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Amrtottaram kvatha is an important ayurvedic formulation prepared using stems of Tinospora cordifolia (6 parts), the pericarp of Terminalia chebula (4 parts) and dried rhizomes of Zingiber officinale (2 parts) (Anonymous I978e). It is reported to reduce uncomfortable symptoms of indigestion, acts as a mild laxative and is used in the treatment of chronic fever, as well as rheumatoid arthritis (Sulaiman et al. 2012; Bhokardankar et al. 2018).
Baldguhicyddi kvatha is a polyherbal liquid preparation. This is a concentrated decoction of herbs which contain water-soluble active principles. Balaguhicyadi kvatha is prepared from three medicinal herbs viz. Bala (Sida cordifolia/Sida rhombifolia/Sida retusa), Gudiici (Tinospora cordifolia) and Devadaru (Cedrus deodara). It is used in the treatment of rheumatoid arthritis, gout, joint inflammation and similar conditions (Khan et al. 2016).
Dasamiila is a group of ten drugs - Aegle marmelos, Stereospermum suaveolens, Clerodendrum phlomidis, Oroxylum indicum, Gmelina arborea, Solanum nigrum, Solatium xanthocarpum, Uraria picta, Desmodium gangeticum, Tribulus terrestris (Arun Raj et al. 2018). The official parts are roots. Dasamiila kvatha is indicated in conditions like disorders of the nervous system (vatavyadhi), including hemiplegia (paksaghata) and low back pain (kapsUla) (Gupta et al. 2016; Inamdar et al. 2017).
Daśamūla Kaṭutraya Kvātha
Dasamiila katutraya kvatha is a unique combination of dasamiila, trikatu (fruits of Piper longum, Piper nigrum and dried rhizomes of Zingiber officinale) and vasd (Adhatoda vasica). While all medicines are beneficial in the postpartum stage, dasamiila are especially useful in pacifying vata. Trikatu is helpful in improving digestion, vasd is useful in nourishing blood, and the combination has an added advantage due to its ability to reduce pain in joints. It is also effective in rheumatoid arthritis (Deshpande et al. 2017).
Dhanvantaram kvatha mentioned in Astdtigahrdaya is widely used in the management of diseases manifested due to vata derangement and vdtarakta (mostly diseases of the connective tissues, bones, joints and nervous system) (Sruthi and Sindhu 2012). It is also effective in traumatic conditions of bone and vital points. It is effectively used in pediatric diseases and postpartum care as well. This kvatha is also effective in fever, flatulence, mental disorders urinary obstructions and hernia (Upadhyay 1975a).
Draksadi kvatha is a potent anthelmintic agent (Revathy 2018). It is effective in vomiting, burning sensation, fainting, fever, alcoholism, excessive thirst, jaundice and rheumatoid arthritis (Aiswarya and Dharmarajan 2015).
Osteonecrosis or avascular necrosis is a pathologic process that results from a critical decrease of blood supply to the bone and elevated intra-osseous pressure. Osteonecrosis is the final common outcome of traumatic and non-traumatic insults, impairing blood circulation to the bone. Consequently, interruption of blood flow to the bone leads to the death of bone marrow and osteocytes, resulting in the collapse of the necrotic segment (Mont and Hungerford 1995). Avascular necrosis is clinically characterized by the gradual onset of pain in motion and relieved by rest in the affected joint with radiation down the affected limb, leading to muscle spasm (Epstein et al. 1965). Gandharvahastadi kvatha is effective in the management of avascular necrosis (Prasad et al. 2018).
It is effective in diabetes mellitus (Priyanka et al. 2017), avascular necrosis (Prasad et al. 2018), seborrheic dermatitis (Devi and Sharma 2017) and in childhood atopic dermatitis (Chethan Kumar et al. 2017).
Mahdrdsnadi kvatha is a formulation widely used in the treatment of neurological diseases. The original formula is believed to have been designed by Prajapati (Radha et al. 2014). It is effective in the management of neurological diseases (vdta vyadhi) such as arthritis (Pandey and Chaudhary 2017; Padekar et al. 2018), lower back pain (Gupta et al. 2016), Bell’s palsy (Akashlal et al. 2019; Sawarkar and Sawarkar 2019), painful joints, arthralgia, sciatica, frozen shoulder and gout (Tike et al. 2018) and in reducing joint pain in Dengue fever (Bhageshwary et al. 2016). It also helps in the improvement of balance in progressive degenerative cerebellar ataxias (Sriranjini et al. 2009) and is also effective in female infertility (Singh et al. 2014).
Nayopaya kvatha is effective in the management of bronchial asthma (tamaka svasa) when dosas are in morbid stage (Shyam et al. 20Ю) and is also prescribed for the treatment of allergic ailments such as cough (kasa) (Balachandran and Devi 2007).
Paṭōla Kaṭurōhiṇyādi Kvātha
Patola Katurohinyadi kvatha is a combination of six herbal ingredients viz. Trichosanthes dio- ica, Picrorhiza kurroa, Pterocarpus santalinus, Marsdenia tenacissima, Tinospora cordifolia and Cissampelos pareira (Upadhyay 1975b). This classical ayurvedic formulation has been reported by many practitioners to be effective in the treatment of liver disorders (Pawar et al. 2015). It is indicated in jaundice, skin disease, vomiting, fever, diseases due to poisoning, viral infections and liver diseases (Rao et al. 2015). It is widely used in the treatment of skin disease involving itching, pigmentation and burning sensations. It is useful in decreasing bad cholesterol and brings forth a potent antitoxic effect. It is used for metabolic corrections, liver dysfunctions and lowered immunity. It is effective in the management of spider poisoning (Sunitha and Hussain 2018b) and ulcers caused by snake bites (Roshni 2017; Vijayan et al. 2018). It improves digestion and relieves anorexia. It is a potent antimicrobial medicine too.
The main ingredients of this formulation are Trichosanthes dioica, Boerhavia diffusa, Azadiracta indica, Zingiber officinale, Picrorhiza kurroa, Tinosporac cordifolia, Andrographis paniculata and Berberis aristata (Vaidyan and Pillai 1985c). It is slightly laxative, so it can easily clear up the channels or srotas. It is effective in the management of uterine fibroids along with polycystic ovarian syndrome (Kumar et al. 2015), edema and hypothyroidism (Singh and Thakar 2018).
Sahacarddi kvatha contains only three ingredients - Zingiber officinale, Cedrus deodara and Barleria prionitis (Vaidyan and Pillai 1985c). In this recipe, Zingiber officinale acts as an improver of “digestive fire” and Cedrus deodara pacifies vata. Sahacaram means “walking along with”. As Barleria prionitis has the specific property of gativisisatvam (ability to cause movement), Sahacarddi kvatha can be administered in conditions like difficulty in walking or improper walking. The combination of all these drugs is therapeutically effective in lower back pain, sciatica, debility of lower limbs (Supraja and Vidyanath 2013) and chronic rheumatoid arthritis with bilateral hip involvement (Mamidi and Gupta 2015; Nimesh and Shetty 2018) It is also effective in nerve-related diseases like hemiplegia, epilepsy (Kumar et al. 2018), disc prolapse, facial palsy and paralysis (Ratha et al. 2018).
Agastya Harītaki Rasāyana
Agastya haritaki rasayana is a formulation useful in the management of various types of respiratory disorders like cough, asthma, and hiccough, and also for piles, diarrhea, heart disease, anorexia, intermittent fever and graying of hair (Sharma 1983a). It is used as a rasayana (nutrient to body and mind with adaptogenic and immuno-stimulatory properties) (Ram et al. 2013; Keshava et al. 2014). It is also proven for its immunomodulatory (Aher and Wahi 2011), cytoprotective (Dahanukar 1983), anticaries (Jagtap and Karkera 1999), antispasmodic and hypolipidemic properties (Ahirwar et al. 2003).
Caraka was the first author to mention Cyavanaprasa. He explains that it is the rasayana par excellence. It is an excellent rejuvenator with the ability to delay aging and enhance general well-being. It is effective in cardiovascular diseases, cough, dyspnea, rheumatic diseases, hoarseness of voice and impotence. It promotes intellect as well (Sharma 1983b). The major ingredient of Cyavanaprasa is gooseberry (Emblica officinalis), which is a known antioxidant and rich source of vitamin C (Parle and Bansal 2006). The primary action of Cyavanaprasa is to strengthen the immune system and to support the body’s natural ability to produce hemoglobin and white blood cells (Pole 2006). As a result, it is reputed as a highly admired rasayana, offering deep nourishment to tissues, preserving youthfulness and promoting systemic health and well-being.
Madan et al. (2015) investigated the immune-stimulatory effects of Cyavanaprasa using in vitro assays, evaluating the secretion of cytokines such as tumor necrosis factor-alpha (TNF-a), inter- leukin-lbeta (IL-lp) and macrophage inflammatory protein-1-alpha (MIP-l-a) from murine bone marrow-derived dendritic cells which play a crucial role in immuno-stimulation. The effects of
Cyavanaprasa on phagocytosis in murine macrophages (RAW264.7) and natural killer cell activity were also investigated. At non-cytotoxic concentrations, Cyavanaprasa enhanced the secretion of all the three cytokines from dendritic cells. Cyavanaprasa also stimulated both macrophage and natural killer cell activity in vitro. These findings substantiate the immunoprotective role of Cyavanaprasa at the cellular level.
Chronic exposure to ultraviolet radiation induces premature skin aging. U.V. irradiation generates reactive oxygen species (R.O.S.), which play a pivotal role in skin photoaging. Takauji et al. (2016) examined the effect of Cyavanaprasa on skin photoaging. Hairless mice were fed with Cyavanaprasa in drinking water for three weeks, and then repeatedly exposed to ultraviolet light В (U.V.B.) irradiation to induce skin photoaging. The effects of Cyavanaprasa were examined in cells cultured in vitro. Cyavanaprasa was added to the culture medium and examined for its effect on the growth of human keratinocytes, and for the ability to eliminate R.O.S. generated by paraquat.
U.V.B. irradiation caused symptoms like rough skin, erythema and skin edema in hairless mice. But the administration of Cyavanaprasa relieved these symptoms. Cyavanaprasa also significantly suppressed epidermal thickening, a typical marker of skin photoaging, in mice. The authors found that Cyavanaprasa enhanced the growth of human keratinocytes, and efficiently eliminated R.O.S. These findings suggest that Cyavanaprasa may have beneficial effects on slowing skin photoaging (Takauji et al. 2016).
In the last 60 years Cyavanaprasa has grown to industrial production and marketing in packed forms to a large number of consumers as a health food. At present Cyavanaprasa has acquired a large consumer base in India and a few countries outside India. The reported clinical studies indicate that individuals who consume Cyavanaprasa regularly for a definite period of time showed improvement in overall health status and immunity. Randomized controlled trials of high quality with larger sample size and longer follow-up are essential to assess evidence on the clinical use of Cyavanaprasa as an immunity booster. More studies involving measurement of current biomarkers of immunity are required to establish the clinical relevance of Cyavanaprasa (Narayana et al. 2017).
Manibhadra guda is a famous ayurvedic formulation described in Astahgahrdaya. It contains Embelia ribes, Emblica officinalis, Terminalia chebula, Operculina turpethum and jaggery. It is effective in the management of worms, piles, skin diseases and fistula (Upadhyay 1975c; Patel et al. 2015b).
Bilvadi lihya contains Aegle marmelos (root), Cyperus rotundus (tuber), Cuminum cyminum (seed), Eletteria cardamomum (seed), Cinnamomum zeylanicum (bark), Mesua ferrea (flower), Zingiber officinale (dried rhizome), Piper nigrum (fruit), Piper longum (fruit) and jaggery (Anonymous 1978f). Bilvadi lihya is effective in reducing the symptoms of hyperemesis such as nausea, salivation and vomiting and helps in improving the body weight and hemoglobin level of patients, along with improvement in general condition (Math and Jana 2019).