Case-presentation: AYURVEDIC LINE OF TREATMENT OF GULMA – A SINGLE CASE STUDY.

 

AYURVEDIC LINE OF TREATMENT IN GULMA – A SINGLE CASE STUDY *Vd. Radha Patel **Vd. Khushali Bhatt ***Prof. Vd. Surendra A. Soni   */** P.G. Scholars, P. G. Department of K. C., G.A.A.C., Ahmedabad, Gujarat. ***H.O.D., P. G. Department of K. C., G.A.A.C., Ahmedabad, Gujarat.

ABSTRACT A male patient with acute abdominal pain having history of intake of excess fast / market food came routine in OPD of GAAC hospital, Ahmedabad for treatment with apprehensive condition. His USG reports was s/o ileitis, typhlitis with sigmoid colitis, gastritis along with gas filled bowel loops. Patient was successfully treated on the line of pakvashaygata vata or vatapaittika gulma and response of treatment was remarkably good.   KEYWORDS: Pakvashaygata vata, Vata Paittika Gulma

Introduction

Gulma is well described by Acharya Charaka in Charaka Samhita Nidana Sthana 3. [1] and Charak Samhita Chikitsa Sthana 5. [2] It is of five types – Vataja, Pittaja, Kaphaja, Raktaja, Sannipataja. Gulma is primarily concerned to Mahastrotasa/GIT. Acharya Charaka has categorized this condition as either Koshthashrita or Shakhashrita -as per concept of trayorogamarga. When gulma doesn’t afflict lumen of GIT, then it is Koshthashrita and vice versa. Vata dosha is mainly responsible for gulma roga and either associated with pitta or kapha as per indulged nidana. Five sites has been described for gulma and signs and symptoms clinically varies as per the site involvement.

 

Samprapti Ghatak

Dosha – Vata pradhan tridosha

                 Anubandha pitta

Vata dosha - dravayataha vridhhi +

                        Gunataha vridhhi ++

                        Karmatahavridhhi +

Pitta dosha- dravayataha vridhhi +

                        Gunataha vridhhi +

                       Karmataha vridhhi +

Dushya–Rasa, Rakta, Mansa, Purish

Agni - vishamagni

Adhisthan–Sharira

Vyaktisthan – Udara-              Pakwashay (mahastrotasa)

Strotas- Annavaha, Rasavaha, 

 Raktavaha, Purishvaha

Rogamarga- Koshtha

Strotodusti –Sanga/ Vimargagaman

Sama/Nirama - Sama

Vyadhi prakara-Ashukari

Sadhyasadhyata - Krichhasadhya

Patient’s Information

Present case study is concerned to a 45 years old male patient having Vata-pitta prakriti who was regularly in intake of spicy, junk fast food and experienced episode of severe pain in abdomen on 12^th November 2021. Then patient consulted telephonically initially & was advised tablet Entrid (1TDS) and tablet Liv compound (4 TDS) with Mudgayush, Manda as pathya, he got mild relief with this treatment only. On 18^th November 2021, he came to OPD no. 4, P.G. Department of Kayachikitsa, GAAC, Ahmedabad with following chief complaints.

Chief complains

Udarashool (Abdominal pain) since 1 month

Udaragauravta (Heaviness of abdomen) since 1 month

Udaraaadhman (Flatulence) since 1 month

Dourbalya (weakness) since 2 months

Samprapti

History of Present Complaint

Patient was relatively healthy before 1 month. Then he had gradually started complaints of abdominal pain, heaviness of abdomen, flatulence, and weakness. On 12^th November 2021, patient experienced episode of severe pain in abdomen. So, he came to GAAC Hospital for ayurvedic treatment.

Past History:- k/c/o hypertension

Family History: Nil

Personal History:

Diet - Veg Diet, Spicy junk/fast food

Addiction: Nil

Appetite –Disturbed

Profession sitting job (labour work)

Sleep – Disturbed

Micturation–4/5 t/day, 1/2/t/night

Bowel-  1 time/ day, regular

On Examination

Blood pressure- 132/90 mmHg

Pulse rate- 78/min

Respiratory rate- 19/min

Weight- 65 kg

O/E:Per Abdomen:

Inspection:- Distended Abdomen

Palpation:- Mild tenderness on Left iliac & hypogastric region

Percussion:- Tympanic sound over  hypogastric region 

Auscultation:- NAD

 

INVESTIGATION

USG Abdomen as on 13^th November 2021

THERAPEUTIC INTERVENTION

TREATMENT

The patient was diagnosed with Vata-paittika gulma on the basis of investigation reports and sign and symptoms. He had mild improvement with telephonic consultation. Then on 18^th November 2021 after he visited OPD was advised following management with the objective of complete samprapti vighatan [5] (permanent cure).

Medicine	Dose	Duration
1)    Tab Entrid	1 TDS	40 days
2) Tab. Liv     Compound	4 TDS	40 days
3)  Lavanbhaskar    churna Muktasukti Bhasma Navayas lauha along with 2 tbsp cow’s ghee	6gm 500 mg 500 mg       TDS	40 days
4)  Samsamani vati	4 TDS	40 days
5)  Chitrakadi vati	4 TDS	40 days
6)Pathyadi kwatha  +  Punarnavadi Kwatha	10gm BDS	40 days

The above treatment was continued for 40 days along with following advice of  pathya and apathya.

Pathya –Apthya (Wholesome diet and activity) :

               Patient was advised for pathya aahar and vihara during the course of medication like – fresh home cooked, warm, easily digestible light diet like- khichadi (vilepi), mudgayusha (green gram soup), vegetables soups etc. and restricted from taking day sleep (divaswapa), awaking at night,  exposure to  pravata (direct exposure of wind ), exess sunlight,  control natural urges ( vegadharana).

  Observation and Results

 

SYMTOMS	13-11-2021	20-11-2021	27-11-2021	4-12-2021	11-12-2021	22-12-2021
1.    Abdominal pain ( udarshool) 2.   Udara gaurava  (Heaviness of abdomen) 3.Ati-udgara (Bloating)          4.Weakness (dourbalya)	+++ +++ +++ +++	+++ +++ +++ ++	++ ++ ++ ++	++ ++ ++ +	+ + + -	- - - -

 

 

INVESTIGATION AFTER TREATMENT

USG abdomen was repeated after 15 days

RESULTS

  After starting above mentioned medications, pathya and apathya were adviced. Patient started feeling improvement from Day-1. Dietary restrictions helped a lot in this case as he was advised specific light diet like yush, krishara etc. After the course of complete treatment patient was completely free from all complaints and marked improvement in USG pathological findings which shows the efficacy of classical ayurvedic management in patients of gulma and inflammatory bowel condition.

FOLLOW-UP

                Follow up was taken for 4 weeks in OPD of Akhandand Ayurveda collage, Ahmedabad.  In follow up, medication was changed to restore healthy life. In last USG, mild edematous terminal ilium and caecum was found  so it can be tried to relieve this with further medicine and follow-up. Same medication was continued for further weeks.

DISCUSSION

       Shakhashrita gulma always involves dushyas (dhatus) of GIT canal. In this case of pakwashayagata gulma/Vata involved thickening of terminal ileum- caecum and sigmoid colon are indicative of involvement of shakha / dhatus. Hence, this is taken as shakhashrita gulma on the basis of modern investigation reports. Selection of drug is mainly to execute the bhedana karma of gulma  as per classical line of treatment of vatika and Pittaja gulma. The use of lavanbhaskar and chitrakadivati is as per principle of bhedana. Being enriched with the properties of Kshara - Deepaña, pachana and anuloman.

            Samshamni vati, punarnavadi kwatha and pathyadi kwatha have been selected as adjuvent to main Bhedana therapy in the form of deepana, pachana, anulomana, shothaprashamana etc Muktasukti and navayasa lauha used as pitta vata shamana, balya, shonita prasadana. Tab. Liv compound was added as yakritabalya and Tab. Enrid was given as antiinflammatory (shotha prashamana) as it is enriched with Panchamrita Parpati. So it can be concluded that classical management of gulma is applicable on the basis of modern investigation, findings along with appropriate history of patient and suitable required pathya karma.

CONCLUSION

                      Modern diagnostic tools are always helpful to Ayurvedic practitioners in finding the diagnosis as per Ayurvedic classical texts.Gulma is such a kind of disease / diagnosis that is practiced/ used very less in clinical practice because of no standard investigation protocol has been established. This case study proves that that shankhashrita gulma does existand can be cured on the classical line of management of gulma.

REFERENCES 

 1. Charaka Samhita savimarsh vidyotini hindi vyakhyopeta chowkhambha Bharti academy by Kashinath shastri and Dr. Gorakhnath Chaturvedi Nidana Sthana 3/3.

 2. Charaka Samhita savimarsh vidyotini hindi vyakhyopeta chowkhambha Bharti academy by Kashinath shastri and Dr. Gorakhnath Chaturvedi Chikitsa Sthana 5/8.

3. Charaka Samhita savimarsh vidyotini hindi vyakhyopeta chowkhambha Bharti academy by Kashinath shastri and Dr. Gorakhnath Chaturvedi Chikitsa Sthana 5/6,7. 

4. Davidson’s principals and practice of medicine 21st edition edited by Nicki colledge, Brian walker, Stuart Ralston. 

5. Charaka Samhita savimarsh vidyotini hindi vyakhyopeta chowkhambha Bharti academy by Kashinath shastri and Dr. Gorakhnath Chaturvedi Chikitsa Sthana 5/21,33.

 

 ****************************************************************************************************************Above article was published in 'World Journal of Pharmaceutical Research www.wjpr.net.

Article Link: https://wjpr.net/abstract_show/20751

 

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Uploaded by

Vd. Rituraj Verma

B. A. M. S.

Shri Dadaji Ayurveda & Panchakarma Center,

Khandawa, M.P., India.

Mobile No.:-

 +91 9669793990,

+91 9617617746

Edited by

Dr. Surendra A. Soni

M.D., PhD (KC) 

Professor & Head

P. G. DEPT. OF KAYACHIKITSA

Govt. Akhandanand Ayurveda College

Ahmedabad, GUJARAT, India.

Email: surendraasoni@gmail.com