BACKGROUND: Primary dysmenorrhea is defined as painful menstruation without any associated pelvic pathology. This debilitating gynecologic disease affects 45–90% of women of reproductive age. In classical texts of Ayurveda, formulations such as Saptasaram Kashaya (SPK) and Saraswatarishta (SSR) have been indicated in the treatment of Kashtartava (primary dysmenorrhea). Based on the classical claim, the present work was planned to assess the effect of SPK and SSR on the treatment of primary dysmenorrhea. MATERIALS AND METHODS: Unmarried girls of age between 13 and 20 years, suffering from at least three painful cycles of menstruation in the last 6 months with pain intensity more than 40 mm as per the Visual Analog Scale (700 mm) (VAS), were included in the trial. Ayurvedic formulations SPK in the dose of 50 ml twice daily before food from the onset of menstruation till next 7 days and SSR in the dose of 10 ml mixed with 20 ml of lukewarm water at bedtime daily were administered for 3 consecutive months. The effect on menstrual pain was assessed by VAS; improvement in quality of life was assessed using the SF-36 (RAND) questionnaire; and changes in the psychosomatic status were assessed using the Menstrual Distress Questionnaire and Hamilton Anxiety Scale. RESULTS: A total of 100 participants were enrolled at two study centers. The data of 96 participants who completed 6 months’ trial period were analyzed. At baseline, the mean VAS score for pain was 90.9 ± 12.3, which decreased to 33.4 ± 24 on the 90th day and further reduced to 23.8 ± 21.3 on the 180th day. The associated symptoms such as nausea, vomiting, anorexia, loss of appetite, giddiness, breast tenderness, diarrhea, flatulence, headache, fainting, frequent urination, and fatigue significantly reduced (P < 0.05) at the end of the treatment. The improvement in quality of life and psychological status at the end of 90th day was also significant (P < 0.001). No adverse events were reported during the treatment period. CONCLUSION: SPK and SSR have a positive effect in the treatment of primary dysmenorrhea.

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BACKGROUND: Anal fissure (fissure in ano) is an excruciating manifestation among common anorectal presentations. The condition inflicts significant personal and social ill health causing considerable morbidity. This study aimed at documenting the effect of Murivenna oil infiltration and Triphala choorna oral use along with sitz bath and fiber diet protocol in the management of fistula in ano. MATERIALS AND METHODS: Retrospective analysis of 15 cases diagnosed with primary fissure in ano who underwent prescribed conservative Ayurvedic treatment between March 2018 and February 2019 at the National Ayurveda Research Institute for Panchakarma, Cheruthuruthy, is reported. All patients were managed with anal infiltration of Murivenna oil (30 ml), internal administration of Triphala choorna (10 g), sitz bath, and fiber diet. Retrospective outcome analysis of recorded change in each case on study variables, viz. pain, bleeding per rectum (BPR), anal discharge, inflammation and tenderness, and healing of fissure, was recorded in structured proforma, was carried out using the Statistical Package for the Social Sciences. A Friedman test for repeated measures, followed by Wilcoxon post hoc test, was conducted on the study variables. Results with P-value<.01 were considered significant. RESULTS: Data of 15 patients was used for analysis. Complete healing of the fissure was documented in 93% of patients by the end of their respective 30th day. There was significant relief in symptoms of inflammation, tenderness, anal discharge, and bleeding per rectum (BPR) in most of the patients within their first 7 days of treatment. Median pain level assessed on VAS was significantly reduced from 9 (on the 1st day) to 1 (on the 7^th day) and eventually to 0 on the 30^th day. Statistically significant difference was observed in the percentage healing of fissure measured on the 8^th day (78 ± 11.464), 15^th day (91.33 ± 9.904), and 30^th day (99.33 ± 2.582). CONCLUSION: The observatory report provides significant elementary evidence on the effectiveness of an Ayurvedic conservative treatment in managing acute and chronic primary fissure in ano.

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BACKGROUND: The disease Pinasa (chronic rhinosinusitis disease) is a chronic nasal disease, which affects nasal canal and paranasal sinuses and the symptoms of this disease are similar to that of chronic rhinosinusitis. In Ayurvedic classics, the internal administration of Chitraka Haritaki Avaleha (CHA) and nasal instillation of Shadbindu Taila (SBT) are mentioned for the management of Pinasa. In view of the literary indication, the present work was carried out with the objective to evaluate the clinical efficacy and safety of CHA and SBT in the management of chronic rhinosinusitis. MATERIALS AND METHODS: A multicenter, single-arm, open-label clinical trial was proposed for the assessment of therapeutic efficacy of oral administration of CHA and nasal instillation of SBT. A total of 60 patients with chronic rhinosinusitis from Central Ayurveda Research Institute (CARI), New Delhi and CARI, Patiala were enrolled in this study. SBT Nasya (nasal drop to be given for three sittings, 7 days in each, with the interval of 7 days between each sitting) and CHA (6 g, twice daily after food) in the form of Avaleha (semisolid confection) were given to all participants for 42 days and the follow-up period was 28 days. The primary outcome was to assess change in SNOT (Sino-Nasal Outcome Test) scores. The secondary outcome was to assess change in RSDI (Rhinosinusitis Disability Index) scores and change in Lund-Mackay scores of computed tomography (CT) scan of paranasal sinuses. CONCLUSION: The effect of CHA and SBT nasal drop in treatment of Pinasa with special reference to chronic rhinosinusitis may provide an evidence-based complementary therapeutic approach for the management of the said condition.

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BACKGROUND: Viral pandemics/epidemics are emerging as one of the biggest challenge for medical fraternity and health-care policy makers. This is high time to explore traditional medicine systems such as Ayurveda, wherein measures such as Dincharya (daily regimen), Ritucharya (seasonal regimen), Sadvritta (good conduct/behavior), and Rasayana (rejuvenation measures) which are said to influence the homoeostatic mechanism of the host defense system along with interventions that may have a promising role in managing such diseases. OBJECTIVES: This review attempts to provide an informative analysis of the daily regimen, seasonal regimen, moral conduct, and interventions recommended in Ayurveda scriptures which can be helpful for the prevention and treatment of viral pandemics. METHODS: A narrative review was conducted and comprehensive search of Ayurveda classical texts, including Bhrihatrayi, Laghutrayi, Dhanwantari Nighantu, Raj Nighantu, Kaiyadev Nighantu, and texts related to Dravyaguna was done. Electronic databases such as PubMed, AYUSH Research Portal, DHARA, and Google Scholar were also searched for relevant literature, pertaining to Ayurveda prophylactic and therapeutic measures in viral pandemics from 2001 to 2020. RESULTS: Prophylactic and therapeutic measures, including daily and seasonal regimen, good conduct/behavior, rejuvenation measures, Dhoopana Karma (medicated fumigation), and medicinal herbs, explained in Ayurveda may be utilized during viral pandemics. Critical analysis of the available scientific evidence suggests potential of Ayurveda interventions in context of immunomodulatory and antiviral activities. CONCLUSION: Unique preventive dietary and lifestyle practices recommended by Ayurveda can play an important role in maintaining the health status and improving the disease resistance capacity. Evidence from preclinical/clinical studies indicates that several herbs used in Ayurveda exhibit immunomodulatory, antiviral properties. The preventive and therapeutic measures narrated in Ayurveda can contribute significantly towards the management of viral pandemics. Generation of more scientific evidence through quality research studies is needed to evaluate the role of Ayurveda approaches for management of viral diseases.

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BACKGROUND: Lymphatic filariasis (LF) is caused by Wuchereria bancrofti, Brugia malayi, or B. timori, the parasitic nematodes that are transmitted through mosquitoes. The World Health Organization has recommended mass drug administration (MDA) as preventive chemotherapy strategy. In Ayurveda, LF has been narrated under the heading Shlipada, and the literature also includes detailed therapeutic measures. AYUSH-SL is a formulation prepared based on the classical information of herbs used in treating LF. MATERIALS AND METHODS: This is a multi-center, prospective, parallel-group, placebo-controlled, double blind interventional study. A total of 180 participants are planned to be recruited, and the duration of the study will be 2.5 years. Diagnosed cases of filariasis (as evidenced by a positive immune-chromatographic card test or enzyme-linked immunosorbent assay or microfilariae (MF) test report) of either sex within the age group of 18–65 years present with features of filarial lymphedema of Grade I and Grade II (lower limbs) will be included in the trial. The study group will be treated with MDA and AYUSH-SL tablet. The control group will receive MDA and a matching placebo. The duration of the therapy will be of 12 weeks, and a last follow-up will be done at the 24^th week. OUTCOME MEASURES: The primary outcome measure is reduction of edema computed for analysis by percentage reduction from the baseline at 4^th, 12^th, and 24^th week. The secondary outcome measures include improvement in quality of life (QoL), which will be assessed using the Lymphatic Filariasis Specific QoL Questionnaire, and prevention of recurrence of acute episodes, which will be assessed by probing the presence and severity of episodes in the past 4 weeks. DISCUSSION: The deformities and disability due to filarial lymphedema vanquish physically as well as mentally leading to hardships in normal life. Management of filarial lymphedema is required for preventing disease progression and episodes of adenolymphangitis. The study is expected to provide evidence on the coded Ayurveda drug AYUSH-SL in the management of chronic filarial lymphedema.

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