|Year : 2020 | Volume
| Issue : 1 | Page : 27-30
Role of traditional system of medicine to reduce the partial mayo score in ulcerative colitis – A case report
Devipriya Soman1, K Pravith Natesan2
1 Assistant Professor, Department of Kayachikitsa, School of Ayurveda, Amrita University, Amritapuri, Kollam, Kerala, India
2 Associate Professor, Department of Kayachikitsa, Government Ayurveda College, Thiruvananthapuram, Kerala, India
|Date of Submission||13-Feb-2021|
|Date of Decision||18-Feb-2021|
|Date of Acceptance||23-Feb-2021|
|Date of Web Publication||09-Jul-2021|
Dr. Devipriya Soman
Amritakipa, F-4/59, C H Housing Colony, Chevarambalam (PO), Calicut - 673 017, Kerala
Source of Support: None, Conflict of Interest: None
Ulcerative colitis (UC) is a disease affecting the colon. Even with various conventional therapeutic interventions, cure rate of this disease is very less. Ayurvedic interventions have been very useful in reducing the symptomatology of this disease. This is a case report of UC, managed following Ayurvedic principles, which focused on the reduction of symptoms and also improve the quality of life of the patient. The patient presented with an increased frequency of stools mixed with blood, mucous, and pus and occasionally pus mixed mucous discharge per rectum for the past 8 months. Colonoscopy reported segmental colitis and histopathology study of colonic mucosa was compatible with the active phase of UC. Based on symptomatology and pathogenesis, the patient was diagnosed with suffering from Pittadhika Sannipata Atisara on Ayurvedic grounds. Pitta Vatasamana, Grahi, Raktha sthambhana, and Vranaropana were the principles of treatment employed. The assessment was done using the Partial Mayo score before and after 45 days of management. The Partial Mayo score reduced from eight to one after 45 days of intervention. The outcome was promising with good subjective relief and patient satisfaction.
Keywords: Pichavasthi, Pittapradhana Sannipata Atisara, ulcerative colitis
|How to cite this article:|
Soman D, Natesan K P. Role of traditional system of medicine to reduce the partial mayo score in ulcerative colitis – A case report. AYUHOM 2020;7:27-30
|How to cite this URL:|
Soman D, Natesan K P. Role of traditional system of medicine to reduce the partial mayo score in ulcerative colitis – A case report. AYUHOM [serial online] 2020 [cited 2021 Oct 26];7:27-30. Available from: http://www.ayuhom.com/text.asp?2020/7/1/27/320925
| Introduction|| |
Ulcerative colitis (UC) is one among the two major clinically defined forms of inflammatory bowel disease (IBD). It is a chronic, remittent, and progressive inflammatory condition that affects colonic mucosa. A multi-center prospective survey study of IBD in Kerala in 2017, involving 2000 patients reported 1112 cases of UC. Looseness of bowel with mucous and blood, abdominal pain, weight loss, and fever are the clinical presentations. This disease is associated with an increased risk for colon cancer. Most pharmaceutical compounds commonly used to treat IBD have side effects such as headache, diarrhea, and nausea. These side effects prompt the patient to opt out the usage of drugs thereby resulting in reduced drug compliance. Abstaining from regular medication results in worsening of the condition. Quality of life too is impaired, due to the chronic association of UC. Thus, there is a need to search a satisfactory mode of management for this clinical condition in other medical systems. This is an endeavor to bring out a diagnosed case of UC which was successfully managed with Pittadhika Sannipata Atisara (Pitta predominant Sannipata diarrhea) line of management at Government Ayurveda College, Thiruvananthapuram in November 2014.
| Presenting Complaints|| |
A 52-year-old male, Indian, married, nonalcoholic, nonsmoking, consulted in Kayachikitsa Out Patient Department (OPD), Government Ayurveda college, Thiruvananthapuram, India, on November 19, 2014, with increased frequency of stools mixed with blood, mucous and pus, and occasionally pus mixed mucous alone for 8 months. There was no relation of symptoms with food intake. There was no undigested food matter with the feces. Fasting did not bring relief to the symptoms. Stress did not aggravate the symptoms. No history of recent travel, abdominal surgery, or continuous usage of any drugs was noted. The case was subsequently admitted in the In Patient Department (IPD) Government Ayurveda College, Thiruvananthapuram, India, for inpatient interventions. There was no history of any bowel diseases or malignancies in the family. The patient was on conventional therapies to which he did not respond. Hence, the subject quit the medications and consulted OPD Government Ayurveda College, Thiruvananthapuram [Table 1].
The subject was moderately built and nourished, alert and responsive with P0I0C0C0 L0E0 (no pallor, icterus, clubbing, cyanosis, lymphadenopathy, and edema). The body weight was 75 kg, height 165 cm, and body mass index of 27.54 kg/m2. Head to toe examination revealed reddish bulbar conjunctiva, cracks in the angle of the mouth, Aphthous ulcer in the oral mucosa, and fissures over the tongue. Clinical examination of cardiovascular, respiratory, and other systems revealed no abnormalities. Per-abdominal examination showed a scar on the right lumbar region. On palpation, there was Grade I tenderness over the left lumbar region. The percussion notes were resonant in all the quadrants and bowel sounds were heard on auscultation. In proctoscopy examination hyperemic rectal mucosa, multiple patchy erosions of mucous membrane of anal canal, second degree pile mass at 3, 7, and 11o'clock positions and multiple bleeding points were visible. Baseline hematological examination revealed leukocytosis (white blood cell 19,460 cell/cmm) and lymphocytosis (76%). Stool microscopy confirmed the absence of ova, cyst, amoeba and presence of 40–50/hpf pus cells, and plenty/hpf red blood cells (RBCs). Colonoscopy reported segmental colitis and histopathology study of colonic mucosa was compatible with active phase of UC. Copenhagen criteria for UC diagnosed him as UC.
The patient was found to have normal appetite and disturbed sleep (wakes up in between for bowel evacuation). The Prakruti (physical constitution) was Vatapitta, with Madhyama Sara (excellence of tissue elements), Pravara Satwa (psychic condition), Madhyama Pramana (measurements of body constituents) and Samhanana (compactness of tissues), Rooksha Satmya (homologation to dryness), Madhyama Abhyavaharana Sakthi (medium power of intake of food), Uttama Jaranasakthi (power of digestion of food) and Madhyama Vyayamasakthi (medium power of performing exercise). There was evident Apana VataVaigunya (impairment of one of the five subtypes of Vĭta (Vĭyu), situated in the pelvic region) and Pitta Kopa (provocative stage of Doṣa responsible for regulating body temperature and metabolic activities). Raktha dhatu (blood tissue) and Pureesha mala (feces) were vitiated. This clinical condition was diagnosed as Pittaadhika Sannipata Atisara based on the presenting symptomatology. [6,7]
Therapeutic focus and assessment
The management of this case aimed at reducing the symptoms and prevents its relapse. The principles adopted were Vatapittasamana (relieves Vata and Pitta) at the asaya (receptacle), Grahi (absorptive), Raktastambhanam (check the flow of blood), and Vranaropanam (facilitating wound healing) [Table 2] and [Table 3].
|Table 3: Partial mayo score observed in the patient during the course of management|
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No concomitant allopathic medication was given during this whole treatment period. The partial mayo score reduced from eight to one after 45 days of treatment.
Follow up and outcome
The patient was re-examined after 3 months. There was no reddishness of the conjunctiva, the cracks and ulcers of the oral cavity were absent. There was no tenderness on any quadrants of the abdomen. Proctoscopy revealed no signs of inflammation. There were no bleeding points. Complete blood count was within normal limits. Stool examination showed the absence of pus and RBC. The patient was nonsymptomatic.
| Discussion|| |
The patient presented with the increased frequency of stools mixed with blood, mucous and pus and discharge of pus mixed mucous per rectum. It could be considered as Muhur Muhur Pureesha Saranam (increased frequency of stools), Saraktam Atisaram (stools mixed with blood), Puyamisra Saranam (pus mixed mucous), PutiGandham (foul smell), Asyapakam (Aphthous ulcer), and Guda Pakam (patchy erosions of anal mucosa). These all symptoms points to Atisara with a Pitta dominance. Koshta Toda (pricking pain), Malagraha (constipation), Amlaudiranam (sour belchings), and Hruddaha (heart burn) were the prodromes. These points to involvement of three doshas, Raktavaha and Pureeshavaha Srotas, Atipravrutti (increase or over flow of the contents in the body channels) as the Dushti Prakara (type of vitiation), Abhyanthara Rogamarga (site of pathogenesis), Pureeshasayam (Pakwasaya) as Udbhavasthanam (site of origin of disease) and Pureeshavaha srotas as Vyaktisthana (site of manifestation). Nidanasevana produced a Tridosha Dushti (Pitta Vata Pradhana) at Pureeshasaya (Pakwasaya). This resulted in improper soshana of Pureesha at Pakwasaya and paka of asaya. This increased Dravamsayukta Pooya-Sonita-Mala Saranam through Guda. This clinical presentation can be diagnosed as Pittapradhana Sannipata Atisara.
Increased frequency of stool indicates a Vata Kopa Avastha. Stool mixed with mucous, pus and blood point to Saama Mala with Pitta predominance. Drakshady Kashaya being Pittavata Samaka reduced the frequency of the stools per rectum. Kutajavaleha is Grahi and aid in bulk-forming, thereby retaining the quality of the stool formed. Vilwadi Gutika with its Pachana Deepana property reduced the Samatwa and helped in reduction of pus. Dadima and Kutajatwak Pana help in Agni Deepthi and enhance the Grahi property of KutajaAvaleha. Guduchyadi Kabala enhances the taste sensation.
Once the frequency of stool was reduced, Guduchyadi Kashaya administered, with its Pittakaphahara nature, helped in improving the quality of the stool formed. After Pitta Kapha Samana, to improve the Pureeshavaha srotas (Lower GI), Matravasthi with Vranaropana Snehas were administered. Pichavasthi also reduced the bleeding and mucous discharge.
Hence, the treatment principles adopted were Pitta Vata Samana, Grahi, Raktasthambhana, and Vranaropana. Drakshadikashaya is Vatapitta-samana and thus helps in alleviating both Pitta and Vata in its Asaya. Both Kutajavaleha and Vilwady gutika are Grahi in nature. Guduchyadi kashaya is VranaRopana. It helps in healing of ulceration in the intestine and oral cavity. The pana prepared out of Dadima Twak and Kutaja Twak was Rakthasthambhaka in nature. Dadimashtaka Choorna is both Grahi and Rakthasthambhaka. Murivenna and Jatyadi Ghritam used in Matravasthi are Vata Pitta Samana and Vranaropana, respectively.
| Conclusion|| |
The clinical presentation of Ulcerative colitis could be considered as Pittadhika Sannipata Atisara. Agni Deepana (increase in power of Agni) and Vrana Ropana should be the principles of management. The drugs chosen should be Grahi rather than Sthambhana in its action. Rakthasthambhana should be given prime importance in the management. The adjuvant use of Pathya Ahara (wholesome diet) and Pana gave an added benefit to the patient.
The patient was satisfied with the improvement in his clinical condition. The frequency of bowel reduced to one, the consistency of bowel improved, and bleeding and pus discharge ceased with our management. He was able to sleep well, take tastier dishes and he hopes recovery from Ayurvedic management.
Written permission for publication of this case study had been obtained from the patient.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support or sponsorship
Conflicts of Interest
There no conflicts of interest.
| References|| |
Philip M, Augustine P, Thomas V, Ramesh GN, Vinayakumar KR, Ramachandran TM, et al. Multi-center prospective survey of inflammatory bowel diseases in Kerala: More than 2000 cases. Indian J Gastroenterol 2017;36:459-67.
Kaser A, Zeissig S, Blumberg RS. Inflammatory bowel disease. Annu Rev Immunol 2010;28:573-621.
Casellas F, López-Vivancos J, Badia X, Vilaseca J, Malagelada JR. Influence of inflammatory bowel disease on different dimensions of quality of life. Eur J Gastroenterol Hepatol 2001;13:567-72.
Langholz E. Ulcerative colitis. An epidemiological study based on a regional inception cohort, with special reference to disease course and prognosis. Dan Med Bull 1999;46:400-15.
Fakhoury M, Negrulj R, Mooranian A, Al-Salami H. Inflammatory bowel disease: Clinical aspects and treatments. J Inflamm Res 2014;7:113-20.
Vagbhata, Astanga Hridaya, with Ayurveda Rasayana and Sarvangasundara Commentary of Hemadri and Arunadatta, Edited by Bhisagacharyaharishastri. Varanasi: Published by Chaukhambha Orientalia Nidanasthana 8/8; 1939. p. 496.
Vagbhata, Astanga Hridaya, with Ayurveda Rasayana and Sarvangasundara Commentary of Hemadri and Arunadatta, Edited by Bhisagacharyaharishastri. Varanasi:Published by Chaukhambha Orientalia Nidanasthana 8/11; 1939. p. 496.
Vagbhata, Astanga Hridaya, with Ayurveda Rasayana and Sarvangasundara Commentary of Hemadri and Arunadatta, Edited by Bhisagacharyaharishastri. Varanasi:Published by Chaukhambha Orientalia Chikitsasthana 1/55-58; 1939. p. 554.
Vagbhata, Astanga Hridaya, with Ayurveda Rasayana and Sarvangasundara Commentary of Hemadri and Arunadatta, Edited by Bhisagacharyaharishastri. Varanasi:Published by Chaukhambha Orientalia chikitsasthana 9/8; 1939. p. 656.
Vagbhata, Astanga Hridaya, with Ayurveda Rasayana and Sarvangasundara Commentary of Hemadri and Arunadatta, Edited by Bhisagacharyaharishastri. Varanasi:Published by Chaukhambha Orientalia Uttarasthana 36/84-85; 1939. p. 913.
Vagbhata, Astanga Hridaya, with Ayurveda Rasayana and Sarvangasundara Commentary of Hemadri and Arunadatta, Edited by Bhisagacharyaharishastri. Varanasi:Published by Chaukhambha Orientalia Sutrasthana 15/16; 1939. p. 235.
Vagbhata, Astanga Hridaya, with Ayurveda Rasayana and Sarvangasundara Commentary of Hemadri and Arunadatta, Edited by Bhisagacharyaharishastri. Varanasi:Published by Chaukhambha Orientalia Chikitsasthana 9/113-115; 1939. p. 664.
Agnivesha, Charaka Samhita, with Ayurveda Deepika Commentary of Chakrapaanidatta Revised by Charaka and Dridabala, Edited by Vaidya Yadhavji Trikamji Acharya. Varanasi:Published by Chaukhambhakrishnadas Academy, Chikitsasthana 19/50; 1850. p. 551.
[Table 1], [Table 2], [Table 3]