See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/325111472

Efficacy and Safety of Dabidulward for the Treatment of Pelvic Inflammatory

Disease: A Placebo Controlled Randomised Clinical Trial

Article · January 2014

CITATIONS READS

0 87

4 authors, including:

Farah Naaz Yasmeen Shamsi

Pharmacopoeia Commission for Indian Medicine & Homoeopathy Jamia Hamdard University
19 PUBLICATIONS 5 CITATIONS 33 PUBLICATIONS 20 CITATIONS

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Revisiting Unani Classical Medicine View project

Research paper View project

All content following this page was uploaded by Yasmeen Shamsi on 13 May 2018.

The user has requested enhancement of the downloaded file.

 ISSN : 2249-5746

International Journal of Ayurvedic and Herbal Medicine 4:5 (2014) 1544-1556

Journal homepage: http://www.interscience.org.uk

Efficacy and Safety of Dabidulward for the Treatment of Pelvic

Inflammatory Disease: A Placebo Controlled Randomised
Clinical Trial
Rais ur Rahman1, Fahmida Kausar2, Farah Naaz3, Y.Shamsi4
1
Prof. H.O.D P.G Dept. of Moalijat, Ayurvedic and Unani Tibia College, Karol Bagh, New Delhi-05
2
Lecturer, P.G Dept. of Amraz-e-Niswan-wa-Atfal, Ayurvedic and Unani Tibbia College,Karol Bagh New Delhi-05
3
M.D, Medicine, Ayurvedic and Unani Tibia College, Karol Bagh, New Delhi-05
4
Corresponding Author, Associate Professor, Dept. of Mahiyatul Amraz, Faculty of Medicine (U), Jamia Hamdard, New Delhi.

ABSTRACT
The objective of the study was to validate and to evaluate the efficacy of Capsule Dabidulward for the
treatment of Pelvic Inflammatory Disease, which is a polymicrobial infection. Excellent data support the
role of Chlamydia trachomatis, Neisseria gonorrhoea and facultative gram-negative and anaerobic bacteria
in causing the symptoms and signs of the infection itself as well as the damage that ensues. Patient with PID
were treated with Capsule Dabidulward 500mg twice daily orally for a total of 21 days. It was a single blind
placebo controlled clinical trial. In total, 40 patients were treated for PID. The patients were screened and
diagnosed as per revised CDC criteria for PID. Rates of clinical success for Capsule Dabidulward were
comparable to those for the comparator regimen. Capsule Dabidulward was well tolerated and no
adverse/side effects were encountered. In conclusion, Capsule Dabidulward was clinically effective and safe
in relieving the symptoms and signs of Pelvic Inflammatory Disease. Hence, patients with PID can safely be
treated with this marketed drug of Dehlvi Naturals.

Keywords: Dabidulward; NFUM; Pelvic Inflammatory Disease; Waram-e-Rehm

INTRODUCTION
Pelvic inflammatory disease (PID) is a polymicrobial ascending infection that causes inflammation of the
upper genital tract, including endometritis, salpingitis, pelvic peritonitis, and occasionally leading to
tuboovarian abscess (TOA) formation[1, 3,4,5]. PID is perhaps the most important avoidable cause of female
[2]
tubal factor infertility, and its association with other chronic sequelae is well documented . The actual
burden of disease is unknown, but data from the USA suggest that > 10.0% of women of reproductive age
have a history of PID and that over 1 million new cases of symptomatic PID are seen annually[6]. A crude
marker of PID in resource-poor countries can be obtained from reported hospital admission rates, where it
accounts for 17% to 40% of gynecological admissions in sub-Saharan Africa, 15% to 37% in Southeast
Asia, and 3% to 10% in India [7]. The majority of clinically recognized cases occur in sexually active women
under the age of 25 years. The sexually transmitted micro-organisms Chlamydia trachomatis and Neisseria
gonorrhoeae, and the facultative and anaerobic microorganisms have all been implicated in the pathogenesis
of PID [8]. Although incidence rates may have declined, PID remains a major source of short- and long-term
morbidity in women. There is no evidence to suggest that there has been any reduction in the serious
reproductive complications traditionally associated with PID, which include infertility, ectopic pregnancy,
 International journal of ayurvedic & herbal medicine 4(5) Sep-Oct 2014(1544-1556)

and chronic pelvic pain. Treatment goals encompass not only the amelioration of the acute inflammatory
condition but also the prevention or lessening of the risk for long-term reproductive sequelae. Hence, an
early and accurate diagnosis of pelvic inflammatory disease (PID) is of paramount importance for the
effective management of the acute illness and for the prevention of long-term sequelae. Current modern
treatment depends on the cause and generally involves use of antibiotic therapy. Despite of the claim of
modern medicine with regard to the presence of anti-bacterial anti parasitic medicines that there is a definite
treatment of PID, the above mentioned incidence of different organisms in causing pelvic inflammatory
disease is still prevailing.
Every antibacterial drug in modern medicine produces more or less adverse effects in the human body. In
present era, everyone tends to become more health conscious and seeks the safer side in respect to treatment.
Natural, herbal or traditional medicine is now being seen with an eye of great interest and hope. Unani
medicine is one of them; this system not only provides the drugs information in abundance but also claims
that the drugs are having least adverse effects.
The clinical study reported in this article validated the efficacy and tolerability of capsule form of Majun
Dabidulward of Dehlvi Naturals, India for the treatment of pelvic inflammatory disease. Majoon
Dabidulward is a well known classsical unani formulation used in the management of warm-e-rahm (PID)
since ages. All the individual herbs of Dabidulward possesses anti-inflammatory, emmenogogue, anti-
spasmodic, astringent, antiseptic, anti-microbial as well as anti-oxidant properties which are well
documented in unani and modern pharmacology. These actions of individual drugs are known for their
efficacy in gynaecological ailments. Similarly the compound formulation ‘‘Majoon Dabidulward’’ has been
prescribed for visceral inflammations such as metritis, hepatitis, ileitis etc, in reknowed unani
pharmacopeias such as Biyaz-e-Kabir[9], Kitab-ul-Murakabat[10], NFUM[11].
MATERIAL AND METHODS
Study Drug: The study drug was capsule Dabidulward of Dehlvi Naturals, India. The ingredients of capsule
Dabidulward are given in Table-1. Both Dabidulward and placebo capsules were supplied by Dehlvi
Naturals.
Table-1: Composition of Dabidulward Capsule
Each 500 mg capsule contains dried aqueous extract of:
Nardostachys jatamansi (Jatamansi)- 13 mg Rubia cordifolia (Majith)- 13 mg
Pistacia lentiscus (Mastagi) )- 13 mg Coccus lacca (Lakh)- 13 mg
Crocus sativus (Kesar)- 13 mg Cichorium intybus (Kasni Beej)- 13 mg
Bambusa arundinacea (Tabasheer)- 13 mg Apium graveolens (Ajmod Beej)- 13 mg
Cinnamomum zeylanicum (Dalchini)- 13 mg Aquilaria agallocha (Agar)- 13 mg
Cymbopogon jwarancusa (Lamjak)- 13 mg Aristolachia longa (Zarawind)- 13 mg
Valeriana wallichii (Tagar)- 13 mg Commiphora opobalsamum (Balsan)- 13 mg

1545
 International journal of ayurvedic & herbal medicine 4(5) Sep-Oct 2014(1544-1556)

Saussurea lappa (Metha Kut)- 13 mg Myrtus caryophyllus (Laung)- 13 mg

Gentiana olivieri (Ghafis Phool)- 13 mg Elettaria cardamomum (Elaichi Choti)- 13 mg
Cuscuta reflexa (Kasoos)- 13 mg Rosa damascena (Gulab Patti)- 253 mg
Study Design
The study was designed as Randomized, Single-Blind and Placebo Controlled Clinical trial; randomization
was done by lottery method.
Patient Selection
The parameters for screening of subjects were lower abdominal pain, abnormal vaginal discharge, and
elevated body temperature with chills associated with nausea & vomiting, irregular bleeding, Urinary
symptoms such as dysuria, burning micturition etc. and dyspareunia. Patients presenting with any of the one
above mentioned symptoms were screened for the clinical evidence of pelvic inflammatory disease. All the
subjects fulfilling the screening criteria were then subjected to inclusion and exclusion criteria. All the
screened subjects with confirmed clinical diagnosis as per Revised CDC criteria, as per inclusion/exclusion
criteria were included in the study.
Treatment of Patients
The eligible patients as per the inclusion/exclusion criteria were randomly assigned to receive either Dabidulward or
placebo capsule (weight of each Dabidulward/Placebo capsule =500 mg) in the dose of 2 capsules twice daily with
plain water starting on 5th day of mensis for a period of 21 days.
During the study period patients were asked to avoid sexual intercourse and were advised to maintain
personal and local hygiene.
Inclusion criteria:
 Married women aged 20 - 40 years.
 Medical diagnosis of uncomplicated pelvic inflammatory disease (sub-acute PID with mild to moderate
signs and symptoms).
 Positive clinical findings confirming the diagnosis of mild to moderate pelvic inflammatory disease as
per CDC Criteria.
 Only women with first episode of PID were included.
 Patients willing to comply with various demands of study executives.
 Patients willing to sign informed consent form to participate in the study.
Exclusion criteria:
 Complicated cases of PID i.e Presence of TO abscess etc confirmed by clinical examination and by
ultrasonography.
 Women with recurrent PID or chronic PID excluded history taking.
 Patients seropositive for syphillis excluded on the basis of VDRL test.

1546
 International journal of ayurvedic & herbal medicine 4(5) Sep-Oct 2014(1544-1556)

 Tubercular peritonitis excluded with the help of Mantoux test and chest radiograph in suspected cases on
clinical examination.
 Malignancy was ruled out and excluded on the basis of PAP smear examination in suspected cases with
bad cervical erosions and hypertrophy and presence of multiple nabothian follicles.
 Pregnant and lactating women.
 Concomitant disease that may affect the evaluation of response to protocol therapy (such as
inflammatory bowel disease or significant renal or hepatic disease).
 Diabetes mellitus excluded by careful history taking and blood sugar random examination.
 Liver diseases and Chronic Renal Failure.
Clinical evaluation of patients
The effects of Dabidulward and placebo were assessed on subjective and objective parameters. Subjective
parameters included pain in lower abdomen, vaginal discharge, odour of vaginal discharge, painful coitus
and fever; while, assessment of objective parameters included fornical tenderness, cervical redness, cervical
discharge and bacteriological examination. As these parameters differ in severity from patient to patient, an
arbitrary grading of subjective and objective parameters was adopted for appropriate assessment and
statistical evaluation to assess the efficacy. The patients were followed up on 7th, 14th and 21st day. At every
visit, the patients were clinically examined and asked about the improvement or worsening in their
symptoms. Concomitant treatment was not allowed during the protocol period.
Subjective parameters
1 Lower abdominal pain
The lower abdominal pain was assessed on Visual Analogue Scale (VAS)[12].
2 Vaginal discharge
Vaginal discharge was assessed on 3 pointer scale from 1– 3 [13], 1= No discharge; 2 = Scanty discharge; 3 =
Excessive discharge.
3 Odour of vaginal discharge
Odour of the vaginal discharge was assessed on 3 pointer scale ranging from 1-3[13],1= No odour; 2 =
Minimal foul odour; 3 = Excessive foul odour.
4 Painful coitus
Degree of pain or discomfort on coitus was assessed on 6 pointer scale [13], 0= Not at all; 1= Mild; 2 =
Moderate; 3 = Severe; 4 = Very severe; 5 = Did not like to have intercourse due to pain
5 Fever:
Fever (temp> 38 C) was assessed as present (+) or absent(-).
Objective parameters
1 Fornical tenderness:

1547
 International journal of ayurvedic & herbal medicine 4(5) Sep-Oct 2014(1544-1556)

Fornical tenderness was assessed on 4 pointer scale [14], 1= If patient says the site is tender’ 2 = If patient
winces; 3 = If patient winces and moves away; 4 = If patient did not allow P/V examination
2 Cervical redness:
Cervical redness was assessed on 3 pointer scale [14], 1 = Mild; 2 = Moderate; 3 = Severe
3 Cervical discharge:
Cervical discharge was assessed on 3 pointer scale from 1– 3 [13], 1= No discharge; 2 = Scanty discharge; 3
= Excessive discharge
4 Cervical movements:
Cervical movement was assessed as painful (+) or non painful (-).
Bacteriological Assessment Of Patients
Samples for microbiological assessment were obtained from the urethra, endocervix, intrauterine-
contraceptive device (if removed) and endometrium before treatment (day 1). All specimens were
Gramstained. Bacteriological response to treatment was based on isolation of bacteria and reduction in
number of PMN`s in gram stain specimen.
Safety Assessment
The safety was assessed by monitoring adverse events either volunteered by the patients or elicited by the
investigator by clinical as well as laboratory investigations at baseline, after one week and at the termination
of the study. The laboratory tests included Kidney Function Test (Blood Urea, S.Creatinine ) , Liver
Function Test (S. Bilirubin, SGOT, SGPT, Alk.Phosphatase) and Haemogram ( Hb%, TLC, DLC, ESR)
Statistical Analysis
The pre-treatment and post-treatment values in each group separately (within group differences) were
statistically analyzed by using Mann-Whitney Test for Intra-Group and Kruskal-Wallis Test with Post
Dunn`s Multiple Comparisons Test for Inter-Groups comparisons.
RESULTS
In total 70 subjects with sign and symptoms of sub-acute PID as per screening criteria were enrolled for the
study, however only 40 completed the study. The baseline characteristics/demographic data of patients in the
two groups are summarized in Table-2
Table-2: Baseline Characteristics/Demographic Data
Treatment Group Drug Control
Characteristics Total No. of Patients 24 16
Mean Age (Years) 27.7 26.4
Illiterate 11(45.83%) 3(18.75%)
Primary 6 (25%) 5 (31.25%)
Educational Status
Hr. Secondary 5 (20.83%) 5 (31.25%)
Sr. Secondary 1(4.16%) 3 (18.75%)

1548
 International journal of ayurvedic & herbal medicine 4(5) Sep-Oct 2014(1544-1556)

Graduate 1(4.16%) 0
Higher 0 1(6.25%)
Socio-economic Status Middle 15(62.5%) 8 (50%)
Lower 9 (37.5%) 7 (43.75%)
Heterosexual 24(100%) 16 (100%)

Sexual Behaviour Homosexual 0 0

Bisexual 0 0
Hindu 15(62.5%) 9 (56.25%)
Religion Muslim 9 (37.5%) 7 (43.75%)
Christian 0 0
Nullipara 3(12.5%) 3(18.75%)
Parity Primipara 2(8.3%) 3(18.75%)
Multipara 19 (79.16%) 10 (62.50%)
Oral Pill 1(4.16%) 1(6.25%)
IUD 2 (8.3%) 3(18.75%)
Contraceptives Barrier 10 (41.66%) 7 (43.75%)
Tubal Ligation 1(4.16%) 1(6.25%)
None 10 (41.66%) 4 (25%))
Lower abdominal pain 22 (100%) 16 (100%)
Vaginal discharge 22 (100%) 16 (100%)
Foul smell of discharge 20 (90.9%) 15(93.75%)
Painful coitus 12 (54.5%) 13(81.25%)
Fever 0 0
Presenting Signs & Symptoms
Fornical tenderness 22 (100%) 16 (100%)
Cervical discharge 22 (100%) 16 (100%)
Cervical redness 22 (100%) 16(100%)
Painful cervical
13(81.25%) 13(81.25%)
movements

Effects of Dabidulward and Placebo on Subjective Parameters:

As shown in Table-2 and Figures 1&2, the median score of pain before starting treatment was 6.4 and on
termination of Dabidulward treatment, it was 1.95, the percentage of improvement was 69.76% (p<.0001
[Mann-Whitney Test]). The median percent change in placebo group was 1.3%, which was found
statistically insignificant. The inter-group comparison by applying Kruskal-Wallis Test showed highly
significant difference between the two groups (p<.001).
In test group vaginal discharge and foul smell of discharge were improved by 33.33% and 66.66%
respectively (both p<.001- Mann Whitney Test). In control group no any improvement was detected in

1549
 International journal of ayurvedic & herbal medicine 4(5) Sep-Oct 2014(1544-1556)

vaginal discharge, however the foul smell of discharge was reduced by 33.33% (p<.0001- on comparison
between the two groups by Kruskal-Wallis Test).
Fifty percent improvement in painful coitus was ascertained in test group (p<.001- Mann Whitney), no any
improvement was detected in control group (p<.0001- on comparison between the two groups by Kruskal-
Wallis Test).
Effects of Dabidulward and Placebo on Objective Parameters:
The percentage of improvement in fornical tenderness was found 33.33% after completion of treatment in
test group (p<.001- Mann Whitney Test), no improvement detected in placebo group (p<.0001- on
comparison between the two groups by Kruskal-Wallis Test). The mean score of cervical discharge was
reduced from 3 to 2 after completion of treatment with Dabidulward and the percentage of improvement
was 33.33% (p<.001- Mann Whitney), whereas no change was observed after treatment with placebo
capsule (p<.0001- on comparison between the two groups by Kruskal-Wallis Test). Cervical redness was
improved by 33.33% in drug group (p<.001- Mann Whitney) no improvement in cervical redness was
detected in placebo group (p<.0001- on comparison between the two groups by Kruskal-Wallis Test ).
Painful cervical movement was noticed in total 18 cases in test group, after accomplishment of Dabidulward
therapy, 14 patients were completely recovered from painful cervical movements. In control group painful
cervical movement before treatment were encountered in 13 patients and persisted even after completion of
treatment in all these cases.
All the subjects in test group and control group showed the presence of Gram +ve Bacteria on Gram`s
Staining of the endocervical swab smear. However, no Gram –ve Bacteria was detected in any subject of
either group. No effect of the drug/control was discovered on Gram +ve Bacteria in either group. However, a
significant reduction in neutrophil count was discovered in test group after completion of therapy. No such
finding was encountered in control group

1550
 International journal of ayurvedic & herbal medicine 4(5) Sep-Oct 2014(1544-1556)

Table-3:Effects of Dabidulward and Placebo on Various Parameters of PID

Neg
Median
No. (%) Of Median Score
Group
Presenting
Subjects Before
Score Percent
P Value ativ
Symptom After Change
Treatment e (-)
Treatment
Lower <.0001 sig
22 (91.66%) 6.45 1.95 -69.76
Abdominal Pain
Vaginal <.001 n is
22 (91.66%) 3.00 2.00 -33.33
Discharge
TEST Foul Smell Of indi
(N=24) 20 (83.33%) 3.00 1.00 -66.66
Discharge <.001
Painful Coitus 12 (50%) 4.00 2.00 -50 <.001 cati
Fever 0 0 0 0 ve
Lower
16 (100%) 6.55 6.4 -1.53
Abdominal Pain NS of
Vaginal NS
16 (100%) 3 .00 3.00 0 imp
CONTR Discharge
OL Foul Smell Of rov
15(93.75%) 3.00 2.00 -33.33 <.001
(N=16) Discharge
Painful Coitus 13(81.25%) 3.00 3.00 0 NS em
Fever 0 0 0 0 NS
ent;
No. Of Median
Subject
Median
After %
NS
Group Presenting Sign Before P Value
presented Treatment Change =
Treatment
With %
Fornical <.001 Not
22 (91.66%) 2 .00 1.00 -50
Tenderness sig
Cervical <.001
22 (91.66%) 3.00 2.00 -33.33
Discharge nifi
TEST
Cervical <.001
(N=24) 22 (91.66%) 3.00 2 .00 -33.33
Redness can
Painful Cervical Improved In
18(75%) t
Movements 14 Subjects
Fornical NS
16 (100%) 2 .00 2.00 0
Tenderness
Cervical NS
16 (100%) 3 .00 3.00 0
Discharge
CONTR
Cervical
OL 16(100%) 2 .00 2.00 0
Redness NS
(N=16)
Not Improved
Painful Cervical
13(81.25%) In All 13
Movements
Subjects

1551
 International journal of ayurvedic & herbal medicine 4(5) Sep-Oct 2014(1544-1556)

Figure-1: Effects of Dabidulward and Placebo on Subjective Parameters

6
Median Score of Symptoms

Lower Abdominal Pain

4
Vaginal Discharge
2 Foul Smell of Discharge

0 Painful Coitus
Before After Before After
Treatment Treatment Treatment Treatment

Dabidulward Placebo

Figure-2: Effects of Dabidulward and Placebo on Objective Parameters of PID

3
2.5
2 Fornical Tenderness
Median Score of Signs

Cervical Discharge
1.5
Cervical redness
1
0.5
0
Before After Before After
Treatment Treatment Treatment Treatment

Dabidulward Placebo

SAFETY
During the course of the study, no adverse events were reported by the patients, no any adverse effects were
detected by clinical examination and/or laboratory investigations. The formulation was well tolerated as
indicated by 90% drug compliance.
DISCUSSION
Analysis of the results of 40 cases of pelvic inflammatory disease treated with capsule Dabidulward revealed
some interesting facts which are discussed in the following lines.
1552
 International journal of ayurvedic & herbal medicine 4(5) Sep-Oct 2014(1544-1556)

 PID is a very common ailment of married women in India. The disease commonly affects married
women of different age groups. In this study maximum number of patients was observed in age group of
25-29 years. These data are in agreement with the findings reported by L Westrom [15].
 The prevalence of PID was found to be higher among Muslims (60%) than in the other religions. No
convincing data is available that demonstrates the distribution of PID among different religious
communities in the society. This study, however, reflects a preponderance of Muslims among the
patients of pelvic inflammatory disease. The probable reason may be the majority of Muslim patients
visiting Tibbia College Hospital, as Unani Medicine is more popular among Muslim community.
 The highest incidence of PID was observed in middle class (57.5%), followed by patients in lower class
(40%). This is in consonance with the unani description that malnutrition and poor sanitation which is
[16,17,18].
common in low socio-economic group are the predisposing factors for warm-e-rahm Low
income, minor communities have higher risk than higher income community [16].
 This study shows the highest prevalence of PID among Illiterates’ group (35%). The prevalence of PID
decreased with the level of education and found to be lowest with Senior Secondary level of literacy
status (10%).
 Higher prevalence of PID was observed in women having multiple child birth (72.50%). According to
unani literature ibtedae jimah (early age of coitus) is included in the etiology of warm-e-rahm and it is
[16,17,18]
also associated with multiparity . PID prevalence was higher among women who were using
barrier methods as means of contraception (42.5%), followed by non users (35%) and it was observed in
12.5% of IUCD users. Contraceptives play an important role in predisposing women to acquisition of
PID. Non-use of contraception is a risk factor for PID, whereas barrier methods can decrease the risk of
[20-24]
STD acquisition and subsequent development of PID . Although use of an intrauterine device
traditionally has been believed by most clinicians to confer an elevated risk of PID, the risk seems to be
primarily restricted to the first 3 months after insertion, likely because of bacterial contamination at the
[25-32]
time of insertion . The differences observed are supposed to be due to relatively small sample size
of the study.
 During the course of the study subjects, were asked about their sexual behaviour and all of them (100%)
replied with heterosexual orientation.
All the participating subjects (100%) were engaged sexually with single partner only but (17.5%) of the
husbands admitted having sexual relationships with other than wives. Though, studies have shown that
women with multiple sexual partners, especially in the preceding 30 days, have a fourfold elevated risk of
acquisition of PID [20-33]. It can be inferred that female subjects did not give the right information about their
sexual activity and the difference may due to the social & cultural shyness regarding the disclosure of
personal sexual relations or may be due to the relatively small sample size.

1553
 International journal of ayurvedic & herbal medicine 4(5) Sep-Oct 2014(1544-1556)

It is evident from the results of present study that the convenient capsule form of Majun Dabidulward has
analgesic, antispasmodic and anti-inflammatory activities as it produced remarkable improvement in various
subjective/objective parameters of PID such as lower abdominal pain, painful coitus, painful cervical
movement, cervical redness and tenderness etc. The significant decrease in polymorphonuclear leucocyte
count also supports its anti-inflammatory activity. However, a large scale, prospective, double blind,
randomized standard controlled clinical trial is warranted to support the efficacy of test formulation in the
management of pelvic inflammatory disease. This test formulation can also be tried and tested in the acute
cases of pelvic inflammatory disease which were not studied due to the limitation of the present trial.
Limitations Of Study
This study had certain limitations like: a small cohort size which failed to yield appropriate epidemiological
data. With a larger sample size, the trial drug might have demonstrated superior efficacy in the onset of
subjective and objective parameters, Lack of blinding of the patients i.e. double blinding, Lack of better and
more precise efficacy assessment investigations in the institution, like culture facility which would have
specifically demonstrated the antibacterial efficacy of the trial drug, We were not able to assess exactly that
for how long the effects of the test formulation persisted owing to the limited time duration. In addition, the
results of the study cannot be extrapolated to the patients of acute pelvic inflammatory disease, considering
the severity of the disease and limitations of the trial, these cases were excluded from the study.
CONCLUSION
On the basis of above observations, it can be concluded that the test drug is clinically effective in relieving
the symptoms and signs of pelvic inflammatory disease and hence can safely be prescribed to the patients
for the management of PID. The test drug is cheaper, easily available and well tolerated by the patients
without having any side effects.
ACKNOWLEDGEMENT
The authors are indebted to Mr. Mohsin Dehlvi, Proprieto of Dehlvi Naturals, who sponsored the trial drug

for this study. We are also thankful to Dr. Ahmad Yasin, Principal & Medical Superintendent, A & U Tibbia

College & Hospital, for his kind support during the study.

REFERENCES
1. Workowski KA, Berman S. Sexually transmitted diseases treatment guidelines, 2010. MMWR
Recomm Rep. 2010;59:1–110.
1. McCormack WM: Pelvic inflammatory disease. N Engl J Med 1994; 330: 115 – 119.
2. Hager WD, Eschenback DA, Spece MR, Sweet RL. Criteria for diagnosis and grading of salpingitis.
Obst Gynecol 1983; 61:113-4.

1554
 International journal of ayurvedic & herbal medicine 4(5) Sep-Oct 2014(1544-1556)

3. Jacobson L, Westrom I. Objectivized diagnosis of pelvic inflammatory disease. Diagnosis and

prognostic value of routine laparoscopy. Am J Obstet Gynecol 1969; 105:1088-92.
4. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2002.
MMWR Morb Mortal Wkly Rep 2002; 51:1–77.
5. Centers for Disease Control and Prevention:1998 guidelines for the treatment of sexually transmitted
diseases. MMWR Morb Mortal Wkly
6. Ensource, Wikipedia.
7. Quan M: Pelvic inflammatory disease: diagnosis and management. J Am Board Fam Pract 1994;7:
110 – 123
8. Hakeem. Kabir uddin, Biyaz e kabir-vol.2, pg-132.
9. Hakeem.Zil-ur-Rahman,Kitab-ul-Murakabat.publication division AMU Edition1991,pg162-163
10. Anonymous, NFUM , part 1, CCRUM , Dept. Of AYUSH 2006, pg 124
11. . Wei Che Lin, Fu Tsai Kung, Tai Yi Chen, Lee Leung Chit Tsang, Wu Der Tsay, Yu Fan Cheng.
Short Term Results Of Transcatheter Uterine Artery Embolization Using Lipiodol And Gelfoam
Cubes For Symptomatic Uterine Leiomyoma. Chin J Radiol 2005; 30:17-24.
12. . Willmott Fe. Mucopurulent Cervicitis: A Clinical Entitiy. Genitiurin Med. 1988;64:169-71.
13. . Jian Xin Zhang, Sheng Chun Dang, Jian Guo Qu, Xue Qing Wang. Preventive Effect Of
Tetramethylpyrazine On Intestinal Mucosal Injury In Rats With Acute Necrotizing Pancreatitis
14. Heinonen PK, Teisala K, Punnonen R, et al. Anatomic sites of upper genital tract infection. Obstet
Gynecol 1985; 66:384-90
15. Majoosi AA (1889). ‘’Kami-Al-Sana’’ Hakeem. Ghulam Hussain Kantoori, Matba Munshi Naval
Kishore, Lucknow, pg.536-537.
16. Kabiruddin. Al-Akseer. Vol II. New delhi: ajaz publishing house; 2003; 1327.
17. Razi. Kitabul Murshid. Urdu translation by nadvi MR, new delhi: taraqqi urdu bureau; 2000: 49
18. Navarro C, Jolly A, Nair R, Chen Y. Risk Factors For Genital Chlamydia Infection. Can J Infect Dis.
2002; 13 (3): 195-207.
19. Joessens MO, Eskenazi B, Schachter J, Sweet RL. Risk factors for pelvic inflammatory disease: a
case-control study. Sex Transm Dis 1996; 23:239–47.
20. Wolner-Hanssen P, Eschenbach DA, Paavonen J, Kiviat N, Stevens CE, et al. Decreased risk of
symptomatic chlamydial pelvic inflammatory disease associated with oral contraceptive use. JAMA
1990; 263:54– 9.
21. Darrow WW. Condom use and use-effectiveness in high-risk populations. Sex Transm Dis 1989;
16:157– 60.
22. Kelaghan J, Rubin GL, Ory HW, Layde PM. Barrier-method contraceptives and pelvic inflammatory
disease. JAMA 1982; 248:184– 7.
1555
 International journal of ayurvedic & herbal medicine 4(5) Sep-Oct 2014(1544-1556)

23. Cramer DW, Goldman MB, Schiff I, Belisle S, Albrecht B, et al. The relationship of tubal infertility
to barrier method and oral contraceptive use. JAMA 1987; 257:2446.
24. Sweet RL. Pelvic inflammatory disease. In: Sweet RL, Gibbs RS, editors. Infectious diseases of the
female genital tract. 4th edition. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 368– 412.
25. Westrom L, Eschenbach D. Pelvic inflammatory disease. In: Holmes KK, Sparling PF, Mardh P-A, Lemon
SM, Stamm WE, Piot P, Wasserheit JN, editors. Sexually transmitted diseases. 3rd edition. New York:
McGraw-Hill; 1999. p. 783–810.
26. Senanayake P, Kramer DG. Contraception and the etiology of pelvic inflammatory disease: new perspectives.
Am J Obstet Gynecol 1980;138:852–60.
27. Eschenbach DA, Harnisch JP, Holmes KK. Pathogenesis of acute pelvic inflammatory disease: role of
contraception and other risk factors. Am J Obstet Gynecol 1997; 128:838–50.
28. Kaufman DW, Shapiro S, Rosenberg L, et al. Intrauterine contraceptive device use and pelvic inflammatory
disease. Am J Obstet Gynecol 1980; 136:159. 790 R.H. Beigi, H.C. Wiesenfeld / Obstet Gynecol Clin N Am
30 (2003) 777–793
29. Ory HW. A review of the association between intrauterine devices and acute pelvic inflammatory disease. J
Reprod Med 1978; 20:200.
30. Osser S, Gullberg B, Lieholm P, et al. Risk of pelvic inflammatory disease among intrauterine device users
irrespective of previous pregnancy. Lancet 1980; 1:386.
31. Fairley TMM. Intrauterine devices and pelvic inflammatory disease: an international perspective. Lancet
1992; 339:785.
32. Eschenbach DA. Epidemiology and diagnosis of acute pelvic inflammatory disease. Obstet Gynecol 1980;
55:142S– 52S.

1556

View publication stats