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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 1  |  Issue : 2  |  Page : 10-15

Picchabasti and Nilotpaladi yoga in the management of Ulcerative colitis


Department of Vikriti Vigyan, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India

Date of Web Publication13-Jul-2022

Correspondence Address:
A C Kar
Department of Vikriti Vigyan, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2667-0593.350865

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  Abstract 


Ulcerative Colitis (UC) is a chronic inflammatory bowel disease, which pursues a protracted relapsing and remitting course. Inflammation invariably involves the rectum (proctitis) and may spread proximally to involve sigmoid colon (procto-sigmoiditis) and in some cases, it involves whole colon (pancolitis). The major symptom of ulcerative colitis is blood in stools. Currently there is no medical cure and Ayurveda treatment approaches are helpful in such diseases. A male patient of 27 years old complaining of bleeding per rectum and colicky pain in abdomen visited the OPD. Earlier medical examinations diagnosed him to be suffering from UC. He was on allopathic medicines since three years with remissions and exacerbations in the condition. Due to resemblance of the signs and symptoms; it was compared with Raktatisara and accordingly the case was treated. Nilotpaladi yoga with Goat milk along with Piccha basti was administered for a month, which resulted in complete remission of signs and symptoms. The report of sigmoidoscopy also showed positive findings. This reveals that Ayurveda treatment modalities can play a significant role in such conditions where successful treatment facilities are minimal in other medical systems.

Keywords: Ulcerative colitis, Raktatisara, Nilotpaladi yoga, Piccha basti.


How to cite this article:
Dabas R, Gupta S, Kar A C. Picchabasti and Nilotpaladi yoga in the management of Ulcerative colitis. J Ayurveda Case Rep 2018;1:10-5

How to cite this URL:
Dabas R, Gupta S, Kar A C. Picchabasti and Nilotpaladi yoga in the management of Ulcerative colitis. J Ayurveda Case Rep [serial online] 2018 [cited 2022 Dec 9];1:10-5. Available from: http://www.ayucare.org/text.asp?2018/1/2/10/350865



Introduction: Ulcerative Colitis (UC) is an inflammatory bowel disease, which can persist for years. Incidences of ulcerative colitis are increasing at an alarming rate due to erroneous dietary habits and faulty lifestyle.[1] Studies reported that prevalence rate of ulcerative colitis is 44.3 per 100000 inhabitants in Punjab and in other parts of North India, which is not much less than that reported from Europe and North America.[2] UC causes rectal bleeding and mucus discharge, sometimes accompanied by tenesmus. In severe cases; anorexia, malaise, weight loss and abdominal pain occur, and the patient becomes toxic with fever, tachycardia and signs of peritoneal inflammation.[3] The prevalence of age of onset of UC is mainly between 15 and 30 years and second peak prevalence occurs between the age of 60 and 80 years. The male to female ratio for ulcerative colitis is 1:1.[4] The prevalence of UC is increasing at an alarming rate and allopathic line of treatment including administration of steroids in the form of oral high dose of prednisolone and enemas etc. is not proved to be effective in the management and puts a huge burden on the health of the patient.[5],[6] It possesses a big challenge for medical health professionals due to its high morbidity and mortality. The highest mortality is during the first years of disease and in long duration due to risk of colon cancer.[4] Hence, there is a need for other modes of treatment that can manage such conditions satisfactorily. Ayurveda described Raktatisara (~haemorrhagic diarrhoea), which has symptoms similar to ulcerative colitis i.e. Shula (~pain in abdomen), Gudapaaka (~burning sensation in rectum) and Trishna (~excessive thirst).[7] In this current study, Nilotpaladi yoga with Piccha basti have been used in the management.


  Case Report Top


A 27 years old hindu, male, married, farmer by occupation visited OPD on 06th Feb, 2017 complaining of bleeding per rectum associated with mucus, abdominal pain while taking meal and generalized weakness since 2013. There was no positive family history. Patient had frequent habit of eating spicy, oily and outside junk food.

Colonoscopy and Esophago-gastro duodenoscopy reports confirmed that the patient is suffering from severe diffuse gastritis and ulcerative pancolitis.

He was being managed with daily oral Mesalazine (4.8 g) and Prednisolone (40mg) and Hydrocortisone (Cortenema) rectal enema during bed time for last three years. This treatment didn’t provided much relief in his signs and symptoms.

On general examination; no pallor, icterus, oedema, clubbing were present. No lymph nodes were palpable. Blood pressure was 90/60 mmHg, pulse rate was 68/min and Respiratory rate was 20/min.

Systemic examination: On gastrointestinal examination; pain and tenderness was felt in lower abdomen. No abnormal functioning of Respiratory, Cardiovascular and Central Nervous Systems was noticed.

Ashtasthana pariksha: Nadi was Vata pittaja, Mala was of Raktavarna with Ama associated with mucus and Jihva was Ruksha.


  Investigations Top


Before starting the treatment; routine hematological tests were done. [Table 1]. On visit, the patients had histopathology reports with him. Stool for occult blood was done before starting and at the end of 40th day of treatment. Colonoscopy and Esophago-gastro duodenoscopy reports were with the patient. A brief of the hematological observations is placed at [Table 2].
Table 1: Blood investigation reports before treatment

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Table 2: Histopathology reports before starting the treatment

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  Treatment: Top


[Table 3] depicts the treatment followed in this case. Besides medicines; patient was advised to consume light diet like Khichdi (made up of rice, green gram, water and turmeric powder in a specific proportion) during the treatment period. Spicy, oily and junk food was avoided.
Table 3: Treatment adopted

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  Results: Top


Bleeding per rectum was stopped after three days of administration of Piccha basti. Severity of abdominal pain was decreased. After 15th days of basti, patient was discharged from the hospital and advised to continue Piccha basti and oral intake of Nilotpaladi yoga. Patient’s attendant was showed and trained the procedure of administering Basti in the hospital and advised to administer it at home for the next 20 days. Oral intake of Nilotpaladi yoga was continued during this time.

The patient reported back to OPD after 20 days with no abdominal pain and no bleeding per rectum. He was admitted in the hospital for follow up and condition of investigations. Analysis of stool for occult blood and sigmoidoscopy were done. Stool for occult blood was negative, which was positive before starting the treatment. Considering financial constraints; colonoscopy could not be done. The patient was followed for the next three months and he became free from all symptoms. [Table 4] gives a comparison on the findings of Sigmoidoscopy done before and after the treatment.
Table 4: Sigmoidoscopy reports before treatment and after treatment

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  Discussion Top


Charaka has described use of Piccha basti in Pravahika (~dysentery), Gudabhransha (~rectal prolapse), Raktatisara (~haemorrhagic diarrhoea) and Jwara (~fever).[8] If diarrhoea persists in spite of administration of Anuvasana basti and Samsarjana karma; Picchabasti is advocated exclusively when Vata shlesma vibandha, Shula and Pravahika persists.[9],[10] Sushruta has also advocated using Piccha basti in Raktatisara (~haemorrhagic diarrhoea) specially when the patient passes blood in small amounts associated with pain and obstructed flatus.[11]

Before starting the treatment; all the conventional drugs were withdrawn and a powdered combination of Triphala, Laksha (Laccifer lacca Kerr.) and Shankha bhasma (calcined conch shell) was administered along with Tambula patra swarasa (fresh juice of Piper betel Linn.) for the first five days. From the 6th day onwards, Piccha basti with oral administration of Nilotpaladi yoga was continued for the next 35 days. The composition of Piccha basti was modified by replacing Ghrita with Jatyadi ghrita, considering its wound healing effects.[12]

Ingredients of Piccha basti have certain unique properties that helped in healing the ulcers of UC. Mocharasa (Resin of Salmalia malabarica Schott & Endl.) acts as Vrana ropaka (~wound healing) due to its Kashaya rasa and Sheeta virya.[13] It is one of the drugs categorized under Shonita sthapaka gana (a group of drugs that act as haemostatics).[14]

Studies established Antioxidant and Anti-inflammatory actions of Mocharasa.[15] Yasthimadhu (Glycyrrhiza glabra Linn.) is Vata pitta shamaka as well as Shothahara and is an anti-inflammatory drug.[16]

Ghrita stimulates Agni, besides possessing properties like Balya and Vrana ropana (healing effect).[17] Charaka described Ghrita as a best Vata pitta shamaka dravya.[18] Jatyadi ghrita in Piccha basti is helpful in cleaning and healing the ulcers which have small openings, situated on vital spots, which have exudation, deep seated, painful and having sinuses.[19]

Time of administration of Pichha basti was not mentioned in classical texts. So, we have decided the timings of administration of Piccha basti based on the previous experiences in successfully treating UC, where Piccha basti was given after dinner. No inconveniences were observed in giving Basti after dinner in that case. Giving Piccha basti after dinner also helps in retaining the medicaments for a longer duration. In the current case, Piccha basti was given at around 8 PM and was retained by the patient for 8 to 9 hours.

After 35 days of administration of Piccha basti; abdominal pain while taking food was reduced and patient started taking solid foods like Chapatis. Patient’s weight was increased from 45 to 48 kg after 40th day of treatment. Sigmoidoscopy was done before starting Piccha basti, which showed loss of vascularity with increased friability with erosion and rectum. Increased mucosal erythema & oedema in sigmoid colon indicating Proctocolitis. After 35 days of the above treatment, normal mucosa and vascularity was observed. Looking into these changes, Basti was stopped.


  Conclusion Top


Ulcerative colitis is a chronic inflammatory bowel disease, whose aetiology is unknown. The dietary habits of the patient i.e. frequent consumption of spicy, oily, junk food may be a predisposing factor of Ulcerative colitis. On the basis of results observed in this case; it can be said that, Ayurvedic management with Piccha basti and Nilotpaladi yoga are effective in the management of UC. These approaches are safe, cost effective and easy to follow. The patient was followed up for 5 months and there were no recurrences of symptoms. As this is a single case study, there is a need for more number of patients to establish the effectiveness of combination of Piccha basti and Nilotpaladi yoga in the management of UC. This case report serves as a lead for further researches.

ACKNOWLEDGEMENTS: Authors are thankful to Superintendent, Deputy Medical Superintendent (IM) and Staff of the male Panchakarma unit of Sir Sunderlal Hospital, IMS, BHU, Varanasi for providing the necessary facilities. We deeply acknowledge the suggestions rendered by Dr. PS Byadgi, Dr. P Tewari and Dr Anurag Pandey. We also acknowledge the inputs provided by Dr Yogendra Kumar, Dr Ruby Singh, Dr Pushpa Kumari and Dr Rakesh Roshan of Vikriti Vigyan Department, IMS, BHU, Varanasi.

Source of Support: Nil.

Conflicts of Interest: Nil.



 
  References Top

1.
SL Jowett, CJ Seal, MS Pearce, E Philips, W Gregory, JR Barton et al. Influence of dietary factors on the clinical course of ulcerative colitis: a prospective cohort study. Gut. 2004; 53(10): 1479-1484  Back to cited text no. 1
    
2.
Sood A, Midha V, Sood N, Bhatia AS, Avasthi G. Incidence and prevalence of ulcerative colitis in Punjab, North India. Gut. 2003; 52(11):1587-1590  Back to cited text no. 2
    
3.
Nicolas A. Boon, Nicki R. Colledge, Brain R. Walker et al., Davidson’s Principles & Practice of Medicine, 20th edition. 2006, P. 910-913.  Back to cited text no. 3
    
4.
Kasper, Braunwald, Fauci, Harrison’s Principles of Internal Medicine Vol.II; 16th Edition, 2005, P. 2477  Back to cited text no. 4
    
5.
Lennard-Jones JE, Misiewicz JJ, Connell AM, Baron JH, Jones FA. Prednisone as maintenance treatment for ulcerative colitis in remission. Lancet. 1965; 1(7378); 188-189.  Back to cited text no. 5
    
6.
Foram Mehta, MS, RPh, Report: Economic implications of Inflammatory Bowel Disease and its Management, The American Journal of Managed Care. Published on 16, March 2016, available at http://www.ajmc.com/ journals/supplement/2016/importance_of_ selecting_appropriate_therapy_inflammatory_ bowel_disease_managed_care_environment/ importance_of_selecting_appropriate_therapy_ inflammatory_bowel_disease_managed_care_ environment_report_economic_implications_ibd last accessed on 10th November 2017 at 2.41 PM  Back to cited text no. 6
    
7.
Acharya YT, editor. Charaka samhita of Agnivesha, Chikitsa sthana, Atisara chikitsitam, chapter 19, verse 70, Chaukhambha Sanskrit Sansthan; Varanasi: reprint 2002; 552.  Back to cited text no. 7
    
8.
Acharya YT, editor. Charaka samhita of Agnivesha, Chikitsa sthana, Arsha chikitsitam, chapter 14, verse 228, Chaukhambha Sanskrit Sansthan; Varanasi: reprint 2002; 510.  Back to cited text no. 8
    
9.
Acharya YT, editor. Charaka samhita of Agnivesha, Chikitsa sthana, Atisara chikitsitam, chapter 19, verse 63, Chaukhambha Sanskrit Sansthan; Varanasi: reprint 2002; 552.  Back to cited text no. 9
    
10.
Acharya YT, editor. Charaka samhita of Agnivesha, Chikitsa sthana, Atisara chikitsitam, chapter 19, verse 117, Chaukhambha Sanskrit Sansthan; Varanasi: reprint 2002;554.  Back to cited text no. 10
    
11.
Sharma PV, editor. Commentary Nibandha Sangraha of Dalhana on Sushruta Samhita of Sushruta, Uttara tantra; Atisara pratishedha, chapter 40, verse 110. Chaukhambha Visvabharti; Varanasi: 2010, p. 393  Back to cited text no. 11
    
12.
Rackova l, Jancinova V, Petrikova M, Drabikova K, Nosal R, Stefek M. et al. Mechanism of anti- inflammatory action of liquorice extract and glycyrrhizin. Nat Prod Res. 2007; 21(14):1234-41.  Back to cited text no. 12
    
13.
Sharma PV. Dravyaguna Vigyaan Vol-II. Chaukhambha Bharati Academy; Varanasi: Reprint 2013, p 491  Back to cited text no. 13
    
14.
Shukla V, Tripathi RD, editors. Charaka Samhita of Agnivesha, Sutra sthana, Shad virechana shataashritiyam, chapter 4, verse 8. Chaukambha Sanskrit Pratishthan; Delhi: Reprint 2007, p. 77  Back to cited text no. 14
    
15.
Kim SH, Jun CD, Suk K, et al. Gallic acid inhibits histamine release and pro-inflammatory cytokine production in mast cells. Toxicol Sci 2006; 91(1): 123–131.  Back to cited text no. 15
    
16.
Sharma PV. Dravyaguna Vigyaan Vol-II. Chaukhambha Bharati Academy, Varanasi: Reprint 2013, p. 253  Back to cited text no. 16
    
17.
Shastri A, editor. Sushruta Samhita of Sushruta, Sutra sthana, Dravadravya vidhi, chapter 45, verse 96, Chaukhambha Sanskrit Sansthan; Varanasi: 2008, p. 204  Back to cited text no. 17
    
18.
Shukla V, Tripathi RD, editors. Charaka Samhita of Agnivesha, Sutra sthana, Yajjahapurushiyam, chapter 25, verse 40. Chaukambha Sanskrit Pratishthan; Delhi: Reprint 2007, p. 337  Back to cited text no. 18
    
19.
Murthy SK, editor. Ashtanga Hridaya of Vagbhata, Uttara sthana, Vrana Pratishedham, chapter 25, verse 67. Chaukhambha Krishnadas Academy; Varanasi, 8th edition, 2015, p. 246  Back to cited text no. 19
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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