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शुक्रवार, 19 फ़रवरी 2016

Acute pancreatitis

Acute pancreatitis ;

 Gall stones alcohol etc - pitta prakopa in term of ushna tikshna vriddhi - paaka karma vriddhi in agni sthaana *(pittaja gulma )- agnisaada - (pittavrita samaana). shoola jvara chhardi due to pitta prakopa , indigestion and malabsorption due to aavrita samaana . Due to pitta vridhi vaata marga avarodha leading to rakta pitta sanchiti in udara ; jalodara.. sanga pradhaan dushti so eka sthaana vriddhi (jalodar) and itar (other ) sthaana kshaya - circulatory failure.. excessive pitta prakopa - rakta dushti - paaka- septicaemia..
Pitta prakopa and vaata gati hanana result in gulma and jalodara , aavrita samaana leading to agnisaada.. apatarpana is severely present.. managament ; laghu santarpana , deepaniya yavaagu , shrita yoosha , shadanga paaniya , pitta shamana , agni vardhana , due to chhardi amalaki mashi with pravala or shankh bhasma and mayurapuchchha bhasma muhurmuhuh , especialy before intake of fluid, food and drugs
Already apatarpana so sanshodhana chikitsa is contraindicated , tiktaksheera ghrita basti /yaapana basti can be considered to work on pitta & vaata.There is exocrine insufficiency - less pancreatic enzyme secretion - indigestion & malabsorption - diarrhea and steatorrhea ( in acute phase severe abdominal pain vomiting and fever ) - agni vardhan chikitsa will decrease the load on pancrease , hence recovery from inflammation will be fast.. Electrolytes and water maintainance is crucial with nutritional support ; shrita yoosha / deepaniya yavaagu are best choice ..
Swarna makshika bh 10 grm+
Pravalapisti 10 grm+
Guduchi satwa 10 grm+
Amlaki churna 30 grms
1 grm twice daily.
On 2-3 days pain intensity gradually drops.lashunaadi vati like drugs are effective.. aamalaki mashi combination is effective in chhardi.In acute pancreatitis (pitta prakopa ) due to inflammatory degeneration of exocrine cells , enzyme secretion is very less *(aavrita samaana), so indigestion and malabsorption (agnisaada) occurs
Agniboosting drugs which provide enzymes to help in digestion so load on pancrease is decreased providing time for healing.. Lashuna ksheerapaaka is mentioned in gulma with indication in antarvidradhi...For samaana boosting chitraka lashuna like drugs are found effective , its not hypothesis , its observation.. Pulling of fluid in peritoneum indicates the role of vaata.These drugs are also helpfull in removing obstructive pathology
. Jalodar is another consequence present in pancreatitis excludes paittik shoola ..ERCP with stent placement is also indicated for pancreatic ductul disruptions that occur as part of the inflammatory process and result in peripancreatic fluid collections...In addition to nutritional support , enteral feeding helps to maintain integrity of the intestinal tract during severe acute pancreatitis..
The maintainance of intestinal integrity is possible with drugs acting on agni or samaana vaayu..
Enteral feeding with a nasojejunal tube has been demonstrated have fewer infectious complications than with TPN and is preffered method of nutritional support.. Therefore i prefer the use of shadangapaaniya , shrita yoosha and laghu santarpana through nasojejunal tube in place of IV fluids and colloid to maintain normal intravascular volume... Analgesics for pain ; shankha vati /chitrakaadi vati /lashunaadi vati/ agnitundi vati..There is future prospectus in ayurveda to treat such diseases which can cause multiple organ failure ; need to select appropriate treatment modalities.. thanks for discussion Gulma chikitsa in charak is best reference to understand the diseases related to GIT and their line of treatment ..Later in charak chikitsa 26 in reference to hridroga acharya charak mentions various shoola for differential diagnosis purpose... acharya madhav referred such shoola dominating diseases in details.. As parinaama shoola annadrava shoolaadi..
In sushruta uttaratantra after gulma hridroga chikitsa is classified and at the end of gulma description , acharya sushruta mentions hrichchhula , the purpose is differential diagnosis. Diagnosis is crucial to decide perfect line of treatment...

.Prof. Dr. Satyendra Narayan Ojha ,
MD (KC), Ph.D.
Director , Yashawant ayurveda college , Post graduate teaching and research center ,
Kodoli ,Panhala , Kolhapur..
 drsnojha@rediffmail. com

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