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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 1  |  Issue : 2  |  Page : 16-21

Management of Bicytopenia using metal based Ayurvedic formulations


1 VCP Cancer Research Foundation, Turner Road, Clement Town, Dehradun, India
2 Action Cancer Hospital, Paschim Vihar, New Delhi, India

Date of Web Publication13-Jul-2022

Correspondence Address:
Balendu Prakash
VCP Cancer Research Foundation, Turner Road, Clement Town, Dehradun
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2667-0593.350866

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  Abstract 


Bicytopenia is a disorder of hematopoietic system and is reflected by lowering of any two of hemoglobin (below 10 g/dL), white cells (3.5-10.5 billion cells/L) and platelets (below 100 × 109/L) in peripheral blood. It is usually treated using corticosteroids, growth factors, immune-suppressants, nutritional supplements, periodical blood transfusion and bone marrow transplantation. However, these treatments have limited effects and may cause moderate to severe side-effects. A young Non Resident Indian male of 28 years old opted for Ayurvedic treatment for Bicytopenia as first choice of treatment, with the consent of a leading oncologist. The patient was prescribed a combination of Herbo-Mineral Formulations (HMFs) along with a regulated diet and lifestyle. Patient has completed fourteen months of Ayurvedic treatment and now leads a normal life. No adverse effects were noticed during the treatment and follow-up period too. Further controlled pilot studies are required to establish proof of efficacy in a systematic way.

Keywords: Ayurveda, Bicytopenia, Case report, Leucopenia, Rasa shastra, Thrombocytopenia


How to cite this article:
Prakash B, Maru A, Prakash S, Tiwari S. Management of Bicytopenia using metal based Ayurvedic formulations. J Ayurveda Case Rep 2018;1:16-21

How to cite this URL:
Prakash B, Maru A, Prakash S, Tiwari S. Management of Bicytopenia using metal based Ayurvedic formulations. J Ayurveda Case Rep [serial online] 2018 [cited 2022 Dec 9];1:16-21. Available from: http://www.ayucare.org/text.asp?2018/1/2/16/350866



Introduction: Bicytopenia is an haematological disorder marked by reduction of any two of the blood components; Hemoglobin below 10 g/dL, Absolute Neutrophil Count 1 x 109 or lower, Platelet count 100 x 109/L or below.[1],[2] The etiology of cytopenia is multifactorial and is related to abnormal progenitor stem cells with subsequent bone marrow insufficiency, hematopoietic growth factor deficiency, and hypersplenism. Other clinical manifestations include autoimmune syndrome, which could be manifested as vasculitis or arthritis, osteolytic bone lesions can occur rarely.[1]

The decrease in red blood cells, resulting in low levels of Hemoglobin (Hb) in blood is termed as anaemia characterised by exhaustion, fatigue, loss of appetite or shortness of breath. Decrease in platelets or thrombocytopenia often leads to rashes, petechiae, purpura and bleeding tendency and the decrease in white cells may lead to recurrent infections.[3]

The treatment of idiopathic bicytopenia involves the use of growth factors, immunosuppressive therapy, corticosteroids, nutritional supplements and regular blood component therapy.[4] However, such treatments have their own limitations and grave consequences. In such conditions, Bone Marrow Transplantation (BMT) remains the only treatment option. BMT from a matched donor reportedly has a good prognosis in the treatment of cytopenias. In absence of perfectly matched donor; risk for complications is high.[4] The overall survival of patients cannot be predicted.

Case Report

A 28 years old Indian male, who was living in Saudi Arabia for two and a half years was incidentally diagnosed for bicytopenia during routine blood checkup at a hospital in Saudi Arabia (Hb - 8.6 g/dL, platelet - 20,000/μL). His haematology report showed Anisocytic Anaemia (ICD 10 code: D64.9) with mild to moderate thrombocytopenia (ICD 10 code: D69.6). The patient went for second opinion at another hospital in India and got haematological indices and bone marrow examination done. Flow cytometric analysis did not show any abnormality, deficiency of GPI-linked antigens on granulocytes and monocytes suggesting absence of clone of Paroxysmal Nocturnal Hemoglobinuria (PNH). Serum Lactic Dehydrogenase - 896.60; Lactate Pyruvate - 692.5 U/L. Bone Marrow Aspirate and biopsy report depicted erythroid hyperplasia and adequate megakaryocytes (BMA # 536/2015; Lab Ref No. 1051518; BLK Super Specialty Hospital, New Delhi); peripheral blood film showed microangiopathic haemolytic anaemia. However, no specific cause could be established for bicytopenia. At this point, patient was clinically asymptomatic except unexplained fatigue.

The patient consulted hematologist and other experts who could not established the aetiology of the problem and advised for plasmapharesis and BMT. After deliberate discussion, the patient opted for Ayurvedic treatment (AYT) with the consent of Hemato-oncologist. He underwent Rogi pariksha involving Darshana (observation), Sparshana (touching) and Prashna (interrogation).[5] On examination, he was found to have Pitta dominant pulse.[6] On palpation, tenderness was found below the costal margin on the right side at the mid clavicular line in right hypochondrium area of abdomen indicating inflammation in gall bladder and at the ilio-caecal junction. The patient was vegetarian, non-alcoholic and non-tobacco user. He was living in Saudi Arabia for the past two and half years. He had no previous history of any illness and his parents did not share any close kinship. His mother had been diagnosed for Acute Promyelocytic Leukemia (APML) at the age of 42 year and has completed nine years of Ayurvedic treatment, with complete remission. The baseline blood tests for Hemogram and Vitamin D3 at the commencement of the treatment showed Hb - 9.70 g/dL, Platelet count - 56 thou/mm3 and Vitamin D3 - <10.50 nmol/L. Hemoglobin HPLC test turned out to be normal.

Management of the disease

The patient was prescribed with an Ayurvedic proprietary formulation Tablet Kidgrow (500 mg) [Table 1] three times a day and Ajeernari vati[7] (500 mg) three times a day for Deepana and Pachana before starting the main course of treatment. From the first day, process of Gall Bladder (GB) flush has been started, which is an eight-day process used in Chinese system of medicine.[8] Besides, he was also given Albendazole 400 mg for deworming on the first and second day at bedtime. Patient had six purgations on the eighth day of GB flush. On Day 9, the tenderness below the costal margin on the right side at the mid clavicular line in right hypochondrium area of abdomen and at the ilio-caecal junction was not felt on palpation. The patient experienced lightness in the body, improved appetite, good sleep and increased energy. He was discharged on Day 9 and was prescribed Siddha makaradhwaja[9] powder 125 mg twice, with an Ayurvedic proprietary formulation Capsule Numax (250 mg) three times a day, Kamadudha rasa[10] 250 mg twice a day and Abhraka bhasma[11] 125 mg twice a day with regulated diet [Table 2]. Patient has completed fourteen months of Ayurvedic treatment till date. He was prescribed strict isolation with complete psychological and physical rest. Tea, coffee, aerated drinks, reheated food, packaged foods and drinks, onion, tomato and garlic were restricted in his diet. He was also prescribed Cholecalciferol[12] (Vitamin D3 supplement) 60,000 IU per week with 100gm of milk cream for sixteen weeks and was advised periodical blood examination from the same pathology lab.
Table 1: Composition of Kidgrow Tablet and Numax Capsule

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Table 2: Diet and medicine plan

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Outcome

Periodic Hematological examination showed rise in Hb levels and platelet count within the first few weeks of starting of Ayurvedic treatment [Graph 1],[Graph 2] and his stamina started building up gradually. Patient did not report any adverse effects and currently leading a normal life. The results of all blood tests conducted after fourteen months of treatment were largely within normal limits, giving a clue regarding safety profile of the medication (Liver Function Test: Total Bilirubin - 0.41 mg/dL, Direct Bilirubin - 0.05 mg/dL, Indirect Bilirubin - 0.36 mg/dL, Alkaline Phosphatase - 86 IU/L, SGOT - 13, SGPT - 28; Lipid Profile: Cholesterol - 157 mg/dL, Triglycerides - 73 mg/dL; Kidney Profile: Creatinine - 0.69 mg/dL, Uric Acid - 5.0 mg/dL, Blood Urea Nitrogen - 6 mmol/L; Thyroid Profile: Total TSH - 2.389 mIU/L, Free Thyroxine - 1.21 ng/dl). The patient is under regular follow up and his peripheral blood film revealed normocytic normochromic blood picture.



Discussion

There are anecdotal case reports regarding spontaneous remission in the patients of cytopenias but their rationality and statistics largely remain unknown and unpredictable. Here, a patient, who is well aware of the consequences related to diagnosis, treatment and prognosis of his illness opted Ayurvedic treatment after deliberate discussions with close family, friends as well as a senior hemato-oncologist.

Ayurveda considers Pitta dosha to be the root cause of hematopoietic disorders. A high risk factor in patients of cytopenia could easily be correlated with the symptoms of Rakta pitta.[13] Therefore, the Ayurvedic treatment was primarily focused on restoring the balance in Pitta by prescribing Kamadudha Rasa,[10] Capsule Numax and

Abhraka bhasma. Capsule Numax is a non-iron containing herbo-mineral Ayurvedic formulation, which is a modified form of two classical medicines, Sootashekhara rasa and Sitopaladi churna. It has shown promising results in treating Nutritional Anaemia and escalating the absorption of iron.[14],[16]

Bicytopenia is an outcome of bone marrow suppression (Majja dosha), hence, Siddha makaradhwaja (SMD), a complex compound prepared on fire using one part Bhubhukshita parada (processed mercury), one fourth part 24-carat Gold and 16 parts of processed Sulphur was prescribed at a dose of 125 mg twice daily. SMD is well known for its Rasayana properties and for imparting longevity and rejuvenation.

Ayurveda emphasizes on diet, lifestyle and medicine. Along with the mentioned diet and treatment; the patient was kept in strict isolation to avoid secondary infections. Complete psychological and physical rest was given to attain maximum sleep as half of the diseases can be cured by adequate sleep.[17]

All the above factors brought significant improvement in Hb and platelets without causing any Grade II toxicity [Graph 1],[Graph 2]. Patient leads a normal life after receiving Ayurvedic treatment, which was aimed to restore balance of Pitta and strengthen the Majja with regulated diet and psychological and physical rest. In this case, amalgamation of other medical systems is done by incorporating modern diagnostic tools, such as bone marrow aspiration and haematological examination; nutrition comprising a balance of carbohydrates, proteins and minerals; and GB flush following Chinese system along with Ayurvedic principles that helped to assess the response to Ayurvedic treatment better. But, these results cannot be explained beyond this point as the chemistry of Ayurvedic formulations, mode of action, dosage schedule and duration largely remain unknown and merely depend on the observation and experience of the treating physician.

Herbo mineral Ayurvedic formulations of Ayurveda are explained in Rasa Shastra,[18] which deals with the therapeutics of processed Mercury and substances of mineral, animal and plant origin. Most of these are moderate to severely toxic in their raw form but a tedious traditional methodology converts these into non- toxic and therapeutic form. However, Rasa shastra is not much understood for its therapeutic effects. We are reporting this case to impart the therapeutic effects of Rasa shastra as potential treatment for hematopoietic disorders. However, there must be intrigue chemistry behind the preparation of these formulations that needs to be understood. Further studies are required to create more evidences and then to move forward to explore the potentials of Ayurveda in the management of hematopoietic disorders.

Conclusion

Traditional medicines may play crucial role in the treatment of hematopoietic disorders and need in- depth and intensive researches. The basic phenomena of Ayurvedic approaches including chemistry of involved formulations, pharmacokinetics and duration of the treatment etc. is not well understood. A controlled pilot study is required to establish proof of efficacy.

Acknowledgements: We duly acknowledge the patient and his family for sharing his medical details.

Source of Support: None

Conflicts of Interest: Both the formulations used in this case are being prescribed by the corresponding author in the clinical practice since years. There is no other conflict of interest.



 
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