Journal of Ayurveda and Integrated Medical Sciences

Ayurvedic herbs have diuretic and anti-inflammatory properties, helping manage CKD symptoms and support kidney health. Ayurvedic treatment plans are personalized, addressing root causes rather than just symptoms. However, further research is needed to establish standardized protocols and ensure safety, especially regarding nephrotoxic herbs.^[10]

Ayurvedic treatment addresses underlying imbalances and improves kidney function, particularly beneficial for patients unable to afford conventional treatments like dialysis. Ayurvedic principles focus on restoring balance in bodily systems, often using Ayurvedic formulations like GFR powder and Chander Vati.^[11]

The integration of Ayurveda which focuses on natural healing methods, can complement Ayurvedic practices by enhancing kidney function and overall health. Lifestyle modifications, such as stress management and physical activity, are crucial for managing CKD ^[12].

Constipation and acidity is found common in CKD patients. Studies show that these are lifestyle disorders which a holistic treatment plan is needed. Ayurveda provides this comprehensive therapy for constipation, acidity along with CKD ^[13].

This case report shows significant improvements in a CKD patient with hypertension and reductions in serum creatinine and blood urea levels.

Case Report

A 35-year-old woman with a history of CKD and Hypertension since 2023 visited Jeena Sikho Lifecare Limited Hospital, Derabassi (Chandigarh) on May 9, 2023. She reported symptoms such as pedal edema, weakness, frothy urine, nausea and vomiting. She was diagnosed with hypertension 1 year prior to her hospital admission. A thorough Ayurvedic evaluation was performed, which included a detailed medical history, physical examination, and diagnostic tests. The findings were observed during the initial examination of the patient on the first day as mentioned in Table 1.

During her IPD stay, the patient received comprehensive Ayurvedic treatments, including Panchakarma therapy. This therapy encompassed Panchakarma therapies such as Avagaha Sweda, Gokshuradi Siddha Sneha Basti, Thalam and Nitya Virechana and performed Postural Therapy (HDT).

DTPA scan of the patient done on May 10, 2024, shows that both the kidneys are shrunk in size with compromised cortical function. Investigations conducted on May 15, 2023, on the day before discharge are detailed in Table 4. Daily vitals observed during the IPD Investigations are detailed in Table 5. The patient was subsequently discharged on May 16, 2023. Medicine given at the time of Discharge is given in Table 6.

Table 3: Medications taken during the IPD

Table 4: Vitals of follow up treatments

Table 7: Medications advised for two months after discharge (28/08/2023)

The patient returned for a follow-up on December 13, 2023, with no urinary complaints. She reported normal urinary output and mild frothy urine with no symptoms of fever that were present during the last visit. His bowel movements were regular, appetite normal and sleep adequate. Vitals observed on examination are written in Table 3.

Investigations revealed a hemoglobin level of 12.0 gm%, with other results in Table 4. The prescribed Ayurvedic medications are described in Table 8.

The patient returned for a follow-up visit on May 10, 2024. She presented clear bowel, good appetite, clear urine and good sleep.

The investigation revealed an eGFR of 37.4 ml/min/1.73m², with additional results detailed in Table 4. The prescribed Ayurvedic medications are described in Table 9.

b. Hydration:

• Drink alkaline water 3 to 4 time throughout day.
• Make herbal tea, living water, and turmeric-infused water part of your daily routine.
• When thirsty, take small sips of water, ensuring only limited amount is consumed at each time.

c. Millet Intake:

• Incorporate five types of millet into your diet: Foxtail, Barnyard, Little, Kodo and Browntop.
• Prepare millets exclusively using steel cookware.
• Utilize only mustard oil for cooking.

d. Meal Timing and Structure:

• Early Morning (5:45 AM): Herbal tea
• Breakfast (8:30-9:30 AM): The patient will have steamed seasonal fruits and a fermented millet shake.
• Morning Snacks (11:00-11:20 AM): The patient will be offered sprouts (100g) along with red juice (150 ml).
• Lunch (12:30 PM - 2:00 PM): The patient will receive Plate 1 and Plate 2. Plate 1 will include a steamed vegetable salad, while Plate 2 will consist of a cooked millet-based dish.
• Evening Snacks: Green juice (100-150 ml) accompanied by 4-5 almonds.
• Dinner (6:15-7:30 PM): The patient will be served a raw salad, chutney, soup and green garden delight as Plate 1, along with fermented millets, millet khichdi or millet chapatti as Plate 2.

e. Fasting:

• It is advised to observe a fast once a week.

f. Special Instructions:

• Express gratitude to the divine before consuming food or drinks.
• Practice sitting in Vajrasana (a yoga posture) after each meal.

g. Diet Types:

• The diet comprises solid, semi-solid, and smoothie options, all without added salt.
• Recommended foods include herbal tea, red juice, a variety of steamed fruits, fermented millet shakes, steamed sprouts, soaked almonds and steamed salads.

Awagah Sweda, as described by Acharya Charak, is a form of Sagni Sweda therapy that helps to liquify and mobilize the Doshas lodged within the body’s microchannels.

2. Gokshuradi Siddha Sneha Matra Basti

Procedure:

• The medicated oil (Gokshuradi Siddha) is warmed.
• The patient is positioned comfortably and the oil is administered rectally.
• The procedure may require the retention of the oil for a specified duration.

Physiology:

• The oil penetrates the rectal mucosa, enhancing its absorption.
• It lubricates the intestines and promotes bowel movements.

Mode of Action:

Matra Basti normalizes Vata, facilitating the proper elimination of flatus, feces, urine and more, leading to improved physiological functioning of the Vata Dosha. The Basti Dravya (medicated liquid) spreads throughout the body and pacifies the aggravated Vata Dosha. Upon entering the Pakvashaya (Large intestine) or Guda (anus), Basti exerts effects both locally and systemically. The Guda is considered the root of the body (Sharira Mūla), containing Sira (veins) and Dhamani (arteries) that extend throughout the entire body. In the context of Gokshura Siddha Sneha Basti, Gokshura is known for its diuretic properties, balancing the Tridosha and promoting strength.

Sanskrit References:

"गोक्षुरःशीतलःस्वादुःबलकृत्, बस्तिशोधनः
मधुरोदीपनोवृष्यः, हृष्टिदच, अश्मरीहरः
प्रमेहश्वासकासार्थ, कृच्छहृद्रोवातनुत्।" (Bhavaprakash)

Additional Reference:

"यथेष्टाहारचेष्टस्यसर्वक।लं सन्नरत्ययः।
ह्रस्वायाः स्न॓हमात्रायाः मात्राबस्तिः समो भवेत् ।" (Charaka Samhita, Siddhi Sthana 4/53)

3. Thalam

Procedure

• Prepare a medicinal paste or oil using herbs like Brahmi, Shankhapushpi and Ashwagandha mixed with oil, ghee or water.

• Nitya Virechana given at night daily with Trivrit Avleha upto 12/05/2023 and after that with Divya Shakti powder.
• After taking the purgative, patients should rest and stay hydrated. The physician monitors their bowel movements, which typically begin within a few hours.
• Avoid any heavy physical or mental activities at night.
• Ensure going to bed early to allow the body to rest and prepare for the purgative action the next day.

Physiology

• Cleanses the digestive system by removing toxins (Ama), supporting proper digestion.
• Reduces excess heat and bile to help with issues like acidity and inflammation.
• Enhances detoxification and bile production by promoting regular bile flow.
• Uses mild laxatives to clear waste and toxins from the intestines.
• Promotes muscle contractions in the intestines for better waste elimination and prevents constipation.
• Alleviates symptoms related to inflammation by removing toxins.
• Supports fluid and electrolyte balance to prevent dehydration during detox.
• Removes toxins from deeper tissues to improve overall health.
• Stabilizes mood and emotional balance by eliminating excess heat and toxins.
• Improves the body's ability to get rid of metabolic waste, keeping it clean.

Mode of action

Nitya Virechana is a treatment that uses mild purgative herbs to promote bowel movements and cleanse the gastrointestinal tract, eliminating toxins and balancing Pitta dosha.

It improves liver and gallbladder function, strengthens Agni, and reduces systemic inflammation. It prevents toxins from reabsorption through regular bowel movements, maintaining digestive health and preventing constipation.

Chander Vati, Kidney Care Syrup, Liver tonic, Puroderm G syrup, Renal support syrup, JS BP cure capsule, Sama Vati, along with Panchakarma therapies. The global GFR and renal function before and after treatment was analyzed using a DTPA Renogram, as shown in Table 10. The DTPA scan reports indicates that the patient has experienced symptomatic improvement (Fig 1.). Details of this symptom improvement are presented in Table 11.

while Losartan 50 mg BD, Atorvastatin 5 mg OD and Dapagliflozin 10 mg OD were previously prescribed but not continued from the first day of treatment.

Figure 1b: DTPA scan report on August 25, 2023

Result

Effectiveness of Ayurvedic Treatments: After 7 days of Ayurvedic treatment, the patient experienced significant improvement in both symptoms and diagnostic parameters, indicating that these interventions can effectively assist in managing chronic kidney disease (CKD).

The positive changes in global glomerular filtration rate (GFR) and the decrease in pain highlight the potential benefits of these traditional therapies for enhancing kidney function and overall health.

Need for Further Research: While the results appear promising, this case report involves only one patient, so the findings should be viewed with caution. Additional studies, including larger and randomized controlled trials, are required to confirm the efficacy and safety of Ayurvedic treatments for CKD and to establish standardized guidelines for their use in clinical settings.

Discussion

In this regard, incorporating Ayurvedic medicine into the treatment of chronic kidney disease (CKD) offers a promising alternative. This case report outlines the use of various Ayurvedic therapies in a 35-year-old woman diagnosed with CKD and hypertension for 1 year.

The patient exhibited symptoms such as joint swelling, leg pain, abdominal tenderness, backache, fever, tingling sensations, numbness, vomiting and loose motions. Initially, her condition included symptoms like pedal edema, weakness, frothy urine, nausea and vomiting.

The Ayurvedic treatment comprised several Panchakarma procedures:

1. Awagaha Sweda: In this procedure, the patient sits in a tub filled with warm, herbal-infused water at 42°C. This induces sweating and enhances blood circulation, facilitating the elimination of metabolic waste and toxins while improving the absorption of herbal properties.

2. Gokshuradi Siddha Sneha Matra Basti: Warm Gokshuradi Siddha oil is administered rectally to lubricate the intestines, normalize the Vata Dosha, and enhance overall physiological functioning as it spreads throughout the body via the large intestine.

and includes antioxidants to protect kidney cells from oxidative stress, aiding in the management of chronic kidney disease.

3. GFR Powder: This powder enhances kidney function by minimizing inflammation and removing accumulated toxins. Its anti-inflammatory properties help reduce renal inflammation, supporting overall kidney health and detoxification.

4. Nephron Plus: This supplement contains ingredients like Punarnava, Varuna, Gokshura, Amla, and Bhumyamalaki, which possess renal protective and detoxifying qualities. It supports kidney function, promotes urinary health, reduces fluid retention, and provides antioxidant protection, making it beneficial for chronic kidney disease.

5. Chander Vati: This formulation balances Pitta Dosha, crucial for relieving urinary tract infection (UTI) symptoms such as burning during urination and promoting healthy urine flow. It aids in eliminating harmful toxins like urea, creatinine and uric acid, showcasing significant anti-inflammatory, analgesic and diuretic effects that contribute to effective management of chronic kidney disease.

6. Kidney Care Syrup: The ingredients in this syrup work together to reduce inflammation, enhance kidney function, and support detoxification. Punarnavarishtha and Ushirasava help reduce renal inflammation, while Chandanasava alleviates urinary discomfort and Gokshuradi Kadha promotes diuresis and toxin elimination.

7. Liver Tonic: This tonic contains a blend of herbs and natural ingredients like Rakt & Shweta Punarnava, Bala, Atibala, Dalchini, Nagakesar, Mulethi, Methi, Tejpatta. These ingredients offer various benefits, including detoxification, liver protection, improved digestion, reduced inflammation and enhanced liver function.

8. Puroderm G Syrup: This syrup is made from a combination of herbs and natural ingredients, including Neem, Turmeric, Amla, Giloy, Pudina and Khadira. Neem has antibacterial and anti-inflammatory properties, Turmeric is a powerful anti-inflammatory and antioxidant, Amla is rich in vitamin C, Giloya aids in detoxification, Pudina soothes skin, and Khadira is astringent and antiseptic. These ingredients work together to improve skin texture, combat bacteria, reduce inflammation, protect skin from oxidative stress, and enhance immunity.

Vitals: The patient's vital signs fluctuated throughout the treatment period. Blood pressure was initially recorded at 110/70 mmHg and remained stable throughout the treatment period. The patient's weight also decreased from 48 kg to 47 kg, reflecting positive lifestyle changes and potential improvements in kidney function.

Investigations: Laboratory tests showed marked improvements in renal function parameters. Serum urea levels decreased from 63 mg/dL to 36.8 mg/dL, indicating better kidney function. The glomerular filtration rate (GFR) improved from 20.5 ml/min/1.96 sq m to 37.4 ml/min/1.82 sq m, reflecting a significant increase in the kidney's filtration capacity. Additionally, DTPA Renogram results showed improvements in perfusion phase visualization and cortical function, further supporting the effectiveness of the Ayurvedic treatment approach.

In conclusion, integrating Ayurvedic treatments along with previously prescribed allopathic medicines for CKD yielded promising results, demonstrating substantial improvements in symptoms, vital signs, and laboratory investigations. This highlights the potential of traditional therapies in enhancing kidney health and overall patient outcomes. However, further research is essential to validate these findings and establish standardized treatment protocols.

References

1. Nair R. Chronic Kidney Disease - An Overview. Kerala Medical Journal. 2012;5(4):89-93.

2. Raghavan R, Eknoyan G. What Is Chronic Kidney Disease? In: Management of Chronic Kidney Disease: A Clinician’s Guide. Berlin, Heidelberg: Springer Berlin Heidelberg; 2014. p. 3-13.

3. Mathew T. Chronic Kidney Disease–An exemplar for collaboration between the clinic and the laboratory. Clin Biochem Rev. 2011 May;32(2):51.

4. Chen TK, Hoenig MP, Nitsch D, Grams ME. Advances in the management of chronic kidney disease. BMJ. 2023 Dec 5;383.

5. Kasiske BL, Wheeler DC. Kidney disease: improving global outcomes—an update. Nephrol Dial Transplant. 2014 Apr 1;29(4):763-9.

13. Vaishnav V, Ameta T, Sharma PD, Sharma DK. A Case Study of Chronic Kidney Disease.

14. Chaudhary M, Gitika C, Pratap SS, Singh M, Richa S. Clinical Evaluation of Chronic Kidney Disease Management: Integrating Lifestyle Modification and Ayurveda. Int J AYUSH. 2024 Oct;2013(10). doi: 10.22159/PRL.IJAYUSH.V2013I10.1152.

15. Pandey A, Singh A, Bhardwaj A, Thakur G, Prakash G. Effectiveness of Gravitational Resistance and Diet (GRAD) system in reversing chronic kidney disease (CKD) - among dialysis patients. Dayanand Ayurvedic College, Shridhar University; 2022. Available from: https://davayurveda.com/wp-content/uploads/2022/10/j-GRAD-System-Paper-FINAL-Mar-27-2.pdf.