Title : “ A clinical study on the efficacy of jamboobija churna in shayyamutra ( enuresis ) w . s . r . to nocturnal enuresis . ”

Children in the modern age suffer at large due to physical problems; in addition to that they suffer from psychological problems too. The event leaves a lasting impression on the tender mind of children and later become the cause of behavioral or psychosomatic disease. Ancient scholars have also described Shayyamutra as psychosomatic origin. Enuresis is one of the obstinate problems. Enuresis is defined as the voluntary or involuntary repeated discharge of urine into cloth or bed after a developmental age when bladder control should be established. Due to this problem a lot of concealment and profound repercussions occur in family life, since a child’s psychosomatic health and mothers pride involved with this problem. Therefore, this study was planned keeping in mind the mental condition of parents as well as the children. For this, 60 patients of age group 6 to 10 years of both sexes were randomly selected from OPD of the department of Kaumarbhrityaof D. Y. Patil College of Ayurveda, Nerul, New Mumbai Maharashtra and divided into two groups, i.e. 30 in each group. Jamboobijachurna(trial drug) was administered to 30 such children with counseling. Another set of 30 children was administered with wheat flour churna (placebo drug) with counseling. All children were subjected to clinical signs and symptoms, before treatment and 2 month after treatment. The study has proved that efficacy of the trial drug along with counseling is found to be effective for Shayyamutra. Keyword: Shayyamutra, Enuresis,Jamboobijachurna, Counseling. SPRING / SUMMER EDITION Ayurlog: National Journal of Research in Ayurved Science ISSN: 2320-7329 ISBN: 978-93-5137-179-3 Website: http://www.ayurlog.com Volume: 6 th |Issue: 4 th | June 2018


Introduction:
Kaumarbhritya emerged as an independent medical specialty right from the dawn of civilization. This evolutionary development was the result of increasing awareness among the health professionals that, the problems of children differ considerably from those of adults and from the point of view of medical therapeutics, "A child cannot be considered as miniature adult".
Children health needs great care as their physical and mental status helps them to build the future as well as nation. Parents and family members are frequently stressed by child's bedwetting. Soiled linen and clothing causes additional laundry. Wetting episodes can cause lost sleep if the child wakes and/or cries, waking the parents. A European study estimates that a family with a child who wets nightly will pay about $1,000 a year for additional laundry, extra sheets, disposable absorbent garments such as diapers and mattress replacements. The ancient scholars have described this obstinate health problem of children as Shayyamutra. Shayyamutra(enuresis) is one of the quite common obstinate social problems whose etiology, clinical feature, pathogenesis and management part are not found vividly in the ancient texts. Vangsen has noticed first the common complaints of Shayyamutra(enuresis) and mentioned its management in his text.

Material and Method
The present study was conducted to examine the efficacy of an Ayurvedic compound in decreasing frequency of bedwetting in Shayyamutraaffected children. For this study, we selected all affected children attending the OPD of the department of Kaumarbhrityaof D.Y.Patil College of Ayurveda, Nerul, New MumbaiMaharashtra.
Only children between 6 to 10 years were included n the study. Selected patients were randomly divided into two groups, ensuring both the groups had children from various grades, schools and socioeconomic status.
Group A-This group of 30 children was given Jamboobijachurna with counseling. 5. Subject with worm infestation. 6. Patients on another treatment for same disease.

Time And Duration Of The Study
The duration of the study was 2 months.

Administration Of The Drug And Observation Of Patient
Each child of Group A was givenJamboobijachurna (twice a day before meal) for 2 months with counseling. Each child of group B was given Wheat flour churna(twice a day before meal) for 2 months with counseling. 2. Serve dinner to child before 8:00 pm.
3. Asked child to go to bed before 9:30 pm. 4. Habit of watching television till ate night was also condemned.
5. Liquids like butter milk, cold coffee or tea, juice, ice cream; were strictly avoided especially after dinner. 6. Excessive quantity of water was limited after as well as during dinner. 7. Children should urinate before going to sleep. 8. Wake the child twice in the whole night and walk unaided to the toilet to urinate.

Significance Of Counseling
The most important reason for treating enuresis is to minimize the embarrassment and anxiety of the child and frustration experience by the parents.
The main role of counseling is to give moral support to express his suppressed emotions and feeling. Parental counseling was done to give child emotional support, not to criticize and changing the bed wetting sheets without the child knowing. Also parents were asked for positive reinforcement for remaining dry at night. It gives encourage to child for dry nights by using gifts as a token of appreciation.  Diff-Difference; S.D.-Standard Deviation The median reduction in bedwetting score for group A was 3 with mean reduction equal to 3.03 (S.D. = 0.556). In group B, the median reduction was 1 with mean reduction of 0.80 (S.D. = 0.551). Using Mann-Whitney U test, the reduction in bedwetting score for group A was significantly higher than that of group B (P-value < 0.001). Thus it can be inferred that, Jamboobijachurnais significantly more effective than placebo in reduction of bedwetting frequency.

Discussions and Conclusion:
Shayyamutra is considered to be shameful problem to our society. It causes shame both to child and parents. Nidrathe sleep is Tamomula and Tamomayi induced by increase of Tamas-an invert universal attribute. So, it mainly exhausted state of mind and body. It is generally seen in nights. The sleep induced by excessive increase of Tamogunaoccurs at terminal stage of sleep, where Tamogunaand increased KaphaDosha are involved. When KaphaDosha occludes the sensory channels then the terminal sleep manifest. It is difficult for affected child in night to awake and go to the toilet. In the present study the drug was selected from CharakSamhita. As per the classical reference of the text, the drug is having Kashaya Rasa and Madhura, AmlaAnurasa; KatuVipaka; Virya is sheeta and having Laghu, RukshaGuna. Charak have mentioned it as a Mutrasangrahaniya (herb that cause urine retention). Many researches are also available providing the drug ass a highly effective oral antihyperglycemic and also as anthelminthic. This action further leads us to provoke its action on the cardinal symptoms of Prameha i.e. Prabhutaand AvilMutrata.
Thus a probable mode of action of this drug may be assumed on hypothetical basis as causing by action as Mutrasangrahaniya, or it may have the properties to reduce urine formation or it may arouse the child on having sensation of bladder fullness and thereby being effective in the present study. Fluid intake may enhance bedwetting, so instead of syrup preparation churnapreparation was proven more beneficial in the present study.