RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE,KARNATAKA

COMPLETED PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

A COMPARATIVE STUDY OF TWO MODALITIES OF TAKRADHARA IN ESSENTIAL HYPERTENSION

BY DR. SUMI S.R P.G SCHOLAR, DEPT OF P.G.STUDIES IN PANCHAKARMA, S.K.A.M.C, H & R.C, VIJAYANAGAR, BANGALORE-560040

GUIDE: DR. SWATI DESHPANDE M.D(AYU), READER, DEPT OF P.G STUDIES IN PANCHAKARMA, S.K.A.M.C, H & R.C, VIJAYANAGAR, BANGALORE-560040

2010 2011

SRI KALABYRAVESHWARA SWAMY AYURVEDIC MEDICAL COLLEGE, HOSPITAL & RESEARCH CENTRE, VIJAYANAGAR, BANGALORE-560040
From, DR. SUMI S.R P.G SCHOLAR, Dept of P.G Studies in Panchakarma, S.K.A.M.C, H & R.C, Vijayanagar, Bangalore-560040 To, THE REGISTRAR Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka.

Through, THE PRINCIPAL, DEAN, PG STUDIES & H.O.D. OF PG STUDIES IN PANCHAKARMA, S.K.A.M.C,H & R.C, Vijayanagar, Bangalore-560040

Respected Sir, SUB: Submission of completed Proforma for Registration of subject for Dissertation.

I hereby request you to kindly register the below mentioned subject against my name for the submission of Dissertation to the Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka for partial fulfillment of M.D.(Ayu) in Panchakarma.

Title of the Dissertation: A COMPARATIVE STUDY OF TWO MODALITIES OF TAKRADHARA IN ESSENTIAL HYPERTENSION

Here with,I am enclosing completed Proforma of Synopsis for Registration of subject for Dissertation. Thanking You

Place:Bangalore Yours faithfully, Date:

(Dr.Sumi.S.R) 1) NAME OF THE CANDIDATE: DR. SUMI S.R

ADDRESS:

P.G SCHOLAR, DEPARTMENT OF P.G STUDIES IN

PANCHAKARMA, S.K.A.M.C, H & R.C, NO 10, PIPE LINE ROAD, R.P.C LAYOUT, VIJAYANAGAR, BANGALORE-560040, KARNATAKA.

PERMANENT ADDRESS:

REVATHY, THEKKEVILA.P.O, KOLLAM-691016, KERALA.

2) NAME OF THE INSTITUTION: AYURVEDIC

SRI KALABYRAVESHWARA SWAMY

MEDICAL COLLEGE, HOSPITAL & RESEARCH CENTRE, VIJAYANAGAR, BANGALORE-560040

3) COURSE OF STUDY & SUBJECT:

M.D.(AYURVEDA) PANCHAKARMA

4) DATE OF ADMISSION TO THE COURSE : 27.11.2010

5) TITLE OF THE DISSERTATION : A COMPARATIVE STUDY OF TWO MODALITIES OF TAKRADHARA IN ESSENTIAL HYPERTENSION

6) BRIEF RESUME OF THE STUDY: 6.1) NEED FOR THE STUDY:

Hypertension is a major health problem throughout the world owing to its high prevalence and its association with increased risk of cardiovascular disorders1. 95% of the cases are idiopathic in origin2. According to an analysis of world wide data, about 972 million adults were suffering from Hypertension in the year 2000 which is estimated to go up to 1.6 billion adults by year 20253. Essential Hypertension which is of unknown aetiology, generally detected on routine medical check-up, if untreated may lead to many serious complications4.

In the present scenario many drugs that are administered to treat this condition, which in the long run may lead to various adverse effects and the condition may require multiple drug regimens. Shirodhara is found to be beneficial in various psychosomatic disorders, Hypertension being the commonest. Among the cluster of Shirodhara, Takradhara5 serves this purpose in a better way. It is evident in references in classics and through various clinical trials that Takradhara is effective in a multitude of psychosomatic disorders6. Patients of Hypertension, owing to such high prevalence, would certainly derive significant benefits from Takradhara. In the present study, among the various modalities of Takradhara7, 8, two methods which are found to be popular among the fraternity of Panchakarma are adopted to compare the efficacy of both in the management of Essential Hypertension.

6.2) REVIEW OF LITERATURE:

1 Detailed description of Essential Hypertension is mentioned in Harrisons Principles of Internal Medicine9. 1 2 3 4 Sushruta explained the properties of Takra10. Astanga Hridaya mentioned about Shiroseka11. Detailed description of Takradhara is mentioned in Sahasrayoga12. Vaidyaratnam.P. S. Varier, mentioned about the preparations of Takradhara dravyas using Ushira, Chandana, Yastimadhu in place of Musta13. 5 The qualities of Amalaki14 and Musta15 are mentioned in Raja Nighantu.

PREVIOUS WORKS DONE: 1 Rajashekhar.V.Sanapeti, A clinical study on the effect of Takradhara in Essential Hypertension, SDM College of Ayurveda, Udupi, RGUHS, Karnataka, 2006. 2 Shukla Maheshwar, Effect of Shirodhara by Takra in patients suffering from Hypertension, IPGT & RA, GAU, Jamnagar, 1983. 3 Pathaniya Sumit, Role of Takradhara & Sarpagandha ghanavati in the management of Uccharaktachapa (EHT), IPGT & RA, GAU, Jamnagar, 2001. 4 Birla.o.ch, Abhivriddha Raktachapa par Shirodhara, IPGT & RA, GAU, Jamnagar, 1973.

Tamrakar B.ch, Comparative therapeutic evaluation of Shavasana and Shirodhara Panchakarma therapy in Hypertension, Govt Ayurvedic college , Ravishanker University,Raipur, 1987.

6.3 ) OBJECTIVES OF STUDY:

1 To evaluate the therapeutic effect of Takradhara using Musta Ksheerapaka Siddha Takra mixed with Amalaki Kashaya in the management of Essential Hypertension. 2 To evaluate the therapeutic effect of Takradhara using Takra mixed with Mustamalaki Kashaya in the management of Essential Hypertension. 3 To compare the therapeutic effects in both groups.

7) MATERIALS AND METHODS:7.1) SOURCE OF DATA:

Randomly selected 40 patients diagnosed with Essential Hypertension will be taken for the study from OPD and IPD of S.K.A.M.C, H & R.C, Bangalore-40.

7.2) METHOD OF COLLECTION OF DATA:

1 A comparative clinical study with pre-test and post-test design where in 40 patients diagnosed with Essential Hypertension of either sex will be selected randomly. 2 A case proforma will be specially designed with all the points of history taking, physical signs and laboratory investigations as mentioned in the texts. 3 4 The parameters of signs and symptoms will be scored as mentioned in the proforma. The following statistical method will be employed for data collection - descriptive statistics, contingency table analysis, paired sample t test and ANOVA, using SPSS for windows software. repeated measure

DIAGNOSTIC CRITERIA:
Criteria for diagnosis of Hypertension as defined by 7th Joint National Committee Report will be followed16: Category Normal Prehypertension Systolic <120 120-139 Diastolic <80 80-89

Stage I Hypertension Stage II Hypertension

140-159 >160

90-99 >100

Three consecutive readings of blood pressure in supine posture will be observed and their average is recorded for diagnosis. Patient with Stage I Hypertension will be selected.

INCLUSION CRITERIA:
Freshly diagnosed patient of Essential Hypertension / Primary Hypertension / Idiopathic Hypertension. Patient aged above 18 years. Stage I Hypertension.

EXCLUSION CRITERIA:
1 2 3 4 5 Secondary Hypertension. Patient below 18 years. Stage II Hypertension. Pregnant women. Patient with any other systemic disorder which interfere with the course of treatment.

INTERVENTION:
All patients will be randomly categorized into two groups. Group A: - 20 patients will be subjected to Takradhara prepared by Musta Ksheerapaka Siddha Takra mixed with Amalaki Kashaya. Group B: - 20 patients will be subjected to Takradhara using Takra mixed with Mustamalaki Kashaya. Duration: The procedure will be performed for 45 minutes for 7 consecutive days in the afternoon. Post- test recording of B P will be done after Takradhara on 7thda y. Follow up: - On 14th and 21st da y.

ASSESSMENT CRITERIA:

The following subjective parameters17 and objective parameters will be assessed 1 2 3 4 5 6 7 8 9 Headache Palpitation Giddiness Perspiration Fatigue Impotence Epistaxis Haematuria Blurring of vision

10 Assessment of blood pressure with Sphygmomanometer.

7.3) Does the study require any investigation or intervention to be conducted on patient or other humans or animals ? If so please describe briefly.
Study will be conducted on humans who match inclusive criteria only.

LABORATORY INVESTIGATIONS
1 2 3 4 5 Random Blood Sugar Blood urea Serum creatinine Blood-Lipid profile Electro-Cardio Gram

7.4 ) Has ethical clearance been obtained from your institution in case of 7.3? - YES

8) LIST OF REFERENCES:
1. Robbins and Cotran Pathologic Basis of Disease, edited by Vinay Kumar, Abdul K. Abbas, Nelson Fausto, W.B.Saunders International Edition, 7 edition, reprint-2006, Pp1525, Pg no 525.
th

2. Robbins and Cotran Pathologic Basis of Disease, edited by Vinay Kumar, Abdul K. Abbas, Nelson Fausto, W.B.Saunders International Edition, 7 edition, reprint-2006, Pp1525, Pg no 526. 3. www.ncbi.nlm.nih.gov/pubmed/15652604, Global burden of Hypertension: analysis of world wide data, Kearney PM, M Whelton, K Reynolds, P Muntner, Whelton P.K, Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, U.S.A, 2005. 4. Robbins and Cotran Pathologic Basis of Disease, edited by Vinay Kumar, Abdul K. Abbas, Nelson Fausto, W.B.Saunders International Edition, 7 edition, 2006, Pp-1525, Pg no 526. 5. Dr. Ramnivas Sharma, Dr. Surendra Sharma, Sahasrayogam, Sanskrit-Hindi translation, translated by Pandit Rao,edited by Vaidya Mahendrapal Simha Arya, CCRAS, New Delhi, 1st edition, 1999, Dharakalpa, Pp-621, Pg no 521. 6. Padmasri Dr. K.Rajagopalan, Keraliya Chikitsa Paddhati, Ayurveda Series-3, translated by Dr.Pavana.J, Dr.Manoj Sankaranarayana, published by Dr.Rajagopalan Ayurveda Granthamala Samithi, 1st edition, Pp-195, Pg no 116,117. 7. Vaidya Haridas Sridhar Kasthure, Ayurvediya Panchakarma Vignana, Sri Vaidyanath Ayurveda Bhavana Limited, 9th edition, 2006, Pp-654, Pg no 95, 96. 8. Vaidyaratnam P.S. Varier, Chikitsa Samgraha, Kottakkal Ayurveda Series-3, translated by P.U.K.Warrier, Kottakkal Aryavaidyashala Publications, 7th edition, 2008, Pp-271, Pg no 174. 9. Harrisons Principles of Internal Medicine, edited By Braunwald, Fauci, Kasper, Hauser, Longo, Jameson, Mc Graw-Hill Medical Publishing Division, 2001, 15th edition, Volume 1, Pp-1442, Pg no 1414. 10. Sushruta, Sushruta Samhita, edited & translated by P.V.Sharma, Chaukhambha Visvabharati Oriental Publishers & Distributors, Varanasi, 1 edition, 1999, Sutra Sthana, 45th Chapter, Verse 84, Pp-568, Pg no 432. 11. Vagbhata, Astanga Hridaya, translated by K.R.Srikantha Murthy, Chowkhamba Publications, 5th edition, 2007, Sutra Sthana, 22nd Chapter, Verse 23, Pp-520, Pg no 273.
st th th

12. Dr. Ramnivas Sharma, Dr. Surendra Sharma, Sahasrayogam, Sanskrit-Hindi translation, translated by Pandit Rao, edited by Vaidya Mahendrapal Simha Arya,CCRAS, NewDelhi, 1st edition, 1999, Dharakalpa, Pp-621, Pg no 521, 522. 13. Vaidyaratnam P.S. Varier, Chikitsa Samgraha, Kottakkal Ayurveda Series-3, translated by P.U.K.Warrier, Kottakkal Aryavaidyashala Publications, 7th edition, 2008, Pp-271, Pg no 174. 14. Pandit Narahari, Rajanighantu, edited with Dravyaguna Prakasika Hindi Commentary by Dr.Indradeo Tripathi, Chowkamba Sankrit series office Publishers and Oriental and Foreign Book-seller, 2 nd edition, 1998, Pp-703, Pg no 371. 15. Pandit Narahari, Rajanighantu edited with Dravyaguna Prakasika Hindi Commentary by Dr.Indradeo Tripathi, Chowkamba Sankrit series office Publishers and Oriental and Foreign Book-seller, 2 nd edition, 1998, Pp-703, Pg no163. 16. www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.pdf, The7thReport of the Joint

National Committee on Prevention, Detection, evaluation and treatment of High Blood Pressure. JAMA 2003; 289(19):2560-2572. 17. Harrisons Principles of Internal Medicine, edited By Braunwald, Fauci, Kasper, Hauser, Longo, Jameson, Mc Graw-Hill Medical Publishing Division, 2001, 15th edition, Volume 1, Pp-1442, Pg no 212.

9) SIGNATURE OF CANDIDATE

10) REMARKS OF GUIDE

11) NAME AND DESIGNATION OF

11.1) GUIDE

DR. SWATI DESHPANDE M.D(AYU), READER, DEPT OF P.G STUDIES IN

PANCHAKARMA, S.K.A.M.C, H & R.C, VIJAYANAGAR, BANGALORE560040

11.2) SIGNATURE

11.3) CO-GUIDE

11.4) SIGNATURE

11.5) H.O.D.

DR. MURALIDHAR M.D(AYU), PROFESSOR AND H.O.D, DEPT OF P.G STUDIES IN

PANCHAKARMA, S.K.A.M.C, H & R.C,

VIJAYANAGAR, 560040

BANGALORE-

11.6) SIGNATURE

12.1) REMARKS OF CHAIRMAN & PRINCIPAL :

12.2) SIGNATURE