Wide emergence of chronic kidney disease (CKD) may be considered as a global threat, but with simple diet, lifestyle modification and early intervention, it can be managed through Ayurveda. It is possible to withhold morbidity and mortality, which occurs due to CKD. Currently, available conventional treatments for CKD have their own limitations. Considering those, alternate remedies for curing and curbing the disease progression are being worldwide welcomed. In Ayurveda, CKD may be compared with the subtypes of Mutraghata (~obstructive and suppressive uropathies), for which extensive treatment modalities have been described in classics. In the present study, 37-year-old female patient diagnosed with Stage-3 CKD (estimated through either glomerular filtration rate) visited the outpatient department complaining headache, restlessness, shortness of breath, swelling in feet, tiredness, etc. She had a history of anemia and blood transfusion every 6 months for 18 months, for which she was investigated and later diagnosed as a case of CKD. Initially, she was prescribed with Trina panchamoola kwatha, Punarnava mandoora, Syrup Neeri KFT, and Kamadudha rasa for two months, and further treatment was altered and tailored according to the patient's condition and Shatavari, Shivagutika, Punarnava mandoora, Lauhasava, Chandanasava, Varunadi kwatha, and Gokshura churna were prescribed in the different phases of management. The patient was advised to avoid milk and milk products, vegetables such as cabbage, spinach, brinjal, and avoid the suppression of naturalurges. Increase in hemoglobin level (to 10.2 mg/dl) and decrease in creatinine level (to 0.9 mg/dl) were observed. The patient did not have to take blood transfusion either. The case clearly reveals the significance of ayurveda treatment modality in the management of CKD.

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Hearing impairment is a complete or partial loss of ability to hear from one or both ears. It can be congenital or acquired and the clinical features closely resemble to Badhirya explained in Ayurveda. Hearing impairment in the schoolgoing children is a serious problem affecting their education, skills, and social relationship with others, etc., This case report presents an 11-year-old girl with hearing impairment in the left ear since childhood. Audiometry report showed profound hearing loss in the left ear. Treatment was done with Marsha nasya by Anu taila for three days and Karnapurana (~putting oil in ears) with Asanabilwadi taila and Shiropichu (~placing cotton pad overhead soaked in medicated oil) with Ksheerabala taila for seven days each, along with Ashwagandhadi lehyam, Arogya vardhini vati, Sarivadyasava, and Trivrit churna as internal medicines for 22 weeks. After that, audiometry results improved from profound to moderate hearing loss in the left ear. Decreased hearing may be due to vitiated Vata alone or Vata and Kapha dosha, which can be managed with the help of Marsha nasya, Karnapurana, and Shiropichu along with Vata shamana and Rasayana therapy.

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Psoriasis is an immune-mediated disease characterized by chronic inflammatory changes in the skin. Around 5% of all the psoriasis sufferers have palmoplantar psoriasis, which is challenging to treat a variety of psoriasis. Ayurveda is rich in herbs having proven anti-psoriatic action. However, the complex and multifactorial pathogenesis of psoriasis needs a multimodal treatment approach. In the present case report, a 45-year-old female patient presented with soles of feet partially covered, thickened, red skin having sharp, and noticeable borders demarking the psoriasis patches from unaffected skin. There were painful cracks over the soles and thickened erythematous plaques on the right elbow. Clinical examination revealed the involvement of Tridosha (~three biological humors) in the Samprapti (~pathophysiology). The multimodal treatment including Patolakaturohinyadi kashaya, Kaishora guggulu, Mahatiktaka ghrita, Gandhaka rasayana, and Khadirarishta as internal medicines, whereas Winsoria oil and Panchavalkala kwatha as external medicines showed promising results. Within six months of the treatment, the psoriatic lesions and associated signs and symptoms healed effectively. Altogether, multimodal Ayurveda treatment can be an effective and safe solution for palmoplantar psoriasis.

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Nonspecific mesenteric lymphadenopathy is one among the leading causes of cumbersome abdominal colic in children. The severity of the pain is variable and may cause emergency hospitalization in most of the cases. In Ayurveda, these complaints simulate with characteristics of Gulma (~abdominal mass or lump) where vitiated Vata dosha is responsible for clinical picture. Two cases of similar presentation of abdominal pain due to mesenteric lymphadenopathy are presented here. Ayurveda drugs such as Lavana bhaskara churna, Trikatu, Kanchanara guggulu, and Kumaryasava B have a textual indication for Gulma and administered along with Jahar mohra pishti, Panchamrita parpati, and Vidanga lauha. These were well tolerated by both the children. Treatment continued for 180 days. The pain was assessed with Wong-Baker Face scale (WBF scale) and Face, Leg, Activity, Cry, and Consolability scale (FLACC scale) according to the age group. After treatment, WBF scale showed a 2/10 score which was 8/10 before treatment and the FLACC scale showed a 0/10 score after treatment which was 10/10 before treatment. Relief in clinical symptoms was found, and the ultrasonography reports had shown improvement in the underlying pathology.

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Diabetic neuropathies are one among the complications of diabetes. Over a period of time, the nerves of diabetes get affected, especially the peripheral nerves leading to Diabetic Peripheral Neuropathy (DPN). A 67-year-old male diabetic who was diagnosed with DPN was treated with a combination of Ayurvedic oral medication and external therapies. Considering the treatment protocol of Prameha upadrava and Vatavyadhi chikitsa, internally, Balaguduchi ksheera kashaya, Ksheerabala 101 Capsule, and Nishamalaki churna were used during the course of treatment. External therapies including Udvartana, Abhyanga, Patrapotala sveda, and Ksheera vasthi were done for a duration of 22 days. Assessment of the patient was done before and after treatment using the Diabetic Neuropathy Symptom Score, Michigan Neuropathy Screening Instrument, and Toronto Clinical Scoring System. Significant improvement was seen in all the scores after the treatment. This case study shows that DPN can be successfully managed by Ayurvedic treatment.

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Chronic pancreatitis is the long-standing inflammation of the pancreas, leading to irreversible damage of the gland. The disease is characterized by loss of exocrine and endocrine functions of pancreas owing to fibrosis and parenchymal damage. Clinical manifestations of the disease include abdominal pain, episodes of acute pancreatitis, nausea, vomiting, steatorrhea, indigestion, weight loss, and uncontrolled blood sugar. No authentic tools have yet been identified to predict the course of the disease, frequency of acute exacerbations, and rate of disease progression. Pancreatic enzymes, supplements, and a low-fat diet are usually prescribed to patients of pancreatitis. However, patients continue to experience unpredicted flare up of symptoms that are managed by IV fluids, antibiotics, and painkillers in case of acute exacerbations. Surgical intervention and stenting might also be done in some cases to bring relief to patients. However, these have limited effect, and the disease continues to progress and causes pancreatic cancer and casualties as well. Despite advances in medical science, the prognosis of the disease remains variable and unclear. Studies indicate a mortality rate of 17% in 5 years, 30% in 10 years, and 55% in 20 years after the diagnosis of chronic pancreatitis. Here, a case of chronic pancreatitis that was treated in lines of Ayurveda is presented. The patient has not suffered any attack after the commencement of Ayurvedic treatment and completes nine years of symptom-free status with no signs of progression in radiological tests.

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Ankylosing spondylitis (AS) is a condition posing major challenge to health-care system. The disease is characterized by inflammatory stiffening of the spine, affecting the cartilaginous joints of the spine and the sacroiliac joints. Non-steroidal anti-inflammatory drugs and steroids are the drugs of choice in conventional systems but fail to provide a complete cure. There is no direct reference to the disease in Ayurveda, but based on the clinical picture, treatment can be planned. A 25-year-old male diagnosed with AS with bilateral hip arthritis since the past six years was treated by Patrapinda swedana and Erandamooladi basti in Kala krama along with Shamana (~palliative) therapy for 16 days. The disease activity was analyzed using AS Disease Activity Score. Other quality of life parameters were also incorporated for the assessment. After completion of the treatment, considerable improvement was recorded in subjective parameters, pain was decreased, stiffness was resolved, and appetite was improved. Spinal mobility was also improved. Considerable improvement was appreciated in the patient assessed by quality-of-life parameters.

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Dimorphic anemia is one of the common forms of anemia in India, but there is a paucity of literature regarding this entity. It has a complex pathogenesis with involvement of more than one deficiency state, usually due to deficiency of both iron and Vitamin B₁₂or folic acid, characterized by two different cell populations, comprising of microcytic hypochromic with macrocytic normochromic red blood cells. Conventional treatment of such condition is supplementation of iron and Vitamin B₁₂, but the long-term treatment with iron salts is associated with several side effects. An alternative approach of therapy is to enhance the absorption of dietary iron and Vitamin B₁₂, rather than increasing them in the diet. This is a case study of a 33-year-old female patient from Shillong, Meghalaya, presented with dimorphic anemia to Kayachikitsa outpatient department at Ayurveda Hospital, North Eastern Institute of Ayurveda and Homoeopathy, Shillong. Ayurvedic treatment regimen comprising of herbo-mineral and metallic preparations was administered for a period of 70 days, which resulted in marked rise in hemoglobin level, hematocrit, mean corpuscular volume, and reticulocyte count along with changes in the peripheral blood smear. Ayurvedic principles and drugs with its multidimensional approach can prove to be immensely effective in the management of this condition as evident in this case study.

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Herpes zoster is a viral skin infection though uncommon in childhood can be caused by the reactivation of the varicella zoster virus due to lower immunity. This clinical entity can be compared with Visarpa (~vesicular or bullous eruptions). Visarpa is a clinical syndrome in which vitiated Vata-Pitta dosha along with vitiated Rakta (~blood plasma) cause progressive skin lesions, which are painful and look like scalds or burns, and require Pitta allaying internal and local treatment. An 8-year-old female child presented along with her father with the vesicular lesions on her left cheek associated with mild fever, itching, and pain on the local lesion. She was administered with 125 mg of Kamadudha rasa (plain) thrice a day before meals with milk and Pinda taila for local application on the facial lesions. The patient reported on the 5^th day with significant relief in the size and shape of the facial lesions and other symptoms. The scars limited to minimal without any inflammatory signs by the 7^th day of follow-up. Kamadudha rasa and Pinda taila are two readily available and cost-effective compound ayurvedic formulations, which can be used in the management of herpes zoster infection, especially in low-resource settings.

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Microalbuminuria is one initial diagnostic marker of progressive Diabetic Nephropathy (DN). Urine Albumin Excretion (UAE) between 30 and 300 mg/24 h is found in Stage 2 DN. In Ayurveda, no description is found, which can be directly correlated with DN, but Nidana and Samprapti of Prameha can be correlated for its manifestation. In this case, a 56-year-old male patient visited to Shalya Tantra OPD with complaints of type 2 diabetes and 135 mg UAE in 24 h with estimated Glomerular Filtration Rate (eGFR) of 77 ml/min/1.73 m². This case report was aimed to evaluate the effect of Ayurveda formulations (Gokshuradi guggulu, Haritakyadi kwatha, Bhumyamalaki churna, and Gokshura churna) with Pathya ahara (Plant-based diet) in the management of microalbuminuria in DN Stage 2. This formulation was given for one month and Pathya ahara advised for two months. UAE significantly decreased and came to normoalbuminuria state. eGFR increased up to 87 ml/min/1.73 m². The present study suggested that using Ayurveda formulations with Pathya ahara is effective in the management of microalbuminuria in DN Stage 2.

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Idiopathic thrombocytopenia is a disorder that leads to easy or excessive bleeding results from unusually low levels of platelets. Treatment modalities for Idiopathic Thrombocytopenic Purpura (ITP) are available in modern science, namely corticosteroids, etc., have a lot of side effects, and include risky surgical procedures such as splenectomy. However, Ayurveda approach gives an understanding of its causes, pathogenesis, and treatment planning. Here, a case of chronic ITP diagnosed as per western medicine is being presented, which was treated with Ayurveda modalities. The patient was diagnosed with Raktapitta (~bleeding/hemorrhagic disorder) and was treated with oral medicines mentioned in Raktapitta chikitsa along with medicated food for two months. The patient's condition was assessed based on the symptoms of Raktapitta like Atyartava (~excessive menstrual bleeding), along with standard objective parameters such as platelets count, WHO bleeding scale, and ultrasonography. Significant improvement was noted in this case in both classical signs and symptoms (Atyartava and Bhrama) as well as in objective parameters. This case gives a focus on the prognosis and treatment approach of ITP through Ayurveda point of view.

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Psoriasis is a chronic autoimmune condition caused due to rapid over-production of new skin cells resulting in scaling. Inflammation and redness around the scales are common. Among all types of psoriasis, plaque psoriasis makes up 90% of cases. Its contemporary treatment has some limitations thus affecting quality of life of patients. In this report, the management of a diagnosed case of plaque psoriasis is presented. The patient was treated through Ayurvedic multimodal approach using Shamana chikitsa (~pacifying therapy) including oral administration of decoctions, medicated ghee and external application of medicated coconut oil processed in presence of leaves of Shweta kutaja (Wrightia tinctoria Roxb.), Eranda taila (~castor oil) and Dadhi (~curd). Although Shodhana is treatment of choice in Kushta (~skin diseases) considering age factor of the patient, Shamana chikitsa was planned. Significant relief was noticed with no relapses until after six months of follow-up inferred efficacy of Ayurvedic protocol in the management of such autoimmune disorders.

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Obesity is one of the most challenging health issues in the present scenario, which has almost taken the shape of an epidemic and affected the developed as well as the developing nations across the globe. Obesity exposes an individuals' susceptibility to several diseases which may affect multiple systems. Acharya Charaka has quoted Ati-sthaulya under the eight varieties of impediments which are designated as Ashtau-nindita purusha. Ati-sthaulya is one among eight such morbidities. Modern medications available for obesity have not yet been established to be as effective as proper diet, and exercise still remains the mainstay of obesity management. Ayurveda, though incorporating Panchakarma treatment modalities, may be considered as an alternative for management of obesity and correction of Doshas, Dhatus, and Malas involved at the basic level. This work was aimed to study and evaluate the effect of Virechana karma (~purgation therapy) in the management of Sthaulya. A 33-year-old male obese patient was treated with Virechana karma after Deepana (~appetizers), Pachana (~digestives) followed by Snehapana (~internal administration of oleaginous substance) with Murchita taila. After the treatment, significant reduction was noticed in weight as well as in the anthropometric measurements. Significant changes were also observed in the biochemical markers such as lipid profile after Snehapana and after Virechana karma. No untoward effects with this therapy were observed during the treatment regimen.

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Hashimoto’s Thyroiditis (HT) is the most common auto-immune thyroid disease and the commonest cause of hypothyroidism. In conventional medicine, treatment of choice for HT is replacement of thyroid hormone. A case of HT was managed at the OPD level by following Ayurveda principles and found to be effective. A treatment protocol was designed based on the signs and symptoms and assigned in this patient. Snehapana followed by Vamana and Virechana and at the end Shamana was done with Varunadi kwatha bhavita shilajatu for a period of three months with two months follow up. The treatment protocol was found to be effective in symptomatic and biochemical profiles of the patient. Patients of HT should be able to have a choice against the lifelong hormone therapy. This can be achieved by adequate evaluation of the individual action of the therapies adapted here and replicating the same in a much larger group.

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Chronic wounds are becoming challenge for scientific community due to their economical and psychological burden. Contemporary science tried hard to cop up with this difficult situation by the use of tissue engineering, cell-based therapy, plasma therapy along with various dressings, and surgical procedures, but the results are not very promising. Wounds are described under the heading of Vrana in Ayurveda along with various herbs and herbomineral preparations for their management. Gojihva (Launaea nudicaulis [L.] Hook.f.) is an herb mentioned to be useful in various diseases as well as for wounds. It is also practiced ethnomedicinally for wound management in various countries. A 60-year-old male having non-healing wound on his dorsal surface of the forearm for the past 45 days was treated with dressing of Gojihva kwatha (~ decoction) for 28 days. Bates–Jensen Wound Assessment Tool (BWAT), wound tracing and digital photography was used to asses wound healing on every week. BWAT score was 52 before treatment and 13 after the treatment. The surface area was 42.9 cm² before treatment and nil after treatment. The wound was completely healed in 28 days without any complications.

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Hemangioblastoma is a benign, highly vascular tumor that can occur in the brain, spinal cord, and retina. This tumor accounts for about 2–3% of brain tumors. As it expands, it creates pressure on the brain and can cause neurological symptoms such as headache, weakness, sensory loss, impaired balance and co-ordination, and/or hydrocephalus. In this case study, a middle-aged female patient, a known case of multiple cystic lesions (hemangioblastoma) in brain with ventriculoperitoneal shunt, presented with weakness of legs, giddiness, stiffness in body, and difficulty in speech for eight years. The first Magnetic Resonance Imaging (MRI) of brain was done in 1997 which revealed chronic hydrocephalous with superadded atrophic changes and cystic lesion in the region of left foramen of luschka. The patient was treated on the line of Aavranajanya vata vyadhi. Ayurvedic medicines along with Yoga therapy was advised and continued for ten months. The patient showed marked improvement in the clinical signs and symptoms. Brain MRI of the patient also showed decrease in the size of the lesion as compared to the previous scan.

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Beauty and attraction of an individual depend on skin condition. However, there are certain pathologies which wipe out this beauty and attraction by altering skin health. Vitiligo is a condition, which means “to have white skin.” In Ayurveda, it is referred as Switra or Kilasa and cited under the category of Kushta rogas (~skin diseases). It is caused by the imbalance of all the three Doshas (~three regulatory functional factors of the body) vitiating Rakta (~blood tissue), Mamsa (~muscle tissue), and Medas (~fat tissue). A 32-year-old male came to the outpatient department with complaints of chalky white patches with hypo-pigmented border without itching over the chest and face for two years, gradually spreading over the chest. The patient was treated with Ayurvedic oral medications and Virechana karma (~therapeutic purgation) along with the instructions of Pathya (~wholesome diet and lifestyle) and Apathya (~unwholesome diet and lifestyle). After treatment, there was repigmentation of skin without any side effects. The treatment modalities showed color changes of patches from chalky white to pinkish inferring that Ayurveda has treatment approaches to manage condition like Switra (~vitiligo).

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Alopecia areata is an autoimmune disorder characterized by transient, nonscarring hair loss, especially on the scalp ranging from well-defined patches to diffuse or total hair loss with hair follicle preservation. It affects approximately 2% of the general population. This condition is described as Indralupta (~alopecia) in Ayurveda. The current presentation is a case report of 36-year-old female patient who visited the outpatient department with patchy hair loss of scalp over the vertex and occipital region and generalized hair loss for two years with no associated symptoms. The treatment was determined giving significance to systemic effects of disease along with localized pathology in the skin caused by the vitiation of Tridoshas (~three body humors). She was treated on outpatient level with Ayurvedic internal medications, external applications and Kuttanam (~a minor operative procedure) for four months. The uniqueness of this case is that transition of hairs from gray to black occurred over the course of a single hair follicle growth cycle. The phenomenon of natural reversal of depigmentation of hair in a single hair follicle growth cycle is not found in any of the scientific databases. The patient showed remarkable improvement including regeneration of black hair at the site of hair loss. During the follow-up period of two years, no recurrence was observed. This case report shows that holistic approach of Ayurvedic treatment can produce clinically significant results in Indralupta and shows possibility of application of these principles in repigmentation of hairs.

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Bullous pemphigoid is a rare, potentially fatal autoimmune blistering disease in which the immune system produces antibodies to the fibers that connect the outer layer (epidermis) and next layer (dermis) of the skin. These antibodies trigger inflammation that produces the blisters and itching of bullous pemphigoid. It is uncommon in childhood. This manifestation has close resemblance with Visphota in Ayurveda. A case of five month-old female patient with chief complaints of multiple ruptured blisters or bullae and reddish black lesions over both upper and lower extremities, face, lower abdomen, lower back, and scalp for two months is presented here. Oral administration of Paripathadi kadha and Mahatikta ghrita to mother and local application of Rasonta (~decoction of Daruharidra) with milk and Jatyadi taila to patient simultaneously were prescribed. Complete recovery within a month with no signs of relapse after three months of follow-up was noticed.

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Xerosis cutis is one of the common clinical conditions in clinical practice. Reduced skin hydration is the alarming characteristic of xerosis, that if ignored, can lead to insidious onset of cutaneous infections and chronic ulcers. Although various studies have been in vogue in this field, no standard method of treatment has yet been formulated. An abundantly available drug, cashew shell oil, has been used as a folklore practice in various parts of Kerala, for this condition. This case study is an attempt to evaluate the efficacy of cashew shell oil in cream form in the management of xerosis cutis of plantar surface. A 31-year-old female presented with the complaints of dry skin in the plantar region of the right foot with deep cracks, fissures, and flakes in the skin for two years. Diagnosis was done based on the clinical examination. Pre and post assessments were done based on DermaLab Combo parameters, namely hydration, transepidermal water loss (TEWL), skin pH, elasticity, temperature, skin color, videoscope, and Specified Symptom Sum Score system (scaling, roughness, redness, crack or fissure). Cashew shell oil cream was applied for a period of 30 days. Skin hydration levels improved and TEWL reduced after treatment. Skin pH, though raised during the period of intervention, came to normalcy by the end of treatment. There was improvement in skin viscoelasticity (VE), with reduced retraction time. The oil constituent being an antioxidant, reduces lipid peroxidation and protects from cell membrane damage, thus maintaining skin barrier function. Digital images evaluated using the DermaLab Combo parameters also depicted flaky dry skin being replaced by normal Stratum Corneum (SC) cells, with increased skin hydration. Cashew oil, though being a skin irritant, can be efficiently used in skin conditions, especially xerosis cutis, when administered in appropriate dose and formulation.

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COVID-19 patients have cutaneous manifestations such as herpes zoster, urticaria, chilblains, purpura, livedo racemosa, chickenpox-like eruptions in very small percentage. However, the major focus is on pulmonary and cardiac symptoms as it leads to increased mortality. Globally, many cases of herpes zoster as coinfection of COVID-19 are observed. Here, a 65-year-old female with Herpes Zoster Ophthalmicus (HZO) managed by Ayurveda stand-alone treatment is reported. She tested RT-PCR (Real-Time Polymerase Chain Reaction) positive, had mild COVID-19 symptoms, and preferred home isolation and Ayurveda treatment. The patient was monitored twice daily through teleconference (zoom/video calls), photographs of the condition were procured, and guidance was sent in return. Initially, the patient complained of fever, pain, and burning sensation in scalp, left ear, and eye with left periorbital swelling. Once the fever subsided, the patient developed vomiting and loose stools as COVID-19 symptoms. There was complete relief from all the symptoms in four weeks, and the medicines for the postherpetic lesions were continued for another week. Treatment of herpes coinfection in COVID-19 under home isolation is in itself a challenge requiring leech application. However, the case was managed with Ayurveda oral medications and topical therapies such as Seka and Bidalaka to achieve relief from pain, burning sensation, and swelling. The drugs and therapies used in the above case assisted increasing circulation relieving pain thereby, assuring good sleep and faster respite from all symptoms. This case is reported to add to clinical literature and to showcase the importance of local therapies and teleconsultation in condition like HZO associated with COVID-19.

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