Evaluation of efficacy of Navakarshik Kwath Ghan in Sheetpitta with special reference to Urticaria

found all over the world. In Ayurveda, allergic manifestation is mentioned under the concept of Satmya-asatmya (Beneficial-non beneficial).(3) It manifests due to exposure to Asatmya Ahara-vihara (Non beneficial diet and regimen) and contact with different poisonous materials (allergens). Symptoms of allergic skin reaction is mentioned as Kotha in Brihata Trayi later on it is developed as separate disease under the title Sheetapitta-Udarda-Kotha by Acharya Madhavakara.(4) As the name Sheetpitta suggests the involvement of Vata and Pitta Doshas, along with Rasa and Rakta dhatus . Here the study is selected to find out simple, sure and effective medicament for Sheetpitta which have least or no side effect. For this purpose, Navkarshik Kwath Ghana from Bhaishjya ratnawali is selected for study.(5) study As it is a very distressing, frustrating and challenging dermatological condition with no satisfactory treatment.(6) This study is taken to explore effective remedy for above condition. Abstract Background: Sheetapitta (Urticaria) is one among the Tvak Vikara (Skin disease) that have similar Hetu (Cause) of Kotha and Udarda . Vata and Kapha are two " Doshas" (energies), which are primarily, disturbed which in turn is associated with Pitta resulting in Tridosha Prakopa (Aggravation of three energies) leading to redness, swelling itching on the skin etc. Symptoms include appearance of wheals all over the body with severe itching, burning sensation and pain. Symptomatology and causative factors of Sheetapitta can be considered similar to that of 'Urticaria'. Aim: This clinical study was carried out to evaluation of efficacy in Sheetpitta with special reference to Urticaria. Material – Navakarshik Kwath Ghan in dose of 2 tab of 500 mg twice a day with water after meal in duration of 15 days. Methodology – In this study include single group of 30 subjects of either gender in the age group of 16-60 years having complaining of reddish wheals, itching and pricking pain on body. Observation and Result – Data regarding age wise, sex wise, allergy wise, diet wise, Prakruti (Nature) wise, hematological parameters and UAS (Urticarial Activity Score). Conclusion – Internal use of Navakarshik Kwath Ghan is found effective in the severity of itching.


Introduction
In present life style, one can't follow the rules o f ' D i n a c h a r y a ' ( D a i l y r e g i m e n ) a n d 'Ritucharya' (Seasonal regimen) described in 'Ayurveda'. Due to industrialization and traffic one constantly comes into contact with various pollutants. The spicy and fast food eaten now a days, which have very less nutritional values and also having similar properties to 'Viruddhahara' (Incremental). These all ultimately resulted into 'Dhatudurbalya'(Tissue debilation), which causes sensitization towards allergens as well as antibodies and produces various types of allergic reactions, one of them is 'Urticaria', which is very common.
Urticaria is such a widespread debilitating condition having highest impact on quality of life and required most visits to the Emergency Department. It affects about 15-20 % of total population(1) . It is a vascular reaction characterized by transient, erythematous swelling over the skin and/or on mucus membranes which may appear on any part of the body. They are usually transient and resolve in a few hours.(2) It makes the patient restless due to severe itching, burning sensation and pain. The symptoms of Urticaria are similar to Sheetpitta-Udarda-Kotha.
Skin allergies frequently cause rashes, or swelling and inflammation within the skin, which is known as a "wheal and flare" reaction characteristic of hives (Urticaria) and angioedema. Itching is a common characteristic of nonexfoliative skin disorders; these may be associated with burning sensation, change of colour etc. Out of these nonexfoliative skin diseases Sheetpitta (Urticaria) is one of the common dermatoses found all over the world. In Ayurveda, allergic manifestation is mentioned under the concept of Satmya-asatmya (Beneficial-non beneficial).(3) It manifests due to exposure to Asatmya Aharavihara(Non beneficial diet and regimen) and contact with different poisonous materials (allergens). Symptoms of allergic skin reaction is mentioned as Kotha in Brihata Trayi later on it is developed as separate disease under the title Sheetapitta-Udarda-Kotha by Acharya Madhavakara.(4) As the name Sheetpitta suggests the involvement of Vata and Pitta Doshas, along with Rasa and Rakta dhatus. Here the study is selected to find out simple, sure and effective medicament for Sheetpitta which have least or no side effect. For this purpose, Navkarshik Kwath Ghana from Bhaishjya ratnawali is selected for study.(5)

Need of study
As it is a very distressing, frustrating and challenging dermatological condition with no satisfactory treatment. (6) This study is taken to explore effective remedy for above condition.

Evaluation of efficacy of Navakarshik Kwath Ghan in
Sheetpitta with special reference to Urticaria Background: Sheetapitta (Urticaria) is one among the Tvak Vikara (Skin disease) that have similar Hetu (Cause) of Kotha and Udarda. Vata and Kapha are two "Doshas" (energies), which are primarily, disturbed which in turn is associated with Pitta resulting in Tridosha Prakopa (Aggravation of three energies) leading to redness, swelling itching on the skin etc. Symptoms include appearance of wheals all over the body with severe itching, burning sensation and pain. Symptomatology and causative factors of Sheetapitta can be considered similar to that of 'Urticaria'. Aim: This clinical study was carried out to evaluation of efficacy in Sheetpitta with special reference to Urticaria. Material -Navakarshik Kwath Ghan in dose of 2 tab of 500 mg twice a day with water after meal in duration of 15 days. Methodology -In this study include single group of 30 subjects of either gender in the age group of 16-60 years having complaining of reddish wheals, itching and pricking pain on body. Observation and Result -Data regarding age wise, sex wise, allergy wise, diet wise, Prakruti (Nature) wise, hematological parameters and UAS (Urticarial Activity Score). Conclusion -Internal use of Navakarshik Kwath Ghan is found effective in the severity of itching.

Aim and Objectives Aim
"Evaluation of Efficacy of Navakarshika Kwatha Ghana in Sheetpitta with special reference to Urticaria".

Exclusion criteria
• History of allergy to any medicine. • Urticaria associated with other skin diseases. • Acute Urticaria will be excluded.

Investigations
Before commencement of medication and after completing the medication HB %, ESR, Absolute Eosinophil count (AEC) was investigated.

Methodology
The patients were selected by simple random sampling method irrespective of their sex, religion and occupation. The informed consent was obtained from each patient before participation in the study. Total 34 patients were registered as per the inclusion criteria .Out of these, 30 patients have completed the treatment. Following treatment was given.
Navkarshika Kwatha Ghana which was prepared in Rasashala of Mahatma Gandhi Ayurved College, Hospital and Research Centre, Salod (H), Wardha. For the palatability of drug, the Navkarshika kwatha prepared in Ghana form , 500 mg 2 tablet twice a day was given orally with water after meals for continuous 15 days. If needed, tablet Cetirizine hydrochloride 5 mg stat was given and it was recorded.

Assessment Criteria
The patients were treated for continuous 15 days and the assessment was done according to UAS (Urticaria activity score) and Itching score on 0th, 8th and 15th day.

Observation and Result
The data obtained was coded and entered into Microsoft Excel Worksheet. The data was analyzed by using frequency distribution, descriptive statistics, analysis of variance and t-statistic with the help of statistical software SPSS 17.0 version and tabulated as below.

Table No. 3. Sex wise distribution of patients
Total 30 patients were selected for study. It was found that out of these patients 16 (53.3%) were male and 14(46.7%) were female. In this series maximum no. of patients i.e. 40 % belonged to age group of 16-26 years, 26.7% belonged to age group of 27-37 and 49-60, 6.7 % belonged to age group of 38-48 years. In allergy-wise (food) distribution of patient, most of the patient were no allergy to any food in 18 (60.0%) patients, 12 (40.0%) of having allergy to food.  Analysis of data obtained reveals that majority of the patients 46.7% were having Kaphaj Pitta Prakruti and 30.0% patients were having Vata Pittaj , 13.3% patients were having Pittaj vata, 6.7% patients were having Kaphaj vata and 3.3% Pittaj Kapha Parakuti respectively.

Table No. 8. Mean Hb (in gm%) of Patients
Mean of Hb% before treatment were 12.56±1.50 is and after treatment 12.92±1.66 its t value is 2.248 and its p value is 0.032 which is statistically significant.

Table No.9. Mean ESR (/mm 1st hour) of Patients
Mean of ESR before treatment were 27.97±19.18 and after treatment 19.67±16.27 and its t value is 5.248 and its p value is 0.001 it is statistically significant.

Table No. 10. Mean AEC (Absolute Eosinophil Count) (/cumm) of Patient
Mean of AEC (Absolute Eosinophil Count) before treatment was 157.70±57.36 it is in normal limit and after treatment 161±76.65 and its t value is 0.311 and its P value is 0.758 statistically it is non-significant.

Table No. 11. Mean Tablet Cetirizine taken by the Patients
The mean of Cetirizine taken by patients before treatment were 4.63±2.95, at 8th day it was 2.80±1.78, at 15th day 0.80±1.18 and its F value is 24.819 and its P value is 0.001, statistically significant difference was found in mean of tablet Cetirizine taken between 1st-15th day.  In Urticarial activity score mean were at 0th day 2.20±0.66, at 8th day 1.53±0.57, at 15th day0.36±066 it is statistically significant.

Discussion
Urticaria is commonly manifested in 2nd and 3rd decade of life. (8) In ourstudy also maximum no. of patients were found in 2nd and 3rd decade of life. This indicates more incidence of chronic Urticaria in youngsters, Ayurvedic texts have described Sheetpitta as Pittapradhana Tridoshaja Vyadhi. This is evident from above data as Sheetpitta is more prevalent in age group which was Pitta Pradhana. Primary outcome of the study was there is significant improvement in Urticarial Activity Score and secondary outcome was there is significant improvement in Hb%, ESR and AEC counts. Also decreased the rate of consumption of Tablet Cetirizine. The present study was conducted limited number of patients, limited period of assessment up to 15 days, long term follow up is necessary and proper pathological investigation could not done like IgE etc. Controversy raised that trial will done by taking comparative group with tab. Cetrizine. In future, due to unhealthy lifestyle like cold drinks, living in cold atmosphere may increase chances of urticaria. For that its need to more study by applying TLC, HPTLC for drugs.

Conclusion
This study was conducted to analyse effect of Navakarshik Kwath Ghana in Sheetapitta. The Rate of ESR is elevated in Sheetpitta it has been significantly decrease by Navakarshik Kwath Ghana. Urticarial activity score is improved and Itching score also was reduced in all patients. Internal use of Navakarshik Kwath Ghana is found effective in the severity of itching. No side effect of Navakarshik Kwath Ghana was observed in any patient.

Mean
Effect