Role of Ubhaya Shodhana in Hyperlipidaemia - A Case Report

Padmavati Venkatesh; Chinmayee Mohanty; Rupendra Kumar Sahu

Role of Ubhaya Shodhana in Hyperlipidaemia - A Case Report

Venkatesh P.^1, Mohanty C.^2, Sahu R.³

DOI:

^1* Padmavati Venkatesh, Professor, Department of Panchakarma, Ayurveda Mahavidyalaya, Hubli, Karnataka, India.

^2* Chinmayee Mohanty, Final Year Post Graduate Scholar, Department of Panchakarma, Ayurveda Mahavidyalaya, Hubli, Karnataka, India.

³ Rupendra Kumar Sahu, Final Year Post Graduate Scholar, Department of Panchakarma, Ayurveda Mahavidyalaya, Hubli, Karnataka, India.

Hyperlipidaemia is an abnormal derangement of lipids in the blood and is found in many conditions including Diabetes Mellitus, Hyperthyroidism and Hypertension etc. The ability of hyperlipidaemia is to engage in the pathology of atherosclerotic diseases such as coronary heart disease, which dominates the scenario of diseases causing morbidity and mortality in the world. In Ayurveda, it can be correlated with Medovaha Stroto Dushti (vitiation of channels carrying fat tissue), management of which follows the treatment principles of Medo Roga (disorders of fat tissue). Here an attempt is made to discuss a successful case study of a 41 years male patient who presented with complaints of lethargy, unwillingness towards performing daily activities and easy fatigability since last 3 years diagnosed with hyperlipidaemia with Total cholesterol 317 mg%, LDL 193mg/dl, VLDL 45 mg% and HDL 79 mg% and Triglycerides 226 mg/dl. The patient was treated on Kapha-Meda Nashak Chikitsa using combination of Shodhana Chikitsa followed by diet and life style modifications. After the course of treatment, lipid profile was repeated. There was significant improvement in the biochemical parameters, indicating that hyperlipidaemia can be effectively treated with Ayurvedic interventions.

Keywords: Hyperlipidemia, Ayurveda, Medovaha Sroto Dushti, Shodhana

Corresponding Author	How to Cite this Article	To Browse
Chinmayee Mohanty, Final Year Post Graduate Scholar, Department of Panchakarma, Ayurveda Mahavidyalaya, Hubli, Karnataka, India. Email:	Padmavati Venkatesh, Chinmayee Mohanty, Rupendra Kumar Sahu, Role of Ubhaya Shodhana in Hyperlipidaemia - A Case Report. J Ayu Int Med Sci. 2022;7(4):136-140. Available From https://jaims.in/jaims/article/view/1814

Introduction

Lipids are substances which are insoluble in water but soluble in hot alcohol, ether, benzene, petroleum ether and acetone. Lipids are either actual esters or potential esters of fatty acids.^[1] Elevated levels of fasting lipid levels in blood plasma with increased concentration of LDL cholesterol are known as Hyperlipidaemia. Physiologically lipids may be simple or complex. In human plasma lipoprotein metabolism, the most important simple lipids are Fatty acids, Sphingosine and cholesterol. Cholesteryl esters and triglycerides are important complex lipids. Hyperlipidaemia is one such dietary condition described as a possible risk factor for cardiovascular disease, metabolic syndrome, and even hypertension. Hyperlipidaemia is elevated serum levels of cholesterol, triglycerides or both which may lead to pathology of atherosclerotic diseases such as coronary heart disease.

Hyperlipidaemia in Ayurveda classics can be studied as Rasagata Sneha Vriddhi, Rasa Raktagata Sneha Vriddhi, Medovriddhi, etc. Hyperlipidaemia is identical to elevated Asthayi Sama Medo Dhatu Vriddhi when stored in body for a longer time results in complications. Kapha Dosha and Medo Dhatu are affected which play an important role in the pathogenesis of Atisthaulya and Prameha in Hyperlipidaemia.

According to Charaka, Sarabhaga or Annarasa of ingested food by action of both the Jatharagni and the Bhutagnis is directly absorbed from the Amashaya and is distributed throughout the body by means of the Dhamanis.^[2] After the action of the Bhutagnis, the Upadana Medo Dhatu thus formed is further subjected to the action of Medodhatvagni. Chakrapani has mentioned two types of Dhatus viz., Asthayi and Sthayi Dhatus after the action of Dhatvagni. Of these the Asthayi Dhatus are the precursors of the Sthayi Dhatus and are circulated throughout the body by means of Srotas which is specific for each of the Dhatus. The Asthayi or Poshaka Medo Dhatu thus formed circulates through the Medovaha Srotas for nourishing the Medo Dhatu.^[3]

Asthayi Medo Dhatu undergoes two Pakas or reactions viz; the Prasada Bhaga leading to the nourishment of the same Sthayi Dhatu and the preceding and Kitta Bhaga leading to the formation of the waste materials.

Medodhatvagni results in Sara-Kitta Vibhajana and results in the formation of Asthayi or Poshaka Medo Dhatu (Prasada Bhaga) and Sweda (Mala Bhaga). Thus, Dhatvagnis act in a twofold manner performing both, anabolism (for formation of Sthayi Medo Dhatu or Adipose tissue) and catabolism (to produce wastes like Sweda).

Hypo-functioning of Dhatvagni leads to increased synthesis leading to a quantitative increase of the Dhatu whereas its hyper-functioning will lead to a quantitative decrease. The same can be applied to Medodhatvagni which on impairment would lead eventually to either Atisthoulya or Karshya.^[4]

In case of the hypo-functioning of the Medodhatvagni, homologous nutrients present in circulation as the Poshaka Medo Dhatu (comprising of different categories of lipoproteins) will be in excess. This in circulation can be referred to the conditions such as quantitative increase of Abaddha Meda or Asthayi Medo Dhatu which is known as Hyperlipidemia (lipoprotein lipase deficiency, Apoprotein deficiency, LCAT deficiency, CETP deficiency, receptor proteins and receptor deficiency can be referred to Medodhatvagni Mandyata which will cause Hyperlipidemia).

Basic line of treatment includes avoidance of etiological factors, Apatarpana Chikitsa (depleting procedure), Shodhana (purification therapy) and Shamana Chikitsa (palliative therapy).

Case Report

Pradhana Vedana

A 41 years old male approached Panchakarma OPD of Ayurveda Mahavidyalaya and Hospital, Hubballi, with complaints of weight gain, lethargy and unwillingness to do any work since 3 months. He also complained of easy fatigability since past 3 months.

Anubandhi Vedana

Flatulence
Abdominal heaviness after meal.
Epigastric burning sensation since last 6 months.

History of Present Illness

Patient was said to be healthy before 6 months after which he had repeated complains of flatulence,

abdominal heaviness after consumption of meals and epigastric burning sensation on and off. Patient also complains of gradual weight gain over a period of 3 months of about 4 kg, he also experienced easy fatigability on mild exertion and no will to perform day to day activities.

Patient has past history of Hypothyroidism for which he is on oral medication, with no history of Diabetes Mellitus, Hypertension or cardiac illness.

Family history: Nothing significant.

Personal History

Patient was consuming more of non-vegetarian diet, with disturbed sleep pattern. He consumes betel nut 3-4 times a day and He also stand for prolonged duration with untimely eating habits due to work.

Systemic Examination

Respiratory, Cardiovascular, Gastrointestinal and Central nervous systems were within normal limits.

Astavidha Pariksha

Nadi - Kapha Pitta, 74/min
Malapravrutti - Prakruta
Mutrapravrutti - Prakruta
Jiwha - Lipta
Shabda - Prakruta
Druk - Prakruta
Akruti - Sthula

Roga Pareeksha

Nidana

Consumption of more Guru, Madhura, Sheeta, Snigdha, Dadhi
Prolonged standing for hours
Shrama Atiyogat (excess work)
Avyayama, Avyavaya, Divaswapana, Bhojanottara Nidra

Purvaroopa

Stholya

Roopa

Weight gain
Lethargic
Easy fatigability

Samprapti

Samprapti Ghataka

Dosha - Tridosha (Kapha - Kledaka Dravyatah Gunatah Vruddhi, Pitta - Pachaka Karmatah Kshaya, Vata - Samana and Vyana Karmatah Kshaya)
Dushya - Rasa, Meda, Vasa, Mamsa
Srotas - Medovaha Srotas, Rasavaha Srotas, Swedavaha Srotas, Udakavaha Srotas
Srotodusthi - Sanga, Margavarodha and Ama Annarasa Atipravriti
Udbhava Sthana - Amashaya
Sanchara Sthana - Rasayani
Vyakta Sthana - Sarva Shareera (buttocks, elbow, tendons, eyelids etc.)
Agni - Jatharagni, Medodhatvagni
Adhisthana - Vapavahana and Meda Dhatu Kala

Chikitsa (treatment given)

The patient was administered Ubhaya Shodhana (Emesis and purgation therapy). After proper Deepana Pachana patient was given Snehapana followed by which Vamana and Virechana was administered in the following sequence.

The details of the procedure are as described below.

Chikitsa Upakrama	Aushadha Dravya	Duration
Amapachana	Trikatu Churna	15 days
Snehapana	Murchhita Ghrita	5 days
Vamana	Madanaphaladi Yoga	Vega - 11 Upavega - 05
Abhyanga and Svedana	Murchhita Tila Taila	3 days
Virechana	Trivrut Lehya	Vega - 22 Upavega - 04

Result

A significant difference was observed in all parameters of assessment post treatment which were reflected in the investigations performed, the details are as follows.

Table 2: Functional Assessment

Parameter	Before treatment	After treatment
Height	164cm	164cm
Weight	85kg	81kg
BMI	31.6kg/m2	30.1kg/m2

Table 3: Pathological Investigation

Parameter	Before treatment	After treatment
Total Cholesterol	317mg/dl	226mg/dl
Serum Triglycerides	226mg/dl	156mg/dl
Serum LDL	193mg/dl	129mg/dl
Serum HDL	79.2mg/dl	66mg/dl
Serum VLDL	45mg/dl	31mg/dl
Total/HDL Cholesterol Ratio	4.0	3.4
LDL/HDL Cholesterol Ratio	2.4	2

Discussion

Trikatu Churna was given for Amapachana, Vata Anulomana and Kostha Shuddhi. Trikatu Churna possess Ushana Veerya, Katu Rasa acts as Kaphahara, Deepana and Pachana helps in breakdown of Ama.

Murchhita Ghrita: Main ingredients Pathya, Dhatri, Bibhitaki. In this study, Ghrita instead of Taila was selected for Snehapana considering palatability and Taila is heavier (hard to digest) than Ghrita. It has power to assimilate effectively properties of other substances (Sanskara Anuvartana). After attaining Samyak Snigdha Laxana next day Abhyanga was done with Murchita Tila Tail followed with Bashpa Swedan prior to Vamana. Before Virechana in three days of Vishrama Kala, Abhyanga was done. Abhyanga and Swedana facilitate diffusion of Dosha towards Koshtha. Pressure given in direction of Lymph drainage increases flow of lymph and bring excess Doshas from tissue spaces towards Koshtha. By Swedana heat is transformed inside body which liquifies Dosha, increases blood flow and leads to increased osmotic pressure.

After Samyak Snehana, Vamana is carried out with Madana Phala, Pippali Churna,Vacha, Saindhava Lavana, Madhu, Yastimadhu Phanta. Vamana drugs have Ushna, Tikshna, Sukshma, Vyavayi, Vikasi

Gunas. Ushna Guna helps in Pachana, Deepana, Swedana. Agneya property of Vamaka Dravya spreads drug at Sukshma Srotas. Chinna detaches from Srotas and brings to Koshta by virtue of Prabhava. Udana Vayu Prerana with Agni and Vayu Mahabhuta helps in Doshaharana. Vamana Karma was the best line of management for Medoroga. Vamana Karma is one of the classical Bio-Cleansing therapy which eliminates the morbid material, like vitiated Dosha, metabolic waste, unwanted excessive accumulated substance from the body. It is specific for Kapha Dosha which belongs to the category of Medo Dhatu (Fats), there by having its direct effect on Fat tissue which may be one of the reasons for reduction in lipid levels, further Vamana also corrects Pitta Dosha to moderate extent indirectly improves functioning of liver which plays an important role in the lipid metabolism.

Trivrut Lehya with ingredients Trivrut, Khanda Sharkara, Trijataka, Ghrita was selected for Virechana Karma - Sukha Virechana. Trivrut being Tikta, Katu Rasa, Ushna Veerya, Katu Vipaka acts as Pitta Kaphahara and removes Doshas from Koshtha by Rechana property. Katu Rasa “Margan Vivrunoti”- dilates Srotas at cellular level. Laghu, Rooksha, Teekshna Guna help for Deepana and Pachana. Srotoshodhana acts on minute channels and Twak Prasadana. Virechana procedure breaks the pathology by two ways - first by correction of deranged lipid metabolism and secondly by increasing the excretion of lipids through bile salts thus reducing the plasma overload.

Conclusion

Hyperlipidemia shows its resemblance to Medovaha Srotodusti Vikara based on the causative factor, clinical features and pathophysiology. Ubhaya Shodhana plays potential role in management as well as on its prevention by reversing pathogenesis. While this case study was conducted with a single patient over a short period of time, the mass study with a broad statistical approach is necessary for further evaluation.

Reference

1. Concise Human Physiology, Chapter: Lipid Metabolism, pg.357

2. Agnivesha, Charaka Samhita with Ayurveda Deepika commentary of Chakrapanidatta

revised by Charaka and Dridhabala, edited by Vaidya YadavJi Trivikramji Acharya, published by Chaukamba publishers, edition 2020 Vimanasthan, 2/18, p.g no.-240.

3. Agnivesha, Charaka Samhita with Ayurveda Deepika commentary of Chakrapanidatta revised by Charaka and Dridhabala, edited by Vaidya YadavJi Trivikramji Acharya, published by Chaukamba publishers, edition 2020 Chikitshasthan, 8/39, p.g no.-461.

4. Vagbhata, Ashtanga Hridaya with Sarvanagasundara Commentary of Arunadatta and Ayurveda Rasayana Commentary of Hemadri, edited by Pt. Bhishagacharya Harishastri Paradkar Vaidya, Chowkhamba Krishnadas Academy, Varanasi, 2006, Sutrasthana, Chapter- 11, Verse-34, p.188.

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-04-04	2022-04-06	2022-04-13	2022-04-20	2022-04-27
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	17%

Case Report

Hyperlipidaemia

Journal of Ayurveda and Integrated Medical Sciences