“ROLE OF TILNILOTPAL GANDUSHA IN  MANAGEMENT OF MUKHAPAKA”

 

Dr. Dubey Vikas

M.D. _(Scholar)

Bharti Vidyapeeth AyurvedaCollege,

Dhankawadi, pune 411043

E-mailAddress- This email address is being protected from spambots. You need JavaScript enabled to view it.,

Phone no. – 08237250287, 09479427096

 

Second Author-

 Dr.PATWARDHAN. R.P

M.D. (AYU)

PROFESSOR SWASTHAVRITTA

Bharti Vidyapeeth AyurvedaCollege, Dhankawadi, pune 411043

Phone no.- 09422522723

 

ABSTRACT:-

 

Now a day lifestyle is drastically changed. Due to increased pollution,Fast life style, junk food habit and addictions  problems of oral health are arising progressively. Therefore there are increased problems regarding bad oral hygiene.Among various Mukharogas, Mukhapaka is Pittaja Nanatmaja and Rakta Pradoshaja Vikara, characterized by VedanayuktaVrana in the Mukhaguha. The lakshanas of Mukhapaka can be co-related with apthous ulcer (recurrent ulcerative stomatitis) explained in modern medical science.

In Ayurveda,  non-practice of  gandusha etc. are  said to be major cause for mukhapaka.Indirectly  it infers  the  importance of  gandusha  because the  physical,  thermal and  chemical causes  of injury  to  oral cavity  (due to  exposure  to various  risk factors)  can  be  better  counteracted  by  practicing  gandusha  daily.  Clinical trial on a single group of 60 patients having mukhapaka,was carried out.

Patients was given Tilnilotpaladi  kwatha Gandusha for period of 7 days in every morning empty stomach.

60 patients studied, maximum number of patients(51.66) belonged to the age group of 20-30 years,Male sex (65%), and upper middle socio economics status (41.6%),mixed diet (61.66),addicted to smoking(38.33%),occupation (20% ) IT professionals.

32% individuals have shown good response,53% sown moderate Response,and 15% shown mild response.

KEYWORDS: Mukhapak, Tilnilotpaladi Yoga, Apthous ulcer.

INTRODUCTION-:

-: Mukha Swasthya (oral hygiene) has gained importance now a day, because mukha is such anga, which is exposed to many risk factors in day-to-day life.

Ø Due to increased pollution, junk food habits and addictions like tobacco-guthaka chewing, smoking, soft drinks; problems are arising progressively.

Ø Therefore, problems regarding bad oral hygiene are progressively increased.

Ø In Ayurvedic text, Aphthous ulcer is denoted as ‘Sarvasar rog’ or ‘Mukhapaka’ due to its spread in the complete oral cavity (mukha) [2, 3, 4].

Ø Mukhapaka is Pittaja Nanatmaja & rakta Pradoshaja Vikara, characterized by Vedanayukta Vrana in the Mukha guha.

Ø The lakshanas of Mukhapaka can be co-related with Apthous ulcer; explained in modern medical science

AIM :-

—  Management of Mukhapaka by Tilnilotpaladi Gandusha.

 OBJECTIVES :-

—  To study the role of Gandusha as an Upakrama of Dinacharya.

—  To assess the role of Tilnelotpaladi Gandusha in the prevention of recurrent Mukhapaka.

—  To study in detail about Mukhapaka. (Apthous ulcer).

This section includes following headings.

1. Ayurvedic review

a.   Mukha Shareera

b.  Mukhapaka

c.   Gandusha

2. Modern review

a.   Anatomy of oral cavity

b.  Pathology related to Apthous ulcer.

MUKHAPAKA

Ø  Mukhapaka is a condition characterized by vedana & shopha yukta vrana in the mukha guha pratyangas.

Ø Mukhapaka can be correlated with a disease entity ulcerative stomatitis, in which apthous ulcers are very common with recurrent episodes.

Types – Acc. to Charak, Sushrut & Madhav nidan

1. Vataja Mukhapaka

2. Pittaja Mukhapaka

3. Kaphaja Mukhapaka

Vaghbata - Raktaja and Sannipataja mukhapaka.

 GANDUSHA

Ø The word Gandusha is formed by Gadi + Gandescha which mean mukha purnam i.e. filling the mouth.

Gandusha is the procedure of holding any liquid in the mouth to its full capacity without any movement inside. It is usually done with drava (liquid

TYPES

Based on doshagnata and karmukata Gandusha is classified mainly into four types. They are - 

• Snaihika (lubricating) – indicated in diseases of vata

• Shamana (matigating) – indicated in diseases of pitta

• Shodhana (purificatory) - indicated in diseases of kapha

• Ropana (healing) – indicated in ulcerations of mukha

Anatomy of Mouth

Ø A mucosa lined cavity is also called the oral cavity or Buccal (bucca-cheeks) cavity.

Ø It is formed by cheeks laterally, soft and hard palate superiorly.

Ø Anterior opening is oral orifice & posteriorly it is continuous with the oropharynx.

REVIEW OF STOMATITIS :

Definition: General term for diffuse inflammation of the mouth.

Apthous ulcer (recurrent ulcerative stomatitis) :

Ø This is a commonest recurrent condition of unknown etiology characterized by painful superficial ulcers in movable mucosa of the mouth.

Ø Generally these ulcers are seen in buccal mucosa, lips, tongue, floor of the mouth, soft palate & oro-pharynx.

ETIOLOGY :-

Ø The cause is obscure.

Ø Some probable causative factors are emotional stress, viral infections, endocrine disorders psycho-somatic factors, habitual constipation, auto-immune reaction.

 

TYPES :-

There are three main clinical types

1. Minor apthae

2. Major apthae

3. Herpetiform apthae

MATERIALS AND METHODS:

Title of study:-

        “Role of Tilnilotpaladi Gandusha in Management of Mukhapaka”

Place of study:-

         OPD and IPD of  B.V.D.U. Ayurved Hospital, Pune ,Maharashtra (India).

Sample Size:- Clinical trial on a single group of 60 persons having mukhapaka, was carriedout.

Drug & Duration of Therapy:-

Selection of Upakram :-

Upakrama  :- Gandusha

Time          :- In Morning (After Dantadhavana)

Form         :- Kashaya (Decoction)

Quantity     :- 80-120 ml (As per oral liquid  holding capacity  of the patients)

Drug Ingredients-

 Tilnilotpaladi yoga:- 

 1.Tila (Sesamum Indicum)

2.Nilotpal (Nymphaea stella)

3.Ghee       

4.Sugar,

5.Milk

6.Honey. (5,10)

 

Procedure  :-

Ø The patient asked to sit in erect posture.

Ø The neck, cheeks and the forehead of the patient to be treated with Gandusha, massaged and fomented.

Ø Gandush has been so long held in the mouth by the patient till the aggravated dosha accumulated in regions of the cheeks or secreted through the nostrils & the eyes.

Inclusion Criteria :-

Ø Patient complaining of recurrent Mukhapaka.

Ø Patients between age group of 20-50 years.

Ø Patients of both sex included in the study.

Exclusion Criteria :-

As per Bhavaprakasha Purvakhanda, patient contraindicated for Gandusha excluded –

Ø Gandusha is contraindicated in unconscious, poisoned, weak, krisha person, patient suffering from bleeding disorders and conjunctivitis.

Ø Patient having chronic or carcinogenic ulcers in oral cavity.

Ø Mukhapaka due to any other disorders e.g. Syphilis, AIDS, Dengue Haemorrhagic Fever etc.

Ø Patients suffering from any other systemic disorders.

 

ASSESMENT CRITERIA

Efficacy of  the therapy  was assessed in  the signs  and symptoms before  and after the course of Gandusha.

It was assessed on the basis of self-formulated scoring scale to signs and symptoms of Mukhapaka as follows.

 

Assessment of parameters for Mukhapaka:

1.  Ruja (pain) – using VAS scale for pain Assessment

 

No pain	0
Mild-pain during churning of food	1
Moderate-pain during talking and gets relief by topical anesthetics	2
Severe- pain even during rest, No relief by topical anesthetics	3

 

2.  Daha (burning sensation)

No daha	0
Mild-tolerable, no need of cooling agents Likeglycerin or cold juice	1
Moderate-intolerable,Gets relief by cooling agents	2
Severe- intolerable, no relief by cooling agents	3

 

3.   Raktavarnata (Reddness)

No redness	0
Dull red or pink red	1
Colour of mazanta	2
Bright red	3

 

4.  Size of the vrana

Size of the vrana 0 mm	0
Size of the vrana between 0—5 mm	1
Size of the vrana between 6—10 mm	2
Size of the vrana more than 10 mm	3

 

5.  No of Vrana

No Vrana	0
Number of Vrana  0  - 1	1
Number of Vrana  1  - 3	2
Number of Vrana more than  3	3

 

 

Assessment of Parameter for mukhaswasthya

1.  Frequency of attack:-

 

No relapse up to 2 Months	0
One attack every 2 Months	1
One attack every Months.	2
Two or more attacks in a months	3

 

 

FOLLOW UP

 

Follow up will be done periodically for total duration of 21 days.

—  1^st  follow up :-  3^th day

—  2^nd  follow up:- 7^th day

—  3^rd follow up :- 14^st day (Post Treatment)

—  4^th  follow up:- 21^th day (Post Treatment) 

 

Observation and results

1.Age wise distribution :-There were maximum no. of patients i.e.51.67 % in age group 20-30 and 38.33% in age group 30-40 also minimum no. of patients i.e.10% in age group 40-50.

 

2.Sex wise distribution

Sex	No of Patients	Percentage
Female	21	35.00%
Male	39	65.00%
Total	60	100%

There were Maximum no. of patients i.e. 65 % were males and 35% were females.This indicated its more incidence rate in males.

3.Dietary Habitat wise distribution

There were Maximum no. of patients i.e. 61.67% were mixed and minimum i.e.38.33% were vegetarian. The ancient Ayurvedic physicians were aware of the ‘Apathyakara Ahara and Vihara' (unsalutary life style and food habits) as the most important causative agent [6, 7, 8].

Diet	No of Patients	Percentage
mixed	37	61.67%
vegetarian	23	38.33%
Total	60	100.00%

 

4.Marital status wise distribution

Marital status	No of Patients	Percentage
married	39	65.00%
unmarried	21	35.00%
Total	60	100.00%

It was found that maximum number of patients i.e. 65% were married, While 35 % Patients were unmarried.

 

5.Occupation wise distribution

 

On considering the nature of occupation, it was found that maximum i.e.20% no. of patients were IT professionals while minimum i.e.3.33% no of patients having government job.

 

6.Vyasanawise distribution:-

 

This showed that maximum i.e. 38% patients were having smoking vyasan and mimimum no. of patients  i.e.5% having alcohol tobacco vyasan .

7. vihara  wise distribution:-

Patients  with  history  of ratrijagrana  were 60% and  16.67% had history  of Diwaswapa.

 

8.Socio economic condition wise distribution

The classification of patients based on their economic status indicates that people of high socio economic status were more susceptible (41.67%) to mukhapaka.

 

Socio eco cond	No of Patients	Percentage
Upper middle class	25	41.67%
middle class	23	38.33%
Lower class	12	20.00%
Total	60	100.00%

 

9.Family History  wise distribution

 

Family Histroy	No of Patients	Percentage
no	35	58.33%
yes	25	41.67%
Total	60	100.00%

Here, it was found that maximum numbers of patients i.e. 58.33% were having family history while 41.67% were not having family history.

 

10.Prakriti  Family History

It was found that  maximum no. of patients i.e. 46 .67% were belonged to pitta- kaphaPrakriti,, and minimum no. of patients i.e. 1.67% kapha –vataPrakriti.

RESULTS:-

 

1.Effect of  Tilnilotpaladi Yoga on Ruja in the management of Mukhapaka

Ruja (Pain) :-

 

 

Parameter	N	Mean		Std Deviation		Positive rank	Negative rank	Tie	Z value	P value	Interpretation
		BT	AT	BT	AT
Ruja	60	0.766	0.253	0.721	0.536	10	17	24	-0.652	0	S

Here P value was >0.05 hence accept H₀  i.e.

On associated symptoms of Mukhapaka, the improvement observed on Ruja (66.97%) was statistically significant.

2.Effect of  Tilnilotpaladi Yoga on Daha in the management of Mukhapaka

Daha (Burning Sensation) :-

Parameter	N	Mean		Std Deviation		Positive rank	Negative rank	Tie	Z value	P value	Interpretation
		BT	AT	BT	AT
Daha	60	2.6	0.466	0.616	0.503	0	59	1	0.679	0	S

Here P value was <0.05 hence reject H₀  i.e.

On associated symptoms of Mukhapaka, the improvement observed (82%)on Daha was statistically significant.

3.Effect of Tilnilotpaladi Yoga on RaktaVarnata of vrana in the management of Mukhapaka

Rakta Varnata of vrana[ Redness] :-

 

Grade	BT		AT
	No. of patients	BT	No. of patients	AT
No Redness	0	0%	14	23%
Dull Red (or) pink red	33	55%	44	73%
Color of Magenta	22	37%	2	3%
Bright Red	5	8%	0	0%
Total	60	100%	60	100%

 

Parameter	N	Mean		Std Deviation		Positive rank	Negative rank	Tie	Z value	P value	Interpretation
		BT	AT	BT	AT
Rd.ofVran	60	1.533	0.8	0.65	0.48	0	38	22	-5.809	0	S

Here P value was <0.05 hence reject H₀  i.e.

On associated symptoms of Mukhapaka, the improvement observed (91%)on RaktaVarnata of vrana was ethically significant.

4.Effect of  Tilnilotpaladi  Yoga on No. Of  Vrana in the management of Mukhapaka

Parameter	N	Mean		X	% of relief	SD		Std error		Z value	p value
		BT	AT			BT	AT	BT	AT
No.OfVrana	60	1.116	0.433	0.683	61.20%	0.666	0.499	0.086	0.065	7.827	0.00003

 

 

Before treatment the mean score of No.Of Vrana was 1.116 which was reduced to 0.433 after treatment with 61.20% relief also p value is <0.05 hence it is statistically significant .

 

5.Effect of  Tilnilotpaladi Yoga on Size of Vrana in the management of Mukhapaka

 

Before treatment the mean score of Size of Vrana was 0.726 which was reduced to 0.266 after treatment with 63.36 % relief  but p value is <0.05 hence it is statistically significant.

 

6.Effect of Tilnilotpaladi Yoga on frequency of attack in the management of Mukhapaka:-

 

Parameter	N	Mean		X	% of relief	SD		Std error		Z value	p value
		BT	AT			BT	AT	BT	AT
Freq attack	60	0.867	0.3	0.5667	65.39%	0.5956	0.462	0.076	0.059	6.082	0.000032

 

Before treatment the mean score of Freq attack was 0.867which was reduced to 0.3 after treatment with 65.39% relief also p value is <0.05 hence it is statistically significant .

7.OVERALL IMPROVEMENT

 

improvement	No. of patients	percentage
Marked improvement	19	32%
moderate improvement	32	53%
Mild improvement	9	15%
No improvement	0	0%
Total	60	100%

 

The above graph showed  that  there were 32 % patients  have  shown  good  response,  53%  shown  moderate while only 15% patients have shown mild response

 

8.Study of Recurrence:-

Grade			No. of Patients		%
Recurrence			53		88.33
	Mild Recurrence	04		6.66
	Moderate Recurrence	03		5
	Sever Recurrence	00		0

 

-88.33% Patient had no. recurrence after 21 days follow up study.

-6.66% patients had recurrence of mild intencity.

-5% patients had moderate degree of recurrence.

 

  

 

 Conclusion

       The conclusions drawn on the basis of this study are as follows.

1.  Among various mukharogas ,mukhapaka is considered as pittaja Nanatmaja and raktapradoshaja vikara ,characterized by vedana Yuktavrana inside the mukhakuhara.Nearly 60% of the population is suffering with this problem.

2.  The lakshanas of mukhapaka can be correlated to a clinical entity“Apthous ulcer” (recurrent ulcerative stomatities) explained in the contemporary medical science,which is also characterized by painful Superficial ulcers in the movable mucosa of the mouth with recurrent  episodes.

3.  Gandusha upakrama of dinacharya on of the important methods Mentioned in Ayurveda for maintenance of oral hygiene.

4.  Out of 60 patients studied, maximum number of patients (51.666%)  belonged to the age group of 20-30 years, Male sex (65%), and upper middle socio economic status (41.66%), mixed diet (61.66%), addicted to smokinge (38.33%).occupation ( 20%  ) IT professionals.

5.  Most of the patients were of pitta kaphaprakriti (46.33%), with positive history of ratrijagarana (60%).

6.  32% individuals have shown good response,53% shown moderate Response, and 15% shown mild response.

7.  As Tilnilotpaladi Gandusha having madhur,kashyarasa,shetavirya and kaphahe-pittaghnaproperties,It removes aggravated kaph and pitta Guna from oral cavity.

8.  Hence from the study it is concluded that,Tilnilotpaladi Gandusha is an important upakrama of Dincharya mentioned in Samhitas which should befolled regularly,in order to prevent Mukharogas and  maintain  oral  hygine.

 

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