A COMBINED EFFICACY OF KAISHORE GUGGULU AND PUNARNAVADI GUGGULU IN THE MANAGEMENT OF VATARAKTA (GOUT): A CASE SERIES

Vikas Nariyal 1 , Om Raj Sharma 2 and K.S. Dhiman 3 . 1. Research Officer (Ayu), Regional Ayurveda Research Institute for Nutritional Disorders, CCRAS, Ministry of AYUSH, Govt. of India, Mandi H.P. 2. Assistant Director & Incharge, Regional Ayurveda Research Institute for Nutritional Disorders, CCRAS, Ministry of AYUSH, Govt. of India, Mandi H.P. 3. Director General, Central Council for Research in Ayurvedic Sciences (CCRAS), Janakpuri, New Delhi. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

Even though Gout is generally grouped under Arthritis, it is a metabolic disorder of Uric Acid. Extensive description of Vatarakta in ayurvedic classics shows that it was prevalent widely in that era too. In present era changes in lifestyle & food habits leads to recognizable increase in incidence of Vatarakta in common people.
Total 35 patients of Vatarakta (Gout), out of which 32 patients completed the course of treatment. Study was Open label, Interventional, Prospective and Single arm clinical trial for the duration of 42 days (6 weeks). Patients were given Kaishore Guggulu and Punarnavadi Guggulu 2 tablets (500 mg) each twice a day with lukewarm water. The required amount of medicines was supplied by the IMPCL (A Govt. of India Enterprise) Mohan -Dist. Almora, Uttrakhand after ensuring safety and quality batch to batch. Patients were followed 2-week interval i.e. on 2 nd ,4 th and 6 th week of treatment period. The effects of treatment on subjective and objective parameter evaluated. Results obtained shows encouraging results in the management of Vatarakta (Gout) with no side effects observed so far.

Introduction:-
Non-communicable diseases and chronic diseases/ disorders get favor from the faulty life style of modern society. The factors contributing to the life style disorders includes faulty food and drink habits like irregular eating, fast food eating, alcohol, smoking, tobacco chewing, drugs addiction, and sedentary life, irregular sleeping pattern & stress. Non-communicable diseases are different because they are preventable and their incidence can be lowered by adopting healthy dietary habits and life style. Vatarakta also known as Adhayavata i emerges from inappropriate dietary regime, occupation and environment. The term Adhayavata is self-explanatory that it is more prevalent among Adhya (Rich people). The causative factors of Vatarakta mentioned in Charak samhita are closely related to faulty eating habits and sedentary life style. The symptomatology of Vatarakta like Shool, Shotha, Sparshasahatvam etc. mimics the symptoms of Gout.Purines metabolism (found in many foods and in human tissue) result into production into uric acid ii .Gout is caused by hyperuricemia (serum uric acid >7mg/dL), which leads to the deposition of monosodium urate (MSU) crystals in tissue. An imbalance in the production and excretion of urate, i.e., overproduction, underexcretion or both leads into hyperuricemia. Asymptomatic hyperuricemia (serum uric acid ISSN: 2320-5407 Int. J. Adv. Res. 5(6), 1793-1798 1794 up to 8mg/dL) does not need to be treated. Risk factors for gout include being (Adhya) obese, having insulin resistance, hypertension (obesity, insulin resistance & hypertension collectively called Metabolic X Syndrome), congestive heart failure, alcohol (Sura-Asava) intake (beer and spirits more than wine), diuretic use, a diet rich in meat and seafood (Kllin-Shuksha-Ambuj-Anoop Mansa), and poor kidney function iii,iv .
Vatarakta is a burning problem of the society. This may compromise the quality life of patient due to permanent inflammatory and degenerative changes in the joints.

Aim And Objective:-
To study combined clinical efficacy of Kaishore Guggulu andPunarnavadi Guggulu in the management of Vatarakta (Gout).

Material And Methods:-
Present study was Open label, Interventional, Prospective and Single arm clinical trial for the duration of 42 days. Total 35 patients were enrolled, in which 32 patients completed clinical trial. Three dropout patients left study due to their personal reasons.

Selection of Cases:-
The selection of patients was made randomly from OPD of Regional Ayurveda Research Institute for Nutritional Disorders ( Intervention:-Kaishore Guggulu and Punarnavadi Guggulu 2 tablets (~500 mg) each twice a day with lukewarm water after meals. The required amount of medicines was supplied by the IMPCL (A Govt. of India Enterprise) Mohan, Almora, Uttrakhand, after ensuring safety and quality batch to batch. Patients were followed every 2-week interval i.e. on 14 th day, 28 th day and 42 nd day of treatment period. Results were statically analyzed at the end of the study by Paired Student's t-test. Drug Contents: Table 1 showing contents of Kaishore Guggulu and Table 2 showing contents of Punarnavadi Guggulu.

Observations and Results:-
Observations: In present study patients were selected from age group of 20-90 years (

Discussion:-
Gout is a metabolic disease that most often affects middle-aged to elderly men and postmenopausal women v ; in present study age group 41-70 year (68.75 %, n=22). Gout is more prevalent in males vi , in this study males are 68.75% (n=22) of sample size (n=32).

Kaishore Guggulu:-
Kaishore Guggulu vii is a drug of choice in Vatarakta (Gout). It corrects purine metabolism and checks on uric acid production. Further, it improves the elimination process of uric acid through urine. Anti-inflammatory properties of Guggulu viii,ix , Guduchi x,xi , Shunthi xii , and Trivrit xiii relieves in inflammation induced by crystals to synovial membrane and adjacent tissues. Amalaki xiv and Shunthi 11 act as analgesics, relieving in Toda (Piercing pain), tenderness, Sandhi Shula (Pain in joints) in gout patients. Haritaki xv and Amalaki xvi,xvii has adaptogenic property reducing acute flares in gout patients. Bibhataki xviii shows nephroprotective property, a reduces chances of Uric acid stone development in patients of Gout. Danti xix and Pippali xx have immunomodulator property, hence reducing symptoms of Gout. Punarnavadi Guggulu: Punarnavadi Guggulu potentiate treatment with its diuretic effect. Through urine increasing uric acid excretion and hence lowering blood serum levels of Uric Acid.

Conclusions:-
Combine therapy with Kaishore Guggulu and Punarnavadi Guggulu in Vatarakta (Gout) shows marked improvement in various parameters with no apparent adverse effects observed so far.        Percentage relief in various parameters after intervention at 42nd day.
Percentage relief in various parameters after intervention at 42nd day.