Ayurvedic Management of Kampavata w.s.r. to Wilsons Disease: A Case Report

Abstract

Ayurveda has described various disorders along with its prevention as well as it’s cure for disorders. Also, this was described as main aim of Ayurveda [1]. Wilson’s disease is one of the uncommon recessive autosomal diseases which typically manifests before the age of forty. Here, an excessive buildup of copper occurs in the brain and liver. It can be correlated with Kampavata in Ayurveda science. Since it is characterised by Sarvanga Kampa or Shiro Kampa also, it is one of the Vatavyadhis [2]. As in Kampavata, Chala Guna of Vata Dosha excessively increases which causes Kampa in the body parts. In this case study, Shodhana and Shamana Chikitsa were given to the patient in order to manage Kampavata. Matrabasti, Rajayapan Basti along with Shamana Yoga Dravyas were given for the management of this case.

Introduction

I. INTRODUCTION

Wilson’s disease where Hepatocellular degeneration occurs is an uncommon recessive autosomal condition that typically affects people under forty. There are about 30 cases per million people worldwide. The illness is typified by an overabundance of copper deposits in the brain and liver.

The chromosomal 13 genetic abnormality has been demonstrated to impact the liver’s adenosine triphosphatase [AP7B], which transports copper, resulting in copper build-up and oxidative damage to the liver’s mitochondria. Increased deposition, particularly in the liver, brain, cornea and kidney, is the maim physiological abnormality associated with Wilson’s disease, which is caused by excessive absorption of copper from the small intestine and impaired excretion of copper by the liver. [3]

Kampavata is one of the Vata Nanatmaja disorder described by Acharya Charaka in his Samhita [4]. In this disease Kampa is one of the characterising features. It occurs due to the Vata Dosha vitiation or Prakopa. As for Vata Dosha Snehana, Swedana, Basti are the best line of treatment mentioned in Ayurveda. Here in this case study, Sarvanga Snehana, Swedana, Matrabasti, Rajayapan Basti along with Shamana Yogas are used for the management of Kampavata.

II. OBJECTIVES

 To study the effect of Shodhana and Shamana Chikitsa in the management of Kampavata w.s.r. to Wilson’s disease.

III. METHODOLOGY

A. Case Report 

A female patient, 24, presented to the hospital with symptoms like Aspashta Vaka Pravrutti, Hastapada Kampa, Tongue twist for 2-3 years. Patient’s Nidana was done initially along with Ashtavidha, Dashavidha Pariksha and General examination with proper observations.

1. Name of Patient: Mrs. Rajeshwari Deva Bundele, 24 year - Female
2. Religion: Hindu
3. Occupation: Student
4. Pradhana Vedana [Chief Complaints]

1. Aspashta Vaka Pravrutti
2. Hastapada Kampa
3. Tongue twist

5. Ashtavidha Parikshana

6. General Examination

• Pulse - 72/min
• Blood Pressure - 120/70 mmHg
• RS – Clear, AEBE; RR = 19/min
• Dehoshma = 98.60 F
• CVS – S1 S2 +
• CNS – Oriented to TPP
• P/A - Soft, Non-Tender
• Agni = Prakruta
• Kshudha = Prakruta
• Trushna = Prakruta
• Prakruti = Vatapitta Pradhan Prakruti
• Koshtha = Madhyam
• Nidra = Khandita

7. Personal History

8 am – Breakfast, Chai

1 pm – Dinner Chapati, Sabji, Dal, Rice

4 pm – Chai, Snacks

8 pm – Lunch, Rice, Roti, Daal

B. Past History

1) CGHS / CSMA Authorised [Dated 13/1/2014]

Large mass in pelvis with cystic and fatty areas with few calcifications within it, measuring 13 × 12 × 10 cm. The mass seen to displace uterus posteriorly & bowel laterally. However, fat plane is maintained.

There is seen mild to moderate ascites. Dermoid cyst.

2) USG Abdomen & Pelvis [Dated 13/5/2016]

Multiple lesions in both lobes of liver with heterogenous echotexture? Metastasis.

3) USG Abdomen & Pelvis [Dated 30/6/2017]

Multiple hepatic hypoechoic lesions as described, No ascites.

Needs HPR Correlation

Few enlarged mesenteric nodes in periumbilical region likely inflammatory.

No obvious bowel wall thickening is seen.

IV. INVESTIGATIONS

1. BHCG [Beta Human Chorionic Gonadotropin] = 2.62 mIU/ml
2. Blood Urea = 14.7 mg/dl
3. Serum Creat. = 0.72 mg/dl
4. LFT = Sr. Bilirubin total = 0.56 mg/dl, Sr. Bilirubin Direct = 0.45 mg/dl, Sr. Bilirubon Indirect = 0.11 mg/dl, SGPT /ALT = 52 U/L, SGOT / AST = 45 U/L, Alkaline Phosphatase = 141 U/L, Protein total = 6.70 gm/dl, Albumin = 3.92 gm/dl, Globulin = 2.78 gm/dl, Albumin to Globulin Ratio = 1.41
5. CBC = Hb = 13.6 gm/dl%, WBC = 5600 / Cmm, Platelet = 120000/Cmm, Neutrophils = 59%, RBC = 4.38 mil/Cmm

V. MANAGEMENT

Kampavata were treated with the help of Shodhana and Shamana Chikitsa, the following managements were given to the patient till 15 days.

A. Shodhana Chikitsa

Table I

Process Of Shodhana With Dravya, Duration And Period

B. Shamana Chikitsa             

Table II

Shamana Therapy With Formulations With Doses, Timming & Anupana

VI. OBSERVATIONS

Table III

Effect On Symptoms Before And After The Treatment

Fig 1. Patient’s Handwriting (Signature) before treatment and on the first follow-up.

Fig. 2. Patient's Handwriting (Signature) on the second follow-up.

Fig. 3. Patient's Handwriting (Signature) after treatment.

VII. DISCUSSION

Encouraging results was seen in the patient during her course of the treatment of this autosomal disorder. Many rare cases have been reported to show promising result in such short span of Ayurvedic intervention. the study used the VAS Scale (a psychometric response scale) – which is often used for Aspashta Vaka Pravrutti, Hastapada Kampa, Tongue twist etc, along with symptom-based observations to track the patient both before and after the treatment.

Photos and videos of her symptoms were taken with her consent, during the case study. The picture attached reveals the impact of the whole treatment regimen in her handwriting (here, signature). Since the patient had severe grade of Kampa in her initial days of the treatment, it is reflected in her signature as well. With time, her shakiness significantly reduced leading to a clear and free flowing handwriting.

1. Sarvanga Snehana – Sarvanga Swedana were done with the help of Mahanarayan Taila. As Taila is described to be one of the best line of treatment for Vatavyadhi since it helps to decreases the Vata Prakopa from the whole body.
2. Sarvanga Swedana – Shastika Shali Swedana were done after Snehana process. Shashtika Shali Swedana were given for the management of Vata Dosha since it helps to reduces the Kampa from all the body by working on the Chala Guna, Ruksha Guna, Sheeta Guna of Vata Dosha.
3. Matrabasti – Basti is mentioned as best management of Vata Dosha and Vatavyadhi in all the Ayurvedic texts. In accordance, Matrabasti were given for initially 2 days for helping to reduce the Vata Prakopa in the body.
4. Rajayapanbasti – It includes Kalka of Shatavari, Shatapushpa, Kwatha of Musta, Bala, Rasna, Manjishtha, Ashwagandha, Punarnava, Guduchi, Shatavari, Laghupanchmoola, Gokshura, Mamsarasa, Godugdha, Goghruta, Madhu, Saindhava. It has properties like Brimhana, Rasayana, Balyajanana which will in turn be required for the pacification of the disease along with tarpan of the all the emaciated Dhatus.
5. Kapikacchu Ghan Vati, Guduchi Ghan Vati – This helps to give strength to the whole-body parts and helps to reduces the Vata Prakopa and Kampa. The drugs used are clearly indicated in disease of extreme Dhatu Kshaya causing Vata Vyadhi. Provides strength and stability along with nourishment for replenishment.
6. Ashwagandharishta + Dashamoolarishta – Dashmoola, Ashwagandha have Karmas mentioned as Brimhana, Balya, Rasayana, Vatanulomaka, etc as their properties.
7. Mahanarayan Taila – This Taila is applied externally and internally both. This Taila is used in various Vatavyadhi.
8. Ajamamsa Rasayana – Ajamamsa Rasayana is Ayurvedic formulations which helps to improve body mass, muscle bulk, strength of bones. It helps to promotes strength in the body.

Conclusion

In this Kampavata w.s.r. to Wilson’s disease case study, all symptoms like Aspashta Vaka Pravrutti, Hastapada Kampa, Tongue twisting were diminished in this 1-month study. In conclusion Sarvanga Snehana, Swedana, Matrabasti, Rajayapan Basti and Shamana chikitsa greatly aided in the management of Kampavata, followed by proper Pathya-Apathya.

References

[1] Vaidya Yadavaji Trikamji Acharya, Ed.., Chakrapani Tika on Charaka Samhita by Agnivesa, Reprint 2017, Chaukhambha Publications, New Delhi, Sutrasthana 30/26, p. 187. [2] Shastri R, Charak Samhita, Vidyotini hindi commentary part 1st, reprinted edition, Bharati academy, Varanasi, 2001, Sutrasthana, 20/11, p. 399. [3] CMDT Lange, Textbook of Medicine, 2018, Chapter 16, p. 721. [4] Vaidya Yadavaji Trikamji Acharya, Ed.., Chakrapani Tika on Charaka Samhita by Agnivesa, Reprint 2017, Chaukhambha Publications, New Delhi, Chikitsasthana, 28/59, p. 619. [5] Vd. Gangadhar Shastri Gune, Textbook of Ayurvediya Aushadhi Gunadharma Shastra, Part 2, Chaukhambha Sanskrit Pratishthana, Delhi, Reprint 2014. [6] Dr. P. Yadaiah, Clinical Panchkarma, Bhyasnehana therapy, Jaya publications, Hyderabad, 3rd edition. [7] Aacharya Vidyadhar Shukla, Ed., Agnivesha, Charaka, Dridhabala, Charaka Samhita, II edition, Chaukhamba Sanskrit Pratishthana Varanasi, 2002, Siddhisthana, 12/17, p. 984. [8] Aacharya Vidyadhar Shukla, Ed., Agnivesha, Charaka, Dridhabala, Charaka Samhita, II edition, Chaukhamba Sanskrit Pratishthana Varanasi, 2002, Siddhisthana, 12/22, 990. [9] Vd. G. S. Gune, Textbook of Ayurvediya Aushadhi Gunadharma Shastra, Part 2, Chaukhambha Sanskrit Pratishthana, Delhi, Reprint 2014. [10] G. D. Sen, Vidyotini tika, Bhaishajya Ratnawali, 9th edition, Chaukhamba Sanskrit Sansthan, Varanasi, 1991, Mutrarogadhikara, 13-17. [11] Brahmanand Tripathi, Sharangdhara Samhita, Reprint, Chaukhambha Prakashan, Varanasi, Madhyamkhanda, 10/78-92. [12] Arya Vaidya Sala, Ajamamsa Rasayana, Kottakkal Pharma

Copyright

Copyright © 2024 Abhilasha Singh, Jibi Varghese, Aarti Gaikar, Megha Sawle, Isha Kandwal. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.