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INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH  
Integrated Ayurveda-Jyotisha Framework For Hridrava: Classical Basis,  
Therapeutic Rationale, And A Proposed Protocol For Clinical Validation  
Dr.Pachore Shreyansh ¹, Dr.Wade Avinash2, Dr.Vanganekar Namdev 3  
1 Professor, Department of Rachana Sharir, Nootan Ayurvedic College and Research Centre, Sankalchand Patel  
University, Visnagar, District Mahesana, Gujarat – 384315, India.  
²Associate Professor, Department of Rognidan & Vikriti Vijnan, Nootan Ayurvedic College and Research Centre,  
Sankalchand Patel University, Visnagar, District Mahesana, Gujarat – 384315, India.  
3 Vice Principal and Associate Professor, Department of Rasashastra evam Bhaishajya Kalpana, Nootan  
Ayurvedic College and Research Centre, Sankalchand Patel University, Visnagar, District Mahesana, Gujarat –  
384315, India.  
Corresponding Author: Dr.Pachore Shreyansh  
ORCID ID: 0009-0006-2661-9938  
Article Info: Article Received on : 24/03/2026  
Article Reviewed on: 13/04/2026  
Article Published on : 15/04/2026  
Cite this article as: - Pachore, S., Wade, A., & Vangnekar, N. (2026). Integrated Ayurveda-Jyotisha Framework For Hridrava:  
Classical Basis, Therapeutic Rationale, And A Proposed Protocol For Clinical Validation. International Journal of Diagnostics And  
Abstract  
Background and Aim: Hridrava, understood in Ayurvedic literature as a functional cardiac symptom-complex  
characterised by distressing palpitations and Vata aggravation in the Hridaya, is a clinically significant presentation  
in the context of rising functional cardiovascular complaints linked to anxiety, autonomic dysregulation, and stress.  
Classical Ayurvedic texts describe Hridaya as a vital seat of Prana and circulatory function, while Jyotisha literature  
identifies Surya (Sun) as a principal significator of vitality and cardiac integrity. This article develops an integrative  
Ayurveda-Jyotisha conceptual framework and proposes a clinical validation protocol.Methods: A systematic  
analysis  
of  
primary  
classical  
Sanskrit  
texts  
was  
undertaken,  
including Charaka  
Samhita (Chikitsa  
Sthana 28/96), Sushruta  
Samhita (Sharira  
Sthana 4/31-35), Ashtanga  
Hridaya (Nidana  
Sthana 6), Brihat  
Jataka (Varahamihira, Adhyaya 2/12), Brihat Parashara Hora Shastra (Adhyaya 12, 14), and Aditya Hridaya  
Stotra (Valmiki Ramayana, Yuddha Kanda 107). Pharmacological and clinical literature relevant  
to Shaliparni (Desmodium gangeticum) and Manikya Pishti (ruby calx) was also reviewed.Results: Textual evidence  
supports solar-centric therapeutic rationale for Hridrava management, integrating Shaliparni Siddha  
a
Dugdha (herbal milk preparation), Manikya Pishti (ruby mineral formulation), and Aditya Hridaya recitation as  
conceptually aligned therapeutic elements. A Planetary Affliction Scoring System (0-12 scale) is proposed to  
quantify Jyotisha-based cardiac vulnerability. A prospective, four-arm, randomised controlled trial design is outlined  
for future clinical validation.Conclusion: An Ayurveda-Jyotisha integrated model for Hridrava is conceptually  
grounded and methodologically testable. Rigorous clinical evaluation through blinded, controlled trial design,  
pharmaceutical standardisation, and ethics-compliant protocol will be necessary to translate this framework into  
evidence-based clinical practice.  
Keywords: Hridrava; Hridaya; Ayurveda; Jyotisha; Shaliparni; Manikya Pishti; cardiac palpitations  
Copyright @ : - Dr.Pachore Shreyansh Inter. J.Digno. and Research IJDRMSID0124 |ISSN :2584-2757  
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INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH  
epithet Amshumati connotes solar radiance),  
Introduction :  
and Aditya Hridaya Stotra (the solar heart-hymn  
from the Valmiki Ramayana) — provides a  
conceptually unified basis for an integrative  
therapeutic model.The present article has three  
objectives: (1) to review classical Ayurvedic  
and Jyotisha foundations relevant to Hridrava; (2)  
to articulate the therapeutic rationale for a solar-  
centric intervention model; and (3) to outline a  
prospective research protocol suitable for rigorous  
clinical validation within the Indian Knowledge  
Systems (IKS) research framework.  
Functional cardiac disturbances — particularly  
palpitations unaccompanied by structural cardiac  
abnormality — represent a substantial proportion of  
outpatient cardiovascular consultations. Patients  
presenting with episodes of distressing heart  
awareness, restlessness, sleep disruption, anxiety,  
and breathlessness frequently receive a reassuring  
normal investigation workup, yet continue to  
experience symptoms that erode quality of life.  
Biomedicine provides limited therapeutic pathways  
for such functional presentations beyond anxiety  
management and lifestyle modification.[1]  
Classical Ayurvedic Understanding Of Hridaya  
And Hridrava :  
Ayurveda offers a conceptually richer framework  
for addressing such symptom-complexes through  
the interconnected doctrines of Hridaya (the heart  
Hridaya in Ayurvedic Anatomy and Physiology :  
Hridaya occupies a position of cardinal importance  
across all three principal classical Ayurvedic  
compilations. Charaka Samhita (Sutra Sthana 30/3-  
4) describes Hridaya as the root of Rasavaha  
Srotas and the site of Prana residence, classifying  
it as one of the three Paramardiya Marmas (most  
as  
a Pranayatana  
), Vata  
-
Pitta  
Kapha  
imbalance, Rasavaha Srotas dysfunction, and the  
psychosomatic  
continuum  
[2,3,21]  
linking  
The Ayurvedic concept  
Manas and Sharira.  
of Hridrava — denoting distressing, irregular, or  
forceful cardiac awareness — emerges from this  
framework as a clinically meaningful entity  
vital  
structures)  
alongside Basti and Shira.[6]  
Sushruta Samhita (Sharira Sthana 4/31-35) places  
Hridaya at the centre of circulatory physiology,  
describing it as the originating vessel from which  
the Dhamani (vessels) distribute Rasa to the entire  
amenable  
to  
herbal,  
mineral,  
dietary,  
and  
psychospiritual interventions.[4] In parallel, Jyotisha  
Shastra — the classical Indian science of planetary  
body.[7] Ashtanga  
Hridaya (Nidana  
Sthana 6)  
astronomy  
and  
predictive  
Sun)  
interpretation  
—
further elaborates the role of Sadhaka Pitta seated  
in the Hridaya in governing mental clarity, volition,  
and emotional equilibrium. This multidimensional  
model — simultaneously anatomical, physiological,  
and psychological — positions Hridaya not as a  
simple mechanical pump but as a convergence  
point of Prana, consciousness, and circulatory  
identifies Surya (the  
as the primary  
significator of Atman, Prana, and vitality, and  
specifically associates solar affliction with  
disorders involving the heart and thoracic region.[5]  
This  
convergence  
between  
Ayurveda  
and Jyotisha around solar symbolism — evident in  
the  
therapeutic  
use  
of Manikya (ruby, Surya's  
vitality.  
multidimensional therapeutic responses.  
Copyright @ : - Dr.Pachore Shreyansh Inter. J.Digno. and Research IJDRMSID0124 |ISSN :2584-2757  
Pathology  
here  
therefore  
demands  
gemstone), Shaliparni  
(whose  
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Recent  
pharmacological  
investigations  
have  
Hridrava  
Pathogenesis:  
Hridroga, the broader category of heart disease, is  
classified into five types in classical  
texts: Vataja, Pittaja, Kaphaja, Tridoshaja,  
—
Classification,  
Aetiology,  
and  
confirmed  
the cardioprotective  
relevance  
of Desmodium gangeticum. Mridula and Ansary  
(2023) documented the cardioprotective secondary  
metabolites of this plant, including alkaloids and  
flavonoids demonstrating negative inotropic and  
chronotropic properties in experimental models.[11]  
HPTLC fingerprinting, alkaloid quantification, and  
and Krimija. Among these, Vataja Hridroga most  
closely corresponds to the functional palpitation  
complex. Features include spandana (throbbing)  
, toda (pricking), shula (pain), kshobha (agitation),  
bhrama (giddiness), and parva-bheda (intermittent  
distress).[8]  
microbial  
load  
testing  
are  
now  
feasible  
standardisation tools for milk decoctions prepared  
by the classical Siddha Dugdha method.  
Manikya Pishti — Pharmacological and Classical  
Basis  
Hridrava, as a term, specifically denotes rapid,  
irregular, or forceful cardiac activity as a symptom  
within  
the  
broader Hridroga framework.  
Its  
Manikya Pishti, prepared from authenticated ruby  
aetiology includes excessive physical exertion,  
undue fear, grief, emaciation, depletion of Rasa  
Dhatu, and Vata aggravation through inappropriate  
diet and lifestyle.  
(corundum,  
Al2O3  
with  
chromium)  
through  
classical Rasa Shastra Shodhana (purification) and  
prolonged trituration, is described in Rasa Ratna  
Samuccaya and  
related  
texts  
as  
The  
pathway  
involves Vata disturbing  
the  
possessing Hridya (cardiotonic), Medhya (nervine),  
normal Spandana (rhythmic contractile activity)  
of Hridaya , producing irregular and distressing  
sensations.[4] Modern correlates include functional  
arrhythmia, anxiety-related palpitations, vasovagal  
episodes, and autonomic dysregulation.  
and Balya properties.[12]  
Yadav  
(2015)  
demonstrated  
anxiolytic  
and neuroprotective  
activity of Manikya Pishti in experimental models,  
consistent with its traditional use in psychosomatic  
and cardiac anxiety presentations.[13]  
Safety of Pishti formulations requires rigorous  
quality assurance. Heavy metal analysis (Pb <10  
ppm, Hg <1 ppm, As <3 ppm per AYUSH  
standards), particle size verification (<10 microns),  
pH, and organoleptic assessment are mandatory  
Shaliparni Siddha Dugdha — Textual Basis :  
Charaka Samhita (Chikitsa Sthana 28/96) contains  
the direct reference: when Vata is aggravated in  
the Hridaya,  
milk  
processed  
with Amshumati (Shaliparni) is beneficial.[6]  
This is a targeted, clinically specific prescription  
rather than a generalised tonic formula. Shaliparni  
(Desmodium gangeticum [L.] DC.) is a constituent  
of the classical Dashamula formulation, known for  
its Vata-pacifying, Balya (strength-promoting),  
and Hridya (cardiac-supportive) properties. [9,10]  
before  
clinical  
deployment.[14]  
The  
cow  
classical Shodhana protocol  
employing  
milk, Kulattha decoction, cow urine, and lemon  
juice over seven cycles must be documented and  
reproduced with GMP-level batch records.  
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Jyotisha Framework For Cardiac Vulnerability  
Surya as Atmakaraka and Cardiac Significator  
In Jyotisha literature, Surya is recognised as the  
Table 1: Planetary Affliction Scoring System  
(PASS) for Cardiac Vulnerability  
Component  
Indicator  
Score  
debilitation 2  
or  
Sun in  
(Libra/Tula)  
combust  
planetary  
lord  
of  
vitality, Atman (individual  
self), Prana, and governance of the corporeal  
frame. The dictum health is to be sought from the  
Sun — encapsulates the solar principle in  
maintaining bodily integrity.[15]  
Sun conjunct malefic 2  
(Saturn, Rahu, or Ketu)  
Solar Afflictions  
(Primary)  
Sun  
aspected  
by 2  
malefic without benefic  
relief  
Moon weak or afflicted  
(debilitated, or within  
72° of Sun)  
Mars in or aspecting  
fourth house  
2
Brihat Parashara Hora Shastra designates Surya as  
the Atmakaraka and the signifier of bone structure,  
heart, and vital energy, while the fourth house in  
the natal chart is identified as the primary cardiac  
significator.[5]  
1
Other Cardiac  
Indicators  
(Secondary)  
Malefic occupying  
fourth house  
1
Fourth house lord weak  
or afflicted  
1
Varahamihira on Solar Affliction and Cardiac  
Disorders :Varahamihira's Brihat Jataka (Adhyaya  
2, Shloka 12) that afflictions of the Sun produce,  
among other consequences, diseases of the heart  
and chest region.[5] This classical textual statement  
provides the Jyotisha basis for examining solar  
planetary configuration as a factor in individual  
Current Dasha of a  
malefic planet  
1
Maximum Possible Score  
12  
Risk categories: Low (0-3), Moderate (4-7), High  
(8-12)  
Hypotheses to be tested :  
ï‚· H1 — Participants with High Risk score  
(≥8) will show significantly greater baseline  
Visual Analog Scale palpitation scores and  
Hamilton Anxiety Rating Scale scores than  
Low Risk participants (≤3).  
susceptibility  
to  
cardiac  
disorders,  
including Hridrava. The hypothesis proposed here  
is not that astrological factors mechanistically cause  
disease, but rather that natal planetary patterns may  
reflect constitutional vulnerabilities expressible  
through the lens of classical Jyotisha in a manner  
susceptible to systematic scoring and correlation  
with clinical data.  
ï‚· H2  
remediation) will demonstrate superior  
clinical outcomes among High Risk  
participants.  
ï‚· H3 — Planetary Affliction Score will  
—
Group  
C
(complete  
solar  
correlate  
negatively  
with  
therapeutic  
Proposed Planetary Affliction Scoring System :  
A Planetary Affliction Scoring System (PASS) is  
proposed (range 0-12) based on established  
classical indicators, weighted to prioritise solar  
afflictions in accordance with Varahamihira's  
observations. The components are set out in Table  
1
response  
across  
all  
arms.  
Integrative Solar-Centric Therapeutic Rationale  
ï‚· The conceptual integration proposed here  
rests on the shared solar axis identifiable  
across Ayurveda and Jyotisha. In Ayurvedic  
pharmacology, Shaliparni  
(bearing the  
Copyright @ : - Dr.Pachore Shreyansh Inter. J.Digno. and Research IJDRMSID0124 |ISSN :2584-2757  
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epithet Amshumati,  
connoting  
solar  
Proposed Clinical Validation Protocol  
radiance) directly corresponds to classical  
prescription  
Study Design :  
ï‚· A prospective, randomised, single-blind,  
placebo-controlled, four-arm parallel-group  
trial is proposed. The design follows  
for Hridrava in Vata aggravation.  
Shastra, Manikya (ruby) is specifically  
the ratna (gemstone)  
is prescribed  
In Rasa  
CONSORT  
CONSORT herbal medicine extension[17]  
2010  
standards[16]  
with  
identified  
as  
of Surya and  
for Hridya and Medhya applications. In the  
Vedic-epic tradition, Aditya Hridaya  
applied to the pharmaceutical arms.  
ï‚· Participants  
Stotra (Valmiki Ramayana, Yuddha Kanda  
ï‚· Inclusion criteria: adults aged 30-60 years;  
persistent palpitation complaint of ≥3  
months duration; Visual Analog Scale  
(VAS) palpitation severity score ≥4/10;  
willingness to provide accurate birth date,  
time, and place for astrological chart  
preparation; written informed consent.  
107) represents a structured mantra-based  
invocation  
of  
solar  
healing  
energies,  
employed at a moment of physical and  
psychological crisis.  
ï‚· This solar axis is therefore not merely  
symbolic. It reflects a consistent classical  
logic: that disturbance of solar energy  
ï‚· Exclusion  
criteria: organic  
cardiac  
governance  
—
whether  
interpreted  
pathology confirmed by 12-lead ECG and  
echocardiography; structural heart disease;  
as Atmakaraka affliction  
in Jyotisha or  
as Vata disorder in the Hridaya in Ayurveda  
— is amenable to solar-resonant therapeutic  
restoration. The three interventions thus  
constitute a coherent layered protocol:  
ï‚· Layer 1 — Herbal (Shaliparni Siddha  
Dugdha): Vata-pacifying, Hridya, nutritive,  
cardiac-supportive.  
uncontrolled  
hypertension  
or  
diabetes  
mellitus; pregnancy or lactation; concurrent  
use of cardiac medications or psychiatric  
medications that may confound outcomes;  
prior adverse reaction to Ayurvedic mineral  
preparations.  
Sample size: N = 120 (30 per arm), calculated  
using G*Power (effect size d = 0.6, power = 0.80, α  
= 0.05, with 15% dropout allowance).  
ï‚· Layer  
2
—
Mineral  
(Manikya  
Pishti): Mineral  
fortification, Hridya, Medhya,  
solar  
Randomisation and Allocation Concealment :  
Computer-generated block randomisation (block  
size = 4) with allocation concealment via  
sequentially numbered, opaque, sealed envelopes  
maintained by a biostatistician independent of the  
clinical team.  
gemological correspondence.  
ï‚· Layer 3 — Mantric (Aditya Hridaya  
Stotra recitation): Psychospiritual, breath-  
regulatory,  
invocation.  
adherence-promoting,  
solar  
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3. Ayurvedic Symptom Composite Score  
Intervention Arms:  
(Vata-related domains: sleep, restlessness,  
chest discomfort, breathlessness, fatigue; 0-  
15 range)  
ï‚· Group A: Shaliparni Siddha Dugdha 125  
ml once daily (morning, empty stomach), 8  
weeks.  
4. Adverse  
event  
log  
(structured  
diary,  
ï‚· Group B: Shaliparni Siddha Dugdha 125  
ml once daily + Manikya Pishti 125 mg  
twice daily with honey as anupana, 8  
weeks.  
reviewed at each visit)  
5. Safety bloods: CBC, LFT, RFT, Lipid  
Profile (Baseline and Week 8)  
Outcome assessors will remain blinded to group  
allocation throughout.  
ï‚· Group C: Shaliparni Siddha Dugdha 125  
ml once daily + Manikya Pishti 125 mg  
twice daily + guided Aditya Hridaya  
Astrological Assessment :  
Natal horoscopes (Lagna Kundali) will be prepared  
for all 120 participants using verified birth data,  
Lahiri Ayanamsa, and standardised software  
Stotra recitation  
108  
times  
daily  
(standardised audio recording provided), 8  
weeks.  
(Parashara's  
Light  
or  
Jagannatha  
Hora).  
A
ï‚· Group D (Control): Lifestyle counselling  
+ lactose placebo capsule twice daily, 8  
weeks.  
qualified Jyotisha expert  
will score  
charts  
independently, blinded to clinical data, using  
participant codes. The PASS (Table 1) will be  
applied consistently. Inter-rater reliability will be  
calculated using intraclass correlation coefficient  
(ICC) on a 10% subsample independently scored  
by a second Jyotisha expert.  
Outcome Measure:  
Primary outcomes, assessed at Baseline, Week 4,  
Week 8, and Week 12 (follow-up):  
1. Hamilton Anxiety Rating Scale (HAM-A):  
14-item clinician-administered scale, range  
0-56  
Statistical Analysis :  
SPSS v26 and R software will be used. Between-  
group comparisons will use one-way ANOVA with  
Tukey HSD post-hoc adjustment. Within-group  
changes will be analysed by paired t-test. Repeated  
measures will be examined via mixed-model  
ANOVA (Time × Group interaction).  
2. Heart Rate Variability: RMSSD and SDNN  
parameters via 5-minute resting ECG  
recording  
3. Palpitation severity: VAS (0-10 cm) and  
weekly frequency count from structured  
patient diary  
Jyotisha correlations will use Pearson's r between  
affliction scores and clinical variables. Multiple  
regression will assess predictors of treatment  
response. Significance level α = 0.05 throughout;  
effect sizes (Cohen's d) will be reported. Intention-  
to-treat analysis will be applied using Last  
Secondary outcomes:  
1. 12-lead ECG parameters (heart rate, PR  
interval, QTc, rhythm)  
2. WHOQOL-BREF: 26-item quality of life  
instrument  
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Observation Carried Forward (LOCF) for missing  
data.  
and stored under the Digital Personal Data  
Protection Act 2023.  
Pharmaceutical Preparation and Standardisation  
Shaliparni Siddha Dugdha :  
Discussion :  
The present framework addresses a recognised gap  
at the intersection of Ayurvedic cardiac care and  
Indian Knowledge Systems research methodology.  
Existing Ayurvedic cardiovascular literature —  
Authenticated Desmodium  
gangeticum root  
(verified pharmacognostically per API standards)  
will be processed with organic A2 cow milk  
following Sharangdhara  
Khanda 2/161) guidelines. Herb:milk:water ratio  
1:8:32, reduced by gentle heating to 1:4  
(Siddha state). Standardisation: HPTLC  
fingerprinting, alkaloid content, microbial load  
Samhita (Madhyama  
including  
systematic  
management,  
reviews  
and  
of Hridroga classification,  
pharmacological correlates[4,8,18,19,21] — provides a  
sound foundation. What remains absent is a  
controlled clinical evaluation specifically targeting  
functional palpitations (Hridrava) through a graded  
herbo-mineral protocol, and a blinded quantitative  
correlation between astrological indicators and  
clinical cardiac parameters. The solar-centric  
integration proposed here is notable for its internal  
conceptual consistency. The therapeutic triad —  
Shaliparni (Amshumati), Manikya (Surya's Ratna),  
and Aditya Hridaya Stotra â€” emerges organically  
testing[20]  
.
Manikya Pishti: Authenticated ruby specimens  
will undergo seven-cycle Shodhana using cow  
milk, Kulattha decoction, cow urine, and lemon  
juice. Purified material triturated with Gulaba  
Jala (rose water) for 72 hours to particle size <10  
microns. Quality control: heavy metal analysis (Pb  
<10 ppm, Hg <1 ppm, As <3 ppm per AYUSH  
standards), pH, organoleptic assessment. Both  
preparations under GMP-certified conditions with  
full batch documentation.  
from  
both  
classical  
pharmacological  
texts  
and Jyotisha cosmological principles rather than  
being assembled arbitrarily. This consistency  
strengthens the theoretical basis for the proposed  
study. At the same time, several methodological  
considerations deserve explicit discussion. Mantra  
adherence presents a standardization challenge;  
structured guided audio and adherence diaries are  
Ethical Compliance :  
Institutional Ethics Committee (IEC) approval will  
be obtained prior to participant recruitment. The  
study will be registered with the Clinical Trials  
Registry of India (CTRI) in accordance with  
ICMJE requirements. Informed consent will be  
proposed, but  
objective verification remains  
difficult. The placebo comparability between active  
and control arms requires careful justification in  
available  
in  
Gujarati,  
will be  
analysis  
Hindi,  
explicitly  
is  
and  
English.  
informed  
research  
any  
ethics  
submission.  
The  
exclusion  
of  
Participants  
participants with organic cardiac disease is essential  
for safety and interpretive clarity but limits  
that Jyotisha chart  
a
investigation tool and does not constitute medical  
prediction or diagnosis. Data will be anonymised  
generalisability.  
Finally,  
interpretation  
of  
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any Jyotisha correlation  
findings  
must  
remain  
sound, and scientifically testable model for  
preventive and supportive management of  
cautious: statistical association, even if found, does  
not establish causation and must be discussed as  
hypothesis-generating rather than confirmatory.  
The cost-effectiveness dimension — estimated at  
approximately INR 50 per day for the integrated  
Ayurvedic protocol versus INR 250 and above for  
conventional anxiolytics and cardiac medications  
— is a relevant public health consideration but  
should be formally modeled and documented in any  
clinical paper. This framework aligns with the NEP  
2020 vision for Indian Knowledge Systems  
research and the AYUSH Ministry's emphasis on  
evidence-based Ayurvedic practice.[20] Successful  
validation would constitute a meaningful addition  
to the evidence base for integrative preventive  
cardiology within the IKS paradigm.  
functional cardiac disturbances within the Indian  
healthcare system.  
References :  
1.  
World Health Organization. Cardiovascular  
diseases fact sheet. Geneva: WHO; 2023.  
2.  
Charaka Samhita, Sutra Sthana 30/3-4. In:  
Sharma PV, editor. Charaka Samhita (with  
Chakrapani  
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ISSN: 2584-2757  
Dr. Pahore Shreyansh Inter. J.Digno. and Research  
This work is licensed under Creative  
Commons Attribution 4.0 License  
Acknowledgements: The authors acknowledge the  
academic guidance received from the Department  
Submission Link : http://www.ijdrindia.com  
of Rachana  
of Rasashastra evam Bhaishajya Kalpana, Nootan  
Ayurvedic College and Research Centre,  
Sankalchand Patel University, Visnagar. No  
Sharir and  
the  
Department  
Benefits of Publishing with us  
Fast peer review process  
external funding was received for this review  
manuscript. Future clinical validation work will be  
supported through the IKS BG Samvardhan Yojana  
Programme of the Indian Knowledge Systems  
Division, Ministry of Education, Government of  
India  
Global archiving of the articles  
Unrestricted open online access  
Author retains copyright  
Unique DOI for all articles  
Funding Statement: No funding was received for  
the preparation of this review article. The proposed  
clinical protocol is intended to be submitted  
separately  
acknowledgement.  
Ethical Statement: This  
with  
appropriate  
funding  
manuscript  
is  
a
conceptual review article and proposed clinical  
protocol. No new participant data are reported  
herein. No ethics approval was required for this  
article. Future clinical trial implementation will  
require IEC approval and CTRI registration prior to  
commencement.  
Declaration :  
Conflict of Interest : None  
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