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Tuesday, June 25, 2013

Scientific Basis for Ayurvedic Therapies -38











































































Scientific Basis for
Ayurvedic Therapies 


edited by
Brahmasree Lakshmi Chandra Mishra







15
Diet and lifestyle are not very specific. Eating healthy foods and doing some simple
exercises (e.g., yoga) are believed to be beneficial according to the Ayurvedic treatment.
32.6.6 Premenstrual Syndrome (PMS)
32.6.6.1 Etiopathogenesis
In Ayurveda there is no specific information about this disease. The concept and symptoms
can be perceived on the basis of tridosa theory. The symptoms like heaviness of breasts,
change in appetite, nausea, vomiting, depression, and nervousness can be correlated to
kapha imbalance. Aggravated pitta contributes to irritability, anxiety, anger, vomiting, headache,
food cravings, and sleep disorders. Bloating of the stomach, pelvic pain, headache,
difficulty in concentrating, sleep disorders, mood swings, and anxiety are the features of
provoked vata.11

In the conventional medicine, though the exact cause of PMS is not yet known, the most
popular theory is cyclic change in hormones or estrogen levels. Another cause is chemical
changes in brain, especially seretonin levels. Some habits or addictions like eating salty
food and consuming alcohol and cold beverages containing caffeine aggravate the problem.
1,15
32.6.6.2 Clinical Features
PMS is a psychoneuroendocrinological disorder. It is characterized by physiological and
psychological changes in the body before or during each menstrual period and is severe
enough to disturb a woman’s routine life. Approximately 75% of women suffer from PMS.
Among them, 40% have a disturbed routine due to severity. The range of the symptoms
is very high. Common physical symptoms include tenderness and heaviness of breasts,
change in appetite and food cravings, nausea, vomiting, headache, pelvic pain, and bloating
of the stomach. Common psychological symptoms include mood swings, depression,
irritability, anger, sleep disorders, nervousness, anxiety, and difficulty concentrating.2,15
32.6.6.3 Diagnosis and Prognosis
PMS is diagnosed by using a proper history. No major investigations are required to
diagnose PMS. From an Ayurvedic point of view, the symptoms are differentiated based
on the dosa involved to choose the right remedy. Prognosis of PMS is good and is quite
successful.
32.6.6.4 Treatment
Externally, oleation with sesame oil and fomentation with herbal decoctions give excellent
results. In severe cases, medicated oil enema (anuvasana basti) is very beneficial (e.g.,
sesame oil and dashamoola kwatha).8 Internally, ashokarishtam and A. vera in combination
with some other drugs are used in Ayurvedic practice. For vata and pitta symptoms,
shatavari (asparagus), ashwagandha (Withania somnifera), amalaki (Indian gooseberry), and
yashtimadhu (licorice) work very well. To reduce kapha symptoms such as heaviness of
breasts and fluid retention, herbs such as triphala, trikatu (pepper, ginger, and long pepper),
and vacha (Acorus calamus) are very useful. Jeerakadyarishtom, manasamitra vatakam, saraswatarishtam,
shatavari kalpa, and kumaryasavam are some of the effective herbal formulas.10,14
In conventional medicine, a definite treatment has not yet emerged as a definition, and
the etiology of the disease is unclear. Symptomatic treatment can be given using sedatives,
diuretics, laxatives, and analgesics. Progesterone or its derivatives are recommended to
improve the condition.15
Women suffering from this disorder should specifically avoid vata aggravating a week
before the menstruation. Examples include dried fish and dry meat, deep fried and very
spicy foods, very cold foods, sprouts, beans, and potatoes.
32.6.7 Menopausal Syndrome
32.6.7.1 Etiopathogenesis
In Ayurveda, menopause is called rajonivrutti. It means that the menstrual flow stops
forever. As this is a natural phenomenon, it is not considered a disorder in Ayurveda.
However, a common understanding is that the three dosas are imbalanced during menopause.
Symptoms of menopause can be correlated to change in dosa dynamics. Among

the three dosas, vata is of prime importance. It is said that there is not a single disorder of
the reproductive system without aggravated vata. Women generally reach menopause
after the age of 45, which is when vata is dominant in the body. Pelvic region is a seat of
vata. It usually becomes vitiated when monthly flow ceases. All pains, roughness of skin,
etc. during menopausal age can be attributed to aggravated vata. Finally, vata can also
provoke kapha and pitta. Symptoms such as heaviness of body, fluid retention, and hot
flashes are some of the symptoms attributed to an imbalance in kapha and pitta during
menopause.3,10,11
Modern medicine defines menopausal age as between 47 and 52. Menopause is exactly
a last or final menstruation. Postmenopause refers to the phase that comes after menopause.
Menopause occurs when oocytes responsive to gonadotropins disappear from the
ovary, or the oocytes remaining do not respond to gonadotropins. When this phenomenon
occurs at certain age due to hormonal imbalance (i.e., change in levels of concentration
of FSH, estradiol, LH, etc.), it is called physiological menopause. If menopause is due to
cessation of ovarian function because of surgery (e.g., hysterectomy, oophorectomy), then
it is called as artificial menopause.22,23
32.6.7.2 Clinical Features
Symptoms start to show up from the pre- or perimenopausal period. The first and foremost
symptom is the alteration of the menstrual cycle. Abrupt cessation is rare. The usual
pattern is a gradual decrease in quantity, duration, and frequency of the menstrual flow.
In some patients it is heavy or more frequent before menopause. Another common symptom
is hot flashes. This is a feeling of excessive heat or burning sensation on the face,
neck, chest, and back, sometimes followed by sweating. Many times it is preceded by
pressure in the head or a headache. Other symptoms like regression of breasts, inadequate
lubrication in vagina, urinary urgency or incontinence, loss of libido, sleep disturbances,
or fatigue may be present. Psychological symptoms are also equally important, as they
may disturb a woman’s life. Mood swings, irritability, depression, anxiety, and dysphoria
are common psychological changes during menopause. Additionally, there are some major
metabolic changes that manifest in the body during in the postmenopausal period (e.g.,
osteoporosis and increased risk of heart attacks).22,23
32.6.7.3 Diagnosis and Prognosis
Menopausal syndrome is essentially diagnosed from the patient’s age and history. Routine
blood work will help differentiate the fluid retention in menopause from anemia and other
disorders. Menopause can be treated successfully using Ayurvedic herbs and dietary
advice.
32.6.7.4 Treatment
The major goal of the treatment is to reduce symptoms and discomfort as well as to
enhance well-being and prevent cardiovascular changes or osteoporosis. No drastic
cleansing procedures are advised to menopausal women. Shirodhara (continuous flow
of medicated oil, decoctions, or buttermilk on the head) and gentle a body massage are
advised, as these treatments relieve muscle spasms, pains, burning, and restlessness.
Internally, chandanasava, ushirasavam, and draksharishtom are some of the drugs that
reduce hot flashes, burning, and urinary incontinence. Shatavari, vidari, and kumari are
the herbs that reduce fatigue and vaginal dryness and give a rasayana effect. For psycological
symptoms, like irritability, anxiety, or depression, there are very effective drugs

like brahmi, vacha, jyotishmati, and shankhapushpi or formulas such as panchagavya ghrita,
kalyanaka ghrita, stresscom cap, and manasmitra vatakam. On the whole, Saraca indica
(ashoka) is the herb of choice that takes care of most of the problems.3,8,14
The American Association of Clinical Endocrinologists recommends hormone replacement
therapy (HRT) as a preventive medicine for menopausal syndrome. HRT relieves
menopausal symptoms and prevents osteoporosis. It also plays a role in protecting the
heart. A goal of this treatment also is managing weight, stress reduction, vagina lubrication,
etc. Steroids, moisturizers, and oral contraceptives may be used to treat menopause.
15,22
No specific diet is advised other than avoiding those that have been mentioned above
for other conditions.
32.7 Scientific Basis of Ayurvedic Therapies
Our literature search found very few scientific studies and clinical trials on Ayurvedic
therapies. These studies are reviewed and summarized here.
32.7.1 Clinical Studies on Compound Formulas
In one study24 on leucorrhea (n = 52), the resin of Shorea robusta was given at a dose of
1 g/day in divided doses for 30 days. Externally, a Terminalia chebula decoction was
administered for vaginal douche. At the end of 30 days of treatment, there was 100%
improvement in the symptoms of leucorrhea. Of the 12 cases infected with trichomonas
infection at the baseline, 10 cases showed a negative smear test for trichomonas infection
at the end of treatment. Similarly, 5 cases of erosion of cervix showed complete healing
of erosion at the end of the treatment. The authors of the study reported that there were
no adverse reactions observed during the full length of the study.
In the second study (n = 32) on leucorrhea, Masilamani et al.25 reported that the combination
of oxidized alum ash (padigara barpam) in the dosage of 300 mg three times/day
with milk, along with a vaginal douche and a decoction of T. chebula, showed promising
results. The duration of the study was 30 days. Of the 32 patients, 26 (81%) were clinically
cured and 6 (19%) were clinically relieved of their symptoms of leucorrhea. There are no
follow-up data or any adverse event information given in the article.
Ashokarishta, a very popular formulation for gynecological disorders, was studied for
its efficacy in 22 subjects suffering from menorrhagia (dysfunctional uterine bleeding) for
3 months. A dose of 25 ml three times/day was given until the onset of the next menstruation.
It was continued for another 2 months from the fourth day of the menstrual cycle
with another break during the next cycle. The trial drug was continued for three consecutive
cycles. Results of the study indicate that ashokarishta gave relief from excessive
bleeding and pain in all the cases. Subjects who had vata- and kapha-predominant symptoms
showed relief within 3 days after starting the formulation. One patient with a
follicular cyst and one patient with an ovarian cyst had to undergo a hysterectomy after
3 months of the study. An interesting finding of this study was that the hemoglobin
automatically increased as soon as the bleeding was stopped. With the help of this study,
we can infer that the properties of Saraca indica — oxytocic, hemostatic, and analgesic —
have been investigated.26

32.7.2 Pharmacological Studies on Single Herbs and Bhasmas
32.7.2.1 Saraca indica
Research has found that Saraca indica (saracin) is a good uterine tonic, which is effective
in normalizing menstruation and reducing associated symptoms.27,28 In another study,29
saracin seems to be an interesting immunomodulator for the mammalian immune system.
It has been found to be mitogenic for human lymphocytes, and this mitogenic activity
could be inhibited in presence of fetuin. It also revealed that treatment with saracin could
induce secretion of interleukin-2 (IL-2) in a culture of resting human peripheral blood
mononuclear cells after 48 h. The study found that saracin has a higher affinity for the
CD8(+) than the CD4(+) T-cells.
32.7.2.2 Aloe vera
In an interesting study,30 the aqueous extract of Aloe barbadensis Miller in an in vitro culture
of Trichomonas vaginalis revealed that within 24 h, percentages of inhibition greater than
50% were obtained from concentrations of 20.8 mg/ml. The researchers studied three
strains of this parasite. The aqueous extracts were used as an initial concentration of 400
mg/ml of the extract and double serial dilutions were performed; final concentrations
based on the dried weight of the extract were 10.4, 20.8, 41, 83, and 160 mg/ml. The
inhibition of growth was greater than 50% even when tried with lower concentrations of
the extract but it took 48 to 72 h for such an action.
In another study,31 CARN 750 (injectable acemannan), a polydispersed beta-(1,4), linked
acetylated mannan isolated from the A. barbadensis plant, was evaluated for its multiple
therapeutic properties. It was found helpful in wound repair and acts as a biological agent
for the treatment of neoplasia in animals; it was also noted for its ability to activate
macrophages.
It was also found that CARN 750 directly or indirectly has significant hematoaugmenting
properties. Subcutaneous administration of CARN 750 significantly increased splenic and
peripheral blood cellularity, as well as hematopoietic progenitors in the spleen and bone
marrow as determined by the IL-3-responsive colony-forming unit culture assay and the
high-proliferative-potential colony-forming cell assay (a measure of primitive hematopoietic
precursors) in myelosuppressed (7 Gy) C57BL/6 mice. It was observed that the greatest
hematopoietic effect was obtained after sublethal irradiation in mice receiving 1 mg of
CARN 750/animal, with less activity observed at higher or lower doses. Results showed
activity equal to or greater than the injection of an optimal dose of granulocyte-colonystimulating
factor in myelosuppressed mice when CARN was injected daily.
In another study,32 lyophilized A. barbadensis at concentrations of 7.5 and 10% proved
to be spermicidal when used along with zinc acetate. The action was attributed to the
multiple microelements boron, barium, calcium, chromium, copper, iron, potassium, magnesium,
manganese, phosphorus, and zinc; these elements were toxic to the tail and caused
instant immobilization. The two compounds did not show any signs of irritation or cause
ulceration of rabbit vaginal epithelium. These results suggest the possibility of using zinc
acetate and lyophilized A. barbadensis as a new, effective, and safe vaginal contraceptive.
The effects of another species of aloe on some physiological and biochemical parameters
of reproduction in immature female rats based on the history of their use by the folklore
medicine in Cameroon was studied.33 Aloe buettneri, Justicia insularis, Hibiscus macranthus,
and Dicliptera verticillata were given in different doses daily to 22-day-old rats for 5, 10,
15, 20, and 25 days by gastric intubation. The weights of ovaries and uteri, levels of uterine
and ovarian proteins, ovarian cholesterol, and serum estradiol were evaluated at the end

of each experimental period. The results of the study showed a decrease in growth rate
of animals treated with 94 mg/kg/day at the end of the experimental period. Interestingly
enough, the ovarian and uterine weights increased in all treated groups, especially within
the pubertal period (36 to 41 days old), when compared with the respective controls.
During the same period, other parameters that were also observed showed significant
differences in treated rats when compared with the controls. Ovarian and uterine protein
levels, as well as serum estradiol, also increased in the groups given 49 or 94 mg/kg/day
of the plant extracts. The investigators concluded that these results suggest a possible
presence of estrogenic compounds in the plant extracts.33
The study was repeated with the aqueous extract of the leaf mixtures of A. buettneri,
Dicliptera verticillata, Hibiscus macranthus, and Justicia insularis at doses of 13, 49, and 94
mg/kg/day for 15 days given by oral route to immature female rats. Results showed that
the extracts induced a significant increase in ovarian and uteri weight as well as serum
and ovarian estradiol.34
Aloe vera was also studied for its anti-inflammatory property. In this study, the effects
of aqueous, chloroform, and ethanol extracts of A. vera gel on carrageenan-induced edema
in the rat paw and neutrophil migration into the peritoneal cavity stimulated by carrageenan
were studied. The results showed that the aqueous and chloroform extracts
decreased the edema induced in the hind-paw and the number of neutrophils migrating
into the peritoneal cavity; the ethanol extract decreased only the number of neutrophils.
The mechanism of action of the aqueous extract was due to the inhibited prostaglandin-
E2 production from [14C]arachidonic acid. The investigators conducted an assay of the
extracts and found that the aqueous extract contained anthraglycosides, reductor sugars,
and cardiotonic glycosides; in the ethanol extract, the chemical tests performed for
saponins, carbohydrates naftoquinones, sterols, triterpenoids, and anthraquinones turned
out positive. The chemical tests performed in the chloroform extract showed positive
reaction for sterols type delta 5 and anthraquinones. On the basis of these findings, it was
concluded that the extracts of A. vera gel have anti-inflammatory activity and suggested
its inhibitory action on the arachidonic acid pathway via cyclooxygenase.35
32.7.2.3 Muktashukti Bhasma
Muktashukti bhasma, a compound formulation consisting of pearl, A. vera, and vinegar,
inhibited acute and subacute inflammation in albino rats as induced by subplanter injection
of carrageenan, histamine, serotonin (5-HT), nystatin, and subcutaneous implant of
cotton pellets. The anti-inflammatory response of 1000 mg/kg MSB was comparable with
the response observed with 300 mg/kg acetylsalicylic acid (ASA) in all the test procedures.
According to the investigators, the anti-inflammatory activity of the compound was attributed
to its ability to cause inhibition of prostaglandins, histamine, and 5-HT and stabilization
of the lysosomal membranes. The anti-inflammatory activity of MSB seems to be
only one third to half as potent as ASA.36
32.7.2.4 Glycerrhiza glabra
Glycyrrhyzin, a constituent of Glycerrhiza glabra, inhibits inflammation and prostaglandin
synthesis. It blocks estrogen effects binding to estrogen receptors. In other studies for
treating menopausal syndrome, licorice was found an effective source of estrogen.
Glycyrrhizae radix is found to suppress estradiol-17 beta (E2)-induced expression of
c-fos/jun in uterine corpus and inhibited N-methyl-N-nitrosourea and E2-induced
endometrial carcinogenesis in mice. The probable mode of action could be through

suppression of estrogen-induced c-fos/jun expression and could be promising in preventing
agents for endometrial cancers.37,38
Tamir et al.16 reported that the stimulatory effects of 2.5 to 25 mg/animal glabridin
were similar to those of 5 mg/animal estradiol. Glabridin, the major isoflavon in licorice
root, was tested for the estrogenic properties, in view of the resemblance of its structure
and lipophilicity to those of estradiol. The results indicate that glabridin is a phytoestrogen,
binding to the human estrogen receptor and stimulating creatine kinase activity in
rat uterus, epiphyseal cartilage, diaphyseal bone, aorta, and left ventricle of the heart.
During the course of the study, the researchers found that the position of the hydroxyl
groups has a significant role in binding to the human estrogen receptor and in proliferation-
inducing activity. There was a biphasic effect of increasing concentrations of
glabridin on the growth of breast-tumor cells. It showed an estrogen-receptor–dependent,
growth-promoting effect at low concentrations (10 nM to 10 mM) and estrogenreceptor–
independent antiproliferative activity at concentrations of >15 mM. The investigators
concluded that glabridin and its derivatives exhibited varying degrees of estrogen-
receptor agonism in different tests and demonstrated growth-inhibitory actions on
breast cancer cells.
32.7.2.5 Curcuma longa
It has been proven that this herb has antibacterial, anticancerous, antihemorrhagic, and
anti-inflammatory properties and hence can be effective in menstrual difficulties like
menorrhagia or abnormal uterine bleeding, vaginitis, and leukorrhea. Laboratory research
has shown that it may modulate estrogen and progesteron activity.39
32.7.2.6 Nardostachys jatamansi (Jatamansi)
The clinical trials showed reduced restlessness, insomnia, and aggressiveness. These properties
are very useful in menopause as well as in PMS.
A study was proposed to evaluate the protective effect of Nardostachys jatamansi on
neurobehavioral activities, thiobarbituric acid reactive substance, reduced glutathione,
thiol group, and catalase and sodium-potassium adenosine triphosphatase activities in
the middle cerebral artery (MCA) occlusion model of acute cerebral ischemia in rats.
Findings showed that the changes induced by ischemia were significantly attenuated by
a 15-day pretreatment of N. jatamansi (250 mg/kg orally) and correlated well with histopathology
by decreasing the neuronal cell death after MCA occlusion and reperfusion.
The study provided first evidence of effectiveness of N. jatamansi in focal ischemia probably
by virtue of its antioxidant property.40
32.7.2.7 Zingiber officinale (Ginger)
Ginger was found effective in the symptoms such as nausea and vomiting in pregnant
women. In a randomized, placebo-controlled, double-blind trial (n = 70),41 women received
either oral ginger 1 g/day or an identical placebo for 4 days. At a follow-up visit 7 days
later, all participants except three in the placebo group remained in the study. After the
therapy, nausea decreased significantly in the ginger group (2.1 ± 1.9) compared with the
placebo group (0.9 ± 2.2, p = .014). The number of vomiting episodes also decreased
significantly in the ginger group (1.4 ± 1.3) compared with the placebo group (0.3 ± 1.1,
p < 0.001). No adverse effect of ginger on pregnancy outcome was detected. It can also be
used in PMS symptoms such as nausea and vomiting.

32.7.2.8 Commiphora mukul (Myrrh)
In laboratory research, Commiphora mukul showed antibacterial and antifungal properties,
especially in Candida albicans. Therefore, it can be used in vaginitis and related leukorrhea.42
In a study on the species Commiphora guidotti, known as scented myrrh, all sesquiterpenes
were isolated and characeterized. Seven compounds, with cadinane, guaiane, oplopane,
and eudesmane skeletons, were obtained. Two of seven are new and two are reported
from a natural source for the first time. The present study was planned to compare the
effects of the minor sesquiterpenes with those of the previously isolated major component,
T-cadinol, which has shown to possess smooth muscle-relaxing properties. The results
showed that the minor sesquiterpenes are more efficient in reducing K(+)-induced contractions
than those induced by the alpha-adrenoceptor agonist phenylephrine. However,
they were all less potent than T-cadinol in their action.43
In another study, Kimura et al.44 reported that myrrhanol A, a new triterpene isolated
from Balsamodendron or C. mukul Hook-gum resin, showed a potent anti-inflammatory
effect on exudative pouch fluid, angiogenesis, and granuloma weights in the adjuvantinduced
air-pouch granuloma of mice. The interesting finding of this study is that its
effects were more marked than those of hydrocortisone and the 50% aqueous methanolic
extract of the crude drug.
32.7.2.9 Withania somnifera
Withania somnifera is found effective in combination with other rejuvenating drugs like
licorice in menopausal syndrome in studies conducted by National Institute of Ayurveda,
Jaipur, India. It increases levels of estrogen and helps reduce the symptoms like hot flashes,
fatigue, and depression because of its antioxidant.45,46 It also has immunomodulatory,47
antidepressant,48 anti-inflammatory, and adaptogenic effects.49,50 Information on the studies
on these effects are available in other chapters.
32.7.2.10 Tinospora cordifolia
The active principles of Tinospora cordifolia, cordioside (TC-2), cordiofolioside A (TC-5),
and cordiol (TC-7) are found to possess the macrophage activation. Syringin (TC-4) and
TC-7 inhibited the in vitro immunohaemolysis of antibody-coated sheep erythrocytes by
guinea pig serum. The anticomplementary and immunomodulatory activities were found
to be caused by inhibition of the C3-convertase of the classical complement pathway.
Higher concentrations showed constant inhibitory effects. The authors reported that the
compounds also gave rise to significant increases in immunoglobin-G (IgG) antibodies in
serum. Humoral and cell-mediated immunity were also enhanced but were dose dependant.
51
In another study,52 T. cordifolia extract (100 mg/kg body weight for 15 days) given to
CCl4 intoxicated rats was found to protect the liver, as indicated by enzyme level in serum.
A significant reduction in serum levels of serum glutamic oxaloacetic transaminase
(SGOT), serum glutamate pyruvate transaminase (SGPT), alkaline phosphatase (ALP),
and bilirubin were observed after T. cordifolia treatment during CCl4 intoxication. The
extract also deleted the immunosuppressive effect of CCl4.
32.7.2.11 Asparagus recemosus
Asparagus recemosus was tried in menopausal syndrome for relieving symptoms like hot
flashes, excessive sweating, tiredness, and sleep disturbances in a study conducted by

Government Ayurveda College, Trivandrum, India. The report reads that the treatment
was effective. No further details were available about the author, dosage, and or duration.
In another study,50, 53–55 A. recemosus, T. cordifolia, W. somnifera, and Picrorhiza kurrooa were
tested on the functions of macrophages obtained from mice treated with the carcinogen
ochratoxin A (OTA). At the end of 17 weeks of treatment, the chemotactic activity of
murine macrophages was significantly decreased with OTA compared with controls.
Production of interleukin-1 (IL-1) and tumor necrosis factor (TNF) was also markedly
reduced. OTA-induced suppression of chemotactic activity and production of IL-1 and
TNF-alpha by macrophages was significantly inhibited with the treatment with A. racemosus,
T. cordifolia, W. somnifera, and P. kurroa. It was also noted that W. somnifera treated
macrophage chemotaxis and A. recemosus-induced excess production of TNF-alpha when
compared with controls.
Mandal et al.56 studied the antibacterial activity of A. racemosus and compared it with
chloramphenicol. The methanol extract of the roots of A. recemosus were given in concentrations
of 50, 100, and 150 mg/ml. Results showed considerable in vitro antibacterial
efficacy against Escherichia coli, Shigella dysenteriae, Shigella sonnei, Shigella flexneri, Vibrio
cholerae, Salmonella typhi, Salmonella typhimurium, Pseudomonas putida, Bacillus subtilis, and
Staphylococcus aureus.
Antioxytocic action of saponin isolated from A. recemosus on uterine muscle was further
studied.57 The details of this study could not be accessed. Similar studies58,59 on the
lactogoggue effect of Asparagus recemosus showed positive effects, but details were not
available.
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Om Tat Sat
                                                        
(Continued...) 


(My humble salutations to H H Maharshi ji,  Brahmasri Sreeman Lakshmi Chandra Mishra ji and other eminent medical scholars and doctors   for the collection)


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