"Sugantha Malli Chooranam" "Sugantha Malli Chooranam" For The Treatment of "Lasuna Thabitham" "Sugantha Malli Chooranam"

An open clinical
clinical study to evaluate the clinical

efficacy of Siddha sasthric formulation
“SUGANTHA MALLI CHOORANAM”
for the treatment of
“LASUNA THABITHAM”
THABITHAM”
Dissertation submitted to
THE
HE TAMILNADU Dr. M.G.R MEDICAL UNIVERSITY
Chennai-32
For the partial fulfillment

fulfil ment in awarding the Degree of
DOCTOR OF MEDICINE (SIDDHA)

(Branch IV – Kuzhanthai Maruthuvam)
DEPARTMENT OF KUZHANTHAI MARUTHUVAM

GOVERNMENT SIDDHA MEDICAL COLLEGE AND
HOSPITAL PALAYAMKOTTAI – 627 002.
OCTOBER - 2019
GOVERNMENT SIDDHA MEDICAL COLLEGE PALAYAMKOTTAI,
TIRUNELVELI - 627002, TAMILNADU, INDIA
Phone : 0462-2572736/2572737Fax: 0462-2582010
Email: gsmc.palayamkottai@gmail.com
BONAFIDE CERTIFICATE
This is to certify that the dissertation entitled “AN OPEN CLINICAL

STUDY TO EVALUATE THE CLINICAL EFFICACY OF SIDDHA
SASTHRIC FORMULATION “SUGANTHA MALLI CHOORANAM” FOR
THE TREATMENT OF LASUNATHABITHAM” is a bonafide work done by
Dr.K.RUBA, GOVERNMENT SIDDHA MEDICAL COLLEGE,
PALAYAMKOTTAI in partial fulfillment of the university rules and regulation for
award of the M.D (SIDDHA), BRANCH-IV KUZHANTHAI MARUTHUVAM
under my guidance and supervision during the academic year 2016-2019
OCTOBER.
Name and signature of the Guide:
Name and signature of the Head of the Department:
Name and signature of the Principal:

GOVERNMENT SIDDHA MEDICAL COLLEGE
PALAYAMKOTTAI, TIRUNELVELI-627 002.
TAMILNADU, INDIA
Phone: 0462-2572736/2572737/Fax: 0462-2582010
Email: gsmc.palayamkottai@gmail.com
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation entitled “AN OPEN CLINICAL

STUDY TO EVALUATE THE CLINICAL EFFICACY OF SIDDHA
SASTHRIC FORMULATION “SUGANTHA MALLI CHOORANAM” FOR
THE TREATMENT OF “LASUNATHABITHAM” is a bonafide and genuine
research work carried out by me under the guidance of Dr.K.SHYAMALA,M.D(S).,
Lecturer Grade II, Post Graduate Department of Kuzhanthai Maruthuvam,
Government Siddha Medical College, Palayamkottai and the dissertation has not
formed the basis for the award of any Degree, Diploma, Fellowship or other similar
title.
Date: Signature of the Candidate
Place: Dr.K.RUBA
ACKNOWLEDGEMENT
First of all, I thank ALMIGHTY who empowered me with grace and

blessings from the beginning and till the end of my dissertation work. I sincerely
thank the great SIDDHARS who showed the pathway in Siddha system.
I express my gratitude and acknowledgement to The Vice Chancellor, The

Tamil Nadu Dr.M.G.R Medical University, Chennai. I sincerely thank to The
Director, Indian Medicine and Homeopathy, Chennai.
I would like to thanks Prof. Dr.S.Victoria M.D(S) Principal, Government

Siddha Medical College and Hospital, Palayamkottai for her advice and assistance in
keeping my progress on schedule.
I would like to thank Prof. Dr.R.Neelavathy M.D(s), Ph.D Former Principal

Government Siddha Medical College and Hospital, Palayamkottai for her supporting
during the course of study
I record my thankfulness to Prof.Dr.D.K.Soundararajan, M.D(S).,Head of

the Department, PG IV Kuzhanthai Maruthuvam, Government Siddha Medical
College, Palayamkottai for giving important necessary guidelines and scholarly
comments which helped me in the successful completion of this dissertation work.
I whole heartly extend my thanks to my guide Dr.K.Shyamala, M.D(S).,

Lecturer Grade II, PG IV Kuzhanthai Maruthuvam, Government Siddha Medical
College, Palayamkottai, for her constant support in completion of this dissertation
work.
I express my special and sincere thanks to Dr.S.Vedagiri Subbiah M.D(S).,

Dr.A.Balamurugan M.D(S)., Dr.D.Lakshmi Prabha M.D(S)., Lecturers Grade-II,
Government Siddha Medical College, Palayamkottai for their constant help and
encouragement to complete this work successfully.
My sincere thanks to Dr.S.Sudha M.Sc.,M.Ed.,Ph.D, Associate Professor,

Department of Medicinal Botany, Government Siddha Medical College,
Palayamkottai for her valuable guidelines in identification of herbal drugs.
I express my thanks to Mrs.N.Nagaprema, M.sc.,M.Phil.,Head of the
Department, Department of Biochemistry, Government Siddha Medical College,
Palayamkottai for her kind help and suggestions on biochemical aspects of this
dissertation.
My heartful thanks to Mr.Santhanam M.pharm, Assistant Proffessor,

Department of Pharmacology, Arulmigu Kalasalingam College of Pharmacy,
Krishnankoil for the help in doing pharmacological studies.
I would like to thank Dr.R.Geetha Sudheer MD(s).,Ph.d, for his contribution

in performing Anti-microbial studies and helping in technical understanding of the
study procedures.
I express my gratitude to the Librarian Mrs.T.Poongodi.,M.Lis.,M.Phil,

Government Siddha Medical College, Palayamkottai for her support in providing
referral books.
I also hearty thank to my mother Mrs. K.Krishna Kumari for helping and
supporting me in successful completion of my dissertation work.
I express my thanks to Patients and their family who gave me kind co-
operation during my study.
I express my thanks to the technicians of the laboratory (Malar lab) and

specially thank to Maharaja DTP Services, Palayamkottai for the help offering me
the resources in running the research.
My special thanks to My Friends who gave me the constant support and kind
co-operation during my study.
S. No CONTENTS PAGE NO
I INTRODUCTION 1
II AIM AND OBJECTIVE 3
III REVIEW OF LITERATURE
A.SIDDHA ASPECTS 4
B.MODERN ASPECTS 23
IV MATERIALS AND METHODS 35
V DRUG REVIEW 40
VI BIO CHEMICAL ANALYSIS REPORT 51
VII PHARMACOLOGICAL ANALYSIS REPORT 53
VIII ANTIMICROBIAL STUDY REPORT 78
IX OBSERVATION AND RESULTS 81
X DISCUSSION 110
XI SUMMARY 114
XII CONCLUSION 116
XIII BIBLIOGRAPHY 117
ANNEXURE – I
RESEARCH METHODOLOGY CERTIFICATE i
SCREENING COMMITTEE APPROVAL ii

CERTIFICATE
IEC APPROVAL CERTIFICATE iii
IAEC APPROVAL CERTIFICATE iv
DRUG AUTHENTICATION CERTIFICATE v

S. No CONTENTS PAGE NO
CME CERTIFICATES vi
JOURNAL CERTIFICATES x
CTRI - REGISTRATION xii
ANNEXURE-II
FORM-I: SCREENING AND SELECTION PROFORMA xv
FORM – IA: HISTORY PROFORMA ON ENROLMENT xvi
FORM – IB: CASE SHEET PROFORMA xxii
FORM-II&IIA: CLINICAL ASSESSMENT ON xxxii

ENROLLMENT DURING AND AFTER TRIAL
FORM-III: LABAROTARY INVESTIGATION ON xxxviii

ENROLLMENT AND CONCLUSION OF TRIAL
FORM-IV: CONSENT FORM x1
x1iii
FORM-IVB: WITHDRAWAL FORM
FORM-IVC: PATIENT INFORMATION SHEET x1iv
FORM-IVD: DIETARY ADVICE FORM x1v
FORM-IVE: ADVERSE REACTION FORM x1vi
FORM-IVF: DISCHARGE PROFORMA 1i
1ii
FORM-V: DRUG COMPLIANCE
1. INTRODUCTION
In the 21st century, we are living in the massive development of science and
technology world. Yes, scientific technics made our life very easy and luxurious. The
communication and technology made the world within our hand with the help of
computer.
Eventhough we are comfortable with a modern life, for that each and every
day we have to run as much as possible to know the up-to-date changes in the
technology, But the science and technology doesn’t provide a peaceful life.
People may get tired, because of their fast and mechanical life. Now they want
peaceful mind and natural life. For that purpose all of them turn to look on our
traditional system of medicine – SIDDHA.
THE UNIQUE SPECIALITY OF SIDDHA SYSTEM :

The Siddhars are supreme human beings, the immortal masters of meditation
and also founders of the Indian traditional alchemical system of medicine namely
“The Siddha System”. This system was bloomed by vast knowledge. Siddhars
realized the truth by understanding the life force and maintaining the relationship
between the causal body (Bio Magnetism) and the universal magnetism by their
power of intelligence, They had formulated the method and maintain the quality of
these two. Siddhars have left their imprints not only in medicine but also in Yoga,
Alchemy and Philosophy.
MAJOR ROLE OF PAEDIATRIC DEPARTMENT:

The healthy children are the backbone of a healthy society. So the department
of Kuzhanthai Maruthuvam is trying to establish the good health of every child.
The treatment of children is not a easy way, It is a difficult one. Because they
cannot tell us, what they felt. Especially before they start to speak, here only the
physicians diagnostic skill to help us.
In siddha, the paediatrics is called as, Kuzhanthai Maruthuvam, Balavagadam
and Pillaipini Maruthuvam.
1
ABOUT THE TOPIC: LASUNATHABITHAM
According to WHO, recent publication indicates Respiratory and Nutritional
diseases are major life-threatening diseases in children especially in developing
countries like India.
The author have seen a lot of children in out patient ward of paediatric
department those who are suffered by Tonsillitis. The symptoms are pain in throat,
hoarseness of voice, odynophagia, dysphagia and halitosis. Their parents also worried
about their immunity and complaint whether he/she not able to concentrate on their
studies, etc...
So the author decided to choose LASUNATHABITHAM is also called as
TONSILLITIS in modern term, for this dissertation because of this disease is more
common in our country. Which is more common in all type of age group but it
produce a complication in paediatric age group. So the author has taken this disease
and undergone a dissertation work with a help of siddha drug “SUGANTHA MALLI
CHOORANAM”.
CONCLUSION:
I would like to say that if siddha treatments are available conveniently, they
can benefit their overall health in many ways, people suffering from chronic ailment
can get quick respite from these medicine and other can uses them as preventive
agents that keep you healthy. Let us try to spread the knowledge of siddha medicine
and do well for the public.
2
2. AIM AND OBJECTIVES
AIM :
The principle aim of the study is to evaluate the clinical efficacy of the trial
drug, “Sugantha Malli Chooranam” in the treatment of disease “Lasunathabitham”
without any side effects and also to ensure a new approach in the diagnosis and
treatment of disease.
PRIMARY OBJECTIVE:
To evaluate the clinical efficacy of the drug “Sugantha Malli Chooranam” to
reduce tonsillitis and its presentations .
SECONDARY OBJECTIVE:
To correlate the signs and symptoms of “Lasunathabitham” with modern
aspect. To study the Biochemical, Pharmacological and Antimicrobial activity of the
drug towards the efficacy of the medicine. Along with the analysis of Siddha
investigation techniques such as Envagai Thervu, Neerkuri, Neikuri are to be done.
3
3. REVIEW OF LITERATURE
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22
MODERN ASPECT
ANATOMY OF TONSIL:
• Tonsils are collections of lymphatic tissue facing into the aerodigestive
tract. It is located in the wall of the pharynx. It belongs to the lymphatic
system and immune system. It helps to protect the body from upper
respiratory tract infection.
• The tonsils begin developing early in the third month of foetal life. They
arise from the endoderm lining, the second pharyngeal pouch, and the
mesoderm of the second pharyngeal membrane and adjacent regions of the
first and second arches
• The epithelium of the second pouch proliferates to form solid endodermal
buds, growing into the underlying mesoderm. These buds give rise to
tonsillar stroma.
• Central cells of the buds later die and slough, converting the solid buds
into hollow tonsillar crypts, which are infiltrated by lymphoid tissue.
• Both right and left tonsils form part of the circumpharyngeal lymphoid
ring. The size of the tonsil varies according to the age, individuality and
pathologic status
• At the fifth or sixth year of life, the tonsils rapidly increase in size at
puberty. At puberty, the tonsils measure 20-25 mm in vertical and 10-15
mm in traverse diameters.
BED OF THE TONSIL:
Bed of the tonsil comprises of loose areolar tissue, pharyngobasilar fascia,
superior constrictor muscle.
VASCULAR SUPPLY OF TONSIL:
The arterial supply of the tonsils is derived from the following arteries:
1. Tonsillar artery
2. Ascending pharyngeal artery
3. Tonsillar branch of the facial artery
4. Dorsal lingual branch of the lingual artery
5. Ascending palatine branches of the facial artery
Venous blood drains through a peritonsillar plexus. The plexus drains
into the lingual and pharyngeal veins, which in turn drain into the
internal jugular vein.
23
NERVE SUPPLY OF TONSIL:
• The tonsils are innervated through tonsillar branches of the maxillary
nerve and the glossopharyngeal nerve.
LYMPHATIC SUPPLY OF TONSIL:
• Tonsils do not posses afferent lymphatics. Efferent lymphatics drain
directly to the jugulo digastric node and indirectly through the
retropharyngeal lymph nodes.
NATURAL VARIANTS OF TONSIL:
• The tonsil is more active in childhood and gradually becomes smaller
during puberty.
• Its appearance may give a misleading estimate of its size.
• Some tonsils appear to lie mostly on the surface of the throat, with a
shallow tonsillar fossa others appear to be mostly buried in a deep tonsillar
fossa.
PATHOPHYSIOLOGIC VARIANTS OF TONSIL:
• Tonsillar involution begins at puberty; by old age, only a little tonsillar
tissue remains. Tonsillar crypts may contain desquamated epithelial debris
and cells. Usually, this debris is cleared from the crypts. Rarely, the debris
may remain in the crypts and become hardened and yellow in appearance.
• The tonsil plays important role especially in young children.
Difference between Tonsils and Adenoid:
S.NO TONSILS ADENOID
1 Tonsils are paired Adenoid is single
Situated on the roof and post,wall of
2 Situated in Oropharynx
nasopharynx.
Covering epithelium is Covering epithelium of adenoid is Ciliated
3
Stratified squamous columnar.
In tonsils the crypts are present In adenoid the longitudinal furrows are
4
on the medial surface. present on the ventral surface
In tonsils the capsule is present
5 In adenoid ,there is no capsule at all
on the lateral surface.
24
TYPES OF TONSILS :
Tonsils are majorly classified in to 4 types:
types
• PHARYNGEAL TONSIL
• PALATINE TONSIL
• TUBAL TONSIL
• LINGUAL TONSIL
These four types of tonsils are anatomically connected and it makes
“Waldeyer’s Ring”.
.WALDEYER’S
WALDEYER’S RING:
An interrupted circle of protective lymphoid tissue at the upper ends of the
respiratory and alimentary tracts.
tracts
25
• The palatine tonsils, nasopharyngeal tonsil (adenoid) and lingual tonsil
constitute the major part of Waldeyer ring or nasal associated lymphoid
tissue (NALT) with the tubal tonsils and the lateral pharyngeal bands as
less prominent component.
• A ring composed of NALT at the beginning of food and air passage,
produces T and B lymphocytes which acts as local defence. Waldeyers
ring consists of lymphoid tissue that surrounds the openings of the oral and
nasal cavities into the pharynx.
• The most important aggregation are the right and left palatine tonsils,
usually refers to simply as the Tonsils.
• Posteriorly, and above there is the pharyngeal tonsil; laterally and above
there are the tubal tonsils, and inferiorly that is the lingual tonsil over the
posterior part of the dorsum of the tongue.
NORMAL FUNCTION OF TONSILS:

• Tonsils are the immune’s first line of defense against ingested and inhaled
foreign pathogens.
• Tonsils have on their surface specialized antigen capture cells called M
cells that allow for the uptake of antigens produced by pathogens. These M
cells then alert the underlying B cells T cells in the tonsils and the immune
response is stimulated.
• Lymphoid tissue of Waldeyer ring is most immunologically active
between 4and 10 years of age, but decrease after puberty. Deep crevices
within tonsillar tissue form tonsillar crypts that are lined with squamous
epithelium but have a concentration of lymphocytes at their bases.
-Nelson Text Book of Pediatrics
Page No:1756
DEFINITION OF TONSILLITIS
Tonsillitis is the inflammation of the tonsils and usually occurs secondary to
viral (a) bacterial influenza and staphylococci. On examination, the tonsils are
enlarged and inflamed. Presence of follicles over the tonsils indicates bacterial
infection (usually streptococcal).In addition there may be tender jugulodigastric
lymph nodes.
-Achar’sTextbookofPediatrics
(4th Edition)
26
ETIOLOGIC AGENTS:
Common pathogen:
• Group A Beta Hemolytic streptococci
Less common pathogens:

• Non group A S treptococcus
• Staphylococcus aureus
• Hemophilus influenza
Differentiating Viral origin of Bacterial origin of

Features Tonsillitis Tonsillitis
Entire illness lasts for 5
Duration Of Illness Lasts for 2 weeks
days
Pain occurs initially in
Pain occurs initially in tonsils after 12 to 24 hours
Sore Throat pharynx . with constitutional
symptoms .
Fever may not be noted
upto first day. Later, the
Fever Fever reaches peak by body temperature rise upto
second or third day. 40 C and continues for 4
days.
Cervical Lymph Firm and enlarged lymph Anterior cervical lymph
Nodes nodes node enlarged
TYPES OF TONSILLITIS
There are three main types of tonsillitis:
Acute Tonsillitis Bacterial or viral (75% )origin
Sub Acute Tonsillitis It can last between 3 weeks to 3 months.
Caused by the bacterium Actinomyces.
Chronic Tonsillitis If not treated it can last for long periods, is
almost always bacterial origin.
27
ACUTE TONSILLITIS
Definition:
Acute inflammatory condition of the faucial tonsils often caused by
Streptococcus, Staphylococcus, Hemophilus influenza or specific infections like
diphtheria.
TYPES OF ACUTE TONSILLITIS

• Acute Non specific tonsillitis
• Acute specific tonsillitis
ACUTE NON-SPECIFIC TONSILLITIS:

Definition:
Acute inflammatory condition of the faucial tonsil which may involve the
mucosa, crypts, follicles and tonsillar parenchyma.
Causative Agents :
• Viral: Initially starts with viral infection which is followed by secondary
bacterial infection.
Viruses commonly isolated include influenza, para-influenza, adeno virus
and rhino virus.
• Bacterial: Streptococcus, Staphylococcus, Hemophilus influenza.
PATHOGENESIS
• Usually it starts in childhood when there is a low immune status developed
due to reduction in maternal immunity and an inadequately developed
child’s own immunity which makes the child more prone to for infection
involving the waldeyer’s ring and helps in future production of antibodies
as the firstline defense mechanism.
CLASSIFICATION OF ACUTE NON-SPECIFIC TONSILLITIS:

• Depending on the progress of the disease, this can be classified further into
the following types such as
1.Catarrhal tonsillitis
2.Cryptic tonsillitis
28
3.Acutefollicular tonsillitis
4.Acute membranous tonsillitis
5.Acute parenchymal tonsillitis
6.Peritonsillitis or peritonsillar abscess
CLINICAL FEATURES OF ACUTE TONSILLITIS:
Symptoms:
• Fever which is always high grade
• Generalised malaise and bodyache
• Odynophagia (pain during swallowing)
• Dry cough
• Sore throat
Signs :
• Dry tongue
• Erythematous enlarged tonsil
• Palatine petechiae
• Enlargement of the jugulodigastric
lymph nodes
DIFFERENTIAL DIAGNOSIS OF ACUTE TONSILLITIS:

• Diptheria
• Vincent’s angina
• Agranulocytosis
• Infectious mononucleosis
• Adenoid facies or long face syndrome.
Adenoid facies or long face syndrome.

It is long, open-mouthed, face of children with adenoid hypertrophy. The
mouth is always open upper airway congestion has made patients obligatory mouth
breathers. The most common presenting symptoms are chronic mouth breathing and
snoring. The most dangerous symptom is sleep apnea.
29
CHRONIC TONSILLITIS
Definition
It is the chronic inflammation of the palatine (faucial) tonsils which
occurs as a result of repeated attacks of acute tonsillitis or due to inadequately
resolved acute tonsillitis.
Etiopathogenesis
• The most frequent etiology agent is Beta haemolytic streptococcus.
• It follows as a complication of acute tonsillitis. Pathologically
micro abscesses walled off by fibrous tissue have been seen in
lymphoid follicles of tonsils.
• It may be a subclinical infection of tonsils without an acute attack.
• Mostly affects children and young adults.
• Predisposing factor may be chronic infection in sinuses or teeth.
CLINICO PATHOLOGICAL TYPES OF CHRONIC TONSILLITIS

1. Chronic follicular tonsillitis
2. Chronic parenchymatous tonsillitis
GRADING OF CHRONIC PARENCHYMATOUS TYPE OF TONSILLITIS:

In chronic parenchymatous type of tonsillitis, the tonsils are enlarged and may
be graded into 4 types depending on this size.
• Grade I: Tonsils are congested but are located within the tonsillar fossa
• Grade II: Tonsils hypertrophies till the brim of the tonsillar fossa
• Grade III: Tonsillar hypertrophy extends beyond the pillars but does not
touch each other
• Grade IV: The tonsils are in contact with each other (Kissing tonsils)
causing respiratory and deglutition problems.
30
3. Chronic fibrotic tonsillitis:
CLINICAL FEATURES OF CHRONIC TONSILLITIS:
Symptoms
• Sore throat (recurrent attacks three to four times a year)
• Cough
• Hawking
• Halitosis
• Bad taste in the mouth due to pus in
crypts
• Thick speech
• Difficulty in swallowing
• Sleep apneic episodes
• Acute exacerbations produce symptoms similar to acute tonsillitis.
Signs
• Thin pale child without the usual healthy sparkle and the presence of dark
circle under the eyes
• Local signs in the throat are bands of congestion down the free margins of
flush of the anterior pillars of tonsils whose crypts on pressure.
• The size of tonsils is often small and buried in chronic infection, due to
fibrosis.
• The cervical glands at the angle of the mandible become persistently
enlarged.
DIFFERENTIAL DIAGNOSIS OF CHRONIC TONSILLITIS:
• Peritonsillar abscess (Quinsy)
• Peritonsillar cellulitis (Peritonsillitis)
• Parapharyngeal abscess
• Parapharyngeal neoplasm
• Tonsillar Diphtheria:
The faucial (pharyngeal) form is most common. It is manifested with sore
throat, malaise and mild to moderate fever. Initially there is mild pharyngeal
erythema, usually followed by progressive formation of whitish tonsillar exudate,
31
which is over a period of 24 to 48 hours changes into a greyish membrane that is
tightly adherent and bleeds on an attempted removal. Cervical adenopathy and soft
tissue oedema result in typical bull neck appearance and stridor.
COMPLICATION OF TONSILLITIS:
LOCAL COMPLICATION
• Peritonsillar abscess(Quinsy)
• Parapharyngeal abscess
• Intratonsillar abscess
• Tonsillolith
• Tonsillar cyst
• Recurrent tonsillitis
• Crypt formation
• Hypertrophy of the tonsil
SYSTEMIC COMPLICATION
• Focus of infection in renal failure, acute glomerulonephritis, eye and
skin disorders.
• Rheumatic fever-Rare condition that causes widespread inflammation
throughout the body.
• Lemierre’s syndrome - Rare condition bacteria spread from throat to
major veins and cause infection.
• Septicemia
DIAGNOSIS
DIAGNOSIS OF ACUTE TONSILLITIS:
The signs necessary for the diagnosis of acute tonsillitis are,
• Congested and oedematous tonsils seen in Acute catarrhal tonsillitis.
• Tonsils may be diffusely swollen appearance in Acute parenchymatous
tonsillitis.
32
• Crypts can be seen filled with pus with swollen follicles in Acute
follicular tonsillitis
• When the pus from the crypts coalesce it gives a membranous appearance
and is often seen in Acute membranous tonsillitis.
DIAGNOSIS OF CHRONIC TONSILLITIS:

Four cardinal signs are necessary for the diagnosis of chronic tonsillitis.
They are,
• Persistent congestion of the anterior pillars
• Positive tonsillar squeeze (Ervin-Moore sign).
A tongue depressor is placed on the anterior pillar and pressed against the
tonsil to squeeze.
If purulent yellowish cheesy discharge escapes out from the crypts, the
test is positive.
• The jugulodigastric lymph node on either sides are usually enlarged but
non tender.
• In chronic parenchymatous type of tonsillitis, the tonsils are enlarged.
TREATMENT OF TONSILLITIS
• Conservative-General health, diet and treatment of co-existing infection
of tooth, nose and sinuses. Treatment of acute exacerbations as in acute
tonsillitis
• Surgical-Tonsillectomy
Tonsillectomy
Types
• Dissection method
• Cryosurgery
• Monopolar cautery assisted tonsillectomy
• Bipolar cautery assisted tonsillectomy with or without aid of microscope
• Laser assisted tonsillectomy
• Coblation tonsillectomy(Radiofrequency ablation)
• Harmonic scalpel assisted tonsillectomy
• Guillotine tonsillectomy
33
Contraindications of tonsillectomy: (ABCDEF)
• Active infection or active exacerbation, Aneurysm of internal carotid
artery, Age below three years.
• Bleeding and clotting disorders
• Cervical spine pathology
• Diphtheritic tonsillitis,
• Drugs : Patients under aspirin, oral contraceptives
• Endemic of polio
• Failure to control systemic diseases like hypertension, diabetes, bronchial
asthma.
PREVENTION OF TONSILLITIS:
• Tonsillectomy can prevent tonsillitis, but is only recommended in select
circumstances.
• Avoid direct contact with infected persons. Tonsillitis are spread by
droplet transmission, droplet precautions must be taken by means of
prevention.
• Take enough liquids to keep the body hydrated.
• Eat nutritional diet includes fruits, vegetables soups.
• Should not exposed to passive smoking
• Should not eat unhygienic Food and drinking contaminated water
34
4. MATERIALS AND METHODS
CLINICAL STUDIES
After finishing the studies 40 cases were selected from the OPD and
IPD of Kuzhanthai Maruthuvam Department. The patients were treated with the
trail drug Sugantha Malli Chooranam and observed for prognosis clinically.
STUDY DESIGN AND CONDUCT OF THE STUDY:

Study Type An observational clinical study
Post graduate Kuzhanthai Maruthuvam OPD and IPD
Study Place
Government Siddha Medical College,Palayamkottai.
Study Period: 24 months
Sample Size: 40 Patients ( 20 OP + 20 IP)
The sample consists all patients 5-12 years age group fulfilling all the inclusion and
exclusion criteria.
STUDY PARTICIPANTS:
INCLUSION CRITERIA
Age 5 to 12 years
Sex - Male and female children
Throat pain
Dysphagia
Hoarseness of voice
Enlarged tonsils
Referred pain in the Ear
Malaise
Mild fever with tonsillitis
EXCLUSION CRITERIA
Congenital anomalies of pharynx
Known case of Pulmonary Tuberculosis.
Physiological hyperplasia of lymphoid follicles
Malignancy
Tonsillitis which have indication for surgery
35
WITHDRAWAL CRITERIA
The drug not responding to the condition.
Intolerance to the drug and development of adverse reactions during drug trail.
Patient turned unwilling to continue in the course of clinical trail.
Occurrence of any serious illness
TERMINATION CRITERIA
Not reporting subsequently
Voluntary termination
TESTS AND ASSESMENTS
Clinical assessment
Siddha methodological assessment
Laboratory Investigation Imaging assessment
CLINICAL ASSESSMENT:
Throat pain
Dysphagia
Hoarseness of voice
Enlarged tonsils
Malaise
Mild fever with tonsillitis
Referred pain in ear
Oedema of uvula and congestion
SIDDHA TESTS AND ASSESSMENTS:

I. UDAL KATTUKAL
Saram
Senner
Oonn
Kozhuppu
Enbu
Moolai
Sukkilam/suronitham
II ENVAGAI THERVU
Naadi
Sparisam
36
Naa
Niram
Mozhi
Vizhi
Malam
Moothiram
II - NEERKURI
IV-NEIKURI
INVESTIGATION:
• Blood : TC, DC, ESR, HB, Total RBC Count, Absolute Eosinophil
Count
• Urine : Albumin, Sugar, Deposits
• Motion : Ova, cyst
SPECIAL INVESTIGATIONS:
• Throat swab culture (group A haemolytic streptococcus)
• ASO TITRE
METHODOLOGY OF TREATMENT:
Study Enrollment:
Patient reporting at the OPD associated with Clinical Features of
• Throat pain
• Difficulty in swallowing
• Difficulty in Speaking
• Mild fever with tonsillitis
• General tiredness
• Pain in the Ear
are choosen for enrollment based on the inclusion criteria
The patient’s parents/guardian who are informed (Form IV) about the
study trial drug. Post outcomes and the objectives of the study in the language
and terms understandable to them and the informed consent would be obtained in
writing form them in the consent form (Form IV)
37
CONDUCT OF THE STUDY:
The trial drug will be given in the OPD Department of Kuzhanthai
Maruthuvam GSMC Palayamkottai. The patients will be asked to have a regular
follow up in the OP Department once in 2 days. In each and every visit the
clinical assessment will be recorded in the prescribed proforma, The laboratory
investigation will be done before and after treatment and recorded in the
prescribed format.
DATA MANAGEMENT:
After enrolling the patients in the study, a separate file for each patient
will be maintained and all forms will be kept in the file. Whenever the patient
visits OPD during the study period, necessary entires will be made at the
assessment forms. Data recordings and adverse events, of any, will be monitored
by the Head of the Department and Pharmacovigilance committee.
OUTCOME:
Primary Outcome:
Primary outcome is mainly assessed by comparing the reduction in clinical
symptoms are recurrence before and after treatment.
Secondary Outcome:
Secondary outcome is assessed by comparing the safety Parameters before and
after treatment
PROGNOSTIC CRITERIA
GRADE I : Showed good improvement
GRADE II : Symptoms moderately reduced
GRADE III : Symptoms slightly reduced

GRADE IV : No improvement
ETHICAL ISSUES:
1. To prevent any infection while collecting blood samples from the patient, only
disposable syringes, disposable gloves with proper sterilization of laboratory
equipments will be used.
2. There will be no infringement on the rights of patient. No other external or
internal medicines will be used other than the trail drug in the treatment course
of Lasunathabitham there will be no infringement on the rights of the patient.
38
3. The data collected from the patient’s parents or guardian will be kept
confidential
4. The patient’s parents or guardian will be informed about the disease and other
details of the treatment.
5. After obtaining the written consent of the patient’s Parents or guardian (
through consent form in their vernacular language ) they will be enrolled in the
study.
6. Treatment would be provided free of cost.
7. In case of any adverse reactions, the patients will be referred to the OPD of
Kuzhanthai Maruthuvam Department of Govt, Siddha Medical College and
Hospital, Palayamkottai for further management.
8. The Patient will be allowed to withdraw from this trail if their parents or
guardian are not satisfied with this treatment and procedures.
39
5. DRUG REVIEW
PREPARARTION AND PROPERTIES OF TRIAL DRUG
Rfe;j ky;yp #uzk; (cl;gpuNahfk;
puNahfk;);
NrUk; ruf;Ffs;:
S.NO NAME BOTANICAL NAME QUANTITY
1. gwq;fprf;if Smilax china 35 gm
2. Vyk; Elettaria cardamom 35 gm
3. mjpkJuk; Glycyrrhiza glabra 35 gm
4. rd;dytq;fgl;il Cinnamomum verum 35 gm
5. fUQ;rPufk; Nigella sativa 35 gm
6. fpuhk;G Syzygium aromaticum 35 gm
7. tpijapy;yh jpuhl;ir Vitis vinifera 35 gm
8. rPufk; Cumunim cyminum 35 gm
9. rh[puh Carum bulbocastanum 35 gm
10. nfhj;jky;yp tpij Coriandrum sativum 315 gm
11. fw;fz;L Borossus flabellifer 630 gm
nra;Kiw:
,q;F $wg;gl;l 10 ruf;Ffspy; nfhj;jky;yp tpijia kl;Lk; ed;whf
utpapy; cyh;j;jpAk; kw;w 9 ruf;Ffis nghd;dpwkhf tWj;J ahitAk;
,bj;J #uzpj;J rkndil fw;fz;L #uzk; fye;J itj;Jf; nfhs;sTk;.
msT:
½ fpuhk; (%d;WNtis czTf;F gpd;)
ehs; msT:
msT
14 ehl;fs;
mDghdk;:
ghy;
Mjhuk;:
Ehy; Mjhuk
ek; ehl;L itj;jpak; ghfk;-II gf;f vz;;:182
Ehy; Mrphpah;
Mrphpah:
S.tPu ngUkhs; gps;is
40
Fig. 1. INGREDIENTS OF SUGANTHA MALLI CHOORANAM
hxr<gqs<sg<jg!
g! Wzl<!
!)Smilax china) )Elettaria cardamom)
nkqlKvl<! se<ezur<gh<hm<jm!
m!
)Glycyrrhiza glabra) )Cinnamomum verum)
gVR<sQvgl<! gqvil<H!
)Nigella sativa) )Syzygium aromaticum)
41
INGREDIENTS OF SUGANTHA MALLI CHOORANAM
uqjkbqz<zi!kqvim<js! s! sQvgl<!
!)Vitis vinifera) )Cuminum cyminum)
sii<\qvi!
qvi! ogik<klz<zq!uqjk!
q!uqjk!
)Carum bulbocastanum) )Coriandrum sativum)
gx<g{<M!
)Borossus flabellifer)
42
Fig.2
SUGANTHA MALLI CHOORANAM
43
PROPERTIES OF TRIAL MEDICINE
gwq;fprf;if
Botanical Name : Smilax china

Family : Liliaceae
Part used : Rhizome
Rit : ,dpg;G
jd;ik : jl;gk;
gphpT : ,dpg;G
nra;if : clw;Nww;wp – Alterative
Nkfg;gpzptpyf;fp – Antisyphilitic
fhkk;ngUf;fp – Aphrodisac
Jha;ikahf;fp – Depurative
Chemical constituents:
Kaempferol, Engelatin, Rutin, Vanillic acid, β Sitosterol.
nghJ Fzk;:
jhfk; gythje; jhJel;lk; Gz;gpsit
Nkfq; fbfpue;jp tPo;%ye; - NjfKld;
Fl;il gfe;jNkw; nfhs;tkdk; Nghk;gwq;fpg;
gl;ilapid Ar;rhpj;Jg; ghh;
- Fzghlk; %ypif tFg;G
Vyk;;
Botanical Name : Elettaria cardamom

Family : Zingiberaceae
Part used : Seed
Rit : fhh;g;G
jd;ik : ntl;gk;
gphpT : fhh;g;G
nra;if : ntg;gKz;lhf;fp – Stimulant
mfl;Ltha;tfw;wp – Carminative
grpj;jPj;Jhz;b – Stomachic
Cineole, Terpinyl acetate, Terpineole, Borneole, Terpinene.
44
nghJFzk;:
njhz;il tha;fTs; jhYF jq;fspy;
Njhd;Wk; Nehajp rhuk;gd; Nkfj;jhy;
cz;il Nghy;vOq; fl;b fphpr;ruk;
coiy the;jp rpye;jp tprQ;Ruk;
gz;il ntf;if tpjhfNeha; fhrKk;
ghOQ; Nrhkg; gpzptpe;J el;lKk;
mz;il aPistd; gpj;jk; ,itf;nfy;yhk;
My khq;fko; Vy kUe;jNj...
mjpkJuk;
Botanical Name : Glycyrrhiza glabra

Family : Fabaceae
Part used : Root
Rit : ,dpg;G
jd;ik : rPjk;
gphpT : ,dpg;G
nra;if : twl;rpafw;wp – Emollient
cs;soyhw;wp – Demulcent
Nfhioafw;wp – Mild Epectorent
kykpsf;fp – Laxative
cukhf;fp – Tonic
Glycyrrhizine, Glycyrrhetic acid, Liquiritoside, Lichochalcone
nghJ Fzk;:
fj;jpahp Kg;gpzpahy; tUGz; jhfq;
fz;Nzha;fs;cd; khjk;tpf;fy; typntz;Fl;lk;
gpj;jnkYk; GUf;fp fphpr;ruk; Mth;j;j
gpj;jkj %h;r;ir tpl ghfk; ntg;ge;
jj;jptU thjNrh zpjq;fh khiy
rUttplq; fhkpaNeha; jhJ el;lq;
Fj;jpUky; Mrpaq;fk; ,jo;Neha; ,e;J
Fag;GZk;Nghk; kJhfnkdf; $Wq; fhNy.
- Njud; Fzthflk;
45
rd;dytq;fgl;il
Botanical Name : Cinnamomum verum
Family : Lauraceae
Part used : Bark
Rit : fhh;g;G, ,dpg;G
jd;ik : jl;gk;
gphpT : ,dpg;G
nra;if : ntg;gKz;lhf;fp – Stimulant
fhkk;ngUf;fp – Aphrodisiac
Cinnamaldehyde, Cinnamate, Cinnamic acid.
nghJ Fzk;:
jhJel;lk; Ngjp rUttp]k; MfpaNeha;
G+jfpu fQ;rpye;jpg; G+r;rptplQ; - rhjptplk;
Ml;Lkpiug; NghbUky; MfpaNeha;f; $l;lkw
Xl;Lkpy tq;fj; Jhp.
rd;dytq; fg;gl;il jhd;Fsph;r;rp Az;lhf;Fk;
,d;Dkpuj; jf;fLg;ig aPh;f;Fq;fhz; - Kd;dKWk;
ce;jpf fLg;gfw;Wk; cz;%yg; Gz;Nghf;Fk;
fe;jkpF G+q;FoNy fhz;
- mfj;jpah; Fzthflk;
fUQ;rPufk;
Botanical Name : Nigella sativa

Family : Ranunculaceae
Part used : Seed
Rit : ifg;G
jd;ik : ntl;gk;
gphpT : fhh;g;G
nra;if : mfl;Ltha;tfw;wp – Carminative
rpWePh;g;ngUf;fp – Diuretic
UJTz;lhf;fp – Emmenagogue
ghw;ngUf;fp – Galactogogue
46
GOf;nfhy;yp – Anthelmintic
grpj;jPj;J}z;b – Stomachic
J}f;Fzpg;GOf;nfhy;yp – Parasiticide
twl;rpafw;wp – Emollient
Nigellone, Thymoquinone, Thymol, Carvacrol.
nghJ Fzk;:
fUQ;rP ufj;jhd; fug;gndhL Gz;Zk;
tUQ;rpuha;g; gPerK khw;Wk; - mUe;jpdhy;
fha;r;ry; jiytypAq; fz;typAk; NghKyfpy;
tha;r;r kUe;njdNt it.
fpuhk;G
Botanical Name : Syzygium aromaticum
Family : Myrtaceae
Part used : Flower bud
Rit : fhuKk; tpWtpWg;GKs;sJ
jd;ik : ntl;gk;
gphpT : fhh;g;G
nra;if : ,rptfw;wp - Antispasmodic
Carvacrol, Thymol, Eugenol, Cinnamaldehyde
nghJ Fzk;:
gpj;j kaf;fk; NgjpnahL the;jpAk;Nghk;
Rj;jtpuj;jf; fLg;Ge; Njhd;WNkh – nkj;j
,ytq;fq; nfhz;ltUf; Nfw; RfkhFk;
Kykq;Nf fl;Lnkd tho;j;J.
Rf;fpyel; lq;fh;z #h;tpaq;f yhQ;rde;jhl;

Rpf;fy;tplhr; rh;th rpag;gpzpA – kf;fpf;Fl;
lq;fg; G+NthL jhpglUe; Njhd;wpypy;
tq;fg;G+ NthLiuj;J th.
47
jpuhl;ir
Botanical Name : Vitis vinifera

Family : Vitaceae
Part used : Fruit
Rit : ,dpg;G
jd;ik : jl;gk;
gphpT : ,dpg;G
nra;if : cs;soyhw;wp – Demulcent
fopr;rYz;lhf;fp - Laxative
Catechin, Epicatechin, Gallocatechin, Procyanidin.
rPufk;
Botanical Name : Cuminum cyminum
Family : Apiaceae
Part used : Fruit
jd;ik : jl;gk;
gphpT : ,dpg;G
ntg;gKz;lhf;fp - Stimulant
Jth;g;gp - Astringent
a-pinene, limonene, 1,8- cineole, linalool, a-terpineole
nghJ Fzk;:
gpj;jnkD ke;jphpiag; gpd;dg; gLj;jpatd;
rj;JUit Ae;Jwe;J rhjpj;J – kj;jndDk;
uhridA kPntd;W ez;igg; gyg;gLj;jp
NghrdF lhhpnrAk; Nghh;.
- Njud; ntz;gh
48
gpsg;G rPufk; (rhh;
(rhh[puh)
;[puh)
Botanical Name : Carum bulbocastanum
Family : Apiaceae
Part used : Fruit
jd;ik : jl;gk;
gphpT : ,dpg;G
UJTz;lhf;fp – Emmenagogue
Dillapiole, Germacrene – β, Nothoapiole, β – selinene
nghJ Fzk;:
clYf; fofhk; ciwg;gpj;jk; VFk;
mlYW thjk; mjkhk; - fbNrh;
jsTeiff; Nfhl;LKiyj; ijaNy ehSk;
gpsTeWQ; rPufj;ijg; Ngz;
nfhj;jky;yp
Botanical Name : Coriandrum sativum
Family : Apiaceae
Part used : Seed
Rit : fhh;g;G
jd;ik : rPj ntg;gk;
gphpT : fhh;g;G
nra;if : grpj;jPj;J}z;b – Stomachic
ntg;gKz;lhf;fp - Stimulant
Linalool, λ-terpinene, a-pinene, camphor, limonene
49
nghJ Fzk;:
nfhj;Jky;yp ntg;gk; Fsph;fha;r;ry; gpj;jke;jQ;
rh;j;jptpf;fy; jhfnkhL jhJel;lk; - fj;jpnaOk;
thj tpfhh;klh; td;fh;j;j gptpuzk;
G+jyj;jpy; yhjfw;Wk; Nghw;W
fw;fz;L
Botanical Name : Borossus flabellifer
Family : Arecaceae
Part used : palm jaggery
Rit : ,dpg;G
jd;ik : jl;gk;
gphpT : ,dpg;G
nghJ Fzk;:
Nkf tdYkpf tPRk#hpifahy;
Mf KWfdY khWq;fhz; - Nkfdj;jpy;
jq;fptU ePh;r;RUf;Fe; jhfntg;g Ke;jzpAk;
,q;Fgdq; fw;fz;Lf; Nf
50
6. BIO-CHEMICAL ANALYSIS OF SUGANTHA MALLI
CHOORANAM
Preparation of the extract:
5gms of the drug was weighed accurately and placed in a 250ml clean beaker
then 50ml of distilled water is added and dissolved well. Then it is boiled well for
about 10 minutes. It is cooled and filtered in a 100ml volumetric flask and then it is
making up to 100ml with distilled water. This fluid is taken for analysis.
QUALITATIVE ANALYSIS
S.NO EXPERIMENT OBSERVATION INFERENCE
1. TEST FOR CALCIUM
Indicates the
2ml of the above prepared extract is taken A white precipitate is
Presence of
in a clean test tube. To this add 2ml of 4% formed
Calcium
Ammonium oxalate solution
2. TEST FOR SULPHATE Indicates the
A white precipitate is
2ml of the extract is added to 5% Barium Presence of
formed
chloride solution. Sulphate
3. TEST FOR CHLORIDE Indicates the
A white precipitate is
The extract is treated with silver nitrate presence of
formed
solution Chloride
4. TEST FOR CARBONATE No brisk
Absence of
The substance is treated with effervescence is
Carbonate
concentrated Hcl. formed
5. TEST FOR STARCH Indicates the
Blue colour is
The extract is added with weak iodine presence of
formed
solution Starch
6. TEST FOR FERRIC IRON
No blue colour is Absence of ferric
The extract is acidified with Glacial
formed Iron
acetic acid and potassium ferro cyanide.
7. TEST FOR FERROUS IRON
Indicates the
The extract is treated with concentrated Blood red colour is
presence of
Nitric acid and Ammonium thiocyanate formed
Ferrous Iron
solution
51
8. TEST FOR PHOSPHATE
No yellow Absence of
The extract is treated with Ammonium
precipitate is formed Phosphate
Molybdate and concentrated nitric acid
9. TEST FOR ALBUMIN
No yellow Absence of
The extract is treated with Esbach’s
precipitate is formed Albumin
reagent
10. TEST FOR TANNIC ACID No Blue black Absence of
The extract is treated with ferric chloride. precipitate is formed Tannic acid
11. TEST FOR UNSATURATION Absence of
It does not gets
Potassium permanganate solution is Unsaturated
decolourised
added to the extract compound
12. TEST FOR THE REDUCING SUGAR
5ml of Benedict’s qualitative solution is Indicates the
Colour change
taken in a test tube and allowed to boil for presene of
occurs
2 minutes and add 8-10 drops of the Reducing sugar
extract and again boil it for 2 minutes.
13. TEST FOR AMINO ACID
One or two drops of the extract is placed Indicates the
Violet colour is
on a filter paper and dried well. After Presence of
formed
drying, 1% Ninhydrin is sprayed over the Amino acid
same and dried it well.
14. TEST FOR ZINC
No white precipitate
The extract is treated with Potassium Absence of Zinc
is formed
Ferrocyanide.
Inference:
The given sample of “SUGANTHA MALLI CHOORANAM” contains
Calcium, Sulphate, Chloride, Starch, Ferrous Iron, Reducing sugar and Amino acid.
52
7. PHARMACOLOGICAL ANALYSIS
EVALUATION OF ANALGESIC ACTIVITY OF SUGANTHA MALLI
CHOORANAM
Analgesic activity:
Hot plate method
Animals
Young wistar albino rats of either sex aged 4-5 weeks, average weight 100-
150 gm were used for the experiment. The rat were purchased from the animal
TANVASU. They were kept in standard environmental condition (at 24.0±0°C
temperature & 55-65% relative humidity and 12 hour light/12 hour dark cycle) for
one week for acclimation after their purchase and fed ICDDRB formulated rodent
food and water ad libitum. The set of rules followed for animal experiment were
approved by the institutional animal ethical committee (Zimmermann, 1983).
Experimental animals of either sex were randomly selected and divided into
four groups designated as group-I, group-II, group-III and group-IV consisting of five
Rats in each group for control, positive control and test sample group respectively.
Each group received a particular treatment i.e. control (1% Tween-80 solution in
water, 10ml/kg, p.o.), positive control (Diclofenac sodium 10 mg/kg, p.o.) and the test
sample (drug of 100 mg/kg, p.o. & 200 mg/kg, p.o. respectively). The animals were
positioned on Eddy’s hot plate kept at a temperature of 55±0.5 0C. A cut off period of
15 s (Franzotti et al., 2000) was observed to avoid damage to the paw. Reaction time
was recorded when animals licked their fore or hind paws, or jumped prior to and 0,
30, 60 and 90 min after oral administration of the samples (Eddy et al., 1953;
Kulkarni, 1999; Toma et al., 2003).
Statistical analysis
The results of statistical analysis for animal experiment were expressed as
mean ± SEM and were evaluated by ANOVA followed by Dunnet’s multiple
comparisons. The results obtained were compared with the vehicle control group. The
p<0.05, 0.001 were considered to be statistically significant.
53
Mean latency before and after drug
% inhibition
GROUP DOSE administration
0 min 30 min 60 min 90 min 30min 60min 90min
Group
Vehicle 2.96±0.220 3.35±0.226 2.86±0.198 3.28±0.267 - - -
I
Group
10 3.04±0.088 6.32±0.625 8.67±0.645 12.37±1.008 46.99 67.01 73.48
II
GROUP
100 2.91±0.074 3.97±0.265 5.89±0.776 5.87±0.617 15.61 51.44 44.12
III
Group
200 2.77±0.018 4.27±0.852 7.04±0.514 6.63±0.465 21.54 59.37 50.52
IV
80
70
60
50
Group I
40 Group II
GROUP III
30
Group IV
20
10
0
30min 60min 90min
54
Result:
Results of hotplate test are presented in Table for drugs respectively. The drug
Sugantha Malli Chooranam were found to exhibit a dose dependent increase in
latency time when compared with control. At 90 minutes, the percent inhibition of
two different doses (100 and 200 mg/kg body weight) was 50.09% & 56.49%
respectively. The results were found to be statistically significant (p<0.001)
Discussion:
Siddha is the foremost system of medicine to emphasize health as the perfect
state of physical, psychological, social and spiritual components of a human being.
The fundamental principle of this medicine successfully eliminates the evil side
effects without losing the beneficial medicinal properties. Diclofenac was used as a
reference drug in the current study as it has both central, peripheral actions and can
significantly treat nociceptive pain as in this model. [11] In the current study, pain
threshold increased significantly during the period of observation in all the drug
treated groups, with maximum effect observed in the Sugantha Malli Chooranam at a
dose of 200mg/kg as shown in table 1. The analgesic activity of Sugantha Malli
Chooranam was comparable to diclofenac at 30, 60,120 minutes appears to be a
significant finding and suggests that this drug has a slow onset of analgesic action.
Conclusion:
Sugantha Malli Chooranam possess significant analgesic action in the
preclinical study. These findings support the use of Sugantha Malli Chooranam in
traditional system of medicine for the management of pain. Further studies are needed
to be carried out in other animal models - pain to validate its efficacy and to identify
the active phyto-constituents in the formulation and their targets in pain pathways.
55
ANTI-INFLAMMATORY ACTIVITY OF SUGANTHA MALLI CHOORANAM
The anti-inflammatory activity of Sugantha Malli Chooranam at 100 and 200

mg/kg doses were evaluated using carrageenan-induced paw edema method. The
inflammation was readily produced in the form of edema with the help of irritant such
as carrageenan. Carrageenan is a sulphated polysaccharide obtained from sea weed
(Rhodophyceae), when it injected it release the prostaglandins by the way it produces
inflammation and edema.
REQUIREMENTS:
Animal : Albino rat (180-200 g)
Drugs and chemicals : Carrageenan (1%w/v),
Diclofenac sodium (standard),
Carboxy methyl cellulose (1%w/v),
Plethysmo meter.
Test compounds : Sugantha Malli Chooranam.
METHOD:
Anti-inflammatory activity was performed by the following procedure of
Bhandri et al(1) The animals were divided into 4 groups each having six animals. A
freshly prepared suspension of carrageenan (1% w/v , 0.1 ml) was injected to the
planter region of left hind paw of each rat. One group was kept as control and the
animals of the other groups were pretreated with the Sugantha Malli Chooranam test
Compounds dissolved with 2 ml sterile water given through orally 30 min before the
carrageenan treatment. The paw volumes of the test compounds, standard and control
groups were measured at 60, 240, 360 minutes of carrageenan treatment with the help
of plethysmometer. Mean increase in paw volume was measured and the percentage
of inhibition was calculated.
% Anti-inflammatory activity = (Vc-Vt / Vc) x 100
Where, Vt-mean increase in paw volume in rats treated with test compounds,
Vc-mean increase in paw volume in control group of rats.
56
TABLE NO.1
ANTI-INFLAMMATORY ACTIVITY OF SUGANTHA MALLI CHOORANAM
Paw volume(ml)
as measured by Percentage
Treatment Dose (mg/kg) mercury inhibition of paw
displacement at 6 edema
hour
Group I
10ml/kg orally 5.90±0.96 -
Normal saline
10mg/kg
Group II
I.P.Diclofenac 2.40±0.40 59.32%*a
Std
sodium
Group III
Sugantha Malli 100mg/kg.Orally. 2.76±0.48 53. 22%*a
Chooranam
Group IV
Sugantha Malli 200mg/kg.Orally. 2.60±0.52 55.93%*a
Chooranam
* Data are expressed as Mean ± S.E.M.
*Data were analyzed by one way ANOVA followed by Newman’s keul’s multiple
range tests, to determine the significance of the difference between the control group
and rats treated with the test compounds.
*a Values were significantly different from normal control at P< 0.01.
70
60
50
40
30
20
10
0
10ml/Kg Orally 10mg/kg 100mg/kg.Orally. 200mg/kg.Orally
I.P.Diclofenac
10ml/Kg Orally 10mg/kg I.P.Diclofenac

100mg/kg.Orally. 200mg/kg.Orally
57
Results
Sugantha Malli Chooranam at 100 and 200 mg/kg doeses were tested for their
Anti- inflammatory activity by using carrageenan Induced rat paw edema method and
the results are tabulated in table no 1. The results reveals that both extracts of
Sugantha Malli Chooranam at 100 and 200 mg/kg doses possesses significant Anti-
inflammatory activity when compared to control group at p<0.01.
58
TOXICITY STUDIES
EVALUATION OF ACUTE TOXICITY STUDY OF SUGANTHA MALLI
CHOORANAM
Effect of Acute Toxicity Study (14 Days) of SUGANTHA MALLI
CHOORANAM
Table no –1 Physical and behavioral examinations.
Group Dose(mg/kg) Observation No. of animal affected.
no. sign
Group-I 5mg/kg Normal 0 of 3
Group- II 50mg/kg Normal 0 of 3
Group-III 300mg/kg Normal 0 of 3
Group-IV 1000mg/kg Normal 0 of 3
Group-V 2000mg/kg Normal 0 of 3
Table no-2 Home cage activity
5mg/kg 300mg/kg
Functional 50mg/kg 1000mg/kg 2000mg/kg
Group (G-III)
and (G-II) (G-IV) (G-V)
Observation (G-I)
Behavioural
Female Female Female Female Female
observation
n=3 n=3 n=3 n=3 n=3
Body
Normal 3 3 3 3 3
position
Respiration Normal 3 3 3 3 3
Clonic
involuntary Normal 3 3 3 3 3
Movement
Tonic
involuntary Normal 3 3 3 3 3
Movement
Palpebral
Normal 3 3 3 3 3
closure
Approach
Normal 3 3 3 3 3
response
Touch
Normal 3 3 3 3 3
response
Pinna reflex Normal 3 3 3 3 3
Tail pinch
Normal 3 3 3 3 3
response
59
Table no-3 Hand held observation
5 mg/ 50 300mg/ 1000mg/ 2000mg/
Functional Contr
kg mg/kg kg kg kg
and ol
Observation (G-I) (G-II) (G-III) (G-IV) (G-V)
Behavioral
Femal Femal Femal Female Female Female
observation
e n=3 e n=3 e n=3 n=3 n=3 n=3
Reactivity Normal 3 3 3 3 3 3
Handling Normal 3 3 3 3 3 3
Palpebral Normal 3 3 3 3 3 3
closure
Lacrimation Normal 3 3 3 3 3 3
Salivation Normal 3 3 3 3 3 3
Piloerection Normal 3 3 3 3 3 3
Pupillary Normal 3 3 3 3 3 3
reflex
Abdominal Normal 3 3 3 3 3 3
tone
Limb tone Normal 3 3 3 3 3 3
Table no-4 Mortality

Group no Dose no(mg/kg) Mortality
Group-I 5(mg/kg) 0 of 3
Group-II 50(mg/kg) 0 of 3
Group-III 300(mg/kg) 0 of 3
Group-IV 1000(mg/kg) 0 of 3
Group-V 2000(mg/kg) 0 of 3
RESULT:
From acute toxicity study it was observed that the administration of
SUGANTHA MALLI CHOORANAM at a dose of 2000 mg/kg to the rats do not
produce drug-related toxicity and mortality. So No-Observed-Adverse-Effect-
Level (NOAEL) of SUGANTHA MALLI CHOORANAM is 2000 mg/kg.
60
DISCUSSION
SUGANTHA MALLI CHOORANAM was administered single time at the
dose of 5mg/kg, 50mg/kg , 300mg/kg, 1000mg/kg and 2000mg/kg to rats and
observed for consecutive 14 days after administration. Doses were selected based
on the pilot study and literature review. All animals were observed daily once for
any abnormal clinical signs. Weekly body weight and food consumption were
recorded. No mortality was observed during the entire period of the study. Data
obtained in this study indicated no significance physical and behavioural signs of
any toxicity due to administration of SUGANTHA MALLI CHOORANAM at the
doses of 5mg/kg, 50mg/kg , 300mg/kg, 1000mg/kg and 2000mg/kg to rats.
At the 14th day, all animals were observed for functional and behavioral
examination. In functional and behavioral examination, home cage activity, hand
held activity were observed. Home cage activities like Body position, Respiration,
Clonic involuntary movement, Tonic involuntary movement, Palpebral closure,
Approach response, Touch response, Pinna reflex, Sound responses, Tail pinch
response were observed. Handheld activities like Reactivity, Handling, Palpebral
closure, Lacrimation, Salivation, Piloercetion, Papillary reflex, abdominaltone,
Limb tone were observed. Functional and behavioral examination was normal in all
treated groups.Food consumption of all treated animals was found normal as
compared to normalgroup.
Body weight at weekly interval was measured to find out the effect of
SUGANTHA MALLI CHOORANAM on the growth rate. Body weight change in
drug treated animals was found normal.
INTERPRETATION:
SUGANTHA MALLI CHOORANAM was administered single time at the
dose of 5mg/kg, 50mg/kg, 300mg/kg, 1000mg/kg and 2000mg/kg to rats and
observed for consecutive 14 days after administration. Doses were selected based
on the pilot study and literature review. All animals were observed daily once for
any abnormal clinical signs. Weekly body weight and food consumption were
recorded. No mortality was observed during the entire period of the study. Data
obtained in this study indicated no significance physical and behavioural signs of
any toxicity due to administration of SUGANTHA MALLI CHOORANAM at the
doses of 5mg/kg, 50mg/kg , 300mg/kg, 1000mg/kg and 2000mg/kg to rats.
61
At the 14th day, all animals were observed for functional and behavioral
examination. In functional and behavioral examination, home cage activity, hand
held activity were observed. Home cage activities like Body position, Respiration,
Clonic involuntary movement, Tonic involuntary movement, Palpebral closure,
Approach response, Touch response, Pinna reflex, Sound responses, Tail pinch
response were observed. Handheld activities like Reactivity, Handling, Palpebral
closure, Lacrimation, Salivation, Piloercetion, Papillary reflex, abdominaltone,
Limb tone were observed. Functional and behavioral examination was normal in all
treated groups. Food consumption of all treated animals was found normal as
compared to normal group.
Body weight at weekly interval was measured to find out the effect of
SUGANTHA MALLI CHOORANAM on the growth rate. Body weight change in
drug treated animals was found normal.
62
SUB-ACUTE TOXICITY STUDY IN WISTAR RATS TO EVALUATE
TOXICITY PROFILE OF SUGANTHA MALLI CHOORANAM
Table : 5 EFFECT OF SUB- ACUTE DOSE (28 DAYS) OF SUGANTHA

MALLI CHOORANAM ON BODY WEIGHT IN GRAM
GROUP CONTROL LOW MID HIGH

1st day 122.5±3.06 115±7.876 124.3±5.231 126.3±5.23
7th day 123.3±3.06 122.3±7.676 123±5.113 128±5.11
14th day 125.1±3.007 93.3±7.45 94.4±5.012 94.4±5.012
21st day 94.3±5.450 101.2±7.804 102±4.131 96±4.13
28th day 104.3±3.074 103.3±4.202 134±5.0405 137±5.040
Values are expressed as mean ± SEM Statistical significance (p) calculated by one
ns
way ANOVA followed by Dennett’s (n=6); p>0.05, *p<0.05, **p<0.01,
***p<0.001, calculated by comparing treated groups with control group.
160
140
120
100
CONTROL
80 SMC 200mg/kg
60 SMC 400mg/kg
SMC 600mg/kg
40
20
0
1st day 7th day 14th day 21st day 28th day
63
EFFECT OF SUBACUTE DOSE (28 DAYS) OF SUGANTHA MALLI
CHOORANAM
Table : 6 SUGANTHA MALLI CHOORANAM ON ORGAN WEIGHT
(PHYSICAL PARAMETER) IN GRAM
GROUP CONTROL LOW MID HIGH
HEART 2.39±0.02 2.40±0.04 2.43±0.11 2.44 ±0.02
LIVER 8.27± 0.23 8.29±0.23 8.16±0.01 8.18± 0.23
LUNGS 4.27±0.10 4.27±0.14 4.30±0.24 4.33±0.10
KIDNEY L 1.39±0.02 1.39±0.03 1.40±0.02 1.41±0.02
R 1.37±0.024 1.40±0.02 1.41±0.024 1.42±0.024
ns
way ANOVA followed by Dunnett’s(n=6); p>0.05, *p<0.05, **p<0.01,
10
9
8
7
6
5 CONTROL
4 Low
3 Mid
2 High
1
0
L R
HEART LIVER LUNGS KIDNEY
64
EFFECT OF SUB- ACUTE DOSE (28 DAYS) OF SUGANTHA MALLI
CHOORANAMON HAEMATOLOGICAL PARAMETERS
Table no : 7
RBC Differential count %
Drug
million WBC Haemoglob
treatm Neutrop Eosinop Monoc Lympho
cells/c cells/cmm ingm %
ent hils hils yte cyte
mm
Contr 7.22±0. 5253.40±2 15.39±2.47 32.26±1. 2.51±2.1 0.64±2. 24.12±5.
ol 60 5.34 20 1 15 32
LOW 5.48±0. 4335.03±2 15.19±2.45 26.53±1. 3.09±2.1 0.31±2. 24.21±5.
40 5.24 43 4 30 51
MID 5.34±0. 4305.24±3 15.09±3.05 31.31±2. 2.43±2.1 0.61±2. 24.12±5.
23 3.37 22 2 40 32
HIGH 6.27±0. 5189.24±3 17.10±3.07 29.31±2. 2.49±2.1 0.63±2. 25.12±5.
23 4.37 22 2 40 32
ns
RBC
8
1
Control SMC 200mg SMC 400mg SMC 600mg
65
WBC
6000
5000
4000
3000
2000
1000
0
HAEMOGLOBIN
17.5
17
16.5
16
15.5
15
14.5
14
NEUTROPHILS
35
30
25
20
15
10
5
0
66
EOSINOPHILS
3.5
2.5
1.5
0.5
0
MONOCYTE
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
LYMPOCYTE
30
25
20
15
10
5
0
67
Table : 8 EFFECT OF SUB- ACUTE DOSE (28 DAYS) OF SUGANTHA
MALLI CHOORANAM ON BIOCHEMICAL PARAMETER
Drug SGPT SGOT ALP Urea Creatinine

Treatment (IU/L) (IU/L) (IU/L) (mg/dl) (mg/dl)
Control 41.13±3.02 14.23±4.31 242.10±11.32 34.34±3.00 0.53±0.03
LOW 41.12±3.22 14.22±4.01 250.10±12.42 39.52±2.42 0.39±0.04
MID 39.20±4.44 14.30±2.21 244.44±4.14 38.11±2.22 0.44±0.04
HIGH 41.20±4.44 13.30±2.21 233.44±4.14 39.11±2.22 0.65±0.04
45
40
35
30
Control
25
SMC 200mg
20
SMC 400mg
15 SMC 600mg
10
0
SGPT (IU/L) SGOT (IU/L)
68
255
250
245
Control
240 SMC 200mg
SMC 400mg
235
SMC 600mg
230
225
ALP (IU/L)
40
39
38
37
36 Control
35 SMC 200mg
34 SMC 400mg
33 SMC 600mg
32
31
Urea
(mg/dl)
1
0.9
0.8
0.7
0.6
Control
0.5
0.4 SMC 200mg
0.3 SMC 400mg
0.2 SMC 600mg
0.1
0
Creatinine (mg/dl)
69
CHOORANAM BIOCHEMICAL PARAMETERS
Table: 9
GROUP CONTROL SMC SMC SMC
(200mg/kg) (400mg/kg) (600mg/kg)
TOTAL
BILIRUBIN 0.8±0.2457 1.4±0.27 0.88±0.76 0.14±0.199
(mg/dl)
Values are expressed as mean ± SEM Statistical significance (p) calculated by one-
ns
1
0.9
0.8
0.7
0.6 Control
0.5 SMC 200mg
0.4 SMC 400mg
0.3 SMC 600mg
0.2
0.1
0
70
EFFECT OF SUB - ACUTE DOSE (28 DAYS) OF SUGANTHA MALLI
CHOORANAM ON BIOCHEMICAL PARAMETERS
Table: 10
SMC SMC SMC
GROUP CONTROL
(200mg/kg) (400mg/kg) (600mg/kg)
CREATININE 0.533±0.03849 0.533±0.088 0.572±0.0252
0.720.0446
(mg/dl) 27 8
2.046±0.661
URIC ACID 1.552±0.2766 1.579±0.160 1.588±0.2929
7
(mg/dl)
.
ns
way ANOVA followed by Dennett’s(n=6); p>0.05, *p<0.05, **p<0.01,
2.5
1.5
0.5
0
CONTROL SMC(200mg/kg) SMC (400mg/kg) SMC (600mg/kg)
CREATININE (mg/dl) URIC ACID (mg/dl)
71
CHOORANAM ON FOOD INTAKE IN GRAM
Table: 11
GROUP CONTROL Low mid high
1st DAY 19.34±13.5110 20.1673±14.3 12.12±21.71 18.6±7.62
7th DAY 15.6±11. 11.864±12.67 16.75±9.853 12.18±14.41
14th DAY 19.84±8.72 11.84±14.28 11±13.96 20.73±8.981
21st DAY 12.86±12.4 16±8.466 16.88±9.43 20.18±8.02
28th DAY 13.11±11.38 19.39±11.50 11±8.90 11±7.57
ns
***p<0.001, calculated by comparing treated groups with control group
FOOD INTAKE
25
20
15 CONTROL
SMC 200mgmg/kg
10 SMC 400mgmg/kg
SMC 600mgmg/kg
5
0
72
CHOORANAM ON WATER INTAKE IN ML
Table: 12
SMC SMC SMC
GROUP CONTROL
(200mg/kg) (400mg/kg) (600mg/kg)
1st DAY 98.38±13.10 89.72±14.3426 102.10±21.199 67.5±7.03
7th DAY 85.5±11.78 100.863±12.70 76.63±9.363 81.17±14.50
14th
58.33±8.817 90.8363±14.12 80±13.92 89.12±8.81
DAY
21st DAY 91.67±12.49 85±8.462 65.838±9.450 89.17±8.702
28th
82.10±11.30 88.48±11.504 80±8.061 70±7.53
DAY
ns
***p<0.001, calculated by comparing treated groups with control group
WATER INTAKE
120
100
80
CONTROL
60 SMC 200mgmg/kg
SMC 400mgmg/kg
40
SMC 600mgmg/kg
20
0
73
EFFECT OF SUB ACUTE DOSES (28 DAY) OF SUGANTHA MALLI
CHOORANAM ON ELECTROLYTES
Table: 13
SMC SMC SMC

GROUP CONTROL
(200mg/kg) (400mg/kg) (600mg/kg)
Sodium
4.550±0.55 4.30±0.92 11±0.571 11.80±0.70
(mg/dl)
Calcium
1.50±0.189 3.20±0.13*** 4.7±0.19*** 6.180±0.11***
(mg/dl)
Phosphorus
0.378±0.017 0.30±0.15ns 0.356±0.03ns 5.037±0.02*
(U/L)
way ANOVA followed by Dennett’s(n=6); NS- non-significant, *p<0.05,
**p<0.01, ***p<0.001,
SODIUM
14
12
10
0
74
CALCIUM
7
0
PHOSPHORUS
6
0
75
RESULTS:
CLINICAL SIGNS:
All animals in this study were free of toxic clinical signs throughout the
dosing period of 28 days.
Mortality:
All animals in control and in all the treated dose groups survived
throughout the dosing period of 28 days.
Body weight:
Results of body weight determination of animals from control and different
dose groups exhibited comparable body weight gain throughout the dosing period
of 28 days.
Food consumption:
During dosing and the post-dosing recovery period, the quantity of food
consumed by animals from different dose groups was found to be comparable with
that by control animals.
Organ Weight:
Group Mean Relative Organ Weights (% of body weight) are recorded in
Table No.22 Comparison of organ weights of treated animals with respective
control animals on day 29 was found to be comparable similarly.
Hematological investigations:
The results of hematological investigations conducted on day 29 revealed
following significant changes in the values of different parameters investigated
when compared with those of respective controls; however, the increase or
decrease in the values obtained was within normal biological and laboratory limits
or the effect was not dose dependent.
Biochemical Investigations:
Results of Biochemical investigations conducted on the day 29th and
recorded in Table no 24, 25 revealed the following significant changes in the values
of hepatic serum enzymes studied. When compared with those of respective
control. However, the increase or decrease in the values obtained was within
normal biological and laboratory limits.
76
INTERPRETATION:
1. All the animals from control and all the treated dose groups up to
2000mg/kg survived throughout the dosing period of 28 days.
2. No signs of toxicity were observed in animals from different dose groups
during the dosing period of 28 days.
3. Animals from all the treated dose groups exhibited comparable body weight
gain with that of controls throughout the dosing period of 28 days.
4. Food consumption of control and treated animals was found to be
comparable throughout the dosing period of 28 days
5. Haematological analysis conducted at the end of the dosing period on day
29th, revealed no abnormalities attributable to the treatment.
6. Biochemical analysis conducted at the end of the dosing period on day 29th,
no abnormalities attributable to the treatment.
7. Organ weight data of animals sacrificed at the end of the dosing period was
found to be comparable with that of respective controls.
77
8. ANTIMICROBIAL STUDY REPORT
AIM
To study the Anti-microbial action of Sugantha Malli Chooranam
against Streptococcus pneumoniae, Staphylococcus aureus and other bacterias
such as Pseudomonas aeruginosa, Escherichia coli
MEDIUM
Muller Hinton agar
COMPONENTS OF MEDIUM
Beef extract - 300gms/lit
Agar - 17gms/lit
Starch - 1.5gms/lit
Casein Hydroxylate - 17.5gms/lit
Distilled water - 1000ml
PH - 7.6
PROCEDURE
The media was prepared from the components and poured and dried on a
petri dish. The organism was streaked on the medium and the test drug (1gm drug
in 10ml water) was placed on the medium. This is incubated at 370C for one over
night and observed for night and observed for the susceptibility shown up
clearance around the drug.
RESULT:
The test drug Sugantha Malli Chooranam was resistant against
Streptococcus pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa,
Escherichia coli.
ZONE OF ZONE OF
S.NO ORGANISM SENSITIVITY
DRUG CONTROL
1 Streptococcus Resistant - 16mm
pneumoniae (amikacin)
2 Staphylococcus Resistant - 18mm
aureus (erythromycin)
3 Pseudomonas Resistant - 16mm
aeruginosa (erythromycin)
4 Escherichia coli Resistant - 15mm
(erythromycin)
78
79
Fig. 3
REPRESENTATIVE PICTURE OF THE
ANTIMICROBIAL STUDY
80
9. OBSERVATION AND RESULTS
1.AGE DISTRIBUTION: (Table No:1)
No. Of Cases Percentage

S.NO Age
(out of 40) (%)
1 0-1 Year -
Kappu and Chenkeerai
2 2 years-3 years -
Varugai,Thalattu,Sappani,Mutham
3 4 years-6 years 09 22.5%
Ambuli,Chitril,Chiruparai,Chiruthervidal,Paethai(fem
ale)and Pillai(male)paruvam
4 7 years-10years 22 55%
Paethamai(female)
Chiruparuvam(male)
5 11years-12 years 09 22.5%
Mangai(female),Valibam(male)
AGE DISTRIBUTION
PERCENTAGE
55%
22.50% 22.50%
4-6 Yrs 7-10 Yrs 11-12 Yrs
Children under the age group of 7 years to 10 years were commonly affected.
Among school going children, chocolates consuming children had high incidence of
tonsillar infection.
81
2. SEX-DISTRIBUTION: (Table No:2)
No.of cases
S.No Sex Percentage(%)
(out of 40)
1 Male children 16 40%
2 Female children 24 60%
SEX DISTRIBUTION
MALE
CHILDREN
FEMALE 40%
CHILDREN
60%
Among 40 cases studied 16 were male children (40%) and 24 were female
children (60%).Female children were highly affected than male children.
82
3. SOCIO-ECONOMIC STATUS: (Table No:3)
No.of cases
S.No Socio-economic status Percentage(%)
(out of 40)
1 Poor 10 25%
2 Middle Class 30 75%
3 Rich - -
SOCIO ECONOMIC STATUS
Poor
25%
Middle
75%
According to this study, the disease Lasunathabitham was noticed in 10 cases

(25%) belonging to poor socio economic status,due to lack of nutritious food and and
30 cases (75%) noticed in Middle class due to unhygienic condition .
83
4.DISTRIBUTION OF PARUVA KALANGAL (Table No:4)
No.of cases
S.No Paruvakaalam Percentage(%)
(out of 40)
1 Kaar(Aavani,Purattasi) 14 35%
2 Koothir(Ayppasi,Karthigai) 02 05%
3 Munpani(Markazhi,Thai) 02 05%
4 Pinpani(Maasi,Pankuni) 07 17.5%
5 Ela Venil(Chithirai,Vaikasi) 05 12.5%
6 Muthuvenil(Aani,Aadi) 10 25%
DISTRIBUTION OF PARUVAKALANGAL
35%
25%
17.50%
12.50%
5% 5%
KAAR KALAM KOOTHIR MUNPANI PINPANI KALAM ELAVENIR MUTHUVENIR

KALAM KALAM KALAM KALAM
The incidence of cases in Kaar kaalam 35%, Koothir kaalam 5%, Munpani
kaalam 5%, Pinpani kaalam 17.50%, Elavenir kaalam 12.50% and Muthuvenir
kaalam 25% of cases were affected by Lasunathabitham was noted.
84
5. DIET HISTORY (Table No:5)
No.of cases
S.No Type of Diet Percentage(%)
(out of 40)
1 Vegetarian 08 20%
2 Mixed 32 80%
DIET HISTORY
Vegetarian
20%
Mixed
80%
According to diet history, high incidence of cases 80% was noted in mixed
diet and 20% of cases are noted in vegetarian diet.
85
6.FAMILY HISTORY (Table No:6)
No.of cases
S.No FAMILY HISTORY Percentage(%)
(out of 40)
1 Positive Family History 4 10%
2 Negative Family History 36 90%
FAMILY HISTORY
PERCENTAGE
Negative family history 90%
Positive family history 10%
Out of 40 cases 36 (90%) cases had negative family history and 4 (10%) cases
had positive family history.
86
7.DISTRIBUTION OF LANDS (Table No:7)
No.of cases
S.No Distribution of Lands Percentage(%)
(out of 40)
1 Kurinji (Hill) - -
2 Mullai (Forest) - -
3 Marutham (Fertile) 32 80%
4 Neithal (Coastal) 08 20%
5 Paalai (Desert) - -
DISTRIBUTION OF LANDS
Neithal
(Coastal)
20%
Marutham
(Fertile)
80%
The incidence of Lasunathaitham among the people residing in the Marutham

Nilam was more, due to altered life style and changed environmental conditions.
87
8. MUKKUTRA THEORY (Table No:8)
I.DEARANGEMENT OF VATHAM
No.of cases
S.No Types of Vatham Percentage(%)
(out of 40)
1 Pranan 40 100
2 Abanan 12 30
3 Viyanan 40 100
4 Uthanan 40 100
5 Samanan 40 100
6 Naagan - -
7 Koorman - -
8 Kirukaran 40 100
9 Devathathan 40 100
10 Dhananjeyan - -
DERANGEMENT OF VATHAM
PERCENTAGE
100 100 100 100 100 100
30
Pranan Abanan Viyanan Uthanan Samanan Kirukaran Devathathan
In Vatham, all cases had dearangement in Pranan, Viyanan, Uthanan,

Samanan, Kirugaran, Devathathan. In 30% of cases Abanan was affected.
88
II.DEARANGEMENT OF PITHAM
No.of cases
S.No Types of Pitham Percentage(%)
(out of 40)
1 Anilapitham 12 30
2 Ranjakapitham 12 30
3 Saathakapitham 40 100
4 Pirasakapitham - -
5 Aalosakapitham - -
DERANGEMENT OF PITHAM
PERCENTAGE
100
30 30
Analpitham Ranjakapitham Sathakapitham
In Pitham, incidence of Analpitham and Ranjakapitham affected in 30% of

cases. In Sathakapitham 100% of patients were affected.
89
III.DEARANGEMENT OF KABAM
No.of cases
S.No Types of Kabam Percentage(%)
(out of 40)
1 Avalambakam 40 100
2 Kilethakam - -
3 Pothakam - -
4 Tharpakam - -
5 Santhikam - -
DERANGEMENT OF KABAM -
AVALAMBAGAM
PERCENTAGE
100%
In Kapham, the incidence of Avalambakam affected in all 40 cases was 100%.
90
9. UDAL KATTUGAL (Table No:9)
No.of cases
S.No UDAL KATTUGAL Percentage(%)
(out of 40)
1 Saaram 40 100
2 Senneer 12 30
3 Oon 40 100
4 Kozhuppu - -
5 Enbu - -
6 Moolai - -
7 Sukkilam/Suronitham - -
UDALKATTUGAL
1.2
Saaram, 100% Oon, 100%
1
0.8
0.6
0.4 Senneer, 30%
0.2
0
UDALKATTUGAL Saaram Senneer Oon
In Udal kattugal, Saaram and Oon was affected in all patient because of
increased Kabam. Incidence of Senneer affected in patients were 30%.
91
10.ENN VAGAI THERVUGAL (Table No:10)
ENN VAGAI No.of cases(out of
S.No Percentage (%)
THERVUGAL 40)
1 Naadi
A. Vathapitham 02 5
B. Pithakabam 18 45
C. Vathakabam - -
D. Kabapitham 14 35
E. Pithavatham 04 10
F. Kabavatham 02 5
2 Sparisam 10 25
3 Naa 12 30
4 Niram 40 100
5 Mozhi 40 100
6 Vizhi 12 30
7 Malam 12 30
8 Moorthiram - -
ENN VAGAI THERVUGAL

100% 100% 100%
30% 30% 30%

25%
Naadi Sparisam Naa Niram Mozhi Vizhi Malam
In Envagai thervugal, pale appearance and white coating of tongue, dull voice,
redness of eyes, fever and burning micturition were noticed respectively.
92
11.NEI KURI (Table No:11)
No.of cases Percentage
S.No Neikuri Reference Character of Urine
(out of 40) (%)
1 Vatha Neer Spreads like Snake 4 10
2 Pitha Neer Spreads like Ring 15 37.5
3 Kaba Neer Spreads like Pearl 21 52.5
NEI KURI
Vatha neer
10%
kapa neer Pitha neer

52% 38%
Among the 40 cases, 10% cases were observed Vatha Neer, 38% case Pitha
Neer and 53% cases were Kabha Neer.
93
12. ETIOLOGICAL FACTORS OF LASUNATHABITHAM (Table No:12)

S.No Etiological factors
(out of 40) (%)
1 Intake of cold food stuffs,cool 35 87.5
drinks,Ice creams
2 Drinking contaminated water 20 50
3 Seasonal Variations 30 75
4 Family History - -
5 Living in congested 10 25
areas,using same vessels by
many
AETIOLOGICAL FACTOR
87.50%
75%
50%
25%
Intake of cold food Drinking Seasonal variations Living styles

stuffs, cool drinks, ice contaminated water
creams
From the study, the author concludes that the main cause for the occurrence of
Lasunathabitham was intake of cold food stuffs like ice creams and drinking of
contaminated water. Seasonal variations,living in congested area,Family history are
the other causes of Lasunathabitham.
94
13. CLINICAL FEATURES-SIGNS AND SYMPTOMS (Table No:13)
The signs and symptoms of patients with Lasunathabitham under the clinical
study was given below
S.No Clinical Features
(out of 40) (%)
1 Sore throat 40 100
2 Dysphagia 35 87.5
3 Redness and swelling of the tonsil 40 100
4 Nasal congestion and Nasal discharge 14 35
5 Cough 35 87.5
6 Hoarseness of voice 35 87.5
7 Headache 5 12.5
8 Cervical lymphadenitis 30 75
9 Fever 20 50
10 Nausea 2 5
11 Ear ache 20 50
12 Halitosis 10 25
13 Constipation 15 37.5
14 Distaste - -
CLINICAL FEATURES
100% 100%
87.50% 87.50%87.50%
75%
50% 50%
35% 37.50%
25%
12.50% 5%
Most of the patients had high incidence of sore throat, cough, redness and
swelling of tonsils, dysphagia, cervical lymphadenitis were noted.
95
14. RESULTS AFTER TREATMENT (TOTAL) (Table No:14)
S.No Result No.of cases Percentage

(out of 40) (%)
1 Mild - -
2 Moderate 10 25
3 Good 30 75
RESULTS AFTER TREATMENT
Moderate
25%
good
75%
10 cases (25%) showed moderate results, 30 cases (75%) showed good results.
These results were based on the clinical improvement.
96
Fig. 4
Patient Name: Girl. Mahalakshmi Age: 5 Yrs Sex: Female Child
BEFORE TREATMENT
TREATMENT AFTER 5 DAYS
AFTER TREATMENT- 14 DAYS
97
Fig 5
Patient name: Master Mathan Age: 11 Yrs Sex: Male Child
BEFORE TREATMENT
TREATMENT AFTER 5 DAYS
AFTER TREATMENT – 14 DAYS
98
HEMATOLOGICAL INVESTIGATIONS : 20 INPATIENTS OF LASUNATHABITHAM
HEMATOLOGICAL INVESTIGATIONS
S.NO IP NO Name of the patient Before Treatment After Treatment
TCL DC% ESR mm HB TCL DC% ESR mm HB
Cu mm gms Cu gms%
% mm
P L E ½ hr 1 hr P L E ½ hr 1 hr
1 1409 L.VISHNU 7600 66 31 3 8 15 12.6 7600 66 32 2 5 10 12.6
2 1410 L.ELAKKIYA 8700 56 36 8 9 18 10 8600 55 38 7 3 6 11
3 2062 S.RATHINAVEL 8600 60 33 15 10 20 12.2 8400 57 41 2 6 12 12.4
4 2061 S.INDHU 8000 67 25 8 8 15 11.3 8200 63 33 4 4 8 11.8
5 2089 M.KAVIYA 8400 53 40 7 8 16 10 8200 56 49 5 2 4 12
6 2197 A.RITHICK 8800 62 22 16 11 22 12.3 8600 58 38 4 6 12 12.6
7 2198 A.MANO AADHVICK 8400 57 33 10 7 14 11.2 8000 64 33 3 4 8 11.5
8 2244 S.SRI MAHALAKSHMI 8600 53 43 4 7 15 9.8 8300 55 42 3 2 4 10.2
9 2431 KRITHIGA 8600 61 23 16 10 20 12.2 7600 58 39 3 5 10 12.3
10 2465 S.MAHESHWARAN 8700 56 34 10 8 16 11.2 8400 61 35 4 2 4 11.6
11 2835 S.AKIM 8900 54 40 6 9 18 9.6 8100 56 40 4 3 6 10.8
12 169 N.ISTHAR PARK 8700 61 23 16 11 22 12.4 8100 56 37 7 4 8 12.4
13 171 S.ABINAYA SARASWATHY 8900 57 33 10 12 24 11.4 8600 52 46 2 3 6 11.4
14 225 IRPHANA 8800 56 34 6 11 22 9.8 8300 49 36 15 5 10 9.8
15 369 JEFRIN 8800 62 23 17 12 24 12.5 8500 53 43 4 3 6 12.5
16 370 JESLIN 8900 66 24 10 13 26 11.8 8900 59 38 3 7 14 11.8
17 680 JOSEPH 8600 56 30 14 13 26 9.8 8400 54 39 7 10 20 10.9
18 681 FENISTA 9000 62 22 16 13 26 12.2 8500 58 40 2 3 6 12.2
19 688 ANUSHYA 8700 50 35 15 13 26 13.4 8100 59 33 8 6 12 13.2
20 689 POORVIKA 8600 53 43 4 12 24 12.8 8300 54 42 4 2 4 12.6
99
INVESTIGATIONS OF 20 INPATIENTS OF LASUNATHABITHAM
URINE ANALYSIS MOTION ANALYSIS
SL.NO IP Name of the patient
NO. Before Treatment After Treatment BeforeTreatment After Treatment
Alb Sug Dep Alb Sug Dep Ova Cyst Ova Cyst
1 1409 L.VISHNU Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
2 1410 L.ELAKKIYA Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
3 2062 S.RATHINAVEL Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
4 2061 S.INDHU Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
5 2089 M.KAVIYA Nil Nil 1-2 Epithelial cells Nil Nil NAD Nil Nil Nil Nil
6 2197 A.RITHICK Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
7 2198 A.MANO AADHVICK Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
8 2244 S.SRI MAHALAKSHMI Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
9 2431 KRITHIGA Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
10 2465 S.MAHESHWARAN Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
11 2835 S.AKIM Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
12 169 N.ISTHAR PARK Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
13 171 S.ABINAYA SARASWATHY Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
14 225 IRPHANA Nil Nil 1-2 pus cells Nil Nil NAD Nil Nil Nil Nil
15 369 JEFRIN Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
16 370 JESLIN Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
17 680 JOSEPH Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
18 681 FENISTA Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
19 688 ANUSHYA Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
20 689 POORVIKA Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
100
CASE REPORT OF 20 INPATIENTS OF LASUNATHABITHAM
Duration of
S.No IP.No Name Age/Sex Signs and Symptoms Admission Discharge Results
illness/days
Pain in throat, Nasal discharge, Hoarseness of
voice, Difficult to swallow, Difficult to breath,
1 1409 L.VISHNU 12/MC 4 Fever. 28.5.2018 11.6.2018
Good
O/E, Cervical lymphadenitis on Rt side,
Halitosis present.
Pain in throat, Cough without expectoration,
Hoarseness of voice, Difficult to swallow,
2 1410 L.ELAKKIYA 7/FC 7 Difficult to breath, Rt ear pain. 28.5.2018 11.6.2018 Moderate
O/E, Cervical lymphadenitis on both side,
Halitosis present.
3 2062 S.RATHINAVEL 5/MC 12 Snoring. 11.8.2018 29.8.2018
Good
O/E, Cervical lymphadenitis, Halitosis not
present.
4 2061 S.INDHU 9/FC 6 Fever. 11.8.2018 29.8.2018 Moderate
O/E, Cervical lymphadenitis on Lt side,
Halitosis present.
Difficult to breath, Lt ear pain, Constipation.
5 2089 M.KAVIYA 6/FC 10 O/E, Cervical lymphadenitis on Lt side, 15.8.2018 29.8.2018 Moderate
Halitosis present.
101
6 2197 A.RITHICK 7/MC 14 Snoring. 27.8.2018 10.9.2018 Good
present.
7 2198 A.MANO AADHVICK 9/MC 4 Fever. 27.8.2018 10.9.2018
Good
Halitosis present.
S.SRI
8 2244 5/FC 15 Difficult to breath, Rt ear pain, Constipation. 01.9.2018 15.9.2018 Good
MAHALAKSHMI
Halitosis present.
9 2431 KRITHIGA 8/FC 5 Snoring. 26.9.2018 10.10.2018
Good
present.
10 2465 S.MAHESHWARAN 10/MC 5 Fever. 29.9.2018 13.10.2018
Good
Halitosis not present.
11 2835 S.AKIM 6/MC 20 19.11.2018 2.12.2018
O/E, Cervical lymphadenitis on Lt side, Good
102
12 169 N.ISTHAR PARK 8/FC 10 Snoring. 26.1.2019 09.2.2019
Moderate
present.
S.ABINAYA
13 171 10/FC 7 Fever. 26.1.2019 09.2.2019 Moderate
SARASWATHY
14 225 IRPHANA 12/FC 15 Difficult to breath, Rt ear pain, Constipation. 01.2.2019 14.2.2019 Good
15 369 JEFRIN 9/MC 12 Snoring. 14.2.2019 27.2.2019 Good
present.
16 370 JESLIN 5/FC 5 Fever. 14.2.2019 27.2.2019 Moderate
Halitosis present.
17 680 JOSEPH 9/MC 8 16.3.2019 29.3.2019 Good
103
18 681 FENISTA 5/FC 12 Snoring. 16.3.2018 29.3.2018 Good
present.
19 688 ANUSHYA 12/FC 7 18.3.2019 01.4.2019 Good
Fever. O/E, Cervical lymphadenitis, Halitosis
not present.
20 689 POORVIKA 7/FC 10 Difficult to breath, Rt ear pain, Constipation. 18.3.2019 01.4.2019 Good
present.
From this study, Out of 20 Patients 14 Patients (70%) had good Relief, 6 Patients (30%) had moderate relief.
104
THROAT SWAB CULTURE : 20 INPATIENTS OF LASUNATHABITHAM
Before Treatment After Treatment

S.No IP.No Name Age/Sex
Present Culture (Micro organism In Throat) Present Culture
1 1409 L.VISHNU 12/MC Streptococcus pneumonia Nil
2 1410 L.ELAKKIYA 7/FC Streptococcus pneumonia Nil
3 2062 S.RATHINAVEL 5/MC Streptococcus pneumonia Nil
4 2061 S.INDHU 9/FC Streptococcus pneumonia Nil
5 2089 M.KAVIYA 6/FC Staphylococcus aureus Nil
6 2197 A.RITHICK 7/MC Streptococcus pneumonia Nil
7 2198 A.MANO AADHVICK 9/MC Staphylococcus aureus Nil
8 2244 S.SRI MAHALAKSHMI 5/FC Streptococcus pneumonia Nil
9 2431 KRITHIGA 8/FC Streptococcus pneumonia Nil
10 2465 S.MAHESHWARAN 10/MC Streptococcus pneumonia Nil
11 2835 S.AKIM 6/MC Staphylococcus aureus Nil
12 169 N.ISTHAR PARK 8/FC Streptococcus pneumonia Nil
13 171 S.ABINAYA SARASWATHY 10/FC Streptococcus pneumonia Nil
14 225 IRPHANA 12/FC Streptococcus pneumonia Nil
15 369 JEFRIN 9/MC Streptococcus pneumonia Nil
16 370 JESLIN 5/FC Staphylococcus aureus Nil
17 680 JOSEPH 9/MC Streptococcus pneumonia Nil
18 681 FENISTA 5/FC Streptococcus pneumonia Nil
19 688 ANUSHYA 12/FC Streptococcus pneumonia Nil
20 689 POORVIKA 7/FC Streptococcus pneumonia Nil
105
ABSOLUTE EOSINOPHIL COUNT
Before Treatment AfterTreatment

S.No IP No Name Age/Sex
Cells/Cu mm Cells/Cu mm
1 1409 L.VISHNU 12/MC 360 320
2 1410 L.ELAKKIYA 7/FC 400 360
3 2062 S.RATHINAVEL 5/MC 410 310
4 2061 S.INDHU 9/FC 350 290
5 2089 M.KAVIYA 6/FC 340 300
6 2197 A.RITHICK 7/MC 410 310
7 2198 A.MANO AADHVICK 9/MC 380 290
8 2244 S.SRI MAHALAKSHMI 5/FC 420 330
9 2431 KRITHIGA 8/FC 390 240
10 2465 S.MAHESHWARAN 10/MC 450 360
11 2835 S.AKIM 6/MC 210 210
12 169 N.ISTHAR PARK 8/FC 480 290
13 171 S.ABINAYA SARASWATHY 10/FC 350 200
14 225 IRPHANA 12/FC 440 310
15 369 JEFRIN 9/MC 360 250
16 370 JESLIN 5/FC 380 170
17 680 JOSEPH 9/MC 510 400
18 681 FENISTA 5/FC 450 300
19 688 ANUSHYA 12/FC 390 210
20 689 POORVIKA 7/FC 420 280
106
HEMATOLOGICAL INVESTIGATIONS : 20 OUT PATIENTS OF LASUNATHABITHAM
HEMATOLOGICAL INVESTIGATIONS
S.NO OP NO Name of the patient Before Treatment After Treatment
TCL DC% ESR TCL DC% ESR mm
Cumm mm HB Cum HB
P L E ½ 1 gms% m P L E ½ 1 hr gms%
hr hr hr
1 4350 Selvaharish 7800 61 30 9 12 24 10.4 7600 59 34 7 4 8 10.8
2 44044 Oviya 8200 57 33 10 2 4 11.2 8200 56 35 9 2 4 11.5
3 45085 Esakkimuthu 7900 55 34 11 12 24 10.4 8100 52 40 8 7 14 11
4 47747 K.Priya 8400 53 38 9 14 27 10.8 8300 54 40 6 7 14 10.5
5 48075 Dhivya 8200 56 36 8 9 18 10 8200 57 37 6 5 10 10.7
6 48377 Senthamizh 8900 57 33 10 12 24 11.4 8600 52 46 2 3 6 11.4
7 54082 Palanisaranya 7000 66 30 4 5 10 10.7 7100 65 30 5 4 8 11.3
8 55525 Saja 8300 56 32 12 3 6 9.5 8200 61 33 6 2 5 10.9
9 60699 Serina 8200 56 41 3 4 9 10.4 8200 56 41 3 2 4 11
10 60670 Suriya 8100 51 45 4 3 6 11 8000 55 45 3 3 6 11.6
11 61601 Esakki srinivasan 7800 56 44 2 3 7 10.8 7700 56 42 4 2 4 11.2
12 62836 Sabia 8300 51 34 15 5 10 10 8200 56 34 10 4 8 10.8
13 63351 Syyed alifathima 8100 56 31 13 4 9 11 8000 57 34 9 3 6 10.6
14 67189 Siddhika 9800 78 20 2 7 15 8.5 9800 61 35 4 4 7 9
15 69695 Bency 8100 57 37 6 10 20 9.8 8000 57 38 5 8 16 10
16 78642 Mathan 8500 51 45 4 4 7 10.2 8500 52 45 5 4 8 10.6
17 79266 Maharajan 8600 50 40 10 9 18 11.2 8500 51 42 7 5 10 11.6
18 79395 Muralidharan 7800 50 48 2 6 12 12.1 7800 52 46 2 4 8 12.3
19 79418 Vadivu 8000 52 42 6 11 22 10.2 8000 56 41 3 7 14 11.8
20 81488 Keerthana 7600 56 36 8 12 25 11.9 7600 58 36 6 8 16 12
107
INVESTIGATIONS OF 20 OUT PATIENTS OF LASUNATHABITHAM
URINE ANALYSIS MOTION ANALYSIS

S.NO OP NO. Name of the patient Before Treatment After Treatment BeforeTreatment After Treatment
Alb Sug Dep Alb Sug Dep Ova Cyst Ova Cyst
1 4350 Selvaharish Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
2 44044 Oviya Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
3 45085 Esakkimuthu Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
4 47747 K.Priya Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
5 48075 Dhivya Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
6 48377 Senthamizh Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
7 54082 Palanisaranya Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
8 55525 Saja Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
9 60699 Serina Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
10 60670 Suriya Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
11 61601 Esakki srinivasan Nil Nil 1-2 Epithelial cells Nil Nil NAD Nil Nil Nil Nil
12 62836 Sabia Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
13 63351 Syyed alifathima Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
14 67189 Siddhika Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
15 69695 Bency Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
16 78642 Mathan Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
17 79266 Maharajan Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
18 79395 Muralidharan Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
19 79418 Vadivu Nil Nil 1-2 pus cells Nil Nil NAD Nil Nil Nil Nil
20 81488 Keerthana Nil Nil NAD Nil Nil NAD Nil Nil Nil Nil
108
Case Report : 20 outpatients of Lasunathabitham
S.No OP.NO PATIENT NAME AGE/SEX No.of days treated Result

1 4350 Selvaharish 12/MC 14 Moderate
2 44044 Oviya 8/FC 14 Good
3 45085 Esakkimuthu 12/MC 18 Moderate
4 47747 K.Priya 12/FC 14 Good
5 48075 Dhivya 8/FC 12 Good
6 48377 Senthamizh 7/MC 14 Good
7 54082 Palanisaranya 9/FC 14 Good
8 55525 Saja 7/FC 14 Good
9 60699 Serina 9/FC 14 Good
10 60670 Suriya 7/MC 11 Good
11 61601 Esakki srinivasan 5/MC 14 Moderate
12 62836 Sabia 7/FC 10 Good
13 63351 Syyed alifathima 10/FC 14 Good
14 67189 Siddhika 8/FC 10 Good
15 69695 Bency 5/FC 8 Good
16 78642 Mathan 11/MC 14 Moderate
17 79266 Maharajan 12/MC 8 Good
18 79395 Muralidharan 12/MC 20 Good
19 79418 Vadivu 5/FC 14 Good
20 81488 Keerthana 7/FC 10 Good
109
10. DISCUSSION
Lasunathabitham is one of the Respiratory problem in paediatric age group,
the clinical features of which are clearly described in various siddhar’s text. This
disease most probably correlates with Tonsillitis in modern science.
In this study 40 cases were treated at the post graduate department of
Kuzhandhai Maruthuvam. Siddha methods of diagnosis were carried out and recorded
in the selection proforma, and the diagnosis was confirmed with the help of modern
investigations. The patients were treated with the drug Sugantha Malli Chooranam
and clearly observed. The results and observations are discussed here.
1. Distribution according to age:
This study indicates the children’s under the age group of 5 to 12 years were
commonly affected, since they contributed to school going age group,
overpopulation of the children had high extent of tonsillar infection.
2. Distribution according to sex:
Among 40 cases of study 60% were female children and 40% were male
children.
3. Distribution according to socio economic status:
The patients affected by Lasunathabitham, 25% of cases belonged to low
income group and 75% of cases belonged to middle income group. Due to
poverty, overpopulation and unhygienic practices which are all of this disease was
more prevalent among the poor and the middle class.
4. Distribution of paruva kaalangal:
According to paruva kaalangal the highest distribution of cases 35% was
noticed in Kaar kaalam and 25% of patients were affected in Muthuvenil kaaalam.
5. Diet history:
According to diet history, 80% of cases had mixed diet and 20% had
vegetarian diet. The highest incidence of cases were observed in mixed diet of
food habits.
6. Family History:
According to family history, 90% of the cases had negative family history, and
10% of the case had positive family history. The higher incidence of cases had no
relvant family history.
110
7. Distribution of Land:
Among the selected cases 80% of them were from Marutham land and 20% of
them were from Neithal land. According to the siddha concept Marutham land does
not produce any disease. But due to altered life style and environmental condition the
incidence of this disease occurs in land of Marutham and Neithal land.
8. Distribution according to Uyir thathukkal:
a) Derangement of Vatham:
Due to derangement of vatham, the following symptoms may occur. Pranan
was deranged in 100% of cases and it causes difficulty in breathing. Abanan (30%)
causes constipation in some patients. Viyanan (100%) causes fatigue, Uthanan
(100%) causes cough and wheezing in some patients. Samanan (100%) causes
difficult in controlling other vathams, Kirukaran was deranged in 100% of cases,
cause loss of appetite, cough, running nose and Devathathan (100%) cause tiredness
in some cases.
b) Derangement of Pitham:
Anilapitham was deranged in 30% of patients causing indigestion.
Ranjakapitham was deranged in 30% of patients due to malnutrition and pallor,
Saathapitham was dearanged in 100% of patients causing limitations in their daily
physical activities.
c) Derangements of Kabam:
Due to derangements of Kabam, Avalambagam was deranged in 100% of
patients causing difficulty in breathing.
9. Distribution according to Ezhu Udal Kattugal:
In ezhu udal kattugal, saaram (100%) senneer (30%), oon (100%) were
affected causing General Fatigue, Anaemia, and swelling of the tonsils.
10. EnVagai Thervugal:
According to this study, 45% of cases had pithakabam naadi, 35% of cases
had kabapitha naadi, 10% 0f cases had pithavatha naadi5% of cases had vathapitha
naadi 5% of cases had kabavatha naadi. Sparisam was affected in 25% of cases
(Fever), Naa was affected in 30% of cases (coated and pallor) Niram was altered in
100% of cases due to Redness of Tonsil. Mozhi was affected in 100% of cases due to
hoarseness of voice, vizhi was affected in 30% of patients due to pallor. Malam was
altered in 30% due to constipation and Mothiram was not altered in any cases.
111
11. Nei Kuri:
In this study most of the patients had Kaba Neer (52.5%) which stood as a
pearl indicating that the most predominant manifestation of the lasunathabitham is
Kabam.
12. Distribution according to aetiological factors:
Intake of cold food stuff, cooldrinks, Ice cream, etc., contribute to 87.5% of
cases. Seasonal variations contribute to 75%, Drinking contaminated water contribute
to 50% of cases and Living in congested areas, using same vessels by many,
contribute to 25% of cases.
13. Distribution of clinical features:
Before treatment almost all cases (100%) were presented with sore throat,
redness and swelling of the tonsil and after treatment it was reduced to 10%. Before
treatment, 87.5% of cases had cough and after treatment it reduced to 5%. Before
treatment, 87.5% of cases had dysphagia and hoarseness of voice, after treatment it
reduced to 5%. Before treatment, 75% of cases had cervical lymphadenitis and after
treatment it reduced to 7.5%. Before treatment, 35% of patients had Nasal congestion
and Nasal discharge and after treatment it reduced to 2.5%. Before treatment 50% of
patients had fever and after treatment it reduced to 2%. Before treatment, 37.5% of
patients had constipation and after treatment it reduced to 1%. Before treatment, 5%
of cases had Nausea and 25% of cases had Halitosis and after treatment it reduced to
0%. Before treatment, 12.5% of cases had headache and after treatment it reduced to
0% .Almost all the signs and symptoms were decreased after treatment
14. Lab Investigations:
Routine Examination of blood, urine and motion were done before and after
treatment. In blood investigation most of the cases (75%) elevated ESR and
eosinophil count was decreased after treatment.
Throat swab were don on before and after treatment. In most of the cases
streptococcus pneumoniae were present in throat swab. After treatment there
is no bacterial growth in throat swab culture.
15. Biochemical Analysis:

Qualitative analysis of the trial drug Sugantha Malli Chooranam revealed
the presence of ferrous iron which is more soluble and readily absorbable form
that in treating children who are associated with anaemia. The study also indicates
112
the presence of Calcium, Sulphate, Chloride, Starch, Reducing Sugar and Amino
acid etc., which are all brings about the therapeutic action in bone mineralisation,
electrolyte balance, muscle growth, enhancement of haemoglobin level, kills the
pathogen like virus and bacteria, wound healing activity and regulate the immune
system in body.
16. Antibacterial Activity:
Antibacterial activity of Sugantha Malli Chooranam showed that it inhibited the
growth of bacterial strains of Staphylococci aureus, Streptococci pneumoniae,
Pseudomonas aeruginosa and Escherichia coli.
17. Pharmacological Analysis:
Pharmacological Analysis showed the trial drug Sugantha Malli Chooranam
has significant Anti – inflammatory and Analgesic activity.
18. RESULT:
Satisfactory improvement was reported in 14 days of commencement of
treatment. Out of 40 cases 30 patients (75%) showed Good response with
remarkable relief of symptoms, frequency of similar episodes is reduced. Moderate
result was observed in 10 cases (25%) with decreased in signs and symptoms.
113
11. SUMMARY
The aim of this dissertation subject is to assess the efficacy of trial drug
“Sugantha Malli Chooranam” for “Lasunathabitham” without any adverse
effects.
Sufficient literatures with reference to Lasunathabitham was not found in siddha
system. Hence from the available texts, signs, symptoms and characteristic
features were collected and the medicine was choosen for the study.
The Etiopathogenesis and symptoms of Lasunathabitham have been correlated
with that of Tonsillitis with evidence of literature.
Clinical diagnosis and selection of cases was based on clinical features
described in Kuzhanthai Maruthuvam text book.
Laboratory diagnosis was done by modern methods of examination.
20 cases were selected and treated in IPD, Department of Kuzhanthai
Maruthuvam, Government siddha medical college and hospital, Palayamkottai
for the clinical study.
The medicine choosen for treatment and management of Lasunathabitham was
Sugantha Malli Chooranam (2 gms) Internal, thrice a day.
The trial drug selection is based on its siddha pathological and pharmacological
action to rectify the deranged Mukuttram and also due to its Anti-inflammatory,
Analgesic effect of ingredients.
All the children were kept under strict dietary control during the treatment. The
observation on effect of therapy was encouraging.
The documentation of observation made during the clinical study showed that
the drug Sugantha Malli Chooranam is clinically effective.
The Biochemical analysis of the trial drug had ferrous iron which adds to the
clinical prognosis of Lasunathabitham by Sugantha Malli Chooranam. The
study also indicates the presence of Calcium, Sulphate, Chloride, Starch,
Reducing Sugar and Amino acid etc., which are all brings about the therapeutic
action in bone mineralisation, electrolyte balance, muscle growth, enhancement
of haemoglobin level, kills the pathogen like virus and bacteria, wound healing
activity and regulate the immune system in body.
114
Anti bacterial activity of Sugantha Malli Chooranam showed that it resistant the
growth of bacterial strain against Staphylococci aureus, Streptococci
pneumoniae, Pseudomonas aeruginosa and Escherichia coli.
In pharmacological analysis, the trial medicine Sugantha Malli Chooranam had
siginificant Anti – inflammatory, Analgesic action which help to improve the
patients quality of life.
With there benefits “Sugantha Malli Chooranam” can be deemed as an effective
drug for “Lasunathabitham” (Tonsillitis).
115
12. CONCLUSION
The Global burden of Tonsillitis in children increasing prevalence and its
impact in reducing the quality of life in children has prompted the author to
choose an effective drug without any side effects, it is believed to improve
the quality of life in children.
The trial drug is safe to the children.
The treatment of Lasunathabitham with Sugantha Malli Chooranam has
showed Good response with no adverse effect and ensure to be safe, effective
and simple to administration.
The trial drug Sugantha Malli Chooranam is in easy form of preparation.
The ingredients of trial drug are feasible and useful, these compounds may
serves as potentially useful drug at lower cost.
Clinical results were found to be significant good improvement was found in
75% of cases, Moderate in 25% of cases.
Therefore it is concluded that the trial drug “Sugantha Malli
Chooranam” along with the modalities of Pranayama proves to be excellent
in attack the tonsillitis among children.
116
13.BIBLIOGRAPHY
SIDDHA LITERATURE:
1. Srirangam – Siddha Vaithiyar S. Veeraperumal pillai Nam Nattu Vaithiyam
Part – II p182, Published by Shanmuganantha Book Dipo, Chennai, First
Edition.
2. Murugesa Mudaliar K.S Text book of Materia Medica (Gunapadam)
Mooligai, Published by Department of Indian Medicine and Homeopathy,
Chennai (2008).
3. K.S Murugesa Mudaliar, Dr. Pon.Gurusironmani Balavagadam, Published by
Department of Indian Medicine and Homeopathy, Chennai. Fifth Edition
(2016).
4. Anonymous Sarakku Suthi Muraigal, Siddha Maruthuva Nool Veliyita Pirivu
Indian Medicine and Homeopathy Department, Chennai. First Edition (2008).
5. Dr.S.Somasundharam Taxonomy of Angiosperms Fourth Edition (2011),
Ilangovan Pathippagam, Tirunelveli.
6. Pharmacy and Pharmaceutics of Siddha Medicine National Institute of Siddha
(2016)
7. T.V Sambasivampillai, Tamil – English Dictionary volume – IV, Published by
Department of Indian Medicine and Homeopathy, Chennai.
8. Tamil – Lexicon Agarathi volume – IV
9. Dr. R. Thiyagarajan L.I.M, Udalkoorugal, Published by Department of Indian
Medicine and Homeopathy, Chennai. Third Edition (2007).
10. Dr. R. Thiyagarajan L.I.M, Gunapadam Thathu – Jeeva vaguppu, Published by
Department of Indian Medicine and Homeopathy, Chennai. Eigth Edition
(2013).
11. Sri. K. Vasudeva Sashthri B.A, Dr.S. Vengada Rajan L.I.M, Sarabendhra
Vaithiya Muraigal (Siroroga sigitchai), Published by Director, Saraswathi
Mahal Noolagam, Third Edition July (2003).
12. Dr. A. Sundhararasan B.I.M, Pillaipini Maruthuvam, Published by Department
of Indian Medicine and Homeopathy, Chennai.
13. Dr. S. Vengadarajan L.I.M, Dhanvanthiri Vaithiyam, Published by Director,
Saraswathi Mahal Noolagam, First Edition, October (1990).
117
14. Dr. T. Mohana Raj, Madhalai Noi Thoguthi – II, Published by A.T.S.V.S
Siddha College and Hospital, Munsirai, Kanniyakumari (Dt).
15. Dr. K. Anbarasu B.S.M.S, Yugimuni Vaithiya Sinthamani 800, Second
Edition, July (2013).
16. Dr. M. Shanmugavelu H.P.I.M, Siddha Maruthuva Noinadal Noimudhalnadal
Thirattu Part - I, Published by Department of Indian Medicine and
Homeopathy, Chennai. First Edition, (Reprint:2014).
17. Dr. S. Arangarasan 4448 Viyathigal.
18. Dr. K. S. Uthamarayan, Siddhar Aruvai Maruthuvam, Published by
Department of Indian Medicine and Homeopathy, Chennai. First Edition,
(Reprint:2013).
19. Dr. S. Chithambarathanu pillai, Kuzhanthai Kann – Sevi – Thondai
Marithuvam, Published by, Siddha Medical Literature Research Center, Anna
Nagar, Chennai. First Edition (2004).
20. Subramania Pandithar – Jeevaratchamirtham.
21. Dr. S. Sivashanmugaraja B.S.M.S (S.I), MD(S) (INDIA), Pararasasekara
Vaithiyak Kaiyedu – Piniarithal, Siddha Maruthuva Valarchi Kalagam,
Yazhppanam (2016).
22. Dr. S. Sivashanmugaraja B.S.M.S (S.I), MD(S) (INDIA), Kuzhanthai
Maruthuvam, Siddha Maruthuva Valarchi Kalagam, Yazhppanam. First
Edition (2013)
23. Dr. K. N. Kuppusamy Mudaliar H.P.I.M, Siddha Maruthuvam (Pothu),
Published by Department of Indian Medicine and Homeopathy, Chennai. First
Edition, (Reprint:2012).
24. Dr. K. S. Uthamarayan H.P.I.M, Siddha Maruthuvanga Surukkam, Published
by Department of Indian Medicine and Homeopathy, Chennai. First Edition,
(Reprint:2006).
25. Dr. M. Shanmugavelu H.P.I.M, Noigalukku Siddha Parigaram Part - I,
Published by Department of Indian Medicine and Homeopathy, Chennai.
Fourth Edition, (2004).
26. Dr. K. S. Uthamarayan H.P.I.M, Thotrakkirama Aarayichiyum Siddha
Maruthuva Varalarum, Published by Department of Indian Medicine and
Homeopathy, Chennai. First Edition, (Reprint:2016).
27. A. K. Nadkarni – Indiam Materia Medica.
118
28. Wealth of India.
29. Dr. Durairasan, Noi Illa Neri, Published by Department of Indian Medicine
and Homeopathy, Chennai. First Edition.
30. Theran – Gunavagadam.
MODERN LITERATURE:
1. Richard L. Druke PhD, A. Wayne Vogl PhD, Adam W.M. Mitchell MBBS,
FRCS, FRCR, GRAY’S Anatomy, Second Edition (2010).
2. Kliegman, Stanton, St. Geme, Schor & Behrman Nelson Textbook Of
Pediatrics, Nineteenth Edition.
3. Vinod K Paul, Arvind Bagga GHAI Essential Pediatrics, CBS Publishers &
Distributers, New Delhi. Eighth Edition (2013).
4. R. Ananthanarayan, C.K Jayaram Paniker, Text Book Of Microbiology,
Nineth Edition (2013).
5. Brian R.Walker, Nicki R.Colledge, Stuard H. Ralston, Ian D. Fenman,
Davidson’s Principles & Practice Of Medicine, Twenty Second Edition
(2014).
6. Inderbir Singh, Text Book Histology, Published by Jaypee Brothers Medical
Publishers (P) Ltd. Fifth Edition (2006).
7. Fauti, Braunwald, Kasper, Hauser, Longo, Jameson, Loscalzo Harrison’s
Principles Of Internal Medicine Volume I, Seventeenth Edition (2008).
8. PL Dhingara MS, DLO, MNAMS, Shruthi Dhingara MS (MAMC), Disease
Of Ear, Nose and Throat, Published by Reed Elsevier India Private Limited.
Fifth Edition (2010).
9. Mohammed Maqbool MBBS, DLO, MS FICS, Suhail Maqbool MBBS, MS,
Text Book Of Ear, Nose, and Throat Diseases, Published by Jaypee Brothers
Medical Publishers (P) Ltd, Eleventh Edition (2007).
10. Robbins and Lotran, Pathologic Basis Of Disease, Published by Reed Elsevier
India Private Limited. Eighth Edition (2012).
11. Pediatric Otolaryngology - Ferguson, Kendig, W.B. Saunders Text Book Of
Ear, Nose, Throat and Head & Neck Surgery P.Hazarika Third Edition (2013).
119
ANNEXURE - I
i
ii
iii
iv
v
vi
vii
viii
ix
x
xi
xii
xiii
xiv
ANNEXURE - II
GOVERNMENT SIDDHA MEDICAL COLLEGE & HOSPITAL
PALAYAMKOTTAI
POST GRADUATE DEPARTMENT OF KUZHANTHAI MARUTHUVAM
PRECLINICAL AND CLINICAL STUDY ON “LASUNATHABITHAM” –
A PEDIATRIC DISORDER AND THE DRUG OF CHOICE IS
Form 1-SCREENING & SELECTION PROFORMA
1. S.I.No: 2.OP/IP No: 3.Name:
4. Age: 5.Gender: 6.Date of Enrollment:
7. Date of Completion: 8. Information:
INCLUSION CRETERIA: YES NO
• Age 5-12 years.
• Sex - Male and Female Children
• Throat pain
• Dysphagia
• Hoarseness of voice
• Enlarged tonsils
• Referred pain in the ear
• Malaise
• Mild Fever with tonsillitis
EXCLUSION CRITERIA:
• Congenital anomaly of pharynx
• Known case of pulmonary Tuberculosis
• Physiological hyperplasia of lymphoid follicles
• Mailgnancy
• Tonsillitis which have indication for surgery
Signature of Guide: Signature of Investigator:
Signature of HOD:
xv
PALAYAMKOTTAI
PRECLINICAL AND CLINICAL STUDY ON “LASUNATHABITHAM”-
A PEADIATRIC DISORDER AND THE DRUG OF CHOICE IS
FORM IA – HISTORY PROFORMA ON ENROLLMENT
Patient id: OP/IP NO. VISIT DATE (___/____/_____)

NAME :
AGE:
Gender: MALE FEMALE Date Of Birth :( ____/____/_____)
Fathers/Mother/Guardian name :
Fathers Occupation:
Fathers Monthly income:
Religion:
Socioeconomic status:
Patient informant :
Postal Address
Contact no :
1. Complaints and duration
2. Present illness
xvi
History of past Illness
History /Symptoms /Signs Yes No if, Yes Details
Any Similar Complaints _____________
Bronchial Asthma _____________
Dust Allergy _____________
Hospitalization _____________
Any Other _____________
Family History
Any hereditary familial Disease Yes No
If yes, details…………………………………………………………………………..
Immunization History
Proper Immunization given Yes No ……………………..
Food Habits:
1. Veg 2. Non-Veg 3. Mixed
General assessment Yes No

1. Picca
2. Nail Biting
3. Bowel Movements
General Examination Yes No

1. Pallor
2. Jaundice
3. Cyanosis
4. Clubbing
5. Pedal oedema
6. Lymph adenopathy
Vital signs:-
1. Pulse rate / mint
xvii
2. Heart rate / mint
3. Respiratory Rate / mint
4. Temperature
5. BP
Anthropometry:
Height
Weight
Head Circumference
Chest Circumference
Mid Arm Circumference
CLINICAL EXAMINATION:
Other Systems: Normal Affected
Cardio Vascular system:
Gastro intestinal system:
Masculo skeletal system:
Central nervous system:
Endocrine system:
Nilam:
Kurinji Mullai Marutham Neithal Paalai
Kaala Iyalbu
Kaarkalam Koothirkaalam Munpanikaalam
Pinpanikaalam Illavenikaalam Muthuvenrkaalam
Yaakai
Vatham Vatha Pitham Vatha Kabam
Pitham Pitha Vatham Pitha Kabam
Kabam Kaba Vatham Kaba Pitham
xviii
Uyir Thathukkal
Vatham
Normal Affected Remarks
Pirannan
Abanan
Uthanan
Viyanan
Samanan
Nagan
Koorman
Kirujaran
Devathathan
Dhanajeyan
Pitham
Analam
Ranjagam
Saathagam
Alosagam
Prasagam
Kabam
Avalambagam
Kilethagam
Pothngam
Tharpagam
Santhigam
xix
Udalthathukkal
Saaram
Senneer
Oon
Kolupu
Enbu
Moolai
Sukilam/Suronitham
Envagai Thervugal
Naa
Niram
Mozhi
Vizhi
Sparisam
Malam
Niram
Edai
Erugal
Elagal
Moothiram
Neerkuri:
Niram Normal Affected
Edai Normal Affected
Nurai Normal Affected
Manam Normal Affected
Enjai Normal Affected
xx
Neikuri:
Vatham
Pitham
Kabam
Others
Naadi:
Thani Nadi
Vadhan Pitham Kabam
Thontha Nadi
Vatha Pitham Pitha vatham Pitha Kabam Kaba pitham
Diagnosis__________________________________
Admitted to trial : 1. Yes 2. No.
if yes, S.No: 1IP 2.OP
Diagnosis:
DRUG ISSUED:______________
Date :________________________
Station _______________________
Date :
Signature of the Guide Signature of Principal Investigator:
Signature of the HOD
xxi
GOVERNMENT SIDDHA MEDICAL COLLEGE AND HOSPITAL
BRANCH IV – KUZHANTHAI MARUTHUVAM
PALAYAMKOTTAI - 627 002.
FORM-IB: CASE SHEET PROFORMA-“LASUNATHABITHAM”
I.P.No : Nationality:
Bed. No : Religion:
Name of the Medical unit: Occupation (Parents):
Name : Income:
Age/Sex: Date of Admission:

Religion:
Permanent Address:
Date of Discharge:
Diagnosis:
Temporary Address:
PG-Pediatric Ward - IPD, Government
Siddha Medical College and Hospital,
Palayamkottai.
Informant:
Invesitgator:
Medical Officer:
xxii
Complaints and duration :
History of present illness :
History of past illness :
Personal History:
Family History:
Consanguinity :
Ataxia :
Blindness :
CP :
MR :
Seizure :
Movement disorder :
Deafness :
Socio-Economic Status:
Habits:
Bowel and micturation habit :
Sleep :
Enuresis :
Thumb sucking :
Nail biting :
Pica :
xxiii
Diet History :
Appetite :
Types of diet :
Antenatal History :
Medication :
Infection (STARCH) :
Irradiation :
Toxaemia :
Hemorrhage :
Severe Anaemia :
Eclampsia :
H/o Decreased foetal Movements :
Maternal malnutrition :
Maternal Diabetes Mellitus(DM) :
Maternal Hypertension :
Natal:
Breech presentation :
Forceps / - C- Section :
Home / Hospital :
H/o prolonged labour :
Post Natal
Post partum Haemorrhage :
Sepsis :
xxiv
Neonatal History:
Birth Weight :
Term / Pre term baby :
Congenital malformations :
Birth Asphyxia – APGAR – Score :
Neonatal convulsions :
Kernicterus :
Diarrhoea :
Birth injury / Head injury / Activity of the child
a) at birth :
b) after birth :
Time of cry after birth :
Resusscitation done or not :
(if done nature of resusscitation)
Respiratory distress / cyanosis :
Fever / altered sensorium :
Feeding after birth :
Lymphadenopathy :
Developmental History :
Immunization History :
General Examination
Anthropometry:
Height :
Weight :
Head Circumference :
Chest Circumference :
Mid Arm Circumference :
xxv
1. Consciousness :
2. Decubitus :
3. Anemia :
4. Jaundice :
5. Cyanosis :
6. Clubbing :
7. Pedal oedema :
8. Lymphadenopathy :
9. Nourishment :
10. Skin changes :
11. Edema:
12.JVP:
13.Pulse Rate:
14.Heart Rate:
15.Respiratory Rate:
16.Temperature:
17.Blood Pressure:
18.Spine:
19.Skin:
Systemic Examination
Cardio Vascular System:
Respiratory System:
Gastro Intestinal System:
Genito Urinary System:
Nervous System:
Consciousness:
Temper Tantrum: Sociable- Irritable - Playful
Memory:
Orientation:
Speech:
Intelligence (I.Q):
Handedness:
Cranial Nerve Examination:
xxvi
Motor System:
Power:
Tone:
Reflex:
Grip:
Gate:
Sensory Examination:
Superficial Sensation:
Touch:
Pain:
Temperature:
Deep Sensation:
Position sense:
Joint sense:
Vibration sense:
Cortical Sensation:
Cerebellar Signs:
Autonomic System:
Siddha Systems – Clinical Examination:

Nilam
Kurinchi :
Mullai :
Marutham :
Neithal :
Palai :
xxvii
Paruva Kaalam
Kaar :
Koothir :
Munpani :
Pinpani :
Elavenil :
Muthuvenil :
Uyir thathukal:
Vatham
Piranan :
Abaanan :
Uthaanan :
Viyaanan :
Samaanan :
Naagan :
Koorman :
Kirugaran :
Devathathan :
Dhananjeyan :
Pitham
Analam :
Ranjagam :
Sathagam :
Alosagam :
Pirasagam :
Kabam
Avalambagam :
Kilethagam :
Pothagam :
Tharpagam :
Santhigam :
xxviii
Udal Kattugal
Saaram :
Senneer :
Oon :
Kozhuppu :
Enbu :
Moolai :
Sukkilam/Suronitham :
Ennvagai Thervugal
Naadi :
Sparisam :
Naa :
Niram :
Mozhi :
Vizhi :
Malam :
Moothiram :
Neerkuri
Niram :
Manam :
Nurai :
Edai :
Enjal :
Neikuri
Malakuri
Nirami :
Nurai :
Edai :
Erugal :
Elagal :
xxix
Lab Investigations
1. Blood
TC :
DC :
Hb :
ESR :
Total RBC Count ......................................... Cells / cu.mm
Absolute Eosinophil Count :
Differential Count
P___% L___% E___% M___% B___%
2. Urine
Albumin :
Sugar :
Deposits :
3. Motion
Ova :
Cyst :
Occult blood :
3. Other Investigation :
Throat Swab Culture :
xxx
DIFFERNTIAL DIAGNOSIS :
PROGNOSIS :
MARUTHUVAMURAI :
ADVICE :
DAILY PROGRESS :
Date Symptoms Medicine
xxxi
PALAYAMKOTTAI
FORM-II & IIA PRE-CLINICAL AND CLINICAL STUDY ON

“LASUNATHABITHAM”- A PEDIATRIC DISORDER AND THE DRUG OF CHOICE
IS SUGANTHA MALLI CHOORANAM
CLINICAL ASSESMENT ON ENROLLMENT DURING AND AFTER TRIAL

S.I.No: …………. OP/IP No: ………… Name: ………………
Age: ……………. Gender: ………….. Date of Enrollment: ………….
Date of Completion :…………. Informant: …………. Reliability : ……………
SIDDHA SYSTEM OF EXAMINATION
I.ENVAGAI THERVU: [EIGHT-FOLD EXAMINATION]
1.NAADI: [PULSE PERCEPTION]
2.NAA:[TONGUE]
1 Maa Padithal (Coated tongue) :
2. Naavin Niram (Colour of the tongu :
3. Suvai (Taste Sensation) :
4. Vedippu (Fissure) :
5. Vai Neer Ooral (Salivation) :
6. Deviation :
7. Pigmentation :
xxxii
3.NIRAM: [COMPLEXION]
4.MOZHI: [VOICE]
5.VIZHI: [EYES] (Lower palpebral conjunctiva)
6.MALAM; [BOWEL HABITS / STOOLS]
7. MOOTHIRAM [URINE EXAMINATION]
NEERKURI 1st Day 5th Day 7th Day 14th Day

Niram White/ White/ White/ White/
[Colour] Yellowish/ Yellowish/ Yellowish/ Yellowish/
Straw Straw Straw Straw
coloured/ Coloured/ coloured/ coloured/
Crystal Crystal Crystal Crystal
Clear clear Clear clear
Manam[Odour] Present/ Absent Present/ Absent Present/ Absent Present/ Absent
Nurai [Froth] Nil/Reduced/ Nil/Reduced/ Nil/Reduced/ Nil/Reduced/

Increased Increased Increased Increased
Edai Normal/ Normal/ Normal/ Normal/
[Sp.gravity] Increased/ Increased/ Increased/ Increased/
Reduced Reduced Reduced Reduced
Enjal [Deposits] Present/ Absent Present/ Absent Present/ Absent Present/ Absent
Volume Normal/ Normal/ Normal/ Normal/

Increased/ Increased/ Increased/ Increased/
Reduced Reduced Reduced Reduced
NEIKURI 1st Day 5th Day 7th Day 14th Day

Serpentine fashion
Annular/Ringed fashion
Pearl beaded fashion
Mixed fashion
xxxiii
8.SPARISAM: [PALPATORY PERCEPTION]
II.THEGI: [TYPE OF BODY CONSTITUTION]
Vatham predominant Kabam predominant

Pitham predominant Thondha udal
III.NILAM: [ LAND WHERE PATIENT LIVED MOST]
Kurinji Mullai Marutham Neithal Palai

(Hilly terrain) (Forest range) (Plains) (Coastal belt) (Arid regions)
IV.KAALAM:
Kaarkalam - Pinpanikalam -
Koothirkalam - Ilavenil -
Munpanikalam - Muthuvenil -
V.MUKKUTRAM:[AFFECTION OF THREE HUMORS]

A)VATHAM:
1st Day 5th Day 7th Day 14th Day
Praanan
Abaanan
Viyaanan
Udhaanan
Samanan
Naagan (Higher intellectual function)
Koorman (airway of yawning)

Kirukaran(Air of salivation/nasal
secrection)
Devathathan (Air of laziness)
Dhananjeyan(this air that acts on death)
xxxiv
B.PITHAM:

Analpitham (Gastric juice)
Ranjagam (Haemoglobin)
Saathagam (Life energy)
Praasagam (Bile)
Aalosagam
C.KABAM:

Avalambagam (Serum)
Kilaethagam (saliva)
Pothagam (lymph)
Tharpagam(cereb rospinal fluid)
Santhigam (synovial fluid)
VI.SEVEN DHATHUS: (7 SOMATIC COMPONENTS)

Saaram [Chyme]
Senneer [Blood]
Oon [Muscle]
Kozhuppu [Fat]
Enbu [Bones]
Moolai [Bonemarrow]
Sronitham[Genital discharges]
xxxv
1.SYSTEMIC EXAMINATION:

1)Gastrointestinal System
2) Respiratory System
3)Cardiovascular System
4)Central Nervous System
5)Urogenital System
2. GENERAL EXAMINATION:
Height (cms)
Weight (kg)
Head Circumference
Chest Circumference
Mid Arm Circumference
Temperature (F0)
Pulse rate (per min)
Heart rate (per min)
Respiratory rate(per min)
Blood pressure (mm/Hg)
Anaemia
Jaundice
Cyanosis
Lymph adenopathy
Pedal edema
Clubbing
Jugular vein pulsation
xxxvi
3. CLINICAL SYMPTOMS:
COMPLAINTS 1st Day 5th Day 7th Day 14th Day
Sore Throat
Cough
Cough with
expectoration
Dysphagia
Fever
Headache
Ear ache
Anorexia
Swollen & Erythema of

the tonsils
Cervical lymphadenitis
Date:
Station:
Signature of the Guide : Signature of the Investigator:
xxxvii
GOVERNMENT SIDDHA MEDICAL COLLEGE AND HOSPITAL,
PALAYAMKOTTAI.
DEPARTMENT OF PG - KUZHANTHAI MARUTHUVAM
PRECLINICAL AND CLINICAL STUDY ON “LASUNATHABITHAM”- A

PEADIATRIC DISORDER AND THE DRUG OF CHOICE IS
FORM III
LABORATORY INVESTIGATIONS
1. Serial No: ________ 2. Registration No: ________
3. OPD No: ________ 4. Lab No: ________
5. Name: ________________
6. Date of birth:
D D M M Y Y Y Y
7. Age: _______ years
8. Date of assessment: ____________________
Urine Examination:
1. Sugar : ______
2. Albumin : ______
3. Deposits : ______
Blood Investigations:
1. TC, DC, ESR, HB,

2. Total RBC Count ______________ cells / cu. mm.
3. Differential Count
P___% L ___% E ___% M ___% B ___%
xxxviii
4. Hb _____ gms%
5. ESR at 30 minutes _______ mm
at 60 minutes _______ mm
6. Blood
Absolute Eosinophil Count
7. Special investigations :
i. Throat swab culture
ii. ASO TITRE (group A - β haemolytic streptococcus)
Date:
Station:
Signature of the Guide : Signature of the Investigator:
xxxix
GOVT SIDDHA MEDICAL COLLEGE AND HOSPITAL
PALAYAMKOTTAI
PG. DEPT. OF KUZHANTHAI MARUTHUVAM
CONSENT FORM – IV
An open clinical study to evaluate the safety and clinical efficacy of Siddha sasthric
formulation “SUGANTHA MALLI CHOORANAM” for the management of
“LASUNATHABITHAM”
CERTIFICATE BY INVESTIGATOR
I certify that I have disclosed all the details about the study in the terms readily
understood by the parent.
Date ………………. Signature…………..
Place ………………. Name ………………
CONSENT OF INFORMANT
I have been informed to my satisfaction, by the attending physician, the

purpose of the clinical trial, and the nature of drug treatment and followup including the
laboratory investigations to be performed to monitor and safeguard my Son / Daughter
body functions.
I am aware of my right to put out of the trial at any time during the course of the trial without
having to give the reasons for doing so. I am, exercising my free power of choice; hereby
give my consent to be included as a subject in the clinical trial of Siddha drug “SUGANTHA
MALLI CHOORANAM” for the treatment of “LASUNATHABITHAM”.
Date : Informant Signature : ..................................
Place : Informant Name :.......................................
Signature of witness Patient Name : ...........................................
Relationship : ..........................................
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xlii
GOVERNMENT SIDDHA MEDICAL COLLEGE&HOSPITAL
PALAYAMKOTTAIPOST GRADUATE DEPARTMENT OF
KUZHANTHAI MARUTHUVAM
PRECLINICAL AND CLINICAL STUDY ON “LASUNATHABITHAM”-
A PEDIATRIC DISORDER AND THE DRUG OF CHOICE IS
S.I.No: …………. OP/IP No: ………… Name: ………………

FORM IVB – WITHDRAWAL

Date of Trial commencement :
Date of withdrawal from trial :
Reason (s) for withdrawal : Yes /No
Long absence at reporting : Yes /No
Irregular treatment : Yes /No
Shift of locality : Yes /No
Complication adverse reactions if any: Yes /No
Exacerbation of symptoms : Yes /No
Pt. not willing to continue : Yes /No
Date :
Station :
Signature of HOD:
xliii
FORM IV-C – PATIENT INFORMATION SHEET
Name of the principal investigator: …………………………………………………….
Name of the institution : GOVERNMENT SIDDHA MEDICAL
COLLEGE AND HOSPITAL,
Palayamkottai
Information sheet for patients participating in the open clinical, trial
1, _____________________________________ Studying as PG Scholar at

PALAYAMKOTTAI is doing a trail on the study “LASUNATHABITHAM”. It is a most
common disease in children. In this regard, I am in a need to ask you few questions. I will
maintain confidentially of your comments and data obtained. There will be no risk of
disclosing your identity and no physical, psychological or professional risk is involved by
taking part in this study. Taking part in this study is voluntary. No compensation will be paid
to you for taking part in this study.
You can choose not to take part. You can choose not to answer a specific question.
There is no specific benefit for you if you take part in the study. However, taking part in the
study may be of benefit to the community, as it may help us to understand the problem of
defaulters and potential solutions.
If you agree your child to be a participate in this study, he / she will be included in the study
primarily by signing the concern form and then you will be given the internal medicine
“SUGANTHA MALLI CHOORANAM” (½ gram-tds) internal for 14 days.
Date :
Station :
Signature of HOD:
!
xliv
PALAYAMKOTTAI.
DEPARTMENT OF PG KUZHANTHAI MARUTHUVAM
PRECLINICAL AND CLINICAL STUDY ON “LASUNATHABITHAM”.
A PEADIATRIC DISORDER AND THE DRUG OF CHOICE IS

FORM IV D - DIETARY ADVICE FORM
The following diet to be taken : The following food should be avoided
Drink adequate water Sesame Seeds

Drink Fruit Juice (Without Ice) Horse Gram
Take Vegetable Soup Chicken
Vegetable / Spinach Fish
Nuts Sweetened Beverages
Honey Cold Water
Banana Flower Bakery Food Items
Oily Food
Excessive Salty & Spicy
Mangos
Coconut
Bitter Guard
Date :
Station :
Signature of the Guide Signature of the Investigator
Signature of HOD
xlv
FORM – IV E ADVERSE REACTION FORM
NATIONAL PHARMACOVIGILANCE PROGRAMME FOR
SIDDHA DRUGS
Reporting Form For Suspected Adverse Reactions to Siddha Drugs
Please Note: i. All Consumers/Patients and reporters information will remain

confidential.
ii. It is requested to report all suspected reactions to the concerned,
even if it does not have complete data, as soon as possible.
Peripheral centre code : State :

1. Patient /Consumer Identification (Please complete or tick boxes below as
appropriate)
Name Father Name Patient record no
Ethnicity Occupation
Address Date of Birth/Age
Village/Town
Post/Via Sex: Male /Female
District /State
Weight:
Degam:
2. Description of the suspected adverse reactions please complete boxes below

Date and time of initial Season:
observation
Description of reaction Geographical area:
xlvi
3. List of all medicines/Formulations including drugs of other systems used by the
patient during the reporting period:
Route of Date
Daily administration Diagnosis for which
Medicine
dose Vehicle – Starting Stopped medicine taken
Adjuvant
Siddha
Any other
system of
medicines
4. Brief details of the Siddha Medicine which seems to be toxic :
Details Drug – 1
a) Name of the Medicine
b) Manufacturing unit and batch no. and date
c) Expiry date
d) Purchased and obtained from
e) Composition of the formulation / part of the
drug used
Dietary restrictions if any

Whether the drug is consumed under institutionally qualified medical supervision or
used as self medication
Any other relevant information
xlvii
5. Treatment provided for adverse reaction:
6. The result of the adverse reaction /side effect / untoward effects ( Please complete the
boxes below )
Recovered Not Unknown Fatal If fatal
recovered: Date of death:
Severe Yes /No Reaction abated after drug stopped or dose reduced
Reaction reappeared after re introduction :
Was the patient admitted to hospital? If yes,

give name and address of hospital
7. Any laboratory investigation done to evaluate other possibilities? If yes specify:
8. Whether the patient is suffering with any chronic disorders?
Hepatic Rental Cardiac Diabetes Malnutrition
Any Others
9. H/O previous allergies /Drug reactions:
10. Other illness (please describe):
Type (please tick):Nurse/Doctor/Pharmacist/Health

worker/Patient/Attendant/Manufacturer/ Distribution /Supplier /Any other (please
Specify)
xlviii
Name :
Address:
Telephone /E-mail if any:
Signature of the reporter Date :
Please send the completed from to
To From
The co- ordinator, Government Siddha Medical College
Pharmacovigilence, & Hospital, Palayamkottai, Post
Government Siddha Medical Graduate Department of Kuzhanthai
College and Hospital,
Maruthuvam
Palayamkottai.
xlix
This Filled- in ADR report may be send within one month of observation / occurrence of
ADR
Who can report?

Any health care professionals like Siddha Doctors
/Nurses /Siddha Pharmacists / Patients Etc.,
What to report?
All reactions, Drug interactions
Confidentiality
The patient’s identify will be held in strict confidence
and protected to the fullest extent
Date :
Station:
Signature of Guide: Signature of the Investigator
Signature of HOD
l
GOVERNMENT SIDDHA MEDICAL COLLEGE AND HOSPITAL
PALAYAMKOTTAI
BRANCH-IV KUZHANDHAI MARUTHUVAM
Form IV F
Admission – Discharge Proforma
Name of the Medical Unit:
Name of the Medical Unit:
I.P. NO : Occupation :
Bed no : Income :
Ward : Nationality :
Name : Religion :
Age : Date of Admission :
Sex : Date of discharge :
Permanent address: : Diagnosis :
Temporary address: : Results :
Informant : Medical officer :
S.NO CLINICAL FEATURES During During Discharge

(Signs and symptoms) Admission
1 Sore throat
2 Cough
3 Cough with expectoration
4 Dysphagia
5 Fever
6 Headcahe
7 Earache
8 Anorexia
9 Swollen and Erythema of the
tonsils
10 Cervical lymphadenitis
Date :
Place:
Signature of the Medical officer
li
PALAYAMKOTTAI
PRECLINICAL AND CLINICAL STUDY ON “LASUNATHABITHAM”-A PEDIATRIC

DISORDER AND THE DRUG OF CHOICE IS
FORM V-DRUG COMPLIANCE
S.I.No: …………. OP/IP No: ………… Name: ………………

NAME OF THE DRUG : SUGANTHA MALLI CHOORANAM
FORM OF THE DRUG : CHOORANAM
ADMINISTRATION & ADJUVANT : PER ORAL (Internal ) & milk
DOSE & DURATION : ½ gram tds for 14 days
NO OF DRUG PACKS GIVEN : ________________
NO OF DRUG PACKS RETURNED : ________________
DATE OF
DAY DRUG MORNING AFTERNOON EVENING
INTAKE
DAY 1
DAY 2
DAY 3
DAY 4
DAY 5
DAY 6
lii
DAY 7
DAY 8
DAY 9
DAY 10
DAY 11
DAY 12
DAY 13
DAY 14
Date :
Station
Signature of the Guide Signature of Investigator:
liii

"Sugantha Malli Chooranam" "Sugantha Malli Chooranam" For The Treatment of "Lasuna Thabitham" "Sugantha Malli Chooranam"

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An open clinical

clinical study to evaluate the clinical

“SUGANTHA MALLI CHOORANAM”

for the treatment of

For the partial fulfillment

DOCTOR OF MEDICINE (SIDDHA)

DEPARTMENT OF KUZHANTHAI MARUTHUVAM

Phone : 0462-2572736/2572737Fax: 0462-2582010

This is to certify that the dissertation entitled “AN OPEN CLINICAL

Name and signature of the Guide:

Name and signature of the Head of the Department:

Name and signature of the Principal:

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation entitled “AN OPEN CLINICAL

Date: Signature of the Candidate

First of all, I thank ALMIGHTY who empowered me with grace and

I express my gratitude and acknowledgement to The Vice Chancellor, The

I would like to thanks Prof. Dr.S.Victoria M.D(S) Principal, Government

I would like to thank Prof. Dr.R.Neelavathy M.D(s), Ph.D Former Principal

I record my thankfulness to Prof.Dr.D.K.Soundararajan, M.D(S).,Head of

I whole heartly extend my thanks to my guide Dr.K.Shyamala, M.D(S).,

I express my special and sincere thanks to Dr.S.Vedagiri Subbiah M.D(S).,

My sincere thanks to Dr.S.Sudha M.Sc.,M.Ed.,Ph.D, Associate Professor,

My heartful thanks to Mr.Santhanam M.pharm, Assistant Proffessor,

I would like to thank Dr.R.Geetha Sudheer MD(s).,Ph.d, for his contribution

I express my gratitude to the Librarian Mrs.T.Poongodi.,M.Lis.,M.Phil,

I express my thanks to the technicians of the laboratory (Malar lab) and

II AIM AND OBJECTIVE 3

III REVIEW OF LITERATURE

IV MATERIALS AND METHODS 35

VI BIO CHEMICAL ANALYSIS REPORT 51

VII PHARMACOLOGICAL ANALYSIS REPORT 53

VIII ANTIMICROBIAL STUDY REPORT 78

IX OBSERVATION AND RESULTS 81

XII CONCLUSION 116

XIII BIBLIOGRAPHY 117

RESEARCH METHODOLOGY CERTIFICATE i

SCREENING COMMITTEE APPROVAL ii

IEC APPROVAL CERTIFICATE iii

IAEC APPROVAL CERTIFICATE iv

DRUG AUTHENTICATION CERTIFICATE v

CTRI - REGISTRATION xii

FORM – IA: HISTORY PROFORMA ON ENROLMENT xvi

FORM – IB: CASE SHEET PROFORMA xxii

FORM-II&IIA: CLINICAL ASSESSMENT ON xxxii

FORM-III: LABAROTARY INVESTIGATION ON xxxviii

FORM-IVC: PATIENT INFORMATION SHEET x1iv

FORM-IVD: DIETARY ADVICE FORM x1v

FORM-IVE: ADVERSE REACTION FORM x1vi

FORM-IVF: DISCHARGE PROFORMA 1i

THE UNIQUE SPECIALITY OF SIDDHA SYSTEM :

MAJOR ROLE OF PAEDIATRIC DEPARTMENT:

(,) “rPh;ngU khh;Gjd;dp;w; nrwpe;jpLQ; Nrw;gde;jhd;

kjiy Neha; njhFjp – II” d; gb oki{<jmbqz<!uVl<!Ofib<gt<!.!7/!

2! gii<gizl<! uikl<! Oux<Xfqjz! -eqh<H?!Htqh<H?!dh<H!

5! hqe<heqg<gizl<! ghl<! ke<eqjz!uti<s<sq! -eqh<H?!Htqh<H?!

NORMAL FUNCTION OF TONSILS:

Less common pathogens:

Differentiating Viral origin of Bacterial origin of