A 45yrs aged male patient presenting with Udarvriddhi (abdominal distention), Kshudhamandya (decreased appetite), Dourbalya (gen. weakness), Ubhaypadshoth (bilateral pedal edema) diagnosed as Udarvyadhi (ascites) was brought to Dr. M. N. Agashe Charitable Hospital, Satara. Patient was treated with an integrated approach of ayurveda. According to Ayurveda, treatment of Udar is Nityavirechana (purgative), Agnideepan (increase appetite), Balaprapti (increase strength), Yakrituttejjak (stimulant for hepatic function and external application of Arkapattbandhan (belt made by leaves of Calotropis procera). In this study we used the Gandharvahasta Sneha with Dashmula Kwatha as purgative. Appreciable results were observed in the form of reduction in abdominal girth, decreased pedal edema, increased appetite, increased strength and significant changes in investigations

Dr. Mayur Mahadev Madake

Dr. P. D. Londhe

English

Journal of Ayurveda and Integrated Medical Sciences (JAIMS)

                                                      CASE REPORT Jan-Feb 2020  Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb  2020 | Vol. 5 | Issue 1 268  The effect of Gandharvahasta Sneha with Dashmula Kwatha in the management of hyperamonaemia in alcoholic liver cirrhosis w.s.r. to Dushyodara/Sannipatodara - A Case Study Dr. Mayur Mahadev Madake1, Dr. P. D. Londhe2  1Post Graduate Scholar, 2Associate Professor & HOD, S. C. Mutha Aryanglavaidyaka Mahavidyalaya, Satara, Maharashtra, INDIA.                    INTRODUCTION Charak has described Dushyodara as one of the Ashtomahagada, so it’s difficult to cure. Considering its chronicity and severity due to excessive accumulation of Mala and toxins, the disease become difficult to cure. The Vatadosha becomes dominating and affects whole body metabolism and patients become prone for having its complications including hepatic failure, hepato-renal syndrome, muscle wasting, hyper ammonia and encephalopathy. Address for correspondence:  Dr. Mayur Mahadev Madake S. C. Mutha Aryanglavaidyaka Mahavidyalaya, Satara, Maharashtra, INDIA.. E-mail: drpdlondhe4@gmail.com  Submission Date: 05/01/2020 Accepted Date: 08/02/2020 Access this article online Quick Response Code Website: www.jaims.in  Published by Maharshi Charaka Ayurveda Organization, Vijayapur, Karnataka (Regd) under the license CC-by-NC-SA As per modern science elevation in blood ammonia may cause hepatic encephalopathy. To combat this chain of pathogenesis we have selected Gandharvahasta Sneha with Dashmula Kwathkalpa. The major cause of liver disease are chronic and excessive alcohol consumption. Alcoholic liver disease are of three types; 1. Alcoholic fatty liver  2. Alcoholic hepatitis 3. Alcoholic liver cirrhosis Alcohol is a direct hepatotoxic and they will develop alcoholic hepatitis and liver disease. The disease progresses with some facility in factors such as diet, obesity, gender and drinking pattern. Cirrhosis is present up to 50% of patients and develops further complication like encephalopathy, in liver cirrhosis presence of portal hypertension contributes to development of ascites. As the disease becomes advanced serious complications of cirrhosis occurs. In chronic liver A B S T R A C T  A 45yrs aged male patient presenting with Udarvriddhi (abdominal distention), Kshudhamandya (decreased appetite), Dourbalya (gen. weakness), Ubhaypadshoth (bilateral pedal edema) diagnosed as Udarvyadhi (ascites) was brought to Dr. M. N. Agashe Charitable Hospital, Satara. Patient was treated with an integrated approach of ayurveda. According to Ayurveda, treatment of Udar is Nityavirechana (purgative), Agnideepan (increase appetite), Balaprapti (increase strength), Yakrituttejjak (stimulant for hepatic function and external application of Arkapattbandhan (belt made by leaves of Calotropis procera). In this study we used the Gandharvahasta Sneha with Dashmula Kwatha as purgative. Appreciable results were observed in the form of reduction in abdominal girth, decreased pedal edema, increased appetite, increased strength and significant changes in investigations. Key words: Ayurveda, Udar, Ascites, Virechana, Gandharvahasta Sneha, Dashmula Kwatha, Hyperamonaemia. Dr. Mayur Mahadev Madake et al. Management of hyperamonaemia in alcoholic liver cirrhosis - A Case Study ISSN: 2456-3110                                                             CASE REPORT Jan-Feb 2020  Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb  2020 | Vol. 5 | Issue 1 269  disease, gut derived neurotoxins that are not removed by the liver because of vascular shunting and decreases hepatic mass get to the brain. Ammonia is produced during normal protein metabolism in the colon. Liver and striated muscle plays a major role in detoxification of ammonia. Patients with advance liver disease typically have significant muscle wasting and renal dysfunction as well. When patients present in this situation all the sings resembles with Dushyodara in which there are all mixed clinical features. Including abdominal distension, peripheral oedema, ascites, breathlessness, hepatic hydrothorax, malnourishment, muscle wasting, with gases accumulation and weakness. AIM AND OBJECTIVES 1. To study the etiopathology of Dushyodara. 2. To study the standardization of ingredient of Gandharvahasta Sneha with Dashmula Kwatha. 3. To study the mode of action of action of Gandharvahasta Sneha with Dashmula Kwatha by Ayurvedic point of view. 4. To study the adverse effect of Gandharvahasta Sneha with Dashmula Kwatha if any. CASE REPORT The present case study is successful Ayurvedic management of hyperammonemia in the patients of alcoholic liver cirrhosis. A 45yr old patient came with Complaints of Udarvriddhi Kshudhamandya Dourbalya Ubhaypadshotha Aayesen Shwasa, since 2-3 month H/O - Typhoid fever, Jaundice. No H/O any major illness Sx H/O - Appendectomy Addiction - Smoking; tobacco chewing, alcohol consumption from 22 yrs. On Examination ▪ Nadi (Pulse) - 78/min ▪ Mala (Stool) - Asamyakpravrutti, Malavshtambha (occasional) ▪ Mutra(Urine) - Samyakpravrutti, Peetavarni ▪ Jivha(Tongue) - Sama ▪ Kshudha - Mandya ▪ Nidra - Khandita ▪ Ura - B/L Air entry decreased ▪ Udara - Abdomen was distended with bulging of flanks. Veins on the wall appears prominent. Umbilicus transverse, On palpation live enlarged, Shifting dullness present, Fluid thrill positive, Bipedal pitting edema present. ▪ Bala - Alpa ▪ Akruti - Krusha ▪ Twak - Ruksha ▪ B.P. - 110/70 mm of Hg Investigations 1. Serum Ammonia (NH3) 2. LFT’s 3. KFT’s 4. CBC 5. Urine - Routine and Microscopic 6. USG - Abdomen and Pelvis MATERIAL AND METHODS In the present study, a single patient of symptoms of Alcoholic liver Cirrhosis selected from Dr. M.N. Agashe Charitable Hospital, Satara. Dr. Mayur Mahadev Madake et al. Management of hyperamonaemia in alcoholic liver cirrhosis - A Case Study ISSN: 2456-3110                                                             CASE REPORT Jan-Feb 2020  Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb  2020 | Vol. 5 | Issue 1 270  Details of Gandharvahasta Sneha with Dashmula Kwatha SN  Drug  Latin Name  Part used  Quantity  1.   Erand Ricinus communis Linn.  Sneha 20 ml  2.  Bilva Aegle marmelos Mula 1 Part  3.  Agnimanth Premna mukrunata Mulatwaka 1 part  4.  Shonyak Oroxylum indicum Mulatwaka 1 part  5.  Kashmari Gmelina arborea Mula 1 part  6. Patala Stereospermum sauveolens Mulatwaka 1 part  7.  Prushniparni Uraria picta Mula 1 part  8.  Shaliparni Desmodium gangeticum Mula 1 part  9.  Bruhati Solanum indicum Mula 1 part  10.  Gokshura Tribulus terestris Mula 1 part  11.  Kantkari Solanum suratense Mula 1 part  Method of preparation of Gandharvahasta Sneha with Dashmula Kwatha ▪ Take 20 ml Gandharvahasta Sneha.  ▪ The useful part of Bilva, Agnimantha, Shyonyak, Kashmari, Patala, Prushniparni, Shaliparni, Bruhati, Gokshura, Kantakari will be taken in same quantity and 60 parts of water added in it.  ▪ Allow the herbs to completely get soaked in water for 1 to 2 hrs. Start boiling the mixture in wide mouth container in a mild fire. Keep on stirring the contents with a ladle, boil the kwath till it reduces to 1/4th quantity.  ▪ After preparation of Dashmula Kwath add Gandharvahasta Sneha 20 ml. Details of Drug administration Drug  Gandharvahasta Sneha with Dashmula Kwatha Form of drug  Sneha / Kwatha Dose  20 ml/20 ml  (At 7.00 AM)  Anupana -  Sevana Kala Abhakta (onces  in a day)  Duration  7 days  Ahara (Diet)  As per Pathyakara Ahara mentioned in Ayurvedic texts.  Vihara As per Pathyakara Vihara mentioned in Ayurvedic texts.  Use of appropriate masks  OBSERVATION In the patient of Alcoholic Liver Cirrhosis (Dushyodara/Sannipatodara) having the symptoms like hyperamonaemia and jaundice are observed. In this single case study after the intake of Gandharvahasta Sneha with Dashmula Kwatha we see the changes regarding the Ammonia and Serum bilirubin before and after the treatment. It is observed that, the Gandharvahasta Sneha with Dashmula Kwatha is effective in the management of Hyperamonaemia in alcoholic liver cirrhosis w.s.r. to Dushyodara/ Sannipatodara. Test  Before Treatment After Treatment Total Bilirubin 11.7 mg/dl 2.4 mg/dl Direct Bilirubin 7.50 mg/dl 1.2 mg/dl Dr. Mayur Mahadev Madake et al. Management of hyperamonaemia in alcoholic liver cirrhosis - A Case Study ISSN: 2456-3110                                                             CASE REPORT Jan-Feb 2020  Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb  2020 | Vol. 5 | Issue 1 271  Indirect Bilirubin 4.20 mg/dl 0.8 mg/dl Serum Ammonia 246 Ug/dl 74 Ug/dl DISCUSSION According to Ayurveda treatment of Udara is Nityavirechana (purgative). The Eranda in the form of Gandharvahasta Sneha is very useful as a purgative. Appreciable results were observed in the form of reduction in abdominal girth, decreased pedal oedema, increased appetite and increased strength. Also the parameters like increased serum ammonia (NH3) and Serum bilirubin levels are also goes on lower side after the intake of Gandharvahasta Sneha with Dashmula Kwatha. That is one of the sign of good health. Chikitsa Sidhantha for Udarvyadhi is ‘Nityamev Virechayet’. Virechana checks improper Jatharagni and Dhatvagni, after Virechana, Jatharagni and Dhatvagni increases. It has laxative action which helps to eliminate toxins out of the body, which is caused due to chronic constipation in ascites. It possesses Cholagogue, hepatoprotective and liver stimulant action. Therefore it is useful in generalised oedema and ascites as it has laxative and diuretic action which helps to excrete excess fluid outof body. CONCLUSION Thus, Gandharvahasta Sneha with Dashmula Kwatha is effective in the management of Hyperamonaemia in alcoholic liver cirrhosis w.s.r. to Dushyodara / Sannipatodara. REFERENCES 1. Chakradatta Tika Adhayaya 37, Shlok No. 50, Page no. 307  2. Charak Samhita Nidansthana Adhyaya 6. 3. Charaka Samhita (Uttarardha) Chikitsasthana Adhyaya 13/34. 4. Sushruta Samhita Nidansthana Adhyaya 7.  5. Ashatang Hridaya Nidansthana Adhyaya 12.  6. Ashatang Hridaya Chikitsasthan Adhyaya 15.  7. Dravya Guna Vigyana by Acharya Priyavrat Sharma, Part II, Chaukhamba Bharati Academy, Varanasi, 2015.  8. Baghel  M.S., Researches in Ayurveda, Jamnagar, Mridu Ayurvedic Publications and scales: 2005.  9. Siddharth N. Shah, API Text Book of Medicine 8th edition.  10. Nicki R. Colledge, Brian R. Walker, Stuart H. Ralston, Davidson’s Principle and Practice of Medicine, 21st edition.  11. Fauci, Braunwald, Kasper, Hauser, Longo, Jgmeson, Loscalzo, Harrison’s Principal of Internal Medicine, 19th edition.     *******************************  How to cite this article: Dr. Mayur Mahadev Madake, Dr. P. D. Londhe. The effect of Gandharvahasta Sneha with Dashmula Kwatha in the management of hyperamonaemia in alcoholic liver cirrhosis w.s.r. to Dushyodara/Sannipatodara - A Case Study. J Ayurveda Integr Med Sci 2020;1:268-271.  Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2020 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.  

The effect of Gandharvahasta Sneha with Dashmula Kwatha in the management of hyperamonaemia in alcoholic liver cirrhosis w.s.r. to Dushyodara/Sannipatodara - A Case Study

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The effect of Gandharvahasta Sneha with Dashmula Kwatha in the management of hyperamonaemia in alcoholic liver cirrhosis w.s.r. to Dushyodara/Sannipatodara - A Case Study

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