E-ISSN:2456-3110

Research Article

Hepatocellular Jaundice

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 12 December
Publisherwww.maharshicharaka.in

A clinical comparative study of Patolakaturohinyadi Kashaya and Trayantyadi Kashaya in Koshtashakhashrita Kamala w.s.r. to Hepatocellular Jaundice

Akshata1*, Mathapati IS2, Dharmannavar GS3
DOI:10.21760/jaims.8.12.2

1* Akshata, Post Graduate Scholar, Department of Post Graduate Studies In Kaya Chikitsa, Shri Shivayogeshwar Rural Ayurvedic Medical College and Hospital, Inchal, Karnataka, India.

2 I S Mathapati, Professor, Department of Post Graduate Studies in Kaya Chikitsa, Shri Shivayogeshwar Rural Ayurvedic Medical College and Hospital, Inchal, Karnataka, India.

3 G S Dharmannavar, Asisstant Professor, Department of Post Graduate Studies in Kaya Chikitsa, Shri Shivayogeshwar Rural Ayurvedic Medical College and Hospital, Inchal, Karnataka, India.

In our Samhita, Kamala Vyadhi is briefly described. Kamala is a Pittaja Nanatmaja Vyadhi as well as Raktapradoshaja Vyadhi. Charaka has considered Kamala as advanced stage of Pandu Roga. Sushruta and Vagbhata has considered Kamala as a separate disease and Sushruta also told it is due to further complications of Pandu Roga, Kamala can be compared with Jaundice (Hepatocellular Jaundice) in contemporary science. Contemporary science has limitations in treating Kamala Vyadhi but Ayurvedic literature clearly explained pathology and treatment of Kamala Vyadhi in detail.

Keywords: Kamala, Kosthashrita Kamala, Rakta Pradoshaja Vyadhi, Pittaja Nanatmaja Vyadhi, Jaundice, Hepatocellular Jaundice, Bilirubine, Bile

Corresponding Author How to Cite this Article To Browse
Akshata, Post Graduate Scholar, Department of Post Graduate Studies In Kaya Chikitsa, Shri Shivayogeshwar Rural Ayurvedic Medical College and Hospital, Inchal, Karnataka, India.
Email: 		Akshata, Mathapati IS, Dharmannavar GS, A clinical comparative study of Patolakaturohinyadi Kashaya and Trayantyadi Kashaya in Koshtashakhashrita Kamala w.s.r. to Hepatocellular Jaundice. J Ayu Int Med Sci. 2023;8(12):08-13.
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https://jaims.in/jaims/article/view/2952

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-10-14 2023-10-22 2023-10-31 2023-11-06 2023-11-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared. nill yes 13.62

© 2023by Akshata, Mathapati IS, Dharmannavar GSand 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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Akshata et al. Koshtashakhashrita Kamala w.s.r. to Hepatocellular Jaundice

Introduction

In our Samhita explained that Raktavaha Srotas take active part in the production of Rakta Dhatu and the Moola of them is Yakrit and Pleeha. Both Yakrit and Pleeha are also the sites of Ranjaka Pitta and store houses for the Rakta Dhatu. Kamala is explained in the Rakta Pradoshaja, Raktavaha Sroto Vikara. Kamala is considered as a Paittika Roga caused by Rakta Dushti due to vitiated Pitta and vice versa.[1] The root word “Kāmu”, which means Kānthi by suffixing “Nhin"Pratyaya, forms the term Kamala. Thus, the term Kamala is Kāmu + Nhin (kalaha).[2]

The literary meaning of Kamala is “Kaamam Lunati Iti Kaamalati” Here Kāmam means Itcha or desires, and Lāti means Runaddhi or Bādhanti or to diminish. Etiological factors which causes Raktadushti like Ushna, Vidahi, Dadhi, Taila, Drava, Snigdha, Kshara, Anupa Mamsa Sevana, Krodha and Sharad Kala etc. are almost similar to that of Pitta Prakopas, which causes Kamala.[3]

The above-mentioned Nidanas causes Pitta Prakopa and Rakta Dusti. When Rakta is vitiated the Srotases through which it circulates (Raktavaha Srotas) also gets vitiated ultimately leading to vitiation of Moolasthanas i.e., Yakrit and Pleeha and causing Kamala. Thus, the Nidanas of Rakta Dusti also causes Kamala and shows Lakshanas like Dourbalya, Alpagni, Aruchi, Haridra Netra, Mutra, Twak, Nakha etc. Therefore, our Acharyas has mentioned Shodhana Chikitsa (Virechana) and Shamana Chikitsa are successful in Kamala by removing to malas from the body and correction of Agni.

The drugs which have Guna Karma of Katu Rasa, Tikta Rasa, Kashaya Rasa, Rechana Guna, Bhedana Guna, Pittahara and Kaphahara Guna which are helpful to reduce the Kamala symptoms by their Guna Karma. Among them Patolakaturohinyadi Kashaya and Trayantyadi Kashaya these drugs have Kamalahara properties like Ushna, Laghu, Ruksha Guna, and having Tikta-Katu Rasa Dravyas (ingredients of internal medication) enhances digestive capacity by hepato- protective action and Pittashamaka Guna. Hence these drugs were selected for ongoing study. In modern science Kamala is can be taken with Hepatic jaundice also known as Hyperbilirubinemia, is defined as a yellowish discoloration of the body tissue resulting from the accumulation of excess bilirubin.

Deposition of bilirubin happens only when there is an excess of bilirubin, and this indicates increased production or impaired excretion. The normal serum levels of bilirubin are less than 1 mg/dl. However, the clinical presentation of jaundice with peripheral yellowing of the sclera, also called scleral icterus, is best appreciated when serum bilirubin levels exceed 3 mg/dl.

The most common signs of jaundice in adults are a yellowish discoloration of eye (sclera) and skin, urine (bilirubinuria) and pale, (acholia) fatty stool (steatorrhea). Despite abysmal record maintenance in the most states of the country, it is unambiguous that the incidence of jaundice has shown a steady and alarming increase. Death to all due to jaundice has been doubled over last two decades.

The statistics of the study conducted by the National Institute of Communicable Diseases (NICD) show that jaundice is a major public health problem in India. An annual incidence of 2.76 per 1000 population were stated.

Objectives of the Study

1. To study the efficacy of Patolakaturohinyadi Kashaya in Kosthashakhashrita Kamala w.s.r to Hepatocellular jaundice.
2. To study the efficacy of Trayantyadi Kashaya in Kostha Shakhashrita Kamala w.s.r to Hepatocellular jaundice.
3. To compare the role of Patolakaturohinyadi Kashaya and Trayantyadi Kashaya in the management of Kosthashakhashrita Kamala w.s.r to Hepatocellular jaundice.

Materials and Methods

Inclusion Criteria and Exclusion Criteria

FactorsInclusion CriteriaExclusion Criteria
Age20 – 60 years<20 years, >60 years
SymptomsHaridra NetraNeurological diseases
Haridra NakhaBlood disorders
Haridra MutraHIV, HbSAG
Haridra TwakPregnant women
AruchiSystemic illness like T.B etc.
Hrullasa
Dourbhalya
OthersWilling for written consentNot willing for willing consent

Diagnostic Criteria

The diagnosis will be made on the basis of signs and symptoms of Kamala and laboratory investigations.


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Akshata et al. Koshtashakhashrita Kamala w.s.r. to Hepatocellular Jaundice

Subjective Parameters

  • Haridra Netra, Mutra, Twak, Nakha.
  • Dourbalya
  • Alpagni
  • Aruchi
  • Hrullasa

Objective Parameters

  • Hb% (above 9 gm%)
  • LFT
  • Urine Bile pigment (present/ absent)
  • Urine Bile salt (present / absent)

Design of study

  • Study type : interventional
  • Allocation : Randomized
  • Endpoint Classification: Efficacy study
  • Intervention model : Double Group
  • Masking : open label, pre-test and post test design.

Intervention1. Group A: 20 diagnosed subjects of Kamala given Patolakaturohinyadi Kashaya in dose of 15ml twice daily, before food for 7 days.2. Group B: 20 diagnosed subjects of Kamala given Trayantyadi Kashaya in the dose of 15ml twice daily, before food for 7 days.

  • Total duration of study - 14 days
  • Interventional period - 7 days
  • Follow-up - 7 days after treatment.

Observation and Results

A total number of 40 subjects fulfilling the inclusion criteria were studied.

  • Number of subjects registered for the study - 42
  • Number of subjects completed the study - 40
  • Number of dropout - 2

Showing Incidence of subject on basis of Age.

AgeGroup APercentageGroup BPercentage
20-300420%000%
31-400420%0840%
41-500945%0945%
51-600315%0315%
Total20100%20100%

Showing Incidence of subject on basis of Gender.

GenderGroup APercentageGroup BPercentage
Male1470%1155%
Female0630%0945%
Total20100%20100%

Showing Incidence of subject on basis of Agni.

AgniGroup APercentageGroup BPercentage
Sama0315%0210%
Vishama0525%0630%
Manda1155%1050%
Teeksna015%0210%
Total20100%20100%

Showing Incidence of subject on basis of symptom of Haridra Netra.

Haridra NetraMeant valueP valueResult
Group A0.652.8090.0078Significant
Group B0.2

Showing result after the treatment in Haridra Nakha.

Haridra NakhaMeant valueP valueResult
Group A0.251.7980.0801Significant
Group B0.05

Showing result after the treatment in Haridra Twak.

Haridra TwakMeant valueP valueResult
Group A0.10.58780.5602Significant
Group B0

Showing result after the treatment in Haridra Mutra.

Haridra MutraMeant valueP valueResult
Group A0.753.1110.035Significant
Group B0.3

Showing result after the treatment in Daurbalya

DaurbalyaMeant valueP valueResult
Group A0.12.6260.0124Significant
Group B0.45

Showing result after the treatment in Alpagni.

AlpagniMeant valueP valueResult
Group A0.150.46730.6429Not Significant
Group B0.1

Showing result after the treatment in Aruchi.

AruchiMeant valueP valueResult
Group A0.10.58780.5602Significant
Group B0

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Showing result after the treatment in Hrullasa.

HrullasaMeant valueP valueResult
Group A0.30.71660.478Significant
Group B0.2

Showing Incidence of subject on basis of Total bilirubin.

Total BilirubinMeant valueP ValueResult
BTAT
Group A1.30.457.768< 0.0001H.Significant
Group B1.150.111.92< 0.0001H.Significant

Showing result after the treatment in Total bilirubin.

Total BilirubinMeant valueP valueResult
Group A0.452.6260.0124Significant
Group B0.1

Showing result after the treatment in Direct bilirubin

Direct BilirubinMeant valueP valueResult
Group A0.352.4940.0171Significant
Group B0.05

Showing result after the treatment in SGOT

SGOTMeant valueP valueResult
Group A0.32.1470.0382Significant
Group B0.05

Showing result after the treatment in SGPT

SGPTMeant valueP valueResult
Group A0.452.1350.0392Significant
Group B0.15

Showing result after the treatment in Alk. Phosphatase.

Alkaline PhosphataseMeant valueP valueResult
Group A0.20.3690.7136Not Significant
Group B0.25

Showing result after the treatment in Bile pigment.Showing the result after the treatment in Bile salt

Bile PigmentMeant valueP valueResult
Group A0.32.1470.0382Significant
Group B0.05

Discussion

When Pandu Rogi or patient who cured from Pandu continues to take Pitta Vardhaka Ahara then this causes excessive aggravation of Pitta Dosha and gives rise to Kamala. When patient of Pandu Roga or person affected with other Roga

consumes Amla, Teekshna, Vidhahi, Kshara etc. Pitta Vardhaka Ahara, that may lead to initiation of Kamala. Ranjaka Pitta and its Sthana Yakrit are also involved in its Samprapti. Ranjaka refers to bile pigments. Pitta refers to bile salts. Bile salts have choleretic action that stimulates the secretion of bile from liver. It is this Ranjaka Pitta, which provides an exceedingly valuable tool for the diagnosis of both Koshtashakashrita and Shakhashrita Kamala.

Aetiological factors which causes Rakta Dushti like Ushna, Vidahi, Dadhi, Taila, Snigdha, Kshara, Anupa Mamsa Sevana, Krodha and Sharat Kala etc. are almost similar to that Pitta Prakopas, which causes Kamala. These Nidanas causes Pitta Prakopa and Rakta Dushti, when Rakta is vitiated the Srotases through which it circulates also gets vitiated ultimately leading to vitiation of Mulasthanas i.e., Yakrit and Pleeha and causing Kamala. Thus, Nidanas of Rakta Dushti also causes Kamala indirectly.

Treatment of choice for Kamala is Mrudu-Virechana as Virechana is best therapeutic procedure for Pittadosha. Virechana is a specific treatment for Pitta Doshas and Pitta Samsarga Doshas. Virechana Dravyas will have properties of Ushna, Tikshna, Sukshma, Vyavayi and Vikasi Guna. These drugs consist of Prithvi and Jala Mahabhutas. Virechana drugs have a specific property of removing the Doshas from lower part of the body (Adhobhaga). Many more Shamana Oushadhi are also explained in the treatment of Kamala. Among the Shamanoushadhi many more Kastaushadhis and Rasaushadhis which containing properties of Rechana Karma, Bhedhana Karma, Pitta Shamana Guna, Rakta Shodhaka Guna should be given as line of treatment for Kamala.

Haridra Netra, Nakha, Twak, Mutra, Dourbalya, Alpagni, Aruchi, Hrullasa were the subjective parameters taken up for present study. Results obtained were interpreted for within the group and between group changes. A significant improvement was seen after the treatment in both groups by giving Patolakaturohinyadi Kashaya and Trayantyadi Kashaya.

In Bahu Pitta Kamala the drugs which act on liver as Yakritottejaka and Yakrit Shodhana given which leads to normal flow of bile. Tikta Rasa Dravyas are used because they are Pitta Shamaka in nature. Patolakaturohinyadi Kashaya have Kapha-Pittahara and Tridoshahara property.


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Patola, Katuki, Chandana, Patha have Kapha Pitta Shamaka property. Murva and Guduchi have Tridoshahara property and Guduchi is mainly act as Pitta Shamaka as Pitta is main Dosha in Kamala Roga. So, this drug Patolakaturohinyadi Kashaya used in Kamala Roga.

Trayantyadi Kashaya is a formulation which is explained in Astanga Hridaya for treatment of Kamala. These drugs contain Tikta, Katu Rasa Pradhanya Dravyas which are useful in symptoms of Aviapaka, Aruchi as they pacify the vitiated Doshas and promote the Dhatu Poshana and thus reducing the Dourbalya. As Tikta Rasa is Rakta Shodhaka and Pitta Shamaka, it attributes to the reduction in Haridra of Netra, Nakha, Twak, Mutra, etc., The hepatoprotective and hepato stimulant properties of the formulation are responsible for the better result in alleviation of elevated SGOT, SGPT, Total, Direct Bilirubin, Bile pigment and Bile salt level reduction in Haridra of Netra, Nakha, Twak, Mutra, etc., The hepatoprotective and hepato stimulant properties of the formulation are responsible for the better result in alleviation of elevated SGOT, SGPT, Total, Direct Bilirubin, Bile pigment and Bile salt level.

Conclusion

Kamala Roga is Pitta Pradhana, Rakta Pradoshaja Vikara which manifest the Haridrata of Netra, Nakha, Mutra, Twak etc. as a Pratyatma Lakshana. In Koshtashakashrita Kamala Chikitsa Shamanoushadi plays important role especially the drug which contents Tikta, Katu Rasa, Rakta Shodhaka property, Virechana property. So, both Patolakaturohinyadi Kashaya and Trayantyadi Kashaya have significant improvement. Both the Patola Katurohinyadi Kashaya and Trayantydi Kashaya have shown significant result. But Trayantydi Kashaya shows more significant than Patolakaturohinyadi Kashaya because Trayantydi Kashaya have the drug Trivrit which considered as a best drug for Rechana.

Statistically this study was found significant showing good results in subjective and objective parameters in both the groups. After giving the Trayantyadi Kashaya the bilirubin level come to normal range, it also helpful in reducing the symptoms of Haridra Netra, Haridra Mutra, Haridra Nakha etc. In Kamala, Yakrit get effected, Yakrit is helpful in purifying the blood, so Trayantyadi Kashaya has the Raktashodhaka property, and it helpful

in clean gut and it is anti-oxidant property. Trayantydi Kashaya contains Triphala drug which is Rasayana and hepatoprotective. Kamala is Pittaja Nanatmaja Vyadhi and Raktapradoshaja Vyadhi Trayantydi Kashaya is Pitta Kaphahara and Anulomana which is helpful in remove the waste product from the gut and liver by detoxifying it. It acts on Antar, Bahir and Madyama Rogamargas. So, to treat the Kamala we can use Trayantyadi Kashaya as a one of the treatable drug.

Reference

1. Sushruta. Sushruta Samhita with commentaries Nibhandha sangraha of Sri Dalhanacharya and nyayachandrika vyakhya panjika of Sri Gayadas Acharya, edited Narayan Ram Acharya:Kavyatirtha’, Chaukhamba Surbharati prakashana, Varanasi, print 2008 PG-824, page no- 729, 7302.

2. Shabda kalpadruma

3. Agnivesha, Charaka, Charaka Samhita, Dr, Bramhanand Tripati Hindi commentary Edited by Charaka Chandrika, published by Choukambha prakashana, vol II, reprint 2020, chikitsa stana, shloka 36, page no 596


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