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\title{Clinical Evaluation of the Effect of Udumberadi Tail Uttar Vasti in the Management of Chronic Cervicitis}
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             \author[1]{Dr. Suneeta  Singh}

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\date{\small \em Received: 11 December 2015 Accepted: 2 January 2016 Published: 15 January 2016}

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\begin{abstract}
        


Majority of the women of the world are suffering from chronic cervicitis in their child bearing age. In modern treatment chronic cervicitis is usually treated by antibiotics, improving local hygiene & vaginal pessaries but the result of this treatment are not long-lasting. In most of the cases recurrence is common. Frequency & duration of recurrence is varying upon person to person. This modern treatment also hampers the normal flora of the lower reproductive organs.So this major issue of the society is selected for the study. In this study 10 patients of chronic cervicitis were selected for Udumberadi tail Uttar vasti. Uttar vasti with Udumberadi tail provides very good results along with the restoration of normal flora of the lower reproductive organs. The action of vasti is multifarious and the properties of udumbaradi tail are antiinflammatory, healing, astringent, antipruritic, analgesic & tridoshahar etc.

\end{abstract}


\keywords{chronic cervicitis, Uttar vasti.}

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\let\tabcellsep& 	 	 		 \par
I. Introduction ervicitis is the most common disorder affecting more than half of the women population regardless of age \hyperref[b9]{(11,} {\ref 17)} . In low socio-economic status prominence of disease is more because of early marriage, aseptic abortion, lack of knowledge about hygiene, low awareness about sexually transmitted infections, lower immunity, poor knowledge about contraceptives etc  {\ref (7,} {\ref 13)} . High-risk populations are multiple partners, adolescent women with a history of previous STIs \& pregnant women  {\ref (7)} . No racial predilection exists. Chronic Cervicitis is becoming a major health problem for women. This condition has deep impact on womens' physical and mental health which disturbs her daily routine life  {\ref (17)} . The treatment suggested in modern science is though effective but recurrence is more common. This modern treatment also hampers the normal flora of the lower reproductive organs.\par
In Ayurveda, there are many curative and preventive measures for the management of Chronic Cervicitis because Ayurveda covers all the physical, mental, and spiritual aspects of human life \hyperref[b10]{(12)} . Uttar vasti is the one of these ayurvedic measures \hyperref[b3]{(5,}\hyperref[b5]{6)} . 
\section[{Aim and Objective:}]{Aim and Objective:}\par
The aim of study to assess the efficacy of Udumberadi tail Uttar vasti in the management of chronic cervicitis.\par
Material and Method: After a detailed preliminary screening 10 patients of chronic cervicitis selected from O.P.D. and I.P.D. of Rishikul Government Ayurvedic Hospital, Haridwar. The patients were administered Udumberadi tail Uttar vasti through vagina \hyperref[b10]{(12)} . The treatment was given for three consecutive menstrual cycles and in each cycle treatment given for three days \hyperref[b3]{(5)} .\par
Following materials were adopted for present clinical trial. 
\section[{II. Selection of Drugs}]{II. Selection of Drugs}\par
In heavy bleeding during menses with short cycle and chronic cervicitis, infection persisted long period, so only Bahiparimarjan is not sufficient for elimination of infection. Due to chronicity the erosion, inflammation, pain occur in uterus and cervix and persist for long time  {\ref (17)} . To keep these points in mind for the above complain the drug should have following properties. 1. Shothahara karma i.e. Anti-inflammatory effect. 2. Vran ropana i.e. healing effect. 3. Stambhan karma i.e. astringent effect. 4. Krimighna i.e. antimicrobial effect. 5. Rakt shodhana karma i.e. purifying effect. 6. Kandughna i.e. anti pruritic effect. 7. Shoolprashmana i.e. analgesic effect. 8. Tridoshahara (especially Kaphpitta shamak drugs.)\par
The drugs with above effect will help in restoring the normal condition of uterus and cervix. Udumberadi tail contents having all the above properties were selected for present study after concerning various text books \hyperref[b1]{(3,}\hyperref[b3]{5,}\hyperref[b12]{15)} . It was prepared by the same method as shown in Charaka samhita \hyperref[b3]{(5)} . 
\section[{III. Ingradiants of Udumberadi Tail}]{III. Ingradiants of Udumberadi Tail}\par
Udumber phala, panchvalkal (bark of Vatt, Pipal. Pakar, Gular, Paras Pipal), leaves of patol, malti and neem, kalk of dhava pushpa, palash, shalmali bark and laksha, til tail \hyperref[b3]{(5)} .\par
Probable mode of action: The drug present in Udumberadi tail Uttar vasti has shothahara, vranropana, stambhana, raktshodhana, krimighna, kandughna, shoolprashaman, Tridoshahar properties \hyperref[b1]{(3,}\hyperref[b12]{15)} . So the Udumberadi Tail applied as Uttar vasti helpful to remove sign and symptoms of chronic cervicitis \hyperref[b3]{(5)} .\par
Preperation and Procedure: Patient was prepared for procedure after the detailed history, physical examination, investigations and consent. Dipan-pachan aushadhi chitrakadi vati 2-tab was given at night continuously for 3 days before procedure for constipation, if required \hyperref[b10]{(12)} .\par
The patient was called for procedure a day after cessation of menses with light diet in the morning hours (1, 5, 12, 18) . Before procedure B.P., Temperature and pulse rate were recorded carefully. Abhyanga was done with panchguna tail \hyperref[b0]{(2)} for 20 minutes in lower abdomen, groin, thigh, buttock and back \hyperref[b0]{(2,}\hyperref[b10]{12)} , followed by nadisweda for 10 minutes. Then patient was shifted into vasti room and placed in lithotomy position \hyperref[b3]{(5,}\hyperref[b13]{16,} {\ref 18)} . Genital parts were cleaned with panchvalkal kwath \hyperref[b11]{(14)} to prevent surface infection go into deeper side. The tail and instruments were autoclaved. The vagina and cervix were visualized with the help of the sim's speculum \hyperref[b6]{(8)} and an anterior vaginal wall retractor \hyperref[b7]{(9)} . The anterior lip of cervix was held with the help of Allis forceps \hyperref[b8]{(10)} . Thinnest dilator used if necessary. Then with no. 3 rubber catheter \hyperref[b0]{(2)} already attached with 5 ml syringe filled with Udumberadi tail was introduced into the uterine cavity and pushing the medicine (Udumberadi tail) slowly . Catheter is filled with tail before inserting into the uterine cavity to minimize air passes in uterus. After procedure patient was sent to bed and observed for 2 hours for any complaint of pain, bleeding or discomfort and also for changes in the vitals. Patients were asked to avoid very spicy foods during treatment. Coitus was prohibited during the course of Uttar vasti.\par
Inclusion Criteria-Married patients, Patients with sign and symptoms of chronic cervicitis. 
\section[{Patients of reproductive age along with premenopausal stage (means 20-55 yrs)}]{Patients of reproductive age along with premenopausal stage (means 20-55 yrs)}\par
Exclusion Criteria-Pregnancy Acute cervicitis Unmarried women and menopausal women HIV/VDRL/Hbs Ag /TB Patients suffering from complaints related to gynecological surgeries. Patients with bleeding disorder like hemophilia.\par
Assessment of Criteria: Following symptoms of chronic cervicitis \hyperref[b9]{(11,} {\ref 17)} were assessed in patients before and after the clinical trial by grade score method-1. Unusual vaginal discharge 2. Irregular menses with heavy bleeding 3. Lower back pain 4. Frequent need to urination with or without burning and itching sensation. 5. Dyspareunia  V. Results 
\section[{IV. Observation and Result}]{IV. Observation and Result} 
\section[{VI. Conclusion}]{VI. Conclusion}\par
? Udumberadi tail Uttar vasti is very effective measure for the treatment of chronic cervicitis. ? Udumberadi tail Uttar vasti provides immediate relief in pain, unusual vaginal discharge and relieves other symptoms with regular treatment. The treatment was given for three consecutive menstrual cycles and in each cycle treatment given for three days.\par
? No patient reported any side effect of this treatment. Total 10 patients were registered for trial. The response of Udumberadi tail Uttar vasti administration found as 89.61\% relief in unusual vaginal discharge, 84.62\% in irregular bleeding, 92.00\% in lower back pain, 91.30\% in frequent urination with or without burning and itching sensation and 69.23\%in dyspereunia. These results of study prove that the patients got relief in most of the symptoms by this treatment \hyperref[b13]{(16)} . The daily routine life, mental calm and marital life were found improved with the course of this treatment.  
\section[{Volume XVI Issue II Version I}]{Volume XVI Issue II Version I}\begin{figure}[htbp]
\noindent\textbf{}\includegraphics[]{image-2.png}
\caption{\label{fig_0}F}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{1} \par 
\begin{longtable}{P{0.11979865771812079\textwidth}P{0.11409395973154363\textwidth}P{0.10838926174496645\textwidth}P{0.2110738255033557\textwidth}P{0.07986577181208054\textwidth}P{0.2167785234899329\textwidth}}
\multicolumn{2}{l}{Sr.No. Age}\tabcellsep BT\tabcellsep \multicolumn{3}{l}{AT Differences \% of relief}\\
1\tabcellsep 30\tabcellsep 9\tabcellsep 0\tabcellsep 9\tabcellsep 100\\
2\tabcellsep 42\tabcellsep 12\tabcellsep 2\tabcellsep 10\tabcellsep 83.33\\
3\tabcellsep 37\tabcellsep 15\tabcellsep 1\tabcellsep 14\tabcellsep 93.33\\
4\tabcellsep 45\tabcellsep 10\tabcellsep 3\tabcellsep 7\tabcellsep 70\\
5\tabcellsep 40\tabcellsep 12\tabcellsep 1\tabcellsep 11\tabcellsep 91.67\\
6\tabcellsep 31\tabcellsep 14\tabcellsep 5\tabcellsep 9\tabcellsep 64.28\\
7\tabcellsep 43\tabcellsep 7\tabcellsep 0\tabcellsep 7\tabcellsep 100\\
8\tabcellsep 45\tabcellsep 13\tabcellsep 3\tabcellsep 10\tabcellsep 76.92\\
9\tabcellsep 40\tabcellsep 10\tabcellsep 1\tabcellsep 9\tabcellsep 90\\
10\tabcellsep 35\tabcellsep 8\tabcellsep 0\tabcellsep 8\tabcellsep 100\end{longtable} \par
 
\caption{\label{tab_0}Table 1 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.85\textwidth}}
Year 2016\\
Volume XVI Issue II Version I\\
D D D D ) F\\
(\\
\% of Relief\end{longtable} \par
 
\caption{\label{tab_1}Patient wise relief in symptoms}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{2} \par 
\begin{longtable}{P{0.4890410958904109\textwidth}P{0.09315068493150684\textwidth}P{0.22123287671232875\textwidth}P{0.02328767123287671\textwidth}P{0.02328767123287671\textwidth}}
\% of relief in symptoms\tabcellsep 90-100\tabcellsep \multicolumn{3}{l}{80-89 70-79 60-69}\\
Number of patients\tabcellsep 06\tabcellsep 01\tabcellsep 02\tabcellsep 01\end{longtable} \par
 
\caption{\label{tab_2}Table 2 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{3} \par 
\begin{longtable}{P{0.02290419161676647\textwidth}P{0.2366766467065868\textwidth}P{0.05598802395209581\textwidth}P{0.03053892215568862\textwidth}P{0.03817365269461078\textwidth}P{0.08907185628742514\textwidth}P{0.11197604790419162\textwidth}P{0.11197604790419162\textwidth}P{0.07380239520958085\textwidth}P{0.07889221556886226\textwidth}}
S.N.\tabcellsep Symptoms\tabcellsep \multicolumn{2}{l}{Mean Score}\tabcellsep Diff.\tabcellsep \%of\tabcellsep SD\tabcellsep SE\tabcellsep t\tabcellsep p\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep relief\tabcellsep +\textunderscore \tabcellsep +\textunderscore \tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep BT\tabcellsep AT\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
1\tabcellsep Unusual Vaginal Discharge\tabcellsep 23\tabcellsep 04\tabcellsep 19\tabcellsep 89.61\tabcellsep 0.737\tabcellsep 0.233\tabcellsep 08.142\tabcellsep < .001\\
2\tabcellsep Irregular Menses\tabcellsep 26\tabcellsep 04\tabcellsep 22\tabcellsep 84.62\tabcellsep 0.632\tabcellsep 0.200\tabcellsep 11.000\tabcellsep < .001\\
3\tabcellsep Lower Back Pain\tabcellsep 25\tabcellsep 02\tabcellsep 23\tabcellsep 92.00\tabcellsep 0.483\tabcellsep 0.152\tabcellsep 15.057\tabcellsep < .001\\
4\tabcellsep Frequent Urination\tabcellsep 23\tabcellsep 02\tabcellsep 21\tabcellsep 91.30\tabcellsep 0.875\tabcellsep 0.276\tabcellsep 7.584\tabcellsep < .001\\
5\tabcellsep Dyspareunia\tabcellsep 13\tabcellsep 04\tabcellsep 09\tabcellsep 69.23\tabcellsep 1.100\tabcellsep 0.348\tabcellsep 2.586\tabcellsep < .050\end{longtable} \par
 
\caption{\label{tab_3}Table 3 :}\end{figure}
 			\footnote{© 2016 Global Journals Inc. (US)} 		 		\backmatter  			  				\begin{bibitemlist}{1}
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\bibitem[Ibid]{b8}\label{b8} 	 		\textit{Companion for Obstetrics and Gynaecology examinations},  		 			Ibid 		.  		p. .  	 
\bibitem[Doshi ()]{b6}\label{b6} 	 		\textit{Companion for Obstetrics and Gynaecology examinations India: Arihant Publishers},  		 			Harish Doshi 		.  		2007. p. .  	 
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\bibitem[Jeffcoate's Principles of Gynaecology]{b9}\label{b9} 	 		\textit{Jeffcoate's Principles of Gynaecology},  		p. .  	 
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\bibitem[Ratnavali ()]{b1}\label{b1} 	 		 			Bhaisajya Ratnavali 		.  	 	 		\textit{With commentary by Shri Ambikadatta Shastri},  				1984.  	 
\bibitem[Sushruta Samhita -translated by Ambika Datt Sashtri Sutra sthana p ()]{b13}\label{b13} 	 		‘Sushruta Samhita -translated by Ambika Datt Sashtri’.  	 	 		\textit{Sutra sthana p},  				 (Varanasi)  		2003. Chaukhambha Orientallia Publication. p. 178.  	 
\bibitem[Sharangdharacharya et al. ()]{b11}\label{b11} 	 		‘Varanasi: Madhyama Khanda’.  		 			Sharangdharacharya 		,  		 			Tra Samhita 		,  		 			Himsagar Chandra Murty 		.  	 	 		\textit{Chaukhamba Surabharati series}  		2007. p. .  	 
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\end{document}
