Dhanyamla Bahiparimarjana

Prof. Dr. K. Shiva Rama Prasad [1] , [1] H.O.D., Dept. of Kayachikitsa (PG), DGM Ayurvedic Medical College,Kalasapur Road,Gadag582103, Karnataka (cell: +91-9633552646), doctorksrprasad@gmail.com

Parimarjanais spectacular word from Ayurvedic literature defined from Shabdha Kalpa drumaas Parishodhana1 a search, colloquially used to clean i.e. Dhavana.Where in the Marjana is added with Anganirmalyokaranam2, whichmeans the body waste removal process. The Parimarjana with a prefix of Bahibecomes the Bahiparimarjana a complete externally modulated waste materialremoval or cleansing treatment, one out of three main methods of treatmentclassifications. The other two are Antahparimarjana and Shastrapranidhana.The Pranidhana3 has a meaning of the visualization of the causeof the Sthambha the obstruction. It other wise refer to the laparotomyexploration and Medinikosha explains it as Praveshanam the entry - ofcourse in to abdomen. BahiparimarjanaChikitsa explained as the treatment procedures that are depend upon theexternal touch such as Abhyanga, Sweda, Pradeha, Parisheka, Unmardana, etc4.A close look at the said examples makes a classification of the BahiparimarjanaChikitsa i.e. trans-dermal cleansing management. The former Abhyanga in termsof Bahya sneha is an external oil application where heat inducted throughrubbing. It is in the texts as not to apply any form of external (tropical)managements with out unctuous application, in terms that lubricates andfacilitates the absorption of the tropical management. The second applicationSweda is an external heat modulation or transportation through steam. The rest of the treatment applicationsinclude either of these two specific methods of heat transportations. Commonlythese Sneha and Sweda administered before to the chief cleansing methods viz. Panchakarma.However, the real utility of Bahiparimarjana as Roga Prashamana visualizedonly after the completion of the Dosha elimination. This verse observed fromthe Charaka at the context of Kusta relay is that the Lepa applied after theeliminative (Samshodhita Ashaya) procedures are effective5. Humanbody is not depends upon the Sun heat and very minimal heat is taken fromexternal and depends upon the internal system to generate the heat required forthe body maintenance. The Dosha in the body are always fluctuating in natureenhances or dislodges from its places to give rise physiological orpathological changes in the body. All these changes generally depend upon thetriad of mass, pressure and temperature. Out of these the mass and pressure inthe body are constant and the only temperature is the variant subjected for thepressure variances. Thus the managements of Dosha triad either for eliminationor for the maintenance requires the cleansing from internally and evenexternally, where the externally mediated procedures are not eventually

cleansingin nature they may be curative. For thesame reason the externally mediated Bahiparimarjana Chikitsa methods viz.Sneha and Sweda are not included in the cleansing methods of Panchakarma. TheseSneha and Sweda along with the co- procedures are not possessing Doshanirharana samardhya i.e. eliminative capacity6. Therefore, theseprocedures administered later to the cleansing are effective to disease relief.In a nut shell, Bahiparimarjana is a Dosha shamana and the Antahparimarjana isDosha Shodhana or doshavasechana management. Dalhanawas the first person to comment over the absorption and pharmaco-dynamics ofthe externally mediated unctuous (fatty oil base) materials at the context ofAbhyanga. He affirms that each 100 of matra (32sec approximately) initiatedfrom 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 theTridosha diseases of such region are implied to alter with the effect ofmedicine, as the Abhyanga is Kapha Vata nirodhana 7. At the sameplace author, refer the Grudhrasi a disease, prevented by the constant use ofAbhyanga, which relays the meaning of Bahiparimarjana as prevention andcurative but not eliminative method of management. In the procedure ofBahiparimarjana, the absorption is minimal but heat conduction is massive, thataffect the blood to flow peripheral to visceral or vice versa. Theunderstanding of contemporary philosophy tells us how our tradition meets the presentday science. Absorption through the skincan be enhanced by suspending the drug in an oily vehicle and rubbing theresulting preparation into the skin.This method of administration is known as inunction i.e. Abhyanga.Because hydrated skin is morepermeable than dry skin, thedosage form may be modified or an occlusive dressing may be used to facilitate absorption. Controlledrelease topicalpatches are recent innovations. Finally, intact stratum corneum is an excellentbarrier, 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. Fewdrugs readily penetrate the intact skin.Absorption of those that do isproportional to the surface area over which they are applied and to their lipidsolubility, since the epidermis behaves as a lipid barrier. Inflammation andother conditions that increase cutaneous blood flow also enhance absorption. The dermis, however, isfreely permeable to many solutes. The diffusion coefficient indicates theextent to which the matrix of the barrier restricts the mobility of the drug.Increases in the molecular size of the drug will increase frictional resistanceand decrease the diffusion coefficient (Franz, 1983); molecules over 1000daltons usually will not be absorbed easily into normal adult skin8. ParametersControlling Absorption in Bahiparimarjana Chikitsa Theabsorption of drug into the skin is a function of the nature ofthe drug, the behaviour of the vehicle, and the status of the skin. Three major variables accountfor differences in the rate of absorptionor flux of different topical drugs or of the same drug in different vehicles:

The concentration of drug in thevehicle, The partition coefficient of drugbetween the stratum corneum and the vehicle, and The diffusion coefficient of drug inthe stratum corneum.

Apartfrom the above the points to be considered are Large Surface area enhance absorption Increase cutaneous blood flow alsoenhance absorption Body temperature and blood flow enhanceabsorption of tropical medicines Transdermal replacement therapy is nota new invention, exists since the birth of Ayurveda

Factorinfluencing Bahiparimarjana Chikitsa (Topical Therapy) Dosage: Anamount of topical medication sufficient to cover affected body surfaces inrepeated applications must be dispensed or applied to the patient. In Ayurvedamuch of applications viz. Abhyanga, Sweda, Parisheka and Avagaha are done oncein a day. Age: Childrenhave a greater ratio of surface area to mass than adults, and a given amount oftopical drug results in a greater systemic dose. The permeability of children'sskin is increased in preterminfants (Barker et al., 1987). RegionalAnatomic Variation: Permeabilityis generally inversely proportional to the thickness of the stratum corneum i.e.Avabhasini. However, in certain areas, differences in lipid concentration mayaffect percutaneous absorption,depending on an individual drug's lipophilicity (Having an affinity for lipids)or hydrophilicity (Having an affinity for water). Drugpenetration is higher on the face, in inter-triginous areas, and especially inthe perineum. Thus these areas are minimal exposed to Bahiparimarjana Chikitsa.Consequently, sensitization, irritation, and atrophy from Bio-steroids are morelikely to develop in these regions. AlteredBarrier Function: Inmany dermatological diseases, the stratum corneum is abnormal, and barrierfunction is lost. Thus not through rub is indicated, more over manyBahiparimarjana Chikitsa are light in touch.

ApplicationFrequency: Topicalagents are often applied twice daily. However, for certain drugs, once-dailyapplication of a larger dose may be as effective as more frequent applicationof smaller doses. The stratum corneum may act as a reservoir and allow gradualpenetration of a drug into the viable skinlayers over a prolonged period of time. Hydration: Drugabsorption is increased withhydration, defined as an increase in the water content of the stratum corneumthat is produced by inhibiting trans-epidermal loss of water. Methods ofhydration include occlusion with an impermeable film, application of lipophilicocclusive vehicles such as Taila, and soaking dry skin before occlusion. Many of the Ayurvedic preparations used inBahiparimarjana Chikitsa are water based or water soluble medicines transformedlipophilic agents. Vehicle: Topicaltherapy is delivered by various vehicles, most frequently soaks, lotions,solutions, creams, and ointments, progressing in that order from least to mosthydrating. The choice of vehicle may be as important as the active drug. InAyurveda it is with many vehicles as Kashaya, Taila or Dhanyamla. An experimental modal of Dhanyamlaprepared in DGM Ayurvedic Medical College, Gadag for want of multi centricstudy in 2001 2003. It facilitated few single case studies and an extendedstudy over Amavata as Kayaseka. The literature and the procedure followed tostandardize the Dhanyamla are narrated here under. DHANYAMLA9 Before going into the details ofDhanyamla Kayaseka it is necessary to understand the term Dhanyamla. A cursoryglance itself reveals that the term Dhanyamla is conjugate of two differentwords, viz Dhanya and Amla which in conjugation means fermented cereal ina broad sense. All the three major classics of Ayurveda at some instance orother 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 usedfor Dhanyamla in Nadi sweda and Upanaha. Synonyms of Dhanyamla A perusal of the ancient text of the medicine reveals that anumber of synonyms have been attributed to Dhanyamla which in most cases referto a specific attribute and when taken collectively gives a clear idea aboutthe character and properties of Dhanyamla. Narisimha has in this context veryrightly stated that these synonyms to Dhanyamla are complementary to each otherand as such there is no difference between Dhanyamla and Kanjhika. Gunadeepika, a

celebrated lexicon on medical plants gives the followingcompilations of synonyms as attributed to Dhanyamla. Aranala: Aranalasya rigathownala gandha i.e having acrid fast spreading odour.Abhishuta: shunj abhishave i.e made of half cooked cereals.Avanthisoma: prepared out of soma found in Avanti Desha.Kulmasha: Kula samsthyana i.e having half cooked masha or black grain.Kunjala: Indicative of fermented water.Sowveeraka: Found in Sowveera desha.Among these, Sowveerka and Avantisoma are synonymspertaining 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 Theknown fact that Dhanyamla, amla or sour in taste serves as an aid in delvinginto other properties of the Ama in the sense that since it is Amla in Rasa theassociated qualities of Amla Rasa as stated in the classics, viz, Laghu, Ushna,Snigdha, Deepana, Vatanulomana etc. can be safely attributed to it. Theproperties of Dhanya like Brimhana, Tarpana, Balya and Vatahara are alsosupplemented. In brief, Dhanyamla cumulatively possessthe following properties. Rasa Guna Vipaka Veerya Amla Laghu,Snigdha, Teekshna, Sheeta sparsa Amla Ushna

General properties of Dhanyamla Manyproperties 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 usedeven for Astapana. Among other indications for its use, Charaka has specified itsuse in Daha jwara where in Avagaha of the patients in Kanji has beenrecommended10. Same procedure is indicated to relieve pain in Arshas11 even. Further in Rajayakshma when Prathishyaya and Peenasa aresuper imposed, renders the ailment complicated. At this juncture the Nadi swedawith Kanji (Dhanyamla) has been advocated12. Since Amla is Sheetasparsa and acts so in external wage, Charaka has felt safe to vouch for its useexternally as Lepa, Seka etc. in Urusthambha also; he mentioned the use of thedrug Dhanyamla 13. In short while going through thereferences 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

theDhanyamla and Dhanyamla as such are preferred in Vatarogas and Vatakapha samsarghajanya diseases. Method of preparation ofDhanyamla 14 Dhanyamlacan be prepared out of different methods. Many drugs in this yoga are easilyget fermented. Traditional physicians of Kerala generally follow present Yoga combinationand proportion is obtained from Sahasrayoga is as follows:

On an auspicious day at a time whenthe 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 throughout the 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 KashayaRasa, Madhura Vipaka as Sheeta Veerya. By Guna it is Guru. It alleviates PittaDosha and provokes Kapha Dosha. 2. PRUTHUKA(N.O. Graminae, L.N. Oryza sativa): It is made out of Tandula. Prepared bylittle 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 itis Laghu, Vidahi and Sara. It acts as Kapha Vatahara. It provokes Pitta Doshaalso. 4. LAJA (N.O. Graminae, L.N.Oryza sativa): It is made out of Tandula. Prepared by dry frying in asmall-mouthed vessel. This process is known to induce Laghu Guna. 5. KANGUBIJA(N.O. Graminae, L.N. Setaria italica): Kangubija possesses Kashaya and MadhuraRasa, Katu Vipaka and Ushna Veerya. By Guna it is Guru and Ruksha. It acts asKaphaPitta shamaka and Vata vardhaka. It possesses Sandhaneeya and Vrushyaproperties. 6. KODRAVA(N.O. Graminae, L.N. Paspalum scrobiculatum): Kodrava is of MadhuraKashaya inRasa, Katu in Vipaka and Sheeta in Veerya. By Guna it is Laghu and Ruksha. Italleviates Kapha and Pitta Dosha and provokes Vata Dosha. 7. NAGARA: Already described inAlambushadi Yoga.

8. NIMBUKA (N.O. Rutaceae, L.N. Citrusacida): Nimbuka is of Amla Rasa, Amla Vipaka and Ushna Veerya. By Guna it isLaghu. It pacifies kapha Dosha. It has got Agnideepana, Rochana, Pachana andTrishnanigraha properties. 9. DIPYAKA (N. O. Umbelliferae, L.N. Carumroxburgianum): Dipyaka possesses Katu and

Tikta Rasa, Katu Vipaka and UshnaVeerya. By Guna it is Laghu, Ruksha. It acts as Samaka for Kapha and VataDosha. It has got Shoola Prashamana, Rochana and Krimighna properties. PHYSIOCHEMICAL ANALYSIS REPORT (Analyzed at K.L.E. societys Pharmacy college,Gadag.) 01. PH 02. Specific gravity 03. Test for Alkaloids a. Mayers Test b. Hagers Test Positive Positive =1.01 =3.03

04. Test for Carbohydrates a. Molish Test b. Benedicts Test c. Barfoedts Test Positive (Carbohydrate present) = Positive (Reducing sugarpresent) = Positive(Monosaccherides present)

Case studies withDhanyamla Pakashaghata: As the Dhanyamla indication isfor all Vata Vyadhi, Pakshaghata was tried with internally for pana andexternally with kayaseka. The patient initially with Dakshina Pakshaghat are covered in 14 days management, without any drawbacks or setbacks. Sandhivata: Eight patients of Sandhivata areundertaken for observational study with Dhanyamla Dhara over the Sandhi, whichmade the patient to have symptomatic relief with in seven days of course. Amavata: 15 Ninepatients of Amavata were treated with Dhanyamla Kayaseka for 21 days. The results obtained with objective and subjective parameters are as follows.

2. Sandhigraha :- In this Group fourpatients (44%) presented with Grade III and five patients (56%) with Grade IISandhigraha.After the treatment there was no patients with Grade III and GradeII was reduced from five to three(33%).3. Sandhiruk:- One patient presented withGrade III (11%), four patients with Grade II (44%), and four patients withGrade 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 presentedwith Grade III (11%) five patients with Grade II (56%) and three patients withGrade I (33%). After the treatment three patients got complete relief (33%) andthere were no patients with Grade III. Number of patients in Grade II wasreduced from five to one (11%) 5. Sparsa asahishnuta:- One patientpresented with Grade III (11%) five patients with Grade II (56%) and three patientswith 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 withGrade 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 GradeIII. Conclusion: Atthe virtue of understanding the fundamentals of the Bahiparimarjana Chikitsa tropicalappliance management, it is very clear that the required cleansing properties suchas Anupravana bhava Utpadakata is not available with and they are said asonly Dosha transport facilitators with the capabilities of Vishyanda, Paka andSrotomukha Vishodhana, well before to the Dosha Shodhana procedure. When DoshaShodhana is done the same Bahiparimarjana Chikitsa becomes potent to pacifyDosha and said as Dosha shamaka. Dhanyamla is such potent externally mediated, temperatureregulated, lipophilicity, moistened, pH regulated (3 approx.), concentration -partition and diffusion coefficient of drug is maintained along with specificVata Dosha pacified properties. Dermalapplications which are hydrophobic in nature (organic solvents Dhanyamla)utilized for sustaining prolonged and slow delivery acts on systemic diseases. Thusthe Dhanyamla Chikitsa becomes ultimate treatment Antahparimarjana (internally)and Bahiparimarjana (externally) Chikitsa.

References 1) Raja Radha Kanta Deva, Shabda Kalpadruma, part 3, 3rd ed, 1967, Chowkhamba Sanskrit Series Office, PBNo 8, Varanasi -1, pp 62 2) 3) Ibid, pp 709 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) 6) Ibid, Chikitsa, 7/53, pp 453 Ibid, Sutra, 2/15 Chakrapani, pp 25

7) VaidyaJadavji Trikamji Acharya et.al., Susruta Samhita Chikitsa 24/30 - Dalhana, 8thed, 2005, Chowkhamba orientalia, PB No 1032,Varanasi, pp 488 Joel G.Hardman et.al., Goodman& Gilman's THE PHARMACOLOGICAL BASIS OF THERAPEUTICS, 9th ed, 1996,McGraw-Hill, Health Professions Division, NewYork 9) Sahasra yoga Edited by Shri K. V. Krishnan Vaidyan et.al.Published by Vidyarabham Publishers, Allepy, 23rd edition April2000. Pp.122

10) Vaidya Jadavji Trikamji Acharya ed, Charaka Samhita Chikitsa 3/259,Nirnaya Sagar Press (1941) reprint, 1984, Chowkhamba Sanskrit sansthan, PB No139, 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 April2000. Pp.122 15) Shyju Ollakkod under the guidance of Dr. K. Shiva RamaPrasad, Evaluation of comparative efficacy of Alambushadi yoga and DhanyamlaKayaseka in Amavata (Rheumatoid Arthritis), 2004, Department of Kayachikitsa(PG), Post graduate studies and research centre, D.G. M. AYURVEDIC MEDICALCOLLEGE, Gadag - 582 103