E-ISSN:2456-3110

Case Report

Hypercholesterolemia

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 6 July
Publisherwww.maharshicharaka.in

Effect of Nitya Virechana in Hypercholesterolemia - A Case Report

Venkatesh P.1, Kumar Sahu R.2*, Mohanty C.3
DOI:

1 Padmavati Venkatesh, Professor, Department of Panchakarma, Ayurved Mahavidyalaya, Hubli, Karnataka, India.

2* Rupendra Kumar Sahu, Final Year Post Graduate Scholar, Department of Panchakarma, Ayurved Mahavidyalaya, Hubli, Karnataka, India.

3 Chinmayee Mohanty, Final Year Post Graduate Scholar, Department of Panchakarma, Ayurved Mahavidyalaya, Hubli, Karnataka, India.

Cholesterol is circulating lipid, part of cell membranes used for synthesis of steroid hormones, bile salts and vitamin D. It is derived from diet as well as synthesized within the body in liver which is essential for proper functioning of the body. The fat tissue mixed with Ama is imbalanced cholesterol. This is responsible for altered quality of fat tissue and cholesterol. It creates number of pathological conditions affecting multiple systems including IHDs, Strokes etc. High cholesterol raises risk for Cardiac ailments like cardiac arrest etc. Nitya Virechana can be planned in Alpa Bala Rogi to eliminate excessive aggravated Doshas (in Bahu Doshavastha) in small quantity on daily basis. Nitya Virechana in Hriswa / Madhyama Matra without any Purvakarma helps for Koshtha Shuddhi, Srotoshodhana (reducing Margavarodha) and Agni Vriddhi, controls further progression of disease. In present case study the patient was said to be healthy before 2 years. He gradually gained weight overtime. Since last 3 months he had complained of fatigue with exertional dyspnoea. Nitya Virechana helped patient in many aspects within two months.

Keywords: Cholesterol, Meda Dhatu, Nitya Virechana, Sthoulya, Margavarodha

Corresponding Author How to Cite this Article To Browse
Rupendra Kumar Sahu, Final Year Post Graduate Scholar, Department of Panchakarma, Ayurved Mahavidyalaya, Hubli, Karnataka, India.
Email: 		Padmavati Venkatesh, Rupendra Kumar Sahu, Chinmayee Mohanty, Effect of Nitya Virechana in Hypercholesterolemia - A Case Report. J Ayu Int Med Sci. 2022;7(6):189-193.
Available From
https://jaims.in/jaims/article/view/1863

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-05-25 2022-05-27 2022-06-03 2022-06-10 2022-06-17
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 19%

© 2022by Padmavati Venkatesh, Rupendra Kumar Sahu, Chinmayee Mohantyand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Venkatesh P et al: Effect of Nitya Virechana in Hypercholesterolemia

Introduction

Hypercholesterolemia may cause IHD, Infarcts like serious medical conditions. Cholesterol (Type of fat) present in blood classified into high-density cholesterol which is said to be cardio protective and low-density, if present in excess quantities may cause coronary blockages. Liver produces approximately 800 mg of cholesterol per day enough for an average adult.

According to WHO, Obesity with Hypercholesterolemia is raising unhealthy condition strongly associated with metabolic disorders like diabetes, hypertension, cardiovascular disease, increased risk of morbidity and mortality in both developed and developing countries.[1]

According to WHO Statistics Report 2012, globally 1:6 adults are obese and nearly 2.8 million individuals die each year due to overweight or Obesity. The risk for disorders appears to start from a body mass index (BMI) of about 21 kg/m2. Obesity generally classified as generalized Obesity and abdominal Obesity. Individuals with Obesity have higher rates of mortality and morbidity compared to non-obese individuals.[2]

Ayurveda emphasizes importance of metabolic processes in health promotion as well as disease management. Agni is the term used in Ayurveda for defining collectively all bodily metabolic activities. Ayurveda classified Agni into Jatharagni - located in alimentary tract essential for major metabolic processes, Dhatwagni - At tissue level capable of processing metabolic requirements of tissues and Bhootagni - subtle metabolic processes that happen at cellular level.[3] More to add, overweight and Obesity have reached epidemic proportions in India in the 21st century affecting 5% of country’s population.[4] Medoroga is an independent disease dealt by Madhavakara[5] and Bhavamishra[6] it is a known risk factor - component of Sthoulya (Obesity) and many other diseases.

In the present case study, observation of Katuki + Triphala + Aragwadha + Trivrut Yukta Leha with lipidolytic action aims at regulating fat accumulation well before the accumulated fats establish as Obesity related complications.

Aim

To observe the effect of Nitya Virechana in Hypercholesterolemia.

Objective

To find out the effect of Nitya Virechana in Medoroga.

Materials and Methods

This study carried out in Panchakarma Department, AMV, Hubbali at OPD level. In present case, Nitya-Virechan Leha Prepared with Katuki, Trivrut, Aragwadha, Triphala 10gms daily on Empty stomach with Hot water administered to treat Hypercholesterolemia for 2 months. Patient was advised to consume Hot water for minimum three hours. Alpa Ghrita and Saindhava Lavana Yukta Jowar Ganji was given as lunch. Rice and Mudga Yusha as Dinner in the evening. Patient was allowed to continue his routine work but restricted from Journey, Ativyayam, Atimaithun and Divaswapna.

Case Report

  • Name of the patient : ABC
  • Age : 50 years
  • Gender : Male
  • OPD no : 67
  • Address : Airport Road, Hubbali
  • Dist : Dharwad
  • State : Karnataka
  • Occupation : Newspaper agent
  • Marital status : Married
  • First Consultation : 02/01/2020

Complaints

SN Present complaint Duration
1.          Increase weight 3-4 months
2.          Fatigue easily 3 months
3.          General weakness 3 months
4.          Excessive sweating 3 months
5.          Excessive hunger 3 months
6.          Exertional Dyspnoea 3 months

Findings

Subjective criteria

1. General weakness

2. Excessive sweating

3. Excessive hunger


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Venkatesh P et al: Effect of Nitya Virechana in Hypercholesterolemia

4. Fatigue easily

5. Exertional dyspnea

Objective criteria

1. Body Mass Index (weight in kg divided by height in meters square)

2. Lipid profile

3. Weight

History of Present illness: Patient was apparently healthy before 2 years. He gradually increased weight since last 3 months of about 6 kg, which was associated with general weakness, excessive sweating, excessive hunger, Fatigue on doing daily activities and Exertional dyspnea. Patient began with morning walks for 1 km and mild exercises at home however he could not get satisfactory results hence approached Panchakarma OPD for further management.

History of Past: N/H/O - DM, IHD

Family history: Not significant

Personal History

  • Diet - Mixed vegetarian less of green leafy vegetables, low fibers, indulges in fatty and sweet foods
  • Addiction - nil
  • Sleep - Sound sleep
  • Bowel - Clear
  • Micturation - 5-6 times/day

Vitals

  • Pulse rate - 70 b/min
  • Respiratory rate - 20/min
  • Blood pressure - 140/90mmHg
  • Temperature - 97°F
  • Weight - 94 Kg
  • Height - 5.4ft
  • BMI - 34.6

General Examination

  • Conscious - Awake, well oriented
  • Nutrition - Moderate
  • Gait - Normal
  • Pallor - Absent
  • Icterus - No yellowish discoloration seen
  • Clubbing - Absent
  • Cyanosis - Absent
  • Lymphadenopathy - Absent
  • Edema - Absent

Systemic Examination

  • CNS - Conscious, Well oriented
  • CVS - S1 & S2 Heard, No Added Sounds
  • RS - Air Entry Bilaterally Equal
  • Per Abdomen - Soft, Non Tender

Ashtavidha Pariksha

  • Nadi : 70/min
  • Mutra Pravrutti : Prakruta, : 5 - 6 times/day
  • Mala Pravrutti : Prakruta
  • Jihwa : Alipta
  • Shabda : Prakruta
  • Sparsha : Anushna sheeta
  • Drik : Prakruta
  • Akriti : Pravara (obese)

Dashavidha Pareeksha

  • Prakriti : Pitta kapha
  • Vikriti : Kapha
  • Sara : Madhyama
  • Samhanana : Pravara
  • Pramana : Madhyama
  • Satmya : Madhyama
  • Satva : Madhyama
  • Ahara Shakti : Uttama
  • Vyayama Shakti : Avara
  • Vaya : Madhya Vaya

Nidana Panchaka

  • Intake of Madhura, Guru, Snigdha and Sheeta Ahara
  • Excessive food intake
  • Sitting for long time
  • Sleeping especially just after lunch.

Roopa

  • Uncontrolled increase in weight

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Venkatesh P et al: Effect of Nitya Virechana in Hypercholesterolemia
  • Dyspnoea on exertion

Samprapti Ghataka

  • Dosha-Kapha (Vriddhi) Dravyata, Gunata and Upalepa Yukta Avarana as
  • Dushya - Meda Dhatu
  • Srotas - Rasavaha and Medovaha
  • Prakara - Sanga
  • Udbhava Sthana - Amashaya
  • Sanchara Sthana - Rasayani
  • Vyakta Sthana - Sarva Sharia
  • Roga Marga - Madhyama
  • Sthana Samshraya - Sarva Sharia
  • Adhistana - Medo Dhatu

Samprapti

Nidana Sevana (Kapha Medo Vardhaka Ahara-Vihara)

↓

Jatharagni Mandya

↓

Saama Anna Rasa Utpatti

↓

Predominance of Aapa and Prithivi Bhoota

↓

Medo Dhatwagni Mandya

↓

Medosrotodushti (Sanga)

↓

Vata Prakopa

↓

Sanchaya of Vata in Kostha

↓

Ati Ahara Sevana

↓

Sanchya of Apachita Meda in Sphik, Sthana, Udara

↓

Hypercholesterolemia

Differential Diagnosis: Sthoulya, Shwasa, Medovriddhi

Diagnosis: Hypercholesterolemia

Sadhyasadhyata: Kasta Sadhya

Treatment Advised

Procedure Medication Dose Anupana Duration
Nityavirechana (10-01-2020 to 10-03-2020) Katuki + Triphala + Aragwadha + Trivrut 10gm daily empty stomach in morning Draksha Kwatha   2 months

Observations and Results

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

Parameters Before treatment After treatment
Total Cholesterol 276   mg/dl 192mg/dl
HDL 52mg/dl 45mg/dl
LDL 87mg/dl 99mg/dl
VLDL 137mg/d 48mg/dl
Triglycerides 685mg/dl 240mg/dl
Weight 94kg 86.8kg
Hb 12.7gm% 13.0gm%
HbA1C 5.80% 5.69%
BMI 34.6 32.8

Discussion

Hypercholesterolemia is the term used to refer to a high blood cholesterol level. Cholesterol is a waxy substance that is produced by the liver and is a component of all cells found in the body.

It is a form of hyperlipidaemia, hypolipoproteinaemia and dyslipidaemia. Elevated levels of HDL cholesterol and LDL in the blood may be a consequence of diet, obesity, inherited diseases, or the presence of other diseases such as type 2 diabetes and an underactive thyroid. All the lipoproteins carry cholesterol, but elevated levels of the lipoproteins other than HDL (termed non-HDL cholesterol), particularly LDL-cholesterol, are associated with an increased risk of atherosclerosis and coronary heart disease. In Ayurveda which can be linked to an increase in Medas in the body and is linked to Medo Roga.

The result obtained regarding the parameter of lipid profile showed marked improvement.


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Venkatesh P et al: Effect of Nitya Virechana in Hypercholesterolemia

The difference in total serum cholesterol is 84 mg/dl, serum triglycerides is 445 mg/dl, serum VLDL is 89 mg/dl and serum HDL is 7 mg/dl. The internal medication used for Nitya Virechana In this case constituted of Triphala, Katuki. Aragvadha and Trivrut which are Rooksha, Teekshna, and Ushna in nature, by virtue of these qualities it helps to penetrate deeper channels and remove obstruction which is the main pathology involved. Because of the above properties, it aids in the liquefaction of these fatty blockages in the circulating channels. Drugs used mainly possesses Tikta-Katu Rasa along with Laghu, Rooksha, and Tikshana Guna, which aids in Sneha-Meda-Kleda Soshana.

The drug Katuki is a combination of bitter taste, pungent Vipaka, dryness, lightness attributes, Katuki helps in mitigating the Kapha Dosha. Aragvadha helps to relieve Ama and detoxifies the digestive tract and having purgative action. Because of its purgative action, it expels the Mala from large intestine without causing irritation to intestines. Trivrut by virtue of its strong, pungent and piercing nature, it helps in expelling Doshas from the Kostha by Rechana property. It dilates Srotas and acts at cellular level. Triphala is known for its spasm releasing, it also possess Rechana properties and does not let the bad cholesterol i.e. LDL, low density lipo protein to propagate in the body and promotes the production of good cholesterol i.e. HDL in the body.

In the present case study Nityavvirechana with the above-mentioned drugs helped in removal of vitiated Doshas from the body and opened the Srotomukha to bring Samyavastha of Doshas. This treatment helped to relieve symptoms of diseases and an attempt to provide safe and effective treatment to the patient and with ease of consumption. The effect was also proven clinically with significant weight loss as well as changes in the cholesterol levels.

Conclusion

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

Reference

1. World Health Organization (WHO). Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000; 894: i-xii, 1-253.

2. World Health Organization (WHO). World Health Statistics 2. 2012. Geneva: WHO; 2012. Available from:http://www.who.int/gho/publications/world_health_statistics/EN_WHS2012_Full.pdf

3. Agnivesha, Charaka Samhitha Text with English Translation and Critical Exposition based on Chakrapanidatta’s Ayurveda Dipika, Sharma RK, Dash VB, 7th edition, India: Chowkhamaba Series; 2002.

4. Wikipedia, Obesity in India/ India facing Obesity epidemic dated 13/10/2008, (Cited Wikipedia foundation, Inc): available from http://en.wikipedia.org/wiki/Obesity_in_india.

5. Bramhmananda Tripatied, Madhav Nidana of Shri Madhavakara (Sanskrit) vol 2, Nidana Medoroganidanam 34/1, Chaukhambha Surbharati Prakashan, Varanasi, p 35.

6. Shri Sanskara Mishraed, Bhavprakash of Shri Bhamishra (vidyotini hindi), vol2, Sthaulyadthikara 39, Chaukhambha Surbharati Prakashan, Varanasi, p404.


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