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

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.

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66 © 2020 Journal of Ayurveda Case Reports | Published by Wolters Kluwer - Medknow
Management of multi-relapsed chronic
pancreatitis through Rasaushadhis: A case study
Vaidya Balendu Prakash, Vaidya Shikha Prakash1, Sneha Tiwari, Shakshi Sharma1,
Vaidya Pooja Jaryal1
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
INTRODUCTION
Chronic pancreatitis is an inammatory
disorder of pancreas that results in
progressive loss of exocrine and endocrine
functions due to atrophy and/or brosis.[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 conrmation 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 specic 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
Address for correspondence:
Dr. Vaidya Balendu Prakash,
VCPC Research Foundaon,
Lane C‑15, Turner
Road, Clement Town,
Dehradun ‑ 248 002,
Uarakhand, India.
E‑mail: balenduprakash@
gmail.com
Submied: 30‑Nov‑2019
Revised: 04‑Jul‑2020
Accepted: 15‑Jul‑2020
Published: 16‑Oct‑2020
VCPC Research
Foundaon, Lane C‑15,
Turner Road, Clement
Town, Dehradun,
1Padaav‑Speciality
Ayurvedic Treatment
Centre, Rudrapur,
Uarakhand, India
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DOI:
10.4103/JACR.JACR_49_20
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.
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Case Report

Prakash, et al.: Management of multi‑relapsed chronic pancreatitis
Journal of Ayurveda Case Reports - Volume 3, Issue 2, April-June 2020 67
in about 70%-90% of cases.[6,7] Mortality is reported in
about 17% cases in ve 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 nancial and social condition
of the patients and their families.[10,11]
Here, the report of a Delhi‑based young man who was rst
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
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 classication. He was treated with intravenous
uids, 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
calcic 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.
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
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] 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, rened our, 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.
FOLLOW UP AND OUTCOME
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 signicant interval change as compared to the previous
positron emission tomography-computed tomography and
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)

Prakash, et al.: Management of multi‑relapsed chronic pancreatitis
68 Journal of Ayurveda Case Reports - Volume 3, Issue 2, April-June 2020
ultrasound reports done in September 2012 and January
2014, respectively. MBAT could bring signicant and
sustainable relief to the patient. He became asymptomatic
and continues to lead a normal life since then.
DISCUSSION
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 articial
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
efcacy 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 signicant 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 ve 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.
Table 1: Details of hospitalizations due to pancreatitis
Number Date Symptoms Hospital Investigations on admission* Treatment
1st January
2005
Severe abdominal pain, nausea,
vomiting, constipation
AIIMS, Delhi Serum amylase ‑ 860; CECT ‑ mildly bulky
pancreas with fuzzy outline
IV fluids and
painkillers
2nd June 2008 PSRI, Delhi Serum lipase ‑ 261; Serum amylase ‑ 433
3rd April 2010 Severe abdominal pain radiating
to back, nausea, and vomiting
Medanta
Hospital,
Gurgaon
EUS ‑ Chronic calcific pancreatitis
4th June 2010 Severe abdominal pain radiating
to back
TLC ‑ 12,990/µL; serum amylase ‑ 426
5th July 2010 Serum amylase ‑ 279; Serum lipase ‑ 1957
6th August
2010
Serum amylase ‑ 395; Ultrasound ‑
heterogenous pancreatic echotexture
*Serum amylase and lipase values are in U/L. CECT: Contrast‑enhanced computed tomography, EUS: Endoscopic ultrasound, IV: Intravenous
Table 2: Details of medicines given
Medicines Duration
Hingwashtak churna (1 g thrice a day before meals),
Amar capsule (125 mg thrice a day during meals)
Initial 3
months
Kamdudha rasa powder (125 mg thrice a day before
meals), Amar capsule (125 mg thrice a day during meals)
4th to 18th
month
Table 3: Diet prescribed
Meal Items
Breakfast (08:00
a.m.)
250 ml milk + one serving of any cereal (Daliya/
Amaranthus seeds/oats) + 100 g fresh cottage
cheese (Paneer) + one small bowl of fresh
seasonal fruits
Mid‑morning
snack (11:00
a.m.)
Buttermilk/a slice of multigrain bread, Paneer
sandwich
Lunch (01:00
p.m.)
Rice + pulses (Daal: Arhar/Moong/Masur) +
salad + vegetable + curd
Evening snack
(05:00 p.m.)
Roasted puffed rice and black grams/potato
and Paneer cutlet
Dinner (07:30
p.m.)
Multigrain freshly cooked chapatti (70 g flour) +
seasonal vegetable + dal/Paneer + curd + salad
Post dinner snack
(09:45 p.m.)
A glass of milk/custard/any Bengali sweet

Prakash, et al.: Management of multi‑relapsed chronic pancreatitis
Journal of Ayurveda Case Reports - Volume 3, Issue 2, April-June 2020 69
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‑inammatory 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 nished compound does not show any
trace of free metals [Figure 1].[12] The nal 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 inammatory disorder which
does not respond to the available steroidal and nonsteroidal
anti-inflammatory agents. Animal studies have also
conrmed 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
This case is a benchmark for the efcacy 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 conicts of interest.
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