Ayurvedic management of Pure Red Cell Aplasia(KAPHA PRADHANA TRIDOSHAJA PANDU): A case study
*Dr. Jigna Yadav1,
**Dr. Komal Sathavara2,
***Vd. Anamika S. Soni3
****Prof. Surendra A. Soni4
*M.D. Scholar,
**M.D. Scholar,
***Associate Professor,
****Professor, and HOD,
PG Department of Kayachikitsa, Akhandanand Ayurveda College, Ahmedabad.
Introduction -
Pure red cell aplasia is rare bone marrow failure with a normocytic
anemia and reticulocytopenia with a normal count of white blood cells and
platelets. Here we can correlate PRCA with Kapha Pradhana Tridoshaja Pandu. Kaphaj Pandu is a type of Pandu where Lakshana of Kapha Dosha
is predominant. Pandu is a Pitta Pradhana Vyadhi, in all types of
Pandu pitta dosha is involved and it is the main contributing factor in Samprapti
of Pandu, but according to symptoms of disease it is further divided
into Vataja, Pittaja, Kaphaj, Sannipataja and Mridbhakshanajanya Pandu.[i]In
case of Kaphaj Pandu, with Pitta, Kapha Dosha also gets
involved in producing this particular condition. Here alongwith 'Pandubhava' the symptoms like Tandra, Alasya, Gaurava, Praseka,
Sweta varnata of Twak, Mukha and Mutra are seen
which indicates Kaphajdusti.
PRCA is a rare disorder. A nationwide epidemiologic study for acquired
PRCA identified 1055 patients, an incidence rate of 1.06 patients per million
per year. The median age was 73 years old with female predominance (1.5: 1),
and 69% of the PRCA was idiopathic.
In this case, we have tried to assess the Samprapti ghatak
(Pathological agent), related Samprapti (Pathophysiology) and break the
cycle of pathogenesis of the disease, and it resulted to the root eradication
of the disease.
Patient Information -
A 27year old male patient came to OPD no.- 4 (P.G. Kayachikitsa
department) at Govt. Akhandanand Ayurveda College and hospital, Ahmedabad with
following complaints on 30th July 2022.
He took many allopathic medicine and blood transfusion approx. every 2 months in the last 3.5 years. Due to Blood transfusion, he used to get rid of his symptoms for short term of period only. He got tired of the blood transfusion procedure and came here for ayurvedic treatment.
Chief complaints -
· Daurbalyanubhuti (Weakness)
+++
· Aayase swasakashtata
(Breath- lessness)+++
· Aruchi (Anorexia)++
· Udargauravata (Abdominal
heaviness) ++
· Ubhayapada shoth
(Pedal edema) ++
· Hridadrava
(Palpitation)+
Patient came with reports which is mentioned below. Bone marrow biopsy shows erythroid hypoplasia and suggestive pure red cell aplasia (20/08/2018). Hemoglobin level is 2.8 g/dl (09/07/2022).
Past History -
Patient was diagnosed PRCA by bone marrow examination and treated with
allopathic medicine and blood transfusion since3.5 years.
Diabetes mellitus – since 4 years
Hypothyroidism – since 4 years
Jaundice - in 2018 and 2020
Family history - no any specific
Addiction -
Alcohol - 4 years
Cigarette smoking - 4 years
Tobbaco - 8 years
Personal history -
· Diet - Mixed,
Fast food
· Sleep -
Disturbed
· Appetite -
Poor
· Bowel movement
- Constipated 1 time / day
· Micturition -
3-4 time/day, 1 time/night
· Pulse - 78/min
· Blood pressure
- 128/80 km hg
· Temperature -
98 F
· Respiration rate - 24/min
Investigation -
Patient came with Bunch of hemogram reports which was taken during
allopathic treatment and Blood transfusion every 2 month since 3.5year. Hemoglobin
and RBC count reports given below.
|
Sr no. |
Date |
Hb% (g/dl) |
RBC count (mill/cmm) |
|
1. |
20/08/18 |
7.6 |
2.58 |
|
2. |
30/08/18 |
7.3 |
2.55 |
|
3. |
04/09/18 |
9.1 |
3.15 |
|
4. |
21/09/18 |
12.9 |
4.58 |
|
5. |
25/02/19 |
5.5 |
1.97 |
|
6. |
05/03/19 |
7.3 |
2.59 |
|
7. |
15/03/19 |
10.3 |
3.49 |
|
8. |
29/03/19 |
12.6 |
4.35 |
|
9. |
07/06/19 |
13.6 |
4.95 |
|
10. |
14/09/20 |
9.9 |
3.15 |
|
11. |
19/09/20 |
12.4 |
4.11 |
|
12. |
28/01/22 |
5.8 |
1.93 |
|
13. |
10/02/22 |
4.2 |
1.37 |
|
14. |
22/02/22 |
7.1 |
2.39 |
|
15. |
28/02/22 |
6.4 |
2.27 |
|
16. |
12/03/22 |
4.1 |
1.52 |
|
17. |
23/03/22 |
4.4 |
1.15 |
|
18. |
05/04/22 |
5.1 |
1.17 |
|
19. |
27/04/22 |
2.9 |
0.52 |
|
20. |
17/05/22 |
7.1 |
1.75 |
|
21. |
09/07/22 |
2.8 |
0.86 |
1.Prakriti: Kapha-pitta
2.Vikriti: Lakshana nimitta
3.Sara: Mamsa sara
4.Samhanana: Uttam
5.Pramana: Madhyama
6.Satmya: Madhyama
7.Satva: Madhyama
8.Aharashakti: Hina
9.Vyayamshakti: Hina
10.Vaya: Bala
Samprapti ghatak
o Dosha: Kapha
Pradhan tridosha
o Dushya: Rasa,
Rakta, Mamsa, Meda, Ashthi, Majja
o Strotas: Anna,
Rasa, Rakta, Mamsa, Meda, Ashthi, Majja, Purishvaha
o Stroto dusti:
Sanga
o Rogamarga:
Madhyama/ Shakha
o Agni: Manda
o Samata: Sama
o Adhisthana:
Sharir & manasa
o Udbhavasthana:
Amashaya samuttha
o Vyaktisthana:
Tvacha
o Swabhava:
Chirakari
o Sadhyaasadhyata:
Kriccha sadhya
|
|
1st
IPD VISIT
Initially, Shamana medicine was started for 5 days which is
described in below table. After 5 days Matrabasti was started with Mahasneha.
Total 25 Matrabasti was given with dose of 25 ml.
|
Sr no. |
Medicine |
Dosage |
|
1. |
Shivakshar pachak churna – 5gm + Navyas lauha – 250 mg + Muktasukti – 500mg |
2 BD With Ghrita |
|
2. |
Haritaki churna – 6gm + Guda – 6gm |
1 BD |
|
3. |
Dashmool kwath – 10ml + Pathyadi kwath – 10ml |
2 BD |
|
4. |
Punarnava mandoor |
2 BD |
|
5. |
Chandraprabha vati |
4 TDS |
After 15 days (15/08/2022)
After 30 days
(01/09/2022)
2nd
IPD VISIT
After Basti chikitsa patient got relief in all signs and
symptoms and got discharged at 06/09/2022. Then again, he started
consumption of alcohol and tobacco and all symptoms get evoked. When all
symptoms occurred, he again came to OPD no – 4 at Govt. Akhandanand Ayurveda
college and hospital on 25/02/2023 and got admitted in IPD.
|
Sr no. |
Medicine name |
Dosage |
|
1. |
Chandraprabhavati |
4 BD (after meal) |
|
2. |
Punarnava mandoor |
2 BD (after meal) |
|
3. |
Arogyavardhini vati |
2 BD (after meal) |
|
4. |
Kshirpaka – Ashwagandha churna - 5 gm Shatavari churna
- 5 gm Gokshura churna -
5 gm Guduchi churna - 5 gm Trikatu churna -
5 gm |
2 BD (after meal) |
|
5. |
Shivakshar pachan churna – 6 gm |
2 BD (before meal) |
|
Sr no. |
Karma |
Duration |
|
1. |
Kala basti –
Makshika
– 10 gm Lavana
– 10 gm Tila taila
– 20 ml Shatpushpa Kalka
– 10 gm Kwatha - Manjisthadi Kwatha
– 50ml Punarnavadi Kwatha –
50 ml
Dhanvantara taila
– 40 ml (till 07/03/2023) after that with Mahasneha – 40 ml |
26/02/2023 to 22/03/2023 |
|
2. |
Vamana karma
–
|
6 days (24/03/2023 to 29/03/2023) |
|
|
Sarvanga abhyanga and
swedana |
2 days (30/03/2023 and 31/03/2023) |
|
|
Vamana dravya Madanaphala
– 6 gm Saindhava – 2 gm Vacha churna
– 4 gm Madhu – 5 gm |
01/04/2023 Vega - 12 Upvega – 8
|
After treatment
|
Reports |
28/02/2023 |
20/03/2023 |
03/04/2023 |
|
Haemoglobin |
3.6 gm/dl |
7.8 gm/dl |
9.8 gm/dl |
|
RBC count |
1.15 mill/cmm |
2.46 mill/cmm |
3.19 mill/cmm |
|
ESR |
14 mm |
10 mm |
- |
|
CRP |
22.06 mg/L |
3.9 mg/L |
- |
|
SGPT |
175 U/L |
- |
113 U/L |
|
SGOT |
96 IU/L |
- |
62 IU/L |
|
S. Bilirubin (Direct) |
1.8 mg/dl |
- |
0.5 mg/dl |
|
S. Bilirubin (Indirect) |
1.0 mg/dl |
- |
0.4 mg/dl |
Result
|
Sr. no. |
Symptoms & Reports |
Before Treatment |
During Treatment (after 15
days) 15/08/2022 |
After Treatment (after 30 days) 01/09/2022 |
25/02/2023 |
03/04/2023 |
Latest 26/08/2023 |
|
1. |
Daurbalyanubhuti |
+++ |
++ |
+ |
+++ |
+ |
+ |
|
2. |
+++ |
++ |
+ |
++ |
+ |
- |
|
|
3. |
Aruchi |
++ |
+ |
- |
+ |
- |
- |
|
4. |
Udara gauravata |
++ |
+ |
- |
++ |
- |
- |
|
5. |
++ |
++ |
- |
+ |
+ |
- |
|
|
6. |
Hridadrava |
+ |
- |
- |
+ |
+ |
- |
|
7. |
Hb% |
2.8 gm/dl |
8.78 gm/dl |
11 gm/dl |
3.6 gm/dl |
9.8 gm/dl |
11.5 gm/dl |
|
8. |
RBC count |
0.86mill/cmm |
2.61 mill/cmm |
3.68 mill/cmm |
1.11 mill/cmm |
3.19 gm/dl |
- |
Discussion
As the young age patient
who had failure in love affairs and as recurrent engagement breakup let him
towards alcoholism, Gutkha chewing, Smoking, etc. abuses with irregular
lifestyle and food habits combinedly these factors affected the Dhatuposhanakrama
severely as the patient is young and with very good built and inherent Kaphaja
prakriti with good Vyadhikshamatva thus the alcoholism, etc
initially relieved the grief and stress leading to the weight gain[ii]
that ultimately converted in to Hypothyroidism then followed by Diabetes mellitus.
Later on, in the presence of diabetes mellitus and continue heavy alcohol
intake led to affection/impairment in liver function in along with
Anti-diabetic drug intake and this is the progress of the disease as per the Dhatugatatva
pattern. After continuously alcohol consumption, junk food and mental stress
leads to Pitta prakopa and as per the Dhatugatatva
principle up to the level of Majja dhatu caused bone marrow
hypoplasia disturb in the normal function of bone marrow and also caused Jaundice.
Simultaneously, the Dhatvagnimandya is the most important and foremost
cause in this case and second is alcoholism.
The management given to
the patient as per the stated above pathology Shivakshar pachana churna,
etc combination was given for Deepana, Pachana and Vatanulomana.
Guda Haritaki
was given to pacify/expel Pitta dosha and to increase the Dhatvagni
and pacify the fluid retention/Shotha.
Dashmool kwath,
Pathyadi Kwath, Punarnava mandoor is also given as
per pathology stated above.
Matrabasti
with Mahasneha was selected for Snehana because it contains Ghrita,
Taila, Vasa and Majja, it acted as per ‘Sarvada sarva
bhavanam samanyama vriddhikaranam’ [iii]enriching
the Majja dhatu specifically. It also pacifies the root cause of
the disease/ Ruksha pitta.[iv]
The above treatment
worked very well gradually patient got relief in all sign and symptoms.
Haemoglobin level raised/increased up to 11 gm/dl in 1 month treatment protocol
and also got rid of Blood transfusion procedures and got discharged.
Later on, patient didn’t
follow our instructions and restarted the sad abuses. Mithyadhatuposhana
krama leads to same condition again. He was brought in our OPD on
25/02/2023 and got admitted again his treatment was started with Chandraprabhavati,
Punarnava mandoor, Arogyavardhini vati, Kshirpaka
of Ashwagandha, Shatavari, etc. Additionally, he was given Basti
(Malashodhana purpose, Panduroga sidhant and Ritu anusar).
Later on, Vamana karma
was done in which Snehapana was done with Mahakalyanaka ghrita
for 6 days and there was a Pravar Shuddhi during Karma and
Samsarjana advised accordingly.
With this management,
there was markedly improvement in all sign and symptoms and in reports.
In his last follow up om
26/08/2023, only Shamana medicine was given as Punarnava mandoor
and Laghu vasant malti rasa and Kshirpaka of
Ashwagandha, Shatavari, Kalamegha, Guduchi, Punarnava.
******************************************************************************************************************************************************************************************************************************************
Above article was published in 'World Journal of Pharmaceutical Research'. www.wjpr.net
https://in.docworkspace.com/d/sILip76y4AaqY2awG?sa=00&st=0t
********************************************************************************************************************************************************
Dr. Komal Sathavara
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