Talk:Udavarta

Contributors
Section/Chapter/topic	Concepts & Practices/Udavarta
Authors	Dubey M.1,; Deole Y.S.2
Reviewer	Basisht G.3,
Editor	Basisht G.3
Affiliations	1Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India ; 2Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India; 3Rheumatologist, Orlando, Florida, U.S.A.
Correspondence emails	dr.manish181@gmail.com, dryogeshdeole@gmail.com carakasamhita@gmail.com
Publisher	Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India
Date of publication:	November 03, 2023
DOI	--

Udavarta literally means the upward and repeated movements of vata. It is one of the important and commonly observed condition in clinical practice. It manifests with a number of clinical features which may lead to manifestation of other secondary diseases further. Udavarta is mentioned as one among the eighty diseases occurred primarily by the vitiated vata dosha (nanatmaja vata vyadhi). [Cha. Sa. Sutra Sthana 20/11] Udavarta (upward movement of vata) is very common now a days due to change in lifestyle of modern society. The change in dietary habits and due to hectic job schedule, suppression of natural urges (vegadharana) is also very common now a days. The two main cause of udavarta explained in classical texts are: suppression of natural urges (vegadharana) and faulty dietary habits (asatmya ahara sevana). Sushrut Samhita describes that suppression of natural urges (adharaniya vega) leads to manifestation of thirteen types of udavarta. Due to aggravating factors, vata dosha is aggravated, especially apana vata (one of the five subtypes of vata i.e., situated in the pelvic region) is affected. Generally, udavarta means upward movement of vata or apana vata, that results in retention of faeces, urine and flatus. However, the scope of udavarta extends to disturbance in normal functions of vata due to obstruction by metabolic wastes. This unique concept is not explained in any other contemporary sciences. So, understanding this concept and to provide better treatment for this disease is need of the society.

Nirukti (etymology)

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.

Definition

‘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.

Etiopathogenesis

Intake of deficient quantity of food causes udavarta. [Cha. Sa. Vimana Sthana 2/7]
Intake of astringent, bitter, pungent and un-unctuous (dry) food and excessive fasting
Withholding natural urges (vegadharana)
Excessive indulgence in sexual activity. [Cha. Sa. Chikitsa Sthana 26/5-6]

Due to all above reasons the apana vata which resides in large intestine (pakvashaya) gets aggravated and further obstructs the downward movement of vata causing retention of movement of stool, urine and flatus. This leads to a dreadful disease named as udavarta. [Ca. Sa. Chikitsa Sthana 26/5-6]

Acharya Sushruta explained suppression of 13 urges leading to udavarta. [Su. Sa. Uttara Sthana 55/ 3-4] Thus, udavarta is caused by 2 main causes, one is suppression of natural urges and other one unwholesome eating. [Su. Sa. Uttara Sthana 55/ 6] Excess consumption of mudga (Phaseolus mungo), kodrava (Paspalum scrobiculatum Linn.), jurnahva (Sorghum vulgare/jowar), karira (Capparis decidua), chanaka (Cicer arietinum L.), etc. i.e., foods with property of dryness and causing constipation vitiate normal status of vata dosha in its own seat (large intestine). This vata becomes powerful and blocks the downward channels and produces severe obstruction in the movement of feces, flatus and urine leading to udavarta. [A. H. Nidana Sthana 7/46-52]

Clinical features

Frequent pain in the region of urinary bladder (basti), heart (hridaya), abdomen (udara) and excruciating or intense pain in the back of chest. Other symptoms are flatulence (adhmana), nausea (hrillasa), gripping type of pain in anus (vikartika), pricking (toda) type of pain in whole body, indigestion and inflammation of urinary bladder. Obstruction in passing stool less frequently and with difficulty and in less quantity, after long time and effort. Upward movement of flatus occurs because of obstruction in channels (srotasa), increased roughness, dryness and coldness in the body. [Cha. Sa. Chikitsa Sthana 26/6-7]

Udavarta janya vikara

If not treated early, udavarta leads to other secondary complications as follows:

Fever (jwara), dysuria (mutrakricchhra), dysentery (pravahika), heart disease (hridroga), diseases due to malfunctioning of duodenum (grihani dosha), vomiting (chhardi), blindness, deafness, burning sensation in the head, affliction of abdomen by vata (vatodara), tumors (asthila), psychological diseases (mano vikara), disorders of excessive thirst (trishna roga), an ailment characterized by bleeding from different parts of the body (raktapitta), aruchi (anorexia), phantom tumor (gulma), cough (kasa), dyspnoea (shwasa), chronic rhinitis (pratishyaya), facial paralysis (ardita), diseases of the flanks including lower respiratory tract disorders (parshva roga) and such other serious diseases caused by aggravation of vata. [Cha. Sa. Chikitsa Sthana 26/8-9]

Udavarta as a causative factor (nidana) of other diseases

Udavarta is the etiological factor of abdominal swelling caused by intestinal obstruction (baddhagudodara) [Cha. Sa. Chikitsa Sthana 13/39]
Udavarta is the cause for abdominal swelling afflicted by spleen (plihodara). [Cha. Sa. Chikitsa Sthana 13/75]
Udavarta is the cause for respiratory diseases including bronchial asthma (pratamaka shwasa-type of tamaka shwasa) characterized by fever, syncope and other such symptoms which are relieved by cold measures. [Cha. Sa. Chikitsa Sthana 17/63]
Udavarta caused by suppression of the urge of urination is causative factor of condition where severe painful distension of abdomen below umbilicus is present along with obstruction of downward movement of urine (mutrajathara- a type of mutraghata i.e., retention of urine). [Su. Sa. Uttara Sthana 58/13]
Vidvighata (type of mutraghata i.e., retention of urine): In debilitated person due to loss of fat, udavarta brings small amount of feces into the channels of urine (bladder and urethra) resulting in patients voiding of urine having odour of feces is termed as vidvighata. [A. H. Nidana Sthana 9/33-34]
Hemorrhoids (arsha): Udavarta is the chief complication in hemorrhoids (durnama/arsha). This udavarta may occur in person who has predominance of vata dosha in alimentary tract (koshtha) even without piles.
Vatodara: Udavarta is one of the causative factors of abdominal swelling afflicted by vata dosha (vatodara). [Cha. Sa. Chikitsa Sthana 13/23]
Hiccups (hikka) & dyspnoea (shwasa): Udavarta is the one of the etiological factors for causation of conditions such as hiccups (hikka) and dyspnoea (shwasa).

Udavarta as symptoms (lakshana) in following diseases

Vataja plihodara (vata predominant plihodara i.e., abdominal swelling afflicted by splenomegaly) [Cha. Sa. Chikitsa Sthana 13/38]
Vatodara (abdominal swelling afflicted by vata dosha) [Cha. Sa. Chikitsa Sthana 13/25]
Vataja gulma (vata predominant gulma/ phantom tumor) [Cha. Sa. Chikitsa Sthana 5/10]
Sahaja arsha (congenital hemorrhoids) [Cha. Sa. Chikitsa Sthana 14/8]
Vataja arsha (vata predominant hemorrhoids) [Cha. Sa. Chikitsa Sthana 14/11]
Vyana avruta apana (type of avarana (occlusion) where vyana vata obstructs the flow of apana vata) [Cha. Sa. Chikitsa Sthana 28/211]
Basti marma viddha (injury to bladder) [Cha. Sa. Siddhi Sthana 9/6]

Types of Udavarta

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]

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;

Asadhyata [incurable stage of diseases]

Udavarta with symptoms of excessive thirst, excessively depressed, emaciated, suffering from pain and vomiting of fecal matter is difficult to manage or incurable.[Su. Sa. Uttara Sthana 55/ 17-18]

Treatment

Treatment principles for udavarta i.e., palliative therapy (shamana) or purification (shodhana) etc., can be selected based on stages of the disease and as well as on the condition of the patient. The treatment guidelines explained in Charaka Samhita are as follows: [Cha. Sa. Chikitsa Sthana 26/11]

The patient suffering from udavarta should be given massage with hot oil described for the treatment of fever presented with cold extremities (sheeta jwara). Then fomentation therapy should be administered for the detachment of the adhered dosha in the tissue cells. This should be followed by the administration of suppository (varti), un-unctuous enema (niruha basti) and unctuous type of purgative (snigdha virechana). The patient should be given food which helps in the normal downward movement (anulomana) of apana vata.

A) Unction therapy (snehana):

Udavarta is produced due to aggravation of vata and sneha (lipids) is the best treatment for pacification of vata vata (shamana). Therefore, unction therapy (snehana) is indicated in udavarta.

B) Fomentation therapy (swedana):

After massage with oil, fomentation therapy should be administered for the detachment of the adhered dosha in the tissue cells.

C) Suppository (varti):

A suppository having the thickness of the thumb is to be prepared with drugs like Shyama Trivrita (Operculina turpethum), Vidanga (Embeila ribes), Kampillaka (Mallotus philippensis) etc., which should be triturated with gomutra (cow’s urine) or arka (Calotropis gigantea) latex (kshira) and made in to form of suppository (phala varti) by adding jaggery. This suppository should be inserted through anus for the downward movement of apana vata to relieve retention of stool, flatus and urine caused by udavarta.

D) Palliative therapy (shamana):

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.

E) Purification therapy (shodhana):

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.

F) Pathya ahara kalpana (wholesome diet):

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]

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]

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]

Different treatments of udavarta

1) Saturating drink (mantha) prepared with sugarcane product (phanita), roasted grain flour (saktu), ghee, curd water and vinegar (amla kanji) alleviate udavarta. [Cha. Sa. Sutra Sthana 23/37]

2) 96 gm (2 pala) of dehusked tila (Sesamum indicum Linn.), 48 gm (1 pala) of jaggery and 24 gm (half pala) of nagara (Zingiber officinale) should be made into a paste and taken along with hot milk helps in udavarta. [Cha. Sa. Chikitsa Sthana 5/91-92]

3) Milk cooked with Allum sativum (Lashuna kshirapaka): Garlic cooked with milk by adding water and reducing to the quantity of milk, cures udavarta immediately [Cha. Sa. Chikitsa Sthana 5/94]

4) Alkali prepared from pippali (Piper longum) and other ingredients (Pippalyadi kshara) used in udavarta [Cha. Sa. Chikitsa Sthana 13/159-161]

5) Medicine prepared by boiling medicinal herbs in water and then kept for fermentation with drugs such as haritaki (Terminalia chebula), amalaki (Emblica officinalis), etc. (Phalarishta) used in udavarta. [Cha. Sa. Chikitsa Sthana 14/148-152]

6) Trivrut (Operculina turpethum), pilu (Salvadora persica), yavani (Trachyspermum ammi) with sour gruel mixed with digestants (pachana) drugs. [Su. Sa. Uttara Sthana 55/42-43]

7) The combination of hingu (Ferula foetida), kushtha (Saussurea lappa), vacha (Acorus calamus Linn.), svarjika (alkali prepared by burning Lona plant), and vidanga (Embelia ribes) – successively in double quantity cures udavarta and colicky pain by vata dosha (vataja shoola) [Su. Sa. Uttara Sthana 55/42-43]

8) Intake of ghee cooked with decoction of dried radish (Raphanus sativus), sunthi (Zingiber officinale), punarnava (Boerhavia diffusa), brihata panchamula (combination of five herbs viz., bilva, patala, agnimantha, shyonaka and gambhari), and fruits of aragvadha (Cassia fistula) subsides severe udavarta completely. [Su. Sa. Uttara Sthana 55/45-46]

9) Vacha (Acorus calamus Linn.), ativisha (Aconitum heterophyllum), kushtha (Saussurea lappa), yavakshara (alkali prepared from barley), haritaki (Terminalia chebula Retz.), pippali (Piper longum) and agnimantha (Clerodendrum phlomidis) with hot water cures udavarta. [Su. Sa. Uttara Sthana 55/47]

10) Devadaru (Cedrus deodara), chitraka (Plumbago zeylanica), triphala (combination of 3 herbs viz., haritaki, bibhitaki and amalaki), brihati (Solanum indicum) should be taken along with cow’s urine. [Su. Sa. Uttara Sthana 55/49]

11) Suppository: Powder of danti (Baliospermum montanum), kampillaka (Mallotus philippensis), shyama trivrita (Operculina turpethum), ikshvaku (Lagenaria vulgaris Ser.), ajamoda (Apium graveolens), kritavedhana (Luffa acutangula Linn Roxb.), pippali (Piper longum) and salts should cook in cow’s urine and made into suppositories to be inserted in the anus. This provides instant relief in the symptoms of udavarta. [Su. Sa. Uttara Sthana 55/51-52]

12) Guggulu (Commiphora mukul) should be taken with decoction of triphala (combination of 3 herbs viz., haritaki, bibhitaki and amalaki), daruharidra (Berberis aristata), patola (Trichosanthes dioica) and kusa (Desmostachya bipinnata) or with urine or hot water for 1 month alleviates udavarta. [Su. Sa. Chikitsa Sthana 5/39-44]

13) Kalyanaka kshara consumed with ghee cures udavarta and constipation (vibandha) [A. H. Chikitsa Sthana 8/142]

14) Erandamooladi enema (basti) helps in alleviating obstruction of faeces, urine and flatus [Ch. Sa. Siddhi Sthana 3/38-42]

15) Palashadi niruha basti alleviates non- passage of flatus and feces (anaha) and udavarta [Ch. Sa. Siddhi Sthana 3/44-45]

Treatment as per different conditions

In hemorrhoids (arsha), if symptoms of udavarta is present then unctuous enema (anuvasana basti) should be administered. [Cha. Sa. Chikitsa Sthana 14/130]
In complications by enema (basti vyapat) when unctuous enema gets obstructed by feces then treatment alleviating udavarta should be adopted. [Cha. Sa. Siddhi Sthana 4/36-37]
In emesis (vamana) and purgation (virechana) complications (vyapta), in extremely vitiated condition of doshas (bahudosha avastha) low dose of medicine is administered, then it causes udavarta, tympanitis (adhmana) in such condition treatment of udavarta is massage (abhyanga), sudation, suppository, non-unctuous enema (niruha basti) and other measures of udavarta should be adopted [Cha. Sa. Siddhi Sthana 6/58-60]
In pain caused by obstruction of feces (vitshula) the measures mentioned for udavarta should be used in the treatment. [Su. Sa. Uttara Sthana 42/140]
In treatment of rakta gulma (a variety of phantom tumor) the measures which cures udavarta should be adopted. [A. H. Chikitsa Sthana 14/129]
Measures which cure udavarta (udavarta hara kriya) should be adopted in abdominal swelling caused by intestinal obstruction (baddhodara). [A. H. Chikitsa Sthana 15/100]
In emesis (vamana) from improper therapy (mithya yoga), therapies of udavarta should be adopted. [A. H. Kalpasiddhi Sthana 3/13]
In complications from enema (basti vyapat) the treatment of udavarta should be adopted if fat (sneha) of enema (basti) gets obstructed or enveloped by feces. [A. H. Kalpa-siddhi Sthana 5/39]

Measures alleviating udavarta (udavarta hara)

Mrudvika (Vitis vinifera/grapes) alleviates udavarta [Cha. Sa. Sutra Sthana 27/125-126]
Haritaki (Terminalia chebula Retz.) used in udavarta [Cha. Sa. Chikitsa Sthana 1/1/31]
Dish prepared with barley (yavapupa), supernatant liquid proportion of barley preparation (yavaka) and bhristha yava odana/ parched cooked barley (vatya) made from yava (barley) helps in alleviation of udavarta. [Cha. Sa. Sutra Sthana 27/265]
Saturating drink (mantha) prepared by churning parched grain flour (saktu) with sour taste (amla rasa), fat and jaggery alleviates udavarta. [Su. Sa. Sutra Sthana 46/386]
Vatya (made by roasted wheat or barley) helps in alleviating udavarta. [Su. Sa. Sutra Sthana 46/410]
Garlic cooked with milk (lashuna kshirapaka) alleviates udavarta. [A. H. Chikitsa Sthana 14/46]

Diet for udavarta

Intake of vegetable preparations prepared from the leaves of trivruta (Operculina turpethum) and snuhi (Euphorbia neriifolia Linn.), tila (Sesamum indicum) and its different preparations, soup of meat of animals inhabiting in marshy land, domestic and aquatic animals, clear top portion of alcohol (prasanna) and molasses rum (sidhu), wine prepared of jaggery, preparations which facilitates motion of flatus, urine and stool. [Cha. Sa. Chikitsa Sthana 26/18] One should never withhold the natural urges of the body. [Su. Sa. Uttara Sthana 55/3]

Researches

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.

2) A physiological study of adharaneeya vega (suppression of natural urges) w.s.r. to apana vayu vega (suppression of apana vata or flatus)

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).

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.

Thesis on udavarta

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.