Abstract :
Cosidering the acute and chronic nature and complications of parinaam shoola (PUD) and nonavailability of its satisfactory treatment, It is necessary to look for drugs from indigenous system of medicine. Accordigly Shatavari (Asparagus racemosus ) Ghruta has been taken on 15 patients of Parinaam shoola (PUD). The drug has provided good clinical relief.

Introduction :
In PUD if attention is not given in early stages it leads to life threatening complications as Perforation, GI bleeding, Gastric outet obstruction, Gastric cancer, Pancreatitis. Shatawari has been described in Ayurveda as Vaatpittaghna and Balya, Raktapittashamak, Pittadahahar. So that the Shatawari Ghruta has been selected for study in the treatment of Parinaam Shoola (PUD).

Discussion :
There is significant results obtained for 15 patients in one month continuation of therapy is also required to resist relapse for 2 to 3 months. Most of the patients show relief from pain within 15 to 30 days also nausea, vomiting gets lower parallel to pain.

Abstract :
Ayurveda is a upanga of Atharvaveda. It is a science which encomprises how to live a long and healthy life. Ayurveda is a mother of all medical sciences. In ayurvedic textual Parinaam Shoola is described in Madhav Nidan. Parinaam shoola is similar to symptomatologically and pathologically to Peptic ulcer disease(PUD). In modern life style era PUD becomes a big medicosocial problem.
Cosidering the acute and chronic nature and complications of parinaam shoola (PUD) and nonavailability of its satisfactory treatment, It is necessary to look for drugs from indigenous system of medicine.
Accordigly Shatavari (Asparagus racemosus ) Ghruta has been taken on 15 patients of Parinaam shoola (PUD). The drug has provided good clinical relief.

Introduction :
Parinaamshoola in Ayurveda is derived from,

"bhookte jeeryati yatshoolam tadev parinaamjam"
                               - MadhavNidan It means the pain in abdomen which aggrevates during digestion process of food, which generally occurs 90 min to 3 hrs after a meal. This period is called as 'Pachyamanawastha' in ayurveda.
Parinaamshoola is described as a separate disease in Madhav Nidana but in Charak and Sushrut Samhita, it is considered in Gulma Adhyaya. Parinaam Shoola is a disease of Amashaya, which is divided in to two parts as Uttramashaya (stomach mainly) and Adharamashya(duodenum). In the pathogenesis of Parinaam Shoola Kapha dosha( protective mucus layer, bicarbonate, phospholipid layer) loss it's normal place, and so pachak pitta ( HCL, pepsinogen ) causes injury to mucosal membrane and leads to formation of ulceration. Also irritation of nerve ends caused by ulceration leads to vaat dosha prakop and it causes shoola.
Burning type of pain after 90min to 3hrs i.e. in Pachyamanawastha and relieved by food is a cardinal symptom of Parinaam shoola. Also nausea , vomiting and epigastric tenderness are also present. Ulcer is defined as disruption of the mucosal integrity of the stomach or dudenum leading to local defect or excavation due to active inflammation.
Gastric epithelium is under constant assault by a series of endogenous noxious factors, including HCL, pepsinogen/pepsin, bile salt. exogenous substances as medication, alcohol, bacteria.
In modern life style era causative factors of PUD are H.Pylori infection, NSAIDs, stress, alcohol, cigarette smoking, junk food with added preservatives, also secondary to chronic pulmonary disease, cirrhosis, CRF, hyperthyroidism, CAD, chronic Pancreatitis. In PUD if attention is not given in early stages it leads to life threatening complications as Perforation, GI bleeding, Gastric outet obstruction, Gastric cancer, Pancreatitis.
Shatawari has been described in Ayurveda as Vaatpittaghna and Balya, Raktapittashamak, Pittadahahar. So that the Shatawari Ghruta has been selected for study in the treatment of Parinaam Shoola (PUD).

Materials and Methods :
This research work was performed in 15 cases of Parinaam Shoola (PUD).
The indigenous drug Shatawari Ghruta was selected for the treatment. The trial was carried out in OPD and IPD units of Dr. M. N. Aagashe Charitable hospital, Satara.
Patients from both sexes and from all socioeconomic groups are selected and of any age group.
Patients for this clinical study were selected who presented themselves with
1) Pain in abdomen (burning type)
2) Nausea
3) Vomiting
And tenderness at epigastric region. Clinical presentation was studied in detail. Clinical Study was done in those patients having Parinaam Shoola(PUD) type pain. Detailed clinical history and physical findings were recorded

Diagnosis of Parinaam Shoola :
The diagnosis is mainly based on history taking (i.e. symptoms and signs) as a typical sign of parinaam shoola, pain is relived just after food taken and pain aggravates after 90min to 3hrs after food.

Measurement of shoola :
B.T. A.T. Diff.

Grade	Symptoms
3	Severe
2	Moderate
1	Mild
0	No Pain

Vomiting :
B.T. A.T. Diff.

Grade	Symptoms
Mild	Every 2 days after
Moderate	Once a daily
Severe	More than once in a day

Selection of drug :
Drug Shatawari Ghruta was selected on the basis of previous observations and textual references. It can be available everywhere and prepared easily in cheaper way.

Preparation, Drug, and Administration of drug :
Shatawari Ghruta is prepared as ghrutapaak vidhi described in ayurvedic textual.

Dose :
10ml Before food, three times a day. With koshnajala.

Follow up :
Weekly.

Duration :
One Month and patients were suggested to continue the drug for minimum 2 to 3 months to prevent recurrences.

Diet :
low quantity diet given 3 to 4 times in a day Patol, karvellak, Mudga Yusha, Khandashrkara. Mrudwika, Kharjura, low salt diet
Avoid- Excessive use of amla dravya. Diwaswap, Fast food added with preservatives, other addiction as alcohol, smoking,

Criteria Of Assessment :
Assessment on the basis of clinical improvements after treatment of one month with shatawari ghruta.

Clinical Improvements :
Complete relief of abdominal pain, decrease in nausea, Vomiting, decrease in epigastric tenderness. Assessment of Results were classified in to Three groups after one month. As Cured
Improved
Unchanged

Observations and Results :
• Incidence of habit - out of 15 patients 40% were alcoholic with smoker,27% were alcoholic only,13% were smoker only and 20% were no addiction.


• Incidence of habitat: - Out of 15 patients maximum no of 80% patients were urban and 20% were rural.
• Distribution of patients according to sex :- Out of 15 patients 90% were male patients and 10% were female.
• Distribution of patients according to age :- Out of 15 patients 0% were of age 0-18yrs, 75% were 18-50yrs of age. And 25% were 50 yrs above.
Incidence of Prakriti :- Majority of the patients were having predominance of Pitta i.e. 60% ,35% patients showed predominance of vata and only 5% patients were of kapha predominant prakriti.
Distribution of patients according to relief :
B.T. A.T. Diff.

Within 1 wk	02	13.33%
Within 2 wk	03	20%
Within 3 wk	10	66.67%

Statistical analysis :
Here for paired 't' test
H0 = there is no effect of given drug in Parinaam Shoola.
H1 = there is effect of given drug in Parinaam Shoola.
Test significance established if, tcal > ttable
For Udarshoola (Paired 't' test)

Average of Shoola :
B.T. A.T. Diff.

Before treatment	After Treatment
2.20	0.13

Here , x^- = 2.06 S.D = 0.5934
S.E = 0.1533
Therefore,t_cal = x^-/S. E. = 2.06/0.1533 = 13.44
Table t14 = 2.15 at 5% level of significance i.e. tcal> ttable at 5% level of significance. Therefore, it can be said that Shatawari Ghruta is effective in reducing parinaamshoola.

Discussion :
Treatment of parinaam shoola based on deepan, pachan, balya chikitsa to aamashaya & vaatpittaghna, kaphadushtihar karma. It is very important to take in to consideration that there is ulcerative pathology within stomach and duodenum. So that extremely teekshna, ushna (irritative ) drugs can't be given. Shatawari Ghruta is very useful formulation in this respect, shatawari is Madhur, Tikta Rasatmak dravya having Madhur veepak and sheet veerya. So that it is said to be vaatpitta har dravya. It useful in Raktapitta (ulcerative pathology). Also it is well-known Balya(nutritive), shoolhar(analgesic).Ghruta also have same properties with snehaguna(Oily), shlakshna, picchilguna. Help in healing process of ulcerative pathology.
There is significant results obtained for 15 patients in one month continuation of therapy is also required to resist relapse for 2 to 3 months. Most of the patients show relief from pain within 15 to 30 days also nausea, vomiting gets lower parallel to pain.

Conclusion :
Ayurveda have given a classical multifactorial consideration of the problem parinaamshoola and its management.

1. In the management of parinaam shoola along with diet and other pathyakar aahar vihar, this simple medicine shatawari ghruta is a simple answer.
2. The drug Shatawari Ghruta gives more effective results in Parinaam shoola, nausea, vomiting and abdominal tenderness.
3. Both Shatawari and Ghruta shows most effective properties of pittavaatshaman, vranahar, dahahar, vedanahar, balya.
4. The Shatawari ghruta is clinically safe and effective herbal formulation in Parinaam shoola.

* MD student
**Lecturer
***H.O.D kaychikitsa dept


Acknowledgement :
Special thanks to Dr Chetan Patil, Dr Shrikant Lokare, Dr Abhineet Pardeshi for their help during study.

References :

1. Madhav nidan Chowkamba prakashan
2. Yogaratnakar Chowkamba Sanskrit Samsthana Varanasi-2002 7th edition
3. Desai R.R, Nidana Chikista Hastamalak, Shree Baidyanath Ayurveda Bhavan Pvt.Ltd, Calcutta 6th edition (1985).
4. Internet, Google, Medical (Ayu)
5. Agnivesa – Charka Samhita revised by charka & Dhridabaka 5th edition – Chowkamba Sanskrit Samsthana Varanasi-2001
6. Brahmanand Tripathi 1996 Charak Samhita Chaukhamba
7. Harrisons Principle of internal Medicine; Vol 2; 18th edition;
8. API textbook of medicine 6th edition

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