|
 
 |
| CASE REPORT |
|
| Year : 2022 | Volume
: 3
| Issue : 1 | Page : 41-46 |
|
Efficacy of Piccha Basti and immune enhancer medicines in the management of ulcerative colitis
Pooja Sharma, Divya Kajaria
Department of Kayachikitsa, All India Institute of Ayurveda, New Delhi, India
| Date of Submission | 03-Feb-2022 |
| Date of Decision | 12-Apr-2022 |
| Date of Acceptance | 21-Apr-2022 |
| Date of Web Publication | 15-Jun-2022 |
Correspondence Address:
Pooja Sharma
Department of Kayachikitsa, All India Institute of Ayurveda, New Delhi
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijaim.ijaim_6_22
Ulcerative colitis (UC) is an immune-mediated disease; the intestine contains an enormous colitis antigenic load derived from the food and microbial flora. There appear to be four main factors which influence the disease: host genetic susceptibility, a dysregulated immune response, impairment of intestinal epithelial barrier function, and environmental factors. According to Ayurveda, it may be correlated with Raktatisara, which is mentioned as advanced stages of Pittatisara with similar signs and symptoms. A 19-year-old female patient was diagnosed with UC in May 2018, with the complaints of frequent defecation of stool mixed with blood and pain in the abdomen. She consulted allopathic physician and where the patient was diagnosed with UC through sigmoidoscopy, colonoscopy, and biopsy. The patient was on conservative treatment for 2 months. The patient gradually developed the following symptoms like bilateral pain in all major and minor joints, hair loss, reddish discoloration on both medial aspect of thigh and hips. After getting no relief, the patient visited outpatient department of AllA, Sarita Vihar, New Delhi. The patient was admitted to the inpatient department of AIIA hospital. After the 41 days of treatment, stool examination shows no occult blood in stool, followed by 2 months follow-up and the patient got 80% relief in all the signs and symptoms. Piccha Basti along with oral medicines is highly effective in the management of Raktatisara. This case report highlights the efficacy of Piccha basti and immune enhancer medicines in the management of UC and provide a better pathway for this disease.
Keywords: Immune enhancer, Piccha basti, Raktatisara, ulcerative colitis
How to cite this article:
Sharma P, Kajaria D. Efficacy of Piccha Basti and immune enhancer medicines in the management of ulcerative colitis. Indian J Ayurveda lntegr Med 2022;3:41-6 |
How to cite this URL:
Sharma P, Kajaria D. Efficacy of Piccha Basti and immune enhancer medicines in the management of ulcerative colitis. Indian J Ayurveda lntegr Med [serial online] 2022 [cited 2023 May 29];3:41-6. Available from: http://www.ijaim.in/text.asp?2022/3/1/41/347501 |
| Introduction | |  |
Ulcerative colitis (UC) is a chronic disease with recurrent uncontrolled inflammation of the colon. The rectum is always affected with inflammation spreading from the distal to the proximal colonic segments.[1] The relevant risk factors include smoking, hygiene hypothesis, microorganisms, appendectomy, medication, nutrition, and stress have all been found to be associated with the modality of UC. In conventional medicine, some drugs like mesalamine may give mild relief in signs and symptoms of UC. Some patients get aid with steroids, which again are not suitable because of their side effects.[2] Even after taking these drugs, patients suffer from the disease. Hence, the patients are always looking for some alternative therapy encouraging more effective and safer outcomes. The author found some encouraging results in patient with UC with certain Ayurvedic treatments. The treatment significantly corrected bowel frequency and bleeding in stool which are the major features of UC. According to Ayurveda, UC is a disease of Purishavaha srotas (~excretory channel). It may be correlated to the disease Atisar (~ diarrhea), which means Atisaradam atisaram (repeated defecation of stool from the rectum). Raktatisara advanced stages of Pittatisara which manifests in the form Shulam (rectal pain), Vidaaham (inflammation), Gudpaka (rectal ulceration), and Rakta-Pravritti (blood mixed stool).[3] In the present study, the drugs used for Piccha basti are Shalmali niryasa, Jatyadi taila, madhu, saindhava lavan, and Yastimadhu siddha Ksheerpaka for kwath. Hence, the drugs used in Basti karma are having combined effects like Vata pitta shamana, Rakta sthambana, Vrana shodhana and Vrana ropana and it reduces the clinical manifestation of colitis such as; inflammation, burning sensation, pain, and cramps.[4] Acharya Charaka has described Piccha basti for the treatment of Pravahika (~ Dysentery), Gudabhransha (~Rectal prolapse), Raktasrava (~Bleeding per rectum) Jwara (~Fever), Pitta-atisaar, Shotha (~Inflammation), Gulma, Jeerna atisaar (~Chronic diarrhea), and Grahani Dosha. Acharya Sushruta has also given similar indications of Piccha basti.[5]
| Case Report | | |
A 19-year-old female patient came to outpatient department of Kayachikitsa, All India Institute of Ayurveda in New Delhi, the complaints of Punaha Punaha Purisha Pravritti (frequent defecation) was 7–8 times per day, Shulam (rectal pain), Vidaaham (inflammation), Gudapaka (rectal ulceration), and Rakta-yukta Purisha (blood mixed stool) was 2–3 times per day, Kshudhahani (reduced appetite) and associated with significant Udara Shoola (abdominal pain) and weight loss of 4 kg.
Clinical findings
On examination,her weight was 74 kg, blood pressure was 100/80 mm Hg, pulse rate was 76/min, temperature was 99 F, pallor was present (+) on the lower palpebral conjunctiva, and icterus, cyanosis, and clubbing were all missing on examination. The personal history of the patient showed that the patient is nonvegetarian with reduced appetite even though patient had a habit of taking very spicy food (Tikshna ahara) and hot (Ushna ahara) food in the past. Systemic examination revealed that she had per abdomen mild tenderness on the right side (right hypochondriac region). She experiences worms in stool and she had a history of mud eating/pica since childhood.
Diagnostic assessment
Laboratory investigations revealed hemoglobin - 9.8 g/dl, erythrocyte sedimentation rate – 39 mm, c-reactive protein – negative, and other hematological parameters were insignificant, including her renal parameters, blood sugar, and urine investigation also within the normal limits. Ultrasonography and computerized tomography abdomen revealed normal impression. The diagnosis was made based on:
- Colonoscopy (May 15, 2018) – Multiple superficial rectal ulcer
- Histopathology report (August 24, 2018) – 4 mucosal fragments, Crypt's architecture – distorted (mild), cryptitis – present, mucosal ulceration – present (focal), lamina propria inflammation – moderate, mixed, impression known case of inflammatory bowel disease-UC (IBD-UC), current HAI Grade 3
- Sigmoidoscopy (August 24, 2018) – Internal hemorrhoids, IBD – UC, distal proctitis
- Stool occult test (December 11, 18) – Positive [Figure 1].
Looking into the signs and symptoms in the differential diagnosis, Grahani and Pravahika from Raktaj Atisar were considered there was no Jirne jeeryate (Ch. Chi. 15/57-61), Muhurbhaddham Muhurdravam Purisha Pravritti, Kasa, Karsha, and Pravahika was also excluded as Pravahan was not present as Pravahatoalpam bahushomalaktam (Su. U. 40) was not present and Vataja Grahani Lakshana such as Vatagulma, Hridroga, Pleeha-Shanki-Lakshana, and Kaphaja Grahani Lakshana such as Asyavairasya and Guruta were not observed. The patient was diagnosed with Raktatisara based on the signs, symptoms, and clinical presentation listed in [Table 1] and the timeline of events listed in [Table 2].
Therapeutic intervention
According to Aacharya Charak following three basic steps should be adopted while treating any disease, i.e., Nidana Parivarjana, Samshamana, and Samshodhana. Considering the patient's physical constitution, treatment was divided into Panchkarma procedure and Shamana Chikitsa. The patient received Piccha Basti [Figure 2] and [Figure 3] for 15 days adjuvant with Shaman Chikitsa for 41 days, including Step 1-Pitta-Shamak + Rakta-Stambhak + Oja-enhancer chikitsa, Step-2 Krimighan + Raktvardhak chikitsa, and Step 3-Deepan-Paachan, Stambhan chikitsa, as mentioned in [Table 3].
Panchkarma procedure
Piccha Basti – 150 ml for 15 days [Figure 4] and [Figure 5].
Follow-up and outcome
After completion of the whole treatment, the patient condition was assessed for results were assessed which showed a significant reduction in the frequency of stool and bleeding per rectum as mentioned [Table 4], and stool examination shows no occult blood in stool, as shown in [Figure 6]. Follow-up was taken regularly for 2 months and advised medicines according to symptoms.
| Discussion | | |
UC is a chronic idiopathic IBD characterized by a superficial mucosal inflammation extending in variable degrees from the rectum to the more proximal colon.[6] The overall incidence and prevalence are estimated to be 1.2–20.3 cases per 100,000 people per year and 7.6–245 instances per 100,000 people per year, respectively. It has a bimodal age distribution, with a peak in the second or third decades of life and a second peak between the ages of 50 and 80. Symptoms of UC include bloody stools, rectal urgency with a loose consistency, tenesmus, and varying degrees of abdominal pain that is often eased by defecation. The clinical presentation and symptoms of UC, as well as results on colonoscopy or a biopsy, are used to make the diagnosis. The goals of treatment in UC focus on improving quality of life and achieving steroid-free remission.
The patient was diagnosed with UC on the basis of signs and symptoms and the main investigations. Shalmali Niryasa is the main content of Piccha basti, which contains resinous extract of Tannin. Acharya Bhavprakash has mentioned the properties of Shalmali niryasa (resinous extract) as Hima (cool in potency), Grahi (astringent). It is astringent in property which, when coming in contact with intestinal ulcered inflamed mucosa, resists the chemical and mechanical injury decreasing local irritation and its anti-oxidant property promotes tissue repair and milk helps in better assimilation of the ulcered colon.[6],[7],[8] Oja act by one of the following three ways: acting at the level of Rasa (directly improving the quality of nutrition), Agni (improving the digestion and metabolism of the body), and Srotas (improving the micro-circulation, it ensures proper perfusion and nourishment of the tissues).[9] During Stage 1, Pitta shamak, Rakta Sthambana, and Oja Vardhaka chikitsa were administered in accordance with the principles of Raktatisara as described in Ayurvedic texts. this includes Piccha basti which was planned for 15 days along with medications. On the day of Piccha basti, Sarvanga abhyanga (~therapeutic whole-body message) was done with Tila taila (~Sesame oil) for 30 min, followed by Sarvanga bhashpa swedana (~whole body sudation) with Dashamoola kwatha for about 10 min. This was followed by the administration of Basti dravya (~enema medication) through the rectal route. The patient was advised to hold the medicament to the best possible extent. Piccha basti was given as it is Shothahara and Vrana-Ropaka (anti-inflammatory and ulcer-healing), Rakta Stambhaka (Hemostatic agent), Sangrahi/Stambhan (anti-diarrheal). Due to its Kashaya Rasa and Sheeta Virya, it has Vranropaka (Ulcer-healing) property[10] Swarna Sutsekhar Ras, as mentioned in [Table 4], a herbomineral preparation was given orally for developing the immunity and strength. The nanoparticles of gold would reach the target site of action through blood after gastrointestinal uptake,[11] and this drug is majorly helpful in preventing the bleeding per the rectum. Madhuyasti churna is given orally because it is Vata-Pitta shamak, Shothahar, anti-inflammatory, analgesic, anti-oxidant and ulcer healing properties.[12] Kushmanda rasayan is having Sheeta virya hence this Rasayan aids in the treatment of bleeding diseases, excess Pitta, and ailments caused by excessive Ushna guna in the body. A major revelation occurred during the course of treatment of the patient that she experiences worms in stool and she had a history of mud eating/pica since childhood, so due to this, the whole treatment was revised at Stage 2-Krimighan chikitsa (deworming) and Oja enhancer an immunity developing chikitsa method was initiated which includes Panchkola Churna along with Vidangadi lauha, Krimimudgar rasa for deworming (Krimighna). Dadimadi Ghrita for enhancing the circulation of the gastric membrane, thus helping in digestion and absorption. In Ayurveda classics, it is mentioned that Ghrita is best Pitta Shamak Dravya and Pitta is responsible for inflammation and ulceration process, so to pacify its effects Dadimadi ghrita was used. This disease is a psychosomatic disorder so to subsides the factors related to this, Shankhpushpi was given because it is considered one of the best Medhya rasayan (nervine tonic) in Charak Samhita. After 7 days, treatment was changed to Stage 3 (Rakta Sthambana and Deepana chikitsa), which includes Bol-Parpati, which is used for different bleeding disorders because it pacifies rakta and pitta and act as sthambana dravya and uses of Bilwadi avleha, it has antidiarrheal, antidysentry, antibacterial, antiprotozoal, antispasmodic, antidepressant, antifungal, anthelmintic, antispasmodic, and antiinflammatory[13],[14] properties. Kutajaghan vati[15] contains ghanasatva of Kutajatvak and has an Atisara nashaka (stambhana) guna that also helps in reducing bowel frequency.
| Conclusion | | |
On the basis of our clinical observation and discussion, it may be concluded that Raktatisara was found in patient, and results obtained may be attributed to the disease-modifying effect of the trial therapy by means of its Pitta-shamaka, vrana shodhana-ropana, grahi, and stambhana properties. Particularly, in this case, the whole course of the treatment process of stool examination and diagnosis shows no occult blood in stool, and the patient got 80% relief in all the signs and symptoms. Piccha Basti, along with oral medicines, is highly effective in the management of Raktatisara. This case report highlights the potential of Ayurvedic management in UC and provides a better pathway for this disease. Hence, stool occult blood examination process is not the last investigation to say patient is free from UC disease, but it needs to be further evaluated by research, respectively, through sigmoidoscopy and colonoscopy of the patient to bring some significant conclusions and better treatment modality even trial therapy could be an ideal drug as a safe and effective alternative in case of UC.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Drossman JM, Andreas S. Current treatment of ulcerative colitis. World J Gastroenterol 2011;17:3204-12.  |
| 2. | Karagozian R, Burakoff R. The role of mesalamine in the treatment of ulcerative colitis. Ther Clin Risk Manag 2007;3:893-903. |
| 3. | Singh V, Srivastav AK. An Ayurvedic approach in the management of ulcerative colitis. Int Ayurvedic Med J 2014;2:1069-74. |
| 4. | Charak Samhita – Chakrapani Commentary. Vaidya Yadavji Trikamji Acharya. (Charak Samhita Chikitsasthan 19/69-70). Varanasi: Chaukhamba Surbharati Prakashan; 2017. p. 379. |
| 5. | Charak Samhita – Chakrapani Commentary. Vaidya Yadavji Trikamji Acharya. (Charak Samhita Chikitsasthan 19/64-68). Varanasi: Chaukhamba Surbharati Prakashan; 2017. p. 570. |
| 6. | Varsakiya JN, Goyal M, Kathad D, Kumari R. Efficacy of Ayurveda modalities in the management Raktaja pravahika (ulcerative colitis): A case report. Ayurveda Case Rep 2021;4:115-20. Available from: http://www.ayucare.org/text.asp?2021/4/3/115/332434. [Last accessed on 2022 Apr 09]. |
| 7. | Jagtap AG, Niphadkar PV, Phadke AS. Protective effect of aqueous extract of Bombax malabaricum DC on experimental models of inflammatory bowel disease in rats and mice. Indian J Exp Biol 2011;49:343-51. |
| 8. | Hussain L, Akash MS, Naseem S, Rehman K, Ahmed KZ. Anti-ulcerogenic effects of salmalia malabarica in gastric ulceration – Pilot study. Adv Clin Exp Med 2015;24:595-605. |
| 9. | Tripathi JS, Singh RH. The concept and practice of immunomodulation in ayurveda and the role of Rasayanas as immunomodulators. Anc Sci Life 1999;19:59-63. |
| 10. | Racková L, Jancinová V, Petríková M, Drábiková K, Nosál R, Stefek M, et al. Mechanism of anti-inflammatory action of liquorice extract and glycyrrhizin. Pubmed 2007;21:1234-41. |
| 11. | Mitra A, Chakraborty S, Auddy B, Tripathi P, Sen S, Saha AV, et al. Evaluation of chemical constituents and free-radical scavenging activity of Swarnabhasma (gold ash), an Ayurvedic drug. J Ethnopharmacol 2002;80:147-53. |
| 12. | Singh S, Tapadia MG. Correction to: Molecular basis for efficacy of Guduchi and Madhuyashti feeding on different environmental stressors in Drosophila. Cell Stress Chaperones 2020;25:193-4. |
| 13. | Mazumder R, Bhattacharya S, Mazumder A, Pattnaik AK, Tiwary PM, Chaudhary S. Antidiarrhoeal evaluation of Aegle marmelos (Correa) Linn. root extract. Phytother Res 2006;20:82-4. |
| 14. | Benni JM, Jayanthi MK, Suresha RN. Evaluation of the anti-inflammatory activity of Aegle marmelos (Bilwa) root. Indian J Pharmacol 2011;43:393-7. [ PUBMED] [Full text] |
| 15. | Patel MV, Patel KB, Gupta SN. Effects of Ayurvedic treatment on forty-three patients of ulcerative colitis. Ayu 2010;31:478-81. [ PUBMED] [Full text] |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
|
Search Pubmed for