dhanyamla bahiparimarjana

Dhanyamla Bahiparimarjana

Prof. Dr. K. Shiva Rama Prasad 1 ,

Parimarjana is spectacular word from Ayurvedic literature defined from Shabdha Kalpa

druma as – “Parishodhana”1 – a search, colloquially used to clean i.e. Dhavana. Where in the

“Marjana” is added with “Anganirmalyokaranam”2, which means the body waste removal process.

The “Parimarjana” with a prefix of “Bahi” becomes the “Bahiparimarjana” – a complete externally

modulated waste material removal or cleansing treatment, one out of three main methods of

treatment classifications. The other two are “Antahparimarjana” and “Shastrapranidhana”. The

“Pranidhana”3 has a meaning of – “the visualization of the cause of the Sthambha – the obstruction.

It other wise refer to the laparotomy exploration and Medinikosha explains it as “Praveshanam” –

the entry - of course in to abdomen.

Bahiparimarjana Chikitsa explained as – the treatment procedures that are depend upon the

external touch such as Abhyanga, Sweda, Pradeha, Parisheka, Unmardana, etc4. A close look at the

said examples makes a classification of the Bahiparimarjana Chikitsa i.e. trans-dermal cleansing

management. The former Abhyanga in terms of Bahya sneha is an external oil application where

heat inducted through rubbing. It is in the texts as not to apply any form of external (tropical)

managements with out unctuous application, in terms that lubricates and facilitates the absorption

of the tropical management. The second application Sweda is an external heat modulation or

transportation through steam. The rest of the treatment applications include either of these two

specific methods of heat transportations.

Commonly these Sneha and Sweda administered before to the chief cleansing methods viz.

Panchakarma. However, the real utility of Bahiparimarjana as “Roga Prashamana” visualized only

after the completion of the Dosha elimination. This verse observed from the Charaka at the context

of Kusta relay is that the Lepa applied after the eliminative (Samshodhita Ashaya) procedures are

effective5.

Human body is not depends upon the Sun heat and very minimal heat is taken from external

and depends upon the internal system to generate the heat required for the body maintenance. The

Dosha in the body are always fluctuating in nature enhances or dislodges from its places to give rise

physiological or pathological changes in the body. All these changes generally depend upon the

triad of mass, pressure and temperature. Out of these the mass and pressure in the body are constant

and the only temperature is the variant subjected for the pressure variances. Thus the managements 1 H.O.D., Dept. of Kayachikitsa (PG), DGM Ayurvedic Medical College, Kalasapur Road, Gadag-

582103, Karnataka (cell: +91-9448746450), [email protected]

Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 1

of Dosha triad either for elimination or for the maintenance requires the cleansing from internally

and even externally, where the externally mediated procedures are not eventually cleansing in

nature they may be curative. For the same reason the externally mediated - Bahiparimarjana

Chikitsa methods viz. Sneha and Sweda are not included in the cleansing methods of Panchakarma.

These Sneha and Sweda along with the co- procedures are not possessing “Dosha nirharana

samardhya” i.e. eliminative capacity6. Therefore, these procedures administered later to the

cleansing are effective to disease relief. In a nut shell, Bahiparimarjana is a Dosha shamana and the

Antahparimarjana is Dosha Shodhana or doshavasechana management.

Dalhana was the first person to comment over the absorption and pharmaco-dynamics of the

externally mediated unctuous (fatty oil base) materials at the context of Abhyanga. He affirms that

each 100 of matra (32sec approximately) initiated from 300 to 900 takes the oil based medicament

for the Roma koopa – Twak – Rakta – Mamsa – Medo – Asthi – Majja. At the context he applies a

note that the Tridosha diseases of such region are implied to alter with the effect of medicine, as the

Abhyanga is Kapha Vata nirodhana 7. At the same place author, refer the Grudhrasi a disease,

prevented by the constant use of Abhyanga, which relays the meaning of Bahiparimarjana as

prevention and curative but not eliminative method of management. In the procedure of

Bahiparimarjana, the absorption is minimal but heat conduction is massive, that affect the blood to

flow peripheral to visceral or vice versa. The understanding of contemporary philosophy tells us

how our tradition meets the present day science.

Absorption through the skin can be enhanced by suspending the drug in an oily vehicle and

rubbing the resulting preparation into the skin. This method of administration is known as

inunction i.e. Abhyanga. Because hydrated skin is more permeable than dry skin, the dosage form

may be modified or an occlusive dressing may be used to facilitate absorption. Controlled-release

topical patches are recent innovations. Finally, intact stratum corneum is an excellent barrier, but in

disease states the resistance to absorption is rapidly lost and absorption can be facilitated. The skin

acts as a two-way barrier to prevent absorption or loss of water and electrolytes.

Few drugs readily penetrate the intact skin. Absorption of those that do is proportional to

the surface area over which they are applied and to their lipid solubility, since the epidermis

behaves as a lipid barrier. Inflammation and other conditions that increase cutaneous blood flow

also enhance absorption. The dermis, however, is freely permeable to many solutes. The diffusion

coefficient indicates the extent to which the matrix of the barrier restricts the mobility of the drug.

Increases in the molecular size of the drug will increase frictional resistance and decrease the

diffusion coefficient (Franz, 1983); molecules over 1000 daltons usually will not be absorbed

easily into normal adult skin8.


Parameters Controlling Absorption in Bahiparimarjana Chikitsa

The absorption of drug into the skin is a function of the nature of the drug, the behaviour of

the vehicle, and the status of the skin. Three major variables account for differences in the rate of

absorption or flux of different topical drugs or of the same drug in different vehicles:

- The concentration of drug in the vehicle,

- The partition coefficient of drug between the stratum corneum and the vehicle, and

- The diffusion coefficient of drug in the stratum corneum.

Apart from the above the points to be considered are -

- Large Surface area enhance absorption

- Increase cutaneous blood flow also enhance absorption

- Body temperature and blood flow enhance absorption of tropical medicines

- Transdermal replacement therapy is not a new invention, exists since the birth of

Ayurveda

Factor influencing Bahiparimarjana Chikitsa (Topical Therapy)

Dosage:

An amount of topical medication sufficient to cover affected body surfaces in repeated

applications must be dispensed or applied to the patient. In Ayurveda much of applications viz.

Abhyanga, Sweda, Parisheka and Avagaha are done once in a day.

Age:

Children have a greater ratio of surface area to mass than adults, and a given amount of

topical drug results in a greater systemic dose. The permeability of children's skin is increased in

preterm infants (Barker et al., 1987).

Regional Anatomic Variation:

Permeability is generally inversely proportional to the thickness of the stratum corneum i.e.

Avabhasini. However, in certain areas, differences in lipid concentration may affect percutaneous

absorption, depending on an individual drug's lipophilicity (Having an affinity for lipids) or

hydrophilicity (Having an affinity for water).

Drug penetration is higher on the face, in inter-triginous areas, and especially in the

perineum. Thus these areas are minimal exposed to Bahiparimarjana Chikitsa. Consequently,

sensitization, irritation, and atrophy from Bio-steroids are more likely to develop in these regions.

Altered Barrier Function:

In many dermatological diseases, the stratum corneum is abnormal, and barrier function is

lost. Thus not through rub is indicated, more over many Bahiparimarjana Chikitsa are light in

touch.


Application Frequency:

Topical agents are often applied twice daily. However, for certain drugs, once-daily

application of a larger dose may be as effective as more frequent application of smaller doses. The

stratum corneum may act as a reservoir and allow gradual penetration of a drug into the viable skin

layers over a prolonged period of time.

Hydration:

Drug absorption is increased with hydration, defined as an increase in the water content of

the stratum corneum that is produced by inhibiting trans-epidermal loss of water. Methods of

hydration include occlusion with an impermeable film, application of lipophilic occlusive vehicles

such as Taila, and soaking dry skin before occlusion. Many of the Ayurvedic preparations used in

Bahiparimarjana Chikitsa are water based or water soluble medicines transformed lipophilic

agents.

Vehicle:

Topical therapy is delivered by various vehicles, most frequently soaks, lotions, solutions,

creams, and ointments, progressing in that order from least to most hydrating. The choice of

vehicle may be as important as the active drug. In Ayurveda it is with many vehicles as Kashaya,

Taila or Dhanyamla.

An experimental modal of Dhanyamla prepared in DGM Ayurvedic Medical College,

Gadag for want of multi centric study in 2001 – 2003. It facilitated few single case studies and an

extended study over Amavata as Kayaseka. The literature and the procedure followed to

standardize the Dhanyamla are narrated here under.

DHANYAMLA 9

Before going into the details of Dhanyamla Kayaseka it is necessary to understand the term

Dhanyamla. A cursory glance itself reveals that the term “Dhanyamla “ is conjugate of two

different words, viz ‘Dhanya’ and ‘Amla’ which in conjugation means ‘fermented cereal’ in a

broad sense. All the three major classics of Ayurveda at some instance or other have referred to its

use at times, singularly or along with other drugs. Maharshi Charaka, Susruta and Vagbhata have

included this either in Amlavarga, Santhana kalpana or in Madya vargha. Charaka further

mentioned the drugs used for Dhanyamla in Nadi sweda and Upanaha.

Synonyms of Dhanyamla

A perusal of the ancient text of the medicine reveals that a number of synonyms have been

attributed to Dhanyamla which in most cases refer to a specific attribute and when taken

collectively gives a clear idea about the character and properties of Dhanyamla. Narisimha has in

this context very rightly stated that these synonyms to Dhanyamla are complementary to each other


and as such there is no difference between ‘Dhanyamla’ and ‘Kanjhika’. ‘Guna deepika’, a

celebrated lexicon on medical plants gives the following compilations of synonyms as attributed to

Dhanyamla.

1. Aranala: ‘Aranalasya rigathownala gandha‘ i.e having acrid fast spreading odour.

2. Abhishuta: ‘shunj abhishave’ i.e made of half cooked cereals.

3. Avanthisoma: prepared out of ‘soma’ found in Avanti Desha.

4. Kulmasha: ‘Kula samsthyana’ i.e having half cooked ‘masha’ or black grain.

5. Kunjala: Indicative of fermented water.

6. Sowveeraka: Found in Sowveera desha.

Among these, Sowveerka’ and ‘Avantisoma’ are synonyms pertaining to geographical

preponderance or indicative of place. Abhishuta, Dhanyamla, KunJala, Kulmasha etc are indicative

of the process of fermentation. Aranala speaks of its acidic odour.

Properties of Dhanyamla

The known fact that Dhanyamla, amla or sour in taste serves as an aid in delving into other

properties of the Ama in the sense that since it is Amla in Rasa the associated qualities of Amla

Rasa as stated in the classics, viz, Laghu, Ushna, Snigdha, Deepana, Vatanulomana etc. can be

safely attributed to it. The properties of Dhanya like Brimhana, Tarpana, Balya and Vatahara are

also supplemented.

In brief, Dhanyamla cumulatively possess the following properties.

• Rasa - Amla

• Guna - Laghu, Snigdha, Teekshna, Sheeta sparsa

• Vipaka - Amla

• Veerya - Ushna

General properties of Dhanyamla

Many properties are attributed to Dhanyamla are - Deepana, Pachana, Rochana, Bhedi,

Vibhandhahrasa, Hrudya, Klamahara, Angasada hara, Dahajwarahara, Hrudrogahara, Panduhara,

Krimighna, Arshohara, Grahanihara, and Bastisulahara. It can be used even for Astapana. Among

other indications for its use, Charaka has specified its use in Daha jwara where in Avagaha of the

patients in Kanji has been recommended10. Same procedure is indicated to relieve pain in Arshas 11

even. Further in Rajayakshma when Prathishyaya and Peenasa are super imposed, renders the

ailment complicated. At this juncture the Nadi sweda with Kanji (Dhanyamla) has been

advocated12. Since Amla is Sheeta sparsa and acts so in external wage, Charaka has felt safe to

vouch for its use externally as Lepa, Seka etc. in Urusthambha also; he mentioned the use of the

drug Dhanyamla 13.


In short while going through the references of the use of Dhanyamla in different context as

found in classics, it is able to conclude that the drugs which are used for the preparation of the

Dhanyamla and Dhanyamla as such are preferred in Vatarogas and Vatakapha samsargha janya

diseases.

Method of preparation of Dhanyamla 14

Dhanyamla can be prepared out of different methods. Many drugs in this yoga are easily get

fermented. Traditional physicians of Kerala generally follow present Yoga combination and

proportion is obtained from Sahasrayoga is as follows:

1 Tandula (Oryza sativa) 5 parts

2 Pruthuka (Pressed form of Oryza sativa) 5 parts

3 Kulatha Dolichos biflorus) 5 parts

4 Laja (Puffed form of Oryza sativa) 20 parts

5 Kangubeeja (Setaria italica) 4 parts

6 Kodravam (Paspalum scrobiculatum) 2 parts

7 Nagara (Zingiber officinale) 1 part

8 Nimbuka (Citrus acida) 4 parts

9 Dipyaka (Carum roxburgianum) 2 parts

10 Water 100parts

On an auspicious day at a time when the astral combinations are favourable, the necessary

drugs and Paraphernalia for the preparation of the Dhanyamla are to be collected. Place a large

deep earthenware pot on an oven and pour 200 Prasthas of boiled water and put the powdered drugs

1-9 separately made into loose bundles in clean cloth bags.

After putting these drugs into the vessel along with water, it has to be loosely covered with

a lid and heated gently and continuously in moderate fire, preferably of paddy husks, for a period of

7 days. The paddy husks are to be put under and around the vessel and fired taking every precaution

that the temperature of the water in the vessel does not rise above the boiling point. On the 8th day

the required quantity of the liquid is taken out and added same quantity of hot water. The important

factors to be recommended during the preparation of Dhanyamla is that - Absolute cleanness

should be maintained and Moderate fire should be kept through out he preparation

The details identification and proprties of the Dhanyamla ingredients are as follows -

1. TANDULA (N.O. Graminae, L. N. Oryza sativa) : Tandula possesses Madhura and Kashaya

Rasa, Madhura Vipaka as Sheeta Veerya. By Guna it is Guru. It alleviates Pitta Dosha and

provokes Kapha Dosha.


2. PRUTHUKA (N.O. Graminae, L.N. Oryza sativa): It is made out of Tandula. Prepared by little

heating and wet pounding of Tandula.

3. KULATHA (N.O. Leguminoceae, L.N. Dolichos biflorus): Kulatha possesses Kashaya Rasa,

Katu Vipaka and Ushna Veerya. By Guna it is Laghu, Vidahi and Sara. It acts as Kapha

Vatahara. It provokes Pitta Dosha also.

4. LAJA (N.O. Graminae, L.N. Oryza sativa): It is made out of Tandula. Prepared by dry frying in

a small-mouthed vessel. This process is known to induce Laghu Guna.

5. KANGUBIJA (N.O. Graminae, L.N. Setaria italica): Kangubija possesses Kashaya and

Madhura Rasa, Katu Vipaka and Ushna Veerya. By Guna it is Guru and Ruksha. It acts as

KaphaPitta shamaka and Vata vardhaka. It possesses Sandhaneeya and Vrushya properties.

6. KODRAVA (N.O. Graminae, L.N. Paspalum scrobiculatum): Kodrava is of Madhura-Kashaya

in Rasa, Katu in Vipaka and Sheeta in Veerya. By Guna it is Laghu and Ruksha. It alleviates

Kapha and Pitta Dosha and provokes Vata Dosha.

7. NAGARA: Already described in Alambushadi Yoga.

8. NIMBUKA (N.O. Rutaceae, L.N. Citrus acida): Nimbuka is of Amla Rasa, Amla Vipaka and

Ushna Veerya. By Guna it is Laghu. It pacifies kapha Dosha. It has got Agnideepana, Rochana,

Pachana and Trishnanigraha properties.

9. DIPYAKA (N. O. Umbelliferae, L.N. Carum roxburgianum): Dipyaka possesses Katu and

Tikta Rasa, Katu Vipaka and Ushna Veerya. By Guna it is Laghu, Ruksha. It acts as Samaka for

Kapha and Vata Dosha. It has got Shoola Prashamana, Rochana and Krimighna properties.

PHYSIOCHEMICAL ANALYSIS REPORT (Analyzed at K.L.E. society’s Pharmacy

college, Gadag.)

01. PH = 3.03

02. Specific gravity = 1.01

03. Test for Alkaloids

a. Mayer’s Test = Positive

b. Hager’s Test = Positive

04. Test for Carbohydrates

a. Molish Test = Positive (Carbohydrate present)

b. Benedict’s Test = Positive (Reducing sugar present)

c. Barfoedt’s Test = Positive (Monosaccherides present)


Case studies with Dhanyamla

Pakashaghata: As the Dhanyamla indication is for all Vata Vyadhi, Pakshaghata was tried with

internally for pana and externally with kayaseka. The patient initially with Dakshina Pakshaghata

recovered in 14 days management, without any drawbacks or setbacks.

Sandhivata: Eight patients of Sandhivata are undertaken for observational study with Dhanyamla

Dhara over the Sandhi, which made the patient to have symptomatic relief with in seven days of

course.

Amavata: 15 Nine patients of Amavata were treated with Dhanyamla Kayaseka for 21 days. The

results obtained with objective and subjective parameters are as follows.

1. Comprehensive statements of objective parameters are as follows.

SN Parameter Mean before

Mean after

Difference of Mean

% of improve

ment SD SE t value p value Remarks

1 Pain in Numerical rating scale 15.22 5.56 9.11 65.77 2.02 1.60 8.12 < 0.001 H. S

2 Pain in Visual Analogue scale 66.67 23.33 34.89 67.05 4.06 2.10 8.19 < 0.001 H. S

3 Swelling of 44 joints 14.67 4.89 7.33 71.80 2.24 1.10 8.87 < 0.001 H. S 4 Swelling of 28 joints 13.22 4.67 7.67 70.62 2.26 1.34 6.36 < 0.001 H. S 5 Tenderness of 28 joints 14.56 6.00 9.67 62.40 2.22 1.16 6.91 < 0.001 H. S 6 Morning stiffness 2.44 1.33 1.67 44.44 0.70 0.20 5.55 < 0.001 H. S 7 Heaviness 1.22 0.33 1.11 77.78 0.67 0.11 8.00 < 0.001 H. S 8 RA index (tenderness) 17.22 6.44 12.78 64.02 2.37 1.69 6.35 < 0.001 H. S

9 Madhavakara index of Amavata 12.78 3.22 13.22 76.35 2.09 1.70 5.59 < 0.001 H. S

10 Anjana nidana index of Amavata 7.56 3.56 6.44 54.78 1.35 0.44 9.07 < 0.001 H. S

11 Basavarajeya index 1.89 1.00 2.11 31.67 1.12 0.35 2.53 < 0.05 H. S

12 Extra articular manifestation 3.33 1.11 2.00 72.09 1.20 0.32 6.86 < 0.001 H. S

13 Global disease assessment (patient's) 59.22 18.11 43.00 70.16 3.75 1.80 8.20 < 0.001 H. S

14 Global disease assessment (physician's) 64.44 25.00 37.22 61.94 4.08 1.84 5.92 < 0.001 H. S

15 Ayurvedic health assessment 36.56 20.56 21.11 43.72 1.96 1.00 16.00 < 0.001 H. S

16 Arthritis impact measurement scale 37.33 19.78 18.78 46.44 2.48 1.94 9.06 < 0.001 H. S

17 Physical disability 13.33 5.00 8.22 62.55 1.64 1.00 8.33 < 0.001 H. S 18 Walking time 55.00 45.22 11.00 17.65 1.97 1.06 9.19 < 0.001 H. S 19 Grip strength 86.56 95.44 18.22 9.73 4.01 2.10 3.38 < 0.01 H. S 20 Range of movements 76.89 82.22 4.56 7.34 2.87 0.86 6.16 < 0.001 H. S 21 ESR 41.44 35.56 7.33 17.19 4.53 1.98 6.02 < 0.001 H. S 22 C reactive protein 0.44 0.33 0.44 11.11 0.70 0.11 1.00 > 0.05 N. S 23 Haemoglobin 11.02 11.32 0.10 2.87 0.88 0.16 1.93 > 0.05 N. S 24 Lymphocyte count 37.56 38.78 2.11 3.76 2.64 0.28 4.40 < 0.05 H. S 25 Disease activity score 4.76 2.78 2.47 42.71 0.96 0.19 10.13 < 0.001 H. S

26 Disease activity score - 28 joints 6.43 4.27 2.56 35.13 1.06 0.26 8.36 < 0.001 H. S


2. Sandhigraha :- In this Group four patients (44%) presented with Grade III and five patients

(56%) with Grade II Sandhigraha.After the treatment there was no patients with Grade III and

Grade II was reduced from five to three(33%).

3. Sandhiruk:- One patient presented with Grade III (11%), four patients with Grade II (44%), and

four patients with Grade I(44%). After the treatment Grade II was reduced from four to one

(11%) and four patients (44%) got complete relief.

4. Sandhisotha:- One patient presented with Grade III (11%) five patients with Grade II (56%) and

three patients with Grade I (33%). After the treatment three patients got complete relief (33%)

and there were no patients with Grade III. Number of patients in Grade II was reduced from

five to one (11%)

5. Sparsa asahishnuta:- One patient presented with Grade III (11%) five patients with Grade II

(56%) and three patients with Grade I (33%). After the treatment six patients got complete

relief (67%) and there were no patients with Grade II and Grade III.

6. Gourava :- Two patients presented with Grade II and seven patients with Grade I. After the

treatment six patients (67%) got complete relief and there were no patients with Grade II and

Grade III.

Conclusion:

At the virtue of understanding the fundamentals of the Bahiparimarjana Chikitsa - tropical

appliance management, it is very clear that the required cleansing properties such as “Anupravana

bhava Utpadakata” is not available with and they are said as only Dosha transport facilitators with

the capabilities of Vishyanda, Paka and Srotomukha Vishodhana, well before to the Dosha

Shodhana procedure. When Dosha Shodhana is done the same Bahiparimarjana Chikitsa becomes

potent to pacify Dosha and said as Dosha shamaka. Dhanyamla is such potent externally mediated,

temperature regulated, lipophilicity, moistened, pH regulated (3 approx.), concentration - partition

and diffusion coefficient of drug is maintained along with specific Vata Dosha pacified properties.

Dermal applications which are hydrophobic in nature (organic solvents – Dhanyamla) utilized for sustaining

prolonged and slow delivery acts on systemic diseases. Thus the Dhanyamla Chikitsa becomes ultimate

treatment Antahparimarjana (internally) and Bahiparimarjana (externally) Chikitsa.


References

1) Raja Radha Kanta Deva, Shabda Kalpa druma, part 3, 3rd ed, 1967, Chowkhamba Sanskrit Series

Office, PB No 8, Varanasi -1, pp 62

2) Ibid, pp 709

3) Ibid, pp 709 medina

4) Vaidya Jadavji Trikamji Acharya ed, Charaka Samhita sutra 11/55, Nirnaya Sagar Press (1941)

reprint, 1984, Chowkhamba Sanskrit sansthan, PB No 139, Varanasi, pp 78

5) Ibid, Chikitsa, 7/53, pp 453

6) Ibid, Sutra, 2/15 – Chakrapani, pp 25

7) Vaidya Jadavji Trikamji Acharya et.al., Susruta Samhita Chikitsa 24/30 - Dalhana, 8th ed, 2005,

Chowkhamba orientalia, PB No 1032, Varanasi, pp 488

8) Joel G. Hardman et.al., Goodman & Gilman's THE PHARMACOLOGICAL BASIS OF

THERAPEUTICS, 9th ed, 1996, McGraw-Hill, Health Professions Division, New York

9) Sahasra yoga Edited by – Shri K. V. Krishnan Vaidyan et.al. Published by Vidyarabham Publishers,

Allepy, 23rd edition April 2000. Pp.122

10) Vaidya Jadavji Trikamji Acharya ed, Charaka Samhita Chikitsa 3/259, Nirnaya Sagar Press (1941)

reprint, 1984, Chowkhamba Sanskrit sansthan, PB No 139, Varanasi, pp 422

11) Ibid, 14/44-47, pp 508

12) Ibid, 8/74, pp 463

13) Ibid, 27/50-55, 615

14) Sahasra yoga Edited by – Shri K. V. Krishnan Vaidyan et.al. Published by Vidyarabham Publishers,

Allepy, 23rd edition April 2000. Pp.122

15) Shyju Ollakkod under the guidance of Dr. K. Shiva Rama Prasad, Evaluation of comparative

efficacy of Alambushadi yoga and Dhanyamla Kayaseka in Amavata (Rheumatoid Arthritis), 2004,

Department of Kayachikitsa (PG), Post graduate studies and research centre, D.G. M. AYURVEDIC

MEDICAL COLLEGE, Gadag - 582 103


dhanyamla bahiparimarjana

Health & Medicine