E-ISSN:2456-3110

Case Report

Systemic Lupus Erythematosus

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 2 February
Publisherwww.maharshicharaka.in

Ayurvedic management of Systemic Lupus Erythematosus - A Case Study

Kumar K S P.1*, Mahesh S.2
DOI:

1* Praveen Kumar K S, Research Officer, Central Ayurveda Research Institute, Guwahati, Assam, India.

2 S Mahesh, Research Officer, Central Ayurveda Research Institute, Patiala, Punjab, India.

Systemic Lupus Erythematosus (SLE) is a multi-system disorder affecting connective tissues and is auto immune in nature. Prevalence of SLE in India is estimated to be 30 per million people. A 25 year old Indian female came to hospital with complaints of pain and burning sensation on both knee joints especially after walking, anxiety and mood disorders since 4 years. She was a known case of SLE and was taking corticosteroids. Clinical evaluation revealed intermittent fever, discoid rashes on elbows and lower limbs, oral ulcers and occasional severe headache. The case was diagnosed as Pittadhika Vataraktam and Deepana Pachana was started with Amapachana Vvati, Udwartana was started with Yava and Triphala Churna. Snehapana was done with plain Goghrita until Samyak Lakshanas and Virechana was done with Trivrut Avaleha. After Peyadi Krama, Ksheera Basti was done for eight days along with intake of Manjistadi Kwath, Kaisora Guggulu and Guduchi Churna. Pain, edema and burning sensation of both the knees was completely relieved after follow up period. ANA was reduced from 1:1640+++ to 1:160+, while Anti ds-DNA value also got reduced from 80.0 IU/mL+++ to 28.0 IU/mL +. Hemoglobin improved from 7.3 gm % to 10 gm% after treatment. SLE may be correlated with Vatarakta and its line of management may be adopted here.

Keywords: Ksheera basti, SLE, Systemic Lupus Erythematosus, Vatarakta

Corresponding Author How to Cite this Article To Browse
Praveen Kumar K S, Research Officer, , Central Ayurveda Research Institute, Guwahati, Assam, India.
Email: 		Praveen Kumar K S, S Mahesh, Ayurvedic management of Systemic Lupus Erythematosus - A Case Study. J Ayu Int Med Sci. 2023;8(2):188-191.
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https://jaims.in/jaims/article/view/2202

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-12-29 2022-12-31 2023-01-07 2023-01-14 2023-01-15
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2023by Praveen Kumar K S, S Maheshand 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].

Journal of Ayurveda and Integrated Medical Sciences 2023;8(2)188
Kumar P et al: Ayurvedic management of Systemic Lupus Erythematosus

Introduction

Systemic Lupus Erythematosus (SLE) is a multi-system disorder affecting connective tissues and is also auto immune in nature. The reported prevalence of SLE ranges from 14 to 60 per 100000 in India.[1] It is said to be more common in women of reproductive age group. Immune disorders affect human tissues causing hypersensitivity, immune deficiency and auto immune disorders. In SLE, the immune system attacks healthy body tissues like skin, joints, kidneys and other organs.

Fever, fatigue, myalgia, arthralgia, arthritis, malar rash, oral ulcers etc. are the general symptoms of this disease. The exact cause of SLE is not clearly understood according to modern science. The presentation of symptoms will be depending upon the site of damage occurring due to the disease. There is no cure for SLE according to modern science other than use of corticosteroids, NSAID’s and immunosuppressant’s. Ayurvedic treatments can provide considerable relief to the patients and without the fear of serious side effects. Mostly the treatment approach in Ayurveda adopted is Vata Rakta and Pittahara in nature. This case study highlights the effectiveness of Ayurvedic management of SLE.

Case Report

A 25 year old Indian female came to the hospital with complaints of pain and burning sensation on both knee joints especially after walking since four years. She also had anxiety and mood disorders since four years. She was a known case of SLE and was under corticosteroids and immune suppressants. Clinical evaluation revealed intermittent fever, discoid rashes on elbows and lower limbs, oral ulcers and occasional severe headache. She had no past history of diabetes mellitus, hypertension, tuberculosis or trauma. The patient’s diet history was mixed including spicy, salty and fried foods. The appetite was good with regular bowel habits and micturition. Sleep was occasionally disturbed due to pain and with no history of addiction. The menstruation was normal with no remarkable changes. On physical examination, her built was moderate, vitals were normal but during febrile attacks, temperature used to touch 100°F. Ashtavidha Pariksha revealed normal findings, her Prakruti was determined

to be Vata Pitta, Koshta was Mridu, and she did irregular exercises and her temperament was sensitive. Her Satva was Rajasik and the knee joints elicited Crepitus at Grade 1 on left and Right Knee joints along with presence of swelling on both knees.

The Nidana factors like eating much of spicy, salty foods along with less sleep during night and anxiety lead to the imbalance of Vata, Pitta and Rakta. Vata was responsible for pain and Pitta was responsible for the burning sensation and fever. Dusta Rakta was causing rashes and ulcers. Considering all these aspects, the case was diagnosed as Vatarakta.

Timeline: The patient was a known case of SLE and based upon the clinical assessment she was diagnosed as having Vatarakta and treated accordingly. All the modern medicines which she was taking were stopped before starting the treatment schedule.

Table 1: Timeline of events

Days in sequence Interventions Details of intervention Observations
4 days Deepana, Pachana Amapachana Vati[2] 2-2-2 Improved appetite
4 days Udwartana Triphala Churna[3] + Yava Churna Rookshana achieved on the body
 6 days Snehapana Plain Goghrita Samyak Snigdha Lakshana[4]
3 Days Abhyanga and Bashpa Sweda Abhyanga with Bala Taila Feeling of lightness of body. Knee joint pain and swelling on both knees reduced
1 day Virechana Trivrut Avaleha[5] 80 gms 18 Vegas with Samyak Virikta Lakshanas
5 days Samsarjana Krama Peyadi (Planned Diet) Normalization of digestion. Knee joint pain significantly reduced
8 days Ksheera Basti [6] 1. Saindhava 12 gms 2. Makshika 100 ml 3. Bala Taila 100 ml 4. Tiktaka Ghrita 100 ml 5. Kalka (Yastimadhu and Satahwa in equal proportion) 20 gms 6. Guduchyadi Ksheera Kashayam 200 ml Patient informed that more than 50% reduction in symptoms was noted
30 days Internal medicines 1. Manjistadi Kwath[7] 50 ml bd 2. Kaisoraguggulu[8] 2-2-2 3. Guduchi Churna[9] 3 gms bd with warm water. Patient informed that almost 50% reduction in symptoms was noted

Outcome: Pain, edema and burning sensation of both the knees subsided completely. Anxiety got improved on the Hamilton Anxiety Rating Scale from 25 to 15.


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Kumar P et al: Ayurvedic management of Systemic Lupus Erythematosus

There was no history of fever since the beginning of treatment. Discoid rashes on elbows and lower limbs decreased considerably, oral ulcers and occasional headache subsided completely. Regarding the lab investigations, the Anti-nuclear antibody (ANA) was reduced from 1:1640+++ to 1:160+, while ds-DNA value also got reduced from 80.0 IU/mL+++ to 28.0 IU/mL + compared to before treatment. Hemoglobin improved from 7.3 gm% to 10 gm% before and after treatment. The patient was followed up for a month and she had not developed any new episodes of symptoms.

Discussion

SLE was considered under Vatarakta spectrum of disease and more specifically in this case as Pitta Pradhana Vataraktam. Here vitiated Vata as well as Rakta was vitiated owing to its own etiology. The Sukshma - Chala Guna of Vata and Drava - Sara Guna of Rakta normally helps in their normal circulation through the Sira. When these become vitiated and after it reaches the joints, where vessels are arranged in circular and tortuous manner, it gets localized there to manifest disease with different signs and symptoms of Vatarakta. The Ruksa Chala Gunas of Vata and Sara Tiksna Gunas of Rakta makes this disease extremely virulent. The Tiksna, Snigdha and Usna nature of Rakta causes inflammation and the Ruksa Tiksna Guna of Vata causes degeneration of tissues. Symptoms of Utthana as well as Gambhira Avasta were observed in this case.

While analyzing the Samprapti of Vatarakta, Rasa, Rakta, Mamsa, Meda, Asthi and Majja Dhatus are also affected along with vitiated Vata and Rakta. Deepana, Pachana was started to reduce Amavasta of the disease. It was not advisable to do Swedana in this case, and Udwartana was selected because it is Rakta Prasadana in nature. Considering the Dhatu level involvement, the line of treatment should be Virechana and Basti. Virechana after Snehapana with Goghrita was done because it was Pitta pradhana Vatarakta and also it is the first choice in Vatarakta Chikitsa.[10] Rakta Dhatu is the Aashrayastana for Pitta and Virechana is the specific Shodhana karma for vitiated Rakta and Pitta. This procedure also clears the Srotas for further treatments. After that Ksheera Basti was selected with Tikta Dravyas which were also Vatahara as well as Raktaprasadana.[11]

Guduchi has promising results in Vatarakta Chikitsa and thus was taken for preparing Ksheera Kashaya in Basti[12] Tikta Rasa Sadhita Ksheera Basti is indicated because of its specific action on Asthi Dhatu.

After Sodhana therapy, Samana Chikitsa was carried out using Manjishtadi Kwatha, Kaisora Guggulu and Guduchi Choorna. Manjistadi Kashaya is Vataraktahara and Raktaprasadana in nature. Kaisora Guggulu is exclusively indicated in Vatarakta conditions as well as it has Rasayana property also. Guduchi Churna was given because Guduchi is best for Vatarakta and it is Balya, thereby it may have the capacity to improve the immune system of the body.

Conclusion

Ayurvedic management was found to be effective in the relieving the symptoms of SLE and there was no adverse drug reactions reported during the treatment period. NSAID’s and corticosteroids are having various side effects even though they are effective, there is always a need of a safer and effective herbal based solution. The study shows the beneficial effect of Panchakarma therapy along with internal medication. In future studies with larger sample size and proper documentation may help to ensure safety and efficacy of the drugs and procedures used.

Reference

1. Malaviya, A. N., Singh, R. R., Singh, Y. N., Kapoor, S. K., & Kumar, A. (1993). Prevalence of Systemic Lupus Erythematosus in India. Lupus, 2(2),115-118.

2. Gokhale B. V. Chikitsa Pradeep. Dhanwantari Pratishtan, Pune: 1989;p108.

3. Sharma Priyavrat, Dravyaguna Sutram, Choukhambha Sanskrit Sansthan, Varanasi, reprint; 2009, Ausadha Prakarana 8/9;p110.

4. Vagbhata. Ashtanga Hrdayam, Sutrathana with commentaries sarvangasundara of Arunadatta and Ayurveda rasayana of Hemadri. Murthy KRS, translator., trans. Varanasi, India: Chowkhamba Krishnadas Academy; 2001:p250.

5. Ashtanga Hridaya. Vagbhata with commentaries of Sarvanga Sundari of Arundatta and Ayurveda Rasayana of Hemadri; Krishnadas Academy, Varanasi. Repr. Kalpasthana, 1982; 2/9,p350.


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6. Brahmanabd Tripathi ed, Caraka Samhita, volume 2, Chikitsasthana, Chapter no 29, Shloka no 88, 1 st ed, reprinted 2009, pub by Chaukhamba Surabharati Prakashan,p998.

7. Krishnan Vaidyan AK, Anekkalil, Gopalapilla S. Kashaya yogas. Sahasrayogam. 21st ed. Alappuzha: Vidhyarambham Publishers; 1996,p77–85.

8. Sharangadhara. Sharangadhara Samhita. 2nd section. Varanasi: Vatakalpana Choukhamba Publications; 1984,p70.

9. Acharya VY, editor. Charaka Samhita of Agnivesha, Sutra Sthana, Ch. 4, Ver. 18, 5th ed. Varanasi: Choukhamba Orientalia; 2001,p34.

10. Charaka, Charaka Samhita (Vidyotini Hindi Commentary). Rajeswaradatta Shastri, Kashinath Shastri, Gorakhnath Chaturvedi, editors. 1st ed. Varanasi: Chaukhamba Bharti Academy; 2004. Chikitsa Sthana, 29/41,p.825.

11. Charaka, Charaka Samhita (Vidyotini Hindi Commentary). Rajeswaradatta Shastri, Kashinath Shastri, Gorakhnath Chaturvedi, editors. 1st ed. Varanasi: Chaukhamba Bharti Academy; 2004. Chikitsa Sthana,29/88,p.831.

12. Chunekar KC, Pandey GS. "Guduchyadi Varga. Bhavprakash Nidhantu". Varanasi: Chaukhambha Bharati Academy; 2006,p269.


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