A Case study: Ayurvedic Management of Hrudadaurbalya-janita-Vrukkamaya (Pre-renal-CKD)

A Case study: Ayurvedic Management of Hrudadaurbalya-janita- Vrukkamaya(Pre-renal- CKD)

**Dr. Priyanka Parmar^1*,**

Dr. Khushali Bhatt²,

Prof. Vd. Surendra A. Soni³

Vd. Anamika S. Soni⁴

^1,2M.D. Scholars, P.G. Department of Kayachikitsa, Akhandanand Ayurveda Collage, Ahmedabad.

³Professor and HOD, P.G. Department of Kayachikitsa, Akhandanand Ayurveda Collage, Ahmedabad.

⁴Associate Professor, P.G. Department of Kayachikitsa, Akhandanand Ayurveda Collage, Ahmedabad.

Abstract

LVH is thickening of wall of heart's main pumping chamber. This thickened heart wall loses its elasticity and may result in elevation of pressure within heart and sometimes poor pumping action. The most common cause is high blood pressure. LVH can often be corrected by treating underlying problem causing heart to work too hard. Depending on type of damage that has occured, treatment measures may include medications like ACE Inhibitors, Beta blockers, Ca channel blockers, diuretics etc as well as healthy lifestyle changes which helps to reduce HTN. If LVH is caused by a value problem, surgery may be needed to repair or replace the valve.Though LVH is considered a disease entity where western medical science has great efficacious drugs and ayurveda is generally not considered a treatment of choice because of fear of emergencies. LVH can closely be corelated with Tridoshaj Hrdroga.^[1] In Ayurvedic texts; detailed description of Hrudroga along with its treatment is mentioned. Here is a case of LVH treated successfully with Ayurvedic treatment.

Keywords: Hrdroga, Vrikkamaya, Mahastrotas, Marmasthana

Introduction

Hrudroga (Heart disease) is very common in present scenario. Due to change in concept of diet and lifestyle; the incidence of Hrudrog is increasing at high rate. Heart failure describes the state that develops when the heart cannot maintain an adequate cardiac output or can do so only at expense of elevated filling pressure.

The prevalence rises from ~1% in group 50-59 years to between 5 and 10%. of those aged 80-89 years. Overall prognosis is poor;~50% of patients with severe heart failure due to LV dysfunction die within 2 yrs, many from ventricular arrhythmias or MI.^[5]

LVH is thickening of the wall of heart’s main pumping chamber.LVH may be present for many years without any noticeable symptoms. As the condition worsens, symptoms may develop such as shortness of breath, fatigue, chest pain, heart palpitations, dizziness or fainting. Because LVH can develop silently over several years without symptoms, it can be difficult to diagnose LVH, even before symptoms become noticable.

As per Ayurveda; hrudaya is marma and mula sthana (origination site) for rasavaha and pranavaha strotas.While pranavaha stroto mula sthana (origination site) is described Mahastrotas (GIT). So we can say mahastrotas (GIT) is most important strotas in the body being the main site of digestion and assimilation of ingested food and producer of adhya dhatu rasa dhatu.

According to ayurveda origination of all disease are instructed from GIT because of disturbance of function of agni/mahastrotas (GIT) .Except mental causes where affection in GIT takes place later;leading to initiation of disease process.

Ayurveda precisely emphasis that prolonged affection of one or two strotas will always affect remaining strotas as per the nature of pathogenesis.^[3]Present case is a very good example of above principle where pathogenesis silently progressed to most important marma Heart primarily and kidney secondarily.And this is all because of varied slow etiological factors,self medication and complex lifestyle of patient;ignoring the basic rules of healthy life mentioned in ayurveda.These are the regions that clinical pictures of various diseases do not found as per textual referances.

Present case is also as per above principle.Thank God that parallel modern science have developed thousands of investigation technology that can identify pathologies;so early helping the human being as well as Ayurveda physicians.

From ancient time Ayurved is known for serving society by cure and prevention (Swasthya Rakshanam) and this concept is exactly applicable on cure and prevention of heart disease.

In present case study, patient has history of Ativyayama, Chinta (Stress) as a cause of disease. Habituation of causative factors resulted in manifestation of vata pradhan tridosha vitiation in Hrudaya marma and hence occurance of LVH. Hence patient was treated with treatment principles like Nidana parivarjana, tridosha shaman, vyadhiviparita and Dhatuposhan chikitsa.

PATIENT INFORMATION:

A 48 year male patient visited OPD no. 4 of (PG Kayachikitsa department) at Govt. Akhandanand Ayurved Hospital Bhadra, Ahmedabad date on 4/6/22 having following complains :

Akshikutashotha (Peri orbital oedema)

Ubhayapadasotha(bilateral Pedal oedema)

Daurbalyanubhuti (Weakness)

katishula (Back Ache)

Ubhayapadashula(Bilateral lower limb pain)

Shwasakasthata (Dyspnoea)

kasa (Coughing)

Kaphasthivana (Sputum expectoration)

Sakastha Savibandha Malapravrutti(Constipation)

Saphena mutra pravruti (Frothy urine)

Bhojanottar Daha (Burning sensation after meal)

since last 6 months.

Patient was healthy before 6 months.He had constipation & was taking Triphala churna for more than 10 yrs by self. Before 6 months he felt weakness and mild swelling at both legs. Then gradually he started feeling difficulty in breathing and coughing, so he visited nearby Hospital and diagnosed Kidney failure and was referred to IKD- civil Hospital Ahmedabad and diagnosed LVH (Heart failure), Hypertension as a cause of kidney failure and thus treated for same. Patient had mild relief in symptoms but reports were worsening consecutively and hence he was advised Renal dialysis. Then patient approached for Ayurvedic teatment at Kayachikitsa OPD Govt. Akhandanand Ayurved Hospital, Ahmedabad.

PAST HISTORY: hypertension

FAMILY HISTORY: Nil

PERSONAL HISTORY:

Diet - excess and frequent consumption of substances having ushna, tikshna, guru, ruksha, kashaya property

Vihara-Excess physical exertion i.e vyayama, krodha, bhaya etc

Sleep-disturbed

Appetite-normal

Bowel movement-once/day(Savibandha)

Micturation-3 to 4 times/day

1-2 times/night

Pulse-78/min

Bp-180/100 mm Hg

Temp-98.6 F

NIDANA PANCHAKA

Nidana - Vyayama, Chinta, Bhaya

Purvarupa - Patient had high blood pressure 7 yrs ago but it was relieved to normal blood pressure within one month of treatment and had mala vibandha.

Rupa- Shwasakashtata, Sakaphakasa, Mukhashotha UbhayapadaShotha, Daurbalyanubhuti.

Samprapti –

Nidana Sevan

vatapradhan tridosha prakopa

Pakvashaya (vibandha)

Sthanasamshaya at Hrudaya marma

V Hrudaya Aagamo

V Hrudroga

Asamyaka Rasa samvahana

Aprinana,Ajivana

V Paraspara marma dusti

V Vrukka dushti

Vrukka Dhatukshaya

VrukkaRoga (Basti marma involvement)

Symptoms of cardiac and kidney failure.

Samprapti Ghataka

1. Dosha-vata pradhan tridosha

2. Dushya - Rasa,rakta, Mamsa,meda,asthi,majja, shukra, Mutra, kleda

3. Strotas - Rasavaha, raktavaha, mamsavaha, medavaha, asthivaha, majjavaha, shukravaha, mutravaha, purishavaha, annavaha

4. ShotodustiPrakara –Sanga,Vimarga gamana

5. Udbhavsthan –Ama- Pakvashaya

6. Adhistham–Shareer,Manas

7. VyaktiSthana-Hundaya, Basti marma

8. Agni- Manda

9. Vyadhi Swabhava- Chirkari

10. Sadhyasadhyata-kricchasadhya/Yapya

Sama-nirama—Sama

INVESTIGATIONS

Before treatment

2D ECHO

USG BEFORE TREATMENT

DIAGNOSIS – On the basis of clinical history,clinical presentation, 2DECHO, RFT investigations, patient was diagnosed as a case of hrudroga janita vrukkamaya.

THERAPEUTIC INTERVATION:

Alternate kshira basti and Niruha basti was planned in the management along with medicines(Shaman chikitsa) was started as below

Medicine	Dose	Duration
Hingwashtak churna-6 gm Navayasa loha 250 mg Mukta shukti 500 mg	1 tsp BD	30 days
Agnitundi vati	2 BD	7 days
Gokshuradi guggulu	2 BD	23 days
Prabhakar vati	2 BD	30 days
Laghu vasant malti rasa	2BD	30 days
Yogendra rasa	2 BD	30 days
Shiva gulika	1 od	30 days
Tablet Cardimap	2 BD	30 days
Dashmula kwath-10 g Pathydi kwath-10 g Prakshepa of Gokshur-20 g Shatavari-5 g Punarnava-5 g	100 ml BD	30 days

All these medicines given with milk before meal

*Vastidravya(Kshira vasti)*	Doses
Kshir	200 ml
Bruhat manjisthadi kwatha	150 gm
Gomutra arka	25 ml
Gokshura churna	20 gm
Punarnava churna	20 gm
Guduchi churna	20 gm

*Vasti dravya(Niruha)*	Doses
Madhu	60 ml
Saindhav	10 gm
Shatpushpa	20 gm
Goghrita	60 ml
Kwatha(Dashmula+pathyadi)	250 ml

Pathya-Apathya

Patient was advised pathya ahara and vihara during the course of medication like-fresh cooked food ,easily digestible light diet like khichdi(Vilepi), mudga yusha(green gram soup), vegetable soup, roti , sabji(bottle gourd, ridge gourd, sponge gourd, pointed gourd, bittergourd, (spiny gourd etc).Patient was barred for day sleep(Divaswapa) and awakening at night(Ratri jagrana),suppression to natural urges, excess physical exertion(Adhika vyayama).

ASSESSMENT OF DISEASE IMPROVEMENT:

SUBJECTIVE CRITERIA

Symptoms	B.T	A.T

		1 st wk	2 nd wk	3 rd wk	4 th wk
Akshikutashotha	+++	++	++	+	-
Ubhayapadasotha	+++	++	+	-	-
Daurbalyanubhuti	++++	+++	++	+	+
Katishula	+++	+	-	-	-
Ubhayapadashula	++	+	-	-	-
shwasakasthata	+++	++	+	-	-
Kasa evum kaphasthivana	++	+	-	-	-
Sakastha savibandha malapravrutti	+++	+	-	-	-
Sphena mutra pravrutti	++	+	-	-	-
Bhojanottar daha	++	+	-	-	-

INVESTIGATIONS AFTER TREATMENT:

RESULT

After 20 days of Ayurvedic treatment, patient got complete relief in symptoms like facial oedema, pedal oedema, breathlessness, weakness, constipation, abdominal pain and backpain. After 30 days of Ayurvedic treatment patient's blood pressure under normal range(On admission on 4/6/22 patient had 180/100 mm Hg and on discharge on 9/7/22 he had 128/82 mm Hg).

FOLLOW UP:

Follow up medicine was given in OPD of Government Akhandanand Ayurveda College Hospital, Ahmedabad. Naimittika Rasayan drugs dispensed as per the condition of patient and 2D Echo report and other blood investigations.

Medicine	Anupana	Dose
Avipattikar churna 6g Navayasa loha 250 mg Muktashukti 250 mg	Ghrita	1 tsp BD
Gokshur churna 5g Punarnava churna 5g Guduchi churna 5g Ashwagandha churna 5g	Milk	50 ml BD
Manjistadi kwatha		100 ml BD
Sudarshan ghanvati	Ushnodaka	2 BD
Shiva gulika	Milk	1 OD
Added after 2 mths
Bruhat bangeshwar rasa	Milk	1 OD
Vastiamayantaka ghrita	Ushnodaka	2 tsp in morning

DISCUSSION:

Heart is one of the most vital organ in the body.The heart is important seat of vata, pitta, kapha, Ojas. The increased incidence of cardiac diseases all over the world is due to faulty diet pattern and lifestyle. Due to food adulteration ,with increased use of pesticides in vegetables and fruits leads to vitiation of dosas, mahastrotas (GIT) which is mulasthan of pranavah strotas. Due to various causative factors like irregular food habits, stress ,anxiety leads to vitiation of aadya dhaatu rasadhatu which leads to leads to vitiation of rasvaha strotas.In present case long term usage of Trifala kept GIT symptom free but alteration in dhaatu poshan krama is estimated in this case because there is no medication in the world which can guarantee to be disease free life. Though triphala is stated one of the best rasayan drug but non judicious regular use without avoiding the factors like ritucharya, vaya, dosha, agni definitely unable to produce its described function of rasayan karma.Prolonged Triphala use as a laxative certainly would produced roukshya (dryness) in GIT as well as adhya rasdhatu. Additonally mental stress/ anxiety/sorrow/ fear and important pathological role as per principle mentioned by acharya charaka in sutrasthan 30. So, the additionally other nidana mentioned collectively work together as mentioned above and leads to rasavaha mula sthana , hridaya and pranavaha strotas mulasthan GIT leading to cardiac pathology which later involved another marma sthana vrukka by principle, So ayurvedic management was planned according to the pathology described above.

Initially patient had akshikuta shotha, ubhayapadashotha ,daurbalya, katishula, ubhayapadashula, shwasakasthatha, kasa, kaphasthivana, sakastha savibandha malapravrutti etc so; the treatment started with kleda harana, vata anuloman, deepan ,pachan, hrudbalya drugs.

Combination of Hingwastaka churna,navayasa loha,muktashukti bhasma,agnitundi vati,gokshuradi guggulu,prabhakar vati,laghu vasant malti rasa,yogendra rasa,cardimap,dashmula pathyadi kwatha were selected and it worked very well and patient got 100% relief in all signs and symptoms except weakness and no changes in lab parameters. There was slight elevation in BP so Agnitundi vati was stopped after 7 days and gokshuradi guggulu tablet was started and this problem was solved. In this management ksheer basti and Niruha basti was given alternatively because of presence of kleda in the body, because of impaired cardiac and renal function.This management kept continued and it improved the LVEF function from 25% to 45% and later on after 2 months it improved to 50%. With this statement patient was totally asymptomatic

On admission reports: S.Creat-5.51, urea-60,LVEF-25%

On Discharge:S.Creat-4.7 and Urea-78,LVEF-45%

The patient was discharged on date 9/7/22 when he was symptom free and following medicines kept continued in followup.

Combination of Avipattikar churna, navayas loha, muktashukti, Manjisthadi kwatha, Sudarshan ghanvati ,along with kshirpaka of gokshur,punarnava,guduchi churna was given.

The drug used in the management are very popular ayurvedic medicines.We hope that all ayurvedic physicians know details about these drugs;so it is not elaborated.

Later on after 2 months patient was advised USG and there was markly increase in size of kidney.Rt. kidney measuring 81 mm and Lf. Kidney measuring 82 mm(on 16/09/22).Thenafter Bangeshwar rasa and Vastiamayantaka ghrita was started along with followup medicines.

CONCLUSION

Here the patient is treated with ayurvedic principles of hrdroga and got marked improvement within 1 months without any side effect or recurrence .All the observation was done on the basis of clinical presentation and clinical investigations. Before the treatment the patient was having symptoms like Akshikutashotha, Ubhayapadasotha, Daurbalyanubhuti, Katishula , Ubhayapadashula, shwasakasthata , Kasa evum kaphasthivana, Sakastha savibandha malapravrutti, Sphena mutra pravrutti Bhojanottar daha. With the internal medication along with Panchakarma treatment ( Kshirbasti and niruha basti alternate) for 20 days he got relief from all symptoms. From this study we can conclude that hrdroga janita vrikkamaya can be managed successfully by ayurvedic principles.

REFERENCES

1. Charak Samhita savimarsh vidyotini hindi vyakhyopeta chowkhambha Bharti academyby Kashinath shastri and Dr. Gorakhnath chaturvedi Sutra Sthana 17/30-35.

2. Charak Samhita savimarsh vidyotini hindi vyakhyopeta chowkhambha Bharti academyby Kashinath shastri and Dr. Gorakhnath chaturvedi Sutra Sthana 30/13.

3. Charak Samhita savimarsh vidyotini hindi vyakhyopeta chowkhambha Bharti academyby Kashinath shastri and Dr. Gorakhnath chaturvedi Viman Sthana 5/8.

4. Charak Samhita savimarsh vidyotini hindi vyakhyopeta chowkhambha Bharti academyby Kashinath shastri and Dr. Gorakhnath chaturvedi Siddhi Sthana 26/.

5. Davidson’s essentials of Medicine – Edited by j.Alastair Innes and Simon Maxwell – 2^nd Edition.

****************************************************************************************************************Above article was published in 'International journal of Ayurveda & Pharmaceutical Chemistry'. www.ijapc.com

Article Link: https://in.docworkspace.com/d/sIE3Q5tggyMPIpgY?sa=share.copy_link

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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

Kayachikitsa (Guj. Ayu. Univ., Jamnagar, Gujarat, India).

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