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<ol style='text-align:justify;'><li style="font-weight:bold">A clinical study on the role of ama in relation to Grahini roga and its management by kallingadi ghanavati and tryushnadi ghrita<span style="font-weight:normal"><br/><b>Discussion over role of ama in relation to Grahani disease: </b>When the vitiated dosha get confined only to the organ grahani (duodenum), then it should be called ‘Grahani dosha’. But when the vitiated doshas travels throughout the rasadi dhatus (seven bodily tissues) i.e. throughout the body, then it should be called as ‘Grahani roga’ (functional impairment of agni). The grahani and agni (digestive process) are having co-existing nature/dependent on each other (adhara adheya sambandha). This view is confirmed by corroborative evidence from recent development in pathology. The mucosal damage in the form of villous atrophy and other microvillus changes in different enteropathies affect the enzymes present in the enterocyte brush borders. When the disease process progresses, further it affects the pancreatic secretion as it depends upon cholecystokinin and secretin secretion from the enterocyte. The immature epithelial cells are unable to secrete the required amount of cholecystokinin and secretin. In the pathogenesis (samprapti) of grahani disease, Acharya Charak elaborated a series of events as below.  

<ol style='text-align:justify;'><li style="font-weight:bold">A clinical study on the role of ama in relation to Grahini roga and its management by kallingadi ghanavati and tryushnadi ghrita<span style="font-weight:normal"><br/><b>Discussion over role of ama in relation to Grahani disease: </b>When the vitiated dosha get confined only to the organ grahani (duodenum), then it should be called ‘Grahani dosha’. But when the vitiated doshas travels throughout the rasadi dhatus (seven bodily tissues) i.e. throughout the body, then it should be called as ‘Grahani roga’ (functional impairment of agni). The grahani and agni (digestive process) are having co-existing nature/dependent on each other (adhara adheya sambandha). This view is confirmed by corroborative evidence from recent development in pathology. The mucosal damage in the form of villous atrophy and other microvillus changes in different enteropathies affect the enzymes present in the enterocyte brush borders. When the disease process progresses, further it affects the pancreatic secretion as it depends upon cholecystokinin and secretin secretion from the enterocyte. The immature epithelial cells are unable to secrete the required amount of cholecystokinin and secretin. In the pathogenesis (samprapti) of grahani disease, Acharya Charak elaborated a series of events as below.  

<br/>Indulgence in causes that vitiate agni (digestive f) → agni dushti (vitiation og agni) → indigestion (apachana) → production of ama (non-metabolized, poorly formed product) → putreification (shukta paka)→ advanced condition of ama manifestating as a poisoning codition (anna visha or ama visha) → grahani dosha (functional impairement of grahini) → grahani dushti (vitiation of grahani)→ grahini roga (diseases manifestating as functional impairement of agni/digestive funtions). Ama is the root cause of almost all diseases produced in the body and the treatment of any disease can be based on stage of the disease associated with ama (saama) & stage of the disease not associated with ama (nirama avastha).  

<br/>Indulgence in causes that vitiate agni (digestive f) → agni dushti (vitiation og agni) → indigestion (apachana) → production of ama (non-metabolized, poorly formed product) → putreification (shukta paka)→ advanced condition of ama manifestating as a poisoning codition (anna visha or ama visha) → grahani dosha (functional impairement of grahini) → grahani dushti (vitiation of grahani)→ grahini roga (diseases manifestating as functional impairement of agni/digestive funtions). Ama is the root cause of almost all diseases produced in the body and the treatment of any disease can be based on stage of the disease associated with ama (saama) & stage of the disease not associated with ama (nirama avastha).  

<br/><br/><b>Outcome of clinical study: </b>This clinical trial was carried out in 66 patients of 16-60 year of age group having cardinal sign and symptoms of grahani disease. Patients were selected randomly into Group A, Group B and Group C treated by kallingadi ghanavati, tryushnadi ghrita and combination of both (ghanavati & ghrita) respectively for 2 weeks. The overall effect of therapies showed that better results observed in group B in comparison to group A. In comparison of all three groups, group C showed slight better results than those of rest two groups.<ref name="ref8">A clinical study on the role of ama in relation to grahini roga and its management by kallingadi ghanavati and tryushnadi ghrita by Alpesh P. Sorathiya, Dept. of Kayachikitsa, IPGT&RA, Jamnagar, 2009. </ref> </span></li>

<br/><b>Outcome of clinical study: </b>This clinical trial was carried out in 66 patients of 16-60 year of age group having cardinal sign and symptoms of grahani disease. Patients were selected randomly into Group A, Group B and Group C treated by kallingadi ghanavati, tryushnadi ghrita and combination of both (ghanavati & ghrita) respectively for 2 weeks. The overall effect of therapies showed that better results observed in group B in comparison to group A. In comparison of all three groups, group C showed slight better results than those of rest two groups.<ref name="ref8">A clinical study on the role of ama in relation to grahini roga and its management by kallingadi ghanavati and tryushnadi ghrita by Alpesh P. Sorathiya, Dept. of Kayachikitsa, IPGT&RA, Jamnagar, 2009. </ref> </span></li>

<li style="font-weight:bold">Association of stress inducing factors (manoabhitapakara bhava) and free radical over madhumeha<span style="font-weight:normal"><br/><b>Discussion over association of stress inducing factors (manoabhitapakara bhava) and free radicals with chronic metabolic diseases such as diabetes mellitus type 2 (madhumeha):</b><br/>This research explains about how adherence with stress (manobhitapakara bhava) lead to produce ama or free radical, and in turn produces chronic metabolic diseases. The harmony of mind (manas) responsible for the perfect harmony of body. Altered external living sources like demographic alteration, change in family system, urbanization, industrialization, westernisation have a potent role to induce the pathogenesis at psychic level as well as body level by the faulty pattern of adaptataion. Repeated attachment with stress (kamadi bhavas) are the potent cause for morbidity and mortality rate of obstinate urinary disease/diabetes melitus type 2(madhumeha). This is not only for the cause but it also responsible for the complication. Excessive generation of free radical sustained affection of stress (manobhitapakara bhavas) altered the body defence mechanism, which in terms can be understand. Treatment like pacifying vitiated manasika dosha (manasa doshahara), counseling, antistress approach, dipana (appetizers), pachana (digestives), can check the vicious pathogenesis involved in madhumeha (obstinate urinary disease/ diabetes mellitus type 2). <br/><br/><b>Outcome of  the study: </b>There is a direct relation of the mean score of manobhitapakara bhavas (stress), lipid peroxide and fasting blood sugar. By changing mode of life style, optimistic attitude, keeping faith in good, decreasing the high blood pressure level stress hormones can be reduced. Which it reflects through the sufficient decrease in signs and symptoms of the disease.<ref name="ref9">Manoabhitapakara bhava, free radical, madhumeha by Bishnupriya, Dept. of Basic principles, IPGT& RA, Jamnagar,2001.</ref></span></li>

<li style="font-weight:bold">Association of stress inducing factors (manoabhitapakara bhava) and free radical over madhumeha<span style="font-weight:normal"><br/><b>Discussion over association of stress inducing factors (manoabhitapakara bhava) and free radicals with chronic metabolic diseases such as diabetes mellitus type 2 (madhumeha):</b><br/>This research explains about how adherence with stress (manobhitapakara bhava) lead to produce ama or free radical, and in turn produces chronic metabolic diseases. The harmony of mind (manas) responsible for the perfect harmony of body. Altered external living sources like demographic alteration, change in family system, urbanization, industrialization, westernisation have a potent role to induce the pathogenesis at psychic level as well as body level by the faulty pattern of adaptataion. Repeated attachment with stress (kamadi bhavas) are the potent cause for morbidity and mortality rate of obstinate urinary disease/diabetes melitus type 2(madhumeha). This is not only for the cause but it also responsible for the complication. Excessive generation of free radical sustained affection of stress (manobhitapakara bhavas) altered the body defence mechanism, which in terms can be understand. Treatment like pacifying vitiated manasika dosha (manasa doshahara), counseling, antistress approach, dipana (appetizers), pachana (digestives), can check the vicious pathogenesis involved in madhumeha (obstinate urinary disease/ diabetes mellitus type 2). <br/><b>Outcome of  the study: </b>There is a direct relation of the mean score of manobhitapakara bhavas (stress), lipid peroxide and fasting blood sugar. By changing mode of life style, optimistic attitude, keeping faith in good, decreasing the high blood pressure level stress hormones can be reduced. Which it reflects through the sufficient decrease in signs and symptoms of the disease.<ref name="ref9">Manoabhitapakara bhava, free radical, madhumeha by Bishnupriya, Dept. of Basic principles, IPGT& RA, Jamnagar,2001.</ref></span></li>

<li style="font-weight:bold">A critical and comparative study of Ama and Free radical theory with special reference to Amavata<span style="font-weight:normal"><br/><b>Outcome of study: </b>Free radical is an atom/molecule that contains one or more unpaired electron, which requires neutralisation by free radical scavengers. Thus it exists in an incomplete metabolic state which is also the state of ama described as incompletely digested (avipakvam). Free radicals cause damage to cell membrane and thus the cell is destroyed. This destruction may lead to putrification and foul smell generations which is similar to one of the property of ama described as unpleasant smell (durgandham). Though ama remains in the body as isolated or not mized (asamyuktam), but due to its properties like excessive sliminess (bahupicchilam) etc. it sticks to normal healthy body tissues very quickly, similar is the case with free radicals. To seek stability in their structure they quickly attack the healthy molecules of the body and thus setting a chain reaction. The cells throughout body are continously exposed to these damaging molecules, same has been described for ama as causing sluggishness of whole body (sadanam sarva gatranam). From above one can observe that properties of free radicals are similar to the properties of ama described in classics. Now the process of production of free radicals in body and production of ama would be considered. So it may be concluded that the causative factors (nidana) such as heavy to digest (guru ), unctuousness (snigdha) etc. qualities of diet (ahara) of amavata (rheumatism) as mentioned in the classics have a specific role to play in production of ama and also in the generation of free radicals. Also the line of treatment of ama advocated in the classics is effective in reducing the level of ama as well as free radicals. So it can be inferred that a positive correlation exists between ama and free radicals.<ref name="ref10">A critical and comparative study of Ama and Free radical theory with special reference to Amavata by Gaurav sharma, Department of Basic principles, IPGT& RA, Jamnagar, 2001.</ref></span></li>

<li style="font-weight:bold">A critical and comparative study of Ama and Free radical theory with special reference to Amavata<span style="font-weight:normal"><br/><b>Outcome of study: </b>Free radical is an atom/molecule that contains one or more unpaired electron, which requires neutralisation by free radical scavengers. Thus it exists in an incomplete metabolic state which is also the state of ama described as incompletely digested (avipakvam). Free radicals cause damage to cell membrane and thus the cell is destroyed. This destruction may lead to putrification and foul smell generations which is similar to one of the property of ama described as unpleasant smell (durgandham). Though ama remains in the body as isolated or not mized (asamyuktam), but due to its properties like excessive sliminess (bahupicchilam) etc. it sticks to normal healthy body tissues very quickly, similar is the case with free radicals. To seek stability in their structure they quickly attack the healthy molecules of the body and thus setting a chain reaction. The cells throughout body are continously exposed to these damaging molecules, same has been described for ama as causing sluggishness of whole body (sadanam sarva gatranam). From above one can observe that properties of free radicals are similar to the properties of ama described in classics. Now the process of production of free radicals in body and production of ama would be considered. So it may be concluded that the causative factors (nidana) such as heavy to digest (guru ), unctuousness (snigdha) etc. qualities of diet (ahara) of amavata (rheumatism) as mentioned in the classics have a specific role to play in production of ama and also in the generation of free radicals. Also the line of treatment of ama advocated in the classics is effective in reducing the level of ama as well as free radicals. So it can be inferred that a positive correlation exists between ama and free radicals.<ref name="ref10">A critical and comparative study of Ama and Free radical theory with special reference to Amavata by Gaurav sharma, Department of Basic principles, IPGT& RA, Jamnagar, 2001.</ref></span></li>

<li style="font-weight:bold">A critical study of Trividhakuksiyavimana w.s.r. to amotpatti and its management<span style="font-weight:normal"><br/><b>Outcome of study: </b>In this study, 2 groups are there, group I (treatment group) patients have been given chaturushna churna (powder) followed by wholesome diet (pathya) and light to digest food. Whereas, in group II (control group) patients received placebo treatment and wholesome diet (pathya) and light to digest food.. Dosha (ama dosha and tridosha (vata,pitta and kapha)) when adhere to amashaya (stomach), the desired response of the medicine may not be obtained which is observed in clinical study. Due to this the 21 days duration of therapy did not produce total cure response. So, we can say that if in disease, treatment regimens opposite to disease (vyadhi viparita ausadha) doesn’t produce good response, then it is to be inferred that here amashaya (stomach) is adhered with ama dosha. In this stage, as advised in Trividhakuksiyavimana adhyaya (2nd chapter of Charak Samhita Vimana Sthana), depleting therapy (apatarpna) should be administered. If presence of disease stage (vyadhi anubandha) remains, then the treatment regimens opposite to disease (vyadhi viparita aushadha)  is to be advised.<ref name="ref11">A critical study of Trividhakuksiyavimana w.s.r. to amotpatti and its management by Mihir vyas, Dept. of Basic principles, IPGT& RA, Jamnagar, 2005.</ref></span></li></ol>

<li style="font-weight:bold">A critical study of Trividhakuksiyavimana w.s.r. to amotpatti and its management<span style="font-weight:normal"><br/><b>Outcome of study: </b>In this study, 2 groups are there, group I (treatment group) patients have been given chaturushna churna (powder) followed by wholesome diet (pathya) and light to digest food. Whereas, in group II (control group) patients received placebo treatment and wholesome diet (pathya) and light to digest food.. Dosha (ama dosha and tridosha (vata,pitta and kapha)) when adhere to amashaya (stomach), the desired response of the medicine may not be obtained which is observed in clinical study. Due to this the 21 days duration of therapy did not produce total cure response. So, we can say that if in disease, treatment regimens opposite to disease (vyadhi viparita ausadha) doesn’t produce good response, then it is to be inferred that here amashaya (stomach) is adhered with ama dosha. In this stage, as advised in Trividhakuksiyavimana adhyaya (2nd chapter of Charak Samhita Vimana Sthana), depleting therapy (apatarpna) should be administered. If presence of disease stage (vyadhi anubandha) remains, then the treatment regimens opposite to disease (vyadhi viparita aushadha)  is to be advised.<ref name="ref11">A critical study of Trividhakuksiyavimana w.s.r. to amotpatti and its management by Mihir vyas, Dept. of Basic principles, IPGT& RA, Jamnagar, 2005.</ref></span></li></ol>