E-ISSN:2456-3110

Case Report

Management of Acute Pancreatitis

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 4 April
Publisherwww.maharshicharaka.in

An Ayurvedic approach towards management of Acute Pancreatitis: A Case Study

Sokiya G1, Painuly P2*, Negi M3, Sharma G4
DOI:10.21760/jaims.9.4.52

1 Gracy Sokiya, Assistant Professor, Department of Kayachikitsa, Patanjali Ayurveda College, Haridwar, Uttarakhand, India.

2* Paridhi Painuly, Post Graduate Scholar, Department of Kayachikitsa, Patanjali Ayurveda College, Haridwar, Uttarakhand, India.

3 Mudita Negi, Post Graduate Scholar, Department of Kayachikitsa, Patanjali Ayurveda College, Haridwar, Uttarakhand, India.

4 Gaurav Sharma, Assistant Professor, Department of Rachana Sharir, Patanjali Ayurveda College, Haridwar, Uttarakhand, India.

In acute pancreatitis, there is sudden inflammation of the pancreas, histologically characterized by the destruction of acinar cells, which can range from mild to life-threatening. A 22-year-old non-alcoholic male patient presented to the outpatient department (OPD) with acute abdominal pain, accompanied by heartburn and nausea. MRCP findings suggested acute pancreatitis, with a large heterogeneous collection observed along the body and tail of the pancreas in the lesser sac, containing internal debris and hemorrhagic contents indicative of a pancreatic pseudocyst, along with elevated serum amylase and lipase concentrations. Due to the similarity between the patient's chief complaints and the symptoms of Pittaja Gulma, treatment was administered based on the principles of Pittaja Gulma. The treatment regimen included Dashmool Kwath, Mulethi Kwath with Narikela Lavana, Drakshovin syrup, and a combination of Avipattikar Churna, Kamdhudha Ras, Praval Panchamrit Ras, and Shankha Bhasma. After 15 days of treatment, serum markers returned to normal levels, and ultrasonography reports indicated satisfactory changes. The therapy's effectiveness was deemed satisfactory, with statistically significant improvements observed in both clinical and laboratory findings.

Keywords: Acute pancreatitis, Pittaja Gulma, Pseudocyst

Corresponding Author How to Cite this Article To Browse
Paridhi Painuly, Post Graduate Scholar, Department of Kayachikitsa, Patanjali Ayurveda College, Haridwar, Uttarakhand, India.
Email: 		Sokiya G, Painuly P, Negi M, Sharma G, An Ayurvedic approach towards management of Acute Pancreatitis: A Case Study. J Ayu Int Med Sci. 2024;9(4):310-315.
Available From
https://jaims.in/jaims/article/view/3095

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-02-13 2024-02-23 2024-03-03 2024-03-13 2024-03-25
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 21.52

© 2024by Sokiya G, Painuly P, Negi M, Sharma Gand 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

Acute pancreatitis is a common inflammatory disease of the exocrine pancreas that causes severe abdominal pain and multiple organ dysfunctions that may lead to pancreatic necrosis and persistent organ failure, with a mortality of 1-5%. It leads to significant short and long term morbidity, which causes prolonged frailty, disease reoccurrence, pancreatic endocrine and exocrine insufficiency. The prognosis mainly depends

on the development of organ failure and secondary infection of pancreatic and peripancreatic necrosis. Despite improvements in treatment and critical care severe acute pancreatitis is still associated with high mortality rates.[1]

Pancreatitis is a serious clinical condition that manifests in either its acute or chronic forms. The underlying pancreatic disease especially if asymptomatic, the diagnosis can be missed. The etiologies of pancreatic ascites and pancreatic pleural effusions are identical and rarely seen together in the same patient. The patients with acute pancreatitis have abdominal pain, persistent vomiting, and fever. The diagnosis is made on the basis of laboratory findings including serum markers such as S. Amylase, S. Lipase and CT abdomen.[2-3]

There is no exact correlation to acute pancreatitis in Ayurveda. It may be correlated with Pittaja Gulma. On the basis of etiology and presenting complaints the Dosha predominance can be understood. As the patient had been taking spicy food and had a sedentary lifestyle for a long duration it was very clear that there is vitiation of Rakta[4-5] as per Acharya Charaka verse (Ca. Su. 24:5) and vitiation of Medovaha Srotas (Ca. Vi. 5:16). Rakta is the causative factor for the suppuration as indicated by Acharya Charaka in Gulma treatment (Ca. Chi. 5:37). Now due to Ashraya Ashrayeebhava of Rakta and Pitta, the vitiated Rakta causes vitiation of Pitta which quickly causes suppuration. Considering the aetio-pathogenesis and diagnosis the treatment was planned focusing Pitta-Shamana (pacifying Pitta), Rakta-Prashadaka (blood purifier) and Medovaha Sroto-Sodhaka. Based on this treatment principle medicine like Mulethi Kwath, Narikela Lavana, Avipattikar Churna, Kamdudha Ras, Shankh Bhasma, Praval Panchamrit Ras and Drakshovin syrup was given for 15 days and restriction of diet was advised.[6]

The causative factors of Paitikka Gulma are the intake of pungent, sour, penetrating, hot, Vidahi (which cause acidity or burning sensation in the stomach) and unctuous articles of diet, excessive intake of alcohol and exposure to sun as well as fire, vitiation of blood.

Case Presentation

A 22 year old male patient from Dehradun was apparently well and was asymptomatic back in July 2022 when suddenly he had his first episode of severe abdominal pain with nausea and heartburn for which he went to a nearby hospital and was given symptomatic relief and was advised ultrasound for further evaluation. He was admitted under a Gastroenterologist in Dehradun for a week and was treated with intravenous fluids, analgesics, antacids and antibiotics. His symptoms were quiet relieved but mild pain in lower abdomen was persistent.

After a month i.e., in the month of August the patient experienced another episode of severe abdominal pain associated with burning sensation and was admitted to the same hospital for a week. He was again treated with intravenous fluids, analgesics, antacids and antibiotics. He was symptomatically relieved and allopathic medication was continued.

Later the patient experienced one more episode of pancreatitis in the month of September.

In the month of October he approached the OPD of Kayachikitsa, Patanjali Ayurveda Hospital, Haridwar, Uttarakhand. The patient complained of heartburn with a burning sensation in the abdomen in the epigastric region that aggravates with food intake, particularly spicy as well as oily food.

Since the 1st episode of pain, the boy had been taking a diet devoid of dairy, protein, and fat and had been taking pancreatic enzymes and antioxidants daily.

He was very much disturbed emotionally and was anxious as well as mildly depressed, on clinical evaluation. On examination of vitals - pulse rate was found to be 72/min., heart rate was 75/min, blood pressure was 110/70 mm Hg (right arm sitting), temperature was 98.4°F (armpit), respiration rate was recorded as 17 min and body weight was 57Kg, having height of


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170cm on measurement. He was emaciated; abdomen was of normal contour with no dilated veins, no visible peristalsis, no striae. On palpation, tenderness was present in the epigastric, left hypochondrim. His laboratory tests revealed hemoglobin level of 10.2 g/dL, serum amylase - 778 IU/L, serum lipase - 504 IU/L. MRCP Upper abdomen revealed acute pancreatitis with a large heterogeneous collection along the body and tail of pancreas in lesser sac with internal debris and hemorrhagic contents s/o pancreatic pseudocyst with high serum amylase concentration.

After 15 days, the patient attended OPD for first follow up with relief in abdominal pain, relief in heart burn and was taking a semi liquid diet. On abdominal examination there was no tenderness in the epigastric region. Patient was suggested to continue the same treatment for next 15 days with a semi-liquid diet. After 15 days, the patient attended OPD for second follow up. Patient was suggested to repeat serum amylase and lipase tests and abdominal sonography to evaluate the improvement. The investigations were done and recorded as normal. MRCP of the abdomen revealed reduction in size of Pseudo pancreatic cyst and minimal perisplenic fluid with minimal B/L pleural effusion.

As maintenance therapy, he was advised to continue

Dashmool kwath 1 tablespoon full boiled in 400ml of water, reduced to 100 ml twice a day for 15 days. No further episodes were reported for the next three months.

SNInterventionAnupana
1.Dashmool Kwath (1tsf) + Mulethi Kwath (½ tsf) - boil in 400ml water reduce it to 100 ml100 ml twice a day empty stomach
2.Narikela Lavana - 1 tsf twice a day after mealLukewarm water
3.Syp. Drakshowin - 4 tsf with equal amount of water twice a day after mealLukewarm water
4.Avipattikar Churna - 100g, Kamdudha Ras - 20g,
Pravaal Panchamrit Ras - 10g, Shankh Bhasma - 10g
Mix all of the above and make 60 doses, take 1 dose thrice a day before meal		Lukewarm water

Result

Since the intervention of ayurvedic therapy, the patient reported gradual improvement in all symptoms. His pain in abdomen with heartburn was completely gone after 15 days of treatment. His appetite although improved gradually after one month treatment. He reported no symptoms or discomfort after the treatment. This led to

a significant improvement in his general well-being, enabling him to lead a normal life.

In October 2023, the administration of ayurvedic therapy was ceased. He was asymptomatic and clinically fine. Follow-up MRCP indicated the arrestation of the disease process. The comparative MRCP report done in October 2022 and June 2023 showed decrease in the size of pseudo pancreatic cyst and peri pancreatic fluid around the pancreas.

Discussion

The present case is worth enough to be discussed as it helps to understand the efficacy as well as utility of fundamentals of Ayurvedic treatment methodology in treating the complicated cases.

The case above discussed is a case of acute pancreatitis complicated with pleural effusion and mild ascites. Most of the time, in such cases the patient seeks contemporary medicines due to severe pain, vomiting and restlessness associated with the disease and if rarely anyone took Ayurvedic medicines it may be either as add-on therapy or just to compensate the long- term side-effects caused by the contemporary medicines (if any). And unfortunately, in such rare instances most of them remain undocumented, making it difficult to rationalize the treatment protocol. In the above case it is tried to use very simple herbal medicines based on treatment principle that are easily available so that the results can be reciprocated and moreover the rationality of treatment principle can also be adjudicated. It can be assumed that the medicines have profound anti-inflammatory properties. During the treatment, the patient neither developed any complications (e.g. Organ failure) nor showed any worsening of symptoms.

Dashmool Kwath - helps in the vitiation of Vata Dosha by reducing its aggravation. It balances Vata, Pitta and Kapha known to be as a Tridosha Shamak. Inflammation or Vata Vyadhi is treated by this medicine very well. It has potent anti-inflammatory and antioxidant properties, as a result, it is utilized to treat painful, inflammatory musculoskeletal disorders.[7]

Mulethi Kwath - Mulethi naturally has sweet taste i.e., Madhur Rasa, Sheeta Virya and Madhur Vipaka, it possesses anti-inflammatory properties. It is often used to soothe gastrointestinal


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problems like indigestion, acidity and ulcers due to its anti-inflammatory properties. It also has hepatoprotective properties. Sodium glycyrrhizate present in Mulethi shows anti-ulcer activity and stimulation of regeneration of skin.[8] It aggravates Vata, scrapes Kapha and normalizes Pitta and Rakta. It promotes healing process.

Narikela Lavana - an Ayurvedic formulation mentioned in Rastarangini, is stated to be used for diseases like Amlapitta (hyperacidity), abdominal pain due to G.I tract disorders i.e., Vataj, Pittaj, Kaphaj and Sannipataj Shula and Parinamshula (duodenal ulcer) and because of the presence of Saurvarchala Lavan, Saindhav Lavan it can be useful in Anaha, Gulma, Udarshula.[9]

Drakshowin syrup - An Ayurvedic formulation which is curated with ingredients like Brahmi, Draksha and Ashwagandha which helps in boosting digestion and improving appetite. It is effective in Agnimandya and Aruchi by regularizing Pitta secretion and enhancing the action of Agni. It also strengthens the Annavaha Srotas by reestablishing metabolic activity.[10]

Avipattikar Churna - it exhibits the antiulcer properties. Haritaki, Maricha and Pippali exert cytoprotective effects on the gastric mucosa. Shunthi decreases the gastric secretion, it increases the mucosal resistance and potentiates the defensive factors of the gastric mucosa. Lavang helps in maintaining the basal gastric mucosal blood flow and it increases the mucus secretion.[11]

Kamdhudha Ras - its action can be seen right from Amashaya like it reduces heat of the stomach, reduces inflammation of the organs of the digestive system and lowers the tendency of bleeding. The main Karya of Kamdudha Ras is Pittashaman, Raktastambhan, Kshobhanashan and is Shitviryatmak. Therefore it is used in various Mahastrotasa Vyadhis like Raktapitta, Amlapitta, Raktaj and Pittaj Atisara, Pittaj Hrudrog, Sarvanga Shotha etc.[12]

Praval Panchamrit Ras - the drugs are of Madhura, Tikta, Kashaya and Katu Ras, Madhur Vipaka and Sheetvirya which are Pittashamaka hence symptoms like Amla Tikta Udgara, Urakantha Daha due to Vidagda Pitta get relieved.[13]

Shankha Bhasma - In Rasa Shastra literatures so many formulations of Shankha Bhasma

are described in the context of treatment of diseases like Udara roga, Grahani, Gulma, Agnimandya, Amlapitta, Parinamashoola, Swasa, Vamana, Vishuchika, Arsha, Kushtha, Prameha, Netraroga and other chronic disease. Shankha Bhasma had been documented to be prescribed in indigestion (Ajirna), decreased enzymatic secretion (Agnimandhya), irritable bowel syndrome (Grahani), sour eructation/acidity (Amlapitta), duodenal ulcer (Parinamashula), hepatosplenomegaly (Yakrittaplihavriddhi) and toxins (Visha).[14]

Dashmool Kwath + Drakshovin syrup + Mulethi Kwath + Narikela Lavan work as an anti-inflammatory, helps in reducing abdominal pain and also improves appetite and boosts up the digestion, whereas Avipattikar Churna with the combination of Kamdudha Ras, Praval Panchamrit Ras and Shankha Bhasma helps in regulating hyperacidity and work as Pitta Shamak.

Conclusion

MRCP Oct 2022

Acute pancreatitis associated with mild ascites and bilateral pleural effusion is a complicated presentation with significant mortality and morbidity. It requires a skillful management plan.


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MRCP June 2023

MRCP Feb 2024

Delay in assessing or mismanagement may have serious consequences. Management of such cases

with the Ayurvedic medicines within time constraint and without any complications is encouraging and needs to be further evaluated on a large number of subjects to bring some concrete conclusion and better treatment modality.

S.Lipase and Amylase July 2022

S.Lipase And Amylase Aug 2022


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S.Lipase October 2022

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14. Meena V, Bhushan S and Chaudhary A: Pharmaceutical validation & process conceptualization of ancient Indian calcium preparation: Shankha Bhasma. Int J Pharm Sci & Res 2019; 10(10): 4724-30. doi: 10.13040/IJPSR.0975-8232.10(10).4724-30.


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