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Table of Contents
CASE REPORT
Year : 2020  |  Volume : 8  |  Issue : 3  |  Page : 225-229

Clinical management of lipoma with Triphala Kala Basti—A case study


Department of Panchakarma, All India Institute of Ayurveda, New Delhi, India

Date of Submission23-Jul-2020
Date of Decision27-Jul-2020
Date of Acceptance10-Aug-2020
Date of Web Publication11-Nov-2020

Correspondence Address:
Dr. Poonam Verma
Department of Panchakarma, All India Institute of Ayurveda, New Delhi.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISM.JISM_68_20

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  Abstract 

Background: Lipoma is the most common type of soft tissue tumors. Patients having more of the cosmetic value than the morbidity and mortality. It appears as a solitary, soft, movable, and painless mass that may remain stationary or grow slowly. The masses are often benign, and while the age of onset can vary, they most often develop between the age of 40 and 60 years. Everyone seeks medical care due to cosmetic reasons. There is no permanent cure found yet. In Ayurveda, lipoma can be correlated with Medoj Granthi based on similar signs and symptoms. The present clinical study is a case report on the lipoma (Medoj Granthi) along with an altered lipid profile managed successfully through Triphala Kala Basti. Aims and Objectives: The aim of this study was to assess the efficacy of Triphala Kala Basti in the management of lipoma, lipid profile, and reduction in weight. Case Details: In this study, a patient with lipoma visited the outpatient department of Panchakarma, AIIA Hospital. He was managed here according to Ayurveda principles and Panchakarma therapies. The lipid profile and size of lipoma were assessed before the treatment, after the treatment, and during follow-up. Result and Observation: There is a significant reduction in the size of lipoma, weight, body mass index, and lipid measurement. Discussion and Conclusion: Medoj Granthi is Meda pradhan Vata Kaphaja vyadhi. Drug required is the one which is having property against the vitiated body humors and thus Triphala is selected for the trial.

Keywords: Lipoma, Medoj Granthi, Panchakarma, Triphala Kala Basti


How to cite this article:
Bhatted S, Verma P, Latika. Clinical management of lipoma with Triphala Kala Basti—A case study. J Indian Sys Medicine 2020;8:225-9

How to cite this URL:
Bhatted S, Verma P, Latika. Clinical management of lipoma with Triphala Kala Basti—A case study. J Indian Sys Medicine [serial online] 2020 [cited 2020 Dec 1];8:225-9. Available from: https://www.joinsysmed.com/text.asp?2020/8/3/225/300495




  Introduction Top


Lipomas are most common tumors in the subcutaneous tissues. These are usually solitary lesions. Approximately 5–8% of patients with lipoma have multiple tumors known as lipomatosis, which may remain stationary or grow slowly.[1] It usually arises in the subcutaneous tissues, which is a small round to oval and encapsulated mass. Encapsulated subcutaneous lipoma is the most common variety. The cut surface is soft, lobulated, yellowish-orange, and greasy. The most common sites are the subcutaneous tissues in the neck, back, shoulder, and upper extremities. Lipoma etiology is not clear. According to some studies, there is a positive correlation between trauma and lipoma formation. Anatomical pathology shows that it is made up of normal fat containing overactive fat cells and arranged in lobules separated by fibrous septa and enclosed in delicate capsules. Some studies have indicated genetic pathology mostly with abnormality in about 1/3 of lipoma. The gene HMGA2 (located at 12q14.3) has been involved in tumor pathogenesis.[2] Obesity, alcoholism, heredity, or sedentary lifestyle is also a risk factor for lipoma formation.

According to Acharya Sushruta, vitiated Vata and Meda pierced with Kapha, lipoma produces round, protruded, and knotty swelling called Granthi and affects muscle and blood. It occurs in Rohini, the sixth layer of skin. Based upon the symptoms of lipoma which share similarity with Medoj Granthi such as Mridu (soft), Chala (moving), and Deha Kshaya Vridhi Kshaya (increase or decrease in the size of lipoma in proportion to body growth). Shleshma Tulya Akriti or Snigdha (smooth, ghee like appearance), Pindyak Sarpi Pratimam (when burst, the lipoma fat simulating oil or ghee is discharged).[3] A wide range of treatment modalities has been mentioned in Ayurveda which may be effective in such manifestations.


  Case Report Top


A 60-year-old male patient with UHID no. 456325 visited the outpatient department (OPD) of Panchakarma, All India Institute of Ayurveda (AIIA), on November 23, 2019, with complaints of multiple cystic swelling in both the hands. According to the patient, the swelling was movable and painless for the past 15 years. He also feels lethargic and heaviness in the body during daily activities. There is no history of any injury, and the size of multiple cystic swelling increased day by day.

Past History

  • Hypertension: for past 5 years


  • Medicine taken: Amlodipine 5mg OD


  • Family history: no such history in the family


Personal History

Vegetarian, irregular bowel (constipated), increased sleep, having an addiction to tobacco, and cigarette

Clinical Examination

  • Inspection: multiple nodular swelling


  • On palpation: soft palpable swelling, no tenderness


Vitals

  • Pulse: 74/min


  • BP: 130/80mm Hg


  • General Examination


  • Weight: 78 kg


  • Height: 167 cm


  • BMI: 26.5


  • Waist–hip ratio—1.14


Blood Investigations

  • Lipid Profile: (24/11/2019)


The detailed Dashavidha Pariksha is given in [Table 1].
Table 1: Dashavidha Pariksha

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  Materials and Methods Top


Type of Study

The present study is a case report on Ayurveda management of lipoma (Medoj Granthi).

Source of Data

A patient from the OPD of Panchakarma, AIIA, Sarita Vihar, New Delhi.

Treatment Plan

The details of treatment given with drug used, quantity, and duration are provided in [Table 2].
Table 2: Treatment given

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Daywise schedule of Anuvasana Basti and Niruha Basti in a form Kala Basti is given in [Table 3].
Table 3: Schedule of Basti given

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  Observation and Result Top


The assessment was made before treatment on the 0th day, after treatment on completion of Kala Basti, that is on the 16th day, and after the follow-up period, on the 60th day. During this period, the patient did not develop any other complaint. Before treatment, the consistency of lipomas was slightly hard and movable [Figure 1] and [Figure 2] and, after 15 days of Kala Basti (therapeutic enema) assessment was done, the size of lipomas was reduced and became soft [Figure 3] and [Figure 4]. On final assessment done on the 60th day [Figure 5] and [Figure 6], we found that weight, BMI, and waist–hip ratio were reduced significantly. Marked improvement was observed in lipid profile including an increase in high-density lipoprotein value.
Figure 1: Before treatment (on 0 day) – left hand

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Figure 2: Before treatment (on 0 day) – right hand

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Figure 3: After Basti karma (after 16 days) – left hand

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Figure 4: After Basti karma (after 16 days) – left hand

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Figure 5: Follow-up (after 60 days) – right hand

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Figure 6: After Basti karma (after 16 days) – left hand

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Changes in parameters of lipid profile, weight, BMI, waist–hip ratio before treatment, after treatment, and during follow-up are given in [Table 4].
Table 4: Observation before the treatment, after the treatment, and during follow-up

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  Discussion Top


Lipoma is a cluster of fat cells which become overactive and so distended with fat that produces a palpable swelling.

As mentioned by Acharya Vagbhata in Medoj Granthi, when a patient takes Medavardhak Ahara (fatty diet), Meda (fat) increases in the body. Due to Vata Dosha, increased fat slowly accumulates at the subcutaneous or muscular site and gives rise to round, elevated, and slightly nodular swelling.[4] Due to similar signs and symptoms, lipoma can be correlated with Medoj Granthi. The patient had multiple cystic swelling which is Mridu (soft), Chala (moveable), and Snigdha (glossy), also complaining Guruta (heaviness) and Alasya (laziness). The present case was Meda Pradhana Kapha Vataja Vyadhi due to Lakshanas (symptoms) of Bahudoshavastha Shodhana Karma (purification) specifically Basti Karma with Kapha Medaghna Dravya was adopted.

Purva Karma

Deepana pachana

It is the first line of treatment selected prior to the Panchakarma procedure for obtaining Nirama state of the body. 3 g Nagarmotha Choorna was adviced orally with luke warm water, twice before food, which possesses Laghu, Ruksha Guna and Tikta, Katu and Kashaya Rasa, Katu Vipaka these properties of drug having Aampachana, Medo Lekhana action which corrects the Aagnimandhya (diminished digestive fire). Nagarmotha is hypolipidemic and has antioxidant properties (due to a rich source of polyphenol and ascorbic acid).[5],[6]

Sthanik Abhyanga and Nadi Swedana

Sthanik Abhyanga with lukewarm Tila Taila 20min followed by Nadi Swedana with Dasmoola Kwatha for 10min was done. External application of Taila and Swedana helps to mobilize the Doshas from Shakha to Koshtha and increases the body temperature, which may cause increased colonic permeability, thus increasing the absorption of Basti.[7]

Pradhan Karma

Basti karma

Before the administration of Anuvasana Basti, the patient is advised to take a light diet less than the routine quantity, and Niruha Basti was administered when the patient is having the symptoms of Jirnahara (easily digested food) and is not very much hungry. Basti is the best to treat Vata disease but also to treat Pitta, Kapha, Rakta, and Sannipataja condition. Basti enters into the Pakvasaya (colon) by virtue of its Virya (potency), reaches the whole body through the Srotas (channels), and expels out the vitiated Meda and other Mala (impurities) from all over the body.

Here Triphala is used because it has Medohara (fat reducing), Lekhana (fat scraping), and Medo Upashoshana (fat metabolizing) properties which may reduce the increased Kapha and Meda and simultaneously pacify the Vata which is the main aggravating factor in the pathogenesis of Medoj Granthi. Triphala is used in both Basti (Anuvasana and Niruha) and possesses an antihyperlipidemic effect.[8] Animal studies have reported that Triphala reduces the total cholesterol, low-density lipoprotein, very low-density lipoprotein, and free fatty acid levels in rats that fed an atherogenic diet for 48 days, has anticancer and antioxidant effects,[9] and antitumor activity (with chebulinic acid and chebulagic acid, along with other phenolic acids).[10]

Paschata Karma

Basti Pratyagaman and Samyak Niruha/Anuvasan Lakshanas are noted. The patient was advised to take lukewarm water and easily digestible, light food during and full course of the treatment.


  Conclusion Top


Medoj Granthi is Meda Pradhana Kapha Vataja Vyadhi. So, Basti therapy with Triphala Kwatha and Triphala Taila was selected and administered as per the schedule of Kala Basti. This Triphala Basti treatment reduces the Meda and regulates the movement of Vata Dosha and, in turn, a marked reduction in the size of lipoma including the lipid profile and weight is noted. In contemporary science, the management for lipoma is surgical excision, liposuction, and lipolysis with steroids. But the surgery too has its own limitations as in the case of multiple lipomatosis, and the outcome of scar formation causes psychological stress apart from the financial burden. From this clinical study, it can be concluded that Kala Basti with Triphala Kwatha and Triphala Taila is a safe and cost-effective therapy for successful management of lipoma.

Patient consent statement

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Somen D, . editorChapter 3: Examination of lump and swelling. In: A Manual on Clinical Surgery. 7th ed. Kolkata: Dr. S Das; 2008. p. 38-9.  Back to cited text no. 1
    
2.
Charifa A, Badri T Lipomas, Pathology. Treasure Island: StatPearls Publishing; 2020.  Back to cited text no. 2
    
3.
Kaviraj AS, commentator. Granthi apache arbuda galaganda: Chapter11, Verse 7. In: Nidansthana S, editor. Sushruta Samhita. Varanasi: Chaukhamba Surbharati Prakashan; 2014. p. 350.  Back to cited text no. 3
    
4.
Harishastri P, editor. Granthayadivigyaniya: Chapter 29, verse 7–8. In: Uttarsthana V, editor. Ashtanga Hridayam. Varanasi: Chaukhambha Surbharati Prakashan; 2017. p. 883.  Back to cited text no. 4
    
5.
Chandratre R, Chandarana S, Mengi S Lipid lowering activity of alcoholic extract of Cyperus rotundus. Int J Res Pharm Chem 2011;1:1.  Back to cited text no. 5
    
6.
Imam H, Zarnigar , Sofi G, Seikh A, Lone A The incredible benefits of Nagarmotha (Cyperus rotundus). Int J Nutr Pharmacol Neurol Dis2014;4:23-7.  Back to cited text no. 6
    
7.
Dalhanaacharaya S, commentator. Niruhakramachikitsa Adhyaya: Chapter 38, verse 34. In: Chikitsasthana S, editor. Sushruta Samhita. Varanasi: Chaukhamba Prakashan; 2014. p. 542.  Back to cited text no. 7
    
8.
Saravanan S, Srikumar R, Manikandan S, Jeya Parthasarathy N, Sheela Devi R Hypolipidemic effect of Triphala in experimentally induced hypercholesteremic rats. Yakugaku Zasshi 2007;127:385-8.  Back to cited text no. 8
    
9.
Prasad S, Srivastava SK Oxidative stress and cancer chemo preventive and therapeutic role of Triphala. Antioxidants (Basel) 2020;9:72.  Back to cited text no. 9
    
10.
Wang M, Li Y, Hu X Chebulinic acid derived from Triphala is a promising antitumour agent in human colorectal carcinoma cell lines. BMC Complement Altern Med 2018;18:342.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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