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Introduction

Ayurveda is an ancient science of life. Acharya mentioned different types of Vyadhi due to Ahitakara-Ahara-Vihara and treatment has also mentioned in Ayurvedic Samhitas. The references about the smoking were found since Vedic Kala.[1] In Ayurveda the smoke of the plants having strong irritating smell are used for medicinal purposes mainly in Manasika Vyadhi. Habitual intake of tobacco chewing was not found in Samhita or Veda. Everyone at any time chew the Gutkha and spilt here and there. There is no any specific time to chew the Gutkha, like some people eat Pan-Supari after meals. People started to chew Gutkha from early morning to the late night. Most of the people stand near the Pan-Tapari and chew Gutkha eagerly. The Gutkha chewers chew it during walking and talking, in classrooms, traveling, on a motorbike or in a city bus or S.T. bus, in a cinema hall, in gardens and in most of the public places. Some people have habit to chewing Gutkha after Dinner. Most of the people have a very bad habit to chew Gutkha before defecation. They are unable to defecate or they don't defecate easily, if Gutkha is not taken. Some people place a Gutkha in the mouth and take sleep at night. This is a very bad habit. This usage of Gutkha is associated with cancers of mouth, lips, nasal cavities, oesophagus and gut.[2] Due to continuous Gutkha chewing there is whitish red coloration which leads to sub mucosal fibrosis.[3] This is the first stage of oral cancer. Tobacco and Gutkha are the proven factors for the increasing cancers in the society.[4] Along with the tobacco and Supari other injurious and poisonous substances are added in Gutkha like magnesium carbonate, ammonium sulphate, magnesium sulphate etc.[5] It also contains synthetic Kattha which is manufactured from Geru, Multani Mati, dried blood of sacrificed animals like cow, buffalo etc.[6] The manufacturer wants to keep their formula confidential, hence they do not write the formula on the Gutkha pouch. The contents of Gutkha show the following effects on the human body.[7]

• Nicotine - It increases heart beats, blood pressure, it constricts the blood vessels.

• Marsh gas - It shows injurious effects on reproductive organs. It develops infertility.

• Ammonia - It disturbs the digestive system and chemical balance of blood.

• Pyridine - It produces cough, dryness of larynx, acidity etc.

• Colodine - It produces dizziness, death of cerebral cells etc.

• Perfirole - It blackness the teeth, it also provides weakness.

• Tarnayatosamine - It produces carcinoma.

 Moreover, Gutkha contains lime, catachu, Supari, permitted spices and flavours. These ingredients have their own effects as well as they have effects in combination.

• Lime (calcium hydroxide) - irritation of the oral cavity which leads to the oral ulcers.

• Catechu - It contains polyphenol and tannins. It avoids absorption of iron and produces anorexia and anaemia.

• Supari - In these various alkaloids are present which are responsible for various cancers.

• Permitted spices and flavours - They contain aromatic hydrocarbons which are responsible for many oral disorders.

Effects of Gutkha -

  It is proved that Gutkha is more responsible for cancer than Tobacco alone.[8] Due to the Gutkha chewing there is constriction of blood vessels with increasing in blood sugar and cholesterol.[9]There are atherosclerotic changes which results in deprivation of blood circulation in the lower extremities. Due to this, gangrene formation takes place. Ultimately leading to amputation. The heart vessels get constricted too which further leads to paralytic attacks. Other conditions like pharyngitis, asthma, heart disorders, lung disorders etc. with burning sensation in the eyes, hoarseness of voice may be developed by the time. Nicotine constricts the atrial flow leading to atherosclerosis. Due to the Nicotine, Methyl haemoglobin reduces by 10-15% which is important factor of transport of oxygen. Due to this, pressure is created on the heart to pump more so as to provide oxygen to other parts of the body. Exchange of oxygen and carbon dioxide is hampered in lungs which increases blood pressure. Due to all these factors, pressure on the heart is more and afterwards it gets depressed leading to Myocardial Infarction and death.

  In Cancer Research Institute of Paris, it has been proved that tobacco leads to impotency and also malnutrition in the sperm which is transported to the next generation.[10] Due to polycyclic aromatic hydrocarbons and nicotine, there is no spermatogenesis and also it leads to loss of motility and counts of sperms, ultimately leads to sterility. People chew the Gutkha and spit here and there, they become reservoir for spreading droplet infection in the society. It inhibits individual health as well as social health by uncleanliness. It also inhibits nation’s progress by destruction of capable youth. So now-a-days consumption of Gutkha is a very serious problem throughout the world.

Inclusive Criteria:

1. The persons having the habit of Gutkha chewing minimum last 5 years and having age above 18 years are considered for the case study.

2. The person chews a minimum of five pouches per day.

3. The volunteers are selected irrespective of sex.

Exclusive Criteria:

1. The school children and persons having age below 18 years are excluded from case study because they are innocent and they have irregularity in habitual Gutkha chewing.

Aim and Objective:

1. To study and understand the Gutkha from Ayurvedic review.

2. To study patients with this habit and analyses the effects from Ayurvedic view

Materials and Methods:

1. Various brands of Gutkha were collected from the market for its composition. Their trade names are different, but composition is same. It contains Tamraparni, Betel Nuts, catechu, Lime, permitted spices and flavours. Some of them are saffron blended and contain magnesium carbonate.

2. The study material of Gutkha and available information about Gutkha is collected.

3. Ayurvedic information about constituents of Gutkha is collected.

4. For the Case Study Gutkha chewing volunteers.

Methodology:

The literary information about the contents of Gutkha is compiled from Ayurvedic texts. The case paper is formed considering the signs and symptoms of Dosha Dushti given in Ayurvedic texts. The case paper is finalised after some pilot cases. The case paper highlights Mukha Parikshana with aim to ask questions regarding different organs in it. Similarly various Sharirika and Mansika Lakshana included in the case paper.  

The detailed questionnaire for Srotasa Parikshana was included considering the textual references. The effect of Gutkha on Dosha, Dhatu, Mala, Bala, Srotasa, Agni, Avayava, Indriya etc. was noted. The collected data was analysed with the help of Ayurvedic views as well as statistical methods wherever applicable.

Observations and Results: The observations of 240 cases (195 Males & 45 Females) studied are as follows. We find all the social and economic groups addicted to Gutkha. Mainly the younger and the middle-aged people (age in between 20 to 40 years) are more addicted to Gutkha.

While studying these cases following answers were noted about their habit of Gutkha.

 1) The answer for the first question i.e. why they chew the Gutkha? Is common like time-pass, habit or addiction etc.

 2) How did they get addicted to Gutkha?

 For this every patient held their friends responsible. Some of the patients are firstly addicted to tobacco-chuna and later on shift to Gutkha chewing regularly.

3) Furthermore, once they keep the Gutkha in their mouth they get kicked and they get excited, but they cannot definitely explain their feelings of kick.

   The Gutkha is kept sublingually, due to this the chemicals and toxic substances spread through the blood circulation to the heart and it gives temporally mental excitement. After sometime the kick goes and the person again feels restless and finally he takes Gutkha again.

 4) And once they are deprived of Gutkha they complain of lack of concentration and feel restless. The person does not stay in this stage for a long time, and finally they take Gutkha again.

5) While eating Gutkha very few people ingest the saliva but most of the people spit, which is largely contributing to the public unhygienic. There are so many problems in front of the people who ingest the saliva while chewing the Gutkha. The Gutkha is one of the most important etiological factors of various diseases like stomatitis, mucous fibrosis, carcinomas etc. Thus Gutkha inhabits individual health as well as social health by uncleanliness. That's why this is the duty of each and every civilian to prevent the people from this bad addiction.

   In Mukha Parikshna we have examined Mukha, Oshta, Danta. Dantavestana, Gilayu, Jivha and Talu. These seven Avayava of mouth were examined under the 29 Lakshana.

tables

tables

Mukhapaka is found in 79.16% of patients. Most of the patients are having Mukhapaka at least once in the month and they are slowly moving towards the Pitikotapti and Vrana which is found in the first stage of oral cancers.[11]

Due to the habitual chewing of Gutkha, Vata Vriddhi takes place in the human body and it shows above Lakshana.

 Loss of lustre of teeth is frequently observed in Gutkha chewers. Teeth color is changed in to Peeta-Varna. So, the Shukla, Snigdha Guna of Danta described in Ayurveda Samhita are greatly affected. These patients also get affected by Krumi-Danta or it is also called as Dental carries leading to Danta-Shoola Laxana. In Astang Sangraha, Doshbhediya Adhyaya Danta-Shoola and Danta-Bheda are described as Vataja Nanatmaja Vyadhi and Mukhapaka is described as Pittaja Nanatmaja Vyadhi. So that we can say that Gutkha is one of the cause of such diseases.

About the Gilayu & Talu, Daha Lakshna is observed disastrously. Sharira Agni and Pitta has Ashrayashrayi Bhava. It means that Daha Lakshna is developed due to Pitta Prakopa. Most of the Sharirika Vedana is developed due to the Samana Vayu. The Ushna Gunatmak Pachak Pitta and Samana Vayu are situated in the Amashaya. Due to Atisevana of Gutkha, Pachak Pitta and Samana Vayu gets vitiated and Pitta & Vata Prakopa takes place. It develops Daha Lakshna of Gilayu and Talu.

When the Gutkha is placed in the mouth, the Rasanendriya gets stimulated as it has Adhisthana on the Jivha and the patient feels the kick. After some time, this stimulation is released and the patient feels normal. But due to the habitual use of Gutkha, Jivha shows Arochaka, Samata, Jivhakantak etc. Lakshana. When the Gutkha chewers are deprived, they feel restless and uncomfortable and they start to get it again and again. Hence we can say that the Gutkha disturbs the normal role of Rasanendriya which is one of the most important Panchagyanendriya. Continuous chewing of Gutkha leads to Atiyoga of Rasanendriya. It is Asatmya Indriyartha Samyoga which is one of the main causes of different types of diseases. Jivha is a Moolsthan of Bodhak Kapha. Due to continuous chewing of Gutkha it gets vitiated, it produces different Lakshana like Aruchi, Arasadyanata etc.

 In Sharirika Laxana, 81.25% patients show Malavarodha, 74.16% patients show Malavashtambha, 54.58% patients show Adhmana, 81.25% patients can not defecate easily without taking Gutkha.The other Sharirika Laxana mostly seen are Kshudhamandya, Apachana, Ajirna, Alpa-Bala, Ati-sweda, Anidra and Ati-pipasa. These Sharirika Laxana are frequently observed in Gutkha chewers.

After Sharirika Lakshana we come to the Manasa Lakshana. In the Manasa Lakshana, Manasika Durbalata is observed in 57.91% of patients, Chidchidepana or Kshobha is observed in 59.16%, Nairashya is observed in 41.25% and Aswashtata is observed in 49.95%. These Lakshana are typically observed in Gutkha chewers.

Table no .10 Test for Proportion

The calculated value and “P” values for the percentage of Lakshnas observed in different sections are as shown in the table.

Discussion

Tamraparni is the main content of Gutkha.[12] Actual percentage of Tamraparni is not mentioned on the Gutkha pouch but it is the chief constituent of Gutkha. In different Ayurvedic texts it is mentioned that it acts as a Madaka by its Prabhav.[13] So that we can also say that patients cannot defecate easily without taking Gutkha was observed due to the effect of Prabhava of Tamraparni. The Samana Vayu, Pachak Pitta and Kledaka Kapha are situated in the Amashaya. Due to the habitual chewing of Gutkha this all Doshas are vitiated. Due to the vitiated Samana Vayu, Agnimandya, Kshudamandya and Ajirna symptoms are observed. Due to the vitiated Pachak Pitta Lakshana like Amla pitta, Apachan, Ati sweda, Ati pipasa, and Netra Araktata are frequently observed in the patients. As we know the Prajnaparadha is a one of the main causes of disease described in Charak Samhita.[14] Prajna means optimum function of Dhee, Dhriti, and Smruti. Although people know about the poisonous and harmful effects of Gutkha still they are not able to leave this habit. All these lead to the increase of Raja and Tama Guna on Prajna. In Dhriti Bhransha though Budhi has taken the right decision considering what is rational or irrational but due to objective destruction of the material world the decision is not followed.The symptoms like Panduta, Mandagni, Kasa, Pratiloma Vayu particularly Apana Vayu; Anidra, Adhman, indications of Yakruta and Pleeha Vriddhi, Durbalata, Alasya and Shotha are observed due to the Garavisha. All these symptoms are also observed in habitual Gutkha chewers. It causes Vata and Pitta Vriddhi and Kapha Kshaya. The Atisevana of Gutkha causes Lakshana of Vata and Pitta Prakopa. Among Tridoshas and its subtypes, Samana, Udana and Apana Vayu; Pachak Pitta, Bodhaka and Kledaka Kapha were seen to be affected more. This is nothing but Prajnaparadha which is the most common cause of diseases. Though the hazardous effects of Gutkha chewing are known to the people they carry on with it.

Conclusion

Gutkha disturbs the normal role of Dosha and produces Kriyahani of the above Doshas. Rasa, Rakta, Mansa, Asthi, Shukra Dhatus are mostly affected due to Gutkha. Mostly the Dhatu Kshaya and Shukra Kshaya is observed. In Malas, Purisha gets affected the most. The Lakshana like Malavashtambha, Sashoola Mala Pravruti, Sakashta Mala Pravruti and Drava Mala Pravruti are commonly observed in Gutkha chewers. The Sweda and Mutravaha Srotasa were also affected to some extent. In Srotasa, Rasavaha Srotasa, Purishavaha Srotasa and Shukravaha Srotasa were seen to be affected disastrously. The effect of Gutkha on Mana results in Mano-Dourbalya, Nairashya and Kshobha etc. This might be due to the disturbances of Mano Guna with concern to Prajnaparadha and Asatmya Indriyarth Samyoga. Due to the effect of Gutkha the Bala also get affected at some extents results in "Alpa Balatwa”. All these effects produce Shukra Kshaya in the body which ultimately leads to Oja Kshaya.With the help of statistical calculations, we can say that Gutkha may affect Dosha, Dhatu, Mala, Srotasa, Agni, Mana etc. Hence, we can conclude by saying that Gutkha affects Dosha, Dhatu, Mala, Agni, Srotasa, Mana, Bala, Oja etc.