Around the world over thousands of years, patients have received root-cause holistic treatment for their diseases with personalized
treatment, diet and lifestyle modification recommendations. Read the inspiring true stories of practitioners who heal people and who recovered
from their problems after ayurveda treatment at their clinics. Many have been generous to share their knowledge and experience for the benefit
of other holistic experts and patients alike. Many practitioners share their Case Studies and the healing powers of ayurveda and related therapies
as they heal people who benefited from our expertise.
Effects of Ayurvedic treatment on forty-three patients of ulcerative colitis
August 2020
Introduction
Ulcerative colitis is a chronic inflammatory bowel disease. Its incidence is more from 20 to 40 years of age and 5–10 per 100,000 persons are at risk.[/ rid=”ref1″ role=”button” style=”color: rgb(100, 42, 143);”>1] Bleeding in the stool with increased bowel frequency is the cardinal feature of this disease. Weakness is more common due to the loss of water and blood in the stool. In conventional Western medicine, some drugs like sulfasalazine may give mild relief in symptoms and signs but after some time patients need more doses of the same drug. Some patients get to benefit from steroids, which again are not suitable because of their side-effects. Even after taking steroids and sulfasalazine drugs patients suffer from the disease. So the patients are always seeking some alternative therapy promising more effective and safer outcomes.
The authors found some encouraging results in the patients of ulcerative colitis with certain Ayurvedic treatments. The treatment significantly corrected bleeding in stool and bowel frequency which are the cardinal features of ulcerative colitis, In addition, the treatments also improved the general condition of the patient. Ulcerative colitis is a disease of Purishavaha srotas. In Ayurveda, Raktatisara is mentioned as an advanced stage of Pittatisara. Piccha basti also mentioned as the management of Raktatisara in Charaka Samhita.[/ rid=”ref2″ role=”button” style=”color: rgb(100, 42, 143);”>2] This disease can be co-related with ulcerative colitis.
Aims and Objectives
The aims and objectives of this study were as follows –
-
To prove the efficacy of Ayurvedic treatment in the management of ulcerative colitis.
-
To provide a large population suffering from ulcerative colitis, a future possibility of safer treatment; this can be helpful in reducing the need of steroids and surgical processes.
Materials and Methods
Selection of patients
Forty-three cases with a classical picture of ulcerative colitis were randomly selected irrespective of age, sex, and chronicity from the OPD and IPD of the P. D. Patel Ayurveda Hospital, attached to J. S. Ayurveda College, Nadiad, Gujarat.
Criteria for inclusion
-
Signs and symptoms of ulcerative colitis
-
Colonoscopic diagnosis of ulcerative colitis
Criteria for exclusion
-
Patients who had undergone surgeries
-
Patients who had complications like anal fistula
-
Patients with any other associated disease
Plan of study and treatments
-
Proforma compiled with detailed clinical history and physical exam of the patients.
-
Investigations like Hb g%, Erythrocyte sedimentation rate, Stool routine – microscopy and colonoscopy
-
After confirming the diagnosis 43 patients were given the following treatment –
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Udumbara kvatha (ingredient is Udumbar tvak-Ficus glomerata) – 40 ml/two times a day
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Lodhra tvak churna (Symplocos racemosa) – 1 g + Musta moola churna (cyperus rotundus) – 1 g + Nagakesara (Mesua ferrea) churna – 1 g + Mukta panchamrut rasa-125 mg / three times in a day with water (the ingredients of Mukta panchamrut rasa are Mukta bhasma – 8 parts + Praval bhasma – 4 parts + Banga bhasma – 2 parts + Shankha bhasma – 1 part + Shukti bhasma – 1 part, processed in Ikshurasa, Godugdha, Vidai svarasa, Kumari svarasa, Shatavari Svarasa, Tulasi svarasa and Hansapadi svarasa).
-
Kutaja Ghana vati (ingredient is Kutaja tvak-Holarrhena antidysenterica) – 1g / three times a day.
-
Udumbara kvatha basti (ingredient is Udumbar tvak-Ficus glomerata) daily for one week and then twice a week for the next three weeks.
-
This treatment was given for a study period of one month.
Preparation of medicines
Medicines were prepared under expert supervision and purchased from Sunder Ayurveda Pharmacy, Nadiad.
Diet
Patients were kept on pitta –shamaka, laghu, grahi and pathya food articles.
If the patient was taking any modern medicine, doses of these were gradually reduced as the patient responded to Ayurvedic treatments.
Criteria for assessment
The improvement in the patients was assessed on the basis of relief in the symptoms and signs of the disease together with laboratory investigations. All the symptoms and signs were given grade scores and assessed before as well as after treatment. Changes in hemoglobin, ESR, and body weight were also recorded before and after treatment. Reductions in the doses of steroid and sulfasalazine drugs were also recorded.
Observations, Results and Discussion
Most of the patients (93.02%) belonged to the 20 – 40 years age group [/ rid-figpopup=”T1″ rid-ob=”ob-T1″ style=”color: rgb(100, 42, 143); display: inline-block !important; zoom: 1 !important;” target=”table”>Table 1]. In this study 65.12% of them were males and 34.88% were females [/ rid-figpopup=”T2″ rid-ob=”ob-T2″ style=”color: rgb(100, 42, 143); display: inline-block !important; zoom: 1 !important;” target=”table”>Table 2]. In other studies of modern medicines, the incidence of this disease in males and females is equal. Of the patients, 83.72% were Hindu [/ rid-figpopup=”T3″ rid-ob=”ob-T3″ style=”color: rgb(100, 42, 143); display: inline-block !important; zoom: 1 !important;” target=”table”>Table 3]; 46.51% had less than 1 year chronicity; 20.93% patients belonged to the 1 to 3 years chronicity group; 20.93% were found in the more than 3 to 5 years chronicity group. Only 11.63% patients were found in the more than 5 years’ chronicity group [/ rid-figpopup=”T4″ rid-ob=”ob-T4″ style=”color: rgb(100, 42, 143); display: inline-block !important; zoom: 1 !important;” target=”table”>Table 4].
Table 1
Distribution of the patients according to age
Table 2
Distribution of the patients according to sex
Table 3
Distribution of the patients according to religion
Table 4
Distribution of the patients according to chronicity
Bowel frequency was reduced by 81.81% and this benefit was statistically highly significant, Bleeding in stool was reduced by 91.58% and this was also statistically highly significant, Abdominal pain was reduced by 86.76% and this too was statistically highly significant, Weakness was reduced by 65.97%, again a statistically highly significant result, Body weight was increased by 2.31% and it was also statistically highly significant [/ rid-figpopup=”T5″ rid-ob=”ob-T5″ style=”color: rgb(100, 42, 143); display: inline-block !important; zoom: 1 !important;” target=”table”>Table 5]. Hemoglobin level was increased by 16.76%, which was statistically a highly significant result, ESR was decreased by 44.16% and it was also statistically highly significant, RBC in stool was decreased by 93.02% and it too was statistically highly significant, Pus cells in stool were decreased by 80.76% and it also was statistically highly significant [/ rid-figpopup=”T6″ rid-ob=”ob-T6″ style=”color: rgb(100, 42, 143); display: inline-block !important; zoom: 1 !important;” target=”table”>Table 6]. Forty-three patients had positive occult blood test before starting this treatment. Only four patients were found with positive occult blood test after the trial therapy. So 90.70% patients showed negative occult blood test after this treatment.[/ rid-figpopup=”T7″ rid-ob=”ob-T7″ style=”color: rgb(100, 42, 143); display: inline-block !important; zoom: 1 !important;” target=”table”>Table 7]. The drug prednisolone was taken by 16 patients in this study and the dose was reduced by 87.32%, that suggests a highly significant result, The dose of the sulfasalazine drug was reduced by 77.00% and it was also statistically highly significant [/ rid-figpopup=”T8″ rid-ob=”ob-T8″ style=”color: rgb(100, 42, 143); display: inline-block !important; zoom: 1 !important;” target=”table”>Table 8]. None of the patients developed any new complication or new undesirable features [/ rid-figpopup=”T9″ rid-ob=”ob-T9″ style=”color: rgb(100, 42, 143); display: inline-block !important; zoom: 1 !important;” target=”table”>Table 9]. All the signs and symptoms, laboratory investigations and dose of steroids and sulfasalazine drugs were reduced, which was statistically highly significant.
Table 5
Effects of Ayurved therapy on signs and symptoms of ulcerative colitis
Table 6
Effects of Ayurvedic therapy on investigations of patients of ulcerative colitis
Table 7
Effects of Ayurvedic therapy on occult blood test
Table 8
Effects on reduction of the dose of steroids and sulfasalazine drugs
Table 9
Improvement in symptoms and signs and investigations
Probable mode of action of the therapy
Ulcerative colitis is a disease of purisha vaha srotas which is caused by Pitta pradhana Vata doshas. Udumbara kvatha has properties of Pitta Vata shamana and also vrana shodana and ropana[/ rid=”ref3″ role=”button” style=”color: rgb(100, 42, 143);”>3] which help in healing ulcers in the colon by basti karma. It also has stambhana properties that help in reducing the bowel frequency and check bleeding. Kutaja ghan vati[/ rid=”ref4″ role=”button” style=”color: rgb(100, 42, 143);”>4] contains ghana satva of Kutaja tvak and has an Atisara nashaka (stambhana) guna that also helps in reducing the bowel frequency. Musta[/ rid=”ref5″ role=”button” style=”color: rgb(100, 42, 143);”>5] with its grahiaction relieves the ama in the body and also reduces the bowel frequency. Nagakeshara has Raktatisara nashaka[/ rid=”ref6″ role=”button” style=”color: rgb(100, 42, 143);”>6] and Lodhra[/ rid=”ref7″ role=”button” style=”color: rgb(100, 42, 143);”>7] has rakta stambhaka action that checks the bleeding. Mukta panchamrut rasa[/ rid=”ref8″ role=”button” style=”color: rgb(100, 42, 143);”>8] is a classical compound Ayurveda drug that relieves excessive Pitta dosha and ushna guna in body. One of the ingredients of Mukta also relieves mental stress which is a contributing factor to the disease.
Conclusion
On the basis of our clinical observation and discussion, it may be concluded that ulcerative colitis was found in middle-aged people between 20 to 40 years of age. The results obtained may be attributed to the disease-modifying effect of the trial therapy by means of its anti-pitta, vranashodhana-ropana, grahi and stambhana properties. All the signs and symptoms were reduced by more than 80% and the reduction was statistically highly significant. RBCs in stool which is the main clinical sign of this disease was reduced by 93.02%. Hemoglobin increased by 16.76%. The dose of steroids was reduced by 87.32%. All the results were statistically highly significant. The trial therapy is an ideal drug as a safe and effective alternative in case of ulcerative colitis.
Acknowledgments
The authors are thankful to the management and the Principal of J.S Ayurveda College and P.D.Patel Ayurveda Hospital, Nadiad for providing the permission and facilities for this study.
References
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/>AYU: An international’s quarterly journal of research in ayurveda
Hair loss Remedies in Ayurveda a Clinical Documentation
The present day lifestyle is more sophisticated but moving away from nature in case of food habits, pollution, stress etc. Now-a-days humans are more prone to metabolic disorders, hormonal disorders and stress related disorders of which hair fall spreads to all the categories. In Ayurveda this is called as Khalitya and has suggested classical remedies of herbs and Upacharas. While modern science claims that once the hairline goes up it never comes back and the only remedy is hair implant. We have done clinical documentation to prove the efficacy of Ayurveda treatment in Hair fall management by following a proper Pathya-Apathya and using some classical herbs internally as well as externally for the Khalitya (early age hair loss). The clinical documentation of more than 200 patients is made.
All the patients were given the same protocol of Keshya herbs and specially prepared Hair oil with Keshya herbs in the base of black sesame oil. The study was conducted for three months. Before and after treatment data was compared, which gave a statistically highly significant result.
Introduction:
We humans consider hair as a part of beauty. Each person wants to have the right amount of hair at the right places. Less or too much hair or hairs at the wrong places pose a problem.
Hair loss is a common complaint in the 21st Century. There are several causes of hair loss. Most common among them are malnutrition, chronic illnesses, hormonal imbalance, unhealthy lifestyle, metabolic disorders, stress related disorders, seasonal changes, pollution, certain medications, allergies, hormonal changes during pregnancy, menopause, genetic tendencies and use of chemicals in hairs etc.
Excess of Pitta dosha in the body is the chief cause of hair problems. Pitta is increased by excessive intake of tea, coffee, alcohol, meats and excessive smoking. Eating too much fried, oily, greasy, spicy, sour, and acidic foods also aggravates pitta.
Intake of too many chemical medicines, low blood circulation, anemia, and general weakness after different diseases, stress, anxiety, and mental tension are also prime causes of hair loss.
Chronic diseases like typhoid fever, presence of dandruff or lice and hormonal imbalance also cause hair loss. Frequently, patients are faced with a number of manufacturer’s claims that their products will benefit hair loss. Keeping Khalitya’s problem in mind, the author suggested physicians of Chakrapani Ayurveda Clinic and Research Center based in Jaipur to do some work in this direction. Chakrapani Centre have been treating hair fall with the Ayurveda herbs and have been seeing positive results which paved way for documentation on hair loss intending the information to serve as the true scenario behind genuine claims of hair regrowth in pure Ayurvedic way so that healthcare providers and patients can separate some of the valid claims for hair regrowth from those that are purely fiction.
AIim of the Study
The purpose of the study is to generate initial evidence of Ayurveda regimens which can then provide lead for large scale study with more precise protocols like with control group and having Prakriti based analysis of the effect of these remedies.
Materials and Methods
Selection of Patient
34 patients of the age group between 20 years to 35 years from the OPD of Chakrapani Ayurveda Clinic and Research Center irrespective of sex, caste, religion, economical status etc. have been randomly selected for the study. Of these 25 persons have done the usual follow up and final data was compiled from the results of these 25 patients.
Selection of herbs
Internal Herbs:
Hair care capsule has Brahmi, Jatamansi, Bhringaraj, Guduchi, Yashtimadhu and Neem that supports the hair growth.
Amalaki Rasayan is a fortified (by 7 Bhavna of fresh Amalaki juice) tablet of Amalaki powder given in the dose of 2 tablets of 300 mg each thrice daily. In case of associated symptoms Ayurveda herbal remedies and lifestyle counseling are done.
External Oils and Herbs:
Special Amla Oil – contains Amalaki fruit, Brahmi leaf, Ela seed, rose petal, Kapur Kachri rhizome, Bhringaraj whole plant, Musta rhizome, Japakusum flower prepared in fresh Amla juice and sesame oil.
Duration:
A time period of 3 months is selected for the treatment so as to show visible positive results.
Dose:
Hair care capsule 2 capsules X 3 times a day after each meal with water
Amalaki Rasayan 2 capsules X 3 times a day after each meal with water
Assessment of Hair Loss and Clinical Evaluation Methods:
We have considered evaluating hair loss by means of three methods. They are:
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60 seconds hair fall test: For conducting this test the patient should comb the hair downwards from the vertex part to all the sides in 60 seconds time period. The fallen hair should be collected and counted.
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Global Photography: The world wide done photographic documentation is called serial photographic documentation of hair loss. There are five photographic views taken by a high resolution digital camera from a standard distance.
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Vertex view.
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Mid Pattern view
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Frontal view to reveal the hair line.
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Temporal view (on both sides)
Hair Line Measurement:
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The hair line along the midline starting from between the eyebrows
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The left oblique starting from the middle of the left eyebrow and
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The right oblique hair line starting from the middle of the right eyebrow; should be noted.
Observation Results:
The results were incredible. More than 90% of people have received great results. Comparison of photographs between before and after 3 months of treatments showed very significant results.
The observations and measurements were statistically analysed using paired ‘t’ tests and probability was assessed. The observations and results are being presented as below:
Table 1
Age wise distribution of 25 patients
Table 2
Sex wise distribution of 25 patients
Table 3
Effect of treatment on the measurement of MidLine of the eyebrow
Statistical evaluation = Paired t test N=25, t=5.679, two tailed P<0.0001.
This shows that the results were extremely significant.
Table 4
Effect of treatment on the measurement of Right Oblique of the right middle of the eyebrow
Statistical evaluation = Paired t test N=25, t=5.956, two tailed P<0.0001
This shows that the results were extremely significant.
Table 5
Effect of treatment on the measurement of Left Oblique of the right middle of the eyebrow
Statistical evaluation = Paired t test N=25, t=5.758, two tailed P<0.0001
This shows that the results were extremely significant.
Table 6
Comparison of treatment on the number of Hair fall in 60 second
Statistical evaluation = Paired t test N=25, t=4.054, two tailed P<0.0005
This shows that the results were very highly significant.
Discussion
This study is a beginning. On the basis of the positive observations, we have started a large scale study on more number of patients, with more precise criteria, considerations of Prakriti of patients and having a control group. We have observed that in addition to regimens, correction of food habits and lifestyle also plays an important role.
Conclusion
The effort was to look for evidence of good effect on hair growth by the Ayurveda regimen. The study is giving a lead for a large scale research on this line so that firm evidence can be acquired. The significance of this study is its non invasive nature of treatment. Moreover, it is quite economical and not costly for the end user. It is usually said that the Ayurveda regimen does have great results on different health issues but the World always asks us about the evidence. So, we thought of generating evidence. It seems that our study was able to go to the right goal.
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Evaluation of Hepatoprotective effective of Liver Care Capsule and Tablet in Viral Hepatitis
Evaluation of Hepatoprotective effect of Liver Care Capsule and Liver Care Tablets in patients of acute viral hepatitis. Hepatitis infection has become a major worldwide health problem because of the potential nature of course of the disease to cirrhosis and the hepatocellular carcinoma (HCC). Acute viral infection is the most common cause of all forms of hepatitis. The viral hepatitis have been thought to be self limiting in nature but sometimes the majority of patients of viral hepatitis have been observed ending up with serious complications like hepatic failure, etc. So, the clinical study was planned to evaluate the hepatoprotective effect of Liver Care Capsules and Liver Care Tablets on scientific parameters. In the clinical trial, two groups of patients of viral hepatitis have been studied to evaluate the hepatoprotective effect of Liver Care Capsules and Liver Care Tablets. The first group was given a Liver care capsule and Liver care tablet, two capsules and two tablets, twice daily. The second group was given 100 gm of glucose powder daily. The trial was conducted for one month and liver functions were periodically evaluated to assess the hepatoprotective effect of drugs under trial. At the end of the trial, the group first exhibited hepatoprotective efficiency over the control.
Acute viral hepatitis is considered to be a self limiting disease, caused by the infected virus, but sometimes the majority of hepatic viral diseases are ending up with serious complications. So, a faster restoration is desirable for every patient, even though they suffer from a self limiting disease. Viral hepatitis and its complications still do not have appropriate drugs in modern medicine.
Ayurveda has a lot of hepatoprotective drugs, which can fill up this gap. Hepatoprotective drugs like Bhumyamalki (Phyllanthus niruri), Kalmegha (Andrographis paniculata) and Bhringraja (Eclipta alba) etc. have been suggested to be useful in hepatitis. All the selected trial drugs are bitter and are considered hepatoprotective and cholagogues. In Ayurvedic pharmacopoeia, they are considered Katu (Pungent), Tikta (Bitter) taste predominant drugs and as Pitta Virechaka (help in secretion of bile), Deepan (Appetizer), Yakrit Vikarahara (helps cure liver disorders) and thus protect liver damage.
Methodology
The clinical research was undertaken at Chakrapani Ayurveda Clinic and Research Center. Only those patients were selected for a clinical trial, who presented themselves with anorexia, nausea, vomiting, low grade fever, weakness, dark urine, jaundice and tender hepatomegaly with abnormal liver function test (LFTs). They were confirmed to have abnormal serum bilirubin, ALT, AST, serum alkaline phosphatase, and were not on any other hepatoprotective or hepatotoxic drug at the initiation of trial. Assessment of result therapy was made in different parameters in subjective parameters (chief complaints and associated symptoms and signs) and biochemical parameters (objective parameters). Each patient was subjected to series of laboratory tests such as serum bilirubin, AST, ALT, serum alkaline phosphatase, HbSAg, HCV and liver ultrasound before treatment, after 1 month of treatment and after two months of treatment to know the extent of liver damage as well as the rate of response to trial drugs. The trial was conducted for two months. Fresh raw drugs were procured from the market. After inspection, a Liver Care Capsule and Liver Care Tablet were prepared from the hospital pharmacy. The standard of purify, quality and packing was maintained as per Good Manufacturing Practice.
Trial Group
Formulation A – Liver care capsule and Liver care tablet
OPD patients explained the procedure thoroughly and told the importance of therapy. In this group, 18 patients were registered, of which 15 completed a full course of trial of two months. The group was given a Liver care capsule and Liver care tablet twice daily.
Control Group
Formulation B – Glucose powder
The patients of this group were given a 50 gm of glucose powder per day. In this group (control group), 10 patients were registered of which 7 patients completed full duration of trial.
Discussion
Acute viral hepatitis is a systemic viral infection in which hepatic cell necrosis and hepatic inflammation lead to a characteristic constellation of clinical, biochemical, immuno serological and morphological features. Almost all cases of acute viral hepatitis are caused by one of 5 viral agents, hepatitis A virus (HAV) to hepatitis E Virus (HEV). These agents can be distinguished by their molecular and antigenic properties; all types of viral hepatitis produce clinically similar illness. The first biochemical sign of hepatitis is a rise in the concentration of AST (SGOT) and ALT (SGPT).
The trial is exploration of ancient Ayurvedic literature to screen and standardize the Ayurvedic bitter herbs in protecting the hepatic damage caused by viral infection. The trial drugs Liver care tablet and Liver care capsule showed definitive hepatoprotective effect over the trial period of two months. All these drugs are having potent hepatoprotective, immune stimulating, anti inflammatory, antiviral, antioxidant, cholagogue, adaptogenic and membrane stabilizing properties, which are constitutive qualities for any hepatoprotective drugs to act against viral hepatitis. These activities have been attributed to their anticholestatic action, reduction in free radicals and reduction in cell protein necrosis as well as immune suppression and glutathione depletion reduction potential. The extracts of Phyllanthus niuri inhibit the reaction between HBsAg (surface antigen of HBV) and the antibody (anti HBs) to it and also inhibit the activity of endogenous DNA polymerase of HBV. The patients of all 2 groups showed statistically reduction in markers of enzymes of hepatotoxicity i.e. serum bilirubin, ALT, AST and serum alkaline phosphatase. But patients of the trial group I exhibited hepatoprotective efficiency over the control group.
Conclusion
Liver care capsule and Liver care tablet have proved to be effective hepatoprotective agents as these components have produced statistically significant improvement in the clinical manifestations of the patients registered for the current trial along with reduction in marker of enzymes of hepatotoxicity i.e. serum bilirubin, ALT, AST and serum alkaline phosphatase. Thus it can be concluded that Liver care capsule and Liver care tablet are effective in checking the progress of the acute viral hepatitis.
References
1. Bhaishajya Ratnavali – Vidhyotani Hindi Commentary by Kaviraja Sri Ambika Datta Shastri, (Chowkhamba Sanskrit Series, Varanasi), 1996.
2. Charak Samhita, Commentary by Shastri Kashi Nath & Chaturvedi GN (Chowkhamba Publication, Varanasi), 1974.
3. Harrison’s Principles of Internal Medicine, Vol I & II, 16th edn, (McGraw Hill, USA), 2005.
4. Kirtikar KR & Basu BD, Indian Medicinal Plants, Vol I-IV, 2nd edn, (Lalit Mohan Basu, Allahabad), 1935.
5. Sharma YK, Singh Harbans & Mehra BL, Hepatoprotective effect of few Ayurvedic herbs in patients receiving anti- tubercular treatment, Indian J Traditional Knowledge, 3(4) (2004) 391-396.
6. Sheila Sherlock & James Dooley, Diseases of Liver and Biliary System, 11th edn, (Blackwell Publishing Company, Corlton, Victoria), 2004.
7. Singh Harbans, Sharma YK & Mehra BL, A clinical study of hepatoprotective effect of certain Ayurvedic herbal drugs in patients receiving anti-tubercular treatment, (MD Kayachikitsa, Thesis, HPGIPG Education & Research in Ayurveda, Paprola, Himachal Pradesh), 2003.
8. Singh RH, The holistic principles of Ayurvedic Medicine, (Chowkhamba Sanskrit Pratisthan, Varanasi), 1998.
9. Srivastava AK, A clinical and experimental study of some indigenous drugs in the treatment of viral hepatitis with special reference to their membrane stabilizing effect, (MD Kayachikitsa, Thesis, BHU, Varanasi), 1998.
10. Tierney, McPhee, Papadakis, Current Medical Diagnosis & Treatment, 44th Int Edn, (MC Graw Hill, USA), 2005.
11. Anonymous, The Pharmacopoeia of India, (Government of India, New Delhi), 1970.
12. Zakim Boyer-Hepatology, A Text Book of Liver Diseases, Vol I & II, 3rd Edn, (WB Saunders Company, Philadelphia), 1996.
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Data Analysis of Participants in SRUJANANKUR MODULE OF Garbhasanskar
Data Analysis of Participants in SRUJANANKUR MODULE
A preliminary Analysis of Participants’ Feedback (n = 215) • Out of 363 participants data of 215 participants who had attended the program for a minimum 3 months is taken in consideration for analysis. The data was collected after each session.
A structured feedback form was used. All sessions were very well accepted (100%) with excellent safety profiles. The analysis reflects 29 variables with 26 components of body (12) and mind (17). Mother specific variables were 23 and foetus specific variables were 6.
Effects are proportional to the adherence to sessions Points of observations in Garbhasanskar Session:
• Level of stress
• Concentration in work
• Level Of Acceptance
• Mind Stability
• Feeling of Happiness
• Understanding of good values
• Level Of Acceptance
• Anxiety
• Depression
• Fear values
• Stability in breathing Rhythm
• Increase in Positive thinking
• Sound Sleep
Effects of Garbhasanskar Sessions
Out of 215 Participants, 97 % results were reported in Anxiety, Mind Stability, Positive Thinking and Sound Sleep.Improvement in other dimensions were reported by all 100 % participants.
Points of observations in Music Therapy Session
• Level of stress
• Response of baby during listening classical Music
• Response of baby during Active participation in
• Effect of Music therapy session
• Stability in breathing Rhythm
• Response of baby during Active participation in Music therapy
• Liked Active participation
• Response of Baby
• Response of baby during live Instrumental Music session
• Stability in breathing Rhythm
• Feeling of Happiness
• Anxiety
• Awareness in Breathing Effects of Music Therapy
Effect of Music Therapy:
Out of 215 Participants, 95 % of them reported in effect on breathing of baby; 98 % of them reported breathing stability, positive effects of music. • Improvement in other dimensions of music effects were reported by all 100 % participants.
Points of observations in Yoga Session
• Back problems
• Muscle strength & Tone
• Joint problems
• Flexibility of Abdomen Muscles
• Work stress
• Postural Flexibility Yoga Effects on Musculoskeletal Status
Yoga Effects on Musculoskeletal Status
Out of 215 Participants, back problems and muscle strength were improved in all of them. • Improvement in other problems were 97 – 98 %
Further Plan of Research
• Qualitative research involving in depth interviews (n=60) with focus on acceptance, convenience and effects observed by mother
• Short term and long term effects assessment by cohort study approach
• Experts with research experience (Dr Girish Tillu and Dr Swapnil Gadhave)
• Challenges involved: assessment variables, long term effects and subjective assessment
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/>Ayushmann Ayurveda Center
A RANDOMIZED CONTROLLED TRIAL OF GODANTI BHASMA AGAINST BALAPOSHAKA CHURNA IN MANAGEMENT OF BALASHOSHA W.S.R. TO PROTEIN ENERGY MALNUTRITION
January 2020
ABSTRACT
Title:
A Randomized Controlled
Trial Of Godanti Bhasma Against Balaposhaka Churna In Management Of Balashosha
W.S.R. To Protein Energy Malnutrition
Yogesh Shivaji Chavan1 Dr.G Jai2
Background
& Objective: Today Pediatric malnutrition
constitutes a major public health problem in India & other countries of
third world. Lots of attempts have been made to minimize this at National level
but these are not sufficient. Therefore Indigenous system of medicine
especially Ayurvediy rasasastra can play major role in providing health to
children.
Design:
A Randomized controlled trial was conducted.
Methods:
30 number of participants were selected from nearby rural Govt. UP School,
Velliyakulam (Chertala) satisfying the inclusion & exclusion criteria. They
were randomly divided in two groups. The trial drug Godanti bhasma is
administered in study group & Balaposhaka churna in control group for
duration of 1 month. Follow up taken after completion of medicine & after 3
months. Assessment based on blood values & clinical features was done
before & after the treatment. The results were statistically analyzed &
compared in between two groups.
Findings:
The
participants were in the age group of 5 to 12 years with mean age 8.89yrs. The
study included nineteen females and eleven male participants. The mean weight
was 19.40 with a S.D. of 2.28. After the
treatment weight, height, MUAC, S.Albumin was significantly increased in both
the groups.In symptomatic evaluation both drug were significantly effective,
But the trial drug was more effective on height gain, Mukha snigdhata, Netra
snigdhata & S.Albumin than
the control drug.
Conclusion:
Godanti
bhasma is effective in management of Balashosha (Protein energy malnutrition).
Key
Words: Godanti bhasma, Protein energy malnutrition,
Balaposhaka churna
1 MD(Ay) Scholar,
Dept of Rasasastra, Govt. Ayurveda College, Tripunithura, Kerala. 2 Professor, Dept
of Rasasastra, Govt. Ayurveda College, Tripunithura, Kerala.
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/>IJAPC
Pancha Karma Therapy a Boon for Chronic Disease
September 2019
Pancha Karma Therapy: a Boon for Chronic Disease
Dr. Shekhar Annambhotla, B.A.M.S., M.D. (Ayurved -India),
RYT, CMT
In Ayurveda, Pancha Karma therapy is considered a complete,
holistic approach to the elimination of the root cause of each and every
chronic disease. Today, in the USA, 70% of deaths are due to chronic diseases
rather than infectious diseases. Acharya Charaka has described that imbalances
in Doshas can be pacified by Shamana therapies (palliation methods), such as
administration of herbo-mineral supplements, lifestyle changes, adopting
fasting, etc. but deep rooted imbalances in Doshas can be completely
eliminated by the administration of Shodhana therapies (purification methods),
such as Pancha Karma, including – Vamana,
Virechana, Niruha Basti, Anuvasana Basti and Nasya.
Acharya Charaka emphasized the importance of Panchakarma
as –
“Doshah Kadachith Kupyati Jitaa Langhana Pachanaih /
Jitaah Samsodhanardhe Tu Na Tesham Punarudbhavaha” //
(Charak Sutra Sthana 16-20)
The vitiated doshas are pacified by fasting and by taking
digestive herbo-mineral compound preparations, but when the imbalances of
doshas are stronger and deep seated, only through sodhana — purification
therapies — can doshic imbalances be removed from their deep roots.
The analogy has been narrated here as the unwanted weeds
and trees can be completely destroyed by removing them from their roots, but by
cutting the branches, the weeds and trees will regrow and become stronger than
the earlier disease.
During the purification and detoxification therapy, the
balanced dhatus are eliminated along with the vitiated doshas; hence, one
should remember to provide a nourishing diet with ghee, milk, and vegetable
soups to maintain proper energy. During panchakarma therapy, the impurities dislodge
from the cells and are flushed from the body.
Candidates for Panchakarma include those who show signs
and symptoms of indigestion, anorexia (lack of enthusiasm of meals), obesity,
anemia, heaviness, excessive mental and physical exhaustion, acne, pimples and
urticaria, pruritus, lack of inclination for work, laziness, fatigue, weakness,
foul odor of the body, lassitude, excessive production of kapha and pitta doshas,
sleeplessness or excessive sleep, drowsiness, impotency, lack of intelligence,
lack of clarity of mind and senses, inauspicious dreams, impaired energy and
strength, and loss of complexion, even though they may be taking a nourishing
diet.
Advantages of Panchakarma therapy include the following:
The vitiated Doshas are eliminated from the body through the gastrointestinal
system, digestion is improved, and metabolism is increased. Overall health is
restored, the sensory faculties are improved, and intelligence and complexion
become clearer.
Seasonal Panchakarma program –
• Late autumn to winter (approximately October to February) –
predominance of Vata Dosha, the importance is given to Basti (colon cleansing,
restorative) therapies.
• Midsummer to early autumn (approximately July to October) –
the predominance of Pitta Dosha, it is important to administer Virechana
(purging) therapies.
• Spring to early summer (approximately March to June) –
predominance of Kapha Dosha, the importance is given to Vamana (therapeutic
emesis) and Nasya therapy.
The following Panchakarma Therapies were adopted –
Poorva Karma (preparatory therapy)
• Ama pachana (administration of herbal preparations for about
1-2 weeks)
• Snehana –Bahya (external oleation) – self-massage with
herbalized oil and internal oleation (abhyantara snehana) with ghee
• Swedana – Sweating / sudation / fomentation therapy
Digestive (Ama pachana) tea –prepared with
• Cumin – 1 part, Ginger – ½ part, Fennel – 1 part, Cardamom – ½
part, Cinnamon – ½ part – 6 cups water boil for 5 minutes / drink several times
a day.
• Trikatu – 1-2 tablets / 3 times daily
Digestive and deep rooted Ama reduction –
• For Vata Prakriti persons – a combination of Chitrak – 1 part,
Haritaki – ½ part, Fennel – 1 part,
• For Pitta Prakriti persons – a combination of Avipathikara
churna – 1 part, Triphala – 1 part, Licorice -1 part, Fennel -1 part, Coriander
-1 part
• For Kapha Prakriti persons – a combination of Chitrak -1 part,
Musta -1 part, Ginger – ½ part, Licorice -1 part, Trikatu – ½ part
Snehana – Oleation
• Internal oleation – Administered ghee 2, 4, and 6 teaspoons,
respectively, for three consecutive days. People who are intolerant to ghee
were administered flaxseed oil in the same quantities with warm milk, soy milk
or rice milk.
• External oleation –Clients were advised to self-massage
regularly with Ojas Rejuvenation oil.
Swedana
• The candidates were put in the steam tent to provide complete
sweating, providing
Amalaki Kalka (paste of Phyllanthus emblica with rose water) or
coconut oil to protect excess heat to brain (Mastishka)
Pradhana Karma (Main actions) –
Vamana (therapeutic emesis) –
• It is highly recommend in imbalanced Kapha Dosha. For
candidates who are strong, Vamana Therapy with Madanaphala (Randia dumatorum)
fruit powder – 2 parts, Vacha (Acorus calmamus) root powder – 1 part and
Saindhava Lavana (Mineral salt) – 1 part, mixed with honey was administered
early in the morning on an empty stomach. After 15-20 minutes,
candidates were given Yastimadhu Jala (Licorice water) – 8-10 oz
to drink.
Virechana (therapeutic purgation) –
• This therapy is recommended for imbalanced Pitta Dosha and
removes excess pitta through increasing bowel movements. The purgative therapy
was administered with castor oil and TriDosha cleanse capsule – a combination
of Triphala, Haritaki, Cascaria, and Sonamukhi.
Basti Therapy (both Kashaya and Matra Basti) –
• Basti therapy is administered on alternative days for 5, 7, or
10 days according to the duration of Panchakarma therapy. For Kashaya basti,
different herbs were used for preparing Kashaya. We followed a specific method
of mixing Kashaya basti substance –
“Makshikam Lavanam Tailam Kalkam Kwatham” – In this procedure
first taking honey, mineral salt, sesame oil and kashaya are given. In some
specific cases, we have used
Kalka churna.
• For Matra basti, we administered Ashwagandha Bala oil, sesame
oil or specific therapeutic oils for specific disease conditions.
Nasya Karma –
• According to doshic imbalances, Rechana (eliminative) nasya
was provided. In some cases, we also provided Ardraka swarasa (fresh ginger
juice) with jaggary to eliminate excess Kapha Dosha from sinuses and nasal
passages.
Other supportive Panchakarma therapies –
• Netra Basti (eye therapies), Kati Basti (lumbar therapy), Hrit
Basti (Heart therapy), Nabhi Basti (Naval therapy), Shiro Basti, Shiro Dhara,
Shiro Pichu, and other therapies were provided as needed.
Panchakarma Results
Tables showing distribution of 80 subjects of Panchakarma
therapy
Age distribution of 80 Panchakarma subjects (Table: 1)
Age Number of subjects Percentage
20 – 30 years 12 15 %
30 – 40 years 14 17.5 %
40 – 50 years 28 35 %
50 – 60 years 18 22.5 %
60 – 70 years 8 10 %
Deha Prakriti (Physical constitution) Distribution of 80
Panchakarma subjects (Table: 3)
Deha Prakriti Number of subjects Percentage
Vata 2 2.5 %
Pitta 1 1.25 %
Kapha 4 5 %
Vata Pitta 8 10 %
Vata Kapha 11 13.75 %
Pitta Vata 13 16.25 %
Pitta Kapha 12 15 %
Kapha Vata 16 20 %
Kapha Pitta 10 12.5 %
Tridosha 3 3.75 %
Manasa Prakriti (Psychological constitution) Distribution of 80
Panchakarma (Table: 4)
Manasa Prakriti Number of subjects Percentage
Satvik 12 15 %
Rajasik 41 51.25 %
Tamasik 27 33.75 %
Sub Dosha Imbalance Distribution of 80 Panchakarma subjects
(Table: 5)
Sub Dosha Number of subjects Percentage
Prana Vata 52 65.0%
Udana Vata 24 30.0 %
Samana Vata 29 36.25 %
Apana Vata 34 42.5 %
Vyana Vata 15 18.75 %
Pachaka Pitta 38 47.5 %
Ranjaka Pitta 24 30.0 %
Sadhaka Pitta 59 73.75 %
Alochoaka Pitta 28 35 %
Bhrajaka Pitta 42 52.5 %
Kledaka Kapha 32 40 %
Avalambaka Kapha 14 17.5 %
Bodhaka Kapha 18 22.5 %
Tarpaka Kapha 12 15 %
Sleshaka Kapha 32 40 %
Dhatu (tissue) Imbalance Distribution of 80 Panchakarma subjects
(Table: 6)
Dhatu Number of subjects Percentage
Rasa (Plasma) 48 60.0 %
Rakta (Blood) 29 36.25 %
Mamsa (Muscle) 13 16.25 %
Medas (Adipose tissue) 56 70.0 %
Asthi (Bone) 19 23.75 %
Majja (Bone marrow) 12 15 %
Shukra (Reproductive tissue) 24 30 %
Agni (digestive fire) Distribution of 80 Panchakarma subjects
(Table: 7)
Agni Number of subjects Percentage
Sama – Balanced 13 16.25 %
Vishama – Irregular 33 41.25 %
Teekshna – Sharp 8 10 %
Manda – Dull 26 32.5 %
Koshta (Competence of stomach) Distribution of 80 Panchakarma
subjects (Table: 8)
Koshta Number of subjects Percentage
Mrudu – soft, supple 17 21.25 %
Madhyama – medium 25 31.25 %
Krura – rigid, tough 38 47.5 %
Diet and Pattern of Eating Habits Distribution among 80
Panchakarma subjects (Table: 9)
Diet Number of subjects Percentage
Vegan 12 15 %
Vegetarian including diary 23 28.75
Mixed (Veg + Non-Veg) 45 56.25 %
Pattern of eating habits
Regular 32 40 %
Irregular 48 60 %
Pancha Karma Therapies Distribution among 80 Panchakarma
subjects (Table: 10)
Name of Panchakarma Therapies Number of subjects Percentage
Snehana 80 100.0 %
Abhyanga 62 77.5 %
Vishesha 65 81.25 %
Udvartana 58 72.5 %
Swedana 80 100.0 %
Vamana 12 15.0 %
Virechana 80 100.0 %
Basti – Asthapana (Matra) 80 100.0 %
Basti – Niruha (Kashaya) 48 60.0 %
Nasya 72 90.0 %
Netra Basti 15 18.75 %
Kati Basti 21 26.25
Hrut Basti 19 23.75 %
Nabhi Basti 34 42.5 %
Shiro Basti 11 13.75 %
Shirodhara with Oil (Taila dhara) 74 92.5 %
Shirodhara with Takra (Takra dhara) 19 23.75 %
Shiro Pichu 25 31.25 %
Pizhichil 28 35.0 %
Gandoosha 14 17.5 %
Level of Improvement Distribution among 80 Panchakarma subjects
(Table: 11)
PHYSICAL BENEFITS
Health issue Complete improvement (100 %) Marked improvement (75
%)
Moderate improvement
(50%) Mild improvement
(25 %) No improvement
(0%)
Digestion 32 (40.0) 21 (26.25) 15 (18.75 ) 8 (10.0) 4 (5 .0)
Sleep 15 (18.75) 24 (30.0) 18 (22.5) 16 (20.0) 7 (8.75)
Constipation 37 (46.25) 16 (20.0) 11 (13.75) 14 (17.5) 2 (2.5)
Clearance of
sinuses 12 (15.0) 18 (22.5) 23 (28.75) 16 (20.0) 11 (13.75)
Flexibility of
joints 17 (21.25) 20 (25.0) 17 (21.25) 18 (22.5) 8 (10.0)
Physical energy 22 (27.5) 13 (16.25) 15 (18.75) 20 (25.0) 10
(12.5)
Lightness of
body 12 (15.0) 14 (17.5) 20 (25.0) 22 (27.5) 12 (15.0)
Discomfort / pain 22 (27.5) 18 (22.5) 14 (17.5) 15 (18.75) 11
(13.75)
Dryness of skin 51 (63.75) 8 (10.0) 12 (15.0) 7 (8.75) 2 (2.5)
Fatigue 28 (35.0) 16 (20.0) 12 (15.0) 15 (18.75) 9 (11.25)
Circulation 18 (22.5) 22 (27.5) 18 (22.5) 14 (17.5) 8 (10.0)
Vision 12 (15.0) 15 (18.75) 16 (20.0) 18 (22.5) 19 (23.75)
Breathing pattern 14 ((17.5) 15 (18.75) 22 (27.5) 16 (20.0) 13
(16.25)
Cardiovascular
endurance 6 (7.5) 15 (18.75) 22 (27.5) 25 (31.25) 12 (15.0)
Gas, flatulence 29 (36.25) 17(21.25) 12 (15.0) 16 (20.0) 6 (7.5)
Complexion 21 (26.25) 18 (22.5) 16 (20.0) 13 (16.25) 12 (15.0)
Allergy 20 (25.0) 16 (20.0) 17 (21.25) 18 (22.5) 9 (11.25)
Immune system 16 (20) 22 (27.5) 14 (17.5) 18 (22.5) 10 (12.5)
Physical
endurance 22 (27.5) 12 (15.0) 15 (18.75) 17 (21.25) 14 (17.5)
Strength of spine 16 (20.0) 15 (18.75) 17 (21.25) 15 (18.75)
17(21.25)
Allergies 22 (27.5) 16 (20.0) 18 (22.5) 14 (17.5) 10 (12.5)
Migraine 23 (28.75) 18 (22.5) 21 (26.25) 13 (16.25) 5 (6.25)
Menstrual pain 25 (31.25) 16 (20.0) 14 (17.5) 15 (18.75) 10
(12.5)
Backache 29 (36.25) 17 (21.25) 14 (17.5) 12 (15.0) 8 (10.0)
Overall physical
wellness 19 (23.75) 20 (25.0) 18 (22.5) 14 (17.5) 9 (11.25)
PSYCHOLOGICAL BENEFITS
Clarity of mind 26 (32.5) 16 (20.0) 18 (22.5) 12 (15.0) 8 (10.0)
Self awareness 15 (18.75) 26 (32.5) 18 (22.5) 13 (16.25) 8
(10.0)
Thought process 12 (15.0) 17 (15.0) 22 (27.5) 19 (23.75) 10
(12.5)
Mental energy 21 (26.25) 14 (17.5) 19 (23.75) 18 (22.5) 8 (10.0)
Meditation 19 (23.75) 17 (21.25) 18 (22.5) 19 (23.75) 7 (8.75)
Memory 12 (15.0) 26 (32.5) 16 (20.0) 14 (17.5) 12 (15.0)
Deep relaxation 21 (26.25) 16 (20.0) 21 (26.25) 15 (18.75) 7
(8.75)
Chronic stress 27 (33.75) 15 (18.75) 16 (20.0) 14 (17.5) 8
(10.0)
Relationship
with others 10 (12.5) 16 (20.0) 15 (18.75) 18 (22.5) 21 (26.25)
Connectedness of
mind, body, spirit 24 (30.0) 14 (17.5) 12 (15.0) 16 (20.0) 14
(17.5)
Inner harmony 26 (32.5) 15 (18.75) 16 (20.0) 11 (13.75) 12
(15.0)
Mental fatigue 29 (36.25) 14 (17.5) 17 (21.25) 12 (15.0) 8
(10.0)
Calmness of
mind 21 (26.25) 18 (22.5) 16 (20.0) 14 (17.5) 11 (13.75)
Creativity 18 (22.5) 14 (17.5) 19 (23.75) 16 (20.0) 13 (16.25)
Mental stamina 22 (27.5) 18 (22.5) 14 (17.5) 14 (17.5) 12 (15.0)
Self confidence 18 (22.5) 12 (15.0) 18 (22.5) 17 (21.25) 15
(18.75)
Positivity 22 (27.5) 14 (17.5) 16 (20.0) 12 (15.0) 16 (20.0)
Mental alertness 16 (20.0) 18 (22.5) 13 (16.25) 16 (20.0) 17
(21.25)
Concentration 19 (23.75) 15 (18.75) 16 (20.0) 18 (22.5) 12
(15.0)
Overall mental wellness 21 (26.25) 16 (20.0) 18 (22.5) 12 (15.0)
13 (16.25)
Figures in parenthesis indicate percentage.
Duration of Panchakarma Distribution among 80 Panchakarma
subjects (Table: 12)
Duration of therapy Number of subjects Percentage
5 days 48 60.0 %
7 days 24 30.0 %
10 days 8 10.0 %
Overall Improvement in Physical Health Distribution among 80
Panchakarma subjects (Table: 13)
Improvement Physical Health Percentage
Complete improvement 27.85 %
Marked improvement 21.80 %
Moderate improvement 20.75 %
Mild improvement 19.85 %
No improvement 9.75 %
Overall Improvement in Psychological Health Distribution among
80
Panchakarma subjects (Table: 14)
Improvement Psychological Health Percentage
Complete improvement 24.04 %
Marked improvement 20.17 %
Moderate improvement 23.32 %
Mild improvement 19.18 %
No improvement 13.29 %
Overall improvement in both physical and psychological health
among 80
Panchakarma subjects (Table: 15)
Improvement Psychological Health Percentage
Complete improvement 25.94 %
Marked improvement 20.98 %
Moderate improvement 22.03 %
Mild improvement 19.5 %
No improvement 23.04 %
Conclusion and Summary:
The highest number of subjects (35%) to undertake Panchakarma therapy in the present clinical study fell in the 40-50 years age group (Table 1). More females participated in the Panchakarma therapy (72%) as compared to male subjects (Table 2). In the present clinical study, 20% of subjects were Kapha Vata Deha Prakriti (Table 3) and 51% were Rajasik Manasa Prakriti (Table 4). 73% of subjects had Sadhaka Pitta imbalances, and 65% had Prana Vata imbalances noted in the pulses of subjects (Table 5). In the present clinical study, 70% of subjects had Medo Dhatu vitiation, and 60% has Rasa Dhatu (60%) vitiation (Table 6). We observed 41% of subjects with Vishama Agni, as depicted in Table 7 and also observed that 37% had Krura Koshta as mentioned in Table 8. Regarding diet – a mixture (non-vegetarian and vegetarian) is represented in the present clinical study (56%), and their eating habits are irregular (60%) (Table 9). Different Panchakarma and allied therapies were provided for the subjects, according to their individual needs (Table 10). Regarding their symptoms, large numbers of subjects were completely relieved of their symptoms – dryness of skin (63%), constipation (46%), digestion (40%), in physical symptoms and in psychological symptoms – chronic stress (33%) and mental fatigue (36%) (Table 11). A large number of subjects (60%) underwent only 5-day Panchakarma therapy, whereas only 10% subjects have undergone 10-day Panchakarma therapy (Table 12). If more subjects were to undergo 10, 14 or 21 days of Panchakarma therapy, we may expect a greater percentage of subjects to note complete relief from symptoms. We found about 27% complete improvement in physical symptoms and about 24% complete improvement in psychological symptoms (Tables 13 & 14). Approximately 25 % of subjects noted complete overall improvement, while 23% noted no overall improvement in their health issues. (Table 15)
About the author:
Dr. Shekhar Annambhotla, B.A.M.S., M.D. (Ayurveda), RYT, CMT, has been a dedicated International Ayurvedic Specialist (Vaidya), consultant and educator since 1988. He began his eight-year course of study in Ayurvedic medicine at the age of 17, first at Nagarjuna University and then at Gujarat Ayurved University in India, where he earned his Doctor of Medicine in Ayurveda. He traveled extensively throughout Europe, West Indies and North America for seven years, practicing and teaching Ayurveda. He is a Registered Yoga Teacher with Yoga Alliance, a Certified Integrative Bodywork and Massage Therapist, and is also a faculty member of various Ayurveda schools throughout the USA. He serves on the Board of Directors for National Ayurvedic Medical Association (NAMA), USA and is Founding Director of Association of Ayurvedic Professionals of North America (AAPNA), USA. Dr. Shekhar lives in Lehigh Valley, Pennsylvania with his family.
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