KAMLA (JAUNDICE)

If the patient suffering from Pandu indulges in Pitta aggravating diet and regimen, the Pitta so aggravated burns the Rakta (blood) and Mamsa (Muscle tissue) to cause the disease Kamala [Jaundice].

SO, KAMLA TREATMENT IS SAME AS PANDU ROGA. 

Classification of Kamala

(Caraka) 1. Kosthashrita, 2. Sakhashrita, 3. Halimaka, 4. Kumbha Kamala.

(Sushruta) 1. Kamala, 2. Halimaka, 3. Kumbhahvaya, (Kumbha sahva), 4. Lagharaka (lagharaka-alasaka).

(Vagbhata) 1. Svatantra, 2. Paratantra, 3. Kumbha kamala, 4. Lodhara, 5. Alasaka[4]

1

LAKSHANA

Kosta-ashrita-

- Yellowish discolouration of nails,eyes,skin,mouth.

- Yellowish reddish discolouration of stool & urine

- Indigestion-weakness-sadan-aruchi-daha

- Skin colour like frog’s colour

Shakha-ashrita-

- Dark yellowish coloured eyes,nails,mouth,skin.

- White colour stool

- Consipation-atopa-agnimandhya-aruchi.

- Jvar-weakness-parshvshoola-hikka-svasa. 

SYMPTOMS OF KAMALA

Haaridranetrahasabhrushamhaaridratwaknakhaaananaha

Raktapeetashakrutmootrobhekavarnohataindriyaha

Daahaavipaakadourbalyasadanaaruchikarshitaha

Kaamalaabahu pitta ushakoshtashaakaaashrayahamataa (CharakaChikitsa 16/35-36)

• Haaridranetraha – eyes become turmeric coloured

• HaaridraTwak – Skin becomes turmeric coloured

• HaaridraNakha – nails become turmeric coloured

• HaaridraAanana – face becomes turmeric coloured

• RaktapeetaShakrut – Bloody red or yellow colour of faeces

• Raktapeetamutra – Bloody red or yellow colour of urine

• Bhekavarnaha – body looks like that of a ‘frog in rainy season’

• Hataindriyaha – destruction of sense organs and their capacity of perception

• Daaha – Burning Sensation

• Avipaaka – Indigestion

• Dourbalya – Weakness

• Sadana – tiredness, fatigue

• Aruchi – Tastelessness, anorexia

• Karshitaha – Emaciation

2

NIDANA

Kamala is produced by two different ways. - Excessive consumption of Paittika ahara & vihara by Pandu rogi or patient suffering from any disease and radically cured. - Use of excessive paittika ahara & vihara by disease free person i.e. the persons who have aggravation of Pitta.

- Kshar-Amla-Lavana-Atiushna-Virudha, Asatmaya Bhojana

- Atimadhyapana-divaswapna-maituna-vyayama-vegadharana

- Ritu vaimanasya

- Nishpava-masha,tila taila ati sevana

- Kama-chinta-bhaya-soka-krodha

- Ruksha-sheeta-guru-madhur dravya ati sevana

- Pandu rogi duara pitta vardhak bhojana sevana 

When the patient who is suffering from Pandu, during the process of recovery or after getting cured, consumes pitta aggravating foods and life activities in excess, the blood gets severely aggravated and burns the muscles.

This leads to the manifestation of Kamala vis-à-vis jaundice. Since the disease manifests on the backdrop of neglected or improperly cured Pandu roga, the same causes which cause Pandu roga are also the causes for Kamala.

3

VISHISTA NIDANA(CHARAKA)

If the patient suffering from Pandu indulges in Pitta aggravating diet

and regimen, the Pitta so aggravated burns the Rakta (blood) and

Mamsa (Muscle tissue) to cause the disease Kamala [Jaundice].

The signs and symptoms of Kamala are as follows:

Haridra Netra – yellowish discolouration of sclera of eyes

Haridra twak, Nakha,

Anana – yellowish discoloration of skin, nails and face

Urine and feces turns red and yellow

Bheka Varna – He develops complexion like that of a frog

Hatendriya – sense organs are impaired and

Daha – burning sensation Avipaka,

Aruchi – indigestion, anorexia

Daurbalya, Sadana – weakness, bodyache

Kamala disease is caused by excess of Pitta. It is of two types- Koshtashrita Kamala – one is located in the gastro- intestinal tract ( Shakhashrita Kamala – located in the peripheral tissues (Sakhashraya).

4

SAMPRAPTI

Though Kamala shares similarity with Pandu in Nidana and Samprapti, it has its own Samprapti in the evolution of disease. When Pandurogi, Pitta predominant person or Patient cured of Pandu or any disease, intake of Pitta vardhaka ahara then Excessive aggravation/ vitiation of Pitta occur; this further lead to Kosthashrita Kamala, Kosthasakhashrita Kamala and Sakhashrita Kamala.

1)Nidana sevana-> Pitta prakopa-> rasa mamsa ati dushan-> kamla roga

2)Guru-sheet-madhuradi nidan sevana-> kapha vradhhi-> marga avrodha->vata prakopa-> vayu duara pitta ko shakha me fekana-> tvach,netra,nakha pitta varna->mala sveta varna->shakhashrita kamla 

5

PURVARUPA

Prodromal symptoms have not been mentioned separately for Kamala, but Acarya Caraka and Sushruta included general Purva rupa of Kamala within the Panduroga. The general prodromal features by Acarya Sushruta -

1.Tvaka sphotanam (cracking of skin),

2.Sthivanam (salivation or spitting),

3.Gatrasada (lassitude),

4.Mridbhakshana (desire for eating clay, pica),

5.Preksana kuta sotha (swelling of eye lids),

6.Pita mutra and vit (yellow urine and stool),

7.Avipaka (indigestion).[5]

According to Caraka:

1.Nissara (devoid of strength),

2.Alparakta (Anaemia),

3.Alpa medasa (Hypo activity of bone marrow),

4.Gatra vaivarnya (discoloration),

5.Sithilendriya (lack of interest).[

6

PROGNOSIS

Initial stage of Kamala is sadhya. On long standing becomes kricch-sadhya if asadhya lakshana develop it become asadhya (incurable).[11]

Asadhaya lakshana Kamala roga (Incurable status)

1) Krishna peeta purisha 2) Krishna peeta mutra 3) Sotha 4) Sarakta Netra and Mukha, chardi, pureesha, mutra, 5) Murcha 6) Daha 7) Aruci 8) Trishna 9) Anaha 10) Tandra 11) Moha 12) Nashtagni 13) Nasthagni sangya.[12][13]

Asadhya lakshana of Kumbha kamala

1) Vamana 2) Aruci 3) Hrillasa 4) Jvara 5) Klama 6) Svasa 7) Kasa 8) Vid-bheda[

7

SAMPRAPTI GHATAKA-

DOSHA- pittapradhana tridosha

DUSHYA-rakta,jeernavastha me mamsa

ADHISTHANA- tvak,netra,nakha,putra

SHROTAS- ratvaha

SVABHAVA- chirkari

SADHYAASADHYATA- Sadhya

8

UPADRAVA

- Kumbh-kamla

- Halimaka 

9

PRICIPAL OF CHIKITSA 

(CHARAKA)

The patient suffering from Kamala (jaundice) is given Virechana – purgation therapy with mild and bitter medicines. After the gastro-intestinal tract is cleansed by the above mentioned elimination therapies, patient is given wholesome food containing old rice, barley and wheat mixed with the Yusha (vegetable soup) of Mudga (green gram), Adhaki (pigeon pea) and Masura (lentil) and the Jangala Mamsarasa (meat soup) of animals inhabiting arid zone. On the basis of Doshas aggravated to cause these diseases, specific medicines are to be administered to these 2 categories of patients (which will be described later in this chapter) For the purpose oleation,

the patient suffering from Pandu Roga (Anemia) and Kamala (Jaundice) is given

Panchagavya Grutha,

Maha-Tikta Ghruta and

Kalyanaka- Ghruta.

A. Sodhana (Purificatory therapy) - Snehana virecana

B. Sanshamana (Palliative therapy) - Kapha pitta haranama cikitsa As the Kamala is classified into two groups the main line of treatment for Sakhashrita Kamala needs special emphasis because malaranjaka pitta is situated in Sakha therefore Virecanadi karma will not be effective till dosha are not brought to the kostha.[17] So Caraka has mentioned especially some measures to bring dosha from kostha to sakha. There are five measures - 1) Vridhyat, 2) Vishyandanat, 3) Pakata, 4) Srotomukhovishodhanata, 5) Vayu nigrahat

Management of Kamala

In Ayurvedic texts scholars with their treasure of knowledge and experience have scientifically explained the principles of management of Kamala. Acarya Caraka has mentioned “Kamale tu virecanam” i.e. purgation therapy with mridu and tikta dravyas. Acarya Sushruta mentioned drug and dieted regimens. Acarya Vagbhata quoted “Kamalayam tu pittaghnam Pandurogavirodi yat” i.e. drugs which pacify Pitta and drugs which do not interfere with Panduroga should be used.[16] The principle of management of Kamala can be classified in a broad sense (1) Samshodhana (2) Samshamana.

Treatment of Sakhashrita Kamala

Ruddhapatha Kamala needs different principle of management, since malarupa pitta is in the Sakha and Virecana will not be effective till dosha are brought into kostha (Mahasrotasa). Here Kapha which obstructs the path of Pitta, should be treated primarily thereafter Pitta should be alleviated. The recipes which alleviate Kapha, like katu, ruksha, amla, teekshna and usna drugs have to be administered. 1. Soup of peacock, teetara (partride), and cock and sushkamulaka, kulattha, 2. Matulunga svarasa with honey, pippali, maricha and sunthi have to be given, 3. By giving these drugs Pitta is brought in kostha and then Pittahara cikitsa is done.[20]

Duration of treatment (Mukta Kamala lakshana) Treatment should be continued till the stool of patient acquires the colour of Pitta and Vayu is alleviated. When Pitta reaches svasthana (kostha) and patient is relieved of upadrava, earlier line of treatment should be resumed.

10

SODHANA CHIKITSA 

1. Snehana

By using medicated ghrita like Panchagavya ghrita, Kalyanaka ghrita, Draksha ghrita, Mahatikta ghrita, Haridradi ghrita & Dadima ghrita etc.

Svedana is contraindicated in Kamala. ******

Virecana should be done by tikta and mridu dravya the following are advised by Caraka in Panduuroga cikitsa.[17] 1. Aragvadha phanta with sunthi, pippali, marica, bilva, along with the svarasa of ikshu, vidari and amalaki, Gomutra haritaki.[18] 2. Dantimula kalka and guda with cold water 3. Triphala kwatha with trivrit kalka 4. Triphala kvatha, Guduchi svarasa, Daruharidra kvatha or Nimba patra svarasa with Madhu in the early hours.[19]

Samshamana

After Virecana karma, Samshamana drugs are to be administered. They can be given as single drugs or compound drugs. Single drugs proved to be very effective and are substantiated by various clinical and experimental trials. (Table 2) The actions of the samshamana drugs were Pitta hara / Tridoshahara Pitta recana (Choleratic), Yakrid uttejaka (Liver stimulant), Dipana (Appetiser), Recana (Purgative), Sothahara (Anti-inflammatory), Jvarahara (Anti-pyretic), Rakta shodhana(Blood purifier), Rasayana (Geriatric), Sroto shodhana (Channel purifier).

Pathya(DO):

Palak, louki,muli,bathua, kaccha papita, kaccha kela, aalu, amla, dadima, munakka, anjeera, purana chaval papita, wheat, java, arhar,munga, masura, parval, goghrita, godugdha, takra, saka, paha aam

Virecha,snehan,agnikarma,vishram

Apathya(DON’T):

Vidahi,guru, sarso tail,udad,pan, garam masala, rai, hing, tila, matar,

Raktmokshana,dhumapana, vaman, svedana, divaswapna, vyayama, atimatra taila-ghrita sevana.  

HERBAL FORMULATIONS FOR PANDU AND KAMALA

Haritaki kalka – Paste of Terminalia chebula with Gomutra (urine of cow)

Argwadhakalpa –

• Pulp of Aaragwadha (Cassia fistula) mixed with powders of shunti (ginger), pippali (long pepper) and maricha (black pepper)

• Pulp of Aaragwadha (Cassia fistula) mixed with ikshurasa (sugarcane juice

• Pulp of Aaragwadha (Cassia fistula) with vidari rasa (juice or decoction of Pueraria tuberose)

• Pulp of Aaragwadha (Cassia fistula) with Amalaka rasa (juice of Gooseberry fruit)

• Pulp of Aaragwadha (Cassia fistula) with Bilwapatraswarasa (juice of Aegle marmelos)

Trivritkalka – paste of Trivrit (Operculinaturpethum) with TriphalaKwatha (decoction of 3 fruits of Terminalia chebula, Terminalia bellirica and Emblicaofficinalis)

Triphalakwatha – Decoction of Haritaki (Terminalia chebula), Bibhitaki (Terminalia bellirica) and Amalaki (Emblicaofficinalis) mixed with honey

Guduchiswarasa – Decoction or juice of Guduchi (Tinosporacordifolia) mixed with honey

Daruharidra rasa – Juice or decoction of Daruharidra (Berberisaristata) mixed with honey

Nimba rasa – juice of neem leaves mixed with honey

Godugdha (milk of cow) mixed with Go mutra (urine of cow)

Mahishadugdha (milk of buffalo) mixed with Mahishamutra (urine of buffalo)

Triphalakwatha (decoction of 3 fruits, Haritaki, Bibhitaki and Amalaki) mixed with gomutra (urine of cow)

GomutraHaritaki – powder of Haritaki (Terminalia chebula) mixed with gomutra (urine of cow)

Mandura yoga– Mandurabhasma (Iron oxide or Ferric oxide calx) mixed with puranaguda (old jaggery), shuntichurna (ginger powder), tilachurna (sesame powder) and pippalichurna (long pepper powder)

Darvyadileha – Powders of Daruharidra (Berberisaristata), Haritaki (Terminalia chebula), Bibhitaki (Terminalia bellirica), Amalaki (Emblicaofficinalis), Shunti (ginger), Pippali (long pepper), Maricha (black pepper), Vidanga (Embeliaribes) and LohaBhasma (iron calx or ash) mixed in ghee and honey so as to make their confection

Ayorajadi yoga – ayoraja (iron calx), powders of Haritaki (Terminalia chebula) and Haridra (turmeric) mixed in ghee and honey

HaritakiChurna – powder of Haritaki (Terminalia chebula) mixed with guda (jaggery) and madhu (honey)

Triphaladi Yoga – Powder prepared using Haritaki (Terminalia chebula), Bibhitaki (Terminalia bellirica), Amalaki (Emblicaofficinalis), Haridra (turmeric), Daruharidra (Berberisaristata), Katuki (Picrorhizakurroa) and Lohabhasma (ash of iron) mixed in honey and ghee.

USEFUL KASHAYA FOR JAUNDICE

VASA GULUCHYADI KASHAYA – Contains Neem, Guduchi, Licorice, Vasa, Kataka – Strychnospotatorum and Amrutavalaka / Hribera – Pavoniaodorata

It is recommended to be used along with honey.

NIMBADI KASHAYA / NIMBATWAGADIKASHAYAM –

Ingredients –

• Nimbatwak – bark of Azadirachtaindica / neem tree

• Triphala – fruits of Terminalia chebula, Terminalia bellirica&Emblicaofficinalis

• Patola – Trichosanthesdioica

• Rajani / Haridra – Curcuma longa / turmeric

• Vasa – Adhatodavasica

• Amruta – Tinosporacordifolia

• Sariva – Hemidesmusindicus

• Shyama – Ocimumtenuiflorum

• Tamalaki / Bhumyamalaki – Phyllanthusniruri

• Palamkasha / Gokshura – Tribulusterrestris

• Bala – Sidacordifolia

• Nili – Indigoferatinctoria

• Sthira / Prishniparni – Urariapicta

• Yashti – Glyzyrrhizaglabra

It is should be consumed mixed with honey, powder of long pepper and Shilajatu i.e. Asphaltum for five days.

Indications – Kumbha kamala &Halimaka i.e. complicated stages of jaundice

YASHTIVASADI KASHAYA

Ref – Sahasrayogam, ParishishtaPrakarana, Kashaya

Ingredients –

• Yashtimadhu – Glyzyrrhizaglabra

• Vasa – Adhatodavasica

• Amruta / Guduchi – Tinosporacordifolia

• Balaka / Hribera – Pavoniaodorata

• Kataka – Strychnospotatorum

• Hatha / ArdraAmalaki – Emblicaofficinalis

• Ikshu – Saccharumofficinarum

• Gokshura – Tribulusterrestris

Method of administration – The decoction prepared with the above said ingredients should be administered internally early in the morning.

RASODHI/BHASMA/PISTI-(120-250MG WITH MADHU/USHNODAKA)

- Navayas loham-(triphala,trikatu,trimada,loha)

- Dhatri loham-(amla,loha,trikatu,haridra)

- Nisha loham-(loha,haridra dvya,triphala,kutki)

- Vidangadi loham-(vayvidanga,triphala,trikatu,pippali,loha)

- Darvyadi loham-(daruharidra,triphala,trikatu,vidanga,loha)

- Yograja-(triphala,trikatu,trimada,shilajitu,svarnamakshik,rajatmakshik,loha)

- Shilajatu vatak-(indrayava,triphala,patolpatra,musatk,shilajatu)

- Icchabhedi rasa-(sunthi,marich,parad,gandhak,tankan,jaypal)

- Punarnava mandur-(punarnava,mandur,nisotha,trikatu,vidanga,triphala,danti)

- Mandur vatak-(triphala,trikatu,trimada,daruharidra,svarn makshika,mandur)

- Pranavallabh rasa-(hingul,parad,gandhak,kesar,loha,tamra,karpada,suddha tatya)

VATI-(250-500MG WITH USHNA JALA)

- Arogyavardhani vati-(triphala,shilajatu,trikatu,kutki,parad,gandhak,loha,abhrakh,tamra)

- Panchanan vati-(parad,gandhak,tamra,gugglu,jaypal)

CURNA-(3-6GM WITH MADHU/USHNODAKA)

- Darvyadi curna-(daruharidra,triphala,trikatu)

- Triphala curna-{haritaki(harad),bhibhitaki(behda),amla(amlaki)}

- Vishaladi curna-(indrayana,kutki,motha,meetha kuth)

- Motha curna-(mustak,loha)

KAVATH/ASAV/ARISHTA-(20-40ML WITH SAMABHAG WATER)

- Atrusadi kvatha-(adusha,draksha,harad)

- Phalatrikadi kvatha-(triphala,vasa,guduchi,kutki,chirayata)

- Beejakarista-(vaijaysara,triphala,munakka,triphala,trikatu)

- Kumaryasava-(ghrita kumari,chirayata,kutki,chitrak,mustak,trikatu)

- Vasakadi kvatha-(vasa,guduchi,nimba chala,chirayata,kutki)

- Draksharista-(draksha,mahua,dhatki,triphala,amlaki,trikatu)

GHRITA-(10-30ML WITH USNODAKA/DUGDHA)

- Panchtikta ghrita-(guduchi,nimb,vasa,chirayata,patol,ghrita)

- Drakshadya ghrita-(ghrita,manukka)

- Haridradhya ghrita-(haridra,triphala,neem,mulethi,ghrita)

- Vayoshadhya ghrita-(trikatu,bilva,haridra,ghrita)

- Danti ghrita-(danti,ghrita)

- Katukadhya ghrita-(kutki,mustak,haridra duya,indrayava,patol)

- Dadima ghrita-(anardana,dhaniya,trikatu,ghrita)

AVLEHA/PAKA/KHANDA-(15-20GM WITH DUGDHA)

- Amalkyadi leham-(amla,manukka,pippali,mulethi)

- Dravyadi leham-(daruharidra,triphala,trikatu,vidanga,loha)

- Dhatriyavaleham-(vanshlochan,sonth,mulethi,pipper,manukka,amla)