Ayurvedic management of Ulcerative colitis-
A Case Report: Ulcerative colitis is a chronic inflammatory condition in which patients show altered bowel habit such as diarrhoea, constipation, rectal bleeding, tenesmus, passage of mucous and crampy abdominal pain etc. These symptoms may be relapsing and remitting episodes of inflammation limited to the muscles layer of colon. Allopathic medicine definitely made the life comfortable for human beings with various research and advancement in treatment modalities but in certain disease like ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, inflammatory bowel disease and many more diseases it also searches a search engine and probably Ayurveda play this role in several ways. In Ayurveda Raktaja Arsh, Raktatisara, Raktaja Pravahika, Grahani shows symptoms having resemblance with Ulcerative colitis. Ayurveda described various treatment modalities for the management of Ulcerative colitis such as Matra Basti, Ksheer Basti, Samshamanyogas, proper nutritional supplements, herbal therapy, Yoga and meditation etc. In present study, A diagnosed case of ulcerative colitis, age 14yrs male from khushinagar gorakpur, came to OPD of Kayachikitsa, Guru Gorakshnath Institute of medical science, Gorakhpur. He complained bleeding per rectum, Stools with blood during defecation. Associated with fresh bleeding after defecation, since 8 months, weight loss 6-7 kgs in 6 months. He was given Matra Basti and ksheera Basti along with some drugs and his complaints not only relieved delayed remission as well. The goals of the treatment are to improve quality of life, minimize the risk of colon cancer and achieve steroids free remission of the disease ulcerative colitis. INTRODUCTION
Ulcerative colitis is a cause of significant morbidity worldwide and its incidence [1] and prevalence appear to be increasing day by day. Its incidence is rising especially in Northern India, due to erroneous dietary habits and faulty lifestyle. This is substantiated by the fact that urban areas have a higher incidence than rural areas, and High socio-economic classes. It is idiopathic in nature, but there are diet, drugs and stress. It is the result of an abnormal response by body's immune system. According to Ayurveda,vitiated Pitta and Rakta are responsible for inflammation and ulceration[2] The symptoms of ulcerative colitis can be co-related with Rakta tisara [3](bloody diarrhoea), Raktajpravahika[4] as the frequent stool and blood in stool are the main culprits deteriorating the patient's general health. According to Ayurvedic classics, people with Pitta Atisara[5] have tendency to develop Raktatisara when they do not follow Pathya ahara and Vihara. Again, consumption of hot, spicy and fried food along with stress, anxiety etc leads to Raktatisara. Therefore, the first line of treatment is Nidana parivarjana followed by use of Sansamana Chikitsa like Rakta stambhaka (blood coagulatory) and Purisha Sanghrahi i.e., anti-diarrheal medicines. To measure to digest the Ama (bio toxin) to bring Agni (digestive fire) in its normal state and control the diarrhea and get the restoring health digestion and creating a bacteria friendly environment in the body and relief in all other complaints. Case Study a diagnosed patient of Ulcerative colitis, age 14yrs male from Khushinagar Gorakpur, came to OPD of Kayachikitsa, Mahant Digvijaynath ayurveda chikitsalaya Gorakhpur. He complained bleeding per rectum, Stools with blood during defecation. Associated with fresh bleeding after defecation, since 8 months, weight loss 6-7 kgs in 6 months. His report of colonoscopy biopsy from rectum shows crypt architectural distortion, crypt shortening with inflammatory expansion of the lamina propria with basal lymph plasmacytosis. Cryptitis and crypt abscess are also seen. Thin caliber blood vessels granulation tissue and hemorrhage also seen in background. And sigmoidoscopy shows proctitis, loss of vascular pattern, multiple small ulcerations. Other hematological parameters were normal, renal parameters and blood sugar also within normal limits. Stool examination occult blood present.
General Examination
1. No pallor, clubbing cyanosis found
2. Blood pressure observed normal
3. Pulse -regular and thready in nature
Systemic Examination
4. CVS- S1 & S2 Heard, no abnormality detected in cardiovascular system
5. RS - B/L air entry normal
6. CNS- conscious and oriented with date, time & place
7. GIT- no organomegaly
8. P/R- no piles mass present In Ayurveda, the ancient system of India medicine, is mainly based on the concept of Dosha and Dushya. Due to sedentary life style, faulty food habit, stressful working nature, Pitta dosha aggravated diet intake finally led to suppression of Agni (Digestive fire) which are mentioned as root cause of Pittatisara which in chronic stage manifest as Raktatisara or adhogata raktapitta or pittaja grahani Treatment 1) Shodhana therapy: Shodhana therapy was given for 15 days in three session with two intervals, the following table no: 1, 2 & 3 shows the treatment Table no: 1 DaysShodana treatment1st dayJatyadi tala matra basti- 40ml2nd dayJatyadi taila Yashtimadhu ksheera basti3rd dayJatyadi taila matra basti- 60ml4th dayJatyadi taila matra basti- 80ml5th dayJatyadi taila matra basti- 80ml Table No: 2 Days Shodhana therapy1st dayMurivenna taila yastimadhu ksheera basti2nd dayMurivenna taila yastimadhu ksheera basti3rd dayMurivenna taila yastimadhu ksheera basti4th dayMurivenna taila yastimadhu ksheera basti5th dayMurivenna taila yastimadhu ksheera basti Table no: 3Days Shodhana therapy1st dayMurivenna taila yastimadhu ksheera basti2nd dayMurivenna taila yastimadhu ksheera basti3rd dayMurivenna taila yastimadhu ksheera basti4th dayMurivenna taila yastimadhu ksheera basti5th dayMurivenna taila matra basti -70ml 2) Shamana therapy: Following combination, the drug had been used as follow and changed according to response of the disease. Internal medicine was given continuously for 2 months. Table no: 4 Table no: 4S. NoAushadhiMatraAnupanaTime and durationDays1Kutaja parpati2waterTID1 month2Kutaja ghanavati2waterTID1 month3Lakshadi churna5 gmLuek warm waterBD1 month4Usheerasava40mlwaterTID2 months5Lakshadi guggulu 2Luek warm waterBD1 month6Pushyanuga churna15gmwaterBD1 month7Shimshapa patra churna15gmMishri BD10 days Ayurvedic perspective:Acharya Vagbhatta described Mandagni refers to diminished digestive fire or diminished enzymatic activities of our body. Acharya Charaka has described digestive system as Mahasrotas. While Acharya Sushruta described as Annavaha srotas and Purishavaha Srotas in which these diseases like Grahani, Raktatisara, Raktaja Arsh, Raktaja Pravahika occurs, which alone or as a complication produces ulcerative colitis like symptoms. Yasthimadhu having Rakta-pittashamaka, Varano-ropaka, Stambhaka properties. It activates ulcer healing vatapitta hara, Madhura guru guna &snigdha properties of yastimadhu pacifies pitta & it helps in healing ulcers. Observation : Based on the bleeding per rectum the progress of the treatment was achieved. Patient on his first consultation in our hospital reported 9-10ml bleeding per rectum during and after defecation which gradually reduced during the treatment. The following table shows the treatment progress.Table no:5Sl. noNo: of daysBleeding per rectumFirst session5 days10ml – 5 mlSecond session5 days3ml- 0.5, 1mlThird session5 days1.5ml – 4 ml After three sessions of treatments investigation were done. Histopathology report shows there is multiple mucosal pieces exhibiting surface epithelium, lamina propria with muscularis mucosa, glands are lined by tall columnar epithelium dense chronic inflammatory cells infiltrate seen in lamina propria with occasional polymorphs, cryptitis is noted. There is no findings of crypt architectural distortion, there is no plasmacytosis of basal lymph in lamina propria. Crypt abscess are also not seen. Thin caliber blood vessels granulation tissue and hemorrhage also not seen in background. Sigmoidoscopy shows there is diffuse erosion, erythema, mucosal edema, sloughing seen in rectum. There is no proctitis, loss of vascular pattern, multiple small ulcerations.it is reduced to diffuse erosion, erythema, mucosal edema, sloughing seen in rectum. Other hematological parameters were normal, renal parameters and blood sugar also within normal limits. Stool examination occult blood present.Discussion:As per presentation of disease is progressive disorder of unknown etiology on the basis of sign and symptoms that diagnosed as Ulcerative colitis correlated with Raktatisara/Adhogata rakta pitta/Pittaja grahani The disease Ulcerative colitis is not curable as we know well, but we can improve the life span and quality of life of the patient. Here some of the preparation selected on the basis of involvement of Doshas, Dushya of the disease. All the treatment of Ayurevda formulations mainly Rakta Pitta Shamaka, Deepana & Grahi are in nature. Kutaja parpati: it balances vata pitta and kapha, it is indicated in malabsorption syndrome, diarrhea, intestinal ulcers. Kutaja ghana vati: it balances vata and pitta, it is used in treating diarrhea, dysentery, ulcerative colitis, malabsorption syndrome.Lakshadi churna: it is effective herbal powder to treat the bleeding disorders. It is used to treat the various problems like nasal bleeding, heavy periods, hemoptysis etc (B.R 27/13) Ushirasava (B.R Raktapitta rogadhikar): it is liquid form of medicen used in treatment of bleeding disorders like rectal bleeding, menorrhagia epistaxis etc, skin diseases, blood purification and urinary problems etc. this is cooling in nature and pacifies excess pitta dosha in body. Pushyanuga churna: (Cha. Chi 30/90-96, B.R Strirogadhikara46-49): Pushyanuga churna is an eminent Ayurvedic medicine, in the form of herbal powder that can soothe Vata, Pitta and Kapha. It is kasahya(astringent), katu(pungent), Madhura(sweet) and tikta(bitter) In taste. It acts on plasma, blood, muscles and reproductive system. This is very useful in bleeding disorders. Shisham patra churna: it is used for the treatment of vitiligo, fever non healing wounds, ulcers, intestinal parasites. It pacifies all three doshas. Ksheera Basti has a definitive role in the management of Raktatisara. Here Pitta shamaka dravya (styptic drugs) are used for the preparation of the ksheera Basti. Because of this property it has ulcer healing effect. Actions of Ksheera Basti [16] are – Shothahara and Vrana-Ropaka (anti-inflammatory and ulcer-healing), Rakta-stambhaka (haemostatic agent), Sangrahi (anti-diarrhoeal), Pitta Shamaka. Ingredients of Ksheera basti Yasthimadhu having Rakta-pittashamaka, Varano-ropaka, Stambhaka properties. It activates ulcer healing vatapitta hara, Madhura guru guna & snigdha properties of yastimadhu pacifies pitta & it helps in healing ulcers.
CONCLUSION Matra vasti and Ksheera vasti with medicated drugs not only reduces the complications and also fully stopped the per rectal bleeding completely , symptoms of the disease but also inhibit relapses or re-occurrence of the disease.