACKGROUND: Excessive Daytime Sleepiness (EDS) is inferred as persistent sleepiness and often a general lack of energy during the day even after apparently adequate or even prolonged nighttime sleep. The subjects may not be identifying excessive daytime sleepiness but may present as feeling tired, lack of energy etc. They may seem apparently healthy and without any other systemic illness. The prevalence was found to be as high as 18 % in 2012 in United Kingdom. Also, it is a risk factor for diseases like Alzheimer's disease, Parkinson's disease and other neurodegenerative diseases. Conventional management (Modafinil, Sodium Oxybate and Stimulants) addresses only the subjective condition in EDS and is associated with adverse effects compromising the quality of life. In the current health scenario there is a need for alternative interventions to manage this disease. On analyzing this condition through Ayurveda, we could understand it as Nidradhikya (Excessive daytime sleepiness) which is caused due to vitiated Kapha Dosha along with Vriddha Tamoguna (increased Tamoguna) that can be managed by Shodhana (biopurification) followed Shamana (pacification) therapies. OBJECTIVE: This study was aimed to assess the combined effect of Vamana (therapeutic vomiting) and Sarasvata Churna in reducing Excessive Daytime Sleepiness. MATERIALS AND METHODS: This was a single-arm exploratory open-label clinical trial. 10 subjects having EDS diagnosed using Modified Epworth Sleepiness Scale (MESS) with a score of 10-24 with proper exclusion were recruited from OPD and IPD, Department of Kayacikitsa, Amrita School of Ayurveda. All the participants were clinically examined, sought for medical history and further checked biochemically to exclude any other systemic illness that may lead to this condition. Only healthy subjects with quality night sleep (assessed by PSQI) and without any other systemic illness were selected. The treatment protocol adopted was Vamana Karma followed by 30 days of Sarasvata Churna as Shamana Aushadha (medicine for pacification). Assessment was done using MESS on 0th day and after 30 days of Shamana Aushadha Sevana. After completion of treatment, the results were statistically analysed using Wilcoxon Signed Rank Test and final conclusion was drawn. RESULTS: On analysis of the symptoms using Modified Epworth Sleepiness Scale, the mean total score reduced from 14.8 to 2.8 with 81.08 % relief in these 10 subjects and a significant p value < 0.05 after Vamana followed by 30 days of Shamana Aushadha Sevana. DISCUSSION: Vamana helps in Kapha Nirharana (expelling) which removes the Avarana (occlusion) of Manas seen in Nidradhikya. This results in Hrit Shuddhi (purity of heart) that helps in bringing the equilibrium of Mano Gunas (qualities of mind) (Satvoudaryam Tamojayaha) which forms the line of management. Sarasvata Churna which was administered as Shamana Aushadha possesses Medhya (Nootropic), Buddhi Smriti Dhriti Vardhaka (intellect, memory and patience promoting) attributes and is being indicated in Vicetas. Most of the drugs in Sarasvata Churna are Rasayana (rejuvenation) that imparts Indriya Bala (strengthening of senses) and Priti (contempt) to Manas by Prinana (nourishing) of Rasa Dhatu. CONCLUSION: From this study, we could conclude that the combination of Vamana Karma followed by Sarasvata Churna administration is effective in reducing EDS.

Efficacy of Ayurvedic treatment protocol in gouty arthritis - a clinical study.

OBJECTIVES: Gout is an inflammatory response to the Monosodium urate crystals formed secondary to hyperuricaemia. The prevalence of gout has increased in recent years. The current conventional medical management aims at symptomatic management. In Ayurveda, gouty arthritis has similarity to Vata-Pittadhika Vatarakta, owing to its comparable aetiology and clinical features and treatment was planned accordingly. The present study is designed to evaluate the combined effect of Ayurvedic formulations and therapy in reducing the signs and symptoms and uric acid level in Gouty Arthritis. METHODS: The study was a single group pre-post test design. The patients diagnosed on the basis of ACR EULAR Gout classification 2015 criteria. They were given Guduchi Siddha Ksheeravasthi (Therapeutic enema), Guduchi (Tinospora cordifolia) Kashaya (diluted decoction) and Punarnava Guggulu. Assessment of pain was done by Visual Analogue Scale and serum uric acid level was assessed on day 1 and on 31st day. Also, the change in symptoms were analyzed before and after the treatment. This study has been registered in the clinical trial registry-India. RESULTS: The obtained data were evaluated using paired t-test and Wilcoxon signed rank test. A significant improvement (p=0.0001) was observed in VAS scale (98.77%), serum uric acid levels (57.81%), subjective parameters. Moreover, erythrocyte sedimentation rate was observed to be normal level as compared to baseline of the therapy also with an enhancement of hemoglobin (Hb) levels. CONCLUSIONS: Thus, the present study revealed that Ayurvedic therapeutic interventions can play a major role in the management of gouty arthritis.

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.

An exploratory clinical study to determine the utility of heart rate variability analysis in the assessment of dosha imbalance.

The present study is a comparison of the data of spectral analysis of heart rate variability with clinical evaluation of pathological state of doshas. The calculated cardiointervalography values are combined into three integral indexes, which according to the authors' opinion reflect the influence on heart rhythm of vata, pitta and kapha, the regulation systems of the body known as doshas in Ayurveda. Seven gross dosha imbalances were assessed to test the agreement between the two methods in this study. Heart Rate Variability (HRV) spectral data was collected from 42 participants to make the comparison with the clinical assessment of dosha imbalance. Clinical method of dosha assessment and method of calculating integral indexes by cardiointervalography data showed substantial agreement by Kappa coefficient statistic (k = 0.78) in assessment of gross dosha imbalance. The results of the data generated from this pilot study warrant further studies to rigorously validate the algorithms of HRV analysis in understanding dosha imbalance in Ayurvedic clinical practice and research settings.

Management of wooden foreign bodies in craniofacial region.

Even though variety of foreign bodies has been reported in a various locations in the craniofacial region, wooden foreign bodies are uncommon. Appropriate management of wooden foreign bodies is considered essential because of their infectious complications and difficulty in radiographic localization. Even though literature is replete with articles on management of foreign bodies in the craniofacial region, specific management of wooden foreign bodies are rarely reported. The purpose of this article is to report two cases of deeply placed wooden foreign body and a protocol for managing them in the maxillofacial region.