Ayurveda Treatment Methods

A Guide Line To Ayurveda Treatments & Principles

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

  1. Patients not responding to above mentioned management
  2. Imbalance in fluid input-output ratio
  3. Signs of jaundice, cardiac failure or renal failure
  4. 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:

  1. Cases not responding to above therapy.
  2. Patients with increased level of bilirubin
  3. 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

  1. Nitya Mridu Virechana
  2. Virechana Karma
  3. Abdominal tapping may be done as per requirement.
  4. Rasayana - Vardhamana Pippali

Shilajatu Rasayana

Pathya - Apathya (Diet and life style): Same as level 1

 

REFERENCES

 

 

  1. Govind Das Sen, Bhaishajya Ratnavali, Jwara Rogadhikar, Adhyaya 5/172 edited by Brahma Shankara Mishra. 11th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1993.
  2. Govind Das Sen, Bhaishajya Ratnavali, Udara Rogadhikar, Adhyaya 40/36 edited by Brahma Shankara Mishra. 11th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1993.
  3. Govind Das Sen, Bhaishajya Ratnavali, Chardi Rogadhikar, Adhyaya 19/9 edited by Brahma Shankara Mishra. 11th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1993.
  4. Govind Das Sen, Bhaishajya Ratnavali, Ashmari Rogadhikar, Adhyaya 36/22 edited by Brahma Shankara Mishra. 11th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1993.
  5. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, PART-I (4:22)
  6. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, PART-I (4:16).
  7. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, PART-II (4:15).
  8. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, PART-I (7:8).
  9. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, PART-I (7:8).
  10. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, PART-I (7:19).
  11. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, PART-I ( 1:12).
  12. Govind Das Sen, Bhaishajya Ratnavali, Udara Rogadhikar, Adhyaya 40/87-90 edited by Brahma Shankara Mishra. 11th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1993.
  13. Govind Das Sen, Bhaishajya Ratnavali, Udara Rogadhikar, Adhyaya 40/60 edited by Brahma Shankara Mishra. 11th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1993.
  14. Govind Das Sen, Bhaishajya Ratnavali, Udara Rogadhikar, Adhyaya 40/139 edited by Brahma Shankara Mishra. 11th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1993.
  15. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part-II ( 16:19)
  16. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, PART-I ( 20:4)
  17. Govind Das Sen, Bhaishajya Ratnavali, Udara Rogadhikar, Adhyaya 40/65-66, edited by Brahma Shankara Mishra. 11th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1993.