) Efficacy of Sida cordifolia Linn. decoction as vehicle of drug ( anupanam ) in the management of joint

https://doi.org/10.30574/gscbps.2020.12.3.0240 Abstract Copy and paste here the content of the article. Copy and paste here the content of the article. Copy and paste here the In 21 st century, whole world is returning back to ancient life style. As a huge medical system, herbal drugs are very effective for many diseases. However, Arthritis also controls by herbal drugs even though not efficiency reducing the symptoms of joint pain. This is the identified problem. Therefore, this research tries to correct that problem by treating vehicle ( anupanam) with herbal medicine formula. In commonly patients are suffering from joint pain caused by Arthritis. This research was finding-out the efficacy of Sittamatti (Bala- Sida cordifolia Linn) decoction as an anupanam (Vehicle of drug). Control clinical study measured to assess the effect of the treatment by significant relief of symptoms of Arthritis within three months. This research is clinical control study and qualitative analysis research. Selection of samples (60 samples) and same time preparation of our new research drug is initial works. There after data collections and observation of the progress of the effect of the research drug. Finally, analyzed by the tables, charts and statistical way. According to tables, charts results; every table explained various angle of collection of the data and observations with sum of numbers and percentage level. Male samples are 60%, and Females are 40% in total sample population in research. 73.3% - High Marked improvement, 26.6% - Moderate improvement is this research result of whole results. Therefore, anupanam with medicine (Group-I) is best than medicine without anupanam (Group-II). Vatha Gajendra Singhe Rasa with Sida decoction, Mudakku Chooranam with Sida decoction treatment are better clinically efficacy than Vatha Gajendra Singhe Rasa without Sida decoction, Mudakku Chooranam without Sida decoction treatment.In statistical result says, compare with sample group-I & sample group-II was 0.0001 (p value < 0.05) within three month of treatment. Finally, we concluded effectiveness of our vehicle with medicine most effective than medicine control Group -II for symptoms of joint disorder significantly. In Arthritis symptoms, Joint Pain, tenderness, limitation of movements and swelling was highly notified changes as reducing within three months all


Introduction
Symptoms of Joint disorders are compared with symptoms of keel vaatham in siddha system of medicine. Keel vaatham is mentioned under vaatha noi by all Siddhars. It can define as a disease of joint with symptoms of joint pain, joint swelling, limitation and painful movements, restricted joint movement. Osteoarthritis is the most articular disorder begins asymptomatically in the second and third decade and is extremely common by age 60 years. Almost all persons by age 40 years have some pathologic change in weight bearing joint particularly in knee joint. 40% females and 60% males have symptomatic Osteoarthritis. No treatment is available which can prevent the disease process. In medical science, mainly analgesics, anti-inflammatory drugs or finally surgery are the options for the treatment of Osteoarthritis. Considering all these factors, the present study was taken up with the objective to evaluate the efficacy of herbal medicine with vehicle (Anupanam) to keel vaatham (osteoarthritis). Anupanam is the main roll in administration of drug in Siddha system and Ayurvedic system of medicine. One medicine cures many diseases by changing of Annupanam is special characteristic of poly herbal medicine. Combination of Vatha Gajendra Singhe Rasa and Mudakku Chooranam medicines are normally reduce symptoms of Arthritis but this research enhances the most effective than other drugs for arthritis are medicine with anupanam. Selected commonly used anti-arthritis treatment plan and that involve to research for identify better treatment with anupanam.
Sida cordifolia (Bala, Country Mallow, Heart-Leaf Sida or Flannel Weed) is a perennial subshrub of the mallow family Malvaceae native to India & Sri Lanka. It has naturalized throughout the world, and is considered an invasive weed in Africa, Australia, the southern United States, Hawaiian Islands, New Guinea, and French Polynesia. The specific name, cordifolia, refers to the heart-shaped leaf. [6] Common Name: Indian Ephedra, Mallow plant, Janglimedhi, Bala, Vatya, Bariyar, Kharethi, Tamil: Sitamati / Chittamati, Sanskrit: Bala, Sinhala: Babila (Sulu boo Babila), English: Yellow sticky Mallon. Part Used: Roots and leaves, whole plant. [6] Sida Cordifolia, an erect, minutely hairy and branched under shrub with a firm woody stem and intricate branches, contains 0.8% to 1.2% of the alkaloid ephedrine. It has been used by Ayurveda as a rejuvenating herb and an aphrodisiac. [6]

Organoleptic Characters
Taste (suwai) -Astringent, Veerya (thanmai) -Cooling (Seetha), Viphaka (pirivu) -Sweet [3] Properties: Sida cordifolia has ephedrine and pseudo-ephedrine along with other compounds as active ingredients that stimulate the cardiovascular system and CNS. It is considered to have diaphoretic, diuretic, central nervous system stimulating and antiasthmatic properties. The stem of Sida cordifolia contains a number of active compounds, including small amounts of an essential oil, 1-2% alkaloids composed mainly of ephedrine and pseudoephedrine, with ephedrine ranging from 30-90%, depending on the source. It is a rejuvenating herb, an aphrodisiac herb which helps in curing those diseases that occur due to inflammation of the nerves. [6] Actions: Emollient, Astringent, Stomachic, Diuretic [6]

Medicinal use
S. cordifolia is used in Ayurvedic medicine, known as "malva branca", is a plant used in the folk medicine for the treatment of inflammation of the oral mucosa, blenorrhea, asthmatic bronchitis and nasal congestion, stomatits, of asthma and nasal congestion and in many parts of Africa for various ailments, particularly for respiratory problems. It has been investigated as an anti-inflammatory, for treating cancer, and for encouraging liver re-growth. Due to its ephedrine content, it possesses psychostimulant properties, affecting the central nervous system and also the heart. [6] Sida Cordifolia has been used in India for over 2,000 years now to treat a variety of health disorders like bronchial asthma, cold & flu, chills, lack of perspiration, headache, nasal congestion, aching joints and bones, cough & wheezing, and edema. One of its uses is in weight loss too as the ephedrine alkaloids control metabolism in human body. It is one of the best medicines for Rheumatism, cardiac tonic. It is beneficial in nervous and urinary diseases, bleeding piles, hematuria, gonorrhea, cystitis, leucorrhea, chronic dysentery, nervous disorders, insanity, asthma and disorders of blood and liver. Fresh decoction mixed with ginger is used for intermittent fever with cold shivering fits. The root is pounded and applied for elephantiasis to reduce pain. The root is processed with milk and used internally and externally for hemiplegia, stiff neck, facial paralysis, diseases of the nervous system, and diseases of nose, ear, mouth and head. Its herbal extract or tea is used for obesity and obesity related disorders, especially in western countries. It is used for all kinds of detoxification and rejuvenation therapies like in medicated enema where its root extract is used for all kinds of nervous disorders like paralysis, arthritis etc. In one of the rejuvenation therapies named "Navara Kizhi", medicated Navara (rice) with milk and Sida cordifolia is applied all over the body or to a particular body part. In condition of sexual weakness, the milk extract of Sida cordifolia root is recommended as an effective remedy for sperm mobility and low sperm count disorders. [6]
In this research selected 60 research samples. In 30 samples for only common treatment (control group) and other 30 samples involved with research anupanam with common treatment. This is conducted in District Ayurvedic Hospital, Mulliyawalai, Sri Lanka. Permission and Ethical Clearance are given by the Provincial Commissioner of Indigenous medicine, Northern Province, Sri Lanka. Samples were follow-up with their measurements in once in two weeks altogether 03 months duration data collected and studied by scientific research methodology. In this research is help to prove scientifically that indigenous medical systems' theory as co-drug or anupanam for effective treatment and management of diseases. Objectives were; To relief the Symptoms of Arthritis through Herbal Medicine. To identify effectiveness of anupanam. To evaluate efficacy of combination of drug and anupanam for joint disorders.

Type of Research: Control -Clinical Study
Research area: District Ayurvedic Hospital (DAH), Mullaitivu, Sri Lanka Research Samples: 60 patients Identification of Arthritis patients according to clinically diagnosis.

Parameters Measured
The parameters measured were both objective and subjective.
Subjective parameters included pain, tenderness, swelling, and crepitation

Inclusive criteria
Patients were eligible if they were 21-75 years of age, had according to the known joint disorder patients by past diagnostic medical report, were treated with diet, oral anti-arthritic agents, and had evidence of symptomatic symmetrical or Asymmetrical Arthritis.

Exclusive criteria
Were the following: Presence of foot ulcers, peripheral vascular disease (non-palpable foot pulses, intermittent claudication), myopathy, causes of Arthritis by significant neurological diseases, participation in a study of any investigational drug for Arthritis within the 3 months before the study, use of oral or external anti-arthritic agents within 1 month before the study, severe concomitant diseases, and pregnancy, lactation, or childbearing age without birth control devices. Recently fractured part pain involvement. any other NCDs or systemic diseases.

Analysis of the data and making the thesis
Qualitative Scoring analysis:

Drug preparation
Prepared Research drug -vehicle of drug (anupanam) with medicine and control drug as without anupanam which as change compares.

Method of preparation
Normal Decoction preparation. Add 08 cups of water then heat and reduction for 01 cup for 01 day.

Clinical study
Clinical trial for research drug and Compare drugs to 60 patients in OPD (Out Patient Department) and data collecting from a suitable Proforma.

Grouping the Samples
In this research, total sample divided into two (02) groups but all are same symptomatically Arthritis condition. Those two groups are given below,

 Group I: Arthritis patients with medicine + Sittamatti decoction treatment (30 patients).  Group II: Arthritis patients with medicine without anupanam treatment without any decoction or liquid formulas (30 patients).
Treatment is as follows It is commonly used as anti-arthritis treatment in Sri Lanka. It is Ayurvedic Medicine.

Mudakku Chooranam [1]
It is commonly used as anti-arthritis treatment in Northern part of Sri Lanka. It is Siddha Medicine.
Combination of Vatha Gajendra Singhe Rasa and Mudakku Chooranam medicines are normally reduce symptoms of arthritis but this research enhance the most effective than other drugs for arthritis is medicine with anupanam.

Clinical Trial
Clinical consultation and follow-up the patients in District Ayurvedic Hospital (DAH), Mullaitivu, Sri Lanka.

Data Collection
Selected samples with modified Proforma.
Symptoms measured as qualitative measures with grading score.

Statistical Analysis
Statistical analysis with Minitab software.

Conclusion
In statistical result says, compare with sample group-I & sample group-II was 0.0001 (p value < 0.05) within three month of treatment. Finally, we concluded effectiveness of our vehicle with medicine most effective than medicine control Group -II for symptoms of joint disorder significantly.

Disclosure of conflict of interest
The author declared that no conflict of interest.