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Table of Contents
CASE REPORT
Year : 2019  |  Volume : 7  |  Issue : 3  |  Page : 185-188

Management of jalodar (ascites) through treatment principles of ayurveda: A case report


Department of Kayachikitsa, Mahatma Gandhi Ayurved College, Hospital and Research Centre, Salod (H), Wardha, Maharashtra, India

Date of Submission26-Nov-2019
Date of Decision13-Dec-2019
Date of Acceptance19-Dec-2019
Date of Web Publication12-Feb-2020

Correspondence Address:
Dr. Mukul P Singh
Department of Kayachikitsa, MGAC, Salod(H), Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISM.JISM_53_19

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  Abstract 

Introduction: Ascites is an abnormal accumulation of fluid in peritoneal cavity. It has numerous etiological factors, but the most common cause is cirrhosis of liver. It can be correlated with Jalodar, which is one of the types of Udarroga (disease of abdomen). It is described in Charaka, Sushruta, and Ashtanghridaya. Case Report: This is a case of ascites having fullness of abdomen, bilateral pedal edema, loss of appetite, and generalized weakness. The patient was chronic alcoholic and had no history of hypertension or diabetes. He was treated on the basis of treatment principles of Jalodar described in Charaksamhita, such as Nityavirechan daily purgation by using Ayurveda medicines, Strotoshodhan (cleaning of microchannels), and some hepatoprotective medicines. Observation and Result: Patient had complete relief from all complaints such as pedal edema, abdominal distension, and lack of appetite. Conclusion: The positive results of this study motivate to conduct further studies to establish treatment protocol of ascites.

Keywords: Ascites, hepatoprotective, Jalodar, Nityavirechan, Strotoshodhan


How to cite this article:
Singh MP, Kuchewar V. Management of jalodar (ascites) through treatment principles of ayurveda: A case report. J Indian Sys Medicine 2019;7:185-8

How to cite this URL:
Singh MP, Kuchewar V. Management of jalodar (ascites) through treatment principles of ayurveda: A case report. J Indian Sys Medicine [serial online] 2019 [cited 2020 Apr 4];7:185-8. Available from: http://www.joinsysmed.com/text.asp?2019/7/3/185/278140




  Introduction Top


Ascites is an abnormal accumulation of fluid in peritoneal cavity.[1] The most common cause of ascites is liver cirrhosis and other causes are cancer, heart failure, tuberculosis, pancreatitis, and blockage of the hepatic vein.[2] Mild ascites is difficult to diagnose. In moderate-to-severe ascites, patient may complain of abdominal heaviness and shortness of breath due to mechanical pressure on the diaphragm. It can usually be diagnosed with abdominal ultrasound. According to Ayurveda, ascites can be correlated with Jalodar, which is one of the types of Udarroga (disease of abdomen). It is well described in Charaka, Sushruta, and Ashtanghridaya.[3],[4],[5]

In Ayurveda literature, many herbs are described to improve the function of liver. Various studies are also conducted to explore the action of herbs on liver.

Here we present a case of ascites in which patient got complete relief within a short duration of treatment.


  Case Presentation Top


A 35-year-old male patient was brought to outpatient department of Kayachikitsa (registration no. 1908100007) on August10, 2019, with the following complaints:

  1. Swelling over both legs and fullness of abdomen since 3 months.


  2. Loss of appetite and generalized weakness since 1 month.


  3. Low-grade fever since 15 days.


Past History

The patient was non-hypertensive and nondiabetic. In personal history, he was a labor by profession and alcoholic since 10–15 years. He had taken modern medicinal treatment from general practitioner in his village. It included hematinic and diuretic medicines. He got some relief in pedal edema, but other complaints remained same. He quit alcohol since 1 month.

The clinical findings of the studied case are depicted in [Table 1]:
Table 1: Clinical findings

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Therapeutic intervention: The patient was treated per the treatment principle of Jalodar described in Charaksamhita [Table 2].
Table 2: Treatment schedule

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Diagnostic assessment: Complete blood count (CBC), liver function test (LFT), urine examination, and ultrasonography (USG) were carried out to confirm the diagnosis [Table 3][Table 4][Table 5][Table 6].
Table 3: Changes in CBC

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Table 4: Changes in LFT

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Table 5: Changes in urine examination

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Table 6: Changes in USG abdomen

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Pathyapathya: The patient was advised to reduce water intake and take only cow milk mixed with Trikatuchurna (10g in 1L milk) as a diet for 24h.

Follow-up and Outcome

The patient was admitted for 8 days. He was on aforementioned medication and Pathya. He followed all the instructions except milk diet. He was having a feeling nausea with only milk, so he was taking Jowar roti with milk in the afternoon and night. During his hospital stay, abdominal girth was measured every day (morning at 9 am). There was improvement in abdominal girth and pedal edema with 8 days of treatment [Table 7]. Due to Erand Taila (oil extracted from Ricinus communis), his bowel frequency was increased (four to five times a day). His appetite started improving after 8 days of treatment. He was treated for 2 months with complete relief in all complaints.
Table 7: Measurement of abdominal girth

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  Discussion Top


In Ayurveda, excessive use of Ushna, Tikshna Ahara, and Madyapana (consumption of spicy diet and alcohol) is described as etiological factors of Udarroga.[6],[3] These factors were found in the patient. Therefore, he was advised to quit these because Nidanparivarjan (avoiding causative factors of disease) has prime importance in treatment. Nityavirechan (purgation and diuretic), Strotoshodhan (cleansing of microchannel), and use of hepatoprotective drugs are the mainstay of treatment of Jalodar.[3]

For Nityavirechan, Erand Taila was advised because the patient had Mrudukoshtha (easy evacuation of bowel).[7]

Gomutra Arka (cow urine extract)) and Punarnavadi Kwath were used for its Strotoshodhan, Agnideepak (appetizer), Mrudukoshtha (diuretic), and Shothashamak (anti-inflammatory) properties. It removes Strotosanga (obstruction of microchannels) and helps in Sampraptivighatana (reverse pathophysiology).[8],[9] In one study, aqueous extract of Boerhavia diffusa produced a notable diuretic effect.[10]Sarpagandhaghanvati was used because of its antihypertensive property. Its active principle, reserpine has depressant action on central and peripheral nervous system by binding to catecholamine storage vesicles present in the nerve cell.[11]Samshamanivati helped to decrease the body temperature because of its Jwarshamak (antipyretic) property.[12]

Poly Herbal formulation was given to improve the function of the liver. It contains mainly Kalmeg (Andrographis paniculata), Bhumyamlaki (Phyllanthus urinaria), Punarnava (B. diffusa), Kumari (Aloe vera Tourn), Amlaki (Emblica officinalis), Guduchi (Tinospora cordifolia), and Daruharidra (Cedrus deodara). These all medicines have hepatoprotective properties.[13]

Guduchi (T. cordifolia) was used in large quantity because of its antioxidant property.[14] Antioxidants are found to be helpful in protecting the liver.[15]

Udarpattabandhan (wrapping of abdomen) with Arkapatra was performed to prevent further accumulation of fluid.

With 12 days of treatment, patient’s appetite was improved, body temperature was normalized, and abdominal girth was reduced. In the later period, Punarnavamandoor was given because it is indicated in Panduroga and Shoth.[16]Gandharvaharitaki was used to prevent further accumulation of abdominal fluid because of its Amapachan (digestive), Vatanulomana (to normalize the direction of Apanavayu), Mruduvirechan (mild purgation), and Strotoshodhan properties.[17]


  Conclusion Top


This patient had complete relief from all complaints such as pedal edema, abdominal distension, and lack of appetite within a short duration of treatment with no adverse reaction. Therefore, this case study motivates to conduct further studies to establish treatment protocol of ascites.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.



 
  References Top

1.
Ascites. Lexico Dictionaries. Available from https://www.lexico.com/definition/ascites [Last accessedon 2019 Nov 4].  Back to cited text no. 1
    
2.
Pedersen JS, Bendtsen F, Møller S. Management of cirrhotic ascites. Ther Adv Chronic Dis 2015;6:124-37.  Back to cited text no. 2
    
3.
Shukla V, editor. Chikitsasthan. In: Charaksamhita. Varanasi, India: Choukhamba Sanskrit Publication; 2017. Chapter13.  Back to cited text no. 3
    
4.
Thakral K, editor. Nidansthan. In: Sushrutsamhita. Varanasi, India: Choukhamba Oriantalia Publication; 2014. p. 778.  Back to cited text no. 4
    
5.
Tripathi B, editor. Nidansthan. In: Ashtanghriday. Varanasi, India:Choukhamba Sanskrit Publication; 2017. p. 512.  Back to cited text no. 5
    
6.
Upadhyaya Y, editor. In: MadhavNidan. Varanasi, India:Choukhamba Publication; 2008. p. 412.  Back to cited text no. 6
    
7.
Tripathi B, editor. Chikitsasthan. In: Ashtanghriday. Varanasi, India: Choukhamba Sanskrit Publication; 2017. p. 751.  Back to cited text no. 7
    
8.
Pandey G, editor. In: Bhavprakashnighanthu. Varanasi, India: Choukhamba Bharti Academy; 2010. p.761.  Back to cited text no. 8
    
9.
Choudhari A. In: BhaishajyaRatnavali. 1st ed. Varanasi, India:Choukhamba Sanskrit Publication; 2006. p. 571.  Back to cited text no. 9
    
10.
Madhuri S, Kalasker V, Rambhimaiah, Sreekantha . Evaluation of diuretic activity of aqueous extract of Boerhaavia diffusa roots in rat. Int J Pharm Biosci2013;4:843-8.  Back to cited text no. 10
    
11.
Kumaria R, Rathib B, Ranic A, Bhatnagar S. Rauvolfia serpentina L. Benth. Ex Kurz.: phytochemical, pharmacological and therapeutic aspects. Int J Pharm Sci Rev Res2013;23:348-55.  Back to cited text no. 11
    
12.
Vaidyanash S, editor. In: Ayurved Sarsangraha. Nagpur, India: Ayurved Bhavan; 2017. p. 430.  Back to cited text no. 12
    
13.
Giby A. A review on hepato-protective herbs used in Ayurveda. Global J Res Med Plants Indigen Med 2014;3:303-11.  Back to cited text no. 13
    
14.
Kuchewar V, Borkar M, Nisargandha MA. Evaluation of antioxidant potential of Rasayana drugs in healthy human volunteers. Ayu 2014;35:46-9.  Back to cited text no. 14
[PUBMED]  [Full text]  
15.
Casas-Grajales S, Muriel P. Antioxidants in liver health. World J Gastrointest Pharmacol Ther 2015;6:59-72.  Back to cited text no. 15
    
16.
Shukla V, editor. Chikitsasthan. In: Charaksamhita. Vol 2. Varanasi, India: Choukhamba Sanskrit Publication; 2017. p. 407.  Back to cited text no. 16
    
17.
Chunekar KC, editor. HaritakyadiVarga. In: Bhavprakashnighantu of Bhavmishra. Varanasi, India: Chaukhamba Bharati Academy; 2015. p. 5. Reprint .  Back to cited text no. 17
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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Abstract
Introduction
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