JALODARA (ASCITES) Treatment Protocol by Ayush
INTRODUCTION
Eight different types of Udara Roga are mentioned in Ayurvedic classics, such as Vatika, Paittika, Kaphaja, Sannipaatika, Pleehodara, Baddhodara, Kshatodara and Jalodara. If untreated, all types of Udara will culminate into Jalodara. Jalodara is considered as one among the ‘Ashta Mahagada’. The main pathogenesis involved in Udara is Agnimandya, Doshopachaya & Srotorodha. Therefore, the treatment involves Deepana, Pachana & Nitya Virechana.
Case Definition:
Distention of abdomen due to accumulation of fluid in peritoneal cavity associated with loss of appetite, heaviness of abdomen, general debility and edema.
Differential Diagnosis:
- Gulma
- Yakrutodara
- Pleehodara
- Kamala
- Cirrhosis
- Hepatitis
- Hepatocellular adenoma
- Hepato-renal syndrome
- Protein-Losing enteropathy
LEVEL 1: AT SOLO AYURVEDA PHYSICIAN’S CLINIC / PHC
Clinical Diagnosis: On the basis of history and clinical presentation, patient can be diagnosed provisionally as case of Jalodara. Distended abdomen, excessive thirst, anal wetness, presence of averted umbilicus, shifting dullness, fluid thrill, engorged vessels over abdomen etc. may confirm the diagnosis.
Investigations: Though much can be diagnosed based on the clinical signs and symptoms, laboratory investigations may help the clinician to confirm the diagnosis and rule out other conditions.
- Blood for Hb, TLC (leucocytosis), DLC (Neutrophilia)
- Urine Routine and microscopic
Treatment: In the initial stage when the patient is having mild features of Jalodara, along with diet restriction, two or more of following drugs may be given:
Table 4.1: Medicines at level 1 for Jalodara
Drugs |
Dosage form |
Dose |
Time of administration |
Duration |
Anupana |
Bhumyamalaki |
Churna |
3-6 gm |
After meal / thrice a day |
2-3 weeks |
Honey / water |
Katukarohini1 |
Churna |
3-6 gm |
After meal / thrice a day |
2-3 weeks |
Honey / water |
Kumari |
Swarasa |
10-20 ml |
After meal / thrice a day |
2-3 weeks |
With water |
Punarnavadi Churna2 |
Churna |
3-6 gm |
After meal / thrice a day |
2-3 weeks |
Honey / water |
Haritaki3 |
Churna |
3-6 gm |
After meal / thrice a day |
2-3 weeks |
Luke warm water |
Indrayana4 |
Churna |
3-6 gm / 10-20 ml |
After meal / thrice a day |
2-3 weeks |
Honey / water |
Punarnavashtaka Kwatha5 |
Kwatha |
12-24 ml |
before meal / twice a day |
2-3 weeks |
- |
Dashamoola Kwatha6 |
Kwatha |
12-24 ml |
before meal / twice a day |
2-3 weeks |
- |
Phalatrikadi Kwatha7 |
Kwatha |
12-24 ml |
before meal / twice a day |
2-3 weeks |
- |
Pathyadi Kwatha8 |
Kwatha |
12-24 ml |
before meal / twice a day |
2-3 weeks |
- |
Gomutra Haritaki Churna9 |
Churna |
3–6 gm |
After meal / twice a day |
2-3 weeks |
Luke warm water |
In addition to these, patients may be advised to maintain input-output chart for fluid regulation, and record of abdominal girth.
Pathya - Apathya (Diet and life style):
Do’s -
- Ahara: Only milk diet is advised. Goat / camel / cow / buffalo milk, buttermilk, Peya – Jangala Mamsa Rasa, Khichadi prepared with seasoned rice and Moong Daal, Shigru, fresh vegetables soup. Diet with Deepana (digestive) property and Laghu (light to digest) property
e.g. Yavagu, Yusha, Tilanala Kshara or Palasha Kshara, Vartaka Kshara, Swarjika Kshara etc. semi liquids are advised. Yava along with Vastuka (Bathua leaves), Karela (Karavellaka) are advised.
- Vihara: Timely meals, relaxation techniques
Don’ts -
- Ahara: Salt and water intake should be restricted, heavy food, green peas, black eyed beans, lentils, yellow gram, raw vegetables and
salads, refined foods such as white flour (Maida- bread, pizza, biscuits), sprouts, etc. are contraindicated.
- Vihara: Physical and mental stress, excessive exercise, suppression of natural urges, day sleep, blood-letting,
Referral Criteria: Refer to level 2
- Patients not responding to above mentioned management
- Imbalance in fluid input-output ratio
- Signs of jaundice, cardiac failure or renal failure
- Signs of hepatic encephalopathy
LEVEL 2: CHC’S OR SMALL HOSPITALS WITH BASIC FACILITIES
Clinical Diagnosis: The diagnosis is made on the basis of criteria mentioned in level-1 for fresh cases. The case referred from level-1 or fresh case must be evaluated thoroughly for any complication.
Investigations: Same as Level 1, In addition; the following tests can be done:
- Liver Function Tests: Elevated amino transferase - ALT/AST > 45U/lit, disturbed albumin: globulin ratio; raised alkaline phosphates; higher values of prothrombin time
- Lipid profile - Increased values of S. Cholesterol, S. Triglyceride
- Renal function tests
- Sr. electrolytes (Na, K, Ca)
- ECG for cardiac function monitoring.
- USG
Treatment: In addition to the management mentioned in Level 1, few of the following drugs may be added as per the requirement and status of the patient. Rasaushadhi (Herbo-mineral drugs) can be used at this level. Patient may be kept under observation while prescribing these kinds of medicines.
Table 4.2: Medicines at level 2 for Jalodara
Drug |
Dosage form |
Dosage |
Time of administration |
Duration |
Anupana |
Narayana Churna10 |
Churna |
3-5 gm |
Before meal / twice a day |
2-3 weeks |
Takra |
Kumaryasava11 |
Asava |
20-40 ml |
Before meal / twice a day |
2-3 weeks |
Equal quantity of water |
Abhaya Vati12 |
Vati |
1-2 Vati |
After meal / thrice a day |
2-3 weeks |
Lukewarm water |
Shilajatu Churna13 |
Churna |
1-2 gm |
After meal / thrice a day |
3 months |
Cow urine |
Chitraka Ghrita14 |
Ghrita |
3-5 gm |
before meal / twice a day |
2-3 weeks |
Luke warm water |
Jalodaradi Rasa15 |
Vati |
1-2 Vati |
After meal / thrice a day |
2-3 weeks |
Water |
Arogyavardhini Rasa16 |
Churna / Vati |
250–500 mg (1-2 Vati) |
After meal / thrice a day |
2-3 weeks |
Water |
Icchabhedi Rasa17 |
Vati |
1 Vati |
Early morning empty stomach |
2 times a week |
Water |
In addition to these, patients may be advised to maintain input-output chart for fluid regulation and record of abdominal girth.
Pathya - Apathya (Diet and life style): Same as level 1
Referral Criteria:
- Cases not responding to above therapy.
- Patients with increased level of bilirubin
- Severe persistent vomiting or diarrhea
LEVEL 3: AYURVEDA HOSPITALS AT INSTITUTIONAL LEVEL OR
DISTRICT HOSPITAL / INTEGRATED AYURVEDIC HOSPITALS
Clinical Diagnosis: Same as level 1 for a fresh case reporting directly
Investigation:
- USG Abdomen
- Abdominal paracentesis and analysis of ascitic fluid
- CT Scan
Treatment: In addition to the management of Level 1 and Level -2, if needed Panchakarma procedures indicated for Jalodara can be performed.
Shodhana Chikitsa
- Nitya Mridu Virechana
- Virechana Karma
- Abdominal tapping may be done as per requirement.
- Rasayana - Vardhamana Pippali
Shilajatu Rasayana
Pathya - Apathya (Diet and life style): Same as level 1
REFERENCES
- Govind Das Sen, Bhaishajya Ratnavali, Jwara Rogadhikar, Adhyaya 5/172 edited by Brahma Shankara Mishra. 11th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1993.
- Govind Das Sen, Bhaishajya Ratnavali, Udara Rogadhikar, Adhyaya 40/36 edited by Brahma Shankara Mishra. 11th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1993.
- Govind Das Sen, Bhaishajya Ratnavali, Chardi Rogadhikar, Adhyaya 19/9 edited by Brahma Shankara Mishra. 11th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1993.
- Govind Das Sen, Bhaishajya Ratnavali, Ashmari Rogadhikar, Adhyaya 36/22 edited by Brahma Shankara Mishra. 11th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1993.
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, PART-I (4:22)
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, PART-I (4:16).
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, PART-II (4:15).
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, PART-I (7:8).
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, PART-I (7:8).
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, PART-I (7:19).
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, PART-I ( 1:12).
- Govind Das Sen, Bhaishajya Ratnavali, Udara Rogadhikar, Adhyaya 40/87-90 edited by Brahma Shankara Mishra. 11th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1993.
- Govind Das Sen, Bhaishajya Ratnavali, Udara Rogadhikar, Adhyaya 40/60 edited by Brahma Shankara Mishra. 11th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1993.
- Govind Das Sen, Bhaishajya Ratnavali, Udara Rogadhikar, Adhyaya 40/139 edited by Brahma Shankara Mishra. 11th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1993.
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part-II ( 16:19)
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, PART-I ( 20:4)
- Govind Das Sen, Bhaishajya Ratnavali, Udara Rogadhikar, Adhyaya 40/65-66, edited by Brahma Shankara Mishra. 11th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1993.