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===Nirukti (etymology)===
===Nirukti (etymology)===
<p style="text-align:justify;">The term udavarta is derived from Utt + Aavat i.e., “Ut + Ang + Vrut + Dhaya” to form word Udavarta. [ ] Udavarta is a Sanskrit word derived from 'Ut' verb root (dhatu) with 'Ang' and 'Vrut' preposition (upasarga), suffixed by ‘Dhaya’ pratyaya (suffix). “Ut” means upper side, (Urdhva) “Ang” means entirely and “Vrut” means to move (bhramana). Udavarta means upwards movement, to cause to go out, excrete, to secrete and to retain. Udavarta is a class of diseases marked by retention of the feces i.e., disease of the bowel so, in general urdhwa (upward direction) or pratiloma (moving in abnormal direction) movement of apana vata (one of the five subtypes of vata, situated in the pelvic region) is termed as udavarta.</p>
<p style="text-align:justify;">The term udavarta is derived from Utt + Aavat i.e., “Ut + Ang + Vrut + Dhaya” to form word Udavarta.<ref>Shabdakalpadruma by Raja Radhakanta Deva, Prathama Khand. Second edition. Delhi: Naaga Publishers; 2003. pg.no. 237.</ref> Udavarta is a Sanskrit word derived from 'Ut' verb root (dhatu) with 'Ang' and 'Vrut' preposition (upasarga), suffixed by ‘Dhaya’ pratyaya (suffix). “Ut” means upper side, (Urdhva) “Ang” means entirely and “Vrut” means to move (bhramana). Udavarta means upwards movement, to cause to go out, excrete, to secrete and to retain.<ref>M. Monier Williams Sanskrit English dictionary. </ref> Udavarta is a class of diseases marked by retention of the feces i.e., disease of the bowel so, in general urdhwa (upward direction) or pratiloma (moving in abnormal direction) movement of apana vata (one of the five subtypes of vata, situated in the pelvic region) is termed as udavarta.</p>
===Definition===
===Definition===
<p style="text-align:justify;">‘Udavarta’ is that disease in which there is whirlpool movement (avartana) and upward movement (urdhva gamana) of vata is seen due to retention of vata, urine (mutra) and stool (purisha). The condition in which vata begins to move upwards is called as ‘udavarta’ and in this disease vata is the predominant dosha. </p>
<p style="text-align:justify;">‘Udavarta’ is that disease in which there is whirlpool movement (avartana) and upward movement (urdhva gamana) of vata is seen due to retention of vata, urine (mutra) and stool (purisha). The condition in which vata begins to move upwards is called as ‘udavarta’ and in this disease vata is the predominant dosha.<ref>Bhavaprakasha of Sri Bhavamishra edited with Vidyotini hindi commentary by Pandit Shri Brahma Sankar Mishra, Part II, Adhyaya- 31/2, Chaukhambha Sanskrit Bhawan, Varanasi, Ed: 2009, 11<sup>th</sup> edition. pg. no. 332.</ref> </p>
===Etiopathogenesis===
===Etiopathogenesis===
===Types of Udavarta===
===Types of Udavarta===
<p style="text-align:justify;">Udavarta is of 6 types which occur by suppression of natural urges viz., apana vata nirodhaja (suppression of flatus), mutra vega nirodhaja (suppression of urine), purisha vega nirodhaja (suppression of faeces), shukra vega nirodhaja (suppression of ejaculation of semen), chhardi vega nirodhaja (suppression of vomiting) and kshavathu vega nirodhaja (suppression of sneezing). [Cha. Sa. Sutra Sthana 18/3]</p>
<p style="text-align:justify;">Udavarta is of 6 types which occur by suppression of natural urges viz., apana vata nirodhaja (suppression of flatus), mutra vega nirodhaja (suppression of urine), purisha vega nirodhaja (suppression of faeces), shukra vega nirodhaja (suppression of ejaculation of semen), chhardi vega nirodhaja (suppression of vomiting) and kshavathu vega nirodhaja (suppression of sneezing). [Cha. Sa. Sutra Sthana 18/3]</p>
<p style="text-align:justify;">As per Sushruta Samhita, there are 13 types of suppression of natural urges (vegadharana) namely flatus, faeces, urine, yawning, flow of tears, sneezing, eructation, vomiting, ejaculation of semen, hunger, thirst, breath and sleep. [Su. Sa. Uttara Sthana 55/ 3-4] Suppression of these vega (urges) gives rise to their respective type of udavarta and manifest their respective symptoms which are as follows;</p>
<p style="text-align:justify;">As per Sushruta Samhita, there are 13 types of suppression of natural urges (vegadharana) namely flatus, faeces, urine, yawning, flow of tears, sneezing, eructation, vomiting, ejaculation of semen, hunger, thirst, breath and sleep. [Su. Sa. Uttara Sthana 55/ 3-4] Suppression of these vega (urges) gives rise to their respective type of udavarta and manifest their respective symptoms which are as follows;</p><p style="text-align:justify;">'''Table no. 1:''' '''Types of udavarta and their symptoms''' [Su. Sa. Uttara Sthana 55/6-17]</p>
{| class="wikitable"
|'''Sr.'''
'''No.'''
|
''' Udavarta type'''
|
''' Symptoms'''
|-
|1.
|'''Apana vata/ Adhovata nirodhaja udavarta'''
(Suppression of flatus)
|Flatulence, colic abdominal pain, obstruction in cardiac region, headache, severe dyspnea, hiccoup, cough, coryza, obstruction in throat, terrible spread of kapha and pitta dosha, movement of feces through mouth (reverse peristalsis).
|-
|2.
|'''Purisha vega nirodhaja udavarta'''
(Suppression of urge of defecation)
|Abnormal bowel sounds (atopa), colicy abdominal pain, cutting type of pain in abdomen, retention of feces, upward movement of vata causing excessive belching (urdhwavata).
|-
|3.
|'''Mutra vega nirodhaja udavarta'''
(Suppression of urge of micturition)
|Passing of scanty urine with difficulty with distension of urinary bladder, intense pain in penis, groin, anus, groin, pelvis, scrotum and umbilical region or head as if the body is being torn with spikes.
|-
|4.
|'''Jrimbha vega nirodhaja udavarta'''
(Suppression of yawning)
|Stiffness of neck (manyastambha), stiffness of throat, diseases of head (shiroroga) and vata predominant diseases (other vataja vyadhi). Severe diseases of ear, mouth, nose and eye are also produced.
|-
|5.
|'''Ashru vega nirodhaja udavarta'''
(Suppression of flow of tears/lacrimation either from pleasure or grief)
|Heaviness of head, severe diseases of eye and coryza (peenasa).
|-
|6.
|'''Kshavathu vega nirodhaja udavarta'''
(Suppression of sneezing)
|Severe diseases of head, eye, nose and ears; filling of mouth and throat, excessive pricking pain, obstruction in breath.
|-
|7.
|'''Udagara vega nirodhaja udavarta''' (Suppression of urge of belching)
|Severe diseases caused by vata dosha.
|-
|8.
|'''Chhardi vega nirodhaja udavarta'''
(Suppression of urge of vomiting)
|Various skin diseases (kushtha) arise with predominance of dosa by which food is vitiated.
|-
|9.
|'''Shukra vega nirodhaja udavarta'''
(Suppression of semen ejaculation)
|Swelling and pain in urinary bladder, anus and testicles, retention of urine, seminal calculus, discharge of semen and other related disorders of semen.
|-
|10.
|'''Kshudha vega nirodhaja udavarta'''
(Suppression of urge of hunger)
|Drowsiness, body-ache, anorexia, giddiness and weakness of vision.
|-
|11.
|'''Trishna vega nirodhaja udavarta'''
(Suppression of urge of thirst)
|Dryness in throat and mouth, deafness and cardiac pain.
|-
|12.
|'''Shrama shwasa/ Shranta nishwasa nirodhaja udavarta'''
(Suppression of holding breath after exertion)
|Cardiac disorder, mental confusion and phantom tumor (gulma).
|-
|13.
|'''Nidra vega nirodhaja udavarta'''
(Suppression of urge of sleep)
|Yawning, body ache, dullness in limbs, head and eyes, drowsiness.
|}
===Asadhyata [incurable stage of diseases]===
===Asadhyata [incurable stage of diseases]===
'''D) Palliative therapy (shamana):''' <p style="text-align:justify;">Shamana includes administration of internal medication such as dviruttara- hingvadi churna, hinguvachadi churna given with warm water as an anupana (co-administers with medicine) for correcting the upward movement of vata.</p>
'''D) Palliative therapy (shamana):''' <p style="text-align:justify;">Shamana includes administration of internal medication such as dviruttara- hingvadi churna, hinguvachadi churna given with warm water as an anupana (co-administers with medicine) for correcting the upward movement of vata.</p>
'''E) Purification therapy (shodhana):'''<p style="text-align:justify;">When the disease is chronic and relief is not observed even by adopting above measures, then purification (shodhana) by non-unctuous enema (niruha basti) or purgation (virechana) is advised.</p>
'''E) Purification therapy (shodhana):'''<p style="text-align:justify;">When the disease is chronic and relief is not observed even by adopting above measures, then purification (shodhana) by non-unctuous enema (niruha basti) or purgation (virechana) is advised.</p>
'''F) Pathya ahara kalpana (wholesome diet):'''<p style="text-align:justify;">Intake of wholesome diet (pathya ahara) which helps in normal downward movement (anulomana) of apana vata whereas, intake of unwholesome diet (apathya ahara) should be avoided for better recovery. Generally, in all types of udavarta all measures for controlling vata should be adopted in order to restore it to its normal channels (srotasa). [Su. Sa. Uttara Sthana 55/ 19]</p>
'''F) Pathya ahara kalpana (wholesome diet):'''<p style="text-align:justify;">Intake of wholesome diet (pathya ahara) which helps in normal downward movement (anulomana) of apana vata whereas, intake of unwholesome diet (apathya ahara) should be avoided for better recovery. Generally, in all types of udavarta all measures for controlling vata should be adopted in order to restore it to its normal channels (srotasa). [Su. Sa. Uttara Sthana 55/ 19]</p><p style="text-align:justify;">'''Table no. 2:''' '''Types of udavarta and their respective treatment''' [Su. Sa. Uttara Sthana 55/20-34]</p>
{| class="wikitable"
|'''Sr.'''
'''No.'''
|
'''Udavarta type'''
|
''' Treatment'''
|-
|
1.
|'''Apana vata/ Adhovata nirodhaja udavarta'''
(Suppression of flatus)
|Massage (abhyanga) and sudation (swedana) followed by asthapana basti (non-unctuous enema).
|-
|
2.
|'''Purisha vega nirodhaja udavarta'''
(Suppression of urge of defecation)
|Treatment of non- passage of flatus and feces (anaha) should be adopted.
|-
|
3.
|'''Mutra vega nirodhaja udavarta'''
(Suppression of urge of micturition)
|Treatment of renal calculi (ashmari), dysuria (mutrakrichha) and retention of urine (mutraghata) should be adopted.
|-
|
4.
|'''Jrimbha vega nirodhaja udavarta'''
(Suppression of yawning)
|Unction therapy (snehana) and fomentation therapy (swedana).
|-
|
5.
|'''Ashru vega nirodhaja udavarta'''
(Suppression of flow of tears/lacrimation either from pleasure or grief)
|After unction therapy (snehana) and fomentation therapy (swedana) the flow of tears should be stimulated by applying irritant collyrium etc.
|-
|
6.
|'''Kshavathu vega nirodhaja udavarta'''
(Suppression of sneezing)
|Induce sneezing by application of irritant collyrium, pressed snuff (avapidana nasya), inhalation of irritant odor or by using smoking wick (dhuma varti).
|-
|
7.
|'''Udagara vega nirodhaja udavarta''' (Suppression of urge of belching)
|Unctuous smoking (snehaika dhumapana) with prescribed order and also intake of wine (sura) mixed with bijapura (Citrus medica) juice and added with black salt (sauvarchala lavana/ Unaqua sodium chloride).
|-
|
8.
|'''Chardi vega nirodhaja udavarta'''
(Suppression of urge of vomiting)
|Unction according to the dosa involved. Massage with ghee mixed with a pinch of alkali prepared from barley (yavakshara) and rock salt (saindhava lavana).
|-
|
9.
|'''Shukra vega nirodhaja udavarta'''
(Suppression of semen ejaculation)
|Patient advised to drink milk boiled with four times water added with diuretic drugs up to full satisfaction and then indulge in sexual activity.
|-
|10.
|'''Kshudha vega nirodhaja udavarta'''
(Suppression of urge of hunger)
|Intake of unctuous and warm food in little quantity.
|-
|
11.
|'''Trishna vega nirodhaja udavarta'''
(Suppression of urge of thirst)
|Intake of churned drink (mantha) or liquid gruel (yavagu) of cold nature. Use of cold water for drinking and other purpose.
|-
|
12.
|'''Shrama shwasa/ Shranta nishwasa nirodhaja udavarta'''
(Suppression of holding breath after exertion)
|Complete rest and intake of meat soup.
|-
|
13.
|'''Nidra vega nirodhaja udavarta'''
(Suppression of urge of sleep)
|Advised to go to sleep after intake of milk and listening to favorite stories.
|}
<p style="text-align:justify;">Complications of udavarta, flatulence (adhmana) and other diseases should be managed with respective measures according to condition. [Su. Sa. Uttara Sthana 55/34-35] For example when vayu in abdomen (koshtha) is aggravated by rough, pungent, bitter and astringent food, it immediately produces udavarta owing to which the channels (srotasa) carrying flatus, feces, urine, blood, kapha and adipose tissue (medas), move in upward direction and harden the feces too much. This results in manifestation of symptoms such as pain in cardiac and pelvic region, heaviness, anorexia, passing of urine, flatus and feces with difficulty. The person gets afflicted with many other disorders caused by aggravation of vata such as dyspnoea, (shwasa), cough (kasa), hiccoup (hikka), thirst (trishna), coryza (pratishyaya), burning sensation (daha), mental confusion (moha), vomiting (chhardi), fever (jwara), diseases of head and abnormalities of mind and ears. [Su. Sa. Uttara Sthana 55/2] </p>
<p style="text-align:justify;">Complications of udavarta, flatulence (adhmana) and other diseases should be managed with respective measures according to condition. [Su. Sa. Uttara Sthana 55/34-35] For example when vayu in abdomen (koshtha) is aggravated by rough, pungent, bitter and astringent food, it immediately produces udavarta owing to which the channels (srotasa) carrying flatus, feces, urine, blood, kapha and adipose tissue (medas), move in upward direction and harden the feces too much. This results in manifestation of symptoms such as pain in cardiac and pelvic region, heaviness, anorexia, passing of urine, flatus and feces with difficulty. The person gets afflicted with many other disorders caused by aggravation of vata such as dyspnoea, (shwasa), cough (kasa), hiccoup (hikka), thirst (trishna), coryza (pratishyaya), burning sensation (daha), mental confusion (moha), vomiting (chhardi), fever (jwara), diseases of head and abnormalities of mind and ears. [Su. Sa. Uttara Sthana 55/2] </p>
<p style="text-align:justify;">One should advise non-unctuous enema (niruha basti) after the patient is massaged with oil mixed with salt and sudation; then after feces are eliminated, he should be advised to take food followed by administration of unctuous enema (anuvasana basti) according to the dosha involvement. If by above procedures, still no relief found then in severe cases of udavarta, patient is advised to undergo repeated unction therapy (snehana) and fomentation therapy (swedana) and then undergo unctuous purgation (snigdha virechana). [Su. Sa. Uttara Sthana 55/40-41]</p>
<p style="text-align:justify;">One should advise non-unctuous enema (niruha basti) after the patient is massaged with oil mixed with salt and sudation; then after feces are eliminated, he should be advised to take food followed by administration of unctuous enema (anuvasana basti) according to the dosha involvement. If by above procedures, still no relief found then in severe cases of udavarta, patient is advised to undergo repeated unction therapy (snehana) and fomentation therapy (swedana) and then undergo unctuous purgation (snigdha virechana). [Su. Sa. Uttara Sthana 55/40-41]</p>
===Researches===
===Researches===
<p style="text-align:justify;">1) A review on diseases manifested due to withholding natural urges (vegadharana janya vikara) focused to identify the effects of suppression of natural urges (adharaneeya vegas) on various system of body such as CVS, gastrointestinal tract, respiratory system urinary system and reproductive system. CVS and gastrointestinal systems are the mostly affected systems. Out of thirteen urges (vegas), seven play major role in both systems. Common clinical features produced by suppression of natural urges (vegadharana) were weakness of the body, constipation, anorexia, headache, diseases of eye, difficulty in micturition, bending of the body and stiffness of the neck. Weakness of the body and anorexia are the commonest clinical features produced by suppression of natural urges. These clinical features arise due to vitiation of vata by vegadharana. Withholding (dharana) of natural urges is strictly prohibited to stay healthy.</P>
<p style="text-align:justify;">1) A review on diseases manifested due to withholding natural urges (vegadharana janya vikara) focused to identify the effects of suppression of natural urges (adharaneeya vegas) on various system of body such as CVS, gastrointestinal tract, respiratory system urinary system and reproductive system. CVS and gastrointestinal systems are the mostly affected systems. Out of thirteen urges (vegas), seven play major role in both systems. Common clinical features produced by suppression of natural urges (vegadharana) were weakness of the body, constipation, anorexia, headache, diseases of eye, difficulty in micturition, bending of the body and stiffness of the neck. Weakness of the body and anorexia are the commonest clinical features produced by suppression of natural urges. These clinical features arise due to vitiation of vata by vegadharana. Withholding (dharana) of natural urges is strictly prohibited to stay healthy.<ref>Zahara M.S.F, Kulathunga R.D.H, Chathurika L.A.W.J. A Review of Vegadharana. International Ayurvedic Medical Journal. ISSN 2320 5091, March 2021.</ref></P>
<p style="text-align:justify;">2) A physiological study of adharaneeya vega (suppression of natural urges) w.s.r. to apana vayu vega (suppression of apana vata or flatus)</p>
<p style="text-align:justify;">2) A physiological study of adharaneeya vega (suppression of natural urges) w.s.r. to apana vayu vega (suppression of apana vata or flatus)</p>
<p style="text-align:justify;">Understanding the physiology of suppression of natural urges (vegarodhajanya) symptoms and analyzing them as a pathology of various diseases related to apana vayu (one of the five subtypes of vata situated in the pelvic region). As, seen in clinical practice many a times diseases reoccur after giving proper treatment. Also, in such case causative factors (nidana) of vitiation of apana vayu (one of the five subtypes of vata situated in the pelvic region) is to be analyzed properly for better result. Among the fourteen adharaneeya vega (suppression of natural urges), apana vayu (one of the five subtypes of vata situated in the pelvic region) vega (urge) is most commonly suppressed which leads to vitiation of vata dosha in the pelvic region). Adharaneeya vega (suppression of natural urges) is a reflex mechanism and it is a nervous activity. Nerve supply to gastrointestinal tract is in the form of sympathetic, parasympathetic, enteric nervous system (ENS) and gastrointestinal reflexes. The ENS is to be referred as second brain, it uses serotonin to communicate with the central nervous system. This “brain gut axis’ helps us in understanding how psychological and social stress might cause digestive problems. ENS is closely related to central nervous system (CNS). As mentioned, blindness (‘andhya’) is one of the udavarta janya vikara (diseases caused by udavarta) which is difficult to understand how eyes are related to apana vayu (one of the five subtypes of vata situated in the pelvic region). In an article named ‘Gut microbes linked to eye diseases’ observations have been made by the researchers regarding the possible connection between the gut microbes and the eye diseases. Apana vayu (one of the five subtypes of vata situated in the pelvic region) is mostly parasympathetic in action and its action is related to urine (mutra), stool (purisha), flatus (adhovata) and seminal discharge (shukra vega). Obstruction in passing flatus (apana vayu rodha) invariably affects the prana vayu (one type of the five subtypes of vata situated in upward body or head) among and other vital points in body (marma sthana) like herat (hrudya), brain (shiras), and urinary bladder (basti).</p>
<p style="text-align:justify;">Understanding the physiology of suppression of natural urges (vegarodhajanya) symptoms and analyzing them as a pathology of various diseases related to apana vayu (one of the five subtypes of vata situated in the pelvic region). As, seen in clinical practice many a times diseases reoccur after giving proper treatment. Also, in such case causative factors (nidana) of vitiation of apana vayu (one of the five subtypes of vata situated in the pelvic region) is to be analyzed properly for better result. Among the fourteen adharaneeya vega (suppression of natural urges), apana vayu (one of the five subtypes of vata situated in the pelvic region) vega (urge) is most commonly suppressed which leads to vitiation of vata dosha in the pelvic region). Adharaneeya vega (suppression of natural urges) is a reflex mechanism and it is a nervous activity. Nerve supply to gastrointestinal tract is in the form of sympathetic, parasympathetic, enteric nervous system (ENS) and gastrointestinal reflexes. The ENS is to be referred as second brain, it uses serotonin to communicate with the central nervous system. This “brain gut axis’ helps us in understanding how psychological and social stress might cause digestive problems. ENS is closely related to central nervous system (CNS). As mentioned, blindness (‘andhya’) is one of the udavarta janya vikara (diseases caused by udavarta) which is difficult to understand how eyes are related to apana vayu (one of the five subtypes of vata situated in the pelvic region). In an article named ‘Gut microbes linked to eye diseases’ observations have been made by the researchers regarding the possible connection between the gut microbes and the eye diseases. Apana vayu (one of the five subtypes of vata situated in the pelvic region) is mostly parasympathetic in action and its action is related to urine (mutra), stool (purisha), flatus (adhovata) and seminal discharge (shukra vega). Obstruction in passing flatus (apana vayu rodha) invariably affects the prana vayu (one type of the five subtypes of vata situated in upward body or head) among and other vital points in body (marma sthana) like herat (hrudya), brain (shiras), and urinary bladder (basti).<ref>Gugulothu Ramesh, Yadav C.R. A physiological study of Adharaneeya vega w.s.r. to Apanavayu vega. International Ayurvedic Medical Journal. ISSN: 2320 5091, September 2017, 5(9).</ref></p>
<p style="text-align:justify;">3) Nidra vegadharana (suppression of sleep) leads to vitiation of vata dosha. Vata controls the functions of mind (mana). Stress is mainly due to mental and physical stimuli which cause disturbances in the internal biological equilibrium. Disturbed and interrupted sleep is very common in the IT professionals due to their work culture. Here, nidra vegadharana (suppression of urge of sleep) acts as a stress stimulus which causes impairment in both sharirika (biological elements vata, pitta and kapha) and manasika (psychological constitution like raja and tama) dosha which causes further loss of sleep (nidranasha). Udavarta affects mind and leads to abnormalities in mental functions similar to mental stress. Hence it is important to avoid nidra vegadharana (suppression of urge of sleep) to prevent further kriyakala i.e., stage of progression of disease leading to stress and other mental disorders. </p>
<p style="text-align:justify;">3) Nidra vegadharana (suppression of sleep) leads to vitiation of vata dosha. Vata controls the functions of mind (mana). Stress is mainly due to mental and physical stimuli which cause disturbances in the internal biological equilibrium. Disturbed and interrupted sleep is very common in the IT professionals due to their work culture. Here, nidra vegadharana (suppression of urge of sleep) acts as a stress stimulus which causes impairment in both sharirika (biological elements vata, pitta and kapha) and manasika (psychological constitution like raja and tama) dosha which causes further loss of sleep (nidranasha). Udavarta affects mind and leads to abnormalities in mental functions similar to mental stress. Hence it is important to avoid nidra vegadharana (suppression of urge of sleep) to prevent further kriyakala i.e., stage of progression of disease leading to stress and other mental disorders.<ref>S. Gopakumar, M. A. Shajahan. A Review on Conceptual Relationship between Nidra vegadharana and Manifestation of Stress among IT professionals. International Ayurvedic Medical Journal, ISSN: 2320 5091, April- May 2107, 1(4). </ref> </p>
<p style="text-align:justify;">4) In this study total 74 patients have been enrolled which were divided in two groups randomly. The selected drug for clinical trial in group A was Yavanikadi vati (tablet) which contains haritaki (Terminalia chebula), yavani (Trachyspermum ammi), hingu (Ferula foetida), sauvarchala (black salt), yavakshara (alkali prepared from barley) and saindhava (rock salt). The powder of these raw drugs was given 3 times trituration (bhavana) of these raw drugs was given 3 times trituration (bhavana) of lemon juice (nimbu swarasa) to prepare tablet. In group B, Shankha vati (tablet) was taken for control group, which contains purified mercury (shuddha parada) and purified sulphur (shuddha gandhaka). In the group A 31 patients were given Yavanikadi vati in tablet form 1 gm B.D. in two divided doses (1 tablet = 500 mg.) daily, after food for 28 days with water whereas, in Group B total 30 patients were given Shankha Vati. The dose, duration, time of administration and anupana (co-administers with medicine) is same as group A. Comparison of the therapies showed that overall better results as observed in group A as compared to group B which stands closely parallel to group A. </p>
<p style="text-align:justify;">4) In this study total 74 patients have been enrolled which were divided in two groups randomly. The selected drug for clinical trial in group A was Yavanikadi vati (tablet) which contains haritaki (Terminalia chebula), yavani (Trachyspermum ammi), hingu (Ferula foetida), sauvarchala (black salt), yavakshara (alkali prepared from barley) and saindhava (rock salt). The powder of these raw drugs was given 3 times trituration (bhavana) of these raw drugs was given 3 times trituration (bhavana) of lemon juice (nimbu swarasa) to prepare tablet. In group B, Shankha vati (tablet) was taken for control group, which contains purified mercury (shuddha parada) and purified sulphur (shuddha gandhaka). In the group A 31 patients were given Yavanikadi vati in tablet form 1 gm B.D. in two divided doses (1 tablet = 500 mg.) daily, after food for 28 days with water whereas, in Group B total 30 patients were given Shankha Vati. The dose, duration, time of administration and anupana (co-administers with medicine) is same as group A. Comparison of the therapies showed that overall better results as observed in group A as compared to group B which stands closely parallel to group A.<ref>A clinical study of Udavarta with special reference to Udavarta by Taruna Modhera, Department of Roga Nidana Evam Vikriti Vigyana. Institute for Post Graduate Teaching and Research in Ayurveda. Gujarat Ayurved University, Jamnagar, 2008.</ref> </p>