Ayurvedic Management of Vatarakata (Gout) - A Case Report

 

Sima Balaprasad Jaju1, Digambar G. Dipankar2, Almas M. Shaikh1,

Anjali Rajesh Pote1, Anupama M. Bathe5

1Post Graduate Scholar, Department of Kayachikitsa, Dr. D. Y. Patil College of Ayurved and Research Centre, D. Y. Patil Vidyapeeth (Deemed To Be University), Pimpri, Pune- 411018, Maharashtra, India.

2Professor, Department of Kayachikitsa, Dr. D. Y. Patil College of Ayurved and Research centre,

D. Y. Patil Vidyapeeth (Deemed To Be University), Pimpri, Pune- 411018, Maharashtra, India.

3Associate Professor, Department of Kayachikitsa, Dr. D. Y. Patil College of Ayurved and Research Centre,

D. Y. Patil Vidyapeeth (Deemed To Be University), Pimpri, Pune- 411018, Maharashtra, India.

*Corresponding Author E-mail: simajaju04@gmail.com, drdgdipankar@gmail.com, alludiamond33@gmail.com, anjupote@gmail.com, dranupamabathe@gmail.com

 

ABSTRACT:

Vatarakta (gout) is a common metabolic disorder. It is a Vatapradhana Tridoshaj Vyadhi caused by both, Vata Dosha and Rakta Dushti is called Vatarakta. Vatarakta (Gout) is an inflammatory disorder, which causes swelling including burning pain in metatarso-phalangeal joints and other joints and eventually it leads to inability to walk. At first it settles in its root (initial involvement) in hands and feet and then spread all over the body. According to modern science Vatarakta can be correlated with Gouty arthritis. This leads to increase in blood and serological parameters like serum uric acid. Here is a single case report of patient who got better results with Ayurvedic medication like Guduchyadi Kashaya, Guduchi Ghana vati, Kaishora Guggul, Eranda tail (castor oil) and Panchkarma therapy such as Oleation therapy (Snehan), Sudation therapy (Swedan) and Enema therapy (Basti)  Jalaukavacharana. Ayurvedic oral medicines and Panchkarma therapy alleviate Vata by bringing back its normal function and obstruction in Raktavaha Srotas by Kaphamedoghna action. After 35days of treatment patient got symptomatic relief and also decrease level of serum uric acid in blood.

 

KEYWORDS: Gouty arthritis, Serum uric acid, Ayurvedic medicine, Panchakarma therapy, Jalaukavacharana, Vata Dosha, Rakta Dushti.

 

 


INTRODUCTION:

Vatarakta (Gout) is caused by predominantly vitiated Vata and Rakta, which impede the Gati (movement) of each other. People of Pittaprakriti (Pitta constitution) are prone to develop Vatarakta, because Sukumaratva (youthful personality) is the characteristic feature of Pitta Prakriti. According to Acharya Sushrut Vatarakta (Gout) is a variety of Vata-Roga (group of diseases caused by Vata). The disease which is caused by both, Vata and Rakta which mixed with each other and it develops a disease is called Vatarakta (Gout) 1.

 

Health is depends upon lifestyle and diet of the patients. Etiology of the Vatarakta (Gout) is excessive intake of salty, sour, spicy, alkaline, oily, hot and unprocessed food. Intake of non vegetarian food, excessive intake of alcohol, highly protein diet. Intake of meal before the previous meal is digested. Sleeping during day time and remaining awake at night, also the mental stress anger is the factors2. According to the Acharya Charak the main symptom in Vatarakta (Gout) are Stiffness, swelling, and pain in joints are responsible for crippling or disability in patients. Samprapti of Vatarkata (Gout) obstruction in Raktavahasrotas hinders the normal movement of Vatadosha which is root pathology behind manifestation of the illness Vatarakta (Gout). Furthermore, the illness becomes more incurable if Vata covering Rakta causes blood impurities. Its sites are hands, feet, fingers and all other joints. At first it settles in its root (initial involvement) in feet greater toe and hands and then spread all over the body3. This impairment leads to increase in blood and serological parameters like uric acid, C-reactive protein, etc. These can be used as biomarkers for assessment of efficacy of Ayurvedic medicine and Panchkarma therapy.

 

According to modern science Vatarakta (Gout) can be correlated with Gouty arthritis4. Gout is a composed a group of joints or musculoskeletal disorder. Gout mainly affects middle aged, elderly persons more common in male and post-menopausal women. Gout is an inflammatory response to Monosodium Urate (MSU) crystals deposition in joints and connective tissue tophi5. In India, prevalence of Gout is 2.0 to 2.6 per 1000 patients usually between the age group of 25 to 50 years6. It is reported that the incidence is increasing since the last ten years. In Gout metatarsolphalangeal joints of the first toe involved initially, but ankles, knee joint, tarsal joints are the common sites for gout. Joint pain swelling, redness, warmth and tender are symptoms of gout7. Pain is the most common symptoms which affects life of the people. In modern science it treated conservatively with painkillers, steroids, which give temporary or short term relief. Hence, here Ayurvedic management is useful. The below mentioned is the Ayurvedic medicine and Panchkarma therapy followed in Vatarakta (Gout): Oleation therapy, Bloodletting, Purgation therapy. After this, mild purgation therapy continued. In addition, medicated Basti (Enema) given. Cases with acute as well as chronic inflammatory joint disorders commonly suffer from Vatarakta (Gout). The following is a case report of a patient who was received treatment at Dr. D. Y. Patil Ayurved Hospital, Pimpri for Vatarakta. Ayurvedic treatments given to the patient demonstrated effectiveness.

 

MATERIAL AND METHODS:

A single clinical case study was performed on the patient after taking informed consent before treatment.

 

For study 21 years old male patient having symptoms of Vatarakta (Gout) since 2 months is been mentioned in detailed.

 

Assessment criteria: Subjective Parameters according to gradation of signs and symptoms of Vatarakta (Gout) and objective parameters according to serum uric acid level.

 

Patient was treated with some Ayurvedic oral medication and Panchkarma therapy

 

Patient information and clinical findings:

A 21 years old Male patient visited Dr. D. Y. Patil Ayurved Hospital Pimpri, Pune. He had symptoms such as multiple small joint pain (throbbing type), swelling on right foot for 2 months, early morning stiffness (lasting for less than 15 minutes), and bilateral lower limb pain with burning sensation. He was admitted on June 20, 2019 for 35 days. Considering all the symptoms, Patient was diagnosed as Vatarakta (Gout). He was treated with Ayurvedic medicines and Pachakarma therapy for treating her illness.

 

History of Present Illness:

Patient was alright 2 months back then he started complaining of bilateral lower limb pain with burning sensation, multiple small joint pain (throbbing type) and early morning stiffness (lasting for less than 15minutes) swelling over right foot which started increasing day by day, hence patient got admitted in Dr. D. Y. Patil Ayurved Hospital, Pimpri, Pune for Ayurvedic Treatment.

 

Past History:

No History of any significant past illness/Drug Allergy/ Surgery/ Addiction.

 

Family History: 

No History of any major illness.

 

Personal History:

DIET- Mixed type; Sleep - Disturbed due to pain; Bowel habit- irregular/unsatisfactory; Micturition- Day- 4-5 times, Night- 2-3 times; Addiction- No any addiction.

 

Ashtavidh Pariksha (Eight-fold Ayurvedic examination):

Nadi (pulse) –Vata predominant Pitta, 85/min; Mala (stool) - irregular unsatisfactory; Mutra (urine)- Normal 4-5 time per day; Jiwha (tongue)- Coated; Shabda (speech)- Normal; Sparsha (touch)- Normal; Drik (eyes)- Normal; Akruti (Built)- Medium

 

Vital examination:

Blood Pressure (B.P.) -130/80 mmHg; Pulse (P) - 85/min; Respiratory Rate (RR)-16/min; Weight -50 kg ; Temperature- 98.1F

 

Local Examinations (Joint):

Swelling present at bilateral knee joints, right greater toe, ankle joint. Tenderness present in bilateral knee joints. Warmth in bilateral knee joint. Redness Absent. Crepitus  present on and off in bilateral knee joints. Deformity absent.

 

Systemic Examination:

Cardiovascular system Examination – S1 S2 Heard Normal, No added sounds.

Central nervous system Examination- No any deformities

Per Abdomen - Soft and Non-Tender

Respiratory system – Clear

Investigations:

Investigations done before treatment as follows

21/6/2019- Cytology: Hb 12.9 mg/dl, WBC 7100/cu mm (N-58, L-38, E-02, M-02, B-00), ESR- 18, Platelet count-2.94 lakhs/cu mm, Urine Examination: Nil

21/6/2019- Blood Chemistry: Blood Group- O Rh positive, C- Reactive protein- Negative, RA factor- Negative, Sr.Uric Acid- 9.5 mg/dl

Investigations done during and after treatment as follows

01/07/2019- Sr. Uric Acid- 8.2 mg/dl

13/07/2019- Sr. Uric Acid- 5.4 mg/dl

30/6/2019- USG Abdomen and Pelvis- No any abnormalities detected.

 

Table 1: Etiopathogenesis (Samprapti Ghatak) of Vatarakta (Gout)8

Doshaj Prakruti (Physical constitution)

Vata Kapha

Manas prakruti (Mental constitution)

Rajas

Dietary etiological factors

Improper diet habits, stale food

Behavioral etiological factors

Excess anger, day sleep, physical stress

Dosha

Vata predomiant Pitta Dosha

Dushya

Rakta, Mamsa, Twak

Agni (Digestion capacity)

Jatharagni, Dhatvagni reduced

Type of Srotodushti             

Sanga and Vimargamana

Origin of disease

Pakvashyayotha

Adhishtan  ( Seat of disease)

Sandhi specially Parva Sandhi, Twak, Mamsa

Rogamarga  (Route of disease)

Shakhagata Rogamarga

 

Table 2: Signs and Symptoms chart

Sr. No.

Signs and symptoms

Gradations

1

Bilateral lower limb pain with burning sensation

3

2

Multiple small joint pain (Throbbing type)

3

3

Early morning stiffness (Lasting for less than 15 mins

3

4

Swelling

3

 

Criteria for assessment:

 

Table 3: Subjective criteria9- Assessment of subjective parameters according to gradation of signs and symptoms as mentioned below

Subjective Parameter

Observation

Scale

Sandhishula (Joint Pain)

No Pain

0

Mild Pain

1

Moderate Pain

2

Severe Pain

3

Daha (Burnning sensation)

Absent

0

Mild

1

Moderate

2

Severe

3

Sandhisotha

(Joint Swelling)

No Swelling

0

Swelling but not apparent

1

Swelling obvious on lesser than 2 joints

2

Swelling obvious on greater than 2 joints

3

Sparshaasahatva

(Tenderness)

No tenderness

0

Mild, deep touch causes sparshaasahatva

1

Moderate, deep touch causes sparshaasahatva

2

Severe

3

Twak lohita (Reddish discolouration of skin)

Absent

0

Present

1

The patient was diagnosed with Vatarakta (gout) based on the above criteria (Table 3)

 

Table 4: Subjective and Objective Criteria on day 1th day 15th and day 35th as mentioned below

Sr. No.

Symptoms

1st Day

15th Day

35th Day

1

Daha (bilateral lower limb pain with burning sensation)

3

1

0

2

Shandhishool (multiple small joint pain (pricking type)

3

1

0

3

Stambha (early morning stiffness (lasting for less than 15 minutes)

3

2

0

4

Shoth (swelling )

3

2

1

 

Follow up

Date – 22/06/2019

Date – 01/07/2019

Date – 13/07/2019

Serum uric acid level

9.5 mg/dl

8.2 mg/dl

5.4 mg/dl

       

DIAGNOSIS: Vatarakta

PRINCIPLES OF MANAGEMENT10:

According to all Ayurvedic texts Vatarakta (Gout) is treated as follows

 

Table 5: Treatment given for 35 days mention as below Oral Ayurvedic medicaltions

Sr.No

Dravya

Dose

Duration

Anupana

Time

1.

Guduchyadi kashaya

40 ml

Twice daily

-

Before meals

2.

Guduchi ghana vati

250 mg

Twice daily

Lukewarm water

Before meals

3.

Kaishora guggulu vati

250 mg

Twice daily

Lukewarm water

Before meals

4.

Shankha vati

250 mg

Twice daily

Lukewarm water

Before meals

5.

Eranda tail (Castor oil)

15 ml

At bedtime

Lukewarm milk

After meals


Panchakarma given as follows:

·       Oleation therapy (Snehan) - Locally with Bala Tail for 35 days.

·       Sudation therapy (Swedan) - Locally with Nadi Sweda for 35 days.

·       Guduchyadi Ksheer Basti - Guduchyadi ksheer Basti - Guduchi, Bala, Erand, Manjishta, Nimba powder Each 4 gms, boiled with Milk 250ml make Ksheera paka and add Madhu 10ml, Bala Tail 50ml, Panchatiktak Ghrita 20ml for 16 days.

·       Bloodletting therapy (Jalaukavacharana)

 

DISCUSSION:

Ayurveda explains Vatarakta (Gout) as an example of Avarana pathology.

 

The states of the disease, Uthan (superficial) and Gambhira (deep) indicate progression of the illness and involvement of multiple organs and tissues. Symptoms like leg pain and joint pain because of diminished Vata were observed in this case. Rakta and Pitta get involved as the disease progress and patient develops Dushti Pradhana Vatarakta (Gout).

 

First, relieving Avarana and later correcting vitiated Pitta and Vata along with Raktaprasadak and Rasayana drugs, Samprapti Vighatana can be achieved. The drug of choice in this illness is Guduchi. The medicines is hot in potency (Ushana Veerya), has bitter in taste (Tikta Rasa). However, it becomes sweet after digestion (Madhur Vipaka). Furthermore, it is indicated in Vatarakta (Gout). Avarana condition as it has Vatahara Rakta Prasadak. Mode of action of oral Ayurvedic medicine and Panchakarma therapy as described in detailed as follows.

 

Mode of action of Ayurvedic medicine:

1.     Guduchyadi Kashaya- It act as a Agnideepan, Tridoshashamak, Excellent Rasayana thus acts as antipyretic, anti-inflammatory, antiarthritic, antioxidant, immune modulatory actions11.

2.     Guduchi Ghana Vati - It acts as a Agnideepan, Tridoshashamak, Excellent Rasayana thus acts as antipyretic, anti-inflammatory, antiarthritic, antioxidant, immune modulatory actions12 Antioxidant activity13. Guduchi plant is used in the treatment of numerous diseases14 Guduchi is used in Ayurvedic medicine as a tonic energiner, antipyretic15 remedy for other metabolic disorders.16 Guduchi is a  antioxidant, hepatoprotective, antiulcer and anti-inflammatory drug17 rejuvenative, anti-rheumatic diuretic property18  .

3.     Kaishorag Guggulu- It works as an Anaabhishyandi, Snigdha, Srotoshuddhikaraka, Vatashamana along with Kaphamedonashak properties19.

4.     Shankha Vati - It helps in Deepan, pachan, Vatanulomana20.

5.     Eranda Taila (Castor oil) - It pacifies vitiated Vata by giving normal direction to Vata i.e. Vatanulomana, Srotovishodhana, Kaphahara21. Nonsteroidal anti-inflammatory Drugs (NSAIDs) and used for the treatment of some diseases including arthritis symptoms like swelling, pain, tenderness at joints its used like pain killers.22 antimicrobial activity23  The highest antimicrobial potential were observed for the extracts of pomegranate and castor.24 

 

Mode of action of Panchkarma therapy:

1.     Oleation therapy (Snehan) – It works as a Vataghna (Decrease Vata Dosha in body), softness in Dosha, purification of Kostha (Abdomen), increase in digestive power, and increase the strength of the body25.

2.     Sudation therapy (Swedan) – Sudation act as if, there is heaviness in body, it is away from sweat, coldness is removed by sweating, and sweating comes from perspiration which is a shit. With this stool, the skin remained an all seven levels and its impurities are removed in the muscles, gout, juice, blood, and fattening26.

3.     Enema (Basti)Basti mainly possesses Vedanasthapana, Shothahara, Deepana, Pachana, Mutrala, Vatahara, Rasayana. Basti collectively decreases Vata Dosha and nourishes Asti and Majja Dhatu.  Ksheera basti is a Mrudu Niruha Basti which does Dosha Shaman and Brimhana.27

4.     Bloodletting therapy (Jalaukavacharana) - Healing of the skin, the strength of the body increases, the sensory and mind becomes happy and embodied in their work, the work of fire increases which is beneficial in digestive diseases, there is a benefit in inflammation, blood pressure is of special importance in Shul, Vata Vyadhi, Vatarakta, Lephadhi, Visarpadi the above mention diseases are prevented28.

 

CONCLUSION:

The below mentioned conclusions can be drawn from the current case study.

·       On 7th day, some improvement in sign and symptoms was seen.

·       The used drugs alleviate Vata by bringing back its normal function and removed obstruction in Raktavaha Srotas by Kaphamedoghna action.

·       Therapy such as Oleation therapy (Snehan), Sudation therapy (Swedan) and Enema therapy (Basti) treated Vata by bringing the aggravated Doshas from peripheral region of the body to alimentary tract and eliminating through gut.

 

RESULTS:

·       Symptomatic results were seen when the patient was treated with Ayurvedic medicine and Panchakarma therapy.

·       This study proves that Ayurvedic treatment is effective in the treatment of Vatarakta (Gout). Changes observed in subjective and objective parameters such as serum uric acid were significant.

·       This was single case study which proves effect of Ayurveda treatment of Vatarakta (Gout). Ayurveda herbs along with Panchkarma therapy shows highly encouraging results in Vatarakta (Gout).

 

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17.  Prativa Biswasroy, Sthitapragnya Panda, Chandan Das, Debajyoti Das, Durga Madhab Kar, Goutam Ghosh. Tinospora cordifolia– A plant with Spectacular natural immunobooster. Research J. Pharm. and Tech 2020; 13(2):1035-1038. doi: 10.5958/0974-360X.2020.00190.0

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22.  Bayu Eko Prasetyo, Karsono, Sakro Mega Maruhawa, Lia Laila. Formulation and Physical Evaluation of Castor Oil based Nanoemulsion for Diclofenac Sodium Delivery System. Research J. Pharm. and Tech 2018; 11(9): 3861-3865. doi: 10.5958/0974-360X.2018.00707.2

23.  Vd. Haridas Shridhar Kasture. Ayurvediya Panchakarma vidyan. Shree vaidhyanath Ayurved Bhavan pvt. Lt. Orientalia publisher, Nagpur. 1979; 2nd edition: pp. 128.

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25.  Ranjith Anishetty, Satya Swapna, B. Aishwarya, K. Chaitanya Sravanthi. Evaluation of antibacterial activity potential of extracts of Ricinus communis, Zingiber officinalis and Punica granatum in a Polyherbal Extract. Research J. Pharm. and Tech. 5(11): Nov. 2012; Page 1385-1388.

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27.  Vd. Haridas Shridhar Kasture. Ayurvediya Panchakarma vidyan. Shree vaidhyanath Ayurved Bhavan pvt. Lt. Orientalia publisher, Nagpur. 1979; 2nd edition: pp. 464.

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Received on 22.06.2021             Modified on 25.11.2021

Accepted on 10.02.2022           © RJPT All right reserved

Research J. Pharm. and Tech 2022; 15(11):5026-5030.

DOI: 10.52711/0974-360X.2022.00845