Ayurvedic Treatment of Ascites – Ascites Causes, Symptoms & Diagnosis

Abstract

Ascites means fluid accumulation or fluid build up in the peritoneal cavity of our abdomen through various causes and origins. It is also known by the names as abdominal dropsy, peritoneal fluid etc. It can be cirrhotic as well non cirrhotic in nature. People with cirrhotic ascites have a 3 year mortality rate of 50 percent cases involved. The edema formation is the dysregulation of pressures between the internal and external systems of body. This can be due to hormonal issues also and also due to volume factors as described (dysregulation of capillary and vein pressures). The ascites formation can transgress to more of major complications like sepsis, SBP, hepatorenal syndrome etc which are life threatening. Let’s discuss it in detail!

INTRODUCTION

Ascites is the general pathological condition involving fluid buildup in the peritoneal cavity of the abdomen through various causes and origins. Peritoneum is the sheet in our abdominal wall having two layers and fluid builds up between these two layers. The most common is liver cirrhosis which accounts for 90 percent of this disease and has only a 3 year mortality rate. Due to rapid change in lifestyle and dietary factors the health of the liver and its echotexture is rapidly changing leading to cirrhosis and this ultimately develops into the ascitis condition. Non cirrhotic causes include carcinomatous changes, cardiac failures (right heart failures), kidney failure, pancreatitis and TB.

SYMPTOMS

• Shortness of breath
• Leg swelling
• Gynecomastia
• Abdominal distension with bloating and constipation
• Fatigue
• Back pain

CAUSES

• Liver cirrhosis (cirrhotic cause)
• Cardiac failure
• Kidney failure
• TB
• Infections
• Pancreatitis
• Carcinomatous cause

PATHOGENESIS

The dysfunction in liver function combines with portal hypertension to cause ascites. Portal hypertension is high pressure in the portal vein that delivers blood to your liver. The high pressure causes fluid to leak out of your veins into your abdomen and collect there.

DIAGNOSIS

• Saag (exudate vs transudate)
• Usg abdomen
• Ct abdomen
• Cbc, albumin levels, pt/inr, bt/ct

AYURVEDA VIEW ABOUT ASCITES (UDARA ROGA)

Though Ascites means fluid buildup in abdomen due to many causes but udara includes classification of modern ascites as well it’s complications (SBP and perforations with septic causes (Bhaddgaudara) with hepatic encephalopathy (tama pravesha) and ambuvaha sroto avrodh (hepatorenal syndrome)

These terminologies are well mentioned in Ayurveda classics of charaka and shushruta. Ayurveda has a broad understanding of ascites and its treatment followed by each type.

Samprapti (Etiopathogenesis)

• Occurs by 2 factors — AGNI NASHA AND MALA VRIDDHI
• Sortas involved —- Ambuvaha and sweda vaha srotas vikruti
• Dosha – Apana vayu and prana vayu vikruti

The Ayurveda view of Ascites is also multifactorial with deep understanding of its complications well written with individual treatment. The vata in amashya is blocked by kapha in pak vashya leading to retention of stool, faeces, urine , sweat etc.

MODERN CORRELATION WITH AYURVEDA TERMINOLOGIES

• Pancreatitis, acute hepatitis with liver cirrhosis can cause major enzymatic dysfunction leading to loss of appetite (kshuda nasha) and digestive functions and can lead to fluid build up.
• Mala vriddhi (liver and kidney failure mostly AKI with Hepatorenal syndrome) can cause fluid build up.
• Fluid build up can lead to symptoms of dyspnea (prana vayu vitiation) with apana vayu dysfunction leading to mutra sanga and varscha sanga (AKI /CKD), ambuvaha (AKI), swedavaha obstruction (conditions like hyperkalemia can occur)
• Hypersplenism and protein losing enteropathy is well mentioned in ayurveda classics (pleeha and grahani roga) in fluid build up inside the abdomen.
• Sroto Avrodh (portal system dysfunction by obstruction of vata by kapha leading to increased oncotic pressure)
• Aam formation from hemolysis (hyperbilirubinemia) and over nutrition (Hypertriglyceridemia) can also be the cause well mentioned in ayurveda.
• Vidha causing food items (alcohol or acidic food items)
• Chidrodara (perforation of intestines) leading to SBP complications are well written.

Symptoms (Ayurveda)

• Loss of strength (karshya) (protein losing enteropathy, hemolysis, TB etc)
• Swelling (Shotha)
• Raji jama (caput medusae, esophageal varices)
• Cullen’s sign with deranged PT/INR is well marked and explained in pleehodara in charaka samhita.
• Agni Nasha (bloating and constipation symptoms)

Precautions

• Limit alcohol intake
• Low salt intake
• Mild exercise (weight reduction)
• Limit fatty food articles.(sweets, potatoes, dairy products etc)
• Small gradual intake of water (1.2 L /day)

Home Remedies

• Kulattha intake (diuretic)
• Fennel seeds, cumin seeds
• Moong dal, fruit intake
• Laxatives and digestive promoters like triphala, hingu etc
• Hepatoprotectives like giloy, kutki etc

AYURVEDIC MEDICINES

1. Vasa Guduchyadi Kashayam – It is potent hepatoprotective agent and has tendency to act as hemostatic agent due to its tikta ras property. Mainly used for liver cirrhosis related esophageal varices and deranged PT/INR. It normalises SGOT/SGPT enzymes.
2. Dashmula Kashayam – It has anti-inflammatory properties and helps to reduce edema by acting on prostaglandin inhibitors thus reducing edema formation. Has a positive effect on the cardiac system as it reduces afterload and increases ejection fraction thus helps in heart failure conditions.It also reduces dyspnea and cough related to cardiac failure.
3. Punarnava Kashayam – It acts as a diuretic agent and also reduces afterload condition in heart failure and also helps in hepatorenal syndrome. It normalises potassium by its diuretic action (similar to furosemide).
4. Ichhabhedi Ras – It works on Apana vayu dysfunction (Cathartic action) and helps to eliminate retention of stool, urine etc. It eases bloating issues and also has a diuretic action.
5. Arogyavardhini Vati – It helps to ward off excessive fatty production and reduces triglycerides and cholesterol in our body. Also helps in NON-ALCOHOLIC STEATOHEPATITIS. Normalises SGPT levels through its anti-inflammatory property and also helps in elimination of retentive stools, urine etc. Also helps to decrease inflammatory markers like ESR.

Panchakarma

• Snehapana with vasa ghrita, mahatikta ghrita.
• Vamana with Mridu dravya is suitable in liver cirrhotic conditions with bleeding tendencies and esophageal varices.
• Gandharvahastadi tailam is best among this.
• Virechana is nitya type with ichchbehdi rasa, trivrt lehyam.