The document discusses the role of Panchakarma in managing ulcerative colitis, an inflammatory bowel disease characterized by chronic inflammation of the colon, and highlights various clinical features and complications. It outlines the pathophysiology, diagnosis, and treatment strategies including lifestyle changes, dietary recommendations, and Ayurvedic therapies, particularly Panchakarma techniques for effective management. Additionally, the document emphasizes the importance of individualized treatment based on patient condition and dosha balance in Ayurveda.

1. Role of panchakarma in
ulcerative colitis
-By Karuna Deswal

2. Introduction
Inflammatory bowel disease (IBD) is an immune-mediated chronic intestinal
condition,Ulcerative colitis (UC) and Crohn’s disease (CD) are the two major types
of IBD.UC is a mucosal disease that usually involves the rectum and extends
proximally to involve all or part of the colon.
About 40-50% of patients have a disease limited to the rectum and recto-
colitis.sigmoid, 30-40% have disease extending beyond the sigmoid but not
involving the whole colon and 20% have a total colitis.
Prevalence of IBD known to be high in western countries but now there is rising
incidence and prevalence of disease in India topping the Southeast Asian (SEA)
countries.

3. Aetiology
Genetic predisposition.
Environmental factors may trigger disease (viral or
bacterial pathogens, dietary).
Immunologic imbalance or disturbances.
Defect in intestinal barrier causing hypersensitive
mucosa & increased permeability.
Defect in repair of mucosal injury, which may develop
into a chronic condition.

4. Pathology
Ulcerative colitis is usually limited to the
colon. Typically, inflammation begins at the
rectum and continuously involves all or part of
the colon.
The transition to normal areas may be either
abrupt or gradual, and it may occur anywhere
from the rectum to the cecum.
Some cases only involve the rectum—often
called ulcerative proctitis. Less commonly,
isolated or discontinuous proximal segments
of disease may be identified at presentation—
also called patch colitis.

5. Pathophysiology

6. Site of involvement-Common site is rectum and
a part of sigmoid colon
Type of involvement- Continuous with no skip
areas
Ulcers in intestines- Superficial and
haemorrhagic
Appearance of intestinal mucosa- Polyps and
pseudopolyps present
Inflammation- Mucosal and submucosal
Width of mucosa- Normal or reduced
Differentiating pathological features

7. Clinical features
Diarrhoea with blood, mucus and pus (4-6 stools /day)
Pain abdomen and fever may be present in moderate to severe cases.
Increased bowel sounds
Crampy abdominal pain.
Anal area may be irritated & reddened
left lower abdomen may be tender on palpation.
remissions & relapses.
Increased risk of developing colorectal cancer.
Patients with severe disease have diarrhoea with tenesmus, anaemia,
weight loss present.

8. Complications-
Relapses or remissions- Common
Haemorrhoids/skin tag- Uncommon
Stricture/anal tissure- Less common
Abscess and fistulas- Less common
Carcinoma in situ- More common in long
standing cases.

9. Extra intestinal features
Eye (Uveitis, episcleritis, conjunctivitis)-
Common
Joints (arthritis, arthralgia, ankylosing
spondylitis)-Common
Skin (erythema nodosum, pyoderma
gangrenosa)- Less common
Liver (sclerosing cholangitis, hepatitis,
fatty liver)- Uncommon
Heart (AR, mitral valve prolapse)-
Common

10. Investigations
Laboratory Tests:-
Stool examination to rule out enteral pathogens; fecal analysis positive for blood during active
disease.
Complete blood count- hemoglobin & hematocrit may be low due to bleeding; WBC may be
increased.
Elevated erythrocyte sedimentation rate (ESR).
Decreased serum levels of potassium, magnesium, & albumin
Other Diagnostic Tests:-
Barium enema to assess extent of disease & detect pseudopolyps, carcinoma and strictures.
Proctosigmoidoscopy/colonoscopy
Rectal biopsy

11. Management-
General Measures:-
Bed rest, I.V. fluid replacement,
clear liquid diet.
For patients with severe
dehydration & excessive
diarrhea, fluid may be
recommended to rest the
intestinal tract & restore
nitrogen balance.
Treatment of anemia- iron
supplements for chronic
bleeding, blood replacement for
massive bleeding.
Drug Therapy
Sulfasalazine (Azulfidine)
Oral salicylates, such as mesalamine
(Pentasa), olsalazine (Dipentum)
Mesalamineenema available for
protosigmoiditis; suppository for
proctitis.
Corticosteroids- 5-aminosalicylic acid
preparations
Immunosuppressive drugs- purine
analogues, 6-mercaptopurine,
azathioprine
Antidiarrheal medications.

12. Surgical treatment-
I. Noncurative approaches-
Temporary loop colostomy
1.
Subtotal colectomy, ileostomy and hartmann's
pouch.
2.
Colectomy with ileorectal anastomosis.
3.
ii.Reconstructive/curative approaches-
Total proctocolectomy with permanent end-
ileostomy.
1.
Total proctocolectomy with continent ileostomy
2.
Total colectomy with ileal reservoir- anal (or ileal
reservoir-distal rectal) anastomosis
3.
The ultimate surgical goal is to remove the entire
colon & rectum.
4.

13. 1. Foods to limit or avoid-
-Dairy products
-Fibre rich food
-spicy food
-Alcohol
-Caffeine
2. Other dietary measures-
- Eat small meals
-Drink plenty of liquids
3. Stress,exercise, regular relaxation and
breathing exercises.
Lifestyle

14. According to ayurveda-
Agnimandhya is the root cause of this disease. In all kinds of Atisara, sign of Ama and pakva should be determined first. This
is the first line of Atisara treatment.
The basic principle to consider during treatment mentioned as Ama or Pakva features of the patient. Agni Dipana, Ama
Pachana, Grahi, Stambhana, Dhatu Poshaka, Sattvavajaya Chikitsa should be given according to the condition of the patient.
Keeping in mind the strength of the patient, In case of amavasta Langhana should be done first, then drinking of Yevagu
made with Deepan, Pachana drugs like sunthi, chitrak etc is beneficial.
Grahi drugs should be avoided in Amavastha condition as it may cause Pliha Vridhi, Pandu,anaha, Prameha, Kustha , Jwara,
Śopha,, Gulma , Grahani, Arsha,Shula, Alasaka, Hrid Graha.
According to the patient condition shamana and shodhana chikitsa is indicated. In Raktatisar basically Basti Karma is
indicated, among different type of Basti described in Ayurveda classics Pichha Basti is considered best for the treatment of
Raktatisara.

15. Samprapti of rakta atisara

16. Dosha- Pitta dominant tridosha
Dushya - Rasa, Rakta
Srotas- Purishavaha Srotas, UdakvahaSrotas,
Annavaha Srotas
Srotodushṭi- Atipravrtti
Agni- Jaṭharagni, Dhatvagni
Utbhavasthana - Pakvashaya
Samprapti ghatak-

17. Comparison of signs and symptoms of ulcerative colitis with pitta atisara,
rakta atisara and raktaj pravahika-

18. Management according to Ayurveda-
Shaman chikitsa-
1.Churna-
Madhukadi churna
Nagkeshar churna
Nilotpaladi yog
Powder of Yestimadhu, Shankha Bhasma, Black mud and Nagkeshar with honey or tandulodak.
Paste of black sesame mixed with sugar and honey followed by tandulodak.
Rasanjana, Ativisha bark, Indrayava, Haritaki, Sunthi, with honey followed by Tandulodak
2.Ghrita preparations-
Shatavri ghrita
Nyagrodhadi ghrita
3.Kashaya-
Kutajadi kashaya
Dadimadi kwatha
Dhanyapanchak kwatha
4.Ksheer- Kutaja ksheer
5.Rasa preparation- Karpura rasa
6.Parpati preparation- Vijaya parpati, panchamrit parpati
7.Vati- Kutajghana vati

19. Shodhana chikitsa-
Anuvasana basti-During chronic stage of the disease when Vata gets dominant in
Pakvashaya and inflammation occurs in anorectum due to vitiated pitta, Anuvasana
Basti (oily enema) is beneficial.
Piccha basti-Possible actions of Piccha Basti are –Shothahara and Vrana-Ropaka
(Anti-inflammatory and Ulcer-healing), Rakta stambhaka, Sangrahi / Stambhana,
Pitta Shamaka andagni deepaka.