Implementation of Ayurvedic Treatment Principles in Hepatocellular Jaundice: A Case Report
Correspondence Address :
Dr. Pankaj Yadav,
Postgraduate Scholar, Department of Kayachikitsa, Datta Meghe Institute of Higher Education and Research, Wardha-442107, Maharashtra, India.
E-mail: py84442@gmail.com
Jaundice is a yellow colouring of the skin, mucous membranes, and the conjunctival membrane surrounding the sclera. It is a clinical indication of underlying hepatocellular dysfunction, biliary obstruction, or anomalies in bilirubin metabolism. Kamala might be linked to jaundice based on shared traits. Ayurveda has been well known for treating liver disorders for centuries. In this case report, a 29-year-old male patient, visited the Kayachikitsa outpatient department with primary complaints of pricking pain in the abdomen, loss of appetite, yellow discolouration of urine, nausea, vomiting, generalised weakness, and constipation for 10 days. Based on clinical examination and Liver Function Tests (LFT), he was diagnosed with jaundice. The patient was effectively treated with Shodhan (bio-purification) with sadya virechan (purgation therapy) followed by medicinal treatment for 45 days. Within 7-8 days, there was a significant improvement in abdominal pain with mild tenderness, frequency of vomiting, complaints of anorexia, nausea, constipation, and yellow discolouration of urine, along with substantial improvement in liver function. After 45 days of Ayurvedic treatment, all symptoms and liver functions showed highly significant results. The treatment was given by considering the vitiation of Pitta and Rakta. It can be concluded that by implementing Ayurvedic treatment principles, liver function can be improved in cases of jaundice in a short duration without causing any adverse effects.
Abdominal pain, Hepatitis, Kamala, Liver disorders, Sadya virechan
A case report of a 29-year-old male patient, who visited the Kayachikitsa outpatient department with the leading complaints of pricking pain in the abdomen, gradually increasing over 10 days, along with symptoms of Agnimandya (loss of appetite), Pitta Varniya Mutra (yellow discolouration of urine), Hrullas (nausea), Chardi (vomiting), Daurbalya (weakness), and Vibhandha (constipation) from 10 days. Upon inquiry, the patient disclosed that he had a fever 20 days prior, for which he had received treatment from a general practitioner. The patient felt better with the medication of Tablet (Tab.) Acetaminophen 500 mg twice a day, Tab Pantoprazole 40 mg twice a day, Domperidone 10 mg once a day, and Capsule (Cap) Vitamin B complex 400 mg once a day for five days. After 20 days, he developed the afore-mentioned symptoms.
Further history it is found that the patient was a factory worker who had been consuming food from roadside stalls, including fried and spicy items, for one and a half years. The case had no history of blood transfusions, hypertension, diabetes, or any chronic illnesses. Clinically examined, he was found to be afebrile, with abdominal distention, mild tenderness in the epigastric region, no hepatomegaly, and a tympanic sound present throughout the abdomen. Other systemic examinations did not reveal any significant findings. Based on the clinical examination, he was provisionally diagnosed with viral hepatitis and was advised to undergo Complete Blood Count (CBC), Liver Function Tests (LFT), Hepatitis B surface Antigen (HBsAg) testing, and abdominal Ultrasonography (USG) abdomen to specify the diagnosis. Later on, diagnosed with jaundice. His findings were as follows (Table/Fig 1).
Treatment plan: This case was diagnosed as Bahupitta Kamala, and the treatment was planned as per the treatment principles of Kamala.
• Sadhya Virechana (Purgation therapy): Sadhya Virechana was administered using two tablets of Abhyadi Modak with lukewarm water at bedtime, resulting in 8 Vegas (frequency of stool).
• Shaman Chikitsa (Internal Medication):
To alleviate the symptoms and cure the disease, the Ayurvedic treatment protocol has been administered (Table/Fig 2).
Observation
The therapeutic outcome of the patient’s subjective assessment during the 45-day treatment course is detailed in (Table/Fig 3) (1),(2). The changes in blood investigations during the 45-day treatment period are outlined in (Table/Fig 4). The alterations in scleral colour before start of treatment and after the 45-day treatment are depicted in (Table/Fig 5).
After 45 days of treatment, the patient experienced complete relief from all symptoms. Following a 15-day treatment follow-up, the patient completely recovered with no complaints of pain in the abdomen, yellow discolouration of urine, nausea, vomiting, Generalised weakness, or constipation.
Jaundice, sometimes referred to as hyperbilirubinemia, is characterised by the yellowing of the skin, mucous membranes, and the sclera of the eyes. Jaundice occurs due to an increased level of bilirubin, a yellow pigment produced during the breakdown of red blood cells, in the blood (3). Bilirubin only residues when there is an excess of it, which indicates either unnecessary production or inadequate excretion. The ancient Acharyas of Ayurveda considered Pitta dosha and Agnimandya as the primary etiological aspects of Kamala. In the above patient, due to frequent intake of Lavan, Katu, and Amla Ahara, there was Pitta’s vitiation which led to dysfunction of Jatharagni followed by the production of Amavisha, causing Kamala (4). The vitiated Pitta later affects the liver, blood, and muscle tissue, obstructing the liver’s channels and the release of Pitta back into the blood, resulting in nausea, pain in the abdomen, vomiting, and eye and skin discolouration.
In this study, SGOT, SGPT, and total serum bilirubin levels were 870 U/L, 1240 U/L, and 12.30 mg/dL, respectively, which were reduced to 42 U/L, 35 U/L, and 1.26 mg/dL, respectively. In a similar study conducted by Deshmukh S et al., it was found that SGOT, SGPT, and total serum bilirubin levels were 439 U/L, 1543 U/L, and 4.62 mg/dL, respectively, reduced to 17 U/L, 14 U/L, and 0.96 mg/dL, respectively over the duration of five months (5). Additionally, a similar study conducted by Sinha N et al., revealed that SGOT, SGPT, and total serum bilirubin levels of 1098.76 U/L, 1175.84 U/L, and 5.41 mg/dL were reduced to 30.9 U/L, 36.1 U/L, and 0.78 mg/dL, respectively in a 10-year-old female patient (6). From similar studies, it can be inferred that the Virechana procedure removes toxins from the body, promotes the immune system, and after Virechana, internal medication works better, providing additional relief to eradicate the disease. This procedure plays a major role in the management of Kamala. Both single drugs and compound drugs have been mentioned in our ancient classics for Kamala. These medications have ‘Kamalahara’ characteristics, treating symptoms such as weakness, loss of appetite, nausea, vomiting, discolouration of urine, and pain in the abdomen.
Virechana means the administration of a purgative to alleviate doshas from the body. Pitta dosha becomes vitiated as a result of ingesting Pittakara aahara (hot, spicy food) repeatedly, and Virechana (purgation) is the first line of treatment for Pittadushti, known as “Kamalatu virechana.” In Kamala, pitta dosha is vitiated and accumulated, requiring the elimination of accumulated pitta. Mrudu virechana (mild purgation) is useful in Bahupitta Kamala. Abhayadi Modak (7) contains Trivrut, Danti, Pippali, Maricha, and Amalaki. Abhayadi Modak has Katu Rasa, Teekshna Guna Ushna Virya, and Katu Vipak, which acts as Pitta Rechan, Kapha Samshodhan, and Vatanuloman, facilitating easy purgation and eradication of the aggravated pitta dosha in the body.
Arogyavardhini vati (8) It contains Shuddha Parada, Shuddha Gandhaka, Herbal Loha Bhasma, Abhraka Bhasma, Tamra Bhasma, Triphala, Shilajatu, Guggulu, Chitramool, Kutaki, and Juice extract of Nimba leaf. The main ingredient Kutaki has Kapha pittaghana dosha karma and Tikta Rasa properties, reducing Pitta dosha and promoting liver regenerating activities by restoring cytochrome.
Rohitakaristha (9) comprises Rohitak, Pippali, Sontha, Dhataki, and Jaggery. These drugs pacify Kapha Dosha and Pitta Dosha, acting as a hepatic stimulant that helps in detoxification, reducing toxins developed due to viral, bacterial, or parasitic infections, enhancing white blood cell production, reducing low-grade liver inflammation, increasing bile flow, and offering protective action on the liver.
Syp Amlycure (10) mainly contains Kutaki, Kalmegh, Sharpunkha, Tulsi, Bhuiamla, and Punernava. The combination of these drugs helps maintain cellular integrity of hepatocytes, improving appetite and digestion, regulating LFT parameters, preventing liver damage from toxins, boosting immunity.
Livomyn tablet contains herbs like Bhumiamalki, Kutaki, Guduchi, Daruharidra, Aloe vera, and Triphala, known hepato-protectives, ensuring the protection of liver cells from toxins, viruses, bacteria, reducing free radical activity, preventing oxidative stress, and hepatic cell damage (11). Among all these drugs, Kutaki is present and plays a significant role in curing liver-related disorders due to its Pitta Rechak property (12). Because of a properly concentrated dose of Kutaki, quick and significant results were observed in symptoms and liver-related investigations.
From this case report, it can be concluded that by implementing Ayurvedic principles of bahupitta kamala (hepatocellular) liver functions can be improved. Kutaki (Picrorhiza kurroa) is specifically described in Ayurvedic literature for its hepatoprotective properties. It can also be due to a properly concentrated dose of kutaki, which acts in breaking the pathogenesis of Kamala and leads to quick and significant results. The Virechana procedure removes toxins from the body and promotes the immune system. After Virechana, internal medication works better and provides additional relief, eradicating the disease. No side effects were observed in the patient, indicating that it can be considered a safe and effective therapy. Based on this successful outcome of Ayurvedic management in jaundice, planning further clinical trials with a large sample size, if needed in the future, is necessary.
The authors would like to thank Dr. Vaishali Kuchewar for giving appropriate guidance regarding the diagnosis and treatment of the patient.
DOI: 10.7860/JCDR/2024/68307.19275
Date of Submission: Oct 27, 2023
Date of Peer Review: Jan 08, 2024
Date of Acceptance: Jan 29, 2024
Date of Publishing: Apr 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Oct 28, 2023
• Manual Googling: Jan 09, 2024
• iThenticate Software: Jan 27, 2024 (9%)
ETYMOLOGY: Author Origin
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