Clinical Evaluation of Vanga Bhasma on Shweta PradarA

INTRODUCTION

Metals have always been a matter of curiosity to humans. Indians were the first to use metals for their therapeutic values. Vanga, known as pootiloha¹ (which melts easily) is one among the loha which was in use during samhita period as an external medicine (krimighna). In the later period, Sidda Nagarjuna and Rasacharyas used the metals for Parada Banda (loha vada) and Vyadhinirharana (Dehavada).Vanga is one such metal used for shukrakshaya, Shweta asrigdhara nasha² . The properties of Vanga bhasma are tiktarasa, laghu, teekshna, sheeta guna and shleshmahara, and it is indicated in uro-genital system as stambaka. Shwetapradara is not mentioned as an independent disease in great trios,but can be seen as a symptom in many yonirogas, especially kaphaja yoni rogas³ .

‘Yonigata pichchila sheeta panduvarnayukta srava’ along with kandu and alpavedana are the classical symptoms of shweta pradara as per Acharya Charaka⁴ . But chakrapani in his commentary has used the term shwetapradara for paandura ashrugdhara, here pandura asrugdhara refers to shwetapradara. Later Sharangadhara, Bhavaprakasha,Yogaratnakara have used the word shweta pradara for white vaginal discharge. Leucorrhea is strictly defined as an excessive normal vaginal discharge⁶ . The excessive secretion is due to either Physiologic excess, Cervical causes or Vaginal causes which include high estrogen levels during puberty or during menstrual cycle , pregnancy; non infective cervical lesion; uterine prolapse, chronic pelvic inflammation, pill use and vaginal adenosis.

Rasataranginikara is the only Acharya who quotes vanga as shweta asrigdara nashaka⁷ . By observing properties of vangabhasma and its indications in the urogenital system as stambaka, an observational study has been conducted to confirm the efficacy of vanga bhasma in shweta pradara.

AIMS AND OBJECTIVES

• Preparation of vanga bhasma as per classical method

• To evaluate efficacy of vanga bhasma on shwetapradara.

MATERIALS AND METHODS

1) Pharmaceutical study: Raw vanga purchased from the local market, Bellary, identified, according to classical reference. Samanya shodhana⁸ , Visheshashodhana⁹ , jarana of shodhitavanga¹⁰ and marana¹¹, was carried out. Seven puta was required to attain the bhasma siddha lakshanas.

2) Clinical study: 30 patients were selected from the special camp conducted for shwetapradara, through PG Department of Rasashastra and Bhaishajyakalpana, GAMC and Hospital Bellary.

Method of collection of data:

• Patients were diagnosed on the basis of clinical findings. • General examination, per-vaginal, per speculum examinations were carried out

• For vaginal smear, discharge was taken with sterile cotton swab and collected in a sterilized bottle. This was tested for candidiasis and T.V (Trichomonas Vaginalis) by using normal saline and 10% potassium hydroxide solution respectively.

• The pH of vagina was noted by using exact pH paper. It was kept in vaginal canal for one minute and change in the color of pH paper was compared with standard colour pH chart (standard pH value of vaginal canal is 4-5.5)

All these investigations were carried out before and after the treatment.

Inclusive criteria:

• Patients aged between 20-50 years.

• signs and symptoms mentioned in Ayurvedic classics

Exclusive criteria:

• Patients with other systemic diseases like madhumeha, karkatarbuda, samsargajavyadhi etc. which interfere with the cause of diseases and treatments will be excluded.

Parameters:

a) Per Vaginal examinations

I) manual ii) speculum.

b) Vaginal pH test

c) Vaginal smear test

Treatment schedule:

Dosage: 250mg./day,in two equally divided doses.

Anupana: madhu

Duration:15 days

Follow up:

The patients were followed up on the 45th day and 60th day.

Parameters for the assessment of results:

I. Subjective parameters: These are the parameters that were observed before, and after first and second week of treatment

i. Shweta srava

ii. Yoni kandu

iii. Kati shoola

iv. Mootradaha

II. Objective parameters: Improvements in the signs i,e.

i. Quantity,consistency,colour,and smell of the discharge.

ii. Vaginal smear test

iii. pH of the vaginal canal

These parameters were carried out before and after the treatment. The parameters were graded based on the severity as 3,2,1,0.

Sweta srava

• 3 (severe), denotes excess secretion which wets the undergarments, requires a sanitary pad throughout the month.

• 2 (moderate), denotes discharge which wets the undergarments and lasts for 10-15 days in a month.

• 1 (mild), denotes occasional discharge of 5 days in a month.

• 0 denotes normal secretion.

Kandu

• 3 - Itching throughout the day.

• 2 - Increases particular time of the day/night.

• 1 - Occasional

• 0 - Nil

Low backache

• 3 - Severe continous pain, no relief even after rest.

• 2 - Pain particular

• 1 - Particular time concerned with menstrual cycle

• 0 - Nil

RESULTS

Table 1 : Range of vaginal pH test conducted in the study group

Patients having normal pH range was more in no.56.66%

Table 2 : Clinical assessment data

• Total no. of patients with shwetasrava before treatment 30 i.e. (100%)

• Total no. of patients with shwetasrava after treatment 13 i.e. (43.3%)

• Treatment effect in terms of reduction - 56.7%

• Reduction in quantity of srava highly statistically significant at 0.1%

• Level of significance P<0.001;t=9.8.

Table 3 - Efficacy of vangabhasma on kandoo

• Total no.of patients with kandoo before treatment 30 i.e. (100%)

• Total no.of patients with kandoo after treatment 17 i.e. (56.66%)

• Treatment effect in terms of reduction - 44%

• Reduction in kandoo due to treatment is statistically highly significant at 0.1%

• Level of significance P<0.001; t=95.

Table 4: Efficacy of vangabhasma on katishoola

• Total patients with katishoola before treatment 26 i.e.(87%%)

• Total patients with katishoola after treatment 14 i.e.(47%)

• Treatment effect in terms of reduction-40%

• Reduction in katishoola due to treatment is statistically highly significant at 0.1%

• Level of significance P<0.001;t=9.52.

Table 5: Efficacy of vangabhasma on mootradaha

• Total patients with Mootradaha before treatment 28

• Total patients with Mootradaha after treatment 10 i.e. (33.3%)

• Treatment effect in terms of reduction- 46%

• Reduction in Mootradaha due to treatment is statistically highly significant at level of 0.1

• Level of significance P<0.001;t=9.4.

Table 7: Statistical assessment data on clinical parameters before and after treatment

The assessment data on clinical parameters before and after treatment was found to be statistically significant at rate P<0.001.

DISCUSSION

In this study 30 patients with shweta pradara lakshana were selected and clinically evaluated. On observation it is found that shweta pradara is more common during active reproductive phase of women in multiparous, in local contraceptive uses, in anaemic patients and in unhygienic conditions like home made sanitary pad users.

After the vaginal smear test, two types of patients were found- 17(56.67%) patients with non nonspecific groups and 13 patients (43.33) were with specific groups. Among specific group 6 (20%) patients were having candida infection and 7 (23.33%) were having T.V infections.

Both types of patients were treated with vanga bhasma 125mg with madhu as anupana, two times a day for 15 days. There was a significant response in a non-specific group of patients, but there was no response in specific types of patients during the first course of treatment. In such patients, treatment was carried out for second and third courses also.

The clinical assessment observation reveals that there was significant reduction in srava along with associated complaints like kandoo, katishoola and mootradaha which was statistically significant at a rate of p<0.001. T.V. infected patients remained in the mild form even after the third course of treatment.

CONCLUSION

Reduction in clinical parameters in nonspecific group patients is statistically highly significant whereas in specific groups is statistically not significant. The action of vangabhasma in both nonspecific and specific group leucorrhoea is effective in variation with duration of treatment.