|Year : 2019 | Volume
| Issue : 1 | Page : 44-49
Evaluation of effect of kalyanaka kshara in vibandha with special reference to constipation: An open clinical trial
Shubham Brajesh Gupta1, Pradeep S Shindhe1, RR Hiremath2
1 Department of Shalya Tantra, Kaher's Shri B. M. Kankanawadi Ayurveda Mahavidyalaya, KLE Ayurveda Hospital and MRC, Belgavi, Karnataka, India
2 Department of Agada Tantra, Kaher's Shri B. M. Kankanawadi Ayurveda Mahavidyalaya, KLE Ayurveda Hospital and MRC, Belgavi, Karnataka, India
|Date of Web Publication||18-Jan-2019|
Dr. Shubham Brajesh Gupta
Department of Shalya Tantra, Kaher's Shri B. M. Kankanawadi Ayurveda Mahavidyalaya, KLE Ayurveda Hospital and MRC, Shahpur, Belagavi, Karnataka
Source of Support: None, Conflict of Interest: None
INTRODUCTION: Constipation (vibandha) is a common clinical problem and symptoms of many diseases. It is not described as a separate disease in the classical text. Westerned life style, mental stress and diets are play major role in occurring in constipation (vibnadha). The diagnostic and evaluation of vibandha includes an proper history and investigation to exclude any other abnormalities and disease.
OBJECTIVE: The objective of this study was to evaluate the effect of kalyanaka kshara in vibandha.
MATERIALS AND METHODS: A clinical trial was conducted on a group of 30 patients diagnosed with the help of rome III criteria and Bristol stool scale with constipation (vibandha). Patients were selected openly irrespective of their religion, race, occupation, sex etc. They were internal administered kalyanaka kshara, a herbal formulation, at a dose of 500 mg Bid a day for ten days for internal administration with ghee and monitored at 3rd, 5th, 7th, 10th and 15th days for any adverse effect and effect of drug. Symptoms of constipation like straining, lumpy and hard stool, stisfction after daefecation, nature of stool etc. were observed over the treatment.
RESULTS: Analysis of result showed improvement in vibandha (constipation).
CONCLUSION: Finally study concluded that kalyanaka kshara is effective in the treatment of vibandha.
Keywords: Constipation, kalyanaka kshara, vibandha
|How to cite this article:|
Gupta SB, Shindhe PS, Hiremath R R. Evaluation of effect of kalyanaka kshara in vibandha with special reference to constipation: An open clinical trial. Indian J Health Sci Biomed Res 2019;12:44-9
|How to cite this URL:|
Gupta SB, Shindhe PS, Hiremath R R. Evaluation of effect of kalyanaka kshara in vibandha with special reference to constipation: An open clinical trial. Indian J Health Sci Biomed Res [serial online] 2019 [cited 2019 Dec 6];12:44-9. Available from: http://www.ijournalhs.org/text.asp?2019/12/1/44/250398
| Introduction|| |
Constipation is a common problem in today's century., In countries like India, only 24.8% of people are having proper access to toilet, leading to delaying in defecation which could have direct consequences causes in rest of the people, other than dietary. It can be correlated to vibandha which is explained as a symptom rather than a separate disease. Increased stress, Westernized life style, and abnormal food habits seen in the modern society are the causes of constipation (vibandha). Constipation is characterized by difficulty in emptying the bowels, usually associated with hardened feces and unsatisfactory passing of stool. Vibandha occurs due to Vikruti of Vayu (Pratilom gati of Apan Vayu) and Purisavaha Srotas Dusti. The symptoms of vibandha are likely to be the symptoms of constipation from modern science. Definition of constipation is many in numbers according to different authors, characterized by infrequent stools, hard stools, difficulty passing stools (straining), or a sense of incomplete evacuation, etc.
Ayurveda believes agni as the main cause for vibandha because the properly formed stool is easily evacuated. If there is derangement in proper functioning of agni, it may cause improper formation of stool that may lead to Vibandha. Many formulations have been laid down in classical texts that are widely used, showing efficient results in relieving vibandha.,
However keeping in view for the correction of agni, kalyanaka kshara is one among such formulations that aims correcting agni which enables proper formation of stools and easy defecation.
With this idea, this clinical study was conducted to evaluate the effect of kalyanaka kshara in thirty patients for 10 days. Two patients (7%) experienced mild improvement, 11 patients (36%) were getting moderate improvement, and 17 patients (57%) were getting marked improvement. The overall effect of the treatment was 62.13%.
Aim and objectives
The aim and objective of this study was to evaluate the effect of kalyanaka kshara in vibandha.
| Materials and Methods|| |
Open clinical study
This study was registered under Clinical Trials Registry – India (CTRI) with no. CTRI/2018/01/011540. Having obtained ethical clearance from the Institutional Ethical Committee and consent from the patients, a total of thirty patients were enrolled from the outpatient department of KAHER Ayurveda Hospital and Research Centre, Belagavi. The patients were treated with 1 g divided dose/day of kalyanaka kshara for 10 days and observations were noted on 0th, 3rd, 7th, 10th, and 15th day. Statistical analysis was done for Rome III Criteria with Paired t-test, Pain withVisual Analog Scale (VAS) was used and Bristol scale with Wilcoxon sign rank.
Method of preparation
[Table 1] all ingredients taken were cleaned, dried, powdered and mixed with crushed shodhita bhallataka to a fine state and the mixture was passed through sieve no. 85. The above mixture was levigated with tila taila and gomutra and a homogeneous blend was prepared. The homogeneous blend was kept in an earthen pot and covered with a sharava. The edges of the pot were sealed by seven consecutive layers of clay-smeared cloth and dried. The pot was heated until it became red hot. The content was removed from the pot and ground to a fine powder. Finally, the content was tightly packed in a close container to protect it from light and moisture.
Considering the symptoms of constipation as given in modern science, the assessments were done with parameters such as VAS, Rome III Criteria,, and Bristol Stool Scale.
First, data analysis was made on observations on general components such as age, sex, Prakruti, agni, and kostha. secondly comparison of pre treatment measurements of the outcome with that of post treatment measurements were done, where we used inferential method. Statistical analysis was done for the results using paired t test and Wilcoxon signed rank test.
Analysis of age incidence of thirty patients suffering from constipation showed more number of patients between the age group of 30 and 39 years, i.e., 43.33%.
In the sample taken for the study, 36.67% of males were registered in comparison to 63.33% of females.
Among the thirty registered patients, majority, i.e., 50%, had Vata pittaja Prakriti and 33.3% had Vata Kaphaja Prakriti.
Out of the thirty patients, 70.67% of the patients had krura koshta and 30% of patients had madhyama koshta.
Diet-wise distribution shows that majority of the patients, i.e., 73.3%, were taking mixed diet, whereas 31.25% were vegetarians.
Among thirty patients, 70% of the patients had a chief complaint of passing hard stool and 30% with well-formed stool. Among 30 patients 70% of patients and a chief complaint of excessive straining while passing stool and 36% with mild straining. 53.3% of patients had a chief complaint of dissatisfaction after passing stool and 46.66% were not fully satisfied.
| Results|| |
Effect on straining
Statistical analysis showed that the mean score which was 2.97 before treatment was reduced to 1.03 with 65.17% improvement, and there was a statistically significant change (P < 0.05) [Table 2].
Effect on lumpy stools
Statistical analysis showed that the mean score which was 2.93 before treatment was reduced to 1.03 with 64.77% improvement, and there was a statistically significant change (P < 0.05) [Table 3].
Effect on incomplete defecation
Statistical analysis showed that the mean score which was 2.67 before treatment was reduced to 0.83 with 68.75% improvement, and there was a statistically significant change (P < 0.05) [Table 4].
Effect on obstruction
Statistical analysis showed that the mean score which was 1.17 before treatment was reduced to 0.30 with 74.29% improvement, and there was a statistically significant change (P < 0.05) [Table 5].
Effect on manual methods
Statistical analysis showed that the mean score which was 0.10 before treatment was reduced to 0.03 with 66.67% improvement, and there was no statistically significant difference (P > 0.05) [Table 6].
Effect on Less than 3
Statistical analysis showed that the mean score which was 2.97 before treatment was reduced to 1.03 with 16.67% improvement, and there was no statistically significant difference (P > 0.05) [Table 7].
Effect on pain
Statistical analysis showed that the mean score which was 3.10 before treatment was reduced to 1.60 with 48.39% improvement, and there was a statistically significant difference (P < 0.05) [Table 8].
Effect on Bristol Stool Scale
Statistical analysis showed that the mean score which was 2.10 before treatment was increased to 3.40 with 93.14% improvement, and there was a statistically significant difference (P < 0.05) [Table 9].
| Discussion|| |
Straining during at least 25% of defecations
Hard stools which lead to straining may be reduced due to the osmotic laxative action of gallic acid present in triphala and other drugs such as lavana, which also does the vatanuloma karma by hastening the elimination of stool by stimulating bowel after loosening and relaxation. Presence of sodium and magnesium helps in maintaining fluid balance and proper functioning of gastrointestinal tract. Sodium actively reabsorbed fluid from intestinal wall, help in softening of stool.
Lumpy or hard stools in at least 25% of defecations
The formation of lumpy stools is due to excess absorption of water from the stool. Drugs such as chitraka and triphala help in agni deepana and pachana; hence the stool is well formed, as dissociation is guna of vata, and lavanas used having snigdha guna does the vata shamana results in passing of soft stool.
Sensation of incomplete evacuation for at least 25% of defecations
Chitraka, bhallataka, and pippali by their teekshna and ushna properties increase the peristaltic movements of gut, and drugs such as triphala and lavanas help in vatanulomana as there is apana vayu dusti which increases the intestinal contractions along which the stool mass moves and gets evacuated easily. Potassium and chloride help in increasing peristalsis, enhancing the motility. Bicarbonate helps in proper sphincter relaxation for easy evacuation.
Sensation of anorectal obstruction/blockage for at least 25% of defecations
The sensation of anorectal obstruction/blockage occurs due to hard stool and reduced gut movements, causing feeling of obstruction of the stools. Drugs such as pippali, chitraka, maricha, and bhalataka by their bhedana guna break down the hard stool so that defecation becomes easy without any obstruction.
Manual maneuvers to facilitate at least 25% of defecations
Decreased motility of the colon results in dry, hard stools that in the case of fecal impaction requires manual methods for removal, the drugs having ushna teekshna drugs helps in deepana pachana by which formation of stool occurs properly and lavana and triphala used causes vatanulomana by increasing the gut mobility by softening the hard stools.
Improvement in this case was mild and not statistically significant; very hard stools indicate krura koshta with vata predominance and the period of administration of drugs should have been extended for a long period to show better effects and to achieve good improvement in krura kostha patients.
Fewer than three defecations per week
It can be considered in krura kostha persons who pass stool with difficulty and very irregularly, kalyanaka kshara have teekshna ushna drugs which does ama pachana and the stool is formed properly, all the type of lavana used does vatanulomana so helps in easy passing of stool. Improvement in this case was not statistically significant; this may be because drugs may show less effect in krura koshta which may require higher dose for long period.
- Pain (VAS scale): Pain is caused by straining or obstruction of bowel movements due to hard stools. The severity of the pain may be reduced by the action of pippali maricha sunthi and chitraka which have shoolaghna properties and other drugs such as triphala and lavana which help in vatanuloma, so the obstruction is relieved which in turn facilitates passing of stools easily without any pain
- Bristol Stool Scale: Among the thirty patients, most of the patients were passing Type 1 and Type 2 of stool which was reduced greatly to Type 3 and Type 4 after treatment. It may be because of the action of ushna teekshna and vatanulomaka drugs that facilitate easy passage of stool by softening the feces.
| Conclusion|| |
In this study, it was observed that kalyanaka kshara showed significant improvement in vibandha. In this study, among the thirty patients registered, maximum improvement was seen in Vata kapha prakruti patients. Most of the patients were aged between 20 and 39 years. The statistical analysis revealed that there were statistically significant improvements in parameters such as passing hard stool, excessive straining, and feeling incomplete evacuation, and no significant improvement was seen in patients having <3 defecations/week and who were using manual method for defecation. This indicates krura koshta with vata predominance and the period of administration of drugs should have been extended for a long period to show better effects and to achieve good improvement in krura kostha patients. The overall results showed 17 patients with marked, 11 patients with moderate, and 2 patients with mild improvement.
Financial support and sponsorship
This study was financially supported by KAHER's Shri. B. M. Kankanawadi Ayurveda Mahavidyalaya, PG Studies, KLE Ayurveda Hospital and MRC, Shahpur, Belagavi.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Thompson WG, et al.
U.S. Householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci 1993;38:1569-80.
Higgins PD, Johanson JF. Epidemiology of constipation in North America: A systematic review. Am J Gastroenterol 2004;99:750-9.
Costiveness-Definition and More from the Free Merriam-Webster Dictionary. Archived from the Original; 11 April, 2010.
Brahmanand T. Charak Samhita-1, Viman Sthana 5/8. Varanasi: Chaukhambha Surabharti Prakashan; 2008. p. 698.
Chatoor D, Emmnauel A. Constipation and evacuation disorders. Best Pract Res Clin Gastroenterol 2009;23:517-30.
Nadkarni KM. Indian Materia Medica. Vol. 1. Mumbai: Bombay Popular Prakashan; 2007. p. 982-5.
Srikantha Murty KR, editor. Bhavprakash of Bhavmishra. Purva Khanda. Vol. 1. Varanasi: Chaukhamba Shrikrishna Das Academy; 2008. p. 275.
Govt of India Ayurvedic Formulary of India Part 1. 2nd
ed., Sec. 10. New Delhi: The Controller Publications Civil Lines; 2003. p. 165.
Mitra J. Vagbhata, Astanga Samgraha, Sasilekha Sanskrit Commentary by Indu Translation. Chikitsa Sthana 10:36. Varanasi: Chaukhambha Orientalia; 2012. p. 496.
Powell RA. Pain History and Pain Assessment. Chapter. 10. Vol. 33. International Association for the Study of Pain (IASP); 2017. p. 229-32.
Sung IK. Classification and treatment of constipation. Korean J Gastroenterol 2008;51:4-10.
Rao SS. Constipation: Evaluation and treatment. Gastroenterol Clin North Am 2003;32:659-83.
Shrama Y. Charaka: Charaka Samhita, Text with Hindi Translation and Critical Exposition Based on Chakrapani Dutta's Ayurveda Dipika. Part 1. Sutra Sthana 26/3. Varanasi: Chowkhamba Orientalia; 2011. p. 385.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]