A case report on effect of Dronapushpi Swarasa Nasya in Kamala induced...

[Full title: A case report on effect of Dronapushpi Swarasa Nasya in Kamala induced Hyperbilirubinemia]

[[[ p. 1 ]]]

[[[ p. 2 ]]]

[Find the meaning and references behind the names: Netra, Shri, Kumar, Rohit, Kamala, Rasa]

CASE REPORT August 2022 Journal of Ayurveda and Integrated Medical Sciences | August 2022 | Vol. 7 | Issue 7 191 A case report on effect of Dronapushpi Swarasa Nasya in Kamala induced Hyperbilirubinemia Rohit Kumar 1 , Rajalaxmi MG 2 1 Post Graduate Scholar, Department of PG Studies in Panchakarma, Shri Dharmasthala Manjunatheshwar College of Ayurveda, Udupi, Karnataka, India. 2 Associate Professor, Department of PG Studies in Panchakarma, Shri Dharmasthala Manjunatheshwar College of Ayurveda, Udupi, Karnataka, India. I NTRODUCTION Jaundice, also known as icterus is a yellowish or greenish pigmentation of the skin and yellowish of the eyes due to high bilirubin levels [1] It is commonly associated with itching. The face was having pallor and urine was also pale. Causes of jaundice vary from nonserious to potentially fatal. Levels of bilirubin in blood are normally below 1.0 mg/dl (17 μmol/L) and levels Address for correspondence: Dr. Rohit Kumar Post Graduate Scholar, Department of PG Studies in Panchakarma, Shri Dharmasthala Manjunatheshwar College of Ayurveda, Udupi, Karnataka, India. E-mail: rk 0550538@gmail.com Submission Date: 19/06/2022 Accepted Date: 25/07/2022 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 over 2-3 mg/dl (34- 51 μmol/L) typically results in jaundice. High bilirubin is divided into two types: unconjugated (indirect) and conjugated (direct). Conjugated bilirubin can be confirmed by finding bilirubin in the urine. Other conditions that can cause yellowish skin but are not jaundice include carotenemia from eating large amounts of certain foods and medications like rifampicin [2] This case study shows that Ayurvedic herbs which give effective result in jaundice. Kamala is one among the Pittaja Vyadhi and explained under Rakta Pradoshaja Vikara [3] The Haridra Mutra, Netra and Twak are the Pratyatma Lakshana of Kamala. [3] Dronapushpi Swarasa was selected for the Nasya Karma. Dronapushpi is having Katu Tikta Rasa, Kapha Vatahara, Ushna Virya and Katu Vipaka. [3] In this patient with Kamala , who is not responding to usual internal medications, was treated with Nasya Karma ten drops of Dronapushpi Swarasa was administered into each nostril, once in a gap of two days. The idea behind the treatment was to assess its effect on A B S T R A C T Human body eliminates metabolic wastes either through sweat, urine, or through faeces. Any derangement in the normalcy leads to building up of metabolic wastes within the body. One such condition where in there is accumulation of bilirubin in the blood is hyperbilirubinemia. Viral infection is the cause and presenting with yellowish discoloration of sclera, dark urine, pale stool, fatigue, flu like symptoms, loss of appetite etc. In Ayurveda, such symptoms are mentioned under the broad name Kamala. The line of management mainly highlights the advice of Shodhana in the form of Virechana and different Shamana Aushadhis based on the stages of the disease. In traditional folklore practice, the patients of these symptoms are treated with Tikshna, Shodhana Nasya Karma . With that practice in backdrop, a 17 years female patient presented with hyper-bilirubinaemia, was treated with Dronapushpi Swarasa Nasya ten drops to each nostrils, in a gap of 2 days. When the bilirubin level was raising gradually even after usual internal medication, this treatment was planned and administered. The bilirubin level from 5.7 was reduced to 1.4 after the treatment gradually over a period of 12 days. The patient showed gradual recovery from almost all the symptoms clinically and in haematological parameters. During the procedure nasya did not show any complications in the patients. Dronapushpi Swarasa can be effectively used to manage hyper-bilirubinaemia. Key words: Kamala, Virechana, Dronapushpi Swarasa, Shodhana Nasya, Hyper-Bilirubinaemia

[[[ p. 3 ]]]

[Find the meaning and references behind the names: Sara, Mala, Min]

Rohit Kumar et al. A case report on effect of Dronapushpi Swarasa Nasya in Kamala ISSN: 2456-3110 CASE REPORT August 2022 Journal of Ayurveda and Integrated Medical Sciences | August 2022 | Vol. 7 | Issue 7 192 hyperbilirubinemia. The result observed was promising towards the management of Kamala w.s.r. hyperbilirubinemia. C ASE R EPORT A 17 year old female patient was said to be apparently healthy before 10 days. Gradually she developed fever, which was on and off in nature associated with yellowishness in eyes, urine, and faeces. Along with this reduced appetite. The quantity of food intake was reducing day by day. Also, there was body ache, headache, and weakness which were worsening gradually. No H/o of loose stools, vomiting. Details of the examination are given below. Examination (Ayurvedic) ▪ Nadi - 76/min ▪ Mutra - Pitavarna ▪ Mala - Tilapishtanibha ▪ Jihva - Saama ▪ Shabda - Prakruta ▪ Sparsha - Ushna ▪ Druk - Netra-Pitta ▪ Prakruti - Vatakapha ▪ Sara, Samhanana, Satmya - Madhyama ▪ Aharashakti – Alpa General examination ▪ Pallor - Present ▪ Icterus - Present ▪ Lymph nodes - Absent ▪ Clubbing - Absent ▪ Oedema - Absent Systemic examination ▪ RS - NVBS ▪ CVS - S 1 S 2 heard, no murmur ▪ CNS - HMF intact Abdominal examination Inspection Abdomen contour - Normal Umbilicus inverted & centrally placed. No scar, no visible veins are present. Palpation Soft, non-tender Liver firm, smooth with distinct border Palpable measuring about 2 fingers (2.5 cm) from the lower costal margin Spleen - non palpable Percussion Normal tympanic note heard Shifting dullness absent Auscultation Normal bowel sounds heard Hematological report suggesting of Hyperbilirubinemia - On 18/05/2021 Haemogram Hemoglobin - 8.0 GM% TC WBC - 5800 cells/cu mm Deferential Count of WBC Neutrophills - 61% Lymphocytes - 34% Eosinophills - 02% Monocytes - 03% Basophills - 00% ESR - 30 mm/Hr Liver Function Test Total Billirubin - 5.7 mg/Dl Direct Billirbin - 2.9 mg/Dl Indirect Billirubin - 2.8 mg/Dl SGOT/AST - 261.0 U/L

[[[ p. 4 ]]]

[Find the meaning and references behind the names: Nil]

Rohit Kumar et al. A case report on effect of Dronapushpi Swarasa Nasya in Kamala ISSN: 2456-3110 CASE REPORT August 2022 Journal of Ayurveda and Integrated Medical Sciences | August 2022 | Vol. 7 | Issue 7 193 SGPT/ALT - 367.0 U/L Alkaline Phosphatase - 179.0 U/L Total Protein - 7.9 g/Dl Albumin - 3.0 g/Dl Globulin - 4.9 g/Dl A/G Ratio - 0.6 Ratio Urine Test Report Urine Albumin - Trace Urine Sugar - Nil Microscopic Examination Epithelial Cells - 2-3/Hpf Pus Cells - 2-3/Hpf Rbc’s - 0-1/Hpf Casts - Nil Crystals - Nil Others - Nil Urine For Bile Salt - Present Urine For Bile Pigment - Present Treatment The details of internal medicine given are: ▪ Aarogyavardhini Vati 1 TID ▪ Mrutyunjaya Rasa 1 TID ▪ Kumaryasava 20 ml TID ▪ Madiphala Rasyana 10 ml BD B/F with hot water ▪ Bhumiamalaki + Guduchi + Nimba + Bhringraja Kashaya 50 ml BD ▪ Nirocil 1 TID Intervention: Nasya procedure Purva Karma Medicine preparation Fresh leaves of Dronapushpi were collected. After washing, it was grinded into a fine paste and filtered through a cloth and Swarasa / juice was collected. Patient preparation After the digestion of the food, at around 11 AM procedure was done. Pradhana Karma Patient was made to lie down in supine posture with neck hyper extended. With dropper, 10 drops of the Swarasa was administered into each nostril. The patient was asked to spit out the secretion into the tray Paschat Karma After 30 minutes of observation, patient was sent to the room and advised rest. Observation of patient Burning sensation in eyes, nose and headache was present. Watering of eyes and nose lasted for 3-4 hours. Headache lasted for 1 hour after the procedure. After that, patient was comfortable. R ESULTS In this patient, Nasya has shown significant improvements both clinically and haematologically after 2 courses of Nasya . The severity of symptoms like Pitanetra, Nakha, Twak , Anana , Mutra and Varchas , Avipaka , Dourbalya , etc. in the patient, following the treatment. After second Nasya , all the symptoms were reduced significantly. The itching, weakness reduced completely. Appetite is normal. Yellowishness reduced gradually. Liver Function Test showed significant changes which are mentioned in Table 1. Table 1 Date Bilirubin(T) Direct Indirect SGOT SGPT 18/05/2021 5.7 2.9 2.8 261 367 21/05/2021 5.1 2.7 2.4 --- --- 22/05/2021 Nasya 24/05/2021 Nasya 25/05/2021 2.5 1.1 1.4 75 85 31/05/2021 1.4 0.4 1.0 43 34

[[[ p. 5 ]]]

[Find the meaning and references behind the names: Guna, Green]

Rohit Kumar et al. A case report on effect of Dronapushpi Swarasa Nasya in Kamala ISSN: 2456-3110 CASE REPORT August 2022 Journal of Ayurveda and Integrated Medical Sciences | August 2022 | Vol. 7 | Issue 7 194 DISCUSSION Discussion on intervention In this case report, patient had the symptoms of Kamala . The ideal treatment in this stage of the disease will be Virechana Chikitsa. But as the patient is Durbala and the appetite was also less, the patient is not fit for Virechana . Hence initially, the patient was prescribed with internal medications. When the condition was not responding and as the haematological reports started worsening, the alternate treatment was searched. In traditional folklore practice, the Shodhana Nasya Karma is widely practiced in the management of Kamala . Hence with that idea, Rechana Nasya was selected. Dronapushpi Swarasa was selected due to its Ushna Teeksha Guna and Rechana action can be achieved through the same. After one Nasya Karma, patient was observed for any complications for 6 hours. As patient was comfortable, it was decided to administer second dose after 1 day. After this dose too, patient was comfortable and drastic, significant changes were seen clinically and haematologically. Even though, Samhitas advised Nasya Karma in the prevention and management of Jatru Urdhwa conditions, in folklore practice, Nasya is commonly advised in the management of Kamala . It is difficult to explain the mode of action of Nasya in this condition. Any published data is not available to explain the systemic action of the drug administered through the nasal route. But as the drug possessed Ushna Teekshna properties, might have removed the Sanga (as it is the Rudha Patha Kamala ), it eliminated the Doshas to some extent. But there is a definite benefit achieved in the patient where drug is administered through the nasal route and benefit is seen clinically. The possible explanation may be as: Nervous stimulation - Nasal administration of drugs causes stimulation of brain matter resulting in stimulation of Parasympathetic nerves. All the abdominal organs are supplied by Parasympathetic nerves. The stimulation of Hepatic nerve plexus and Vagus nerve stimulates the hepatocytes and contributes in the hepatic repair. The Swarasa , due to the high concentration of phytoconstituents, when administered in high dose, helps in more stimulation of nerves. The blood supply to Nerve is through Vasa Nervosa. Some amount of the medicine may enter the systemic circulation through this route also [5] Lymphatic pathway - From nose, it drains to Sub mental and Sub mandibular lymph nodes. From there, on the right side, it drains into the Right Lymphatic Duct and on the left side it drains into Thoracic duct. Thoracic duct and Right Lymphatic duct open at the junction of internal jugular vein and Subclavian vein, on either side of the body. Thus, joining to the venous drainage. The lymphatic drugs thus enter the venous circulation. The larger plasma proteins or larger molecules passes / are better absorbed through the lymphatics. The nasal cavity is covered by a thin mucosa which is well vascularized. Therefore, a drug molecule can be transferred quickly across the single epithelial cell layer directly to the systemic blood circulation without first pass hepatic and intestinal metabolism. The effect is often reached within 5 min for smaller drug molecules [6] CONCLUSION Based on the common folklore practice of Rechana Nasya in the management of Kamala , a case diagnosed as Kamala was treated with Dronapushpi Swarasa Nasya (10 drops to each nostril) of 2 sitting with a gap of 1 day. This treatment showed promising result in the management of Kamala . The Shodhana effect of Nasya along with the hepatoprotective nature of Dronapushpi helped in attaining the normalcy of the patient. REFERENCES 1 Davidson, Edited by brain R. Walker, Davidsons Principles and practice of medicine, 22 nd edition, Daibetic neuropathy, page 831, syear-2006 2 Green JB, Bethel AN, Armstrong PW, Duse JB, Engel SS, Garg J, et al. Effect of Sitagliptin on cardiovascular outcomes in type II Diabetes. New England Journal of Medicine, 2015; 232 -242 3 Sushruta, Sushruta Samhita, Chakrapanidatta, 14 th edition. 2017, Chaukamba Sanskrit Samsthan, Varanasi, Pg- 310 4 Vaidya Bapalal G, Adharsha Nighantu, Vol-II, II edition, Varanasi, Chowkambha Bharti Academy. 1999, p-279-280.

[[[ p. 6 ]]]

[Find the meaning and references behind the names: Marcel, Chang, Med, Manfred]

Rohit Kumar et al. A case report on effect of Dronapushpi Swarasa Nasya in Kamala ISSN: 2456-3110 CASE REPORT August 2022 Journal of Ayurveda and Integrated Medical Sciences | August 2022 | Vol. 7 | Issue 7 195 5 Rohkamm, Reinhard. Color atlas of neurology. III. by Manfred Guther.Transl.rev.by Ethan Taub.2004;p.90 6 W. Chien, K.S.E.Su, S.-F. Chang. Nasal systemic drug delivery, Marcel Dekker, Inc., New York,1989. ******************************* How to cite this article: Rohit Kumar, Rajalaxmi MG. A case report on effect of Dronapushpi Swarasa Nasya in Kamala induced Hyperbilirubinemia. J Ayurveda Integr Med Sci 2022;7:191-195. Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2022 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 (https://creativecommons.org/licenses/by-nc-sa/4.0), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

Other Health Sciences Concepts:

[back to top]

Discover the significance of concepts within the article: ‘A case report on effect of Dronapushpi Swarasa Nasya in Kamala induced...’. Further sources in the context of Health Sciences might help you critically compare this page with similair documents:

Samhita, Nadi, Shodhana, Ayurveda, Sanga, Sushruta-samhita, Shabda, Kamala, Mala, Pradhana-karma, Paschat-karma, Jihva, Tikshna, Mutra, Sparsha, Ushnavirya, Ri, Durbala, Purvakarma, Virechana, Panchakarma, Avipaka, Katuvipaka, Nasyakarman, Aharashakti, Liver, Edema, Discussion, Weakness, Crystal, Urine, Faeces, Burning sensation, Prakruti, Source of support, Conclusion, Treatment, Fresh leaves, Medicine preparation, Jaundice, Ayurvedic medicine, Patient Preparation, Internal medicine, Headache, Internal medication, Pallor, Journal of Ayurveda, Conflict of interest, Mode of action, Microscopic examination, Case report, Case study, Shodhana Chikitsa, Systemic examination, Hyperbilirubinemia, Significant improvement, Nasal route, Kumaryasava, Hematological Report, General examination, Ayurvedic Herb, Viral Infection, Shamana Aushadhi, Katu-Tikta Rasa, Vagus Nerve, Nasal administration, Nasal cavity, Pratyatma Lakshana, Dourbalya, Metabolic waste, Aarogyavardhini Vati, Shodhana Nasya, Rakta Pradoshaja Vikara, Liver function test, Table 1, Reduced appetite, Alkaline phosphatase, Albumin, Urine sugar, Total protein, Intervention, Lymph Node, Abdominal examination, Folklore Practice, Kapha-Vatahara, SGOT, SGPT, Bilirubin level, Urine Albumin, Post Graduate Scholar, Associate Professor, Body ache, Icterus, Watering of Eyes, Lymphatic pathway, Clinical parameter, Phytoconstituent, Internal jugular vein, Reference, Virechana Chikitsa, Creative Commons Attribution, Subclavian vein, Globulin, Haematological parameter, Epithelial cell, CN, Abdominal organ, CV, Key-word, Symptom, How to cite, Pus cell, Venous circulation, Department of PG.