Takayasu arteritis (TA) is a rare disorder and it is a devastating condition of aorta. The presently available treatments for the condition in the modern medicine have limited benefits. This is case of TA which was better managed with Ayurvedic intervention. An Ayurvedic diagnosis for this case was Siragata Vata (vitiated Vata Dosha affecting the blood vessels). A 42-year-old woman was diagnosed with TA and treated on the line of management of Siragata Vata with Shastikashali Pinda Swedana (sudation with bolus of medicated cooked rice) for 16 days, Erandamuladi Niruha Basti (enema mainly with decoction) along with Ashwagandha Taila Anuvasana (enema with medicated oil) for 16 days in Kala Basti Krama (16 days in alternate order of decoction and oleation enema) followed by one day gap and then 7 days of Nasya Karma (nasal therapy) with Triphaladi Taila (oil) on alternate days along with a combination of Ayurvedic oral drugs [Brihadvatachintamani Rasa-125 mg, Dashamula Kwatha-40 ml, Narsinha Churna (powder)-3 g, Yogaraja Guggulu-1g (500mgx2tab) and Shiva Gutika-500 mg, twice a day for 1 month. Same Panchakarma procedures were repeated after 6 months. A similar combination of oral medications were continued in between and during this period. Chyavanaprasha Aveleha in the dose of 10g twice a day with milk were also added after completion of this treatment regime. Patient condition was assessed on Indian Takayasu Clinical Activity Score (ITAS-2010) for disease activity of TA. Satisfactory results were observed in the patient with improvement in ITAS-2010 scoring. TA may be managed with Ayurvedic drugs and Panchakarma procedures.
Discussion
TA disease is having the close resemblance with Siragata-Vata. The disease is included in Vata Vyadhi. General line of treatment of Vata Vikara, namely Snehana, Swedana, Asthapana, Anuvasana and Shirovirechana was adopted in the patient. Mridu Virechana was given with castor oil. Shastikshali Pinda Swedana which is a combination of Abhyanga (massage) and Mridu Swedana (mild sudation) was given to the patient. It was done on whole body as TA can affect multiple organs. It is shown to provide a good result in the management of various Vata Vyadhi.[12],[13] In TA, occlusion and stenosis of artery and aorta are more prominent. Shiragranthi (knot in micro-channels) type of Srotodushti (vitiation of micro-channels) is the pathogenesis of stenosis. Stenosis is considered in Ayurveda as Margavarodha (obstruction in natural passage of Vata Dosha) or Stambhana or Tanvi Sira and can be removed by Shastikashali Pinda Swedana and Basti procedures. Erandamuladi Niruha Basti is helpful in treating Vata Kaphaja (diseases due to Vata Dosha and Kapha Dosha) disorders, Pakshaghata etc. It has Srotoshodhana (purification of micro channels) property hence it may remove occlusion of vessels. Right subclavian artery, left subclavian artery and left vertebral artery were affected in the case which affected the blood supply for both arms and the head. Shirovirechana is indicated for the diseases above the clavicle region. Hence, Shirovirechana was done with Triphaladi Taila which has Vata Kaphahara (suppression and removal of deranged Vata Dosha and Kapha Dosha) property.[14] It may be helpful in removing the obstruction of Vata Dosha at supra clavicular region. Brihadvatacintamani Rasa is indicated in all type of Vataja (disease due to Vata Dosha) and respiratory diseases.[15] Dashamula Kwatha is useful in all types of Vataja and respiratory disorders and has Tridoshaghna (alleviating deranged Dosha of the body) property.[16] Yogaraja Guggulu is useful in all types of Vataja (neurodegenerative) disorders.[17] Shiva Gutika can treat Shosha (emaciation or weight loss) and has Rasayana (immunomodulatory) property and helpful in diseases of mouth, head and eye.[18] Narsinha Churna is indicated in all types of Vata Vyadhi and it is also having the property of Vajikarana (aphrodisiac property).[19] The combination of all these drugs may treat all the manifestation and complication due to TA. Brimhana (nourishment up to tissue level) is the main treatment of Nanatamaja Vata Vyadhi and Rasayana must be prescribed to any chronic Vata Vyadhi.[20] Brahadvatacintamani Rasa has Rasayana property and is popular in Ayurvedic practices for various diseases of rheumatic spectrum. Chyavanaprasha Avaleha[21] is important for longer uses as Rasayan and is indicated in chronic Vatavyadhi, Nanatmaja Vata Vikara and Avrita Vata Vikara.[22] Thus, these combinations of Ayurvedic oral medications are useful in treating the patient.
The modern treatments of TA have lots of adverse effects.[23] There is a need to watch liver profile at certain interval as changes in liver profile are more prominent during high dose steroid and mycophenolete mofetil administration. In the present case, ESR, serum glutamic-oxaloacetic transaminase and serum glutamic pyruvic transaminase levels were within normal limits after 1 year of Ayurvedic management. This may suggest the safety of Ayurvedic regime in this case. Pulse was noticeable in both upper limb and BP was measurable from upper limbs. This might be considered as remarkable improvement, since very few cases published in Pub Med reported this improvement even after using high doses of steroid.[23] It is now accepted that approximately half of patients of TA which are treated with steroids may respond.[24] There is uncertainty in success and also more side effects are associated with use of steroid, biological agents and mycophenolate mofetil. Apart from this multi-centric trial involving 34 patients for efficacy of abatacept (CTLA4-Ig)) in maintaining relapse-free survival of TA patients over placebo did not revealed any difference.[25] The primary aim of the Ayurvedic management was to control the disease activity and preserve vascular competence. ITAS 2010 scores were 4 or more than 4 during most treatment periods. This indicated that the disease was active. However low ITAS 2010 scores showed satisfactory response of the treatment. Ayurveda can only provide palliative management to this case of TA considering the incurable nature of the disease. However considering the uncertainty about complications of TA the case needed periodical imaging, cardiovascular assessment and surgical intervention if symptoms worsen. Arterial blood analysis must be done periodically which was lacking in this study due to patient’s reluctant nature and economic status. The patient was advised to consult annually. The condition of the patient was stable when she was lastly assessed. There was no worsening in disease condition. This was an important finding considering the prognosis of the disease. Understanding of the etiology and pathophysiology of the Siragata-Vata disease may be helpful in the context of TA which is mostly unknown. The findings of the case is important as it throws new light on the possible treatment of TA through Ayurvedic management. This case study shows that Ayurvedic management may be beneficial in the management of TA.
The case study shows that Takayasu arteritis (TA) was managed with Ayurvedic medication and Panchakarma procedures with satisfactory outcome. More studies are required to be done to confirm these findings and establish the place of Ayurvedic line of treatment in the management of TA.
Read Details : https://www.ayujournal.org/article.asp?issn=0974-8520;year=2020;volume=41;issue=2;spage=79;epage=86;aulast=Singh
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