|Year : 2021 | Volume
| Issue : 3 | Page : 115-120
Efficacy of Ayurveda modalities in the management Raktaja pravahika (ulcerative colitis): A case report
Jitendrakumar Nathabhai Varsakiya1, Mandip Goyal2, Divyarani Kathad3, Ritu Kumari2
1 Department of Kayachikitsa, CBPACS, New Delhi, India
2 Department of Kayachikitsa, ITRA, Jamnagar, Gujarat, India
3 Punarvasu Ayurveda Health Care and Panchakarma Center, Delhi, India
|Date of Submission||11-May-2021|
|Date of Acceptance||13-Sep-2021|
|Date of Web Publication||14-Dec-2021|
Dr. Jitendrakumar Nathabhai Varsakiya
Department of Kayachikitsa, Chaudhary Brahm Prakash Ayurved Charak Samsthan, Najafgarh, Khera Dabar, New Delhi - 110 073
Source of Support: None, Conflict of Interest: None
Ulcerative colitis is an idiopathic, chronic inflammatory disorder of the colonic mucosa that commonly involves the rectum and may extend in a proximal and continuous fashion to involve other parts of the colon. Cardinal symptoms of this disease are bloody diarrhoea with rectal urgency and tenesmus with or without mucus, and abdominal pain which alleviates after defecation. Raktaja pravahika described in Ayurvedic treatise bears symptomatic and etiological resemblance with ulcerative colitis. A 26-year-old female who was suffering with Atipravahana of Purisha (~repeated defecation), Udarashoola (~abdominal pain), Saphena and Raktayukta purisha (~blood mixed frothy stools) for eight months was treated with Ayurvedic medicaments. Pichcha basti was administered in this patient followed by oral medications including Sanjivani vati, Dadimastaka churna and Bilva churna along with Pathya-apathya. After treatment of 15 months, the condition was improved from grade four to grade one, which was assessed through colonoscopy. This case report illustrates the significance of Ayurvedic treatment modalities in the management of ulcerative colitis.
Keywords: Colonoscopy, Pathya-apathya, Pichcha basti, Sanjivani vati
|How to cite this article:|
Varsakiya JN, Goyal M, Kathad D, Kumari R. Efficacy of Ayurveda modalities in the management Raktaja pravahika (ulcerative colitis): A case report. J Ayurveda Case Rep 2021;4:115-20
|How to cite this URL:|
Varsakiya JN, Goyal M, Kathad D, Kumari R. Efficacy of Ayurveda modalities in the management Raktaja pravahika (ulcerative colitis): A case report. J Ayurveda Case Rep [serial online] 2021 [cited 2022 Aug 13];4:115-20. Available from: http://www.ayucare.org/text.asp?2021/4/3/115/332434
| Introduction|| |
Ulcerative colitis is a chronic idiopathic Inflammatory Bowel Disease (IBD) that causes a superficial mucosal inflammation extending from the rectum to the more proximal colon, in varying extents. It is characterized by a relapsing and remitting course. The overall incidence and prevalence is reported to be 1.2–20.3 and 7.6–245 cases per 100,000 persons/year, respectively., It has a bimodal age distribution with incidence peak in the second or third decades of life followed by a second peak between 50 and 80 years of age. The classic presentation of ulcerative colitis includes symptoms of blood tinted stools, loose in consistency with or without mucus, rectal urgency, tenesmus, and variable degrees of abdominal pain that is often relieved by defecation. The diagnosis of ulcerative colitis is based on the clinical presentation and symptoms consistent with the disease and findings on colonoscopy or sigmoidoscopy showing continuous colonic inflammation starting in the rectum. Pathological findings of chronic colitis confirm the diagnosis. The goals of treatment in ulcerative colitis focus on improving quality of life, achieving steroid free remission and minimizing the risk of cancer.
The symptomatology resembles with Raktaja pravahika in Ayurveda which manifests in the form of Atipravahana (~frequent defecation), Atidrava (~watery), Saphena (~frothy) and Raktayukta purisha (~blood tissue mixed stool) associated with Udara shoola (~pain abdomen). A diagnosed case of Grade 4 ulcerative colitis was managed with Piccha basti and Ayurveda oral medications.
| Patient Information|| |
A 26-year-old Hindu, female doctor by profession visited the Outpatient Department (OPD) on August 2019 with the complaints of frequent diarrhoea with blood tissue and mucus associated with mild to moderate tenesmus abdominal pain since eight months. The symptoms were gradually decreased and the prescribed conventional drugs were also withdrawn on tapering basis. The pain subsides after defecation. The other complained symptoms were loss of appetite, fatigue and irritability. The symptoms were mild in the beginning, however gradually increased with the passage of time. The colonoscopic investigations under the supervision of consulting physician confirmed grade 4 ulcerative colitis. Corticosteroid tablets (hydrocortisone) 400 mg once a day at morning, mesalazine suppository (1 g) at bed time, Vitamin E (400 mg) once a day at evening, Esabgol husk (5–10 g), at bed time and capsule zevit (500 mg) once daily after food in the evening. Though the medicines were continuing, no satisfactory improvement was noticed, and the symptoms worsened gradually along with a decline in her quality of life. Her personal and professional life was severely affected due to worsening of symptoms. Further, she visited the OPD with a hope of satisfactory management.
| Clinical Findings|| |
The patient was very lethargic and irritable with pallor conjunctiva. Patient was well conscious and oriented, however was lethargic and irritable. Mild tenderness in right and left inguinal and pubic region was observed without any organomegaly. Blood pressure was 104/76 mmHg pulse rate was 74 per minute and was regular. Body temperature was 98.9°F. No addictions were noticed. None of her family members had the history of ulcerative colitis. No history of major dietary changes or life style changes she had given. However, she is habituated to frequently consume canned, processed or refrigerated food. She had irregular timings in food consumption. She didn't have any surgical history. Being a doctor by profession, she had a stressful professional life.
| Diagnostic Assessment|| |
Diagnosis of the patient was done on the basis of clinical features. Colonoscopy (sigmoidoscopy) reports confirmed the diagnosis as ulcerative colitis (Grade 4). In Ayurveda parlance, the condition is considered as Raktaja pravahika [Table 1].
| Timeline|| |
Timeline of events is described in schematic representation. [Figure 1]
| Therapeutic Intervention|| |
Piccha basti was planned in the management. On the day of Piccha basti, Sarvanga abhyanga (~therapeutic whole body message) was done with Tila taila (~Sesame oil) for 30 min followed by Sarvanga bhashpa swedana (~whole body sudation) with Dashamoola kwatha for about 10 min. This was followed by administration of 400 ml of Basti dravya (~enema medication) through rectal route following the standard procedure [Table 2] and [Table 3] Patient was advised to hold the medicament to the best possible extent. Initially the retention time was 2–10 min (Phase-I) which improved to 20–30 min (Phase-IV) in subsequent settings. The procedure was continued for 15 days. This was followed by oral medications i.e., Sanjivani vati (500 mg) twice daily before meal with lukewarm water, and Dadimashtaka churna (2 g) and Bilwa churna (2 g) twice after meal with lukewarm water were advised as Shaman chikitsa (~palliative treatment) for the next three months. This treatment regimen (15 days Piccha basti followed by three months oral medication) was repeated in four cycles.
Assessment of disease improvement
Assessment of treatment was based on the changes observed in the symptomatology and colonoscopy findings. Colonoscopy was done on November 25, 2020, the reports suggests ulcerative colitis of Grade 1. The physical and mental ease to do daily chores was more comfortable and effective after the treatment [Table 1] and [Graph 1].
Pathya ahara-vihara (~wholesome diet and activity)
Apart from medications, patient was advised Pathya aahara and Vihara (~wholesome diet and activities) during the course of medications. She was advised to take fresh home cooked, easily digestible light diet like Laja manda (~liquid portion of gruel of parched grain), Peya (~thin gruel of rice), Vilepi (~thick gruel of rice), Khichadi (~porridge), Takra (~buttermilk), adequate amounts of Shritasheeta jala (~boiled and cool water). Green seasonal vegetables, seasonal fruits, [like Chenopodium, fenugreek, carrot and other citrus fruits in winters and sponge gourd, cucumber, pointed guard in summers, rice, pomegranate and banana] were advised.
Foods are difficult to digest, sweets and cold items, milk and milk products except buttermilk were avoided. Overeating, daytime sleep, night awakening, physical and psychological stress were also advised to be avoided. Proper rest was advised. A good, night sleep (9 PM to 4 AM) with morning meditation session or a morning walk was advised. She was advised to moderately use electronic gadgets like TV, mobile, computer, video games during night time. Omkara chant for 15 min, Anuloma viloma pranayama (~control of breath) for 2–5 min, and Bhramari pranayama for 5 times were specially advised early morning on an empty stomach during the course of treatment.
| Follow-up and Outcome|| |
Follow-up was taken telephonically on fortnight basis for four months. The symptoms were reduced considerably, and currently she is following all specified regulations. No recurrence of symptoms nor any new complications were observed.
| Discussion|| |
The status of Ama (~indigested) or Pakva (~digested) condition of Mala (~faeces) is the foremost factor considered while treating Atisara or Pravahika. Furthermore, maintenance of Agni is also required. Agni deepana (~enhance digestive fire), Ama pachana (~digestion of indigested particles), Grahi (~anti diarrheal), Stambhana (~checks bleeding), Dhatu poshaka (~nutrition supplement in tissue level), Sattvavajaya chikitsa (~psychotherapy) treatments should be considered according to the stage of disease in the management.
Dadimashtaka churna possess Katu (~pungent) and Tikta (~bitter) Rasa (~taste), Grahi (~anti-diarrheal) Guna, Ushna virya (~hot potency) and Katu and Madhura vipaka (~sweet in bio-transformed). It has Deepana, Tridoshaghna (~alleviate vitiated three Doshas) in Prabhava (~exceptional activity). It is useful in Atisara (~diarrhoea), Grahani, Ajeerna (~indigestion), Agnimandya (~low digestive power), and Arochaka (~loss of appetite). It has Dadima (~Punica granatum Linn.) and Sita (~candy sugar) as main content, which is Balya (~strength promoting) in nature. Extract of P. granatum owing to its mast cell stabilizing properties, anti-inflammatory and anti-oxidant properties may help in colitis.
Sanjivani vati by virtue of its Deepana (~enhance digestive fire), Pachana (~digest Ama), Rochana (~taste enhancers) properties, may help in stimulating other digestive/metabolic factors. Stimulated Agni helps in Ama pachana and restrict its further making and lodging in different part of body. This Ama pachana causes Srotomukha vishodhana (~opening up the blocked channels of body). Drugs like Pippali (~Piper longum Linn.), Shunthi (~Zingiber officinale Roxb.), Vidanga (~Embelia ribes Burm F.), Vacha (~Acorus calamus Linn), Guduchi ([Tinospora cordifolia (Willd.) Miers.] etc., are proven Ama pachaka drugs. Thus, the product will help as Ama pachana and Agni deepana. Vayu (~an entity which is responsible for movement) and Aakash mahabhuta (~space element) prevail in Tikta rasa (~bitter taste), which absorb Kapha dosha's liquid essence. Hence, digestive fire gets free from the covering of Kapha then Ama gets digested.
Bilva (~Aegle marmelos Corr.) is anti-inflammatory, and anti-oxidant effects. Decrease colonic inflammation and mucosal damage, inhibit free radicals and reduce the TNBS (2, 4, 6-trinitrobenzene sulfonic acid) induced increase in myeloperoxidase level. This activity of the extract was comparable with the colitis protective medicine sulfasalazine at an oral dose of 100 mg/kg.
Basti is accredited to be the best mode of administration in Vata or Vata pitta pradhana atisara (~Atisara caused by vitiated Vata and Pitta dosha). It overcome the disease and gives Bala to Kati (~lower back), Pakvashaya sthana (~colon). Pichha basti is mentioned in this condition. Mocha rasa is classified under Purisha-sangrahaniya mahakashaya (~group of ten drugs which helps in faecal consolidation), Shonit sthapana mahakashaya (~group of ten drugs which normalize blood), Vedana sthapana (~group of ten analgesic drugs) and as per taste classified in Kashaya skanda (~astringent group of herbs). Mocha rasa was described under Priyangvadi gana having properties of Pitta shamana (~drugs which alleviate perturbed Pitta dosha) and causes Sthambhana (~check any flow through or out of the body). Therefore, it is indicated in condition of Pakwa-atisara, Vrana (~promotes healing) and Raktpitta like bleeding disorders and can be useful for Sandhana karma (~type of haemostatic procedure) in tissue injury cases and acts as Vrana ropana (~facilitates wound healing).
This treatment protocol collectively Improve the condition of the patient which was assessed on the basis of colonoscopy which improved from grade four to grade one and subjective assessment of Vyadhi lakshana (~characteristic symptoms). Her professional life was considerably improved and there the dependency of steroids was also not noticed by the end of management.
| Conclusion|| |
Diseases of the digestive system, such as ulcerative colitis, are becoming more widespread as a result of changing lifestyle choices. There is a need to explore the use of traditional medicines, since there is a paucity of cost-effective, safe, and disease-specific therapeutic approaches. This single case report of ulcerative colitis that was managed satisfactorily has significantly improved the professional life of the patient with no side effects has brought hope to those who have been facing similar challenges.
Declaration of consent
Authors certify that they have obtained patient consent form, where the patient/caregiver has given his/her consent for reporting the case along with the images and other clinical information in the journal. The patient/caregiver understands that his/her name and initials will not be published and due efforts will be made to conceal his/her identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR, et al.
Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: Report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol 2005;19 Suppl A: 5A-36A.
Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences. Gastroenterology 2004;126:1504-17.
Shivashankar R, Tremaine WJ, Harmsen WS, Loftus EV Jr. Incidence and prevalence of Crohn's disease and ulcerative colitis in Olmsted county, Minnesota from 1970 through 2010. Clin Gastroenterol Hepatol 2017;15:857-63.
Langholz E, Munkholm P, Nielsen OH, Kreiner S, Binder V. Incidence and prevalence of ulcerative colitis in Copenhagen county from 1962 to 1987. Scand J Gastroenterol 1991;26:1247-56.
Danese S, Fiocchi C. Ulcerative colitis. N Engl J Med 2011;365:1713-25.
Tripathi K, Feuerstein JD. New developments in ulcerative colitis: Latest evidence on management, treatment, and maintenance. Drugs Context 2019;8:212572.
Gajendran M, Loganathan P, Jimenez G, Catinella AP, Ng N, Umapathy C, et al
. A comprehensive review and update on ulcerative colitis. Dis Mon 2019;65:100851.
Acharya YT, editor. Sushrutha Samhita of Sushruta, Uttar Tantra. 2nd
ed., Ch. 34, Ver. 5. Varanasi: Chaukhambha Sanskrit Sansthan; 2004. p. 224.
Shastri K, editor. Charak Samhita of Agnivesa, Chikitsa Sthana. Ch. 19, Ver. 71. Varanasi: Chaukhambha Bharati Academy; 2005. p. 744.
Acharya YT, editor. Sushrutha Samhita of Sushruta, Chikitsa Sthana. 2nd
ed., Ch. 38, Ver. 3. Varanasi: Chaukhambha Sanskrit Sansthan; 2004. p. 256.
Tripathi B, editor. Shadangdhar Samhita of Shadangdhar, Madhya Khanda. Ch. 7, Ver. 18-22. Varanasi: Chaukhmbha Surbharti Prakashana; 2020. p. 135.
Tripathi B, editor. Shadangdhar Samhita of Shadangdhar, Madhya Khanda. Ch. 6, Ver. 60-61. Varanasi: Chaukhmbha surbharti Prakashana; 2020. p. 121.
Acharya YT, editor. Sidhha Prayoga Samgraha. Ch. 2, Ver. 5. Mumbai: Neha Graphics Parel; 2017. p. 24.
Shastri K, editor. Charak Samhita of Agnivesa, Chikitsa Sthana. 3rd
ed., Ch. 19, Ver. 26-28. Varanasi: Chaukhambha Bharati Academy; 2005. p. 754.
Sharma PV, editor. Sushruta Samhita of Sushruta, Uttara Sthana. Ch. 40, Ver. 17-18. Varanasi: Chaukambha Visvabharati; 2010. p. 377.
Narang R, Herswani I. Ayurveda review on “Dadimashtaka Churna” and its clinical importance. J Drug Deliv Ther 2018;8:80-2.
Mishra S, editor. Bhaisjya Ratnawali of Govind das sen, Grahani Rogadhikar. Ch. 8, Ver. 38-39. Varanasi: Chaukhambha Surbharati Prakashan; 2007. p. 259.
Rosillo MA, Sánchez-Hidalgo M, Cárdeno A, Aparicio-Soto M, Sánchez-Fidalgo S, Villegas I, et al.
Dietary supplementation of an ellagic acid-enriched pomegranate extract attenuates chronic colonic inflammation in rats. Pharmacol Res 2012;66:235-42.
Gairola S, Gupta V, Bansal P, Maithani M, Murali Krishna C. Pharmacological activities of Sanjivani Vati. Int J Ayurvedic Med 2010;2:1-19.
Sharma PV. Dravya Guna Vigyana. Part 2, Vol. II, Ch. 4. Varanasi: Chaukhambha Bharti Academy; 2013. p. 275.
Sharma PV. Dravya Guna Vigyana. Part 2, Vol. II. Ch. 5. Varanasi: Chaukhambha Bharti Academy; 2013. p. 333.
Sharma PV. Dravya Guna Vigyana. Part 2, Vol. II. Ch. 5. Varanasi: Chaukhambha Bharti Academy; 2013. p. 505.
Sharma PV. Dravya Guna Vigyana. Part 2, Vol. II. Ch. 1. Varanasi: Chaukhambha Bharti Academy; 2013. p. 28.
Sharma PV. Dravya Guna Vigyana. Part 2, Vol. II. Ch. 9. Varanasi: Chaukhambha Bharti Academy; 2013. p. 762.
Sharma PV. Dravya Guna Vigyana. Part 1, Vol. II. Ch. 4. Varanasi: Chaukhambha Bharti Academy; 2013. p. 218.
Rajaram A, Vanaja GR, Vyakaranam P, Rachamallu A, Reddy GV, Anilkumar K, et al.
Anti-inflammatory profile of Aegle marmelos
(L) Correa (Bilva) with special reference to young roots grown in different parts of India. J Ayurveda Integr Med 2018;9:90-8.
Ghatule RR, Gautam MK, Goel S, Singh A, Joshi VK, Goel RK. Protective effects of Aegle marmelos
fruit pulp on 2,4,6-trinitrobenzene sulfonic acid-induced experimental colitis. Pharmacogn Mag 2014;10:S147-52.
Acharya VS, Tripathi RD, editors. Charak Samhita of Agnivesha, Sidhhi Sthana. Ch. 1, Ver. 39-41. Varanasi: Chaukhambha Prakashan; 2011. p. 883.
Acharya VS, Tripathi RD, editors. Charak Samhita of Agnivesha, Chikitsa Sthana. Ch. 19, Ver. 93-94. Varanasi: Chaukhambha Prakashan; 2013. p. 479.
Shastri K, editor. Charak Samhita of Agnivesha, Sutra Sthana. Ch. 4, Ver. 31-46. Varanasi: Chaukhambha Bharati Academy; 2005. p. 87-95.
Shastri A. Sushruta Samhita of Maharshi Sushruta, Sutra Sthan. Ch. 38, Ver. 45. Varanasi: Chaukhambha Sanskrit Sansthan; 2010. p. 187.
[Table 1], [Table 2], [Table 3]