1 J Res Educ Indian Med 2018; 24 (3-4): 71-8PR0 ISSN 0970-7700

2 Published Online First: December 23 2018 DOI 10.5455/JREIM.82-1528260487

3 MANAGEMENT OF METABOLIC SYNDROME IN AYURVEDA

4 – A CASE REPORT
5 RAMAN KAUSHIK1,* AND PRAGYA SHARMA2
6 Central Council for Research in Ayurvedic Sciences (CCRAS)1,
7 Jawahar Lal Nehru Bhartiya Chikitsa avum Homeopathy Anusandhan Bhavan,
8 No.61-65, InstitutionalArea, Opp.’D’Block, Janakpuri, New Delhi-110058 (India)
9 Department of Samhita & Siddhant2, All India Institute of Ayurveda,
10 Ministry of Ayush, Govt of India Gautampuri, Mathura Road,
11 Sarita Vihar, New Delhi - 110076 (India),
12
13 Abstract: Introduction - Metabolic syndrome is a rapidly emerging disease related to sedentary
14 lifestyle and faulty dietary habits. The major features of metabolic syndrome include central obesity, raised
15 triglycerides, low levels of High-density lipoprotein (HDL), hyperglycemia and hypertension. These
16 abnormalities confer increased risk of cardiovascular diseases and diabetes mellitus. Prevalence of metabolic
17 syndrome has increased promptly in India as well as world-wide since last couple of decades. Materials and
18 Methods - In present case study, Ayurveda formulation i.e. Tablet M-LIV, Phalatrikadi kwatha and M-
19 Sarpagandha mishran vati were given to a diagnosed patient of obesity, diabetes mellitus type II,
20 hypertension with dyslipidemia i.e. metabolic syndrome for around seven months (232 days). Along with oral
21 medication, dietary and lifestyle modification including regular physical activity were also suggested to the
22 patient. Physical and laboratory parameters were assessed before initiation and during the treatment in third
23 month & after six months of treatment. Results - Apparent improvement in objective parameters like waist
24 circumference (48 to 43 inches), body weight (104 to 95.5 kg ), blood pressure, Body Mass Index (36.8 to
25 33.7 kg/m2) were reported. Significant reduction in FBS (140 to 90.75 mg/dL), PPBS (201 to 147.03 mg/dL)
26 serum cholesterol (266 to 184.10 mg/dL) and serum triglycerides (167 to148 mg/dL) were also found.
27 Conclusion - This case study suggests competency of Ayurveda medicines along with lifestyle modification
28 in the management of metabolic syndrome.
29 Keywords: Metabolic syndrome, Medoroga, Phalatrikadi kwatha, Sarpagandha mishran vati.
30 Received Jun 06, 2018 Revised Sep 10, 2018 Accepted Sep 30, 2018 Published Online First First Dec, 23, 2018

31 INTRODUCTION
32 Metabolism is an important mechanism of our body through which we generate energy and build
33 essential elements for the growth and development. It includes catabolic and anabolic reactions via different
34 metabolic pathways occurring in the body. Such activities also render nitrogenous waste products which are
35 eliminated through excretory system. Thus, an orderly metabolism is required to maintain cell milieu and
36 general health. Irregularities in the body’s metabolism itself results in numerous disorders. Obesity, Diabetes
37 mellitus, Hypertension, Gastro-intestinal disorders are some of the major diseases among them. Lifestyle also
38 plays an important role in maintaining good metabolism. Genetic predisposition, sedentary lifestyle, faulty
39 eating habits are some of the common factors that can alter metabolism. Metabolic syndrome is one amid such
40 disorders and is also known as syndrome X, insulin resistance syndrome, or dysmetabolic syndrome [1]. Its
41 prevalence has increased during last couple of decades. Analysis of study data from almost three decades
42 concluded increased prevalence of metabolic syndrome among US adults [2]. Another study on
43 underdeveloped urban locale of eastern India reported that age standardized prevalence rates of metabolic
44 syndrome were 24.9% males, 42.3% females and overall 33.5%. [3] In urban population of India, Metabolic
45 syndrome is more prevalent in 41-60 years age group. In addition, obesity was found as the main driving force
46 for the development of metabolic syndrome [4]. With its holistic approach, Ayurveda has a great potential to
47 address rapidly emerging non-communicable lifestyle related diseases like metabolic syndrome.
48
1. Research Officer (Ayurveda), 2. MD scholar,
49 Metabolic syndrome
50 Metabolic syndrome (syndrome X, insulin resistance syndrome) consists of constellation of metabolic
51 abnormalities that confer increased risk of cardiovascular diseases and diabetes mellitus. The major feature of
52 metabolic syndrome includes central obesity, hyper-triglyceridemia, low levels of High-density lipoprotein
53 (HDL) cholesterol, hyperglycemia and hypertension [5]. Increased risk of metabolic syndrome is more related
54 to obesity, old age, female gender, inadequate fruit intake, hypercholesterolemia, and middle-to-high
55 socioeconomic status [3]. The guidelines and definition of metabolic syndrome had been revised several times
56 in the past. As per the latest guidelines of National Heart, Lung, and Blood Institute [6] and American Heart
57 Association [7], a person can be considered for metabolic syndrome when patient has three or more of the
58 following measurements (Table 1):

59

60 Table 1. Components of Metabolic syndrome

Abdominal obesity
WC > 40 inches in males
1. (Waist
WC > 35 inches in females
circumference)
Triglyceride (TG) > 150 mg/dL or on TG
2.
level lowering treatment
< 40 mg/dL in males
3. HDL cholesterol
< 50 mg/dL in females
Systolic blood pressure ≥
130 mmHg
Or diastolic blood pressure
4. Blood Pressure
≥ 85 mm Hg
or on blood pressure
lowering treatment
Fasting glucose ≥ 100 mg/dL or on glucose
5.
Level lowering treatment
61
62

63
64 People with metabolic syndrome have high risk for diabetes type II and cardiovascular disorders or
65 stroke. Insulin resistance or hyperinsulinemia was described as the main cause for the development of
66 hypertension, hyperglycemia, by Reaven in 1988 in his Banting lecture [8]. Large visible waistline is an easily
67 observable component for metabolic syndrome. Other clinical features may be related to hypertension or
68 hyperglycemia. The primary line of treatment for metabolic syndrome is focused to reduce the morbidity due
69 to coronary artery disease by lowering blood sugar, serum cholesterol, and blood pressure.
70
71 Ayurveda Perspective
72 In Ayurveda, Agni has been described to have a pivot role in human body, especially in all metabolic
73 processes. Mandaaagni (poor digestion/metabolism) is mainly caused by vitiated kapha dosha [9] and it has
74 been told to be the root cause of almost all diseases [10].
75 Among the sapta dhatus (seven body tissue), meda dhatu simulates with fat or adipose tissue [11].
76 Excessive production and accumulation of meda in the body has been described as medo-roga. Lack of
77 exercise/ physical activity, sleeping in daytime, excessive intake of sweet, unctuous or other kapha dosha
78 vitiating food items results in medovaha sroto dushti [12] with redundant increase in meda dhatu [13]. It is
79 described in Ayurveda that excessive intake of sweets leads to its conversion in to sneha or fat [14]. It results
80 in deposition of meda dhatu in different parts of body, especially over abdomen [15]. Aberrantly raised meda
81 dhatu up to the cellular level provides abadha meda [16] as a substrate for the pathogenesis of prameha
82 including madhumeha. As the causative factors for medo dhatu dushti & Kapha vitiation are nearly similar,
83 vitiated kapha dosha can lead to a condition Dhamanipratichaya [17] and its association with vitiated meda

2
 84 dhatu may result in vyanabala vaishamya (hypertension). Hypertension can develop as a chronic complication
85 or associated condition with obesity. Eventually it creates all conditions of medo roga with vyanabala
86 vaishamya which simulates with metabolic syndrome. Acharya Charaka has also explained Prameha and
87 Atisthoulya along with other diseases caused by similar etiological factors under Santarpana janya
88 vyadhi [18].
89
90 CASE STUDY
91 A 62 years old male with post retirement sedentary lifestyle had attended OPD with chief complaints of
92 gradual increase in body weight since 2 years with intermittent occasional headache and weakness. He was a
93 chronic smoker for more than 10 years (about half to one pack of cigarettes per day). He was a known case of
94 Diabetes mellitus since 5 years and essential hypertension since 3 years. He was under allopathic oral
95 hypoglycemic (Glibenclamide 5mg + Metformin 500 mg) and antihypertensive (Enalapril 5 mg) medication
96 from the respective onset of diseases and his blood sugar and blood pressure were maintained within normal
97 limits. In routine investigations, his serum cholesterol and LDL were elevated along with Grade II fatty liver in
98 abdominal ultrasonography. His echocardiography was reported normal with LVEF >60%. After which, his
99 consulting physician had added cholesterol- lowering medicine (Atorvastatin 20mg). Continuing these
100 medications for one year, only cholesterol- lowering medicine was stopped after attaining normal lipid values.
101 Patient used to have routine investigation like FBS-PPBS in every 15-20 days, HbA1c in every 3 months, lipid
102 profile in every 3-4 months.
103 Patient had also noticed hyper-pigmentation over his neck (Acanthosis nigricans) since 4-5 months.
104 Since 2 months, he was experiencing headache and he also noticed increased blood pressure (through self
105 monitoring at home). His physician had changed some of his medicines but he didn’t follow that and
106 continued his previous medications. There is no other significant history of other illness or surgery. Patient’s
107 father was also a diabetic and obese person with history of coronary bypass surgery, died due to cardio-
108 respiratory failure. Patient did his recent investigation on 01.08.2017 and came to institute’s OPD for
109 Ayurvedic treatment of obesity, raised blood sugar, high blood pressure and raised lipids level. The clinical
110 and Laboratory findings of the patient along with Aatura pariksha are as follows (Table 2 & Table 3) -
111

112 Table 2. Clinical and Laboratory findings of the patient .

I. Relevant clinical findings of the present case on 03.08.2018 are as follows
1 Height 168 cm
2 Weight 104 kg
3 Blood pressure 168/98 mmHg
4 Abdominal girth 48 inches
5 Addiction Smoker
6 Diet Mixed
7 Appetite Good
8 Sleep Excessive (8-10 hours in night and 1-2 hrs daytime)
9 Body Mass Index 36.8 kg/m2 (class II obesity)
II. Laboratory investigations (done on 01.08.2017 ) :
1 Fasting Blood sugar (FBS) 140 mg/dL
2 Post prandial Blood sugar (PPBS) 201 mg/dL
3 LDL 70 mg/dL
4 HDL 38 mg/dL
5 Total cholesterol 266 mg/dL
6 Serum triglycerides 167 mg/dL

3
113 Table 2. Clinical and Laboratory findings of the patient

I. Relevant clinical findings of the present case on

03.08.2018 are as follows
1 Height 168 cm
2 Weight 104 kg
3 Blood pressure 168/98 mmHg
4 Abdominal girth 48 inches
5 Addiction Smoker
6 Diet Mixed
7 Appetite Good
8 Sleep Excessive (8-10 hours in
night and 1-2 hrs daytime)
9 Body Mass Index 36.8 kg/m2 (class II obesity)

II. Laboratory investigations (done on 01.08.2017 ) :

1 Fasting Blood 140 mg/dL
sugar (FBS)
2 Post prandial 201 mg/dL
Blood sugar
(PPBS)
3 LDL 70 mg/dL
4 HDL 38 mg/dL
5 Total cholesterol 266 mg/dL
6 Serum 167 mg/dL
triglycerides
114

115 Table 3. Aatura Pariksha

Kapha pradhana
1. Nadi (pulse)
Pulse rate – 82/minute
Mutra (Urine frequency/ Diurnal – 4-5 times /day
2.
Bladder habbits) Nocturnal – 2-3 times during night
3. Mala (Bowel habits) Kosthabaddhata (constipated)
4. Jivha (Tongue) Saama (Coated)
5. Shabda (speech) Unclear
6. Sparsha (Touch) Warm
7. Drika (Eyes) Normal
8. Aakrati (Built) Sthoola (Obese)

9. Prakriti Kapha pradhana pitta

Abhyaharana – Normal
10. Agni
Jarana – Poor
11. Vyayamashakti Avara (poor)
12. Satmya Madhyam
13. Satva Madhyam

4
116

117
118 The patient was diagnosed as a case of medoroga associated with vyanabala vaishamya and treatment
119 was planned accordingly. Patient had been told to continue his allopathic oral hypoglycemic (Glibenclamide
120 5mg + Metformin 500 mg) and anti-hypertensive antihypertensive (Enalapril 5 mg) medication. He had also
121 been advised about the dietary modification like reduction in intake of saturated fats, refined carbohydrate,
122 sweetened beverages, munching/snacking in between major meals, intake of low-fat dairy items like tone milk,
123 avoidance to salted and processed food items, increase intake of green leafy vegetables & fruits and rich fibre
124 diet [19], quitting/reducing smoking, performing regular 30 minutes of exercises and about 03-05 Kms of brisk
125 walk (at least 05 days/week).
126
127
128 The patient was diagnosed as a case of medoroga associated with vyanabala vaishamya and treatment
129 was planned accordingly. Patient had been told to continue his allopathic oral hypoglycemic
130 (Glibenclamide 5mg + Metformin 500 mg) and anti-hypertensive antihypertensive (Enalapril 5 mg)
131 medication. He had also been advised about the dietary modification like reduction in intake of saturated fats,
132 refined carbohydrate, sweetened beverages, munching/snacking in between major meals, intake of low-fat
133 dairy items like tone milk, avoidance to salted and processed food items, increase intake of green leafy
134 vegetables and fruits and rich fibre diet [19], quitting/reducing smoking, performing regular 30 minutes of
135 exercises and about 03-05 Kms of brisk walk (at least 05 days/week).
136
137
138 Table 4. Details of oral medication given.

Sr. Name of the medicine Dose Route Kala Anupana

No. (Manufactured by IMPCL,
Mohan)
1 Phalatrikadi kwatha 20 ml Oral Prakbhakta -
(Sharagdhara samhita, (Before meals),
madhayam khanda-2/111) twice daily
2 Tab. M.Liv 500 mg Oral Adhobakta (after Ushna
meals), twice Jala
daily
3 M-Sarpagandha mishran 250 mg Oral Adhobakta (after Ushna
vati meals), twice Jala
daily
139
140 Preparation of Phalatrikadi kwatha – Patient was instructed to prepare it by adding 20 gms of coarse
141 powder of Phalatrikadi kwatha in 160 ml (8 times of coarse powder) of water. Then it needs to be boiled until
142 it reduces to one-fourth of its quantity i.e. 40 ml and then taken in two equal divided doses.
143 Case Follow-up – During the treatment, follow up of the patient was done on every 7 days in the initial
144 month of treatment and then after every 15 days.
145

5
146
147 OBSERVATIONS & RESULTS
148 The patient was assessed and results obtained are as follows (Table 5):
149

150 Table 5. Observations during the study

Sr. Parameters Normal Before After
No. observed range treatment treatment
1 T- 0 On T-1 on T-2 on
01.08.2017 10.10.2017 * 18.02.2018**
2 Blood sugar Fasting 60-100 mg/dL 140 mg/dL 120 mg/dL 90.75 mg/dL
3 Blood sugar Post prandial 80-150 201 mg/dL 176.33 mg/dL 147.03 mg/dL
4 HbA1c ≤ 7% 7.2% 7.0% -
5 LDL 130 to 159 mg/dL 194 mg/dL 169 mg/dL 114 mg/dL
6 HDL > 40 mg/dL 38 mg/dL 40 mg/dL 40 mg/dL
7 Total cholesterol 123-199.0 mg/dL 266 mg/dL 241.50 mg/dL 184.10 mg/dL
8 Serum triglycerides < 150 mg/dL 167 mg/dL 161 mg/dL 148 mg/dL
9 Body weight - 104 kg 99 kg 95.5 kg
10 Waist circumference - 48 inches 45 inches 43 inches
11 Body Mass Index - 36.8 kg/m2 35.1 kg/m2 33.7 kg/m2
151 *In third month of treatment ** After six months

152

153
154 Figure 1. Graphical presentation of lab. Investigations

300
250
200
150 T0
100
T1
50
T2
0

155
156
157

6
158
159 Figure 2. Changes observed in blood pressure during initial month

180
160
140
120
100
80
60
40
20
0
Ist day
3rd day 8th day 15th day 21th day 28th day
(BT)
Systolic B.P 168 160 156 148 142 138
Diastolic B.P 98 92 92 90 88 88
160
161
162 DISCUSSION
163 Metabolic syndrome has various symptoms of different diseases but the fundamental pathology behind
164 the development of this syndrome is meda dhatu dusti. Meda dhatu accumulates and obstructs the body srotas
165 (channels) deriving the development of medoroga, madhumeha and vyanbalavaishamya also. Vyanabala
166 vaishamya (~essential hypertension) may occur sometimes due to upchaya inside the blood vessesls reduces
167 the internal passage of channels and causes sankochana (constriction) of passage [20]. Acharya Chakrapani in
168 his commentary on charaka samhita has explained that treatment of sthaulya should be planned to deplete only
169 medo dhatu [21]. In the present case study, the intention for the management of the disease was to avoid the
170 causative factors like faulty diet, sedentary lifestyle thereby improve status of agni and depletion of meda
171 dhatu. Tablet M-Liv (Table 6), a patent medicine containing Ayurvedic drugs which augment liver functions
172 and improve lipid metabolism was included in the treatment.
173 Other medication of this study is Phalatrikadi kwatha (Table 7). It’s an important Ayurvedic
174 formulation indicated in the management of all types of prameha including madhumeha [22]. It has unique
175 combination of six drugs that have significant hypoglycemic activity. Triphala containing equal proportion of
176 Haritaki (Terminalia chebula Retz.), Vibhitaka (Terminalia bellirica Roxb.) & Aamalaki (Emblica officinalis
177 Gaertn.) bears significant anti-oxidant property [23], Daruharidra (Berberis aristata DC) [24], Mustaka
178 (Cyperus rotundus Linn.) possess good hypoglycemic activity [25] and Indrayana (Citrullus colocynthis
179 Schard.) also holds hypoglycemic [26] with hepato-protective activity [27]. All these constituents make this
180 formulation a unique and effective formulation in medo dushti and madhumeha. Initial dose of this formulation
181 was 20 ml twice a day, empty stomach. After one week of treatment, its dose was reduced to 10 ml, twice a
182 day as the patient was experiencing abdominal cramps with loose stools after taking phalatrikadi kwatha. No
183 similar complaints were noted after lowering dose of phalatrikadi kwatha while other concomitant medicines
184 were continued with previous dosage.
185 M-Sarpagandha mishran vati (Table 8) is also a patent Ayurvedic medicine used in patients suffering
186 from vyanabala vaishamya (hypertension). Numerous In -vitro and In-vivo research studies had been
187 conducted which very well established the anti-hypertensive activity of sarpagandha (Rauwolfia serpentine
188 Benth ex Kurz.) [28, 29, 30]. In a clinical study, M-Sarpagandha mishran vati has shown its efficacy in the
189 management of essential hypertension [31]. The rational for including the above said three Ayurveda
190 formulations in the present case study were their therapeutic potentials, appropriateness for the patient
191 according to his vyadhi- samprapti (atarpana chikitsa for santarpanajanya vyadhi) & avastha ( to pacify
192 vitiated kapha dosha )and easy availability within the institute.
193 During this case study, patient lost about 8.5 kg of body weight but he never experienced physical
194 weakness or drowsiness. Waist circumference of the patient was also reduced significantly up to 05 inches.
195 Body Mass Index (BMI) is an important assessment parameter for obesity. In the present case study, BMI was

7
196 36.8 kg/m2 with class II obesity (as per the International Classification of adult underweight, overweight and
197 obesity by W.H.O). BMI has been significantly reduced to 33.7 kg/m2 with class I obesity. Blood pressure
198 was raised before treatment and it was monitored weekly during initial month. Gradual lowering of blood
199 pressure was observed from 168/98 mmHg to 138/88 mmHg. As the blood pressure of the patient was
200 significantly raised on its first day, weekly monitoring of blood pressure was done for initial one month.
201 Afterwards, blood pressure was measured intermittently during the study and was around134-138 / 86-88
202 mmHg.
203 FBS was significantly reduced from 140 to 90.75 mg/dL and PPBS from 201 to 147.03 mg/dL.
204 Glycosylated hemoglobin (HbA1c) is an exclusive marker to estimate glycemic control in diabetic patient.
205 During this case study, HbA1c was reduced from 7.2% to 7.0 % which precisely indicates good control over
206 diabetes. Significant reduction in total cholesterol (266 to 184.10 mg/dL), serum triglycerides (167 to 148
207 mg/dL) and LDL (194 to 114 mg/dL) was observed. As per the definition of metabolic syndrome, all five
208 components were present in this case study. Significant results were observed in three components (i.e. Serum
209 triglycerides, HDL & FBS) with improvement in waist circumference & blood pressure. Previously, patient
210 also had irregular bowel habits with altered constipation before treatment but it also become normal during the
211 treatment.
212 After attaining normal levels of lipid profile (as on 18.02.2018), Tablet M- liv has been stopped and the
213 patient is advised to continue other two medicines. In weekly follow-up up to 20.03.2018, no significant
214 alteration in blood sugar levels, blood pressure and lipid levels was noted.
215
216
217 CONCLUSION
218 Faulty dietary habits and sedentary lifestyle are the common causes for the development of metabolic
219 syndrome. In current western system of medicine, though treatments for different components of metabolic
220 syndrome are available but still its prevalence has been increased significantly in last couple of decades. In
221 Ayurveda perspective, metabolic syndrome may be considered as a constant manifestation of meda dhatu
222 dushti or medo roga with vitiated kapha dosha. This case study apparently suggests competency of Ayurved
223 medicines along with lifestyle modification as an adjuvant modality in the management of metabolic
224 syndrome. Further clinical trials over large sample incorporating efficacy markers and moderation/ tapering
225 dosage of allopathic medicines may create more supporting data for Ayurvedic management of such disorders.
226

227 Table 6. Constituents of Tablet M-Liv (each tablet)

Sr.No. Name of the constituents Quantity
1. Bhringraj (Eclipta alba Hassk.) 80mg
2. Tamalaki (Phyllanthua niruri Linn.) 80 mg
3. Kasni (Cichorium intybus Linn.) 24mg
4. Raktapunarnava (Boerhavia diffusa Linn.) 24mg
5. Katuka (Picrirhiza kurroa Royle ex Benth.) 8 mg
6. Kirattikta (Swertia chirata Roxb. ex Flem.) 4mg
7. Kalmegh (Andrographis panniculata Nees) 4mg
8. Kakmachi (Solanum nigrum Linn.) 8 mg
9. Haritaki (Terminalia chebula Retz.) 16mg
10. Mandoor bhasma (Calcined iron) 8 mg
Triturated by: Katuka (Picrirhiza kurroa), Amalaki (Emblica officinalis Gaertn.),
Ghritakumari (Aloe vera Mill) Parpat (Fumaria parvifloralum Lam).

228

229

8
230 Table 7. Constituents of Phalatrikadi kwatha
Sr.
Name of the constituents Quantity
No.
1 Haritaki (Terminalia chebula Retz.) 1 part
2 Bibhitaki (Terminalia bellirica Roxb.) 1 part
3 Amalaki (Emblica officinalis Gaertn.) 1 part
4 Daruharidra (Berberis aristata DC) 1 part
5 Nagarmotha (Cyperus rotundus Linn.) 1 part
6 Indrayana (Cirullus colocynthis Schard. ) 1 part
Prakshepa dravya- Haldi (Curcuma longa Linn.)
231

232 Table 8. Constituents of M-Sarpagandha mishran vati (each tablet)

Sr.
Name of the constituents Quantity
No.
1 Sarpagandha (Rauwolfia serpentine Benth ex Kurz.) 39 mg
2 Jatamansi (Nardostachys jatamansi DC) 39 mg
3 Vacha (Acorus calamus Linn.) 39 mg
4 Punarnava (Boerhavia diffusa Linn.) 39mg
5 Brahmi (Bacopa monnieri Linn.) 39 mg
6 Shankhapushpi (Convolvulus pluricaulis Chois.) 39mg

*Triturated by liquid extract of Guduchi (Tinospora cordifolia (Willd) Miers ex Hook f. & Thoms.), Sarpagandha (Rauwolfia
serpentine Benth ex Kurz.)

233

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304 How to Cite this Article (PubMed Style)
305 Raman Kaushik and Pragya Sharma. Management of Metabolic Syndrome in Ayurveda
306 – A Case Report, J Res Educ Indian Med DOI http://dx.doi.org/10.5455/JREIM.82-1528260487
307 (also Available at https://www.jreim-ayushjournal.com/index.php?sec=archive)

308 *Address for Correspondence: 1. Dr. Raman Kaushik, M.D. Ay (Kayachikitsa), Research Officer (Ayurveda), Central
309 Council for Research in Ayurvedic Sciences (CCRAS) Jawahar Lal Nehru Bhartiya Chikitsa avum Homeopathy
310 Anusandhan Bhavan, No.61-65, InstitutionalArea, Opp.’D’Block, Janakpuri, New Delhi-110058 (India)
311 Mail: drraman47@gmail.com
312 2. Dr. Pragya Sharma MD scholar, Department of Samhita & Siddhant2, All India Institute of Ayurveda,
313 Ministry of Ayush, Govt of India Gautampuri, Mathura Road, Sarita Vihar, New Delhi - 110076 (India),
314
315 *Residencial Address for Correspondence: 1. Dr. Raman Kaushik, M.D. Ay (Kayachikitsa), Research Officer (Ayurveda),
316 1/5691, Street No. 18, Balbir Nagar, Shahdara, Delhi – 110032 (India) eMail: drraman47@gmail.com

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