WhatsApp Discussion Series 39: "Raktaja-pravahika/atisar" (Ulcerative Colitis)" by Dr. Dinesh Katoch, Dr. Pawan Madaan, Dr. Manish Patel, Dr. Mayur Surana, Vd. Bhooshan Bhakkad, Dr. Pankaj Chhayani, Dr. Ashwini Kumar Sood and others.

[6/3, 12:38] Priya-ranjan Tiwari Dr.: 

one lady pt age 35 is suffering from ulcerative colitis since 15 yrs what could be the best TT for her suggestions are invited

details to Abhi yahi hai

 loose stool mix with blood

 pain abdomen during defaecation

[6/3, 22:37] pawan madan Dr: 

Very important.

I have tried/used many different regimens with No satisfactory results.

 Really need to discuss this disease....

[6/3, 22:50] Satish Sharma ji Dr: 

1.
chandrakala ras 250mg 

panchamrit parpati 250mg 

grahani kapat ras 250mg 

prawal pishti 250mg 
BD

2.
kuttajarishta+lodhrasav40ml              BD

3.
vilvadi churn+ajmodadi churn 5g 

                                                        BD with takra 

4.
kutaj ghan bati 4bd

amarsundri bati 2                        bedtime

sampurn pathya vyavastha

[6/3, 22:53] Satish Sharma ji Dr: 

parpati kalp is the best.

[6/3, 22:54] Dr Surendra A Soni: 

Pawan Sir !

Acharya Priyaranjan ji !

Cured/controlled case of UC With pichchha vasti along with Shaman..

[6/3, 22:57] Dr Surendra A Soni: 

Demo. Video of P. Vasti is also there.

[6/3, 23:00] Dr Surendra A Soni: 

I followed the line of management of Raktaja pravahika.

[6/3, 23:00] Kapil kapoor: 

Wonderful Concept Sir !! 

[6/3, 23:03] Ranvir Rajpurohit Dr:

  great sir !!

[6/3, 23:14] Anupma Patra Dr.: 

Thank u sir, I ve already go through this.

[6/3, 23:14] pawan madan Dr: 

Very nice.

Will go through the details tomorrow.

[6/3, 23:14] Anupma Patra Dr.: 

[6/3, 23:16] priya-ranjan tiwari Dr.: 

[6/3, 23:37] D.C. Katoch sir: 

Ulcerative colitis is an autoimmunity induced disease and it's background (Viprakrishta- hetu)  is psychological but clinical manifestion is somatic in the form of inflammation and ulceration in the intestinal walls leading to frequented loose, blood stained or mixed stools. In Ayurvedic terms I put Ulcerative Colitis equivalent to advance stage of Shokaj Atisaar.  My drug of choice for this condition is Mulethi with Sangejarahat or Dugdhpashan pishti as medhya, shonitsthapan, vranropak and rasayan.

[6/3, 23:43] pawan madan Dr: 

I have used mulethi in many UC cases.

Kaharava, mujta, prawal pishti, sangeyashaba, ..deepan paachan line........brahmi and other medhyas.......kushmaand rasaayan........kutaja parpati...bilbadha rasa......lodhra+ mocharas.......but really benefitting only 10-20%

I need to learn really....!!

[6/3, 23:44] Dr Surendra A Soni: 

Said patient had a history of playing cricket up to late night daily along with frequent fast food intake in between.

He didn't have any kind of stress.

This is about shared case only.

I agree with your great description.

Many scholars correlate UC With Raktatisar also.

I shall also try Rx suggested by you.

Thanks Resp. Katoch Sir for your valuable inputs.

[6/3, 23:46] pawan madan Dr: 

Dr. Soni ! this is One of Specific aamavaataj hetu as described by Maadhav nidaan...

[6/3, 23:55] D.C. Katoch sir: 

Not appropriate prescriptions Dr. Pawan !  Why Kutaj Bolbaddha Ras , Kushmand avleha, deepan pachan ....? UC is basically not agnimandyajanya disorder but disturbed immunity disorder with psychological hetu ( may be hidden or not properly analysed/thought of). Patient's Prakriti and Saar and food items matter a lot in the treatment outcome.

Mithya Aahar Vihar is the specific factor generally used in the causation of Dosholvanata anusaar rogaprakar. It is for the practitioner to see what Mithya Vihar of the patient could have been according to his prakriti, agni, desh, kaal etc and accordingly advise lifestyle regimen(food, behavior and emotional status).

[6/4, 00:02] pawan madan Dr: 

Sir there have been different nidaans in different cases. 

Some were thaoght as raktaatisaar , otherr jeern pakva atisaar, others pittaja or tridoshaj grahni.......depending on the stage and symptomatogoy and history of the presenting patient.

Even if I supposed this to be auto immune and  used mulethi and  other rasayan, .....even in few cases ...chikitsa  sidhaant of aamavaata......it couldnt work...

[6/4, 00:23] D.C. Katoch sir: 

Extent of Oja dushti in Ulcerative C. determines the line of treatment. Symptomatic treatment usually misfires and brings bad name to Ayurveda and practitioner as well. Ojas protection should be the prime objective in the treatment plan that may succeed.

[6/4, 09:25] Dr Surendra A Soni: 

Usually starting of Rx depends on the condition of patient- 

acute/chronic, alpa, madhya/uttam bala; 

Dominance of Clinical features-

Abdo. Cramps/pain

Malenna

Anorexia

Weight loss

Weakness

Anaemia etc.

Also disease modifying factors to be looked that effect the patient as well as Clinical presentation like use of steroids etc.

Patient should be treated in IPD or day to day management should be preferred.

Different said Conditions demands the wide  and variant approach step by step in management.

If agnimandya presents due to excessive bleeding then disease oriented deepan like Siddha ghrita- (shatavari, panchatikta, yashtimadhu etc. May be needed) as front line Rx. If profuse bleeding persist, Rx should be accordingly. Same as per pain abdomen etc.

Actually this is a condition of vat-sthan gat  pitta so you can leave vat. Vataghna management should always be added folloed by pittaghna.

Pichchha vasti covers almost all contents of the disease including ojas.

Pawan Sir !

[6/4, 09:26] Dr Surendra A Soni:  

Pawan Sir 

[6/4, 10:15] J K Pandey Dr. Lukhnau: 

Almost all aspect covered..

well compiled chikitsa sutra soni sir..

[6/4, 10:27] Dr. Manish Patel Nadiad: 

In more than 10 Frequency, kutajaghanvati 1gm thrice or four times with musta+nagakesara+lodhra each 1gm thrice. Give concentrated Udumbarakvath basti 100 ml after lunch every day. If frequency reduces up to 3 to 5 and less amount of blood, start pichha basti and jatyadi tails matra basti alternate day after lunch and dinner. Follow pathyapathya of raktatisara as possible according to present era. Contact to Dr surendra Soni sir for more details. He will give you a link of kayachikitsa Blog of GAU where evidence based protocol was already uploaded.

[6/4, 10:32] Dr.  Manish Patel  Nadiad:

https://4.bp.blogspot.com/-EHaxCuut3-0/WCs5fXaVRVI/AAAAAAAAAy0/IyTpH6TYJv8Ydu2cD3NLKY4HkBYPK0ILwCLcB/s1600/M1.png

[6/4, 10:32] Dr. Manish Patel Nadiad:

https://kayachikitsagau.blogspot.in/search?q=Ulcerative+colitis&m=1

[6/4, 10:34] Dr. Manish Patel Nadiad: 

These are already used therapy in more than 150 patients with satisfactory results. Use and get the benefit. Thanks !

[6/4, 10:35] priy rnjan tiwari Dr.: 

[6/4, 10:45] Dr. Manish Patel Nadiad: 

Shokaj atisar happens in particular situation and frequency and bleeding are not as much as UC. Hence I disagree with it. Also raktaj pravahika also a another clinical condition which is adopted as separate disease by samgraha Grantham which doesn't contains all signs of UC. Hence it is advanced stage of pittatisara abbreviated as raktatisara by charaka samhita.

[6/4, 11:02] Dr Surendra A Soni: 

Thanks Manish Bhai for your valuable guidance.

I hope acharya pawan ji and priyaranjan ji will use said Rx and give feedback to us.

[6/4, 11:17] Pankaj Chhayani Dr: 

Sadyaska Navaneet and Sharkara can be given in diet. Petha (Kushmand) is also very good Medhya and Raktapita nashaka...

There is not good prognosis in thin pts and over thinking pts..

[6/4, 16:00] D.C. Katoch sir: 

Interesting perspective and the way to conclude !

[6/5, 11:56] pawan madan Dr: 

very true practically sir.  Thanks

 thank u Manish sir for giving so much details. I totally agree with u. This disease is really a tough job. Different stages or conditions present in a different way and we need to think differently in each stage. In 99% of the cases patient has gone far away from the agnimaandya stage and has reached to a pakva avastha. Soni sir and Manish sir has provided excellant links which are giving many workable leads to follow so that I may be able to help the patients, I hope. Thanks once again.

[6/5, 15:29] Dr Surendra A Soni: 

Thanks Manish bhai for your valuable inputs.

Few facts to be reviewed.....

1. As per description of Atisar in ayurved, it seems  it is an acute condition (due to fluid loss) that either subsides or causes further complications or leads as nidanarthakar rog like grahani. This is the reason that charak describes parikartika, gud-bhrinsha etc complications there. So chronicity in UC should be taken as Raktatisar...?? Acute / initially it may be considered.

2. As tenesmus  in pravahika is  due to frequent reactive mucoid secretions that causing irritation on anal canal resulting frequent urge for evacuation, similarly bleeding also causing said mechanism in UC.

3.  Suppurative infection may cause modification in clinical picture.

4. Some time it seems that modern diagnosis is mile stone, and this should always be kept in mind with either vyadhi/dosha-pratyanik chikitsa.

[6/5, 16:51] pawan madan Dr: 

These observations are quite right -- Most of the patients come under Raktatisaar and few may come under Raktaja pravaahika.  

                                                                                                                                                        TYPICAL PATIENTS OF UC PRESENT AS BLOODY DIARRHEA AS FOLLOWS -- 

पित्तकृन्ति यदाऽत्यर्थं द्रव्याण्यश्नाति पैत्तिके |

तदोपजायतेऽभीक्ष्णं रक्तातीसार उल्बणः ||२०|| - MADHAVA NIDAANA

ननु, रक्तजोऽप्यतिसारोऽस्ति तस्य सप्तमत्वापत्तेरुक्तं षट्कं विरुध्यते, इत्याशङ्क्य पैत्तिकस्यैवायमवस्थाविशेष इत्याह– पित्तेत्यादि| पैत्तिकेऽतीसारे विद्यमाने भविष्यति वा पित्तकृन्ति पित्तकारकाणि द्रव्याण्यत्यर्थं प्रभूतमभीक्ष्णं निरन्तरमश्नाति तदा रक्तातीसार उल्बणो महानुपजायत इति सम्बन्धः| अत्र चारुणकृष्णपाण्डुत्वादिना वातादयो दूषका बोद्धव्याः| यदुक्तम्– “दोषलिङ्गेन मतिमान् संसर्गं तत्र लक्षयेत्||” इति| एवं स्नेहाजीर्णविसूचिकाविषार्शःक्रिमिप्रभृतिजन्येष्वतीसारेषु षट्कातिरिक्तत्वं प्रतिक्षिप्तं बोद्धव्यम्, अव्यभिचरितदोषलिङ्गत्वादिति जेज्जटः||२०|| - VIJAYRAKSHITA

-this is a special altered stage of PITTA ATISAARA in which a person of PITTA PRAKRITTI indulges in excessive PITTA VARDHAKA AAHAARA VIHAARA so there is presentation of diarrhea with too much blood. Other than the blood one may find different colors in the stools like brown, black or yellowish which may indicate the ULAVANATAA of VAATA, PITTA OR KAPHA. 

तन्द्रायुक्तो मोहसादास्यशोषी वर्चः कुर्यान्नैकवर्णं तृषार्तः ||१२|| 

सर्वोद्भूते सर्वलिङ्गोपपत्तिः कृच्छ्रश्चायं बालवृद्धेष्वसाध्यः |१३| - 

SUSHRUTA UTTAR TANTRA 40

-patient may also have drowsiness, extreme fatigue, unconsciousness like state, dryness of mouth, stools having many colors.                                                                                                                                                         

Some others are ---- 

वायुः प्रवृद्धो निचितं बलासं नुदत्यधस्तादहिताशनस्य | 

प्रवाहतोऽल्पं बहुशो मलाक्तं प्रवाहिकां तां प्रवदन्ति तज्ज्ञाः ||२१|| 

प्रवाहिका वातकृता सशूला पित्तात् सदाहा सकफा कफाच्च |

सशोणिता शोणितसम्भवा च ताः स्नेहरूक्षप्रभवा मतास्तु |

तासामतीसारवदादिशेच्च लिङ्गं क्रमं चामविपक्वतां च ||२२|| - MADHAVA NIDAANA

(सु. उ. तं. अ. ४०) |

-when there is evacuation of stools with mucus in small amounts and with pain, this is called PRAVAAHIKA

-this may be VAATAJ, PITTAJ OR KAPHAJA

-in PITTAJA PRAVAHIKA there is expulsion of blodd with mucus and with pain abdominal before the evacuation

तस्या वातादिभेदेन रूपमाह– प्रवाहिकेत्यादि| ननु, वायुः प्रवृद्धो निचितं बलासमित्युक्तं तत् कथं वातकृतेति? उच्यते, आधिक्येन व्यपदेशात्| ननु, तथाऽपि पित्तरक्तसम्भवा कुतः? उच्यते– अहिताशनस्येत्युक्तम्, आहारो हि विरुद्धस्तस्यामवस्थायां पित्तं रक्तं च कोपयति, ते च पश्चाद्वातस्यानुबले स्वलिङ्गं यदा दर्शयतस्तदा ताभ्यां व्यपदेशः| स्नेहरूक्षप्रभवा इति स्नेहप्रभवा कफजा, रूक्षप्रभवा वातजा; तुशब्दाच्च [तीक्ष्णोष्णप्रभवा पित्तजा रक्तजा च| लिङ्गं वातादिभेदेन लक्षणम्| क्रममामपक्वभेदेन चिकित्साक्रममिति||२२||

-When a patient indulges in excessive AHITA AAHAARA and VIRODHI AAHAARA the PITTA and RAKTA gets PRAKUPITA and then they cause the dysfunction of the VAATA so there is clinical presentation of the PRAVAAHIKAA.

[6/5, 17:20] Ashwini Kumar Sood Dr: 

Good analysis of UC.

[6/5, 19:57] Dr Surendra A Soni: 

Pawan ji✔

[6/5, 20:56] D.C. Katoch sir: 

Raktatisaar should then be treated successfully with Atisaar Chikitsa and Shonitsthan Chikitsa, obviously considering all the necessary factors. It does not  happen so unless immunomodulator, adagtogenic and demulcent remedies are added in the line of treatment.

[6/5, 21:26] Shantanu Das Prof KC: 

Can we consider as...Savrana antra sotha...with shokaja atisara....as per as the view of Shusrruta...(Uttar-tantra 40/14,23) spl   mentioned.....GUNJA PHALA....colour Rakta with Mala...due to vitiated  pachakagni causes local irritation to Blood  ..by which....sagandha/nirgandga  sarakta...mala passes....Need more discussion.....

Swarn malini vasanta ..with satamulya di loha....is a better option....

 Regarding U C....sir

[6/5, 21:29] D.C. Katoch sir: 

Important input, needs microthinking.

[6/5, 22:24] pawan madan Dr: 

That was my observation when I said all treatment fails when acting on the lines of atisaar.

[6/5, 22:27] pawan madan Dr: 

I have also noted this reference in sushrut and asthaang.....Svrana shotha.....we need to really work on this..

[6/5, 22:30] Dr Surendra A Soni: 

तैस्तैर्भावैः शोचतोऽल्पाशनस्य बाष्पावेगः पक्तिमाविध्य(श्य)जन्तोः ।।१३।। 

कोष्ठं गत्वा क्षोभयत्यस्य रक्तं तच्चाधस्तात् काकणन्तीप्रकाशम् । 

वर्चोमिश्रं निःपुरीषं सगन्धं निर्गन्धं वा सार्यते तेन कृच्छ्रात् ।।१४।। 

शोकोत्पन्नो दुश्चिकित्स्योऽतिमात्रं रोगो वैद्यैः कष्ट एष प्रदिष्टः ।

डल्हण टीका

शोकजलक्षणमाह- तैस्तैर्भावैरित्यादि। एवम्भूतस्य पुरुषस्य बाष्पावेगः कोष्ठं गत्वा, पक्तिमाविध्य, रक्तमस्य क्षोभयतीति सम्बन्धः। तैस्तैर्भावैः बन्धुवियोगादिभिः, शोचतः शोकं कुर्वतः, बाष्पावेगः शोकोत्थतेज उद्रेकः, पक्तिमग्निं पक्तिहेतुत्वात्, आविध्य आकुलीकृत्य, क्षोभयति। तच्चेति रक्तं, अधस्तादिति पदं क्षोभयतीत्यनेन सम्बन्धनीयं, अन्ये सार्यते तेन इत्यत्र सम्बध्नन्ति। काकणन्ती गुञ्जा। सगन्धं निर्गन्धं वेति सपुरीषापुरीषत्वादित्यर्थः। केचिदत्र अल्पाशनस्येत्यस्यानन्तरं शोकोत्पन्न इत्यतः प्राक् अन्यथा पठन्ति "शुष्कं भुक्तं तेज ऊष्मगृहीतं कोष्ठं गत्वा रक्तमत्यर्थमुष्णम्। गुञ्जाप्रख्यं प्रेरयेच्चाप्यधस्ताद्वर्चोयुक्तं निष्पुरीषं सगन्धम्।। निर्गन्धं वा सार्यते सोऽतिसारः" इति। व्याख्यानयन्ति च,- शुष्कं शुष्कतां गतं, अल्पत्वात्; भुक्तं भोजनं, तेजः शोकोत्थं तेजः, ऊष्मगृहीतम् ऊष्मणा गृहीतम्।।१३-१४।।

Shantanu Sir !!

There is no pain abdomen etc other symptoms along with bleeding. That's why it creates little doubts.

[6/5, 22:33] Dr Surendra A Soni: 

Absolutely correct !!

UC doesn't seem as per

  *'prakriti-sam-samveta'* pattern if we review the management.

[6/5, 22:40] pawan madan Dr: 

There are manny diverse symptoms in UC.

In many cases there is no abd pain in spte of bleeding and too much diarhea.

[6/5, 22:41] D.C. Katoch sir: 

Seeing the Dalhan Teeka what you like to say- Raktatissar is close to UC or Shokajatissar ?.

[6/5, 22:42] pawan madan Dr: 

Teevra pittaja atisaar

Rakta atisaar

Sannipaataj sangrahni

Raktaja pravahika

Svaran shotha

These are the five main conditions in which .....most of UC patients can fit.

 This is what I observe practically.

[6/5, 22:47] D.C. Katoch sir: 

Pratyatam Lakshan are important not the other symptoms for Rogvinishachaye. Diversity of symptoms in one particular condition can be due to variable associated factors but the fundamental/classical symptoms usually remain the same.

[6/5, 22:50] Mayur Surana Dr.: 

That's why in many anukta vyadhis...seeing d samutthan, and guna dominance d condition should be visualised...rather than trying to fit in d possible vyadhis given in texts...

D guna samucchay is quite different which we encounter today which can give many deviations to d samprapti...

[6/5, 22:52] Dr Surendra A Soni: 

If I review my experience then I can say that I didn't see a single patient as sushrut describes with only psychogenic origins.

Completely agree with Pawan Sir that said 5 conditions almost covers the UC.

Starting signs and symptoms will be key that will help us to understand the mechanism of pathology, then followed by

Presenting features when patient reaches vaidya.

[6/5, 22:53] D.C. Katoch sir: 

It means any of these five diagnoses could be of UC in Ayurvedic terms. If so, then what is the differential diagnosis between Paittik Atisaar and Paittik Atisaar advanced as UC ?

[6/5, 22:57] pawan madan Dr: 

Sir

you are right.

but many times we have to do the aavasthika chikitsaa as per the presenting complaints...thats what I prefer to do.

Its like in chronic aamavaat....jeerna avastha.......we don start with the deepan paachan as that stage has been passed.

Just my thinking ....

[6/5, 22:58] Dr Surendra A Soni: 

In GIT disorders it is very very difficult to establish classical concept of pratyatma-lakshana practically as well as minutely if we corelate as modern diagnosis because many times there is no clear cut symptomatology seen. I say this is in generalised manner not for UC only.

[6/5, 22:59] pawan madan Dr: 

Yes sir...

All paittika atisaar doesnt contain rakta.....but could be havibg different colored stools...this could be differential diagnosis.

[6/5, 23:00] Dr Surendra A Soni: 

Mayur ji ! What do you say about UC ?

[6/5, 23:00] pawan madan Dr: 

[6/5, 23:03] pawan madan Dr: 

The motive to name it as paittik atisaar is to have an idea to make a  good chikitsaa sidhaant to give help to pts.

[6/5, 23:03] Mayur Surana Dr.: 

I see it as a manifestation of लीन खर-उष्ण गुण at पक्वाशय..

A thorough षट्क्रियाकालीन status of d patient of many years will help to understand d interplay of Gunas...

[6/5, 23:05] Mayur Surana Dr.: 

A retrospective study of a few patients is necessary to understand d common thread...

[6/5, 23:07] Dr Surendra A Soni: 

Vat-sthan-gat pitta....

स्थानं हि जयेत पूर्वं....!!

[6/5, 23:09] D.C. Katoch sir: 

In such patients can good chikitsa siddhant be made only by naming it as Paittik Atisaar?.

[6/5, 23:09] Dr Surendra A Soni: 

आगन्तू द्वावतीसारौ मानसौ भयशोकजौ ।

तत्तयोर्लक्षणं वायोर्यदतीसारलक्षणम् ॥११॥

Charak includes in vataja atisar.

[6/5, 23:10] Mayur Surana Dr.:

Yes...and sometimes cheerkalin malavashtambh ...kharguna of vata superadded by ushna later on...

[6/5, 23:10] Dr Surendra A Soni: 

[6/5, 23:15] pawan madan Dr: 

No sir....this is only one type......there could be many other things...

[6/5, 23:16] pawan madan Dr: 

Thats a good point....

[6/5, 23:17] D.C. Katoch sir: 

Atisaar as Vyadhi (not as lakshan) is basically amashayotth (small intestine) not pakvashyotth like UC, which is confined to colon, mainly lower part only. Whereas atisaar as lakshan may result from  morbid implication of any GI part.

[6/5, 23:17] Mayur Surana Dr.: 

We can call it as Chronic Large intestinal insult...

[6/5, 23:17] Mayur Surana Dr.: Katoch Sir ! 

[6/5, 23:18] pawan madan Dr: 

I also think of the Dooshi Visha......thats a point which may solve many things.........to resove auto immunity....perhaps....

[6/5, 23:18] Dr Surendra A Soni: 

Perfect

 अल्पाल्पं बहुशो रक्तं सशूलमुपवेश्यते ॥९३॥

यदा वायुर्विबद्धश्च कृच्छ्रं चरति वा न वा ।

पिच्छाबस्तिं तदा तस्य यथोक्तमुपकल्पयेत् ॥९४॥

Pichchha vasti is best.

 Ch chi 19

[6/5, 23:22] pawan madan Dr: 

Mayur ji...these leena gunas of which dosha?

[6/5, 23:23] Dr. Tushar shah: 

In cases of UC...

The piccha basti described in Arshodhikar gives better symptomatic results compared to the piccha basti described in Atisar Rx...

This is my personal observation.

[6/5, 23:24] D.C. Katoch sir: 

So what is the sum & substance of the discussions ?

[6/5, 23:25] Dr Surendra A Soni: 

We are to give as per availability in our ipd. In shared case I gave as per availability.

[6/5, 23:26] Mayur Surana Dr.:

वात दोष mostly and पित्त later on...due to absence of Rutushodhan and continuous  anomaly of these two doshas coz of Ritusandhikala/ahitahar/manas hetu...

[6/5, 23:28] D.G. Katoch sir: 

Discussions in the group must lead to lay down some guiding principles otherwise it would be just beating the bush and after some days again we will discuss the same issue with different ifs  & buts forgetting the previous points raised by the discussants.

[6/5, 23:29] Mayur Surana Dr.: True..

[6/5, 23:30] Vd Ranga Prasad,Chennai:

 

UC is getting discussed in विस्तीर्ण for record 2nd time over the forum.

[6/5, 23:31] Dr Surendra A Soni: 

Resp. Katoch Sir ! In presence of you and other gurujan, I can't dare to do so. I m not as compitent to make a consensus.

I ve put my view.

[6/5, 23:32] Mayur Surana Dr.: 

I think Dinesh sir can do a उपसंहार for us in d end

[6/5, 23:35] Katoch sir: 

Let this be done unbiasedly by Dr Pawan Madan-  who remained so active in the fire exchanges and placing different goal posts. He will do the justice.

[6/5, 23:38] Katoch sir: 

Ranga Sir ! Have you noticed any common points/opinions between the previous and present discussions on UC ?

[6/5, 23:38] Vd Ranga Prasad Ji Chennai: 

Mayur Sir ! Seconding the opinion. 

[6/5, 23:39] priy rnjan tiwari Dr.: 

but tenderness is found in UC.

[6/5, 23:39] Dr Surendra A Soni: 

Because of inflammation

[6/5, 23:41] Vd Ranga Prasad Ji Chennai:

 Almost the same opinions and stand taken by the vaidyas.

[6/5, 23:44] pawan madan Dr:

 

Katoch Sir !

सर आप मुझे फसा रहे है....

I cant do this...

I can just list all the points.....and u do the final word....

Give me a day....

[6/5, 23:45] Dr Surendra A Soni: 

[6/5, 23:53] pawan madan Dr: 

This is wonderful. 

I just gone through it today as the link was sent yesterday.

Good regimens given but doses are quite high and palatability and acceptence of the patient.

[6/6, 09:38] Sukhvir Verma Dr.: 

क्या अन्तराद कृमि का व ulcerative colitis का परस्पर कोई संबंध हो सकता है ?

[6/6, 09:41] D.C. Katoch sir: 

Possibly there is this kind of relation.  Bacterial infection is reported to coexist in UC.

[6/6, 09:48] Dr Surendra A Soni: 

कृमि चि. से उपशयानुपशय निर्धारित किया जा सकता है । सैद्धांतिक रूप से कृमि चि. कार्यकर प्रतीक नहीं होती जब तक उसमें वात पित्तघ्न गुण न हो ।

[6/8, 18:20] pawan madan Dr: 

RESP ALL - as per the discussion this is a try to sum up, nevertheless additions/modifications may be needed by the experts - CASES OF ULCERATIVE COLITIS - AYURVEDIC NIDAAN AND CHIKITSAA SIDHAANT -                                                              *SYMPTOMS OF UC AS DESCRIBED IN TEXT BOOKS OF MEDICINE*– 

-diarrhea with blood, tenesmus in abdomen, fever on and off, weight loss                                                                                              

*Symptoms depend on the location* – 

ULCERATIVE PROCTITIS – 

-sometimes intermittent rectal bleeding is the only symptom

-rectal pain and urgency in some patients may be there

-and tenesmus may be there in some patients

PROCTOSIGMOIDITIS – 

-rectal bleeding, urgency and tenesmus may be there

-some patients may have bloody diarrhea

LEFT SIDED COLITIS – 

-bloody diarrhea, abdominal cramps, weight loss and left sided abdominal pain

PANCOLITIS OR UNIVERSAL COLITIS

-having all the above symptoms with fatigue, fever and night sweats

FULMINANT COLITIS – 

-it’s a severe form of pan colitis

-with all acute symptoms as described with dehydration like state

DIFFERENT TYPES OF UC CAN BE CLASSIFIED UNDER FOLLOWING VYAADHIS AS PER AYURVEDIC TEXTS...          

1. *PITTAZA ATISAARA* -

MANY PATIENTS OF UC PRESENT WITH BLOODY DIARHEA AND WITHOUT PAIN ABDOMINAL AS FOLLOWS -  

SUSHRUTA UTTAR 40,  

CHARAK CHIKITSA 19

-the stools are with bad smell

-the bouts of stools are felt like very hot

-the color of the stool may be yellow, greenish, bluish, blackish, or reddish

-with systemic symptoms like fever, burning, sweating, fainting, colic

-there can be hot feeling and burning at the anus

पित्तात् पीतं नीलमालोहितं वा तृष्णामूर्छादाहपाकोपपन्नम् |७| 

- MADHAV NIDAAN

2. *TRIDOSHAJA OR SANNIPAATAJA* – 

MANY CASES OF UC PRESENT WITH DIARRHEA WITH MUCUS OR BLOOD OR FAT LIKE STICKY MATERIAL ON AND OFF AS FOLLOWS - 

वराहस्नेहमांसाम्बुसदृशं सर्वरूपिणम् |

कृच्छ्रसाध्यमतीसारं विद्याद्दोषत्रयोद्भवम् ||८|| - MAADHAVA NIDAANA

3. *RAKTATISAARA* –

TYPICAL PATIENTS OF UC PRESENT AS BLOODY DIARRHEA  AS FOLLOWS -- 

पित्तकृन्ति यदाऽत्यर्थं द्रव्याण्यश्नाति पैत्तिके |

तदोपजायतेऽभीक्ष्णं रक्तातीसार उल्बणः ||२०|| - MADHAVA NIDAANA

VIJAYRAKSHITA

-this is a special altered stage of PITTA ATISAARA in which a person of PITTA PRAKRITTI indulges in excessive PITTA VARDHAKA AAHAARA VIHAARA so there is presentation of diarrhea with too much blood. Other than the blood one may find different colors in the stools like brown, black or yellowish which may indicate the ULAVANATAA of VAATA, PITTA OR KAPHA. 

तन्द्रायुक्तो मोहसादास्यशोषी वर्चः कुर्यान्नैकवर्णं तृषार्तः ||१२|| 

सर्वोद्भूते सर्वलिङ्गोपपत्तिः कृच्छ्रश्चायं बालवृद्धेष्वसाध्यः |१३| - SUSHRUTA UTTAR TANTRA 40

-patient may also have drowsiness, extreme fatigue, unconsciousness like state, dryness of mouth, stools having many colors

4.*RAKTAJA PRAVAAHIKA* -                                                                                                     

IN SOME STAGES OF UC PATIENT MAY PRESENT LOOKONG LIKE CLINICAL FEATURES OF RAKAJ PRAVAAHIKAA.  

वायुः प्रवृद्धो निचितं बलासं नुदत्यधस्तादहिताशनस्य | 

प्रवाहतोऽल्पं बहुशो मलाक्तं प्रवाहिकां तां प्रवदन्ति तज्ज्ञाः ||२१|| 

प्रवाहिका वातकृता सशूला पित्तात् सदाहा सकफा कफाच्च |

सशोणिता शोणितसम्भवा च ताः स्नेहरूक्षप्रभवा मतास्तु |

तासामतीसारवदादिशेच्च लिङ्गं क्रमं चामविपक्वतां च ||२२|| - MADHAVA NIDAANA, (सु. उ. तं. अ. ४०) |

-when there is evacuation of stools with mucus in small amounts and with pain, this is called PRAVAAHIKA

-this may be VAATAJ, PITTAJ OR KAPHAJA

-in PITTAJA PRAVAHIKA there is expulsion of blood with mucus and with pain abdominal before the evacuation

-When a patient indulges in excessive AHITA AAHAARA and VIRODHI AAHAARA the PITTA and RAKTA gets PRAKUPITA and then they cause the dysfunction of the VAATA so there is clinical presentation of the PRAVAAHIKAA

5. *KOSHTHAGATA VRANA*–

  ASHTAANGA SANGRAH UTTAR TANTRA – 30/9, 29/20, 29/25 - many cases of UC may present as described in the above references in ASHTAANGA SANGRAHA                                                                                                                                 SAMPRAAPTI --                                                                                                                                                                पित्तलस्यपुनरम्ललवणकटुकक्षारोष्णतीक्ष्णातिमात्र निषेविणः प्रतताग्निसूर्यसन्तापोष्णमारुतोपहतगात्रस्य क्रोधेर्ष्याबहुलस्य पित्तं प्रकोपमापद्यते| 

तत् प्रकुपितं द्रवत्वादूष्माणमुपहत्यपुरीषाशय विसृतमौष्ण्याद् द्रवत्वात् सरत्वाच्च भित्त्वा पुरीषमतिसाराय प्रकल्पते| 

CHARAK CHIKITSAA 19/6

-when a person who is already PITTALA SWABHAAVA YUKT indulges in all PITTA increasing diet, routine and PITTA increasing psychological state then the DRAVA GUNA of the PITTA gets increased too much and it overpowers the USHNA GUNA of PITTA and there is increased defecation due to the GUNAS of USHNA, DRAVATAA and SARATAA, this is then called ATISAARA.                          

When some other factors present in the KOSTHA and/or PAKVAASHYA like DOOSHI VISHA due to many diverse HETUS (known or unknown), are associated with this then there is evacuation of blood in the stools with many other symptoms then this condition is called UC.

      

CHIKITSAA SIDHAANT -                                                                                                       

 1. PAKVA ATISAARA STAMBHANA - 

यदा पक्वोऽप्यतीसारः सरत्येव मुहुर्मुहुः | 

ग्रहण्या मार्दवाज्जन्तोस्तत्र संस्तम्भनं हितम् ||६८|| - SUSHRUTA UTTARA 40/70-72

-LAJJALU, DHATAKI, MANJEETH, LODHRA, MOTHA

-MOCHRASA, LODHRA, KUTAJA CHAAL, ANAAR KA CCHILKAA

2. RAKTAJA PRAVAAHIKAA NAASHAKA GRAAHI SHAMANA AUSHADHA – 

BILVAADI CHURAN, GANGADHAR CHURAN, KUTAJAADI VATI, PANCHAMRITA PARPATI

3. RAKTASTAMBHNA – 

with RAKTA STAMBHAKA SHAMANA YOGAS AND PICCHA VASTI wherever needed as per the case

JAATYAADI TAIL MATRA VASTI to stop blood immediately

LODHRA + MUSTA + NAAGKESAR, VATSAKAADI VATI, CHANDERKALA RASA, RAMBAAN RASA

4. KOSHTHAGATA VRANA ROPANA CHIKITSAA –

SHATAVARI, MADHUYASHTHI, KUSHMAANDA, SOOTSHEKHAR RASA.

5. RASAAYANA – to combat DOOSHIVISHA 

Vd Pawan Madaan !

[6/8, 18:22] pawan madan Dr: 

The last part - DOOSHI VISHA CHIKTSAA still need to be dicussed and can be added to above list.                                                 

*This is a compilation of the discussion in this forum 2 days back as well as from some other discussions in other groups. Kindly add/modify if something I missed. Thanks*

[6/8, 19:06] Raghuram Dr Banguluru: 

[6/8, 19:13] Dr. Rameshwar Rao Rane: perfect 

[6/8, 20:09] D.C. Katoch sir: 

Nicely summed up at one place all the views about UC in Ayurvedic terms except the ones related to Ojodushti, Shokaj (stress induced) hetutva and associated antrad krimi condition (chronic bacterial infection.  Weldon Dr Pawan-   this will be useful for future reference of all.

[6/8, 20:39] pawan madan Dr: 

Thank U very much sir.

Yes sir. U rightly pointed out the tgree factors but I had a plan to list these in the HETUS. Earlier I was planning to list all hetus here also but then decided to cut short because it was already going lengthy.

Thats why named it ....as Nidaan and chikitsaa sidhaant. (Diagnosis and line of treatment as per ayurveda texts)

Thank U very much sir for giving such an opportunity. 

[6/8, 21:02] D.C. Katoch sir: 

Challenge is not finished as yet. We need to work out Samprapti break up of UC in accordance with Ayurvedic nidan siddhant. Otherwise practitioners will continue to do hit & trial treatment without understanding the basis of Dosh-Dusya -srotas-agni implications of UC.

[6/8, 21:04] Trivendra Sharma Jpr: Yes sir .

[6/8, 22:47] Dr Surendra A Soni: 

Excellent respected pawan Sir !!

Your presentation proves your passion and love to Ayurved.

Really it's a big task that you concluded as a super teacher.

Namo namah !!

[6/8, 22:51] Dr Surendra A Soni: 

If each member conclude an experienced topic of his/her choice, then all will get good exchange of trusted knowledge.

That will be the real sense of saahacharya-dharma.

[6/8, 22:53] Nikita Kakkad PG DG: 

[6/8, 22:55] Dr Jyothi: 

[6/8, 23:01] Hardik Chudasma: 

[6/8, 23:02] Ranvir Rajpurohit Dr: Pawan sir

[6/8, 23:11] pawan madan Dr:

 

Thank u Soni sir for the kind words.

[6/8, 23:12] Vd Ranga Prasad Ji Chennai: 

*Super Teacher* 

[6/8, 23:12] Mayur Surana Dr.:

 Pavan sir

[6/8, 23:45] Shivali Arora KC: 

[6/8, 23:57] Kapil kapoor:

 महाSध्यापक 

Pawan sir in saama avastha of above said conditions

Saama Pittaj/ raktaj  ▶ mahasudershan , kudaj ghan 

Saama kaphaj/ vataj ▶

Hinguvachadi choornam, amarsundari vati, agnitundi vati.

Can this be added ?

[6/9, 06:36] pawan madan Dr: 

Good mng Kapil ji.

It may be added.

Little I need to understand......why u are considering these cases as SAAMA?

In my exp....I see that Aama nashak and agnideepan doesnt work in such cases?

What do u say?

[6/9, 06:49] D.C. Katoch sir: 

Pl see the post of Dr Soni about the stage specific use of agni deepan pachan aushadhies in UC. Perhaps due to involvement of amashaye in later stage of the disease or associated condition of agnimandya-ajirna.

[6/9, 09:56] Kapil kapoor: 

The condition of 

"Nishedha of aam Rakta sangraha aadou "

Shall it not be applicable here ?

[6/9, 09:59] Kapil kapoor: 

[6/9, 10:02] Dr Pratibha P Mahesh: 

sir   whatever  ayu  dignosis  is  given  is  it  sufficient  to  diagnose  as   uc...

no  need  of  any  investigations  like  barium   enema  n all...

if  v  dignosing  uc  based  on  above  lakshanas  whatever  u  quoted   without  investigation    r  v  not   missing   sm  major   disease  like  ca  colon...  polyp  or  tb  chrons  or  any  other  rectal  disorders...

wts  the  role  of  investigations  in ayu diagnosis...

[6/9, 10:04] Dr Pratibha P Mahesh: 

if  v  are   managing  through  ayu  dravyas    can  v   replace  loss  of  haustrations  which is  seen  in  UC...

if so  wts  the  minimum duration  of treatment..

in  ayu  also is  it kashta  sadhya vyadhi...

please  clarify...

if  v  want  to  manage  disease  how  long   pt  can  take  ayu  drugs  without  any  adverse  effects...

in  tenesmus  if   picchabhasthi   is  given  its not going  to  injure   sphincters...

[6/9, 10:38] Dr Surendra A Soni: 

Dr. Pratibha ji !

No any active participants in the group opined that modern diagnosis should not done.

I mentioned that modern investigations/ diagnosis are mile stone.

The whole discussion aimed how to manage effectively as per Ayurved with root eradication of the disease.

Thanks for opinion.

[6/9, 10:42] Vd Ranga Prasad Ji Chennai: 

I observed that the whole discussion was moving towards deciphering chikitsa sUtra for a modern Dx of U.C, with *probabilities of DDx in our Samhitas*. 

Dx-ing UC in itself makes things gets confirmed that modern gadgets and investigations were used, without saying. 

The topic just started with *plain mentioning of UC* from the very first beginning and didnot start with *presentation of clinical symptoms*. 

[6/9, 10:48] Dr Pratibha P Mahesh: 

yes  i  agree   sir...

if  any  fresh  pt  without  any  previous h/o  investigation  can  v diagnose  uc or  its  relative  vyadhi   in  ayu  .....

is  it  investigation  is must...

its  not  ayu  roga  lakshana  n  its  management  is  not  sufficient  to   dignose  uc..

[6/9, 10:52] Vd Ranga Prasad Ji Chennai: 

That ain't possible in the first sitting either with Malena or P/R bleeding or sans it, particularly when it is an acute case. 

But if the pt is quite a good observer and the Physician is vigilant, with the help of the consistency, frequency and color of the stools, from the clinical point of view the *benefit of doubt* may be pointed towards UC and further investigations be done to confirm it to exclude polyp or Ca pathologies. 

[6/9, 10:54] Dr Surendra A Soni: 

Dr. Pratibha ! It needs larger scale study to prove. So it is difficult to say with few cases only.

 when patient get symptomatic relief  mostly he doesn't want to go for repeatation of investigations like barium or colonoscopy.

Pichha vasti is healer how can it injure sphincter...? 

If method of administration is defective and instrument is defective then complications may there.

[6/9, 11:07] Bhushan bhakad Vd. Nasik: 

In lecture of vaidya sameer jamadgni sir, Pune, he told that

In any case of UC Inspite of dosh dushya, following basti works very nicely-

Padmakadi Ghrut + shatavari Ghrut ( 2 parts) + 16 part milk + 1 part mochras 

Heat this mixture, then after becomes semisolid filter it, and administer it. 

I personally not used it but any of u vaidya havi patient of UC, nd want to give basti for bleeding can try this. 

Acc to jamadgni sir 100% results are there. 

So please try it

[6/9, 11:09] Ashwini Kumar Sood Dr: 

UC is confirmed by colonoscopy. In p/r examination can finger go so high to reach colon ? FOR a better understanding of a disease it is always good to confirm it.

[6/9, 11:09] Dr Surendra A Soni:

Vd. Bhooshan ! 

Not exactly same but I have used.

[6/9, 11:09] Bhushan bhakad Vd. Nasik: 

Padmakadi Ghruta From raktpitta Chikitsa, and shatavari is plain shatavari Ghruta.

[6/9, 11:42] pawan madan Dr: 

Very good question Dr. Pratibha ! *But u havent noticed here that we are not in a process of making modern diagnosisi of a case ----- but we are in a process of making ayurvedic diagnosis of the already diagnosed cases of ulcerative colitis by modern doctors*  

          

*PLEASE SEE THE HEADING OF THE TOPIC --- HERE WE ARE WORKING ON THE ALREADY DIAGNOSED ULCERATIVE COLITIS CASES*  

I hope the things are clear for u now. Thanks.

[6/9, 11:47] pawan madan Dr: 

yes sir. But before deciding the chikitsa sutra of UC ---- it was tried that the patients of UC fall in which categories of the ayurvedic vyaadhis and then the chikitsa sutra of those vyaadhis needed to be applied. Thank u sir for clarification.

[6/9, 11:48] Dr Surendra A Soni: 

[6/9, 11:52] pawan madan Dr: 

Dr. Pratibha ! if u want to confirm that it is UC or not.....why not u send the patient to gastroenterlogist and confirm ------- then u make ur own ayurvedic nidaan of that particular UC case and proceed......    to see what changes have been there in pathology u can again take the help of ur gastroenterlogist ----- at least we have to take benefit of them also.....

[6/9, 15:55] D.C. Katoch sir: 

What does it mean - not to convert UC in to Ayurvedic terms or only to name/classify the patient as of Raktaja Pravahika, Raktatissar etc... In the latter option there will be different lines of treatment.

[6/9, 16:06] pawan madan Dr: 

No no sir

It means...

.....to diagnose a patient having UC as per ayurveda

....and to treat that patient as per the Ayu Nidaan.......which can be different as u mentioned...there can be different lines of treatment.

So different cases of UC may have different lines of treatment as per the ayu Nidaan.

[6/9, 18:28] Anupma Patra Dr: 

Sir I am feeling very happy that gradually we are orienting more and more  towards  samhita. Very nice discussion going on about uc. I am missing it in time but simultaneously  enjoying later. 

Very nice compilation sir

One thing I want to quote that perhaps kosthagat vrana described by acharya Vagbhatt will come under adhag raktapitta.

Nice point raised by Pratibha madam also. Madam I think not a single diagnosis as per modern tools have been excluded in our literature. But we have to prove the effectiveness of our drugs or therapies for indivisual diagnosis in a scientific way. Each point raised by u are  separate  topic for research. help of modern tools are inevitable to show our efficacy in present time but not compulsory for a confident clinician.

********************************************************************************************************

Above discussion held on 'Kaysampraday" a Famous WhatsApp discussion group  of  well known Vaidyas from all over the India. 

Compiled & edited by

Dr.Surendra A. Soni

M.D.,PhD (KC)

Associate Professor

Dept. of Kaya-chikitsa

Govt. Ayurveda College

Vadodara Gujarat, India.

Email: surendraasoni@gmail.com

Mobile No. +91 9408441150