Project report on Outpatient services provided by the department of Ayurveda in Gautam Budha Nagar district of Uttar Pradesh. Covers total number of dispensaries, facilities available, total patient treated, budget allocation etc. includes the Essential Drug List for Ayurveda Dispensaries prepared by department of AYUSH, GOI
Título original
Towards Organisational effectiveness of OPD service in Ayurvedic Dispensaries in District Gautam Budha Nagar,U.P
Project report on Outpatient services provided by the department of Ayurveda in Gautam Budha Nagar district of Uttar Pradesh. Covers total number of dispensaries, facilities available, total patient treated, budget allocation etc. includes the Essential Drug List for Ayurveda Dispensaries prepared by department of AYUSH, GOI
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Project report on Outpatient services provided by the department of Ayurveda in Gautam Budha Nagar district of Uttar Pradesh. Covers total number of dispensaries, facilities available, total patient treated, budget allocation etc. includes the Essential Drug List for Ayurveda Dispensaries prepared by department of AYUSH, GOI
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Attribution Non-Commercial (BY-NC)
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Baixe no formato PDF, TXT ou leia online no Scribd
Submitted by Dr. Surendra Chaudhary (PGC/ 3756/2010)
For Certificate Course in Health and Family Welfare Management 2010-2011
National Institute of Health and Family Welfare-New Delhi
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Acknowledgement I am gracefully acknowledge, the immense support of my family members for their constant motivation. I am personally thankful to my wife for her motivation and allow me for sparing time for this project. My daughter, make this project error free by her editing and my sons overseas calls always boost me for timely completion of the project. I am also graceful to all the faculty of distance learning cell, NIHFW New Delhi for their guidance. All my fellow medical officers and paramedical staff of district Ayurveda dispensaries support me warmly by providing the relevant data, answering my survey questions and other information. I personally thank Divisional Ayurvedic Officer Gautam Budh Nagar, Dr. Dhruv Singh for proving the budget and other data required for this project. Last but not the least; I thank all my friends for their pschycological support, and my patients who missed me during my leaves for the contact programs.
I am very much thankful to Dr. Deoki Nandan , Director, NIHFW New Delhi for inspiring me of joining this course during my earlier visits to the institute as U.P. Government representative for trainings under NRHM.
-Surendra Chaudhary 3
Contents
S.N. Contents Page number
1. Introduction 5-6 About Ayurveda 6 2. Section I: Description of the selected Organization 7-15 Divisional Ayurvedic Office G.B.Nagar 7 Map Uttar Pradesh 8 Map Gautam Budha Nagar 9 District profile 10 Location of Ayurveda dispensaries on map 12 Organizational chart 13 Staffing pattern 14 Budget of the organization 15 3. Section-II: Situational analysis 17-23 Health status 17 Health facilities 17 Service program 18 Management analysis 19 Community participation, inter- sectoral coordination 22 SWOT analysis 22 Management problems and causes 23 Future development plan 23 4. Section-III: Selected health care programme 24-35 Objectives 24 Infrastructure 24 4
Staff position at field level 25 Basic qualification, experience and training- 26 Status of Medical Officers (experience) 27 Facilities at dispensaries 27 Performance, coverage and quality of the services 28 Patients growth 29 Other services 30 Target achieved 31 Observation 32 5. Section-IV: Managerial problems 36-37 Problems 36 Priorities of the problems 37 6. Section-V: suggested Interventions 39-41 7. Section VI: Action Plan 42-46
Appendix
Photos during field survey 47-49
List of medicine purchased by District officer 50 Questionnaire for medical officers- General Knowledge based 51 Questionnaire for medical officers- Hospital specific- 52
Essential drug list 54-75
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Introduction Ayurveda services are mainly availed by the poor population groups who are not served by the popular medical care. For last few decades modern health care system develops very fast resulting drastic decline in the services of Ayurvedic dispensaries. Most of the Ayurvedic dispensary limited to serve the chronic or the common ailments only. Ayurveda, even having an old medical delivery institute and such a tremendous community involvement, OPD attendance is very thin in this district. The main propose of this project is to find out the factors which affect the working of the system and how we can improve after studying the public health management tools. About Ayurveda Ayurveda can be defined in terms of basics which include the Tridosha and Panchmahbhoot theories. A brief introduction is given below- Basics of Ayurveda Life in Ayurveda is conceived as the union of body, senses, mind and soul. The living man is a conglomeration of three humours (Vata, Pitta &Kapha), seven basic tissues (Rasa, Rakta, Mansa, Meda, Asthi, Majja & Shukra) and the waste products of the body such as faeces, urine and sweat. Thus the total body matrix comprises of the humours, the tissues and the waste products of the body. The growth and decay of this body matrix and its constituents revolve around food which gets processed into humours, tissues and wastes. Theory of Panchamahabhutas According to Ayurveda all objects in the universe including human body are composed of five basic elements (Panchamahabhutas) namely, earth (Prithvi), water (Jal), fire (Agni), air (Vayu) and vacuum (Akaash, ether). There is a balanced condensation of these elements in different proportions to suit the needs and requirements of different structures and functions of the body matrix and its parts. The tissues of the body are the structural whereas humours are physiological entities, derived from different combinations and permutations of panchmahbhoot Health and Sickness Health or sickness depends on the presence or absence of a balanced state of the total body matrix including the balance between its different constituents. Both the intrinsic and extrinsic factors can cause disturbance in the natural equilibrium giving rise to disease. This loss of equilibrium can happen by dietary indiscrimination, undesirable habits and non- observance of rules of healthy living. Seasonal abnormalities, improper exercise or erratic application of sense organs and incompatible actions of the body and mind can also result in creating disturbance of the existing normal balance. The treatment consists of restoring the balance of disturbed body-mind matrix through regulating diet, correcting life-routine and 6
behaviour, administration of drugs and resorting to preventive Panchkarma and Rasayana therapy
Preventive Treatment and the concepts of Aetio-Pathogenesis Ayurveda has developed a very vivid analytical description of the stages and events that take place since the causative factors commence to operate till the final manifestation of disease. This gives this system an additional advantage of knowing that possible onset of disease much before the latent symptoms become apparent. This very much enhances the preventive role of this system of medicine by making it possible to take proper and effective steps in advance, to arrest further progress in pathogenesis or to take suitable therapeutic measures to curb the disease in its earliest stage. Treatment The basic therapeutic approach is, that alone is the right treatment which makes for health and he alone is the best doctor who frees one from disease. This sums up the principal objectives of Ayurveda, i.e. maintenance and promotion of health, prevention of disease and cure of sickness. Treatment of the disease consists in avoiding causative factors responsible for disequilibrium of the body matrix or of any of its constituent parts through the use of Panchkarma procedures, medicines, suitable diet, activity and regimen for restoring the balance and strengthening the body mechanisms to prevent or minimize future occurrence of the disease. Diet and Ayurvedic Treatment In Ayurveda, regulation of diet as therapy has great importance. This is because it considers human body as the product of food. An individuals mental and spiritual development as well as his temperament is influenced by the quality of food consumed by him. Food in human body is transformed first into chyle or Rasa and then successive processes involve its conversion into blood, muscle, fat, bone, bone-marrow, reproductive elements and ojas. Thus, food is basic to all the metabolic transformations and life activities. Lack of nutrients in food or improper transformation of food lead to a variety of disease conditions
Section I: Description of the selected Organization District Ayurvedic office Guatam Budha Nagar Sponsoring agency - Government of Uttar Pradesh The entire district Ayurveda service is governed by the Director Ayurveda services Uttar Pradesh and comes under the ministry of Medical education headed by a cabinet minister and supported by the minister of state (Ayurveda). The department is headed by the director at state level and Regional Ayurvedic and Unani Officer at district level. We have 71 districts and 59 Divisional Ayurvedic officers. Ayurveda department of this district is a new one and was created only on 15 th Nov 2008. Gautam Budha Nagar district was created in year 1997 from district Ghaziabad and Buland shar. Department of Ayurveda was controlled by Divisional Ayurvedic Officer Ghaziabad for 7 dispensaries and 5 dispensaries were governed by the Divisional Ayurvedic Officer Bulandshahar. Now all the administrative control is under Divisional Ayurvedic Office Gautam Budha Nagar, located at Government Ayurvedic dispensary Dadri. District Gautam Budha Nagar is one of the small districts of U.P. so is our department. DEPARTMENT OF AYURVEDA is one of the oldest departments in U.P. providing health care services through its dispensaries and hospitals throughout the state particularly in rural areas. We are not the partner of any National Health Programmes run by the Government of India (GOI). We had an annual budget of Rs. 8000 (eight thousand only) per dispensary for medicine supplied by the Government Ayurvedic Pharmacies situated at Lucknow and Pilibhit. Budget allocation for district office includes contingencies, rent and very nominal amount for maintenance of the building. For last two years medicines worth Rs. 25 thousand for every dispensary are being supplied by the department of AYUSH, GOI under the scheme strengthening of the existing AYUSH dispensaries. Most of the dispensaries of this district lack in proper maintenance of building, furniture, equipments and all the other basic facilities. 8
District Gautam Budha Nagar Uttar Pradesh showing district and state boundaries (Source- http://censusindia.gov.in/2011-prov-results/prov_data_products_up.html - Provisional Population Totals Paper 1 of 2011 Series 10 - Uttar Pradesh)
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Map G.B. Nagar (http://gbnagar.nic.in/) District profile Gautam Budh Nagar The District Gautam Buddh Nagar was formed on 6/9/97 with effect from Govt. order no 1249/97/82/97.District Gautam Buddh Nagar includes Dadri,Noida and Greater Noida from gaziabad and Tehsil Sikandrabad and part of Khurja from Bulandshahar.The district has 4 development blocks,3 administrative tehsils and 16 police station.
District Gautam Budha Nagar is surrounded by Delhi NCR,Haryana, Bulandshar, Ghaziabad and Aligarh district of U.P (Map courtesy-http://gbnagar.nic.in/Map/map.jpg) Population India Uttar Pradesh GB Nagar Total 1,21,01,93,42 199,581,47 1,674,714 Male 62,37,24,24 104,596,41 904,505 Female 58,64,69,17 94,985,06 770,209 Population Density/sq.Km 382 828 1306 Sex ratio(per 1000 males) 940 908 852 Child 0-6 yrs Total 158,789,28 29,728,23 245,232 Child 0-6 yrs (Male ) 82,952,13 15,653,17 132925 112307 Child 0-6 yrs (Female ) 75,837,15 14,075,06 Literacy Rate 74.0 69.72 82.20 Literacy Rate-Male 82.1 79.24 90.23 Literacy Rate-Female 65.4 59.26 72.78
(Source- http://censusindia.gov.in/2011-prov-results/prov_data_products_up.html - Provisional Population Totals Paper 1 of 2011 Series 10 - Uttar Pradesh) Description Figure Reference Area 1442 Sqr KM
http://gbnagar.nic.in/ No. Of Tehsil 3 No. Of blocks 4 No. Of Lokshabha seats 1 No. Of Vidhan Sabha 3 Total village 373 Climate-Rainfall 303 Maximum temperature 44.4 http://www.uponline.in/Profile/districts/ Gautam.asp Minimum temperature 2.2 11
Government Hospitals at Gautam Budh Nagar as on 2009-10 (As per development atlas of G.B. Nagar, dept of statics,Vikas Bhawan, SurajPur-G.B.nagar) S.N. Nature of hospitals Numbers 1. Allopathic 4 2. Ayurvedic 12 3. Homeopathic 19 4. Unani 0 5. Community Health Centre 3 6. Primary Health Centre 18 7. Family and Mother-Infant Centre 43 8. Family and Mother-Infant Sub-Centre 327 9. Tuberculosis 1 10. Leprosy 1
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Location of Ayurvedic dispensaries in District Gautam Budh Nagar- Block wise distribution (http://gis.up.nic.in:8080/srishti/)
Geographical data of Ayurvedic dispensaries (http://gis.up.nic.in:8080/srishti/) S.No. Village Tehsil Block Population* As per 2001 census Distance from health centre(KM) 1. Beel Dadri Dadri 1976 6-10 2. Bhaipur Jewar Jewar 2624 6-10 3. Parsaul Gb nagar Dankaur 4098 6-10 4. MandiShyamnagar GB Nagar Dankaur 4882 0 5. Dadri Dadri Dadri 57416 0 6. Surajpur GB Nagar Bisrakh 5569 6-10 7. Dujana Dadri Bisrakh 7901 0 8. Noida* Dadri Bisrakh 305058 0 9. Jahangirpur Jewar Jewar 7901 0 10. Sarfabad* Dadri Bisrakh 4291 6-10 11. Sidipur Dadri Dadri 1197 6-10 12. Bhunna Taga Jewar Jewar 1391 6-10 *Noida and Sharfabad dispensary are working at another place. Sharfabad is situated at Chhijarsi and Noida, even being Urban dispensary is situated in villege Bajid Pur , Sec-63 Noida 13
Organization Chart #
*There are 71 districts in Uttar Pradesh and Divisional Ayurvedic Officers are working in only 59 districts. Minister Medical Education Director Ayurveda Additional Director Administeration Deputy Director(3) Administeration, Planning ,Education Divisinal Ayurvedic Officer(59)* Adittional Drug Controller Finance Controller Director Education (Pathyakarm Mulyankan) Principal Secretory Medical Education Special Secretory Ayush-2 (Ayurveda) Joint Secretory Ayush-2 State Minister (Ayurveda) 14
# Restructure of department of Ayush is in progress and post of Director General Ayush has been created, but no further development has done at the time of preparing this project. Resources- a. Human-Staffing pattern- S. N. Designation Sanctioned Positioned Vacant Remarks A. At Divisional Ayurveda and Unani Office 1. Divisional Ayurvedic Officer 1 1 1* Officiating 2. L.D.C. 1 1 3. Chowkidar 1 1 4. Peon 1 1 B. At field level (Dispensary) 1. Medical Officer 13 11 2 2. Pharmacist 13 6 7 3. Staff Nurses 3 3 4. Bhritya 12 10 2 5. Chowkidar 1 1 6. Sweeper 2 3* 0ne surplus 7. Sweeper cum Chowkidar 7 6 1 8. Part time sweeper* 3 3 *Rs.25/month *Dispensary having OPD facilities only, doesnt have sweeper, Only three (25%) dispensaries have full staff against the sanctioned post, while 75% of dispensaries are short of staff in the form of Pharmacist, M.Os and class IV employees. There is one dispensary where post of Medical Officer and Pharmacist are lying vacant and Medical Officer of another dispensary is on attachment there. Availability of the field staff- Description of dispensary Number Dispensary having Medical officer along with pharmacist 5 Dispensary having Medical officer but without pharmacist 5 Dispensary Without Medical officer and Pharmacist 1 Dispensary having Pharmacist only 1 Dispensary having full staff as sanctioned 3
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b. Financial-Budget allocation for the year 2009-10 B u d g e t
H e a d
B u d g e t
Budget Items (Rs. Laks) Salary TA/DA Raw Drugs Aushadi and Rasayan* Anurakshan (Maintenan ce) Others
R u r a l
45.9 R E R E R E R E R E R E 30 30 6.0 6.0 1.50 1.50 3.50 3.50 1.50 1.50 2.40 2.40
U r b a n 26.65 20 20 4.0 4.0 0.20 0.20 0.70 0.70 0.15 0,00 1.60 1.60 T o t a l
72.55 50 50 10.0 10.0 1.70 1.70 4.20 4.20 1.65 1.50 4 4 Year end surrender amount Rs 15,000 Budget allocation for the year 2010-11 B u d g e t
H e a d
B u d g e t
Budget Items(Rs. Laks) Salary TA/DA Raw Drugs Aushadi and Rasayan (Prepared and dressing materials) Anuraksha n (Maintena nce) Others
R u r a l
85.70 R E R E R E R E R E R E 62 56 21 16.75 0.10 0.10 2.50 2.50 Nil Nil Nil N il U r b a n
37.13 24 24 8.5 5.30 0.10 0.10 0.30 0.30 Nil Nil 4* 4 Total 122.83 86 80 29. 5 22.05 0.20 0.20 2.80 2.80 Nil Nil 4 N il
Year end surrender amount Rs 6, 33,000
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Section-II: Situational analysis 1. Health status situation- S.N. Rates and Ratio Value reference 1. Crude death rate 8.4 SRS 2008 2. Crude birth rate 29.1 SRS 2008 3. Infant mortality rate (IMR) 67 SERS 2008 4. Maternal mortality rate (MMR) 440 SRS 2008 5. Total fertility 3.8 SRS 2008 6. Sex Ratio/1000 male 852 Provisional population report census2011 7. Total literacy rate 90.23 8. Literacy rate female 72.78 9. Growth rate % 51.52
2. Health facilities- Health facilities in Gautam Budh Nagar are provided by the government, private and corporate hospital. Government facilities are more rural population centric while private and corporate health sector is available in urban areas only. Private health facilities- Corporate multispecialty hospitals- 2 Private multispecialty hospital - 2 Private hospitals >100 beds 10 Private hospitals <100 beds >50 There is one medical college at Greater Noida having a 500 bed hospital
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Government Hospitals at Gautam Budh Nagar as on 2009-10 (As per development atlas of G.B. Nagar, dept of statics,Vikas Bhawan, SurajPur-G.B.nagar) S.N. Nature of hospitals Numbers 1. Allopathic 4 2. Ayurvedic 12 3. Homeopathic 19 4. Unani 0 5. Community Health Centre 3 6. Primary Health Centre 18 7. Family and Mother-Infant Centre 43 8. Family and Mother-Infant Sub-Centre 327 9. Tuberculosis 1 10. Leprosy 1 Two multispecialty hospitals are under construction, one each at Noida and Greater Noida urban area. Total number of dispensary-12 Dispensary running in Rented 6 Government owned 2 Rent free/ Panchayat, Mandir, School , other 4 Having own land 2 Having only one room 4 Insufficient space 4 18
3. Service Program- All the National health programmes are run by the district health and family welfare department. Department of Ayurveda is providing OPD services as primary service with very limited IPD service, which is being utilized as day care facility. 4. Management analysis of- 1) Policy, objectives, strategies and inputs- There are no clear objectives and targets other than attending at least 20 new patients per day. Strategies are framed at state level and forwarded to district level. Inputs- Human resources- Medical Officers are available in most of the dispensary but pharmacist are short and affecting the function of the organization. There are some dispensaries without medical officer and pharmacist. Pharmacist or medical officer of another dispensary is attached, thus affecting both the dispensary. Infrastructure Infrastructure is very poor in the entire district. Rent free buildings are in bad shape and need a lot of money for repairing or maintenance. Furniture and equipments- Most of the dispensaries do not have enough or good quality furniture. Equipments and instruments are neither adequate nor appropriate in nature. Budget- Budget provision other than committed like salary, arrears etc is not sufficient. Budget for maintenance or repairing is not provided every year. Medicinal budget is sufficient as medicines are supplied as central assistance. 2) Organizational structure- District organization is headed by Divisional Ayurvedic Officer supported by a junior clerk and two class IV employees. There is no vehicle so management cant be up to the mark. At dispensary level management is done by the medical officer and pharmacist (in case of un availability of the M.O.) 3) Status of human resources management- a) Staffing norms- S. N. Designation Sanctioned Positioned Vacant 1. Divisional Ayurvedic Officer 1 1 1* 2. L.D.C. 1 1 3. Chowkidar 1 1 4. Peon 1 1 1. Medical Officer 13 11 2 2. Pharmacist 13 6 7 19
* Presently, post is holding on officiating base. b) Status of the vacant posts- Name of the post Sanctioned Posting Vacant Vacant % 1. Medical Officer 13 11 2 15 2. Pharmacist 13 6 7 54 3. Bhritya 12 10 2 17 4. Sweeper cum Chowkidar 7 6 1 14
c) Availability of the staff-Most vacant posts belong to pharmacists which are more than 50% followed by class IV employees, while medical officers are posted in all the dispensaries other than two. Observations on availability of the staff- In the absence of pharmacists medicines are distributed by the class IV employees, who are not competent and technical. This increases the waiting time and medical officers always fear about any lapse in distribution of the medicine. 90% of the field staff not staying at the headquarters. Reasons are- No residential quarters- There is no provision for residence at the field units, so staff is not staying there. Class IV employees are generally posted near their villages, so they dont reside there. Medical officers reside in nearby towns. Location of the field unit- These are situated in villages far from the city or town having no facilities like education, entertainment and electricity etc, so medical officers and pharmacist reside 10-20 km away from the headquarters. d) Staff motivation- Staff motivation is at the lowest level. Entire staff is doing its duties just till the withdrawal of their salary only. Salary, T.A, and other dues of the staff are not paid in time because of lack of commitment of the district office. Lack of motivation concerts the low turn up of the patients and cleanliness of the premises. 20
e) Training- Training was never planned. There is no provision of in-service training for technical personnel. There is no organizational policy for training. Few of the medical officers take training for the financial management. If there is any training program sponsored by the central government, employees are not informed and never relieved for the training. Technical skills of the medical and Para-medical staff are never evaluated and they never feel the need of any training. f) Leadership and supervisory practices- At district level no supervision or monitoring is performed because of unavailability of the vehicle to inspect the dispensaries. Medical officers are not trained in modern tools of management including monitoring and supervision. There is no supervisory plan for regular supervision. There is no supervisory check-list. No feedback is provided to the superiors. Supervisors do not have adequate skill to supervise. g) Team work- There are some units where entire staff works as a team and achieves the desired targets. Most of the units have some inter-personal conflicts, which require timely intervention of solution. h) Support system: 1. Financial support- Financial support is in the form of budgetary allocation from the state government for the wages, medicine and equipments. 2. Materials support- Medicines are supplied from the following sources- 1. State government- A total of Rs. 8,000 is earmarked for the medicine supplied by the two state Ayurvedic pharmacies. 2. Local supply- Budget is provided for the local procurement of medicine and other equipments. For local purchase three categories are defined, I. Raw drugs- As per Ayurveda principle, certain medicines are available in certain geographical areas which are very beneficial for the ailments which exist 21
in those areas, so government allocates certain budget to purchase these raw drugs for individual dispensaries. II. Aushad and Rasayan- This category has readymade medicines including classical medicines. Dressing material is also procured under this category. III. Third category consists of drugs from various sources including patent Ayurvedic medicines. Budget allocation for medicine (Last two years) Year Raw drug Aushadi and Rasayan 2010-11 20,000 2,80,000 2009-10 1,70,000 4,20,000
3. Central government assistance- Under the Ayush, GOI scheme for medicine @Rs. 25 thousand per dispensary is being supplied for last two years. From year 2010-11 this amount has been increased to Rs.50, 000 per dispensary. Procurement process- For central assistance and state supply, directorate of Ayurveda services purchases medicines on the recommendation of the purchase committee, while at district level procurement is done on the bases of demand letter from the dispensaries. But this practice is not followed and purchase is made at divisional Ayurvedic officers discretion only. 4) Community participation, inter- sectoral coordination and IEC- Total aversion from community, there is no involvement. Medical officers are not aware about the community need although Ayurveda has very good community involvement in terms of knowledge. No interaction between field unit staff and the community. Most of the time community is not aware about the services we are providing, resulting in loss of faith as well as patients. NGOs never involve Ayurvedic dispensaries in their working environment. There is no inter-sectoral coordination; involvement of main stream health service department is limited to engage Ayurveda medical officer in immunization program or using their facilities for setting up of the immunization booths during Pulse Polio drive. 22
No IEC material ever supplied to the hospitals, neither staff is aware about any IEC services. Ayurvedic medical officers are not aware about the Village health societies and/or Togi Kalian Samitis. No Medical Officer is member of any Village health society or RKS.
Swot analysis Strengths: 1. Strong community involvement in terms of Ayurveda knowledge. 2. Good acceptance among the people. 3. Experienced, committed medical and paramedical staff. Weaknesses: 1. Poor infrastructure. 2. Poor record keeping. 3. No clear policies. Opportunities: 1. Conducting of specialized clinic- kshar sutra, geriatric and rasayan therapy. 2. Propagation of lifestyle modification for prevention of disease. 3. Potent integration with the National Health Programs. Threats: 1. Political patronage does not provide support to this system and political interference is the biggest threat. 2. If involved in national health programs, department of health will misuse the workforce and medical officers will be used for any work other than the treatment. 5) Decentralization- No decentralization is done. There are two types of planning which are supposed to be done at dispensary level- 23
Purchase of crude drugs- budget is allocated for purchasing local need based crude herbs to provide the effective treatment, but this is not being followed. Divisional Ayurvedic officer purchases raw drug on his own and supplies to the dispensaries. User charges- 50% of user charges are supposed to be used exclusively for the betterment of that particular unit in the form of purchase of most essential equipment, instrument or furniture, but it is not performed at dispensary level. 6) Management problem and causes- Most important management problems are supervision and monitoring. There is no evaluation of the service at all. Vehicle is the main cause of the problem, without which field movement is not possible. Dispensaries are situated far from the district headquarter and public transport is not available every time. Disbursement of wages and other arrears- most of the staff is facing this problem. Salary is not disbursed in time and the cause is inter-personal conflict between LDC and the Divisional Ayurvedic officer. 7) Future development plan of the organization- At district level every year provision of certain new dispensaries is made in the district plan, but never succeeds in releasing the state budget. This year also six new dispensaries are proposed in district plan. 24
Section-III: Selected health care programme OPD services in Ayurveda dispensaries of Gautam Budh Nagar III. i. Objective- Main objective of Ayurveda services is to provide quality health care on two grounds- Preventive- As Ayurveda theory explains that most of the diseases occur because of unhealthy life style, we can prevent many diseases by adopting a healthy life style as per our Prakriti as stated by Ayurveda. This can be done by advising people to eat properly and act in accordance of nature. Curative- If we are not following the regimen explained by the Ayurveda we can take medicine to cure the diseases. Main goal and objective is to attend at least 20 new patients per day i.e. a total of at least 7300 patients annually. III. ii. Infrastructure, facilities and resources- There are 12 dispensaries in the district covering mainly the rural population. S.No. Dispensary at Tehsil Block Nature of Dispensary Bed capacity 13. Beel Dadri Dadri Indoor 4 14. Bhaipur Jewar Jewar Indoor 4 15. Parsaul Gb nagar Dankaur Indoor 4 16. MandiShyamnagar GB Nagar Dankaur Out door 0 17. Dadri Dadri Dadri Indoor 15 18. Surajpur GB Nagar Bisrakh Out door 0 19. Dujana Dadri Bisrakh Out door 0 20. Noida* Dadri Bisrakh Indoor 4 21. Jahangirpur Jewar Jewar Out door 0 22. Sarfabad* Dadri Bisrakh Indoor 4 23. Sidipur Dadri Dadri Indoor 4 24. Bhunna Taga Jewar Jewar Indoor 4
Total bed capacity 43
*Noida and Sharfabad dispensary are working at another place. Sharfabad is situated at Chhijarsi and Noida, even being Urban dispensary is situated in villege Bajid Pur , Sec-63 Noida
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Rural -Urban classification- Total dispensaries Urban Rural 12 2* 10
*Although classification of the dispensaries are as per budgetary provision in terms of Rural or Urban, but due to fast urbanization of Noida and Greater Noida more and more Rural dispensaries are serving urban population as well. Building status of the dispensaries Type No. % Rented 6 50 Own 2 17 Rent free 4 33
Staff position at field level- Name of the post Sanctioned Posting Vacant Posting % 1. Medical Officer 13 11 2 85
2. Pharmacist 13 6 7 46 3. Staff Nurses 3 3 X 100 4. Bhritya 12 10 2 83 5. Chowkidar 1 1 X 100 6. Sweeper 2 3* X 150 7. Sweeper cum Chowkidar 7 6 1 86 8. Part time sweeper* 3 3 X *Rs.25/month
Availability of the staff- Description of dispensary Number % Dispensary having Medical officer along with pharmacist 5 42 Dispensary having Medical officer but without pharmacist 5 42 Dispensary Without Medical officer and Pharmacist 1 8 Dispensary having Pharmacist only 1 8
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Basic qualification, experience and training status of Medical Officers- S. N. Name Q u a l i f i c a t i o n
D u r a t i o n
i n
s e r v i c e
( I n
Y e a r s )
D u r a t i o n
o f
p r e s e n t
p o s t i n g
( I n
Y e a r s )
E x t r a
q u a l i f i c a t i o n
( i f
a n y )
A n y
i n
- s e r v i c e
t r a i n i n g
1. DR. Surendra Chaudhary B.A.M. S. 28 5 Nil TOT in NRHM from NIHFW 2. Dr.Ashok Sharma -do- 22 13 Nil X 3. Dr. Anjali Sharma -do- 22 3 Nil DDO Training 4. Dr. Sneh Lata -do- 23 6 Nil Ultra sound training 5. Dr. Kavita Singh -do- <1 < 1 Nil X 6. Dr. Digvijay Pal Singh -do- 18 5 Nil X 7. Dr. Sukh Pal Singh -do- 24 3 Nil X 8. Dr. Dhruv Singh Rajawat -do- 31 3 Nil DDO training 9. Dr.Dinesh Chandra Salwani -do- 2 2 Nil X 10. Dr. Umesh Agarwal -do- 24 3 Nil X 11. Dr. Archna Singh -do- 10 days 10 days nil X
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Experiences of Medical officer- A. Length of service B. Posting at one place
Facilities at dispensaries Total number of dispensary-12 Facilities Availability Non-availability 1. Appropriate location of dispensary Y=58% No=42% 2. Space as per facility 50% 50% 3. Signage and board 85% 15% 4. Drinking water- Hand pump 90% 10% 5. Toilet 50% 50% 6. Electricity* 67% 33% 7. Fan for patients* 50% 50% 8. Sufficient Sitting space for patients 100% 0 9. Separate sitting space for patients 70% 30% 10. Sitting furniture 100% 0 11. Public telephone 0 100% 12. Separate registration counter No No 13. Separate dressing room 0 100% 14. Sufficient Dressing material 80% 20% 15. Cleanness of the premises Yes 0 *There is no electricity in rural dispensaries during day time, even though dispensaries have electricity connections.
3 or <3 yrs, 3 18 yrs, 1 20-30 yrs, 6 >30 yrs, 1 0 to 3 years, 6 3 to 5 years, 3 > 5 years , 1 28
III. iii. Performance, coverage and quality of the services- Outpatient services across the district are low as compared to the objective and target of the department. Quality is not being provided because of poor infrastructure and low morale of the staff. Medicines are adequate in terms of supply but are not as per the diseases prevalence, resulting low turnout of the patients. There are many drugs which are supplied in excess, while some drugs are not supplied in sufficient quantity. There are some diseases for which no medicine is being supplied for the last many years. Total number of patients-
Dispensary wise distribution of the total patients for last three years 143368 138408 100598 0 20000 40000 60000 80000 100000 120000 140000 160000 2010-11 2009-10 2008-09 Total Patients Total Patients 29
Patient growth- there is a remarkable growth in last two years as compared with the year 2008-09. It was 38% in year 2009-10 and 43% in 2010-11. The main reason is supply of medicine from the central government assistance and budgetary allocation for medicine at district level. Patients growth in last two years-(Base 2008-09)
Comparison with other Ayush Facility Homeopathy is another component of Ayush providing health care services in the district with the same number of dispensaries (12). The comparative yearly total for the 2010-11 is given below-
Other services Indoor patients (IPD) Department has a bed capacity of 43 beds in 8 dispensaries including a 15 bed hospital. Indoor facility is not being used by the department; only three dispensaries used indoor facility and only 139 patients (old and new) were admitted as day care facility. Main reason is unavailability of the facilities like diet, electricity, 24 hour staff and medical officer. III. iv. Operational strategies- Waiting time was more during peak hours of the OPD which was monitored and cut short by adopting quick disbursement of the medicine. Cleanliness was taken care of on daily basis. Facilities like drinking water, toilets and sitting space was being observed as a routine by the medical officer. III. v. Assessment of Performance - Daily total of 20 new patients target was not achieved by most of the dispensaries. If we compare target with base year of 2008-09 performance increases considerably, but was below the target other than one dispensary. In year 2008-09 only one dispensary achieved the target of attending a total of 7300 or more new patents in a year, only one dispensary achieved 75-90% target, while 10 out of 12 dispensaries achieve less than 75% 0f the target. 143368 110073 0 20000 40000 60000 80000 100000 120000 140000 160000 Ayurveda Homeopathy 2010-11 31
It is clear from the table below that only one dispensary achieved the target in all the three years. This is 15 beds hospital with a provision of two medical officers. Annual patient target (%) achieved against a total of 7300 new patients. Name 2010-11 2009-10 2008-09 Beel Akbar Pur 92 97 38 Bhunna Taga 90 67 21 Sheedi Pur 84 75 30 Mandi Shyam Nagar 97 89 28 Jahangir Pur 99 89 40 Noida 89 87 41 Dadri 114 122 102 Sharfabad 89 73 33 Parsaul 79 62 28 Bhai Pur 79 70 29 Dujana 80 59 22 Suraj Pur 87 90 77 Comparison between new and old patients- As total numbers of the patients increases in good numbers, but a reverse trend was noticed between new and old patients after 2008-09. In this year most of the dispensaries show more old patients in comparison to new one, while in successive years it starts in other way of more new patients. There were 92%(11) having more older patients than new followed by 50%(6) in 209-10 and only 25%(3) dispensary attend more older patients in year 2010-11.
100% 90-99% 75-90% <75% 2010-11 1 4 7 0 2009-10 1 2 4 5 2008-09 1 0 1 10 0 2 4 6 8 10 12 N u m b e r
o f
D i s p e n s r i e s Target Achieved 32
New and old patients daily average
2010- 11
2009- 10
2008- 09
Dispensary New Old New Old New Old Beel Akbar Pur 18 6 19 8 8 13 Bhunna Taga 18 15 13 9 4 9 Sheedi Pur 17 11 15 12 6 11 Mandi Shyam Nagar 19 18 18 16 6 9 Jahangir Pur 20 20 18 22 8 16 Noida 18 22 17 27 8 17 Dadri 23 24 24 18 20 22 Sharfabad 18 34 15 30 7 29 Parsaul 18 14 12 14 6 16 Bhai Pur 16 14 14 9 6 10 Dujana 16 9 12 11 4 11 Suraj Pur 17 8 18 8 15 12 In this table bold and red are older patients more than the new.
Observation- After interaction with medical officers and pharmacists of the respective dispensaries, it was revealed that in the year 2008-09 there was no fix target for new patients, afterwards more and more new patients were enrolled to achieve the target. There are two dispensaries showing the static position in all the years in attending patients having less number of old patients. These dispensaries witness patients for problems like fever, vomiting, minor injuries, and diarrhoea having short duration of incubation. To achieve the targeted goal medicines play an important role; medicines were not available as per the disease demand resulting in inability of reaching the target. If we look at the chart below (Total daily average), we will find that most of the dispensaries failed to achieve the target even on total patients count which is less than the targeted figure of 20 new patients. As I stated earlier, in year 2008-09 no target for new patient was laid by the department, so most of the dispensaries daily average was in between 15-21 patients per day.
Daily average of new and old patients for last three years:
0 5 10 15 20 25 30 35 40 2010-11 New 2010-11 Old 2009-10 New 2009-10 Old 2008-09 New 2008-09 Old 35
Months of attending minimum monthly patients maximum monthly patients Y e a r
D i s p e n s a r i e s
M o n t h s
D i s p e n s a r i e s
M o n t h s
2010-11 25% Jun 17% February & June 17% Oct 17% August 17% Dec 42% September 41% Other months 8% Other months 2009-10 50% April 17%each March &Oct 33% May 33% each July & Aug 17% Other months 2008-09 17% April 17% February 17% July 42% march 25% November 17% June 41% Other months 24% Other months
There is no definite pattern of attending minimum and/or maximum daily patients across the district.
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Section-IV: Managerial problems i. Problems There are many problems which affect the functioning of the OPD services. These are categorized as follows- A. Infrastructure- 1. Non-availability of toilets. 2. Signage and board are not clear. 3. Inadequate infrastructure. B. Human resources- 1. Punctuality of the staff. 2. Indoor patients facility is zero percent. 3. Malpractice such as absenteeism, pilfering of drugs. 4. Lack of interest. C. Managerial problems 1. Display of Citizen charter- what we are providing and responsibilities of patients. 2. Working hours. 3. No in-service training. 4. No inter-sectoral coordination. 5. Motivation of the employees. 6. Decentralization of raw drug purchase. 7. User charges are not being utilized by the M.O. 8. Dispensing table not organized. 9. Very poor record keeping. 10. No SOPs. 11. No specialized clinic. 12. Timely disbursement of the salary and other dues. 13. Monitoring and evaluation. 14. Divorced from community. 15. No assessment of communitys health need. 16. No clear policies. 17. No evaluation of the services. 18. No regular in service training. 19. No defined targets. 20. Isolation from district officials and other workers. D. Medicine- 1. Decentralization of raw drug purchase. 2. Timely supply of the medicine. 3. Appropriate supply of the drug. 4. Shortage of essential drugs and equipments. 5. Unused and broken down equipments. 37
ii. Priorities of the problems: P r o b l e m s
A B C D Low impact on performance Medium to high impact with low severity Require attention, easy to resolve Remaining problem need more attention
1.Infrastructure
2.Inter-sectoral Coordination
3.Poor record Keeping
4.Toilet
5.Location
6.No specialized clinic
1. Motivation
2.Timely supply of the drugs
3.Adequate drugs
1.Punctuality of the staff
2.Opd strictly follow 8 AM to 2 PM schedule
3.Cleanliness
4.Organised dispensing room
5.Waiting time
6.Availability of the drug 7. supply of the rational drugs 8..Timely Disbursement of the salary and other dues
1.Infrastructure- repairing, construction of new building
2.Monitoring
3.Decentralizatio n of raw drugs
4.Training
5.Rational supply of the drugs and equipments
6.Specialized clinic
7.Inter-sectoral coordination
8.SOPs
May be ignored Low priority Right now take action Prepare an action plan
38
Section-V: suggested Interventions After finding the problem I would suggest the following intervention to resolve and solve the problem- Problem Gap Solution Motivation Not getting salary and other dues in time Timely disbursement of all the dues and wages Punctuality 8AM to 2PM timing are not being followed Motivation of the staff about the fact of being in time, regular supervision and inspection Waiting time at OPD Longer during peak hours Early distribution of the medicine Fan and light at waiting area No fan available Solar fans and lights can be obtained through non conventional energy department at a very nominal price. Toilets Not available With coordination of PRI toilets can be prepared without problem. Toilets Not clean Sufficient water storage in the toilets can resolve the problem. Dispensing In very bad shape Medicine racks be well organized having label at all the containers. Dispensing time Maximum time As Ayurveda prescription have multi ingredient formulation, some common formulation can be prepared by mixing the ingredients in advance. Dressing room No separate room If separate room is not available, a corner of the room can be used as 39
dressing table which can be separated by curtains. Quantity of medicine In Sufficient As most of the essential medicines are in short supply, donation is the best way of maintaining required amount of medicine. Irrational supply Some medicines are in large quantity while some few. Medicine purchase must strictly be demand based. Boards and signage Boards are not placed Boards should be host in a manner that it is visible from distance Records keeping Very poor OPD registered has name, age, sex, provisional diagnosis and name of the medicine. There must be provision for records like main complaints, finding and symptoms with local address and phone number (if any). Prescription is not clear and quantity of medicine should be mention clearly. Progressive chart Not up to date Progressive report chart about monthly patients must have the number of male, female, child, and disease wise classification. SOPs Not available SOPs be prepared for OPDs as well as dressing and certain diseases. Community involvement Divorced from the community Community involvement can be done by hosting health melas or clinic in 40
temple or community centres. Dhanwantari jyanti or Ayurveda day can be celebrated with the community. Damaged and unusable equipments and furniture No C&D Condemnation and destroy can be done periodically Monitoring and evaluation Not performed Be done regularly at field unit level. Decentralization Not done Decentralization of drug procurement be done at dispensary level. Raw drugs should be purchased by the medical officer as per his requirement. Other medicine should be procure as per the demand from the medical officer Inter-sectoral coordination No coordination at all Irrigation, ICDS, women welfare, health and family welfare, education, PRI and forest departments are the integral part of health delivery system. Ayurveda awareness can be spread very fast through coordination with these departments. IEC Not available IEC material can be obtained from department of ayush ,GOI regarding prevention of certain disease through diet, general information about plants and herbs which may grown in kitchen gardens. Specialized clinic Not conducted Specialized clinic in the field of geriatric care and 41
use of Rasayan as rejuvenate therapy can be started with a little training. Training Not provided Several training schedule are being offered by the central government in the form of campaign for Amla, Kshar Sutra and MCH. National campaign Not aware Our medical can start different national campaign on Ayurveda, which increase the credibility and popularity. National health programs Not involved Most of the national health programs can easily be performed by the medical officer who again creates awareness among the people. Citizens charter Not available There must a display of services provided by us, facilities available and duties and responsibilities of the patients be displayed at an appropriate place.
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Section VI: Action Plan For the proper functioning of OPD services main problem is very poor infrastructure in the form of building. There are 4 out of 12 dispensaries which are located in a single room and 4 others do not have sufficient space as per services provided by those dispensaries. For the proper functioning of OPD services main problem is very poor infrastructure in the form of building. There are 4 out of 12 dispensaries which are located in a single room and 4 other do not have sufficient space as per services provided by those dispensaries. Analysis of the steps
S.N . Activities to be performed Where Time (Month s) Resources input required Who does Monitorin g to done by 1. Adverisement Local news papers 1-3 Budget Director D.A.O. 2. Constitution of the Bhawan Samiti District 1 Medical officer D.A.O. D.A.O 3. Scrutinizing of the request applications District 2 days Human resource committee D.A.O 4. Selection of the owner District 2 days committee D.A.O. 5. Inspection of the building District 1 day Human resource committee D.A.O. 6. Recommendati on of the rent District 1 day Human resource committee D.A.O. 7. D.Ms Approval District 1 District magistrate M.O/ D.A.O. 8. Forwarding the recommendatio ns District 1 day Informatio n D.A.O. D.A.O. 9. Follow up Directorate 2
D.A.O D.A.O. 10. Sanctioning of rent Directorate 6 Director D.A.O. 11. Provision of the budget directorate 3 Informatio n Finance controller/Dir ector D.A.O. 12. Payment of the rent District Any time budget D.A.O. D.A.O.
43
My action plan as follows- Time it will take at least one year in case of rented buildings and 1 to 5 years for the organizations owned or rent free premises. A) For rented buildings- Rented and rent free/ department owned has the equal ratio, 50:50. Main sufferings No maintenance of the building, No electricity supply No provision of toilet Not allowing using drinking water facility Not allowing sign board on their wall other than the rented portion Not ready to provide any help to the employee Sometimes spread negative remarks to get their promises vacated Reason for these- Rent not paid in time Rent was not revised even after the contract period Fear of not vacating their property- being government organization With inflammation rent, increased many fold and land lord will get more rent once vacated by the department. Lack of fund in case of rent free/ department owned Consequences- Tense working environment Low turnout of the patients Facilities for the patients in waiting area are not adequate Who are involved? Landlord Medical officer and other staff 44
It comes from Internal weakness and lethargic attitude of the organization Inability to feel the need of landlord Lack of knowledge about procedure and steps of rent related problems External factors like inflation in rental value of the property. To be solved by Land lord Medical officer Divisional Ayurvedic Officer Director, Ayurvedic services Strategic choices- There may two strategic choices Increase the rent- the process takes less time for disposal and the land lord feels that department is taking interest in solving his genuine problem. The day process starts his attitude and behaviour changes a lot. It involves all the parties from landlord to director. There is a procedure for this which requires an application from the landlord for requesting increase in the rent. A three members committee constituted at district headquarter having the concerned medical officer as one of its member. Committee recommends the need of increment in rent and new rate also defined. These recommendations are sent to district magistrate for approval and he has sent back the signed certificate after getting required information about the rates and need of increasing rent. Now divisional officer will send these recommendations along with his own remarks to the director for final sanctions. Shifting the hospital in new building- takes a longer time and procedure. It should be published in local news papers and acceptance letters are invited with rent quotations. The committee constituted for this purpose evaluate the proposals and after physical inspection of the building gives its recommendations and approval. Further process is the same as for increasing the rent. 45
Try for rent free space- It is the best option with many hurdles. Gram sabha can provide the required space in panchayat ghar, primary school, dharamshala, if there is any space available. My strategy- new building on rent Change in the system- as old building does not have enough space as per the services available, and landlord never provides the extra space, I will choose the new building at more appropriate location with all the requirements, like electricity, toilet and drinking water available. Inputs- required input is the money for advertisement which in this case is done by the publicity department of the state. Man power in terms of monitoring the whole process and finally the budget approval above and over the sanctioned money. Role and Responsibility Medical officers role is very important. As being the local officer he can search better space with the help of local community involvement. District officers responsibility will make the whole process easy and sanctioning of the rent can be speedy. Obstacles- there are certain obstacles in this process. Foremost is negative remarks by the present landlord and another is political pressure, where gram pradhan or members of the gram panchayat pressurize about the location of the building should be in their area. Process- Publication in the news papers, analysis of the request applications by the Bhavan Samiti and choosing the best one on the bases of location, space specification and facilities provided. Choosing the best one will initiate the further process like submission of the application by the owner in the prescribed form supported by the blue print of the premises and signing of the government agreement. Committee recommends the quoted rent and its recommendations are send to district magistrate for approval and he send back the signed certificate after getting required information about the rates and justification. Now divisional officer will send these recommendations along with his own remarks to the director for final sanctions. 2) For rent free or government owned- As these are the rent free or government owned spaces, the only way is to improve the facilities by constructing new building where land is available (in this case two dispensaries have land and one has building).
46
Process- Only input is finance which can be try from MLA fund MP fund Donations Departmental budget allocation for the same Evaluation and follow up of implementation of action plan- Follow of the plan is very important for its implementations. In this plan I will review and evaluate following- What to review- Request applications in response to advertisement Following the status of district magistrates recommendation letter and review it if some problem arises. At directors office for any legal lacunae How to review- If the request application are as per the government guidelines Committees recommendations are as per Performa Personal contact with the concerned officer in other departments to get the D.Ms letter At directors office requesting her for speedy approval
47
No proper signage-
Properly place sign board-
48
Indoor- un organised-
Indoor- organised
49
Organised dispensing desk-
Un-organised dispensing desk-
50
List of medicine purchased by the divisional Ayurvedic Officer year 2010-11
51
Questions regarding medical officers awareness assessment- :1 i<<i >rii><i i<i+i c<ii fa (i i<i+ii i aii+i1 z1 fii +i <i ( (Infant Mortality Rate-IMR) i Qi >i+iSia <if( i ai <i ( c<ii ? s1 Maternal Mortality Ratio i Qi >i+iSia <if( i ai <i ( c<ii ? 4. NRHM c<ii ? 5. JSS iaiai >i8ii <iiiaii c<ii ? 6. ASHA c<ii ? 7. Mainstreaming of Ayurveda-c<ii Qiai S>i >iaii ? <if( i ai <i c<ii
8. National campaign of Ayurveda f>i f>i frii<i -i~i i ? 9. c<ii >i f>i >i a <fai=i +i Qiai >ii=i f~i<ii 1<if( i ai i Qi f>i a ? :c1 Qai f-if>ii~i<i i Qi Qfi >i8i+i iaiiai f~i<i fai (i Q>iirii Qirii Q>ifriiiQi i >ii+iaii aii o i 1S>i f(ii +i Qi -iaii+i >iSiiri1
52
Questionnaire about hospital premises and OPD facilities. aii+i f-if>ii~i<i 1. +i-ii >i+ifaia - c>ic aii+i / ( fi8ii fri>ii=i +i i >i ria+iiai >iiai i >i Qa<i : f-if>iifii z i+iif>i>< z1 f-if>ii~i<i >i+ifaia :1 f-if>ii~i<i i i if=i i<<ii <ica z1 >iriai ii<i fi<i i faii~1 fii~i a>iai ai1 s1 f-if>ii~i<i i iio ~i=ii <ii ai .1 f>fifa c<ii f-if>ii~i<i 3f-ia >iiai Qrif>ia Qirii ai1 <if( ai ai i iaii -iif<i1 a1 c<ii f-if>ii~i<i >iriai 3~ii >ifriiiQi Qai <iia <if( ai ai f>i >iiai >ii>i <ii(i Qiri<iai c1 f-if>ii~i<i Qi>ii>i Qa<i f-if>ii >ifriiiQi i fririi <iii ~iifi i+<iifi i+iii c~ifai <if( i ai i c<ii Sai >ifriiiQi >i Qi f-if>ii~i<i i=i >i<ii >iiri o i :1 f-if>ii~i<i i>i i~i f>i 3~ii <if( i ai 3>ii c<ii 3<ii=i f<ii ii i 1 s1 if =i i=i aiii~i :1 if=i i=i 8i +i if=i<ii ioai i >i+if-ia >iiai ri ai-i Qirii ai z1 if=i<ii f~i<i ai iai r<iri>ii ai1<if( i ai~i < i iai ><ii < i iai Qa<i 3~ii f< s1 >iiriifai Qirii fri>ii=i<i <f~iiai ai .1 i=i fii f<ii >i a1 f>i >iiS >i 53
c1 c<ii ii-ii~i<i <if( i ai 3>i >ri-uai >i .1 Qiii >i+ifaia :1 Qiifi<ii <iia +ii>i +i 3~ii ai z1 Qiifi<ii Qiri<iai Qai ai s1 Qi Qai>ii iS Qiii Q<ifi +ii>i +i Qifa =iS 3>ii aii+i .1 c<ii iS Q<ia Qiri<i Qiii +i +ii>i +i Qifa =iS 3>ii aii+i a1 fri=ia aai riii +i f>i i=i Qiii Q<ia +i +ii>i +i QiS Qirii fi~~i ai QiS1 Qiri<i i=i ri riifua Qiii i aii+i a1 of>i =i :1 c<ii of>i=i +i Q~i=i >i iaii z1 c<ii of>i=i f~i<i Qiri<i >ii+i=i <iii -i f-i+i< faifo~i ii=ii i<ai << Qif( <iia +ii>i +i ai <if( ai ai fririi (1 c1 Qa<i :1 Qi f-if>ii~i<i +i >iriifi i=i fai r<iifi<ii Qia 1 :1 z1 s1 z1 c<ii Qi i=i fai(iai a ~iii< <>< ia s1 c<ii Qi i=i i >i ~iifi f-if>ii~i<i +i a <if( i ai i<i f>i a if=i<ii i Qi f>i Qri>ii +i .1 c<ii if=i<ii i -i~i ai> iaia a1 Qi f-if>ii~i<i Qi>i i>i iS +i Qirii iai(iai ri( <iii riiai i~iii <ii=i oo ioiai rii~i >ii fi-u Qirii Qa<i i f-if>ii ai rii~i c1 c<ii Qi i=i i f>i >i i<<i >rii><i i<i+i iiaii Qirii i+ii ( a <if( i ai fai i<i+i :1 c<ii Qi =iiri +i i=i ~<iii >i+ifa i =ioai <if( i ai c<ii Qi 3>i >i(><i
54
Essential Ayurvedic Drugs For Dispensaries & Hospitals (This list is a compilation work based on main streaming of Ayush undewr NRHM, published by dept. Of Ayush ministry of health and family welfare, Government of India)
Ayurvedic system of medicine holds numerous single and multi-ingredient formulations made up of herbal, mineral and herbo-mineral combinations. Their use by the Ayurvedic practitioners varies to a large extent. While some formulations being so frequently prescribed in one part of the country may not find place in the prescription of the other part. Region-wise traditions of Ayurvedic practice is also one of the important causes of popularity of certain medicines in one particular region. Interestingly, the uses of Ayurvedic formulations are also so diverse that sometimes not only the patients but doctors too, get confused in situations where a medicine not indicated in a specific disease condition is prescribed by the Ayurveda physician solely because of his own experience of treating that particular disease condition with that very medicine. Though, it is rightly claimed that the medicines have certain limit of actions yet the physician with his judicious approach can use one particular medicine for various clinically diverse diseases or symptoms provided he is well versed with underlying pathogenesis of the ailment and simultaneously has the understanding of complete range of action and scope of the drug. Such guidelines for varied uses of medicines are already described in the classical texts of Ayurveda. List of ASU medicines procured in various States differ so much and some of the departments and institutions have restricted its number to too little to cover the variety of disease-condition. In view of this and the administrative problems being faced for selection the Adyurvedic drugs for a dispensary or a hospital, the need was felt to create a standard list of optimally required medicines likely to be acceptable to the practitioners all over the country, who would be able to prescribe the enlisted medicines in a judicious way. The Department of Indian Systems of Medicine & Homoeopathy, took initiative in this direction and the concerted efforts of various experts of Ayurveda and departmental technical staff members have resulted in bringing out this document "Essential Ayurveda Drugs for Dispensaries and Hospitals". It is worthwhile to mention that Essential Ayurvedic Drugs List is notably different from Essential Drugs List of Allopathic System of Medicine. The former includes only those medicines which are essentially required in any Ayurvedic dispensary or hospital whereas the latter one is the list of essential drugs for the treatment of various clinical states of the patients. The bid to formulate Essential Ayurveda Drugs List got through with great deal of interaction with various eminent Ayurvedic Physicians in Government and private sectors in different parts of the country. Due care was undertaken to include experts from all fronts of Ayurveda, like institutionally & non-institutionally qualified Ayurveda experts, old & new Ayurvedic doctors, dispensary and hospital doctors, college and pharmacy attached doctors, graduates and postgraduates. The response from these experts was compiled, analysed and put in a systematic format. Then a core group comprising technical officers of 55
the department and a renowned Ayurvedic expert as a private sector representative discussed in details for final selection of essential drugs for Ayurvedic dispensaries and hospitals, on the basis of availability, reliability, cost-efficacy and therapeutic efficacy of the medicines. Due scrutiny was done for short-listing. Ample care was taken to cover maximum disease conditions treatable with Ayurvedic medicines. Classical Ayurvedic texts, formulary of Ayurvedic drugs published by Govt. of India and personal experience of the Vaidyas were considered for finalising the list.
The present publication aims at providing ready reference for selection or procurement of Ayurvedic drugs for dispensaries and hospitals of various levels. Its utility is much higher for the learners and practitioners of Ayurveda as it will provide a window to peep into the wide range of Ayurvedic medicines required for setting up their professional establishments. The single drug preparations in the end of the list are incorporated to fill the gaps left in the original list for different kinds of uses of simple remedies in a cost effective manner.
56
A- List of essential Drugs for various ailments. Sl. NO Name of the Drug Dose (1) JWARA (FEVER) 1:1 Navajwara (Acute fever) 1. Tribhuvan Kiriti Ras 125 to 250 mg. 2. Sanjivani Vati 125 to 250 mg. 3. Godanti Mishrana 125 to 250 mg. 1:2 Visamajwara (Malarial fever) 4. Ayush 64 500 mg. To 1 gm. 5. Saptaparna ghana Vati 250mg. To 500 mg. 6. Sudarshana Churna 3 to 6 gm. 1:3 Vat shaishmak Jwar (Viral Fever) 7. Laksmi Vilas Ras 125 to 250 mg. 8. Samsamani Vati 500mg. to 1 gm. 1:4 Jirna jwara (Chronic fever) 9. Pratap Lankeshvar Ras 125 to 250 mg. 10. Mahasudarsana Churna 3 to 6 gm. 11. Amritarishta 20 to 30 ml. 1:5 Sannipatika jwara (Typhoid fever) 12. Nardiya luxmi Vilas Ras 250 to 500 mg. 13. Bhunimbadi Kwath 10 to 20 ml. (2) DISORDERS OF RESPIRATORY SYSTEM 2:1 Kas (Cough) 14. Gojihvadi Kvath 20 to 40 ml. 15. Sitopaladi Churna 5 to 10 gm. 57
16. Kantakaryavaleha 5 to 10 ml. 2:2 Kapha nissarana (Expectorant) 17. Tankana Bhasma 500 mg. to 1 gm. 18. Talisadi Churna 3 to 5 gm. 19. Vasavaleha 5 to 10 gm. 2:3 Svasanika Soth (Bronchitis) 20. Laghu malini Vasanta 125 to 250 mg. 21. Lavangadi Churna 3 to 5 gm. 22. Chounsath prahari pipal 500 mg. to 2gm. 2:4 Rajyakshma (Tuberculosis) 23. Raj Mrigank Rasa 125 to 250 mg. 24. Svarna Basant Malati Ras 125 to 250 mg. 25. Abhrak Bhasma Shatputi 0.75 to 125 mg. 26. Mukta Panchamrit 125 to 250 mg. 27. Shilajatwadi louha 250 to 500 mg. 2:5 Pratisyaya (Common cold) 28. Hinguleshwar Rasa 125 to 250 mg. 29. Panchakola Churna 2 to 5 gm. 2:6 Peenas (Sinusitis) 30. Shadbindu Tel 2 to 5 drops in nose 31. Dashmula Rasayanam 5 to 15 gm. 2:7 Tundikeri sotha (Tonsilitis) 32. Ksara Madhu Throat paint Local application 33. Khadiradi Vati Chewable 34. Vyoshadi Vati 2 to 4 tab. 2:8 Shvasa (Asthma) 58
35. Dhanvantar Gutika 1 to 2 pills 36. Pushkarmula Churna 5 to 15 gm. 37. Shringyadi Churna 5 to 15 gm. 38. Kanakasava 10 to 30 ml. 39. Vasarishta 10 to 30 ml. (3) DISORDERS OF CARDIO-VASCULA RSYSTEM 3:1 Hrid-Daurabalya (Cardiac weakness) 40. Nagarjunabhra Rasa 250 to 500 mg. 41. Muktapisti 125 to 250 mg. 42. Jwahar Mohra 125 to 250 mg. 43. Arjunarishta 10 to 30 ml. 3:2 Rakta Chap (Hypertension) 44. Yogendra Rasa 50 to 125 mg. 45. Sarpagandha Mishran 2-4 Pills 3:3 Raktabhar Alpta (Hypotension) 46. Makaradhvaja gutika 50 to 125 mg. 47. Kasturi bhairav Ras 50 to 125 mg. 3:4 Hritshoola (Angina) 48. Sringa Bhasma 125 to 250 mg. 49. Mahavat Raj Ras 75 to 125 mg. (4) BLOOD DISORDERS 4:1 Pandu (Anemia ) 50. Punarnavadi Mandura to 1 gm. 51. Lohasava 10 to 30 ml. 4:2 Raktpitta/Raktsrav (Haemorrhagic Tendency and Bleeding Disorders) 52. Trin Kantmani Pisti 250 to 500 mg. 59
53. Lakshadi Churna 5 to 10 gm. 54. Usheerasava 15 to 30 ml. 4.3 Rakta Dushti (Blood impurity) 55. Nimbadi Kvatha 20 TO 40 ml. 56. Panchanimba Churna 5 to 10 gm. 57. Manjisthadi Churna 5 to 15 gm. 58. Sarivadyasava 15 to 30 ml. 59. Khadirarishta 15 to 30 ml. (5) DISORDERS OF DIGESTIVE SYSTEM 5.1 Atisara (Diarrhoea) 60. Karpoora Rasa 50 to 125 mg 61. Jatiphaladya Churna 5 to 10 gm. 62. Karpoorasava 10 to 20 drops 63. Babbularishta 15 to 30 ml. 5:2 Pravahika (Dysentery) 64. Panchamrit Parpati 250 to 500 mg. 65. Bilwadi Churna 5 to 10 gm. 66. Bilwadi Kwath 20 to 40 ml. 67. Kutajarishta 15 to 30 ml. 5:3 Amlapitta (Hyperacidity) 68. Kamdudha Ras 125 to 250 mg. 69. Dhatri Rasayana 5 to 15 gm. 70. Madhuyastyadi Churna 5 to 10 gm. 71. Avipattikara Churna 5 to 10 gm. 5:4 Samgrahani (Colitis/Ulcerative Colitis) 72. Samkhodar Ras 75 to 150 mg. 60
73. Sutsekhar Ras 125 to 250 mg. 74. Bilwadi Avaleha 5 to 10 gm. 75. Mocharas Churna 3 to 5 gm. 5:5 Yakrit roga (Liver disorders) 76. Arogya Vardhini 500 mg. To 1 gm. 77. Navayas Louha 250 to 500 mg. 78. Phalatrikadi kwatha 15 to 30 ml. 79. Sarbat phalasa 30 to 50 ml. 80. Daruharidra phala churna 5 to 10 gm. 81. Rohitakarishta 15 to 30 ml. 5:6 Shoola (Abdominal colic) 82. Shankha bhasma 250 to 500 mg. 83. Shankha Vati 2 to 4 tab. 84. Lasunadi Vati 2 to 4 tab. 85. Hingu vachadi Churna 3 gm. to 5 gm. 86. Narikel lavana 250 to 500 mg. 5:7 Adhman (Flatulence) 87. Kankayan Vati 500 mg. to 1 gm. 88. Hingvastaka Churna 5 to 10 gm. 89. Ark Ajmod 5 to 15 ml. 90. Lavana Bhaskar Churna 5 to 10 gm. 5:8 Chhardi (Vomiting) 91. Mayur pichha bhasma 50 to 125 mg. 92. Bilvadi leham 1 to 3 gm. 2 hrly 93. Eladi Churna 2 to 5 gm. 5:9 Ajirna (Indigestion) 61
94. Yavani Sandhav Churna 5 to 10 gm. 95. Shivakshara pachana churna 3 to 5 gm. 96. Chitrakadi Vati 2 to 4 tab. 5:10 Agnimandya (Anorexia) 97. Agnitundi Vati 250 to 500 mg. 98. Vaishvanara Churna 3 to 5 gm. 99. Panchakola Churna 3 to 5 gm. 5:11 Vibandh (Constipation) 100. Ichhabhedi Ras 125 to 250 mg. 101. Panchasakara Churna 5 to 10 gm. 102. Svadista Virechana Churna 5 to 10 gm. 103. Abhayarishta 15 to 30 ml. 104. Isabgol Husk 10 to 20 gm. 105. Haritaki Churna 10 to 15 gm. 5:12 Arsha-Bhagander (Piles and Fistula-in-ano) 106. Shigru guggul 500 mg. to 1 gm.. 107. Bol baddha ras 125 to 250 gm. 108. Pranada Vati 2 to 4 tab. 109. Rasanjana Vati to 1 gm. 110. Kasisadi tel 2 to 5 ml. 111. Jaya Vati 250 to 500 mg. 112. Kshar Sutra & Kshar Varti Q.S. for Kriya 5:13 Krimi Rog (Helminthiasis) 113. Vidangadi louha to 1 gm. 114. Palash beej churna 3 to 6 gm. 115. Kampillaka yog 2 to 4 gm. 62
(6) DISEASES OF CENTRAL NERVOUS SYSTEM 6:1 Medhya (Brain Tonics for concentration, memory, sleep disturbances) 116. Brahmi Vati 2 to 4 tab. 117. Tagaradi Churna 3 to 5 gm. 118. Brahmi Rasayana 5 to 10 gm. 119. Saraswatarishta 15 to 30 ml. 120. Brahami Ghrita 5 to 10 gm. 6:2 Nadi Dourbalya (Nervine Weakness) 121. Krishna Chaturmukh Ras 125 to 250 mg. 122. Dhanvantara tel Q.S. for body Application 123. Mahanarayana tel Q.S. for body Application 124. Eranda pak 5 to 15 gm. 125. Balarishta 10 to 30 ml. 6:3 Kampavat ( Parkinsonism) 126. Chaturbhuj Ras 125 to 250 mg. 127. Kaunch Churna 2 to 5 gm. 6:4 Sirasula (Migrain) 128. Sirah shooladi Vajra Ras 250 mg. to 1 gm. 129. Chandrakant Ras 125 to 250 mg. 130. Godanti praval yog 500 mg. to 1 gm. 131. Pathyadi kwath 10 to 20 ml. 6.5 Pakshaghat (Hemiplegia) 132. Yogendra Ras 125 mg 133. Ksheer Bala Tail 5-10ml Internal/external 134. Ksheer Bala Tail (Aavarti) Nasal- 5-10 drops (7) PHYCHIATRIC PROBLEMS 63
7:1 Anidra (Insomnia) 135. Nidrodaya Ras 125 to 500 mg. 136. Jatamansi kwath 10 to 20 ml 137. Madananand Modak 5 to 15 gm. 138. Aswagandha Churna 5 to 10 gm. 139. Him sagar Tel Q.S. for Head 7:2 Akshepa (Convulsive Disorders) 140. Svarna bhasma 15 to 30 mg. 141. Panchagavya ghrita 5 to 15 ml. 142. Aptantrakari Vati 125 to 250 mg. 7:3 Unmad (Psychosis) 143. Unmad gajkesari Ras 125 to 250 mg. 144. Maha paishachik ghrita 5 to 15 gm. 145. Maha chaitasa ghrita 5 to 15 gm. 146. Manas mitra vatak 125 to 250 mg. 7:4 Vishad (Depression) 147. Jyotismati Tel 10-20 drops 148. Smriti Sagar Ras 125-250 mg 149. Vacha Churna (shudh) 75-125 mg (8) JOINT DISORDERS 8:1 Amavata (Rheumatic/Rheumatoid Arthritis) 150. Amavatari Ras 125 to 250 mg. 151. Trayodashang guggulu to 1 gm. 152. Kottamchukadi Tel Q.S. for application on body 8:2 Vat Rakta (Gout) 153. Kaishore guggulu to 1 gm. 64
154. Maharasnadi kwath 5 to 15 ml. 155. Pinda Tel Q.S. for application on body 8:3 Sandhi Vat (Osteoarthritis) 156. Simhnad guggulu to 1 gm. 157. Yograj guggulu to 1 gm. 158. Panchaguna Tel Q.S. for application on joints 8:4 Sandhigat Vat (Arthralgia) 159. Vatari guggulu to 1 gm. 160. Sameergaj keshari Ras 125 to 250 mg. 161. Maha vishgarbh Tel Q.S. for topical use (9) DISEASES OF URINARY SYSTEM 9:1 Alpa Mutrajanana (Oliguria/Anuria) 162. Punarnavastaka kwath 20 to 40 ml. 163. Panavirladi bhasma 5 to 20 gm. 164. Punarnavasava 9:2 Ashmari (Urolithiasis) 165. Pasan Bhedadi Kwath 20 to 40 ml. 166. Hajaral yahood bhasma 250 to 500 mg. 167. Kulathadi ghrita 10 to 20 ml. 9:3 Mutrastheela (prostatic hypertrophy) 168. Varunadi guggulu to 1 gm. 169. Shilajtwadi Vati to 1 gm. 170. Punarnavadi Guggulu to 1 gm. 9:4 Mutravishmayata (Uraemia) 171. Sarbato Bhadra Ras 50 to 250 mg. 172. Veeratarvadi kwath 20 to 40 ml. 65
173. Trina panchmula kwath 20 to 40 ml. 174. Kanmad bhasma 500 mg. to 1.5 gm. 175. Vastyamayantaka ghrita 5 to 15 gm. 9:5 Mutra krichra (Dysurea) 176. Svarna Bang 125 to 250 mg. 177. Chandrakala Ras 250 to 500 mg. 178. Traikantakadi kwath 20 to 40 ml. (10) DERMATOLOGICAL DISORDERS 10:1 Twak Roga (Skin Disorder),Kushtha (Dermatoses) 179. Ras Manikya 125 to 150 mg. 180. Gandhaka Rasayana 250 mg. to 500 mg. 181. Eladi Tel Q.S. for topical use 182. Kustha Rakshasa Tel Q.S. for topical use 10:2 Twak-Karshnya (Hyperpigmentation) 183. Kumkumadi Tel Q.S. for topical use 184. Dashanga Lepa Q.S. for topical use 10:3 Kandu (Pruritus) 185. Haridra Khand 5 to 15 gm. 186. Bilwadi gutika 1 to 2 pills for topical use 187. Nalpamaradi Tel Q.S. for topical use 188. Maha Marichyadi Tel Q.S. for topical use 10:4 Twak Vaivarnya (Skin Discolouration) 189. Chalmongra Tel Q.S. for topical use 190. Sidhmahara Lepa Q.S. for topical use 191. Markava Rasayanan 10 to 20 gm. 10:5 Keshya (Hair Tonic for Poor Hair Growth) 66
192. Bhringaraja Tel Q.S. for head & hair 10:6 Khalitya (Premature Hair fall) 193. Dhasturpatra Ker Tel Q.S. for head & hair 194. Durvadi Ker Tel Q.S. for head & hair 195. Kayyonyadi Ker Tal Q.S. for head & hair 10:7 Palitya (Premature greying of hair) 196. Neeli Bhringyadi Ker Tel Q.S. for head & hair 197. Kuntal Kanti Tel Q.S. for head & hair 10:8 Svitra (Vitiligo) 198. Kakodumbarikadi Kwath 10 to 40 ml. 199. Markava Rasayana 5 to 15 gm. 200. Avalgujadi Lepa Q.S. for topical use 201. Gomutrarishta 10 to 20 ml. (11) FEMALE DISEASES 11:1 Asrigdara Menorrhagia-Metrorrhagia) 202. Pradarantak Ras 250 to 500 mg. 203. Patrangasav 10 to 30 ml. 204. Lodhrasava 10 to 30 ml. 205. Ashokarishta 10 to 30 ml. 11:2 Svet Pradara (Leucorrhoea) 206. Kukkutand Twak Bhasma 1 to 3 gm. 207. Pusyanug Churna 5 to 10 gm. 208. Supari Pak 5 to 15 gm. 209. Satavari gud 5 to 15 gm. 210. Panchavalkala kwath 10 to 30 for douche 11:3 Rajah Krichra (Dysmenorrhoea) 67
211. Rajah Pravartini Vati 250 to 500 mg. 212. Kumarika Vati 250 to 500 mg. 213. Kumaryasava 10 to 30 ml. 11:4 Yoni Vyapat (Vaginal Disorders) 214. Subhakari Vati to 1 gm. 215. Somanath Ras 125 to 250 mg. 216. Soubhagya Vardhana Tel 5 to 10 drops for Tampon 11:5 Rajah Purva Tanav (Premenstrual Tension) 217. Yavakshara Yog 500 mg. To 1.5 gm. 218. Saptasaram Kasayam 10 to 20 ml. 11:6 Garbhapat (Habitual Abortion) 219. Garbhapal Ras 250 to 500 mg. 220. Garbh Raksini Gutika 2 to 4 tab. 11:7 Raktla Yoni (Dynfunctional Uterire Bleeding D.U.B.) 221. Kaharuva Pisti 250 to 500 mg. 222. Ashok Ghrita 5 to 15 gm. 223. Lakshmana Louha 500 mg. To 1 gm. 11:8 Stanya alpata (Hypo lactation) 224. Stanya janana kashaya 10 to 20 ml. 225. Shatavaryadi Churna 5 to 10 gm. 11:9 Sutika Roga (Postpartal Disorders) 226. Soubhagya Sunthi 5 TO 10 gm. 227. Dashmularishta 15 TO 30 ml. 11:10 Bandhyatva (Primary Sterlity) 228. Phala Kalyan Ghrita 5 to 15 gm. 229. Palash puspasava 15 to 30 ml. 68
230. Lakshmanarishta 15to 30 ml. 11:11 Stri Beej Pranali Dushti (Hypo-ovarianism/Poor ovarian funcion) 231. Puspa Dhanva Ras 250 to 500 mg. 11:12 Beej Kosh Puti (Ovarian Cyst) 232. Siggru Gugglu to 1 gm. 233. Sobhanjanarishta 10 to 30 ml. 234. Punarnava Mandur 250 to 500 mg. (12) VAJEEKARANA (SEXUAL WEAKNESS/LOSS OF LIBIDO) 235. Manmath Rasa 125 to 250 mg. 236. Akarkarbhadi Gutika 1 to 2 tab 237. Asvagandhadi Leha 5 to 15 gm. 238. Sukrastambhana Rasayana 5 to 15 gm. 239. Srigopal Tel For topical use 240. Kamini Vidravana Ras 250 to 500 mg. (13) RASAYANA (GERENTOLOGICAL CONDITIONS) 241. Brahm Rasayana 5 to 15 gm. 242. Chyavan Prasha Avaleha 5 to 15 gm. 243. Brinhani Gutika 1 to 2 tab. (14) VRANA ROPANA (WOUND HEALING) 244. Jatyadi Tel For topical use 245. Marma Gutika 250 to 500 mg. 246. Triphala Guggulu 250 to 500 mg. 247. Lakshadi Guggulu 250 to 500 mg. 248. Yashad Malhar Q.S. For topical use 249. Manjishtadi Tel Q.S. For topical use (15) DISEASES OF EYE AND ENT 69
15:1 Netra Roga (Opthalmic Disorders) 250. Saptamrit Louha 2 to 4 tab. 251. Maha triphala Ghrita 5 to 15 gm. 252. Chandrodaya Varti Q.S. For topical use 253. Elaneer kuzhampu 2 to 5 drops topical use 254. Shatpatryark (Gulab Arka) 2 to 5 drops topical use 15:2 Nasa Roga (Nasal Diseases) 255. Anu tel 2 to 5 drops as nassal drop 256. Nasika Churna to 1 gm. topical use 257. Chitrak haritaki 5 to 15 gm. 258. Katphal Churna to 1 gm. topical use 15:4 Galganda (Goitre) 259. Kanchanara Guggulu 500 mg. To 1 gm. 15:5 Mukh Rog (Oral Disorders) 260. Pitaka Churna Q.S. for gargle 261. Sudh Soubhagya Q.S. for paint 262. Irimedadi Tel Q.S. for paint 263. Brihatyadi Kwath Q.S. for gargle 15:6 Dant Roga (Dental Problems) 264. Dasana Samskar Churna Q.S. for local rubbing in tooth & gum (16) PRAJANAN SAMSTHAN DUSTHTI (REPRODUCTORY PROBLEMS) 16:1 Purush Prajanan Akshamta (Male sterility) 265. Jund Vadastar Vati 2 to 3 pill 266. Puspadhanva Ras 125 to 250 mg. 16:2 Stri Prajanan Akshamta (Female sterility) 70
267. Jiyapota Churna 5 to 15 gm. 268. Sivalingi Beej 3 seed daily for 28 days 16:3 Parivar Niyojana (Contraception) 269. Pipplyadi Yog 2 to 4 gm. 270. Neem Tel 2 to 5 ml. (17) DAURBALYA (General weakness/Asthenia/Loss of strength) 271. Drakshasava 5 to 30 ml. 272. Sudh Shilajit 250 to 500 mg. 273. Phalasava 10 to 30 ml. 274. Tapyadi Louha 250 to 500 mg. (18) METABOLIC DISORDERS) 18:1 Madhumeha (Diabetes mellitus) 275. Trivanga Bhasma 125 to 250 mg. 276. Vasant Kusumakar Ras 125 to 250 mg. 277. Nisha Katakadi Kwath 10 to 30 ml. 278. Nyagrodhadi Churna 5 to 15 gm. 279. Jambavadyarishta 10 to 30 ml. 280. Ayaskriti 10 to 30 ml. 18:2 Visama Meda (Dyslipidaemia) 281. Medohara Churna 5 to 15 gm. 282. Medohar Vidangadi Louha 1 to 2 gm. 18:3 Sthaulya (Obesity) 283. Navak Guggulu 2 to 4 tab. 284. Triphala Churna 5 to 15 gm. 18:4 Shotha (Oedema/inflammation) 285. Rasna-erandadi Kwath 10 to 20 ml. 71
286. Shigru Varun Kwath 10 to 20 ml. 287. Gomutrarka 5 to 10 ml. 288. Kansa Haritaki 5 to 10 gm. 289. Shoth Kalanal Ras 125 to 250 mg. 290. Grihdhoomadi Lepa For topical use as poste 291. Kokilakshak kashaya 10 to 20 ml. 18:5 Sleepada (Filariasis) 292. Nityanand Ras 250 to 500 mg. 293. Shakhotak Kwath 20 To 40 ml. 294. Sapta parna ghan Vati 500 mg. to 1gm. 18:6 Krimi-upsarg (Infective/Septic conditions) 295. Rasanjana Vati to 1 gm. 296. Shudh Gandhak 250 to 500 mg. 297. Nimbadi Tel For topical use 298. Nimbadi Vati 500 mg. to 1 gm. 299. Jaya Vati 250 to 500 mg.
(19) BAL-ROG (PAEDIATRIC PROBLEMS) 300. Dantodbheda gadantaka Ras 125 to 250 mg. 301. Balark Ras 62.5 to 125 mg. 302. Kumar Kalyan Ras 62.5 to 125 mg. 303. Bal Chaturbhadra Churna 250 mg. 1 gm. 304. Ras Pipari 250 mg. 500 gm. 305. Gopi Chandanadi Gutika 250 to 500 mg. 306. Tambula Leha 2 to 5 gm. 307. Sankhpuspi Tel For head 72
308. Arvindasava 5 to 15 ml. 309. Kamal beej gatta churna 1 to 3 gm. 310. Sudha vacha 125 to 250 mg. 311. Jatiphal Churna to gm. 312. Lakshadi Tel For massage 313. Blal Rasayana 1 to 3 gm. 314. Ayush Ghutti to 1 gm. 315. Ark Pudina 3 to 5 ml. 316. Ark Ajwayan 1-2 ml 73
S.No. Name of the Drugs Uses 1. Karpoor Ras For acute diarrhoea 2. Vedanantak Ras For severe pain of musculo-skeletal or visceral origin 3. Siddha-makardhwaj For peripheral circulatory failure. 4. Jwaharmohra For palpitation, syncope, cardiac tonic 5. Mutka pisti For acute tachycardia, palpitation, cardiac problems 6. MaHavatraj ras For neurogenic shock, angina 7. Sameer gajkesari ras Neurological shock, angina, neuro-muscular pains 8. Shvaskaschinlamani ras For severe dyspnoea of pulmonary origin 9. Suvarn sameer pannag ras For acute dyspnoea, arthralgia 10. Mritsanjivani sura For high grade fever, with delirium, shock 11. Dhanwantar gutika For acute respiratory distress 12. Manasmitra vatak For mental disorders, insomnia 13. Marma gutika For pain and inflammation in vital parts 14. Gorochanadi vati For cardio respiratory problems, fever 15. Murivenna oil Local application for traumatic pain and inflammation etc.