Case Report AYURVEDIC MANAGEMENT OF PANCREATIC CALCULI, THE SEQUELAE OF CHRONIC PANCREATITIS: A CASE REPORT

Abstract

Background: Pancreatitis is the inflammation of the pancreas, which may be acute or chronic. Chronic pancreatitis is characterised by epigastric pain, which is persistent and severe. Pancreatic calculi are sequelae of chronic pancreatitis, which causes pancreatic duct obstruction. In the present case, a 29-year-old female suffering from epigastric pain and burning sensation was diagnosed with pancreatic calculi and was treated with Ayurvedic treatment protocol. Results and discussion: At the end of the treatment, she had relief from symptoms. The prescribed medicines prevented further inflammation and had litholytic properties, as no evident calculi were noted in the reports.

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AY UR VE DI C M AN A GE ME NT OF PAN C RE ATI C C AL C UL I, TH E S EQ UE LA E O F
CHRONIC PANCREATITIS: A CA SE RE PORT
Anuroop IV 1, BK Mugilmathi 2*, Arya S Menon 1, K Vasudeva Reddy 3, T. Udaya Kiran 4
1 Assistant Professor, Department of Shalya Tantra, Sri Jayendra Saraswathi Ayurveda College and Hospital,
Nazarathpet, Chennai, (Department of Ayurveda), Sri Chandrasekharendra Saraswathi Viswa Mahavidyalaya
Kanchipuram, India
2 PG Scholar, Department of Shalya Tantra, Sri Jayendra Saraswathi Ayurveda College and Hospital, Nazarathpet,
Chennai, (Department of Ayurveda), Sri Chandrasekharendra Saraswathi Viswa Mahavidyalaya Kanchipuram, India
3 Assistant Professor, Department of Shalya Tantra, Sri Jayendra Saraswathi Ayurveda College and Hospital,
Nazarathpet, Chennai, (Department of Ayurveda), Sri Chandrasekharendra Saraswathi Viswa Mahavidyalaya
Kanchipuram, India
3 Professor, Department of Shalya Tantra, Sri Jayendra Saraswathi Ayurveda College and Hospital, Nazarathpet,
Chennai, (Department of Ayurveda), Sri Chandrasekharendra Saraswathi Viswa Mahavidyalaya Kanchipuram, India
4 Professor & Head, Department of Shalya Tantra, Sri Jayendra Saraswathi Ayurveda College and Hospital, Nazarathpet,
Chennai, (Department of Ayurveda), Sri Chandrasekharendra Saraswathi Viswa Mahavidyalaya Kanchipuram, India
Received on: 04/6/24 Accepted on: 29/7/24
*Corresponding author
E-mail: dr.mugilmathi@gmail.com
DOI: 10.7897/2277-4343.154113
ABSTRACT
Background: Pancreatitis is the inflammation of the pancreas, which may be acute or chronic. Chronic pancreatitis is characterised by epigastric pain,
which is persistent and severe. Pancreatic calculi are sequelae of chronic pancreatitis, which causes pancreatic duct obstruction. In the present case, a
29-year-old female suffering from epigastric pain and burning sensation was diagnosed with pancreatic calculi and was treated with Ayurvedic treatment
protocol. Results and discussion: At the end of the treatment, she had relief from symptoms. The prescribed medicines prevented further inflammation
and had litholytic properties, as no evident calculi were noted in the reports.
Keywords: Calculi, Gutika, Kashayam, Pancreatitis, Sudarshana, Va r a n a d i
INTRODUCTION
The pancreas, also known as the abdominal tiger, is an elongated
retroperitoneal organ. The word pan means ‘all’ (pan=all), and
kreas means ‘flesh’ (kreas=flesh). It is divided into head, neck,
body and tail. The Duct of Wirsung, or the main duct of the
pancreas, begins at the tail of the pancreas, while the Duct of
Santorini or the accessory pancreatic duct, begins in the lower
part of the head.1
Pancreatitis is the inflammation of the pancreas. According to
Marseilles’ classification, pancreatitis may be acute, acute
relapsing, chronic or chronic relapsing pancreatitis. Acute
pancreatitis refers to acute inflammatory changes that are
reversible, and chronic pancreatitis refers to chronic
inflammatory changes that are irreversible.2
Suppose the biliary and pancreatic ducts join to share a common
channel before ending at the ampulla. In that case, obstruction of
this passage may lead to the reflux of bile or activated pancreatic
enzymes into the pancreatic duct. This results in acute
pancreatitis.3 Sentinel Acute Pancreatitis event (SAPE)
hypothesis is the most accepted hypothesis regarding the
pathogenesis of chronic pancreatitis.4
Chronic pancreatitis is one of the most common gastrointestinal
diseases. It is a persistent inflammatory condition with abdominal
pain, loss of parenchyma, fibrosis, and calculus formation.5
Pancreatic calculi are sequelae of chronic pancreatitis that can
occur in 50% of patients. These calculi aggravate the typical
pancreatic pain by obstructing pancreatic ducts and thereby
producing upstream ductal hypertension and subsequent
parenchymal hypertension. Endoscopic or surgical therapy is
advised in contemporary science to clear these calculi.6
In the present case study, a 29 years female suffering from
epigastric pain for five months was diagnosed with pancreatic
duct calculi and was treated with Ayurvedic formulations like
Sudharshana gutika, Va r a na d i K a s h a ya m tablet along with other
herbo-mineral combinations. At the end of the treatment, the
patient had relief from symptoms, and no evident calculi were
noted in the reports.
CASE REPORT
Patient Information
A 29 -years old female patient who is a homemaker visited the
OPD of Shalya Tantra of Sri Jayendra Saraswathi Ayurveda
College and Hospital, Nazarethpet, Chennai - 600123 with the
complaint of pain over the upper abdomen and between the

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sternum in the past five months. She also complained of a burning
sensation over the chest region associated with on-and-off fever.
Consent and Ethical Statement: This study is carried out as per
the International conference of Harmonization-Good Clinical
Practices Guidelines (ICH-GCP).
History of Present Illness: The patient was well before five
months. She developed pain in the upper abdomen and between
the sternum, along with chest burn and on-off fever. Based on the
reports of CT and USG abdomen and pelvis, she was diagnosed
to have pancreatic calculi. Few intra-ductal calculi measuring 3-
4 mm were noted, which might be sequelae of chronic
pancreatitis.
History of Past Illness: H/o gestational diabetes.
Surgical History - Nothing specific
Family History - No related family history
General Examination
Height - 155 cm
Weight - 78 kg
BMI - 32.5
BP - 130/80 mmHg
PR - 98 bpm
HR - 86 bpm
RR - 14/min
The patient was also assessed with Dashavidha Pariksha (Tabl e
1) and Ashtavidha Pariksha (Tab le 2).
Nidana: Pancreatitis
Dosha: Kapha Pitta
Dushyas involved: Medas
Lakshanas: Calculi formation with pain and burning sensation in
the epigastric region.
Rogamarga: Abhyantara rogamarga
Tab l e 1: Dashavidha Pariksha (10-fold examination)
Dashavidha pariksha
Result Interpretation
Prakriti
Kapha-Vata
Vikriti
Kapha-Pitta
Sara
Mamsa
Samhanana
Madhyama
Pramanam
Madhyama
Satmyam
Sarvarasa
Satvam
Madhyama
Vayah
Madhyama
Ahara Shakti
Avaram
Vyayama Shakti
Madhyama
Tab l e 2: Ashtavidha Pariksha (8-fold examination)
Ashtavidha pariksha
Result Interpretation
Nadi
Kapha Pitta
Mala
Nirama
Mutra
Alpa
Jihwa
Lipta
Shabda
Madhyama
Sparsha
Sheeta
Drik
Madhyama
Akruthi
Pravara
Addictions - Nil
Clinical Investigation
20.07.23 - USG - Complete abdomen showed few intraductal
calculi measuring 3-4 mm with grade 1 fatty liver. (Figure 1 and
Figure 2)
21.07.2023 - CT abdomen - revealed multiple pancreatic duct
calculi measuring 5.9 mm in the head and 3.6 mm in the neck.
(Figure 3)
02.09.2023 - USG of the complete abdomen - showed no
evidence of sonological detected calculus. (Figure 4)
27.11.2023 - USG of the abdomen showed no evidence of any
calculi. (Figure 5 and Figure 6)
Figure 1: USG Complete abdomen – 20.07.2023
Figure 2: USG Complete abdomen – 20.07.2023 (continued)

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Figure 3: CT Abdomen – 21.07.2023
Figure 4: USG Abdomen and Pelvis – 02.09.2023
Figure 5: USG Complete Abdomen – 27.11.2023
Figure 6: USG Complete Abdomen – 27.11.2023 (continued)
Timeline: The timeline of interventions and results is given in Tab le 3.
Tab l e 3: Timeline with Interventions and Results
Date
Investigations Result
Treatment
20.07.2023
USG - Complete abdomen showed few intra-ductal
calculi measuring 3-4 mm with grade 1 fatty liver.
21.07.2023
CT abdomen revealed multiple pancreatic duct calculi
measuring 5.9 mm in the head and 3.6mm in the neck.
22.07.2023
1. Sudarshana gutika, 1 – 0 – 1 (After food)
2. Varanadi Kashaya Tablet, 2 – 0 – 2 (After food)
01.08.2023
1. Herbo-mineral compound tablet, 2 – 2 – 2
2. Sudarshana gutika, 1 – 0 – 1 (After food)
3. Varanadi Kashaya Tablet, 2 – 0 – 2 (After food)
02.09.2023
USG of the complete abdomen showed no evidence of
sonological detected calculus.
27.11.2023
USG of the abdomen showed no evidence of any calculi.

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Therapeutic Intervention – Internal medicines and
ingredients
Internal Medicines
1. Tab . Suda rs hana g utik a: 1 – 0 – 1 After food
2. Va r an a d i K as h a y a tablet: 2 – 0 – 2 After food
3. Herbo-mineral compound tablet: 2 – 0 – 2 After food
Ingredients
Sudharshana gutika
The ingredients of Sudharshana gutika are as mentioned in
Tab le 4. 7
Tab l e 4: S ud h ar sh an a g ut ik a
Ingredients
Botanical Name
Haritaki
Terminalia chebula
Vibhitaki
Terminalia bellirica
Amalaki
Phyllanthus emblica
Haridra
Curcuma longa
Daruharidra
Berberis aristata
Kantakari
Solanum virginianum
Brhati
Solanum indicum
Sati
Hedychium spicatum
Maricha
Piper nigrum
Pippali
Piper longum
Nagara
Zingiber officinale
Granthika
Roots of Piper longum
Moorva
Marsdenia tenacissima
Guduchi
Tinospora cordifolia
Dhanwayashaka
Fagonia arabica
Katuka
Picrorrhiza kurro
Parpata
Mollugo cerviania
Mustha
Cyperus rotundus
Trayamana
Gentiana kurroo
Valaka
Coleus vettiveroides
Nimba
Melia azadirachta
Pushkaramoola
Inula racemosa
Madhuyashti
Glycyrrhiza glabra
Vatsaka
Holarrhena antidysenterica
Yamani
Trachyspermum ammi
Indrayava
Seeds of Holarrhena antidysenterica
Bharngi
Shigrubeeja
Seeds of Moringa pterygosperma
Surashtraka
Alum
Vacha
Acorus calamus
Twak
Cinnamomum cortex
Padmaka
Prunus puddum
Usheera
Vetiveria zizanioides
Chandana
Pterocarpus santalinus
Ativisha
Aconitum heterophyllum
Bala
Sida cordifolia
Saliparni
Desmodium gangeticum
Prishniparni
Uraria picta
Vidanga
Embelia ribes
Tagara
Valeriana wallichii
Chitraka
Plumbago zeylanica
Devadaru
Cedrus deodara
Cavya
Piper chaba
Patolapatra
Leaves of Trichosanthes cucumerina
Jeevaka
Malaxis acuminata
Rsabhaka
Malaxis mucifera
Lavanga
Clove
Vamsalocana
Bamboo manna
Pundarika
Nelumbo nucifera
Kakoli
Fritillaria roylei
Patraka
Cinnamomum tamala
Jati patra
Myristica fragrans
Talisapatra
Abies webbiana
Kirata
Swertia chirata
Va ra na d i K as ha y am
The ingredients of Var a n a d i K as h a y a m are as mentioned in
Tab le 5. 8
Tab l e 5: Va ra na di Kashayam
Ingredients
Botanical name
Varana
Crataeva magna
Sairyaka
Nilgirianthus ciliates
Shatavari
Asparagus racemosus
Dahana
Plumbago zeylanica
Morata
Chenomorpha macrophylla
Vilva
Aegle marmelos
Vishanika
Gymnema sylvestre
Brhati
Solanum anguivi
Kantakari
Solanum xanthocarpum
Karanja
Pongamia pinnata
Putikaranja
Holoptelea integrifolia
Tarkari
Premna serratifolia
Haritaki
Terminalia chebula
Shigru
Moringa oleifera
Darbha
Desmostachya bipinnata
Rujakara
Semecarpus anacardium
Herbo-mineral compound
The ingredients of the herbo-mineral compound adopted for the
treatment is as mentioned in Tabl e 6. 9
Tab l e 6: Herbo-mineral compound
Ingredients
Botanical name
Sookty Bhasma
Kapur kachali
Hedychium spicatum
Jatamansi
Nardostachys jatamansi
Ganthoda
Piper longum
Khurasani ajvayan
Hyoscyamus niger
Kelpan rakh
Musa sapientum
Vacha
Acorus calamus
Datura pan
Datura stramonium
DISCUSSION
Fatty liver disease involves hepatic fat accumulation, which is a
metabolic abnormality. Studies reveal that there is a possibility
that severe fatty liver disease might be a risk factor for acute
pancreatitis.10
In the present case, the patient had grade 1 fatty liver, which might
have led to pancreatitis. Hence, medications which act on the
metabolism were prescribed.
Sudarshana gutika: It helps to alleviate the vitiation of
tridoshas. It is useful in all types of Jwara (fever), including
Dhatugata Jwara (fever located in tissues) and Sannipataja Jwara
(fever caused by all the tridoshas). It reduces dhatu agnimandya
by increasing the dhatu Agni due to its tikta rasa pradhanata
(predominance of bitter taste).11
Va ra na d i Ka s ha y am tablet: It causes the pacification of Kapha,
the leading cause of calculi formation. Va r un a (Crataeva nurvala)
is considered one of the best litholytic herbs.12 Among the
indications of Va r an a d i K a s h ay a m , like agnimandhya, Gulma,
Antravidradhi, etc., it can be found that antravidradhi suggests a
broad term for inflammation of the alimentary tract, which also
includes pancreatitis.13 Hence, the Va r an a d i K as h a y a m tablet has
helped manage pancreatitis, pancreatic calculi and fatty liver
disease in the present case.
Herbo-mineral compound: It is a herbo-mineral compound
whose ingredients were found to act as antiulcer and

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antispasmodic agents.14 It also helps reduce the burning sensation
and increase metabolic activities.
CONCLUSION
Pancreatic calculi, which are sequelae of chronic pancreatitis, are
characterised by severe pain. By the administration of
Sudharshana gutika, further inflammation may be prevented.
Va r an a d i Kashayam tablet, which is Kaphahara and litholytic,
helps disintegrate the calculi as Kapha causes all the calculi. The
herbo-mineral compound prescribed here helps bring down the
burning sensation in the epigastric region. Therefore, the
administration of Ayu rv e di c t re a tm en t protocol may help manage
pancreatic calculi caused by chronic pancreatitis.
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Cite this article as:
Anuroop IV, BK Mugilmathi, Arya S Menon, K Vasudeva Reddy
and T. Udaya Kiran. Ayurvedic Management of Pancreatic
Calculi, the Sequelae of Chronic Pancreatitis: A Case Report. Int.
J. Res. Ayurveda Pharm. 2024;15(4): 39-43
DOI: http://dx.doi.org/10.7897/2277-4343.154113
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