Dr. Amritha Edayilliam
Dept of PG studies in kayachikitsa
Management of Chronic Kidney Disease with
Rookshana involving Udwarthana and
Triphaladi lekhana basthi- A case study
• Name : Mrs. XYZ
• Age : 59 years
• Sex :Female
• Socio-Economic status : Rich
• Marital status :Married
• Education :Graduate
• Occupation : housewife
• Date of Admission
• Date of discharge: 4/6/2016
• Address : Hyderabad
•Pain and burning
sensation while micturition
since 1 month.
•Fatigue since 4 years
aggravated since 1month.
•Puffiness of face on and off
since 4 years aggravated
since 1 month.
• Feeling breathlessness while
walking for short distance
since 4 years,
aggravated since 1 month.
• Giddiness while getting up from
bed, walking- since 10 years
aggravated since 1 month.
• Back pain
• Numbness over left lower limb on and off.
• Reduced appetite.
• Nausea on and off.
• Incomplete evacuation.
• Increased frequency of urine.
Since 4 years aggravated since 1month.
• Patient is a k/c/o hypertension since 10 years and CKD since 4
years. All relevant blood examination done showed raised creatinine,
low GFR. For which medication was started. 1 month back suddenly
she developed fever with chills along with painful and burning
sensation while micturition. It was a squeezing type of pain which
develop prior, during and even after voiding the urine associated with
burning sensation. She developed puffiness of face (no periorbital
swelling)and swelling over bilateral feet persisting throughout the day
and lasting up to 3 days or more. For which they consulted their
physician and given symptomatic treatment. By which fever and
swelling over feet subsided. Puffiness of face, burning sensation and
painful micturition persisted. 6
HISTORY OF ILLNESS
• Simultaneously patient developed complaints of tiredness through
out the day, needs support to get up from bed, walking, climbing steps,
breathlessness while walking for short distances(from bed to till door)
, feeling sleepiness after taking a little quantity of food, no interest to
do any activities, reduced appetite and nausea. Pt also complaining of
backpain(lumbar region) non radiating which she feels like originating
from deep inside and numbness of left leg which will be during early
mornining, sitting for long hours.
• As she is undergoing regular checkup and taking treatment for CKD,
her consultant advised to start with dialysis as the kidney function tests
were much hampered.
• H/o haemorrhage in right eye
treatment for the same 6 year
• H/o cataract in left eye 4 yr back
operated for the same.
• H/o Asthma in the year of 1987
subsided in same year.
• H/o headache for 20 yrs- used to
• H/o Herpes 3 year back.
• H/o chicken pox age of 7.
• H/o UTI 1 year back
• Not a k/c/o DM, Hypothyroidism,
• Menarche at the age of 13.
• Menopause at the age of 45year (
• H/o severe menstrual bleeding,
for 6 years with dysmenorrhea.
For which she used to take
Meftalspas continuously for 15
days in the dose of 3 tab/day for 1
and ½ year along with brufen
• P8 A6 L2 D0.
• All are induced abortions
• P2- Female age- 37 year
• P8- Female age-32 year.
• No h/o tubectomy done.
• H/o copper T contraception for 2
Menstrual history Obstetric history
• H/o 3 D&C in between 2002-
• On medication
• Tab Twincal BD
• Tab Prazopress XL 2.5mg OD
• Tab Dytor OD
• Tab Alpha ketoanalogue TID
• Tab PTH cinacalcet OD
• Tab Refil OD
• Cap. Oferol 0.25mg OD
• Epofit injection(weekly once)
• Cap. Rencap OD
• There was no family history
pertaining to the present illness.
Treatment history Family history
• Diet - Mixed,
Nonveg – twice/week
• Appetite - reduced
• Sleep - disturbed
• Micturition – hourly once (10 times/day, 8 times/night),urgency +
• Bowels - once/day, hard stools (No clear evacuation)
• Sleeping after lunch >2 hours.
• Chilled softdrinks such Fanta, cococoala daily. 11
• A female patient obese built moderately nourished and afebrile, is
oriented to time place and in person
• P+ E0 N- transverse lines C0 Io L0
• Tongue - non coated
• Pulse - 75 BPM
• B.P - 150/100 mmHg
• Temp - 98.6° F
• Respiratory rate - 18/min
• Height -150 cm
• Weight - 73kg
• BMI - 32.4
• Shape of abdomen- Distended
• Umbilicus- inverted , centrally
• Tenderness – Epigastrium
• No rebound tenderness.
• No organomegaly
• Percussion and auscultation-NAD 14
Kidney &Urinary system
• Bilateral NVBS heard,
• Crepitation heard over right and left
• S1 & S2 heard, no added sounds
Tenderness over L1,L2, L3.L4
• Pradushta ahara,teekshna ahara,
• Ati amla,katukahara,
• Jalaja anoopamamsasevana,
• Ati Snigdaahara
• Abhishyandi bhojana
• Divaswapna, avyayama
• Meftalspas 3 tab/day for 1 ½
• Brufen (monthly thrice) for 25
• Painkillers for headache for 20
• Chintyanam cha atichinthanath
Tiredness Breathlessness Anorexia Nausea
0. no tiredness 0. No
0. Takes full diet and also
presence of proper appetite at
the next meal hour.
0. no nausea
1. Presence of moderate
apetite and proper appearance
of appetite in next meal hour
1. less than 2
on light physical
2. Presence of moderate
apetite but delayed appearance
of appetite in next meal hour
2. 2-5 times
tiredness all the
3. presence of low appetite
and delayed appearance of
appetite in next meal hour
3. >5 times
• On 31/5/16
• Blood urea- 87.6
• Puffiness of face reduced 50%,
• Tiredness reduced 40%,
• No pain and burning sensation
• Back pain reduced 95%.
• Bowel- complete evacuation
• Bladder- 6 times/day, 4 times at
night.(complete evacuation) no
• On 4/7/16
• Blood urea- 75.6mg/dl
• S .creatinine – 7.4 mg/dl
Tiredness 3 2
Anorexia 3 1
Nausea 3 1
Blood urea 106.3mg/dl 75.6mg/dl
• Chronic kidney disease is progressive loss in renal function over a
period of months or years and is caused by any condition which
destroys the normal structural properties possibly help to transport the
drug molecules in the systemic circulation through mucosa.
• The treatment modality adopted here based on the dosha dushya
• Since the patient was mamsala medura and dosha involved was kapha
pitha, rookshana was done in the fom of udwarthana , takradhara and
lekhana basti was selected.
• The drugs selected for lekhana basthi are capable of liquefying viscid
matter and breaking into minuteminute particles ang helping in
doshavilayana. Along with that Saindhava lavana helps in removal of
doshas by its lekhana property.
• Triphala is rich source of galic acid, tannins exhibits anti oxidant anti
inflammatoryand detoxification activities. It is rasayana, tridoshahara,
amapachaka action which helps in rejuvenating damaged capillaries
apart from improving blood circulation and GFR.
• Katuki help to bring collective benefits for its pitha rechaka and
kaphahara action. Varunadi Kashaya which mentioned as varunaadi
gana which possess the quality of kapha medo hara and
agnipradeepana, the contents of veeratharvadi Kashaya which
mentioned as veeratharvadi gana possesses quality like mootrala and
acts on mootrakruchra mootraghata rujahara.
• Presence of pippali in pippalyasava enhances the bio availabilioty and
thus allowing the faster penetration of phytomolecules. Bhringaraja in
bringarajasava act as anti inflammatory antimicrobial activity thus
pacifies chronic, non specific UTI with CKD
• In this case Basthi is very much effective in improving the kidney
functions and basthi dravyas and shamanaoushadis used in this case
having srothovishodhana property.
• This treatment approach is safe and effective in cases of CKD, Further
studies to be conducted to establish the facts with more statistical and