Treatment and Prevention of Chylous Ascites Through Ayurveda

ABSTRACT

Chylous ascites is a condition in which there is leakage of lymph(Rich in lipids) into the peritoneal cavity. It is one of the rarest forms of ascites. This condition was first reported in 1912. People of all age groups are affected by this disease but it is more common in adults in their late 40s. The prognosis of chylous ascites is easier in children and adults who have undergone surgery or trauma whereas adults in their late 40s have a poor prognosis. There are various factors that can cause leakage from the lymphatic system. Chylous ascites can lead to malnutrition and poor immunity. Increased alcohol intake, electrolyte imbalance, age, and tumours are some of the risk factors associated with Chylous ascites.

INTRODUCTION

Chylous ascites is defined as triglyceride-rich(usually greater than 200mg/dl) peritoneal fluid in the abdominal cavity. The fluid appears like milk which is rich in proteins and immunoglobulins that become pathologically unavailable to the body after accumulation in the peritoneal cavity which leads to dehydration, and malnutrition in other parts of the body. Chylous ascites occur as a result of portal etiologies or non-portal etiologies. PHTN(Portal Hypertension) is the most common cause of chylous ascites. The hepatic venous pressure gradient (>5mmHg) is an indicator that shows that PHTN is the cause of Chylous ascites. Other etiologies may include leakage of lymph from the fistula into the peritoneal cavity through dilated retroperitoneal vessels that can be acquired or congenital. Patients may complain of shortness of breath, weight gain, edema, abdominal distension, and increased abdominal pressure.

1. Injuries to the lymphatic system
2. Lymphatic obstruction
3. Tumours
4. Pulmonary hypertension
5. Elevated venous pressure
6. Underlying inflammatory condition
7. Lymphoperitoneal fistula

SYMPTOMS

1. Abdominal Distension
2. Abdominal Pain
3. Bipedal edema
4. Decreased urine output
5. Weight loss/ gain
6. Edema
7. Anorexia
8. Dyspnea
9. Night sweats

DIAGNOSIS

Chylous ascites is diagnosed by the presence of milky fluid in the abdominal cavity through the following investigations:

1. Paracentesis
2. Routine blood investigations(CBC)
3. Lipoprotein electrophoresis
4. Cytology and peritoneal biopsy
5. Ultrasound of abdomen
6. CT of abdomen
7. Lymphangiography
8. X-ray and MRI

AYURVEDIC OVERVIEW

According to the Ayurvedic point of view, Chylous ascites is a tridoshaj condition (involving vata, pitta, and kapha) with the predominance of Vata and Kapha. Reduced agni (digestive fire) leads to the formation of ama and  blockage of channels causing kapha to accumulate in the peritoneal cavity under the action of vata. Udar Shoola (abdominal pain), Aruchi (Loss of appetite), Guruta (heaviness), and ang daurbalya (weakness) are the clinical features seen in Chylous ascites. Procedures like Swedana ie. Sedation, Diuresis, Nitya Mridu Virechana ie. regular use of mild purgatives are used. Herbs like Punarnava, Pippali, Haritaki, etc are used along with herbs that are carminative and hepatoprotective in nature. Dietary measures like decreasing salt intake and only milk diet is recommended.

TREATMENT

Ayurveda gives effective results in Chylous Ascites by treating Agni (Digestive fire) and unbalanced Dosha. Through Nidana Parivarjana (avoiding causative factors), Agni Deepan (Provocation of digestion), and Nitya Virechana (daily therapeutic purgation followed with sodium restriction Chylous ascites can be managed. Further Treatment of Chylous Ascites is given below:

Herbal formulations include

Powders: Patola Muladha Churana, Narayan Churan, Yakritaplihantak churan.

Vati: Arogyavardhini vati, Punarnava Mandoor Vati.

Ghrita: Panchakola Ghrita, Chitrak Ghrita, Nagaradi Ghrita.

1. Herbal Drugs like Punarnava, Brihata Panchamoola, Shunthi, etc.
2. Snehan(Oleation): It is used before the Panchakarma treatment. Dashamoola oil and Narayan oil is used in oleation therapy.
3. Swedana (Sedation): Swedan is done to remove toxins accumulated in circulatory channels.
4. Virechana (Purgation): In Virechan there is induction of purgation to remove toxins from the body. Nitya Virechan is given in ascites. Castor oil with rock salt, and castor oil with Triphala kwath, Kutki, Mustaka, and Trivrita are used for Nitya Mridu Virechan.
5. Shastra Karam: It is a surgical procedure done using an instrument. An incision is given on the left side of the abdomen below the umbilicus. A metallic tube is inserted through a puncture and accumulated fluid is drawn out. All the accumulated fluid is not drained out once and this procedure is repeated again. Administration of water is strictly prohibited after Shastra Karama.
6. Kshara: The patient is given Tikshana Kshara with Gaumutra.

HERBAL REMEDIES FOR CHYLOUS ASCITES BY PLANET AYURVEDA

Planet Ayurveda provides the best combination of effective herbal remedies like Punarnava Capsules, Shothari Capsules, Tribulus Powder, Indian Echinea, and Yakritaplihantak Churan for the management of Chylous Ascites. For natural and herbal treatment always look for natural products which contain pure extracts and are formulated under GMP guidelines. Planet Ayurveda products are scientific and certified. They are free from any chemicals, additives, and preservatives. Planet Ayurveda products are formulated by MD Doctors and are 100% natural, pure, and free from side effects. Planet Ayurveda offers the following herbal remedies for the management of Chylous Ascites.

PRODUCT DESCRIPTION

1. Punarnava Capsules

Punarnava Capsules is a herbal formulation that contains Punarnava(Boerhavia diffusa). According to Ayurveda Punarnava is considered a good diuretic (Mutra verachaniya). It is Madhura (Sweet), Tikta (Bitter), Kashaya(Astringent), in rasa (taste). It also balances Pitta, and Kapha and relieves Shotha (Edema), water retention. Punarnava is extensively used in Udar roga, Shotha (Edema), kidney disorders, and blood-related disorders.

Dosage: Two capsules twice daily with plain water after meals.

2. Shothari Mandoor

Shothari Mandoor is an effective herbal preparation that contains Mandoor bhasma(calx of iron), Haritaki (Terminalia chebula), Vibhitaki (Terminalia billerica), Amalaki (Emblica officinalis), Shunthi (Zingiber officinale), Nirgundi (Vitex nigundo) and many other herbs. Ingredients present in Shothari Mandoor balance all three doshas. It is anti-inflammatory and good for liver health. This medicine is used for the treatment of anemia, and edema associated with ascites.

Dosage: Two tablets twice daily with plain water after meals.

3. Tribulus Power

Tribulus power is a standardised ayurvedic formulation that contains Gokshura(Tribulus terrestris). Gokshura is known for its diuretic (Mutra verachaniya) function. It balances all three doshas (Vata, Pitta, and Kapha). Gokshura removes excess water present in the body through urine. It manages a number of diseases like ascites, diabetes, urine retention, kidney disease,  heart disease, etc.

Dosage: One to two capsules twice daily with plain water after meals

4. Indian Echinacea

Indian Echinacea is a herbal formulation that contains Indian Echinacea (Andrographis Paniculata)/ Kalmegh. According to Ayurveda, Kalmegh is Yakritya (Hepatoprotective) in function. It is tikta (bitter) in rasa and Pitta pacifying. Kalmegh helps in managing Pitta vikar (Pitta disorders), liver diseases, and burning sensations.

Dosage: One capsule twice daily with plain water after meals.

5. YakritPlihantak Churna

YakritPlihantak Churan is a wonderful formulation that contains Bhumiamla (Phyllanthus niruri), Bhringraj (Eclipta Alba), Kalmegh (Andrographis paniculata), and many other ingredients. This powder helps in managing increased SGOT and SGPT. Yakrit Plihantak churna reduces the increased size of the liver and spleen. It manages liver disease, fatty liver, alcoholic liver disease, and ascites due to liver disease.

Dosage: One tablespoon twice daily with plain water after meals.

CONCLUSION

Chylous ascites is a rare disease that should be taken seriously by treating the cause of disease with conservative measures like dietary restrictions and addition of medium-chain triglycerides in the diet. Ayurveda takes a very holistic approach to manage Chylous Ascites through Panchakarma and herbal medicines that are hepatoprotective in nature.