Beruflich Dokumente
Kultur Dokumente
C.S.HANAMANTAGOUDAR
As partial fulfillment of post graduation degree
Ayurveda Vachaspati M.D. (Kayachikitsa)
Under Rajeev Gandhi University of Health Sciences, Bangalore, Karnataka
Guide
Reader in Kayachikitsa
Postgraduate Studies and Research Center,
Department of Kayachikitsa
This is to certify that the contents of this thesis entitled Evaluation of the
comparative efficacy of Ojokalpa Rasayana and Amruta Kayakalpa Rasayana in
Bhutabhishangaja
Ojokshaya
(HIV
infection)
is has
been
worked out
by
Guide
Reader in Kayachikitsa
Postgraduate Studies and Research Center,
Department of Kayachikitsa
J.S.V.V. SAMSTHES
Certificate
This is to certify that C.S.HANAMANTAGOUDAR has worked for his thesis on the
topic entitled Evaluation of the comparative efficacy of Ojokalpa Rasayana and
Amruta Kayakalpa Rasayana in Bhutabhishangaja Ojokshaya (HIV infection).
We here with forward this thesis for the evaluation and adjudication.
Dr. V.Varadacharyulu
M.D.(K.C)(Osm),
Dr. G. B. Patil
Principal
D.G.M. Ayurvedic Medical College,
Gadag
ACKNOWLEDGEMENT
I take this glorious opportunity to acknowledge with the deep sense of gratitude
to my guide, Dr. K. Siva Rama Prasad, Reader, Department of Postgraduate Studies
and Research (Kayachikitsa), D.G.M.A.M.C., Gadag, for his valuable guidance and
close supervision during entire phase of the study.
With profound sense of gratitude I express my sincere thanks to Dr. G. B. Patil,
Principal, D. G. M. A. M. C, Gadag. For encouragement and facilities provided during
my postgraduate studies.
I am very much thankful to Father, Mother,Sister,Brother in law, Pavitra,
Amritagouda and cousins for their affection and lots of co-operation.
I wish to add my warmest thanks to my PG teaching faculty Dr. M. C. Patil, Dr.
Shashidhara
Doddamani,
Dr.
Kuber
Sankh,
Dr.
R.
V.
Shetter,
Dr.Girish
Danappagoudar for their valuable suggestions and timely help which made me to
complete this dissertation work successfully.
I am very much thankful to Dr. B. G. Swami, Dr. K. S. Paraddi, Dr.C. S.
Kudarikannur, Dr.V. M. Sajjan, Dr. V. M. Malagoudar, Dr. S. B. Govindappanavar, Dr.P.
C. Chappanamath, for their encouragement and moral support during the study.
I extend my gratefulness and sincere heartfelt gratitude to my colleagues,
Dr. Shakuntala C. Garwad, Dr. Shankaragouda, Dr. U. V. Purad, Dr. Shyju O. Dr.
mulki patil Dr. G.S. Hadimani Dr. Yasmeen Panibhandha Dr. Anilkumar Bacha, Dr.
Sitaram prasad, and Dr. Vinay. Kulakarni , my friends Dr. Kallesha Murushillin and Dr.
Vishwanatha Kokare, for their timely support during the course.
I am very much thankful to all teaching and non teaching staff of college and
special thanks for librarian Shri. V. M. Mundinamani and Mr. Surreban for their timely
help and co-operation during the study.
Index
Evaluation of the comparative efficacy of Ojokalpa Rasayana in
Bhutabhishangaja Ojokshaya (HIV infection)
Chapter-1
1 to 4
Introduction
Chapter-2
5 to 54
55 to 73
74 to 81
82 to 113
114 to 130
Annexes
References
Bibliography
case sheet
131 to 136
List of tables
Table explanation
Page
Number
55
57
82
83
Diet incidences
84
Religion incidences
85
Economic incidence
86
Occupational incidence
87
88
10
Source of infection
89
11
Chief complaints
90
12
Associated complaints
91
13
93
14
94
15
95
16
96
17
Changes in Weight
97
18
98
19
99
20
100
21
101
22
102
23
Observations on Chronicity
103
24
103
25
105
26
105
27
106
28
109
29
110
30
111
31
Result in-group 1
113
32
Result in-group 2
114
List of graphs
Graph item
Page number
82
83
Diet incidences
84
Religion incidences
85
Economic incidence
86
Occupational incidence
87
88
Result in-group 1
113
Result in-group 2
114
List of Figures
1
32
Structure of HIV
33
Ingredients of Ojokalparasayana
55
Acknowledgement
I am deeply indebted to several people who have helped me during the study.
I acknowledge my sincere gratitude to my guide Dr. K. Shiva Rama Prasad, Reader/
Asst. Professor, Post-Graduate studies and Research Center in Kayachikitsa,
D.G.M.A.M.C, Gadag, for his expert comments, critical analysis and affectionate
encouragement, throughout the study.
I am grateful to Dr. V. Varadacharyulu, H.O.D., Post-Graduate studies and Research
Center in Kayachikitsa, D.G.M.A.M.C, Gadag for inspiring me to take up this
dissertation subject and supporting me with timely guidance and encouragement
Words are poor substitutes for my immense feelings of gratitude for Dr. G. B. Patil,
Principal, DGMAMC, Gadag. I thank him for his ever inspiring encouragement,
facilities provided and for his personal interest in overall supervision of this study.
I extend my immense gratitude to Dr. M.C. Patil, Dr. Raghavedra Shettar and Dr.
Kuber Sankh, Dr. Shashidhar H. Doddamani, faculties of Post-Graduate studies and
Research Center in Kayachikitsa, D.G.M.A.M.C, Gadag.
I scenically remember the co-operation and support extended by Dr. B.G. Swami, Dr.
Chappanmath.P.C., Dr. V.M. Malagoudar, Dr.A.K.Panda, Dr.S.B.Govindappanavar
,Dr. V.M. Sajjan, Dr. Gireesh Danappagoudar and Dr. C.S. Kudarikhannur, Dr K S
Paraddi, and all the staff of DGMAMC. I thank all my P.G. colleges for their constant
support and co-operation.
I am very much great full to my beloved father, mother, brother, sister, brother in law
Amrutagouda and Pavitra for their lots of affection and co-operation.
I sincerely thank Mr. P.M. Nandakumar, statistician, for the statistical analysis of the
results and librarian V.M. Mundinamani and assistant librarian Sureban for their
timely assistance.
I honestly remember the co-operation and support of Dr.G.S.Hadimani, Dr.
Shankaragouda, Dr. Srinivasa Reddy, Dr. A.P.Yasmin Dr. U. V. Purad, Dr.O.Shyju,
and all the scholars of DGMAMC PG branches. I thank all my P.G. colleagues and
my friends Dr Kallesha Moorashillin, Dr Vishwanatha Kokare for their constant help
and co-operation.
I am very thankful to Sunil. L. Mundra, M.D., Natural Capsules Pvt. Ltd., Bangalore
who supplied Natural Vegetable and Gelatin capsules for the study. I am thankful to
M/s R.Y.Shettar, Doddappa Billal and Dhanwantari Pharmacy who supplied me
components of my trail medicine. I am thankful to Hubli diagnostics, Hubli for their
constant cooperation through out the study.
With deep sense of gratitude I thank all the subjects who participated in this study.
(C.S.Hanamantagoudar)
period it has emerged as one of the most serious public health problem in the country.
Introduction to Bhutabhishangaja Ojokshaya
AIDS is a multi dimensional disease syndrome, affecting physical, mental, social and
spiritual facets of the affected person. The virus HIV hampers the Immune system. Where
as in Ayurveda the immunity is termed as Ojas. So the vitiated Immune system is called as
Ojovikruti. Bhootopaghata is one of the causative factors for Ojovikruti. The unique feature
of human immune-deficiency virus is that it attacks the basic defense mechanism of human
beings and gradually destroys the system completely. Then body becomes playground for
all types of microbes like viruses, bacteria, fungi, protozoa, to inter play. In absence of any
check force the microorganisms that enter the body through various entry points. And freely
multiply to cause numerous infections, which may leads to life threatening. The Ojokshaya
is one among the Ojovikruti. Symptoms are also identical to the advanced AIDS sign and
symptoms for example Moorcha, Moha, Pralapa, Mrutyu, Mamsakshaya, etc. There for
Acquired Immune Deficiency Syndrome can be termed as Bhootopaghata Ojokshaya.
At the same time there is no specific treatment available for the AIDS /HIV infection.
AZT the costly medicine is still in practice, which is use full for the preventing the ARC, and
further duplication of HIV virus.
Recent advances in medical treatment
Recent advances in medical treatment have given scientists renewed strength in the
struggle against HIV-the virus that causes AIDS. Many of todays scientists are using AZT
and DDI as a source of treatment. AZT inhibits reverse transcription, which is vital for HIV to
infect its host. Since HIV is a retrovirus it must convert its RNA to DNA. AZT and DDI will
stop this from occurring and thus stop the HIV virus from spreading. There are also many
scientists trying to use CD4 as a potential type of vaccine. CD4 is a membrane protein that
many cells in our body use. Those cells include the immune system cells, blood cells, and
the nervous system cells. It has been found that HIV only infects cells with CD4. It is for this
that HIV infects its host in only areas whose cells contain CD4 1.
Introduction to Bhutabhishangaja Ojokshaya
Vaccine in trial
The vaccine in Evaluation of an HIV-1 DNA Vaccine Encoding a Modified Gag-Pol
in Uninfected Adult Volunteers (Contact: Grace Kelly, RN) trial, VRC 4302, is classified as a
genetic vaccine. Genetic vaccines contain the genes (hereditary material) which direct the
production of the proteins of the HIV virus. VRC 4302 contains the gene for the Gag and Pol
proteins of HIV. It is important to know that you cannot catch HIV or AIDS from this vaccine.
Volunteers will be randomized in a blinded manner to receive either active vaccine (at one of
3 doses, 0.5mg, 1.5mg or 4.0 mg) or vehicle ("control") alone. Participants will receive VRC
4302 by intra-muscular injection once a month for 3 months. The injection is given using a
needle-less injection device. A total of approximately 21 individuals will be evaluated.
Volunteers will be evaluated over the course of one-year (approximately 15 visits).
Present study - as Ojokalpa Rasayana
.Present study is a comparative study to assess two Ayurvedic combinations of
immune builders, Immuno-modulators and acts on Ojovikruti by preventing ARC. Food
supplements of immune modulation through well-known herbo-mineral origin, Amruta
KayaKalpa Rasayan of Amruta pharmaceuticals Hyderabad, is compared with the trail drug
combination of Bilvadi Vati and Agnikumar Vati (Sahasrayoga) as Ojokalpa Rasayana. In
Sahasrayoga Bilvadi vati and Agnikumar vati are indicated for Chira Atisara and AmaAtisara, Visarpa, Garavisha and Bhoota visha, symptoms, which are appearing in ARC.
Limitations of the study
This study is of only 3 months period and attempt is not made to see in vitro effect of
therapy on HIV virus. The total work dwells on inferences based on both subjective and
objective parameters such as KPS score and CD4 count. With this duration, sample size and
design, it is not possible to conclude the exact role of Ayurvedic treatment but this is a good
beginning for further study. Serological test for HIV is not a criterion for assessment rather it
is a diagnostic tool for inclusion of subjects.
Viral load test (PCR) is not employed because of financial constrains, instead CD4
enumeration, which is an internationally accepted surrogate marker of HIV status was under
taken.
Study design
So a rational combination was made to tackle cause of disease and management of
resultant condition under the shelter of Sahasra yoga. The Ojokalpa Rasayana, which has
Ojovardhaka, Ama pachaka, jwarahara, and krimighna drugs in it. Recent researchers have
proved all the properties of individual drugs also. An attempt has been made to develop
non-pharmacopeal methods of management of this condition by adopting Sadvritta
(disciplines), do and donts prescribed by Charaka and other Acharyas 2.
This dissertation begins with literary review of Ojokshaya and HIV infection and a
comparative study of both. The basic physiology concerned with this disease, pathophysiology, causative factors, signs and symptoms, diagnostic tests involved are discussed.
A detailed drug review has been done which speaks about the rationale behind the
combination. There is a chapter continued on materials and methods, which was adopted
for this research work and in observation and results detail description of findings of
research are given. In discussion and conclusion, the possible mechanisms involved in the
pharmacological intervention and subsequent improvement are discussed.
There is a summary of over all work followed by the references and bibliography.
It is a fond hope of people of this country that a successful drug will emerge out of
this traditional knowledge and this is a humble effort to bring this much-cherished hope into
a reality.
The normal healthy state of such a body requires normalcy of several factors. They
are Dosha, Agni, Dhatu, and Mala along with peaceful disposition of Atma, Indriya and
Mana 3. For this normal functioning body requires strength, which is called as Bala.
Ayurveda describes human body as seat of Chetana (consciousness) and a product
of panchabhoutic vikara, existing in equilibrium. When this equilibrium gets disturbed, that
results in defective bodily tissues. This is the beginning of any disease 4.
This normal strength in the body is called as Sleshma 5, which has synonym -Ojas.
This Ojas is transformed from the parents to the progeny through Sukra and Sonita 6, which
forms the zygote and from that moment development of foetus continues.
The strength of any living is disturbed either by internal humors viz. Vata, Pitta and
Kapha or exogenous factors such as bacteria and virus. The virology and bacteriology is not
much discussed from the ancient literature but the existence was not denied. Thus the
present study which is based on the existence of the Bhuta described from the Vedic
literature.
The principle of the disease development commences either from the endogenous or
exogenous factors. The endogenous factors are grouped as physical and psychological.
The physicals are of three humors and the psychological are rajas and tamas. The
exogenous factors which gives rise the disease because of Achayapurvaka prakopa
ultimately has to land for the vitiation of Dosha. Thus the terminus of the disease is under
the influence of the Dosha triode.
Here in this concern discussed about the Ojas, Dosha and immunity as the virus
makes the deficiency of immunity and disturbs the Dosha triode.
Ojas in general
Man is a creature composed of millions of cells. A microbe is composed of only one.
Yet, through out the ages, the microbes have had the upper hand in their ceaseless conflict
with man. The above sentence is narrated from Atharvaveda, which dates backs to 5000
years.
Ayurveda describes human body is seat of Chetana (consciousness) and a product
of Panchabhoutika vikara, existing in equilibrium gets disturbed. That results in defective
bodily tissues. This is the beginning of any disease 7.
The normal healthy state of a body requires normalcy of several factors they are
Dosha, Agni, and Dhatu, and Mala, Peaceful deposition of Atma, Indriya and Manas.8 for
their normal functioning, body requires strength, which is called as Bala. The same normal
strength had synonym as Shlesma
9.
understanding of immuno deficiency, depilated vigor and vitality. This Ojas is transformed
from the parents to the pregnancy through Sukra and Shonita
10
at the time of zygote formation. Ojas is the essence of all the Dhatus. The Beeja is
responsible for the formation of particular organ or tissue, if it is vitiated, that results in
deformity of the respective organ. If it develops undisturbed there will not be any deformity
of the respective organ.
There for it is clearly understood that every part of the healthy human body (Dhatu
and Mala) develops according to the healthy state of the Beeja and Beejabhaga. There for
the essence of Dhatus as represented by Ojas of Pumbeeja and Stribeeja plays the major
role in this mechanism.
12
13
. As long as Dhatus are strong and healthy and are conducting their normal
functions which their essence i.e. Ojas being both qualitatively and quantitatively effective.
The body will be strong enough to resist and counter the decay and degeneration caused by
either the natural processes or disease. So in this contest this is very essential that, to know
about etymology and normal physiology of Ojas.
Nirukti (Etymology) of Ojas
Ojas the word has its root in ujor vaj dhatu. That means confer or strong (Ugra)
Ojas is the subanta pratyaya of word Ojas, which means Deepti, Prakasha and Balam
14.
Kalidas in Raghu vamsha kavya writes Rudraoujasa with reference to the potency of Shiva
15
16
. Chakrapani contradicts this opinion and says Ojas sustains the body but does
the parents to the pregnancy through Shukra and Shonita. Which is the essence of the
Dhatus. If a part of Beeja, which is responsible for the formation of particular organ or tissue,
is vitiated, that results in deformity of the respective organ. If it develops undisturbed there
will not be any deformity of the respective organ. There for it is clearly understood that every
part of the healthy human body (Dhatu and Mala) develop according to the healthy state of
the Beeja and Beejabhaga, there for the essence of Dhatus as represented by Ojas of
Pumbeeja and Steebeeja plays the major role in this mechanism.
Ojas depends upon healthy state of Kapha. Kapha in physiologically represents
potential sours of strength and resistance to disease and decay of Bala and Ojas. These
terms reflect to the force and power which resists the factors responsible for decay and
disease. Bala may be sahaj (inherited) kalaj (seasonal) and yuktikrita (acquired). But these
all are equally capable of resisting the diseases. As long as Dhatus are strong and healthy
and conducting their normal functions with the essence i.e. Ojas being both qualitatively and
quantitatively effective. The body will be strong enough to resist and counter the decay and
degeneration caused by either the natural processes or disease. So in this contest this is
very essential that, to know about etymology and normal physiology of Ojas.
Formation of Ojas in the body
Ojas is the Sara i.e. essence of all Dhatus
17
Which is collected by bees from various flowers and fruits. Ojas is derived from all the
Sapta Dhatus in other words all the Dhatus contributes to its making. Ojas is the product of
the prasada paka of Dhatvagni vyapara.That has the essence of all the Sapta Dhatus in it.
Essentially Ojas depends on Ahara for its production and sustenance 18.
Panchaboutic sangatan
Apara Ojas is also known as slismika ojas and it is considered somatmak denoting
the predominance of Aap and prithvi mahabhootas 19.
Conceptual study of Bhutabhishangaja Ojokshaya
20
26,
Sheeta,
27,
23
28
25
, Stira (stable),
, Mridu
29
Shukla
34
, Madhu rasam,35.Lajagandhi.
36,
Lohita peetakam, 37
Ojas Poshana 38
Ojas is nurrished mainly by Ahara, from the AharaAhara rasa- Rasa dhatu- RaktaMamsa-Medha-Asthi- Majjaa-Shukra dhatus
Classification of Ojas 39
There are two classifications of Ojas, made by Charaka, Susruta, Chakrapani, and
by all other acharyas. Those are
1)
2)
Apara Ojas 40
These two types of Ojas have a direct bearing on bodys defense against
degeneration and infection.
Para Ojas
Ojas marks the beginning of the formation of embryo. It is the essential nourishing
fluid developed from the Rasa of the embryo.
letters initial formation and is permanently locates there, sustaining the life of fetus. Loss of
Ojas amounts to the loss of life itself. Chakrapani comments that the above function pertains
to both the Ojas and further explains that Ojas plays a role in three different stages of the life
of the fetus. It permeates to through Rasa in entire body and nourishes entire body
41
and
Dhatus. Any loss in the quantity would cause sudden death. Commenting on function of
Ojas Susruta has made a significant observation. Ojas permits entire body nourishes limbs
and organs. In the absence or deficiency of Ojas in the body there will be wasting, decay,
degeneration, and destruction of the body. This statement indicates the nutritive nature of
the Apara Ojas in preventing the decay of the body. It is one of the ten seats of life. It gives
firmness to physical structures and gives strength to motor activity. Ojas spreads all over the
Conceptual study of Bhutabhishangaja Ojokshaya 10
body. In the absence of it life does not exist. The seat of Apara Ojas is the ten dhamanies
connected with Hrudaya 43.
According to Vagbhata, the function of Apara Ojas is Dehastitanibhandana. Which
means it keeps the physical fitness of the body. Chandranandana
44
protection of the body in all the states. Hemadri also states that the changes in the Ojas are
the root cause for all the changes in the body. Ojas is Bala, which is a potential source of
resistance to disease and decay. Bala controls the Doshas that cause disease. This is
called Vyadhi kshamatva.45.
Synonyms of Ojas
The term Ojas has been stated in Ayurvedic classics represents Kapha, Bala,
Shleshma, Rasa and Rakta.46
Sleshma in normal state apart from other confers 47.
1. It gives Weight and bulk.
2. It gives Strength to perform work
3. It resists disease and decay.
4. Promotes durability, (preserves the body from decay)
5. Promotes healing process (Ropanam)
6. It promotes tissue building.
Ojas vriddhi lakshanas
Increase in Ojas results in vriddi of Bala, Varna, Agni, Medha, Ayu and Sukha.
Decrease results in kshaya. 48
Nidana of Ojokshaya
The pathological state of Oja is called as Ojokshaya .49. Charaka and all other
classics have described this Oja vikriti as Ojokshaya. Susruta has classified this condition in
to three different stages
50
which causes depletion of any Dhatu, can also causes depletion in the Ojas qualitatively and
quantitatively. The factors influencing the Ojokshaya are as follows.
1) Ahar karana.
2) Vihar karana.
3) Manashika karana,
4) Aagantu karana.51
Ahar karanas: Alpaasha (mal nutrition)
Anashana (starvation)
Vihara karanas: Vaata atapa shevana (expose to sun heat and winds)
Ativyayama (excessive work beyond the capacity)
Ativyavaya (excessive sex)
Shonit ativartana (loss of blood) and
Prajagara (keeping awake at night)
Manashikakaranas: Kopa, (anger)
Shoka (grief)
Chinta (worry)
Bhaya (Phobia).
Agantu karan: Sankramana or Upasarga denote infection
Krimi, Rakhsa, Rakshasa, yathudhana, Pishacha, Gandarva, Boota,
Nishachar, presents different types of microbes, and
Oja bhakshaka rajanichra. 52
Conceptual study of Bhutabhishangaja Ojokshaya 12
54
, Prameha
58
55
Pandu
56,
57
Susruta pointed such possibility while dealing Abhinyasa jwara where in he used
happen due to loss of structural integrity of Dhatu vaha srotas and obstruction in the supply
system. Such other disease syndromes are Rajayaksma, Madhumeha, Ojomeha
60
, Pandu,
Nidra
Ojokshaya
1) Murcha (loss of conscious ness)
2) Mamsa kshaya (emaciation of mussels)
3) Moha (stupor)
4) Pralapa (delirium)
5) Marana (death)
along with the growth of the body elements i.e. Sapta dhatus .It comprehends both sharira
and satwa i.e. body and mind.
Kalaja Bala 65
Kalaja Bala is influenced by the factors like seasonal variations and age of the
individuals. Thus kalaja Bala is supposed to be dissipated at its lowest leveling the Adana
kala comprising of Sishira.Vasanta and Greeshma ritus. On other hand Bala is stated to be
conserved and at its high peek level in the visarga kala, inceasing over Varsha, Sharat and
Hemanta ritus. Those are known as Sheeta kala or cooler period.
Yuktikrita Bala 66.
Yuktikrita Bala refers to the bodys resistance against disease, which can be
enhanced by appropriate nutrition such as meat, Ghee, etc. Restorative and Rasayana
therapy in keeping with the seasonal requirements, adaptation of swastha vritta principles of
Ayurveda along with Achara Rasayana also contributes the growth of Yuktikrita Bala.
Dalhana in his commentary on Bala lakshanas as explained by Susruta observes
Ojas and Bala as synonyms, especially with Chikitsa point of view. However they are distinct
in the sense the former is the essence of all the dhatus and it has physical properties like
Roopa, Rasa, Veerya etc., the later has to be determined from the power to lift heavy weight
and the capacity to bear heavy loads etc. it does not possess physical properties. 67
The Vyadhikshamatva is not the same merit/order in all constitutions. In other wordsThis Shakti varies from individual. The same is explained in the Charaka Samhita Na cha
sarva shareerani vyadhikshamatva samarthani bhavantani. In the discussion on factors that
influence Bala, held between Punarvasu Atreya and Agnivesha is recorded in the chapter
Vividaashitiyapeeya in the Charaka sutra sthana. This discussion throws considerable
amount of light on the views held on resistance to disease.
68.
Avalambakakapha and Shlesmakakapha. Each one is limited to some part or parts of body
by their functions. They look after the functions of the Kapha locally and project the body
collectively.
The function of Kapha 69
The important functions, attributed to the Sleshma by the different Acharyas are,
1. Kapha is responsible for growth, weight, and bulk of the body. That is
Brimhanam, and Gouravam.
2. It is Vrishya, a function relates to sexual stamina and productivity.
3. Sthairyam- it imparts stability and durability to the body and strength to the
limbs.
4. It confers strength required to perform labors physical activity i.e. physical
activity i.e. Vyayama Shakti.
5. It also provides the power to resist and overcome forces or factors, which
bring about disease and decay popularly known as Vyadhikshamatva viz.
Vyadhibala viroditva, Vyadhi utpadaka hetupratibhandakatvam.70.
6. Ropana- promotes healing process.
7. Ambukarma- Kapha being a repository of water, Makes this important fluid
function to sub serve its vital secretary activities.
8. It has a function responsible of cohesion of various units and structures of the
body.
IMMUNE MECHANISM
Defense mechanism of the body is classified in to two.
1. Immune
2. Non immune
Conceptual study of Bhutabhishangaja Ojokshaya 18
Gastric juice.
Enzymes.
exposure to a foreign substance produces a more rapid and greater Hum oral immunity is
immunity due to circulating antibodies in the globulin fraction of the plasma proteins. It is a
major defense against bacterial infections.
Cellular immunity is responsible for delayed allergic reactions and rejection of
transplants of foreign tissue. It constitutes a major defense against infections due to viruses,
fungi, and a few bacteria such as the tubercular bacillus. It also helps to defend against
tumors.
There have been spectacular advances in immunology in recent years, and the field
is now large and complex. Only the fundamentals are presented here.
Development of the Immune System
During fetal development, Iymphocyte precursors come from the bone marrow.
Those that populate in the thymus become transformed by the environment in this organ
into the lymphocytes responsible for cellular immunity i.e.-Imphocytes. Lymphocytes
responsible for humeral immunity are B-lymphocytes. Four different varieties of T cells have
been identified: helper / inducer T cells suppressor T cells, cytotoxic T cells (which are also
known as effectors T cells or killer cells), and memory T cells. The first 2 types are involved
in the regulation of antibody production by B cells derivatives, whereas the cytotoxic T cells
destroy transplanted and other foreign cells. Cytotoxic and suppressor T cells have on their
surface the glycoprotein CD8, which can be detected by monoclonal antibodies, so they are
frequently called T, cells. Helper / inducer T cells have on their surface the glycoprotein CD4
and are therefore called T cells. CD8 is a co receptor for MHC class I molecules and CD4 is
a co receptor for MHC class II molecules.
Memory B and T cells are cells those have been exposed to an antigen and are
readily converted to effectors cells by a later encounter with the same antigen. Unlike other
lymphocytes, they persist in the body for months or even years.
Conceptual study of Bhutabhishangaja Ojokshaya 21
call them cytokines. This field is growing very rapidly, and most of the cytokines are initially
named for other actions, e.g. B cell differentiating factor, B cell stimulating factor 2. There is
a convention that once the amino acid sequence of a factor in humans is known its name is
changed to interleukin.
Thus, for e.g. the name of B cell differentiating factor was changed to interleukin-4.
However, nomenclature in this field remains somewhat confused and uncertain.
Hemoglobin
The red, oxygen-carrying pigment in the red blood cells of vertebrates is
Hemoglobin, Hemoglobin is a globular molecule made up of 4 sub units. Each sub unit
contains a hem moiety conjugated to a polypeptide. The average normal Hemoglobin
content of blood is 16g/dl in men and 14g/dl in women, all of it in red cells. In the body of a
70- kg man, there is about 900gms of Hemoglobin, and 0.3gm of hemoglobin is destroyed
and 0.3gm synthesized every hour.
Platelets
The platelets are small, granulated bodies 2-4 micrometers in diameter. There are
about 3 lakhs / liter platelets in circulating blood, and they normally have a half-life of about
4 days. The megakaryocytes giant cells in the bone marrow, from platelets the pinching of
bits of cytoplasm and extruding them into the circulation. Platelet production is regulated by
the colony stimulating factors that cintroll the production of megakaryocytes. Between 60
and 75% of the platelets that have been extruded from the bone marrow are in the
circulating blood, but the reminder are mostly in the spleen. Splenectomy causes an
increase in the platelet count (thrombocytosis).
Non specific resistance represents a wide variety of body reactions against a wide of
pathogens. Specific resistance or immunity involves the production of specific antibody
against specific pathogen or its toxin.
Conceptual study of Bhutabhishangaja Ojokshaya 24
it started spreading from big cities to smaller ones. People, who travel from cities to city and
those who travel from villages to cities, were found to be more susceptible because of
unprotected, non-martial sexual contact. Even though thousands of people got infected
through blood transfusion during the first decade of epidemic, the heterosexual contact is
the major cause of spread. Every year 3 lakh Indians die due to AIDS. Since the beginning,
amount of the death of the AIDS patients is 25 lakhs. It is second highest figure
communicable diseases, which cause death.
Definition of AIDS
Any HIV-infected individual with CD4+T cell count of<200/microliter had AIDS by
definition, regardless of the presence of symptoms or opportunistic diseases. The clinical
conditions like pulmonary tuberculosis, recurrent pneumonia, and invasive cervical cancer.
While the definition of AIDS is complex and comprehensive, the clinician should not focus
on presence of AIDS but should view HIV disease as a spectrum ranging from primary
infection, with or without the acute syndrome, to the asymptomatic stage, and to advanced
disease.
It is important to distinguish between being infected with HIV and having AIDS.
People infected with HIV may take 5-7years or more to develop as AIDS. Some time it may
be sooner because of malnutrition and poor state of health, toxins and malnutrition out plaid
factors that stress the immune system probably cause AIDS. During this interval HIV
infected individuals may suffer from a variety of disorders and develop signs which are
suggestive of being infected with HIV. Mainly those symptoms are pain less swelling of
Lymph nodes in the neck, Armpits and Groin, Fever, Night Sweats, Diarrhea, Loss of weight
and infections such as Herpes, Pneumonia, etc.
Etiologic agent
The etiologic agent of AIDS is HIV (the Human Immuno deficiency Virus), which
belongs to family of (Heterogenous) human retroviruses and the subfamily of Lentiviruses.
Lentiviruses cause disease in other animal species, including Sheep, Horses, Goats, Cattle,
Cats and Monkeys. The four recognized human retroviruses belong to two distinct groups,
i.e.HIV-1 and HIV-2. The most common cause of HIV disease throughout the world is HIV-1
comprises several subtypes with different geographic distribution. HIV-2 was first identified
in 1986 in West African patients and was originally confined to this region.
Electron microscopy shows that the HIV virus is an icosahedra structure containing
numerous external spikes formed by the two major envelope proteins, the external Gp120
and the transmembrane Gp41.The virion buds from the surface of the infected cell
incorporates a variety of host proteins, including Major Histo-compatibility Complex (MHC)
class I and II, antigens into its lipid bilayer.
This virus contains two Snake like single strands of Ribose Nucleic Acid (RNA), slow
in nature, having reverse transcriptase enzyme. Having size about 90-120 mm. this virus is
a tiny, a thousand times smaller than the thickness of a hair. Looks like a roller up
porcupine. This lies firmly wrapped up in a care which resembles a cone with a dimple at its
base. This cone is protected by an envelop that has a knob like protein sticking out its
surface. HIV is free from live, when it is out side the body. It dies immediately in dry area.
It can alive in blood at 4o c, about three weeks or till the cell disintegrates.
Pathology and Pathogenesis
The hallmark of HIV disease is a profound immunodeficiency resulting primarily from
a progressive quantitative and qualitative deficiency of the subset of T lymphocytes referred
to as helper or inducer T cells. This subset of T cells is defined phenotypicaly by the
presence on its surface of the CD4 molecule. This serve as the primary cellular receptor of
Conceptual study of Bhutabhishangaja Ojokshaya 27
HIV it has recently been demonstrated that a co-receptor must be present together with CD4
for effective fusion and entry of HIV-1 into its target cells. It is important appreciate that the
pathogenic mechanisms of HIV disease are multi factorial and multi-phased and are
different at different stages of the disease.
HIV has a number of mechanisms to evade elimination by the immune system. HIV
has as extraordinary ability to mutate, but this mechanism probably acts mainly after the
establishment of chronic infection and contributes to the maintenance of chronic. Since the
transmitted virus and the virus that initially becomes established as a chronic infection are
relatively homogeneous, the initial escape from immune system control likely involves other
mechanisms. Molecular analysis of clono types has demonstrated that clones of
CD8+Cytolytic T Lymphocytes (CTLs) that expand greatly during primary HIV infection and
likely represent the high-affinity clones that would be expected to be more efficient in
eliminating virus infected cells disappear after their initial burst of expansion.
Viral Dynamics
HIV-1 and HIV-2 are both viruses that belong to the same family, but vary in genetic
make up. HIV-1 was first discovered in 1983 in France and appears to be more prevention
Europe and America. HIV-2 was first discovered in 1986 and is more prevalent in Africa.
Both HIV-1 and HIV-2 have been detected in India and both leads to AIDS.
It was originally thought that very little virus replication occurred during clinical
latency. However studies of lymphoid tissue using PCR analysis for HIV RNA and in site
hybridization for individual virus expressing cells clearly demonstrated that HIV replication
occurs throughout the course of HIV infection, even during clinical latency. The availability of
sensitive PCR techniques leads to the demonstration that viremia present at all stages of
HIV disease.
The behavior of the HIV is very much similar to poison. The HIV is fragile, once the
virus is out side the body in a dry form, it dies immediately. When stored in blood banks at
4oc, it can live for about 3 weeks or till the cell is integrates.
Mode of Transmission
Transmission is of two types, horizontal and vertical. HIV is transmitted by
homosexual and heterosexual contact. Blood, Blood products are the important routes of
infection. Infection spreads from mothers to infants either intrapartum, perinatally, or via
breast milk. After more than 15 years of scrutiny, there is no evidence that HIV is transmitted
by casual contact or that the virus can spread by insects, such as by a mosquito bite.
1) Sexual transmission: Homo sexual: More HIV infections occur in homo sexual and bisexual
men (lesbianism) who have a large number of sexual partners the
sexual practice often involves anal intercourse (anal sex) and fella tic
with ejection of semen in to the mouth (oral sex).
Hetero sexual: Multiple, Hetero sexual contacts often prostitutes.
Blood and tissue liquids:
i. Contaminated blood and blood based products,
ii. Blood transfusion,
iii. Semen and Sperm,
iv. Brest milk,
v. Urine, Tear, Saliva, CSF with visual blood containing,
Contaminated instruments like needles, syringes, surgical and dental.
Transplantation of tissues and organs, (Kidney, Cornea, Skin, Bone
marrow)
Conceptual study of Bhutabhishangaja Ojokshaya 29
Mother to child.
Antenatal (In Uterus),
Delivery (at birth),
Postnatal (After birth by Breast feeding)
HIV has been demonstrated in seminal fluid both within infected mononuclear cells
and in the cell free state. The virus appears to concentrate in the seminal fluid, particularly in
situations where increased numbers of lymphocytes and monocytes are. The virus has also
been demonstrated in cervical smears and vaginal fluids. There is a strong association of
transmission of HIV with receptive intercourse. Owing to the fact that only a thin and fragile
rectal mucosal membrane separates the deposited semen from potentially susceptible cells
in and beneath the mucosa this transmission takes place. Trauma associated with anal
intercourse provides at least two modalities of infection; direct inoculation into blood in cases
of tears in the mucosa, and infection of susceptible target cells, such as langerhans cell, in
the mucosal layer in the absence of trauma. There is approximately a 20 fold greater chance
of transmission of HIV from a man to a woman than from a woman to a man through vaginal
intercourse. This difference may be due to the prolonged exposure of the vaginal and
cervical mucosa and endometrium to infected seminal fluid.
2) Transmission by blood and blood products:
HIV can be transmitted by blood products, both among individuals who share
contaminated paraphemalia (needles and syringes) for injection drug use and in those who
receive transfusions of blood and blood products. It is estimated that 90 to 100% individuals
who were transfused with HIV-infected blood became infected. Transfusions of whole blood,
packed red blood cells, platelets, leukocytes, and plasma are all capable of transmitting HIV
infection. The precautionary measures taken to check this: (1) the screening of all blood for
p24 antigen and for HIV antibody body enzyme linked immuno-absorbent assay (ELISA),
Conceptual study of Bhutabhishangaja Ojokshaya 30
with a confirmatory western blot where applicable; (2) the self-deferral of donors on the
basis of risk behavior.
3) Occupational transmission of HIV:
There is a small but definite occupational risk of HIV transmission among health care
workers, laboratory personnel, and potentially others who work with HIV infected specimens,
particularly when sharp objects is used. It is estimated that 250,000 to 1 million health care
workers are stuck with needles or other sharp medical instruments in each year large.
4) Maternal to fetal / infant transmission (vertical):
HIV infection can be transmitted from an infected mother to her fetus during
pregnancy or during delivery. This is an extremely important form of transmission of HIV
infection in developing countries, where the proportion of infected women to infected men is
approximately 1:1
5) Transmission by other body fluids:
There is no convincing evidence that saliva can transmit HIV infection, either through
kissing or through other exposures, such as occupationally to health care workers. But blood
contaminated saliva and wet kissing will leads to HIV infection
Epidemiology of HIV infection
HIV infection and AIDS is a global pandemic, with cases reported virtually from every
country. The current estimate of the number of cases of HIV infection among adults
worldwide is approximately 22 million, and approximately 2.6 Million HIV-infected children
have been born since the start of the HIV pandemic, and approximately one half of these
have developed AIDS and have died. The global projections for the number of HIV-infected
individuals by the year 2000 range from 40 to 100 million.
The reverse transcriptase enzyme, which is contained in the infecting Virions, then
catalyzes the reverse transcription of the genomic RNA into double-stranded DNA. The DNA
trans-located to the nucleus, where it is integrated randomly into the host cell chromosomes
through the action of another virally encoded enzyme Integrate.
Morphology of HIV
Electron microscopy shows that the HIV virus is an icosahedral structure containing
numerous external spikes formed by the two major envelope proteins, the external gp 120
and the transmembrane gp41. The Virion buds from the surface of the infected cell
incorporates a variety of host proteins, including Major Histo-compatibility complex (MHC)
class I and II, antigens into its lipid bilayer.
Figure 2
Structure of HIV
Glycoprotein
GP120
Glycoprotein
GP41
Fatty (Lipid
Bilayer
membrane
Protein
P18
Protein
P24
Reverse transcriptase
enzyme
HIV genetics
HIV-1 has genes that encode the structural proteins of the virus gag encodes the
proteins that from the core of the Virion (including p24 antigen) I Pol encodes the enzymes
Conceptual study of Bhutabhishangaja Ojokshaya 33
responsible for reverse transcription and integration and env encodes the envelope
glycoprotein.
Molecular heterogeneity of HIV-1: Molecular analysis of various HIV isolates reveals
sequence variation over many parts of the viral genome.
Types and Sub types
There are two types of HIV-1 group M (major), which is responsible for most of the
infections in the world, and group O (outlier) a relatively rare viral form found at this time in
Cameroon, Gabon and France. The M group comprises at least light sequence subtypes, or
clad, designated A to H.
How does the HIV virus attack the immune system,
Once the human immuno deficiency virus enters the body, it gets attacked to a type
of white blood cell called T lymphocytes. The RNA genetic material of the virus then gets
converted to DNA genetic material by an enzyme that the virus produces. This virus DNA
then gets incorporated in to the DNA of the T lymphocyte, and remains there for the lifetime
of individual. This infected cell knows becomes a virus factory producing more viruses which
bud out the cell, attack new T lymphocytes, and destroy them. Over a period of years, the T
cell count of the infected person drops to a critical level and the individual develops AIDS.
Duration of an HIV infected person to develop AIDS.
This depends on the mode of the HIV transmission and life styles of the HIV positive
person. Persons those are infected through blood transfusion develop symptoms of an
average from 3-5 years. With the other modes of transmission, when the dose of the virus is
less, the person can remain healthy for 8-12 years or longer, if an HIV positive person
improves his or her quality of life by adopting safer sex, has a good nutrition, regular
exercise, seeks immediate medical attention for any ill health. Avoids stress, continues to be
active he or she is likely to live longer.
Conceptual study of Bhutabhishangaja Ojokshaya 34
IL-
(INF) 2, IL-4, IL-10 and INF 3 can either induce or suppress HIV expression, depending on
the system involved.
Clinical manifestation of HIV infection
HIV disease can be divided empirically on the basis of the degree of
immunodeficiency into an early stage (CD4+T cell count 200 to 500/ micro liter), an
intermediate stage (CD4+T cell count 200 to 500 /micro liter) and an advanced stage
(CD4+T cell count < 200 / micro liter). Most AIDS defining opportunistic infections and true
malignancies occur in the advanced stage of disease, while neurological disease and
Kaposis sarcoma are not as strictly related to the degree of immunodeficiency. The two
major classification systems for staging HIV disease are the CDC system and the Walter
reed medical center system; these are to be distinguished from the case definition for AIDS,
which is used for surveillance purposes.
Disease control classification system for HIV infection
Group 1, Acute HIV syndrome
Group 2, asymptomatic infection
Group 3, Persistent genaralised lymph-adenopathy
Group 4, other diseases
Constitutional disease
Neurological diseases
Secondary neoplasms
Other conditions
subside as an immune response to HIV develops and the levels of plasma viremia
decrease. Opportunistic infections have been reported during this stage of infection,
reflecting the immunodeficiency that results from reduced numbers of CD4+T cells. Total
lymphocyte and T cell subsets (CD4+ and CD8+) are initially reduced. An inversion of the
CD4+/CD8+ T cell ratio occurs later because of the rise in the number of CD8+T cell subsets,
as determined by T cell receptor analysis. The total circulating CD8+T cell levels usually
remain some what depressed although there may be a slight rebound towards normal.
Lymph-adenopathy occurs in approximately 70% of individuals with primary HIV infection.
Most patients recover spontaneously from this syndrome and have a mildly depressed
CD4+T cell count that remains stable for a variable period before beginning its progressive
decline. In most patients, primary infection with or without the acute syndrome is followed by
a prolonged period of clinical latency.
The asymptomatic stage
Clinical latency although the length of time from initial infection to the development of
clinical disease varies greatly the median time is approximately 10 years. HIV disease with
active virus replication usually progresses during this asymptomatic period. Some patients
called long term non-progressors, show little decline in CD4+T cells counts over an extended
period. These patients generally have extremely low levels of HIV RNA. In these patients,
the appearance of an opportunistic disease may be the first manifestation of HIV infection.
Some patients otherwise asymptomatic develop persist generalized lymph-adenopathy
during this time. With few exceptions, CD4+T cell counts fall progressively during this
asymptomatic period at an average rate of approximately 50 cells / micro liter per year.
When the CD4+T cell count falls below about 200/micro liter, the resulting stage of
immunodeficiency is severe enough to place the patient at high risk for opportunistic
infections and neoplasm and hence are clinically apparent disease.
Conceptual study of Bhutabhishangaja Ojokshaya 37
Window period
Even after a person is infected with HIV, he/she will remain healthy for some period
of time. Patient will have no complaints. In this time HIV tests will become negative for 6-12
weeks after infection. In this period the person is highly infectious, viral load (number of virus
in the body) is extremely high.
Asymptomatic period
After about 6 weeks of HIV infection, the HIV test will become positive. The HIV
infected person can remain healthy without any complaints for periods of up to 3-5 years.
This period when the HIV test is positive but the person remains without symptoms or
complaints is called the HIV positive asymptomatic period.
HIV positive symptomatic period
The HIV continues to multiply in the body.
Early symptomatic disease
At some point, usually after the CD4+T cell count has fallen below 500 /micro liter
patients begin to develop signs and symptoms of clinical illness. Many of these problems
can be traced to minor opportunistic infections, not sufficiently indicative of a defect in cellmediated immunity to be considered AIDS defining illness, while some of them appear to be
direct affects of long standing HIV infection. This stage of HIV infection has been given a
variety of names in the past, among them pre-AIDS and AIDS-related complex (ARC),
generalized lymph-adenopathy.
This condition, defined as the presence of enlarged lymph nodes (1cm) in two or
more extra inguinal sites for more than 3 months without an obvious cause, its often the
earliest symptom of HIV infection after primary infection. It is due to marked follicular
hyperplasia. The nodes are generally discrete and freely moveable. This feature of HIV
disease, which may be seen at any point of time, is not associated with an increased
likelihood of developing AIDS.
Paradoxically a loss in lymph-adenopathy or a decrease in lymph nodes size may be
a prognostic maker of disease progression. In the early and intermediate stages of HIV
infection, the main differential diagnosis is an idiopathic form of Kaposis sarcoma.
Late in the course of disease, differential diagnosis expands to include lymphoma,
mycobacterium infection, toxoplasmosis, systemic fungal infection and bacillary angio
matosis. Lymph node biopsy is not indicated in patients with early stage disease unless
there are science and symptoms of systemic illness such as fever and weight loss, or unless
the nodes begin to enlarge, become fixed or coalesce.
Oral lesions
Oral lesions, including fresh, hairy leukoplakia-and aphous ulcers, are particularly
common during this phase. Thrush due to Candida infection and oral hairy leukoplakia, are
usually indicate of fairly advanced immunologic decline, generally occurring in patients with
fever than 300 CD4+T cells/ micro liter.
Herpes zoster (shingles)
This condition is seen in 10 to 20% of patients. This reactivation syndrome of
varicella zoster virus indicates a modest decline in immune function and is often the first
clinical indication of immunodeficiency.
Thrombocytopenia
Thrombocytopenia also may be an early consequence of HIV infection.
Approximately 3% of patients with HIV infection and CD4+T counts above 400/ micro liter
have platelet count fewer than 150,000/ micro liter. This incidence increases to 10%.
Thrombocytopenia is really a serious clinical problem in these patients.
Neurologic disease
Clinical disease of the nervous system accounts for a significant degree of morbidity
in a high percentage of patients. The neurologic problems that occur in HIV-infected
individuals may be either primary to the pathogenic processes of HIV infection or secondary
to opportunistic infections or neoplasm.
Opportunistic infections
Opportunistic infections are late complications of HIV infection, for the most part
occurring in patients with less than 200 CD4+T cells per micro liter. While the causative
agents characteristically are opportunistic organisms, such as pneumocytis carimi,
mycobacterium avium complex, CMV, and other organisms that do not ordinarily cause
disease in the absence of a compromised immune system, they also include common
bacterial and mycobacterium pathogens. Opportunistic infections are the leading cause of
morbidity and mortality I patients with HIV infection. Approximately 80% of AIDS patients die
as direct result of an infection other than HIV, with bacterial infections heading the list.
Protozoal infections
Pneumocystis carinii infection is one of the most common causes of infection
patients generally present with fever and cough that is usually nonproductive or productive
of only scant amounts of white sputum. They may complain of a characteristic retro-sternal
chest pain, which is usually course on inspiration and described as either sharp or burning.
In more severe cases, patient usually notes dyspnoea on exertion, fatigue and weight loss.
One may see a chest x-ray pattern with upper lobe cavity disease, reminiscent of
tuberculosis.
Protozoal diarrhea:
Cryptosporidium is a well-known cause of Diarrhea in animals and may cause a selflimited Diarrheal infection in the immuno competent host. It is spread through fecal-oral
Conceptual study of Bhutabhishangaja Ojokshaya 40
viremia increase during active tuberculosis and successful treatment of tuberculosis causes
plasma viremia to fall back to baseline levels. Given the fact that, in contrast of HIV infection,
with M. tuberculosis can be spread via respiratory droplets and close, non-sexual contact,
this epidemic of tuberculosis probably represents the greatest health risk to the general
public and the health care profession associated with the HIV epidemic.
Tuberculosis may be the earliest clinical sign of HIV infection. Patients present with
fever, cough, and dyspnoea on exertion, weight loss, night sweats and a chest x-ray
revealing cavity apical disease of the upper lobes.
Disseminated disease is more common with low CD4+T cell counts.
Viral infections:
Herpes virus infection: Human herpes virus infections present substantial problems
throughout the course of HIV infection. Among the members of this group that are
particularly disabling of patients with HIV infection are CMV, Herpes simplex viruses,
Varicella zoster, Epstein Barr virus and HIV-8.
Cytomegalo virus infections: Retinitis, esophagitis, and colitis are the most
common manifestations of CMV infection in-patients with AIDS.
Treatment for Cytomegalo: Three drugs-ganciclovir, foscarrnet and cidofavir are
currently licensed for systematic treatment of CMV infection.
Herpes simplex virus infection: Infection with herpes simplex virus (HSV) in HIV
infected individuals is associated with recurrent labial, genital, and peri anal lesions. As HIV
disease progresses and CD4+T cell count declines, these infections become more frequent
and severe. Lesions often appear beefy red, are exquisitely painful and have a tendency to
occur high in the gluteal cleft.
Treatment for Herpes simplex: The treatment for severe or recurrent HSV infection
is acyclovir. For most cases, 200mg is given orally five times per day 10 to 14 days.
Conceptual study of Bhutabhishangaja Ojokshaya 42
use a commercial ELISA kit that contains antigens from both HIV-1 and HIV-2 and that will
detect either.
The most commonly used confirmatory test is the Western Blot. It takes advantage of
the fact that multiple HIV antigens, having different molecular weights elicit the production of
specific antibodies. These antigens can be separated on the basis of molecular weight, and
antibodies to each component can be detected as discrete bands on the Western Blot. A
negative western blot is one in which no bands are present at molecular weights
corresponding to HIV gene products. In a patient with positive or indeterminate ELISA and a
negative western blot, one can certainly that the ELISA reactivity was a false positive.
List of some laboratory tests concerned to HIV/AIDS
1) Specific tests
i. Serological
tests
by
ELISA,
Western
blot
and
immunofluorescence test.
ii. Antigen detection test using envelopand core proteins
of HIV by recombinant DNA techniques. (HIV P24)
iii. Virus isolation and culture in neoplastic T cell line.
iv. Polymerase chain reaction (PCR)
2) Indirect tests
a. CD4 and CD8 cell counts, reversal of CD4 to
CD8 cell ratio
b. Lymphopenia
c. Lymph node biopsy
d. Plate let count revealing thrombocytopenia
e. Increased B2 microglobulinlevels
assays generate date in the form of number of copies HIV RNA per milliliter and is positive
in >90% of patients. ALL effective forms of anti retroviral therapy to date have been
associated with a drop in levels of HIV RNA.
B2 Microglobulin levels
B2 microglobulin is an 11 Kda protein that is expressed on the surface of most
nucleated cells. Free B2 microglobulin can be measured in the serum and urine. Levels of
B2 microglobulin are elevated in a variety of conditions characterized by lymphocyte
activation and / or lymphocyte destruction among these or lympho-proliferative syndromes,
auto-immune diseases, and viral infections, including HIV infection.
MANAGEMENT OF HIV INFECTION IN PARLANCE
Prevention and controlling measures of HIV infection/AIDS
At present due to absence of preventive vaccine and curative drud, prevention and
control is the only cure for AIDS.
Counseling and Education
These are of paramount importance in providing patients with optimal overall care.
Patients must be educated about the potential transmission of their infection, including frank
discussions concerning sexual practices and sharing of intravenous needles.
The treating physician must not only be aware of the latest medications available for
HIV infection and its complications but most also educate patients concerning the history of
their illness and listen to their fears and concerns.
Education, counseling and behavior modification are the corner stones of an HIV
prevention strategy. Wide spread voluntary testing of individuals who practiced or are
practicing high-risk behavior, together with counseling of infected individuals, is
recommended. Information gathered from such an approach should serve as the basis for
behavior-modification programs, both for infected individuals who may be unaware of their
Conceptual study of Bhutabhishangaja Ojokshaya 46
HIV status and who could infect others for uninfected individuals practicing high-risk
behavior.
Antiretroviral Therapy
The cornerstone of medical management of HIV infection is antiretroviral therapy.
Suppression of HIV replication is an important component in prolonging life. Nucleoside
analogues (reverse transcriptase inhibitors) are the ante retroviral agents. Ex, Zidovudine,
Didanosine, Zalcitabine, Lamivudine, stavudine.
Among them Zidovudine was the first drug approved for the treatment of HIV
infection. Patients treated with Zidovudine had increase in lymphocyte counts, including
CD4+T cell counts, declines in circulating levels of p24 antigen and weight gain. Initial
studies indicated that elevations of CD4+T cell counts from this approach.
Non-nucleus reverse transcriptase inhibitors
The non nucleoside reverse transcriptase inhibitors interfere with the function of the
viral enzyme reverse transriptase by binding to regions outside the active site and causing
conformational charges in the enzyme that render it inactive.
Two members of this class, Nevirapine and Delavirdine are currently available for
use.
Conceptual study of Bhutabhishangaja Ojokshaya 47
Protease inhibitors
The licensure of four separate HIV-1 inhibitors (Saquinavir, Ritonavir, Indinavir and
Nelfinavir) heralded a major change in the options available for antiretroviral therapy of HIV
infection. Unlike reverse transcriptase inhibitors, which interface with cellular DNA
polymerases as well as inhibiting the transcriptase of HIV-1; the HIV protease inhibitors are
exquisitely selective for the protease enzyme of HIV-1.
Vaccines
Given the fact that human sexual behavior is extremely difficult to change, the best
hope for preventing the spread of HIV infection rests with the development of a safe and
effective vaccine. This task is extremely problematic for number of reasons including the
high mutability of virus.
AYURVEDIC PERSPECTIVE OF HIV INFECTION AS BHUTABHISHANGA OJOKSHAYA
Samannya Samprapti 71
Indulgence in above said Nidana leads to aggravation of Vata, Pitta and Kapha,
ultimately it leads to Kapha kshaya. The aggravated doshas causes damage to
Ojovahasrotamsi leading to ojo visramsa (loss of Ojaswhen), when the further advancement
of the disease process continues the Doshas vitiate Ojas, causing qualitative change in
Ojas. The further advancement of the disease leads to depletion of Ojas both quantitatively
and qualitatively.
Vishesha Samprapti
Bhootopaghata janya Ojakshaya manifests in a different manner. The infectious
organisums (Bhoota) cause cell damage and entry of pathogen to the cell (Bootopaghata) is
the hallmark of this process. These pathogen causes srotorodha, which leads to Vata
vriddhi and vitiation of other doshas. From this stage onwards the pathological processes
continue like samanya Samprapti.
Conceptual study of Bhutabhishangaja Ojokshaya 48
Bhoota + Upaghata
HIV- destruction (third stage) =Ojokshaya (complete loss of Ojas or immunity as found in
AIDS)
Rasavaha srotas and in the Rasavaha srotomoola the virus aggravate doshas to creat some
symptom which is called prakopam.
Prakopam
This condition generally occurs within 10 -30 days after exposure and resolves in 321 days. The person develops an acute flu like ill ness with a verity of symptoms and signs
including lethargy. Malaise fever sore throat myalgio anorexia sweating orthalgia headache
diarrhea nausea generalized lymph-adenopathy. This phase is called acute condition phase
because prakupita doshas come out from their place and create abnormalities.
Pasaram and stanasamsraya
After prakopa doshas migrate in others path way. Then these dosha occupy places
other than their own place and circulate in channels other than their own. This stage of
dosha is called as stanasamsrayam.
These two stages of doshas can consider as a symptomatic perio phase. The acute
condition phase followed by asymptomatic period, which may last up to 10 year after the
acquisition of infection. During this phase patient is infective and the virus can be isolated for
peripheral blood lymphocytes. The number of functions of lymphocytes sub population is
however normal. Latest period a-symptomatic phase show some so0me signs of
opportunistic infections delayed healing of minor illness.
Of course this can be considered as Purvaroopa of AIDS. During this period
progressive weight loss, mild weakness, anorexia, generalized lymph-adenopathy, and
occasionally low-grade form etc. sign and symptoms observed.
Vyakti and Bheda
Presence of signs and symptoms is called Vyakti and difference from prakriti / nature
is called Bhedam. These two parts of stages of Samprapti can be included in the
symptomatic infection phase. After the perio latency commonly manifests with weight loss
and weakness.
Accelerated weight loss in an HIV infected patient is sign of disease progression. No
specific cause of weight loss can be identified in most of the cases. Weakness and loss of
appetite are very frequently present. Fever is generally low grade may be accompanied by
night sweats and chills. AIDS patients have persistence diarrhea lasting more than one
month as one of the major complaints.
Among respiratory manifestations persistent cough of more than one months
duration is found in majority of patients. It may be due to pulmonary tuberculosis.
Pnemocytis cornii is common in western countries.
In addition to these symptoms the patient with AIDS may suffer from various
cutaneous, neurological, oral manifestations as well as tumors and lymph-adenopathy.
Upashayanupashaya 72
Depletion in Doshas and Dhatus as well as Ojas will make the person desire for such
foods and drinks, which will increases the depleted one. The foodstuffs so desired are called
Upashaya. E.g. Sneha, Sheeta and Madhura Rasa yukta dravyas like milk, sugar, ghee etc.
the Dravyas having opposite qualities like ruksha, Ushna, Katu and Kashaya Rasa Dravyas
are Anupashaya.
Vyavachedaka Nidana
It is also possible that Lakshanas of Visramsa /Vyapat/Kshaya may be felt in various
other clinical conditions apart from Ojokshaya. Sannipataja Jwara, Vishama jwara.
Rajayakshma and Kshata ksheena are the differential diagnosis of Ojokshaya.
Samprapti ghataka
Nidana-
Dosha-
Dushya-
Srotus-
All srotus
Srotodusti prakara-
Adhistana-
Sarva shareera
Agni-
Rogamarga-
Madyama rogamarga
Satwa-
Heena
Bheda-
Raktaja vyadi
Vyadhiswaroopa-
Chirakari
Swabhava-
Dharuna
Sadhya-sadhyata-
Anupakram
Udbhava sthana-
Manas dosha -
In Prameha Nidana Charaka has explained the reasons for absence of disease and
causation of disease.
According to particular features of Aetiology, Doshas (innate pathogenic factors),
Dushyas (substratum of pathos) response occurs in the form of non-manifestation or other
wise of disorders.
That When these three factors do not combine together, or if combined together after
a long time, or informed or with out all the said symptoms. On the contrary the result will be
contrary. 73 Here the Vighata bhava as said by Charaka is innate immunity.
Conceptual study of Bhutabhishangaja Ojokshaya 52
Roopa (symptomatogy)
Charaka has described the Ojokshaya lakshanas as follows 74
Bhaya beeta (frightened)
Dowrbalya (severe fatigue)
Abheekshna (stress full)
Duschaaya (lost of luster)
Ruksha (ematiated and dry)
Vyatitendreeya (loss of sensory and motor functions)
Durmana (sorrowful)
Kshama (inability to talk)
Ojovardhaka Chikitsa
For the treatment of patients with HIV infection the physician requires not only a
comprehensive knowledge of the disease processes, but also the ability to deal with the
problems of a chronic, life-threatening illness. Specific antiretroviral therapy and
antimicrobial treatment and prophylaxis are critical measures in prolonging an acceptable
quality of life.
Since the disease is aggravated with the loss of immunity, the main theme of is to
increase Ojas in the body. The therapies used in Ayurveda for the same are 1) Rasayana (Rejuvenation therapy), which restores and prevents, the loss of
mental power, the loss of efficiency of functioning of sense organs, dimension of mental
vigor, and restoring of normal balancing of three Doshas establishing the most effective
interaction between the seven body constituents recovering the vitality.
2) Vajikarana (Aprodiasic therapy) helps to increase the physical potency and Oja,
vitality through increasing the quantity of Shukra dhatu, the last vital product of the seven
body constituents.
Conceptual study of Bhutabhishangaja Ojokshaya 53
Drug Review
The combinations for the evaluation in Bhutobhishanga Ojokshaya considered
are as follows in two groups. The first group patients receive Bilvadi vati fortified with
Agnikumar vati called as in the trial as Ojokalpa Rasayana, collected from the
Sahasrayoga. The second group receives Amrita kayakalpa Rasayana a patient
medicine available from market prepared from Amrut pharmaceuticals, Hyderabad.
Drug review of Bhutabhishangaja Ojokshaya 55
Ojokalpa Rasayana
The combination and proportions of Ojokalpa Rasayana is as follows:
Table -1
Sanskrit name
Latin name
Proportion
Bilva
Aegle marmelos
Three parts
Tulasi
Ocimum santum
Three parts
Haridra
Curcuma longa
Three parts
Daru Haridra
Berberis aristata
Three parts
Devadaru
Cedrus deodaru
Three parts
Shunti
Zingiber oficinalis
One part
Maricha
Pipper nigram
One part
Pippali
Pipper longum
One part
Amalaki
Phyluntus emblica
One part
Haritaki
Terminalia chebula
One part
Vibitaki
Terminalia bilirica
One part
Karanja
Pongomia glabra
Three parts
Tagara
Valerana wullichi
Three parts
Vidanga
Embelia ribes
Three parts
Saussurea lappa
Vacha
Acorus calamus
Musta
Cyperus rotundus
Vatsanabha
Aconitum ferox
Maricha
Pipper nigram
Goat Urine
Three parts
Q.S.
5mg
2. Mandurabhasm
5mg
3. Purnachandrodaya makardwaj
5mg
5mg
5. Lauve bhasma
5mg
6. Vangabhasma
5mg
7. Yashadabhasma
5mg
8. Jayapala
10mg
9. Jatiphala
2mg
10. Vidarikanda
50mg
11. Ashvaganda
25mg
12. Katukia
15mg
13. Punarnava
15mg
14. Gokshura
15mg
15. Shankpuspi
20mg
20mg
17. Pippali
40mg
18. Shatavari
Q.S
19. Milk
Q.S
Table-2
Guna Karmas of each drug of Ojo kalp Rasayana
Sanskrit name
Botanical
Name
Guna
Rasa
Veerya
Vipaka
Bilva
Aegle marmelos
Ruksha Laghu
Kashaya, Tikta
Ushna.
Katu.
Tulasi
Ocimum
Laghu, Ruksha.
Katu, Tikta.
Ushna,
Katu,
Rooksha,
Tikta, katu,
Ushna.
Katu.
santum
3
Haridra
Curcuma Longa
Laghu.
4
Daru Haridra
Berberis
Ruksha, Laghu,
Tikta, Kashaya,
Ushna,
Katu
Devadaru
Cedrusdeodaru
Laghu, Snigda.
Tikt katu.
Ushna.
Katu.
Shunti
Zingiber
Guru,
Katu,
Ushna,
Madhura
Oficinalis
Teekshna
Pipper Nigram
Laghu,
Katu.
Ushna.
Madhura.
Katu.
Anushna-
Madhura.
Mareecha
Ruksha
Teekshna.
8
Pippali
Pipper Longum
Laghu snigdha
Teekshna.
9
10
Amalaki
Haritaki
sheeta.
Phyluntus
Laghu, Ruksha,
Lavana
varjit
Sheeta.
Madhura.
Emblica
Sheeta
Pancha rasa
Terminalia
Laghu, Pramati
Lavana
Ushna,
Madhura.
Chebula
Ruksha,
Pancha rasa,
Ushna
Madhura,
Katu,
Ushna
Katu
Katu,
Ushna,
Katu,
Ushna,
Katu.
Ushna,
Katu,
varjita
lekhani,
11
Bibitaki
Terminalia
Ruksha, Laghu
Kashaya,
Pongomia
Laghu,
Tikt,
Glabra
Teekshna
Kashay
Valerana
Laghu, Snighda
Tikta,
Bilirica
12
13
Karanja
Tagara
wullichi
14
Vidanga
Embelia Ribes
Kashaya
Ruksha, Laghu,
Katu
Teekshna
15
16
17
Kusta
Vacha
Vatsanabha
Saussurea
Laghu, Ruksha,
Tikta,
Katu,
luppa
Teekshna,
Madhura
Acorus
Laghu, Teeksn,
Tikt, Katu
Ushna,
Katu
Calamus
Sara,
Aconitum ferox
Ruksha, Laghu
Madhura.
Ushna,
Madhura,
Sheeta,
Katu,
Ushna
Madhura,
Teekshna,
Vyavai, Vikashi
Yogavahi,
18
19
Musta
Ajamootra
Cyperus
Laghu, Ruksha,
Katu,
Tikta,
Rotundus
Grahi,
Kashaya,
Goat urine
Ruksha, Laghu,
Katu, Madhura,
Teekshna,
Tikta
2.395% w/w
2.
Ash value
7.68% w/w
3.
0.338% w/w
4.
5.
Solubility
6.
7.
8.
a.
Mayers test
Positive
b.
Hagers test
Positive
Test of CArbohydrates
a.
Molish test
b.
Benedicts test
c.
Barfoedits test
0.4828 grams.
Dose
Anupana : Jala
75,
Grahani
76
78.
Antidiarrahoeal activity 80
Anti periodic Anti` catarrhal Fragrant and Aromatic used in Skin disease
Chemical compositions: -1% of volatile oil, Resin, Cur cumin is responsible for its
colour; Turmeric oil has a peculiar odour and taste. Curcumene, Curcumenone, curcone,
curdione, cineole, cineole, curzerenone, epiprocurcumenol, eugenol, camphene,
camphor, borneol, procurcumadiol, procurcumenol, curumins, ukonan A,B andD, sitosterol etc.
Karma:- Raktashodhaka, Twagdoshahara, Shothahara, Deepana, Grahi, Kaphagna,
Vatahara,
Pratishyaya,
Netrabhishanda,
Prameha,
Kaphaghna,
Kamala,
Yakritvikara,
Paryayika
jwara,
It was found that the antibacterial activity of C. longa against gram positive and gramnegative organism was less in degree as compared to penicillin and streptomycin 91
1.A clinical trial with C. longa was conduced in 114 patients of respiratory disease 94
The anti-inflammatory effect of volatile oil has been found to be greater than that of
hydrocortisone 95.
Three curcuminoids (curcumin I,II, III) were compared for their cytotoxic, tumor
reducing and anti-oxidant activities. Curcumin III was found to be more active than
Drug review of Bhutabhishangaja Ojokshaya 61
the other two in short term cytotoxic activity but inhibited the growth of tumor cells
(L929) in culture at similar concentration (IC 50-1 g. /ml). The curcuminooids also
inhibited lipid peroxidation. The amount needed for 50% inhibition was 20,14,11
micro/ml for curcumin I, II and III respectively 96.
4) Daru Haridra (Berberis)
Synonyms: - Daru nisa, Pita daru, Pacampaca, Katankateri, Parjani, Darvi
Chemical compositions: - B. Aristata Karachine (a protoberberine alkaloid),
taxilamine, berberine, palmatine, jatrorrhizine, and oxycanthine.
C. Fenestratum Berberine, berberrubine, jatrorrhizine. Palmattine, berlambine,
oxypalmatine etc,
Karma: - Balya, Poushtika, Deepana, Pachana, Grahi, Pittavirechaka, Jwarahara,
Swedala, Shleshmaghna, Phiranga, Apachi, Rasayana, Twagdoshahara, Vishamajwara,
Kupachana, Gandamala, Bhagandar, Pradar, Prameha, Pandu, Krimi, Peenasa, Meda
Rasayana Raktagami Used in Eyes liver Spleen and skin
97
The alcoholic extract of the stem was found to have anticancer activity against
human epidermal carcinoma of the nasopharynx in tissue culture 101
Drug review of Bhutabhishangaja Ojokshaya 62
Sandhivata,
Swasa, Kasa, Hikka. Pratishyaya, Samanyanda Sannipata Jwara, Jeerna Jwara, Kushta,
Pandu, Amavata, Vata Kapha hara, use in Vibhanda, Vrishya, Varnya,
Vamana,
Hridhya, Shoola, Slipada, Anaha,Udara, Seeta pitta, Grahani vikara, Guda keela hara,
Atisaara, 102 Jaladosa 103 Pratisyaya 104, Kaphaja Arasa 105, Murcha 106
Research works It has shown marked anti-inflammatory activity in rats, which is comparable to
prednisolone 107
The alcoholic extract showed some significant activity against E. coli, Proteus
vulgaris, S. typhimurium, Stap. Aurens and strep, Viridans 109
In a clinical study on Grahani roga, the effect of Z. officinale has been found
significant in term of control of number of motions, improvement of body weight,
appetite, Hb% etc 111.
Acetone extract of ginger (100 mg/kg) significantly reduced serotonin (5-HT)- induced
hypothermia. At 750 mg/kg it significantly inhibited 5-HT-induced diarrhea 112.
A single case report (42F) on migraine headache reveals the efficacy of Z. officinale
in this condition 113.
Ginger juice produces anti-motion sickness action possibly by central and peripheral
anticholinergic and antihistaminic effect 114.
Shunthi was put to trial on 111 patients with Ghrahani roga. The effect of the
treatment was observed with in a short period. The regulation of bowel habits,
improvement in general health including anemia and body weight and improvement
in GL function was noted 115.
The aqueous extract of ginger arrested with growth of M. tuberculosis in vivo 117.
called chavicin, starch, oil, gum, fats 1%, protein 7%, and alkaloids 4%,
Research works
The fruit extract respond to be inhibitory to each. Coli, Acrobactor aerogens, L casei,
Staph, Faecalis, Staph, Aureus and Sh. Sonnei123,
The Essen. Oil inhibited vib, Cholerae, staph, Albus, C, Diphtheriae, Sh,
Dyscenteriae, Pr. Pyogener, strep pyogenes etc, 124.
Essential oil also inhibited B. subtilis, Stap aureus, Sal, Typhi, Sal, Paratyphi and
pestalotia Sp, 125,
Essential oil reported to be anti-fungal against Trich. Terrestre. Can. Albicans. Asp.
Niger etc. 126.
The crude extract of P. longum and piplartine suppressed the ciliary movements of
the esophagus of frog. These findings suggest that its efficacy could be due to
suppression of cough reflex 135.
The milk extract was report to increase the rate of respiratory flow 137
Significant effect in controlling the frequency and severity of the asthmatic attack was
observed with P. longum powder in a clinical study 139.
Research works
Anti-microbial activity- Emblica fruit found to have very potent anti-bacterial activity 144
Antioxidant activity- the long-lived belief that the therapeutic effect of Amla is due to
its rich vitamin C (L-ascorbic acid) content has thus been dispelled. The patent
vitamin C-like activity (antioxidative effect against reactive O2 species, Ros) of Amla
Drug review of Bhutabhishangaja Ojokshaya 66
fruits has now been located in the Low Mr (Mol. Wt. Less than 1000) hydrolysable
tannins. Four such compounds, emblicanin-A (1), emblicanin- B (2), puniglucomin
and penduculgin, have been isolated from the fruit pericarp 146.
Hepatoprotective activity- Dry powdered pulp of fruits (1.0g/kg) reduced the levels of
serum, aortic and hepatic cholesterol significantly in rabbits 147.
vitamin C. Fruit kernel arachidic, behenic, lindeic, oleic, palmitic and stearic acids.
Karma: -Tridoshahara, Mukharoga, Arsha, Kamala, Yakrit Pliha, Krimi, Balapradhan,
Raktavikara, Pratishaya, Kasa, Swarabheda, Hikka, Kustha, Visarpa, kamalahara,
Twagsdoshhara, srotogamitva, vatanulomini, Medhya, Vatarakta hara, klibhya hara
149,
Study of in vitro antibacterial activity of extracts from the plants of T. chebula, E. Alba
and O. sanctum was carried out by the disk diffusion technique. All showed such
activity against human pathogenic Gram positive and Gram-negative bacteria. The
activity against Salmonella organisms was shown only by T. chebula; against shigella
organism by T. chebula and E. Alba, but not by O. sanctum. The widest spectrum of
antibacterial activity was shown by T. chebula. It was also most potent 150
Drug review of Bhutabhishangaja Ojokshaya 67
Various extracts prepared from the powdered fruits have been wide antibacterial and
anti-fungal spectrum 151.
It also inhibits growth of E. coli, the most common organism responsible for urinary
tract infection 152.
Ether extract showed higher antioxidant activity than BHA and BHT. Acid esters
present in phenolic fraction of extract were found most effective 153,
46 children with diarrhea wee given T. chebula and T. vulgare decoction. 57.17%
children were cured within 3 days of treatment 154.
Research works Out of 93 cases of cough and astma treated with T. bellerica, 22 showed complete
relief, 27 were significantly relieved, while 35 cases were moderately relieved. The
drug exhibited bronchodilatory, antispasmodic and antiasthamatic activities 159
The HIV-1 protease (PR) inhibitory activity was determined by using the fruit peal
methanol extract 160
T. Bellerica showed significant activity against both gram positive and gram-negative
bacteria. In addition it showed anti-fungal activity also 161.
12) Karanja (Pongomia Glabra)
Synonyms: - Karaja, Cirabilvaka, Naktamala, Gucchapuspaka, Ghrtapura, Snigdhapatra
Chemical compositions: - Fruit is having Pongamia oil 27-39%, Karangin, which is
Jantughn,
is
present.
Pongamol.
Karanjin,
pongapin,
3-methaoxypongapin,
The essential oil from leaves showed marked in vitro antibacterial activity against B.
antharcis, Ps. Mangiferae, sal. Typhi, B mycoides, B pumilus, Esch Coli, Sar, Lutea,
Stap, Aureus, Staph, Albus etc. 163.
The oil of P. pinnate showed antibacterial activity against several organisms 164
Drug review of Bhutabhishangaja Ojokshaya 69
The essential oil from P. Pinnata showed mild anti-fungal activity 166.
Swapakaraka,
Vatanulomana,
Vedanastapaka,
Vranaropaka,
alpha
cyclocostunolide,
sitosterol,
sesquiterpenes,
Ar-curcumene,
169
Unmada
50
weight 178.
17) Vatsanabha (Aconitum ferox)
Synonyms
Amrutam,
Ugravisha,
Garalam,
Nagam,
Nabhi,
Mahoushadha,
179-187
188,
pseudoacontitine (Manske and Rodrigo, 1979). Two new alkaloids 2 (IH)- quinolinone
and 3,4- dihydro-6-hydroxy 2 (IH)- quinolone189. A new diterpenoid alkaloid 14-0
acetylsenbusine A; Vakognavine, Chasmaconitine, crassicauline A. falconericine,
bikhaconine, pseudoaconine, neoline, senbusine A. neoline, senbusine B, isotalatizodine
and
aconine
are
reported
190.
Four
lipoalkaloids
viz.,
liposeudo
aconitine,
192.
The
writhing response induced by acontine has been used for the measurement of analgesic
activity. The characteristic pattern of aconite-induced writhing response in albino mice
has been found to be similar to that induced by bradykinin. Acontine-induced writhing
response was found to be quicker than that induced by bradykinin, it lost for a longer
period and was consistently observed at 2 mg dose level. Analgesic agents 193 blocked
the response.
18) Musta (Cyperus Rotundus)
Synonyms: - Krodesta, Hima, Sugandhi, Varida, Gundra, Gangeya, Ghana, Megha,
Abda, Krodesta, Hima, Sugandhi, Varida, Gundra, Gangeya, Ghana, Megha, Abda.
Chemical compositions: -Cineol (+) copadiene, capaene cyperen I and II, cyperenone,
isopatchoulenone, cyperotudone, cyperol, cyperolone, -cyperone, copaene, cyperen I
and II, cyperenone, isopatcoulenone, cyperotundone, cyperol, cyperolone, cyperone,
(+) epoxyguaiene, isocyperol, isokobusone, kobusone, muystakon,e patchulene, (+)
rotundone, and -selinene, sugenul, -sitosterol etc.
Drug review of Bhutabhishangaja Ojokshaya 72
201
. A long healthy life has been the cherished wish of man since ages, but
often many challenges are posed to this in the form of grave diseases. Ayurveda is able to
provide good health care by effectively managing the diseases from time to time 202.
Ayurveda describes a number of drugs with the proven or proposed immuno
modulating and immuno potentiating activities
203
many herbs have drawn the attention of the scientists to study the effect of Ayurvedic drugs
in HIV infection. A number of herbal drugs have been individually evaluated in the treatment
of HIV and AIDS related complex (ARC)
204
infected by HIV would have crossed 50 million and till now there were 12 million deaths due
to AIDS in entire world. In India since the detection of HIV infection in 1986, the epidemic
has been frankly out of control. As of now an estimated 4 to 6 million HIV infected cases are
present in India.
The present study is designed to assess the therapeutic effect of Ojokalpa
Rasayana in HIV infected patients, which could be a safe, effective and economical drug
and compared with the market available Amrut Kaya Kalpa Rasayana
205
, which claims as
immuno-modulator.
Ojas is the essence of all Dhatus and also called as Bala, which is responsible for
Vyadhikshamatva or immunity against infections
206
depleted is called Ojokshaya. Susruta explained the stages of the depletion of Ojas as Ojovisramsa, Ojovyapat and Ojokshaya 207.
quantitative lessening of Ojas. Ojas, the essence of all Dhatus, controls the vital functions
and immuno regulation. It is classified in to two types i.e. Para and Apara, out of which
Astabindu (Para) Ojas is depleted by the infection 208.
The symptomatology of the HIV infection resembles that of Ojokshaya. Clinical
stages of HIV infection is classified in to five stages on the basis of CD4 count. The anti
retro-viral drugs available now, act at different levels of the stages of the life cycle of HIV
and the combination therapy of them has shown to prolong the life span and to decrease
opportunistic infections and to increase CD4 cells count.
Ojokalpa Rasayana is an herbo-mineral compound rationally formulated on the
basis of Immunomodulatory effect, Antiretroviral and Antioxidant properties, Krimiharatwa
i.e. germ (Virus) killing property along with Rasayana (Tissue nourishment). Individual and
cumulated properties of yoga is carefully thought about from Bilwadi vati
Sahasrayogam added with Agnikumaravati
210
209
of
1 Part
1 Part
1 Part
1 Part
1 Part
1 Part
1 Part
1 Part
9. Trikatu 219
1 Part
1 Part
1 Part
222
is as
follows.
Swarna Bhasma
1 mg
Makaradhwaja
2 mg
5 mg
5 mg
Vanga Bhasma
5 mg
Yashada Bhasma
5 mg
Moti pisti
5 mg
5 mg
Swarnamakshika Bhasma
5 mg
Jayaphala
10 mg
Shankhapushpi
20 mg
Ashwagandha
25 mg
Vidarikanda
50 mg
Katuki
15 mg
Punarnava
15 mg
Gokshura
15 mg
Yastimadhu
20 mg
Pippali
40 mg
Milk
Q.S.
Shatavari Kashaya
Q.S
b) Patients: Patients with Ojokshaya (HIV +ve) will be selected from O.P.D. of Post
Graduation and Research center of Sri D.G.M. Ayurvedic medical college & Hospital,
Gadag by preset inclusion and exclusion criteria.
The patients are included in the study after obtaining the informed
consent.
The identity of all the patients are kept confidentially.
All Patients undergone individually and couples together for special
counseling sessions before and after serological investigations and
periodically during the course of treatment.
2. The patients having diabetes mellitus and other systemic diseases will be
excluded and the patients with concomitant therapy will be excluded.
d) Inclusion criteria
1. The patients with the HIV infection diagnosed by serological test and Western
blot method will be taken in the study.
2. CD4 count ranging from 200 to 500/cu.mm.
3. Karnofsky Performance score 50 and above.
4. The patients are selected irrespective of Sex and race based on the clinical
signs & symptoms other than that of exclusive criteria,
e) Posology: 3-gm/24 hours or 50mg/Kg-body weight in divided dose orally
f) Study duration: 120 days
g) Follow up period: 60 days
h) Assessment of result: subjective as well as objective parameters are assessed.
1. General health condition (Grade)
2. Karnofsky performance score
3. Body weight.
4. Total WBC count.
5. Total count platelets.
6. Total count lymphocytes.
7. Erythrocytes sedimentation rate.
8. CD4 cell count
9. CD8 cell count.
10. CD4 : CD8 ratio
For the assessment grades were fixed depending upon the condition.
Overall assessment is made taking into consideration both subjective and
objective parameters.
Score range
Best responded
8 to 11
Moderately responded
5 to 8
Responded
2 to 4
0&1
cell count assay is conclusive of CDB cell count, total platelet count. CD4 cell count assay is
inclusive of CD8 cell count also. All the investigations are repeated after three months of trail
medication. Those patients who had respiratory system symptoms were investigated
radiological.
1. Screening tests
: Tri-dot
2. Confirmatory tests
: Western Blot
3. Other tests
In this clinical study a total of 26 patients were reported either with known HIV status.
Those who indulged in risk factors of HIV infection also reported. Outs of all patients were
serologically diagnosed as having HIV infection. HIV status and intake of concurrent
therapy, A total of 18 patients were enrolled in this study as they fulfilled the inclusive
criteria. Out of these 26 patients 8 patients dropped out, during the trial study for various
reasons including subsequent diagnosis of opportunistic infections. Remaining 18 patients
have completed the total treatment schedule and follow up.
Total patients reported
26
26
Excluded
Initially included
Withdrawal
Each and every data pertaining to every patient was recorded in a well-designed
case taking perform. The final data is divided into 3 sections for better analysis and
convenience of observation.
1.
2.
3.
GROUP -1
Age (Years)
GROUP -2
20-30
Number of
patients
7
31-40
11.12
44.45
41-50
11.12
Total
%
77.77
Number of
patients
5
55.55
Maximum patients with ailment were found in 20-30 years group i.e. 7 (77.77%) in
group-1 and, (55.55%) in group-2. 31-40-age interval in-group-1 patients are 1 (11.11%) and
4 patients (44.44%) in group-2. And 41-50 age group observed with 1 patient (11.11%) in
group-1 and no patients in group-2 (0%). The data collected in the trail resembles with
international observations of HIV incidences in different age groups.
Graph -1
8
7
6
5
4
3
2
1
0
7
5
4
1
0
20-30
31-40
41-50
GROUP-1
GROUP-2
GROUP-1
Sex
Male
Female
Number of
patients
6
3
GROUP-2
%
66.66
Number of
patients
6
%
66.66
33.33
33.33
Maximum patients in this study are men and male verses female ratio is 2:1. This is
contradictory to the Indian data sex incidence. Which 1:1 this various can be due to the male
dominance in the local society with rural and illiteracy background. This observation
suggests that the lack of freedom and social stigma for female in India.
Graph -2
10
8
6
Female
4
6
GROUP-1
GROUP-2
Male
2
0
3) Diet incidences
Table -5
Sl no
Parameters
GROUP-1
Vegetarian
Number of
patients
0
Mixed diet
Total
GROUP-2
%
Number of
patients
0
100
100
In the study incidence among people of two different food habits, it was interesting to
note that all the patients (100%) consume mixed diet. But is also interesting to note that not
even a single vegetarian subject was seen in this study. As Ayurvedic concept speaks about
the role of predisposing factors, there must be a physiological or psychological impact of
non-vegetarian food that may be having a role to play in high incidence of HIV among nonvegetarians populations. And in further it was observed that patients who avoid nonvegetarian food during treatment improved a lot and deteriorated as they start consumption
of non-vegetarian food.
Graph -3
10
8
6
4
Mixed diet
Vegetarian
0
GROUP-1
GROUP-2
4) Religion incidences
Sl no
Table -6
GROUP-1
Religion
GROUP-2
Number of
patients
Number of
patients
Hindu
77.77
100
Muslim
22.23
Christian
Others
Total
10
9
7
8
6
4
0 0
0 0
th
er
s
GROUP-2
n
Ch
ris
tia
m
us
li
M
in
du
GROUP-1
5) Economic incidence
Table 7
S. No
GROUP-1
ECONOMIC
STATUS
Number
GROUP-2
%
Number
of patients
of patients
Poor
33.33
44.44
Middle Class
55.55
55.55
Higher Middle
11.11
Higher
Total
The maximum patients were in middle class 5 patients (55.55%) in each group of 1
and 2. Economically poor or B.P.L. patients are 3 (33.33%) and 4 (44.44%) in groups 1 and
2. Very less i.e. only one patient (11.11%) reported in higher middle class of group-1. It
doesnt reveal the clear status of economical status verses infection because the study was
made at district level and that too in small sample. It also reflects the easy acceptance of
infection to middle class and B.P.L. Class patients, as they are economically not strong to
consume immuno-potent food.
Graph 5
6
5
Poor
Middle Class
Higher Middle
Higher
2
1
1
0 0
0
GROUP-1
GROUP-2
6) Occupational incidence
Table - 8
Sl no
OCCUPATION
GROUP-1
GROUP-2
Sex Worker
Driver
11.11
Businessman
22.22
22.22
Service / Agriculture
33.33
44.44
Student
House wife
33.33
33.33
Total
5
4
3
2
1
Sex W orker
Driver
Businessman
Service
Student
House wife
1
0
0
0
0
GROUP-1
GROUP-2
Marital Status
Group-1
Group-2
Married
Single
Divorced
Widower
2 Or 3 Marriages
Total
It is observed that the extramarital affairs are more in the married people. Neither
divorced nor widowers are reported with the HIV infection. In the study related to disease,
maximum number of male patients (100%) got the infection from heterosexual contact. This
data coincides with the international data. Women usually come in contact with disease
through their husbands. Even though the incidence charges are more among the patients
who got it from blood transmission or intra-venous injections, in almost got it with
heterosexual contact. It evidential for the high risk unsafe heterosexual practices in India.
Graph -7
9
8
7
6
5
4
3
2
1
0
8
Married
Single
Divorced
W idower
2 Or 3 Marriages
1
0 0 0
Group-1
0 0 0
Group-2
8) Source of infection
Table - 10
Sl
Infections
Before
After
Before
After
Anashana
Alpashana
Rooksha
Ahara
Pranita Ahara
Vatatapa Sevana
Ati Vyayama
Ati Vyavaya
Shonita Ativartana
10
Hetero Sexual
11
Prajagar
12
Kapa
13
Shoka
14
Chinta
15
Bhaya
16
Bhootopaghata
no
1(11%)
Bhootopaghata
9) Chief complaints
Table -11
GROUP-1
Sl, no
Complaints
Loss Of Weight
General Weakness
Before
Group-2
After
Before
After
Loss Of Appetite
Fever
Loss Of Complexion
Emaciation
Looseness Of Joints
Somnolence
10
Delirium/Conversion
Complaints
Group 2
Before
After
Before
After
Bleeding Gums
Pain Abdomen
White tongue
Hairy tongue
Cough
Breathlessness
10
Headach
11
Skin Eruption
12
Morlascum
13
Herpes Zoster
14
Giddiness
15
Palpitation
16
Burning Micturation
17
Diarrhea
18
Anal Itching
19
Cymphodenites
Group -2
OPD No
Before
After
Difference
OPD
Before
After
Difference
216
14.2
12.8
-1.4
412
10
14
318
10.5
13
2.5
576
12.8
13
-2
561
10
10.8
0.8
4180
14.6
13
-1.6
2726
12
7.2
-4.8
5050
10.4
10
0.4
2784
11.0
7.0
-4
6421
12
13
3187
13.8
12.9
-0.9
6614
6.8
10.8
3427
13.5
11.0
-2.5
7187
12
11
-1
3434
12.8
13
0.2
8274
13.2
15
1.8
7221
10.2
10.2
8275
13
14
1.81
108
97.9
104.8
113.8
Group - 2
OPD No
Before
After
Difference
OPD
Before
After
Difference
216
10
24
14
412
33
15
-18
318
30
32
576
25
25
561
40
68
28
4180
10
28
18
2726
25
82
57
5050
10.5
20
9.5
2784
20
64
44
6421
30
20
-10
3187
80
16
- 64
6614
38.1
35
-3
3427
80
38
- 42
7187
50
35
-15
3434
28
22
-6
8274
60
32
-28
7221
70
30
- 40
8275
77
24
-53
383
376
333.6
234
ESR of 1st hour measurement decreased in 4 patients (44.44%) in1st group and 6
patients (66.66%) in 2nd group. This is a good prognosis for the patients. 5 (55.55%) patients
of group-1 and 2 patients of group-2 show increase in the E.S.R., which is a bad prognosis.
One patient (11.11%) in the group-2 shows no change. But both groups exhibit decrease in
the mean values.
Group - 2
OPD
Before
After
Difference
OPD
Before
After
Difference
216
3300
3500
200
412
900
2300
400
318
2200
4400
2200
576
1500
1000
-500
561
1100
1100
4180
1800
1700
-100
2726
1200
1000
-200
5050
1700
1463
-237
2784
1470
1300
-170
6421
1700
2400
700
3187
2600
2300
-300
6614
900
1000
100
3427
1400
1000
-400
7187
4600
3500
-1100
3434
1900
4000
2100
8274
2300
2550
250
7221
3200
2900
-300
8275
2700
2800
100
18370
21500
18100
18713
Group - 2
OPD
Before
After
Difference
OPD
Before
After
Difference
216
8.2
7.8
-.4
412
6.5
8.3
1.8
318
5.8
7.5
1.7
576
8.9
7.5
1.4
561
5.6
5.6
4180
7.5
8.7
1.2
2726
6.3
4.9
-1.4
5050
13.5
6.2
-7.3
2784
10.7
9.6
-5.1
6421
10
8.7
1.3
3187
8.9
5.0
-3.9
6614
8.0
6.2
-1.8
3427
7.3
7.5
.2
7187
10.1
9.0
-1.1
3434
8.2
6.3
-1.9
8274
6.9
6.8
-1
7221
8.9
9.8
.9
8275
8.8
8.9
2.1
Total
69.9
64
80.2
70.3
It is significant that the viral activity is more in the samples and the fighting against
the infection is continuous. Thus the WBC counts doesnt show marked changes. Both
groups express the reduction in the mean values as minimum, which could be a good
prognosis.
Group - 2
OPD
Before
After
Difference
OPD
Before
After
Difference
216
60
61
412
46
51
318
58
61
576
64
67
561
40
44
4180
65
66
2726
50
54
5050
48
53
2784
56
58
6421
51
52
3187
45
47
6614
37
40
3427
58
60
7187
56
61
3434
45
45
8274
73
73
7221
53
54
8275
57
61
Total
465
484
497
524
All the patients in the group-1 exhibit 1-2 Kg increase and group-2 even up to 5-Kg
weight increase. This is a good prognosis and expresses that the patient recovery is started.
Usually in the HIV+ves weight loss is a sign reversed with the present management. This
variation may be due to the various factors, including inclusion of proteins in the food and
Agni vardhaka herbs in the formula.
Group - 2
OPD
Before
After
Difference
OPD
Before
After
Difference
216
2.05
2.14
0.9
412
1.5
1.52
.02
318
1.94
1.30
-.64
576
2.6
1.81
-.8
561
1.43
1.49
.06
4180
2.3
2.22
-.8
2726
1.07
1.26
.19
5050
1.95
2.10
+15
2784
2.23
2.60
0.37
6421
3.0
2.63
-37
3187
2.05
2.0
-.05
6614
1.36
1.20
-.16
3427
.81
1.5
+. 69
7187
2.5
3.5
1.5
3434
2.41
2.82
.41
8274
2.13
2.55
.42
7221
2.15
2.18
.03
8275
2.69
2.56
-.13
16.14
17.29
20.03
20.09
. Both groups express the reduction in the mean values of Platelet counts as
minimum, which could be a good prognosis.
Group - 2
OPD
Before
After
Difference
OPD
Before
After
Difference
216
90
90
412
80
90
10
318
80
90
10
576
90
90
561
90
90
4180
90
90
2726
80
90
10
5050
80
90
10
2784
80
90
10
6421
80
90
3187
80
90
10
6614
80
90
10
3427
80
90
10
7187
80
90
10
3434
90
90
8274
90
90
7221
80
90
10
8275
90
90
750
810
60
760
810
40
Kornefsky grade: - 6 (66%) increased by 10 grades and 3 (33%) were static in 1st group, 4
(44%) increased by10 grades and 5 (55%) were static in 2nd group. Kornofsky performance
score (KPS) is a widely accepted parameter for evaluation of HIV-AIDS. All patients (100%)
in this study have crossed the score 90, and none has reached score 80. This data is better
than Alka Despande study 1998. It interesting to note that, Despande administered the drug
for 1 year and the mean was 89, where as in this trial drug was administered for four months
and the mean KPS is 90 and 88. Therefore this drug is capable of controlling the
opportunistic infections, which indirectly helps for raise in CD4 cell count.
Group - 2
OPD
Before
After
Difference
OPD
Before
After
Difference
216
+1
412
318
+1
576
561
4180
2726
+1
5050
2784
+1
6421
3187
6614
3427
7187
3434
8274
7221
8275
13
20
15
22
General health condition: -7 (77%) increased and 2 (22%) static in both groups by 1 grade,
There was a significant improvement in GHC of all the patients, from lower grade to upper
grades like grade 2 and grade 3 after medicatioin. This result is quite similar with K.
Rajagopal
226
227
in general health condition may be due to the reduction in viral load, in plasma and reduction
in the viral replication.
Group 2
OPD
Before
After
Difference
OPD
Before
After
Difference
216
590
650
60
412
310
530
220
318
510
700
190
576
460
310
-150
561
320
320
4180
440
510
70
2726
410
310
-100
5050
480
203
-277
2784
520
410
-110
6421
410
430
20
3187
510
590
80
6614
290
320
30
3427
440
320
-120
7187
718
233
-485
3434
440
610
170
8274
580
490
-90
7221
630
580
-50
8275
590
350
-210
4370
4490
4278
3376
Group - 2
OPD
Before
After
Difference
OPD
Before
After
Difference
216
1720
1800
80
412
320
1080
760
318
1030
2380
1350
576
590
390
-200
561
450
450
4180
820
680
-140
2726
430
390
-40
5050
710
899
189
2784
950
500
-450
6421
780
620
-160
3187
1110
1020
-90
6614
340
380
40
3427
540
380
-160
7187
1780
578
-1202
3434
890
2190
1300
8274
1030
840
-190
7221
1610
1420
-190
8275
1300
320
-980
8730
10530
7670
5787
CD 8 cell count: - 5 (55%) decreased, 3 (33%) increase in 1st group, 6 (66%) decreased and
3 (33%) increased in 2nd group,
8:
groups, This may be due to fast acting drugs, having better bio-availability and perhaps due
to its potent viral action.
Group-1
Group-2
1-2 Year
Above 2 Year
Total
Out of observations it was found that maximum number of patients appear with the 2
years and above chronicity. Out of two groups together only 4 cases found 1 - 2 years of
history and/or less then one year for 4 patients. It evidential that the disease does not have
any cure but it is only palliative and to be managed with the symptoms presented by the
patient and to attend the patient for the opportunistic or AIDS related complications.
22) Observations on Ojo vyapat lakshana
Table 24
GROUP-1
SL.NO
Symptoms
GROUP-2
Before
After
Before
After
Stabdagatrata
Gurugatrata
Vata Shopha
Varna Hani
Glani
Tandra
Nidra
GROUP-2
Symptoms
Before
After
Before
After
Gatra Sadana
Doshachavanama
Sandhi Vishlesha
Kriyasannirodha
Symptoms
GROUP-2
Before
After
Before
After
Bhaya
Chinta
Dushchata
Rooksha
Moorcha
Moha
Dourbalya
Vyatitendriya
Durmaan
10
Kshama
11
Mamsakshaya
12
Pralapa
Total
Result
0
1
1
0
0
1
1
1
0
1
0
0
1
1
1
1
1
0
1
1
1
0
1
0
1
0
1
1
0
1
0
1
1
1
1
0
0
1
1
1
1
1
1
1
0
1
1
1
1
0
1
1
0
1
1
1
1
1
0
1
1
1
1
Group 2 Amritakayakalpa rasayana
1
1
1
1
0
0
1
1
0
1
0
0
1
1
1
1
0
1
0
1
1
1
1
1
0
0
1
0
0
0
1
1
1
1
1
1
1
0
1
1
1
0
0
1
0
1
1
1
0
0
1
0
1
1
1
1
1
0
1
0
1
1
1
1
1
1
0
0
1
1
1
1
Grade
Score range
Best responded
8 to 11
Moderately responded
5 to 8
Responded
2 to 4
Static / Not responded
0&1
BR= Best Responded, MR= Moderately Responded,
R = Responded, S = Static, NR = Not Responded
11.GHC
1
1
0
0
1
1
1
1
1
10.KFS
1
1
0
1
1
1
0
1
1
9.WEIGHT
1
2
3
4
5
6
7
8
9
8.RATIO
1
1
1
0
0
0
0
1
0
7.CD8
0
0
0
0
0
1
1
1
1
6.CD4
3.TLC
0
1
1
0
0
0
0
1
1
5.Platelet
count
2.ESR
1
2
3
4
5
6
7
8
9
4.WBC
1.Hb%
1
1
1
1
1
1
1
1
1
6
7
9
5
6
7
8
9
9
MR
MR
BR
MR
MR
MR
BR
BR
BR
1
1
1
1
1
1
1
1
1
9
8
7
5
10
8
7
9
9
BR
BR
MR
MR
BR
BR
MR
BR
BR
No
Parameter
Hemoglobin %
Before
12.0
Mean
S.D
S.E
t-Value
P value
Remarks
Difference
After
10.87
1.9
1.677
0.559
3.398
<0.01 Highly
significant
42.5
41.77
33.0
21.97
7.325
4.505
<0.005 Highly
2041.11
2388.89
652.22
856.3618
285.539
2.284
>0.05 Not
significant
significant
Highly
significant
Highly
significant
Highly
significant
7.766
6.667
1.722
1.731
0.577
2.984
<0.002
Platelet count
1.793
1.921
0.3711
0.317
0.1056
3.514
<0.001
485.55
498.89
97.777
59.113
19.704
4.962
<0.005
970.00
1170.0
406.66
536.702
178.9
2.273
>0.05 Not
Ratio
0.575
0.562
0.113
0.1017
0.033
3.433
<0.01 Highly
Weight
51.667
53.777
2.111
1.364
0.454
4.649
<0.005
10
83.333
90.00
6.666
5.00
1.666
4.00
<0.005
11
1.444
2.222
0.777
0.440
0.146
5.32
<0.001
significant
significant
Highly
significant
Highly
significant
Highly
significant
Parameter
Hemoglobin %
Before
11.644
S.D
S.E
t-Value
P value
Remarks
Mean
Difference
After
12.644
1.666
1.414
0.471
3.537
<0.01 Highly
significant
Highly
significant
Highly
significant
Highly
significant
Highly
significant
Highly
significant
Highly
significant
37.066
26.00
17.166
15.862
5.287
3.246
<0.02
2011.11
2079.22
387.44
336.832
112.277
3.450
<0.01
8.688
7.811
2.011
2.064
0.688
2.922
<0.02
Platelet count
2.225
2.232
0.482
0.474
0.158
3.051
<0.02
475.333
378.444
172.44
147.317
49.105
3.511
<0.01
852.22
676.333
429.00
430.85
143.616
2.987
<0.02
Ratio
0.653
0.686
0.195
0.259
0.086
2.273
>0.05 Not
Weight
55.22
58.222
3.600
1.936
0.645
4.651
<0.005 Highly
10
84.44
88.888
4.444
5.27
1.756
2.53
<0.05
11
1.666
2.222
0777
0.440
0.146
5.32
<0.001
significant
significant
Highly
significant
Highly
significant
Parameter
Hemoglobin %
Platelet count
Ratio
Weight
10
11
General health condition
group
Mean
SD
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
10.877
12.644
41.777
26.00
2388.89
2079.22
6.667
7.811
1.921
2.232
498.89
378.44
1170.00
676.33
0.562
0.686
53.777
58.222
90.00
88.88
2.22
2.22
2.3936
1.6845
23.504
7.071
1362.39
848.85
1.612
1.158
0.567
0.683
157.356
120.112
85.155
275.032
0.234
0.248
6.887
10.133
0.0
3.33
0.66
0726
S.E
0.2659
0.561
7.834
2.357
454.13
282.95
0.537
0.386
0.189
0.227
52.45
40.375
268.38
91.677
0.078
0.0828
2.295
3.377
0.0
1.11
0.22
0.242
P.S.E
t-Value
P value
Remarks
Highly
0.6208
2.846
<0.02 significant
8.18
1.928
>0.05 significant
535.065
0.578
>0.05 significant
0.661
1.73
>0.05 significant
0.295
1.050
>0.05 significant
66.19
1.819
>0.05 significant
283.606
1.74
>0.05 significant
0.113
1.097
>0.05 significant
4.083
1.088
>0.05 significant
1.111
1.00
>0.05 significant
0.328
Not
Not
Not
Not
Not
Not
Not
Not
Not
The effect of two groups in all parameters are the same there is a highly significant in
HB % when we compared two groups (P < 0.05) and all the after parameters and not
significant (P>0.05).
The group-1 is not significant in TLC and CD8 sell count (P>0.05) and after
parameters shows highly significant in-group II except ratio all the parameters are highly
significant (P>0.05).
Group-1 E.S.R. Platelet counts Kornefsky gradings and CD4 are highly significant
when compared to group 2 (P<0.05 and T values).
The WBC, Weight and General Health Condition are having same effect in both
groups (by comparing P and T values).
The parameter HB%, TLC and CD8 cell counts are highly significant in-group 2
compared with group 1.
Over all there is a more variation in group I.
In-group 2, HB% EWR, TLC, WBC and CD8 are having uniform effect and in group 1
platelet count CD4 and weight are having uninformed effect (by comparing co-efficient of
veriation).
Result in-group 1
As mentioned that in the Table 27, group-1 has show the results with reference to
the grade declared in the study is as follows. The Best responded group is 4 patients
(44.44%) and moderately responded are of 5 (55.55%) patients. There was no patient who
doesnt respond for the treatment of Ojokalparasayana. Tabulation of group 1 is shown as
under in table-31 and the graphical form is displayed as under in the graph-8.
Table -31
Result category
Patients
Best responded
44.44
Moderately responded
55.56
Responded
Static
Not responded
Graph-8
Responded
0.00%
Moderately
responded
55.56%
Static
0.00%
Not
responded
0.00%
Best
responded
44.44%
Result in-group 2
As mentioned that in the Table 27 group-1 has show the results with reference to the
grade declared in the study is as follows. The Best responded group is 6 patients (66.66%)
and moderately responded are of 3 (33.33%) patients. There was no patient who doesnt
respond for the treatment of Ojokalparasayana. Tabulation of group 2 is shown as under in
table-32 and the graphical form is displayed as under in the graph-9.
Table 32
Result category
Patients
Best responded
66.67
Moderately responded
33.33
Responded
Static
Not responded
Graph-9
Responded
0.00%
Moderately
responded
33.33%
Static
0.00%
Not
responded
0.00%
Best
responded
66.67%
Observations and Results Bhutabhishangaja Ojokshaya113
The second factor may be due to fewer incidences of infectious diseases in those
days. But with the changing times, these are sudden changes in environment due to
industrialization, deforestation, and pollution. Rapid explosion of population led us to usage
of chemical fertilizers, chemical medicines, pesticides, insecticides etc. this brought about a
devastating reduction in nutritional value of food products, human life span (Ayu) resistance
power (Vyadhi Kshamatva), and peace of mind (prasanna atma, indirya manah (is also
severely affected. This has lead to increased susceptibility of human beings, for infectious
diseases associated with emergence of new infectious organisms and their rapid growth.
So it is high time for all Ayurvedic practitioners to make necessary modifications in
their approach to infections diseases, in the light of changing scenario.
HIV is the etiological agent for the newfound immuno deficiency, which came to light
in 1981. This infection spectrum is ranging from primary infection with or without acute
syndrome are a symptomatic stage and to an advanced disease.
Immuno deficiency is refereed to as Ojokshaya in Ayurveda. Ojas is the essence of
sapthadhatus (all the bodily tissues) and it is responsible for vigor and vitality. It is the
protective mechanism against decay and degeneration, any depletion of Ojas can lead to
infection disease and death. There is clear description regarding the depletion of Ojas by
microorganisms. The resultant Ojokshaya also goes for different pathological stages like
microorganisms. The resultant Ojokshaya also goes for different pathological stages like
Ojovishramsha, vyapath and Kshaya. But in the concept of Ojokshaya we do not find a
stage similar to clinical latency. The reasonfor this may be perhaps in those days this
particular type of infections was not found or in those days there use to be a different
immunological response to same infection. Whatever we see as symptoms of Ojokshaya,
they are the general immuno deficiency symptoms.
The HIV epidemic has occurred in waves in different regions of world. Each wave
having somewhat different characteristics, depending upon the demographics of the country
and region in question and the timing of the introduction of HIV into the population,
In the large-scale deaths some people used to survive and Acharyas have
recognized this phenomenon as Vyadhi Ksamatva and those died has Ojokshaya as a
predisposing factor.
Discussing the root cause of Janapadodhawamsa, it is said adarma (bad conduct)
is the reason for such fact transmission and fatality. When we analyze the basic cause
behind the origin of this disease and subsequent transmission, we understand bad conduct
of human beings unnatural behavior of man resulted in a disease called HIV infection.
HIV, a virus of green monkey of Africa started infecting human beings. The exact
methodology of this jump is highly debatable. But one this is sure, somewhere, some body
has behaved unnaturally and further spread speaks about the immoral conduct of a big
population of the world.
The transmission scenario of HIV has changed to heterosexual route as a
predominant cause from a homosexual route and intravenous drug use. The change has
been recognized in type of people, sex and their economical background. A disease of men
has infected equal number of women, a disease of cities in commonly seen in small villages,
a disease of rich and ducated is infecting most backward and uneducated population. Sex is
a basic instinct of human beings and the experience says these will not change even when
society doesnt permit is in unnatural means.
Susruta described communicable diseases in kusta chapter of Nidana stana. He has
given prasanga or sexual contact as the main cause of disease transmission. This gives us
an idea about the prevalence of sexually transmitted diseases in ancient period also. But we
do not find the reference of transmission of infection from mother to child, even though there
Discussion and conclusion - Bhutabhishangaja Ojokshaya116
are references about the congenital disorders and role of genetics in occurrence of
diseases. But there is a reference in Ayurveda about transfer of maternal Ojas to the foetus
in intra-uterine life. This is significant observation with regard to vertical transmission.
It is estimated that over 6 million Indians are HIV carriers, WHO and UNAIDS are the
internationally operating organizations, who do research on epidemiology of infection in
India NACO (National AIDS Control Organization) is working on same guidelines since
1987. In 1992 government of India HIV control project along with many N.G.Os.
But all the activities of government and non-governmental organizations involve only
modern medical professionals. Nowhere Ayurvedic doctor is involved in the AIDS control
program. On the contrary, Ayurveda is a popular medical science in India and the
unqualified quacks started exploiting people in the name of Ayurveda. WHO recognized the
importance of Ayurveda 3 decades ago and since then many modern medical professionals
and scientists are doing research on Ayurvedic drugs. But these are scattered ones, and run
by private people. But in most of these researches, there is no involvement of Ayurveidc
scholars. To succeed in developing a framework of Ayurvedic treatment modality, there
should be profound knowledge of Ayurveda along with scientific research methods.
Ojokshaya is not a disease dealt with in Nidanastana or Chikitsa stana of any Samhita. It is
not discussed as and Aristalakshana also rather it is a terminal condition of all debilitating
diseases, which cause death. Acharya Charaka and Susruta dealt in chapters where
general Vriddhi Kshaya Lakshanas of Dosha Dhatu and Mala are discussed. Ojokshaya is
pathological condition associated with kshataja kasa, grahani, jaja yaksma, sannipahaja
jwara raktasha, pandu, grahani, raktaatisara, and shosha, kshayaja kasa, many of which are
infectious diseases.
According Ayurveda, the Ahara (food) Vihara (activities) and Manasika vaikalya
(psychological disorder) are also causes Ojokshaya. Alpashana (malnutrition), Anasana
Discussion and conclusion - Bhutabhishangaja Ojokshaya117
(starvation) are said to be nutritional factors, which directly effect the bodys, defense
mechanism, against infection. In the modern parlance, it is a well-understood fact that
malnutrition is a common cause of immuno deficiency, because protein takes part in the
formation of antibodies. In Vihara (physical activities) Vatatapa sevana (exposing to wind
blow and hot sun) associated with Ativyayama (excessive work) lead to Ojokshaya. Extreme
heat and blows of wind cause severe exhaustion, which leads to immuno deficiency in long
run. This also speaks about the socioeconomic conditions of said population, which is
susceptible to this kind of Ojokshaya. The next cause, Ativyavaya or excessive indulgence
in sex is also a cause for Ojokshaya. Here modern medical understanding differs.
According to Ayurveda, Kshaya (emaciation) can result by two ways. The first type is
anulomakshaya second one pratiloma kshaya. Anulomakshaya is caused due to
malnutrition in which bodily tissues from Rasa, Rakta, Mamsa progressively undergo
depletion this is caused due to anashana, alpasana, vatatapa sevana type of causes.
Pratiloma kshaya is caused due to shukra kshaya (depletion of shukra dhatu) due to over
indulgence in sex. This is a reverse or opposite type of depletion of bodily tissues. According
to this principle loss of Shukra causes immuno deficiency and modern science doesnt relate
sex and immuno deficiency. Rather there are studies, which revel that sex does immuno
modulation. For this reason, ayurveda explains seasonal sexual schedule where as modern
science does not believe in this. This ayurveda has recognized brahmacharya (celibacy) as
one of the sub-pillars of the life where as modern science does not attach any importance to
celibacy in sustaining life.
Prajagara (sleeplessness) has been considered as a cause of Ojokshaya. Modern
science also believes in this and a good sleep increases ones immunity.
The next set of causes is manasika karanas (Psychological reason). They are kopa
(anger), shoka (grief), chinta (worry) and bhaya (phobia). In modern pariance the new
Discussion and conclusion - Bhutabhishangaja Ojokshaya118
(Bala), and this results in to the temporary reduction in Ojo-visramsa Lakshanas. But
because virus survives and camouflages, it enters in to chronic phase of infection and the
slow damage of Ojas continues.
In the II stage of HIV infection there will be occasional symptoms of fever, loss of
appetite, loss of body weight, asthenia, diarrhoea, cough etc. this stage can be compared to
Ojovishramsha stage with special reference to the sequence of symptomatology explained
in sannipataja Jwara where there ill be interns of limbs, chills, looseness of limbs, low grade
fever, body pain etc. it may not be as severe as a acute phase of sunnipathaja Jwara.
In the stage of III of HIV infection along with the above mentioned symptoms there
will be further immuno deficiency due to which many opportunistic infections like herpes
simplex, herpes zooster, oral Candidiasis, tuberculosis, hairy leukoplakia.
In second stage of Ojovikriti natural properties of Ojas under the influence of vitiated
Doshas goes for vyapath phase chih given rise to stabha gurugatrata, vatasopha,
varnabedha, glani, tandra and nidra
228
caused due to infection are of two different Samprapti. The description about general
Samprapti can be summarized as sited by Charaka in madhumeha
229
and panduroga
230
Vitiated Doshas (either Vata or Pitta) vitiate Dhatus, which later loose integrity and get
depleted and subsequently results in depletion of Ojas. This is also called as
Anulomakshaya. The autoimmune mechanism resembles this type of Ojovikriti. The
Samprapti of Ojokshaya caused by infection can be summarized with the available
references in the context of Rajayakshma
231
232
. Here in the
individuals who have basic susceptibility for infection, when get infected due to already
discussed causes, get Bhootopaghata a damage of cells (carrying CD4 makers) followed by
abhishanga (penetration) and entry of viral materiel into the cell. This foreign toxic material
works like jangama visha (poison of animal origin) 233, but as virus is a live matter with RNA
genome instead of causing immediate death if replicates here getting sustenance from
bodily cells. Those cells where virus replicates become reservoirs of virus. This virus is
capable of causing srothorodha, raktadi Dhatu Kshaya. Due to the lowered functioning of
dhatwagni resulting inAma and apachaya (catabolic activity) due to the deficiency of
nutrition, which further leads of Ojokshaya 234.
The Ama so formed causes further Vata Vriddhi associated with Vikrita Pitta leads to
sannipathika Jwara. Vitiated Vata and Pitta cause damage to Dhatu vaha srotamsi and this
leads to Ojo-visramsa, vypth and Kshaya in due course of time. So in this way pathological
events following bhootopaghata correlate with modern understanding of HIV infection.
Sadhyasadhayata
Susruta has clearly said the Ojovishramasha and vyapth can be managed by
rasayana and vajeekarana Chikitsa along with appropriate diet, which increases Bala and
antagonistic to the causative factors of Ojokshaya
235
explained in Ayurveda and modern science are similar as the early stages of HIV infection
can be managed with antiviral and immuno modulators and advanced stage will not improve
with any available treatment.
Chikitsa sutra
General management of Ojokshaya is by rasayana and Vajikarana, which are
Ojokara in nature
236
additional line of treatment, which can be developed on the basis of Krimi Chikitsa an
explained in Charaka Vimana 7th chapter. Among 3 major principles of Krimi Chikitsa, the
prakriti vighata type suits the present context of HIV infection. This can be achieved by
usage of drugs having Krimi prakriti vagata property.
The Selection of drugs
Keeping the Samprapti of Ojokshaya in mind, there is a need for both Ojoskara
(immuno-stimulant) and Krimigna (anti-viral) and protecting and cures for the Aids related
complications along with potent action. The conceptualization of ideal drug should also
involved drugs having faster action and better cell penetration capacity. An attempt is made
in the formulation of Ojokalparasayana for the management of the HIV infection. The main
ingredients are Bilva, Tulashi, Haridra, Daru haridra, Devadaru, Trikatu, Triphala, Karanja,
Tagara. To get additive values and fortify the drug action Vidanga and Agnikumara vati. The
vidanga is krimighna and Agnikumara vati is anti-pyrexial. Ajamootra is used as Bhavana
dravya for the bilwadivati as directed in the text. The composition of Agni kumar vati is
Kusta, Vacha, Musta, Vatsanabha, Maricha. Therapeutic effect of Agni kumar vati is
jwarahara, Atisara shamaka and also prevents and cures upper respiratory tract infections.
Another drug undertaken for the comparison is Amruta kayakalpa Rasayana
established immuno-modulator, manufactured by a well-known company Amruta Herbs,
Hyderabad.
Discussion and conclusion - Bhutabhishangaja Ojokshaya122
the
patients
have
undergone
these
investigations
before
starting
Ojokalparasayana and Amruta kayakalparasayana that to soon after the completion of four
months schedule.
The effect of both Ojokalparasayana and Amruta kayakalparasayana on each of the
parameters was assessed with base line data. The Ayurvedic assessment was done with
detailed clinical analysis of Dosha status and Ojas status on the basis presenting symptoms
using darshana sparshana and prasna methodology. This was done before and soon after
completion of both trials on both compounds.
General observations
From the initial inclusion of 26 patients, 8 patients dropped out during the study. Due
to the decision by these patients to take medicine from a so-called AIDS specialist who had
released and advertisement in local newspaper, claiming a cure of HIV disease.
Maximum number patients in this study are men and male verses female ratio is 2:1.
This is contradictory to the Indian data sex incidence. Which 1:1 this various can be due to
the male dominance in the local society with rural and illiteracy background,
22% Muslim patients in the study may be due to religion ratio of local population and
there is a study that claims less incidence of sexually transmitted disease in subjects who
under went circumcision 237.
Discussion and conclusion - Bhutabhishangaja Ojokshaya123
The maximum patients were in middle class 55% followed by poor 33%, and 11% in
higher middle class reflect the socioeconomic status of the particular area. It also reflects the
easy acceptance of free treatment of middle class and poor class.
It is interesting to note that not even a single vegetarian subject was seen in this
study. As Ayurvedic concepts talk about the role of predisposing factors, there must be a
physiological or psychological impact of non-vegetarian food that may be having a role to
play in high incidence of HIV among non-vegetarians populations.
Coming to the study related to disease, maximum number of patients (100%) got the
infection from heterosexual contact. This data coincides with the international data.
Even though the incidence changes are more among the patients who got it from
blood transmission and intra-venous drug intake, but more patients got it from heterosexual
contact only. This clearly shows the high rate of unsafe heterosexual practices in our society
population.
Aids stages
Stages of HIV infection are well understood. It is a proven fact that HIV causes AIDS
and AIDS related complex. The mathematical and statically evaluated is often used to
explain the biological phenomena, through the years of studying the HIVI disease. The
investigation of CD4 and CD8 cells along with lymphocyte count is very much helpful in the
prediction of stages of HIV infection. CD4 count cell is a surrogate marker of immunodeficiency because lower HIV RNA level and higher CD4 cell counts correlates with long
time survivors in both adult and children
238.
symptomatic stage 0% in-group I and group II respectively followed by 88% in second stage
at both groups.
symptoms with the herbs in the composition. The bhavana dravya, Aja mutra is also a best
component to relieve dyspnoeas.
Annavaha Srotas:
Almost all dravyas have deepana and pachana effect, which makes sence to the
concept Agni Chikitsa is the modality management in the Ayurveda. Bilwa, Haridra,
Daruharidra, Shunti and Musta are reported with the Deepana and Pachana effect.
Main symptoms from the gastro-intestinal tract commonly reported are nausea and vomiting.
This is controlled with the Shunti, Pippali and Vibhitaki.
Pureeshavaha Srotas
Diarrhea is common symptom managed by the composition such as Bilwa, Tulasi,
Devadaru, Shunti, Vibhitaki, Musta and Haridra. All other conditions which develop from this
Srotas is also managed.
Rasavaha Srotas
Bilwa, Haridra, Daru haridra, Shunti, Pipplai, Kusta, Vatsanabha and Musta are the
best alliterative and anti pyrexial herbs included in the combination. These herbs not only
anti-pyrexial but also assists to potentiate the rasavaha sroto moola.
Raktavaha Srotas
Commonly observed skin conditions revile the inclusion of skin and its importance in
HIV infectious conditions. Few drugs included in the combination for the prevention and
curative aspect are Amalaki, Haritaki, Tulasi, Maricha, Vatsanabha, Karanja, Kusta,
Daruharidra, Shunti and Ajamutra.
Anemia (Pandu) is commonest complaint. Thus Haridra, Daru Haridra, Shunti and
Ajamutra are added to supplement the deficiencies in the formation of blood.
Statistical evaluation
The clinical evaluation of Ojokalparasayana and Amruta kayakalparasayana was
conducted in 18 cases of Ojokshaya in two different groups due to the HIV infection. The
over all response is significant (P<0.001) in both subjective and parameters.
The effect of two groups in all parameters are the same there is a highly significant in
HB % when we compared two groups (P < 0.05) and all the after parameters and not
significant (P>0.05).
Recommendations for further study:
The following recommendations are made on the basis of the observations
made for further studies as well as to observe the limitations.
(a) Same yoga can be repeated by taking a large number of samples with
randomized control groups.
(b) The effect of Ojokalpa Rasayana can be studied along with Shodhana
therapy or individually as Bilwadivati and Agnikumara vati.
(c) The effect of Ojokalpa Rasayana can be studied on long duration to
evaluate its efficacy as antiretroviral therapy along with viral load
studies.
Limitations of the study:
Sample size is small to generalize the result.
Samples are selected incidentally.
Conclusion
AIDS is a multi dimensional disease syndrome, affecting physical, mental,
social and spiritual facets of the affected person.
The virus HIV hampers the Immune system. At the same time there is no
specific treatment available for the AIDS /HIV infection.
Susruta explains about abhigata or injury as a cause of Ojokshaya. Very
specifically an injury in sexual organs or anus is a high risk factor for
transmission of HIV infection.
The Ojokshaya occurred due to general causes apart from infection and
that caused due to infection are of two different Samprapti. So in this way
pathological events following bhootopaghata correlate with modern
understanding of HIV infection.
The prognosis of diseases as explained in Ayurveda and modern science
are similar as the early stages of HIV infection can be managed with
antiviral and immuno modulators and advanced stage will not improve
with any available treatment.
Among 3 major principles of Krimi Chikitsa, the prakriti vighata type suits
the present context of HIV infection.
In other words the management is
As antioxident - Amalaki, Shunti and Haritaki
Anti tubercular - Pippali, Karanja and Vacha
Anti bacterial -Amalaki, vibhitaki, Karanja, Musta, Maricha and
Haritaki
Anti fungal - Haritaki. Vibhitaki and Karanja
The effect of two groups in all parameters are the same there is a highly
significant in HB% when we compared two groups (P < 0.05) and all the
after parameters and not significant (P>0.05).
The Ojokapla Rasayana group is not significant in TLC and CD8 sell
count (P>0.05) and after parameters shows highly significant in Amruta
Kayakalpa Rasayana group except ratio all the parameters are highly
significant (P>0.05).
Ojokapla Rasayana group E.S.R. Platelet counts Kornefsky gradings and
CD4 are highly significant when compared to Amruta Kayakalpa
Rasayana group (P<0.05 and T values).
The WBC, Weight and General Health Condition are having same effect
in both groups (by comparing P and T values).
The parameter HB%, TLC and CD8 cell counts are highly significant
Amruta Kayakalpa Rasayana group compared with Ojokapla Rasayana
group.
Over all there is a more variation in Ojokapla Rasayana group.
Amruta Kayakalpa Rasayana group, HB% EWR, TLC, WBC and CD8 are
having uniform effect and in Ojokapla Rasayana group platelet count CD4
and weight are having uninformed effect (by comparing co-efficient of
variation).
Summary
Among them since two decades sudden emerge of new epidemics such as SARS and
AIDS/HIV, termed in Ayurveda as Bhootopaghataja Ojokshaya.
The etymology of words, Bhoota and Upaghata developed form the word Bhootopaghata
is, Bhoota denotes as Krimi or Virus and Upaghata means as infection. So exclusively
the word Bhootopaghata indicates as viral infection.
In 1983, Human Immuno Deficiency Virus (HIV) was isolated from a patient with lymphadenopathy.
HIV-infected individuals are presenting in increasing numbers to family physicians,
obstetricians, gynecologists, pediatricians and surgeons with clinical problems that may
be directly or indirectly related to their HIV-infection.
When we analyze the basic cause behind the origin of this disease and subsequent
transmission, we understand bad conduct of human beings unnatural behavior of man
resulted in a disease called HIV infection.
As of now an estimated 4-6 million HIV infected cases are present in India.
The first case of HIV infection was identified in India in 1986 at Chennai.
AIDS is a multi dimensional disease syndrome, affecting physical, mental, social and
spiritual facets of the affected person.
The virus HIV hampers the Immune system. At the same time there is no specific
treatment available for the AIDS /HIV infection.
Susruta explains about abhigata or injury as a cause of Ojokshaya. Very specifically an
injury in sexual organs or anus is a high risk factor for transmission of HIV infection.
Charaka does not explain the signs and symptoms of Ojokshaya, whereas Susruta then
explained different stages of Ojokshaya.
When we see the modern classification of HIV disease there are 4 stages of HIV
infection, which results in death at the end.
The first stage is primary infection or acute sero-conversion stage. This particular stage
of HIV infection can not be correlated to the stages of Ojokshaya.
The Ojokshaya occurred due to general causes apart from infection and that caused due
to infection are of two different Samprapti. So in this way pathological events following
bhootopaghata correlate with modern understanding of HIV infection.
The prognosis of diseases as explained in Ayurveda and modern science are similar as
the early stages of HIV infection can be managed with antiviral and immuno modulators
and advanced stage will not improve with any available treatment.
Among 3 major principles of Krimi Chikitsa, the prakriti vighata type suits the present
context of HIV infection.
In other words the management is
As antioxident - Amalaki, Shunti and Haritaki
Anti tubercular - Pippali, Karanja and Vacha
Anti bacterial -Amalaki, vibhitaki, Karanja, Musta, Maricha and Haritaki
Anti fungal - Haritaki. Vibhitaki and Karanja
Recent advances in medical treatment have given scientists renewed strength in the
struggle against HIV-the virus that causes AIDS.
AZT inhibits reverse transcription, which is vital for HIV to infect its host. AZT and DDI
will stop this from occurring and thus stop the HIV virus from spreading.
Those cells include the immune system cells, blood cells, and the nervous system cells.
It has been found that HIV only infects cells with CD4.
Summary - Bhootopaghataja Ojokshaya132
Ojas depends upon healthy state of Kapha. Kapha in physiologically represents potential
sours of strength and resistance to disease and decay of Bala and Ojas.
Antigens can also be processed and presented to T4 cells by various types of cells in
the body in addition to macrophages. The other types of antigen presenting cells include
the B cells themselves, the Langerahans cells of the skin, and specialized cells called
dendritic cells in the lymph nods and spleen.
T8 cells mediate cellular immunity. The cytotoxic T cells attack and destroy cells that
have antigen, which activated them. To ensure maximal specific T cells response the
antigen is linked to molecular components of the HLA system (by B cells, dendritic cells
and macrophages) and presented to T cell.
Cytotoxic T cells cause antigen-specific lyses by direct cell-to-cell contact.
Any HIV-infected individual with CD4+T cell count of<200/microliter had AIDS by
definition, regardless of the presence of symptoms or opportunistic diseases.
It is important to distinguish between being infected with HIV and having AIDS. People
infected with HIV may take 5-7years or more to develop as AIDS.
The four recognized human retroviruses belong to two distinct groups, i.e.HIV-1 and
HIV-2.
The most common cause of HIV disease throughout the world is HIV-1 comprises
several subtypes with different geographic distribution.
HIV is free from live, when it is out side the body. HIV has a number of mechanisms to
evade elimination by the immune system.
HIV-1 and HIV-2 are both viruses that belong to the same family, but vary in genetic
make up. Both HIV-1 and HIV-2 have been detected in India and both leads to AIDS.
However studies of lymphoid tissue using PCR analysis for HIV RNA and in site
hybridization for individual virus expressing cells clearly demonstrated that HIV
replication occurs throughout the course of HIV infection, even during clinical latency.
The availability of sensitive PCR techniques leads to the demonstration that viremia
present at all stages of HIV disease.
HIV is transmitted by homosexual and heterosexual contact.
Transfusions of whole blood, packed red blood cells, platelets, leukocytes, and plasma
are all capable of transmitting HIV infection. It is estimated that 90 to 100% individuals
who were transfused with HIV-infected blood became infected.
HIV has been demonstrated in seminal fluid both within infected mononuclear cells and
in the cell free state. There is a strong association of transmission of HIV with receptive
intercourse.
HIV infection can be transmitted from an infected mother to her fetus during pregnancy
or during delivery.
HIV is an RNA virus whose hallmark is the reverse transcription of its genomic RNA to
DNA by the enzyme reverse transcriptase. Life cycle of HIV infection
Opportunistic infections are late complications of HIV infection, for the most part
occurring in patients with less than 200 CD4+T cells per micro liter. Opportunistic
infections are the leading cause of morbidity and mortality in-patients with HIV infection.
Approximately 80% of AIDS patients die as direct result of an infection other than HIV,
with bacterial infections heading the list.
Tuberculosis is a particularly important problem with HIV infection. Tuberculosis may be
the earliest clinical sign of HIV infection. Disseminated disease is more common with low
CD4+T cell counts.
The diagnosis of HIV infection depends on the demonstration of antibodies to HIV and or
the direct detection of HIV or one of its components. The standard screening test for HIV
is the enzyme linked immuno sorbent assay (ELISA).
Patients with CD4+T cell counts below 200/ul are at high risk of infection with
preumocytis carini, while patients with CD4+T cell counts below 100/microliter are at high
risk of infection with cytomegalovirus and mycobacterium avium-intracellular complex.
The cornerstone of medical management of HIV infection is antiretroviral therapy.
Suppression of HIV replication is an important component in prolonging life.
Accelerated weight loss in an HIV infected patient is sign of disease progression.
Prevention of STDs would also reduce the risk of HIV transmission.
By running public awareness campaigns for HIV
T. Chelaula inhibited HIV-1 proteas activity at a concentration of 25 microg/ml in the
flurogenic assay.
The HIV-1 protease (PR) inhibitory activity was determined by using the fruit peal
methanol extract of Vibhitaki.
Objectives of the study
To evaluate the efficacy of Ojokalpa Rasayana and Amrut Kayakalpa Rasayana in
improving the clinical status of Ojokshaya with special reference to HIV infection
To assess the role Ojokalpa Rasayana and Amrut Kayakalpa Rasayana on CD4 cell
count, which is a marker of stages of the HIV infection along with viral load.
Drug: Ojokalpa Rasayana
General health condition (Grade), Karnofsky performance score, Body weight, Total
WBC count, Total count platelets, Total count lymphocytes, Erythrocytes sedimentation
rate, CD4 cell count, CD8 cell count and CD4: CD8 ratio are elicited in the patients
before and after the treatment.
This infection spectrum is ranging from primary infection with or without acute syndrome
are a symptomatic stage and to an advanced disease.
1. http://www.aidsnyc.org/network/trials/hiv.html
2. Charaka Samhita sutra 8/20-24
3. Susruta Samhita sutra 15/41
4. Charaka Samhita Shareera 6/3
5. Charaka Samhita sutra 17/117
6. Charaka Samhita sutra 30/9-11
7. Charaka Samhita Shareera 6/4
8. Susruta Samhita Sutra 15/41
9. Charaka Samhita Sutra 17/117
10. Charaka Samhita Sutra 30/9-11
11. Charaka Samhita Sutra 11/36
12. Charaka Samhita Sutra 28/7
13. Susruta Samhita Sutra 15/23.
14. Sanskrit-English Shabdakosha.
15. Viadhika Shabda Sindhu.
16. Astanga Hrudaya Sutra 11/37, Charaka Samhita Sutra 30/9-11.
17. Astanga Hrudaya Sutra 11/37
18. Charaka Samhita Sutra 17/75
19. Astanga Hrudaya Sutra 17/38
20. Charaka Samhita Sutra 17/74
21. Sharangadhara Samhita Purvakhanda 5/18 Gangadhara and Chakrapani (Charaka
Samhita Sutra 17/76)
22. Charaka Samhita Chikitsa 3/167, Susruta Samhita Sutra 15/20, Charaka Samhita
Soo 30/9, Astanga Hrudaya Sutra 11/37, indu
23. Susruta Samhita Soo15/21,
24. Charaka Samhita Chi24/31
25. Charaka Samhita Chi24/31,
26. Susruta Samhita Sutra 15/21, Charaka Samhita Chi24/31
27. Charaka Samhita Chi24/31
28. Susruta Samhita Sutra 15/21
29. Susruta Samhita Sutra 15/21, Charaka Samhita Chi24/31
30. Susruta Samhita Sutra 15/21,
31. Susruta Samhita Sutra 15/21
32. Susruta Samhita Sutra 15/21
33. Charaka Samhita Chikitsa 24/31,,
34. Charaka Samhita Chikitsa 24/31
I
100.
101.
102.
103.
Bhava Prakasha
104.
105.
106.
Bhava Prakasha
107.
108.
109.
110.
111.
112.
113.
114.
115.
116.
117.
118.
Bandyopadhaya, 2001
119.
S.S.Ut. 52/18
120.
Vaidya madhava
121.
Ibid
122.
Astanga Hrudaya
123.
124.
125.
126.
127.
128.
Abstr, 1987.106,38300t),
129.
Vanga sena
130.
Gadanigraha
131.
Vangasena
132.
133.
Chakradatta
134.
135.
136.
137.
138.
139.
140.
141.
Gadanigraha
142.
(A.H.Ut. 40
143.
C.S.Ci. 17
144.
Vinayagamorthy, 1982.
145.
146.
147.
Thakur, 1995
148.
149.
, Susruta Samhita Sutra 46, Bha pr, Ra Ni, Charaka Samhita Soo-25, Charaka
Samhita Chi 1, Dh Ni
150.
151.
152.
153.
154.
155.
156.
157.
158.
159.
160.
161.
162.
163.
164.
165.
166.
167.
Kayyadeva nighantu
168.
169.
Ra Ma Va Ni,
170.
171.
172.
Vaidya Madhava
173.
174.
175.
Gadanigraha
176.
Vangasena
177.
178.
179.
180.
181.
182.
183.
184.
185.
186.
187.
188.
189.
190.
191.
192.
193.
194.
195.
A.C.Ci.1
196.
197.
Ibid
198.
199.
200.
Kandavisha, Poison
varga.
201.
203.
Indian medicinal plants, Lithium carbonate and Glucan, 1988, October, (10) 639-44
204.
A survey of some Indian medicinal plants for anti human immuno deficiency virus
(HIV) activity, M. Premanathan et.al. The Indian journal of medicinal research, vol
112-9
205.
206.
207.
210.
Ibid, 189
211.
212.
Ibid 856
213.
Ibid 1001
214.
Ibid 1260
215.
Ibid 295
216.
Ibid 414
217.
Ibid 187
218.
219.
Ibid 60-61
220.
221.
222.
223.
(a) Choi S, Lagakos SW, Schooley RT, Volberding PA. CD4+ lymphocytes are an
225.
226.
229.
230.
231.
232.
233.
234.
235.
236.
Ibid
237.
238.
Philips AN, Lee CA, Elford J, et al. Serial CD4 lymphocyte counts and
VIII
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and
Dr.
Gorakhanatha
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Astanga hridayam 1-2 by prof. K.R. Srikantha murthy 2nd edition 1995, published
by Krishnadasa academy.
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Astanga Sangraha 1-2 by prof. K.R. Srikantha Murthy 1st edition 1996 ,
published by Chaukhambha orientalia, Varanasi.
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6.
Dravya Guna Vignanan II part by prof. P.V. Sharma, 16th edition 1994, published
by Chaukhambha Bharati academay Varanasi.
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Dravya Guna Vignanan II part by Dr. JLN Shashtri Ist edition 2004, published by
Chaukhambha orientalia Varanasi.
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9.
A Sanskrit - English dictionary by Shri Monier Monier Williams 1st edition 1993,
published by Motilal Banarasidas, publishers pvt. Ltd. Delhi.
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11.
Madanapalana Nighantu
12.
Raj Nighantu by Dr. Indradeo, tripati, 2nd edition 1998, published by krishnadasa
academy Varanasi.
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Indian medicinal plants by K.R. Kirtikar and B.D. Basu 2nd edition published by
Lalitamohana Basu Allahabad.
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15.
16.
Bhavaprakasha
of
Shri
Bhavamishra
vidhyotini
hindi
commentary
by
Bhaishajyaratna Pt. Shri Bramha Shankar Mishra. 5th edition 1988, published
chaukhumba Sanskrit Samsthana Varanasi.
17.
18.
19.
20.
21.
Essentials of Basic Ayurveda concepts by prof. V.V.S. Shashtri 1st edition 1999,
published by Principal D.G.M.A.M.C. Gadag.
22.
Shareer kriya vignana by Dr. P.V. Sharma 4th edition 1982, published by
Chaukhambha Bharati Academy.
ii
23.
Shabdha kalpa druma by Raja Radha Kanthadeva 1-5 Vol 3rd edition 1967,
published by Chaukhambha Bhavan Varanasi.
24.
25.
26.
27.
28.
29.
Text book of Medical Physicology by Arthur C Guyton and John Hall 10th edition
2000, published by Harcourt. Asia pvt. Ltd.
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32.
33.
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brothers medical publications pvt. Ltd. New Delhi.
Bibliography- Bhutabhishanga Ojokshaya iii
34.
Schola r:
C .S.Ha nama nta go ud ar
Sl.No.
OPD No
3. Age -
IPD No
Years
Birth data:
Place of Birth
Date
4. Religion
District
Month
State
Year
Hindu
Muslim
Driver
Hours
Minutes
PM
Christian Other
Business
Service
Middle class
Single
AM
Time
Student
Household
Higher middle
Divorced
8. Address
Widow/er
Higher class
2/3 M a r r i a g e s
Phone:
Pin
Schedule initiation
9. Selection
Included
Excluded
10. Group
A) Ojokalpa Rasayana
11. Result
Responded
Schedule completion
B) AKK Rasayana
Not responded
Discontinued
INFORMED CONSENT
I
Son/Daughter/Wife of
am
Complaints
No
1
Loss of weight
Fever (Jwara)
Somnolence (Anidra)
10
Duration
Less than 1 yr
1 to 2 years
2. ASSOCIATED COMPLAINTS
Annavaha Srotas
Rasavaha Srotas
Giddiness
Bleeding gums
Palpitation
Burning micturition
Urethral discharge
Mutravaha Srotas
Pureeshavaha Srotas
Pranavaha Srotas
Diarrhea
Cough
Breathlessness
Genital ulcers
Chest pain
Genital warts
Headache
Vaginal Candidiasis
Prajanana Samstana
Raktavaha Srotas
Others
Skin eruptions
Drowsiness
Molluscum
Lymphdenitis
Warts
Acne Vulgaris
Herpes zoster
4
2
Above 2 years
Intentional / Accidental
Blood transfusion
Injections
2) Early symptoms
3) Later symptoms
(c) Mode of progress
Typical
Rapid
Diabetes Mellitus
Venereal diseases
5. TREATMENT HISTORY
6. FAMILY HISTORY
Hypertension
Cardiac disease
7. PERSONAL HISTORY
a) Food habits
Vegetarian
Taste
preferred
Mixed diet
Sweet
Sour
Salty
Pungent
Bitter
Astringent
b) Sleep
Day
Night
Sound
c) Hygiene
Good
Unhygienic
d) Addictions
Tobacco
Disturbed
Alcohol
Drugs
e) Sexual behaviors
Heterosexual
Marital
Homosexual
Extra marital
Single
multiple
Recipient
Frequency
g) Bowel habits
Loose
Constipated
Normal
Irregular
Amenorrhea
Menopause
8. EXAMINATION
a) Vitals
Temperature
F Pulse
Weight
Blood pressure
Height
Respiratory rate
Body-Mass Index
b) General
Built & Nutrition
Oral Cavity
well
Ulcers
Moderate
Hairy Leucoplakia
Poor
Coated
Cervical
Supra clavicular
Axillary
Inguinal
Any other
c) Ayurvedic assessment
1. Hetu
Ahara
Vihara
B
Anashana
Alpashana
2. Dosha
Vata Vriddhi
B
Karshya
Karshnya
Ushnakamitwa
Kampa
Anaha
Shakritgraha
Balabhramsha
Nidrabhramsha
Pralapa
Bhrama
Anya
B
Vatatapa sevana
Ati Vyayama
Ati Vyavaya
Sonita a t i v a r t a n a
Prajagara
Pitta Vriddhi
B
Peetamootra
Peetanetra
Peetavit
Peeta twak
Atikshudha
Atidaha
Kapha Vriddhi
B
Agnisadana
Praseka
Alasya
Gowrava
Swetangata
Sheetangata
Shlathangata
Swasa
Kasa
Atinidra
Vata Kshaya
Pitta Kshaya
Kapha Kshaya
B
A
B
A
B
Angasada
Mandagni
Bhrama
Urah shoonyata
Alpabhshite
Shareera
sh
ee
ta
tw
am
Ahitam
Chesta heenata
Prabhahani
Shira shoonyata
Vyamoha
Hriddrava
Sleshma vriddhi
Sandhi saithilya
3. Lakshana
Ojo Vishramsha
Ojo Vyapat
B
A
B
Gatra sadanam
Stabdha gatrata
Dosha chyavanam
Guru gatrata
Sandhi vislesha
Vata shopha
Kriya sannirodha
Varna hani
Glani
Tandra
Nidra
Ojo Kshaya
Bhaya
Dowrbalya
Chinta
Vyathitendriya
Duschaaya
Durmana
Rooksha
Kshama
Moorcha
Mamsa kshaya
Moha
Pralapa
5
Koapam - Anger
Soka
Chinta
Bhaya
Bhootopaghgta
d) Systemic
1) Respiratory system
Shape of chest
Normal
Deformed
Trachea
Normal
Right Shift
Movements
Normal
Restricted
Left Shift
Auscultatory findings
Breath Sounds
Vesicular
Added sounds
Ronchi
Bronchial
Crepitation
Rub
2) Gastrointestinal tract
Tenderness
Organomegaly
Fluid
Mild
Moderate
Severe
Liver
Mild
Moderate
Severe
Spleen
Mild
Moderate
Severe
Thrill
Present
Absent
Shifting dullness
Present
Absent
Present
Absent
Abdominal Lump
(Advise U.S.G if required)
Report: -
3) Cardiovascular system
S1
S2
Murmur
9. LABORATORY INVESTIGATIONS
HAEMATOLOGICAL
Hb%
Total Count Lymphocytes
Total Count Platelets
Total Count Leucocyte
E.S.R
gm/dl
/l
/l
/l
mm/1
st
Hour
DIFFERENTIAL COUNT
Lymphocytes
Neutrophils
Eosinophils
Basophils
Monocytes
mg/dl
SPECIAL INVESTIGATIONS
Elisa
HIV- I & II
Rapid (Tridot)
Western Blot
CD4 cell count
CD8 cell count
CD4 : CD8 Ratio
10. DIAGNOSIS
/mm 3
/mm 3
STAGE
Before
SUBJECTIVE
After
Parameter
Karnofsky
performance score
OBJECTIVE
Total Count
Platelets
Total Count
Lymphocytes
E.S.R.
Body weight
Before
After
PERIODICAL ASSESSMENT
Date
Baseline
Data
0 days
Date
st
2nd
3rd
Final
Assessment
Assessment
Assessment
Assessment
Follow up
Assessment-1
Follow up
Assessment-2
30 days
60 days
90 days
120 days
150 days
180 days
GH Sc or e
K P Sco re
Pulse Rate
B lo od P res su re
T e mpe ra t ur e
Re sp irat ory R a te
w eight
T LC
CD4
CD8
CD4:CD8
FINAL ASSESSMENT
ASSESSMENT CATEGORY
NOTES
S L .NO
1
2
3
Patients impression
Side effects
Investigators note
Score
100
90
80
70
60
50
40
30
20
10
00