E-ISSN:2456-3110

Case Report

Ulcerative colitis

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 3 March
Publisherwww.maharshicharaka.in

Ayurvedic management of Ulcerative Colitis: A Case Study

Mori V.1*, Patel M.2, Gupta S.3, Patel K.4
DOI: http://dx.doi.org/10.21760/jaims.8.3.29

1* Vishal Mori, Post Graduate Scholar, Department of Kayachikitsa, J. S. Ayurved Mahavidhyalaya, Nadiad, Gujarat, India.

2 Manish Patel, HOD and Professor, Department of Kayachikitsa, J. S. Ayurved Mahavidhyalaya, Nadiad, Gujarat, India.

3 SN Gupta, Vice Chancellor, Maganbhai Adenwala Mahagujarat University, J. S. Ayurved Mahavidhyalaya, Nadiad, Gujarat, India.

4 Kalapi Patel, Dean & Hospital Superintendent, Maganbhai Adenwala Mahagujarat University, J S Ayurveda College & P.D. Patel Ayurveda Hospital, Nadiad, Gujarat, India.

Introduction: Ulcerative colitis (UC) is an inflammatory bowel disease with remitting and relapsing pattern in which long term or repeated cortico-steroid and biological medicines are only available treatment which have limited effect and carrying many serious adverse effects.[1] Purpose: Inflammation invariably involves the rectum (proctitis) and may spread proximally to involve sigmoid colon (procto-sigmoiditis) and in some cases, it involves whole colon (pancolitis). The major symptom of ulcerative colitis is blood in stools.[2] In conventional medicine there is no any treatment which give completely relief or surgical treatment. But in Ayurveda treatment approaches are helpful in such diseases. With the changing demand and awareness among these days, the role of Ayurveda is an emerging reality. Brief case history: A 36-year-old male pharmaceutical manager by occupation at Canada, patient came to the P D Patel Ayurveda Hospital, Nadiad with confirmed diagnosis of ulcerative colitis since 10 years. He has more than 10 times stool frequency in which average 5 frequencies contain blood and mucus. Before he came to us, he took conventional medicine for the same complaints but didn’t get any satisfactory result. He was hospitalized and treated with Basti and oral Ayurvedic medicines for one month period. His stool frequency reduced significantly in a day without bleeding and mucus. After one month of treatment, he is continuing oral medicine at OPD. Now he has one or two frequencies with normal consistency of stool without blood or slime. His haemoglobin level was also increased significantly. Result: He got an excellent result with complete relief from all symptoms as well as marked reduction in objective criteria (lab investigation) within 1 month.

Keywords: Ulcerative colitis, Raktatisara, Ayurveda

Corresponding Author How to Cite this Article To Browse
Vishal Mori, Post Graduate Scholar, Department of Kayachikitsa, J. S. Ayurved Mahavidhyalaya, Nadiad, Gujarat, India.
Email: 		Vishal Mori, Manish Patel, SN Gupta, Kalapi Patel, Ayurvedic management of Ulcerative Colitis: A Case Study. J Ayu Int Med Sci. 2023;8(3):154-160.
Available From
https://jaims.in/jaims/article/view/2246

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-01-25 2023-01-27 2023-02-03 2023-02-10 2023-02-17
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 19%

© 2023by Vishal Mori, Manish Patel, SN Gupta, Kalapi Pateland 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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Introduction

Ulcerative-colitis is a chronic inflammatory bowel disease. It is characterized by relapsing and remitting mucosal inflammation, starting in the rectum and extending to proximal segments of the colon. In Crohn's disease and ulcerative colitis are two distinct but connected disorders that are referred to as inflammatory bowel diseases (IBD). The hallmark symptoms of this condition include increased bowel frequency and bleeding in the stool. Due to the loss of water and blood in the stool, weakness is more frequent.[3]

The incidence rate is 9 to 20 cases per 100,000 persons per year. No sex predominance exists in ulcerative colitis.it affect the age group of 15-35 years which is most important decades of life and less common in 50-75 years.

The goal of treatment is inducing and maintaining clinical and endoscopic remission. While topical and systemic steroids can be used to treat ulcerative colitis flares, amino salicylates are the primary therapeutic option for mild to moderate ulcerative colitis. Immunosuppressants and biological medications are used to treat moderate to severe illness.[5] The high morbidity and mortality present a significant issue for medical practitioners. The risk of colon cancer causes the largest mortality to occur in the early years of the illness and over an extended period. Therefore, people are constantly looking for alternative therapies that promise better, safer results.

 Ayurveda described Raktatisara, a type of hemorrhagic diarrhoea that shares certain symptoms with ulcerative colitis, including Shula (abdominal pain), Gudapaaka (rectal burning), and Trishna (excessive thirst). Treatments additionally helped the patient's overall health. Ulcerative colitis is a disease of Purishavahasrotas. Raktatisara is described as a more advanced stage of Pittatisara in Ayurveda.[6] In the Charaka Samhita, Basti Chikitsa is listed as a method of managing Raktatisara. Ulcerative colitis and this condition may be connected.[7]

Case Report

Patient information: A 36-year-old hindu, male, married, non-smoker, pharmaceutical manager by occupation at Canada visited P. D.

Patel Ayurveda Hospital on 08th Nov,2021 complaining of bleeding per rectum associated with mucus, abdominal pain while taking meal and generalized weakness since 2020. There was no positive family history. Patient had frequent habit of eating spicy, oily and outside junk food. Colonoscopy reports confirmed that the patient is suffering from severe diffuse gastritis and ulcerative colitis (Proctosigmoiditis). He was being managed with daily oral Tab. mesalamine- 1.2 mg (4 tab at morning), Tab. prednisone 5 mg (40 mg per day), Salofalk suppository (2 time per day). For last three month. This treatment didn’t provide much relief in his signs and symptoms.

According to patient he was working in an pharmaceutical manager, due to high workload he was working from seven in the morning to late night either 12 or 1 p.m. And during this duration he was eating food from his office canteen, which used to be spicy. According to Ayurveda, Ratrijagaran (late night work) and spicy food (Amla, Lavana, Katu, Vidahi Aahara) are the cause for outbreak of Vata and Pitta which caused Pittaj Atisar as he continued the same life style so it finally caused the Raktaj Atisar. On general examination; no pallor, icterus, oedema, no lymph nodes were palpable. Blood pressure was 110/70 mmHg, pulse rate was 68/min and Respiratory rate was 20/min.

Table 1: Stool Examination

Stool examination Date: 08/11/2021
Occult blood Positive
Pus cell 10-12
RBC 8-10
Mucus Absent

Table 2: Blood Examination

Blood Examination Date: 08/11/2021
Hb (g/dl) 7.5gms%
Neutrophils (%) 53%
Lymphocytes (%) 32%
Monocytes (%) 3
leucocytes mm3 8,380mm3
Plate late count /cumm 2,55,00/cumm
HBsAg Non- reactive
Hepatitis C Virus Negative
HIV Negative

Clinical Finding

Systemic examination
Pain and tenderness were noticed in the lower abdomen during a gastrointestinal examination.


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There were no signs of aberrant respiratory, cardiovascular, or nervous system function.

Ashtavidha Pariksha

Table 3: Astavidh Pariksha

Nadi 70 / min, Pittadhik Vata
Mutra Samyak ,6-7 time /day
Mala with blood (less stool no blood) and Mucus 4-5 times/day
Jihva Sama
Sabdha Parakrut
Saprsha Prakrut
Dak Singhdha
Akruti Madhyam

Personal history

  • Diet: mixed (veg)
  • Addiction: not any
  • Job: pharmaceutical manager
  • Past history: not ant major illness
  • Family history: not any
  • Surgical history: not any

Treatment Schedule

Table 4: Treatment Schedule

Date   Given Treatment
08/10/2021 1st day 1. Kutaja Ghanvati - (3tab/3time)
2. Musta Churna + Nagkesar Churna + Lodhra Churna = 3gm /3time
3. Udumbar Kwatha - 40ml - 2 time
4. Chhardiripu - 2gm + Shankh Bhasma - 250mg - 2 time / day (before food)
07/11/2021 To 7/12/2021 2nd day to 35th day 1,2,3,4 treatment continued with
5. Udumbar Kwatha Basti 40ml (after lunch) - (Udumbar Kand Twak)
6. Jatyadi Taila Matra Basti- 40ml (after dinner)
7. Shatavari Ghrita (orally) - 20ml / 2 time
8. Nasya Karma - 8-8- Drops

Investigations

Before starting the treatment; routine haematological tests were done. On visit, the patients had histopathology reports with him. Stool for occult blood was done before starting the treatment. (Table-2).

Colonoscopy reports were with the patient. A brief of the haematological observations is placed at (Table-1)

Timeline

SN Duration Symptoms Interventions
1. July 2021 to August 2021 Stared having complain of constipation or some time diarrhea, abdominal pain nausea   No any specific treatment taken
2. 25/8/2021 Watery diarrhoea with mucus 10-12 times/day, vomiting 2-3times/days for 3days Consulted orthopaedic doctor -prescribe medicine but patient didn’t take any medication  
3. 26/8/2021 Watery diarrhoea with mucus 10-12 times/day, vomiting 2-3times/days for 3days Diagnosed with Ulcerative colitis (proctosigmoiditis)  
4. 14/10/2021 to 20/10/2021 Watery diarrhea mixed with blood and mucus 5-8 times/day. Vomiting 1-2times/day & Weakness   he consulted gastroenterologist Cap.Mesacol, Tab. mesalamine- 1.2 mg (4 tab at morning), Tab. prednisone 5 mg (40mg per day), Salofalk suppository (2 time per day). Initially got relieved but again the symptoms got worst.
5.   Watery diarrhea 10-11 time, mixed with blood and mucus times/day, Vomiting 1-2times/day & Weakness Patient admitted to P.D. Patel Ayurveda hospital Nadiad  
6. 09/11/2021 to 15/11/2021 Watery diarrhoea mixed with blood and mucus 5-8 times/day, No Vomiting times/day & Weakness 1. Kutaja Ghanvati,
2. Musta Churna + Nagkesar Churna + Lodhra Churna
3. Udumbar Kwatha
4. Udumbar Kwatha Basti
5. Jatyadi Taila Basti
6. Chhardiripu + Shankh Bhasma
7. Shatavari Ghrita (Orally) +
8. Go Ghrita with Pathyapathya
7. 29/11/2021 Watery diarrhoea mixed with and mucus 3-4 times/day, no blood No Vomiting 1-2times/day Same as above
8. End of November Watery diarrhoea mixed with and mucus 2-3 times/day Above treatment  
9. 07/12/2021 Watery diarrhoea mixed with and mucus 2-3 times/day Patient is discharged  
10. Follow up after 1 month Sometime Watery diarrhoea mixed with and mucus 1-2 times/day 1. Musta Churna + Nagkesar Churna + Lodhra Churna
2. Udumbar Kwatha
3. Shatavari Ghrita (Orally) +
4. Go-Ghrita
11. Follow up after 3 month Sometime Watery diarrhoea mixed with and mucus 1-2 times/day Same as above

Outcome and Follow-Up

Table 5: Outcome and Follow-Up

SN Striking Features Before Treatment After Treatment After 2 month of follow up
1. Bowel Frequency 4 (More than 12 times in a day) 0 (1 or 2 times in a day) 0 (1 or 2 times in a day)
2. Blood in stool 4 (Bleeding daily and more than 8 times in a day) 0 (No bleeding) 0 (No bleeding)
3. Mouth ulcers ++++  - -
4. Weakness 3 (Moderate weakness) 1 (Tolerable weakness) -
5. Vomiting 2-3times/day No vomiting No vomiting

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Diagnostic Assessment

Colonoscopy (18/10/21)

Proctosigmoditis present

Loss of vascular pattern erythema, mild ulceration at sigmoid and rectum colon.

Therapeutic Intervention: The treatment given during hospitalization is as follows:

Upon the admission patient was started with Udumbarkwath Basti, Samanarth Snehan with Shatavari Grita, Musta Churna (3gm) + Nagkesar Churna (1gm) + Lodhra Churna (1gm) and Yastimadhu Churna (3gm). On second day (Jatyadi Taila Matra Basti - 40ml) after dinner was started. Nasya Karma with Bhamhi Ghrita. This following treatment was continued for 40 days.

Shamana Aushadha were also given which are mention in below (Table 4).

Outcome and Follow-Up: Patient was assessed before and after the treatment as well as after follow up after 2 months of discharge. Reduced frequency of watery stool mixed with blood, mucus, no vomiting, and no mouth ulcers were observed after the treatment.

Discussion

In Ayurveda, Raktatisara is described as a type of hemorrhagic diarrhoea that shares certain symptoms with ulcerative colitis, including Shula (abdominal pain), Gudapaaka (rectal burning), and Trishna (excessive thirst). UC is a Purisha Vaha Srotas disease. The disease is caused by Pitta Pradhan Vata Doshas. Udumbara Kwatha possesses Pitta Vata Shamana characteristics, as well as Vrana Shodana and Ropana, which aid in the Basti Karma treatment of colon ulcers. Additionally, it has Stambhana qualities that lessen bowel frequency and stop bleeding. Nagakeshara has Raktatisara Nashaka and Lodhra has Rakta Stambhaka action that reduces the bleeding. The actions of Musta are Amapachana, Agnideepana, and Grahi decrease bowel frequency and relieve the body from Ama. Aisara Nashaka (Stambhana) Guna of Kutaja Ghan Vati, which also aids in lowering bowel regularity, contains the Ghana Satva of Kutaja Tvak. Yasthimadhu (Glycyrrhiza glabra Linn.) is Vata Pitta Shamaka as well as Shothahara and is an anti-inflammatory drug.[8]

Ghrita stimulates Agni, besides possessing properties like Balya and Vrana Ropana (healing effect).[9] Charaka described Ghrita as a best Vata Pitta Shamaka Dravya. Jatyadi Taila in Matra Basti is helpful in cleaning and healing the ulcers which have small openings, situated on vital spots, which have exudation, deep seated, painful and having sinuses.[10] Bramhi Ghrita helps in relvivng stress, and Medhya Guna.[11]

Shatavari Ghrita is described in Charak Samhita Chikitsa Sthana, having property of Sheeta Guna, Pitta Shamak and Balya Guna relieves mental stress which is a contributing factor to the disease.[12]

After consuming Matra Basti with Jataydi Taila and Udumbar Kwath Basti for 35 days, the patient's stomach pain while eating decreased, and he or she began eating solid foods like chapatis. The patient weigh increased after the 40th day of treatment, going from 45 to 48 kg. Before beginning Basti, a sigmoidoscopy was performed. Which revealed a decrease in vascularity and an increase in friability. With rectum and erosion. More mucosal erythema and Proctocolitis is indicated by oedema in the sigmoid colon.

After receiving these mentioned medication for 35 days, healthy mucous membranes and vascularity was observed. Looking into these changes, Basti was stopped.

Conclusion

This case report presents a potential of Ayurveda treatment in the management of ulcerative colitis. So, from above discussion it can be concluded that, Ayurvedic management is very successful in the management of Ulcerative Colitis. Ayurvedic management with oral herbs and Basti along with dietary modifications is very beneficial. It is safe, cost effective and having no adverse effects. This disease is a challenging medical problem. Continuous degradation of health disturbs the daily routine life and mental wellbeing of the patient. The patient is suffering from ulcerative colitis since last 10 years.

Long follow-up and a greater number of patients are required to reach any conclusion but, in this case, it can be stated that this treatment is a hope for the patients with ulcerative colitis resistance to conventional medicine.



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Colonscopy Report

jaims_2246_01.JPG

Patients Perspective

The patient – “When I came to this hospital, I had watery stool mixed with blood and mucus, vomiting, mouth ulcers, and disturbed sleep. I had weakness, Now, after the treatment, I have much relief from all symptoms and my stool frequency is decreased with is up to normal 2-3 time per day.

I was told by the allopathic doctors that I will have to go for surgical operation and continue allopathic medication for life time, since I was admitted at this hospital I had stopped my all allopathic medication. but here after Basti Karma, Nasya, Karma and other Ayurveda treatment I got relief in symptoms.

Written permission for publication of this case study has been obtained from the patient.

Acknowledgements

Authors are thankful to Superintendent, Deputy Medical Superintendent (IM) and Staff of the Male Panchakarma Unit of P D Patel Ayurvedic Hospital, JSAM, Nadiad for providing the necessary facilities. We deeply acknowledge the suggestions rendered by Prof. Dr. S. N. Gupta, Prof. Dr. Manish Patel and Prof. Dr. Kalapi Patel, and Dr. Pankaj Chhayani.



Reference

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2. Nicolas A. Boon, Nicki R. Colledge, Brain R. Walker et al., Davidson’s Principles & Practice of Medicine, 20th edition. 2006, P. 910-913.

3. Kasper, Braunwald, Fauci, Harrison’s Principles of Internal Medicine Vol.II; 16th Edition, 2005, P. 2477.

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5. Lennard-Jones JE, Misiewicz JJ, Connell AM, Baron JH, Jones FA. Prednisone as maintenance treatment for ulcerative colitis in remission. Lancet. 1965; 1(7378); 188-189.

6. Acharya YT, editor. Charaka samhita of Agnivesha, Chikitsa sthana, Atisara chikitsitam, chapter 19, verse 70, Chaukhambha Sanskrit Sansthan; Varanasi: reprint 2002; 510.

7. Acharya YT, editor. Charaka samhita of Agnivesha, Chikitsa sthana, Atisara chikitsitam, chapter 19, verse 71, Chaukhambha Sanskrit Sansthan; Varanasi: reprint 2002; 510.

8. Sharma PV. Dravyaguna Vigyaan Vol-II. Chaukhambha Bharati Academy, Varanasi: Reprint 2013, p. 253.

9. Shastri A, editor. Sushruta Samhita of Sushruta, Sutra sthana, Dravadravya vidhi, chapter 45, verse 96, Chaukhambha Sanskrit Sansthan; Varanasi: 2008, p. 204.

10. Shukla V, Tripathi RD, editors. Charaka Samhita of Agnivesha, Sutra sthana, Yajjahapurushiyam, chapter 25, verse 40. Chaukambha Sanskrit Pratishthan; Delhi: Reprint 2007, p. 337.



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11. Acharya ambikadatta sasahtri, editor. bhaisajyaratnavali, Chikitsa sthana, Apasamara chikitsitam, chapter 25, verse 35, Chaukhambha Sanskrit Sansthan; Varanasi: reprint 2002; 510.

12. Acharya YT, editor. Charaka samhita of Agnivesha, Chikitsa sthana, Atisara chikitsitam, chapter 19, verse 78, Chaukhambha Sanskrit Sansthan; Varanasi: reprint 2002; 510.


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