Ayurvedic Treatment Protocol for Hereditary Pancreatitis: A Case Report Demonstrating Disease Arrestation

Abstract

The case report presented here highlights the use of an Ayurvedic treatment protocol (ATP) in managing hereditary pancreatitis (HP) in a 14-year-old boy. HP is a rare form of pancreatitis caused by specific gene mutations that are inherited within families. It is known to be aggressive and can lead to pancreatic cancer in later stages. The boy, in this case, experienced multiple episodes of pancreatitis and required several hospitalizations despite following a conventional treatment approach, which included a dairy-free, protein and fat-restricted diet, and pancreatic enzyme supplementation. However, after starting the ATP in February 2022, which involved a modified diet and the use of herbo-mineral Ayurvedic formulations, the boy reported significant improvement in his general well-being and was able to lead a normal life without experiencing any discomfort. The ATP included a customized diet comprising dairy products with moderate amounts of fat and protein, along with specific herbo-mineral formulations and the withdrawal of pancreatic enzymes. The boy also received vitamin D3 supplementation. After approximately one year of following the ATP, the disease progression was arrested, as indicated by follow-up images and investigations. The size of the pancreatic duct decreased from 8 mm to 2.8 mm. This case report suggests that the ATP may have potential efficacy in managing hereditary pancreatitis and halting disease progression. However, it is important to note that this is a single case report, and further research and clinical studies are needed to validate the long-term benefits and understand the underlying mechanisms of Ayurvedic interventions in hereditary pancreatitis.

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Published 08/02/2023
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Ayurvedic Treatment Protocol for Hereditary
Pancreatitis: A Case Report Demonstrating
Disease Arrestation
Vaidya B. Prakash , Shikha Prakash , Neha Negi , Sneha T. Sati
1. Immunology, Village Child Protection Committee (VCPC) Research Foundation, Rudrapur, IND 2. Medicine, Padaav
- A Specialty Ayurvedic Treatment Centre, Rudrapur, IND 3. Clinical Research, Padaav - A Specialty Ayurvedic
Treatment Centre, Rudrapur, IND 4. Clinical Research, Village Child Protection Committee (VCPC) Research
Foundation, Rudrapur, IND
Corresponding author: Vaidya B. Prakash, balenduprakash@gmail.com
Abstract
The case report presented here highlights the use of an Ayurvedic treatment protocol (ATP) in managing
hereditary pancreatitis (HP) in a 14-year-old boy. HP is a rare form of pancreatitis caused by specific gene
mutations that are inherited within families. It is known to be aggressive and can lead to pancreatic cancer
in later stages. The boy, in this case, experienced multiple episodes of pancreatitis and required several
hospitalizations despite following a conventional treatment approach, which included a dairy-free, protein
and fat-restricted diet, and pancreatic enzyme supplementation. However, after starting the ATP in
February 2022, which involved a modified diet and the use of herbo-mineral Ayurvedic formulations, the boy
reported significant improvement in his general well-being and was able to lead a normal life without
experiencing any discomfort. The ATP included a customized diet comprising dairy products with moderate
amounts of fat and protein, along with specific herbo-mineral formulations and the withdrawal of
pancreatic enzymes. The boy also received vitamin D3 supplementation. After approximately one year of
following the ATP, the disease progression was arrested, as indicated by follow-up images and
investigations. The size of the pancreatic duct decreased from 8 mm to 2.8 mm. This case report suggests
that the ATP may have potential efficacy in managing hereditary pancreatitis and halting disease
progression. However, it is important to note that this is a single case report, and further research and
clinical studies are needed to validate the long-term benefits and understand the underlying mechanisms of
Ayurvedic interventions in hereditary pancreatitis.
Categories: Gastroenterology, Integrative/Complementary Medicine
Keywords: ras shastra, ayurveda, inflammation, pancreas, hereditary pancreatitis
Introduction
Hereditary pancreatitis (HP) is a rare form of pancreatitis characterized by severe abdominal pain, nausea,
and vomiting. It is caused by mutations in specific genes that are inherited within families [1]. Although
children and adolescents are primarily affected by HP, it can also develop later in life [2]. HP is considered
the most aggressive variant of pancreatitis, as approximately 40% of HP cases progress to pancreatic cancer
in later stages [3]. Despite conventional treatment approaches aimed at controlling pain, ensuring proper
nutrition, and periodic checkups, the natural course of HP often leads to a significant fatality, prompting
families to seek alternative solutions [4].
In this context, a Specialty Ayurvedic Treatment Center based in North India has reported remarkable and
sustained relief in pancreatitis patients through an Ayurvedic treatment protocol (ATP). The main herbo-
mineral formulation used in the treatment is named AMAR [5]. AMAR was first prepared by Late Vaidya
Chandra Prakash ji in the mid-seventies and was incidentally discovered to be effective in treating
pancreatic disorders. Later, ATP was structured by combining AMAR with some dietary and lifestyle
modifications, and few other medicines based on individual symptoms. Here, we present the case of a
patient of HP who underwent Ayurvedic treatment. This report provides intriguing insights into the
potential efficacy of ATP in managing HP and curbing disease progression.
Case Presentation
A 14-year-old boy from Haryana in India had his first episode of severe pain in his upper abdomen with
nausea in December 2018. He was admitted under a Gastroenterologist at a leading hospital in New Delhi for
five days and was treated with intravenous fluids, analgesics, antacids, and antibiotics. The boy experienced
another episode in the form of severe abdominal pain along with nausea and vomiting and was admitted to
the same hospital for thirteen days. He was again treated with intravenous fluid, analgesics, antacids, and
antibiotics. Ultrasound revealed homogenous echotexture with a prominent pancreatic duct measuring 2.8
mm and MRCP showed pancreatic pseudocyst.
1 2 3 4
Open Access Case
Report DOI: 10.7759/cureus.42876
How to cite this article
Prakash V B, Prakash S, Negi N, et al. (August 02, 2023) Ayurvedic Treatment Protocol for Hereditary Pancreatitis: A Case Report Demonstrating
Disease Arrestation. Cureus 15(8): e42876. DOI 10.7759/cureus.42876

Later, the boy experienced thirteen more episodes of pancreatitis until February 2020 and had nine
emergency hospitalization to control the symptoms (Table 1). His genetic test for Pancreatitis done in
September 2019 showed mutations of PRSS1, SPINK1, Chymotrypsin C, and Cathepsin B genes. Thus, his
diagnosis of chronic HP was made [6]. The boy’s great-grandmother had also been diagnosed with
pancreatitis at the age of 77 years in 2016. She had two attacks of the disease and died of natural causes in
2022 at the age of 83.
2023 Prakash et al. Cureus 15(8): e42876. DOI 10.7759/cureus.42876 2 of 6

No. Date Symptoms Hospital Investigations on admissions Treatment
1st December
2018
Severe abdominal
pain, nausea
Medanta-
The
Medicity,
Delhi
--- IV fluids, analgesics, and
antacids for 5 days
2nd January
2019
Severe abdominal
pain radiating
toward back,
nausea
Medanta-
The
Medicity,
Gurgaon
Serum Amylase – 196, ALP - 529 USG – homogenous
echotexture with 2.8mm prominent pancreatic duct MRCP –
Acute on chronic pancreatitis with Pseudocyst
IV fluids, analgesics,
antacids, and pancreatic
enzymes for 13 days
3rd February
2019
Severe abdominal
pain, vomiting
Medanta-
The
Medicity,
Gurgaon
USG whole abdomen – Chronic Pancreatitis with small
pseudocyst
IV fluids, analgesics,
antacids, and pancreatic
enzymes for 7 days
4th March
2019
Severe abdominal
pain
Medanta-
The
Medicity,
Gurgaon
ALP – 398, serum amylase – 399 USG – Acute on Chronic
Pancreatitis
IV fluids, analgesics for 6
days
5th April 2019
Severe abdominal
pain, nausea
PGI,
Chandigarh --- IV fluids, analgesics for 3
days
6th June 2019 Abdominal pain PGI,
Chandigarh USG – Chronic Pancreatitis IV fluids, analgesics for 1
day
7th August
2019
Severe abdominal
pain, nausea
PGI,
Chandigarh Serum amylase – 481, Serum lipase – 311 IV fluids, analgesics for 4
days
8th September
2019
Severe abdominal
pain
AIG,
Hyderabad
USG – Pancreatitis with pseudocyst Genetic test reveals positive
genes (SPINK1, PRSS1, Chymotrypsin C and Cathepsin B)
IV fluids, analgesics for 2
days
9th February
2020
Severe abdominal
pain, vomiting
PGI,
Chandigarh USG –Chronic Pancreatitis with a pancreatic cyst IV fluids, analgesics for 1
day
10th May 2020
Severe abdominal
pain, nausea, and
vomiting
PGI,
Chandigarh
Serum Amylase – 612, Serum lipase – 734 USG – Chronic
Pancreatitis with a pseudo pancreatic cyst
IV fluids, analgesics for 4
days
11th June 2020
Severe abdominal
pain, nausea, and
vomiting
A local
hospital,
Hisar
MRCP - Chronic Pancreatitis with pancreatic pseudocyst IV fluids, analgesics for 4
days
12th July 2020
Severe abdominal
pain, nausea, and
vomiting
A local
hospital,
Sirsa
USG – Chronic Pancreatitis with a pseudo pancreatic cyst IV fluids, analgesics for 9
days
13th August
2020
Severe abdominal
pain, nausea, and
vomiting
Fortis
Escorts,
New Delhi
--- IV fluids, analgesics for 2
days
14th June 2021 Severe abdominal
pain
A local
hospital,
Sirsa
USG – Chronic Pancreatitis IV fluids, analgesics for 3
days
15th February
2022
Severe abdominal
pain, nausea, and
vomiting
AIG,
Hyderabad USG – Chronic Pancreatitis IV fluids, analgesics for 2
days
TABLE 1: Details of hospitalizations
Since the first episode of pain, the boy had been taking a diet devoid of dairy, protein, and fat and had been
taking pancreatic enzymes and antioxidants daily. However, starting in February 2022, the boy's treatment
approach was modified to include the ATP, which involved a diet comprising dairy products with moderate
amounts of fat and protein. Pancreatic enzymes and antioxidants were stopped from the day of
2023 Prakash et al. Cureus 15(8): e42876. DOI 10.7759/cureus.42876 3 of 6

commencement of treatment.
The boy was initially admitted for three weeks long residential Ayurvedic treatment in February 2022. He
presented with the symptoms of moderate pain in upper abdomen, low appetite, nausea, vomiting and a
Body Mass Index (BMI) of 26. All blood parameters, including liver function, lipid profile, kidney function,
and hemogram, were normal. He was deficient in Vitamin D3 (32.7 nmol/L) and his fecal elastase was also
low (<15 μg/g stool). He was treated with a customized diet (Table 2), along with Herbo-mineral Ayurvedic
formulations. He was advised to have complete rest for the initial four months and avoid any physical or
mental exertion during the course of the treatment. Apart from AMAR, the other medicines prescribed
included Sootshekhar Ras Tablet, Kamdudha Ras Powder, Aarogyvardhini Vati Capsule, Ajeernari Vati Tablet,
Chitrak Haritaki Avleh paste, Punarnavadi Mandoor Powder, Giloy Satva Powder, Rason Vati Tablet, Narikel
Lavan Powder and Kalmeghnavayas Capsule [7,8]. The details of the dose and duration of medicines are
presented in Table 3.
Snacks/Meals Items
8am
(Breakfast)
Sooji kheer/ Upma/ Jave/ Poha (Semolina Porridge/ Vermicelli/ Flattened rice pilaf) + k ishmish (raisins) + chena/ paneer (cottage
cheese) + 1bowl seasonal fruits
11am (Mid-
morning
snacks)
Roasted puffed rice with black grams (Chane Murmure) or Makhana (Fox nuts) with herbal tea / 200 ml buttermilk / 1 bowl seasonal
fruits/ juice
1pm (Lunch) Moong dal khichdi (Green gram lentils and rice hotchpotch)/ Jhangora millet + Dal (moong/masoor/arhar) (Barnyard Millet + Lentils) +
curd + seasonal green vegetable + roasted papad + chutney + lemon pickle
4pm (Evening
snacks)
Roasted puffed rice with black grams (Chane Murmure) or Makhana (Fox nuts) with herbal tea / 200 ml buttermilk / 1 bowl seasonal
fruits/ juice
7 pm (Dinner) Jhangora millet Khichdi (Barnyard millet hotchpotch) / Chapati (chokar:jau:chana) (Mix flour chapati) + seasonal green vegetable +
curd + roasted papad + chutney + lemon pickle/ moong dal soup (lentils soup) + a squeeze of lemon
9pm (post-
dinner snacks) 1 small serving of custard/ Jhangora kheer (Barnyard millet porridge) / fruit cream
TABLE 2: Details of prescribed diet
2023 Prakash et al. Cureus 15(8): e42876. DOI 10.7759/cureus.42876 4 of 6

Medicines prescribed Dose Schedu le Duration
Sootshekhar tablet 250 mg Two tablets in the morning and evening on empty stomach with water Month 1 -2.5
Kamdudha ras powder 250 mg One sachet in the morning and evening without water (after taking Sootshekhar
Ras) Month 1 -2.5
Aarogyavardhani capsule 500 mg Two capsules before breakfast and dinner with water Month 1 -2.5, Month 12 -
13
AMAR capsule 62.5
mg One capsule during breakfast, lunch, and dinner with water Month 1, Month 12 – 13
Ajeernari vati tablet 250 mg Two tablets after breakfast, lunch, and dinner with water Month 1 to 2.5
Chitrak haritki avaleha paste 10 gm One tablespoon at bedtime with hot lukewarm water Month 1 -2.5
Punarnavadi Mandoor
powder 1 gm One sachet four times a day without water Month 1 - 13
Giloy satva powder 250 mg One sachet before breakfast, lunch, and dinner w ithout water Month 2.5 - 5.5
Rason vati tablet 500 mg Two tablets after breakfast, lunch, and dinner with water Month 2.5 - 13
Narikel lavana powder 1 gm One sachet twice a day with 250 ml buttermilk Month 5.5 - 13
Kalmeghnavayas capsule 500 mg Two capsules during breakfast, lunch, and dinner with water Month 5.5 - 13
TABLE 3: Details of medicines prescribed
He was also prescribed 60,000 IU Vitamin D3 suspension every week for four months along with ATP. He was
refrained from consuming tea, coffee, aerated drinks, alcohol, refined flour, onion, garlic, tomato, and
packaged or reheated food items.
Outcome
Since the initiation of ATP, the boy reported gradual improvement in all symptoms. His abdominal pain was
completely gone after the first three days of indoor treatment. His appetite and nausea improved from the
sixth day. He reported no symptoms or discomfort after six days of treatment. Even after the indoor
treatment, he did not report any uncomfortable symptoms or episodes of pain and hospitalization. This led
to a significant improvement in his general well-being, enabling him to lead a normal life.
In March 2023, the administration of ATP was ceased. He was asymptomatic and clinically fine. His BMI had
reduced to 23.1. Follow-up MRCP and laboratory investigations indicated the arrestation of the disease
process. The comparative MRCP report done in January 2022 and March 2023 showed reduced degree of
irregular dilatation of main pancreatic duct (from 8 mm to 2.8 mm) and its lateral side branches. Pancreatic
parenchymal atrophy in distal body and tail was stable. All laboratory investigations were also normal and
he reported no adverse effects due to the treatment.
Discussion
This case report highlights the experience of a 14-year-old boy with HP who underwent Ayurvedic treatment
using HMFs at a specialty center in North India. HP is a chronic form of pancreatitis that typically starts in
childhood [1]. The conventional treatment for HP involves pain management, nutritional support, and
pancreatic enzyme supplementation [4]. However, the progression of HP remains a challenge, and a
significant number of patients with HP eventually develop pancreatic cancer [3].
In this case, the boy had multiple episodes of acute pancreatitis over a period of three years, leading to
hospitalizations. Seeking alternative options, the parents turned to an Ayurvedic treatment center known
for its expertise in pancreatic disorders. The ATP included AMAR, along with a balanced diet and regulated
lifestyle, and the discontinuation of pancreatic enzymes. After starting the Ayurvedic treatment, the boy did
not experience any further episodes of pancreatitis and completed the treatment protocol. Despite severe
exocrine deficiency as indicated by the fecal elastase test, the boy's clinical condition improved significantly.
His BMI reduced, liver and kidney function tests remained normal, and there was a visible reduction in the
size of the main pancreatic duct.
AMAR, the main medicine used in the ATP is derived from Rasa-shastra, which deals with the therapeutic
use of processed metals in Ayurvedic medicine. AMAR is prepared using copper, mercury, and sulfur but does
2023 Prakash et al. Cureus 15(8): e42876. DOI 10.7759/cureus.42876 5 of 6

not show the presence of free metals in the finished form [5]. The formulation has demonstrated pancreatitis
protective properties in experimental models [9]. The case report suggests that the formulation might have
contributed to the improvement in the clinical condition of the boy, as well as the reduction in the size of the
main pancreatic duct. Since pancreatitis is a disease of inflammation, the report also highlights the
potential anti-inflammatory properties of copper-based compounds.
It is important to note that this is a single case report, and further research and studies with a larger patient
population are needed to evaluate the safety and efficacy of Ayurvedic treatments, particularly in the context
of chronic pancreatitis. While this case report may draw attention to the potential benefits of Ayurveda in
the management of chronic pancreatitis, it should be considered preliminary evidence and further research
should be planned.
Conclusions
In conclusion, the case of this 14-year-old boy with chronic HP demonstrates a promising outcome
associated with the implementation of the ATP. The reported relief, cessation of discomfort, and arrestation
of the disease process observed in this case warrant further investigation into the potential of Ayurvedic
interventions in managing HP.
Additional Information
Disclosures
Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In
compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services
info: All authors have declared that no financial support was received from any organization for the
submitted work. Financial relationships: All authors have declared that they have no financial
relationships at present or within the previous three years with any organizations that might have an
interest in the submitted work. Intellectual property info: The patent has been applied for the herbo-
mineral Ayurvedic formulation, Amar, via Indian Patent Application No.: 3373/DEL/2014. Other
relationships: All authors have declared that there are no other relationships or activities that could appear
to have influenced the submitted work.
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