AN AYURVEDIC MANAGEMENT OF BAHUPITTA KAMALA (JAUNDICE): A CASE STUDY

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1 WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES Nilesh et al. SJIF Impact Factor Volume 7, Issue 8, Case Study ISSN AN AYURVEDIC MANAGEMENT OF BAHUPITTA KAMALA (JAUNDICE): A CASE STUDY Dr. Nilesh Gore* 1, Dr. Ujwala Chavan 2 and Dr. Prashant Baghel 3 1,2 PG Scholar of Agandtantra Department, Govt. Ayurvedic College, Osmanabad. 3 PG Scholar of Kriyasharira Department, Govt. Ayurvedic College, Osmanabad. Article Received on 09 June 2018, Revised on 28 June 2018, Accepted on 20 July 2018 DOI: /wjpps *Corresponding Author Dr. Nilesh Gore PG Scholar of Agandtantra Department, Govt. Ayurvedic College, Osmanabad. ABSTRACT The incidence of neonatal jaundice is about 40,000 in 1,00,000 patients, and adult it is about 270 per 1 lac patient. Male are more commonly affected for hepatocellular jaundice and female are for haemolytic jaundice. [1] Jaundice is a yellow tint to the skin, sclera or mucous membrane caused by increase level of bilirubin in body fluid. [2] It is formed due to some causes like haemolysis (breakdown of RBCs), liver diseases, and obstruction of bile duct, etc. Jaundice is managed by treating its cause. In Ayurveda, Kamala is a next step of Pandu (anaemia). According to Acharya Charaka, Kamala is mainly cause due to frequently consumption of Ushna (hot), Tikshna (spicy) food i.e. Pittaprakopak Ahara (increasing level of Pitta). Due to these factors vitiation of Pitta (bile), Rakta (blood) and Mamsa (muscles) Dhatu occurred. Kamala is clinically correlated due to its similarity of symptoms like yellowish of skin (Twak pitata), sclera (netra), urine (Mutra), stool (Purisha), etc. [3] In Ayurvedic literature, Kamala is treated mainly by Snehana (Oleation therapy) and Mrudu Virechana (mild purgation therapy). Present case study is on the successful Ayurvedic management of Kamala by Virechana Karma in combination with Haritaki Churna and Manuka Phanta along with internal medication of Arogyavardhini Vati, Sutashekhar Rasa, Kumari Asava and Bhunimbadi Kwatha. KEYWORDS: Kamala, Jaundice, Pittaprakopa, Virechana. INRODUCTION Jaundice is not a particular disease but it is occurred due to associated pathologies of other diseases like infective hepatitis, obstruction of the bile duct by gall stone or tumour, alcoholic Vol 7, Issue 8,

2 liver diseases, haemolysis, etc. It refers yellowish discoloration of skin, sclera or mucous membrane and it is resulting of excess level of bilirubin in the blood. Bilirubin is the breakdown product of catabolism of haem cells. Bilirubin undergoes conjugation within the liver resulting water soluble, then excreted in the form of bile into the gastrointestinal tract. Jaundice occurred when this pathway is disturbed. There are mainly three types of jaundice wisely prehepatic jaundice due to excessive breakdown of RBCs which leads to unconjugated hyperbilirubinemia. Hepatocellular jaundice which is also called as intrahepatic jaundice and it is due disfunction of the liver itself. This leads to both conjugated as well as unconjugated bilirubin in the blood. Third is post hepatic jaundice due to obstruction of biliary drainage and result into conjugated hyperbilirubinemia. [4] In Ayurveda Kamala is described under Raktavaha Strotasa (circulatory system) (5). Yakruta (liver) and Pleeha (spleen) are the Moolasthana (origin) of the Raktavaha Strotasa. [6] Kamala is caused due to Ushna- Tiksna (hot, spicy) food which is responsible for aggravation of Pitta (bile) in blood and circulating all over body through blood circulation. Due to this symptoms like Nakha, Netra, Twaka, Mutra, Purish Pitata (discoloration of nails, sclera, skin, urine and stool) are seen. [3] There are mainly two types of Kamala i.e. Bahupitta Kamala (Haemolytic or hepatocellular jaundice) and Ruddhapatha Kamala (obstructive jaundice). Main difference in between both Kamala is Tilapishtanibha Malapravrutti which is present in Ruddhapatha Kamala due to biliary duct obstruction results in bile not entered in gastrointestinal tract and this symptom is formed. Bahupitta Kamala is also known as Koshtha shakhashrita Kamala due to circulation of Pitta (bile) into Koshtha (all systems) as well as Shakha (limbs). Ruddhapatha Kamala is also called as Shakhashrit Kamala or Alpapitta Kamala because of in this type production of bile (Pitta) is normal but obstruction to biliary system present. Jaundice is mainly treated by underline cause. There is no significant treatment for jaundice. In Ayurvedic Samhita there are main two type of treatment given for Kamala i.e. specific and non-specific. Non-specific treatment is given for all diagnosed patient of jaundice. Specific treatment is for specific type of Kamala i.e. in Bahupitta Kamala, Snehana and Mrudu Virechana are given and in Ruddhapatha Kamala, Snehana karma (procedure) is totally Varjya (restricted) and Tikshna Virechana is given. Present case study is on Ayurvedic management of Kamala including Virechana (purgation procedure) and oral drug administration of Arogyavardhini Vati, Sutashekhar Rasa, Haritaki Churna, Kumari Asava Vol 7, Issue 8,

3 and Bhunimbadi Kwatha. By above medication patient was successfully managed and had a significant relief. AIM To evaluate Ayurvedic management of Kamala (Jaundice). OBJECTIVE 1. To study concept of Kamala. 2. To study concept of Jaundice. 3. Detail study of Ayurvedic management of Kamala. MATERIALS AND METHOD Setting: Government Ayurvedic college and hospital, tuljapur road, Osmanabad. CASE REPORT This case study is on successful management of Kamala (Hepatocellular jaundice) by Ayurvedic purification procedure like Virechana karma (Purgation therapy) along with internal medication such as Arogyavardhini Vati, Sutashekhar Rasa, Haritaki churna with Manuka phant, Bhunimbadi Kwath as well as fermented drug like Kumari Asava. A 65-year-old male patient having registration no.(opd) came to government ayurvedic hospital, Osmanabad. Patient having following chief complaints 1. Twakvaivarnya (discoloration of skin) 2. Pita Netra (yellowishness of sclera) 3. Pita Nakha (yellowishness of nails) 4. Pita Mutra (yellowishness of urine) 5. Pita Purish (yellowishness of stool) 6. Daurbalya (weakness) 7. Anannabhilasha (anorexia) Along with associated symptoms like 1. Anidra (insomnia) 2. Bhrama (giddiness) 3. Agnimandya (indigestion) Vol 7, Issue 8,

4 Patient had all clinical sign and symptoms last 15 days. History of present illness The patient was healthy and normal before 15 days. But after that he was complaining that yellowishness of the skin, nails and urine, discoloration of skin, anorexia, weakness along with symptoms like insomnia, giddiness, indigestion. Resulting all above clinical sign and symptoms patient came to government ayurvedic hospital, Osmanabad for ayurvedic management. Past history - No any history of major illness such as Hypertension, Diabetes mellites, Asthma, - No any specific maternal history - Addiction: Alcohol consumption - frequently consumption of hot, oily and spicy food - No any surgical history Personal history: (Table no.1) Sr. No. Sr. No. 1. Name: XYZ 6. Pulse: 60 /min 2. Age: 65year 7. Blood pressure: 110/70 mm of Hg 3. Sex: Male 8. Addiction: Alcohol, Tobacco 4. Occupation: Fruit seller 9. Appetite: poor 5. Marital status: Married 10. Prakriti: Pitta Pradhan Kapha Ashtavidha Parikshana: (Table no.2) Investigation 1. Haemoglobin: 11.2 gm/dl Sr. No. Priksha Value 1. Nadi (Pulse) 60/min 2. Mala (Stool) Pita Mala (yellowish stool) 3. Mutra (Urine) Pita Mutrata (yellowish urine) 4. Jivha (Tongue) Sama (coated) 5. Shabda (Speech) Spashta (clear) 6. Sparsh (Touch) Samashitoshna (warm) 7. Druka (Eyes) Pita (yellowish) 8. Aakruti (Built) Madhyama 2. Blood sugar level (random): 114 mg/dl 3. Bilirubin: - Total: mg/dl - Direct: 6.25 mg/dl Vol 7, Issue 8,

5 - Indirect: 4.04 mg/dl 4. SGOT: 249 U/L 5. SGPT: 178 U/L 6. Urine: - Albumin : Nil - Sugar : Nil - Microscopic: Nil 7. USG: Abdomen and pelvis Fatty liver Plan of study - Patient was managed on OPD basis - Virechana karma - Internal ayurvedic medications - Observation of investigation report 1. Virechana karma According to Acharya Charaka Kamala is treated under Virechana karma (i.e. kamali tu virechana). [3] Due to frequently taken of Ushna- Tikshna Ahara (hot and spicy food) leading vitiation of Pitta Dosha. Also, patient having Pittapradhan Kapha Prakruti and as mentioned in Ayurveda, Virechana is the best karma (procedure) for Pitta Dushti. 2. Internal medication: (Table no.3). Sr. No. Name of drug Matra (Dose) Kala (Time) Anupana Media 1. Arogyavardhini Vati 250 mg twice a day Adhobhakta (After meal) Jala (Water) 2. Sutashekhar Rasa 250 mg twice a day Adhobhakta (After meal) Jala (Water) 3. Bhunimbadi Kwath 20 ml twice a day Adhobhakta (After meal) Sama praman jala 4. Kumari Asava 20 ml thrice a day Adhobhakta (After meal) 5. Haritaki churna + Manuka phant 7 gm 20 ml twice a day Pratakala (early morning) Empty stomach (equal water) Sama praman jala (equal water) Koshna Jala (Luke warm water) Internal Ayurvedic formulation was selected on the basis of their properties which resulting in breakdown in Samprapti (Pathology) and helps to reduce all symptoms of Kamala. Duration of study: 1 month. Vol 7, Issue 8,

6 Assessment criterion for Kamala (Hepatocellular jaundice): (Table no.4). Sr. No. Symptoms Normal Mild Moderate Severe (0) (1) (2) (3) 1. Pita Netra (yellowish sclera) Pita Nakha (yellowish nails) Pita Mutra (yellowish urine) Twakavaivarnya (discoloration of skin) Daurbalya (wakness) Anannabhilasha Observation of result: (Table no.5) Sr. No. Symptoms 1 st 2 nd 3 rd follow up follow up follow up 1. Pita Netra (yellowish sclera) Pita Nakha (yellowish nails) Pita Mutra (yellowish urine) Twakavaivarnya (discoloration of skin) Daurbalya (wakness) Anannabhilasha Investigations: (Table no.6) Sr. No. Investigation Before treatment After treatment 1. Haemoglobin gm% 11.7 gm% 2. Total bilirubin mg/dl 1.85 mg/dl 3. Direct bilirubin 6.25 mg/dl 0.88 mg/dl 4. Indirect bilirubin 4.04 mg/dl 0.97 mg/dl 5. SGOT 249 U/L 99 U/L 6. SGPT 178 U/L 61.6 U/L Before management : After management DISCUSSION In Ayurvedic Samhita, Kamala is described under Raktavaha Strotasa Vyadhi (Disease of circulatory system). [5] It is caused due to when Pandurogi (Anaemic patient) frequently consumption of Ushna- Tikshna Ahara (hot and spicy food) then vitiation of Pitta Dosha occurred and all symptoms are seen. [3] All above aggravating factors along with prolong consumption of alcohol was taken by patient. Ayurvedic treatment is cost effective and it is famous for irreversible treatment (Apunarbhava Chikitsa) hence patient came for ayurvedic management. Vol 7, Issue 8,

7 Acharya Charaka explained management of Kamala in detail. Kamala is formed due to increased level of Pitta Dosha. In Ayurveda, treatment for Kamala contain Snehana (internal oleation therapy) and Virechana Karma (purgation therapy). Patient having Pitta Pradhan Kapha prakruti and consume all causative factors leading Pitta Dushti. According to Ayurveda Virechana therapy is best for Pitta Vikara. It removes increased Pitta (bile) and purify the body and give significant relief in Kamala patient. Haritaki churna in combination with Manuka Phant is used for Virechana Karma due to its purgative property. In combination of Shodhana Chikitsa (purification of body) Shamana Chikitsa (conservative treatment) selected for better result. The drugs and its properties are as follows (described in table no.7). Drugs and its properties: (Table No.7). [7] Sr. No. Name of drug Properties 1. Arogyavardhini Vati Malashuddhikara (Purgative), Kshudhavardhaka (Appetizer), Balya (Toinic), Hrudya (Heart tonic) 2. Sutashekhar Rasa Pittashamak (Reduces Pitta), Yakruduttejak (Liver tonic), Dahashamak (Reduces Burning), Pachak (Digestive), Hrudya (Heart tonic). 3. Bhunimbadi Kwath Laxative, Digestive, Antibacterial, Haemostatic 4. Kumari Asava Mutral (Diuretic), Stransak (Mild purgative), Raktaprasadak (blood purifier), Dahashamak, Pachak 5. Haritaki churna + Manuka phant Purgative Arogyavardhini Vati was selected due to it increases appetite and as patient was complaining giddiness, weakness and anorexia, it reduces due to its Balya property. Also, it contains Tamra Bhasma which act as a Hridya, hence reduces sign of fatty liver. Sutashekhara Rasa is mainly act on Yakrita (Liver), Pleeha (Spleen) and Grahani (duodenum). It also acts as Rasayana (Rejuvation). Bhunimbadi Kwatha mainly used for liver disorders. Kumari Asava mainly acts on Yakrita (Liver) and it regulate the secretion of Pitta (bilirubin). CONCLUSION So, it is concluded that patient of Kamala (Hepatocellular jaundice) is successful managed by Virechana Karma, oral Ayurvedic drug like Arogyavardhini Vati, Suitashekhar Rasa, Haritaki Churna with Manuka phant, Kumari Asava and Bhunimbadi Kwath. Above treatment is highly effective in Kamala without any harmful effect. Vol 7, Issue 8,

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