Review Article: Ayurvedic management of 'Pure Red Cell Aplasia' (KAPHA PRADHANA TRIDOSHAJA PANDU).

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

 

Dashavidha pariksha

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   

Therapeutic intervention –  

1^st 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)             

 

2^nd 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 – Niruha basti – Makshika – 10 gm Lavana – 10 gm Tila taila – 20 ml Shatpushpa Kalka – 10 gm Kwatha -  Manjisthadi Kwatha – 50ml                   Punarnavadi Kwatha – 50 ml Anuvasana basti – Dhanvantara taila – 40 ml (till 07/03/2023) after that with Mahasneha – 40 ml	26/02/2023 to 22/03/2023
2.	Vamana karma – Snehapana with Mahakalyanaka Ghrita	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.	Aayase swasakashtata	+++	++	+	++	+	-
3.	Aruchi	++	+	-	+	-	-
4.	Udara gauravata	++	+	-	++	-	-
5.	Ubhayapada shoth	++	++	-	+	+	-
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.

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

Article Link: 

https://in.docworkspace.com/d/sILip76y4AaqY2awG?sa=00&st=0t

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Presented by

Dr. Jigna Yadav

Dr. Komal Sathavara

B.A.M.S

M.D Final year

P.G Department of Kayachikitsa

Government Akhandanand Ayurveda College and Hospital

Bhadra, Ahmedabad 380001, Gujarat, India

Email:- 

yadavjigna9@gmail.com 

komalsathavara141@gmail.com

Guided by :

Dr. Surendra A. Soni

M.D., PhD (KC) 

Professor & Head

P. G. DEPT. OF KAYACHIKITSA

Govt. Akhandanand Ayurveda College

Ahmedabad, GUJARAT, India.

Email: kayachikitsagau@gmail.com