Original Article Journal of Indian

System of Medicine

Management of childhood Protein Energy Malnutrition

through Ayurvedic interventions

Renu Rathi, Bharat Rathi, Shrihari S, Dhiraj Rajput

Abstract: Joinsysmed ID: JID17068OA

Submitted Date: 01-11-2017
Background: Protein Energy Malnutrition (PEM) in early
Approved Date: 10-01-2018
childhood has serious long term consequences. India contributes to 1/3rd
Corresponding Author:
of severely wasted children under five in the world. There are several Renu Rathi, Professor, Department of
Ayurvedic interventions which can be effectively utilized for Koumarbhritya, Mahatma Gandhi
management of PEM such as Shramhara Dashemani Kashaya (SDK) Ayurveda College Hospital & Research
which acts as an appetizer and has nutritional value. Objective: To Centre, Salod (H) Wardha (MH)
Email: rbr.226@gmail.com
evaluate the comparative efficacy of SDK syrup with and without
Co-author (s):
Panchakarma procedures. Material & Methods: Children affected with
Bharat Rathi, Professor, Department of
Moderate Acute Malnutrition aging 1year to 6 years were selected for the Rasashastra and Bhaishajya Kalpana,
present prospective work. As pilot study, total of 30 patients were enrolled Mahatma Gandhi Ayurveda College
divided equally into 2 groups. Group A patients received only medicines Hospital & Research Centre, Salod (H)
Wardha (MH)
while group B received medicines alongwith Sarvanga Snehan- Swedan
Shrihari Sharma, Assistant Professor,
& Matra basti(external oleation, sudation and medicated enema)by
Department of Koumarbhritya,
Dashmool tail for 7 days per month up to 3 months for 21 days (Parihar Mahatma Gandhi Ayurveda College
kala). Patients were treated with Parasik yavani syrup-PYS with Hospital & Research Centre, Salod (H)
Hingwashtak churna for initial 7 days. Thereafter SDK syrup for 3 Wardha (MH)
months, at a dose of 5ml twice/thrice a day as per age(calculated by Dhiraj Rajput, Assistant Professor,
Department of Rasashastra and
Young's formula)was given to both groups. Observation & Results: The Bhaishajya Kalpana, Mahatma Gandhi
BMI in post treatment was found significant in Group A (P<0.001) and Ayurveda College Hospital & Research
Group B (p<0.001). Owing to additional Panchkarma procedures, Group Centre, Salod (H) Wardha (MH)
B had shown better efficacy than Group A. However there were no Conflict of Interest: NIL
significant changes in BMI Z score, weight for height and height for age % Source of Support: NA
Ethical Clearance: NA
of post treatment in both groups. Conclusion: It was found that Group B
Registered to: NA
was effective but not significant compared to Group A. Further research
Acknowledgment: NIL
with large sample size and duration may give consolidated outcome. How to cite the article: Rathi R, Rathi
Key words: Protein Energy Malnutrition, Parsik Yawani, Shramhar B, Sharma S, Rajput DS. Management of
kashaya childhood Protein Energy Malnutrition
through Ayurvedic interventions.
Joinsysmed 2017, vol 5(3), pp 196-202
Introduction:
PEM in early childhood has serious long term consequences
because it impedes motor, sensory, cognitive, social and emotional
development[1]. India contributes to 1/3rd of severely wasted children
under five in the world[2]. Underweight means percentile weight for age
lies below -3[3]. In Nelson's textbook of Pediatrics, Heird William has
used “Severe childhood Under nutrition” for protein energy malnutrition
as PEM is almost always accompanied by deficiencies of other
nutrients[4]. According to NFHS-4 (National Family Health Survey)
38.4% children were stunted, 43% were underweight and 21% were
wasted in less than five years age group, belonging to SAM (Severe Acute
Joinsysmed Vol.5 (3), July-September 2017 196
 Rathi R et.al. Management of childhood PEM through Ayurvedic interventions.. Joinsysmed 2017, vol 5(3), pp 196-202
Malnutrition) variety.[5]It also costs lives about total
50 per cent of all childhood deaths including urban
and rural or 30,000 deaths each day in children under
five years[5]. According to UNICEF, in India,
around 46 per cent of all children below the age of
three are too small for their age, 35.7% are
underweight come under MAM (Moderate Acute
Malnutrition)[6]. Even after 30 years of
implementation of Integrated Child Development
Services (ICDS), a single major child program in
India, about half of below three years children in
Maharashtra were found under-nourished
[7].Therefore, it is the need of the hour to check what
Ayurved can do in this regard to prevent the shift of
MAM into SAM.
According to Ayurved, Vatadosha is the
main causative factor to induce malnutrition in
children[8]. PEM can be correlated with(~) Karshya
(emaciation) on the basis of similar clinical features.
In Karshya, Agnimandya (lack of appetite) is
present, which creates Ama (undigested toxic
element) and Strotorodh (blockage in micro-
channels)[9]. There are many causes of Karshya, like
improper nutrition, un-hygiene, recurrent health
problems with no quality care etc[10]. The ideal
treatment is to stimulate appetite, increase micro-
circulation to remove Ama, supplement of nutrition,
anti-helminthes, immune-modulators[11]. There are
several Ayurvedic interventions which can be
effectively utilized for management of PEM such as
SDK mentioned by Acharya Charaka[12]. It
contains ingredients which have high nutritional
value act as anti-oxidant, immunomodulator and
prop up gastro-intestinal system[13]. Basti
(medicated enema), Abhyanga (oleation therapy)
and Svedana (Sudation therapy) are the best
available Vatahara (opposing Vata properties) and
Brhuhana (anabolic) external procedure mentioned
inAyurveda[14].
There are few studies available on PEM but none
comparing with Z score of anthropometry and
Panchkarma procedures[15]. Though it was a pilot
study, an effort has been made to compare the
efficacy of an ancient drug by modern parameters
like z score of anthropometry and BMI.
Objectives:
st nd
To identify MAM (1 and 2 grade–IAP
classification) affected children and to create
awareness among the parents about consequences;
197
prevention and management through Ayurvedic
interventions. Hence the combination of internal
medications and external procedures in the form of
Snehana (massage) with Dashamoola Taila,
Svedana with Vatahara Kwatha and Matra Basti
with Dashamoola Taila along with internal
medication was proposed to be evaluated.
Methods:
Place of the study- It was carried out at Mahatma
Gandhi Ayurved College, Hospital & Research
centre, Salod, Wardha.
Study design- It was a randomized parallel group
pilot study with 1:1 allocation ratio as per lottery
method. The study was approved by the local
Institutional Ethics Committee.(IEC/ 2014-15/
603).
Study Participants: The consent was received
from all informers before enrollment as study
participants who were matched the below inclusion
criteria.
a. Inclusion Criteria
MAM affected children of 1yr to 6 years age group
irrespective of gender, caste, religion and socio-
economic condition, fulfilling the diagnostic criteria
of IAP for Malnutrition of Grade I, Grade II (MAM)
were included in this study.
b. Exclusion criteria
Incorporated children who were supposed to have
infectious diseases and any chronic illness like
malignancies, mal-absorption syndrome, metabolic
error etc. and the children having genetic, hereditary
diseases were excluded from the study.
c.Assessment Criteria
All selected patients were assessed by WHO growth
standards like Weight for height, height for age to
check wasting and stunting along with BMI Z
score[15].
Study interventions:
Selected patients were treated by PYS [16] with
Hingwashtak churna[17] in doses as per Young's
formula for initial 7 days. Thereafter SDK syrup
was given at dose of 5ml twice a day to toddler (1-3
years) and 5ml thrice a day to children of 4-6 years
age group for a duration of 3 months as per dose
derived by Young's formula[18]. Internal
medication was same for both groups. These were
prepared, authenticated and standardized. Follow up
was taken twice in a month for another three months
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 Rathi R et.al. Management of childhood PEM through Ayurvedic interventions.. Joinsysmed 2017, vol 5(3), pp 196-202

after main treatment and educated for preventive Statistical analysis:

measures like wholesome diet, hygiene and
awareness about the disease to check for residual
effect of drug as medicine cannot be given during
follow-up period. The Hingwashtak churna with
PYS was intended to strengthen appetite, metabolism
and laxative with anti-helminthic action. The
posology of advised treatment is depicted in table
no.1
Study Procedure:
Children attending Kaumarbhritya OPD and IPD
diagnosed with MAM (PEM 1st and 2nd grade as per
IAP) were enrolled for the study. Total 30 patients
were divided into 2 groups by lottery method by
principle investigator. Patients of Group A received
only medicines while group B were given same
medicines for same duration and doses along with
Panchkarma procedures such as Sarvanga Snehan-
Swedan and Matra basti by Dashmool tail for 7 days
per month up to 3 months for 21 days in all.
Monitoring was done throughout the study for any
untoward effects by history taking, examination and
lab investigations whenever needed on weakly visit.
Outcomes:
The primary outcome measure was increase in
appetite, hygiene, awareness about proper diet and
decrease in fatigue with worm's removal. Secondary
outcomes were increase in weight gain, BMI Z score,
weight for height percentage and prevent the shift of
MAM to SAM.
Sample size:
As it was a pilot study, total 30 patients were divided
in to two groups of each 15. There were 36 cases
enrolled to get 30 anticipating dropouts of 15%
Primary and secondary end points were analyzed as
average change in the response from baseline.
Student's paired t test was used to compare pre- post
efficacy and unpaired t test for comparison of post
treatment between two groups at 95 % confidence
interval. All statistical analysis was done by Sigma
stat software.
Observation and Results:
After assessing pre-post anthropometry Z score, it
was found that the mean BMI group A pre-post
treatment was 15.3, 16.5 and SD of BMI 1.79, 1.8,
t=-4.24, (P<0.001), while Group B pre-post t/t
mean was 14.4, 15.83 and Standard deviation 1.37,
1.40 respectively. (t=-7.842, p<0.001).The Z score
of BMI was divided into 3 grades severe (-2 to-4),
moderate (-1 to 0) and 0-3 as mild. In group A, pre-
treatment grades were 46.6 and 53.3 in severe and
moderate category while post treatment, they were
shifted to left showing improvement in BMI Z
score 0, 20 and 80 % as compare to group B pre-
treatment were 66.6, 6.6 and 26.6 while post-
treatment 26.6, 0 and 73.33 grades(Table 4). The
medicine also had an efficacy on Hb%, (p=0.034)
in groupAand significant in B (p<0.001).
The average height for age in group A and B post
treatment had shown the first grade stunting 90%
(Waterlow classification)[20] (t=-1.924, p=0.065),
also not much change in MUAC and Head
circumference, may be due to less sample size and
treatment duration. The average weight for height
% of post treatment group A was 92.5 as compare to
93.9 of group B respectively depicting relief in
wasting among them. (Table 5)

Table no. 1: Posology of both groups.

SN Drug Dose Anupana Duration
1 Parasiyavanyadi churna 5ml twice a day, with water Up to 7 days
based syrup for de-worming (1-3 yrs twice, 3-6 yrs prior
thrice) management
2 Hingwashtak Churna 1-3gm before meal, (1-3 With honey or
yrs twice, 3-6 yrs thrice) /water for 7 days
3 Shramhara Dashemani 5ml,Twice/thrice a day With water 3 months
Syrup, these 3 medicines post meal, (1-3 yrs twice,
common to both groups 3-6 yrs thrice)
4 Balpanchakarma Oil quantity sufficient for External 7 days in a
Snehan, Swedan, Matrabasti massage. Matrabasti oil procedures month for
with Dashamool Taila for 10 ml for toddlers & 15 3months, total 21
only group B pts. ml to 4-6 years days.

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Table no. 2: showing the details of SDK syrup

Sr. Medicine Pharmacodynamics Action Calories/100gm
N [19]
1 Ikshu-Saccharum Galactogogue, VP pacify Kapha 111.43
officinarum(Linn) Aphrodisiac boosting effect
2 Draksha- Vitis Anti-oxidant, anti- VP pacify Kapha 103
vinifera(Linn) inflammatory, cardio- boosting effect
protective, antimicrobial
3 Khajur- Phoenix Analgesic, neuro- VP pacify Kapha 282
sylvestris (Roxb) protective, aphrodisiac boosting effect
4 Shali- Oryza sataive Aphrodisiac, diuretic Tridosh destroying 112
(Linn)
5 Yava- Hordeum Anti-oxidant, anti- Kapha boosting effect 324
vulgare (Linn) inflammatory, cardio- VP* pacify
protective, antimicrobial
6 Priyal buchanania Anabolic/tonic, anti- VP pacify 66.5
lanzan (Sprung) oxidant, anti-inflamatory
7 Badar- Zizyphus Anti-oxidanHepato- VP pacify 79
protective, anti-pyretic,
jujuba(Linn) anti-microbial
8 Dadim-Punica Immuno-modulator, Tridosh destroying 83
granatum (Linn) analgesic, anti- effect
inflammatory,
antimicrobial
9 Falgu-Ficus carica Antiseptic, haemostatic, VP pacify 107
(Linn) anti-diarrheal
10 Parushak- Grewia Hepatoprotective, anti- VP pacify 90
asiatica (Linn) inflammatory, anti-
microbial,
*VP-Vata Pitta
Table no. 3: showing details of Parsik Yawanyadi Syrup
Sr no Medicine Botanical Part used Pharmacodynamics Action
Name
1 Vidang Embelia Fruit Antimicrobial, astringent, Vata kapha
ribes Burm. f. anti-inflammatory pacifying,
2 Nagarmotha Cyperus Root Diuretic, analgesic, Kapha, vata
rotundus Linn carminative, anti-helminthic pacifying
3 Pippali, Piper longum Fruit Appetizer, antimicrobial, Kapha, vata
Linn rejuvenating, pacifying
4 Karkatashringi Pistacia Galls Appetizer, aphrodisiac, Vata
integerrima anti-pyretic, antiseptic pacifying
Stew. ex
Brandis
5 Amlavetas Cassia fistula Root bark Mild laxative, antiseptic, Kapha, vata
Linn antihelminthic pacifying
6 Parsik Yawani Hyoscyamus Leaves Carminative, antispasmodic Tridosha
niger Linn & antihelminthic pacifying

Table No. 4: showing changes in BMI & Hb % of both groups

Parameters Pre-Post t/t Mean Std Dev with SEM Paired t test P value
BMI Pre 15.332 1.788 ± 0.462 -4.237 <0.001
Group A Post 16.494 1.753±0.453
BMI Pre 14.372 1.370± 0.354 -7.842 <0.001
Group B Post 15.83 1.395±0.360
Hb Pre 9.827 0.420±0.108 -2.351 0.034
Group A Post 9.953 0.453±0.117
Hb Pre 9.693 0.752±0.194 -7.982 <0.001
Group B Post 9.920 0.738±0.191

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Table No. 5: Statistical parameters of both groups by t test (unpaired) post treatment
Post t/t Group A vs B Mean Std Dev
Parameters
Weight for Group A 92.467 6.034
height Group B 93.867 5.303
Height for Group A 89.133 3.739
age Group B 91.600 3.269
BMI Group A 16.494 1.753
Discussion:
The symptoms of PEM are much similar to that of
Karshya as both have malnutrition as a root cause.
PEM can be correlated with (~) Karshya in which
vitiated Vayu creates dryness, disturbs in nutrition of
next Dhatus (body tissues) thereby emaciation of
body fat and muscles occur[20]. There are visible
veins, bones due to dry food intake, less or improper
diet, grief, phobia, suppression of natural urges,
hereditary effect (body composition-Prakruti),
exertion and recurrence of diseases are common
causes of malnutrition[21]. Owing to exposure of
etiological factors, less nutrition provokes Vata
which again vitiates metabolism to create further
impairment of Dhatus and formation of more Mala
(body waste) to produce Karshya[22]. PEM has so
many complications specially it again decreases the
immunity to flare infections and weakness[23].
According to Acharya Sushrut, very lean & thin
person is undesirable/cencured so prompt treatment
must be initiated to overcome the disease condition at
earliest[24].
The maximum ingredients of SDK having sweet
taste, cool potency and sweet post effect of
metabolism (Vipak) with digestive and unctuous
properties which favors Kapha and opposes Vata. The
maximum ingredients of PYS having bitter-spicy
taste, hot potency, piquant post effect of metabolism
with digestive and unctuous properties thereby
capable as good anti-helminthes[18].
Details of syrup SDK is depicted in Table 2 [19] It has
good caloric values to supply energy and act as an
immune-modulator, appetizer, and anti-oxidant
properties to breakdown the etio-pathogenesis of
disease. Internal administration of it with external
massage, hot fomentation and medicated enema play
a key role in the management of this disease with
healthy lifestyle by counseling, wholesome diet and
rest by Vatahar action act synergistically[14].
Abhyang (massage) provides instant nourishment to
emaciated tissues with promotion of appetite,
Joinsysmed Vol.5 (3), July-September 2017
SEM Unpaired Remark
t test
1.558 t = -0.675 P = 0.505
1.369
0.965 t = -1.924 P = 0.065
0.844
0.453 t=1.141 P = 0.263
strength, plumpness and vitality[25]. It facilitates
the entry of nutrition due to increase in circulation
and exit of accumulated toxins/Ama which
expelled out through elimination
procedure–medicated enema[26]. It also creates
calm and pleasantness by muscle relaxation[27].
Skin is the site of Vata so Abhyang facilitates
Vatashaman by Vatahar properties of oil[28]. The
role of Swedana is beneficial in terms of removal of
stiffness to pacify vitiated Vata by moist, hot
properties and increases metabolism[29].
Concealed Doshas (humors) are liquefy and
expelled out by vasodilatation[30]. Matrabasti is
“Ardhachikitsa”(half treatment) in Vatavyadhi [31]
as it expels morbid Doshas from all the three
disease pathways hence aptly said by Acharyas
“Basti Vataharanam Shreshta” (importance of
medicated enema in Vatavyadhis)[32]. It also acts
as Rasayan (rejuvenation), boost immunity and
increases longevity. Dashamoola Taila is good
Vatahar oil[33]. In general, Panchkarma is very
useful in prevention and treatment of diseases[34].
The reason of keeping gap between procedural
seating was to avoid suppression of appetite as
Parihar kal (Precaution period) mentioned by
Acharya Charak and Sushrut[35]. As PEM is a
Apatarpanjanya vyadhi (debilitating) therefore
counseling for balanced diet has key role in
treatment. Deficient nutritious food supplement
with poor hygiene are major prevalent causes of
it[36]. If prompt care would not have been taken
then MAM patients would shift into SAM category
which is considered under “Ashtaunindit
vyadhi” (The eight censured diseases) in
Ayurved[37].
Maximum patients were benefitted with increased
weight gain, significant result obtained in pre-post
treatment in both groups but better results observed
in group B owing to effect of additional procedural.
As Vatadosha is the main cause, therefore Bruhan-
Balya medicines and Vatahar procedures not only
200
 Rathi R et.al. Management of childhood PEM through Ayurvedic interventions.. Joinsysmed 2017, vol 5(3), pp 196-202
revealed good subjective and objective improvement
but also prevented the shift into SAM by improvement
in weight. The same concept is supported by other
published research work that Karshya is directly
related to less intake of nutritious diet therefore
Bruhan-Balya medicines has given good subjective as
well as objective relief [38, 39, 40].
Insignificant results in unpaired t test of weight for
height and height for age may be due to small sample
size. The difference is not enough to reject the
possibility of sampling variability; however it can be
expected that at larger sample size and keeping
patients in-door for keen observations and care, the
line of PEM management may prove as a significant
treatment protocol.
Anthropometry is the measurable parameter to assess
growth and development of growing children[41]. In
group B there was comparatively significant
subjective improvement in anthropometrical values.
As compare to z score and percentile, former has more
advantages because it reflects the reference
population (mean and Standard deviation),
comparable across age, gender, all anthropometric
measures and it can quantify extreme growth status at
both ends of distribution[42]. The limitation of study
includes smaller sample size and limited laboratory
investigation. It is recommendable that similar work
needed to be done on larger sample size with
necessary laboratory investigations such as serum
proteins, calcium etc.
Conclusion:
It can be concluded that PYS, SDK syrup with
Panchkarma procedures (Group B) has good effect
compared to group A (only medicine). However, both
groups showed statistically significant results which
represent effective way of managing PEM with
Ayurvedic interventions. Current work was a pilot
study with small sample size and duration with
encouraging results and further research with large
sample and long term follow-up may lead to
consolidated outcome.
References:
[1]. Paul V, Bagga A, Ghai. Essential Pediatrics. 7th ed.
Nutrition. CBS publishers, New Delhi: 2009; 57-58
[2]. Parthasarathy A, Menon PSN, Mehta MN. 4 th ed.
Indian academy of Pediatrics, New Delhi: 2010; Volume 1,
Protein energy malnutrition: chapter 4; 136-7.
[3]. Bhat PNM, Fred A, Gupta K. National Family Health
Survey-3, International Institute for Population Sciences,
201
2005-06, , Child health: chapter 9. P.233Last accessed on
4/6/17, at 8pm
[4]. Kliegman, Behrman, Jenson, Stanton. Nelson. Text
book of Pediatrics. Reed Elsevier India private Limited,
th
New Delhi: 2008, 18 ed. vol 1, p.227-8
[5]. www.mohfw.nic.in, - National Family Health
Survey-4, India's factsheet by Ministry of Health, Family
welfare, IIPS, Mumbai, 2016-17;2
[6]. https://www.unicef.org/uganda/IMAM_Guidelines
_final_version.pdf last accessed on 08/06/2017 at 4.19
PM
[7]. Dongre AR, Deshmukh PR, Sinha N, Garg BS- Acute
childhood morbidities in rural Wardha, Indian J Med Sci,
Vol 63, No.8,Aug 2009; 345-353.
[8]. Garde Ganesh Krishna, editor, (7th ed.). Ashtang
Hriday of Acharya Vagbhata. Maharashtra Sahkari
Mudranalaya; Pune: 1983, Sutrasthan; Doshadividyniya
Adhyay: chapter 11, verse 6.p.52.
[9]. Tewari PV, editor, (1st ed.). Kashyapa Samhitha of
Vr i d d h a J i v a k . C h a u k h a m b h a Vi s v a b h a r a t i ,
Varanasi:2008, Phakka Chikitsasthan; Phakka
Chikitsadhyaya:chapter 17, verse12-20. p. 243
[10]. Tewari PV, editor. (1st ed). Kashyapa Samhitha of
Vriddha Jivak. Chaukhambha Visvabharati, Varanasi:
2008, Chikitsasthan; Phakka Chikitsadhyaya, chapter 17,
verse 41.p. 244
[11]. Shastri K, editor. (4th ed.) Charak Samhita of
Agnivesha. Chaukhambha Sanskrit Sansthan, Varanasi:
1994, Sutrasthan, Ashtaunindit Adhyaya, Purvardha,
chapter 21 verse 29-33. p. 282-3
[12]. Shastri K, editor. (4th ed.) Charak Samhita of
Agnivesha. Chaukhambha Sanskrit Sansthan,
Varanasi:1994, Sutrasthan; Shadvirechanshatasritiya
Adhyaya: chapter 4 verse16.p. 67
[13]. Sharma PV. Dravyaguna, Volume 2, 2nd ed.
Varanasi: Chaukhambha Bharati Academy,1996; 51, 275,
339, 350, 370, 503
[14]. Tripathi RD, Shukla VD, editor. Reprint ed., Charak
Samhita of Agnivesha. Chaukhambha Sanskrit
Pratishthan, Varanasi: 2015, Chikitsasthan, Vatavyadhi
Adhyaya; chapter no. 28, verse104-5. p.705-706
[15]. Waly MI, Nutritional Assessment of Pre-school
children using Z score analysis, The Canadian journal of
Clinical nutrition, volume 2(2), June 2014, ISSN1927-
8942, print ed., P.50-59
[16]. Shastri RD, editor. 12 th ed. Vidyotini Hindi
Commentary on Bhaishjya Ratnavali of Govind Das.
Chaukhambha Sanskrit Sansthan, Varanasi:1996,
Agnimandya Chikitsa; chapter 10 verse 59. P.242
[17]. Mishra SN, editor. Revised ed. 'Siddhiprada' Hindi
vyakhya on Bhaishjya Ratnavali of Govind Das.
Chaukhambha Surbharati Prakashan, Varanasi:2007,
Krimirogadhikar: chapter 11, p. 367
Joinsysmed Vol.5 (3), July-September 2017
 Rathi R et.al. Management of childhood PEM through Ayurvedic interventions.. Joinsysmed 2017, vol 5(3), pp 196-202
[18]. Dinesh KS. 3rd ed. Kaumarabhritya Updated.
Chaukhambha Publications, New Delhi, 2011; 80
[19]. www.fruitvs.com>comparison/calories-27-22-0, last
accessed in 22/06/2016, at 6pm
[20]. Elizabeth KE, Nair MKC, Reprint 3rd ed. Pediknots,
Paediatric case studies, Nutrition and Child development.
Hyderabad: Paras publishing, 2007; 29
[21]. Tewari PV, Kashyapa Samhitha of Vriddha Jivaka.
C h a u k h a m b h a Vi s v a b h a r a t i , Va r a n a s i : 2 0 0 8 ,
Chikitsasthan; Phakka Chikitsaadhyaya: chapter 17verse
12-13. p. 243
[22]. Ibidem Phakka Chikitsaadhyaya, 17/20
[23]. Shastri K, editor 4th ed. Charak Samhita of
Agnivesha, Chaukhambha Sanskrit Sansthan, Varanasi:
1994; Sutrasthan, Ashtaunindit Adhyay: chapter 21verse
14 ,p.282-3
[24]. Shastri AD,editor. 8th ed. Ayurved Tatvasandipika
Hindi Commentary on Sushrut samhita of Acharya
Sushrut. Chaukhambha Sanskrit Sansthan,
Varanasi:1993,Sutrasthan; Vranaprashna Adhyay: chapter
21, verse 33-37. P.93-94
[25]. Srivasta M. 1st ed. A handbook of Pediatric
procedures for Ayurvedic Pediatricians. Chaukhambha
Orientalia, Varanasi:1993,p.126-128
[26]. Shastri S, editor, Charak Samhita of Agnivesha.
Chaukhambha Bharti Academy, Varanasi: 1998,
Sutrasthan, MaharogaAdhyay: chapter 20 verse 13,p.272
Ibidem Charak Samhita,Chikitsa sthan; Vatavyadht
chikitsa adhyay: chapter 28, verse 78-81. P.791
[27]. Srivastav M. 1st ed. A handbook of Pediatric
procedures for Ayurvedic Pediatricians, Chaukhambha
Orientalia, Varanasi:2014,p.126-128
[28]. Garde GK, editor, 7th ed. Sartha Vagbhat (Marathi)
Ashtang Hriday of Acharya Vagbhat. Maharashtra Sahkari
Mudranalay, Pune:1983, Sutrsthan; Doshabhediya
Adhyay: chapter 12 verse 1.p.54
[29]. Yadaiah P. 2nd ed. Clinical Panchkarma. Jaya
publication,Akola: 2008, Swedan chapter 2nd, p.44
[30]. Shukla VD, Tripathi RD. Editor Reprint ed. Charak
Samhita of Acharya Agnivesha. Chaukhambha Sanskrit
Sansthan, Varanasi:2011, Sutra sthan Yajjapurushiy
Adhyay: chapter 25 verse 40, p.338
[31]. Shastri S, editor, 19th ed. Charak Samhita of Acharya
A g n i v e s h a . C h a u k h a m b h a B h a r t i A c a d e m y,
Varanasi:1998, Siddhisthan, Kalpanasiddhi Adyaya:
chapter 1 verse 39,p. 975
Joinsysmed Vol.5 (3), July-September 2017
[32]. Garde GK, Editor, 7th ed. Sartha Vagbhat
(Marathi) Ashtang Hriday of Acharya Vagbhat.
Maharashtra Ahkari Mudranalay, Pune:1983,
Sutrsthan; BastividhiAdhyay:chapter 19 verse1, p. 61
[33]. Mishra SN, Bhaishjya Ratnavali of Govind Das.
Chaukhambha Surbharati Prakashan,Varanasi: 2007,
Balarogadhikar: chapter 71, p. 1089
[34]. Shastri S, editor, 19th ed. Charak Samhita of
Acharya Agnivesha. Chaukhambha Bharti Academy,
Varanasi:1998, Siddhisthan, Kalpanasiddhi Adyaya:
chapter 1 verse 53, p. 975
[35]. Shastri AD, editor. 8th ed. Ayurvedtatvasandipika
Hindi Commentary on Sushrut samhita of Acharya
Sushrut, Chaukhambha Sanskrit Sansthan,
Varanasi:1993, Chikitsasthan; Anuvasanouttarvasthi
ChikitsitamAdhyay: chapter 37, verse73, 75, 77, p.164
[36]. Shukla VD, Tripathi RD. Editor Reprint ed.
Charak samhita of Acharya Agnivesha. Chaukhambha
Sanskrit Pratishtan, Varanasi:2011, Sutrasthan,
Santarpana adhyay: chapter 23rd verse 27-29,p.329
[37]. Shastri S, editor, Charak Samhita of Acharya
Agnivesha. Chaukhambha Bharti Academy,
Varanasi:1998, Sutrasthan, Ashtaunindit Adhyay:
chapter 21 verse 11-12, p. 278
[38]. Geeta, IP Anand, Patel KS, A Comparative study
on the effect of Vidarigandhadi vati and Kshirbala tail
Basti in the management of Karshya in children. J AYU
2009; 30 (1):73-76
[39]. Bhagat VV, Kotangale YT, Rampurkar MV. To
study the Brihan Siddhant on the basis of efficacy of
Vidarikand on Karshya vyadhi, Int Ayur Med J
2015;3(1):1397-1402.
[40]. Masram P, Patel KS, Kori VK, Rajgopala. A
Critical Review on Pharmacodynamics of Paushtic
biscuits in the management of Karshya. Int J Res in alter
Med 2014; 1(4):79-90
[41]. www.who.int/anthropometry/z score/BMI/Height
for age/weight for age, last accessed on 22/12/2016 at 4
pm
[42].https://www.coursehero.com/file/12418575/9
781441917874-c1/ Wang Y, Chen HJ. Use of
percentile & Z score in anthropometry. Last
accessed on 6/6/17, 2pm
202