KAMALA (JAUNDICE) Treatment Protocol by Ayush

INTRODUCTION

Kamala is a disease of Pitta Dosha involving Yakrit characterized by yellow discoloration of skin, sclera, urine, stools, other body parts and mucous membranes. This can be correlated with jaundice.

Case definition:

Kamala (Jaundice) is the yellow discoloration of skin and mucous membranes associated with complaints like anorexia, malaise, indigestion and with or without palpable enlargement of liver.

Types:

• Kosthashrita
• Shakhashrita
• Halimaka
• Kumbha Kamala

Differential Diagnosis

1. Pittaja Jwara
2. Pittaja Pandu
3. Pittaja Udara

Line of Treatment

• Nidana Parivarjana should be the first line of treatment

• Shodhana Chikitsa – Virechana
• Shamana Chikitsa: Pachana, Deepana, Snehana, Pittashamaka
• External applications - Nil
• Rasayana Chikitsa - Nil
• Treatment according to Doshik involvement
• General line of treatment prescribed for Pitta Vyadhi

LEVEL 1: AT SOLO AYURVEDIC PHYSICIAN CLINIC/PHC

Clinical Diagnosis: On the basis of history and clinical presentation

Investigations:

• Blood for Hb, TLC (leucocytosis), DLC (neutrophilia)
• Serum bilirubin- Direct /Indirect
• Urine routine and microscopic examination

Treatment: In Koshtha-Shakhashrita Kamala, Pittahara Chikitsa and in Shakhashrita Kamala, initially Kaphahara Chikitsa followed by Pittahara Chikitsa is prescribed. Some of the following medications can be advised.

Table 9.1: Medicines at level 1 for Kamala

Pathya-apathya (diet and life style education):

Do’s –

• Ahara: Khichadi prepared from old rice (Purana Shali), green gram, fruits like Draksha (dried grapes), sugarcane juice, Shritashita Jala (boiled and cooled water), vegeVatiles like Patola (Trichosanthes dioica), gourd, Haridra, Ardrak.
• Vihara: Complete rest

Don’ts -

• Ahara: Heavy food, fried food articles, pungent food articles like chilli, alcohol
• Vihara: Excessive physical exercise, day sleep,

Referral criteria: Patient not responding to above mentioned management and showing signs of deep Jaundice; severe vomiting, pos­ing danger of dehydration, signs of hepatic encephalopathy etc.

LEVEL 2: CHC’S OR SMALL HOSPITALS WITH BASIC FACILITIES

Clinical diagnosis: Same as level 1 for a fresh case reporting directly.

Investigation: Same as level 1. In addition

• HBsAg positive
• LFT - Elevated amino transferase- ALT/AST > 45U/lit, disturbed

albumin: globulin ratio; raised alkaline phosphatase; higher values of prothrombin time

• Lipid profile- increased values of S. Cholesterol, S. Triglyceride
• USG Abdomen

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) or herbal drugs containing poisonous plants can be used at this level. Patient may be kept under observation while prescribing these kinds of medicines

Table 9.2: Medicines at level 2 for Kamala

Mridu Virechana: As per the status of the patient, Mridu Virechana/Koshtha Shuddhi with Avipattikara Churna 5-10 gm with Drakhshadi Kashaya may be done for 3-5 days before treatment.

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

Referral criteria:

1. Cases not responding to above mentioned therapy.
2. Patients having increased levels of bilirubin with mental confusion and altered sensorium
3. Severe persistent vomiting
4. Not able to take anything orally due to vomiting and nausea

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:

• Immuno assay for infective hepatitis
• Liver biopsy
• CT Scan

Treatment: In addition to the managements mentioned for Levels 1 and 2, Panchakarma procedures indicated for Kamala can be performed.

Shodhana Chikitsa

Indicated only in the patients who are having Uttama Bala and can tolerate Shodhana procedures

Virechana

Vata-Pitta presentation of Kamala - Avipattikara Churna, Manibhadra Leha, Aragwadha Phala Majja, Draksha Kwatha

Both Vamana and Virechana can be done in Kapha Pitta presentation

• Vamana with Yashtimadhu Kwatha or Iskhu Rasa + Madana Phala

Rasayana Chikitsa

Guduchi- 3 to 6 gm with warm water for one month

Amalaki – 1-3 gm with water for one month

Haridra - 3-6 gms with water for one month

Nimba - 3-6 gms with water for one month

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

REFERENCES

1 Chakrapani, Chakradatta, Indradev Tripathi, Vaidya Prabha hindi commentary, Chaukhambha Sanskrit Bhawan, Varanasi, Reprint 2014, Chakradatta Amlapitta Chikitsa 52/12, p.no. 296

2 Vagbhata, Ashtanga Hridaya, Atridev Gupt, Vidyotini hindi commentary, Chaukhambha Prakashana, Edition Reprint 2008, Varanasi, Chikitsa Sthana Jwara Chikitsa 1/55, p. no. 395

3 Vagbhata, Ashtanga Hridaya, Atridev Gupt, Vidyotini hindi commentary, Chaukhambha Prakashana, Edition Reprint 2008, Varanasi, Chikitsa Sthana Pandu Chikitsa 16/13, p. no. 540

4 Rasa Ratna Samuchchaya Vipadika Chikitsa Adhikara.

5 Vagbhata, Ashtanga Hridaya, Atridev Gupt, Vidyotini hindi commentary, Chaukhambha Prakashana, Edition Reprint 2008, Varanasi, Sutra Sthana 15/15, p. no. 141

6 Vagbhata, Ashtanga Hridaya, Atridev Gupt, Vidyotini hindi commentary, Chaukhambha Prakashana, Edition Reprint 2008, Varanasi, Chikitsa Sthana Pandu Chikitsa 16/16-19, p. no. 540

7 Agnivesha, Charaka, Dridhabala, Charaka Samhita, Edited by Vaidya Yadavji Trikamji, Reprint Edition, Chaukhambha Surbharti Publication, 2011 Chikitsa Sthana Pandu Chikitsa Adhyaya 16/93-96, p.no.530