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Dhanyamla Bahiparimarjana
                                                                  Prof. Dr. K. Shiva Rama Prasad 1 ,


         Parimarjana is spectacular word from Ayurvedic literature defined from Shabdha Kalpa
druma as – “Parishodhana”1 – a search, colloquially used to clean i.e. Dhavana. Where in the
“Marjana” is added with “Anganirmalyokaranam”2, which means the body waste removal process.
The “Parimarjana” with a prefix of “Bahi” becomes the “Bahiparimarjana” – a complete externally
modulated waste material removal or cleansing treatment, one out of three main methods of
treatment classifications. The other two are “Antahparimarjana” and “Shastrapranidhana”. The
“Pranidhana”3 has a meaning of – “the visualization of the cause of the Sthambha – the obstruction.
It other wise refer to the laparotomy exploration and Medinikosha explains it as “Praveshanam” –
the entry - of course in to abdomen.
         Bahiparimarjana Chikitsa explained as – the treatment procedures that are depend upon the
external touch such as Abhyanga, Sweda, Pradeha, Parisheka, Unmardana, etc4. A close look at the
said examples makes a classification of the Bahiparimarjana Chikitsa i.e. trans-dermal cleansing
management. The former Abhyanga in terms of Bahya sneha is an external oil application where
heat inducted through rubbing. It is in the texts as not to apply any form of external (tropical)
managements with out unctuous application, in terms that lubricates and facilitates the absorption
of the tropical management. The second application Sweda is an external heat modulation or
transportation through steam. The rest of the treatment applications include either of these two
specific methods of heat transportations.
         Commonly these Sneha and Sweda administered before to the chief cleansing methods viz.
Panchakarma. However, the real utility of Bahiparimarjana as “Roga Prashamana” visualized only
after the completion of the Dosha elimination. This verse observed from the Charaka at the context
of Kusta relay is that the Lepa applied after the eliminative (Samshodhita Ashaya) procedures are
effective5.
         Human body is not depends upon the Sun heat and very minimal heat is taken from external
and depends upon the internal system to generate the heat required for the body maintenance. The
Dosha in the body are always fluctuating in nature enhances or dislodges from its places to give rise
physiological or pathological changes in the body. All these changes generally depend upon the
triad of mass, pressure and temperature. Out of these the mass and pressure in the body are constant
and the only temperature is the variant subjected for the pressure variances. Thus the managements
1
    H.O.D., Dept. of Kayachikitsa (PG), DGM Ayurvedic Medical College, Kalasapur Road, Gadag-
582103, Karnataka (cell: +91-9448746450), doctorksrprasad@gmail.com

                                             Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 1
of Dosha triad either for elimination or for the maintenance requires the cleansing from internally
and even externally, where the externally mediated procedures are not eventually cleansing in
nature they may be curative. For the same reason the externally mediated - Bahiparimarjana
Chikitsa methods viz. Sneha and Sweda are not included in the cleansing methods of Panchakarma.
These Sneha and Sweda along with the co- procedures are not possessing “Dosha nirharana
samardhya” i.e. eliminative capacity6. Therefore, these procedures administered later to the
cleansing are effective to disease relief. In a nut shell, Bahiparimarjana is a Dosha shamana and the
Antahparimarjana is Dosha Shodhana or doshavasechana management.
       Dalhana was the first person to comment over the absorption and pharmaco-dynamics of the
externally mediated unctuous (fatty oil base) materials at the context of Abhyanga. He affirms that
each 100 of matra (32sec approximately) initiated from 300 to 900 takes the oil based medicament
for the Roma koopa – Twak – Rakta – Mamsa – Medo – Asthi – Majja. At the context he applies a
note that the Tridosha diseases of such region are implied to alter with the effect of medicine, as the
Abhyanga is Kapha Vata nirodhana 7. At the same place author, refer the Grudhrasi a disease,
prevented by the constant use of Abhyanga, which relays the meaning of Bahiparimarjana as
prevention and curative but not eliminative method of management. In the procedure of
Bahiparimarjana, the absorption is minimal but heat conduction is massive, that affect the blood to
flow peripheral to visceral or vice versa. The understanding of contemporary philosophy tells us
how our tradition meets the present day science.
       Absorption through the skin can be enhanced by suspending the drug in an oily vehicle and
rubbing the resulting preparation into the skin. This method of administration is known as
inunction i.e. Abhyanga. Because hydrated skin is more permeable than dry skin, the dosage form
may be modified or an occlusive dressing may be used to facilitate absorption. Controlled-release
topical patches are recent innovations. Finally, intact stratum corneum is an excellent barrier, but in
disease states the resistance to absorption is rapidly lost and absorption can be facilitated. The skin
acts as a two-way barrier to prevent absorption or loss of water and electrolytes.
       Few drugs readily penetrate the intact skin. Absorption of those that do is proportional to
the surface area over which they are applied and to their lipid solubility, since the epidermis
behaves as a lipid barrier. Inflammation and other conditions that increase cutaneous blood flow
also enhance absorption. The dermis, however, is freely permeable to many solutes. The diffusion
coefficient indicates the extent to which the matrix of the barrier restricts the mobility of the drug.
Increases in the molecular size of the drug will increase frictional resistance and decrease the
diffusion coefficient (Franz, 1983); molecules over 1000 daltons usually will not be absorbed
easily into normal adult skin8.


                                              Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 2
Parameters Controlling Absorption in Bahiparimarjana Chikitsa
         The absorption of drug into the skin is a function of the nature of the drug, the behaviour of
the vehicle, and the status of the skin. Three major variables account for differences in the rate of
absorption or flux of different topical drugs or of the same drug in different vehicles:
         -   The concentration of drug in the vehicle,
         -   The partition coefficient of drug between the stratum corneum and the vehicle, and
         -   The diffusion coefficient of drug in the stratum corneum.
         Apart from the above the points to be considered are -
                -   Large Surface area enhance absorption
                -   Increase cutaneous blood flow also enhance absorption
                -   Body temperature and blood flow enhance absorption of tropical medicines
                -   Transdermal replacement therapy is not a new invention, exists since the birth of
                    Ayurveda
Factor influencing Bahiparimarjana Chikitsa (Topical Therapy)
Dosage:
         An amount of topical medication sufficient to cover affected body surfaces in repeated
applications must be dispensed or applied to the patient. In Ayurveda much of applications viz.
Abhyanga, Sweda, Parisheka and Avagaha are done once in a day.
Age:
         Children have a greater ratio of surface area to mass than adults, and a given amount of
topical drug results in a greater systemic dose. The permeability of children's skin is increased in
preterm infants (Barker et al., 1987).
Regional Anatomic Variation:
         Permeability is generally inversely proportional to the thickness of the stratum corneum i.e.
Avabhasini. However, in certain areas, differences in lipid concentration may affect percutaneous
absorption, depending on an individual drug's lipophilicity (Having an affinity for lipids) or
hydrophilicity (Having an affinity for water).
         Drug penetration is higher on the face, in inter-triginous areas, and especially in the
perineum. Thus these areas are minimal exposed to Bahiparimarjana Chikitsa. Consequently,
sensitization, irritation, and atrophy from Bio-steroids are more likely to develop in these regions.
Altered Barrier Function:
         In many dermatological diseases, the stratum corneum is abnormal, and barrier function is
lost. Thus not through rub is indicated, more over many Bahiparimarjana Chikitsa are light in
touch.


                                                 Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 3
Application Frequency:
          Topical agents are often applied twice daily. However, for certain drugs, once-daily
application of a larger dose may be as effective as more frequent application of smaller doses. The
stratum corneum may act as a reservoir and allow gradual penetration of a drug into the viable skin
layers over a prolonged period of time.
Hydration:
          Drug absorption is increased with hydration, defined as an increase in the water content of
the stratum corneum that is produced by inhibiting trans-epidermal loss of water. Methods of
hydration include occlusion with an impermeable film, application of lipophilic occlusive vehicles
such as Taila, and soaking dry skin before occlusion. Many of the Ayurvedic preparations used in
Bahiparimarjana Chikitsa are water based or water soluble medicines transformed lipophilic
agents.
Vehicle:
          Topical therapy is delivered by various vehicles, most frequently soaks, lotions, solutions,
creams, and ointments, progressing in that order from least to most hydrating. The choice of
vehicle may be as important as the active drug. In Ayurveda it is with many vehicles as Kashaya,
Taila or Dhanyamla.
          An experimental modal of Dhanyamla prepared in DGM Ayurvedic Medical College,
Gadag for want of multi centric study in 2001 – 2003. It facilitated few single case studies and an
extended study over Amavata as Kayaseka. The literature and the procedure followed to
standardize the Dhanyamla are narrated here under.
DHANYAMLA 9
          Before going into the details of Dhanyamla Kayaseka it is necessary to understand the term
Dhanyamla. A cursory glance itself reveals that the term “Dhanyamla “ is conjugate of two
different words, viz ‘Dhanya’ and ‘Amla’ which in conjugation means ‘fermented cereal’ in a
broad sense. All the three major classics of Ayurveda at some instance or other have referred to its
use at times, singularly or along with other drugs. Maharshi Charaka, Susruta and Vagbhata have
included this either in Amlavarga, Santhana kalpana or in Madya vargha. Charaka further
mentioned the drugs used for Dhanyamla in Nadi sweda and Upanaha.
Synonyms of Dhanyamla
          A perusal of the ancient text of the medicine reveals that a number of synonyms have been
attributed to Dhanyamla which in most cases refer to a specific attribute and when taken
collectively gives a clear idea about the character and properties of Dhanyamla. Narisimha has in
this context very rightly stated that these synonyms to Dhanyamla are complementary to each other


                                               Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 4
and as such there is no difference between ‘Dhanyamla’ and ‘Kanjhika’. ‘Guna deepika’, a
celebrated lexicon on medical plants gives the following compilations of synonyms as attributed to
Dhanyamla.
   1. Aranala: ‘Aranalasya rigathownala gandha‘ i.e having acrid fast spreading odour.
   2. Abhishuta: ‘shunj abhishave’ i.e made of half cooked cereals.
   3. Avanthisoma: prepared out of ‘soma’ found in Avanti Desha.
   4. Kulmasha: ‘Kula samsthyana’ i.e having half cooked ‘masha’ or black grain.
   5. Kunjala: Indicative of fermented water.
   6. Sowveeraka: Found in Sowveera desha.
   Among these, Sowveerka’ and ‘Avantisoma’ are synonyms pertaining to geographical
preponderance or indicative of place. Abhishuta, Dhanyamla, KunJala, Kulmasha etc are indicative
of the process of fermentation. Aranala speaks of its acidic odour.
Properties of Dhanyamla
       The known fact that Dhanyamla, amla or sour in taste serves as an aid in delving into other
properties of the Ama in the sense that since it is Amla in Rasa the associated qualities of Amla
Rasa as stated in the classics, viz, Laghu, Ushna, Snigdha, Deepana, Vatanulomana etc. can be
safely attributed to it. The properties of Dhanya like Brimhana, Tarpana, Balya and Vatahara are
also supplemented.
       In brief, Dhanyamla cumulatively possess the following properties.
                      •   Rasa        -      Amla
                      •   Guna        -      Laghu, Snigdha, Teekshna, Sheeta sparsa
                      •   Vipaka      -      Amla
                      •   Veerya      -      Ushna
General properties of Dhanyamla
       Many properties are attributed to Dhanyamla are - Deepana, Pachana, Rochana, Bhedi,
Vibhandhahrasa, Hrudya, Klamahara, Angasada hara, Dahajwarahara, Hrudrogahara, Panduhara,
Krimighna, Arshohara, Grahanihara, and Bastisulahara. It can be used even for Astapana. Among
other indications for its use, Charaka has specified its use in Daha jwara where in Avagaha of the
patients in Kanji has been recommended10. Same procedure is indicated to relieve pain in Arshas 11
even. Further in Rajayakshma when Prathishyaya and Peenasa are super imposed, renders the
ailment complicated. At this juncture the Nadi sweda with Kanji (Dhanyamla) has been
advocated12. Since Amla is Sheeta sparsa and acts so in external wage, Charaka has felt safe to
vouch for its use externally as Lepa, Seka etc. in Urusthambha also; he mentioned the use of the
drug Dhanyamla 13.


                                              Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 5
In short while going through the references of the use of Dhanyamla in different context as
found in classics, it is able to conclude that the drugs which are used for the preparation of the
Dhanyamla and Dhanyamla as such are preferred in Vatarogas and Vatakapha samsargha janya
diseases.
Method of preparation of Dhanyamla 14
       Dhanyamla can be prepared out of different methods. Many drugs in this yoga are easily get

fermented. Traditional physicians of Kerala generally follow present Yoga combination and

proportion is obtained from Sahasrayoga is as follows:

               1   Tandula        (Oryza sativa)                     5 parts
               2   Pruthuka       (Pressed form of Oryza sativa)     5 parts
               3   Kulatha        Dolichos biflorus)                 5 parts
               4   Laja           (Puffed form of Oryza sativa)      20 parts
               5   Kangubeeja     (Setaria italica)                  4 parts
               6   Kodravam       (Paspalum scrobiculatum)           2 parts
               7   Nagara         (Zingiber officinale)              1 part
               8   Nimbuka        (Citrus acida)                     4 parts
               9   Dipyaka        (Carum roxburgianum)               2 parts
               10 Water                                              100parts

       On an auspicious day at a time when the astral combinations are favourable, the necessary
drugs and Paraphernalia for the preparation of the Dhanyamla are to be collected. Place a large
deep earthenware pot on an oven and pour 200 Prasthas of boiled water and put the powdered drugs
1-9 separately made into loose bundles in clean cloth bags.
       After putting these drugs into the vessel along with water, it has to be loosely covered with
a lid and heated gently and continuously in moderate fire, preferably of paddy husks, for a period of
7 days. The paddy husks are to be put under and around the vessel and fired taking every precaution
that the temperature of the water in the vessel does not rise above the boiling point. On the 8th day
the required quantity of the liquid is taken out and added same quantity of hot water. The important
factors to be recommended during the preparation of Dhanyamla is that - Absolute cleanness
should be maintained and Moderate fire should be kept through out he preparation
       The details identification and proprties of the Dhanyamla ingredients are as follows -
1. TANDULA (N.O. Graminae, L. N. Oryza sativa) : Tandula possesses Madhura and Kashaya
   Rasa, Madhura Vipaka as Sheeta Veerya. By Guna it is Guru. It alleviates Pitta Dosha and
   provokes Kapha Dosha.


                                              Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 6
2. PRUTHUKA (N.O. Graminae, L.N. Oryza sativa): It is made out of Tandula. Prepared by little
   heating and wet pounding of Tandula.
3. KULATHA (N.O. Leguminoceae, L.N. Dolichos biflorus): Kulatha possesses Kashaya Rasa,
   Katu Vipaka and Ushna Veerya. By Guna it is Laghu, Vidahi and Sara. It acts as Kapha
   Vatahara. It provokes Pitta Dosha also.
4. LAJA (N.O. Graminae, L.N. Oryza sativa): It is made out of Tandula. Prepared by dry frying in
   a small-mouthed vessel. This process is known to induce Laghu Guna.
5. KANGUBIJA (N.O. Graminae, L.N. Setaria italica): Kangubija possesses Kashaya and
   Madhura Rasa, Katu Vipaka and Ushna Veerya. By Guna it is Guru and Ruksha. It acts as
   KaphaPitta shamaka and Vata vardhaka. It possesses Sandhaneeya and Vrushya properties.
6. KODRAVA (N.O. Graminae, L.N. Paspalum scrobiculatum): Kodrava is of Madhura-Kashaya
   in Rasa, Katu in Vipaka and Sheeta in Veerya. By Guna it is Laghu and Ruksha. It alleviates
   Kapha and Pitta Dosha and provokes Vata Dosha.
7. NAGARA: Already described in Alambushadi Yoga.
8. NIMBUKA (N.O. Rutaceae, L.N. Citrus acida): Nimbuka is of Amla Rasa, Amla Vipaka and
   Ushna Veerya. By Guna it is Laghu. It pacifies kapha Dosha. It has got Agnideepana, Rochana,
   Pachana and Trishnanigraha properties.
9. DIPYAKA (N. O. Umbelliferae, L.N. Carum roxburgianum): Dipyaka possesses Katu and
   Tikta Rasa, Katu Vipaka and Ushna Veerya. By Guna it is Laghu, Ruksha. It acts as Samaka for
   Kapha and Vata Dosha. It has got Shoola Prashamana, Rochana and Krimighna properties.
   PHYSIOCHEMICAL ANALYSIS REPORT (Analyzed at K.L.E. society’s Pharmacy
   college, Gadag.)
   01. PH                                           = 3.03
   02. Specific gravity                             = 1.01
   03. Test for Alkaloids
            a. Mayer’s Test                         = Positive
            b. Hager’s Test                         = Positive
   04. Test for Carbohydrates
            a. Molish Test                          = Positive (Carbohydrate present)
            b. Benedict’s Test                      = Positive (Reducing sugar present)
            c. Barfoedt’s Test                      = Positive (Monosaccherides present)




                                             Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 7
Case studies with Dhanyamla
Pakashaghata: As the Dhanyamla indication is for all Vata Vyadhi, Pakshaghata was tried with
internally for pana and externally with kayaseka. The patient initially with Dakshina Pakshaghata
recovered in 14 days management, without any drawbacks or setbacks.
Sandhivata: Eight patients of Sandhivata are undertaken for observational study with Dhanyamla
Dhara over the Sandhi, which made the patient to have symptomatic relief with in seven days of
course.
             15
Amavata:          Nine patients of Amavata were treated with Dhanyamla Kayaseka for 21 days. The
results obtained with objective and subjective parameters are as follows.
1. Comprehensive statements of objective parameters are as follows.

                                                           % of
              Parameter             Mean Mean Difference improve
 SN                                 before after of Mean   ment       SD     SE    t value   p value   Remarks
      Pain in Numerical rating
 1    scale                         15.22   5.56    9.11    65.77    2.02   1.60    8.12     < 0.001    H. S
      Pain in Visual Analogue
 2    scale                         66.67 23.33     34.89   67.05    4.06   2.10    8.19     < 0.001    H. S
 3    Swelling of 44 joints         14.67 4.89      7.33    71.80    2.24   1.10    8.87     < 0.001    H. S
 4    Swelling of 28 joints         13.22 4.67      7.67    70.62    2.26   1.34    6.36     < 0.001    H. S
 5    Tenderness of 28 joints       14.56 6.00       9.67   62.40    2.22   1.16    6.91     < 0.001    H. S
 6    Morning stiffness              2.44 1.33      1.67    44.44    0.70   0.20    5.55     < 0.001    H. S
 7    Heaviness                      1.22 0.33       1.11   77.78    0.67   0.11    8.00     < 0.001    H. S
 8    RA index (tenderness)         17.22 6.44      12.78   64.02    2.37   1.69    6.35     < 0.001    H. S
      Madhavakara index of
 9    Amavata                       12.78   3.22    13.22   76.35    2.09   1.70    5.59     < 0.001    H. S
      Anjana nidana index of
 10   Amavata                       7.56    3.56    6.44    54.78    1.35   0.44    9.07     < 0.001    H. S
 11   Basavarajeya index            1.89    1.00    2.11    31.67    1.12   0.35    2.53     < 0.05     H. S
      Extra articular
 12   manifestation                 3.33    1.11    2.00    72.09    1.20   0.32    6.86     < 0.001    H. S
      Global disease assessment
 13   (patient's)                   59.22 18.11     43.00   70.16    3.75   1.80    8.20     < 0.001    H. S
      Global disease assessment
 14   (physician's)                 64.44 25.00     37.22   61.94    4.08   1.84    5.92     < 0.001    H. S
      Ayurvedic health
 15   assessment                    36.56 20.56     21.11   43.72    1.96   1.00   16.00     < 0.001    H. S
      Arthritis impact
 16   measurement scale             37.33   19.78   18.78   46.44    2.48   1.94   9.06      < 0.001    H. S
 17   Physical disability           13.33    5.00    8.22   62.55    1.64   1.00   8.33      < 0.001    H. S
 18   Walking time                  55.00   45.22   11.00   17.65    1.97   1.06   9.19      < 0.001    H. S
 19   Grip strength                 86.56   95.44   18.22   9.73     4.01   2.10   3.38      < 0.01     H. S
 20   Range of movements            76.89   82.22   4.56    7.34     2.87   0.86   6.16      < 0.001    H. S
 21   ESR                           41.44   35.56   7.33    17.19    4.53   1.98   6.02      < 0.001    H. S
 22   C reactive protein             0.44    0.33    0.44   11.11    0.70   0.11   1.00      > 0.05     N. S
 23   Haemoglobin                   11.02   11.32   0.10    2.87     0.88   0.16   1.93      > 0.05     N. S
 24   Lymphocyte count              37.56   38.78   2.11    3.76     2.64   0.28   4.40      < 0.05     H. S
 25   Disease activity score         4.76    2.78    2.47   42.71    0.96   0.19   10.13     < 0.001    H. S
      Disease activity score - 28
 26   joints                        6.43    4.27    2.56    35.13    1.06   0.26    8.36     < 0.001    H. S



                                                     Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 8
2. Sandhigraha :- In this Group four patients (44%) presented with Grade III and five patients

   (56%) with Grade II Sandhigraha.After the treatment there was no patients with Grade III and

   Grade II was reduced from five to three(33%).

3. Sandhiruk:- One patient presented with Grade III (11%), four patients with Grade II (44%), and

   four patients with Grade I(44%). After the treatment Grade II was reduced from four to one

   (11%) and four patients (44%) got complete relief.

4. Sandhisotha:- One patient presented with Grade III (11%) five patients with Grade II (56%) and

   three patients with Grade I (33%). After the treatment three patients got complete relief (33%)

   and there were no patients with Grade III. Number of patients in Grade II was reduced from

   five to one (11%)

5. Sparsa asahishnuta:- One patient presented with Grade III (11%) five patients with Grade II

   (56%) and three patients with Grade I (33%). After the treatment six patients got complete

   relief (67%) and there were no patients with Grade II and Grade III.

6. Gourava :- Two patients presented with Grade II and seven patients with Grade I. After the

   treatment six patients (67%) got complete relief and there were no patients with Grade II and

   Grade III.

Conclusion:

       At the virtue of understanding the fundamentals of the Bahiparimarjana Chikitsa - tropical
appliance management, it is very clear that the required cleansing properties such as “Anupravana
bhava Utpadakata” is not available with and they are said as only Dosha transport facilitators with
the capabilities of Vishyanda, Paka and Srotomukha Vishodhana, well before to the Dosha
Shodhana procedure. When Dosha Shodhana is done the same Bahiparimarjana Chikitsa becomes
potent to pacify Dosha and said as Dosha shamaka. Dhanyamla is such potent externally mediated,
temperature regulated, lipophilicity, moistened, pH regulated (3 approx.), concentration - partition
and diffusion coefficient of drug is maintained along with specific Vata Dosha pacified properties.
Dermal applications which are hydrophobic in nature (organic solvents – Dhanyamla) utilized for sustaining
prolonged and slow delivery acts on systemic diseases. Thus the Dhanyamla Chikitsa becomes ultimate
treatment Antahparimarjana (internally) and Bahiparimarjana (externally) Chikitsa.



                                               Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 9
References
1) Raja Radha Kanta Deva, Shabda Kalpa druma, part 3, 3rd ed, 1967, Chowkhamba Sanskrit Series
    Office, PB No 8, Varanasi -1, pp 62
2) Ibid, pp 709
3) Ibid, pp 709 medina
4) Vaidya Jadavji Trikamji Acharya ed, Charaka Samhita sutra 11/55, Nirnaya Sagar Press (1941)
    reprint, 1984, Chowkhamba Sanskrit sansthan, PB No 139, Varanasi, pp 78
5) Ibid, Chikitsa, 7/53, pp 453
6) Ibid, Sutra, 2/15 – Chakrapani, pp 25
7) Vaidya Jadavji Trikamji Acharya et.al., Susruta Samhita Chikitsa 24/30 - Dalhana, 8th ed, 2005,
    Chowkhamba orientalia, PB No 1032, Varanasi, pp 488
8) Joel G. Hardman et.al., Goodman & Gilman's THE PHARMACOLOGICAL BASIS OF
    THERAPEUTICS, 9th ed, 1996, McGraw-Hill, Health Professions Division, New York
9) Sahasra yoga Edited by – Shri K. V. Krishnan Vaidyan et.al. Published by Vidyarabham Publishers,
    Allepy, 23rd edition April 2000. Pp.122
10) Vaidya Jadavji Trikamji Acharya ed, Charaka Samhita Chikitsa 3/259, Nirnaya Sagar Press (1941)
    reprint, 1984, Chowkhamba Sanskrit sansthan, PB No 139, Varanasi, pp 422
11) Ibid, 14/44-47, pp 508
12) Ibid, 8/74, pp 463
13) Ibid, 27/50-55, 615
14) Sahasra yoga Edited by – Shri K. V. Krishnan Vaidyan et.al. Published by Vidyarabham Publishers,
    Allepy, 23rd edition April 2000. Pp.122
15) Shyju Ollakkod under the guidance of Dr. K. Shiva Rama Prasad, Evaluation of comparative
    efficacy of Alambushadi yoga and Dhanyamla Kayaseka in Amavata (Rheumatoid Arthritis), 2004,
    Department of Kayachikitsa (PG), Post graduate studies and research centre, D.G. M. AYURVEDIC
    MEDICAL COLLEGE, Gadag - 582 103




                                              Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 10

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Dhanyamla bahiparimarjana

  • 1. Dhanyamla Bahiparimarjana Prof. Dr. K. Shiva Rama Prasad 1 , Parimarjana is spectacular word from Ayurvedic literature defined from Shabdha Kalpa druma as – “Parishodhana”1 – a search, colloquially used to clean i.e. Dhavana. Where in the “Marjana” is added with “Anganirmalyokaranam”2, which means the body waste removal process. The “Parimarjana” with a prefix of “Bahi” becomes the “Bahiparimarjana” – a complete externally modulated waste material removal or cleansing treatment, one out of three main methods of treatment classifications. The other two are “Antahparimarjana” and “Shastrapranidhana”. The “Pranidhana”3 has a meaning of – “the visualization of the cause of the Sthambha – the obstruction. It other wise refer to the laparotomy exploration and Medinikosha explains it as “Praveshanam” – the entry - of course in to abdomen. Bahiparimarjana Chikitsa explained as – the treatment procedures that are depend upon the external touch such as Abhyanga, Sweda, Pradeha, Parisheka, Unmardana, etc4. A close look at the said examples makes a classification of the Bahiparimarjana Chikitsa i.e. trans-dermal cleansing management. The former Abhyanga in terms of Bahya sneha is an external oil application where heat inducted through rubbing. It is in the texts as not to apply any form of external (tropical) managements with out unctuous application, in terms that lubricates and facilitates the absorption of the tropical management. The second application Sweda is an external heat modulation or transportation through steam. The rest of the treatment applications include either of these two specific methods of heat transportations. Commonly these Sneha and Sweda administered before to the chief cleansing methods viz. Panchakarma. However, the real utility of Bahiparimarjana as “Roga Prashamana” visualized only after the completion of the Dosha elimination. This verse observed from the Charaka at the context of Kusta relay is that the Lepa applied after the eliminative (Samshodhita Ashaya) procedures are effective5. Human body is not depends upon the Sun heat and very minimal heat is taken from external and depends upon the internal system to generate the heat required for the body maintenance. The Dosha in the body are always fluctuating in nature enhances or dislodges from its places to give rise physiological or pathological changes in the body. All these changes generally depend upon the triad of mass, pressure and temperature. Out of these the mass and pressure in the body are constant and the only temperature is the variant subjected for the pressure variances. Thus the managements 1 H.O.D., Dept. of Kayachikitsa (PG), DGM Ayurvedic Medical College, Kalasapur Road, Gadag- 582103, Karnataka (cell: +91-9448746450), doctorksrprasad@gmail.com Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 1
  • 2. of Dosha triad either for elimination or for the maintenance requires the cleansing from internally and even externally, where the externally mediated procedures are not eventually cleansing in nature they may be curative. For the same reason the externally mediated - Bahiparimarjana Chikitsa methods viz. Sneha and Sweda are not included in the cleansing methods of Panchakarma. These Sneha and Sweda along with the co- procedures are not possessing “Dosha nirharana samardhya” i.e. eliminative capacity6. Therefore, these procedures administered later to the cleansing are effective to disease relief. In a nut shell, Bahiparimarjana is a Dosha shamana and the Antahparimarjana is Dosha Shodhana or doshavasechana management. Dalhana was the first person to comment over the absorption and pharmaco-dynamics of the externally mediated unctuous (fatty oil base) materials at the context of Abhyanga. He affirms that each 100 of matra (32sec approximately) initiated from 300 to 900 takes the oil based medicament for the Roma koopa – Twak – Rakta – Mamsa – Medo – Asthi – Majja. At the context he applies a note that the Tridosha diseases of such region are implied to alter with the effect of medicine, as the Abhyanga is Kapha Vata nirodhana 7. At the same place author, refer the Grudhrasi a disease, prevented by the constant use of Abhyanga, which relays the meaning of Bahiparimarjana as prevention and curative but not eliminative method of management. In the procedure of Bahiparimarjana, the absorption is minimal but heat conduction is massive, that affect the blood to flow peripheral to visceral or vice versa. The understanding of contemporary philosophy tells us how our tradition meets the present day science. Absorption through the skin can be enhanced by suspending the drug in an oily vehicle and rubbing the resulting preparation into the skin. This method of administration is known as inunction i.e. Abhyanga. Because hydrated skin is more permeable than dry skin, the dosage form may be modified or an occlusive dressing may be used to facilitate absorption. Controlled-release topical patches are recent innovations. Finally, intact stratum corneum is an excellent barrier, but in disease states the resistance to absorption is rapidly lost and absorption can be facilitated. The skin acts as a two-way barrier to prevent absorption or loss of water and electrolytes. Few drugs readily penetrate the intact skin. Absorption of those that do is proportional to the surface area over which they are applied and to their lipid solubility, since the epidermis behaves as a lipid barrier. Inflammation and other conditions that increase cutaneous blood flow also enhance absorption. The dermis, however, is freely permeable to many solutes. The diffusion coefficient indicates the extent to which the matrix of the barrier restricts the mobility of the drug. Increases in the molecular size of the drug will increase frictional resistance and decrease the diffusion coefficient (Franz, 1983); molecules over 1000 daltons usually will not be absorbed easily into normal adult skin8. Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 2
  • 3. Parameters Controlling Absorption in Bahiparimarjana Chikitsa The absorption of drug into the skin is a function of the nature of the drug, the behaviour of the vehicle, and the status of the skin. Three major variables account for differences in the rate of absorption or flux of different topical drugs or of the same drug in different vehicles: - The concentration of drug in the vehicle, - The partition coefficient of drug between the stratum corneum and the vehicle, and - The diffusion coefficient of drug in the stratum corneum. Apart from the above the points to be considered are - - Large Surface area enhance absorption - Increase cutaneous blood flow also enhance absorption - Body temperature and blood flow enhance absorption of tropical medicines - Transdermal replacement therapy is not a new invention, exists since the birth of Ayurveda Factor influencing Bahiparimarjana Chikitsa (Topical Therapy) Dosage: An amount of topical medication sufficient to cover affected body surfaces in repeated applications must be dispensed or applied to the patient. In Ayurveda much of applications viz. Abhyanga, Sweda, Parisheka and Avagaha are done once in a day. Age: Children have a greater ratio of surface area to mass than adults, and a given amount of topical drug results in a greater systemic dose. The permeability of children's skin is increased in preterm infants (Barker et al., 1987). Regional Anatomic Variation: Permeability is generally inversely proportional to the thickness of the stratum corneum i.e. Avabhasini. However, in certain areas, differences in lipid concentration may affect percutaneous absorption, depending on an individual drug's lipophilicity (Having an affinity for lipids) or hydrophilicity (Having an affinity for water). Drug penetration is higher on the face, in inter-triginous areas, and especially in the perineum. Thus these areas are minimal exposed to Bahiparimarjana Chikitsa. Consequently, sensitization, irritation, and atrophy from Bio-steroids are more likely to develop in these regions. Altered Barrier Function: In many dermatological diseases, the stratum corneum is abnormal, and barrier function is lost. Thus not through rub is indicated, more over many Bahiparimarjana Chikitsa are light in touch. Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 3
  • 4. Application Frequency: Topical agents are often applied twice daily. However, for certain drugs, once-daily application of a larger dose may be as effective as more frequent application of smaller doses. The stratum corneum may act as a reservoir and allow gradual penetration of a drug into the viable skin layers over a prolonged period of time. Hydration: Drug absorption is increased with hydration, defined as an increase in the water content of the stratum corneum that is produced by inhibiting trans-epidermal loss of water. Methods of hydration include occlusion with an impermeable film, application of lipophilic occlusive vehicles such as Taila, and soaking dry skin before occlusion. Many of the Ayurvedic preparations used in Bahiparimarjana Chikitsa are water based or water soluble medicines transformed lipophilic agents. Vehicle: Topical therapy is delivered by various vehicles, most frequently soaks, lotions, solutions, creams, and ointments, progressing in that order from least to most hydrating. The choice of vehicle may be as important as the active drug. In Ayurveda it is with many vehicles as Kashaya, Taila or Dhanyamla. An experimental modal of Dhanyamla prepared in DGM Ayurvedic Medical College, Gadag for want of multi centric study in 2001 – 2003. It facilitated few single case studies and an extended study over Amavata as Kayaseka. The literature and the procedure followed to standardize the Dhanyamla are narrated here under. DHANYAMLA 9 Before going into the details of Dhanyamla Kayaseka it is necessary to understand the term Dhanyamla. A cursory glance itself reveals that the term “Dhanyamla “ is conjugate of two different words, viz ‘Dhanya’ and ‘Amla’ which in conjugation means ‘fermented cereal’ in a broad sense. All the three major classics of Ayurveda at some instance or other have referred to its use at times, singularly or along with other drugs. Maharshi Charaka, Susruta and Vagbhata have included this either in Amlavarga, Santhana kalpana or in Madya vargha. Charaka further mentioned the drugs used for Dhanyamla in Nadi sweda and Upanaha. Synonyms of Dhanyamla A perusal of the ancient text of the medicine reveals that a number of synonyms have been attributed to Dhanyamla which in most cases refer to a specific attribute and when taken collectively gives a clear idea about the character and properties of Dhanyamla. Narisimha has in this context very rightly stated that these synonyms to Dhanyamla are complementary to each other Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 4
  • 5. and as such there is no difference between ‘Dhanyamla’ and ‘Kanjhika’. ‘Guna deepika’, a celebrated lexicon on medical plants gives the following compilations of synonyms as attributed to Dhanyamla. 1. Aranala: ‘Aranalasya rigathownala gandha‘ i.e having acrid fast spreading odour. 2. Abhishuta: ‘shunj abhishave’ i.e made of half cooked cereals. 3. Avanthisoma: prepared out of ‘soma’ found in Avanti Desha. 4. Kulmasha: ‘Kula samsthyana’ i.e having half cooked ‘masha’ or black grain. 5. Kunjala: Indicative of fermented water. 6. Sowveeraka: Found in Sowveera desha. Among these, Sowveerka’ and ‘Avantisoma’ are synonyms pertaining to geographical preponderance or indicative of place. Abhishuta, Dhanyamla, KunJala, Kulmasha etc are indicative of the process of fermentation. Aranala speaks of its acidic odour. Properties of Dhanyamla The known fact that Dhanyamla, amla or sour in taste serves as an aid in delving into other properties of the Ama in the sense that since it is Amla in Rasa the associated qualities of Amla Rasa as stated in the classics, viz, Laghu, Ushna, Snigdha, Deepana, Vatanulomana etc. can be safely attributed to it. The properties of Dhanya like Brimhana, Tarpana, Balya and Vatahara are also supplemented. In brief, Dhanyamla cumulatively possess the following properties. • Rasa - Amla • Guna - Laghu, Snigdha, Teekshna, Sheeta sparsa • Vipaka - Amla • Veerya - Ushna General properties of Dhanyamla Many properties are attributed to Dhanyamla are - Deepana, Pachana, Rochana, Bhedi, Vibhandhahrasa, Hrudya, Klamahara, Angasada hara, Dahajwarahara, Hrudrogahara, Panduhara, Krimighna, Arshohara, Grahanihara, and Bastisulahara. It can be used even for Astapana. Among other indications for its use, Charaka has specified its use in Daha jwara where in Avagaha of the patients in Kanji has been recommended10. Same procedure is indicated to relieve pain in Arshas 11 even. Further in Rajayakshma when Prathishyaya and Peenasa are super imposed, renders the ailment complicated. At this juncture the Nadi sweda with Kanji (Dhanyamla) has been advocated12. Since Amla is Sheeta sparsa and acts so in external wage, Charaka has felt safe to vouch for its use externally as Lepa, Seka etc. in Urusthambha also; he mentioned the use of the drug Dhanyamla 13. Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 5
  • 6. In short while going through the references of the use of Dhanyamla in different context as found in classics, it is able to conclude that the drugs which are used for the preparation of the Dhanyamla and Dhanyamla as such are preferred in Vatarogas and Vatakapha samsargha janya diseases. Method of preparation of Dhanyamla 14 Dhanyamla can be prepared out of different methods. Many drugs in this yoga are easily get fermented. Traditional physicians of Kerala generally follow present Yoga combination and proportion is obtained from Sahasrayoga is as follows: 1 Tandula (Oryza sativa) 5 parts 2 Pruthuka (Pressed form of Oryza sativa) 5 parts 3 Kulatha Dolichos biflorus) 5 parts 4 Laja (Puffed form of Oryza sativa) 20 parts 5 Kangubeeja (Setaria italica) 4 parts 6 Kodravam (Paspalum scrobiculatum) 2 parts 7 Nagara (Zingiber officinale) 1 part 8 Nimbuka (Citrus acida) 4 parts 9 Dipyaka (Carum roxburgianum) 2 parts 10 Water 100parts On an auspicious day at a time when the astral combinations are favourable, the necessary drugs and Paraphernalia for the preparation of the Dhanyamla are to be collected. Place a large deep earthenware pot on an oven and pour 200 Prasthas of boiled water and put the powdered drugs 1-9 separately made into loose bundles in clean cloth bags. After putting these drugs into the vessel along with water, it has to be loosely covered with a lid and heated gently and continuously in moderate fire, preferably of paddy husks, for a period of 7 days. The paddy husks are to be put under and around the vessel and fired taking every precaution that the temperature of the water in the vessel does not rise above the boiling point. On the 8th day the required quantity of the liquid is taken out and added same quantity of hot water. The important factors to be recommended during the preparation of Dhanyamla is that - Absolute cleanness should be maintained and Moderate fire should be kept through out he preparation The details identification and proprties of the Dhanyamla ingredients are as follows - 1. TANDULA (N.O. Graminae, L. N. Oryza sativa) : Tandula possesses Madhura and Kashaya Rasa, Madhura Vipaka as Sheeta Veerya. By Guna it is Guru. It alleviates Pitta Dosha and provokes Kapha Dosha. Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 6
  • 7. 2. PRUTHUKA (N.O. Graminae, L.N. Oryza sativa): It is made out of Tandula. Prepared by little heating and wet pounding of Tandula. 3. KULATHA (N.O. Leguminoceae, L.N. Dolichos biflorus): Kulatha possesses Kashaya Rasa, Katu Vipaka and Ushna Veerya. By Guna it is Laghu, Vidahi and Sara. It acts as Kapha Vatahara. It provokes Pitta Dosha also. 4. LAJA (N.O. Graminae, L.N. Oryza sativa): It is made out of Tandula. Prepared by dry frying in a small-mouthed vessel. This process is known to induce Laghu Guna. 5. KANGUBIJA (N.O. Graminae, L.N. Setaria italica): Kangubija possesses Kashaya and Madhura Rasa, Katu Vipaka and Ushna Veerya. By Guna it is Guru and Ruksha. It acts as KaphaPitta shamaka and Vata vardhaka. It possesses Sandhaneeya and Vrushya properties. 6. KODRAVA (N.O. Graminae, L.N. Paspalum scrobiculatum): Kodrava is of Madhura-Kashaya in Rasa, Katu in Vipaka and Sheeta in Veerya. By Guna it is Laghu and Ruksha. It alleviates Kapha and Pitta Dosha and provokes Vata Dosha. 7. NAGARA: Already described in Alambushadi Yoga. 8. NIMBUKA (N.O. Rutaceae, L.N. Citrus acida): Nimbuka is of Amla Rasa, Amla Vipaka and Ushna Veerya. By Guna it is Laghu. It pacifies kapha Dosha. It has got Agnideepana, Rochana, Pachana and Trishnanigraha properties. 9. DIPYAKA (N. O. Umbelliferae, L.N. Carum roxburgianum): Dipyaka possesses Katu and Tikta Rasa, Katu Vipaka and Ushna Veerya. By Guna it is Laghu, Ruksha. It acts as Samaka for Kapha and Vata Dosha. It has got Shoola Prashamana, Rochana and Krimighna properties. PHYSIOCHEMICAL ANALYSIS REPORT (Analyzed at K.L.E. society’s Pharmacy college, Gadag.) 01. PH = 3.03 02. Specific gravity = 1.01 03. Test for Alkaloids a. Mayer’s Test = Positive b. Hager’s Test = Positive 04. Test for Carbohydrates a. Molish Test = Positive (Carbohydrate present) b. Benedict’s Test = Positive (Reducing sugar present) c. Barfoedt’s Test = Positive (Monosaccherides present) Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 7
  • 8. Case studies with Dhanyamla Pakashaghata: As the Dhanyamla indication is for all Vata Vyadhi, Pakshaghata was tried with internally for pana and externally with kayaseka. The patient initially with Dakshina Pakshaghata recovered in 14 days management, without any drawbacks or setbacks. Sandhivata: Eight patients of Sandhivata are undertaken for observational study with Dhanyamla Dhara over the Sandhi, which made the patient to have symptomatic relief with in seven days of course. 15 Amavata: Nine patients of Amavata were treated with Dhanyamla Kayaseka for 21 days. The results obtained with objective and subjective parameters are as follows. 1. Comprehensive statements of objective parameters are as follows. % of Parameter Mean Mean Difference improve SN before after of Mean ment SD SE t value p value Remarks Pain in Numerical rating 1 scale 15.22 5.56 9.11 65.77 2.02 1.60 8.12 < 0.001 H. S Pain in Visual Analogue 2 scale 66.67 23.33 34.89 67.05 4.06 2.10 8.19 < 0.001 H. S 3 Swelling of 44 joints 14.67 4.89 7.33 71.80 2.24 1.10 8.87 < 0.001 H. S 4 Swelling of 28 joints 13.22 4.67 7.67 70.62 2.26 1.34 6.36 < 0.001 H. S 5 Tenderness of 28 joints 14.56 6.00 9.67 62.40 2.22 1.16 6.91 < 0.001 H. S 6 Morning stiffness 2.44 1.33 1.67 44.44 0.70 0.20 5.55 < 0.001 H. S 7 Heaviness 1.22 0.33 1.11 77.78 0.67 0.11 8.00 < 0.001 H. S 8 RA index (tenderness) 17.22 6.44 12.78 64.02 2.37 1.69 6.35 < 0.001 H. S Madhavakara index of 9 Amavata 12.78 3.22 13.22 76.35 2.09 1.70 5.59 < 0.001 H. S Anjana nidana index of 10 Amavata 7.56 3.56 6.44 54.78 1.35 0.44 9.07 < 0.001 H. S 11 Basavarajeya index 1.89 1.00 2.11 31.67 1.12 0.35 2.53 < 0.05 H. S Extra articular 12 manifestation 3.33 1.11 2.00 72.09 1.20 0.32 6.86 < 0.001 H. S Global disease assessment 13 (patient's) 59.22 18.11 43.00 70.16 3.75 1.80 8.20 < 0.001 H. S Global disease assessment 14 (physician's) 64.44 25.00 37.22 61.94 4.08 1.84 5.92 < 0.001 H. S Ayurvedic health 15 assessment 36.56 20.56 21.11 43.72 1.96 1.00 16.00 < 0.001 H. S Arthritis impact 16 measurement scale 37.33 19.78 18.78 46.44 2.48 1.94 9.06 < 0.001 H. S 17 Physical disability 13.33 5.00 8.22 62.55 1.64 1.00 8.33 < 0.001 H. S 18 Walking time 55.00 45.22 11.00 17.65 1.97 1.06 9.19 < 0.001 H. S 19 Grip strength 86.56 95.44 18.22 9.73 4.01 2.10 3.38 < 0.01 H. S 20 Range of movements 76.89 82.22 4.56 7.34 2.87 0.86 6.16 < 0.001 H. S 21 ESR 41.44 35.56 7.33 17.19 4.53 1.98 6.02 < 0.001 H. S 22 C reactive protein 0.44 0.33 0.44 11.11 0.70 0.11 1.00 > 0.05 N. S 23 Haemoglobin 11.02 11.32 0.10 2.87 0.88 0.16 1.93 > 0.05 N. S 24 Lymphocyte count 37.56 38.78 2.11 3.76 2.64 0.28 4.40 < 0.05 H. S 25 Disease activity score 4.76 2.78 2.47 42.71 0.96 0.19 10.13 < 0.001 H. S Disease activity score - 28 26 joints 6.43 4.27 2.56 35.13 1.06 0.26 8.36 < 0.001 H. S Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 8
  • 9. 2. Sandhigraha :- In this Group four patients (44%) presented with Grade III and five patients (56%) with Grade II Sandhigraha.After the treatment there was no patients with Grade III and Grade II was reduced from five to three(33%). 3. Sandhiruk:- One patient presented with Grade III (11%), four patients with Grade II (44%), and four patients with Grade I(44%). After the treatment Grade II was reduced from four to one (11%) and four patients (44%) got complete relief. 4. Sandhisotha:- One patient presented with Grade III (11%) five patients with Grade II (56%) and three patients with Grade I (33%). After the treatment three patients got complete relief (33%) and there were no patients with Grade III. Number of patients in Grade II was reduced from five to one (11%) 5. Sparsa asahishnuta:- One patient presented with Grade III (11%) five patients with Grade II (56%) and three patients with Grade I (33%). After the treatment six patients got complete relief (67%) and there were no patients with Grade II and Grade III. 6. Gourava :- Two patients presented with Grade II and seven patients with Grade I. After the treatment six patients (67%) got complete relief and there were no patients with Grade II and Grade III. Conclusion: At the virtue of understanding the fundamentals of the Bahiparimarjana Chikitsa - tropical appliance management, it is very clear that the required cleansing properties such as “Anupravana bhava Utpadakata” is not available with and they are said as only Dosha transport facilitators with the capabilities of Vishyanda, Paka and Srotomukha Vishodhana, well before to the Dosha Shodhana procedure. When Dosha Shodhana is done the same Bahiparimarjana Chikitsa becomes potent to pacify Dosha and said as Dosha shamaka. Dhanyamla is such potent externally mediated, temperature regulated, lipophilicity, moistened, pH regulated (3 approx.), concentration - partition and diffusion coefficient of drug is maintained along with specific Vata Dosha pacified properties. Dermal applications which are hydrophobic in nature (organic solvents – Dhanyamla) utilized for sustaining prolonged and slow delivery acts on systemic diseases. Thus the Dhanyamla Chikitsa becomes ultimate treatment Antahparimarjana (internally) and Bahiparimarjana (externally) Chikitsa. Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 9
  • 10. References 1) Raja Radha Kanta Deva, Shabda Kalpa druma, part 3, 3rd ed, 1967, Chowkhamba Sanskrit Series Office, PB No 8, Varanasi -1, pp 62 2) Ibid, pp 709 3) Ibid, pp 709 medina 4) Vaidya Jadavji Trikamji Acharya ed, Charaka Samhita sutra 11/55, Nirnaya Sagar Press (1941) reprint, 1984, Chowkhamba Sanskrit sansthan, PB No 139, Varanasi, pp 78 5) Ibid, Chikitsa, 7/53, pp 453 6) Ibid, Sutra, 2/15 – Chakrapani, pp 25 7) Vaidya Jadavji Trikamji Acharya et.al., Susruta Samhita Chikitsa 24/30 - Dalhana, 8th ed, 2005, Chowkhamba orientalia, PB No 1032, Varanasi, pp 488 8) Joel G. Hardman et.al., Goodman & Gilman's THE PHARMACOLOGICAL BASIS OF THERAPEUTICS, 9th ed, 1996, McGraw-Hill, Health Professions Division, New York 9) Sahasra yoga Edited by – Shri K. V. Krishnan Vaidyan et.al. Published by Vidyarabham Publishers, Allepy, 23rd edition April 2000. Pp.122 10) Vaidya Jadavji Trikamji Acharya ed, Charaka Samhita Chikitsa 3/259, Nirnaya Sagar Press (1941) reprint, 1984, Chowkhamba Sanskrit sansthan, PB No 139, Varanasi, pp 422 11) Ibid, 14/44-47, pp 508 12) Ibid, 8/74, pp 463 13) Ibid, 27/50-55, 615 14) Sahasra yoga Edited by – Shri K. V. Krishnan Vaidyan et.al. Published by Vidyarabham Publishers, Allepy, 23rd edition April 2000. Pp.122 15) Shyju Ollakkod under the guidance of Dr. K. Shiva Rama Prasad, Evaluation of comparative efficacy of Alambushadi yoga and Dhanyamla Kayaseka in Amavata (Rheumatoid Arthritis), 2004, Department of Kayachikitsa (PG), Post graduate studies and research centre, D.G. M. AYURVEDIC MEDICAL COLLEGE, Gadag - 582 103 Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 10