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Manuscript Title : “Management of Ascites (Jalodara) through treatment principles of Ayurveda”

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 Title Page
Type of article: Case Report

Title of the article: Management of Ascites (Jalodara) through treatment principles of Ayurveda

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Running title : A Case report on management of ascites through Ayurveda.

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1. Dr.Mukul Pratap Singh and institutional affiliation

PG scholar, Dept. Kayachikitsa,MGAC , Salod(H)

2. Dr.Vaishali Kuchewar

Proff. Dept. Kayachikitsa,MGAC , Salod(H)

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Datta Meghe Institute Of Medical Science (Du), Mahatma Gandhi Ayurvedic Medical College, Hospital
And Research Centre, Wardha.
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 Abstract Page

Title of the article: Management of Ascites (Jalodara) through treatment principles of Ayurveda

Abstract:

al fluid accumulation in peritoneal cavity. It has numerous etiological factors

but the most common cause is cirrhosis of liver. It can be correlated with ‘Jalodar’ which is one

of the types of Udarroga. It is described in Charak, Sushrut & Ashtanghriday.

This was a case of ascites having fullness of abdomen, bilateral pedal edema, loss of appetite and

generalized weakness . he was habitual of alcohol He had no history of hypertension or Diabetes.

He was treated on the basis of treatment principles like Nityavirecha (Mala & Mutravirechan),

strotoshodhan and some hepato-protective medicines. His all features were completely

disappeared within one month of treatment. This case drives us to plan a study to reestablish

complete treatment principle to manage ascites.

Key-words: Ascites, Jalodar, Nitya-virechan, Strotoshodhan, hepatoprotective

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Introduction: Ascites is an abnormal fluid accumulation in peritoneal cavity.[1]The commonest cause is

Commented [WK18]: Please include why this case is
liver unique. If it is rare, how rare, how many cases have been
reported.
cirrhosis and other causes are cancer, heart failure, tuberculosis, pancreatitis, and blockage of

the hepatic vein.[2] Mild ascites is difficult to diagnose. In moderate and severe ascites, patient

may complain of abdominal heaviness and shortness of breath due to mechanical pressure on

the diaphragm. It can usually be diagnosed with abdominal ultrasound. In Ayurveda, Ascites

can be correlated with ‘Jalodar’ which is one of the types of Udarroga. It is well described in

Charak, Sushrut& Ashtanghriday.[3,4,5]

This case was a unique because the clinical features of ascites with jaundice were developed

very fast and with less than one month of treatment, patient got complete relief
Commented [WK19]: Include the tables/charts at
Case History: A 35 years old male patient brought to Kayachikitsa OPD (OPD no. 1908100007) on appropriate places in the text it self. Do not include
images in the text. Mark the point of insertion of images
10/8/19
(e.g. Figure 1) along with the legends. Send the images
separately as jpeg files (not larger than 100 kb each)
with the complains of swelling over both legs and fullness of abdomen for three months, loss
of appetite and generalized weakness for one month and low grade fever since fifteen days.

He was non-hypertensive, Non-diabetic. In personal history, He was a labor by profession and

alcoholic since 10-15 years. He had taken modern medicinal treatment from general

practitioner in his village. It included hematinic and Diuretic medicines. He got some relief in

pedal edema but other complaints remained same. He quit the alcohol from one month.

Following were the clinical findings. CBC, LFT, Urine examination and USG abdomen was

done. (Table 4,5,6&7)

Discussion: In this patient, the causative factors of ascites were excessive and chronic

consumption of alcohol and spicy diet. In Ayurveda, these are described as Hetu of Udarroga. [6,7]

The treatment was planned as per the treatment principle described in samhita i.e.Nityavirechan,

Strotoshodhan and Yakruttejak medicines.[8]

For Nityavirechan, Erandtaila was selected because patient had Mrudukoshth..[9]

Gomutraarka and Punarnavadi kwath was used for its Strotoshodhan, Agnideepak and

Shothashamak property.it removes Strotosanga and helps in Samprapti Vighatana.[10,11] In one

study, aqueous extract of Boerhavia diffusa produced a notable diuretic effect.[12] Though he had

no history of hypertension, but on examination he was found to be hypertensive. So Sarpagandha

ghavati was used. It’s active principle, reserpine has depressant action on central and peripheral

nervous system by binding to catecholamine storage vesicles present in the nerve cell.[13]

Samshamani vati was advised for its Jvarshamak property.[14]

Tablet Livomyn was given to improve the function of the liver. It contains mainly Kalmegh,

Bhumyamlaki(Phyllanthus urinaria), Punarnava (Boerhavia diffusa) , Kumari (Aloe vera tourn)

Amlaki(Emblica officinalis) ,Guduchi(Tinospora cordifolia) and Daruharidra(Cedrus deodara) .

These all medicines are hepato-protective property.[15] In this case Guduchi(Tinospora cordifolia)

was used in large quantity. In one study, it was found to be antioxidant.[16]

Antioxidants are helpful in protecting the liver.[17] Udarpattabandhan with Arkapatra was done
to prevents further accumulation of fluid.

In the later period of treatment, Punarnava mandoor was given because it is indicated in

Panduroga and Shoth.[18] Gandharvaharitaki was used to prevent further accumulation of

abdominal fluid by its Amapachan, Vatanulomana, Mruduvirechan and Strotoshodhan properties

.[19]

This patient had complete relief in all the features like pedal edema, abdominal distension, lack

of appetite with a short duration of treatment with no any adverse reaction. Further study can be

conducted on moderate ascites by using treatment principle of Ayurveda.

Commented [WK20]: Follow the punctuation marks
References: carefully. Do not include unnecessary bibliographic
elements such as issue number, month of publication,
1. Ascites: Definition of Ascites by Lexico". Lexico Dictionaries; English. Retrieved on 4 etc. Include names of six authors followed by et al if
there are more than six authors.
November 2019.

2. Pedersen JS et al. Management of cirrhotic ascites-Therapeutic advances in chronic disease.

2015, 6 (3): 124–37.

3. Shukla V. Charak samhita, vol.2, Varanasi: Choukhamba sanskrit Publication; 2017. Cha 13, P.

294).

4. Thakral K. Sushrut Samhita vol.1, Varanasi: Choukhamba oriantaliya Publication; 2014, Cha 7,

P.778.

5. Tripathi B, Ashtanghriday,Varanasi: Choukhamba sanskrit Publication; 2017, Cha.12, P. 512.

6. Upadhyaya Y,Madhav Nidan,Vol. 1, Varanasi: Choukhamba Publication, 2008, Cha.16,P.412.

7. Shukla V, Charak samhita, vol.2, Varanasi: Choukhamba sanskrit Publication; 2017. Cha 13, P.

293

8. Shukla V, tripathi R. Charak samhita, vol.2 Varanasi: Choukhamba sanskrit Publication; 2017.

Cha 13, P.301-302.

9. Tripathi B, Ashtanghriday, Varanasi: Choukhamba sanskrit Publication; 2017, Cha.15, P. 751)

10. Pandey.G.Bhavprakash Nighanthu,Varanasi: Choukhamba Bharti acadamy 2010,cha.18P.761 .

11. Choudhari A. Bhaishajya Ratnavali, 1st ed. Varanasi: Choukhamba Sanskit Publication, 2006

Cha.40,P.571.

12. Madhuri S et al. Evaluation of diuretic activity of aqueous extract of boerhaavia diffusa roots in
rat. Int j pharm bio sci 2013 oct; 4(4): p. 843 – 848.

13. Kumaria R, et al. phytochemical, pharmacological and therapeutic aspects.Int J Pharm Sci Rev

Res, 23 (2) (Nov–Dec 2013), pp. 348-355.

14. Vaidyanash S, Ayurved sarsangraha,Nagpur: ayurved bhavan 2017,cha. 7 P.430

10

15. Giby Abraham. A review on hepato-protective herbs used in Ayurveda;Global J Res.

Med. Plants &Indigen. Med. ;Volume 3, Issue 7 , July 2014 ,303–311

16. Kuchewar V, Mangaln A.Borkar et al. Evaluation of antioxidant potential of Rasayana drugs in

healthy human volunteers,AYU ; Jan-Mar 2014 , Vol 35 , Issue 1 p. 46-49.

17. Sael Casas-Grajales and Pablo Muriel. Antioxidants in liver health;World J

GastrointestPharmacolTher. 2015 Aug 6; 6(3): 59–72.

18. New delhi :government of india ,ministry of health and family welfare ;2003.the ayurvedic

formulary of india.part -1,2nd revised English edition.sec19.mandura-19:1.

punarnavadi mandura ;p,251

19. Chunekar KC. Bhavprakash Nighantu of Bhavmishra. Varanasi Reprint Edition 2015.

Varanasi: ChaukhambaBharati Academy, HaritakyadiVarga; 2007. p. 5

Acknowledgement: