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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE – KARNATAKA

COMPLETED PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

“ROLE OF PANCHAGAVYA GHRITA IN THE MANAGEMENT OF


ATATTVABHINIVESHA (OBSESSIVE COMPULSIVE DISORDER)”

BY
DR. MADHUSHREE R.N.
DEPARTMENT OF MANASAROGA
S.D.M. COLLEGE OF AYURVEDA & HOSPITAL,
HASSAN -573201, KARNATAKA

GUIDE
DR. SUHAS KUMAR SHETTY
M.D. (Ay.),
ASSOCIATE PROFESSOR
DEPARTMENT OF MANASA ROGA

2012-2013
S. D. M. COLLEGE OF AYURVEDA & HOSPITAL,
HASSAN, KARNATAKA
FROM,

MADHUSHREE R.N.
Preliminary M.D. (Ay.) Scholar,
Department of Manasaroga
S.D.M. College of Ayurveda and Hospital,
HASSAN- 573201.
TO,
THE REGISTRAR,
Rajiv Gandhi University of Health Sciences Karnataka,
BANGALORE, Karnataka.
THROUGH,
The Principal and Head of the Dept. of Manasaroga,
S.D.M. College of Ayurveda and Hospital,
Hassan- 573201.
Subject: Submission of Completed Proforma for Registration of Synopsis of Dissertation.
Respected Sir,
I request you to kindly register the below mentioned subject against my name for the
submission of the dissertation to Rajiv Gandhi University of Health Sciences Karnataka,
Bangalore, for the partial fulfillment of M.D. (Ayurveda) in Manasaroga.
THE TITLE OF DISSERTATION:
ROLE OF PANCHAGAVYAGHRITA IN THE MANAGEMENT OF
ATATTVABHINIVESHA (OBSESSIVE COMPULSIVE DISORDER)
Herewith I am enclosing a completed Performa of synopsis for registration of subject for
Dissertation.

Thanking you,
Yours faithfully,
Place: Hassan
Date: 24/03/12 (DR.MADHUSHREE R.N.)
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE.
ANNEXURE
COMPLETED PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION.

1. NAME OF THE CANDIDATE : MADHUSHREE R.N.


AND ADDRESS : PRELIMINARY M.D.(AY.)SCHOLAR.
(IN BLOCK LETTERS) DEPT. OF MANASAROGA,
S.D.M. COLLEGE OF AYURVEDA
& HOSPITAL, P.O. BOX 164,
HASSAN – 573201
PERMANENT ADDRESS : MADHUSHREE R.N.
D/O S.RANGAPPA,
KANAMANA HATTI
RAMADEVRA STREET
TARIKERE. CHIKAMAGALUR(D).
KARNATAKA.
2. NAME OF THE INSTITUTION : S.D.M. COLLEGE OF AYURVEDA
& HOSPITAL, HASSAN – 573201
3. COURSE OF STUDY & SUBJECT : M.D. (AYURVEDA) MANASAROGA
4. DATE OF ADMISSION TO
THE COURSE : 10-10-2012.
5. TITLE OF THE TOPIC :

ROLE OF PANCHAGAVYA GHRITA IN THE MANAGEMENT OF


ATATTVABHINIVESHA (OBSESSIVE COMPULSIVE DISORDER)
6) BRIEF RESUME OF THE INTENDED WORK:

6.1 NEED FOR STUDY:

Atattvabhinivesha is a Manasika Vikara characterized by (a) perceiving Anitya (non


occurring, non existence) as Nitya (occurring ,existence) and doing the activities/ perceiving
Ahita (unwholesome) as Hita (wholesome) and vice versa due to Vishama Buddhi i.e. impaired
Nischayatmika Buddhi (Judgement factor is impaired) (b) Hridaya Vyakula- Feeling of
discomfort. (c) Moodha, Alpa Chetana- Apprehension and anxiety leading to restlessness. Other
components like Mana, SanjnaJnana, Smriti, Bhakti, Sheela, Chesta and Aachara are not
affected, so persons understands his sufferings and wants to get rid of it. The clinical features of
Atattvabhinivesha is similar to those in Obsessive Compulsive Disorder. 1 It is depicted as
“Mahagada” which is the cause of worldly distress.2

Obsessive Compulsive Disorder (OCD) is the anxiety disorder characterized by diverse


group of symptoms that include intrusive thoughts, rituals, pre-occupations and compulsions. An
obsession is a recurrent and intrusive thought, feeling, idea or sensation. In contrast to an
obsession, which is a mental event, a compulsion is a behavior developed to reduce the obsession
thought. Specifically, a compulsion is a conscious, standardized, recurrent behavior such as
counting, checking or avoiding. A patient with OCD realizes the irrationality of obsession and
experiences both the obsession and the compulsion as ego-dystonic (i.e. unwanted behavior) .3

In India prevalence rate of OCD is 0.9% among the psychiatric disorders. 4 The life
time prevalence of OCD in worldwide is estimated to be around 2.5% to 3.29%. The finding of
such high rates of OCD in epidemiological studies resulted in being labelled as “Hidden
Epidemic”. It is one of the 10th most disabling medical conditions worldwide. It is twice as
prevalent as schizophrenia and bipolar disorder.5 In Western countries OCD is the 4th most
common mental health condition after depression, substance abuse and phobias which affects
men, women and children.6 About 58-60% of the OCD patients experience two or more co-
morbid psychiatric condition during their lifetime. Available evidence suggests that OCD
patients report general impairment in their functioning in several areas particularly in marital,
occupational, emotional, social functioning.5 2.5% of global years are lost due to this disability.7

Panchagavya Ghrita is a formulation of five ingredients Goksheera (cow’s milk) ,


Godadhi (cow’s curd) , Gomootra (cow’s urine) , Gomaya (cowdung) and Goghrita (cow ghee)
It is indicated in the treatment of Atattvabhinivesha in the chapter of Apasmara Chikitsa 8.
Since, very few studies have taken place in this area, this study is taken up to assess the
efficacy of Panchagavya Ghrita in the management of Atattvabhinivesha (OCD).

REVIEW OF LITREATURE:


Atattvabhinivesha is described as a Mahagada and its Nidana, Samprapti, Lakshana and
Chikitsa has been explained.9

Atattvabhinivesha is a Manasika Roga which is the cause for worldly distress.2

The clinical features like- Moodha, AlpaChetana, Vyakula have been commented thereby
providing an insight in understanding the disease.10
DRUG REVIEW:

Panchagavya Ghritha is used in the management of Atattvabhinivesha as


mentioned in the context of Apasmara chikitsa.8 It is the formulation of five ingredients i.e.
Goksheera, Godadhi, Gomootra, Gomaya and Goghrita.
Rasa Guna Veerya Vipaka Doshaghnata Karma

Goksheera Madhura Guru, Snigdha, Sheeta Madhura VataPittahara Medhya


(cow’s milk)11 Prasanna jeevaneeya
Godadhi (cow’s Amla, Guru, Snigdha Ushna Amla Vatahara Balya,
curd)12 Kashaya (Charaka, Indriya
Vaghbata), bodhaka,
Madhura Hridya,
(Sushruta)
Gomootra Katu, Laghu, Ruksha, Ushna Katu Kaphavatahara Deepaka,
(cow’s urine)13 Lavana, Teekshna Pachaka,
Kshara Srothovivara
na Medhya
Gomaya Katu, Laghu, Ruksha, Ushna Katu Pittahara Deepaka
(cowdung)14 Lavana Teekshna Pachaka,
Doshavilaya
na
Goghrita (cow’s Madhura Guru,Snigdha, Sheeta Madhura VataPittahara Deepana,
ghee)15 Picchila Medhya,
Vayasthapak
a

By analysing the properties it is evident that Panchagavya Ghrita has its action on Buddhi,
Manas, Indriya and corrects the ManovahaSrotodusti. It purifies Rajas and Tamas. It acts on the
Sadhaka pitta , which is responsible for Dhee, Dhriti and Smriti by improving the nutrition to the
brain cells. Thus it acts as a Medhya Rasayana which helps in promotion of nutritional status of
nervous tissue thereby improving its function .A clinical study has shown that the effect of
Panchagavya Ghrita is highly significant on the Medha Guna.16 By analyzing the chemical
constituents also, milk and its products contain tryptophan-amino acid, which is responsible for
serotonin production. Vitamin E which is present in ghee reduces the oxidative stress produced in
OCD.17 Thus it combats the pathogenesis of Atattvabhinivesha(OCD).
6.3) PREVIOUS WORK DONE:

1. Kotecha Rajesh Kumar -A clinical study on the treatment of Atattva-Abhinivesha with


reference to anxiety states. Jamnagar, Gujarat Ayurveda Univerty, (1991)
2. Sakhara(MS)M. – A study on the role of Guduchyadi Medhya Rasayana in the
management of Atattva-Abhinivesha. Jamnagar, Gujarat Ayurveda University, (1994)
3. Sharma SS -Role of Brahmi compound and Chaitas Ghritha Nasya in the management of
anxiety disorders (Atattva-Abhinivesha). Jamnagar,Gujarat Ayurveda University,(1999).
4. Yardi AB- To study the affect of shirodhara chikitsa on Atattva-Abhinivesha
Nasik Ayurveda University,(1996).
5. Shivaramakrishna- Clinical study on the effect of an Ayurvedic compound in
Atattvabhinivesha with special reference to OCD. B.R.K.R. Government Ayurvedic
college Hyderabad , NTR University of Health science Vijayawada (2009).
6. G.S.Achilya, N.R. Kotagali, S.G. Wadodkar, A.K. Dorle- Hepatoprotective activity of
Panchagavya ghrita against carbontetrachloride induced hepatotoxicity in rats. Indian
Journal of Pharamacolgy 2003; 308-311.
7. Gosavier Devesh D, Premendren, S.John- Effect of Panchagavya ghrita on some
neurological parameters in albino rats. Asian Journal of Pharmaceutical and Clinical
Research. Jan-March- 2012.

6.4) OBJECTIVE OF THE STUDY:

To assess the efficacy of Panchagavya Ghrita in the management of


Atattvabhinivesha(OCD).

7) MATERIAL AND METHODS:

A) CLINICAL STUDY
7.1) SOURCE OF DATA:

20 Patients of Atattvabhinivesha (OCD) will be selected for study from the OPD and IPD
of SDM College of Ayurveda & Hospital, Hassan.

7.2) METHOD OF COLLECTION OF THE DATA:

CRITERIA OF DIAGNOSIS:

For diagnosis detailed medical history and physical examinations will be done,
according to both Ayurvedic and Modern clinical methods. A detail interview will be conducted
to elucidate psychological problems, social problems and other areas of functioning.
The diagnostic guidelines mentioned in ICD-10 diagnostic criteria for obsessive
-compulsive disorder will be followed.18
1. Obsessional symptoms/compulsive acts or both must be present on most days for at least 2
successive weeks and be a source of distress /interference with activities.
2. Obsessional symptoms should have the following characteristics:
(a) They must be recognized as the individuals own thought/ impulses.
(b) There must be at least one thought /act that is still resisted unsuccessfully, even though others
may be present which the sufferers no longer resists.
(c) The thought of carrying out the act must not in itself be pleasurable (simple relief of
tension/anxiety is not regarded as pleasure in this sense)
(d) The thought, impulses or images must be unpleasantly repetitive.
To assess the psychological intactness, mental status examination and Manasika Bhava
Pareeksha will be carried out.

A. INCLUSION CRITERIA:
1. Patients are willing to sign the informed consent form.
2. Age group between 18-50 years of either sex.
B. EXCLUSION CRITERIA:
1. Organic brain disease
2. Schizophrenia, Dementia
3. Conversion disorder
4. Substance abuse
5. Uncontrolled diabetes and uncontrolled hypertension/tuberculosis

C. PLAN OF STUDY:
20 patients diagnosed as Atattvabhinivesha (OCD)will be selected from OPD and IPD of
SDM College Of Ayurveda And Hospital Hassan.
Yale Brown Obsessive Compulsive scale and Manasika Bhavas will be assessed before
and after treatment.
The scale will be assessed after 15 days of treatment and again after 1 month.
Panchagavya Ghrita will be given in the dosage of 6gm (melted) twice in a day with
warm water before food.19
Sl.No Sanskrit name English name Proportion
1 Goksheera Cow’s milk 1 part
2 Godadhi Cow’s curd 1 part
3 Gomootra Cow’s urine 1 part
4 Gomaya Cowdung 1 part
Swarasa
5 Goghrita Cow ghee 1 part

SOURCE: Nagarjuna Pharmacy which is GMP certified

Method of preparation: To 1 part of Goghrita, 4 part of DravaDravya (Goksheera,


Godadhi, Gomootra, Gomaya Swarasa) are added and heated on Mandaagni, till Ghrita Siddha
Lakshanas like Phena Shanthi occurs.

Packaging: 200ml packed in an air tight container.

Standerdization of drug: Is done as per API and the IS standards.

C. CRITERIA FOR ASSESSMENT: Assessment is done using Yale Brown Obsessive


Compulsive Scale rating before and after treatment.
Y-BOCS scale 20- 0-7= Subclinical.
8-15=Mild

16-23=Moderate.

24-31=Severe.

32-40=Extreme.

Manasika Bhavas are assessed through Manasika Bhava Pareeksha scale 21before and after
treatment.

D. STATISTICAL ANALYSIS:
Statistical analysis of the results will be done by paired ‘t’ test .
DURATION OF STUDY: 1 month.

E. FOLLOW UP: Patients will be reviewed after 15 days of completion of treatment and
followed up to 1 month (extended if necessary)

7.3) DOES THIS STUDY REQUIRES ANY INVESTIGATIONS OR INTERVENTION TO


BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS?

The study will be clinical.

INVESTIGATIONS:

7.4) HAS THE ETHICAL CLEARANCE IS OBTAINED FROM YOUR INSTITUTION


IN CASE OF 7.2? YES

REFERENCES:

1. Shivaramakrisna, PrakashChander. Clinical study on the effect of an Ayurvedic compound in


Atattvabhinivesha with special reference to Obsessive Compulsive disorder. PG thesis.
Hyderabad: NTR U.H.S., Vijayawada; 2009.

2. Acharya JT Charaka samhita with Ayurveda Deepika commentary of Chakrapanidatta 4 th ed.


Varanasi : Chowkamba Sanskrit series; 1994. p 111

3. Sadock BJ, Sadock VA. Obsessive Compulsive disorder. In: Kaplan and Sadock’s Synopsis
of Psychiatry. 10th ed. Philadelphia USA: Lippincott Williams and Wilkins ; 2007. p 604

4. Reddy YJ, Rao NP, Khanna S. An overview of Indian Research in Obsessive Compulsive
Disorder. Indian Journal of Psychiatry. 2010; 52: 200-209.

5. Gururaj GP, Badamath S, Reddy JYS, Chandrashekar CR . Family Burden, Quality of life and
disability in OCD : An Indian persepective. Journal of Post graduate Medicine.2008; 54 (e.g.2) :
91-97.

6. Sayegh SEL, Scott BEA, Angele Agelopoulous. Obsessive Compulsive Disorder: Unearthing
a hidden problem. Cleveland Clinic Journal of Medicine. 2003; 70: 10.
7. Jose Luis Ayuso-Mateos. Global Burden of OCD in 2000. Global programme on evidence for
health policy.21-08-2006; WHO Draft.

8. Sharma RK and Bhagwan Das Apasmara Chikitsa. In: Charaka Samhitha with Ayurveda
Deepika commentary of Chakrapanidatta. Reprint ed. Varanasi : Chowkamba Sanskrit series ;
2003: vol iii. p 453.

9. Sharma RK and Bhagwan Das. Apasmara Chikitsa. In: Charaka Samhitha with Ayurveda
Deepika commentary of Chakrapanidatta. Reprint ed. Varanasi : Chowkamba Sanskrit series ;
2003: vol iii. p 455

10. Gupta NS and Gupta BS. Apasmara Chikitsa. In: Charaka Samhitha with Jalpakalpataru
commentary of Gangadhara. 1st ed. Varanasi : Choukamba Sanskrit series ; vol iv. p 2756

11. Lavekar GS. Inventory of animal products used in Ayurvedic, Siddha and Unani-Part I. ed.
Delhi : Central Council for Research in Ayurveda and Siddha ; 2008. p 44.

12 . Lavekar GS. Inventory of animal products used in Ayurvedic, Siddha and Unani-Part I.
ed. Delhi : Central Council for Research in Ayurveda and Siddha ; 2008. p 59

13. Lavekar GS. Inventory of animal products used in Ayurvedic, Siddha and Unani-Part I. ed.
Delhi : Central Council for Research in Ayurveda and Siddha ; 2008. p 78

14. Lavekar GS. Inventory of animal products used in Ayurvedic, Siddha and Unani-Part I. ed.
Delhi : Central Council for Research in Ayurveda and Siddha ; 2008. p 86.

15. Lavekar GS. Inventory of animal products used in Ayurvedic, Siddha and Unani-Part I. ed.
Delhi : Central Council for Research in Ayurveda and Siddha ; 2008. p 54

16. Parma N, Vyer M, Vyer H. Critical study of Jara(ageing) and its management. Ayu Journal.
2012; 2: vol.33.p.264-269.

17. Lakhan SE and Vieria KF. Nutritional therapies for mental disorder. Nutritional Journal.1999.

18. ICD-10. Classification of Mental and Behavioural Disorder. In : (eds.) Clinical description
and diagnostic guidelines. 10th ed. Geneva: WHO; 1993.vol.1.

19. The Ayurvedic Formulary of India- Part I. 2 nd ed. Delhi. The Controller of Publications
Civil lines ; 2003. p 90.

20. Goodman WK, Price LH, Rasmussen SA, et al. The Yale-Brown Obsessive Compulsive
Scale. Development, use and reliability. Arch Gen Psychiatry. 1986; 46: 1006-1011.
21. Charaka, Dridhabala. Trividha roga vijnaneeyam vimanam. In. Acharya JT, The Charaka
samhita of Agnivesa with the Ayurveda dipika commentary by Chakrapani data. 5 th ed. Varanasi;
Chaukhambha Orientalia. 1995. P.248
9. SIGNATURE OF CANDIDATE :
10. REMARKS OF GUIDE :
11. NAME AND DESIGNATION OF GUIDE :

11.1. GUIDE : DR.SUHAS KUMAR SHETTY.


M.D(Ayu).
DEPARTMENT OF MANASAROGA
S.D.M. COLLEGE OF AYURVEDA
& HOSPITAL, HASSAN – 573201
11.2. SIGNATURE AND SEAL :
11.3. HEAD OF THE DEPARTMENT : DR.NARAYANAPRAKASH.B
M.D(Ayu),Ph.D
PROFESSOR AND HEAD,
DEPARTMENT OF MANASAROGA
S.D.M. COLLEGE OF AYURVEDA
& HOSPITAL, HASSAN – 573201
11.4. SIGNATURE AND SEAL :

12.1. REMARKS OF THE CHAIRMAN


AND PRINCIPAL :
12.2. PRINCIPAL : DR.PRASANNA.N.RAO
M.S (Ayu), Ph.D
S.D.M. COLLEGE OF AYURVEDA
& HOSPITAL, HASSAN – 573201
12.3. SIGNATURE WITH SEAL :

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