Role of Satvavajaya Chikitsa and Guduchyadi Yoga in the ...

Role of Satvavajaya Chikitsa and Guduchyadi Yoga

in the management of Madatyayaja Yakrit Vikara.

By

Dr. NIRANJANA. H. P.

Dissertation Submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fulfilment of the requirements for the degree of

AYURVEDA VACHASPATI

(DOCTOR OF MEDICINE - AYURVEDA)

In

MANASA ROGA

Under the guidance of

Dr. NARAYANA PRAKASH. B. M.D. (Ayu)

Professor & H.O.D.

DEPARTMENT OF MANASA ROGA SHRI DHARMASTHALA MANJUNATHESHWARA

COLLEGE OF AYURVEDA & HOSPITAL HASSAN

2011

DDEEPPAARRTTMMEENNTT OOFF MMAANNAASSAA RROOGGAA SHRI DHARMASTHALA MANJUNATHESHWARA

COLLEGE OF AYURVEDA & HOSPITAL, HASSAN – 573 201

(Affiliated to RGUHS, Karnataka, Bangalore)

CCeerrttiiffiiccaattee

This is to certify that the dissertation entitled “Role of Satvavajaya

chikitsa and Guduchyadi yoga in the management of Madatyayaja Yakrit

Vikara ” is the record of research work conducted by Dr. Niranjana H P

under our direct supervision and guidance as a partial fulfilment for the

award of the degree of Doctor of Medicine (Ayurveda) in Manasa Roga.

The candidate has fulfilled all the requirement of ordinances laid down

in the prospectus of Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore, for the award of Degree of Doctor of Medicine (Ayurveda) in

Manasa Roga.

We are fully satisfied with his work and recommend this thesis to

be submitted for adjudication.

Co Guide: Guide:

Dr. Suhas Kumar Shetty Dr. Narayana Prakash B. Reader Professor & H.O.D.

Dept.of Manasa Roga Dept.of Manasa Roga

S D M College of Ayurveda, S D M College of Ayurveda,

Hassan. 573 201 Hassan. 573 201

Date: Date:

Place: Hassan Place: Hassan

DDEEPPAARRTTMMEENNTT OOFF MMAANNAASSAA RROOGGAA SHRI DHARMASTHALA MANJUNATHESHWARA

COLLEGE OF AYURVEDA & HOSPITAL,HASSAN – 573 201

(Affiliated to RGUHS, Karnataka, Bangalore)

EENNDDOORRSSEEMMEENNTT BBYY TTHHEE HH OO DD &&

PPRRIINNCCIIPPAALL // HHEEAADD OOFF TTHHEE IINNSSTTIITTUUTTIIOONN

This is to certify that the dissertation entitled “Role of

Satvavajaya chikitsa and Guduchyadi yoga in the management of

Madatyayaja Yakrit Vikara ” is a bonafide research work done by

Dr. Niranjana H P under the guidance of Dr. Narayana Prakash B.,

Professor, Department of Manasa Roga, S.D.M. College of Ayurveda

and Hospital, Hassan - 573201.

Dr. Narayana Prakash B. Dr. Prasanna N. Rao

Professor & Head Principal

Dept.of Manasa Roga S D M College of Ayurveda

S D M College of Ayurveda & Hospital.

Hassan. Hassan.

Date: Date:

Place: Hassan Place: Hassan

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation entitled “Role of

Satvavajaya chikitsa and Guduchyadi yoga in the management of

Madatyayaja Yakrit Vikara”is a bonafide and genuine research work

carried out by me under the guidance of Dr. Narayana Prakash B.,

Professor & H.O.D., Department of Manasa Roga, S. D. M. College of

Ayurveda and Hospital, Hassan – 573 201.

Date :

Place : Hassan Dr. NIRANJANA H P

COPYRIGHT

I hereby declare that the Rajiv Gandhi University of Health

Sciences, Karnataka shall have the rights to preserve, use and disseminate

this dissertation / thesis in print or electronic format for academic /

research purpose.

Date : Dr. NIRANJANA H P

Place : Hassan .

© Rajiv Gandhi University of Health Sciences, Karnataka.

ACKNOWLEDGEMENT

At the outset, I bow my head at the feet of Lord Dhanvantari and Lord

Manjunatha for giving me strength to complete this academic venture in time and

style.

With the blessings and words of inspiration from Poojya Dr.D. Veerendra

Heggade, I would like to express my deepest gratitude and heartfelt thanks to all the

people and the heavenly powers that have helped me in making my dream a reality.

I am indebted to Prof. Gurudip Singh, for his functional freedom, encouragement,

guidance and support that he showed on me throughout my association with him.

I am greatly indebted to Dr. Prasanna Narasimha.Rao. Principal, for supporting

me in every walk of my life at Hassan. He is the person who was instrumental in

building my basis and sharpening my professional skills.

From the innermost recess of my heart, come sincere gratitude, thankfulness and

immense indebtedness to my esteemed teacher and elite guide Dr.Narayana

Prakash B. HOD & Professor. Dept of Manasa roga under whose guidance, I had

the privilege of carrying out this work, his parental affection and vigilant care have

always encouraged me to right path throughout my work. His constructive valuable

suggestions will always inspire me in my future endeavors.

I express my deep sense of gratitude to my co-guide Dr.Suhas Kumar Shetty, for his

valuable guidelines, concern and genuine interaction towards my study.

It’s my pleasure to convey my gratitude to Dr.Savitha.H.P and Dr. Hrishikesh

Rangnekar, for their precious suggestions and co-operation throughout dissertation

work.

I take this opportunity to thank Dr.Muralidhar P Pujar, Dr.P Hemantha Kumar,

Dr.T.B. Tripathy, Dr.Mallika K.J, Dr.Ashwini Kumar M, Dr.Shailaja.U,

Dr.Prakash L.Hegde, Dr.Harini.A, Dr Prathibha K, who extended their valuable

suggestions and support.

I am extremely greatful to Dr.Girish.K.J, HOD Dept of Kayachikitsa and Dr.Ravi

Bhat for their help and support to carry out all the technical work of thesis.

I am thankfull to all the teaching and non teaching staffs of S.D.M College of

Ayurveda and Hospital. Hassan, for their support and co-operation.

I express my sincere gratitude to Dr.B.G.Gopinath, Dr.Raghvendra R. Bhat,

Dr.Naveen B.S who helped me to gain seat in this esteemed institution.

I am greatfull to Dr.Pankaj Patil, Dr.Geetha.L.Jaiswal and all my classmates for

their never ending encouragement.

I take this opportunity to thank my seniors, Dr.Abhinandan Patil, Dr.Narayan

Namboothiri, Dr.Drisya Ravindran, Dr.Sunil Kumar and my jouniors Dr.Issac

Paul, Dr.Toolika, Dr.Rinjin G Krishna, Dr.Aditya Subrahmanyam,

Dr.JayaKrishnan, Dr.Chitrangana, Dr.Unni, Dr.Vikram C and Dr.VinayShankar

for their love and help.

I thank my patients who subjected themselves for this study and co-operating with

me in every stage of my clinical work.

I am extremely great full to my friends Mr.Akshay Pandith, Mr.Anil, Dr Deepthi

H, Dr.Ashwini Ravishankar, Dr.Hemachandra Shetty, Dr.Niveditha P.N, Miss

Shruthi R Sharma, Miss Abhignya Deshikachar and Mr.Vivek Solapurkar for

their encouragement, love, moral support and co-operation.

I remain thankful to Student Council-2010&2011 and Student Community of

S.D.M College Of Ayurveda Hassan, for their support and co-operation in every step

of my life at this institution.

I feel immensely privileged to credit this work to my parents Mr.H.A.Prabhakar

Rao, Mrs Shantha Prabhakara Rao, sisters Rajashree, Usha Raman, Vani Arun

& Veena Ananth and brother in- laws Mr.R.K.Hegde, Mr.T S Raman,

Mr.T.S.Arun and Mr.B.Ananthmurthy who constantly kept supporting me against

all odds.

Finally I thank all who helped me directly and indirectly in this research work.

NIRANJANA H.P

Role of Satvavajaya chikitsa and Guduchyadi Yoga in the Management of Madatyayaja Yakrit Vikara

ABBREVIATIONS

Bhai. Ra : Bhiashajya Ratnavali

BP : Bhava Prakash

Sa. Sam : Sharngadhara Samhita

YR : Yoga Ratnakara

Bhe.Sa : Bhela Samhita

Ch : Charaka

Su : Sushruta

A.H : Ashtanga Hridaya

A.S : Ashtanga Sangraha

B.T : Before treatment

AV : After Vamana

A.T : After treatment

S.D. : Standard Deviation

S.E : Standard Error

G. S : Grading score

Sl. No : Serial Number

Symbols

+ : Present

- : Absent

df : Degree of freedom

< : Lesser than

> : Greater than

% : Percentage

p : Probability

t : Test of significance


Contents Page no.

1. INTRODUCTION 01- 04

2. CONCEPTUAL CONTRIVE

Review of Ayurveda:

Madya 05-11

Madatyaya 12 -28

Madatyayaja Yakrit Vikara 29-31

Satvavajaya Chikitsa 32-41

Review of the Modern science

Alcohol 42 – 56

Alcohol – Related Disorder 57 – 94

Alcoholic Liver Disorder 95 - 100

3. DRUG CONTRIVE 101 - 108

4. CLINICAL CONTRIVE

Objectives 109

Methodology 110 - 119

5. OBSERVATIONS 120 - 132

6. RESULTS 133 - 147

7. DISCUSSION 148 - 158

8. SUMMARY AND CONCLUSION 159 - 161

9. BIBLIOGRAPHIC REFERENCES 162 - 178

10. ANNEXURE- 1(Model case Performa) 177 -182

11. ANNEXURE -2(Synopsis) 183- 192


LIST OF TABLES

Table no.

Table Contents Page no.

1. General Properties of Madya 8

2. Comparison of Guna of Ojas, Madya and Visha 9

3. Showing Lakshana of Vatapraya Madatyaya 14

4. Showing Lakshana of Pittapraya Madatyaya 16

5. Showing Lakshana of Kaphapraya Madatyaya 17

6. Showing application of Satvavajaya 38

7. Epidemiology of alcohol 60

8. Data Supporting Genetic Influences in Alcoholism 65

9. DSM-IV-TR Alcohol-Related Disorders and Corresponding

ICD-10 Disorders

68

10. DSM-IV-TR Diagnostic Criteria for Alcohol Intoxication 71

11. Impairment Likely to be Seen at Different Blood Alcohol

Concentrations

72

12. DSM-IV-TR Diagnostic Criteria for Alcohol Withdrawal 73

13. State Markers of Heavy Drinking Useful in Screening for

Alcoholism

75

14. Clinical Course of Alcohol Dependence 81

15. Parameters 115

16. Showing Gradation Index 116

17. Severity of MYV 118

18. Showing incidence of Age 121

19. Showing incidence of Sex 121

20. Showing incidence of Occupation 121

21. Showing incidence of Socio – economic status 123

22. Showing incidence of Marital status 123

23. Incidence of Educational status 123

24. Showing incidence of Age of starting of Alcohol. 124

25. Showing incidence of Duration of daily drinking of Alcohol

in years.

124

26. Showing incidence of Type of Alcohol 125


27. Showing incidence of Time of first drink in a day 127

28. Showing incidence of Prakriti 127

29. Showing incidence of Sara 127

30. Showing incidence of Samhanana 128

31. Showing incidence of Satva and Satmya(30.1) 128

32. Showing incidence of Vyayama Shakti 129

33. Showing incidence of Abhyavarana Shakti 129

34. Showing incidence of Jarana Shakti 129

35. Showing incidence of Pramana 130

36. Showing incidence of other habits. 130

37. Showing incidence of Psychiatric complications 130

38. Showing incidence of Relationship with Spouse 131

39. Showing incidence of signs and symptoms 131

40. Effect of Satvavajaya Chikitsa with Placebo on symptoms

of Madatyayaja Yakrit Vikara.

134

41. effect of Satvavajaya Chikitsa with Placebo on Liver function Test

135

42. Overall effect of Satvavajaya Chikitsa 136

43. effect of Guduchyadi Yoga on symptoms of Madatyayaja Yakrit Vikara

137

44. Effect of Guduchyadi Yoga on Liver function test 138

45. Overall effect of Guduchyadi Yoga 139

46. effect of Satvajaya Chikitsa and Guduchyadi Yoga 140

47. Satvavajaya chikitsa and Guduchyadi Yoga on Liver

function Test.

141

48. Overall combined effect 142

49. Severity of Madatyayaja Yakrit Vikara 142

50. Overall effect 142


LIST OF GRAPHS

Graph

no. Graph Contents

Page

no.

1. Effect of Therapy on Symptoms of Madatyayaja Yakrit

Vikara 143

2. Effect of Therapy on Symptoms of Madatyayaja Yakrit

Vikara 144

3. Effect of Therapy on Liver Function Test 145

4. Effect of Therapy on Liver Function Test 145

5. Showing the severity of Madatyayaja Yakrit Vikara 146

6. Overall Effect Of Therapy 147

Introduction

Introduction

Role of Satvavajaya chikitsa and Guduchyadi Yoga in the Management of Madatyayaja Yakrit Vikara 1

INTRODUCTION

Since the antiquity the man is using Madya and it is the part of social and cultural life.

The Madya has nectar like properties when used judicially following all norms,

otherwise it acts as poison1. Man is experiencing the ill effects of Madya since

beginning and invented the modes of overcoming its ill effects.

Now a days alcohol use disorders are common, lethal conditions that often cover-up

as other psychiatric syndromes. The average alcohol-dependent person decreases his

or her life span by 10 to 15 years, and alcohol contributes to 22,000 deaths and two

million nonfatal injuries each year. At least 20 percent of the patients in mental health

settings have alcohol abuse or dependence, including individuals from all

socioeconomic strata and both genders.2

According to US Census Bureau International Data Base 2004, 106,50,70,607

persons in the world were using alcohol and out of which 78,31,407 persons were

affected by Alcoholic liver disease. It manifests as a clinical spectrum ranging from

non specific symptoms to hepatic failure. Classically, alcoholic liver injury comprises

three major forms, 1.fatty liver, 2.alcoholic hepatitis and 3.cirrhosis.

However, any amount of alcohol is considered harmful to the developing fetus,

recovering alcoholics, people taking medications that may adversely interact with

alcohol. Individuals with certain medical disorders or psychiatric syndromes (such as

major depressive disorder or schizophrenia) might be intensified by alcohol. Also, the

intake of more than two drinks a day is likely to increase low-density lipoprotein

(LDL) cholesterol and triglycerides and to increase blood pressure, with the overall

result of increasing the risk of cardiac disorders, and even low levels of alcohol may

increase the risk for breast cancer.3

Introduction


Alcoholic liver disease is the major cause of liver disease in Western countries, (in

Asian countries, viral hepatitis is the major cause). It arises from the excessive

ingestion of alcohol. Even though millions of individuals drink alcohol on a regular

basis, only chronic heavy drinkers develop liver damage. How alcohol damages the

liver is not completely understood. It is known that alcohol produces toxic chemicals

like acetaldehyde which can damage liver cells, but why this occurs in only a few

individuals is still in debate. When alcohol damages the liver, the function of the

organ is not immediately compromised as the liver has a tremendous capacity to

regenerate and even when 75% of the liver is damaged, it continues to function as

normal. When alcohol is consumed chronically, it eventually results in liver scarring

or what is known as cirrhosis or end-stage alcoholic liver disease.

That which produces Mada is called Madya, the disease produced due to improper use

of Madya is called Madatyaya. One should take the Madya with food materials and

judiciously. Madatyaya is produced when person takes the Madya without

considering Prakriti, Satmya, Agni, etc. Continuing same amount of alcohol intake

leads to Madatyayaja Yakrit Vikara. It is a Pitta pradhana Tridoshaja Vyadhi mainly

Pitta Sthana is vitiated along with Agni.

Acharya Bhavaprakasha mentions Yakrit-Vruddhi (hepatomegaly) as one of the

symptoms of Yakrit Vikara due to excessive intake of Vidahi and Abhishyandi

Aharas and Madya (alcohol).

Ayurveda has many options to treat Madatyaya . All the texts mention

Pittahara and Deepana Pachana Dravyas to treat Yakrit-Vikaras. Guduchyadi Yoga

mentioned by Charaka comprising of Guduchi (Tinospora cordifolia), Musta (Cyperus

http://en.wikipedia.org/wiki/Liver_disease

http://en.wikipedia.org/wiki/Hepatitis

http://en.wikipedia.org/wiki/Alcoholic_beverage

http://en.wikipedia.org/wiki/Acetaldehyde

http://en.wikipedia.org/wiki/Liver

http://en.wikipedia.org/wiki/Regeneration_(biology)

Introduction


rotundus), Patola(Tricosanthes dioica) and Nagara(Gingeber officinalis) may relieve

the adverse effects of Madatyaya as well as liver disorders caused by it.

Satvavajaya Chikitsa may help people to address psychological issues

involved in their drinking problem. Astanga Hrudaya explains Vismapana,

Samsmarana, Priyadarshana, Priyashravana, Geeta, Vadya and Charaka advises

Harshanee Kriya and restrain from the things which are harmful to body and mind as

the treatment modalities in the management of Madatyaya.

Alcohol related disorders are earlier called as alcoholism. Diagnostic and Statistical

Manual of Mental Disorders (DSM-IV-TR) in 1994 listed alcohol related disorders as

below- Alcohol use disorders and alcohol induced disorders.

Alcohol use disorders are Alcohol dependence and abuse. Alcohol induced disorders

are Alcohol intoxication, Alcohol intoxication delirium, Alcohol withdrawal, Alcohol

withdrawal delirium, Alcohol-induced persisting dementia, Alcohol-induced

persisting amnestic disorder, Alcohol-induced psychotic disorder, with delusions,

Alcohol-induced psychotic disorder, with hallucinations, Alcohol-induced mood

disorder, Alcohol-induced anxiety disorder, Alcohol-induced sexual dysfunction,

Alcohol-induced sleep disorder and Alcoholic liver disorder.9 The treatment for

alcohol withdrawal is only pacifying the symptoms by tranquilizers; there is no

specific treatment modality available in conventional science for detoxifying the

effects of alcohol. In Ayurveda many drugs are explained for detoxifying,

Guduchyadi Yoga is one among them.

By taking into consideration of the above facts, In this study 54 patients of

Madatyayaja Yakrit Vikara were registered, 16 patients in Satvavajaya(S)group,19

Introduction


patients in Guduchyadi Yoga(GY)group and 19 patients in Combined (S&GY) group,

out of which 3 patients of GY group and 3 patients of S&GY group were drop out. In

this way 16 patients in each group completed full courses of the treatment.

This study revealed Satvavajaya chikitsa and Guduchyadi Yoga combined group is

better than Guduchyadi Yoga group and Guduchyadi Yoga group is better than

Satvavajaya chikitsa with placebo group.

The overall effect shows no patients got cured, where as marked improvement of 6.25

% &37.5% in GuduchyadiYoga and Satvavajaya & GuduchyadiYoga group

respectively. 75.0% and 62.5% had moderate improvement in GuduchyadiYoga and

(Combined) Satvavajaya & Guduchyadi Yoga group respectively, where as 18.75 %

and 56.25% got mild improvement in GuduchyadiYoga and Satvavajaya with placebo

group respectively and but 43.75 % patient remained uncured in Satvavajaya with

placebo group.

This study has been presented in the following headings, literary review, Clinical

study, Discussion, Summary and conclusion. Literary review is again divided mainly

into Ayurveda review and Modern review. Ayurveda review has Madya review,

Madatyaya review, Madatyayaja Yakrit Vikara review and Satvavajaya chikitsa

review. Modern review has Alcohol review, Alcohol related disorders review and

Alcoholic liver disorder review. Clinical study has divided into Materials and

methodology, observations, results, discussion and conclusion.

Conceptual

Contrive

Review of

Ayurveda

Madya Review


MADYA

The one which causes Mada by ingestion is called Madya. Mada means any

exhilarating or intoxicating condition

Nirukti and Nirvacana:

‘Mada’ is derived from the word ‘Madee’ which gives the meaning ‘Harsha’ –

‘Made Harshe’.

Madya is defined as ‘Madyatyanena Karaņe Yat Madya ’i.e., which does the action

of Mada is called Madya.10

Sharngadhara says,

Buddhim Lumpati Yaddravyam Madakari Taducyate |

Tamoguņa Pradhanasca Yatha Madyam Suradikam || 11

Madakari Dravya is that intake of which produces disturbance of the intellect faculty

by its virtue of Tamo-guņa like Madya, Sura etc.

Types of Madya:

All most all Acharyas has explained Madya Varga, and explained many types of

Madya. Those can be classified as based on their use viz.

a) Used as medicine

b) Used as drinking beverage

Madya used as Medicine:

Arishta: When drugs mixed with water are heated to make the decoction which is

then fermented and filtered, the liquid thus obtained is called as Arishta. It is Laghu

and best among the Madya. Depending upon the medicinal drugs added, its properties

vary.12, 13

Madya Review


Asava: Preparation prepared without heating the water and drugs and fermented is

called Asava. Its qualities depend upon the drugs those are added. 14, 15

Caraka explains 84 types of Asava based on the following 9 Yonis (souece

materials): : The following nine are the Yonis (sources) from which Madya is

prepared viz., Dhanya (grain), Phala (fruit), Moola (root), Sara (pith), Pushpa

(flower), Kaņda (stalks), Patra (leaves), Tvaca (bark) and Sharkara (sugar).

84 Types of Madya: There are innumerable varieties of Madya resulting from

different Samyoga (combinations) and Samskara. Among them, some important 84

types of Madya are described by Charaka. They are -

Six from Dhanya - Sura, Sauvera, Tushodaka, Maireya, Medaka, Dhanyaamla

Twenty six types from Phala - Mrdveeka, Kharjura, Kashmarya, Dhanva, Rajadana,

Triņashunya, Parooshaka, Abhaya, Amalaka, Mrigaliņdika, Jambava, Kapittha,

Kuvala, Badara, Karkandu, Peelu, Priyala, Panasa, Nyagrodha, Ashvattha, Plaksha,

Kapitana, Udumbara, Ajamoda And Shankhini.

Eleven type from Moola - Vidari Gandha, Ashvagandha, Krishņa Gandha, Shatavari,

Shyaama, Trivrt, Danti, Dravanti, Bilva, Urubuka, Citrakamoola

Twenty from Sara - Shaala, Priyala, Ashvakarņa, Candana, Syandana, Kshadira,

Kadara, Saptaparņa, Arunasana, Arimeda, Tinduka, Kiņihi, Shami, Shukti,

Shimshapa, Shireesha, Vanjala, Dhanvana, Madhooka

Ten from Pushpa - Padma, Utpala, Nalina, Kumuda, Saugandhika, Puņdreeka,

Shatapatra, Madhooka, Priyangu, Dhataki

Four from Kaņda - Ikshu, Kaņdekshu, Ikshuvalika, Puņdraka,

Two from Patra - Patola, Tada

Four from Tvak - Tilvaka, Lodhra, Elavaluka, Kramuka and

Madya Review


One from Sharkara. 16

Tushambu, Souviraka, Dhanyamla.17

Madya used as Drinking Beverage:

Sura: The Madya prepared from the Shali, Shashtika etc is called Sura. It is having

the properties of Guru, Balakara, Stanyajanana, Pushtikara, Medokara and Kaphakara,

and is indicated in Grahaņi, Shotha, Gulma, Arshas, and Motrakrichra.18, 19

Varuņi: Madya prepared from the water added with Shilapishta of Punarnava is

called Varuņi or Madya prepared from the Rasa of Tala, Kharjura etc, is also called

Varuņi. It is having the same properties that of Sura.20,

Seedhu: Madya prepared from sugarcane juice is called Seedhu. It is of two types, if

prepared from Apakvarasa, it is Sheetarasa Seedhu; and if prepared from Pakvarasa, it

is called Pakvarasa Seedhu. Pakvarasa Seedhu is the best with the actions of Svarya,

Agnikara, Balakara, Varņakara, Vata and Pittakara, Sadya-Snehakara, Rocaka,

Malabandhahara, Medohara, Shophahara, Arsohara, Udarahara and other Kapha-

rogahara actions. Sheetarasa seethu is having Lekhana property 21, 22

Acharya

Sushruha mentioned some more types of seedhu they are Gudaseedhu,

Sharkaraseedhu, Pakvarasaseedhu, Apakvarasaseedhu, Akshikaseedhu,

Jambavaseedhu, Puspayoni Seedhu. 23

PROPERTIES AND ACTIONS OF MADYA:

Guna of Madya in General:

Madya is having the following ten Guna:

Laghu, Ushņa, Tikshņa, Sukshma, Vishada, Amla, Vyavayi, Ashu, Vikashi and

Ruksha. All the Madya are generally Pittakara and Vatahara in nature24

Madya Review


Table - 1

General Properties of Madya According to Brihad-Trayi

Guna Charaka24

Sushruta25

Vagbhata26

Laghu + - +

Ushņa + + +

Tikshņa + + +

Sukshma + + +

Vishada + + +

Amla + - +

Vyavayi + + +

Aashu + + +

Vikashi + + +

Ruksha + + +

Madya are prepared of different types of ingredients, accordingly they have different

Guna and Karma, but all are intoxicating in nature. Charaka and Vagbhata say that

Madya has ten Gunas but Sushruta says only eight Gunas except Laghu and Amla.

Commenting on the Guna of Visha, Charaka, Sushruta and Vagbhata say that the

Gunas of Madya are just opposite to the Gunas of Ojas.

Gunas of Madya verses Ojas:

Madya is having Guna which are just opposite to that of Ojas. Therefore when Madya

reaches the Hridaya, it afflicts the ten Gunas of Ojas, which is located in Hridaya.

Madya by virtue of its ten Guna give rises to mental distortion.

Madya Review


The ten Guna of Madya are Laghu, Ushņa, Tikshņa, Sukshma, Amla, Vyavayi,

Ashuga, Ruksha, Vikashi and Vishada.

The ten qualities of Ojas are Guru, Sheeta, Mridu, Shlakshna, Bahala, Madhura,

Sthira, Prasanna, Picchila, and Snigdha.

The ten Gunas of Ojas viz. Guru, Sheeta, Mridu, Shlakshna, Bahala, Madhura, Sthira,

Prasanna, Picchila, and Snigdha are counter acted by ten Gunas of Madya viz. Laghu,

Ushņa, Tikshņa, Sukshma, Amla, Vyavayi, Aashuga, Ruksha, Vikashi and Vishada.27

Hridaya is the Sthana of the channels of circulation of Rasa, Vata etc., the Satva, the

Buddhi, Indriyas, Atma and Ojas, which are most important one. This Ojas gets

destroyed by the excess intake of Madya, and morbidities appear in the heart and in

the Dhatus located in it.28

Table - 2

Comparison of Guna of Ojas, Madya and Visha

Ojas29

Madya24

Visha30

Guru Laghu Laghu

Sheeta Ushņa Ushņa

Mridu Tikshņa Tikshņa

Shlakshņa Sukshma Sukshma

Bahala Vishada Vishada

Madhura Amla Anirdeshya rasa

Sthira Vyavayi Vyavayi

Prasanna Ashu Ashu

Picchila Vikashi Vikashi

Snigdha Ruksha Ruksha

Madya Review


Pharmacology of Madya:

For living beings, food is the sustainer of life, but when taken inappropriately, it

causes death. Similarly, poison, which causes death, works like Rasayana when used

appropriately.

Madya taken following the rules and regulations produces exhilaration, energy,

happiness, nourishment, good health, excellent virility and pleasant intoxication

(Sukha Mada Prada) instantaneously. It promotes appetite, stimulates the power of the

digestion, tones up the heart, promotes the voice and complexion, produces the

feeling of refreshment and corpulence, increases strength, and removes fear and

fatigue. Patients suffering from insomnia enjoy sound sleep by taking Madya and it

stimulates speech in Mooka (who talks less). It helps persons having excessive sleep

to remain awake and causes bowel movements in constipated patients. It renders the

mind insensitive to the miseries of injury and fatigue.31

In moderate dose and taken with food or after food Madya tends to promote digestion

by direct stimulation of the fundus of stomach causing an abundant secretion of

gastric juice.

Since it causes dilatation of vessels especially of the skin and increases the functional

activity of different organs.

Actions of Madya According to three types of Sattva: 32

A person having Sāttvika type of mental faculty drinks Madya in pleasant conditions

and good quality Madya with wholesome and delicious food and drinks. While taking

Madya, he always engages himself in delightful conversations. He takes Madya in

happy mood leading to a pleasing type of intoxication, which promotes cheerfulness

Madya Review


and passion. It terminates as a pleasing event, and it does not lead to the third stage of

intoxication.

Sattvika type of person does not exhibit perverted activities immediately after taking

Madya because Madya is incapable of adversely afflicting the powerful minds of

Sattvika persons instantaneously.

A person having Rajasika type of mental faculty talks some time gently and at times

rudely, some time distinctly and at times indistinctly and so demonstrates his irregular

varieties of behaviour after taking Madya. It terminates as a tragic event.

A person of Tamasika mental faculty, after taking Madya, becomes excited and

passionate in his talks, he never gets satisfaction in eating and drinking, and his

alcoholic intoxication terminates in unconsciousness, anger and sleep.

Madatyaya Review


MADATYAYA

Word Madatyaya is composed of two terms i.e. Mada - any exhilarating or

intoxicating condition. Atyaya – suffering.

Hence suffering from intoxicating drink is

known as Madatyaya. Madatyaya or the alcoholic disorders are completely based on

stability of one’s own Satva. So mind plays an important role in the de-addiction of

alcohol.

Nirukti of Madatyaya:

“Madena Atyayo Madatyayah |

Madahetuko Vyadhirityarthah |

The Atyayata (disorder) produced by Madya is called as Madatyaya.33

Nidana of Madatyaya:

The general Nidana for Madatyaya are not given separately, but while explaining

various types of Madatyaya the Nidanas of each type are mentioned, which will be

dealt with that particular type of Madatyaya.

General Samprapti of Madatyaya:

Intake of excessive alcohol which is Tikshņa, Ushņa, Amla and Vidahi makes the

Annarasa Utkleda and will be digested improperly which ultimately turns Kshara and

causes Antardaha (burning sensation in the interior of the body), Jvara (fever),

Trishņa (morbid thirst), Pramoha (loss of orientation), Vibhrama (completely

deranged mental faculty) and Mada (intoxication).

The Dosha incited by alcohol causes obstruction to the movement of Vayu in the

Srotas (channels of circulation) because of which the patient suffers from excruciating

pain in the head, bones and joints

Madatyaya Review


Excessive intake of Madya

Anna Rasa Utkleda

Turns to Kshara

Vitiates Hridaya

Madatyaya

Flow chart showing Samanya Samprapti of Madatyaya

Sankhya Samprapti of Madatyaya:

All the types of Madatyaya are caused by the simultaneous aggravation of all the

Doshas and whichever Dosha is dominating in presenting the symptoms, the condition

is named by that Dosha4.

Charaka explains types of Madatyaya as Vatapraya, Pittapraya and Kaphapraya and

considers the disease as Tridoshaja.34

While Acharya Vagbhata explains 4 types of Madatyaya viz. Vataja, Pittaja, Kaphaja

and Sannipataja.35

Acharya Sushruta explains mainly four types viz. Panatyaya, Paramada, Panajeerna

and Panavibhrama. Acharya Sushruta used Panatyaya term in the place of Madatyaya,

and accepts 4 types of Panatyaya viz. Vatakrita, Pittakrita, Kaphakrita and

Sarvakrita.36

In Gadanigraha Acharya Shodala accepted Dvidoshaja Madatyaya.37

Kasyapa explained three kinds of disorders form improper usage of Madya viz.

Panatyaya, Pana Vibhrama, Panapakrama.38

Madatyaya Review


Vatapraya Madatyaya

Nidana: 39

If a person is excessively emaciated because of indulgence in women, grief, fear,

carrying heavy loads, walking long distances and other strenuous activities, while

eating Ruksha type of food, less quantity of food or limited quantity of food, drinks

alcohol at night which is excessively fermented, then this leads to the impairment of

his sleep and Vatapraya type of Madatyaya instantaneously.

Lakshana:

The symptoms of Vatapraya type of Madatyaya are shown in Table-3.

Table – 3

Showing Lakshana of Vatapraya Madatyaya

Lakshana Ch40

Su41

A.H42

A.S43

Ka44

Hikka + - - - -

Shvasa + - + + -

Shareera Kampa + + + + -

Parshva Shoola + - - - +

Prajagara + - + + +

Bahu Pralapa + - - - +

Sthambha - + - - -

Angamarda - + - - -

Hridaya Griha - + - - -

Toda - + - - -

Shiroruja - + + + -

Madatyaya Review


Hrit Ruja - - - - +

Parshva Ruja - - - - +

Unmatta Iva Chabhati - - - - +

Svapne Bhramati - - + + -

Svapne Prettaishcha Saha Bhasyate - - + + -

Pittapraya Madatyaya

Nidana: 45

If a person, indulges in food that is Amla, Ushņa and Teekshņa, having wrathful

disposition, and having liking for excessive exposure to the fire and sun, drinks excess

quantity of alcohol that is Teekshņa, Ushņa and Amla, then he suffers from the

Pittapraya type of Madatyaya.

If Pittapraya Madatyaya is dominated by aggravation of Vayu, then this condition

may be cured immediately or may cause instantaneous death.

Instantaneous effects like those of the fire associated with strong wind in the mundane

world. By implication, if effective treatment is done, then the ailment is cured

instantaneously, and if such treatment is not provided to the patient, then he may

surrender to death instantaneously. 46

Madatyaya Review


Lakshana:

A person suffering from Pittapraya type of Madatyaya have the symptoms as shown

in Table-4 Table – 4

Showing Lakshana of Pittapraya Madatyaya

Lakshana Ch47

Su41

A.H48

A.S49

Ka50

Trishņa, + - + + -

Daha + + + + +

Jvara + - + + +

Sveda + + + + +

Moorcha + + - - -

Atisara + - + + -

Vibhrama + - + + -

Haritavarņa + - + + -

Rakta Netra - - + + -

Rakta Kapola - - + + -

Moha - - + + -

Pralapa - + - - -

Mukha Shoshana - + - - -

Vadana Peetata - + - - -

Lochana Peetata - + - - -

Sroto Paka - - - - +

Vidbheda - - - - +

Peetata - - - - +

Chardi - - - - +

Rakta Prakopa - - - - +

Madatyaya Review


Kaphapraya Madatyaya

Nidana: 51

If a person who is habituated to Madhura, Snigdha and Guru Ahara, who does not

perform exercise, who sleeps during the daytime and who indulges in comforts of

beds and seats, if excessively drinks alcohol which is not an old one or which is

prepared of Guda, and Paishtika, then he immediately develops Kaphapraya

Madatyaya.

Lakshana: Lakshana of Kaphapraya Madatyaya are shown in Table-5.

Table-5

Showing Lakshana of Kaphapraya Madatyaya

Lakshana Ch52

Su53

A.H54

A.S55

Ka56

Chardi + + + + +

Arocaka +

Hrillasa + + +

Tandra + +

Staimitya +

Gaurava + + +

Sheetaparita + +

Kapha Praseka +

Nidra + +

Udarda + +

Seka +

Jvara +

Madatyaya Review


Alasa +

Sthamba +

Visajnatva +

Vishada +

Sannipataja Madatyaya 57

In Sannipataja Madatyaya all or some of the above said features of three individual

Doshas can be seen.

Madatyaya - always a Sannipataja:

Attributes of Visha that cause aggravation of all the three Dosha are also found in the

alcohol; the only difference is that in Visha, these attributes are more severe. Visha at

times causes death and at times diseases in afflicted person. Like Visha, intoxicating

effect of alcohol at times leads to death and at times the adverse effects. 58

Therefore all types of Madatyaya is having the features of three Dosha.

Samanya Lakshana of Madatyaya: 59

All the signs and symptoms manifested in Sannipataja Madatyaya are as follows:

Shareera Duhkham (Excruciating pain in the body), Balavat Sammoha

(Unconsciousness), Hridaya Vyatha (pain in the cardiac region), Aruchi (anorexia)

and Pratata Trishņa (incessant thirst), Jvarah Sheetoshņa Lakshaņa (fever having the

characteristics of cold and heat), Shirah Parshvasthi Sandheenam Vidyuttulya Cha

Vedana (sever pain in the head, sides of the chest, bones and joints), Atibala Jrimbha

(severe yawning), Sphuraņam (throbbing), Vepanam (twitching) Shrama (fatigue)

Urovibandha (feeling of obstruction in the chest), Kasa (cough), Hikka (hiccup),

Shvasa (dyspnoea), Prajagarah (insomnia), Shareera Kampa (trembling of the body),

Madatyaya Review


Karņakshimukharoga (diseases of ears, eyes and mouth), Trikagraha (stiffness of

sacro-iliac joint), Chardi, Atisara and Hrilasa of Tridoshatmaka, Bhrama (giddiness),

Pralapa (delirium), Roopaaņaamasastaanaam Darshanam (visual hallucinations like if

the body is covered with grass, creepers, leaves or dust; and afraid of birds as if they

are colliding with his body), Vyakulanamashastaanaam Svapnaanam Darshanani

(dreaming of terrifying and inauspicious objects).

Madatyaya according Sushruta:

According to Sushruta, the adverse effects of chronic usage of alcohol against the

rules and regulations prescribed for alcohol intake are classified into four types. They

are Panatyaya, Paramada, Panajeerņa and Panavibhrama60

.

Panatyaya: 61

Panatyaya is divided in to four types depending upon the characteristic features of

Dosha predominance.

a) Vatika Panatyaya: It is characterized by Stambha, Angamarda, Hridaya Graha,

Toda, Kampa and Shiroruja

b) Paittika Panatyaya: It is characterized by Sveda, Pralapa, Mukha Shoshaņa,

Daha, Moorcha, Vadana and Locana Peetata.

c) Kaphaja Panatyaya: It is characterized by Vamathu, Sheetata and Kaphapraseka

d) Sannipataja Panatyaya: It characterized by the symptomatology of three

Doshas.

Madatyaya Review


Paramada: 62

Paramada is characterized by Oshmanam, Angagurutam, Virasananatvam,

Shleshmadhikatvam, Aruchim, Malamootrasanga, Trishņa, Shiro and Sandhi ruja.

Panajeerņa: 63

Aadhmanam, Udgiranamamlarasa, Vidahi and other features of aggravated Pitta

characterize Panajeerņa.

Panavibhrama: 64

Panavibhrama is characterized by Hrit, Gatra Toda, Vamathu, Jvara, Kantha Dhooma,

Moorcha, Kaphasravanam, Shiroruja, Vidahi, and Sura, Anna Vikruteshu dvesha.

Dhvamsaka & Vikshaya:

Nidana:

If a person, who has stopped drinking alcohol, suddenly takes recourse to drinking

alcohol in excess, he suffers from Dhvamsaka and Vikshaya. 65

Lakshana:

Dhvamsaka: Shleshma Praseka (excessive salivation), Kaņthasya Shosha (dryness of

the throat and mouth), Shabdasahishņuta (intolerance to noise), Atitandra (excessive

drowsiness) and Nidra (sleep) characterize the Dhvamsaka. 66

Vikshaya: Hritkaņtha Roga (thoracolaryngial disorders), Sammoha (loss of

orientation), Chardi (vomiting), Anga Ruja (body pains), Jvara (fever), Trishņa

(thirst), Kasa (cough) and Shirashoola (headache) characterize the Vikshaya. 67

Madatyaya Review


Prognosis:

Since a person suffering from Dhvamsaka or Vikshaya who is already emaciated

because of his earlier drinking habit, these two diseases appearing in him are difficult

to be cured. 68

Duration of severity of Madatyaya / Panatyaya:

According to Yogaratnakara the severity of disease Madatyaya will persist for seven

or eight days. 69

Upadrava of Madatyaya:

The following are the complications of Madatyaya- Hikkaa associated with Jvara,

Vamathu, Vepathu, Paarshvashoola, Kaasa and Bhrama.70

Asadhya Lakshanani (Characters of bad prognosis):

The following are the characteristics of bad prognosis:

Hinottaraushtham (thinner upper lip), Atisheetam (excessive cold), Amandadaham

(mild burning sensation), Tailaprabhasyam (oily glistering of face), Jihvaushtha

Dantamasitam Vaa Neelam (black or blue tongue, lips and teeth), and Peete Nayana

Rudhirata (reddish eyes immediately after taking alcohol). 71

Madatyaya Review


CHIKITSA OF MADATYAYA

General treatment principles

1. All the varieties of Madatyaya are of Tridoshaja. Therefore, in the beginning,

treatment should be done for the most predominant Dosha. If all the Doshas are

equally aggravated, then the treatment should be done first for the location of

Kapha, followed by that of Pitta and lastly that of Vata.6

2. The ailments caused by the drinking of alcohol in Mithyaa Yoga or in Atiyoga

or in Heena Yoga can be cured by taking the alcohol in appropriate manner and

quantity (Samayoga). Here the same type of Madya or other varieties of Madya

can also be given. 72

3. According to Kaashyapa, Madatyaya is Aamaja. That is why while treating

Madatyaya, Langhana should be done first. 73

4. Why Madya in Madatyaya

Intake of excessive alcohol which is Teekshņa, Ushņa, Amla and Vidaahi

makes the Annarasa Utkleda and will be digested improperly which ultimately

turns Kshaara and causes Antardaaha (burning sensation in the interior of the

body), Jvara (fever), Trishņaa (morbid thirst), Pramoha (loss of orientation),

Vibhrama (completely deranged mental faculty) and Mada (intoxication). To

correct these ailments, alcohol should be administered because when a Kshaara

(alkaline) substance gets mixed with a sour substance, the outcome becomes

sweet in taste, and alcohol is the best among the substances having the Amla

taste. Alcohol by nature is sour in taste and it has four subsidiary tastes like

Madatyaya Review


Madhura (sweet), Kashaaya (astringent), Tikta (bitter) and Katu (pungent). Thus

along with other ten qualities, alcohol has fourteen attributes in total. It is because

of these fourteen attributes, alcohol stands supreme among all the article of sour

taste.

The Dosha incited by alcohol causes obstruction of the movement of Vayu in

the Srotas (channels of circulation) because of which the patient suffers from

excruciating pain in the head, bones and joints. In spite of the availability of other

sour ingredients, alcohol should specifically be administered to such a patient for

the liquefaction of the Dosha because of its Vyavaayi, Teekshņa and Ushņa

properties. Alcohol removes the obstruction in the channels of circulation, helps

in the downward movement of Vaayu, acts as an appetizer, stimulates the power

of digestion and becomes wholesome (Satmya) when consumed habitually

(Abhyaasa). When the obstruction in the channel is removed, and Vaayu moves

downwards, the pain subsides and the ailments caused by intake of alcohol get

cured.74

5. For Vatika type of Madatyaya, Piashtika type of alcohol (prepared of the paste

of cereals) mixed with Beeja Pooraka, Vrikshamla, Kola and Dadima, some

quantity of Yavani, Hapusha, Ajaji and Shringavera should be taken along with

salt. In addition, snacks prepared of Saktu should be taken.

For Vatika type of Madatyaya the following also should be administered: meat

soup, Veshavaara with ghee. After taking food if patient feels thirsty, he should

be given Varuņi Maņda, Dadima juice, Pancamoola Siddha Jala etc. Other

Madatyaya Review


measures which can be followed are Abhyanga, Utsaadana, Agarulepa, residing

with women etc.

6. For Paittika type of Madatyaya Sharkara or Mardveeka type of alcohol which

is diluted with large quantity of water along with the juice of Kharjoora,

Mridveeka, Parooshaka, Daadima should be given. This type of patients should

take sweet and sour type of food, Shaali and Shashthika type of rice, Maamsa and

soups prepared of meat of goat adding the soup of Patola, Mudga, Daadima, and

Aamalaka. Different types of Tarpanas, Yooshas also should be given.

If, in the patient of Paittika type of Madatyaya, Kapha, Pitta located in

Aamaasaya are incited, if there is excessive morbidity and if he is suffering from

burning sensation and morbid thirst, then alcohol, grape juice and other Tarpaka

Dravyas should be given and there after Vamana Karma should be administered

to eliminate the morbid Doshas completely. This gives instant results in this type

of patient. For other complications Kashayas prepared of Guduchi, Bhadra

Mustaa, Patola, Naagara, Daadima, Laaja, or Parņacatushka should be given.

Baahyopacaaras compatible for Pitta also should be done.

7. For Kaphaja type of Madatyaya, Vamana Karma and Upavaasa should be

administered. If the patient suffers from morbid thirst, then the Kashaayas

prepared of Hreebera, Bala, Prishņiparņi, Kaņtakaari together with Naagara

should be given. For Dosha Paacana, Kashaaya prepared of Dussparsha, Musta, or

Parpaataka should be given. When the patient is free from Aama, he should be

given the alcohol prepared of Sharkara, Madhu and old Arishtas, and Seedhu

along with honey. He should be given the food prepared of Yava, Godhooma and

Madatyaya Review


Rooksha type of Yooshas like Kulattha Yoosha etc. meat prepared with profuse

quantity of Marica and other Amla, Katu and Lavaņa Dravyas. Digestive

stimulants and Srotoshodhakas like Ashtaanga Lavaņa should also be given.

8. For Sannipaataja Madatyaya, which can be of thirteen types, according to the

Dosha dominance, the appropriate treatment should be done. When there is

involvement of three Doshas with equal dominance, then first treatment should be

dome for Kapha Dosha followed by Pitta Dosha and Vaata Dosha.

9. The following psychological measures also can be applied for the patients

suffering from Madatyaya because, alcohol cannot cause the disorders related to

improper alcohol intake without causing agitation of the mind and without causing

morbidity in the body. 75

The psychological measures are -

a) Beautiful forests

b) Ponds and lakes with lotus flowers

c) Clean food and drinks

d) Pleasing and delightful companions

e) Use of garlands and perfumes

f) Clean garments

g) Musical performances

h) Exposition of refreshing stories, jokes and songs and

i) Company of lovely and devoted women. 76

Madatyaya Review


10. Dugdha for Madatyaya:

After giving up alcohol, because of Langhana, Paacana, Dosha Shodhana,

Shamana Kapha gets diminished, and body of the patient becomes Durbala and

Laaghava. For this type of patient, whose body is burnt by alcohol, and in whose

body Vaayu and Pitta are aggravated, milk is exceedingly wholesome like the rain

for a tree afflicted with hot summer. 77

11. Re-administration of alcohol:

After the disease is cured by the administration of milk, and after the patient

has strength, the milk should be gradually withdrawn, and alcohol should be

substituted in its place little by little.

12. According to Kaashyapa, for the Madatyaya patients suffering from Pipasa,

Jvara and Daha, the treatment principles of Visarpa, Daha and Jvara should be

applied.78

13. For Panatyaya, Paramada, Panajeerņa and Panavibhrama, the above said

principles can be applied accordingly.

14. Treatment for Dhvamsaka & Vikshaya:

As emaciated and weak persons are suffered from these two types of

disorders, their treatment should be done on the line suggested for the

treatment of Vaatika type of Madatyaya. Such a patient should be given Vasti,

Sarpi, Dugdha, Ghrita, Abhyanga, Snehana, Snaana, food and drinks which

cause alleviation of Vayu. 79

Madatyaya Review


APATHYA

According to Kashyapa, the following are prohibited in patients suffering from

Madatyaya: Ushņa, Rooksha and Guru Anna and Paana; Agni, Aatapa, Divaasvapna,

other activities which does emaciate the bodily tissues, Shoka, Adhva, Maithuna,

other laborious works, excessive exercise, food preparations like Yavagu, Maņda,

Yusha. 80

In Bhelasamhita the following are contraindicated in patients suffering from

Madatyaya:

Ushņodakam, Svedanam, Dhoopanam, Sarpirpaanam, all types of Jvaala and Analam,

Yavaagu, Dadhi, Dugdham, Graamya, Anoopa and Udaka Maamsa, preparations

made up of Tilapishta. 81

In Bhashajyaratnavali, apart from above said descriptions, Dantadhavana, Navana and

Anjana are also contraindicated in patients suffering from Madatyaya. 82

DISCOURAGING ALCOHOL INTAKE:

A wise person who has control over the sense organs and who abstains from drinking

all types of alcoholic preparations never gets afflicted with physical and mental

disorders.

He who is addicted to alcohol is unaware of right and wrong, happiness and

unhappiness, beneficial and non-beneficial, suitable and unsuitable and who do the

wise indulge in it? 83

Madatyaya Review


Some important Yogas for Madatyaya:

Kharjooradi Mantha in all types of Madatyaya, Punarnavadi Ghritam for

Ojovardhana, Ashtanga Lavaņa in Kaphaja Madatyaya. (Cakradatta)

Karkandhoobadara Panakam, Kashmaryadi Panakam, Amritadya Panakam,

Drakshadya Panakam, Triphaladya Kashaya with Madya for Pittaja Madatyaya

(Bhe.Sa.).

Cavyadicoorņa with Madya, Katphaladi Ghritam, Sharkara and Ghrita for acute

intoxication. (YR.)

Phalatrikadi Choorņa, Eladi Modaka, Mahakalyanaka Vati, Sreekhandasava (Bhai.

Ra.)

Madatyayaja Yakrit Vikara Review


MADATYAYAJA YAKRIT VIKARA

In Brihatrayi there is no direct reference of Yakrit Vikara but while explaining

the diseases like Pandu, Kamala, Udara, Yakridalyodara etc , Acharyas explained

some of the signs and symptoms which are manifested because of Yakrit impairment.

In so many contexts they explained the symptoms of Yakrit Vikara indirectly.

Both Charaka and Sushrutha Acharyas have explained that Yakrit is the moola of

Rakta Vaha srotas. As Rakta dhatu and Pitta doshas are Ashrayaashrayi , it can be

consider that the Nidanas for Pitta or Pittakaraka Ahara Vihara leads to Rakta

pradoshaja vikaras and simultaneously it affects the moola of Raktavaha srotas and

thereby leads to the vitiation of Yakrit or Yakrit vikara.

Ranjaka pitta is a type of pitta which is responsible for the rasa ranjana and gives

colour to the rakta, mutra and pureesha. In madatyayaja yakrit vikara, colour of the

puresha and mutra are deranged and rakta dhatu is one among the main dushya. As

Yakrit and pleeha are the moola of rakta vaha srotas, it is very clear that ranjaka pitta

is the main dosha which is responsible for the samprapti of Madatyayaja Yakrit

Vikara.

As Kamala is the Rakta pradoshaja vikara and that leads to the impairment of the

functions of Yakrit. We can consider the symptoms of Kamala for understanding

Yakrit Vikara. Mainly Pitta dosha is involved in the samprapti of Kamala that leads to

the vitiation of Rakta Dhatu and thereby affects the Hridaya and Yakrit.

As Madya is Abhishyandi , Vyavayi, Vikashi, Teekshna, ushna, vidahi and

amlarasayukta , which leads to the vitiation of Pitta and thereby form the Raktadusti



and can affects the Yakrit. So Madya can be considered as the Nidana for the

Madatyayaja Yakrit Vikara and it may generate Yakrit Vikara.

As Madya is having the gunas like Vyavayi, Vikashi, Ashukari etc. it immediately

affects the Ojas and Hridaya and thereby causing Uttarottara Dhatu Hrāsa and leads to

many types of symptoms.

Exessive intake of madya leads to agni dusti and mandagni by its vidahi, teekshna,

usna, and drava guna. Severe agni dusti leads to the samprapti of Udara (accumulation

of fluid in twank-mamsantara pradesha), Kukshimadmapana and mainly

Yakridalyodara and resulting in Madatyayaja Yakrit Vikara, which is similar to that

of alcoholic liver cirrhosis.

There is a direct reference of Yakrit Vikara in BhavaPrakasha, he mentions Yakrit

vriddhi (can be compared with hepatomegaly) is the main feature of Yakrit vikara and

nidana for Yakrit vikara is vidahi, abhishyandi Āharas. Madya being the abhishyandi

and vidahi, it can cause Yakrit vikara and Yakrit vriddi and thereby leads to different

pathological symptoms of Yakrit.

By all these explanations we can consider that Madya leads to Madatyaya and

Madatyaya leads to Yakrit vikara, therefore the study or clinical trials taken on

Madatyayaja Yakrit Vikara.

Symptoms of alcoholic liver disorder and symptoms of Madatyayaja Yakrit Vikara

appears to be same. Hence Madatyayaja Yakrit Vikara can be considerd as Alcoholic

liver disorder.



Alcoholic liver disorder Madatyayaja Yakrit Vikara

Fatty liver Yakrit Vriddi

Fever Mandajvara

Loss of Appetite Mandagni

Nausea Hrillasa

Weakness Ksheenabala

Jaundice Atipandu

Satvavajaya Chikitsa Review


Concept of Satvavajaya Chikitsa

Trividha Aushadha

“Trividham Aushadham Iti Daivavyapashrayam Yuktivyapashrayam

Satvavajayascha167”

Three types of treatment modalities have been explained in

Ayurvedic science for the management of the various ailments related to the body as

well as the mind. They are – Daivavyapashraya, Yuktivyapashraya and Satvavajaya

Chikitsa.

a) Daivavyapashraya - It is termed the divine therapy or the therapy by faith. It

includes mainly the use of Mantra, Aushadha, Mani, Mangala, Bali, Homa, etc.

Detailed description of the Daivavyapashraya Chikitsa can be found in Atharvana-

Veda.

b) Yuktivyapashraya - It is the intellectual adoption of the treatment which includes

planned usage of medicines and the food.

c) Satvavajaya Chikitsa -The Satvavajaya Chikitsa includes various psychotherapies

which help in controlling of the Manas from moving towards the Ahita Arthas.

Satvavajaya Chikitsa

Satvavajaya Chikitsa is mainly aimed at controlling of the Manas from moving

towards the Ahita Arthas.

“Satvavajayam Punar Ahitebhyo Arthebhyo Mano Nigrahah”

The Satvavajaya chikitsa includes all the measures which help in restraining of

the Manas from craving towards the Ahita Arthas (unwholesome objects), and avoid

the involvement of the Manas in abnormal mental faculties i.e. Ati, Heena and Mithya

yoga.



Aims of Satvavajaya Chikitsa:

1. To help individual to discriminate between thoughts and actions.

2. To divert mind and make the person to involve with commitment in other

or next activity.

3. To help individual to discriminate between objective and imagined

dangers and to respond selectively to each.

4. To initiate Bhakti or regard or strengthen his believes in Ishta-Daivam.

5. To take out phobic nucleus by making awareness of subject knowledge

and true facts.

Need for the Satvavajaya Chikitsa

Among the three basic types of treatment explained for the treatment of

diseases–

a) Daivavyapashreya chikitsa – which is mainly aimed in the management of Bhuta

Abhishyanga Vyadhis and the neurotic type of disorders.

b) Yuktivyapshraya chikitsa - is mainly aimed at the somatic and the psycho somatic

disorders.

c) Satvavajaya chikitsa - is mainly aimed for the treatment of the Manasika Vikaras

by restraining the Manas from craving towards the unwholesome objects.

Techniques of the Satvavajaya Chikitsa

a)“Manasam Prati Bhaishajyam, Tadvidyaseva Vijnanamatmadinam Ca Sarvashah”168

b) “Dhi Dhairyatmaadi Vijnanam Manodoshoushadham Param”. 169

The Satvavajaya chikitsa includes

i) Jnana - The word Jnana denotes the application of various techniques in the

management of the mental ailments.



ii) Vijnana – The word Vijnana indicates various types of special techniques which

are applied in the treatment of the various conditions, such as-

a) Relaxation- Deep-muscle relaxation, Jacobsons relaxation, progressive muscle

relaxation, Yogic relaxation, etc

b) Hypnotherapy – Age regression, past life regression therapies etc.

iii) Dhi – The word Dhi indicates various techniques applied in improving the

intellect of the patient. Such as

a) Pancha tantra stories.

b) Play therapy.

c) Group therapy.

iv) Dhairya- “Dhairyam Unnatischetasah”

Charaka mentioned Dhairya as one of the methods of treatment of mental

diseases. Dhairya includes all the measures applied for the upliftment of ones Satva,

such as by direct, simple advice and reassurance, encouragement etc. The supportive

and cognitive psychotherapy of the modern psychology can be compared to the

Dhairya Chikitsa.

Atma Jnana – Providing the knowledge about the self is termed the Atma Jnana.

Such as,” Who am I, what are my aims, what is good and what is bad for me” etc.

Desha Jnana – Providing the knowledge about the Desha i.e.,

i) Dwelling place.

ii) Seasons.

iii) Rituals.

iv) Rules and regulations of the place etc.



Kulajnana – Providing the knowledge about the Kula i.e. the family to which he is

related to and the, Rituals of the family etc

Kala jnana- Providing knowledge about the Kala i.e knowledge about facts and

circumstances at that particular time.

Balajnana – The word Bala here indicates the Sharirika Bala as well as the Mano

Bala and the Vachika Bala. The Manasika Bala is said to be of three types, i.e. the

a) Pravara

b) Madhyama

c) Avara

i) The Bala Jnana includes the various techniques applied to improve the Manasika

Bala of the person and also to provide the knowledge of the self capacity to make him

aware of the dos and the don'ts.

Shakti jnana- Providing knowledge about strength and capacity according to the

situations and show the way towards the opportunities.

II) Psycho-phylaxis, which refers to the development of healthy mental and

emotional habits, attitude and behavior and is concerned with the prevention of

emotional problems and mental illness.

Samadhi-

The Samadhi includes implementation of Yoga, Pranayama, and Meditation etc

“Samadhih Samatavastha Jeevatma Paramatmanoh Yogah Samyoga

Ityuchyate Jeevatma Paramatmanoh”170

.

The union of Jeevatma and Paramatma is called the Samadhi and the state of oneness

of the Jeevatma and Paramatma is called the Yoga.



Yoga- “Yogah Chittavrutti Nirodhah”171

. The controlling of the Chittavrittis (i.e. the

activities of the Manas) is termed the Yoga.

The Yoga has got 8 Steps, they are

“Yama Niyama Asana Pranayama Pratyahara Dharana Dhyana Samadhiretani

Astavangani Yogasya”172

a) Yama, b) Niyama, c) Asana d) Pranayama

e) Pratyahara, f) Dharana, g) Dhyana, and h) Samadhi.

a)Yama (Self control) “Dehendrieshu Vairagyam Yama Ityucchate”.

Detachment from the Indriya Vishayas which yields to the self- control is called the

Yama.

For attaining the state of Yama, five steps have been explained. They are-

a) Ahimsa (Non-Violence),

b) Satya (Speaking truth),

c) Asteya (Abstinence from stealing),

d) Bramhacharya (Abstinence from sex)

e) Aparigraha (Disowning of possessions).

Niyama (Regulation)-

“Anuraktih Paretatve Satatam Niyamah Smrutah”.173

Means the state of continued attachment with the Paramatma is called as Niyama. The

Niyama has got 5 steps. They are

“Shoucha Santosha Tapa Svadhyaya Ishvara Pranidhanani Niyamani.”.174

a) Shoucha (Purity).

b) Santosha (Contentment).

c) Tapa (Right aspiration).



d) Svadhyaya (Study).

e) Ishvarapranidhana (Devotion to God).

Asana (Control of the Limbs)-

“Sthira Sukham Aasanam”

The control of the limbs ting in a stable and a comfort position is termed the Asana.

Pranayama (Cotrolled Breathing)-

“Yasmin Sati Svasa Prasvasa Yorgativicchedah Pranayama”175

The controlled breathing with the ultimate object of suspending it is termed the

Pranayama.

Pratyahara (Withdrawal of the Mind)-

“Chittasyantarmukhi Bhavah Pratyaharastu Satamah”.

In Mandala Bramhopanishad the Pratyahara is explained as the withdrawal of the

Manas from the Indriya Vishayas.

Dhyana (Meditation) –

“Tatra Pratyaikatanata Dhyanam”. 176

Dhyana is keeping the Manas fixed on one subject till a habit and a disposition

grows up.

Dharana –

“Deshabandha Chittasya Dharanah”177

Binding of the Manas with any subject, such as towards God is termed, in a

sense to bring a state of autohypnosis without external suggestion is Dharana.

Samadhi (Super Conscious State) –

“Tadevarthamaatra NirbhasamSvaroopa Shoonyameva Samadih”.178



Concentrating the Manas by getting detached from all sorts of worldly

thoughts is termed the Samadhi.

Importance of the Astanga Yoga –

By the practice of the Astanga Yoga one becomes free from all the sorts of the

disorders of the mind as well as the body, as there by one attains the control over all

his Jnanendriyas as well as Karmendriyas which helps to restrain from the disease of

the mind as well as the body.

Preventive Aspects of Satvavajaya Chikitsa -

The Preventive aspects of the Satvavajaya Chikitsa can be considered as the

Sadvrtta which have been explained in order to maintain the normal mental health.

They are as follows-

a) Respecting the God, teacher, elders, Yogis etc

b) Maintaining the physical and mental hygiene.

c) Avoid the Kayika, Vachika, and the Manasika Papa Karmas, such as

i) Kayika- Physically hurting other, theft, etc.

ii) Vaachika- Telling lies, insulting others by using bad words, etc.

iii) Manasika-Bad thoughts about others, thinking bad about others mentally.

d) Withhold the Dharaniya Vegas.

Summary of the Satvavajaya Chikitsa

The Satvavajaya chikitsa in brief can be explained in the following way.

1) Assurance (Dhairya).

2) By replacing the thought process (Chintya).



3) By regulating the ideas (Vicharya).

4) By channeling the presumptions (Oohya).

5) By polishing the objectives (Dhyeya).

6) By proper guidance and advice for taking the decision (Sankalpa).

7) Reframing the ideas.

8) Proper control of patience.

Table: 6, Application of Satvavajaya Chikitsa in Manasa Vikara

Manasika Vikara Satvavajaya chikitsa

Krodha Samyama, Ahimsa, Svanigraha

Shoka Harshana, Atmadi Jnana

Bhaya Ashvaasana, Dhairya chikitsa

Harsha: Atmadi Jnana.

Vishada Dhairya Chikitsa, Bala Jnana

Eersha Atma Jnana, Bala Jnana.

Abhyasooya: Atma Jnana.

Dainya Atma Jnana.

Matsarya Atmadi Jnana. Ahimsa , Samyama

Kama Samadhi

Lobha Atmadi Jnana, following Yama

Iccha Astanga Yoga, Atmadi Jnana

1) In the treatment of Aruchi in case of Rajayakshma “Chitta-Nirvaanam”

has been explained i.e. to keep the mind free from emotions.180



2) In case of the treatment of the “Dvistarthajanya Chardi” “Anukuulopachara” has

been adviced.181

3) In case of the treatment of the Bhayaja and Shokaja Atisara

“Ashvaasana and Harshana” i.e. creating confidence and happiness are

mentioned.182

4) In case of treatment of the Kustha some of the rituals like “Vruta Dama Seva

Tyaga Sheelabhiyoga” i.e. observance of vows, avoiding of anger and other

emotions, control of the senses, disciplined life, serving others, cultivating habit of

charity have been explained.183

5) In case of the treatment of the Bhutabhishyanga, the Bhuta which is not involved

in causing hurt, harm, should be won by-

“Bhutam Jayed Tapah Sheela Samadana Jnana Danadayadibih”. i.e. by observing

Tapa i.e. Penance, virtuous behavior, right conduct, good knowledge, charity, and by

showing mercy.

Psychotherapies

1) Behaviour therapy –The behavior therapy is mainly based on the theories of

learning (operant and classical), aims at changing maladaptive behavior and

substituting it with adaptive behavior. It involves the methods like

a) Systemic desensitization.

i) Relaxation. ii) Hierarchy construction. iii) Systemic desensitization.

b) Aversion therapy.

c) Operant conditioning procedures for increasing the behavior-

i) Positive reinforcement .ii) Negative reinforcement. iii) Modeling.

d) Flooding.



2) Cognitive Therapy:

Cognitive or cognitive behavior therapy is mainly aimed at correcting the

maladaptive methods of thinking.

The cognitive therapy is used for the treatment of depression, anxiety disorder,

panic disorder, phobias, eating disorders, etc. Techniques followed are teaching of the

problem solving skills, identifying and testing, maladaptive assumptions, activity

scheduling, homework assignments, behavioral rehearsal etc.

3) Supportive Therapy:

The supportive therapy mainly focuses on the existing symptoms or current

life situations. The aims of the therapy are-

i) Correction of situational problems.

ii) Symptom rectification.

iii) Strengthening defenses.

iv) Prevention of emotional breakdown.

v) Teaching new coping skills.

4) Family Therapy or Marital Therapy.-

Can be applied in cases of-

i) Family conflicts.

ii) Drug abuse.

iii) Spouse conflicts.

5) Group therapy-

The group therapy is a-

i) Less time consuming.

ii) Involves at least 8- 10 people at a time in treatment.



iv) The participants mainly suffer from the similar type of disorders such as diabetes,

hypertension, depression, anxiety etc. Which gives them a chance to know that there

are many other people who suffer from a similar disorder, and they will get a chance

to interact with all those people which give them a moral support and help them to

come out of their sufferings.

5) Rehabilitation- In case of chronic disorders.

6) Hypnotherapy– Hypnosis is a state of artificially induced increase state of

suggestibility. In this condition there will be constriction in the peripheral awareness

with increased focal concentration. The hypnotherapy involves providing of positive

thoughts and detachment from the negative thoughts.

Indications-

i) Conversion disorders.

ii) Dissociative disorder (Hysteria).

iii) Eating disorder.

iv) Habit disorder

v) Pain.

vi) Anxiety disorder.

Review of

Modern

Science

Alcohol Review


ALCOHOL REVIEW

Definition of Alcohol:

Alcohols are hydroxyl derivatives of aliphatic hydrocarbons. Alcohols exists naturally

either free or combined as esters; like phenols they generally have names ending „-ol‟

e. g. ethanol, glycerol and mannitol.151

Alcohol is one of the most widely used psychoactive drugs, and alcoholism is

characterized by chronic, repetitive, excessive use of alcohol such that it interferes

with the health, personal relationships, and livelihood of the drinker.

The active ingredient in most common alcoholic beverages is ethanol or ethyl alcohol,

yet other impurities including enanthic eathers, amyl alcohol, and acetaldehyde may

be contained in some liquor152

Types of Alcohol

The alcohols are classified mainly based on their number of hydroxyl group as

follows

Monohydric aromatic alcohols: benzyl alcohol, C6H5CH2OH and Cinnamyl alcohol,

C6H5CH = CHCH2OH, occur both free and as esters of benzoic and cinnamic acids.

Polyhydric aliphatic alcohols: the following are the alcohols with either four or six

hydroxyl groups. Erythritol, CH2OHCHOHCHOH CH2OH, is found in certain lichens

both free and combined with lecanoric acid.

Monohydric terpene alcohols: 1) noncyclic terpene alcohols occur in many volatile

oils for example, geraniol in otto of rose 2) monocyclic terpene alcohols aree

Alcohol Review


represented by terpineol and its acetate in neroli nad menthol 3) dicyclic terpene

alcohols are particularly abundant in the Coniferae (e.g sabinol and its acetate in

Juniperus Sabina)

Amino alcohols: Ecgonine and hydroxyl derivates of tropine are basic heterocyclic

compounds which occur either free or as esters in some of the Erythroxylacea,

Convolvulaceae and Solanaceae.153

Different Alcoholic Beverages:154

There are many alcoholic beverages available in the market those are differ from one

another based on the starch used for their preparation.

A. Malted liquors: produced by fermentation of germinating cereals: are undistilled

– alcohol content is low (3 – 6 %) e. g. Beers, Stout.

B. Wines: produced by fermentation of natural sugars as present in grapes and other

fruits. These are also undistilled.

Light wines: Claret, Cider alcohol content is 9 – 12 % cannot exceed 15%

Fortified wines: Port, Sherry (alcohol 16 – 22 %): distilled beverages are added

from outside

Effervescent wines: Champagne (12 – 16 % alcohol): bottled before fermentation is

complete

Wines are called „Dry‟ when all sugar present has been fermented and „Sweet‟ when

some is left.

C. Spirits: These are distilled after fermentation, alcohol content 40 – 55 %, eg. –

Rum, Gin, Whiskey, Brandy, vodka etc.

Alcohol Review


The taste, flavour and value of alcoholic beverages depend not only on alcohol

content but on presence of higher ethers, higher alcohols, aldehydes, esters, and

volatile oils: many of these are formed during the „maturation‟ of the beverage.

Other forms of alcohol:

i. Absolute alcohol: 99 % w/w/ ethanol (dehydrated alcohol).

ii. Rectified spirit: 90 % w/w ethyl alcohol – produced from mollases, by

distillation.

PHARMACOLOGY:

One cannot understand alcohol-related disorders without knowing something about

alcohol itself, what is alcohol, how it digests, absorbed, metabolise and excreted out

of the body.

Wine, beer, and such distilled spirits as whiskey, gin, and vodka differ in their content

of components other than alcohol. These congeners are responsible for much of the

characteristic taste of the beverage and consist of combinations of methanol, butanol,

aldehydes, phenols, tannins, lead, cobalt, iron, and other substances. Under certain

circumstances, congeners can have physiological effects, but their potency pales in

comparison with the effects of alcohol.

Properties and Metabolism of Alcohol155

Absorption:

Ethanol (beverage alcohol) is a simple molecule that is well absorbed through the

mucosal lining of the digestive tract in the mouth, esophagus, and stomach. The most

Alcohol Review


prominent area of uptake, however, is in the proximal small intestine, which is also

the site of absorption of many of the B vitamins. Ethanol rapidly enters the

bloodstream and, as a result of its high solubility in water, is distributed to almost

every body system. As a consequence of its modest fat solubility, alcohol is likely to

have effects on body membranes rich in fat, including neurons.

A Drink: 156

A standard drink of an alcoholic beverage is usually defined as containing 10 to 12

gm of ethanol. In round figures, this is the amount of alcohol contained in

approximately 12 oz of beer (which, in the United States, has approximately 3.6

percent ethanol), 4 oz of table wine (containing approximately 12 percent ethanol),

and between 1.0 and 1.5 oz of 80-proof spirits (containing 40 percent ethanol).

Blood alcohol level: 155

For an average 70-kg (155 lb) person who has an average amount of body fat, one

drink is likely to raise the blood alcohol level by approximately 15 to 20 mg/dL (the

same as 0.015 to 0.020 g/dL). The body subsequently metabolizes and excretes

approximately one drink per hour.

Factors influencing the absorption of alcohol:

The rate of absorption of alcohol from the digestive tract is likely to be faster on an

empty stomach than after a full meal, especially one rich in fats and carbohydrates.

Metabolism:

The major site of alcohol metabolism is the liver; small amounts are also metabolized

in the stomach, and kidneys. The most important enzyme is alcohol dehydrogenase

(ADH), which converts alcohol into acetaldehyde.

Alcohol Review


Metabolism in that organ occurs mostly through four pathways, with each resulting in

the production of acetaldehyde. Most of the process occurs through the actions of

alcohol dehydrogenase (ADH) in the cytosol of hepatic cells. Especially at high blood

alcohol levels, some of the alcohol is also broken down in the microsomes of the

smooth endoplasmic reticulum (the microsomal ethanol oxidizing system [MEOS]).

The ADH process is the usual rate-limiting metabolic step, occurring relatively slowly

because of the liver's need to handle the produced hydrogen ions through use of a

cofactor that is in relatively short supply, nicotinamide adenine dinucleotide (NAD).

The acetaldehyde produced primarily by ADH and MEOS is then destroyed by the

enzyme aldehyde dehydrogenase (ALDH) in both the liver cell cytosol and

mitochondria. This step occurs rapidly, with the result that the average person does

not have substantial levels of this substance. This is fortunate because, at high levels,

acetaldehyde can produce histamine release and other effects that, through a variety of

mechanisms, contribute to an increase and subsequent decrease in blood pressure

along with nausea and vomiting.

The ALDH and ADH isoenzyme patterns of an individual are related to the risk for

developing alcoholism. This is especially relevant to Asian (e.g., Japanese, Chinese,

Korean) men and women, although the impact of genes that control ADH also extends

to some other groups.

Gastric metabolism:

Alcohol metabolism begins in the stomach by the activity of gastric (ADH). The

degree of metabolism depends upon several factors. It is greater with beverages such

as whisky with high ethanol content compared to low concentration drinks like beer.

Alcohol Review


Alcohol metabolism is less on empty stomach, because of rapid gastric emptying,

which explains the quick „high‟ people experience when drinking without food.

Gastric ADH is inhibited by drugs such as aspirin and H2 receptor blockers, resulting

in higher blood alcohol levels.

Hepatic metabolism:

In the liver, alcohol metabolism is carried out by two different enzyme systems.

Hepatic ADH located in the cytoplasm of the cells, plays the dominant role. Ethanol is

also metabolized in the endoplasmic reticulum by the microsomal ethanol

metabolizing system (MEOS), a part of the P450 enzymes. Acetaldehyde is again

produced but in addition, free oxygen radicals are released which are damaging to the

tissues. MEOS has a lower affinity for ethanol compared to ADH, therefore, at low

blood alcohol levels; ADH is responsible for most of the ethanol metabolism, while at

higher levels, and MEOS also plays an important role.

Excreation: After absorption into the bloodstream from the small intestine, between 2

and 10 percent of the alcohol is then excreted unchanged from the lungs or the

kidneys or through sweat, but the majority is broken down in the liver.

Mechanism of action of Alcohol: 156

The mechanism of action of alcohol on the nervous system has been debated for

decades, and since the turn of the century, some investigators have speculated that

alcohol acts as a non specific drug, producing its action via perturbation of neuronal

membrane lipids. More recently, it has been suggested that ethanol acts at the

interface between membrane lipids and integral membrane proteins

Alcohol Review


Neurotransmitter gated ion channels have also been focus of attention regarding the

potential site of alcohol action, including nicotinic acetylcholine, GABAA, and N –

methyl – D – aspartate (NMDA) receptor – ion channels. Alcohol affects the function

of these receptors - ion channels mostly via direct interactions, yet the molecular

structure of the alcohol binding site has yet to be determined.

Tolerance to alcohol is defined as an acquired resistance to the effects of the drug,

which can be related to pharmacokinetics, pharmacodynamic, environmental and

behavioral factors. It has been hypothesized that tolerance represents an adaptive

changes in the CNS with mechanistic similarities to learning or memory function.

EFFECTS ON THE BODY: 157

Alcohol as a Depressant Drug; Neurochemical Effects of Ethanol:

Alcohol has major effects on most neurochemical systems, depending on the dose,

with opposite actions during intoxication and withdrawal. One series of theories on

the mechanisms underlying intoxication and subsequent craving focuses on changes

in dopamine, tying in the effects of alcohol to the pleasure centers in the limbic

system. Alcohol acutely increases dopamine and its metabolites, brain imaging

reveals enhanced activity in relevant areas of the brain, and chronic drinking changes

dopamine receptor numbers and sensitivity. Another key neurochemical is serotonin,

with alcohol causing changes in key aspects of this transmitter and associated

receptors, and levels of serotonin impact on the amount of alcohol consumed.

Additional studies point out the indirect actions that alcohol has on the

benzodiazepine receptor–sensitive γ-aminobutyric acid (GABA) complexes in the

brain. These effects, especially actions on the GABA type A receptor (GABAA),

Alcohol Review


enhance the acute sedating, sleep-inducing, anticonvulsant, and muscle-relaxing

effects of alcohol. Alcohol has potent effects on glutamate-gated ionophoric receptors,

especially those that bind N- methyl-D-aspartate (NMDA), which are muted during

intoxication and overactive during alcohol withdrawal. Finally, alcohol also acutely

enhances the functioning of the opioid-related brain systems and impacts on

adenosine, neurosteroids, and acetylcholine.

Tolerance:

With repeated administration of alcohol, larger and larger doses of the drug are

required to produce the desired effect. This phenomenon, called tolerance, is also the

ability to tolerate higher and higher doses of the substance and is the result of at least

three processes. Behavioral tolerance reflects the ability of a person to learn how to

perform tasks effectively despite the effects of alcohol. Pharmacokinetic tolerance is

an adaptation of the metabolizing systems, including ADH and MEOS, to rid the body

of alcohol rapidly. Finally, and most important, pharmacodynamic or cellular

tolerance is an adaptation of the nervous system so that it can function, despite very

high blood alcohol concentrations (e.g., as much as 600 mg/dL), by resisting the

actions of alcohol on the cell.

Once tolerance has developed for one of the brain depressants, an individual is likely

to demonstrate a similar reaction to a second drug of that class (cross-tolerance).

Therefore, a person who has been drinking heavily has tolerance for alcohol, and then

stops drinking can be expected to require a higher dose of benzodiazepines for sleep

induction. If the individual took two depressant drugs at the same time, tolerance is

not likely to be observed, and the mixing of the two substances can have lethal

effects.

Alcohol Review


Aspects of tolerance decrease and even disappear with consecutive weeks of

abstinence. In addition, some clinicians and researchers have described a phenomenon

of reverse tolerance, increased sensitivity, or sensitization. This is a complex situation

that might relate to neurochemical adaptations or other mechanisms. For example,

whether alcoholic or not, as people grow older, they have increasing levels of reaction

to most brain depressants, including alcohol. Even more dramatic examples of

increased reaction to alcohol are seen after severe brain damage (e.g., the consequence

of an auto accident or alcohol-related brain deterioration) and after impairment in any

of the major alcohol-metabolizing systems, as occurs in cirrhosis.

Craving:

The state of motivation to seek out alcohol is an important component of drinking

behavior. This phenomenon of craving, however, fluctuates with time and can be

difficult to measure. Aspects of the drive to drink are believed to relate to classical

conditioning and to also reflect neurochemical changes

Blackout:

Blackout indicates memory impairment (anterograde amnesia) for the period when

the person was drinking heavily but remained awake. This common phenomenon is

related to the ability of any brain depressant at high enough doses to interfere with the

acquisition of memory. Perhaps 40 percent of teenaged and young adult males have

had a blackout, and memory loss does not by itself indicate a high likelihood of

alcohol abuse or dependence. The blackout, which is temporary and limited to

memory problems involving a short period is not part of the DSM-IV-TR diagnosis

and is distinct from alcohol-induced persisting amnestic disorder, formerly known as

Wernicke-Korsakoff syndrome.

Alcohol Review


Effect on Sleep:

Alcohol intoxication can help a person fall asleep more quickly, but if the intake in an

evening is more than one or two drinks, the sleep pattern can be significantly

impaired. Most heavy drinkers awaken after several hours and can have problems

falling back asleep. Alcohol also tends to depress rapid eye movements (REMs) and

inhibit stage 4 sleep and, thus, is likely to be associated with frequent alternations

between sleep stages (sleep fragmentation) and with more dreams late in the night as

the blood alcohol level falls. Exaggerated forms of similar problems are seen in

alcoholics in whom sleep stages might not return to normal for 3 or more months of

abstinence.

Effect on nervous system: on Cerebellum:

Characterized by unsteadiness of gait, problems with standing, and mild nystagmus,

cerebellar degeneration is probably caused by a combination of the effects of ethanol

and acetaldehyde along with vitamin deficiencies. Treatment usually consists of total

abstinence and vitamin supplementation, although complete recovery is not usual.

Other Effects on the Central Nervous System:

Several rare but serious neurological and cognitive syndromes can also be observed in

alcohol-dependent men and women. A thiamine deficiency, especially in the context

of a preexisting vulnerability, such as a transketolase deficiency, can present as any of

several neurological syndromes, including a sixth cranial nerve palsy (Wernicke's)

and a severe anterograde amnesia that is out of proportion to the alcohol level of

confusion (Korsakoff's). Two additional central nervous system (CNS) syndromes are

Alcohol Review


often fatal, including a loss of myelin in the central pons that can present as

quadriplegia, lethargy, and cognitive impairment (central pontine myelinolysis) and a

thinning of the corpus callosum along with a change in consciousness, ataxia, and

possible dementia (Marchiafava-Bignami syndrome).

Beneficial Effects on the Body:

Under certain circumstances, one to two drinks per day can have some beneficial

effects. Low doses of ethanol appear to decrease the risk for myocardial infarction and

thrombotic stroke, probably through decreasing platelet aggregation and enhancing

the beneficial impact of high-density lipoprotein cholesterol. Additional

cardioprotective action may occur through antioxidant flavinoids or the inhibition of

the vasoconstrictor, endothelin-1, in the components of red wine. Low doses of

alcohol have also been reported to decrease the risks for some old-age dementias,

peripheral arterial disease, and gallstones.

Peripheral Neuropathy:

Approximately 10 percent of alcoholic people develop a deterioration of nerve

functioning to the hands and feet called peripheral neuropathy. The symptoms

include numbness of the hands and feet, often bilateral, frequently accompanied by

tingling and paresthesias. Although the condition is usually relatively mild and often

improves with abstinence, the pain and the numbness can result in a permanent

impairment.

Alcohol Review


Gastrointestinal Problems

The gastrointestinal (GI) system can be severely affected by heavy drinking, with a

relatively common problem of an acute and at times severe inflammation of the

esophagus or the stomach, often accompanied by vomiting and bleeding. If gastritis

occurs in the presence of dilated esophageal veins, as seen with cirrhosis, it can

induce potentially lethal bleeding.

Effect on Liver:

The liver and the pancreas are especially vulnerable to alcohol. In the liver, increasing

alcohol doses result in the accumulation of fats and proteins in the cells, producing a

reversible swelling often described as a fatty liver. Inflammation of the liver cells

accompanied by a subsequent intense increase in some liver function tests and other

signs of alcohol-induced inflammation, or hepatitis, can lead to the deposition of

excessive amounts of hyalin and collagen near blood vessels, an early stage of

cirrhosis, a condition only seen in approximately 15 percent of alcoholics. As damage

progresses, the normal flow of blood through the liver is impaired, dilated veins or

varices develop from the increased abdominal venous pressure, and fluid seeps from

the liver capsule, accumulating in the abdomen as ascites. As liver failure progresses,

secondary cognitive impairment can develop as various levels of hepatic

encephalopathy.

Effect on pancreas:

Perhaps 10 percent of alcoholic people develop an inflammation of the pancreas that

can present as the abdominal emergency of acute pancreatitis, which can lead to a

Alcohol Review


chronic irreversible condition with associated signs of insufficiency of both sugar

metabolism (a form of diabetes) and digestive enzymes. One corollary of even early-

stage effects of alcohol on the liver and pancreas is an abnormality in blood sugar

levels that often reverts to normal glucose tolerance with maintained abstinence.

Cardiovascular Problems:

Heavy intake of alcohol increases the blood pressure and elevates both LDL

cholesterol and triglycerides, thus enhancing the risk for myocardial infarction and

thrombosis. At high doses, alcohol is also a striated-muscle toxin with a resulting

deterioration in the heart muscle that manifests itself as beating irregularities and

signs of heart failure (alcoholic cardiomyopathy). Thus, it is not surprising that the

leading cause of early deaths in alcoholics is cardiovascular disease. Similar levels of

swelling of muscle cells and subsequent muscle pain can be observed in the skeletal

muscles.

Blood-Producing Systems

Alcohol intake of four to eight drinks or more per day decreases the production of

white blood cells and impairs the ability of those cells to migrate to sites of infection.

Such drinking can also affect the stem cells that produce the red blood components,

significantly increasing the average size of the red cell (the mean corpuscular volume

[MCV]), and can impair the production and the efficiency of blood platelets.

Cancer:

High rates of most cancers are seen in alcoholic people, especially those of the head,

neck, esophagus, stomach, liver, colon, lungs, and breast tissue. An enhanced risk for

Alcohol Review


breast malignancies might be seen with as few as two drinks per day, especially in

women with family histories of this disease. The association with cancer probably

reflects alcohol-related immune system suppression and the direct effects of ethanol

on mucosal membranes. The heightened rates of malignant tumors in alcoholic people

remain significant even when the possible effects of smoking and poor nutrition are

considered, and this is the second leading cause of premature death in alcohol-

dependent men and women.

Withdrawal syndromes:

The manifestation of alcohol withdrawal occur when a person decreases or stops a

high level alcohol intake, either after a binge lasting a matter of days or after the

regular ingestion of alcohol sustained over many months. Although the exact

mechanism are not known, most symptoms appear related to over activity of various

portions of the nervous system resembling a “rebound” phenomenon after profound

suppression, and its basis may relate to alterations in the functions of GABA or

NMDA receptor system. The earliest findings of alcohol withdrawal typically occur

within 6 to 8 hours of alcohol cessation. Tremulousness is the earliest and most

common complaint, and many alcoholics view their so called shakes as an indication

that it is time to resume drinking in order to avoid more severe complications of

withdrawal. Tremors appear within hours of cessation of alcohol ingestion and

gradually increase to peak within 1 or 2 days. The tremor is postural and appears to be

irregular due to its variable but large amplitude. The amplitude may increase at the

end points of an action, and the typical frequency varies from 6 to 11 Hz. This

movement abnormality mainly involves by hands it can cause titubation. The tremor

remits during relaxation and sleep but often persists for weeks after discontinuation of

Alcohol Review


alcohol consumption. The pathophysiological mechanisms of tremors are not known,

but it probably represents an exaggerated physiological tremor. The tremulousness is

associated with hyperacuity of all sensory modalities, hyper - reflexia, hypervigilince,

anxiety, tachycardia, hypertension and insomnia. The severity of these signs and

symptoms vary with the intensity and duration of the previous alcohol exposure. In

mild forms of withdrawal, the signs and symptoms usually resolve after 48 hours.

In severe reactions, patient may experience additional symptoms including

auditory hallucinations, which usually take the form of identifiable voices saying

critical or threatening things to the patients. When they occur, hallucinations generally

appear within 24 hours of withdrawal. At first, patients tend to accept the voice as real

and react accordingly, but as the intensity of hallucinations wanes, they recognize

their true origin. The hallucinations may be accompanied by global confusions, and

the autonomic hyperactivity continues and may become more pronounced.

The alcohol-related disorders


ALCOHOL-RELATED DISORDERS 158

The alcohol-related disorders impact on all aspects of health care delivery systems,

especially psychiatric practice. At least 20 percent of the patients in mental health

settings have alcohol abuse or dependence, including individuals from all

socioeconomic strata and both genders. A recent national evaluation of students on

college campuses reported a 12-month prevalence for alcohol dependence of 6

percent and for abuse more than 20 percent—and alcohol has been estimated to have

contributed to at least 15,000 deaths in students per year. Of particular importance to

the psychiatrist are the estimated 40 to 50 percent of alcoholics who develop alcohol-

induced, but temporary, clinical syndromes that resemble major depressive disorder,

panic disorder, generalized anxiety disorder, and additional mood or anxiety

conditions. In addition, men and women with several independent psychiatric

disorders have elevated risks for the future development of alcohol-related disorders,

including those with manic-depressive disease, schizophrenia, antisocial personality

disorder, panic disorder, and possibly generalized anxiety disorder.

These data emphasize the need for all health care providers, especially psychiatrists,

to develop and maintain skills for diagnosing and treating alcohol-related disorders.

Definition:

Alcohol Use Disorder: 159

In all diagnostic systems, the definition of alcoholism (i.e., alcohol abuse and

dependence) relates to evidence of repeated impairments from alcohol in multiple

areas of life functioning, despite which the person returns to drinking. According to

DSM-IV-TR, alcohol dependence is diagnosed as the repeated presence of at least



three of seven major areas of life impairment related to alcohol that cluster together in

the same 12-month period. These difficulties include tolerance, evidence of a

withdrawal syndrome when the drug is discontinued or intake is decreased, potential

interference with life functioning associated with spending a great deal of time using

the substance, and returning to use despite evidence of physical or psychological

problems. It is the syndrome of dependence for which the best data are available

regarding the usual clinical course of problems, appropriateness of treatment, and

potential importance of genetic factors. All patients with a possible alcohol use

disorder should first be evaluated for the presence of alcohol dependence. For those

who do not meet the criteria for this disorder, however, there is a second potential

syndrome to consider, abuse. Here, an individual who is not dependent on alcohol

demonstrates repeated problems within any 12-month period in any one or more of

four potential areas of difficulties. These include repeated legal, interpersonal, social,

or occupational impairments related to alcohol as well as use of alcohol in physically

unsafe situations. DSM-IV-TR reformulated the concept of abuse to identify criteria

that were not just a subset of those noted for dependence.

A similar definition of dependence is offered in the tenth revision of the International

Statistical Classification of Diseases and Related Health Problems (ICD-10). Here,

however, the threshold for diagnosis is any three of six (rather than seven) items.

ICD-10 also lists a second and less intense alcohol use disorder known as harmful

use. The definition of this second syndrome is quite different from DSM-IV-TR abuse

because the ICD-10 approach is based on evidence of repeated interference with

psychological and physical health functioning and does not include social impairment,

legal problems, or use in physically hazardous situations.



Attempts have been made to further divide alcohol dependence into additional

clinically meaningful subgroups. Some authors have called for the recognition of a

more severe early-onset alcohol dependence syndrome, often accompanied by

criminality and dependence on other drugs, which has been labeled as type II or type

B alcoholism.

Epidemiology: 160

Psychiatrists need to be concerned about alcoholism because this condition is

common, intoxication and withdrawal mimic many major psychiatric disorders, and

the usual alcoholic person does not fit the common stereotype.

Prevalence of Drinking:

At some time during life, 90 percent of the population in the United States drinks,

with most people beginning their alcohol intake in the early to middle teens. By the

end of high school, 80 percent of students have consumed alcohol, and more than 60

percent have been intoxicated. At any time, two out of three men are drinkers, with a

ratio of persisting alcohol intake of approximately 1.3 men to 1.0 woman, and the

highest prevalence of drinking is from the middle or late teens to the mid-20s.

Very high rates of alcohol problems are found among most, but not all, American

Indian and Inuit tribes.



Table – 7

Epidemiology of alcohol

Alcohol Epidemiology

Condition Population (%)

Ever had a drink 90

Current drinker 60–70

Temporary problems 40+

Abuse Male: 10+

Female: 5+

Dependence Male: 10

Female: 3–5

Alcohol Problems: 161

Because a high proportion of people are drinkers, especially in their middle teens to

mid-20s, and because the per capita consumption of alcohol is high, it is not

surprising that a large proportion of people have alcohol-related problems sometime

in their lives. A recent 10-year follow-up study of almost 500 men evaluated at 33

years of age found that, during the preceding decade, between one-fourth and one-

third had alcohol-related blackouts, approximately one-third admitted to driving after



consuming enough alcohol to be impaired, and 20 percent reported missing school or

work because of either a hangover or a desire to party with alcohol rather than work.

As common and costly as these problems are, most people mature out of less severe

alcohol problems with the passage of time. Thus, the average person is likely to

experience fewer alcohol-related difficulties during their 30s than during their 20s,

and even fewer difficulties in their 40s and 50s.

Alcohol Abuse or Dependence: 161

The lifetime risk for alcohol dependence is approximately 10 to 15 percent for men

and 3 to 5 percent for women. The rate of alcohol abuse and dependence combined

may be as high as 20 percent for men and more than 10 percent for women. These

high rates have been reported for all socioeconomic and educational levels.

The age of peak onset of alcohol problems severe enough to lead to a diagnosis of

alcohol dependence is probably in the middle 20s to approximately 40 years of age.

Despite multiple difficulties, most alcohol-dependent people have jobs, families, and

relatively high levels of functioning. Thus, the stereotypical alcoholic person who is a

homeless street person is very much the exception rather than the rule, representing

only 5 percent of all people with severe, recurring alcohol-related difficulties.

Age-related differences are found in the pattern of alcohol-related problems. Earlier

the onset of alcoholism, greater the severity and higher the probability of a preexisting

independent psychiatric condition. Therefore, when alcohol dependence is noted in a

teenager, the person usually also has conduct disorder (e.g., early antisocial

personality disorder). In that instance, the alcohol-related problems are likely to be



associated with severe drug difficulties and antisocial problems in school and with

family or peers that occurred before the onset of alcohol dependence. At the other

extreme, although most alcoholic people have their problems early in life, possibly 10

percent or so have an onset of recurring difficulties after the age of 55 years. The late

onset of the disorder tends to be associated with less severe social difficulties and

more subtle signs and symptoms, but a greater likelihood of associated medical

problems than among younger alcoholic people.

Etiology162

Many factors affect the decision to drink, the development of temporary alcohol-

related difficulties in the teenage years and the 20s, and the development of alcohol

dependence. The initiation of alcohol intake probably depends largely on social,

religious, and psychological factors, although genetic characteristics might also

contribute. However, the factors that influence the decision to drink or those that

contribute to temporary problems might be different from those that add to the risk for

the severe, recurring problems of alcohol dependence.

It is likely that a series of genetic influences combine to explain approximately 60

percent of the proportion of risk for alcoholism, with environment responsible for the

remaining proportion of the variance. Therefore, the divisions are more heuristic than

real, as it is the combination of a series of psychological, sociocultural, biological, and

other factors that are responsible for the development of severe, repetitive alcohol-

related life problems.



Psychological Theories:

A variety of theories relate to the use of alcohol to reduce tension, increase feelings of

power, and decrease the effects of psychological pain. Perhaps the greatest interest

has been paid to the observation that people with alcohol-related problems often

report that alcohol decreases their feelings of nervousness and helps them cope with

the day-to-day stresses of life. The psychological theories are built in part on the

observation among nonalcoholic people that the intake of low doses of alcohol in a

tense social setting or after a difficult day can be associated with an enhanced feeling

of well-being and an improved ease of interactions. However, in high doses,

especially at falling blood alcohol levels, most measures of muscle tension and

psychological feelings of nervousness and tension are increased. Thus, tension-

reducing effects of this drug might impact most on light to moderate drinkers or add

to the relief of withdrawal symptoms but play a minor role in causing alcoholism. The

theories that focus on alcohol's potential to enhance feelings of being powerful and

sexually attractive and to decrease the effects of psychological pain are difficult to

definitively evaluate.

Psychodynamic Theories:

Perhaps related to the inhibiting or anxiety-lowering effects of lower doses of alcohol

is the hypothesis that some people may use this drug to help them deal with self-

punitive harsh superegos and to decrease unconscious stress levels. Also, classic

psychoanalytical theory hypothesizes that at least some alcoholic people may have

become fixated at the oral stage of development and use alcohol to relieve their

frustrations by taking the substance by mouth. However, hypotheses regarding



arrested phases of psychosexual development, although heuristically useful, have had

little effect on the usual treatment approaches and are not the focus of extensive

ongoing research. Similarly, most studies have not been able to document an

―addictive personality‖ present in the majority of alcoholics and associated with a

propensity to lack of control of intake over a wide range of substances and foods.

Although pathological scores on personality tests are often seen during intoxication,

withdrawal, and early recovery, many of these characteristics are not found to predate

alcoholism, and most disappear with abstinence. Similarly, prospective studies of

children of alcoholics who themselves have no co-occurring disorders usually

document high risks mostly for alcoholism. As described below, one partial exception

to these comments occurs with the extreme levels of impulsivity seen in the 15 to 20

percent of alcoholic men with antisocial personality disorder, as these people have

high risks for criminality, violence, and multiple substance dependencies.

Behavioral Theories:

Expectations about the rewarding effects of drinking, cognitive attitudes toward

responsibility for one's behavior, and subsequent reinforcement after alcohol intake all

contribute to the decision to drink again after the first experience with alcohol and to

continue to imbibe despite problems. These issues are important in efforts to modify

drinking behaviors in the general population, and they contribute to some important

aspects of alcoholic rehabilitation.

Sociocultural Theories:

Sociocultural theories are often based on extrapolations from social groups that have

high and low rates of alcoholism. Theorists hypothesize that ethnic groups, such as



Jews, who introduce children to modest levels of drinking in a family atmosphere and

eschew drunkenness have low rates of alcoholism. Some other groups, such as Irish

men or some American Indian tribes with high rates of abstention but a tradition of

drinking to the point of drunkenness among drinkers, are believed to have high rates

of alcoholism. However, these theories often depend on stereotypes that tend to be

erroneous, and there are prominent exceptions to these rules. For example, some

theories based on observations of the Irish and the French have incorrectly predicted

high rates of alcoholism among the Italians.

Yet, environmental events, presumably including cultural factors, account for as much

as 40 percent of the alcoholism risk. The cultural attitudes toward drinking,

drunkenness, and personal responsibility for consequences are important contributors

to the rates of alcohol-related problems in a society. In the final analysis, social and

psychological theories are probably highly relevant, as they outline factors that

contribute to the onset of drinking, the development of temporary alcohol-related life

difficulties, and even alcoholism. The problem is how to gather relatively definitive

data to support or refute the theories.

Table – 8

Data Supporting Genetic Influences in Alcoholism

Close family members have a fourfold increased risk.

The identical twin of an alcoholic person is at higher risk than is a fraternal twin.

Adopted-away children of alcoholic people have a fourfold increased risk.



Possible Biological Mediators of the Alcoholism Risk:

There appears to be a series of independent characteristics that impact the alcoholism

risk. First, as discussed earlier, genes on chromosome 12 that control ALDH and

those on chromosome 4 that relate to ADH can decrease the alcoholism risk. The

most relevant isoenzyme is the low Km ALDH2 located in the mitochondria of cells,

and the gene responsible for the ALDH2*2 polymorphism is seen in approximately 50

percent of Japanese, Chinese, and Korean individuals. If a person carrying this gene is

an ALDH2*2, 2*2 homozygote, they have inherited a disulfiram (or Antabuse)–like

aversive reaction to alcohol because they cannot metabolize low to moderate levels of

acetaldehyde and have almost no alcoholism risk. Heterozygotes (e.g., with

ALDH2*2, 2*1 alleles) have a mild to modest facial flush, enhanced heart rate, and a

moderately more intense (although not more aversive) response to alcohol. It has been

hypothesized that the higher response may contribute to a significant decreased risk

for alcohol use disorders, although the level of protection is much less for that seen

for homozygotes. However, if a person with this heterozygous genotype does develop

alcohol dependence, he or she may carry higher risks for damage to the brain, liver,

pancreas, and testes, perhaps as a consequence of higher acetaldehyde levels when

they drink. In addition, genes that impact on ADH2 and ADH3, which are more

prevalent among Asian, black, and Jewish individuals, might be responsible for a

slight increase in the rapidity of breakdown of alcohol, with a possible modest

increase in acetaldehyde. This has been hypothesized to have a relatively small

protective effect against alcohol use disorders, perhaps through enhancing the level of

response to alcohol.



A second potentially important genetically influenced mechanism appears to relate to

genes that impact on impulsivity, sensation seeking, and disinhibition. Studies using

personality profiles and investigations incorporating electrophysiological measures of

disinhibition both report that these characteristics are seen at a higher-than-expected

prevalence among alcoholics, are observed in a substantial minority of children of

alcohol-dependent individuals, and are strongly related to yet-to-be-identified genes.

These findings might reflect the fact that more impulsive or disinhibited individuals,

who, at the extreme, have the antisocial personality disorder, are both more likely to

drink and less likely to demonstrate self-control when under the influence of alcohol.

Consistent with this hypothesis is the fact that this type of predisposition toward

substance-related disorders extends to all substances of abuse. An alternative

hypothesis is that alcohol or other drugs have specific brain effects that ameliorate

some of the consequences of the biological aspects of the disinhibition.

DIAGNOSIS AND CLINICAL FEATURES163

Alcohol use disorders are among the most common of the serious life-threatening

behavioral or psychiatric syndromes. It is difficult to know whether the person is

having alcohol related disorders or not because the average man or woman presenting

with severe and repetitive alcohol problems is likely to be neatly dressed, to show no

signs of severe alcohol withdrawal. The alcohol-related disorders in DSM-IV-TR and

also presents a comparable listing from ICD-10.



Table – 9

DSM-IV-TR Alcohol-Related Disorders and Corresponding ICD - 10 Disorders

DSM-IV-TR ICD-10 Corollary

Alcohol use disorders

Alcohol dependence Alcohol dependence syndrome

Alcohol abuse Alcohol harmful use

Alcohol-induced disorders

Alcohol intoxication Acute intoxication due to use of alcohol

Uncomplicated With trauma or other bodily

injury, With other medical complications

Alcohol intoxication delirium With delirium

With perceptual distortions

With coma

With convulsions

No DSM-IV-TR equivalent Pathological intoxication

Alcohol withdrawal Alcohol withdrawal state

Specify if: with perceptual

disturbances

Uncomplicated With convulsions

Alcohol withdrawal delirium Alcohol withdrawal state with delirium

Without convulsions

With convulsions

Alcohol-induced persisting dementia Residual and late-onset psychotic

disorder

Dementia

Alcohol-induced persisting amnestic

disorder

Amnestic syndrome

Alcohol-induced psychotic disorder,

with delusions

Psychotic disorder

Specify if: with onset during

intoxication/with onset during

withdrawal

Schizophrenia-like

Predominantly delusional

Predominantly hallucinatory

Predominantly polymorphic

Predominantly depressive symptoms

Predominantly manic symptoms

Mixed Or

Alcohol-induced psychotic disorder,

with hallucinations

Residual and late-onset psychotic

disorder

Late-onset psychotic disorder or



withdrawal

Organic delusional (schizophrenia-like)

disorder or



Organic hallucinosis

Alcohol-induced mood disorder Organic mood (affective) disorder or



withdrawal

Residual and late-onset psychotic

disorder

Residual affective disorder

Alcohol-induced anxiety disorder Organic anxiety disorder



withdrawal

Alcohol-induced sexual dysfunction


intoxication

Alcohol-induced sleep disorder



withdrawal

Alcohol-related disorder not

otherwise specified

Other mental or behavioral disorder

induced by alcohol

Unspecified mental or behavioral

disorder induced by alcohol

Alcohol Dependence

DSM-IV-TR provides general criteria for all substance use disorders. These are stated

in broad terms to be applied to all substances of abuse. Dependence concerns a history

of an array of problems, including compulsive intake of alcohol, an increasingly

important place in life occupied by the substance, and possibly evidence of physical

withdrawal symptoms. Dependence criteria also concern life impairment related to the

substance.

Physical dependence is a phenomenon that overlaps greatly with tolerance. As the

body changes to resist the effects of alcohol, it is likely to reach a condition in which

it cannot function optimally unless the brain depressant is present and in which

rebound or withdrawal symptoms develop if the depressant drug is stopped quickly.



DSM-IV-TR substance dependence criteria include seven items that are subsets of the

nine originally listed in DSM-III-R. These seven items are similar to the ICD-10

dependence syndrome criteria, although ICD-10 deals more directly with evidence of

a compulsion to use. In addition, DSM-IV-TR use the two items that deal with

tolerance or withdrawal to further classify dependent people into those with and those

without evidence of physiological symptoms. Recent data support the conclusion that

a history of tolerance or withdrawal, especially the latter, is associated with a more

severe course of alcoholism both by history and in the future.

Alcohol Abuse

The DSM-IV-TR diagnostic criteria for abuse focus on the impairment of social,

legal, interpersonal, and occupational functioning in a person who is not alcohol

dependent. ICD-10 presents a diagnosis of harmful use that is only approximately

similar to DSM-IV-TR, as the international system is limited to physical or

psychological problems.

Alcohol Intoxication

The DSM-IV-TR diagnostic criteria for alcohol intoxication are based on evidence of

recent ingestion of ethanol, maladaptive behavior, and at least one of six possible

physiological correlates of intoxication. The ICD-10 criteria for acute alcohol

intoxication are generally similar to DSM-IV-TR, listing seven physiological signs of

intoxication, some of which, such as conjunctival injection, are not seen in DSM-IV-

TR.



Table - 10

DSM-IV-TR Diagnostic Criteria for Alcohol Intoxication

A. Recent ingestion of alcohol.

B. Clinically significant maladaptive behavior or psychological changes (e.g.,

inappropriate sexual or aggressive behavior, mood lability, impaired

judgment, impaired social or occupational functioning) that developed during,

or shortly after, alcohol ingestion.

C. One (or more) of the following signs, developing during, or shortly after,

alcohol use:

(1) Slurred speech

(2) Incoordination

(3) Unsteady gait

(4) Nystagmus

(5) Impairment in attention or memory

(6) Stupor or coma

D. The symptoms are not due to a general medical condition and are not better

accounted for by another mental disorder.

E. From American Psychiatric Association. Diagnostic and Statistical Manual of

Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric

Association; 2000, with permission.

Blood Alcohol Concentrations and symptoms:

Evidence of behavioral changes, a slowing in motor performance, and a decrease in

the ability to think clearly occurs at doses as low as 20 to 30 mg/dL. Following table

shows the symptoms at various blood alcohol concentrations.



Table – 11

Impairment Likely to be seen at Different Blood Alcohol Concentrations

Level Likely Impairment

20–30 mg/dL Slowed motor performance and decreased

thinking ability

30–80 mg/dL Increases in motor and cognitive

problems

80–200 mg/dL Increases in incoordination and judgment

errors

Mood liability

Deterioration in cognition

200–300 mg/dL Nystagmus, marked slurring of speech,

and alcoholic blackouts

>300 mg/dL Impaired vital signs and possible death

Alcohol Withdrawal:

In people who have been drinking heavily over a prolonged period, a rapid decrease

in blood alcohol levels might produce a variety of physical symptoms. Typical of

brain depressants, including barbiturates and benzodiazepines, this withdrawal or

abstinence syndrome is characterized by a group of symptoms that are the opposite of

what was initially experienced with intoxication. These include a coarse tremor of the

hands, insomnia, anxiety, and increased blood pressure, heart rate, body temperature

and respiratory rate—a condition labeled in DSM-IV-TR as alcohol withdrawal. In

ICD-10, the criteria for alcohol withdrawal are similar to those listed in DSM-IV-TR,



with some differences in the specific items listed and the number of signs required

(i.e., three) to make a diagnosis. The DSM-IV-TR criteria for alcohol withdrawal also

require that the symptoms must cause clinically significant distress or impairment.

Although 95 percent or more of withdrawals are limited to these mild or moderate

symptoms, for 3 to 5 percent, the symptoms include convulsions or delirium.

Table - 12

DSM-IV-TR Diagnostic Criteria for Alcohol Withdrawal

A. Cessation of (or reduction in) alcohol use that has been heavy and prolonged.

B. Two (or more) of the following, developing within several hours to a few days

after Criterion A:

(1) Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100)

(2) Increased hand tremor

(3) Insomnia

(4) Nausea or vomiting

(5) Transient visual, tactile, or auditory hallucinations or illusions

(6) Psychomotor agitation

(7) Anxiety

(8) Grand mal seizures

C. The symptoms in Criterion B cause clinically significant distress or impairment in

social, occupational, or other important areas of functioning.

D. The symptoms are not due to a general medical condition and are not better

accounted for by another mental disorder.

Specify if: With perceptual disturbances



Withdrawal phenomena are likely to begin within approximately 8 hours of

abstinence, reach peak intensity on the second or third day, and markedly diminish by

the fourth or fifth day. The symptoms persist in a more mild form for as many as 3 to

6 months or more as part of a protracted withdrawal syndrome, which might

contribute to relapse.

Alcohol Withdrawal Delirium

For the small proportion of intoxications and withdrawals that are accompanied by

severe cognitive symptoms, both DSM-IV-TR and ICD-10 list criteria for alcohol

intoxication delirium and alcohol withdrawal delirium When this agitated confusion

is associated with tactile or visual hallucinations, the diagnosis of alcohol withdrawal

delirium (also called delirium tremens) can be made. During withdrawal, some

alcoholic people show one or several grand mal convulsions, sometimes called rum

fits.

Identification in Clinical Settings:

Patients should be asked about patterns of problems related to accidents, interpersonal

difficulties, problems at work, encounters with the law and so on. When a problem is

apparent, one can then determine the time of day, the situation and the complaints

voiced by others. If an alcohol use disorder appears probable, the diagnostic criteria

can be reviewed along with a history of the quantity and frequency of alcohol intake.

Several relatively simple questionnaires can be used to preliminarily survey relevant

problem areas. Two useful examples are the Alcohol Use Disorders Identification

Test (AUDIT) and the Michigan Alcohol Screening Test (MAST), each of which



offer a ten-item form that reviews the pattern of life problems related to alcohol. More

simple instruments, such as the CAGE ([need to] c ut down [on drinking], a

nnoyance, g uilt [about drinking], [need for] e ye-opener), are limited to four

questions and might not be either sensitive or specific enough for many clinical

settings. While the clinician may find the AUDIT or MAST useful, he or she must

remember that the questionnaires do not diagnose alcohol dependence but only

highlight individuals who might be especially appropriate for a more intensive clinical

interview. Table - 13

State Markers of Heavy Drinking Useful in Screening for Alcoholism:

Test Relevant Range of

Results

γ-Glutamyltransferase >30.0 U/L

Carbohydrate-deficient transferring >20.0 mg/L

Mean corpuscular volume >91.0 µm3

Uric acid >6.4 mg/dL for men

>5.0 mg/dL for women

Serum glutamic oxaloacetic transaminase (aspartate

aminotransferase)

>45.0 IU/L

Serum glutamic pyruvic transaminase (alanine

aminotransferase)

>45.0 IU/L

Triglycerides >160.0 mg/dL



The MCV blood test, with perhaps 70 percent sensitivity and specificity, is useful

when the size of the red blood cell is 91 µm3 or more. The 120-day life span of the red

cell does not allow the test to be useful as an indicator of a return to drinking. Other

tests that can be helpful in identifying patients who are regularly consuming heavy

doses of alcohol include high normal values of uric acid (e.g., greater than 6.4

mg/dL), even mild elevations in the usual liver function tests, including aspartate

aminotransferase and alanine aminotransferase, and elevated levels of triglycerides or

LDL cholesterol.

A number of physical findings can also be useful. These include modest elevations in

blood pressure; frequent bruising; cancer of the head, neck, and upper digestive tract;

an enlarged liver; evidence of cirrhosis; and symptoms consistent with pancreatitis.

Differential Diagnosis:

Once the pattern of alcohol-related life problems has been established, the diagnosis

of alcohol abuse or dependence may be fairly obvious. To determine whether an

independent major psychiatric disorder exists or not; briefly, individuals who present

with clinically significant levels of depression, anxiety, or psychotic symptoms in

addition to their alcoholism should be evaluated using the timeline approach to

determine whether the psychiatric symptoms are likely to have been substance

induced (and are thus temporary) or represent independent and longer-term

psychiatric disorders.

Antisocial Personality Disorder:

When the emphasis on the chronological development of symptoms is used, at least

three diagnoses—antisocial personality disorder, schizophrenia, and bipolar I

disorder— are likely to run a course independent of alcohol abuse or dependence and



be true co morbid conditions. Antisocial personality disorder, listed on Axis II, begins

early in life and has major effects on many aspects of life functioning. The diagnosis

is based on evidence of severe antisocial behaviors in many areas beginning before

the age of 15 years and continuing into adulthood. People with antisocial personality

disorder are described as impulsive, frequently violent, highly likely to take risks, and

unable to learn from their mistakes or to benefit from punishment. A person who

carries these characteristics into adolescence, typically the time for experimentation

with alcohol and drugs, can be expected to have difficulty controlling substance use.

Thus, perhaps 80 percent or more of people with antisocial personality disorder are

likely to develop severe alcohol problems in the course of their lives. A diagnosis of

preexisting antisocial personality disorder with subsequent alcohol abuse or

dependence indicates someone who is more likely than the average alcohol-dependent

person to have severe coexisting drug problems, to be violent, to discontinue

treatment prematurely, and to have a less-than-optimistic prognosis.

Schizophrenia

A second disorder in which alcohol problems are more common than in the general

population is schizophrenia. Characterized by what is usually a slow onset of paranoid

delusions and auditory hallucinations in a clear sensorium and typically beginning in

the mid-teens to the 20s, schizophrenia is likely to be severe, long lasting, and

debilitating. Possibly because of a lack of long-term treatment facilities, people with

schizophrenia are likely to live in inner-city areas and to spend a great deal of time on

the streets. Because most alcohol treatment programs exclude actively psychotic

patients, people with schizophrenia rarely appear in inpatient alcohol settings, but

alcohol-related disorders are observed in 30 percent or so of schizophrenic people

being treated in public mental health facilities.



Bipolar I Disorder

The third disorder in which severe alcohol problems are overrepresented is bipolar I

disorder. In a manic episode, the patient is hyperexcited and impulsive, carries out

most activities to excess, has poor judgment, and is likely to develop temporary

alcohol problems. Although the severity of the manic symptoms usually precludes

inpatient alcohol rehabilitation, alcohol-related difficulties must be evaluated in

histories taken from people with manic features entering mental health facilities.

However, bipolar II is difficult to evaluate in substance-dependent patients, as

intoxication, withdrawal, and adjustment to frequent changes in living situations can

easily mimic hypomania. This label should be reserved only for those with clear

hypomanic episodes antedating the alcoholism.

Major Anxiety Disorders

Finally, there are data from recent studies that support a small but statistically

significant association between independent (i.e., not alcohol induced) panic disorder

and perhaps independent social phobia and alcohol dependence. Although

approximately 90 percent of alcohol-dependent men and women did not have an

independent major anxiety disorder, and there was no evidence for a significant

increased risk for most major anxiety disorders, the rates of independent panic

disorder and independent social phobia were significantly higher than in controls.

Other Disorders

Debate in the literature continues about whether major depressive disorder,

agoraphobia, obsessive-compulsive disorder (OCD), posttraumatic stress disorder

(PTSD), and other major psychiatric diagnoses are overrepresented in the histories of



alcoholic people. Several studies indicate that, when the timeline method is used and a

history is obtained from multiple informants, little evidence is found for very high

rates of most independent psychiatric disorders among alcoholic people other than the

disorders noted above. Therefore, although the majority of alcoholic people have

temporary psychiatric symptoms, they are not more likely than are people in the

general population to carry an independent psychiatric syndrome other than the three

exceptions discussed above.

Finally, there are interesting and complex relations between alcoholism and

dependence on other drugs. Men and women with antisocial personality disorder

demonstrate a marked increased risk for dependence on multiple substances,

including alcohol. It is also probable that individuals with dependence on opioids and

stimulants (such as cocaine and amphetamines) exhibit an increased risk for alcohol

dependence, even in the absence of antisocial personality disorder. However,

although, as is true for the general population, many have used other substances, most

alcohol-dependent people do not meet the criteria for dependence on illicit drugs.

Several recent investigations of children of alcohol-dependent men and women, as

well as the large Collaborative Study on the Genetics of Alcoholism (COGA),

indicated that, once the effects of antisocial personality disorder were controlled,

alcohol dependence appeared to run relatively true within families, without evidence

of a marked crossover between alcoholism and most other dependencies. An

exception to this general rule is nicotine dependence, which has long been noted to be

elevated among alcohol-dependent individuals, a finding that has been hypothesized

to relate to either attempts to use nicotine to try to moderate some of the effects of



high doses of alcohol or withdrawal or a possible genetic relationship between

nicotine and alcohol dependence syndromes.

Course and Prognosis:

Several recent large-scale evaluations suggest that most subgroups of alcoholics are

more similar than different on the time course and prevalence of alcohol-related life

difficulties. The clinical courses of alcohol-dependent men and women are relatively

similar. Older alcohol-dependent individuals are more likely to have medical

problems, to take multiple medications, to experience more severe withdrawal

syndromes, and have a less extensive social support system. Again, these

characteristics reflect differences between older and younger individuals in general

more than they indicate unique aspects of alcoholism in the geriatric population.

Early Course

Patients with antisocial personality disorder who go on to develop alcoholism have an

early onset of drinking, intoxication, and alcohol-related problems, but that scenario is

not applicable to the other 80 to 90 percent of alcoholic men and 95 percent of

alcoholic women. Usually, alcoholic people have their first drink (other than taking a

sip from a parent's glass) between the ages of 13 and 15 years, the first intoxication is

likely to occur at 15 or 16 years of age, and the first evidence of a minor alcohol-

related problem is usually observed in the late teenage years. These milestones do not

differ significantly from what is expected for people in the general population who do

not later go on to develop alcohol abuse or dependence.

For the average person, the pattern of severe difficulties becomes apparent in the

middle 20s to the middle 30s when a constellation of symptoms of relatively great



severity is likely to be observed: an alcohol-related breakup of a significant

relationship, a repeat alcohol-related driving or public intoxication arrest, evidence of

alcohol withdrawal, being told by a physician that alcohol has harmed the person's

health, or significant interference with functioning at school or work. This pattern

probably does not vary much with the type of beverage used—beer, wine, or spirits.

Table - 14

Clinical Course of Alcohol Dependence

Age at first drink 13–15 yrs

Age at first intoxication 15–17 yrs

Age at first problem 16–22 yrs

Age at onset of dependence 25–40 yrs

Age at death 60 yrs

Fluctuating course of abstention, temporary control, alcohol

problems

Spontaneous remission in 20%

Later Course

Once alcohol's interference with life functioning has become apparent, unless the

person permanently abstains, the future is likely to include periods of drinking

problems that repeatedly alternate with periods of nondrinking and subsequent alcohol

intake unassociated with problems (temporary controlled drinking). Abstinence often



develops in response to some interpersonal, social, or legal crisis and is likely to

produce only mild withdrawal symptoms. The usual alcoholic person is then likely to

use the temporary cessation of drinking problems to convince themselves that alcohol

is not really a cause for concern after all. Those periods of abstinence, lasting days to

months, are usually followed by times during which drinking rules are established and

are temporarily followed. The person is likely to consume only beer or wine (ignoring

that a glass of beer, a glass of wine, and a shot of whiskey have similar amounts of

alcohol) and tries to drink only at certain times of the day and under certain

conditions. This period of temporary control soon leads to an escalation of alcohol

intake, the accumulation of a new set of problems, and a subsequent crisis. These

events, in turn, are likely to precipitate a new period of temporary abstinence, and the

cycle begins again.

Thus, controlled drinking is a common but temporary condition for most alcoholic

people. Those who have less severe alcohol problems, such as abuse, are probably

more likely to have long-term and even permanent periods of control. However,

several research projects have indicated that long-term continued control is not likely

to be seen once a person meets the diagnostic criteria for alcohol dependence.

However, if drinking continues, the alcoholic is likely to decrease his or her life span

by 10 to 15 years as a result of many causes, including the marked increased risks for

heart disease, cancer, accidents, and suicide among alcoholic individuals. The reasons

for these enhanced mortality rates are likely to reflect the effects of alcohol described

in this chapter.



Prognosis

Between 10 and 40 percent of alcoholic people enter some form of treatment during

the course of their alcohol problems. Although anyone might do well, there are a

number of favorable prognostic signs. First is the absence of preexisting antisocial

personality disorder or a diagnosis of other substance abuse or dependence. Second,

evidence of general life stability with a job, continuing close family contacts, and the

absence of severe legal problems also bodes well. Third, if the person stays for the

full course of the initial rehabilitation (perhaps 2 to 4 weeks), the chances of

maintaining abstinence are good. The combination of these three attributes predicts at

least a 60 percent chance for 1 or more years of abstinence. Few studies have

documented the long-term course, but researchers agree that 1-year rates are

associated with a good chance for continued abstinence over an extended period.

TREATMENT164

The elements of treatment appropriate for patients with severe alcohol problems are

fairly straightforward. The core of these efforts involves steps to maximize motivation

for abstinence, helping alcoholics to restructure their lives without alcohol, and taking

steps to minimize a return, or relapse, to substance-using behaviors. This cognitive

and behavioral approach is similar to efforts appropriate for any long-term disorder

that requires changes in lifestyles such as diabetes or hypertension. Much of the

clinical challenge comes in recognizing how prevalent the alcohol-related disorders

are, how often those conditions present with temporary symptoms of other psychiatric

syndromes, and how to use clinical clues, physical findings, and laboratory tests to

identify alcoholism.



Three general steps are involved in treating the alcoholic person once the disorder has

been diagnosed: intervention, detoxification, and rehabilitation. Those approaches

assume that all possible efforts have been made to optimize medical functioning and

to address psychiatric emergencies. Thus, for example, the alcoholic person with

symptoms of depression severe enough to be suicidal requires inpatient

hospitalization for at least several days until the suicidal ideation disappears, even if it

is a temporary alcohol-induced mood disorder. Similarly, the person presenting with

cardiomyopathy, liver difficulties, or GI bleeding first needs adequate attention paid

to the medical emergency.

The patient with alcohol abuse or dependence must then be brought face to face with

the reality of the disorder (intervention), be detoxified if needed, and begin

rehabilitation. The essentials of these three steps for alcoholic people with and

without independent psychiatric syndromes are quite similar. However, in the former

case, the treatments are often applied after the psychiatric disorder has been stabilized

to the maximum degree possible.

Intervention:

The goal in this step is to break through feelings of denial and to help the patient

recognize the adverse consequences likely to occur if the disorder is not treated.

Intervention is a process aimed at increasing to as high a level as possible the levels of

motivation for treatment and for continued abstinence.

This procedure often involves convincing patients that they are responsible for their

own actions while reminding them how alcohol has created significant life

impairments. The psychiatrist often finds it useful to take advantage of the person's



chief presenting complaint, whether it is insomnia, difficulties with sexual

performance, an inability to cope with life stresses, depression, anxiety, or psychotic

symptoms. The emphasis is then placed in teaching the patient how alcohol has either

created or contributed to these problems and reassuring the patient that abstinence can

be achieved with a minimum of discomfort.

A more systematic approach to this process has been described as various forms of

intervention that might fall under the heading of a brief intervention using

motivational interviewing. Here, the clinician gains an alliance with the patient by

demonstrating an understanding of his or her viewpoint while encouraging the

individual to think through consequences associated with alcohol and the way that

changing behaviors might produce benefits. During this process, it is important to

recognize the patient's ambivalence toward abstinence and to show sensitivity in

monitoring the person's readiness to change. Resistance on the part of the patient is

best handled through discussion and problem solving rather than direct confrontation.

Reaching out to the Family:

The family can be of great help in the intervention. Members must learn not to protect

the patient from the problems caused by alcohol, or else the patient may not be able to

generate the energy and the motivation necessary to stop drinking.

During the intervention stage, the family can suggest that the patient meet with people

who are themselves recovering from alcoholism, perhaps through AA, and they

themselves can attend groups, such as Al-Anon, that reach out to family members.

Those support groups help family members and friends see that they are not alone in

their fears, worry, and feelings of guilt. Members share coping strategies and help



each other find community resources. The groups can be most useful in helping

family members rebuild their lives, even if the alcoholic person refuses to seek help.

Detoxification:

Most people with alcohol dependence have relatively mild symptoms when they stop

drinking. If the patient is in relatively good health, adequately nourished, and has a

good social support system, the depressant withdrawal syndrome usually resembles a

mild case of the flu. Even intense withdrawal syndromes rarely approach the severity

of symptoms described by some early textbooks.

The essential first step in detoxification is a thorough physical examination. In the

absence of a serious medical disorder or combined drug dependence, severe alcohol

withdrawal is unlikely. The second step is to offer rest, adequate nutrition, and

multiple vitamins, especially those containing thiamine.

Mild or Moderate Withdrawal:

Withdrawal develops because the brain has physically adapted to the presence of a

brain depressant and cannot function adequately in the absence of the drug. Giving

enough of a brain depressant on the first day to diminish symptoms and then weaning

the patient off the drug over the next 5 days offers most patients optimal relief and

minimizes the possibility that a severe withdrawal will develop. Any depressant,

including alcohol, barbiturates, or a benzodiazepine, can work, but most clinicians

choose a benzodiazepine for its relative safety. Adequate treatment can be given with

either short-acting drugs, such as lorazepam (Ativan), or long-acting substances such

as chlordiazepoxide (Librium) and diazepam (Valium).



A social model program of detoxification saves money by avoiding medications while

using social supports. This less expensive regimen can be helpful for mild or

moderate withdrawal syndromes. Some clinicians have also recommended β-

adrenergic receptor antagonists, such as propranolol (Inderal), or α-adrenergic

receptor agonists, such as clonidine (Catapres), although these medications do not

appear to be superior to the benzodiazepines. Unlike the brain depressants, these other

agents do little to decrease the risk of seizures or delirium.

Severe Withdrawal:

For less than 1 percent of alcoholic patients with extreme autonomic dysfunction,

agitation, and confusion—that is, those with alcoholic withdrawal delirium, also

called delirium tremens—no perfect treatment has been found. The first key step is to

ask why such a severe and relatively uncommon withdrawal syndrome has occurred;

the answer often relates to a concomitant medical problem that needs immediate

treatment. The withdrawal symptoms can then be minimized either through the use of

benzodiazepines (in which case high doses are sometimes required), or through

antipsychotic agents such as haloperidol (Haldol). Once again, doses are used on the

first or second day to control behavior, and the patient can be weaned off the

medication by approximately the fifth day.

Another 1 percent or so of patients may have a single grand mal convulsion; the rare

person has multiple fits, and the peak incidence is on the second day of withdrawal.

Such patients require a neurological evaluation, but in the absence of evidence of a

seizure disorder, they do not benefit from anticonvulsant drugs.



Protracted Withdrawal:

Finally regarding withdrawal, symptoms of anxiety, insomnia, and mild autonomic

over activity are likely to continue for 2 to 6 months after the acute withdrawal has

disappeared. Although no pharmacological treatment for this syndrome appears

appropriate, it is possible that some of the medications discussed below, especially

acamprosate (Campral), may work, at least in part, by diminishing some of these

symptoms. In any event, it is important that the clinician warn the patient that some

levels of sleep problems or feelings of nervousness might remain after acute

withdrawal and discuss cognitive and behavioral approaches that might be appropriate

to helping the patient feel more comfortable. At least theoretically, these protracted

withdrawal symptoms may enhance the probability of relapse.

Rehabilitation:

For most patients, rehabilitation includes three major components: (1) continued

efforts to increase and maintain high levels of motivation for abstinence, (2) work to

help the patient readjust to a lifestyle free of alcohol, and (3) relapse prevention.

Because these steps are carried out in the context of distractions inherent in acute and

protracted withdrawal syndromes and life crises, treatment requires repeated

presentations of similar materials that remind the patient how important abstinence is

and that help the patient develop new day-to-day support systems and coping styles.

No single major life event, traumatic life period, or identifiable psychiatric disorder is

known to be a unique cause of alcoholism. In addition, the effects of any causes of

alcoholism are likely to have been diluted by the effects of alcohol on the brain and

the years of an altered lifestyle so that the alcoholism has developed a life of its own.



This is true even though many alcoholic people believe that the cause was depression,

anxiety, life stress, or pain syndromes. Research, data from records, and resource

people usually reveal that the alcohol contributed to the mood disorder, accident, or

life stress, not vice versa.

The same general treatment approach is used in inpatient, as well as outpatient,

settings. The selection of the more expensive and intensive and perhaps a bit more

effective inpatient mode often depends on evidence of additional severe medical or

psychiatric syndromes, the absence of appropriate nearby outpatient groups and

facilities, and the patient's history of having tried but failed in outpatient care. The

treatment process in either setting involves intervention, optimizing physical and

psychological functioning, enhancing motivation, reaching out to family, and using

the first 2 to 4 weeks of care as an intensive period of help. Those efforts must be

followed by at least 3 to 6 months of less frequent outpatient care. The latter uses a

combination of individual and group counseling, the judicious avoidance of

psychotropic medications unless needed for independent disorders, and involvement

in such self-help groups as AA.

There are few data that indicate that it is necessary to carefully match specific aspects

of the patient's history with a particular type of treatment program. In general, most

investigations demonstrate relatively high rates of abstinence and improvement in life

functioning regardless of the type of therapeutic approach involved.

Counseling:

Counseling efforts in the first several weeks to months should focus on day-to-day life

issues to help patients maintain a high level of motivation for abstinence and to



enhance their levels of functioning. Psychotherapy techniques that provoke anxiety or

that require deep insights have not been shown to be of benefit during the early phases

of recovery and, at least theoretically, may impair efforts at maintaining abstinence.

Much time in counseling deals with how to build a lifestyle free of alcohol.

Discussions cover the need for a sober peer group, a plan for social and recreational

events without drinking, and approach for reestablishing communication with family

members and friends.

Many clinicians believe that cognitive and behavioral approaches can form a solid

base to these counseling sessions. The goal of these efforts is to help the patient learn

ways of coping while focusing on approaches for identifying life stresses. The

clinician can use role rehearsal, modeling, and role playing while encouraging

patients to practice these skills between sessions. At the same time, individuals are

encouraged to identify areas of problems in day-to-day functioning, paying special

attention to how they react to these challenges and the impact that substance use

might have on the outcomes.

Relapse Prevention:

The third major component of rehabilitation efforts, relapse prevention, begins with

identifying situations in which the risk for relapse is high. The counselor must help

the patient to develop modes of coping to be used when the craving for alcohol

increases or when any event or emotional state makes a return to drinking more likely.

An important part of relapse prevention is reminding the patient about the appropriate

attitude toward slips in which short-term experiences with alcohol can never be used

as an excuse for returning to regular drinking. Rather, recovery is a process of trial



and error; patients use slips when they occur to identify high-risk situations and to

develop more appropriate coping techniques.

Importance of the Family:

Most treatment efforts recognize the effects that alcoholism has on the significant

people in the patient's life, and an important aspect of recovery involves helping

family members and close friends to understand alcoholism and how rehabilitation is

an ongoing process that lasts for 6 to 12 months or more. Couples and family

counseling and support groups for relatives and friends help the people involved to

rebuild relationships, to learn how to avoid protecting the patient from the

consequences of any drinking in the future, and to be as supportive as possible of the

alcoholic patient's recovery program.

Medications:

If detoxification has been completed, and the patient is not one of the 10 to 15 percent

of alcoholic people who have an independent mood disorder, schizophrenia, or

anxiety disorder, there is little evidence in favor of prescribing psychotropic

medications for the treatment of alcoholism. Levels of anxiety and insomnia that can

linger for 6 months or more as part of a reaction to life stresses and protracted

abstinence should be treated with behavior modification approaches and reassurance.

Medications, including benzodiazepines, for these symptoms are likely to lose their

effectiveness much faster than the insomnia disappears; as a result, the patient may

increase the dose and have subsequent problems related to the prescribed drug.

Similarly, although low levels of sadness and mood swings can linger several months,

controlled clinical trials indicate no benefit in prescribing antidepressant medications



or lithium to treat the average alcoholic person who has no independent or long-

lasting psychiatric disorder. The mood disorder clears before the medications can take

effect, and patients who resume drinking while on the medications face significant

potential dangers. With little or no evidence that the medications are effective, the

dangers significantly outweigh any potential benefits from their routine use.

Data from recent years support the probable modest effect of two medications in

addition to the usual cognitive-behavioral approaches for treating alcohol dependence.

These have been hypothesized to possibly decrease the rewarding effects of alcohol if

an individual returns to drinking, diminish the symptoms of the protracted withdrawal

syndrome, or, perhaps, diminish feelings of craving.

The first drug is acamprosate, which is an analog of the amino acid neurotransmitter

taurine and structurally resembles GABA. Although the mechanism of action in

alcoholics is unknown, acamprosate does antagonize neuronal overactivity related to

the actions of the excitatory neurotransmitter glutamate, at least in part by acting as an

antagonist to NMDA receptors. Thus, one possibly important mechanism for this drug

may be in diminishing anxiety, mood swings, and other sleep difficulties associated

with the subacute and protracted withdrawal syndrome observed after the first 4 to 5

days of alcohol abstinence.

The second promising medication is the long-acting, oral, opioid antagonist

naltrexone. This agent has been marketed for many years for the treatment of acute

opioid overdose as well as to help more highly motivated opioid-dependent

individuals maintain abstinence through knowledge that because of the use of this

blocking drug they could not achieve intoxication. Naltrexone works by blocking



opioid receptors in the brain and, thus, at least indirectly changing the levels of brain

activity regarding dopamine and serotonin. In alcohol-dependent individuals,

naltrexone and its cousin nalmefene have been hypothesized to decrease the

rewarding effects of a drink or to diminish craving.

A third drug of possible interest in the treatment of alcoholism is the alcohol-

sensitizing agent disulfiram which is usually given in doses of 250 mg per day. The

goal is to place the patient in a condition in which drinking alcohol precipitates an

uncomfortable physical reaction, including nausea, vomiting, and changes in blood

pressure. However, few data convincingly prove that disulfiram is more effective than

a placebo, probably because most people stop taking the disulfiram when they resume

drinking. Many clinicians have stopped routinely prescribing the agent, partly in

recognition of the dangers associated with the drug itself, including mood swings, rare

instances of psychosis, the possibility of an increase in peripheral neuropathies, the

relatively rare occurrence of other significant neuropathies, and a rare but potentially

fatal hepatitis. Moreover, patients with preexisting heart disease, cerebral thrombosis,

diabetes, and a number of other conditions cannot be given disulfiram because an

alcohol reaction to the disulfiram could be fatal.

Several additional medications are worth brief mention. First, a recent study evaluated

the possibility that an antagonist of the serotonin 3 receptor, ondansetron, might be

better than placebo in treating alcoholics who have an early-onset severe form of their

disorder associated with multiple drug dependencies and criminality. However, this

drug showed no superiority to placebo for the treatment of the usual alcoholic. A

second medication with some potential promise in the treatment of alcoholism is the

nonbenzodiazepine antianxiety drug buspirone, although the effect of this drug on



alcohol rehabilitation is inconsistent between studies. However, at the same time,

there is no evidence that antidepressant medications, such as the selective serotonin

reuptake inhibitors (SSRIs), lithium, or antipsychotic medications, are significantly

effective in the treatment of alcoholism. Another physical treatment, acupuncture, has

been evaluated, although the results are not promising.

Self-Help Groups:

Clinicians must recognize the potential importance of self-help groups such as

Alcoholic Anonymous (AA). Members of AA have help available 24 hours a day,

associate with a sober peer group, learn that it is possible to participate in social

functions without drinking, and are given a model of recovery by observing the

accomplishments of sober members of the group. Learning about AA usually begins

during inpatient or outpatient rehabilitation. The clinician can play a major role in

helping patients understand the differences between specific groups. Some are

comprised only of men or women, and others are mixed; some meetings are

comprised mostly of blue collar men and women, whereas others are mostly for

professionals; some groups place great emphasis on religion, and others are eclectic.

Patients with coexisting psychiatric disorders may need some additional education

about AA. The clinician should remind them that some members of AA may not

understand their special need for medications and should arm the patients with ways

of coping when group members inappropriately suggest that the required medications

be stopped. Although difficult to evaluate using double-blind controls, most studies

indicate that participation in AA is associated with improved outcomes, and

incorporation into treatment programs saves money.

Alcoholic Liver Disease Review


ALCOHOLIC LIVER DISORDER

Alcoholic liver disease is the major cause of liver disease in Western countries, (in

Asian countries, viral hepatitis is the major cause). It arises from the excessive

ingestion of alcohol. Even though millions of individuals drink alcohol on a regular

basis, only chronic heavy drinkers develop liver damage. How alcohol damages the

liver is not completely understood. It is known that alcohol produces toxic chemicals

like acetaldehyde which can damage liver cells, but why this occurs in only a few

individuals is still in debate. When alcohol damages the liver, the function of the

organ is not immediately compromised as the liver has a tremendous capacity to

regenerate and even when 75% of the liver is damaged, it continues to function as

normal. When alcohol is consumed chronically, it eventually results in liver scarring

or what is known as cirrhosis or end-stage alcoholic liver disease.

The risk factors presently known are: quantity of alcohol taken, type of alcohol (beer

and spirits have increased risk), gender (females are twice as susceptible to alcohol

related liver disease, presently explained by the difference in the ability to metabolize

it), hepatitis C infection, genetic factors (changes in the profiles of various enzymes

involved in the metabolism of alcohol, such as ADH, ALDH, CYP4502E1 ,

mitochondrial dysfunction, and cytokine polymorphism) and malnutrition and diet

(particularly vitamin A and E deficiencies). Generally it is believed that certain genes

increase metabolism of alcohol, which may increase risk of cirrhosis and even alcohol

related cancers. Alcohol-induced liver injury can be worsened by hepatitis. If one has

hepatitis B or hepatitis C and consumes alcohol, cirrhosis occurs sooner. Alcohol-

induced liver disease is also worsened in people who have iron overload. Malnutrition

can worsen alcohol-induced liver damage. Most alcoholics tend to eat poorly and

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often substitute alcohol as a meal. The liver has a great capacity to regenerate, but

without proper nutrition, it quickly fails.

Fatty liver

Fatty change or steatosis is the accumulation of fatty acids in liver cells which can be

seen as fatty globules under the microscope. Alcoholism causes development of large

fatty globules (macrovesicular steatosis) throughout the liver and can begin to occur

after a few days of heavy drinking. Development of Macrovesicular steatosis, small

fatty acid globules may have different causes, such as diabetes, obesity and starvation.

The mechanism of action in alcohol induced fatty liver involves an above average

NADH:NAD ratio caused by the heavy demands of alcohol metabolism, including

other damaging metabolites such as free radicals and acetaldehyde that are very toxic,

(Higuchi, Kato, Miura, & Ishi, 1996) Alcohol is metabolized by alcohol

dehydrogenase (ADH)into highly toxic acetaldehyde, then further metabolized by

aldehyde dehydrogenase (ALDH) into acetic acid which is oxidized into Carbon

Dioxide (CO2) and water (H2O). A higher NADH concentration induces fatty acid

synthesis (creation) while a decreased NAD level results in decreased fatty acid

oxidation (processing). Consequently, the higher levels of fatty acids signal the

hepatocytes (liver cells) to compound it to glycerol to form triglycerides.

Alcoholic hepatitis

Between 10% and 35% of heavy drinkers develop alcoholic hepatitis (NIAAA, 1993).

Acute hepatitis or inflammatory reaction of cells affected by fatty change. While

development of hepatitis is not directly related to the dose of alcohol, some people

seem more prone to this reaction than others. This is called alcoholic steatonecrosis

and the inflammation appears to predispose to liver fibrosis.

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Cirrhosis

Between 10% to 20% of heavy drinkers will develop Cirrhosis of the liver.(NIAAA,

1993) Cirrhosis is a late stage of serious liver disease marked by inflammation

(swelling), fibrosis (cellular hardening) and damaged membranes preventing

detoxification of chemicals in the body, ending in scarring and necrosis (cell death.)

Symptoms include jaundice (yellowing), liver enlargement, and pain and tenderness

from the structural changes in damaged liver architecture. It is progressive and

without total abstinence from alcohol use, (80% of alcohol passes through the liver to

be detoxified) will eventually lead to liver failure. Late complications of cirrhosis or

liver failure include portal hypertension (high blood pressure related to kidney

problems), coagulation disorders blood clotting is impaired, ascites (heavy abdominal

swelling due to build up of fluids in the tissues) and other complications, including

hepatic encephalopathy and the hepatorenal syndrome.

Cirrhosis can also result from other causes than alcohol abuse, such as viral hepatitis

and heavy exposure to toxins other than alcohol. The late stages of cirrhosis may look

similar medically, regardless of cause. This phenomenon is termed the "final common

pathway" for the disease.

Fatty change and alcoholic hepatitis with abstinence can be reversible. The later

stages of fibrosis and cirrhosis tend to be irreversible, but can usually be contained

with abstinence for long periods of time.

Diagnosis:

There are many tests to assess alcoholic liver damage. Besides blood examination,

doctors use ultrasound and a CT scan to assess liver damage. In some cases a liver

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biopsy is performed. This minor procedure is done under local anesthesia, and

involves placing a small needle in the liver and obtaining a piece of tissue. The tissue

is then sent to the laboratory to be examined under a microscope.

Treatment:

The first treatment of alcohol-induced liver disease is cessation of alcohol

consumption. This is the only way to reverse liver damage or prevent liver injury

from worsening. Without treatment, most patients with alcohol-induced liver damage

will develop liver cirrhosis.

Other treatment for alcoholic hepatitis include:

Nutrition:

Doctors recommend a calorie-rich diet to help the liver in its regeneration process.

Dietary fat must be reduced because fat interferes with alcohol metabolism. The diet

is usually supplemented with vitamins and dietary minerals (including calcium and

iron).

Many nutritionists recommend a diet high in protein, with frequent small meals eaten

during the day, about 5-6 instead of the usual 3. Nutritionally, supporting the liver and

supplementing with nutrients that enhance liver function is recommended. These

include carnitine, which will help reverse fatty livers, and vitamin C, which is an

antioxidant, aids in collagen synthesis, and increases the production of

neurotransmitters such as norepinephrine and serotonin, as well as supplementing

with the nutrients that have been depleted due to the alcohol consumption.

Eliminating any food that may be manifesting as an intolerance and alkalizing the

http://en.wikipedia.org/wiki/Anesthesia

http://en.wikipedia.org/wiki/Tissue_(biology)

http://en.wikipedia.org/wiki/Microscope

http://en.wikipedia.org/wiki/Fat

http://en.wikipedia.org/wiki/Vitamin

http://en.wikipedia.org/wiki/Dietary_minerals

http://en.wikipedia.org/wiki/Calcium

http://en.wikipedia.org/wiki/Human_iron_metabolism



body is also important. There are some supplements that are recommended to help

reduce cravings for alcohol, including choline, glutamine, and vitamin C. As research

shows glucose increases the toxicity of centrilobular hepatotoxicants by inhibiting cell

division and repair, it is suggested fatty acids are used by the liver instead of glucose

as a fuel source to aid in repair; thus, it is recommended the patient consumes a diet

high in protein and essential fatty acids, e.g. omega 3. Cessation of alcohol

consumption and cigarette smoking, and increasing exercise are lifestyle

recommendations to decrease the risk of liver disease caused by alcoholic stress.

Drugs

Abstinence from alcohol intake and nutritional modification form the backbone in the

management of ALD. Symptom treatment can include: corticosteroids for severe

cases, anticytokines (infliximab and pentoxifylline), propylthiouracil to modify

metabolism and colchicine to inhibit hepatic fibrosis.

Antioxidants

It is widely believed that alcohol-induced liver damage occurs via generation of

oxidants. Thus alternative health care practitioners routinely recommend natural

antioxidant supplements like milk thistle Unfortunately, there is no valid clinical data

to show that milk thistle truly works. Rambaldi A, Jacobs BP, Iaquinto G, Gluud C

(2005). "Milk thistle for alcoholic and/or hepatitis B or C liver diseases--a systematic

cochrane hepato-biliary group review with meta-analyses of randomized clinical

trials". Am. J. Gastroenterol. 100 (11): 2583–91. doi:10.1111/j.1572-

0241.2005.00262.x. PMID 16279916

http://en.wikipedia.org/wiki/Infliximab

http://en.wikipedia.org/wiki/Propylthiouracil

http://en.wikipedia.org/wiki/Colchicine

http://en.wikipedia.org/wiki/Oxidant

http://en.wikipedia.org/wiki/Quackery

http://en.wikipedia.org/wiki/Antioxidant

http://en.wikipedia.org/wiki/Milk_thistle

http://www.ncbi.nlm.nih.gov/pubmed/16279916



Transplant

When all else fails and the liver is severely damaged, the only alternative is a liver

transplant. While this is a viable option, liver transplant donors are scarce and usually

there is a long waiting list in any given hospital. One of the criteria to become eligible

for a liver transplant is to discontinue alcohol consumption for a minimum of six

months.[2]

Complications and prognosis

As the liver scars, the blood vessels become noncompliant and narrow. This leads to

increased pressure in blood vessels entering the liver. Over time, this causes a backlog

of blood (portal hypertension), and is associated with massive bleeding. Enlarged

veins also develop to bypass the blockages in the liver. These veins are very fragile

and have a tendency to rupture and bleed (varices). Variceal bleeding can be life-

threatening and needs emergency treatment. Once the liver is damaged, fluid builds

up in the abdomen and legs. The fluid buildup presses on the diaphragm and can make

breathing very difficult.[3]

As liver damage progresses, the liver is unable to get rid of

pigments like bilirubin and both the skin and eyes turn yellow (jaundice). The dark

pigment also causes the urine to appear dark; however, the stools appear pale. Also

with the progression of the disease, the liver can release toxic substances (including

ammonia) which then lead to brain damage. This results in altered mental state, and

may cause behavior and personality changes.

http://en.wikipedia.org/wiki/Liver_transplantation



http://en.wikipedia.org/wiki/Alcoholic_liver_disease#cite_note-1

http://en.wikipedia.org/wiki/Blood_vessel

http://en.wikipedia.org/wiki/Bleeding

http://en.wikipedia.org/wiki/Varices

http://en.wikipedia.org/wiki/Alcoholic_liver_disease#cite_note-2

http://en.wikipedia.org/wiki/Bilirubin

http://en.wikipedia.org/wiki/Jaundice

http://en.wikipedia.org/wiki/Ammonia

http://en.wikipedia.org/wiki/Brain_damage

Drug Contrive

Drug Review


DRUG REVIEW

Many drugs have been explained in the management of complications of Madatyaya.

As Madatyayaja Yakrit Vikara is one of the complications and in this particular

condition mainly Pitta dosha is affected, agni dusti and ama are the main causes,

hence Guduchyadi Yoga is selected as the drug because of its deepana, pachaka and

pitta rechaka qualities. Guduchyadi Yoga is explained by Acharya Charaka, while

stating the yogas for the complication of Madatyaya in the Madatyaya chikitsa. The

ingredients and their compositions are explained below.

Guduchyadi Yoga:

This medicine contains four drugs viz. Guduchi, Bhadramusta, Nagara and Patola in

equal parts. This choorna can be given before food with luke warm water.

Guduchi:

Latin Name : Tinospora Cordifolia

Family : Menispermaceae

Synonyms : Madhuparni, Amrita, Chinnaruha,

Vatsadani, Tantrika, Kundalini,

Chakralakshanika

Habitat : All over India upto the height of 1000

Feet

Habit: Climber

Chemical composition: Alkaloid - Berberine

Glycoside - Giloin

Volatile oil and fatty acids present

Guna - Guru Snigdha

Drug Review


Rasa – Tikta, Kashaya

Vipaka - Madhura

Virya - Ushna

Doshkarma - Tridosha Shamak

Properties – Rasayana,Balya,Daurbalya hara,Daha Trishnahara.

Part used - Kaanda

Pharmacological Action :

The drug has been observed to relax smooth muscles of intestine, uterus and inhibit

constrictor response of histamine and acetyle choline on smooth muscles (Gupta et al.

1967).

Alcoholic extract of the stem shows activity against Eschorchia Coli. Oral

administration of the aqueous and alcoholic extract of the plant caused reduction in

fasting blood sugar in rabbit and rats. The bitter fraction of the aqueous extract caused

insignificant reduction in blood sugar level, it inhibited the adrenalin induced-hyper

glycaemic significantly (Gupta et al.1967).

Favourable influence on glucose tolerance was observed in rats administered aqueous

extract of Tinospora cordifolia for a month (Gupta et al. 1964).

The drug has further proved to be effective as anti-rheumatic and diuretic (Sisodia and

Laxmi narayan 1961) as well as having anti-inflammatory properties (Rai and Gupta

1966). They (1967) have further carried out experimental evaluation of the drug for

dissolution of urinary calculi.

Recently Patel et al. (1978) reported that the aqueous extract of the stem was found to

antagonise the effects of various agonists such as histamine,5 H-T bradykinin and

prostaglandins E1 and F2X on the smooth muscles of guinea pig and rat.

Drug Review


(Pharmacognosy of Indigenous drugs CCRAI).

Musta:

Botanical name:Cyperus rotundus

Family: Cyperaceae

Kula: Mustaka Kula

Synonyms: Jalada, Nagaramusta Ghana, Shirhira, Bhadra, Gudagranthi, Sugandhi,

Hima.

Classical categorization :

Charaka : Truptighna, Trushnanigrahana, Lekhaneeya, Kandughna, Stanya, Shodhana

Sushruta: Mustadi, Vachadi

Major chemical constituents :

Cyperotundone, Cyperolone, Stearic Acids, Myristic Acid, Starch, Gum,

Sugar.

Properties :

Rasa: Tikta , Katu , Kashaya

Guna : Ruksha , laghu

Virya : Sheeta

Vipaka : Katu

Karma : Kaphahara, lekhana, vishaghna, varnya, Twakdoshahara, Shothahara,

Stanyajanana, Medhya, Deepana, Pachana, Grahi.

Indications : Twakvikara, Apasmara, Aruchi, Agnimandhya, Ajeerna, Kasa,

Swasa, kandu, Jwara, Daurbalya.

Strotogamitva:

Dosha: Kaphahara, Pittahara

Drug Review


Dhatu: Rasa, Meda, Raktha

Mala: Purisha.

Organs : GIT.

Pharmacological Activities:

Tranquilizing, Anti-inflammatory, Antipyretic, Diuretic, Smooth muscle

relaxant.

Used part : Moola

Dose:

Churna : 1-3 grms

Shunti/Nagara:

Botanical name: Zinziber Officinale Roscoe

Family: Scitaminaceae

Synonyms: Shunti, Vishva, Nagara, Vishvabheshaja, Vishvoushadha, Katuranthi,

Katubhadra, Katushana, Sauparna.

Classical categorization:

Charaka : Truptighna, Arshoghna, Deepaniya, Shoolaprashamana, Trushnanigrahana,

Sushruta:Pippalyadi, Trikatu

Bhavaprakasha: Panchakola, Shadushana

Major chemical constituents:

Votatile Oil, Gingerol, Gingerin, Haeptane, Zingiberene.

Properties :

Rasa: Katu

Guna : Laghu, Singdha

Drug Review


Virya : Ushna

Vipaka : Madhura

Karma : Sheeta prashamana, Shothahara, Vedanasthapana, Deepana, Rochana,

Pachana, Bhedana, Grahi, Hridya, Jwaraghna.

Indication : Amavata, Gulma, Chardi, Vishamajwara, Ajeerna, Pratisyaya.

Strotogamitva:

Dosha: Kapha-Vatahara

Dhatu: Rasa, Shukra, Raktha

Mala: Purisha.

Organs : GIT, Heart.

Pharmacological Activities:

Anti-inflammatory, Antipyretic, Antiatherosclerotic, Hepatoprotective,

Hypouricemic, Hypolipidaemic.

Used part : Kanda, Rhizomes

Dose:

Churna : 0.75-1.5 grms

Swarasa : 2-4 ml

Yoga:

Ardrakhanda

Saubhagyashunthipaka

Drug Review


Patola:

Botanical name: Trichosanthes dioica

Family: Curcurbitaceae

Synonyms: Karkasacchad, Kulaka, Bijagarbha, Pancha Rajiphala, Rajiphala,

Amritaphala, Panduphala, Tiktottama, Nagaphala.

Classical categorization :

Charaka : Truptighna, Trushnanigrahana,

Sushruta: Patoladi, Aragvadhadi.

Vagbhata: Patoladi, Aragvadhadi

Major chemical constituents:

Nicotinic acid, riboflavin, vit.C, thiamine, linoleic acid, colocynthin, oleic

acid, trichosanthin, cucurbita-5.

Properties :

Rasa: Tikta , Katu

Guna : Ruksha , laghu

Virya : Ushna

Vipaka : Katu

Karma : Kapha-Pittahara, Vrishya, Varnya, Dipana.

Indication : Jwara, Kusta, Kandu, Amlapitta, Daha

Strotogamitva:

Dosha: Kaphahara, Pittahara

Dhatu: Rasa, Raktha

Mala: Purisha.

Organs : GIT.

Drug Review


Therapeutic Uses:

Indralupta, Medoroga, Netraroga.

Pharmocological action:

Antipyretic, Antiatherosclerotic, Hepatoprotective, Hypouricemic, Hypolipidaemic.

Used part : Moola, Phala, Patra

Dose:

Churna : 1-3 grms

Svarasa: 10-20ml

Kvatha : 30-50 ml.

Drug Review


Guduchyadi Yoga (Choorna)

Guduchi Musta

Nagara Patola

Clinical

Contrive

Objectives


OBJECTIVES OF THE STUDY

1. To evaluate the efficacy of Satvavajaya chikitsa in Madatyayaja Yakrit Vikara

(Alcoholic liver disorder).

2. To evaluate the efficacy of Guduchyadi yoga in Madatyayaja Yakrit Vikara


3. To evaluate the efficacy of combined effect of Satvavajaya Chikitsa and

Guduchyadi yoga in Madatyayaja Yakrit Vikara (Alcoholic liver disorder).

Methodology


METHODOLOGY

Madatyaya or the alcoholic dependency is completely based on stability of

one’s own Satva. So mind plays an important role in the de-addiction of alcohol.

Word Madatyaya is composed of two terms i.e. Mada -any exhilarating or

intoxicating condition. Atyaya – suffering.

Hence suffering from intoxicating drink

is known as Madatyaya.

Chronic and excessive alcohol ingestion is one of the major causes of liver

disorders across the world. Despite the untoward effect of alcohol, alcoholism is a

major problem in India. The different drug abuse surveys have shown the prevalence

of alcoholism as 5 to 20 percent worldwide. In India, general population surveys

shows the prevalence rate as high as 16 to 50 percent . Atleast 20% of the patients in

mental settings have alcohol abuse or dependence or withdrawal , including

individuals from all socioeconomic conditions and both the genders.



affected by Alcoholic liver disease. It manifests as a clinical spectrum ranging from


three major forms, 1.fatty liver, 2.alcoholic hepatitis and 3.cirrhosis.

Bhavaprakasha mentions Yakrit-Vruddhi (hepatomegaly) as one of the


Aharas and Madya (alcohol).



mentioned by Charaka comprising of Guduchi (Tinospora cordifolia), Musta(Cyperus

Methodology






Samsmarana, Priyadarshana, Priyashravana, Geeta, Vadya and Charaka advises


the treatment modalities in the management of Madatyaya.

The three therapies i.e. cognitive behavioral coping skills, motivational enhancement

therapy and 12 step facilitation approaches of alcoholics anonymous has been found

to be helpful for the people to boost their motivation to stop drinking.

As the number of alcohol related disorders are increasing in the society and till

date no study has been conducted , hence it is decided to carry out the present study to

evaluate the effect of Guduchyadi Yoga and Satvavajaya Chikitsa in the management


Material and Methods

Source of data :

54 patients of Madatyaya were selected from the Out Patient Department and In

Patient Department of ManasaRoga of the S D M College of Ayurveda and Hospital,

Hassan.

Method of Collection of Data :

54 patients of Madatyaya with liver disorder who fulfills the inclusion criteria

were selected and randomly assigned into the following 3 groups; each group

comprising of 16 patients and 6 were dropouts.

Methodology


Group A: The patients of this group were subjected to Satvavajaya Chikitsa

daily along with placebo capsule 500 mg starch thrice daily for 1 month. Satvavajaya

Chikitsa was carried out as follows:

Jnana- 12 Step facilitation (Atmadi Jnana) approach.

1. We admit we are powerless over alcohol- that our lives have become

unmanageable.

2. We believe that a Power greater than ourselves can restore us to sanity.

3. We make a decision to turn our will and our lives over to the care of God as we

understand Him.

4. We make a search and fearless moral inventory of ourselves.

5. We admit to God, to ourselves and to another human being the exact nature of

our wrong doings.

6. We’re entirely ready to have God remove all these defects of character.

7. We shall humbly ask Him to remove our shortcomings.

8. We shall make a list of all persons we have harmed and become willing to

make amends to them all.

9. We shall make direct amends to such people wherever possible, except when to

do so would injure them or others.

10. We shall continue to take personal inventory and when we are wrong,

promptly admit it.

Methodology


11. We will search through prayer and meditation to improve the conscious

contact with God as we understood Him, praying only for knowledge of Him for

us and the power to carry it out.

12. After experiencing this, we shall carry this message to alcoholics, and to

practice these principles in all their affairs.

Vijnana- Specific information about effect of alcohol on various organs.

Dhairya- Supportive Psychotherapy – motivational enhancement therapy.

Smriti - Methods to cope with high-risk drinking situations and develop social

support systems.

Samadhi – Yoga for 30 minutes and Pranayama for 15 minutes daily for 1 month.

Yogasana – Standing Asana- Vrikshasana , Pada Hastasana, Ardha Chakrasana,

Trikonasana.

Supine Asana – Pavana Muktasana, Matsyasana.

Prone Asana - Bhujangasana, Dhanurasana.

Sitting Asana – Vajrasana, Ushtrasana, Vakrasana.

Pranayama - Kapalabhati, Bhastrika, Anuloma-Viloma, Shitali, Shithkari and

Bhramari.

Dhairya Chikitsa will be also done on 15th

and 30th

day of treatment.

Group B: The patients of this group were given Guduchyadi yoga in the dose of

5 gm, before food with warm water thrice daily for 1 month.

Methodology


Group C: The patients of this group were subjected to Satvavajaya Chikitsa as

mentioned above and simultaneously Guduchyadi Yoga was given in the dose of 5gm

before food with warm water thrice daily for 1 month

Diagnostic Criteria:

Diagnosis was made on the basis of Lakshanas of Alcoholic liver disorder and


Fatty liver Yakrit vruddhi

Right upper quadrant discomfort. Manda jvara

Tender hepatomegaly. Mandagni.

Nausea Ksheenabala.

Jaundice Atipandu.

Fever and Abdominal pain

Elevated AST (Aspartate amino transferace)

Elevated ALT (Alanine amino transferace)

Inclusion Criteria:

1.Patients presenting with symptoms of Madatyaya along with Alcoholic liver

disorder.

2. Age group of 16-70 years of either sex.

Methodology


Exclusion Criteria:

1.Patients suffering from any Organic brain disorder.

2.Patients suffering from complications of Alcoholic liver disorders.

3.Patients suffering from other types of addictions.

4.Patients suffering from other Systemic or Psychiatric illnesses.

Assessment Criteria:

Assessment of clinical study was done based on subjective and objective

parameters. Self scoring of symptoms of Madatyayaja Yakrit Vikara were done and

self prepared scale was used for assessment.

Table: 15: Parameters

Subjective parameters : Objective parameters:

Aruchi. Chardi

Prajagara Manda jvara

Hrillasa Atipanduta

Pralapa Atisara

Bhrama Shareera kampa

Mandagni. USG Abdomen

Liver Function Test

Hepatomegaly.

Methodology


TABLE:16 : GRADATION INDEX

To give some objectivity to the symptoms for the statistical analysis grading was

assigned as shown in table- Showing Gradation Index

Subjective parameters

Aruchi 0 – Absent

1 – occasionally present

2 – frequently present

3 – Continuous present.

Hrillasa 0 – Absent

1– Nausea

2 – Nausea with vomiting

Chardi 0 – Absent

1– Two times a day

2 – Six times a day

3 – More than six times a day

Prajagara 0 – Sleeping more than 8 hours day

1– Sleeping 6 to 8 hours a day

2– Sleeping 4 to 6 hours a day

3– Sleeping less than 4 hours a day

Manda Jvara 0 – Absent

1 – Occasionally present

2 – Present but not disrupting in daily life

3 – Disrupting daily life

Panduta 0 – Absent

1-Mild pallor

1-Moderate pallor

2-Severe pallor

Bhrama 0 – Absent

1 – Getting vertigo in position change

2 – Positional Vertigo with vomiting able to sit.

Methodology


3- Cannot even sit

Pralapa 0 – Normal talk

1 – Relevant talk with 5 – 10 words per minute

2 – Relevant talk with 10 – 15 words per minute

3 – Irrelevant talk.

Shareera Kampa 0 – Absent




Mandagni 0- Absent

1-Occasionally present

2-Regularly present

3-No appetite

Weakness 0 – Absent




Laziness 0 – Absent




Methodology


Table No: 17

Severity of Madatyayaja Yakrit Vikara

For assessing the severity of Madatyayaja Yakrit Vikara in each patient the above

adopted scores were grouped and assessed as follows

Absent 0 0

Mild 1 1-11score

Moderate 2 12-24

Severe 3 >24

Follow up study:

After stopping the treatment the patients will be asked to attend OPD at the

interval of 15 days for two months to know whether the relief provided by the

therapies is sustained or not.

Assessment of results:

Statistical evaluation of the results was done by using unpaired and paired‘t’ test.

CRITERIA FOR ASSESSMENT OF OVERALL EFFECT:

Overall effect of the therapy was assessed in terms of complete remission, marked

improvement, moderate improvement, and mild improvement and unchanged by

adopting the following criteria.

Complete remission: 100% relief in Chief complaints and no recurrence during

follow up study were considered as complete remission.

Methodology


Marked improvement: 75 – 99 % improvement in chief complaints is

considered as marked improvement.

Moderate improvement: 50 - 74% improvement in chief complaints is

considered as moderate improvement.

Mild improvement: 25 - 49% improvement in chief complaints is considered as

mild improvement.

Unchanged: Less than 24% reduction in chief complaints or recurrence of the

symptoms to the similar extent of severity is noted as unchanged.

Observations

Observations


OBSERVATIONS

54 patients of Madatyaya were registered for this clinical study, out of which 6

patients were dropouts and totally 48 patients completed the study plan. They were

treated in three groups as Satvavajaya Group (S), Guduchyadi Yoga Group (GY) and

Combined (S&GY). The age, sex, religion, Socio – Economic Status, occupation, etc.

noted in the patients of this study were as follows.

Incidence of Age: In this study maximum number (34.70 %) of patients were

belonging to 30 – 40 years age group, 27.30 % to 20 – 30 years age group, 27.30% to

40 – 50 years age group, 8.60 % to 50 – 60 years age group and only 2.10 % were

belonging to 60 – 70 years age group (Table - 18).

Incidence of Sex: In this study the prevalence of Madatyayaja Yakrit Vikara was

found only in males, out of 48 patients all were males only (Table - 19).

Incidence of occupation: This study reveals that prevalence of Madatyayaja Yakrit

Vikara is more in Business people with 48.2 %, then Agriculturist were 27.6 %, 25.2

% were of Students. (Table - 20).

Socio – economic status: 91.6 % of patients were belonging to Middle class income

group, 6.3% to higher income group and 2.1 % to lower income group (Table - 21).

Incidence of Marital Status: Out of 48 patients 76.8% were married and only 23.2

% were unmarried (Table - 22

Observations


Table – 18

Showing incidence of Age

Age S GY S & GY Total

No. of pt % No. of pt % No. of pt % No. of pt %

20 - 30 9 56.4 3 18.8 1 06.3 13 27.3

30 - 40 4 25.0 6 37.4 7 43.6 17 34.7

40 - 50 2 12.4 6 37.4 5 31.2 13 27.3

50 - 60 1 06.2 1 06.4 2 12.6 04 08.6

60 - 70 0 0.00 0 00.0 1 06.3 01 02.1

Table – 19

Showing incidence of Sex

Sex S GY S&GY Total


Male 16 100 16 100 16 100 48 100

Female 00 00 00 00 00 00 00 00

Table – 20

Showing incidence of Occupation

Occupation S GY S&GY Total


Business 7 43.7 6 37.6 10 63.0 23 48.2

Agriculturist 2 12.6 8 49.8 3 18.5 13 27.6

Student 7 43.7 2 12.6 3 18.5 12 25.2

Observations


Incidence of education status: Educational status of this study revealed maximum

(65.1%) patients were educated till higher secondary while 2.1 % of patients educated

till primary level. 14.4 % of patients were graduates and 12.3% were educated till post

graduate level. Only one person (2.1%) was up to primary level.(Table - 23).

Age of starting of first drink: Among total no of subjects (48 patients), 46.2 % of

people had their first drink in between 10 – 20 years of age of life, 45.2 % people had

their first drink in between 20 – 30 years of age of life, where as 8.6 % had their first

drink in between 30 – 40 years of age of life (Table - 24).

Incidence of period of daily drinking: In this study 79.0 % of people were having

alcohol daily since 1 – 5 years, 8.4% were having since 5 – 10 years, where as 10.5%

since 10 – 15 years and 2.1% since 15 – 20 years. (Table - 25).

Incidence of type of alcohol: This study shown maximum people (64.3 %) took

Whisky, 12.6 % of people took Brandy, 8.4 % people had Beer, 8.4 % people had

Rum and 6.3% had Vodka. (Table - 26).

Incidence of time of first drink in a day: Out of 48 patients 48.0 % of patients start

days drink at morning and 42.0 % of patients drink at evening. (Table – 27).

Incidence of Prakruti: Vatapitta Prakruti patients were more with 35.7 %,

Vatakapha Prakruti patients were 27.3 %, only 6.3 % of patients were of Vataja

Prakruti and 30.7 % of patients belong to Pittakaphaja Prakruti (Table – 28).

Observations


Table – 21

Showing incidence of Socio – economic status

S – E

status

S GY S&GY Total

No. of

pt

% No. of

pt

% No. of

pt

% No. of

pt

%

Poor 1 06.2 0 0 0 0 01 2.1

Medium 12 75.0 16 100.00 16 100.00 44 91.6

High 3 18.8 0 0 0 0 03 6.3

Table – 22

Showing incidence of Marital status

Marital

status

S GY S&GY Total

No.

of pt

% No.

of pt

% No. of pt % No.

of pt

%

Married 8 50.0 14 87.5 15 93.8 37 76.8

Unmarried 8 50.0 02 12.5 01 06.2 11 23.2

Table – 23

Incidence of Educational status

Educational

status

S GY S&GY Total

No. of

pt

% No. of

pt

% No. of

pt

% No. of

pt

%

Primary 00 0.0 01 06.2 00 00.0 01 02.1

Higher

secondary 05 31.2 13 81.2

13

81.2 31 65.1

PU 03 18.8 00 00.0 00 00.0 03 06.1

Graduate 02 12.5 02 12.6 03 18.8 07 14.4

Post Graduate 06 37.5 00 00.0 00 00.0 06 12.3

Observations


Table – 24

Showing incidence of Age of starting of Alcohol.

Age of

starting

alcohol

S GY S&GY Total

No. of

pt

% No. of

pt

% No. of

pt

% No. of

pt

%

10 - 15 00 00.0 00 00.0 00 00.0 00 00.0

15 - 20 09 56.6 08 50.0 05 31.2 22 46.2

20 - 25 05 31.0 04 25.0 04 25.0 13 27.2

25 - 30 02 12.4 04 25.0 03 18.8 09 18.0

30 - 35 00 00.0 00 00.0 02 12.5 02 04.3

35 - 40 00 00.0 00 00.0 02 12.5 02 04.3

Table – 25

Showing incidence of Duration of daily drinking of Alcohol in years.

Duration of Daily

drinking of

Alcohol

in years

S GY S&GY Total

No. of

pt

% No. of

pt

% No. of

pt

% No. of

pt

%

01 - 05 14 77.5 10 62.4 14 87.4 38 79.0

05 - 10 02 12.5 01 06.3 01 06.3 04 08.4

10 - 15 00 00.0 04 25.0 01 06.3 05 10.5

15 - 20 00 00.0 01 06.3 00 00.0 01 02.1

Observations


Table – 26

Showing incidence of Type of Alcohol

Type of

Alcohol

S GY S&GY Total

No.

of pt

% No. of

pt

% No. of pt % No. of

pt

%

Whisky 09 56.3 11 68.9 11 68.9 31 64.3

Brandy 01 06.2 02 12.5 03 18.7 06 12.6

Rum 02 12.5 01 06.2 01 06.2 04 08.4

Beer 02 12.5 01 06.2 01 06.2 04 08.4

Vodka 02 12.5 01 06.2 00 00.0 03 06.3

Incidence of Sara: Out of 48 patients 93.7 % patients had Madhyama Sara, 4.2%

Avara Sara and 2.1 % Pravara Sara. (Table – 29).

Incidence of Samhanana: 4.2 % of patients had Avara Samhanana, 93.7 % had

Madhyama Samhanana and 2.1% had Pravara Samhanana. (Table – 30).

Incidence of Saatmya: 4.2 % of patients had Avara Saatmya, 93.7 % had Madhyama

Saatmya and 2.1% had Pravara Saatmya. (Table – 30.1).

Incidence of Satva: 6.3 % had Heena Satva, 91.6 % had Madhyama Satva and 2.1%

had Pravara Satva(Table – 31).

Incidence of Vyayama Shakti: Out of 48 patients 63.0 % patients Avara Vyayama

Shakti, 32.8 % had Madhyama Vyayama Shakti and 4.2 % had Pravara Vyayama

Shakti (Table – 32).

Incidence of Abhyavarana Shakti: 42.0 % of patients had Avara Abhyavarana

Shakti, 53.8 % had Madhyama Abhyavarana Shakti and 4.2% had Pravara

Abhyavarana Shakti (Table – 33).

Observations


Incidence of Jarana Shakti: 68.5 % of patients had Avara Jarana Shakti, 27.3 % had

Madhyama Jarana Shakti and 4.2% had Pravara Jarana Shakti (Table – 34).

Incidence of Pramana: 6.3 % patients had Avara Pramana, 91.6 % had Madhyama

Pramana and 2.1 % had Pravara Pramana (Table – 35).

Incidence of other habits: Out of 48 patients 62.2 % people were smokers, 25.2 %

were not having any other habits, 6.3 % were having habit of Tobacco chewing, and

6.3 % of patients were having habit of taking Gutka. (Table – 36).

Incidence of Psychiatric complications: Out of 48 patients 79.0% of patients were

not having Psychiatric complications while 12.6 % of patients were having

Depression, 6.3% of patients were having Suicidal ideation and 2.1% had

Aggression.(Table – 37).

Incidence of Relationship with spouse: Out of 48 patients 68.0 % patients were

having cordial, 14.7 % patients were having moderate and 27.3% patients were

having unaffectionate relationship with their spouse. (Table – 38).

Incidence of Signs and symptoms: Out of 48 patients 100 % had Aruchi, 87.5% had

Hrillasa, 75% had Chardi, and 95.8 % had Prajagara, while 20.8 % patients had

Mandajvara, 20.8% had Panduta, 22.9% Bhrama, 12.5 % had Pralapa, 66.7% had

Shareera Kampa, 85.4% had Mandagni, 87.5% had weakness and 58.3% had

Laziness. (Table – 39).

Observations


Table – 27

Showing incidence of Time of first drink in a day

Time of

first drink

in a day

S GY S&GY Total

No.

of pt

% No.

of pt

% No. of pt % No. of

pt

%

Morning 08 50.0 11 68.8 09 56.2 28 48.0

Afternoon 00 00.0 00 00.0 00 00.0 00 00.0

Evening 08 50.0 05 31.2 07 43.8 20 42.0

Table – 28

Showing incidence of Prakriti

Prakriti S GY S&GY Total


Vata 03 18.8 00 00.0 00 00.0 03 06.3

Vata Pitta 05 31.2 08 50.0 04 25.0 17 35.7

Vata Kapha 06 37.5 02 12.5 05 31.2 13 27.3

Pitta Kapha 02 12.5 06 37.5 07 43.7 15 30.7

Table – 29

Showing incidence of Sara

Sara S GY S&GY Total


Avara 01 6.2 01 6.2 00 0.0 02 04.2

Madhyama 15 93.8 14 87.6 16 100 45 93.7

Pravara 00 0.0 01 6.2 00 0.0 01 02.1

Observations


Table – 30

Showing incidence of Samhanana

Samhanana S GY S&GY Total


Avara 01 6.2 01 6.2 00 0.0 02 4.2

Madhyama 15 93.8 14 87.6 16 100 45 93.7

Pravara 00 0.0 01 6.2 00 0.0 01 02.1

Table – 30.1

Showing incidence of Satmya

Saatmya S GY S&GY Total


Avara 01 6.2 01 6.2 00 0.0 02 04.2

Madhyama 15 93.8 14 87.6 16 100 45 93.7

Pravara 00 0.0 01 6.2 00 0.0 01 02.1

Table – 31

Showing incidence of Satva

Satva S GY S&GY Total


Avara 01 6.2 01 6.2 01 06.2 03 06.3

Madhyama 15 93.8 14 87.6 15 93.8 44 91.6

Pravara 00 0.0 01 06.2 00 00.0 01 02.1

Observations


Table – 32

Showing incidence of Vyayama Shakti

Vyayama

Shakti

S GY S&GY Total

No. of

pt

% No. of

pt

% No. of

pt

% No. of

pt

%

Avara 05 31.2 12 75.0 13 81.2 30 63.0

Madhyama 10 62.5 03 18.8 03 18.8 16 32.8

Pravara 01 06.2 01 6.2 00 0.0 02 4.2

Table – 33

Showing incidence of Abhyavarana Shakti

Abhyavaharana

Shakti

S GY S&GY Total

No. of

pt

% No. of

pt

% No. of

pt

% No. of

pt

%

Avara 05 31.2 10 62.5 05 31.3 20 42.0

Madhyama 10 62.5 05 31.3 11 68.7 26 53.8

Pravara 01 6.2 01 6.2 00 0.0 02 4.2

Table – 34

Showing incidence of Jarana Shakti

Jarana

Shakti

S GY S&GY Total

No. of

pt

% No. of

pt

% No. of

pt

% No. of

pt

%

Avara 07 43.8 12 75.0 13 81.2 32 68.5

Madhyama 08 50.0 03 18.8 03 18.8 13 27.3

Pravara 01 6.2 01 06.2 00 0.0 02 04.2

Observations


Table – 35

Showing incidence of Pramana

Pramana S GY S&GY Total


Avara 01 6.2 01 6.2 01 6.2 03 06.3

Madhyama 15 93.8 14 87.6 15 93.8 44 91.6

Pravara 00 0.0 01 6.2 00 0.0 01 02.1

Table – 36

Showing incidence of other habits.

Habits S GY S&GY Total


Smoking 16 100 09 56.3 05 31.2 30 62.2

Tobacco

chewing 00 00 01 6.2

02 12.5

03 6.3

Gutka 00 00 02 12.5 01 6.2 03 6.3

No habits 00 00 04 25.0 08 50.0 12 25.2

Table – 37

Showing incidence of Psychiatric complications

Psychiatric

complication

S GY S&GY Total


Aggression 01 6.2 00 0 00 00 01 02.1

Depression 05 31.2 01 6.2 00 00 06 12.6

Sucidal ideation 01 6.2 01 6.2 01 6.2 03 6.3

No Psychiatric

complication 09 56.2 14 87.6

15

93.8 38 79.0

Observations


Table – 38

Showing incidence of Relationship with Spouse

Relationship with

Spouse

S GY S&GY Total

No. of

pt

% No. of

pt

% No. of

pt

% No. of

pt

%

Cordial 3 18.8 14 87.6 11 68.8 28 68.0

Moderate 4 25.0 1 6.2 2 12.5 7 14.7

Unaffectionate 9 56.2 1 6.2 3 18.7 13 27.3

Table - 39

Showing incidence of signs and symptoms

Signs and

symptoms

S GY S&GY Total

No. of

pt

% No. of

pt

% No. of

pt

% No. of

pt

%

Aruchi 16 100 16 100 16 100 48 100

Hrillasa 14 87.5 16 100 12 75.0 42 87.5

Chardi 12 75.0 15 93.75 09 56.25 36 75.0

Prajagara 15 93.75 16 100 15 93.75 46 95.8

Mandajvara 7 43.75 2 12.5 1 6.25 10 20.8

Panduta 3 18.75 4 25.0 3 18.75 10 20.8

Bhrama 6 37.5 2 12.5 3 18.75 11 22.9

Pralapa 3 18.75 1 6.25 2 12.5 06 12.5

Shareera Kampa 9 56.25 13 81.25 10 62.5 32 66.7

Mandagni 12 75.0 16 100 13 81.25 41 85.4

Weakness 12 75.0 15 93.75 15 93.75 42 87.5

Laziness 7 43.25 9 56.25 12 75.0 28 58.3

Observations


Table: 39.1

showing the severity of Madatyayaja Yakrit Vikara

Severity S % GY % S&GY %

Absent 00 00 00 00 00 00

Mild 00 00 00 00 00 00

Moderate 16 100 12 75.0 13 81.25

Severe 00 00 04 25.0 03 18.75

Severity of Madatyayaja Yakrit Vikara: In Satvavajaya with placebo group, all 16

patients (100%) had moderate level of severity, in Guduchyadi Yoga group, 12

patients (75%) had moderate level of severity and 4 patients (25%) had severe level of

severity and in Satvavajaya and Guduchyadi Yoga (combined group) group, 1

patients(81.25%) had moderate level of severity and 03 patients (18.75%) had severe

level of severity.

Results

Results


Effect of Therapies

In this study 54 patients of Madatyayaja Yakrit Vikara were registered, 16 patients in

Satvavajaya(S)group,19 patients in Guduchyadi Yoga(GY)group and 19 patients in

Combined (S&GY) group, out of which 3 patients of GY group and 3 patients of

S&GY group were drop out. In this way 16 patients in each group completed full

courses of the treatment. The effects of the therapies are described according to the

group on respective symptoms

1.Effect of Satvavajaya Chikitsa with Placebo on symptoms of Madatyayaja

Yakrit Vikara.

In S group, it was observed that statistically highly significant improvements were

seen in Aruchi i.e 51.44% improvement, 38.16% in Hrillasa, 44.58% in Prajagara and

44.81% in Mandagni with p value < 0.001. Statistically significant results were

observed in the following; 46.0% relief in Chardi(P<0.01),50% in Manda jwara,

54.64% in Bhrama and 42.18% in Shareera kampa (P<0.02), 30.18% relief in laziness

(P<0.05). Statistically insignificant results with p>0.10 were observed in Panduta and

Pralapa.(Table.40)

Results


Table:40

Table showing Effect of Satvavajaya Chikitsa with Placebo on symptoms of


S No Symptoms Mean Diff.

Mean

% of

Relief

SD SE T p

BT AT

1. Aruchi 2.43 1.18 1.25 51.44 0.577 0.144 8.66 <0.001

2. Hrillasa 2.07 1.28 0.79 38.16 0.69 0.18 4.20 <0.001

3. Chardi 2.00 1.08 0.92 46.00 0.99 0.28 3.18 <0.01

4. Prajagara 2.40 1.33 1.07 44.58 0.96 0.24 4.29 <0.001

5. Manda jvara 2.00 1.00 1.00 50.00 0.816 0.308 3.24 <0.02

6. Panduta 1.66 1.00 0.66 39.75 0.57 0.33 2.00 >0.10

7. Bhrama 1.83 0.83 1.00 54.64 0.63 0.25 3.87 <0.02

8. Pralapa 1.66 0.66 1.00 60.24 1.00 0.57 1.73 >0.10

9. Sharira

Kampa

2.11 1.22 0.89 42.18 0.60 0.20 4.43 <0.02

10. Mandagni 2.41 1.33 1.08 44.81 0.51 0.14 7.28 <0.001

11. Weakness 1.75 1.00 0.75 42.85 0.75 0.21 3.44 <0.01

12. Laziness 1.85 1.28 0.57 30.81 0.53 0.20 2.82 <0.05

Effect of Satvavajaya Chikitsa with Placebo on Liver function test

In S group, it was observed that statistically significant improvements were seen in

Total bilirubin level i.e 10.85% improvement, 8.3% in Direct bilirubin, 7.34% in

SGOT, 9.60% in SGPT and 3.65% in Total proteins with p value < 0.01. Statistically

insignificant results with p>0.10 were observed in Indirect bilirubin, Pus

cells,Albumins and USG –Abdomen.(Table.41)

Results


Table:41

Table showing the effect of Satvavajaya Chikitsa with Placebo on Liver function

Test

S.

No

Test BT AT Mean

Diff

% of

Relief

SD SE t p

1 Total

Bilirubin

1.29 1.15 0.14 10.85 0.186 0.046 2.96 <0.01

2 Direct.B 0.72 0.66 0.06 8.3 0.081 0.020 3.10 <0.01

3 Indirect.B 0.56 0.52 0.04 7.14 0.079 0.020 1.57 >0.1

4 SGOT 37.01 34.29 2.72 7.34 2.854 0.713 3.80 <0.01

5 SGPT 39.68 35.87 3.81 9.60 4.391 1.080 3.53 <0.01

6 U-Total

Proteins

7.12 6.86 0.26 3.65 0.328 0.082 3.19 <0.01

7 U-Albumins 3.15 3.05 0.1 3.17 0.231 0.060 1.56 >0.1

8 U-Pus cells 1.29 0.86 0.43 33.33 1.134 0.429 1.00 >0.1

9 USG- Abd 0.62 0.62 0.00 00.00 00.00 0.000 0.00 >0.1

Overall effect of Satvavajaya Chikitsa on 16 Patients of Madatyayaja Yakrit

Vikara.

In this group, consideration of overall improvement showed that the maximum

patients i.e 56.25% got mild improvement, 43.45% patients remained

unchanged.(Table.42)

Results


Table:42

Table showing the Overall effect of Satvavajaya Chikitsa on 16 Patients of


Effect No.of Patients %

Complete remission 00 00

Marked Improvement 00 00

Moderate Improvement 00 00

Mild Improvement 09 56.25

Unchanged 07 43.45

2.Effect of Guduchyadi Yoga on symptoms of Madatyayaja Yakrit Vikara.

In GY group, it was observed that statistically highly significant improvements were

seen in Aruchi i.e 69.06% improvement, 54.11% in Hrillasa, 83.5% in Chardi, 56.25

% in Prajagara, 57.98% in Shareera kampa, 51.17% in Mandagni, 61.25% in

weakness and 77.45%in laziness with p < 0.001. 62.5%( p<0.02). relief in Panduta.

Statistically insignificant result with p>0.10 was observed in Mandajvara.Though it is

insignificant, given 75% relief in Mandajvara.(Table.43)

Results


Table:43

Table showing the effect of Guduchyadi Yoga on symptoms of Madatyayaja

Yakrit Vikara.

S No Symptoms Mean Diff.

Mean

% of

Relief

SD SE T p

BT AT

1 Aruchi 2.812 0.87 1.942 69.06 0.442 0.110 17.51 <0.001

2 Hrillasa 2.31 1.06 1.25 54.11 0.68 0.17 7.31 <0.001

3 Chardi 2.00 0.33 1.67 83.5 0.89 0.23 7.17 <0.001

4 Prajagara 2.56 1.12 1.44 56.25 1.03 0.25 5.57 <0.001

5 Manda jvara 2.00 0.50 1.5 75.00 0.70 0.50 3.0 >0.10

6 Panduta 2.00 0.75 1.25 62.5 0.50 0.25 5.00 <0.02

7 Bhrama 2.00 1.00 1.00 50 0.00 0.00 5.57 <0.001

8 Pralapa 3.00 1.00 2.00 66.66 0.00 0.00 7.27 <0.001

9 Sharira

Kampa

2.38 1.00 1.38 57.98 0.65 0.18 7.67 <0.001

10 Mandagni 2.56 1.25 1.31 51.17 0.60 0.15 8.72 <0.001

11 Weakness 2.40 0.93 1.47 61.25 0.83 0.21 6.81 <0.001

12 Laziness 2.44 0.55 1.89 77.45 0.78 0.26 7.24 <0.001

Effect of Guduchyadi Yoga on Liver function test:

In GY group, it was observed that statistically highly significant improvements were

seen in Total bilirubin level i.e 20.0% improvement, 27.69% in Direct bilirubin,

27.42% in SGPT and 8.3% in Total proteins with p value < 0.001. Statistically

significant improvements were seen in SGOT with 21.79 %( p<0.05), Indirect

bilirubin with 20.51%, Albumin with 14.83%, pus cells with 37.0 %( p<0.01) and

USG Abdomen with 21.42%. (Table.44)

Results


Table:44

Table showing the effect of Guduchyadi on Liver function Test.

S.

No

Test BT AT Mean

Diff

% of

Relief

SD SE T p

1 Total

Bilirubin

1.05 0.84 0.21 20.0 0.13 0.03 5.94 <0.001

2 Direct 0.65 0.47 0.18 27.6 0.10 0.02 6.92 <0.001

3 Indirect 0.39 0.31 0.08 20.5 0.11 0.02 2.93 <0.01

4 SGOT 63.9 49.9 13.9 21.7 14.5 3.6 3.83 <0.05

5 SGPT 57.6 41.8 15.8 27.4 13.2 3.3 4.76 <0.001

6 Total

Proteins

6.8 6.20 0.57 8.30 0.50 0.13 4.16 <0.001

7 Albumins 3.37 2.80 0.5 14.8 0.40 0.12 3.72 <0.01

8 Pus cells 1.27 0.80 0.4 37.0 0.50 0.13 3.50 <0.01

9 USG- Ab 1.12 0.88 0.2 21.4 0.40 0.1 2.23 <0.05

Overall effect of Guduchyadi Yoga on 16 Patients of Madatyayaja Yakrit

Vikara.


patients i.e 75.0% got moderate improvement, 18.75% got mild improvement and

6.25% patients got marked improvement. (Table.45)

Results


Table:45

Table showing the Overall effect of Guduchyadi Yoga on 16 Patients of


Effect No. of Patients %


Marked Improvement 01 6.25

Moderate Improvement 12 75.0

Mild Improvement 03 18.75

Unchanged 00 00

3.Effect of Satvavajaya Chikitsa and Guduchyadi Yoga on symptoms of


In S&GY group, it was observed that statistically highly significant improvements

were seen in Aruchi i.e 70.47% improvement, 80.00% in Hrillasa, 85.13% in Chardi,

85.71% in Prajagara, 100% in Mandajvara, 85.71% in Shareera kampa, 79.69% in

Mandagni, 73.26% in weakness and 82.40%in laziness with p value < 0.001.

Statistically significant results were observed in the following; 85.83% relief in

Panduta and 71.67% in Bhrama (P<0.05). Statistically insignificant result with p>0.05

was observed in Pralapa.(Table:46)

Results


Table:46

Table showing the effect of Satvavajaya Chikitsa and Guduchyadi Yoga on

symptoms of Madatyayaja Yakrit Vikara.

S

No

Symptoms Mean Diff.

Mean

% of

Relief

SD SE T p

BT AT

1. Aruchi 2.75 0.812 1.938 70.47 0.442 0.11 17.51 <0.001

2. Hrillasa 2.50 0.50 2.00 80 0.60 0.17 11.48 <0.001

3. Chardi 2.22 0.33 1.89 85.13 1.05 0.35 5.37 <0.001

4. Prajagara 2.80 0.40 2.4 85.71 0.63 0.16 14.69 <0.001

5. Manda

jvara

2.00 0.00 2.00 100 0.00 0.00 5.21 <0.001

6. Panduta 2.33 0.33 2.00 85.83 0.57 0.33 5.00 <0.05

7. Bhrama 2.33 0.66 1.67 71.67 0.57 0.33 5.00 <0.05

8. Pralapa 1.50 0.00 1.50 100 0.70 0.50 3.00 >0.10

9. Sharira

Kampa

2.80 0.40 2.4 85.71 0.51 0.16 14.69 <0.001

10. Mandagni 2.61 0.53 2.08 79.69 0.64 0.17 11.69 <0.001

11. Weakness 2.73 0.73 2.00 73.26 0.53 0.13 14.49 <0.001

12. Laziness 2.33 0.41 1.92 82.40 0.51 0.14 12.89 <0.001

Effect of Satvavajaya chikitsa and Guduchyadi Yoga on Liver function Test.

In S&GY group, it was observed that statistically highly significant improvements

were seen in SGOT level i.e 37.54% improvement and 50.27% in Pus cells with p

value < 0.001. Statistically significant improvements were seen in Total bilirubin with

19.02% (p<0.05), Direct bilirubin with 13.33% (p<0.01), ,Indirect bilirubin with

18.54% (p<0.05), 50.93% in SGPT(p<0.05) and Albumin with 9.19% (p<0.05), and

USG Abdomen with 22.5% (p<0.05) and statistically significant improvement seen in

Total proteins with 2.49% (p>0.1). (Table.47)

Results


Table:47 Table showing the effect of Satvavajaya chikitsa and Guduchyadi Yoga

on Liver function Test.

S.

No

Test BT AT Mean

Diff

% of

Relief

SD SE t p

1 Total

Bilirubin

3.47 2.81 0.660 19.02 1.20 0.30 2.20 <0.05

2 Direct 1.95 1.69 0.260 13.33 0.35 0.08 2.93 <0.01

3 Indirect 1.51 1.23 0.280 18.54 0.46 0.11 2.36 <0.05

4 SGOT 78.1 48.8 29.36 37.50 26.48 6.62 4.43 <0.001

5 SGPT 97.2 46.7 49.53 50.93 84.74 21.18 2.38 <0.05

6 Total

Proteins

7.61 7.42 0.190 2.490 0.91 0.22 0.82 >0.1

7 Albumins 3.37 3.06 0.310 9.190 0.41 0.11 2.59 <0.05

8 Pus cells 1.85 0.92 0.930 50.27 0.76 0.21 4.38 <0.001

9 USG- Ab 1.20 0.93 0.270 22.50 0.45 0.11 2.25 <0.5

Overall combined effect of Satvavajaya Chikitsa and Guduchyadi Yoga on 16

Patients of Madatyayaja Yakrit Vikara.


patients i.e 62.5% got moderate improvement,37.5% patients got marked

improvement.(Table.48)

Results


Table:48 Table showing the overall combined effect of Satvavajaya Chikitsa and

Guduchyadi Yoga on 16 Patients of Madatyayaja Yakrit Vikara.

Effect No.of Patients %


Marked Improvement 06 37.5

Moderate Improvement 10 62.5

Mild Improvement 00 00

Unchanged 00 00

Comparison between the Severity of Madatyayaja Yakrit Vikara and

Overall effect. Table 49&50

Severity S % GY % S&GY %

Absent 00 00 00 00 00 00

Mild 00 00 00 00 00 00

Moderate 16 100 12 75.0 13 81.25

Severe 00 00 04 25.0 03 18.75

Effect S % GY % S&GY %

Complete remission 00 00 00 00 00 00

Marked improvement 00 00 01 6.25 06 37.5

Moderate improvement 00 00 12 75.0 10 62.5

Mild improvement 09 56.25 03 18.75 00 00

Unchanged 07 43.75 00 00 00 00

Results


Effect of Therapy on Symptoms of Madatyayaja Yakrit Vikara(Table 40,43,46)

0

20

40

60

80

100

120

Aruchi Hrillasa Chardi Prajagara Manda jvara Panduta

S Group

GY Group

S&GY Group

0

20

40

60

80

100

120

Bhrama Pralapa Sharira Kampa

Mandagni Weakness Laziness

S Group

GY Group

S&GY Group

Results


Effect of Therapy on Symptoms of Madatyayaja Yakrit Vikara(Table 40,43,46)

0

10

20

30

40

50

60

70

80

90

100

S Group GY Group S&GY Group

Aruchi

Hrillasa

Chardi

Prajagara

Manda jvara

Panduta

Bhrama

Pralapa

Sharira Kampa

Mandagni

Weakness

Laziness

Results


Effect of Therapy on Liver Function Test (Table 41, 44, 47)

Effect of Therapy on Liver Function Test(Table 41,44,47)

0

10

20

30

40

50

60

Total Bilirubin

Direct Indirect SGOT SGPT Total Proteins

Albumins Pus cells USG- Ab

S Group

GY Group

S&GY Group

0

10

20

30

40

50

60


Total Bilirubin

Direct.B

Indirect.B

SGOT

SGPT

U-Total Proteins

U-Albumins

U-Pus cells

USG- Ab

Results


Showing the severity of Madatyayaja Yakrit Vikara (Table.49)

0

10

20

30

40

50

60

70

80

90

100

AbsentMild

ModerateSevere

S Group

GY Group

S&GY Group

Results


Overall Effect Of Therapy (Table.50)

0

10

20

30

40

50

60

70

80


Complete remission

Marked Improvement

Moderate Improvement

Mild Improvement

Unchanged

Discussion

Discussion


DISCUSSION

Day by day the prevalence of alcohol liver disorders is increasing in India may be

because of effect of media or attraction towards the western culture. An increasing

rate of consumption of alcohol is a major problem with extensive legal, social, moral,

ethical consequences all over the world irrespective of cultural, geographical,

educational, and economic differences. Indiscriminate and repeated use of alcohol

produces a gradual, physical and moral deterioration of the individual and leads to

crimes or perversions. This alcohol abuse interferes with the health, social

relationships, economic stability which have effects further in other areas in terms of

illness, disability, decreased productivity, accidents, crimes, family disorientation,

economic and psychological hardships, and lastly death in all classes of the society.

According to Ayurveda, the good qualities of alcohol when used judiciously well for

health but when used against the rules and regulations it may lead to adverse effects.

The other factors like nutritional deficiency, poor physical health, other systemic

pathologies, lack of emotional and family support etc increase the severity of the

withdrawal state.

For the person suffering from Madatyayaja yakrit vikara due to heavy and prolonged

consumption of alcohol, the first aim of the treatment should be safer resolution of

withdrawal state. That is why this study entitled “Role of Satvavaja chikitsa and

Guduchyadi Yoga in the management of Madatyayaja Yakrit Vikara” was carried out.

Satvavajaya Chikitsa may help people to address psychological issues involved in

their drinking problem. Astanga Hrudaya explains Vismapana, Vismarana,

Priyadarshana, Priyashravana, Geeta, Vadya and Charaka advises Harshanee Kriya

and restrain from the things which are harmful to body and mind as the treatment

modalities in the management of Madatyaya.

Discussion


The patients of this group were subjected to Satvavajaya Chikitsa daily along with

placebo capsule 500 mg starch thrice daily for 1 month.

Ayurveda has many options to treat Madatyayaja yakrit vikara . All the texts mention





Guduchyadi Yoga which is mentioned as Madatyaya upadrava nashaka, is also has

Agni Deepana property. In Madatyaya due to Madya along with Agni Dusthi, Pitta

dosha is also increased. To treat that Guduchyadi Yoga was selected. The patients of

this group were given Guduchyadi yoga in the dose of 5 gm, before food with warm

water thrice daily for 1 month.

Satvavaja chikitsa and Guduchyadi Yoga combined group is taken to study to see the

effect of combined group and to see the difference among other groups.

48 patients of Madatyayaja Yakrit vikara were studied in this series; the significance

of their demographic is being discussed here under in each heading:

Age: This study shows the prevalence of Madatyayaja Yakrit Vikara is more

(34.7%,27.3% and 27.3 %) in 3rd

, 4th

and 5th decade, its prevalence goes down in

elderly people may be either by this time most of the people has left the habit of

alcohol because of their health problem or the problems produced due to alcohol itself

(Table - 18).

A large scale study (Karan Gaur, 2002) showed 21% incidence in

second decade, 42% in third decade and 26.5% in the fourth decade.

Sex: In this study all patients were male, this may be because of the Male dominancy

and addiction are more seen in males around the Hassan or the females may not

Discussion


approach the hospital for taking treatment for such problems (Table - 19). Edwin

Sharon (2006) in his study on “Is Alcohol provokes liver disorder in men than in

women?” reported that male patients were more likely to experience liver disorders

than female.

Occupation: This study reveals the prevalence of Madatyaya is more in Business

people with 48.2 %, then Agriculturist were 27.65 % out of 48 patients. This may

because of stress of business and strain of agriculture, Friends Company and Students

were 25.2% out of 48, because of curiosity and peer group pressure. (Table - 20).

Bidadar (2003) in large sample of more than 2000 patients reported that Business men

(51%) were more prone to alcoholic addictions.

Socio – economic status: 91.6% of patients were belonging to Middle class income

group, this may be because of the more people surrounding Hassan are belonging to

Medium income group, worries and stresses are more in middle class people (Table -

21).

Marital status: Out of 48 patients 76.8 % were married, this may be because the

more incidences were found in the age group of 30 – 40 years in this study, by this

time the most of the people in India were got married, only 23.2% were unmarried

that is because they were belonging to below 30 years of age. The family tensions,

quarrels and conflicts make the married to start or continue the habit of alcohol to get

rid of these problems (Table - 22).

Education status: Educational status of this study revealed maximum ( 65.1%)

patients were educated till higher secondary, this may be because the education status

in the mid 1970s, the only one person has not been educated that was because of his

socio – economic status (Table - 23).

Discussion


Age of starting of alcohol: 46.2 % of people had their first drink in between 10 – 20

years of age of life, this may be because of the first time most people expose to

society individually at this age or the first drink is usually starts at the college days

because a high proportion of people are drinkers, especially in their middle teens to

mid-20s (Table - 24). 161

Duration of daily drinking: In this study 79.0 % of people were having alcohol daily

since 1 – 5 years, this may be because the people come / brought to hospital in the

initial stage of disease, and this study reveals even taking alcohol daily only for few

years will produce noticeable disturbance in health, social, and occupational life

(Table - 25).

Type of alcohol: This study shown maximum people (64.3%) take Whisky, 12.6 % of

people take brandy, this may be because of cost, the Whisky being cheaper and

produces maximum kick hence maximum people use it and local beverages are still in

use in spite of ban over it. (Table - 26).

First drink of the day: Out of 48 patients 48.0 % of patients start drink at morning,

42.0 % of patients drink at evening. Even less number of subjects starts their first

drink at night but they have more serious problems than other may be because of

other factors like their stressful life style, co morbid disorders like Hypertension,

Diabetes. As there are many patients start their first drink at morning so they have

noticeable problems so have approached hospital for assistance. That also shows the

dependency on alcohol or the severity of addiction to the alcohol (Table - 27).

Prakriti: Vatapitta Prakriti patients were more with 35.7%, may be because the

patients with this Prakriti may suffer with Madatyayaja Yakrit Vikara more often

than other Prakriti (Table - 28).

Discussion


Sara, Samhanana, Pramana, Saathmya: Out of 48 patients 93.7% patients had

Madhyama Sara, 93.7 % of patients had Madhyama Samhanana, 91.6 % patients had

Madhyama Pramana and 93.7% patients had Madhyama Saathmya. (Table 29, 30,

30.1, 35) The judicious usage of alcohol improves the health on the contrary the

dependence, excessive usage and improper usages reduces the compactness,

nutritional state and quality of tissues. This may be because of vitiation of Agni and

the Srotosanga which are produced due to Madya.

Jarana Shakti, Abhyavarana Shakti and Vyayama Shakti: Out of 48 patients 68.5

% of patients had Avara Jarana Shakti, 42 % of patients had Avara Abhyavarana

Shakti, 63.0 % patients Avara Vyayama Shakti (Table 34, 33, 32). It’s quite evident

that the Madya directly vitiates the Agni and the persons capacity of quantity of

consumption of food reduces and also the digestion power. Because of the reduced

nutritional status a physical power also hampers. The observations of the present

study also prove the same.

Satva: In the present study 91.6% had Madhyama Satva, followed by 6.3 % had

Avara Satva (Table - 31). The addictions and abuses are commonly seen in the weak

and moderate level minded persons. Though the Pravara Satva people may be

addicted but they may easily overcome the consequences of addiction. The Avara

Satva and Madhyama Satva people needs the help or motivation to overcome the

addiction.

Other habits: Out of 48 patients 62.2% people were smokers, because of alcohol

drinkers’ smoke more often during the time of alcohol intake (Table - 36).

Discussion


Psychiatric complications: Out of 48 patients 12.6% of patients were having

depression, that shows that alcohol dependency causes Vishada because of increased

Tamo guna by Madya.(Table - 37).

Relationship with spouse: Out of 48 patients 27.3% patients were having

unaffectionate relationship with spouse. This clearly shows alcohol addiction directly

affect the healthy family relationships. (Table-38)

Discussion on results:

Satvavajaya chikitsa group, Guduchyadi Yoga group and Combined group showed

different amount of relief on the symptoms of Madatyayaja Yakrit Vikara and

improvement amount of each symptoms and their differences discussed below.

Effect on Aruchi:

S group provided 51.44% improvement, GY group provided 69.06% improvement

and S&GY group provided 70.47% improvement on Aruchi which is statistically

highly significant (p<0.001) .It shows that combined group is given more relief

because the action of therapy acts both on the mind and vitiated condition of the

body. Guduchyadi Yoga showed very good Deepaka- pachaka action and Agni

deepaka property.

Effect on Hrillasa:

S group provided 38.16% improvement , GY group provided 54.11% improvement

and S&GY group provided 80.0% improvement on Hrillasa which is statistically

highly significant (p<0.001). It shows that combined group is given more relief

Discussion


because the Guduchyadi Yoga acts as very good deepaka- pachaka and pitta rechaka

action and satvavajaya chikitsa helped in controlling the nidana.

Effect on Chardi: S group provided 46.0% improvement, GY group provided 83.5%

improvement and S&GY group provided 85.13% relief on chardi which is statistically

highly significant (p<0.001) .It shows that combined group is given more relief

because the action of therapy acts physically and psychologically. Guduchyadi Yoga

acts Deepaka- pachaka, Agni deepaka and Vatanulomaka property. Tikta rasa of

Guduchyadi yoga acts as Pitta shamaka.

Effect on Prajagara: S group provided 44.58% improvement , GY group provided

56.25% improvement and S&GY group provided 85.71% improvement on Prajagara

which is statistically highly significant (p<0.001). It shows that combined group is

given more relief because the action of therapy acts Manah prasadakara and Pitta

shamaka. After therapy food intake become normal which in turn regulate the sleep.

Effect on Mandajvara: S group provided 50.0% relief (p<0.02), GY group provided

75.0% relief and S&GY group provided 100% relief on Mandajvara which is

statistically highly significant (p<0.001) .It shows that Aashwasana therapy and Tikta

rasa of Guduchyadi yoga acted as Jvaragna thereby decreased the body temperature.

Effect on Panduta: S group provided 39.75% improvement which is statistically

insignificant, GY group provided 62.5% (p<0.02) improvement and S&GY group

provided 85.83% improvement on Panduta which is statistically significant (p<0.05).

It shows that Guduchyadi yoga acts as Pittarechaka and removed Amshamsha

Samprapti of Panduta.

Effect on Bhrama: S group provided 54.64% improvement (p<0.02), GY group

provided 50.0% (p<0.05) improvement and S&GY group provided 71.67%

Discussion


improvement on Bhrama which is statistically significant (p<0.05). It shows that

Guduchyadi yoga acts as Pitta shamaka and thereby Bhrama nashaka.

Effect on Pralapa: S group provided 60.24% improvement, , S&GY group provided

100% improvement on Bhrama which is statistically insignificant (p>0.10) which is

statistically insignificant and GY group provided 66.0% (p<0.05) improvement and .It

shows that Guduchyadi yoga alone acted on Pralapa.

Effect on Shareera kampa: S group provided 42.18% improvement (p<0.02) which

is statistically significant, GY group provided 57.98% improvement and S&GY

group provided 85.71% improvement on Shareera kampa which is statistically highly

significant (p<0.001). This data clarifies Satvavajaya given mental streangth to

withhold the Indriya and Guduchyadi yoga acted as Vatanulomaka and Rasayana.

Effect on Mandagni: S group provided 44.81% improvement , GY group provided

51.17% improvement and S&GY group provided 79.69% improvement on Mandagni

which is statistically highly significant (p<0.001). It shows that combined group is

given more relief because the action of therapy acts both on the mind and vitiated

condition of the body. Guduchyadi Yoga showed very good Deepana- pachana action.

Effect on Weakness: : S group provided 42.85% improvement (p<0.01) which is

statistically significant, GY group provided 61.25% improvement and S&GY group

provided 73.26% improvement on weakness which is statistically highly significant

(p<0.001). Satvavajaya given mental strength and that confirms mental stability is

directly influences on physical strength and Guduchyadi yoga acted as Agnivardhaka

and Rasayana.

Effect on Laziness: : S group provided 30.81% improvement (p<0.05) which is

statistically significant, GY group provided 77.45% improvement and S&GY group

Discussion


provided 82.40% improvement on laziness which is statistically highly significant

(p<0.001). Satvavajaya given enthusiasm and helped to start new style of life.

Guduchyadi yoga acted as Agnivardhaka and Rasayana.

Effect on Liver Function Test:

Effect on Total Billirubin:

S group provided 10.85% improvement, GY group provided 20.00% improvement

and S&GY group provided 19.02% improvement on Total bilirubin which is

statistically significant (p<0.05) .

Effect on Direct Billirubin:

S group provided 8.3% improvement , GY group provided 27.69% improvement and

S&GY group provided 13.33% improvement on Direct billirubin which is

statistically significant (p<0.01)

Effect on Indirect Billirubin:

S group provided 7.14% improvement (p>0.1) which is statistically insignificant, GY

group provided 20.51% improvement and S&GY group provided 18.54%

improvement on Indirect billirubin which is statistically significant (p<0.05) .

Effect on SGOT:

S group provided 7.34% improvement, GY group provided 21.79% improvement and

S&GY group provided 37.54% improvement on SGOT which is statistically

significant (p<0.05) .

Discussion


Effect on SGPT:

S group provided 9.60% improvement , GY group provided 27.42% improvement and

S&GY group provided 50.93% improvement on SGPT which is statistically

significant (p<0.05) .

Effect on Total Protein:

S group provided 3.65% improvement, GY group provided 8.3% improvement which

is statistically significant (p<0.05) and S&GY group provided 2.49% improvement in

Total proteins which is statistically insignificant (p>0.1).

Effect on Albumin:

S group provided 3.17% improvement which is statistically insignificant (p>0.1) ,

GY group provided 14.83% improvement and S&GY group provided 9.19%

improvement on Albumins which is statistically significant (p<0.05)

Effect on Pus cells:

S group provided 33.33% improvement which is statistically insignificant (p>0.1) ,

GY group provided 37.00% and S&GY group provided 50.27% improvement on Pus

cells which is statistically significant (p<0.05)

Effect on USG Abdomen:

S group provided 0% improvement which is statistically insignificant (p>0.1) , GY

group provided 21.42% and S&GY group provided 22.5% improvement on Pus cells

which is statistically significant (p<0.05)

As the Liver is one of the major organ related to digestion and metabolism and also

detoxification. Guduchyadi Yoga contains Deepana, Pachana and Srotoshodhan drugs

Discussion


which improves the function of liver and Tikta rasa does Pitta rechana and Pitta

shamana, hence the significant improvement was seen in all the parameter of Liver

Function test in GY, and the virechaka property of Guduchyadi Yoga helps in

minimizing the Udara lakshanas, so that it helps in the positive development in USG

Abdomen. But the results obtained in Satvavajaya with Placebo group may be due to

the effect on Agni.

Overall effect:

The overall effect shows no patients got cured, where as marked improvement 6.25 %

&37.5% in GuduchyadiYoga and Satvavajaya&GuduchyadiYoga group respectively.

75.0% and 62.5% moderate improvement in GuduchyadiYoga and

(Combined)Satvavajaya&GuduchyadiYoga group respectively, where as 18.75 % and

56.25% mild improvement in GuduchyadiYoga and Satvavajaya with placebo group

respectively and But only 43.75 % patient not got cured in Satvavajaya with placebo

group.

This shows Satvavajaya chikitsa and Guduchyadi Yoga combined group is better than

Guduchyadi Yoga group and Guduchyadi Yoga group is better than Satvavajaya

chikitsa with placebo group.

Effect S % GY % S&GY %

Complete remission 00 00 00 00 00 00

Marked improvement 00 00 01 6.25 06 37.5

Moderate improvement 00 00 12 75.0 10 62.5

Mild improvement 09 56.25 03 18.75 00 00

Unchanged 07 43.75 00 00 00 00

Summary

&

Conclusion

Summary and Conclusion


SUMMARY & CONCLUSION

For good health among various factors, Ahara is one important factor. Madya is

considered as one of the Aharadravya and it acts like ambrosia if taken properly

following the rules and regulations, otherwise it acts like a poison. In all the classics,

the adverse effects are described beautifully with suitable similes.

The present study entitled “Role of Satvavajaya chikitsa and Guduchyadi Yoga in the

management of Madatyayaja Yakrit Vikara” has been carried out with two objectives

viz., to study Madatyaya conceptually in detail and to clinically study the efficacy of

Satvavajaya Chikitsa and Guduchyadi Yoga in the management of Madatyayaja

Yakrit Vikara.

The work is presented in four sections viz., Conceptual study, Clinical study,

Observation, Results and Discussion with a brief Introduction as the preface of the

dissertation and Summary & Conclusion at the end.

Introduction gives the details of the study about its need and significance, statement of

the problem, objectives of the study.

In first major section conceptual study, classical descriptions of Madya, Madatyaya,

Madatyayaja Yakrit Vikaras and Satvavajaya chikitsa are explained including

modern explanations.

The second major section Clinical study comprises of two subsections Methodology

of the study and Observations & results.

Under the methodology of the study, the details about statement of the problem,

research design, selection of subjects - inclusion criteria and exclusion criteria,

research techniques and tools, treatment schedule, follow up, assessment & statistical

analysis and total effect of therapy are discussed.



General Observations:

In this study maximum number (34.7%) of patients were belonging to 30 – 40 years

of age, all the patients were male (100 %), occupation wise maximum (48.2%,)

patients were Businessmen, socio – economic status wise 91.6 % of people were

belonging to Middle class income group, 76.8 % were married, 65.1 % patients were

educated till higher secondary, The average age of the starting of alcohol was 46.2 %

of people had their first drink in between 10 – 20 years of age of life, 79.0 % of

people were having alcohol daily since 1 – 5 years, maximum patients (64.3 %) take

Whisky as their drink, 48.0 % of patients start days drink at morning, Vatapitta

Prakruti subjects were more with 35.7 %.

Effect of Satvajaya chikitsa with placebo group:

Improvement were seen on Aruchi i.e 51.44% , 38.16% in Hrillasa, 44.58% in

Prajagara and 44.81% in Mandagni ,46.0% relief in chardi,50% in Manda jwara,

54.64% in Bhrama, 42.18% in Shareera kampa, 30.18% relief in Laziness and In total

bilirubin level i.e 10.85% improvement, 8.3% in Direct bilirubin, 7.34% in SGOT,

9.60% in SGPT ,3.65% in Total proteins, 7.14% in Indirect bilirubin, 33.33% in Pus

cells,3.17% in Albumins and 0% in USG –Abdomen

Effect of Guduchyadi Yoga group:

Improvements were seen in Aruchi i.e 69.06% , 54.11% in Hrillasa,83.5% in Chardi,

56.25 % in Prajagara, 57.98% in Shareera kampa, 51.17% in Mandagni, 61.25% in

Weakness, 77.45%in Laziness, 62.5% relief in Panduta,75.0% Mandajvara and in

Total bilirubin level i.e 20.0% improvement, 27.69% in Direct bilirubin, 27.42% in

SGPT , 8.3% in Total proteins, SGOT with 21.79% ,Indirect bikirubin with 20.51%,

Albumin with 14.83%, pus cells with 37.0% and USG Abdomen with 21.42%.



Effect of Combined group (Satvavajaya and Guduchyadi Yoga group):

Improvements were seen in Aruchi i.e 70.47% improvement, 80.00% in

Hrillasa,85.13% in Chardi, 85.71% in Prajagara, 100% in Mandajvara, 85.71% in

Shareera kampa, 79.69% in Mandagni, 73.26% in Weakness and 82.40%in Laziness,

85.83% relief in Panduta, 71.67% in Bhrama, 100% in Pralapa and SGOT level i.e

37.54% improvement, 50.27% in Pus cells, Total bilirubin with 19.02%,Direct

bilirubin with 13.33%,Indirect bilirubin with 18.54% , 50.93% in SGPT, Albumin

with 9.19%, Total proteins with 2.49% and USG Abdomen with 22.5%.

Overall effect:

The overall effect shows no patients got cured, where as marked improvement 6.25 %

&37.5% in GuduchyadiYoga and Satvavajaya&GuduchyadiYoga group respectively.

75.0% and 62.5% moderate improvement in GuduchyadiYoga and

(Combined)Satvavajaya&GuduchyadiYoga group respectively, where as 18.75 % and

56.25% mild improvement in GuduchyadiYoga and Satvavajaya with placebo group

respectively and But only 43.75 % patient not got cured in Satvavajaya with placebo

group.

This shows Satvavajaya chikitsa and Guduchyadi Yoga combined group is better than

Guduchyadi Yoga group and Guduchyadi Yoga group is better than Satvavajaya

chikitsa with placebo group.

Advises for further study:

Number of the patients should be increased.

Duration of the study should be minimum of six months.

Bibliographic

References

Bibliographic References



1. Charaka: Charaka Samhita of Agnivesha, revised by Charaka and Dridhabala

with the Ayurveda – Dipika commentary of Chakrapanidatta, edited by Vaidya

Jadavji Trikamji Acharya, Munshiram Manoharlal Publishers pvt. Ltd. Fifth

edition 1992, Chikitsa Sthana24/59

2. Kaplan & Sadock: Comprehensive textbook of psychiatry, Lippincott Williams

& Wilkins publication, eighth edition, 2005, 11.2 Alcohol – Related

Disorders,Page No - 1168.

3. Ibid; Page No - 1172




edition 1992, Chikitsa Sthana 24/107

5. Sushruta: Sushruta Samhita with Nibanda Sangraha Commentry of Sri

Dalhanacharya, edited by Vaidya Jadavji Trikamji Acharya. Chaukhambha

Orientalia Varanasi, Seventh edition 2002, Uttaratantra 47/17.





7. Ibid; Chikitsa Sthana 24/177




Disorders,Page No - 1176.

10. Amarasimha: Amarakosha with Ramasrami commentary of Bhanuji Diksita

edited by Pt. Haragovinda Sastri, . Chaukhambha Sanskrit Sansthan Varanasi,

Fourth edition 2001, 3/2/12 page no. – 530.

11. Sharngadhara: Sarngadhara Samhita Edited by Dr Brahmanand Tripathi,

published by Chaukhamba Surabharati Prakashan varanashi. Pu 4/21 PN – 50



12. Sri Bhava Misra: Bhavaprakasha edited with Vidyotini Hindi commentary by Sri

Brahmasankara Misra Chaukhambha Sanskrit Sansthan Varanasi, seventh edition

1990, Page No - 785



Orientalia Varanasi, Seventh edition 2002, Sutrasthana 45/194, 195.

14. Ibid: 45 / 187 - 191 page no 211.



1990, Page No – 786




edition 1992, Sutra Sthana 25/49



Orientalia Varanasi, Seventh edition 2002, Sutrasthana 45/210 – 213

18. Ibid; Sutrasthana 45/175 – 176



1990, Page No – 785 – 786

20. Ibid; Page no – 785

21. Ibid; Page no – 786



Orientalia Varanasi, Seventh edition 2002, Sutrasthana 45/182 – 187.

23. Ibid; Sutrasthana 45/171 – 181









Orientalia Varanasi, Seventh edition 2002, Uttaratantra 47/3

26. Vagbhata: Ashtanga Hridaya with the commentaries Sarvangasundara of

Arunadatta and Ayurvedarasayana of Hemadri, collated by late Dr Anna

Moreswara Kunte and Krsna Ramachandra Shastri Navare, Chaukhambha

Orientalia Varanasi, reprint ninth edition 2005, Nidana Sthana 6 / 1




edition 1992, Chikitsa Sthana 24/31 – 33




31. Ibid; Chikitsa Sthana 24/61 – 64

32. Ibid; Chikitsa Sthana 24/74 - 78

33. Vagbhata: Astanga Sangraha Induvykhyasahita, by Acharya V.J. Thakkar,

published by Central council for Research in Ayurveda and Siddha, New Delhi,

publication 1991, Indu on Nidana Sthana 6/1





35. Vagbhata: Astanga Hridaya with the commentaries Sarvangasundara of



Orientalia Varanasi, reprint ninth edition 2005, Nidana Sthana 6/14.



Orientalia Varanasi, Seventh edition 2002, Uttara Tantra 47/17 -18.



37. Vaidya Sodhala: Gada nigraha with the Vidyotini Hindi Commentary Vol. two,

by Sri Indradeva Tripathi. Chaukhambha Sanskrit sansthan, Varanasi. 3rd

edition

1999 (Kayachikitsa khand 17/21) page no. 451.

38. Kasyapa: Kasyapa Samhita edited by prof (Km) P.V.Tewari, Chaukhambha

Visvabharati Varanasi, Reprint 2002, Chikitsa Sthana Madatyaya Chikitsa

Adhyaya / 3, page no – 234








Orientalia Varanasi, Seventh edition 2002, Uttara Tantra 47/18.







publication 199,1 Indu on Nidana Sthana 6/16








46. Ibid; Chakrapani commentary on Chikitsa Sthana 24/93

47. Ibid; Chikitsa Sthana 24/ 94


















53. Sushruta: Sushruta Samhita with Nibandha Sangraha Commentary of Sri














58. Ibid; Chikitsa Sthana 24/98 – 100

59. Ibid; Chikitsa Sthana 24/98 – 101 - 106






61. Ibid; Uttara Tantra 47/18 - 19

62. Ibid; Uttara Tantra 47/19,20






edition 1992, Chikitsa Sthana 24/ 199




69. Yogaratnakara: Yogaratnakara with Vidyotini Hindi commentary by Vaidya

Laksmipati Sasrti edited by Bhisagratna Brahmasankar Sastri, Chaukhambha

Sanskrit Samsthan Varanasi, Seventh edition 1999, page no 478



Orientalia Varanasi, Seventh edition 2002, Uttara Tantra 47/23

71. Ibid; , Uttara Tantra 47/22




edition 1992, Chikitsa Sthana 24/ 109



Adhyaya 23, page no – 236




edition 1992, Chikitsa Sthana 24/ 112-120



75. Ibid; Chikitsa Sthana 24/ 194.

76. Ibid; Chikitsa Sthana 24/191-193.

77. Ibid; Chikitsa Sthana 24/ 195-198.



Adhyaya 51, page no – 239




edition 1992, Chikitsa Sthana 24/ 204,205

80. Kasyapa: Kasyapa Samhita edited by prof (Km) P.V.Tewari, Reprint 2002,

Chikitsa Sthana Madatyaya Chikitsa Adhyaya 39 - 41, page no – 239

81. Bhela: Bhela Samhita edited by Dr K.H. Krishnamurthy Chaukhambha

Visvabharati Varanasi, First edition 2000, Chikitsa Sthana 28/ 57 – 58

82. Govinda Dasa Sen: Bhaishajyaratnavali with Hindi Tika, Khemaraj Shrikrishna

Das Prakashan Bombay,edition 2004,Madatyaya Roga Chikitsa 25, page no – 585.




Orientalia Varanasi, reprint ninth edition 2005, Nidana Sthana 6/ 8.




edition 1992, Kalpa sthana 1/4.

85. Sarngadhara: Sarngadhara Samhita with the commentary of Adamalla’s Dipika

and Kasirama’s Gudharth parasurama Sastri, Vidyasagar Dipika edited by Pandit

Chaukhambha Orientalia Varanasi, fifth edition 2002, Uttara Khanda 3 / 2




edition 1992, Sutra Sthana – 4 /13.

87. Ibid; Kalpasthana 1 / 5





Orientalia Varanasi, Seventh edition 2002, Sutra Sthana 42/10.




Orientalia Varanasi, reprint ninth edition 2005, Sutra Sthana 9/ 11



Orientalia Varanasi, Seventh edition 2002, Chikitsa Sthana. 33/33.




edition 1992, Sutra Sthana – 16/20




edition 1992, Sutra Sthana– 15/3.

93. Ibid; Siddhi Sthana 2 / 8 – 10



Orientalia Varanasi, Seventh edition 2002, Chikitsa Sthana. 33/14 – 15, 18




Orientalia Varanasi, reprint ninth edition 2005, Sutra Sthana 18/ 1 - 6




97. Ibid; Chikitsa Sthana. 33/47

98. Bhela: Bhela Samhita edited by Dr K.H. Krishnamurthy Chaukhambha

Visvabharati Varanasi, First edition 2000, Sutra Sthana 14/ 11.







100. Ibid; Sutra Sthana 13 / 37







Orientalia Varanasi, reprint ninth edition 2005, Sutra Sthana 16/ 17 – 18








105. Ibid; Siddhi Sthana 1/7





107. Ibid; Sutra Sthana 16/25











111. Ibid; Dalhana Commentary Chikitsa Sthana. 33/6











edition 1992, Kalpa Sthana 1/14




Chaukhambha Orientalia Varanasi, fifth edition 2002, Uttara Khanda 3 / 16 - 17




edition 1992, Kalpa Sthana 15/11









120. Ibid; Chakrapani commentary on Siddhi Sthana 1 / 14













Orientalia Varanasi, reprint ninth edition 2005, Sutra Sthana 18 / 24



publication 1991, Sutra Sthana 27/19














Orientalia Varanasi, reprint ninth edition 2005, Sutra Sthana 18 / 23 - 24



















Orientalia Varanasi, reprint ninth edition 2005, Sutra Sthana 18 / 25 - 26






Chaukhambha Orientalia Varanasi, fifth edition 2002, Uttara Khanda 3 / 25 – 26






138. Ibid; Chakrapani commentary on Siddhi Sthana 1 / 11



Orientalia Varanasi, Seventh edition 2002, Chikitsa Sthana. 33/11






edition 1992, Chakrapani commentary on Siddhi Sthana 6/11

141. Vagbhata : : Ashtanga Hridaya with the commentaries Sarvangasundara of







edition 1992, Sutra Sthana 23/36 – 38




144. Charaka : Charaka Samhita of Agnivesha, revised by Charaka and Dridhabala



edition 1992,Siddhi Sthana 1/12



147. Ibid; Chakrapani Commentary on Siddhi Sthana 6/29 – 30



Orientalia Varanasi, Seventh edition 2002, Chikitsa Sthana. 34/3

149. Ibid; Dalhana commentary onChikitsa Sthana. 34/16 – 18

150. Trease and Evans: Pharmacognosy, Thirteenth edition William Charles Evans

ELBS with bailliere tindall, PN 320 -321

151. Christopher G. Goetz: Text book of Clinical Neurology, Saunders publications,

Second edition, Chapter 40 PN 885

152. Trease and Evans: Pharmacognosy, Thirteenth edition William Charles Evans

ELBS with bailliere tindall, PN 320 -321



153. Tripathy: Textbook of pharmacology



Disorders,Page No – 1169 - 70.

155. Peoples RW, Li C, Weight FF: Lipid vs protein theories of alcohol action in the

nervous system. Annu Rev Pharmacol Toxicol 1996;36:185 – 201



Disorders,Page No – 1171

157. Ibid: 1168 – 1188

158. Ibid: Page no – 1169













Orientalia Varanasi, Seventh edition 2002, Sutra Sthana. 46/13

167. Charaka- Charaka Samhita with Ayurveda Dipika commentary of

Chakrapanidatta, Chaukhambha Sanskrit Sansthan, 5th

edition, Varanasi, 2001

Su. 11/54.

168. Charaka- Charaka Samhita with Ayurveda Dipika commentary of

Chakrapanidatta, Chaukhambha Sanskrit Sansthan, 5th

edition, Varanasi, 2001

Su. 11/47.



169. Vagbhata- Ashtanga Hridaya with the commentaries Sarvangasundara of

Arunadatta and Ayurvedarasayana of Hemadri, Chaukhambha Orientalia,

Varanasi. Su. 1/26.

170. Patanjali Yoga Sutra. Su.2/26.

171. Patanjali Yoga Sutra. 2/46.

172. Patanjali Yoga Sutra. 2/29









Varanasi. Chi.1/191. Chi.5/47.



Varanasi. Chi.5/47.



Varanasi. Chi.6/21.



Varanasi. Chi.7/9.



Varanasi. Chi.19/98.

Annexures

Case proforma


DEPARTMENT OF PG STUDIES, MANASA ROGA.

SDM COLLEGE OF AYURVEDA AND HOSPITAL.

HASSAN.

CLINICAL PROFORMA

TITLE: Role of Satvavajaya chikitsa and Guduchyadi yoga in the

management of Madatyayaja Yakrit Vikara.

Scholar : Dr. Niranjana.H.P.

Guide: Dr. Narayana Prakash B. Co- Guide: Dr. Suhas Kumar Shetty

CASE No: I.P No. O.P.No Date:

GROUP:

Name:

Age: Yrs Sex: M/F

Religion: H /M / C / O

Occupation: Date of commencement of treatment:

Marital Status: Date of end of treatment:

Education:: UN/P/M/HS/G/PG Socio – economic status : VP/P/LM/M/UM/R

Address:

CHIEF COMPLAINTS: AT & BT

Symptoms Duration BT AT(1

WK)

2

WK

3

WK

4

WK

Aruchi (Loss of appetite)

Hrillasa (Nausea)

Chardhi (Vomiting)

Prajagara (Insomnia)

Manda jvara (mild fever)

Panduta (pallor)

Bhrama (Giddiness)

Pralapa (Delirium)

Sharira kampa (Tremors)

Mandagni (Decreased hunger)

Weakness

Laziness

Case proforma


Investigation Reports :

Liver Function Test Duration BT

AT

1 Wk 2

Wk.

3

Wk

4

Wk

Total bilirubin:

Direct:

Indirect:

SGOT:

SGPT:

Urine

Total Proteins

Albumins

Pus Cells

USG Abdomen

HISTORY OF ALCOHOL CONSUMPTION:

1. When drinking did started?

Age of starting:

Total duration:

2. Why did he start drinking?

Curiosity/ Peer group pressure/ Anxiety/ Depression/ Frustration/ Loneliness/ Premorbid

personality/ Individual problems/ Family problems

3. Drinking pattern

Before food/ After food/ Along with the food/ without food

4. Drinking Alone or with Friends

5. Drinking while having

Fear/ Anger/ Worries/ Excessive physical work/ Working at hot conditions

6. When was daily drinking started?

Duration:

7. Which brand?

i. Malted liquors: Beer

ii. Spirits: Whisky/ Rum/ Gin/ Brandy/ Vodka

iii. Mixed/ Local available

8. Quantity/ day (approx):

9. Describe day’s drinking:

i. What time is the first drink of the day?

Case proforma


10. When was the first withdrawal symptom experienced?

i. Age at the time:

11. Previous periods of abstinence from alcohol:

12. What led to resumption of drinking?

13. Previous attempts at treatments any:

a. When:

14. Patients’ attitude towards drinking:

Wants to abstinate/ Defending drinking/ Self motivated/ Not self motivated

15. Myths and misconcepts about drinking:

16. History of any other substance use:

Substance:

Duration:

Quantity:

17. Any medical complications:

Haematemesis / Jaundice / Head injury / Epilepsy /Any other

18. Any psychiatric complications?:

Depression / Suicidal ideations / Suicidal attempts / Aggressive outbursts /

Hallucinations / Paranoid ideas

19. Chronic health problems:

D.M/ Liver disorders/ Epilepsy/ Infection/ Cardiac - Hypertension or IHD or RHD/ Respiratory -

Pulmonary T.B. or Chronic bronchitis or Bronchial asthma/ Others

FAMILY HISTORY:

Family Atmosphere: Harmonious/ Committed/ Conflicted

Relation with neighbors: Cordial/ Moderate/ Quarreling

Relation with spouse: Cordial/Moderate/Unaffectionate/Divorced/Single staying

Children: No. of children:

S.No. Age Sex School Performance Relation with

parents

Emotional/ behavioral disorders

PERSONAL HISTORY:

Bowel:

Appetite:

Micturation:

Sleep:

Duration :

Pattern :

Other Habits:

Childhood history:

Date of birth: Place:

Length of gestation:

Mother’s health during pregnancy:

Nature of delivery:

Case proforma


In later childhood:

Any particular fear: Yes/No

Running away from school: Yes/ No

Physical symptoms at the time of stress or unhappiness: Yes/No

Any physical disorders:

Any emotional disorders:

Schooling:

o Going to school forcefully/ self interest.

o School atmosphere.

o Relationship with classmates, friends

Adolescence:

Episodes of disturbances: Antisocial/ Emotional

Occupation:

Nature of job: Duration:

Relations with peers and superiors: Good / Bad

Reasons for leaving the jobs:

Lack of interest/ Decreased efficiency/Dismissals

Financial condition: Sound/ Middle higher/ Middle/ Poor/ Very poor

Duration of any period of unemployment:

Suicidal behavior: Present/Absent

If present, No. of attempts:

Reasons:

Psycho- sexual function:

Sexual satisfaction: Present/ Absent

Any extra marital/Premarital experiences: Present/ Absent

Do you have:

Reduced libido/ Excessive sexual urge/ Complete abstinence/

Erectile dysfunction/ Delayed ejaculation/ Pathological jealousy

Criminal history:

Any history of road accidents due to alcohol abuse: Present/ Absent

Any history of crimes: Sexual offences/ Violence/ Murders/ Fraud

Menstrual History

Menarche:

Menopause:

Menstrual cycle:

Dasha Vidha Pariksha

Prakruti:

Sara:

Samhanana:

Satmya:

Pramana:

Case proforma


Ahara Shakti: Abhyavarana Shakti: Jarana Shakti:

Vyayama Shakti:

Vaya:

Vikruti:

1. Dosha:

2. Dushya:

3. Avastha:

4. Kala:

5. Bala:

MANAH PARIKSHA (Mental status examination)

MSE Details MSE Details

Mana Bhakti

Buddhi Sheela

Sanjna Jnana Chesta

Smriti Achara

Brief Psychiatric Rating Scale:

Patients Personal Details BT AT 1.Somatic concern 2.Anxiety 3.Emotional withdrawal 4.Conceptual disorganization 5.Guilt feelings 6.Tension 7.Mannerisms and posturing 8.Grandiosity 9.Depressive mood 10.Hostility 11. Suspiciousness 12.Hallucinatory behavior 13. Motor retardation 14.Uncooperativeness 15.Unusual thought content 16.Blunted affect

Total Score

PHYSICAL EXAMINATION:

Case proforma


General Examination:

Pulse:

BP:

Edema:

Nails:

Conjunctiva:

Pupil:

Ictures:

Lymphedenopathy:

Anemia

Systemic Examination: Respiratory System:

Per Abdomen:

Cardio Vascular System:

Nervous System

Laboratory investigations:

Blood routine

Hb%: gm%

TC: cells/cumm

ESR: mm at 1st hour

DC:

Neutrophil: %

Lymphocyte: %

Eosinophil: %

Basophil: %

Monocyte:

DIAGNOSIS:

TREATMENT SCHEDULE:

Chikitsa

Overall effect of therapy:

Marked Improvement / Moderate Improvement / Mild Improvement / Unchanged

Signature of the Scholar Signature of the Co – Guide Signature of the Guide

Signature of the HOD

Department of P.G. studies in Manasa Roga

SDM College of Ayurveda and Hospital, Hassan

Synopsis


RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,KARNATAKA.

BANGALORE

ANNEXURE – II

COMPLETED PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION.

1.NAME OF THE CANDIDATE: NIRANJANA.H.P.

ADDRESS PRELIMINARY M.D (AYU) SCHOLAR.

DEPARTMENT OF P.G STUDIES IN

MANASA ROGA.

SDM COLLEGE OF AYURVEDA AND

HOSPITAL.

HASSAN – 573201

PERMANENT ADDRESS: S/O MR.H.A.PRABHAKARA.RAO.

NO.03, HOSABALE

POST: HOSABALE.

TALUK: SORABA.

DISTRICT:SHIMOGA

KARNATAKA.

PIN: 577-434.

2.NAME OF THE INSTITUTION: SDM COLLEGE OF AYURVEDA AND

HOSPITAL HASSAN – 573-201

KARNATAKA

3.COURSE OF STUDY IN SUBJECT: M.D.(AYU) IN MANASA ROGA.

4.DATE OF ADMISSION TO THE

COURSE : 15TH

JUNE 2009.

Synopsis


5.TITLE OF THE DISSERTATION : “ROLE OF SATVAVAJAYA

CHIKITSA AND GUDUCHYADI

YOGA IN THE MANAGEMENT OF

MADATYAYAJA YAKRIT VIKARA

(ALCOHOLIC LIVER DISORDER)”

6. BRIEF RESUME OF THE STUDY:

6.1 Need For The Study:

Excessive intake of alcohol leads to affliction of heart resulting in

exhilaration, passionate desire, erotic stimulation, sense of pleasure and varieties of

psychic morbidities of Rajasika and Tamasika nature depending upon the mental

attitude of the person and finally resulting in Moha nidra(coma). This type of mental

perversion caused by alcohol is called Mada. And whatever supreme for attaining

salvation are based on the tranquility of the mind of an individual.Alcohol

considerably agitates this mind like a strong wind shakes the tree located on the bank

of the river.1.

Madatyaya or the alcoholic dependency is completely based on stability of

one’s own Satva. So mind plays an important role in the de-addiction of alcohol.2

Word Madatyaya is composed of two terms i.e. Mada -any exhilarating or

intoxicating condition.3 Atyaya – suffering.

4 Hence suffering from intoxicating drink

is known as Madatyaya.

Chronic and excessive alcohol ingestion is one of the major causes of liver

disorders across the world. Despite the untoward effect of alcohol, alcoholism is a

major problem in India. The different drug abuse surveys have shown the prevalence

of alcoholism as 5 to 20 percent worldwide. In India, general population surveys

shows the prevalence rate as high as 16 to 50 percent .5

Atleast 20% of the patients in

mental settings have alcohol abuse or dependence or withdrawal , including

individuals from all socioeconomic conditions and both the genders.6



affected by Alcoholic liver disease.7

It manifests as a clinical spectrum ranging from

Synopsis



three major forms, 1.fatty liver, 2.alcoholic hepatitis and 3.cirrhosis.8

Bhavaprakasha mentions Yakrit-Vruddhi (hepatomegaly) as one of the


Aharas and Madya (alcohol).9





the adverse effects of Madatyaya as well as liver disorders caused by it.10



Samsmarana, Priyadarshana, Priyashravana, Geeta, Vadya 11

and Charaka advises


the treatment modalities in the management of Madatyaya.12

The three therapies i.e. cognitive behavioral coping skills, motivational

enhancement therapy and 12 step facilitation approaches of alcoholics anonymous has

been found to be helpful for the people to boost their motivation to stop drinking.

As the number of alcohol related disorders are increasing in the society and till

date no study has been conducted , hence it is decided to carry out the present study to

evaluate the effect of Guduchyadi Yoga and Satvavajaya Chikitsa in the management


6.2 Review of literature

o The Dukha produced due to Madya is called as Madatyaya.13

o Charakacharya explained types of Madatyaya as Vatapraya, Pittapraya ,

Kaphapraya and considered the disease as Tridoshaja.14

o Vagbhata explains 4 types of Madatyaya viz. Vataja, Pittaja, Kaphaja and

Sannipataja.15

o Sushruta explains mainly 4 types viz. Panatyaya, Paramada, Panajeerna and

Panavibhrama. Sushruta used Panatyaya term in place of Madatyaya and

accepts 4 types of Panatyaya viz. Vatakrita, Pittakrita,Kaphakrita and

Sarvakrita.16

Synopsis


o Acharya Charaka explained the qualities of Satvika , Rajasika and Tamasika

Madatyaya rogi as Uttama, Asaumya and Sammohakrodhitha respectively.

o In Gadanigraha Acharya Shodala accepted Dvidoshaja Madatyaya also.17

o Charaka has mentioned Hrudaya Vyatha, Aruchi, Trishna, Jrimbha, Sphurana,

Vepana, Shrama, Prajagara, Sharirakampa, Chardi, Atisara, Hrillasa, Bhrama,

Pralapa 18

etc as symptoms of Madatyaya.

o Madyapana will affect all aspects of life i.e., physically, psychologically,

socially, economically, occupationally etc.

o Sushruta has mentioned Hikka, Jvara, Vamathu, Vepathu, Parshvashoola,

Kasa and Bhrama as its Upadrava.19

o In allied science they have explained clinical features of alcoholic liver

disorders as fatty liver, right upper quadrant discomfort, tender hepatomegaly,

nausea, jaundice, abdominal pain, malnutrition, severe illness and ascitis.20

o The ingredients of Guduchyadi yoga are Guduchi, Mustha, Patola and Nagara

– equal quantity of all these drugs. It acts as Pittahara, Pitta Rechaka and

Rakta Prasadaka, Pachaka, Deepaka and plays an important role in Yakrit

Vikara and Madatyaya.

o Satvavajaya includes Vismapana, Samsmarana, Priyashravanadarshana,

Vadya, Geeta and Harshanee kriya.

o Charaka has defined Satvavajaya and considerd Jnana, Vijnana, Dhairya,

Smriti and Samadhi as techniques of psychological therapies .

6.3 Objective of the study

1. To evaluate the efficacy of Satvavajaya chikitsa in Madatyayaja Yakrit Vikara


2. To evaluate the efficacy of Guduchyadi yoga in Madatyayaja Yakrit Vikara


3. To evaluate the efficacy of combined effect of Satvavajaya Chikitsa and

Guduchyadi yoga in Madatyayaja Yakrit Vikara (Alcoholic liver disorder).

Synopsis


7. Material and Methods

7.1. Source of data :

45 patients of Madatyaya will be selected from the Out Patient Department and

In Patient Department of ManasaRoga of the S D M College of Ayurveda and

Hospital, Hassan.

7.2 Method of Collection of Data :

45 patients of Madatyaya with liver disorder who fulfills the inclusion criteria

will be selected and randomly assigned into the following 3 groups; each group

comprising of 15 patients.

Group A: The patients of this group will be subjected to Satvavajaya Chikitsa daily

along with placebo capsule 500 mg starch thrice daily for 1 month. Satvavajaya

Chikitsa will be carried out as follows:

Jnana- 12 Step facilitation (Atmadi Jnana) approach.

1. We admit we are powerless over alcohol- that our lives have become

unmanagable.

2. We believe that a Power greater than ourselves can restore us to sanity.

3. We make a decision to turn our will and our lives over to the care of God as we

understand Him.

4. We make a search and fearless moral inventory of ourselves.

5. We admit to God, to ourselves and to another human being the exact nature of

our wrong doings.

6. We’re entirely ready to have God remove all these defects of character.

7. We shall humbly ask Him to remove our shortcomings.

8. We shall make a list of all persons we have harmed and become willing to

make amends to them all.

9. We shall make direct amends to such people wherever possible, except when to

do so would injure them or others.

10. We shall continue to take personal inventory and when we are wrong,

promptly admit it.

11. We will search through prayer and meditation to improve the conscious

contact with God as we understood Him, praying only for knowledge of Him for

us and the power to carry it out.

Synopsis


12. After experiencing this, we shall carry this message to alcoholics, and to

practice these principles in all their affairs.

Vijnana- Specific information about effect of alcohol on various organs.

Dhairya- Supportive Psychotherapy – motivational enhancement therapy.

Smriti - Methods to cope with high-risk drinking situations and develop social

support systems.

Samadhi – Yoga for 30 minutes and Pranayama for 15 minutes daily for 1 month.

Yogasana – Standing Asana- Vrikshasana , Pada Hastasana, Ardha Chakrasana,

Trikonasana.

Supine Asana – Pavana Muktasana, Matsyasana.

Prone Asana - Bhujangasana, Dhanurasana.

Sitting Asana – Vajrasana, Ushtrasana, Vakrasana.

Pranayama - Kapalabhati, Bhastrika, Anuloma-Viloma, Shitali, Shithkari and

Bhramari.

Dhairya Chikitsa will be also done on 15th

and 30th

day of treatment.

Group B: The patients of this group will be given Guduchyadi yoga in the dose of

5 gm, before food with warm water thrice daily for 1 month.

Group C: The patients of this group will be subjected to Satvavajaya Chikitsa as

mentioned above and simultaneously Guduchyadi Yoga will be given in the dose of

5gm before food with warm water thrice daily for 1 month

Follow up study:

After stopping the treatment the patients will be asked to attend OPD at the

interval of 15 days for two months to know whether the relief provided by the

therapies is sustained or not.

Diagnostic Criteria:

Diagnosis will be made on the basis of Lakshanas of Alcoholic liver disorder

and Madatyayaja Yakrit Vikara.

Synopsis


Fatty liver Yakrit vruddhi

Right upper quadrant discomfort. Manda jvara

Tender hepatomegaly. Mandagni.

Nausea Ksheenabala.

Jaundice Atipandu.09.

Fever and Abdominal pain

Elevated AST (Aspartate amino transferace)

Elevated ALT (Alanine amino transferace)08.

Inclusion Criteria:

1.Patients presenting with symptoms of Madatyaya along with Alcoholic liver

disorder.

2. Age group of 16-70 years of either sex.

Exclusion Criteria:

1.Patients suffering from any Organic brain disorder.

2.Patients suffering from complications of Alcoholic liver disorders.

3.Patients suffering from other types of addictions.

4.Patients suffering from other Systemic or Psychiatric illnesses.

Assessment Criteria:

Assessment of clinical study will be done based on subjective and objective

parameters. Self scoring of symptoms of Madatyayaja Yakrit Vikara will be done and

self prepared scale will be used for assessment.

Subjective parameters : Objective parameters:

Aruchi. Chardi

Prajagara Manda jvara

Hrillasa Atipanduta

Pralapa Atisara

Bhrama Shareera kampa

Mandagni. USG Abdomen

Liver Function Test

Hepatomegaly.

Synopsis


Statistical evaluation of the results will be done by using Unpaired and Paired ‘t’ test.

7.3.Laboratory Investigations

Blood routine

Urine routine

Liver Function Test

USG Abdomen.

7.4 Has ethical clearance been obtained from your institution?. YES.

8.List of References:

1.Charaka: Charaka Samhitha with the ‘Ayurveda deepika’ commentary by

Chakrapanidatta edited by Trivikrimatmajena Yadav Sharma, Choukambha Sanskrit

Sansthana,Publications,Varanasi, 1994 year edition. Chikitsaasthana 24/39,40,53.

page no584-585.

2. Ibid. Chikitsa sthana 24/52-55. page no.585.

3.Sir Monier Williams : A Sanskrit –English dictionary, Motilal Banarasidas

publishers, Pvt. Ltd.Delhi. Reprint -1993.Page no. 777.

4. Ibid. Page no 17.

5.Dr. M.S.Bhatia : Essential of Psychiatry, CBS publishers and distributors, New

Delhi. 4th

edition 2004.Page no. 8.6.

6. Kaplan and Saddock: Comprehensive text book of Psychiatry , 8th

edition ,

volume 1, by Lippincott Williams and Wilkings , Page no.1168.

7. US Census Bureau International Data Base.2004.

8.Harrison’s Principles of Internal Medicine . Volume.2, 15th

edition Published by

Times Roman by monotype composition Company. Page no. 1752&1753.

9.BhavaPrakasha : Vidyothini Teeka , Choukambha Sanskrit Sansthana,

Publications, Varanasi. Uttarardha.Chapter.33 ./10.Page no. 346.



Synopsis


Sansthana, Publications,Varanasi, 1994 year edition. Chikitsasthana 24/145.Page

no.589.

11.Vagbhata: Astanga Hrudaya , with the Commentaries Sarvanga Sundari of

Arunadatta and Ayurveda Rasayana of Hemadri edited by Harishastri Padakar vaidya,

Krishnadas Academy, Varanasi. Reprint 2000.Chikitsa stana,7/113-114.Page no.642.

12.Charaka: Charaka Samhitha with ‘Ayurveda deepika’ commentary by


Sansthana.Publications. Varanasi, 1994 year edition. Chikitsa sthana 24/194.Page

no.590.

13. Ibid. Chikitsa sthana 24/101-106.Page no.587.

14. Ibid. Chikitsa sthana 24/89-97.Page no.587.

15. Vagbhata: Astanga Hrudaya , with the Commentaries Sarvanga Sundari of

Arunadatta and Ayurveda Rasayana of Hemadri edited by Harishastri Padakar vaidya,

Krishnadas Academy, Varanasi. Reprint 2000.Nidana Stana 6/14..Page.no.487.

16.Sushrutha : Sushrutha Samhitha with the Nibandhasangraha, commentary of Shri

Dalhanacharya and the Nyayachandrika Panjika of Shri Gayadasacharya on

Nidanasthana , edited by Vaidya Jadavji Trikamji Acharya . Chaukambha Orientalia ,

Varanasi.7th

edition 2002. UttaraTantra 47/17-18.Page.no.743.

17.Vaidya Shodala : Gada nigraha with the Vidyothini Hindi commentary Vol.2 by

Sri Indradeva Tripathi, Chaukambha Sanskrit Sanstan,Publications. Varanasi. 3rd

edition 1999.Page no.451.



Sansthana. Varanasi, Publications. 1994 year edition. Chikitsa stana 24/101-106.Page

no.587.

19. Sushrutha : Sushrutha Samhitha with the Nibandhasangraha, commentary of

Shri Dalhanacharya and the Nyayachandrika Panjika of Shri Gayadasacharya on

Nidanastana , edited by Vaidya Jadavji Trikamji Acharya . Chaukambha Orientalia ,

Varanasi.7th

edition 2002. UttaraTantra 47/23 .Page.no.743.

20.Davidson’s Principles and Practice of Medicine 19th

edition Page

no.867.Published by Churchill Livingstone,An imprint of Elsevier Science Limited.

Synopsis


9.SIGNATURE OF CANDIDATE :

10. REMARKS OF GUIDE :

11. NAME AND DESIGNATION OF

11.1 GUIDE : Dr.NARAYANA PRAKASH. B. M.D.(AYU)

Professor & H.O.D.

Dept.of PG Studies in Manasa Roga.

S.D.M.College of Ayurveda.

Hassan. (Karnataka)

11.2 SIGNATURE :

11.3 CO-GUIDE : Dr.SUHAS KUMAR SHETTY. M.D.(AYU)

Reader,



Hassan. (Karnataka)

11.4 SIGNATURE :

11.5 H.O.D. : Dr.NARAYANA PRAKASH. B.

Professor & H.O.D.



Hassan. (Karnataka)

11.6 SIGNATURE :

12.

12.1 REMARKS OF CHAIRMAN

& PRINCIPAL : Dr. PRASANNA. N. RAO

Role of Satvavajaya Chikitsa and Guduchyadi Yoga in the ...

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