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ABSTRACT
Inflammation of the pancreas is known as pancreatitis and the said pancreatic inflammatory
disease is classified as Acute Pancreatitis and Chronic Pancreatitis. The usual features of Chronic
Pancreatitis are constant pain in epigastric region, vomiting and increase of amylase and lipase three
times greater than the upper limit. In present study, a clinical as well as conceptual co-relation with
Chronic Pancreatitis has been made with the Ayurvedic way, where a new nomenclature Tikshnoshna
pitta has been coined by Dr Pradyot Bikas Kar Mahapatra. Guduchi (Tinospora cordifolia Willd.
Miers.ExHook.), Yashtimadhu (Glycyrrhiza glabraLinn.), a salt preparation Narikela lavana and
Sutashekhara rasa (without gold) have been chosen to treat the established cases of Chronic Pan-
creatitis who were diagnosed and primarily managed by various eminent medical institutes all over
India. Guduchi 2grams, Yashtimadhu 2grams, Narikelalavana 500mg and Sutashekhara rasa (with-
out gold) 500mg twice daily have been introduced to every patient for 2 months. The effectiveness of
the therapy has been found satisfactory and the improvements in clinical as well as laboratory find-
ings are found statistically significant.
INTRODUCTION
Inflammation of the pancreas is known cohol use, although a variety of other causes,
as pancreatitis. Pancreatitis is most often asso- including mumps, measles, some medications,
ciated with recurrent gallstones or chronic al- congenital conditions like alpha-1 antitrypsin
Rishi Vashishth Et Al: Clinical Study Of Chronic Pancreatitis (Tikshnoshna Pitta) Treated With Some Ayurvedic Medicaments
deficiency and even some scorpion stings may grade cholangiopancreatography (ERCP) find-
cause pancreatitis. Pancreatic inflammatory ings of chronic pancreatitis.(4) In Ayurveda,
disease may be classified as Acute Pancreatitis Pitta has been described as Agni or fire, as it
and Chronic Pancreatitis. (1) Globally, the inci- performs actions similar to fire such as pa-
dence of acute pancreatitis is 5 to 35/100,000 chana (digestion), dahana (burning, combus-
new cases per year worldwide, with a mortali- tion, oxidation), parinamana (conversion),
ty rate of about 3%. The incidence of chronic paravritti (transformation, mutation) pra-
pancreatitis is 8.2 new cases per 100,000 per kashana (illumination, radiation), ranjana or
year and a prevalence of 26.4 cases per 100, varnakaram (coloration) prabhakaram (lustre)
000. (2) and tapana (heat production).(5) The physical
Pancreas is a digestive gland which qualities of pitta are ishatsneha (slightly vis-
performs a range of both endocrine and exo- cous), ushna (hot), tikshna (sharp, penetrating
crine functions. In humans, it is located in the or intense), drava (liquid), amla (when
epigastrium and left hypochondrium. In adults, vidagdha, sour), sara (fluid) and katu (ac-
pancreas measures between 12 and 15 cm and rid).(6)
is shaped as flattened tongue of tissue. (3) The A type of pitta, Pachakapitta may refer to the
endocrine part produces several important gastrointestinal hormones responsible for the
hormones, including insulin, glucagon, soma- excitation of achhapitta (which includes a
tostatin and pancreatic polypeptide which are wide variety of digestive secretions viz. bile,
involved in the homeostasis of blood glucose pancreatic juice and intestinal secretions). (7)
and are also involved in the control of upper Like pitta described in Ayurveda, the enzymes
GI motility and function whereas, the exocrine perform analogous functions viz. splitting or
part is responsible for digestion of carbohy- sanghatabheda, transforming or parinamana,
drates, proteins and lipids. The major mutation or paravritti; oxidation or dahana,
enzymes involved in the digestion of proteins etc. Like pitta, enzymes are also present, uni-
are trypsinogen and chymotrypsinogen. Those versally and are built up by the body from ap-
involved in the digestion of fats are lipase and propriate substances derived from aharadra-
amylase. vyas (nutrition). Thus, in pitta we have sub-
Pancreatitis is classified as Chronic stances exactly similar to enzymes. (8)
Pancreatitis, and any episode of acute pancrea- The features of chronic pancreatitis are
titis is considered an exacerbation of inflam- similar to the features of pitta where tikshna
mation superimposed on Chronic Pancreatitis. and ushna guna of pitta are aggravated.
The symptoms are epigastric pain, consistent Hence, this phenomenon may be called as Tik-
with the disease; a serum amylase, lipase shnoshna pitta in Ayurveda. In OPD of IP-
greater than three times the upper limit of GAE&R at SVSP, Kolkata about 63 cases of
normal and radiological imaging consistent chronic pancreatitis attended to take Ayurvedic
with the diagnosis usually using computed to- remedy. Those patients who had come with
mography (CT) or magnetic resonance imag- the reports from different reputed hospitals
ing (MRI). Pancreatitis is classified as acute like Asian Institute of Gastroenterology, Hy-
unless there are CT, MRI or Endoscopic retro- derabad; Christian Medical College, Vellore;
Apollo Hospitals, IPGME&R Hospital, Kolka- sayana by our classics. The ushna viryara-
ta with the history of occasional severe epigas- sayana and sheeta viryarasayana in combina-
tric pain, vomiting, nausea, flatulence, anorex- tion may produce the equilibrium of virya fol-
ia, along with laboratory findings like serum lowed by dosha. Narikela lavana, possesses
amylase, lipase of higher range i.e. more than shulanashaka and vata-pitta kapha shamaka
three times of normal and in USG, CT, action. (11)Sutashekhara rasa (without gold) is
MRCP, features like bulky pancreas in size a potent medicine for pittaja diseases. (12) Also,
and shape with or without hyperechoic echo- it reduces the aggravated vata, so in chronic
texture with or without dilated pancreatic duct conditions it might have some role to reduce
with or without tiny calcific dots noted. Con- all sorts of irritability. So, conceptually these
sidering the signs and symptoms we have co- four agents have been chosen to treat the pa-
related the ailment with Tikshnoshna pitta. tients of pancreatitis because as it is similar to
Pitta may be called as a byproduct of tikshnoshna pitta, so it could be treated by the
Teja and Apa mahabhuta, which means there aforesaid agents by the virtue of their rasa,
is maximum presence of tapa (heat). This heat guna, virya, vipaka, karma and prabhava.
originated through some gastro-intestinal se-
cretion where pancreatic secretion is a compo- AIMS AND OBJECTIVES
nent. It can be assumed that trypsin and chy- 1. To establish and report an Ayurvedic no-
motrypsin are the most heated and splitting menclature of chronic pancreatitis.
substances which are liable of auto digestion, 2. To report the achieved solution of tik-
means destruction of pancreatic cells itself. So, shnoshna pitta (chronic pancreatitis) with
this evidence shows a clear conclusion that Ayurvedic medicines.
pancreatic enzymes trypsin and chymotrypsin 3. To report the effectiveness as well as
are tikshna (sharp) and ushna (hot). Hence, it probable mode of action of guduchi, yash-
may be called as Tikshnoshna pitta which is timadhu and narikelalavana and
produced by ill and inflamed pancreas. sutashekhara rasa on tikshnoshna pitta.
As guduchi, the best Samshamaniya (pacify- 4. To study the adverse effects, if any, of the
ing) drug mentioned by Sarangdhara, has drugs guduchi, yashtimadhu, narikela la-
properties guru and snigdha, rasa tikta and vana and sutashekhara rasa.
kashaya, vipaka madhura and possessing ush- 5. To report the achieved non-toxic effect of
na virya. In such pharmacodynamic infor- the aforesaid drugs.
mation being ushna virya, the only ushna virya MATERIALS AND METHODS
which turns out to be a good pitta shamaka The patients and recipes are the main
and pitta saraka (especially aamashayaga- materials of present clinical study. Total 28
tavridhha pitta). (9) Likewise, Yashtimadhu, established cases of chronic pancreatitis have
having the properties guru and snigdha, rasa been treated at the outpatient clinic of IP-
and vipaka madhura and possessing sheeta GAE&R at SVSP Hospital, Kolkata. During
virya and it acts as a daha shamaka (heat paci- selection of the patients following inclusion
fier), vedna sthapaka (pain reliever). (10) Both and exclusion criteria have been taken into
guduchi and yashtimadhu are said to be Ra- consideration. Though there were about 63
patients who came to us for Ayurvedic man- 4. Having history of serum amylase and li-
agement, yet 35 patients have been discarded pase three times greater than upper normal
on the basis of the following exclusion crite- limit.
ria: 5. Evidence or no evidence of pancreatic di-
EXCLUSION CRITERIA vision and destruction of pancreatic duct
1. Below 16 and above 65 years of age. through CT, MRI or FRCP
2. Having history of malignancy. 6. Those who have intended to go through
3. Gross pathology in the vital organs like the treatment protocol strictly.
heart and kidney.
4. Patient with stent, cyst, stone, etc. in pan- DRUG AND DOSE SCHEDULE
creatic duct. 1. Guduchi churna 2 grams + yash-
5. Those who are suffering from diabetes timadhuchurna 2 grams, 1 dose twice daily
mellitus and hypertension. before principal meals with plain water for
2 months.
INCLUSION CRITERIA 2. Tab. Narikela lavana 250mg two tablet
1. Within the age group of 16 to 65 years of twice daily after principal meals with plain
age. water.
2. Having history of specific features during 3. Sutashekhara Rasa (without gold) 500mg
acute attack like pain abdomen, severe twice daily morning and evening before
vomiting, loss of appetite, severe flatu- food.
lence, etc. METHODS
3. Having history of recurrent occurrence and The following scoring systems in relation to
conservatively treated with IV medications clinical findings have been taken into consid-
and other anti- spasmodic drugs as well as eration:
PPI or H2 blockers.
Table 1: Criteria for assessment
Signs and Symptoms Scoring
0 1 2 3
Frequency of Epigastric pain No pain Mild pain Moderate pain Severe pain
Frequency of Flatulence No Flatulence Mild Moderate Severe
Nausea- Vomiting No Only Nausea, No 1-3 vomit- >3 vomiting
Vomiting ing/day per day
2grams each, Narikela lavana 500mg twice a has also worked along with the other three
day and Sutashekhar rasa 500mg twice a day. components of treatment. From these observa-
After 2 months of administration of the afore- tions, it could be concluded that, treatment of
said drugs, the clinical results have been as- chronic pancreatitis w.s.r tikshnoshna pitta
sessed through clinical and pathological find- could be treated with Guduchi, Yashtimadhu,
ings. It has been found that almost all the pa- Sutshekhara rasa in the dose of 2grams,
tients have not been admitted again to any of 2grams, 500mg twice daily respectively before
the hospitals for epigastric pain and vomiting, food along with narikela lavana 500mg twice
each and every patient have gained weight and daily after food. Guduchi being a potent im-
their appetite has increased and they were ful- munomodulator and the best Shamshamaniya
ly satisfied with the therapy. Before and after drug, it may have some role in avoiding the
therapy a scoring, system has been performed recurrence of such ailment. No notable ad-
to establish the result of therapy over four ma- verse effect found during the therapy.
jor complaints- pain, nausea with vomiting,
flatulence and weight loss. It has been found CONCLUSION
It can be concluded from the above
that pain reduced by 90.25%, nausea and vom-
study that chronic pancreatitis may be taken
iting reduced 62.5%, flatulence reduced by
into consideration as tikshnoshna pitta as no-
48.05% and statistically the relief was found
menclature in Ayurveda. The effectiveness of
highly significant i.e. P<0.001. Body weight
the four drugs viz. Yashtimadhu, Guduchi,
was markedly increased by 3.9% and found
Narikela lavana and Sutashekhara rasa is
statistically significant i.e. P<0.001. Most im-
highly significant. Mode of application of
portant pathological findings i.e. serum amyl-
Yashtimadhu 2grams, Guduchi 2grams twice
ase and lipase have been calculated and per-
daily before principal meals; Narikela lavana
centage of relief was found 88.7% and
500mg twice daily after meals and
90.78%, respectively. Statistically, both the
Sutashekhara rasa 500mg twice daily before
findings were found highly significant i.e.
food. This above-mentioned therapy was able
P<0.001. The above-mentioned success of
to cure all sorts of clinical features and able to
therapy came due to the properties of Yash-
bring back the raised serum amylase and li-
timadhu and Guduchi which are pacifying tik-
pase within normal limits. No such adverse
shna and ushna property of pitta by guru and
effects noted.
snigdha properties. Simultaneously, yash-
timadhu and guduchi possessing the viryash- REFERENCES
eeta and ushna respectively, virtually both the 1. Dan L. Longo, Editor, Anthony S. Fau-
drugs are creating homeostasis or equilibrium ci, Editor, Dennis L. Kasper, Editor, Ste-
of doshas. Sutashekhara rasa is a potent pit- phen L. Hauser, Editor, J. Larry Jame-
tanashaka. Being a rasa aushadhi, it has son, Editor, Joseph Loscalzo, Editor. Har-
shown its rapid action of pitta nashana in pre- rison’s Principles of Internal Medicine.
sent study. As narikela lavana is rochaka, pa-
chaka, pitta nashaka and shula nashaka, so it