EFFECT OF INDIGENOUS SUBSTANCES IN PARINAAM SHOOLA W.S.R. TO DUODENAL ULCER

Dr. Neelam Sajwan 1 and Dr. Swapnil Singhai 2 . 1. Assistant Professor cum Consultant Department of Shalya Tantra Uttarakhand Ayurved University, Dehradun U.K. 2. Professor – Kayachikitsa Uttarakhand Ayurved University, Dehradun, U.K. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

A duodenal ulcer is a type of ulcer that occurs in the duodenum, the beginning of the small intestine. The most common cause of duodenal ulcer is a stomach infection associated with the Helicobacter pylori bacteria. Duodenal ulcers are eroded areas in the lining of duodenum, which result in abdominal pain, possible bleeding and other gastrointestinal symptoms. Other risk factors for duodenal ulcers include overuse of alcohol, tobacco, and medications such as aspirin and non-steroidal anti-inflammatory drugs. Severe illness has also been implicated as a risk factor in the development of duodenal ulcer. The signs and symptoms of duodenal ulcer can be constant or sporadic pain, heartburn, severe nausea and vomiting. Patients with duodenal ulcer will complain of pain that awakens them from sleep. Treatment focused on hospitalization, bed rest, and prescription of special bland foods. Antacids and medications that block acid production became the standard of therapy. Despite this treatment, there was a high recurrence of ulcers. Patients with H. pylori infection can be treated with antibiotics. In Ayurveda, the symptoms, etiopathogenesis of duodenal ulcer resembles with Parinaam Shoola. Treatment includes administration of Sanshodhana, Sanshamana, Nidan Parivarjana, Pathya-apathya and prevention of recurrences. The Patoladi Ghanvati along with some indigenous drugs is found to be effective in combating this disease. Total 30 patients diagnosed as Parinaam Shoola (Duodenal Ulcer) of any socio-economic status, age group of 15-70 years and irrespective of sex were randomly selected. The drugs Patoladi Ghanvati was orally given for three month of duration. Patoladi Ghanvati was effective in alleviating the symptoms of Parinaam Shoola. It was observed that the drug is especially effective in early cases of Parinaam Shoola. This beneficial effect of trial drug may be due to its Deepan, Pachan, Pitta-sarak, Udarshool-nashak, Vatanulomak, Anti-inflamatory, Anti-Ulcer, Anti-oxidant, Anti-Stress and Anti-Spasmodic properties.

Introduction:-
Parinaam Shoola vis-à-vis gastrointestinal disorders especially Duodenal Ulcer is a common problem. It is the leading cause of physician visits worldwide. An ulcer on the mucosa of the duodenum caused by the action of the gastric juice is known as duodenal ulcer. [1] Pre-existing Helicobacter pylori infection increases the risk for the subsequent development of either duodenal or gastric ulcer disease. The interplay of etiological factors in the pathogenesis of idiopathic peptic ulcer disease is poorly defined but may include a genetic predisposition, altered acid secretion, rapid gastric emptying, defective mucosal defense mechanisms, psychological stress, and smoking. [2] Smoking increases acid secretion reduces prostaglandin and bicarbonate production, and decreases mucosal blood flow, delays the healing of gastric and duodenal ulcers. [3] A higher prevalence occurs in areas where the diet is principally polished milled rice, refined wheat or maize, corn flour, sorghum vulgar, yams, sugar, amaranths, brinjal, peanut oil, some pulses, cassava, sweet potato or green bananas and skimmed milk. [4][5] A number of endocrine dysfunctions such as Zollinger-Ellison syndrome, Cushing`s syndrome, Parathyroid tumor, Bronchial CA, Multiple adenoma syndrome, Antral G -Cell hyper-function & or hyperplasia can also lead to duodenal ulceration. [6] Majorrisk factors for duodenal ulcer include smoking, low-dose (≤160 mg) aspirin use &H. pylori infection. [7] Most patients with duodenal ulcers have impaired duodenal bicarbonate secretion, which has also proven to be caused by H. pylori because its eradication reverses the defect. The combination of increased gastric acid secretion and reduced duodenal bicarbonate secretion lowers the pH in the duodenum, which promotes the development of gastric metaplasia (the presence of gastric epithelium in the first portion of the duodenum). H pylori infection in areas of gastric metaplasia induces duodenitis and enhances the susceptibility to acid injury, thereby predisposing to duodenal ulcers. [8][9] Most duodenal ulcers occur in the first part of the duodenum. A chronic ulcer penetrates the mucosa & into the muscle coat, leading to fibrosis. These ulcers vary in shape-circular, oval cresentric, pear shaped or triangular. The ulcer has a punched out appearance, the margins are overhanging. The granulating base is covered with mucopurulent debris. Though the muscle coat is always reached, the depth of the ulcer depends on the degree of penetration. Multiple duodenal ulcers occur in 10-15% of cases. [10] Patients with duodenal ulcer will complain of pain that awakens them from sleep. Duodenal ulcer pain would manifest mostly 2-3 hours after the meal, when the stomach begins to release digested food and acid into the duodenum. The other symptoms are bloating and abdominal fullness, water brash (rush of saliva after an episode of regurgitation to dilute the acid in esophagusalthough this is more associated with gastroesophageal reflux disease), nausea, malena (tarry, foul-smelling feces due to oxidized iron from hemoglobin). [11][12] The most significant complication is hemorrhage, perforation, and probably obstruction appears in a random fashion during an ulcer's course. [13] Treatment focused on hospitalization, bed rest, and prescription of special bland foods. Antacids and medications that block acid production became the standard of therapy. Despite this treatment, there was a high recurrence of ulcers. Patients with H. pylori infection can be treated with antibiotics.
Acharya Madhava has defined Parinaam Shoola to be a disease characterized by pain during the digestion of food. [14] Parinaam Shoola as the name itself suggests is a pain predominant disease related to the Annavaha srotas. This Srotas is the basis for the very subsistence of life. The cardinal feature of this disease is Ahara jiryamana kala shoola and the site affected is Grahani. Hence, it torments the person at every mealtime and is a source of constant discomfort. It predisposes to an overall reduction in the physical activities of the person in its chronic course. By virtue of all the above factors, it needs prompt attention.
As per Madhav Nidaan, Parinaam Shoola has also been described as Durvigyeya Mahagada. [15] It is not described in Brihat-trayee. The gastrointestinal examination like Barium meal and Endoscopy aid a confirmatory diagnosis and treatment at the earliest.
The efficacy of Patoladi gana [16] along with four indigenous substances-Mulethi, Nimba, Chitraka & Sunthi in combating this disease is being studied.

1892
Even though considerable research work is carried out on Parinaam Shoola using single drugs as well as formulations, till date, no study has been carried out on the above formulation regarding their efficacy in treating Parinaam Shoola, hence it is taken up for the present study.
In the clinical study, 30 patients diagnosed as Parinaam Shoola have been registered and an endoscopic evaluation of all the patients has also been carried out to correlate the modern aspect of this disease. The patients are selected and treated with the above formulations. The pre-study and post-study data are observed and analyzed statistically. It is hoped that this study will add to the existing knowledge and result in better and efficient management of  Management:-Patoladi Ghanvati in a dose of 2 tabs (each of 500mg), thrice a day, with honey, before meal. Duration:-Total duration of the treatment was 90 days. Dietary advice:-All the patients were advised to include Honey, Green tea, cabbage, tomato, cucumber, ginger, sprouts, amla, soyabean and apple in their routine and avoid tea, coffee, smoking, alcohol and spicy diet, physical and mental stress.

Results:-
The drugs Patoladi Ghanvati along with some indigenous drugsprovided a highly significant (P<0.001) effect on the symptom; periodicity of pain, nausea and vomiting, pain in relation to food, epigastric pain and acid regurgitation.
The relief percentage of the drug on periodicity of pain was 91.42%, significant improvement in nausea and vomiting was 93.44%. Effect of pain in relation with food was 92.42%. There was 90% relief in epigastric pain. Maximum improvement i.e. 97.43% was observed in acid regurgitation. Every year over three lacks people round the world have ulcer related surgeries, because of persistent symptoms or complications. All the operations for Duodenal Ulcer have achieved their aim to some extent but with varying degree of morbidity, mortality and post-operative side effects. Because of this condition, the person always remains in the state of discomfort.
The treatment which has been advocated for this condition is usually symptomatic and has its own limitations.
Dietary modification in such patients have proved to be successful, however they are of limited value in the chronic progressive nature of the disease. Various drugs have been used for the treatment of Parinaam Shoola in Ayurvedic system; however, till date no remedy is available to make a permanent long lasting therapy.
The present study is the first work on the effect of Patoladi Ghanvati in Parinaam Shoola and it was planned with holy aim to find out a beneficial, safe and cost effective drug in the management of Parinaam Shool.