Herbal Remedies For Hereditary Spherocytosis By Planet Ayurveda

ABSTRACT

Hereditary Spherocytosis is a congenital hemolytic disorder, which affects the red blood cells and causes hemolytic anemia. Blood Disorders affect the blood and blood-forming organs which include HIV, Sickle cell disease and many genetic disorders. Hemolytic anemia is a process where red blood cells are destroyed. Blood disorders can be cancerous or non-cancerous. Non-cancerous blood disorders can be due to an underlying condition which affects the blood and platelets. It is the destruction of the red blood cells before the normal lifespan of 100-120 days. When Erythrocytosis cannot match the destruction of red blood cells. Red blood cells carry oxygen to all parts of the body when the normal amount of RBC is reduced it causes Anaemia. Blood is a living tissue which is made up of liquids (made of plasma, water and salt) and solids (contains red blood cells, white blood cells and platelets). In this article, we are going to discuss causes, symptoms and ayurvedic aspects in detail.

INTRODUCTION

Hereditary Spherocytosis (HS) is a red blood cell condition which happens when there is a breakage of red blood cells faster than normal. In hereditary Spherocytosis, the red blood cells lose the disc-like structure and become round and in the shape of spherocytes which don't function like normal red blood cells. There is a genetic mutation code in the structure of phenotype which changes its shape to spherical morphology. The difference in the shape of normal red blood cells is more prone to rupture under osmotic pressure and during mechanical stress. The cells lead to dysfunction in proteins which further degrade the spleen and lead to a shortage of erythrocytes which further causes hemolytic anaemia. It was first described in 1871 and its most common cause is inherited hemolysis and various genetic mutations of the protein of the membrane. It is the Glucose 6 phosphate dehydrogenase deficiency and the haemoglobinopathies (sickle cell anaemia). Hemoglobinopathies are most common in black Africans and Thalassaemias is more common in the Mediterranean areas. Hemolysis is mainly extravascular.

CAUSES OF HEREDITARY SPHEROCYTOSIS

• It is due to the mutations of 5 genes and mutations in red blood cells resulting in rigid and misshapen cells.
• This dysfunctional membrane interferes with the ability of the cell to change its shape and destruct the spleen and this destruction undergoes hemolysis.
• Blood disease is a spontaneous mutation of the gene.
• Fever and stress destroy the more blood cells.
• The skin and eye white part become yellow as the level of bilirubin rises.
• Bilirubin destroys the red blood cells.
• Mutations in the ANK1 gene cause half of hereditary spherocytosis.

SYMPTOMS OF HEREDITARY SPHEROCYTOSIS

It can range from mild to severe.

1. Anaemia

It breaks down the healthy red blood cells faster and patients look paler which includes symptoms-

• Shortness of breath
• Increased heart rate
• Jaundice
• Fatigue
• Heart palpitations

2. Jaundice

Red blood cells break down and release bilirubin into the bloodstream causing yellowish discolouration of the skin causing jaundice.

3. GallStones

Excess bilirubin causes the formation of gallstones further causing blockages and includes symptoms such as -

• Nausea
• Vomiting
• Jaundice
• Decreased appetite

4. Symptoms in children include

• Jaundice is the most common symptom in newborns
• Difficulty in feeding
• Irritable mood

DIAGNOSIS OF HEREDITARY SPHEROCYTOSIS

• Complete blood count (CBC)
• Peripheral blood smear
• Reticulocyte count
• Direct Antiglobulin (Coombs Test)
• Bilirubin level
• Red cell osmotic fragility
• Plasma membrane electrophoresis
• Ultrasound

TREATMENT OF HEREDITARY SPHEROCYTOSIS

• Phototherapy
• Blood transfusion
• Splenectomy

Cholecystectomy (removal of gallbladder)

• Iron Chelation therapy

AYURVEDIC ASPECT

As it is a hereditary disease so according to ayurveda it is correlated with BEEJ DUSHTI. The smallest unit of Shukra and Shonita is considered Beeja (sperm and ovum). Bheejbhaga is a component which is responsible for the development of organs and various body tissues. It transferred the generation fom one part to another. The formation of the seven dhatus and the 7th dhatu takes place in the building of GARBHA. In hereditary Spherocytosis, it is the beej dushti which causes Kamala (jaundice) and Pandu (Anaemia). Kamala is the pitta region of the body which builds up toxins in the intestinal area, Kamala is the advanced state of  Pandu roga. When Pandu is not treated properly it leads to Kamala.

Pathogenesis

Ancient Reference - Charak Chikitsa Sthan 16/34

In this shloka, It is explained that when the person is suffering from Pandu (Anaemia) and consumes Pitta aggravating food in excess, the blood gets aggravated and burns the muscles which further leads to Kamala (jaundice). It is of two types-

1. Koshthashakaha shrita Kamala
2. Shakhashrita Kamala

Nidana Of Shakhashrita Kamala

• Excessive intake of Ruksha, Sheeta and Madhur Ahar
• Ati Vyayam
• Vega Nirgah

Samprapti Ghataka

• Dosha- Pitta
• Dushya- Rakta and Mamsa
• Adhisthana- Kostha and Shakha
• Srotas- Rasvaha, Raktavaha, Annavaha and Pureeshvaha
• Sroto Dushti- Ati Pravritti, Sanga and Vimargagamana

Chikitsa

The management of this disease is divided into three parts-

1. Nidana Parivarjan
2. Shodhana (purification therapy) and Shamana Therapy (Palliative therapy)
3. Pathya Apathya

1. Shodhana Therapy

• For the management of Kamala, Acharya Charak mentioned Virechana (purgation therapy).
• Purgation therapy eradicates the aggravated Pitta doshas in the body.
• Before Virechana one must have Snehana as a purvakarma.

2. Shamana Therapy

• After Virechana therapy, Shamana Chikitsa is administered.
• Actions of Shaman drugs are
• Pitta Rechana
• Pittahara
• Deepana (appetizer)
• Sroto Shodhan (channel purifier)
• Raktashodhana (blood purifier)

HERBS USEFUL IN HEREDITARY SPHEROCYTOSIS

1. SARIVA

Sariva (Hemidesmus indicus) is helpful in pitta-related disorders used as detoxification of the body and helpful in improving the texture of the skin. It provides cooling properties which neutralise the abnormal acid in the gut. Improves strength and vitality of the body.

2. SHATAVARI

Shatavari (Asparagus racemosus) has antioxidant and antispasmodic properties. It enhances the level of white blood cells and stimulates the macrophages. Relieves stress and has a cooling effect thus lowering fever and inflammation. Balances Vata and Pitta doshas in the body.

3. MANJISTHA

Manjistha (Rubia cordifolia) is helpful in pacifying vitiated Kapha and Pitta doshas. Has blood purifying properties and removes toxins from the body. Has astringent properties which reduce motility and is a good appetiser. Maintains healthy blood circulation and supports healthy skin and tissues.

4. ASHWAGANDHA

Ashwagandha (Withania somnifera) is helpful in balancing tridoshas in the body which improves body mass and nourishment. Has antioxidant properties which boost the immune system  and is considered a nervine tonic which pacifies the nervous system. Supports the good health of the heart and maintains a proper supply of the blood in the body.

Herbal Supplements For Hereditary Spherocytosis By Planet Ayurveda

Planet Ayurveda is a GMP Certified ayurvedic clinic which formulates various remedies to prevent multiple health issues and relieve the disease of the diseased person. All these formulations are free from any kind of additives, colour and gums. These remedies are 100% pure and formulated under the supervision of M.D Ayurveda practitioners as they did not cause any side effects. For the purpose of Hereditary Spherocytosis planet ayurveda provided herbal remedies which we will discuss further in this article in detail.

PRODUCTS LIST

1. PUNARNAVA MANDUR
2. HEMO PLAN SYRUP
3. GANDHAK RASAYAN
4. GREEN ESSENTIALS
5. YASHTIMADHU GHANVATI
6. DRAKSHASAV
7. ASHWAGANDHAGHAN VATI

PRODUCTS DESCRIPTION

1. Punarnava Mandur

Punarnava Mandur is a herbal tablet formulation which is made by planet ayurveda using various ingredients such as Punarnava (Boerhaavia diffusa), Shunti (Zingiber officinale), Amalaki (Emblica officinalis) Chitrak Mool (Plumbago zeylanica) and many more. It is helpful in balancing Kapha and Pitta doshas which have diuretic properties which reduce swelling activity.

Dosage: 2 tablets twice daily after meals

2. Hemo Plan Syrup

Hemo Plan Syrup are herbal syrup formulations which are made by planet ayurveda using Manjistha (Rubia cordifolia), Gorakhmundi (Sphaeranthus indicus), Draksha (Vitis vinifera) and many more. It is helpful in increasing the level of hemoglobin in the blood and increases the absorption of iron. Known for its balya (strength) promoting herb.

Dosage: 10 ml twice daily

3. Gandhak Rasayan

Gandhak Rasayan is a herbal tablet formulation made by planet ayurveda using purified Sulphur (Shuddh Gandhak). It is helpful in treating chronic fever and improves digestion. Balances tridoshas in the body, useful in all types of skin diseases. Treats all types of acne and pimples and purifies the blood and clears away dirt.

Dosage: 2 tablets twice daily after meals 

4. Green Essentials

Green Essentials are polyherbal capsules made by planet ayurveda using various ingredients such as Grape seed (Vitis vinifera), Wheatgrass (Triticulum aestivum), Amla (Emblica officinalis) and more. It is helpful in boosting the immune system and has antioxidant properties. Has anti-inflammatory properties and boosts metabolic rate naturally.

Dosage: 1 capsule twice daily after meals

5. Yasthimadhu Ghan Vati

Yasthimadhu Ghan Vati are herbal tablets formulated by planet ayurveda using ingredients standardized herb Yasthimadhu (Glycyrrhiza glabra). It has Anti-inflammatory and antioxidant properties. Balances Vata and Pitta doshas, helpful in easy healing of the bone and supports the good health of the liver, has antimicrobial activity.

Dosage: 1 tablet twice daily after meal.

6. Drakshasav

It is a classical ayurvedic formulation made by planet ayurveda using various ingredients such as Munakka (Vitis vinifera), Supari (Areca catechu), Sonth (Zingiber officinale), Dalchini (Cinnamomum zeylanicum). It is helpful in cardiac disorders and acts on Vata and Pitta doshas. Useful in curing digestive problems such as in constipation, bloating and in flatulence.

Dosage: 10 ml twice daily after meals.

7. Ashwagandhaghan Vati

Ashwagandhaghan Vati is herbal tablet formulation which is prepared by planet Ayurveda using ingredients such as Ashwagandha (Withania somnifera). It is helpful in relieving stress and anxiety and boosts fertility and testosterone level in the body. It increases the production of insulin and reduces pain and inflammation.

Dosage: 2 tablets twice daily after meals.

Contact Planet Ayurveda Support Team to provide you the costing/ordering and delivery information at – costing.planetayurveda@gmail.com or Call at 0172-521-4040 (India), +91-172-521-4040 (Outside India) or Whatsapp at (+91) 842-749-4030.

Conclusion

Hereditary Spherocytosis is a congenital hemolytic disorder, which affects the red blood cells and causes hemolytic anemia. It is the destruction of the red blood cells before the normal lifespan of 100-120 days. In hereditary Spherocytosis, the red blood cells lose the disc-like structure and become round and in the shape of spherocytes which don't function like normal red blood cells. As it is a hereditary disease so according to ayurveda it is correlated with BEEJ DUSHTI. The smallest unit of Shukra and Shonita is considered Beeja (sperm and ovum).When Pandu is not treated properly it leads to Kamala. Further we studied herbal supplements from planet ayurveda in detail which is helpful in this disease without causing any side effects. 

Ayurvedic Treatment For Crest Syndrome With Herbal Remedies

ABSTRACT

An Autoimmune condition defines all such conditions that includes overactive immune system, in which a person's own immune system starts attacking their own body. As we know, the immune system helps our body to prevent viruses and bacterias. Normally the immune system differentiate the foreign body cells from the body cells but in case of Autoimmune conditions the immune cells can't differentiate the healthy cells and attack the healthy cells instead of foreign body. In this case the immune system attacks various parts of the body such as skin, bones, joints, etc. In this article we are going to discuss one such condition that is Crest Syndrome. So let's take a look!!!!

INTRODUCTION

Crest Syndrome is one of the autoimmune conditions which affects the connective tissues that provide support to all the tissues and organs. This condition may affect various systems of the body, the symptoms depend upon the affected organ. Crest syndrome is a type of systemic sclerosis, a condition in which there is tightening and hardness of Skin. Other names for this condition are limited scleroderma or cutaneous systemic sclerosis. Acronym CREST defines Calcinosis, Raynaud's Phenomenon, Esophageal Dysfunction, Sclerodactyly and Telangiectasia.

SOME FACTS ABOUT CREST DISEASE

Following are some facts about Crest Syndrome:

• 47-56% of the patients suffering from Crest Syndrome may develop Cardiac and Pulmonary involvement.
• It is the only connective tissue disease which has poor survival prognosis.
• Women are more prone to Crest Syndrome than Men.
• More common between the age group of 30 to 50.
• Races commonly affected are Native and Black American people.

CAUSES OF CREST DISEASE

Crest Syndrome is one of the autoimmune conditions which includes production of Anti-centromere antibodies and Autoimmune Anti-nuclear. There is no clear cause of this condition but following are some of the causes which may interact with Crest Syndrome.

• Atypical Immune activity which affects the way of reaction of the Immune System towards the body cells.
• Various Environmental Triggers: Organic Solvents, Silica Dust and L-tryptophan.

SYMPTOMS OF CREST DISEASE

Crest Syndrome shows various symptoms depending upon which organ gets affected due to the condition. Following are one of the common symptoms of Crest Syndrome:

• Stiffness and swelling in joints
• Muscle pain, stiffness and weakness
• Inflammation or Swelling on face or hands
• Kidney Problems
• Heart Problems
• Lungs scarring which affects breathing

DIAGNOSIS OF CREST DISEASE

Various steps to diagnose Crest Disease:

• Checking the skin for thickening, swelling and tightening.
• Blood tests for evaluating Autoimmunity and Inflammation.
• Kidney function test for assessing Kidney health.
• Creatine Kinase Tests for measuring any kind of muscle involvement.
• For analyzing any kind of Atypical growth certain imaging tests are performed such as MRI, CT Scan, X-Ray.
• For Assessing breathing lung function tests are performed.
• EMG to be done for evaluating Nerve Conduction.

AYURVEDIC VIEW OF CREST DISEASE

As we discussed earlier Crest Disease is one of the Autoimmune conditions and as per Ayurveda this condition can be correlated as the disease occurs due to Ama Dosha. Let's discuss what Ama is and how it accumulates in the body and leads to various disorders.

"दुष्यत्यग्नि स दुष्टोअन्नं न तत्त् पचति लघ्वपि |
अपच्यमानं शुक्तत्वं यात्यन्नं विषरूपताम् ||"

Reference: (Ch. Chi. 15/44)

Vitiated Agni when unable to digest food properly, when that undigested food becomes sour then it becomes a cause for a lot of diseases.

Root Cause of Ama

Aharaj Nidaan (Causes related to food):

• Guru (Heavy), Ruksha (Dry) and Sheeta (Cold) Bhojana (Food)
• Shushka (Dry), Dvishta (Unliked), and Vishtambhi (Aversion) Bhojana (Food)
• Vidahi Bhojana (Food which cause burning sensation)
• Ashuchi Bhojana (Contaminated Food)
• Virudha Bhojan (Incompatible food) and Akala Bhojan (Untimely intake of food)

Viharaj Kaaran (Lifestyle Factors):

• Adharniya Veg Dharana (Controlling Natural Urges)
• Diva Shayan (Sleeping in day time)
• Alasya (Laziness)

Mansika Nidaan (Mental factors):

• Kama (Desire)
• Krodha (Anger)
• Lobha (Greed)
• Moha (Confusion)
• Irshya (Jealousy)
• Shoka (Greif)
• Mana (Arrogance)
• Udvega (Agitation)
• Bhaya (Fear)

Symptoms Caused by Ama Dosha

• Fecal Matter Stasis
• Stiffness in body parts
• Fatigue
• Headache
• Fainting
• Vertigo
• Backache
• Yawning
• Malaise
• Thirst
• Fever
• Nausea
• Vomiting
• Tenesmus
• Anorexia
• Indigestion

Treatment for Ama in Ayurveda

In Ayurveda, Ama Chikitsa is done by Aptarpan Karma which means a therapy which helps in detoxifying the body. Apatarpana Chikitsa simply means depleting treatment. This chikitsa is also considered as Langhana which includes starvation, lightening therapies and thinning therapies. Apatarpana Chikitsa includes three types:

• Langhana - Fasting: Langhana commonly indicated in the patients in which dosha are in mild form and it gets normalized with simple fasting. Langhana increases the digestive fire and Samana Vata which aids healthy digestion.
• Langhana Pachan - Fasting and Digestion: When the doshas are aggravated moderately Fasting is indicated along with digestion inducing drugs.
• Doshavsechana - Dosha Elimination: When dosha are aggravated severely, Doshavsechana is done to expel out the highly aggravated dosha.

Below we are going to mention various herbal remedies by Planet Ayurveda for eliminating Ama dosha and for managing the Crest Disease.

HERBAL REMEDIES BY PLANET AYURVEDA FOR CREST DISEASE

Planet Ayurveda is one of the Ayurvedic Companies which formulated their own herbal and herbo-mineral supplements. This company is serving mankind and even animals for providing them a healthy living. All the supplements are totally safe as they don't contain any kind of additives and preservatives. For Crest Disease following remedies are provided by Planet Ayurveda. All the remedies are helpful in managing Crest Disease is many different ways, let's see below:

1. ASHWAGANDHA CAPSULES
2. BOSWELLIA CURCUMIN
3. GOTU KOLA CAPSULES
4. SANJIVANI VATI
5. GANDHAK RASAYAN
6. SINHNAAD GUGGUL
7. PANCHATIKTAKA GHRIT

PRODUCTS DESCRIPTION

1. Ashwagandha Capsules

Ashwagandha Capsules is a single herbal capsule formulation prepared by Planet Ayurveda with a standardised extract of herb Ashwagandha (Withania somnifera). It consists of adaptogenic properties which helps in improving the action of other herbal remedies. Beside this these capsules are helpful in reducing symptoms of Crest Syndrome such as Muscle Pain and Stiffness.

Dosage: 1 capsule twice daily with warm water after meals.

2. Boswellia Curcumin

Boswellia Curcumin is a capsule formulation prepared by Planet Ayurveda with the standardized extract of Shallaki (Boswellia serrata) and Haridra (Curcuma longa). Both these herbs are considered as one of the best Anti-inflammatory and Analgesic. This herbal remedy along with Ashwagandha reduces pain, inflammation and stiffness all over the body.

Dosage: 2 capsules twice daily with warm water after meals.

3. Gotu Kola Capsules

Gotu Kola Capsules is a miraculous herbal remedy prepared by Planet Ayurveda with a single standardized extract Gotukola (Centella asiatica). Gotu Kola is a miraculous herb for maintaining the health of Blood Vessels and improving circulation. It helps greatly with symptoms of Raynaud's Phenomenon such as spasm of blood vessels of toes and fingers.

Dosage: 1 capsule twice daily with warm water after meals.

4. Sanjivani Vati

Sanjivani Vati is a classical Ayurvedic formulation used since ancient times for various Ama associated diseases. This remedy is formulated by Planet Ayurveda under the strict regardance of M.D. Ayurveda practitioners. The formulation is available in tablet form and consists of ingredients such as Vidanga (Embelia ribes), Pippali (Piper longum), Amalaki (Emblica officinalis), etc. Sanjivani Vati promotes the Apatarpana Chikitsa by eliminating aggravated dosha from the body. Thus by eliminating Ama Dosha from the body these tablets help in managing symptoms of Sanjivani Vati.

Dosage: 2 tablets twice daily with warm water after meals.

5. Gandhak Rasayan

Gandhak Rasayan is an Ayurvedic formulation which is serving as a wonderful natural antibiotic. This remedy is made up of a major ingredient, shuddha gandhak (purified sulfur). It is a natural Ayurvedic remedy which is used as a rejuvenator from many years since the time of ancient era. This remedy miraculously helps in Ama Dosha related conditions by eliminating Ama Dosha from the body.

Dosage: 2 tablets twice daily with warm water after meals.

6. Sinhnaad Guggul

Sinhnaad Guggul is one of the best classical Ayurvedic formulations for bone related conditions especially associated with Ama accumulation. The remedy is available in tablet form and made up of ingredients such as Shuddha Gandhaka (Purified sulphur), Shuddha guggul (Commiphora mukul), amalaki (Emblica officinalis), etc. These tablets consist of properties such as anti-rheumatic, anti-toxin, detoxifying, anti-microbial, laxative, antipyretic, etc. All these properties are effectively helpful in reducing various symptoms of Crest Disease.

Dosage: 2 tablets twice daily with warm water after meals.

7. Panchatiktaka Ghrit

Panchtiktaka Ghrit is a classical Ayurvedic remedy which is ghee based. This remedy is prepared by the ingredients such as nimba (Azadirachta indica), Vasa (Adhatoda vasica), Guduchi (Tinospora cordifolia) and various others. It is a great herbal remedy with the best anti-inflammatory properties. This ghrit formulation provides great benefits in any kind of skin diseases. Its use in case of Crest Disease helps in reducing stiffness and makes the skin smooth and revitalised.

Dosage: 1 tsp twice daily with warm water after meals.

Conclusion

Crest Syndrome is one of the autoimmune conditions which affects the connective tissues that provide support to all the tissues and organs. Acronym CREST defines Calcinosis, Raynaud's Phenomenon, Esophageal Dysfunction, Sclerodactyly and Telangiectasia. Atypical Immune activity and Various Environmental Triggers can cause Crest Syndrome but there is no clear cause of this condition. Common symptoms included are Stiffness and swelling in joints, Muscle pain, stiffness and weakness, Inflammation or Swelling on the face or hands, Kidney Problems, Heart Problems, Lung scarring which affects breathing, etc. In Ayurveda this condition can be correlated as the disease occurs due to Ama Dosha. In Ayurveda, Ama Chikitsa is done by Aptarpan Karma which means a therapy which helps in detoxifying the body. Apatarpana Chikitsa simply means depleting treatment. Planet Ayurveda provides you with various supplements that help in eliminating Ama dosha from the body and some supplements that help in managing the symptoms of Crest Syndrome.

URSODIOL Side Effects and Alternatives Of URSODIOL In Ayurveda

ABSTRACT

Liver is one of the heaviest and your body's second largest organ. It is placed right under your ribcage on the right side and is approximately the size of a football. It does a lot of things that keep a person healthy. Liver separates nutrients from toxins as they move through the digestive system. It carries out toxins out from your body and also helps in the process of digestion. So when your liver isn't working well, it affects your entire body. In this article, we will take a look at the modern treatment of ursodiol for liver disease and its safer alternatives options in Ayurveda, a 5000 year old system of medicine.

INTRODUCTION - WHAT ARE DIFFERENT LIVER DISEASES

The term liver disease refers to the different conditions that can affect and damage the liver. According to latest numbers, one out of every five people in India are getting affected by some sort of liver disorder. Some of the different kinds of liver disease are:

1. Alcohol related liver disease
2. Non-alcoholic fatty liver disease
3. Hepatitis
4. Haemochromatosis
5. Primary biliary cholangitis

If left untreated, overtime liver disease can cause cirrhosis (scarring). As more scarring occurs and healthy tissue is replaced by scar tissue, the liver becomes unable to function properly. This can eventually lead to liver failure and liver cancer.

CAUSES OF LIVER DISEASES

Different liver disorders arise from different causative factors. Some of them are:

1. Viral Infections: Hepatitis A, B and C are caused by viral infections.
2. Problems with immune system: When the immune system mistakenly attacks one's own liver cells, it results in autoimmune liver diseases. For example, Primary biliary cholangitis and autoimmune hepatitis.
3. Genetics: Some disorders manifest because of inherited genes. For example, haemochromatosis.
4. Cancer: When abnormal cells present anywhere in your body multiply in the liver, it may lead to tumors. For example, Liver cancer.
5. Consumption of toxins: Excessive alcohol use results in alcohol related fatty liver disease. Excessive fat consumption may lead to non alcohol related fatty liver disease. NAFLD has become more common in the recent past owing to busy and sedentary lifestyles.
6. Drug overdose: Excessive consumption of OTC medicines can also lead to liver disorders in the longer run.

SYMPTOMS OF LIVER DISEASES

Some conditions like NAFLD don't cause noticeable symptoms, while some conditions lead to jaundice when the liver is unable to clear a substance called bilirubin. Other visible common symptoms are:

• Abdominal pain
• Fatigue
• Vomiting
• Swelling in arms and legs
• Changes in the color of urine and stool
• Easy bruising
• Loss of appetite

TREATMENT AS PER MODERN METHODS

Treatment of liver disease is based on multiple factors: the kind of disorder, the cause behind it and the progression of disease so far. Possible treatments include:

1. MEDICATIONS: Medications are normally given for disorders that are caused due to infections and genetic disorders. For example, Wilson's disease and hepatitis infection. Some of the common medications used are:
• Avatrombopag
• Entecavir
• Metadoxine
• Methionine
• Ursodeoxycolic acid
2. LIFESTYLE CHANGES: Diet and lifestyle changes are commonly suggested to patients suffering from fatty liver disease. Avoiding alcohol, fat, and increasing the fiber intake can often lead to the reversal of the fatty liver.
3. LIVER TRANSPLANT: When liver disease progresses and is left untreated for longer periods of time, it leads to cirrhosis and then to liver failure. This often leads to no solution other than a liver transplant in modern medical treatment.

In the further article, we will take a close look at one of the mentioned medications ursodeoxycholic acid (also known as ursodiol), its benefits, side effects and better safer alternatives of ursodiol.

WHAT IS URSODIOL?

Ursodeoxyccholic acid (UDCA),also known as ursodiol, is a naturally occurring bile acid that has a minor fraction of human bile acid. There are many benefits of ursodeoxycholic acid/ursodiol because of which ursodiol has been used in liver diseases and kidney diseases for decades. Ursodiol was first approved by FDA in 1987 for dissolution of gallstones and for primary biliary cirrhosis. Ursodiol works by replacing the hydrophobic or more toxic bile acids from the bile acid pool. This is sold in the market under the brand name UDILIV.

Benefits of ursodeoxycholic acid include:

• Cryoprotectant nature
• Immunomodulating effects
• Choleretic effects

ARE THERE ANY SIDE EFFECTS OF URSODIOL?

Although there are many benefits of ursodiol for liver disorders, there are many toxic side effects reported over the years. These side effects are often ignored considering the benefits of ursodiol. Some common side effects of ursodeoxycholic acid or ursodiol are:

• Diarrhea
• Abdominal discomfort
• Nausea
• Headache
• Joint pain
• Fever
• Indigestion
• Dark stool
• Frequent urination
• Weakness

Along with all these side effects, ursodiol also reacts with other drugs and causes drug-drug interaction leading to more severe adverse effects. Let us take a deeper look into what Ayurveda thinks of liver diseases and if Ayurveda has safe alternatives of ursodiol.

AYURVEDA PERSPECTIVE ON LIVER DISEASES

According To Ayurveda, the liver is formed from the blood during the embryonic stage. Ayurveda believes Liver has a close relation of liver with Agni and Pitta dosha. It is considered to be the main site of blood. Causative factors for liver disorders according to Ayurveda are:

• Madyapana(Alcohol intake)
• Vegadharna (Suppression of natural urges)
• Divaswapna(Day sleep)
• Ushna teekshna ahar (Intake of spicy food)
• Guru abhishyandi bhojana (Heavy food)

In Ayurveda, Liver disorders can be classified as:

• Mlana Yakrit (Decreased function and shrinkage)
• Yakrit Vriddhi (Enlarged liver)

AYURVEDA MANAGEMENT OF LIVER DISEASES

First and foremost, Ayurveda recommends Nidana Parivarjan (eliminating the cause). All the precipitating factors need to be avoided. Patients are advised to avoid exertion and heavy work. Fat is majorly restricted and protein rich food is recommended. For the medication part, Ayurveda has safer alternatives of ursodiol that provide healing properties and yet cause no side effects in the longer run. Many herbs in Ayurveda are effective at balancing pitta, clear accumulated heat, cleanse the blood and detoxify the liver. The herbs recommended in Ayurveda are carefully chosen to have the following properties:

• Deepana (Carminatives)
• Pachana (Digestives)
• Shodhaka (Laxatives)
• Pittavirechaka (Cholegauges)

Alongwith the herbs, certain panchakarma procedures such as Vaman and Virechan are used which expel the toxins out of the body. In this article, let us majorly look at the ayurveda herbs that are safer alternatives to ursodiol and can be used for the treatment of liver disorders.

Herbs That are Safer Alternatives To URSODIOL

Ayurveda, a 5000 year old system of medicine mentions many alternatives to ursodiol. These herbal alternatives to ursodiol help in faster and safer recovery from liver disorders. Some of these herbs are:

1. BHUMYAMALAKI

Bhumyamalaki (Phyllanthus niruri) is an Ayurveda herb mentioned in classical text books of Ayurveda. It majorly affects the health of the liver. This herb has cleansing, soothing and cooling properties. It balances the pitta and kapha dosha and balances the excess agni/heat in the digestive tract. Not only liver, it also helps gallbladder in cleansing and detoxification.

2. TRIPHALA

Triphala, a combination of three ayurveda herbs namely amla (Phyllanthus emblica), Harad (Terminalia chebula), Bahera (Terminalia billerica) is one of the most used ayurveda combinations has a unique ability to provide multiple benefits to the body. A combination of three herbs ,it helps in constipation and digestion.Along With this, it helps to detox, replenish and nourish the liver with its qualities. It can be easily consumed in powder form, tablet form or in a decoction form.

3. TURMERIC

Active ingredient of the most common Indian herb curcumin has strong anti-inflammatory properties. It deeply clarifies the blood and supports the healing of the overall body tissues. Turmeric can be cooked with food but can also be taken in the form of capsules or tablets.

4. KALMEGH

Kalmegh (Andrographis paniculata) is a well documented Ayurveda herb mentioned in Ayurveda textbooks. It is called Indian Echinacea; it is one of the most important and powerful ayurveda herbs against liver disorders. It has been proven to have hepatoprotective properties. It is antiviral, anti bacterial, immune boosting and anti infective which makes it the foremost choice of the herb against liver disorders.

BEST HERBAL ALTERNATIVES OF URSODIOL BY PLANET AYURVEDA

Planet Ayurveda is an authentic, GMP certified company that produces pure Ayurveda herbs and formulations under the expert supervision of Ayurveda doctors. All the formulations are vegetarian, 100% pure and are mentioned in 5000 year old Ayurveda texts. Planet Ayurveda's liver care pack is one of the leading and most trusted combinations of ayurveda herbs against liver disorders.

The ingredients of this pack are:

1. Yakrit Plihantak Churna
2. Phyllanthus Niruri
3. Echinacea Capsules
4. Liver Detox Capsules

PRODUCTS DESCRIPTION

1. Yakrit Plihantak Churna

Yakrit Plihantak Churna by Planet Ayurveda is a powder formulation prepared with the pure ayurveda herbs such as Kalmegh (Andrographis paniculata), Bhringraj (Eclipta alba), Bhumi Amla (Phyllanthus niruri) and many other hepatoprotective herbs. These herbs have katu (pungent) and Tikta (bitter) ras (taste) and help in balancing out kapha and pitta dosha in the body. All these herbs work in sync and assist in sustaining the health of the hepatic system without any side effects.

Dosage: Decoction of 1 tsf of Churna twice daily.

2. Phyllanthus Niruri Capsules

Phyllanthus niruri capsules by Planet Ayurveda contain 500 mg of pure extract of phyllanthus niruri or Bhumiamla. This herb has cold potency, bitter and sweet in taste. This herb has anti viral, antihelminthic and laxative properties. It balances out aggravated Vata and pitta dosha and hence manages thirst, cough and cold. This formulation is known to remove all the mala (waste) from the body and is known to retain health while reversing the liver disorders.

Dosage: 1 capsule twice daily.

3. Indian Echinacea Capsules

Indian Echineace capsules are prepared by 500 mg standardized extract of Kalmegh (Andrographis paniculata). This herb has a bitter taste and is known as the king of bitter in ayurveda texts. According to ayurveda, this is Yakrit Utejak, Pittasark and Rechak which means these capsules by Planet Ayurveda support healthy hepatoprotective activity and sustain good liver health.

Dosage: 1 capsule twice daily.

4. Phyllanthus Niruri Capsules

Phyllanthus niruri capsules by Planet Ayurveda contain 500 mg of pure extract of phyllanthus niruri or Bhumiamla. This herb has cold potency, bitter and sweet in taste. This herb has anti viral, antihelminthic and laxative properties. It balances out aggravated Vata and pitta dosha and hence manages thirst, cough and cold. This formulation is known to remove all the mala (waste) from the body and is known to retain health while reversing the liver disorders.

Dosage: 1 capsule twice daily.

Conclusion

Liver is the most important detox organ of the body. It is very important for the liver to function properly to be able to maintain overall body health. As discussed, liver disorders can be treated with ursodiol but considering the side effects of ursodiol in the longer run, it is better to opt for natural detox herbs to assist the liver. Ayurveda herbs mentioned along with fat restriction can help with liver protection with negligible side effects.

How IV Drug Therapy Helps In Weight Loss And How Ayurveda Can Help You Maintain It?

Abstract

How many people do you find wanting to lose weight? Every second person today is looking for weight loss. However, the journey is not as easy as it sounds. There is no magic pill that makes you lose weight overnight but what we have is a variety of treatments coming up these days that help you fasten the process of weight loss. One of them, which is a rage these days, is IV Drug therapy.

How Does IV Drug Therapy Work?

IV drug therapy is based on the concept that your body needs an adequate quantity of vitamins and minerals to be able to have good metabolism which in turn is responsible for weight loss. Secondly, it helps with the process of hydration and can be customised according to your body’s needs. IV therapy is something that will help you start with the process of weight loss but the tricky part is to maintain it. That is where Ayurveda comes in! Holistic approach of Ayurveda not only helps you initiate the process but also helps you maintain it in the long term.

Ayurveda's Role In Weight Loss!

Ayurvedic View On Obesity

Obesity or as Ayurveda likes to call it, ‘Sthoulya’ is a problem that is caused at the root level of Dhatus (tissues). Ayurveda mentions seven Dhatus (tissues) namely

• Rasa Dhatu: Plasma/lymph fluid
• Rakta Dhatu: Blood
• Mamsa Dhatu: Muscles
• Meda Dhatu: Fat
• Asthi Dhatu: Bone
• Majja Dhatu: Bone marrow
• Shukra Dhatu: Reproductive fluid

One tissue promotes the growth of the next one and in obesity the production and further transition of Meda Dhatu gets hampered. This disruption in the process leads to the imbalance of Doshas and eventually causes impaired agni or as we call it as disturbed digestive fire in Ayurveda.

• If Agni is vitiated with Vata, it leads to Vishmaagni (Irregular Digestive fire)- This results in irregular eating patterns.
• If Agni is vitiated with Pitta Dosha, it leads to Tikshaagni (Increased Digestive fire)- This results in increased eating habits.
• If Agni is vitiated with Kapha Dosha, it leads to Mandagni (Slow Digestive fire)- This results in decreased eating habits.

Whatever the vitiation is it affects your digestion, leads to disruption in metabolism and eventually makes you gain kilos.

Ayurveda Treatment

Weight loss is a comprehensive process. There is no use of jumping to extreme fad diets. Low carb, low fat, keto etc are diets very common these days yet serve no purpose In the longer run. The correct balance of diet correction, lifestyle correction and Ayurveda herbs can lead to a healthy and consistent weight loss.

Aahar And Vihar (Diet And Lifestyle As Per Ayurveda)

Diet As Per Ayurveda

• Start your day with 500 ml of lukewarm water preferably in Brahmamuhurta.
• Ayurveda’s golden rule of eating: Eat ONLY when you are hungry. Eat enough to make you hungry at your next meal time.
• Go for light breakfasts and dinner but heavy lunches. Your digestion is in sync with
• the sun, so around noon when the sun is at its peak, so is the digestion. This helps you restore the normal metabolism.
• Include barley in your diet in any form. A chapatti, a juice or a decoction, barley or
• Yava in Ayurveda helps you lose weight and restore all the metabolic processes of the body.
• Buttermilk is your nectar. A glass of buttermilk post lunch will help you fasten your
• metabolism and thus overall digestion. Curd is heavy and hot in potency. According to Ayurveda, replacing it with buttermilk which is easy to digest and Cold potency helps in overall management of weight loss.

Lifestyle As Per Ayurveda

• Nidra (Sleep) is considered as one of the three pillars of life according to Ayurveda.
• Make sure to get enough sleep to give your body enough energy to restore the lost metabolism and thus achieve a healthy weight.
• 30 minutes of brisk walking at least five times a week is a must.
• Shatpav Vali- Walking 100 steps after every meal.
• Manage Stress- Stress does a lot more to your body than you think.
• Maintain a routine- Everything in this universe follows a routine: Sun, moon, animals or plants. Make a routine and get in sync with nature and see the magic unfold.

Herbs As Per Ayurveda

Ayurveda mentions a variety of herbs that help in weight loss. Herbs like Cyperus Rotundus (Mustak), Myrobalans (Triphala), Plumbago Zeylanica (Chitrak),Picrorhiza kurroa (Katuki) etc helps in burning excess fat from the body.

• Guggul - Ayurveda says, out of all the herbs to manage obesity, Guggula has hot potency which helps in easy burning of fat and thus helps to deal with obesity. (Reference - Guggula medo annilharnam, charaka samhita 25)
• Garcinia, or kokumis a brilliant antioxidant that helps fasten the process of weight loss.

Other Ayurveda Treatments

• Dry Powder  Massage - Udavartan (Dry powder massage) is a method of various herbal powders that have qualities opposite to obesity. For example, Kolkulathadi  Churna which is dry and light helps in weight loss.
• Body Oil Massage - Sesame oil is mentioned as Karshana, something which helps you lose body fat. There is a shloka in Ayurveda that says, ‘STHULANAM KARSANAYA CH’ which means sesame oil is useful in reducing weight in obese people.

Herbal Remedies For Weight Loss By Planet Ayurveda!

Planet Ayurveda’s THINNER YOU PACK has the correct combination of all these herbs. It is made with a perfect combination of all the required herbs in appropriate quality and quantity. 100% natural, preservative free and prepared by the best of doctors, it has the perfect ingredients. Thinner You Pack has the following ingredients:

Thinner You Pack

1. Trim Support Capsules
2. Stholyantak Churna
3. Garcinia Capsules
4. Guggul Capsules

Products Description

1. Trim Support

Planet Ayurveda's Trim Support has Capsules that have herbal mix of Garcinia cambogia, Myrobalans (Triphala), Cyperus rotundus (Mustak) and Katuki (Picrorhiza kurroa). All these herbs help in balancing out the Tridosha imbalances of the body and eventually in weight loss.

Dosage: 1 capsule twice daily with warm water half an hour after meals.

2. Stholyantak Churna

It has a combination of 14 herbs that helps in maintaining weight. It mobilizes the fat and fastens the metabolism and thus helps in easy burning of the fat.

Dosage: 1 tsp, twice daily with warm water after meals. Its decoction can also be prepared by mixing 1 tsp of the powder in a glass of water and boiling it to one-fourth the quantity.

3. Guggul Capsules

As mentioned in Ayurveda,Guggulu is considered as one of the best medicines that helps lose weight.

Dosage: 1 capsule twice daily with warm water half an hour after meals.

4. Garcinia Capsules

Garcinia Capsule is a patent ayurvedic formulation prepared by Planet Ayurveda made using 500 mg standardized extract of Vrikshamla (Garcinia cambogia). Being a natural diuretic and anti oxidant, it helps in fat loss and overall fat mobilisation.It is called as Vrikshamla in Ayurveda and also balances out the Vata and Kapha Dosha.

Dosage: 2 capsules twice daily with warm water half an hour after meals.

As discussed, among the various methods that you can opt for weight loss, natural ayurveda
methods take the cake. Intake of Thinner You Pack along with the diet and lifestyle changes mentioned above will definitely help you shed those extra kilos. See you on the healthier side, folks!

Herbs Useful In Skin Disorders

Abstract

As we all know there are many types of diseases across the world which have an impact on the human brain in multiple ways. Like, if we talk through examples, a person suffering from ulcerative colitis is scared or gets stressed when he or she sees blood in their stools, a neurological patient gets stressed when he or she has symptoms which are hampering their day to day activity, a patient with chest related disorders is stressed when he or she has difficulty breathing, a skin patient is stressed when he or she has itching, burning, discharge, lack of confidence, scared about being ugly etc. as their symptoms and so on. Discussing especially about patients with skin disorders there is a continuous or constant fear of non acceptance in the society and also to be judged by various people too. The patients of all problems suffer but the fear of non acceptance is mostly in the patients who have skin conditions because they hate the look with sympathy, they hate the look with hatred and if someone doesn't care about their appearance they have a hard time believing in it. This article is on the solution for skin disease. The solution is the natural herbs and formulation prepared using these impressive herbs. So, let's start with the details about herbs and herbal formulation for skin diseases.

Introduction

Before starting with the skin diseases let's start with the anatomy and physiology of skin. Skin is the largest organ in the human body and covers an area of approximately 1.4 to 2 metres. It also constitutes the first line of defence. It is responsible for protecting the body from harmful agents such as ultraviolet light, chemical and infective organisms in the atmosphere. Skin helps in the regulation of body temperature, gathers inputs from the environment and stores water, fat along with vitamin D. It also plays an important role in the immune system protecting from diseases.

Moving forward we will discuss skin in detail along with the Ayurvedic aspect of Skin.

Layers of Skin

Skin has many specialised cells and structures. It is divided into three main layers that are as follows:

1. Epidermis: Outermost layer of the skin and protects the body from external environment. It's a kind of shield or works as a shield. The epidermis layer has five sublayers:
• Stratum Basalis: Lowermost layer of the epidermis and is closest to the dermis.
• Stratum Spinosum: This squamous layer of the skin can be around 10 layers thick. Thus making it the thickest layer in the epidermis.
• Stratum Granulosum: The third layer of epidermis gets its name from its constituents. It has granules that contain lipids which help in skin moisturization and protect your skin.
• Stratum Lucidum: This layer is prepared with dead keratinocytes which provide protection to areas that are most exposed to external damage such as palms of hand and soles of your feet.
• Stratum Corneum: The layer is the uppermost layer of epidermis and is made of corneocytes. These corneocytes are basically the mutated keratinocytes. It has around 15 layers of flattened skin cells.
2. Dermis: The dermis is located beneath the epidermis and is the thickest layer of the skin. This layer makes up like 90% of the skin thickness. The purpose of the dermis is to provide or regulate the temperature and to supply the epidermis with nutrients-saturated blood. Much of the body's water supply is stored within the dermis. This layer contains most of the skin's specialised cells and structures, including lymphatics, blood vessels, sweat glands, sebaceous glands, collagen, elastin and nerve endings. This layer has two sub-layers:
• Papillary Dermis: This layer has nerve endings that provide sensation to touch. It also has blood vessels which provide nourishment to epidermal layer.
• Reticular Dermis: Hair follicles, sebaceous glands and sweat glands are present in this layer of dermis. It's a thick layer of connective tissues.
3. Hypodermis: The dermis is attached to an underlying hypodermis or subcutaneous connective Tissue. This subcutaneous connective tissue is a layer of fat and connective tissue that houses larger blood vessels and nerves. This layer is present between dermis and the underlying tissues and the organs. This mostly consists of adipose tissue and is the storage site of most body fat. The Size of this layer depends throughout the body and from person to person it's different.
• Skin Appendages: Hair follicles, sweat glands and sebaceous glands are the main skin appendages.
• Skin Pigments: Melanin, Melanoids, Carotene, haemoglobin and oxyhaemoglobin are major pigments of skin which present through various layers of skin.

Functions of Skin

The functions of the skin are as following:

• The skin is a kind of guard for the underlying muscles, bones, ligaments and internal organs as well.
• There are generally two types of skin: hairy and glabrous skin. The hairy skin is responsible for mechanical protection along with increased sensory function, and also aids in regulating body temperature. On the other hand glabrous skin is automatic control of precision grip while lifting rougher or more slippery objects.
• The main role of skin is to provide a protective barrier against mechanical, thermal and physical injury and hazardous substances. Prevents loss of moisture. Reduces harmful effects of UV radiation.
• Skin also helps in permitting growth and movement. It's a kind of flexible layer without which the human body is not complete.

Ayurvedic Aspect of Skin

Ayurveda explains skin as twak and twak is one among the 5 gyanendriya (sense organs). The twak or skin is also considered as the updhatu of mansa dhatu, attributed with the function of sensation of touch and is the location of sweat channels that is swedoveha srotas along with hairs (loma). Acharya sushruta and bhavmishra have described seven layers of twak, while Acharya charak and Vagbhatta have described 6 layers.

Following table depicts the name of seven layers along with the thickness of each layer

Sr. No.	Name of Different Layers	Width (Thickness)
1.	Avabhasini/ Udakdhara	1/18 vridhi
2.	Lohita/ Asrugdhara	1/16 vridhi
3.	Shweta	1/12 vridhi
4.	Tamra	⅛ vridhi
5.	Vedini	⅕ vridhi
6.	Rohini	1 vridhi
7.	Mansadhara	2 vridhi

Now after all this information let's come to the most important part of this article that is the herbs which help in any type of Skin disorders. There are many herbs which are mentioned in Ayurveda especially to be used in various types of skin disorders.

Moving forward we will discuss them in Detail.

Ayurveda Herbs useful in Skin Disorders

A healthy skin is a source of pleasure, not only to the owner but also to those who look at it. The positive health of skin is like an esurance of a disease free body. A healthy skin is clear, smooth, elastic, uniformly pigmented and is without wrinkles. The best way to keep your skin healthy and disease free is through Ayurvedic herbs and formulations. Following are the most amazing herbs in AYurveda for keeping your skin healthy and also for any diseases condition related to skin:

1. Sariva/Anantamool (Botanical name: Hemidesmus indicus; Family: Dogbanes)

Sariva is known by many names but most popular synonyms of Sariva are Anantmoola & Indian sarsaparilla. The herb balances all the doshas and is best for the purification of blood. Sariva also has anti-inflammatory properties. The herb has its cleansing effect on the level of the brain and helps in better functioning of mind. Better functioning of mind means no stress hormones and no bad impact on skin. The herb is very well known to have a soothing effect on skin thus results in dryness and irritation. It also has antioxidant properties.

2. Chandan (Botanical name: Santalum album; Family: Santalaceae)

Chandan or sandalwood is quite popular globally for its impressive effects on skin. In Ayurvedic texts the herb is having a pitta pacification effect on the body thus helps in cooling down the body. The paste of chandan can be applied on the area of sunburn as well. Sandalwood is rich in antioxidants and also helps in fighting acne as well. In case of oozing blood vessels under skin, Chandan Lepa acts as an hemostatic agent. It also helps in burning sensation, itching etc. which are common symptoms of many skin related conditions.

3. Amla (Botanical name: Emblica officinalis; Family: Phyllanthaceae)

Amla is a herb that has antioxidant and anti-aging properties. Amla which is commonly known as gooseberry is quite famous for its benefits and hence gives really impressive results as well. Herb is mostly used for maintaining the health of skin along with that it can also be used in various types of skin conditions as well. It helps in skin toning as well and provides protection against blemishes or dark pigmentation. It also helps in lightening the skin complexion of the tanned area due to its cooling properties.

4. Ghritkumari/Aloe Vera (Botanical name: Aloe barbadensis miller; Family: Liliaceae)

Ghritkumari, commonly known as aloe vera is popular from ages for its beautiful effects on skin. The aloe vera is given in many skin related conditions due to its various effects. The herb is best for the purification of rakta and pacification of pitta and kapha dosha as well. This herb is known to have anti ageing properties and also is balya that helps in improving strength and immunity. The aloe vera has a very great impact in fastening the wound healing process as well. The herb has a great impact on digestion too, it helps in easy evacuation. The herb also possesses antioxidant properties.

5. Lal Chandan (Botanical name: Pterocarpus santalinus; Family: Fabaceae)

The red sandalwood, also called as lal chandan in Ayurvedic texts is really good and helps in the reduction of inflammation. The inflammation is the commonest symptom of many skin related conditions like psoriasis, eczema, dermatitis etc. Aforementioned our skin is the first organ that comes in direct contact with the external environment and thus can develop many types of infections as well like fungal infections. Bacterial infections, parasitic infections etc. But lal chandan can help in all types of infections as well, especially the parasitic ones. It is an impressive cooling agent and helps in reduction of pain as well. Lal chandan also helps with the spots and eliminates scars or acne on skin.

6. Kumkum/Kesar/Saffron (Botanical name: Crocus sativus; Family: Iridaceae)

Kumkum or saffron is known for its antioxidant properties. The herb has impressive compounds that help in the enhancement of the body's metabolism so that you feel more energetic and your skin is more glowing. Some folks say that having an ounce of saffron is equivalent to having an ounce of gold. In some areas like Kashmir saffron is used in mild quantities in many cuisines as it gives good flavours and also has health benefits. Especially for skin. The herb is known to have tridosha balancing effect and has carotenoids along with thiamine thus acting as an impressive anti ageing herb too. The paste of saffron is applied in pustules and also on wounds. It improves skin complexion if used with milk or honey.

7. Khadir (Botanical name: Acacia catechu; Family: Mimosoideae)

Kahdir is commonly known as kattha plant. In english it is known as Cutch tree. In Ayurveda the Khadir is termed as the sarva shreshta (the best) herb for skin health and skin disorders. The dried powder of khadir bark is well known for healing wounds and ulcers on skin. When it is mixed with berberis aristata and nimba, it helps in the improvement of complexion and relieves acne. In blisters, it is mixed with lal chandan and a paste is formed which can be applied over the affected parts. Khadir decoction is used in washing and healing open wounds. It is also known to be the best blood purifier and has the ability to manage challenging skin conditions in the present scenario.

8. Marigold (Botanical name: Tagetes erecta; Family: Asteraceae)

Marigold is known as Jhandu in Ayurveda. The leaves or flowers of the herb are used in various types of skin conditions. The paste of its leaves is used in the boils, carbuncles, muscle pain etc. The paste of flowers and leaves is also used in the fresh wounds and slo in controlling the bleeding. In wounds filled with pus this paste gives impressive results on application on the local site. In rough and dry skin, the paste of marigold flower along with cow's milk butter gives impressive lubrication. All these remedies are successful because the herb is having antimicrobial, antibacterial and blood coagulation properties.

9. Neem (Botanical name: Azadirachta indica; Family: Meliaceae)

Neem is a herb whose benefits is known to the entire globe and it's being ingested in the form of liquid, capsules etc. The root bark, stem bark, gum, flower, leaves, seeds and seed oil is used in various skin conditions. Mostly its stem bark is used in skin condition as it helps in easing the burning sensation. Neem is also beneficial in reducing skin wrinkles and stimulating collagen production. It has amazing healing properties thus helps in wounds and ulcerations as well. The acne, moles and scars are also very well managed by the neem herb.

10. Papaya (Botanical name: Carica Papaya; Family: Caricaceae)

Papaya is known to improve skin texture and also helps in providing radiant skin. The papaya fruit is known to enhance digestion and also helps in exfoliation of skin. Papaya is a herb that helps in fighting acne and also lightens the skin tone. The peel on the other hand is having Retin-A enzyme, that is responsible for removing dead skin cells and age spots. As it clears out bowels, it is known to be eliminating toxins from the body. The latex from the papaya peel is helpful in relieving local pain or burning after application. In case of pinworms, its dry seed powder is given with honey because it has an anti parasitic effect.

11. Haridra/Turmeric (Botanical name: Curcuma longa; Family: Zingiberaceae)

Haridra or haldi or turmeric is known from ages for its marvellous effects on the skin and we also know what are its effects on ingestion. Turmeric is a very well known healer, whether used internally or externally. Haridra is the best immunomodulatory herb and its consumption helps in fighting various types of bacterial, viral and fungal infections. The paste of turmeric is applied on various types of external wounds, scars, blisters and it is having an impressive healing effect. Haldi if taken with milk on regular intervals can help in enhancing skin complexion and also has a detoxification effect.

12. Manjishtha (Botanical name: Rubia cordifolia; Family: Rubiaceae)

Manjishtha is a famous blood detoxification herb and its roots are extensively used in many skin diseases. The English name of this herb is Indian Madder and is an ingredient of many oils and liquid decoctions used for uplifting skin ailments. Manjistha is very useful in skin cells rejuvenation and also helps in lighting the dark pigmentation in folds of the body. Manjistha is known to lower the melanin levels and helps in regulating its production. In case of heavy pus filled pop outs manjishtha gives impressive results.

With above mentioned herbs there are certain formulations which are prepared that can be given in many types of skin disorders. Such formulations are as follows:

• Panchatikta Ghrita
• Nimbadi Kwath
• Kumkumadi Oil
• Khadiradi Vati
• Khadirarishta
• Mahamanjisthadi Kwath
• Gandhak Rasayan
• Vran rakshas Oil
• Panchatikta Guggul
• Kaishore Guggul
• Neem Oil
• Manjistha Oil
• Babchi Oil
• Tapyadi Loha

Conclusion

The skin is the reflection of the body's health or body's inner status. That is the reason why people take skin health so seriously. You know taking care of your skin is the most difficult task these days and obviously it has to be done because your skin is the first thing that anybody sees when they meet you. So, one can try the above-mentioned herbs for taking care of their skin. In case of a diseased condition, opting for Ayurvedic treatment or Ayurvedic herbs is a really good choice then opting for something else that can worsen your situation with time. Ayurveda is a very deep science with a lot of secrets hidden. But such secrets are willing to be opened and revealed to the world. The aforementioned herbs and formulations can help in many situations and thus can prevent the aggravation in future. In case of any queries kindly visit www.PlanetAyurveda.com

Effect of Ayurveda Management on Liver Cirrhosis with Ascites - A Retrospective Cohort Study

Abstract

Liver cirrhosis with ascites is a challenging medical condition. Ayurveda Clinical experiences suggest of a favourable role but lacks evidence. In a Retrospective cohort study, hospital records of patients with liver cirrhosis and ascites diagnosed though medical ultrasonography, treated at in patient division, department of Kayachikitsa, Medical Research Facility of KLE Ayurveda Hospital Belagavi were screened. Records with Nityavirechana procedure, minimum of 7 days of admission, proper documentation and meeting the other inclusion and exclusion criteria were selected for the study. Assessment were abdominal girth measurements at umbilicus, Xiphisternum to umbilicus measurement, Umbilicus to pubic symphysis measurement, weight, clinical global impression (CGI) scales (Severity, improvement and efficacy index), hemoglobin, liver function tests, Prothrombin time, INR and renal function tests. Fifty five case records met the methodological criteria of the study. Patients were suffering from stage 3, decompensated cirrhosis and Child-Turcotte-Pugh Score was in class C. Analysis of 15 days of interventions was carried out. Assessments were carried out at base line, 7th, 9th, 11th and 15th day of treatment. Interventions included nitya virechana, oral medicaments, diet, salt and fluid restrictions. Ayurveda interventions resulted in significant improvement (p<0.001) at all time points in various parameters of abdominal measurements, weight, CGI scales, hemoglobin, liver function tests, prothrombin time, INR and renal function tests. Study showed complex Ayurveda interventions through nitya virechana, oral medications, diet, fluid and salt restrictions improve the clinical profile, liver function, renal function, prothrombin time, INR parameters in patients of ascites with decompensated cirrhosis and warrants further studies.

Introduction

Liver cirrhosis is the end stage of many chronic liver diseases. It has compensatory and decompensatory phases. Compensated phase lasts for several years . Decompensated cirrhosis leads to major complications including jaundice, variceal hemorrhage, ascites, or encephalopathy . Ascites is the most common presentation. 50% of compensated cirrhosis develops ascites in 10 years of time Ascites treatment requires hospitalization, can lead to life threatening complications and need liver transplantation. The development of ascites marks the onset of worsened prognosis and increased mortality. Cirrhosis within first year of diagnosis causes death in 15% and 40% will die in first 60 months . 10 yrs mortality is 34–66% . Alcohol consumption, viral hepatitis B & C, metabolic syndrome related to obesity are the most common causes of cirrhosis. Liver cirrhosis is responsible for 1,70,000 deaths yearly in Europe . Liver diseases frequency is increasing and huge increase in the liver disease burden is expected. Health care costs of liver cirrhosis in United states is between 12 and 23 billion dollars annually . Hepatic cirrhosis incidence in India could be high due to high prevalence of Hepatitis B & C, fatty liver disease and even increasing trends of alcohol intake. Cost of hepatic cirrhosis on quality of life, loss of productivity, medical expenses are high . Treatments to stop progression from compensated to decompensated stage are being tried . Liver transplantation is the only treatment in the end stage liver disease. Liver transplantation has high costs, high mortality and has paucity of organ donors.

In Ayurveda Ascites can be correlated to Jalodara. All Udara diseases (morbid abdominal disorder) ends up into Jalodara stage . Ayurveda management protocol mainly aims in improving the Jatharagni (metabolism) and stimulating the hepatic function. Jalodara management includes nitya virechana (C.Chi.13.61), teekshna (strong, penetrating) drugs, kshara (alkali), gomutra (Cow's urine), fluid restriction, milk, buttermilk, diet, oral medicaments and rasayana (rejuvenative) drugs etc (C.Chi.13). Nitya virechana is a variant of virechana procedure in which preoperative procedures like snehapana (Internal oleation therapy), swedana (sudation therapy) are not carried out. Virechana is done in lesser intensity and more frequency. However there is scarcity in evidences of Ayurveda management of liver cirrhosis with ascites. A retrospective study in which case records of a tertiary care Ayurveda teaching hospital known for successful management liver cirrhosis with ascites were reviewed. Attempt was made to analyze the hospital data, treatment algorhythms, details of virechana procedure, prescription patterns, dietary considerations, clinical outcomes and biological assessments.

Materials & Methods

1. Settings

Setting of the current study was a 300 bed tertiary care KLE Ayurveda hospital, Belagavi situated in North Karnataka, India. Hospital caters to 7.38 lakhs of urban population directly and also to patients of 10 districts of Karnataka and Maharashtra.

2. Patient cohort

All patients receiving care for liver cirrhosis with ascites were included. Cases were identified retrospectively by evaluating manually and/or computer searches of hospital and laboratory databases from 2014 to 31 October 2020. Searches were carried out on specific terms like Kamala, Udara, Jalodara, Alcoholic liver disease, Cirrhosis and Ascites. Sonologically confirmed case of liver cirrhosis with ascites and records of patients treated in patient section, department of Kayachikitsa for a minimum of 7 days were included.

Initial screening revealed 255 case records. Cases with adequate recording of abdominal measurements, interventions (with virechana), vitals monitoring, observations etc. were included. Patients with concomitant illness like diabetes mellitus, hypertension, cardiovascular disorders were excluded (n = 65). Institutional ethics committee approval was obtained for the study.

(Reference no BMK/20/BRT/01 dated 25.11.2020)

3. Clinical and demographic data

Details of Socio demographic information along with the detailed case history, treatment history, habits, systemic and abdominal examinations, investigations, treatments administered, day to day observations, vitals examination, fluid input and output charts and adequate clinical notes were noted. Assessments noted were.

1. Abdominal measurements at umbilicus, 1 inch above and below the umbilicus, Xiphi sternum to umbilicus and umbilicus to pubic symphysis.
2. Body Weight
3. Blood parameters including haemoglobin, total bilirubin, indirect bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), total protein, albumin, globulin, Albumin globulin (AG) ratio, alkaline phosphatase, prothrombin time & INR (International normalized ratio), serum creatinine and blood urea.
4. Clinical global impression scale (CGI) (Severity, improvement, efficacy index)

4. Ayurveda management details

In all patients Nitya virechan (Daily therapeutic purgation) was planned as it is the prime Ayurvedic intervention in ascites. Other oral medications used were mild purgative, diuretic, blood purifier and hepatoprotective. These includes herbo-mineral formulations, decoctions, water extracts of herbs, diet and life style management. Virechana dosage was planned to obtain avara shuddhi of (3–6 vega) and for Sroto and purisha shodhana (cleansing). On starting days (1–3 days) only purisha shuddhi and later (>4 days) samyak virechan laxanas were observed. Shodhan of purisha, pitta and kapha was noticed and vata antiki was seen. After virechan, assessment was done on the basis of symptoms like hridaya shuddhi (feeling of clearness in chest), clarity in mind, senses and intellect, laghutva (body lightness), increase in thirst and appetite. Pattern of increment was decided by number of vega produced due to virechana. Dose producing 3–6 vega (purgation) with no signs of vata vruddhi, debility, dehydrative symptoms was retained for the next day. During the course, virechan dose was increased whenever there was decrease in virechan vega less than 3. Virechan dosage was decreased if patients develops more than 6 vega, weakness, vata vruddhi. As the virechan days increased, virechan effect was decreased and to retain shodhan effect dose escalations were done. Data showed, 8 patients had abdominal pain after continuous haritaki churna intervention for 3-4 days, hence one day rest was advised and again virechan was initiated by assessing the roga bala etc. factors. Average number of nitya virechan was 10.47 in patients with 15 days of hospital stay. Oral medications were administered post lunch and dinner. [Table 4]

In Ascites diet plays an important role and diet restrictions were advised. Fluid restriction was up to 1.5 L per day. It included 500 ml milk per day, boiled rice water ad linitum, green gram soup measures 100 ml twice a day and medicinal decoctions and juices which was approximately 20–100 ml twice a day. Complete salt restricted diet was administered. Post Nitya virechana (purgation) diet was Peya (boiled rice water) during day time and at night Khichadi (Dish of rice and legumes) was prescribed in all patients. In 23.63% of patients white part of one whole egg twice a day was prescribed as per serum albumin results. Slow walking was advised not producing exertion or vata vruddhi. Patients were advised to maintain psychologically relaxed state by do deep breathing exercise, music etc.

Conventional medication (diuretics- Spironolactone and furosemide) was continued in the initial days. Tapering and discontinuation was advised based on reduction of pedal edema, abdominal girth and increased urine out put. Tapering was observed in 96.3% of patients and it was discontinued in 80% of patients.

5. Statistical methods

Statistical analysis was carried using IBM SPSS version 25 (IBM Corporation, Chicago, Illinois, United States). Descriptive data is expressed in mean, standard deviation and percentages. Pre and post assessment was done with paired sample t test. Values are reported as mean ± standard deviation. All tests were considered statistically significant at p<0.05

Results

Total records extracted during the period of 7 years 10 months were 255. Two hundred records had incomplete documentation, lack of/vague/incomplete documentation of laboratory and sonological reports at the time of admission and discharge, lack of abdominal girth measurements, inadequate documentation of intervention, inadequate documentation of observations on day to day basis etc. 55 patient's data met the inclusion criteria. Virechana was the first preferred panchakarma procedure in patients fit for shodhan procedures. Treatments were planned according to roga, rogi bala (strength of disease and patient) and special precautions were taken to prevent increase of vata and decrease of patient's strength. Hence patients did not suffer from any dehydration symptoms and had no disturbance to their daily functioning. Most of the patients had laboratory and sonological data at baseline but data at the end of treatment were limited. This could be due to satisfactry clinical improvements, leading to treatment discontinuation to avoid financial burden to patients by physicians, reluctance by patients to repeat the investigations, and even due to poorer economic conditions of the patients. In many records clinical improvements could not be substantiated with sonological and blood parameter changes and remains major lacuna in creating evidences. [Fig. 1 ]

1. Patient characteristics

Patients characteristics: mean age (47 years), mean duration of the illness (3.5 months), male (94.5 %), and females (5.4 %), mean weight (64 kilograms). Alcohol history was found in all male patients. Mean abdominal girth at 1 inch above umbilicus was 91.9 cms, at umbilicus was 91.9 cms, and mean abdominal girth below 1 inch of umbilicus was 89.9 cms. Mean measurement from Xiphi sternum to umbilicus was 22.6 cms and mean umbilicus to pubic symphysis measurement was 14.8 centimeters. Mean clinical global impression scale - severity was 5.5. Mean duration of hospital stay was 13.2 days. Number of case records with 7 days admission were 5, with 9 days stay were 9, 11 days admission was 1 and 15 days admission were 40.

All patients were sonologically diagnosed with ascites due to liver cirrhosis. Ascites fluid was mild to moderate. Alcoholic liver disease (ALD) was in 94% and Non ALD was in 5.4%. Mean alcohol history in patients were 8 years. Hospital records did not show patients with any serious complications such as hepatic encephalopathy, gastro intestinal bleeding, hepato renal syndrome etc. at the time of admission and even during the course of intervention. Other baseline characterestics were mean systolic blood pressure (129 mm of Hg), mean diastolic blood pressure (78 mm of Hg), and mean pulse rate (76 beats per minute) were in normative limits.

In blood variables at baseline (n = 55) mean hemoglobin was 9.77 gm %. Mean erythrocyte sedimentation rate (ESR) was 59.41 mm in 1st hour, mean total bilirubin was 5.29 mg/dl, mean direct bilirubin 2.28 mg/dl and mean indirect bilirubin was 3.0 mg/dl mean AST was 89.76 and mean ALT was 45.61 mg/dl. Mean total protein was 6.19 mg/dl, mean serum albumin was 2.57 mg/dl, mean globulin was 3.49 mg/dl and mean A/G ratio was 0.75. Mean alkaline phosphatase was 139.08 IU/L, mean serum sodium levels were 142.2 mEq/L, mean serum potassium was 3.52 mmol/L. Mean serum creatinine levels were 1.48 mg/dl while mean blood urea was 40.43 mg/dl. On evaluation of PT INR at baseline average prothrombine time was 14.80 s while its control was 13.72 s. Mean INR levels was 1.25. These baseline parameters are indicators of hepatic insufficiency (jaundice), portal hypertension (Ascites), deranged renal functions and are diagnostic of decompensated liver cirrhosis [Table 1]

2. Results-Effect of interventions

1. Abdominal girth Gradual reductions in different mean abdominal girths were observed at different time points. Abdominal girth above 1 inch of umbilicus is decreased as follows 7th day 2.2 cms, 9th day 2.82 cms, 11th day 5.44 cms and by 15th day it was reduced up to 6.5 cms from the baseline. Abdominal girth at umbilicus showed reductions as follows 7th day 2.56 cms, 9th day 3.37 cms, 11th day 4.74 cms and on 15th day it was reduced by 6.06 cms from baseline. Abdominal girth below 1 inch of umbilicus decrease at 7th day by 2.17 cms, 9th day 3.02 cms, 11th day 3.98 cms and by 15th day it was dropped by 5.46 cms. Abdominal Girth from Xiphi sternum to umbilicus decreased on 7th day by 2.07 cms, 9th day 2.43 cms, 11th day 3.06 cms and on 15th day it was 4.00 cms. From Umbilicus to Pubic Symphysis decline of 0.99 cms on 7th day, 1.15 cms on 9th day, 1.34 cms on 11th day and 1.69 cms decline is seen on 15th day from baseline (Table 2, Section A) (Fig. 2, Fig. 3).
2. Blood pressure and pulse Interventions produced significant changes in Systolic blood pressure but not on diastolic blood pressure and pulse. Systolic blood pressure showed significant change at 7th, 9th and 15th day. There was a significant decrease compare to base line but were in the normative ranges (Table 2, Section A)
3. Body weight There was gradual decrease observed in body weight. From baseline it reduced by 1.7 kg on 7th day, 2.1 kg on 9th day, 2.7 kg on 11th day and by 15th day it was reduced by 4.9 kg (Table 2, Section A) (Fig. 3)
4. Blood parameters Ayurveda intervention produced significant increase in heamoglobin levels. Significant reduction in elevated liver function tests including total bilirubin, indirect bilirubin, AST, ALT, total protein, albumin, globulin, alkaline phosphatase, prothrombin time and INR values were observed. Interventions produced normalcy in few parameters like total protein, globulin and alkaline phosphatase. Renal functions including serum creatinine (p = 0.04) and blood urea (p = 0.03) levels showed significant decrease as a result of interventions. However they were still in the pathological range (Table 3, Section A)
5. Clinical Global impression scale At baseline mean CGI severity of illness scale was 5.56 which was reduced on 7th day by 1.56, 9th day by 2.08, 11th day by 2.53 and by 15th day it decreased by 2.56 compared to baseline. CGI- Global improvement scale showed that mean improvement was 3 on 7th day, on 9th day it was improved by 0.29, on 11th day 0.70 and on 15th day mean improvement was by 0.94. CGI-Efficacy index scale showed, mean score was 5.51 on 7th day which improved by 1.06 on 9th day, 3.34 on 11th day and improvement by 2.82 was seen on 15th day (Table 2, Section A) ( Fig. 4)
6. Effect of Nitya virechana, Guduchyadi yoga, diet and life style on parameters Intervention (n = 32) showed improvement simlar to cumulative assessments (n = 55). Significant reductions in abdominal measurements such as at umbilicus, and 1 inch above and below the umbilicus. Xiphi sternum to umbilicus and umbilicus to pubic symphysis measurments, body weight, systolic and diastolic blood pressures, pulse and Clinical global impression scale (CGI) (Severity, improvement, efficacy index) (Table 2, Section B). Blood variables (n = 10) assessment indicated that intervention produced significant increase in hemoglobin levels, Significant decrease in elevated liver function tests like total bilirubin, indirect bilirubin, AST, ALT, total protein, albumin, globulin, Alkaline phosphatase, prothrombin time and INR values were observed. Interventions produced normalcy in few parameters like Globulin and Alkaline phosphatase. Renal functions like serum creatinine and blood urea levels showed trends of decrease but were non significant and were in the pathological range. Improvements in most of the parameters were similar to the cumulative sample (Table 2, Section B and Table 3, Section B)

Discussion

The present study has shown that complex intervention with Nitya Virechana, oral medicaments, diet, fluid and salt restriction proved to be efficacious in the management of decompensated cirrhosis with ascites. It has shown reduction in abdominal girth measurements, body weight, clinical global impression scales of severity, improvement and efficacy index. Improvement was also observed in blood variables, liver function tests, prothrombin time, INR values and renal function tests.

All the patients were sonologically diagnosed case of liver cirrhosis with mild to moderate ascites. Patients had stage 3, decompensated cirrhosis and Child-Turcotte-Pugh Score (CTP) score (calculated through serum bilirubin, serum albumin, prothrombin time, severity of ascites, and grade of encephalopathy) was 10 and was in class C. In Class C, 1 year survival is observed in 45% and 2 year survival is observed in 38% cases. Majority (94%) were due to chronic Alcoholic liver disease. Patients were suffering from these symptoms since 3.5 months. More number of patients were between 45 and 50 years of age. All male patients (94.54%) had chronic alcoholic liver disease. Mean alcohol consumption history was 7.76 years.

Administration of Nitya Virechan (daily mild purgatives) with either haritaki churna (fine powder of terminalia chebula retz.), Trivruta leha (compound formulation of operculina turpethum Linn), Goarka (distilled product of cow's urine) or milk can lead to fluid loss. These drugs works as osmotic and stool wetting agents. It increases water content in gut by changing the fluid dynamics of mucosal cells. These drugs may change the fluid dynamics leadings to impairment in water and electrolytes absorption of villous cells inhibiting Na+, K + ATPase , resulting into draining of peritoneal fluid into gut through process of osmosis . Virechan drugs are ushna (hot), tikshna (piercing quality), sukshma (reach up to minute part), vyavayi (spreads all over body), vikashi (flowing capacity) sara (flowing), anu (reaching to cellular level) & vicchina (scrapping and excising) and dosha sannghatahara (dismentaling compactness of dosha) in nature (C.S.K.1.5). By this qualities, virechan drugs may have moved the peritoneal fluid to the intestines and then evacuation through rectal route. Haritaki (Terminalia chebula retz.) contains anthraquinones which is mild and gentle laxative in nature. Anthraquinones metabolize the active aglycones which by impairing epithelial cells, deploys its lenitive action leading to the modification in intestinal absorption, secretion and motility . Trivruta (operculina turpethum Linn) contains Resin glycosides which has aperient property of the purified resin glycoside fraction. It attributes to NF-κB activation in the colon resulting in increment of COX-2-mediated secretion of PGE2 which further decreases AQP3 expression leading to purgative action by absorbing water from intestine to the blood vessel . Cow's Milk has various qualities including guru (heavy), sara (spreading and flowing), prithvi, jala mahabhuta dominanance, mild laxative, rasayana (reguvinative), jeevana (nutritive), balya (strength promoting). Goarka has purgative action because of its ushna (hot), tikshna (penetrating), sara (spreading and flowing) and bhedana (piercing) properties. Frequently used oral formulation was G. yoga and Guduchyadi kwatha. These formulations were derived from the clinical experiences of the departmental faculty. Other oral formulations were also used. These formulations and their ingredients can potentiate the rasayana effect on liver, kidney and nootropic, hepatotropic action, rakta pittahara (bleeding and clotting indices), anti anaemic, correcting hypoproteinaemia and diuretic effects. These drugs are tikta (bitter) in rasa, laghu (light), dravashoshaka (dring up fluid content), kapha hara, rasayana (rejuvenation quality) in nature. Various studies have reported Punarnava (Boerhavia diffusa Linn.) to be effective in improving the urine formation, hepatoprotective and anti-inflammatory in both in vivo and in vitro studies ,.. Nimba (Azadirachta indica A. Juss.) leaf extract has hepatoprotective effect as it contains phytochemicals such as Azadirachtin, Nimbidin, Nimbin, Nimbinin. Guduchi (Tinospora cordifolia Miers.) has anti-inflammatory, immunomodulatory, hepatoprotective, antioxidant and antidiabetic effects. Bhringaraj (Eclipta alba Hassk.) has shown hepato-protective effect. Bhumyamalaki (P. niruri Linn) in animal model has shown to decrease hepatomegaly, visceral fat weight, serum total cholesterol, low-density lipoprotein, free fatty acids (FFAs), Alanine aminotransferases, aspartate aminotransferases, insulin concentration, homeostatic model assessment of insulin resistance (HOMA-IR), hepatic content of cholesterol, triglyceride, malondialdehyde, prevented fibrosis, and has anti NAFLD effect. Fluid and salt restriction is recommended in Ascites as it is a condition of increase of Apa mahabhuta, kleda and mala. Dietary items such as milk has balya, jeevaniya, rasayana, and is indicated in kshina (debilitated individuals). Green gram soup and egg white also have balya and jeevaniya effect. Through these actions improvement in hemoglobin, total proteins and globulins could have been produced.

Comprehensive clinical assessment was through clinical global impression Scale. This intervention shown significant (p-0.001) improvements in severity of illness, global improvement and efficacy index. This may happened due to clinical improvement in the manifestations of liver cirrhosis with ascites, decrease in the abdominal fluid, effect of drugs like immunomodulatory, anti-inflammatory, hepatoprotective, anti-anemic, diuretic, rasayana effects. Improvement in clinical manifestations can help in improving the quality of life and decrease the risk of complications like spontaneous bacterial peritonitis (SBP).

Similarly a prospective study with a complex polyherbal regimen inclusive of purgation with P. kurroa, piper longum Linn administration, punaranvadi kwath, compound powder, diet and life style modifications for 24 weeks showed improvement in liver child-pugh grade scores and clinical manifestations of liver cirrhosis with ascites. A case report of sonologically diagnosed ascites with nitya virechan (therapeutic purgation daily) intervention with Abhayadi modaka, cow's urine Sharapunkha Swarasa, Punarnava Kwatha, Arogya vardhini and restricted diet for 3 months showed improvement in ascites, decrease in abdominal girth and clinical improvements. Another case report of liver cirrhosis with ascites with intervention in the form of nitya virechana (hingu triguna taila with milk for 10 days), punaranvadi Kashaya, panchakola churna, gomutra haritaki, diet, vardhamana pippali regimen for 60 days showed decrease in ascites and no recurrence of ascites after 1 year of observation. The present study shows the evidences for use of different virechana, anupana, oral medications and diet in decompensated cirrhosis.

Study has many merits. Treatment regimen being practiced in the clinical scenario were analyzed and hence has a strong external validity. Thorough evaluation of Ayurveda physicians' thought process, Ayurvedic assessment of the patient, critically analyzing the treatment algorhythm, whole system approach, integrating Ayurveda treatment modalities (virechana, oral medication and diet). Assessments with abdominal measurements, weight, clinical global impression scales, liver function tests, renal function tests, prothrombin time and INR values are the notable components of the study. Study has several limitations including retrospective cohort study. Lack of histopathological assessments through liver biopsy is a lacuna and these would have given better biological action of interventions. Limited study duration (15 days) is relatively shorter period for this disease condition.

Conclusion

Complex Ayurvedic treatment regimen consisting of Nitya virechana, Ayurveda medicaments, diet, salt and fluid restrictions have shown beneficial effect in the management of decompensated stage of liver cirrhosis with ascites. Study gives leads in the Ayurvedic patient assessments, treatment principles, treatment algorhythms, customization, medications and diets in liver cirrhosis with ascites. Proper documentation of all the observations, correlating the clinical changes with the appropriate biological investigations, maintaining the long term follow up records, recording the ayurveda interpretations etc needs to be strongly advocated to the Ayurvedic clinicians.

Conflict of Interest

None

Source of Funding

Nil

Author Contributions

B R Tubaki: Conceptualization, Methodology, Writing - Original draft preparation, Writing- Reviewing and Editing, Statistical analysis. Saish Gawas: Supervision, Data curation, Writing - Reviewing and Editing. Himani Negi: Supervision, Visualization, Data collection, Writing - Reviewing and Editing.

Acknowledgement

We acknowledge the contribution of staff of Kayachikitsa department past and present in admitting and successfully managing the patients of liver cirrhosis with ascites from whom the data was collected. Contributing staff were Dr Sameer Naik, Dr Sukumar Nandigoudar, Dr Kiran Mutnalli, Dr V G Huddar and Dr B R Tubaki. We acknowledge the support and guidance of Dr B S Prasad, Ex Principal Shri BMK Ayurveda Mahavidyalaya Belagavi.

Footnotes

Peer review under responsibility of Transdisciplinary University, Bangalore.

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1. Garcia-Tsao G., Lim J.K., Members of Veterans Affairs Hepatitis C Resource Center Program Management and treatment of patients with cirrhosis and portal hypertension: recommendations from the department of veterans affairs hepatitis C resource center program and the national hepatitis C program. Am J Gastroenterol. 2009 Jul;104(7):1802–1829. doi: 10.1038/ajg.2009.191. Epub 2009 May 19. Erratum in: Am J Gastroenterol. 2009 Jul;104(7):1894. Lim, Joseph [corrected to Lim, Joseph K]. PMID: 19455106.

2. D'Amico G., Garcia-Tsao G., Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006 Jan;44(1):217–231. doi: 10.1016/j.jhep.2005.10.013. Epub 2005 Nov 9. PMID: 16298014.

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ARTICLE SOURCE

Effect of Ayurveda Management on Liver Cirrhosis with Ascites - A Retrospective Cohort Study