CLINICAL STUDY WITH KANAJATA (PIPER LONGUM LINN. ROOT) AND ITS EFFECT ON POSTNATAL ... ·...

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Neeraja et al. World Journal of Pharmaceutical Research

CLINICAL STUDY WITH KANAJATA (PIPER LONGUM LINN. ROOT)

AND ITS EFFECT ON POSTNATAL ABDOMINAL BULKINESS IN

WOMEN

D. S. N. V. Neeraja* and Dr. M. Paramkusha Rao

Department of Dravyguna, S.V. Ayurvedic Medical College, Tirupati.

ABSTRACT

Ayurveda is the science of life. Ayurveda elucidate due importance for

the care of mother at every phase of her life especially to the antenatal

and post natal care. After delivery mother has to take care of her baby

along with her own health care. Puerperium is a period following child

birth which can be certainly co-related with Sutika paricharya

explained in Ayurveda. In this period many changes occurs in the body

physiologically and anatomically to regain the prepregnancy state.

Mithyachaara – inappropriate physical and mental behaviour in this

period definitely results in incurable diseases. Now-a-days many

women are facing problem with acquired bulkiness and post natal

weight retention. The main reason for this bulkiness is mismanagement after delivery.

Conventional care of delivered women is missing. After delivery women has to follow certain

dietetic rules. Ancient Acharyas mentioned certain drugs like pippali, Pippalimula, Nagara,

Chavya etc. and diet for the delivered women. These drugs help in the Dushtasonita sudhi

(purification of the blood), Vatasamsamana and makes the body to attain the prepregnancy

status.

KEYWORDS: Ayurveda, Puerperium, Sutika paricharya, Mithyachara, Postnatal weight

retention.

INTRODUCTION

Reproductive age is the important period in woman’s life. In this life stage women have to

undergo much ebb and flow of which decides her health in the next life stage after 40’s.

Delivery is the re-birth for women. After delivery, care of newborn as well as mother is

World Journal of Pharmaceutical Research SJIF Impact Factor 6.805

Volume 5, Issue 9, 1821-1840. Research Article ISSN 2277– 7105

*Corresponding Author

D. S. N. V. Neeraja

Department of Dravyguna,

S.V. Ayurvedic Medical

College, Tirupati.

Article Received on

22 July 2016,

Revised on 12 August 2016,

Accepted on 02 Sep. 2016

DOI: 10.20959/wjpr20169-7054


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equally important to come back to normal lifestyle, overcoming all physiological and

behavioural changes.

After delivery many women are unable to lose the weight gained during pregnancy. It’s every

woman’s dream to lose all the extra pregnancy pounds the moment baby finally arrives. It is a

burning problem and is a challenge for women to take care of body to attain to prepregnant

state. Pregnancy is a complicated period for women in that it is often the first time weight

gain is expected and accepted. Pregnancy-related weight gain has emerged as a potential

cause of increased adiposity.

In Observational epidemiological studies, the average weight change from preconception to

the first year postpartum is referred to as “Postpartum weight retention.” Postpartum weight

retention includes the weight gain during gestation (Preconception through gestation), early

postpartum weight loss (delivery to 6 weeks postpartum), later postpartum weight changes

after 6 weeks postpartum).[1]

Excess weight retention is increasingly common after pregnancy, a recognized high risk

period for weight gain, with 56% of pre-existing overweight and obese women gaining

beyond the recommendations of International Institute of Medicine recommendations for

gestational weight gain(GWG).[2]

Weight gain and overweight during midlife are strong

independent predictors of cardiovascular disease, particularly among women. It is also may

cause the metabolic syndrome, type 2 diabetes and early mortality.[3]

Postnatal care is a period following child birth which can be certainly co-related with Sutika

paricharya explained in Ayurveda.[4]

Intervening to reduce postpartum weight retention is

important public health initiative; however key gaps remain. The postnatal period represents

a prime opportunity to educate women from all economic backgrounds about proper

nutrition, exercise and the benefits of maintaining a healthy lifestyle. So this is the time to

support this challenging problem of women by the intervention through the treatment as

measure to control.

In folklore it is a common practice to use certain appetizing drugs along with jaggery in

delivered cattle for regaining the normal health and to control the infections.

In certain areas of Andhra Pradesh a spicy powder or chutney (a food recipe) is prepared and

specially given to new mother to maintain the health. The recipe consists of Piper longum.


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Therefore we have selected as the main drug Kanajata (Piper longum Linn. root) in the

present study to prove clinically it as an effective medicine.

वदृ्ध् |

||(B.P. S Yoniroga.Ci.70).

The main reference of the study is in Bhavaprasha samhita belongs to 16th century,

Yonirogadhikaara, Prasuti Cikitsa, Kanajata (Piper longum Linn. root) is advised to take with

Madhita takra for 21 days in the retention of abdominal bulkiness after delivery.[5]

So

Kanajata (Pippalimula) is selected for the present study in the management of Postnatal

abdominal bulkiness in women.

AIMS AND OBJECTIVES

1. To study the effect of Kanjata with takra in the Abdominal bulkiness in women.

2. To study the effect of Kanajata with Guda in the Abdominal bulkiness in women.

3. To study the effect of Placebo (Wheat powder) in the Abdominal bulkiness in women.

4. Comparative effect of the Kanajata and Placebo in the Abdominal bulkiness in women.

MATERIALS AND METHODS

This study was a randomized placebo control study carried out in Sri Venkateshwara

Ayurvedic Hospital, Tirupati, Chittor District. Women suffering from Abdominal bulkiness

from 1 year delivery.

Data was collected using a clinical proforma consisted of the Name, age, educational status,

duration of illness, associated illness, complications during delivery.

(1) Women suffering from Abdominal bulkiness were selected on the basis of

symptomatology with body dissatisfaction, BMI>25, waist and hip circumferences higher

than the recommended levels.

(2) Patients attending Out Patient Department of S.V Ayurvedic hospital, Tirupati, were

selected randomly irrespective of their caste, religion, occupation.

INCLUSION CRITERIA

Age group of 22 yrs to 40 yrs married women.

Women delivered 1 yr before and having bulkiness of abdomen.


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EXCLUSION CRITERIA

Women having bulkiness of abdomen due to endometriosis.

Age group below 22 yrs and greater than 40 yrs.

Women suffering from cervical carcinoma, evidence of renal, hepatic, spleen and cardiac

involvement.

High blood pressure, high glucose levels.

Patients with long term steroid treatment.

Women with hypothyroidism, Cushing's syndrome and growth hormone deficiency.

Subjective Parameters of the Study

Grouping and Sampling

Group 1 KJT: Finely powdered Pippalimula is made into capsules 250mg and is given to the

patient and advised to take 2 capsules twice a day along with Takra as anupana.

Group 2 KJG: Finely powdered Pippalimula is pounded along with jaggery is made into

capsules of 250mg and is given to the patients 2 capsules twice a day.

Group 3 WT: Placebo(Wheat powder) is made into 250mg capsules and is given to the

patients.

Investigations

Routine Pathological tests such as blood, urine, ESR etc., has been carried out to assess the

actual status of patients and to rule out any pathology.

Criteria of Assessment

Subjective assessment criteria

The symptoms that are assessed in patients are:

1. Chala Sphika Udara Stana

2. Kshudra Swasa / Ayasena Swasa Kastata

3. Alasya/ Utshaha hani

4. Daurbalyata (Alpa Vyayam)

5. Nidradhikya

6. Daurgandhata

7. Atipipasa

8. Atikshuda

9. Anga Gaurava (heaviness in body)

10. Vyavaya Kasta


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11. Svedadhikyata

Scoring pattern of Subjective Parameters

1) Chala Sphika Udara Stana

Grade 1 – No presence of Chalatwa

Grade 2 - Little visible movement after fast movement

Grade 3 - Little visible movement after moderate movement

Grade 4 - Movement after mild movement

Grade 5 - Movement even after changing posture

2) Kshudra Swasa / Ayasena Swasa Kastata

Grade 1 Dysponea after heavy work but relieved soon & Up to tolerance

Grade 2 - Dysponea after moderate work but relieved late & Up to tolerance

Grade 3 - Dysponea after little work but relieved soon & Up to tolerance

Grade 4 - Dysponea after little work but relieved soon & beyond tolerance

Grade 5 - Dysponea in resting condition

3) Alasya/ Utshaha hani

Grade 1 –Absence of Alasya

Grade 2 - Doing work satisfactory with initiation late in time

Grade 3 - Doing work unsatisfactory with lot of mental pressure & late in time

Grade 4 - Not starting any work in his own responsibility, doing little work very slow

Grade 5 - Does not have any initiation & not wants to work even after pressure

4) Daurbalyata (Alpa Vyayam)

Grade 1 - Can do routine exercise

Grade 2 - Can do moderate exercise without difficulty

Grade 3 - Can do only mild exercise

Grade 4 - Can do only mild exercise with very difficulty

Grade 5 - Can do even mild exercise

5) Nidradhikya

Grade 1 - Normal sleep 6-7 hrs/ day;

Grade 2 - Sleep upto 8hrs / day with Anga Gurav

Grade 3 - Sleep upto 8hrs / day with Anga Gurav & Jrimbha;


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Grade 4 - Sleep upto 10hrs / day with tandra;

Grade 5 - Sleep upto 10hrs / day with Tandra & Klama

6) Daurgandhata

Grade 1 - Absence of bad smell

Grade 2 - Occasionally bad smell limited to close areas difficult to suppress with deodorants

Grade 3- Persistent bad smell felt from long distance is not suppressed by deodorants

Grade 4 - Persistent bad smell felt from long distance even Intolerable to the patient himself

7) Atipipasa

Grade 1 - Normal thirst

Grade 2 - Upto 1 lit excess intake of water

Grade 3 - 1 to 2 lit excess intake of water

Grade 4 – 2 to 3 lit excess intake of water

Grade 5 - More than 3 lit intake of water

8) Atikshuda

Grade 1 - Unwilling for food but could take the meal

Grade 2 - Willing towards only most liking food & not to others

Grade 3 - Willing towards only one among Katu/ Amla / Madhura food stuffs

Grade 4 - Willing towards some specific Ahara / Rasa Vishesa

Grade 5 - Equal willing towards all the Bhojjaya padartha

9) Anga Gaurava (heaviness in body)

Grade 1 - No heaviness in body

Grade 2 - Feels heaviness in body but it does not hamper routine work

Grade 3 - Feels heaviness in body which hampers daily routine work

Grade 4 - Feels heaviness in body which hampers movement of the body

Grade 5 - Feels heaviness with flabbiness in all over body which causes distress to the person

10) Vyavaya Kasta

Grade 1 - Unimpaired libido & sexual performance

Grade 2 - Decrease in libido but can perform sexual act

Grade 3 - Decrease in libido but can perform sexual act with difficulty

Grade 4 - Loss of libido & cannot perform sexual act


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11) Swedadhikya

Grade 1 - Sweating after heavy work

Grade 2 - Sweating after little work

Grade 3 - Profuse sweating after heavy work

Grade 4 - Profuse sweating after minimum work

Grade 5 - Sweating even in resting condition

Objective Assessment

Body Mass Index (BMI) – also called Quetlet index is a value derived from mass (weight)

and height of an individual. BMI =Weight (kg) /Height (in sq.m.).[6]

1. Waist and Hip Circumference

The waist circumference should be measured at the midpoint between the lower margin

of the last palpable rib and the top of the iliac crest, using a stretch resistant tape that

provides a constant 100g tension.

Hip Circumference should be measured around the widest portion of the buttocks, with

the tape parallel to the floor.

2. Skinfold Thickness Assessment

A skinfold thickness measurement provides an estimated size of the subcutaneous fat

deposit, which is basically the fat under the skin. By estimating the thickness of this area

researchers are able to obtain an estimation of the total body fat.

In the present study Digital body fat calipers is used to estimate the skinfold thickness.

The skinfolds are measured at the 3 skinfold sites Abdominal, Suprailiac, Triceps skinfold

thicknesses.

Abdominal Skinfold

The abdominal skinfold is measured 3 cm adjacent to the umbilicus, to the right side and 1cm

inferior to it.

Pinch: The vertical pinch is made at the marked site and the calipers placed just below the

pinch. Also horizontal pinch is taken from 1cm, 2cm, 3cm from the umbilicus.


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Suprailiac Skinfold

It is measured immediately above the iliac crest (top of hip bone), on the most lateral aspect

(side) i.e., where an imaginary line come from the anterior axillary border.

Pinch: The fold is directed anteriorly and downward in line with natural fold of the skin.

The right arm should be held across the body to keep it away from the measurement area.

The Triceps skinfold

At the level of the mid-point between the acromiale (lateral edge of the acromion process, the

bony of shoulder) and the radiale (proximal and lateral border of the radius bone,

approximately the elbow joint), on the mid-line of the posterior (back) surface of the arm

over the triceps muscle.

Pinch: 1. The arm should be relaxed with the palm of the hand facing towards (supinated).

2. A vertical pinch, parallel to the long axis of the arm, is made at the landmark.

In case of all circumference measurements, the mean values were taken before and after

treatment. The body wt. was also taken before and after treatment.[8]

3. Sagittal Abdominal Diameter

Sagittal Abdominal Diameter, also referred to as “abdominal height,” has been suggested as

an alternative to measuring WC as a way to assess visceral obesity. This measurement is

taken either in supine position or standing.

SAD was measured in the supine position at the top of the iliac crest. Horizontally one scale

on the abdomen and the other vertically placed by the side of abdomen.[9]

4. Body Fat Percentage

Body fat includes essential body fat and storage body fat. Essential body fat is present in

the nerve tissues, bone mass and we cannot lose this fat without compromising

physiological function. Storage body fat consists of fat accumulation in adipose tissue,

part of which protects internal organs in the chest and abdomen.[10]

In the present study we adopted thicknesses of skinfolds which is an anthropometric

method for estimating body fat.

The Jackson-Pollock skinfold method is used to calculate body fat percentage from the

three skinfolds of abdominal, suprailiac, triceps in the study sample.

Hold button

Screen

Zero point


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Guidelines for Exercise Testing and Prescription: American College of Sports Medicine

in 2000 Female Three-site Formula[11]

, Abdomen, Suprailiac, Triceps

% Body Fat Percentage = (0.41563× sum of three skinfolds) – (0.00112 × [sum of three

skinfolds]2 ) + (0.03661 × age) + 4.03653

OBSERVATIONS

Table No: 1

S.No. Parameter No. of Patients

Total Percentage% Group 1 Group 2 Group 3

1. Chala Spik Udara

Stana 10 8 8 26 86.66

2. Kshudra Svasa 8 7 5 20 66.66

3. Alasya 5 8 6 19 63.33

4 Daurbalya 7 6 8 21 70

5 Nidradhikya 6 8 5 19 63.33

6 Daurgandhya 5 9 5 19 63.33

7 Atipipasa 7 6 6 19 63.33

8 Atikshudha 8 8 5 21 70

9 Angagaurava 9 7 6 22 73.33

10 Vyavayi Kashtata 8 8 4 20 66.66

11 Svedadhikya 8 8 7 23 76.66

Assessment of the Result

Overall percentage of improvement of each patient was calculated by the formula

% Change = Mean BT - Mean AT\ Mean BT × 100

Paired t-test was carried out at each symptom individually in three groups, whereas Anova

was applied to study the comparative results of 3 groups at the level of P<0.05, P<0.01 and

P<0.001 levels.

Insignificant: P<0.05

Significant: P<0.05

Highly Significant: P<0.01

Extremely Significant: P<0.001

Total effect of Therapies

Complete remission 100% of relief

Marked improvement 75-100% of relief

Moderate improvement 50-75% of relief

Mild improvement 25-50% relief


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OBSERVATIONS

A total of 30 patients were registered in the present study and 10 patients in each group.

Group 1 KJT

Table No: 2

In the present study 100% of the patients were suffering from the bulkiness of abdomen and

the other symptoms of medoroga.

Group 2 KJG

Table No: 3

S.No. Parameter MEAN SD SE

t Value P value Significance BT AT BT AT BT AT

1. Chala Spik Udara

Stana 1.80 0.20 0.79 0.42 0.25 0.13 9.7980 <0.001 Extremely significant

2. Kshudra Svasa 1.20 0.20 0.92 0.42 0.29 0.13 4.7434 <0.001 Extremely significant

3. Alasya 1.10 0.20 1.45 0.42 0.46 0.13 2.5861 <0.05 Statistically significant

4 Daurbalya 1.60 0.20 1.43 0.42 0.45 0.13 3.7717 <0.05 Statistically significant

5 Nidradhikya 1.50 0.20 1.51 0.42 0.48 0.13 3.2844 <0.01 Highly significant

6 Daurgandhya 1.00 0.50 1.25 0.85 0.39 0.27 3.0000 <0.01 Highly significant

7 Atipipasa 1.20 0.40 1.03 0.70 0.33 0.22 3.2071 <0.01 Highly significant

8 Atikshudha 1.50 0.70 1.08 0.82 0.34 0.26 6.0000 <0.001 Extremely significant

9 Angagaurava 2.10 0.80 1.29 0.92 0.41 0.29 6.0908 <0.001 Extremely significant

10 Vyavayi Kashtata 1.50 0.60 1.08 0.70 0.34 0.22 5.0138 <0.001 Extremely significant

11 Svedadhikya 1.90 0.70 1.20 0.67 0.38 0.21 4.8107 <0.001 Extremely significant


t Value Pvalue Significance BT AT BT AT BT AT

1. Chala Spik Udara

Stana 1.40 0.40 1.07 0.52 0.34 0.16 4.7434 <0.001 Extremely significant

2. Kshudra Svasa 1.10 0.50 0.99 0.71 0.31 0.22 3.6742 <0.01 Highly significant

3. Alasya 1.40 0.70 1.07 1.06 0.34 0.33 4.5826 <0.001 Extremely significant

4 Daurbalya 1.20. 0.20 1.23 0.42 0.39 0.13 3.0000 <0.01 Highly significant

5 Nidradhikya 1.70 0.20 1.34 0.42 0.42 0.13 4.3916 <0.001 Extremely significant

6 Daurgandhya 1.40 0.40 0.84 0.70 0.27 0.22 6.7082 <0.001 extremely significant

7 Atipipasa 0.90 0.20 0.88 0.42 0.28 0.13 3.2796 <0.01 Highly significant

8 Atikshudha 1.50 0.30 1.08 0.48 0.34 0.15 4.1295 <0.01 Highly significant

9 Angagaurava 1.10 0.90 1.43 1.10 0.45 0.35 4.5826 <0.001 Extremely significant

10 Vyavayi Kashtata 1.30 0.50 0.95 0.53 0.30 0.17 4.0000 <0.001 Extremely significant

11 Svedadhikya 1.30 0.70 1.06 0.82 0.33 0.26 3.6742 <0.01 Highly significant


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Group 3 WT

Table No: 4

EFFECT OF THE THERAPY IN THREE GROUPS

Table No: 5

OVER ALL RESULT OF THE STUDY ACCORDING TO % OF RELIEF

Parameter % of Relief

Group-1 Group-2 Group-3

Chala Spik Udara Stana 88.89 20 71.42

Kshudra Swasa 83.33 42.97 54.55

Alasya 81.81 44.44 50

Dourbalya 87.5 47.05 83.33

Nidradhikya 86.67 42.87 88.23

Dourgandhya 50 33.33 71.42

Atipipasa 66.67 36.37 77.78

Atikshudha 53.33 27.27 80

Angagaurava 61.9 27.27 18.18

VyavayaKashtata 60 66.67 61.55

Svadadhikya 63.16 53.85 46.15

Above table shows reduction of symptoms statistically in 3 groups.

In the present study Group 1 (KJT) Kanajata with Takra maximum 88.89%(P<0.001) relief

was observed in Chala Spik Udara Stana, 83.33% (P<0.001) relief in Kshudra swasa, 87.5%

(P<0.05) relief in Dourbalya, 86.67%(P<0.01) relief in Nidradhikya, 66.67% (P<0.01) relief

in Atipipasa, 63.16%(P<0.001) relief in Svedadhikya whereas Atikshudha, Angagaurava and

Vyavayi ksashtata were reduced by 53.33%(P<0.001), 61.9%(P<0.001) and 60% (P<0.001)

respectively. Statistics of the above parameters have shown extremely significant results in

the Group 1 KJT.



1. Chala Spik

Udara Stana 1.50 1.20 0.97 1.14 0.31 0.36 1.9640 >0.05 Insignificant

2. Kshudra Svasa 0.70 0.40 0.82 0.70 0.26 0.22 1.9640 >0.05 Insignificant

3. Alasya 0.90 0.50 0.99 0.71 0.31 0.22 2.4495 <0.05 Statistically significant

4 Daurbalya 1.70 0.90 1.34 0.88 0.42 0.28 4.0000 <0.01 Highly significant

5 Nidradhikya 0.70 0.40 0.82 0.70 0.26 0.22 1.9640 >0.05 Insignificant

6 Daurgandhya 0.90 0.60 1.10 0.84 0.35 0.27 1.9640 >0.05 Insignificant

7 Atipipasa 1.10 0.70 1.10 0.95 0.35 0.30 2.4495 <0.05 Statistically significant

8 Atikshudha 1.10 0.80 1.10 1.14 0.35 0.36 1.9640 >0.05 Insignificant

9 Angagaurava 1.10 0.80 1.10 1.14 0.35 0.36 1.9640 >0.05 Insignificant

10 Vyavayi

Kashtata 0.60 0.20 0.84 0.42 0.27 0.13 2.4495 <0.05 Statistically significant

11 Svedadhikya 1.30 0.60 1.16 0.70 0.37 0.22 3.2796 <0.01 Highly significant


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In the present study in Group 2, (KJG) Kanajata Group with Guda 71.42%(P<0.001) relief

was observed in Chala Spik Udara Stana, 54.55%(P<0.01) relief in Kshudra swasa, 83.33%

(P<0.01) relief in Dourbalya, 88.23%(P<0.001) relief in Nidradhikya, 77.78% (P<0.01) relief

in Atipipasa, 46.15%(P<0.01) relief in Svedadhikya whereas Atikshudha, Angagaurava and

Vyavayi ksashtata were reduced by 80%(P<0.01), 18.18% (P<0.001) and 61.55% (P<0.001)

respectively. Statistics of the above parameters have shown highly significant results in the

2nd

Group KJG.

In the present study Group 3 (WT) Kanajata with Takra maximum 53.85% (P<0.01) relief

was observed in Svedadhikyata, 66.67% (P>0.05) relief in Kshudra swasa, 47.05% (P<0.01)

relief in Dourbalya, 44.44%(P<0.05) relief in Alasya, 42.87% (P>0.05) relief in

Nidradhikyata, 36.37% (<0.05) relief in Atipipasa whereas Angagaurava, Chala Spik Udara

Stana and Atiskshudha were reduced by 27.27% (P>0.05), 20% (P>0.05) and 27.27%

(P>0.05) respectively. Statistics of the above parameters showed that results were

insignificant in the placebo control 3rd

Group.

OBJECTIVE PARAMETERS

Objective Parameters of the study are Body Fat Percentage, Skinfold Thickness, Body Mass

Index, Sagittal Abdominal Diameter, Waist and Hip Circumferences. The observations and

statistical analysis of the parameters are as follows.


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STATISTICAL SIGNIFICANCE OF GROUP 1 KJT

Table No: 6

STATISTICAL SIGNIFICANCE OF GROUP 2 KJT

Table No: 7

Parameter MEAN SD SE


Body Fat

Percentage 28.0132 26.0763 1.661 1.713 0.5254 0.541 11.5486 <0.001

Extremely

significant

Body Mass Index 29.267 27.629 2.8771 2.614 0.909 0.826 10.3659 <0.001 Extremely

significant

Waist

Circumference 35.95 34.81 2.171 2.201 0.687 0.696 8.0521 <0.0001

Extremely

significant

Hip

Circumference 42.370 39.430 2.152 2.340 0.680 0.740 2.9244 <0.01

Highly

significant

Abdominal

skinfold thickness 26.850 24.440 2.953 2.595 0.934 0.821 7.1139 <0.001

Extremely

significant

Suprailiac


Extremely

significant

Triceps skinfold

thickness 20.040 17.470 2.553 2.411 0.807 0.762 9.6367 <0.001

Extremely

significant



Body Fat

Percentage 28.6771 27.2463 0.8127 0.6432 0.2570 0.2034 12.5337 <0.001

Extremely

significant

Body Mass Index 28.5741 27.5004 2.2708 2.7489 0.7181 0.8693 2.8524 <0.05 Statistically

significant.

Waist

Circumference 36.49 34.21 1.374 1.581 0.434 0.500 3.4417 <0.01

Highly

Significant

Hip

Circumference 43.350 41.810 1.346 1.470 0.426 0.465 2.4433 <0.05

Statistically

signifiicant

Abdominal


Extremely

significant

Suprailiac


Extremely

significant

Triceps skinfold

thickness 19.745 17.590 1.970 1.144 0.594 0.362 2.7857 <0.05

Statistically

significant


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STATISTICAL SIGNIFICANCE OF GROUP 3 WT

Table No: 8

Inter Comparison of the Groups KJT, KJG, WT by One way Anova Test

Table No. 9

Parameters f value p value Significance

Chala Spik Udara Stana 13.45 <0.001 Extremely significant

Kshudra Svasa 3.918 <0.05 Significant

Alasya 1.110 >0.05 Insignificant

Dourbalya 1.218 >0.05 Insignificant

Nidradhikya 4.180 <0.05 Significant

Dourgandhya 4.582 <0.05 Significant

Atipipasa 0.9669 >0.05 Insignificant

Atikshudha 4.858 <0.05 Significant

Angagaurava 8.241 <0.01 Highly Significant

Vyavayi Kashtata 2.744 >0.05 Insignificant

Svadadhikya 2.762 >0.05 Insignificant

Above table shows the results of single factor Anova of the parameters.

Inter Comparison of the Groups KJT, KJG, WT by One way Anova Test

Table No: 10

Parameters f value p value Significance

Body Fat Percentage 36.28 <0.001 Extremely significant

Abdominal Skinfold Thickness 12.89 <0.001 Extremely Significant

Suprailiac Skinfold Thickness 1.566 >0.05 Insignificant

Triceps Skinfold Thickness 19.39 <0.001 Extremely significant

Supine Sagittal Abdominal Diameter 67.49 <0.001 Extremely Significant

Waist Circumference 67.83 <0.001 Extremely Significant

Hip Circumference 50.70 <0.001 Extremely significant

Body Mass Index 8.760 <0.001 Extremely Significant

Above table shows the results of single factor Anova of the parameters.


tValue Pvalue Significance BT AT BT AT BT AT

Body Fat Percentage 28.5885 28.4952 1.15118 1.2105 0.36403 0.3827 1.1914 >0.05 Insignificant

Body Mass Index 28.8541 28.7369 1.5258 1.3341 0.4825 0.4219 0.9806 >0.05 Insignificant

Waist

Circumference 36.50 36.42 2.014 2.009 0.637 0.635 0.0889 >0.05 Insignificant

Hip Circumference 43.520 43.490 1.767 1.800 0.559 0.569 0.0376 >0.05 Insignificant

Abdominal skinfold

thickness 28.990 29.000 2.049 2.086 0.648 0.660 0.0328 >0.05 Insignificant

Suprailiac skinfold


Triceps skinfold



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Effect of therapy in the three Groups

OVER ALL RESULT OF THE STUDY ACCORDING TO % OF RELIEF

Table No:

Parameter % of Relief

Group-1 Group-2 Group-3

Body Fat Percentage 6.92% 4.99% 0.31%

Abdominal Skinfold Thickness 8.98% 7.1% 0.38%

Suprailiac Skinfold Thickness 9.13% 6.31% 1.51%

Triceps Skinfold Thickness 12.82% 10.89% 1.36%

Supine Sagital Abdominal Diameter 4.51% 3.64% 0.1%

Waist Circumference 3.17% 6.24% 0.22%

Hip Circumference 6.93% 3.55% 0.06%

Body Mass Index 5.58% 3.75% 0.41%

The above table shows the overall percentage of relief in three groups. In Group 1 KJT The

reduction observed in body fat percentage was 6.92% (p<0.001), in Group 2 KJG it was

reduced by 4.99% (P<0.001) and in Group 3 reduction was 0.31% (P>0.05). The decrease

observed in Abdominal Skinfold thickness was 8.98% (P<0.001), 7.1% (P<0.001), 0.38%

(P>0.05) respectively in Group 1, Group2, Group 3 respectively. Suprailiac Skinfold

Thickness was reduced by 9.13% (P<0.001), 6.31% (P<0.001), 1.51% (P>0.05) in Group 1, 2

and 3 respectively.

There is reduction of 12.82% (P<0.001), 10.89% (P<0.05), 1.36% (P<0.05) is observed in

Triceps Skinfold Thickness in 3 Groups respectively. The reduction observed in Supine

sagittal Abdominal diameter in 3 groups was 4.51% (P<0.001), 3.64% (P<0.001), 0.1%

(P>0.05).

Waist circumference was decreased by 3.17% (P<0.001), 6.24% (P<0.01) and 0.22%

respectively in KJT, KJG and Placebo groups respectively. Reduction observed in Hip

circumference was 6.93% (P<0.01), 3.55% (P<0.05), 0.06% (P>0.05) respectively in 3

Groups. BMI was decreased by 5.58% (P<0.001) in Group 1, 3.75% (P<0.01) in Group 2 and

0.41% (P>0.05) in the placebo control Group.

Statistically all parameters showed extremely significant results in Group 1 KJT and highly

significant results in Group 2 KJG and the results were insignificant in the placebo control

group.


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Statistics representing the overall percentage of relief in 3 Groups

BFP-Body fat percentage, AST-Abdominal skinfold thickness, SST-Suprailiac skinfold

thickness, TST-Triceps skinfold thickness, SAD-supine sagittal abdominal diameter,

WC-Waist circumference, HC-Hip circumference, BMI-Body Mass Index.

DISCUSSION

Giving birth is a life transforming moment for a woman. Losing weight after pregnancy is a

Great challenge for woman in that stage. Post pregnancy abdominal bulkiness is one of the

most common complaints of new mothers. The abdomen and overall hips get enlarged due to

pregnancy and coming back to prepregnant state takes some time. During this time if care

wasn’t taken then it leads to settled abdominal bulkiness which may lead to obesity in future.

Each excess of pound is difficult to loose afterwards. So it is necessary to have proper care

during Postpartum and adapt a healthy lifestyle during Postpartum.

Postpartum obesity is very well managed during yesteryears in India. Several household

practices are observed in the society. In certain areas of Andhra Pradesh a spicy powder or

chutney (a food recipe) is prepared and specially given to new mother to maintain the health.

The recipe consists of Piper longum. So the use of Pippalimula is beneficial in prevention and

cure of Postpartum weight retention and abdominal bulkiness in women.

The various mechanisms identified for postpartum obesity are, Gestational weight gain higher

than the recommended levels may lead to postpartum weight retention in women. Gestational

weight gain above the recommended levels was associated with threefold higher risk of

becoming overweight after pregnancy (BMI≥26) among who were under or average weight

before pregnancy.[13]


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Prepregnancy weight is an attributing factor for the weight retention after delivery. Women

who are already over-weight or obese before first pregnancy tends to retain or gain more

weight after pregnancy than average weight women[13-15]

despite larger newborns[16]

and

wider variability in gestational weight gain. Weight gain before, during and after pregnancy

not only affects the current pregnancy but may also be a contributor to the future

development of obesity in women.[17-19]

Lipid metabolism in lactation, the studies in rats show that the increase in maternal fat

deposits takes place during the first 2/3rd

of the gestation are a consequence of hyperplasia

and enhanced adipose tissue lipogenisis, which is present in both humans and in rats.[20]

The

hormonal shift makes the mobilization of fat from the peripheral to the central parts of the

body during lactation where the pattern is reversed.[21]

Also the adipocyte size varies

depending on the balance between mobilizations.

Adiposity is common in pregnancy which may further increase during postpartum period

which is seen in many women. These influences may lead to a condition in which women

may become obese but metabolically in fine condition. This can be called as “Pro-obesity”

condition. In this condition there are no much metabolic disturbances but physically they are

obese in state due to the fat deposition during pregnancy. The condition may lead to future

obesity due to the modification of lifestyle which is influenced by many hormonal and

environmental factors.

Bhavamisra in Bhavaprakasha Samhita mentioned in Yonirogadhikara, Prasuti Cikitsa that

Kanajata (Pippalimula) should be taken with Madhita takra in the abdominal bulkiness for

21days to attain prepregnant state. The study is on 30 patients in 3 different Groups,

Group 1: Kanajata is given with Takra(KJT).

Group 2: Kanajata and jaggery is given (KJG).

Group 3: Placebo (Wheat powder). Pippalimula is effective when given with takra. Takra

possess kashaya and amla rasa. It is kaphavatahara and laghu in digestion and improves the

digestion by deepana property. So pippalimula along with takra is more effective.

Group1 patients have shown better results when compared to other 2 Groups. On Comparing

Group 2 Kanajata with Guda with 3rd

Group (Placebo) better results are observed. In the

subjective parameters Chala Spik Udara Stana, Kshudra svasa, Alasya, Dourbalya,

Angagaurava, Svedadhikya Kanjata with Takra group shown marked improvement whereas


1838


Kanjata with Guda shown moderate improvement. Nidradhikya, Dourgandhyata, Atipipasa,

Atikshudha, Vyavayi kashtata Kanjata with Guda group shown marked improvement

whereas Kanjata with Takra shown moderate improvement and there was minimal effect

found in placebo group.

In Objective parameters Body fat Percentage, Body Mass Index, Waist Hip Ratio, Abdominal

skinfold thickness, Suprailiac skinfold thickness, Triceps skinfold thickness Kanajata with

Takra group shown marked improvement, Kanajata with Guda shown moderate improvement

and minimal improvement in Placebo group.

Probable mode of action of Pippalimula

Pippalimula having Katu Rasa, laghu, Ruksha guna causes Kleda soshana[22]

; Ushna guna

causes the Ama pachana; Tikshna gunaa causes the Kapha chedana and Lekhana of

Medoavarana in srotas. By removing the kaphavarodha the Medoavrita vata is relieved

which makes the samasthiti of Jataragni and Medodhatvagni.

Piperine, a Piperidine derivative is the main active principle in the piper longum Linn.

Roots and fruits which acts as a melanocyte 4 receptor agonists which is the probable

mode of action for the decrease in the Postpartum weight retention and abdominal

bulkiness in women.

By the increase in MC-4 activity helps in reduction of adiposity (obesity) and its related

metabolic syndromes like dyslipidemia. Melanocortin activity may also be increased by

an endogenous inhibition of inverse agonists (agoulti-related peptide) of melanocortin

receptors. Piperidine, piperazine etc., are the MC4 agonists which help in reduction of

adiposity.[23]

CONCLUSION

Ayurveda has a greater potential to correct these lifestyle disorders. Postpartum bulkiness of

women is a lifestyle disorder. Hence in this study an effort has been made to work out a

convenient single herbal drug to combat the current problem.

Kanajata stands as an appropriate medication and is found very promising in the study. It has

been noticed that the practice of Prenatal and Postnatal care are being in practiced by the

women in the Indian society since long time. Losing the pounds after delivery is becoming a

task nowadays which interferes her health and married life. So it is necessary for the new

mothers to take care about the weight gaining during delivery and postnatal care mentioned in


1839


Ayurvedic care along with traditional care in the communities is to be followed without

missing. This makes the healthy women society preventing the afterward effects of the excess

weight gained after the pregnancy.

Pippalimula having Laghu, Ruksha and Ushna properties and kledasoshana, medohara action

is very beneficial in the treatment of postpartum abdominal bulkiness in women.

REFERENCES

1. Erica P. Gunderson, Childbearing and Obesity in Women: Weight Before, During, and

After Pregnancy; Obstet Gynecol Clin North Am. 2009 June; 36(2): 317.

2. Colditz GA, Willett WC, Rotnitzky A, et al. Weight gain as a risk factor for clinical

diabetes mellitus in women. Ann Intern Med, 1995; 122: 481–6. [PubMed: 7872581].

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15. Gunderson EP, Murtaugh MA, Lewis CE, et al. Excess gains in weight and waist

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long-term obesity and obesity-related illnesses. Obstet Gynecol, 2005; 106: 1349–56.

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43(3): 296-9.

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