Introduction

There are several diseases which arise in gall bladder and one among them is cholelithiasis (gall stones). Percentage of patients with cholelithiasis in the age group of 21-30 years is 8.2%, 24.7% among the patients of age group 61-70. Females are more frequently affected than males in the ratio of about 4:1, study shows that North Indians are more prone to cholelithiasis than south Indians. Recurrent episodes of cholelithiasis are treated only with surgery i.e., removal of Gall bladder (Cholecystectomy) which leads to impaired digestion of fats and proteins[1]. The disease cholelithiasis is not been described directly in Ayurveda. The term Ashmari in Ayurveda stands for stone which is described only in the context of Ashmari (urinary calculi). Gall bladder stores Pitta, hence the organ gall bladder is considered as Pittashaya in Ayurveda and the stone formed in it can be considered as Pittashmari.[2] Hence this case study was considered with the aim to describe the potentiality of Ayurvedic drugs in the management of cholelithiasis.

Case Report

 A Hindu, unmarried, 38 years old female patient visited the outpatient department OPD, B R Harne Ayurvedic Medical College and Hospital, Vangani, Thane, with an OPD no    and complaints of severe pain abdomen, distension of abdomen and vomiting. A history of the present illness revealed that the patient was said to be asymptomatic 6 months back. One fine day she suddenly noticed pain in the right side of the abdomen which was not radiating in nature, she was having distension of the abdomen, vomiting and anorexia. She consulted allopathic physician advised her to undergo USG abdomen and pelvis and it has been diagnosed as Multiple Gall bladder stones with a largest 6.5mm in size and advised surgery for the same. As she was not willing to undergo surgery, she consulted Ayurvedic physician and taken treatment for the same Personal history revealed that the patient is mixed diet with reduced appetite, good sleep and the patient had no addiction. The menstrual history is 28days regular cycle for 3 days of normal flow.

 Systemic Examination of the Patient:

 PA On Inspection: Mild Distension of the abdomen observed.

 On Palpation: Severe tenderness noted over right hypochondriac region.

  USG impression: Cholelithiasis (Multiple stones with a large stone measuring about 6.5mm in size)

The following treatment protocol was followed:

1. Tab. Arogyavardini Vati [3] has been given 2 tablets twice a day after food with warm water

 2. [4] 30ml twice daily with 30ml of warm water before food with 1 Varunadi Kashay Ratti (pinch) of Yavakshara.

       These medications were continued for 1 month and follow up visits, symptoms were assessed. The patient has been advised to continue same medications for another 2 months.

Total duration: 3 months

OBSERVATION AND RESULTS:

Discussion

According to Ayurveda, the patient was diagnosed as a case of Pittashmari with predominant Kapha and Vata Dosha. The clinical presentation is characterized by pain in abdomen, anorexia, distension of abdomen and vomiting. Hence the line of treatment mainly includes Shoolahara (pain reliving) Shothahara (anti-inflammatory), Deepana-Paachana (appetizer and carminative), Agni Deepaka (appetizer) and Ashmari Bhedaka (helps to eliminate calculi).

 Arogyavardhini Vati: All the ingredients of Arogyavardhini Vati possess Madhura, Tikta and Kashaya Rasa leads to Pitta Kapha hara. Main Karma of the ingredients being Deepana (appetizer), Paachana (carminative), does Agnivardhana (appetizer), Bhedana Karma (cathetrics) does Ashmaribhedana (helps to eliminate calculi) and Shothaghna alleviates inflammation. Rogaghnata of almost all the drugs as per the authors is Shothahara (anti-inflammatory), and Yakrit Prasadaka (liver tonic) helps in restoring the Prakrita Karma of Yakrit. Mineral Shudda Shilajatu is an effective agent for renewing vitality. It acts like nectar, it has powerful antioxidant property and thereby delays the process of ageing, useful in relieving liver diseases, kidney diseases and digestive disorders etc. The oleo gum resin of Guggulu (Commiphora mukul) helps in getting rid of cholesterol by converting it into bile. It is an effective remedy for removing the unwanted fats and balancing cholesterol level.

Yavakshara: [5] Ushna, Teekshna Guna of Yavakshara helps in dissolving Pittashmari (cholelithiasis) in the bile. As the Yavakshara is Kaphavatahara helps in removing Kaphavatasanghata which is the main cause for Samprapti of Ashmari. Along with Shunti, Gokshura and Varuna Kwatha if Yavakshara is administered, then the combination helps in removing Ashmari, its Karma being Shulahara helps in relieving pain. Varunadi Kashaya: Combination of Varunadi Kashaya drugs acts as Ashmaribhedaka helps in disintegration of Pittashmari, as well as Deepana, Pachana Karma corrects the Agni and does Amapachana. Karma being Shothahara helps reducing inflammation and most of the drugs are Kaphavatahara helps for Samprapti Vighatana.

Conclusion

In this case study, the patient has shown encouraging results during the management of Cholelithiasis (Pittashmari). As per the USG abdomen, the patient got rid of 6.5mm stone within 3 months of treatment and the general condition of the patient also improved. Therefore, on the basis of observation and results of this case study it can be inferred that Arogyavardini Vati, Varunadi Kashaya with Yavakshara and Katuki Choorna Prayoga has shown marked improvement.