Hurry, worry and curry are the three factors which causes intestinal upsets frequently and leads to gastrointestinal problems in modern life. Pravahika (Amoebic dysentery) is also one of the important and oftenly occurring Vyadhis of Annavaha and Pureeshvaha Srotasas in current time. Pravahika is the Pakwasahayagata kaphajavikara with symptoms of Sarakta mala, Sapravahana mala, Sakapha mala, Daah, Jwara, Bhrama Daurbalya, Anannabhilsha, Sweda and Trishna. A case report of a patient with a history of loose motion with mucous discharge for the 6 months visited Ayurveda OPD, is presented in this study. Routine stool examination, blood glucose, serum lipid profile and liver function test were performed. The patient was treated with Ayurvedic medicine Kutajghan vati (1 gm), Bilvadi churna with Takra (6 gm) and, Chitrakadi Gutika (250 mg) in divided doses for 1 month. The patient was followed up for every 7th day and there was significant improvement in the clinical features after 1 month of treatment with the Ayurvedic medicines. There were no side effects reported. This case study demonstrates the therapeutic efficacy of Bilvadi churna, Kutajghan vati and Chitrakadi Gutika in the rapid management of Pravahika.

Dixit, Amit Kumar

Jadhav, Ankush D

Mangal, Anil

Rotwar, *Dara Singh

English

International Journal of Ayurveda and Pharma Research

ISSN: 2322 - 0902 (P) ISSN: 2322 - 0910 (O)  IJAPR | February 2017 | Vol 5 | Issue 2  37 International Journal of Ayurveda  and Pharma Research  Case Study   THERAPEUTIC MANAGEMENT OF PRAVAHIKA (AMOEBIC DYSENTERY) THROUGH AYURVEDIC REGIMEN: A CASE STUDY  D S Rotwar1* Amit Kumar Dixit2, Anil Mangal1, Ankush Jadhav3 *1Research officer (Ayurveda), 2Research officer (Biochemistry), 3Assistant Director, Regional Ayurveda Research Institute for Drug Development, CCRAS, Ministry of AYUSH, Government of India, Aamkho, Gwalior, M.P., India. ABSTRACT Hurry, worry and curry are the three factors which causes intestinal upsets frequently and leads to gastrointestinal problems in modern life. Pravahika (Amoebic dysentery) is also one of the important and oftenly occurring Vyadhis of Annavaha and Pureeshvaha Srotasas in current time. Pravahika is the Pakwasahayagata kaphajavikara with symptoms of Sarakta mala, Sapravahana mala, Sakapha mala, Daah, Jwara, Bhrama Daurbalya, Anannabhilsha, Sweda and Trishna. A case report of a patient with a history of loose motion with mucous discharge for the 6 months visited Ayurveda OPD, is presented in this study. Routine stool examination, blood glucose, serum lipid profile and liver function test were performed. The patient was treated with Ayurvedic medicine Kutajghan vati (1 gm), Bilvadi churna with Takra (6 gm) and, Chitrakadi Gutika (250 mg) in divided doses for 1 month. The patient was followed up for every 7th day and there was significant improvement in the clinical features after 1 month of treatment with the Ayurvedic medicines. There were no side effects reported. This case study demonstrates the therapeutic efficacy of Bilvadi churna, Kutajghan vati and Chitrakadi Gutika in the rapid management of Pravahika.  KEYWORDS: Pravahika, Ayurveda, Dysentery, Kutajghan vati, Bilvadi Churna. INTRODUCTIONPravahika, as described in the Ayurvedic texts, can be compared with the amoebic dysentery. Pravahika is caused by the infection of Entamoeba histolytica, a protozoan. Pravahika is diagnosed by the symptoms of diarrhoea with blood, mucus, flatulence, abdominal cramps and pyrexia. According to Ayurveda excessive intake of Katu, Amla, Lavana rasa, Guru (not easily digested), Snigdha (fatty), Ruksha (very dry), Ushna, Sheeta, excessively liquid, Teekshana foodstuffs promote pravahika disease. Virudhashana, Adhyasana, Vishamashana, Alpashana, Pramitashana are hetus of Pravahika. Fear, anger, jealousy are Manasika (mental hetu) of disease. Arsha, Grahani, Krimi, Atisara make Pakvashaya favourable ground for development of Samprapti of Pravahika. Avipaka and abdominal bloating are Poorvarupa of Pravahika disease. Pitta and Raktaprakopa hetu play vital role in formation of diseases pathogenesis. Kapha adheres to the walls of Pakwashaya (Large intestine) internally. Because of that Vata (the biological air) requires more force to expel Kapha out. The patient develops Pravahan i.e., forceful defecation or tenesmus. Thus, by more and more Pravahan, there is repeated defecation containing Kapha. This process is called as Pravahika. It is characterized by defecation of stools with small quantity of Shleshma (Mucus) and Rakta (if Pitta is involved) frequently accompanied with tenesmus. Accumulations of Kapha, Prakopa of Vata Dosha, Agnimandya, Strotorodha, Vikruti of Samanaand Apana Vayu are the multifactors in Pravahika disease1.  Classical text of Ayurveda vividly narrated about Pravahika and many classical formulations are in active practice along with Anupana (adjuvant)2. Therefore, we plan to observe the Pravahika case treated with conventional Ayurveda treatment. A case report on rapid management of Pravahika is presented in this study.  Case Presentation  A 47 year old male patient having OPD Registration no -3552/20-06-2016 came to OPD of Regional Ayurveda Research Institute for Drug Development, Gwalior, M.P. with frequent defecation, tenesmus, foul smelling stool, mucous and blood mixed stool, reduced appetite, and distension and pain in abdomen for 1 year along with the associated complaints of weakness, headache, liquid stool mixed with blood and abdominal cramps. Case History The patient is married, non-diabetic, non-vegetarian with reduced appetite, disturbed sleep and the patient had no addiction. A history of the present illness revealed that the patient was apparently normal 1 years back. For the last 6 months, the patient experienced frequent defecation 10-15 times a day which was loose, watery, frothy, and foul smelling stool stained with mucous and blood. Patient consulted a gastroenterologist and was on conservative treatment for the last 6 months where the patient had no relief. Baseline Findings and treatment plan   Examination of the patient showed pulse rate of 70 per min, respiratory rate of 18 per min, blood pressure of 120/72mm of Hg and body weight of 57kg. Abdominal examination showed shrunken abdomen and tenderness in all quadrants of the abdomen. Patient was diagnosed as having Pravahika based on the combination of clinical Int. J. Ayur. Pharma Research, 2017;5(2):37-39  Available online at: http://ijapr.in   38 features and laboratory findings. Patient was advised to stop milk, milk products along with sour, hot and spicy food article. The drug regimen was: Kutajghan vati (1 gm)  Bilvadi churna with Takra (6 gm)  Chitrakadi Gutika (250 mg) in two divided doses.  Kutajghan vati and Chitrakadi Gutika was provided from the Institute dispensary while, Bilvadi churna of Dabur India Ltd., Sahibabad was procured from local market. Follow up was taken once in 7 days for 1 month. On the first follow up (after 7 days of the initiation of treatment), the patient reported reduction in foul smelling stool and frequency of bowel reduced by 5-6 times per day. Improvement was observed in appetite. On the second follow up, the frequency of bowel reduced to 3-4 times per day. Mucous- and blood mixed stool was completely stopped. Improvement was noted in weakness, appetite and reduced sleep. The frequency of bowel reduced to 2-3 times per day and the signs and symptoms of Pravahika reduced in the patient on the third follow up. On the fourth follow up, there was no any previous complaint reported by the patient and improvement in general strength, appetite. Results of the laboratory investigations are presented in Table 1 and 2.  DISCUSSION Pravahika is generally explained in the context of explaining Atisara (diarrhoea). Therefore the clinical picture is similar to Atisara. Modern view also supports this view (diarrhoea is a predominant presentation of dysentery). The root word Pravahana in Pravahika means ‘to strain’. This word denotes tenesmus which is a common feature of dysentery. Ayurveda treatment of dysentery shall be done on the lines of Pravahika chikitsa, Atisara Chikitsa (Ama atisara, Kaphaja atisara, Rakta atisara, sannipataja atisara), Grahani Roga Chikitsa (Kaphaja grahani), Ajeerna Chikitsa. The Ayurved regimen selected for the treatment of Pravahika are well established in the Ayurvedic literature.  Table 1. Laboratory investigations before and after treatment Investigation Before Treatment  After treatment  Fasting blood Sugar (mg/dl) 88 95 Post Prandial Blood Sugar (mg/dl) 100 104 Total leukocyte Count (/cumm) 6300 4400 Haemoglobin (g/dl) 10.6 12.2 Erythrocyte sedimentation rate (mm/Hr) 56 14 Cholesterol (mg/dl) 180 172 Triglyceride (mg/dl) 152 146 LDL-cholesterol (mg/dl) 110 90 Total Bilirubin (mg/dl) 0.9 0.9 SGPT (IU/L) 65 35 SGOT (IU/L) 40 45 Urea (mg/dl) 20 21 Creatinine (mg/dl) 0.8 0.9 Table 2. Stool examination before and after treatment Investigation Before Treatment  After treatment  Physical Examination   Color/Appearance Yellowish Yellowish Consistency  Watery Semi solid Mucus Present Absent Blood  Present Absent Parasites Present Absent Microscopic Examination   Pus cell 8-10/HPF 4-5/HPF RBC’s 40-50/HPF 1-2/HPF Ova  Present Absent Cysts Present Absent Special Examination   Occult Blood Absent Absent   D S Rotwar et al. Therapeutic Management of Pravahika (Amoebic Dysentery) through Ayurvedic Regimen  IJAPR | February 2017 | Vol 5 | Issue 2  39 Kutajghan Vati3 is a classical Ayurvedic anti-dysentery preparation which calms aggravated Kapha and Pitta specifically located in digestive system. It helps retrieve normal tone of intestine by reducing inflammation of small and large intestine promotes healing in colonic ulcers and restores proper digestion thus prevents nutritional deficiency and keeps body's strength intact. Kutajaghana is said to be Tridoshghna (Pacifies all the three Doshas) i.e. it is useful in management of diseases with their origin in either of the Dosha or all of them. Bilwadi Churna4 is Ayurvedic medicine in powder form. It is a classical Ayurvedic formulation indicated in treatment of diarrhoea and dysentery. Bilvadi Churna contains pulp of Bilva fruit (Aegle marmelos), Bhanga (Cannabis indica), dry ginger powder, Mochras, Dhai flowers (Woodfordia fruticosa), coriander seeds and fennel seeds. It has alterative, astringent, amebicide, antibacterial, antiseptic, digestive and stomachic action. The principle ingredient of this medicine is unripe fruit pulp of Bilva fruit (Bengal Quince). Bilva is used in Ayurveda for Pravahika (dysentery), Atisara (diarrhoea), sprue, gastric troubles, intestinal parasites etc. Unripe Bilva powder has significant effect on intestinal parasites, Entamoeba histolytica and Ascaris lumbricoides. Another important ingredient of this medicine is Bhang (Indian hemp) which is used in treatment of variety of diseases. The plant has bitter, astringent, tonic, stomachic and  analgesic properties. In small dosage it is given to treat abdominal disorders, dysentery, diarrhoea and pain.   Chitrakadi Gutika5 is an Ayurvedic medicine used for its digestive and detoxifying actions. It helps digest the undigested food particles and removes the toxins accumulated in the body due to malabsorption of the food. In Ayurveda, AMA (a toxin developed in the body due to malabsorption of food particles) is a main cause of several diseases. Chitrakadi Vati mainly acts on AMA toxin and help digesting and eliminating it and reducing its effects on the body. Therefore, Chitrakadi Gutika is useful in all diseases in which AMA is a main underlying cause. CONCLUSION   Based on the clinical findings as well as the improvement of symptoms it can be safely concluded that the above treatment regimen worked well in case of Pravahika. The treatment was basically symptomatic i.e. Bilvadi churna  with Takra, Kutajghan vati, and Chitrakadi gutika decreases the liquidity of stool and hence the frequency of bowel.   Recommendation  The present study is about the presentation of single case only. Moreover a well structured standardized randomized placebo controlled study is recommended. Authors’ contribution DSR and AKD contributed to conception, designation, acquisition, analysis of data and drafted the case study. AM participated in study design and analysis. ADJ helped in coordination and gave final approval of the version to be published. All authors read and approved the final manuscript. ACKNOWLEDGMENT  The author expresses sincere thanks to the Director General, Deputy Director General, CCRAS, New Delhi for their encouragement, support and guidance. Authors are grateful the patient who has given consent to publish this case report, other experts and staff for their continuous support and cooperation for this case study. REFERNCES 1. Acharya YT, editor. Sushrutha Samhita of Sushruta, Uttar Tantra, Ch. 34, Ver. 5. 2nd ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2004. p. 224.  2. Acharya YT, editor. Charaka Samhita of Agnivesha, Chikitsa Sthana. Ch. 19, Ver. 42. 3rd ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2004. p. 320.  3. Acharya YT, editor. Siddha Yog Sangrah, Ch. 2nd, Nagpur: Shri Vaidyanath Ayurveda Bhavan Ltd; 1979; p. 24.  4. Shastri AD, commentator. Bhaishajya Ratnavali of Govinda Das Sen, Ch. 10, Ver. 269-272. 2nd ed. Varanasi: Chaukhamba Sanskrit Sansthan; 2010. p. 361.  5. Mishra BS, editor. Chakradutta of Chakrapanidatta, Ch. 4th, 4th ed. Varanasi: Chaukhamba Sanskrit Series Office; 1976. p. 62.   Cite this article as:  D S Rotwar, Amit Kumar Dixit, Anil Mangal, Ankush Jadhav. Therapeutic Management of Pravahika (Amoebic Dysentery) through Ayurvedic Regimen: A Case Study. International Journal of Ayurveda and Pharma Research. 2017;5(2):37-39. Source of support: Nil, Conflict of interest: None Declared  *Address for correspondence Dr. DS Rotwar Research officer (Ayurveda), RARIDD, CCRAS, Ministry of AYUSH Government of India, Aamkho, Gwalior - 474009, M.P., India Mobile: +91 8827753466 Email: dsrotwar7@gmail.com 

THERAPEUTIC MANAGEMENT OF PRAVAHIKA (AMOEBIC DYSENTERY) THROUGH AYURVEDIC REGIMEN: A CASE STUDY

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THERAPEUTIC MANAGEMENT OF PRAVAHIKA (AMOEBIC DYSENTERY) THROUGH AYURVEDIC REGIMEN: A CASE STUDY

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