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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 66-69

Management of multi-relapsed chronic pancreatitis through Rasaushadhis: A case study


1 VCPC Research Foundation, Lane C-15, Turner Road, Clement Town, Dehradun, Uttarakhand, India
2 Padaav-Speciality Ayurvedic Treatment Centre, Rudrapur, Uttarakhand, India

Date of Submission30-Nov-2019
Date of Acceptance15-Jul-2020
Date of Web Publication16-Oct-2020

Correspondence Address:
Dr. Vaidya Balendu Prakash
VCPC Research Foundation, Lane C-15, Turner Road, Clement Town, Dehradun - 248 002, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JACR.JACR_49_20

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  Abstract 


Chronic pancreatitis is the long-standing inflammation of the pancreas, leading to irreversible damage of the gland. The disease is characterized by loss of exocrine and endocrine functions of pancreas owing to fibrosis and parenchymal damage. Clinical manifestations of the disease include abdominal pain, episodes of acute pancreatitis, nausea, vomiting, steatorrhea, indigestion, weight loss, and uncontrolled blood sugar. No authentic tools have yet been identified to predict the course of the disease, frequency of acute exacerbations, and rate of disease progression. Pancreatic enzymes, supplements, and a low-fat diet are usually prescribed to patients of pancreatitis. However, patients continue to experience unpredicted flare up of symptoms that are managed by IV fluids, antibiotics, and painkillers in case of acute exacerbations. Surgical intervention and stenting might also be done in some cases to bring relief to patients. However, these have limited effect, and the disease continues to progress and causes pancreatic cancer and casualties as well. Despite advances in medical science, the prognosis of the disease remains variable and unclear. Studies indicate a mortality rate of 17% in 5 years, 30% in 10 years, and 55% in 20 years after the diagnosis of chronic pancreatitis. Here, a case of chronic pancreatitis that was treated in lines of Ayurveda is presented. The patient has not suffered any attack after the commencement of Ayurvedic treatment and completes nine years of symptom-free status with no signs of progression in radiological tests.

Keywords: Ayurveda, chronic pancreatitis, Rasa shastra


How to cite this article:
Prakash VB, Prakash VS, Tiwari S, Sharma S, Jaryal VP. Management of multi-relapsed chronic pancreatitis through Rasaushadhis: A case study. J Ayurveda Case Rep 2020;3:66-9

How to cite this URL:
Prakash VB, Prakash VS, Tiwari S, Sharma S, Jaryal VP. Management of multi-relapsed chronic pancreatitis through Rasaushadhis: A case study. J Ayurveda Case Rep [serial online] 2020 [cited 2020 Dec 3];3:66-9. Available from: http://www.ayucare.org/text.asp?2020/3/2/66/298295




  Introduction Top


Chronic pancreatitis is an inflammatory disorder of pancreas that results in progressive loss of exocrine and endocrine functions due to atrophy and/or fibrosis.[1] The disease is characterized by sudden bouts of severe abdominal pain, vomiting, nausea, steatorrhea, and weight loss.[2] In some patients, the disease may also take a painless course. The clinical symptoms with morphological changes in radiological tests make the confirmation of the diagnosis of chronic pancreatitis.[3] Chronic pancreatitis is irreversible and progressive in nature and is largely attributed to toxins, idiopathic, genetic, auto-immune, recurrent acute pancreatitis and obstructive factors.[4] However, the exact pathogenesis of the disease is not clear.

Acute exacerbations of the disease are managed by emergency hospitalization and strict diet control with pancreatic enzymes, vitamin supplements, or steroid therapy thereafter.[5] Endoscopic and surgical measures are also considered in some cases.[5] In spite of the technological growth of medical science, no specific therapy is available to cure the disease and curb its progression. The disease is known to cause pancreatic cancer in up to 40% of cases and uncontrolled diabetes in about 70%-90% of cases.[6],[7] Mortality is reported in about 17% cases in five years, 30% in 10 years, and 55% in 20 years.[8] Chronic pancreatitis is reported to have an annual incidence rate of 5-12/100,000 people with a prevalence of 50/100,000 people.[9] It majorly occurs in the male population of the productive age group and hampers the psychological state and quality of life of the patients. It is mainly because recurring attacks, emergency hospitalizations, follow-up visits, investigations, and debility, which badly affect the financial and social condition of the patients and their families.[10],[11]

Here, the report of a Delhi-based young man who was first diagnosed and treated for chronic pancreatitis at a leading hospital of India, under a reputed gastroenterologist and later opted for Metal-Based Ayurvedic Treatment (MBAT) in 2010 at a clinic in North India, is being presented.


  Case Report Top


A 24-year-old boy, a strict vegetarian, non-alcoholic, and non-smoker with no family history of pancreatitis, presented with acute symptoms of severe continuous epigastric pain with nausea and vomiting on January 14, 2005. He was admitted in the emergency department at All India Institute of Medical Sciences (AIIMS), New Delhi, and underwent a series of laboratory investigations including imaging under the consultancy of a gastroenterologist. His serum amylase level was elevated (860 U/L), and ultrasound and computed tomography scan of the abdomen revealed mildly bulky pancreas with fuzzy outline. After which, he was diagnosed with mild acute pancreatitis following Cambridge classification. He was treated with intravenous fluids, painkillers, and antacids. After four days of the treatment, he became asymptomatic and was discharged.

In October 2006, the patient had suffered with a similar episode. He consulted a renowned gastroenterologist at Pushpawati Singhania Research Institute, New Delhi, and was managed symptomatically on an outpatient department basis. He presented with similar symptoms to the same hospital in June 2008, was admitted for four days, and was given symptomatic treatment.

Between November 2009 and August 2010, he suffered with similar attacks of pancreatitis almost every month and had to be admitted four times [Table 1]. Endoscopic ultrasound done in April 2010 was suggestive of chronic calcific pancreatitis. The patient lost 26 kg of body weight during this period. He was referred for the condition by one of his relatives for Ayurvedic treatment.
Table 1: Details of hospitalizations due to pancreatitis

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He visited the center and commenced Ayurvedic treatment in November 2010. His treatment continued for 18 months, of which, initial two week indoor treatment was given at the center. At admission, a detailed history of the patient was recorded with proofs of diagnosis and previous admissions. His vitals and symptoms were noted.


  Timeline Top


MBAT is a combination of Ayurvedic medicines and a regulated diet and lifestyle. Medicines prescribed include a metal-based Ayurvedic complex, Amar,[12] at a dose of 125 mg three times a day, and few supportive medicines as per the patient's symptoms, including Hingwashtak churna[13]/sup> and Kamdudha rasa[14] [Table 2] and [Figure 1]. An 1800–2400 calorie daily diet, rich in protein and dairy products, was prescribed to him [Table 3]. He was asked to abstain from the consumption of tea, coffee, aerated drinks, alcohol, refined flour, onion, garlic, tomato, and packaged or reheated food items. He was also advised complete mental and physical rest for the initial 4 months of the treatment with 8 h of sleep at night and avoiding physical and mental exertion. MBAT was continued for 18 months with regulated diet and lifestyle.
Table 2: Details of medicines given

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Figure 1: Composition of Amar; Source: Department of Inorganic and Physical Chemistry, Indian Institute of Science, Bengaluru. Analysis done using XRD (X-ray powder diffraction), EDAX (Energy Dispersive Spectroscopy) and SEM (Scanning Electron Microscopy)

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Table 3: Diet prescribed

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  Follow up and Outcome Top


The patient became asymptomatic during the initial indoor treatment and gradually his general health also improved. After completion of the treatment, all his blood reports were in normal range. Follow-up scans showed stability of the disease with no signs of progression. He also gained 6 kg weight. A follow-up MRCP was conducted in March 2018 (six years after treatment completion), which showed no significant interval change as compared to the previous positron emission tomography-computed tomography and ultrasound reports done in September 2012 and January 2014, respectively. MBAT could bring significant and sustainable relief to the patient. He became asymptomatic and continues to lead a normal life since then.


  Discussion Top


Chronic pancreatitis is characterized by structured changes in the pancreas. The disease has invariable characteristics and is progressive in nature. The symptoms and complications related to the disease increase with time and take a fatal course. Up to 40% cases of chronic pancreatitis develop pancreatic cancer in their lifetime.[6]

Available treatment options include management of symptoms and aiding digestion with the help of artificial pancreatic enzymes. However, none of the contemporary treatments have been found to completely eliminate the symptoms or curb future attacks and progression. With limited options, patients turn to alternative treatment in desperate conditions. It is a more common practice in India where alternative medical systems such as Ayurveda, Yoga, Unani, Siddha and Homeopathy are recognized as independent systems of medicine along with conventional medicine. There are a few studies that report about the efficacy of traditional medicines in treating patients with pancreatitis. Some studies also report about the therapeutics of phytochemicals and plant extracts such as curcumin, caffeine, berberine and sesamol.[15] However, none of these have been widely accepted as a treatment and need to be further validated and explored.

In this scenario, a North India-based Ayurvedic clinic has reported the significant and sustainable effect of MBAT in reducing the intensity and frequency of attacks and improvement in the overall well-being of patients with recurring acute and chronic pancreatitis.[12],[16] The discussed case is one of the cases treated at the clinic. The 24-year-old boy with five year history of chronic pancreatitis was put on Ayurvedic treatment. Pancreatic enzyme supplements were stopped.

Rasaushadhis are well absorbed with a diet rich in protein and fat. Ayurveda treatment is aimed to gradually restore metabolism by harmonizing the state of Jatharagni. The patient was given a diet plan, comprising three meals and three snacks (1800–2400 calorie). The patient responded very well to the treatment with overall improvement in digestion and general condition.

Ayurvedic formulation used in the treatment is derived from Rasa shastra which deals with the therapeutics of processed metals which are termed as Dhatu in Sanskrit.[17] The masters of Rasa shastra have linked body Dhatu with metal Dhatu. According to the available literature, imbalance of metal Dhatu in body Dhatu leads to disturbed body metabolism due to discrepancies in diet, lifestyle, and other factors. Rebalancing these metals in body tissues could bring back the equilibrium state.

Copper stands third among these metals and is toxic in large amounts. However, its presence has been shown in human tissues, including brain, liver, and muscles.[18] It has been described to possess strong anti-inflammatory properties. The complex used in this treatment has been prepared using processed copper as the main ingredient which is further processed with mercury and sulfur following the concepts of Gandhaka jarana. Repeated Gandhaka jarana leads to Gandhaka jeerna state of Parada. In this complex, there is a two fold increase in the quantity of Gandhaka in Parada (Dvigune gandhaka jeerna parada).[19] The chemical analysis of the finished compound does not show any trace of free metals [Figure 1].[12] The final compound is a mineral complex with unexplained phenomenal structure. It could be understood in Ayurvedic terms as “Parada gandhaka marita tamra bhasma.

Chronic pancreatitis is an inflammatory disorder which does not respond to the available steroidal and nonsteroidal anti-inflammatory agents. Animal studies have also confirmed the pancreatitis protective properties of the formulation.[20]

In view of the observed clinical effect of the compound, Amar emerges as a potent pancreatitis protective therapeutic agent and merits further development.


  Conclusion Top


This case is a benchmark for the efficacy of MBAT in bringing complete resolution of symptoms and impeding the progression of the disease.

Declaration of patient consent

Authors certify that they have obtained patient consent form, where the patient/caregiver has given his/her consent for reporting the case along with the images and other clinical information in the journal. The patient/ caregiver understands that his/her name and initials will not be published and due efforts will be made to conceal his/her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kleeff J, Whitcomb DC, Shimosegawa T, Esposito I, Lerch MM, Gress T, et al. Chronic pancreatitis. Nat Rev Dis Primers 2017;3:17060.  Back to cited text no. 1
    
2.
Banks PA, Conwell DL, Toskes PP. The management of acute and chronic pancreatitis. Gastroenterol Hepatol 2016;6:1-16.  Back to cited text no. 2
    
3.
Duggan SN, NíChonchubhair HM, Lawal O, O'conlon, Conlon KC. Chronic pancreatitis: A diagnostic dilemma. World J Gastroenterol 2016;22:2304-13.  Back to cited text no. 3
    
4.
Etemad B, Whitcomb DC. Chronic pancreatitis: Diagnosis, classification, and new genetic developments. Gastroenterology 2001;120:682-707.  Back to cited text no. 4
    
5.
Barry K. Chronic pancreatitis: Diagnosis and treatment. Am Fam Physician 2018;97:385-93.  Back to cited text no. 5
    
6.
Howes N, Neoptolemos JP. Risk of pancreatic ductal adenocarcinoma in chronic pancreatitis. Gut 2002;51:765-6.  Back to cited text no. 6
    
7.
Malka D, Hammel P, Sauvanet A, Rufat P, O'Toole D, Bardet P, et al. Risk factors for diabetes mellitus in chronic pancreatitis. Gastroenterology 2000;119:1324-32.  Back to cited text no. 7
    
8.
Seicean A, Tantău M, Grigorescu M, Mocan T, Seicean R, Pop T. Mortality risk factors in chronic pancreatitis. J Gastrointestin Liver Dis 2006;15:21-6.  Back to cited text no. 8
    
9.
The National Pancreas Foundation. Chronic Pancreatitis; 2019. Available from: https://pancreasfoundation.org/patient-information/chronic-pancreatitis/. [Last accessed on 2020 Jul 07].  Back to cited text no. 9
    
10.
Pezzilli R, Bini L, Fantini L, Baroni E, Campana D, Tomassetti P, et al. Quality of life in chronic pancreatitis. World J Gastroenterol 2006;12:6249-51.  Back to cited text no. 10
    
11.
Gardner TB, Kennedy AT, Gelrud A, Banks PA, Vege SS, Gordon SR, et al. Chronic pancreatitis and its effect on employment and health care experience: Results of a prospective American multicenter study. Pancreas 2010;39:498-501.  Back to cited text no. 11
    
12.
Prakash VB, Prakash S, Sharma S, Tiwari S. Impact evaluation of Ayurvedic Treatment Protocol on Three hundred nineteen cases of different variants of Pancreatitis. Pancreat Disord Ther 2018;8:196.  Back to cited text no. 12
    
13.
Acharya YT. Siddha Yog Sangrah. 9th ed. Jhansi, India: Baidyanath Bhawan; 2003. p. 38.  Back to cited text no. 13
    
14.
Anonymous. Rasatantrasarava Siddhaprayoga Sangraha. Part 1, Kharaliya Rasayana no. 80. Ajmer: Krishna Gopal Ayurveda Bhavan; 1980. p. 444-5.  Back to cited text no. 14
    
15.
Anchi P, Khurana A, Bale S, Godugu C. The role of plant-derived products in pancreatitis: Experimental and clinical evidence. Phytother Res 2017;31:591-623.  Back to cited text no. 15
    
16.
Prakash VB, Prakash VS, Sharma S, Tiwari S. Relevance of metal based Ayurvedic formulations in the management of recurrent acute/chronic pancreatitis. Tang Humanitas Med 2017;7:9.1-9.6.  Back to cited text no. 16
    
17.
Savrikar SS, Ravishankar B. Introduction to 'rasashaastra' the iatrochemistry of Ayurveda. Afr J Tradit Complement Altern Med 2011;5 Suppl 8:66-82.  Back to cited text no. 17
    
18.
Tapiero H, Townsend DM, Tew KD. Trace elements in human physiology and pathology. Copper. Biomed Pharmacother 2003;57:386-98.  Back to cited text no. 18
    
19.
Shastri K. Rasatarangini. Varanasi: Motilal Banarasidas; 2005. p. 98-102.  Back to cited text no. 19
    
20.
Prakash VB, Tiwari S, Prakash VS, Sharma S. Anti-inflammatory properties of a processed copper complex in L-arginine induced pancreatitis Two experimental studies. EC Gastroenterol Digestive Syst 2019;6.7:519-24.  Back to cited text no. 20
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3]



 

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