single case study in ayurveda

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• v.38(3-4); Jul-Dec 2017

A single-case study of management of Jalodara (ascites)

Shital gopalbhai bhagiya.

Department of Panchkarma, Institute for Postgraduate Teaching and Research in Ayurveda, Jamnagar, Gujarat, India

Ram B. Shukla

1 Department of Panchkarma, Government Akhandanand Ayurveda College, Ahmedabad, Gujarat, India

Nayan P. Joshi

2 Department of Panchkarma, J S Ayurved Mahavidyalaya, Nadiad, Gujarat, India

Anup B. Thakar

Most common manifestation of liver dysfunction is ascites and most common cause of ascites is liver disease. Ascites is the accumulation of fluid in the peritoneum. Inspite of advanced medical facilities, still, there is no sure treatment which cures a patient of ascites totally. The modern treatments only provide provisional relief with time dependent recurrence but, the fluid gets collected in the abdominal cavity repeatedly. In such case, Ayurvedic treatment gives relief without any side effect, in such cases and can be correlated with Jalodara (ascites) which mentioned in Ayurveda medical science. Diet restriction, medicinal treatment and surgical procedure are mentioned in Samhita . Diet restriction is an important feature of the management of this condition. A 46-year-old female came to outpatient department with anorexia, abdominal distension, vomiting after meal, respiratory distress etc. She was given Nitya Virechana (daily therapeutic purgation) with Abhayadi Modaka , cow's urine, Sharapunkha Swarasa , Punarnava Kwatha , etc. and restricted diet plan for 3 months. After 3 months, a significant improvement was noted in all the symptoms of the patient. Hb% was also increased from 7.5% to 11.2% and erythrocyte sedimentation rate and serum creatinine were decreased from 35 mm/h to 10 mm/h and 1.2 mg/dl to 0.9 mg/dl respectively. Ultrasonographic findings also showed improvement in comparison with previous report. Hence, it was concluded that Ayurvedic management gives relief in ascites.

Introduction

Ascites is a gastroenterological term for an accumulation of fluid in the peritoneal cavity that exceeds 25 ml.[ 1 ] Ascites can be considered in Ayurveda under the broad spectrum of Udararoga (diseases of abdomen).[ 2 ] Among Tridosha , the Prakupita Vata (aggravated Vata ) gets accumulated in Udara between Twaka (skin) and Mamsa (muscles tissue) leading to Shotha (swelling); this is being termed as Udararoga .[ 3 ] Vata is one of the prime causative factors in the manifestation of Udararoga .[ 4 ]

Along with the aggravated Vata , Agni (digestive fire) which is Manda (low) also causes Udararoga .[ 5 ] Hence, there are multiple factors involved in the causation of Udararoga . In other terms, Udara is manifested because of vitiated Rasa Dhatu portion which gets extravagated from Koshtha and Grahani gets collected in Udara .

Ascites as a disease has been described extensively in Ayurvedic literature along with medical treatment and surgical procedures related to the management of this condition. Diet restriction is an important feature of the management of this condition.

Ayurvedic management with drugs such as provocation of digestion, daily therapeutic purgation, stimulant for hepatic function and only milk diet that acts on root of pathology of ascites and by breaking down of pathogenesis gives good result in ascites.

Case Report

A 46-year-old female [ figure 1 ] came with following chief complaints: anorexia for 1.5 years, abdominal distension for 1 year, vomiting after meal for 8 months and respiratory distress, generalized weakness, disturbed sleep and bilateral pedal edema for 6 months.

BT Photograph of patient

History of present illness

The patient was alright before 2 years. After that, the patient had low grade fever and after investigations, diagnosis of malarial parasite was done. After treatment of malaria fever was subsided, she had pain in the right and left hypochondriac region, for which she started using analgesics frequently without prescription. Thereafter, the patient felt anorexia, vomiting and heaviness of abdomen, respiratory distress, pedal edema etc. For this, the patient took allopathic medicine for 2 months but did not got relief, hence she came to Panchakarma Department, Government Akhandanand Ayurveda Hospital, Ahmedabad and was admitted to the indoor patient department for daily observation.

Past history

• History of malaria before 2 years
• No history of tuberculosis, diabetes mellitus, hypertension, hypothyroidism, any surgery or chronic illness.

Family history

• No evidence of this type of disease in the family.

Physical examination

• Bilateral pedal edema: +++
• Body temperature: 98.6 F
• Mild pallor
• Blood pressure: 126/70 mmHg
• Pulse: 86/min
• Respiratory rate: 20/min.

Systematic examination (per abdomen)

• Inspection: Distended abdomen
• Palpation: Hepatomegaly (2 cm below the right costal margin), splenomegaly, tenderness in the right and left hypochondriac region
• Percussion: Shifting dullness and fluid thrill: Present.

Investigation

Table 1 summarizes the blood profile and ultrasound investigations before and after treatment.

Investigations before and after treatment

Table 2 shows the treatment schedule of the patient.

Treatment schedule of patient

Pathya-Apathya

Diet was restricted to the patient and she was kept on only cow milk ( Shunthi Siddha Godugdha ). All type of food items and water were restricted for 3 months. When the patient was hungry or thirsty, she was given lukewarm Shunthi Siddha Godugdha only. Medicines were also given with cow milk as an adjuvant.

Significant results were found in all the symptoms, abdominal girth and pedal edema [Tables ​ [Tables3 3 - ​ -5 5 ].

Relief in symptoms

Improvement in ( Ubhay - pada Shotha ) pedal edema

Table 3 presents the relief in symptoms and Table 4 provides the measurement of abdominal girth and Table 5 shows the improvement in ( Ubhay - Pada Shotha ) pedal edema (mid-point between knee joint and ankle joint).

Measurement of abdominal girth

Discussion on causes of ascites, Aacharya Charaka has mentioned many causes of Udararoga . In the present case, the patient had low digestive fire, over eating, very hot, salty, spicy, acidic food, taking dry and impure diet, negligence of the treatment of severe diseases and suppression of natural urges.[ 6 ]

Discussion on treatment of ascites[ 7 ]

Nidana parivarjana (avoid causative factors).

For this diet and water, intake was restricted and the patient was kept only on milk diet.[ 8 ]

Agnidipti (provocation of digestion)

Mandagni is the chief factor in any type of Udararoga . For Agnidipti , Trikatu Churna (for 6 days) and Shivakshar Pachana Churna (for 15 days) were given to the patient. It enhances Agni and helps in Samprapti Vighatana (breakdown of pathogenesis).

Apyam Doshaharanam and Sroto Shodhana (removing the accumulated fluid)

Gomutra [ 9 ] was given to the patient (15 days). Tikshna , Ushna Guna of Mutra (urine) enhances Agni (digative power). By its Ushna (hot) , Tikshna (sharp) and Ruksha (dry) Guna , it removes Strotosanga (obstruction) of channels and helps in Samprapti Vighatana (breakdown of pathogenesis). Simultaneously, there was removal of Apya Dosha (water retention) also.

Nitya Virechana (daily therapeutic purgation)

Chikitsa Sutra of Jalodara is “Nitya Virechana.” To break up the Sanga of all Dosha and retained fluid and separate them, Virechana is necessary. Liver ( Yakrita ) is the Mula Sthana (main site) of Rakta . Rakta - Pitta has Ashraya and Ashrayi Sambandha (mutual interdependence), hence for elimination of vitiated Pitta Dosha , purgation is the best treatment. Virechana also decreases abdominal girth and edema by decreasing fluid in the abdominal cavity.[ 10 ] Abhayadi Modaka [ 11 ] was given in present case for Virechana purpose. Daily 5–8 Vega were noted in patient after giving Abhayadi Modaka . More results were achieved in all the symptoms after starting daily therapeutic purgation.

Arogyavardhini Vati and Sarpunkha Swarasa

Arogyavardhini Vati is known for its benefits especially to the liver. Arogyavardhini maintains the liver function and promotes balance as well as a healthy digestive system. Its main content is Katuki ( Picrorhiza kurroa Royle ex Benth.) which acts as Pitta Virechana and acts on Yakrita .[ 12 , 13 ] Ascites may be caused due to any pathology of liver, heart, kidney, etc., but ascites from liver disease is difficult to be treated; hence, there comes the need to correct the pathology from its root cause. In the present case, the patient also has hepatomegaly hence these drugs were administered. Sharapunkha is the drug of choice in spleen and liver diseases. It corrects the working of digestive system. It improves the functioning of liver. The study shows that Sharapunkha has hepatoprotective activity.[ 14 ]

Punarnavadi Kwatha and Punarnavadi Mandura

Punarnavadi Kwatha is indicated in the treatment of Udara Roga and it also reduces Shotha (swelling). It corrects Pandu and Shwasa too. The patient had all these symptoms with Jalodara , hence this Kwatha was prescribed which had shown significant result in all symptoms. Mandura is also indicated in Pandu (anemia), Shotha (oedma) and Shwasa (bronchial asthama) which significantly improved Pandu .[ 15 , 16 ]

Erandabhrishta Haritaki

This was given for Vatanulomana purpose. Apana Vayu is also included in Samprapti of Jalodara . Because of Erandabhrishta Haritaki , Apana Vayu moves toward its normal path and it helps counteracting pathology. It also posses laxative effect.

Daily therapeutic purgation, diet restriction and Ayurvedic medicines had shown improvement in all the symptoms of Jalodara . In the present case, abdominal girth, pedal edema and all above-mentioned symptoms were significantly improved without any side effect. Although the patient was kept only on milk diet, no any side effects were noted during and after the treatment. In the present case, Arogyavardhini Vati was given for 45 days continuously, but no any side effects were noted; hence, it can also be concluded that metallic preparations are not harmful to the body if given in suitable dose, rather it gives more benefits. Hence, it can be concluded that Ayurvedic medicines with Nitya Virechana give better result in ascites without side effect.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understand that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Conflicts of interest.

There are no conflicts of interest.

Year: 2021 | Month: April-June | Volume: 6 | Issue: 2 | Pages: 64-68

DOI: https://doi.org/10.52403/gijhsr.20210409

A Single Case Study of Dermatomyositis and Management in Ayurveda

D. ghosh 1 , r. ghosh 2.

1 MD (AY), PhD (C.U), Superintendent and Ex-officio Professor, Viswanath Ayurved Mahavidyalaya & Hospital, Kolkata 2 MBBS (FINAL), GSL Medical College and General Hospital, Rajahmundry, Andhra Pradesh

Corresponding Author: D. Ghosh

Background: Dermatomyositis is an idiopathic myopathy involving progressive muscle weakness with skin manifestation. Diagnosis is based upon progressive muscle weakness, skin rashes, increased liver enzymes, high ASO titer. The incidence of dermatomyositis is rare. In this case study, we report a case of classical dermatomyositis without incidence of malignancy. Case Presentation: A 28-year female patient visited the outdoor at Viswanath Ayurved Mahavidyalaya & Hospital, Kolkata with a fever for two months with scattered rashes all over the body with pain & swellings and with gradual weight loss. Conclusion: This case is shifted from allopathy to Ayurveda as in allopathy she did not get any relief. First, this case was treated on the outdoor treatment of ayurvedic hospital then She was shifted to an indoor ward and was under Ayurvedic treatment for about a month. The patient was recovered from her illness and symptoms after the completion of the treatment.

Keywords: Dermatomyositis, Ayurveda, Liver enzymes, skin rashes, Uttana vatrakta.

A single case study of Ayurvedic management of Vicharchika w.s.r. to Weeping Eczema

• Reshmi PK Assistant Professor, Department of Panchakarma, Ramakrishna Ayurvedic Medical College, Hospital and Research Center, Bangalore, Karnataka, India.

In the present case study, a 4 years old girl consulted in the Ayurvedic clinic after a spectrum of allopathic treatment with huge disappointment. The girl was with the presenting complaints of recurrent skin rashes over dorsal part of upper ankle joints bilaterally with redness, skin edema, itching, skin flaking, blistering, oozing and bleeding of upper layer of skin. In the present case, parents of patient was intended to treat with Ayurveda. By examining the patient, the signs and symptoms was diagnosed as Vicharchika which has similarities with eczema as per modern medicine. As per Ayurveda, Vicharchika is one among Kshudrakusta with dominance of Kaphadosha . The patient was treated with Gudoochyadi Kashaya , Manjishtadi Kashaya , Aragwadharista , Gorochanadi Gutika , Triphala Churna and Mahatiktaka ointment along with strict restrictions of diet. This study is carried out as per International conference of Harmonization – Good Clinical Practices Guidelines as per Declaration of Helsinki guidelines.

Agnivesha, Charaka Samhita, Vidyotini Hindi Commentary by Kashiram Shastri and Gorakhnath Chaturvedi, Chaukhambha Bharati Academy, Varanasi, Part 2, Reprint 2006, Chikitsa Sthana 7/30, pp 253

Harrison’s Principles of Internal Medicine, McGraw Hill Medical Publishing Division, New Delhi, 1036th Edition 2004, pp 289

Vagbhata, Astanga Hridayam, collated by Dr. Anna Moreswara Kunte and Krishna Ramachandra Sastri Navare, Edited by Bhishagacharya Harisastri Paradakara Vaidya, Chaukhambha Orientalia, Varanasi, Reprint 9th Edition, Sutrasthana 15/16, pp 235

Sahasrayogam with Sujanapriyavyakhya, Editers K V Krishnan Vaidyan and S Gopala Pillai, February 2006, 26th Edition, Vidyarambham Publishers, Vatarakta Adhyaya, pp 85

Vaidyayoga Ratnavali, Gutika Prakarana - 77, A1DS5f vol.1

Vagbhata, Astanga Hridayam, collated by Dr. Anna Moreswara Kunte and Krishna Ramachandra Sastri Navare, Edited by Bhishagacharya Harisastri Paradakara Vaidya, Chaukhambha Orientalia, Varanasi, Reprint 9th Edition, Sutrasthana 15/17,18, pp 235

Susruta, Susruta Samhita, Dalhana Commentary – Nibandha Sangraha, Chaukhambha Orientalia, Varanasi, 2002, Sutrasthana 38/56, 57

Proprietary medicine as per the reference ofVagbhata, Astanga Hridayam, collated by Dr. Anna Moreswara Kunte and Krishna Ramachandra Sastri Navare, Edited by Bhishagacharya Harisastri Paradakara Vaidya, Chaukhambha Orientalia, Varanasi, Reprint 9th Edition, Chikitsa Sthana 19/8-10, pp 711

Susruta, Susruta Samhita, Dalhana Commentary – Nibandha Sangraha, Chaukhambha Orientalia, Varanasi, 2002, Chikitsasthana 9/43, pp 446

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A Single Case Study of Ayurvedic Management of Yakraddalyudaraw.s.r. toHepatomegaly

Doi:https://doi.org/10.47223/irjay.2022.5213.

• Seema Meena P.G. Scholar P.G. Dept. of Kaya Chikitsa M.M.M. Govt. Ayurved College, Udaipur, 313001
• Ravi Sharma Prof. & HODP.G. Dept. of Kaya ChikitsaM.M.M. Govt. Ayurved College, Udaipur, 313001

Ayurveda has many propositions to hepatobiliary diseases which are akin to modern understanding of hepatology. Besides elaborate clinical descriptions of various hepatic conditions, Ayurveda further proposes many herbal, Herbo mineral and dietary interventions to prevent and to manage such conditions. Kalmegha( Andrographis panniculata ), Bhumiamalki churna, Kutki churna, are trusted drugs from Ayurvedic repertory which is variously used in many hepatic conditions. We had gone through a pilot study to evaluate its role in various hepatic conditions and found that it has a beneficial role in hepatocellular pathologies. The ayurvedic method aims to reduce disability while also easing symptoms. Here, we discuss a case of Yakrddalyudara that was effectively treated by Ayurvedic medicine

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A UNIQUE COMBINATION OF AYURVEDIC MEDICINES AND PANCHAKARMA IN MANAGEMENT OF DARUNAKA: A SINGLE CASE STUDY

• Pranjal Sanjay Jain MD Scholar, Department of Kayachikitsa, S.G.R. Ayurveda College, Solapur, Maharashtra.
• Amey Chandrakant Nakil MD Scholar, Department of Kayachikitsa, S.G.R. Ayurveda College, Solapur, Maharashtra.
• Vivek Shrirampant Chandurkar Professor and HOD, Department of Kayachikitsa, S.G.R. Ayurveda College, Solapur, Maharashtra.

In today’s era, Darunaka (Dandruff) is one of the irritative and embarrassing diseases which have high prevalence rate. The disease is mainly concerned with hair root. Due to the poor cleaning, pollution, changing lifestyle and food habits that ultimately leads to the disease. According to Ayurveda, it can be correlated with Seborrhoic dermatitis. Cardinal symptoms of Darunaka are Kandu (itching), Rukshata (dryness), Twaksphuthan (cracking of skin), Keshachutti (falling of hair). As dandruff doesn’t produce any hazards effect to body but cosmetically it looks ugly. It is mainly due to the vitiation of Vata and Kapha Dosha. In present paper, a 30yr male patient came to the OPD with symptoms of Shweatvarniya Twakvevarnya at Shir Pradesh , Kandu, Twaksphuthan , Keshachyuti, Rukshata, since 3yrs along with he also developed Kurpar and Vankashanpradeshi Twakavaivarnya and Kandu. He was treated with the help of Ayurvedic medicines and some Panchakarma procedures. The improvement provided by therapy was assessed on the basis of sign and symptoms before and after treatment.

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• Pranjal Sanjay Jain, Amey Chandrakant Nakil, Vivek Shrirampant Chandurkar, A UNIQUE COMBINATION OF AYURVEDIC MEDICINES AND PANCHAKARMA IN MANAGEMENT OF DARUNAKA: A SINGLE CASE STUDY , AYUSHDHARA: Vol 8, Issue 2: March - April 2021

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Cited By: CrossRef DOI: 10.47070/ayushdhara

ISSN: 2393-9583 (Print) ISSN: 2393-9591 (Online) RNI No: TELENG/2014/60297

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Ayurvedic management of bhagna - a single case study

Fracture is a multifaceted pathology and its judicious management requires a rational holistic approach. Principle aim of the management of fracture is to restore the normal or near to normal structural integrity and physiology of the fractured part at the earliest, without complications or with minimal complications. Modern medical science gained excellence in the management of these injuries. But in Ayurveda, also the fundamental principles are mentioned as adopted by the modern medical science. In addition to the local technical management, adjuvant therapies viz, oral medications, panchakarma treatment modality, diet regimen have also mentioned. Sushruta described exclusively mentioned about bhagna. He explained depending upon nature of trauma, shape of fracture displacement, fracture fragment and fracture with or without wound. Sushruta explained if fracture occurs in the bone is called as kand bhagna that is bone fracture. Conservative modalities includes kushabandha, Alepa, Chakrayoga, Taila Droni, Basti, based upon the consideration of the prakruti and nutritional status. By adopting these ayurvedic principles many such injuries can be managed successfully with minimal rate of complications. Even in injuries requiring surgical management these play a crucial role as adjuvant therapy. In the present paper an effort has been done to show the efficacy of Majja basti, Asthishrunkala lepa and Prustabasti in Vertebral burst fracture.

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Ayurvedic Management of Ashmari – A Single Case Study

• Damini Parmar P.G. Department of Shalyatantra, Govt. Akhandanand ayurved College and hospital, Ahemdabad.
• Jigna Patel P.G. Department of Shalyatantra, Govt. Akhandanand ayurved College and hospital, Ahemdabad.
• Dhruval Padadharia P.G. Department of Shalyatantra, Govt. Akhandanand ayurved College and hospital, Ahemdabad.
• Divyabahen Ninama P.G. Department of Shalyatantra, Govt. Akhandanand ayurved College and hospital, Ahemdabad.

Since ancient times Ashmari is mentioned in Ayurvedic texts. Ashmari is a disease related to the urinary system ( Mutravahasrotas ). Mutrashmari is described under Asthamahagad (difficult to cure) in Ayurveda. It possesses symptoms such as Jwara ( Fever), Basti Pida (Discomfort and pain in the bladder), Aruchi ( Anorexia), Mutrakriccha (Difficulty in micturition), Bastishira Vedana (Pain in Urethra), Mushka Vedana (Pain in testicles) and Shepha Vedana (Pain in the penis) have been described in Ayurvedic classical texts.

 A 34-year-old female patient visited OPD, with complaints of pain in the right side of the Abdomen, Burning Micturition, Nausea and Vomiting. The USG reported calculus measuring 16-17mm in right upper ureter 5mm in lower calyx of right kidney and few tiny 3-4 mm in right kidney 5-4 mm in Left kidneywith the normal functioning of vitals. The patient was treated with Chandraprabha Vati 2 BD, GokshuradiGuggulu 2 BD, Gokshurchurna +Punarnava churna and Hajrulyahoodbhasma BD on OPD basis. The patient was advised initially follow up after 7 days and later after every 15 days. Along with medication, the patient was also advised to follow diet and lifestyle restrictions. The patient got relief in signs and symptoms and the USG report showed size of calculus decrease and some small calculi expelled.

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P.G. Department of Shalyatantra, Govt. Akhandanand ayurved College and hospital, Ahemdabad.

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