1

INTRDUCTION

The etiopathogenesis of yakritodara and plihodara are similar except the anatomical location. It is classified into five types as vataja, pittaja, kaphaja, sannipataja and raktaja and again based on the etiopathogenesis it is classified into chyuta and achyuta yakrut vriddhi. One by chyuta (displacement) and other by achyuta vriddhi (not displaced). Chyuti means displacement from its own place. In achyuta type, dusta rasadi dhatu is considered in the pathogenesis of yakrutodara/pleehodara. Vardhaman Pliha (There will be progressive enlargement of the Yakrit/Pleeha. Liver/spleen becomes stony hard initially and on palpation feels like a tortoise back and if neglected the enlarging yakrit puts pressure and expands over the kukshi, remaining part of the abdomen and agniadhisthana, dourbalya (debility), arochaka (lack of taste in the mouth), avipaka (indigestion), varchagraha (Constipation), mutragraha (Retention of urine), tamapravesha(Darkness infront of the eyes), pipasa (excessive thirst), angamardha (malaise), chardi (vomiting), moorcha (Transient loss of consciousness), angasada (Tiredness of body parts), kasa (cough), swasa(dyspnoea), mridu jwara (mild fever),anaha (flatulence), agninasha(loss of appetite), karshya (emaciation), asyavairasa (abnormal taste in the mouth), parvabheda(pain in joint of the digits) ,Koshtashoola(abdominal pain),Vatashoola (abdominal pain due to morbid vata), Udara arunavarana (red discoloration of the abdomen) Udara vivarna, (discoloration of the abdomen) udara neelaharitaharidra raji (appearance of network of veins having blue, green or yellow color).[8]

Sneha-swedana, virechana, niruha and anuvasana basti is advised. Siravyadhana in left arm is also a part of its treatment. Pippali, guda haritaki, kshara and arishta preparations are used. Pippali Vardhaman rasayana can be prescribed.

Pleehodara, according to Ayurveda is one among the eight types of Udara Roga i.e. abdominal enlargement. When spleen enlarges beyond normal dimensions, it presents as an abdominal enlargement. Pliha means spleen. Udara means abdomen. Therefore Plihodara means enlargement of spleen in the abdomen causing its enlargement. It is often called as just Pliha.

If the word Pliha is used in the context of explanation of disease it means ‘enlargement of spleen’. Else, the word just means the ‘organ spleen’. Spleen along with liver is considered as roots of origin of channels of formation and transportation of blood. It is said that the rasa tissue on reaching the liver and spleen get colored red by the action of ranjaka pitta and transformed into blood tissue.

DEFINITION OF SPLENOMEGALY BY WEIGHT AND SIZE – A normal spleen weighs approximately 150 grams. It is approximately 11 cm in craniocaudal length. A spleen weight of 400-500 grams indicates splenomegaly. When the spleen weighs more than 1000 grams, it is labeled as massive splenomegaly. Poulin et al defined splenomegaly as moderate if the largest dimension is 11-20 cm and severe if the largest dimension is greater than 20 cm. (read more)

Treatment of splenomegaly is usually done based on the underlying condition that is causal. Surgical removal of spleen may be advised if other treatments fail.

functions of spleen

Spleen is a soft and spongy organ, which filters out old and damaged blood cells, prevents infection by producing white blood cells, stores red blood cells and platelets which are helpful in clotting of blood. When the spleen enlarges these vital functions are hampered. As it becomes larger, the spleen filters even normal red blood cells and traps too many platelets. Excess blood cells and platelets will eventually clog your spleen and afflict its normal functioning. Its own blood supply will be hampered with time. As a result some portions of the spleen may get damaged or even destroyed.

Chief functions of spleen –

• Clearance of microorganisms and particulate antigens from blood stream

• Synthesis of IgG (Immunoglobulin G), properdin and tuftsin

• Removal of abnormal red blood cells

• Extramedullary hematopoiesis in certain diseases

2

LAKSHANA

1. Daurbalya -Weakness, Aruchi -anorexia,

Vipaka-indigestion, Varchamutragraha – retention of stool and urine,

Tamahpravesha – entering into darkness,

Pipasa -excessive thirst, Angamarda -malaise,

Chardi -vomiting, Murchha -fainting,

Angasada- prostration, Kasa -cough,

Shwasa-dyspnoea, Mrudujwara -mild fever,

Anaha (immobility of wind in the abdomen),

Agni nasha -loss of the power of digestion,

Karshya – emaciation, Aasyavairasya – distaste in the mouth,

Parvabheda -pain in finger joints, Kosthavatashula -distension of alimentary tract by wind and colic pain.

2. Shyavaarunaudara -Redness or discolouration of the abdomen and

3. Appearance of net-work of veins having blue, green or yellow colour

Similarly signs and symptoms are manifested by the enlargement of liver (Yakrddalyudara) which is located in the right side of abdomen. Since its etiology, signs and symptoms and treatment are similar to those of Plihodara (splenic enlargement), it is included in the description of the latter.

SYMPTOMS (MODERN)

In some cases, splenomegaly will be symptomless. Below mentioned symptoms may be found when the spleen gets enlarged –

• Pain or fullness in the left upper part of your abdomen, the pain may spread to your left shoulder

• Having a feeling of fullness without eating food or even after eating small quantity of food (this happens due to pressure of enlarged spleen over your stomach)

• Anemia

• Fatigue

• Frequent infections

• Easy bleeding

When you have severe pain in your left upper abdomen or if the pain gets worse when you take deep breathe, you have to see your doctor without delay.

3

NIDANA

The entire body and body parts getting stimulated and agitated (jerk, shake violently) following one of the below mentioned events –

• Riding on animals immediately after taking food

• Getting indulged in many kinds of physical activities immediately after intake of food

Extreme emaciation of the body occurring due to one or more of the below mentioned factors –

• Excessive sexual intercourse

• Lifting heavy weights

• Excessive walking

• Suffering from vomiting or other diseases for long duration

Due to the above said etiological factors, the spleen located in the left side of the abdomen will get displaced from its place and undergo excessive growth. Alternatively the increased quantity of rasa tissue will lead to the formation of excessive blood tissue. This increased blood will cause enlargement of spleen.

TEXTURE OF ENLARGED SPLEEN

• Hard on touch

• Stony appearance

• Initially / proximally gets enlarged

• Raised and appears similar to the shell of tortoise

• If it is not treated early, the enlarged spleen will encroach over the entire abdomen, over the stomach, pancreas and causes enlargement of the abdomen

CAUSES OF SPLENOMEGALY (MODERN)

Below mentioned are some of the common infections, diseases and conditions which cause enlargement of spleen –

1. Viral infections- Mononucleosis

2. Bacterial infections- Syphilis, Endocarditis (infection of inner layer of heart)

3. Parasitic infections- Malaria

4. Liver diseases - Cirrhosis of liver etc

5. Anemia - Various kinds of hemolytic anemia

6. Blood cancers / neoplastic- Leukemia, Myeloproliferative neoplasms, Lymphomas (example – Hodgkin’s disease)

7. Metabolic disorders- Gaucher’s disease, Niemann-Pick disease

8. Venous problems / congestive -Pressure on splenic veins or liver veins or blood clot in these veins, spleen vein thrombosis, portal hypertension, Banti disease

9. Infiltrative - Sarcoidosis and some neoplasms

10. Myeloproliferative - Chronic myeloid metaplasia

11. RBC destruction work hypertrophy -Hereditary spherocytosis and thalassemia major

12. Immune response work hypertrophy- Sub-acute bacterial endocarditis or infectious mononucleosis

Other causes –

• Hemangiomas

• Metastasis

• Trauma

• Cysts

• Giant abscess

Certain drugs

4

DOSHA SYMPTOMS OF ENLARGEMENT OF SPLEEN

• In vata predominant splenomegaly upward movement of vata, pain in the abdomen and flatulence can be found.

• In pitta predominant splenomegaly burning sensation, confusion, severe thirst and fever are the symptoms.

• In kapha predominant splenomegaly heaviness in the abdomen, tastelessness and hardness of belly can be found.

• In splenomegaly associated with association of all three vitiated doshas, the symptoms of all three doshas are present in mixed proportions.

• In splenomegaly caused by vitiated blood, the symptoms of vitiation of blood explained in Vidhishonitiya Adhyaya i.e. 24th chapter of Sutra Sthana section are available.

5

SAPEKSH NIDANA

PLEEHODARA -non bellotable lump,sharp edge & splenic notch absent, ribs & spleen k bich rikt sthan nhi hota

VRUKKA ARBUDA - bellotable lump,ribs & spleen k bich rikt sthan hota

COMPLICATIONS (MODERN0

Infection – frequent infections occur when you have splenomegaly because your enlarged spleen can reduce the number of healthy red blood cells, platelets and white blood cells in your bloodstream. There is also a possibility of increased bleeding to occur and consequential anemia. Both these conditions also give base for infections.

Rupture of spleen – the enlarged spleen may easily rupture. This will eventually cause life threatening bleeding into your abdominal cavity.

RISK FACTORS

Spleen enlargement can take place in anyone at any age but certain groups of people are at highest risk. They are –

• Children and young adults with infections, such as mononucleosis

• Those having Gaucher’s disease, Niemann-Pick disease and many other inherited metabolic disorders affecting the liver and spleen

People living in or traveling to areas wherein malaria is common

6

TYPES OF PLIHODARA

1. SANKSHOBHADI CHYUTASYA PLIHA VRIDDHI – enlargement due to displacement caused by sudden jerks or violent shaking of abdomen caused by riding vehicles or doing excessive physical activities immediately after taking food. This is of 5 sub-types and are called Pancha Pliha Doshas i.e. 5 kinds of spleen morbidities.

• VATAJA PLIHA – caused by vitiated vata

• PITTAJA PLIHA – caused by vitiated pitta

• KAPHAJA PLIHA – caused by vitiated kapha

• SANNIPATAJA PLIHA – caused by simultaneous vitiation of all three doshas

• RAKTAJA PLIHA – caused by vitiated blood

2. RAKTA VRIDDHI JANYA PLIHA VRIDHHI – enlargement of spleen taking place due to increased blood tissue. Blood tissue is formed from rasa tissue in spleen and liver. If more quantity of rasa tissue is formed, more quantity of blood too is formed in the spleen. Due to this there is enlargement of spleen.

TYPES OF SPLINOMEGALY (MODERN)

1. INFLAMMATORY SPLENOMEGALY – caused due to various infections or inflammatory processes. It results from an increase in the defense activities of the organ. Example – enlargement of spleen occurring from lupus and Felty syndrome and from viral infections like EB Virus induced mononucleosis.

2. HYPERPLASTIC SPLENOMEGALY – Caused due to removal of abnormal blood cells from circulation. It is also caused due to extramedullary hematopoiesis, as in myeloproliferative disease.

3. CONGESTIVE SPLENOMEGALY – It is caused due to one or more of –

• cirrhosis with portal hypertension,

• splenic vein thrombosis,

• congestive heart failure with increased venous pressure

4. INFILTRATIVE SPLENOMEGALY – occurs in sarcoidosis, Gaucher disease, amyloidosis or metastatic malignancy due to engorgement of macrophages with indigestible materials.

5. INFECTIOUS SPLENOMEGALY – This happens due to formation of multiple abscesses in the spleen. This happens due to splenic filtering of blood-borne pathogens especially encapsulated organisms.

6. ACUTE SPLENIC SEQUESTRATION CRISIS (ASSC) – is a major cause of morbidity and mortality in children with sickle cell disease and other hereditary hemolytic anemias. It is characterized by –

• sudden enlargement of spleen due to trapping of a significant proportion of blood volume

• rapid drop in hematocrit with hypovolemia

• thrombocytopenia

This condition is rare in adults with sickle-beta thalassemia. But splenomegaly is common in these patients.

7

PRICIPAL OF CHIKITSA

1. Principles of Treatment

The below mentioned therapies shall be done in enlargement of spleen –

• Snehana – oleation

• Swedana – sudation

• Virechana – purgation

• Niruha – decoction enemas

• Anuvasana – oil / fat enemas

Siravedha – Bloodletting – If all the above said treatments are not able to cure splenomegaly then bloodletting through venesection of the vein located in the left arm should be done.

Alternatively the below mentioned shall be used –

• Shatphala Sarpi ghee mentioned in the chapter dealing with treatment of Rajayakshma i.e. tuberculosis

• Combination of jaggery and Terminalia chebula

• Use of alkalis

• Use of Arishtas

2. DOSHA WISE TREATMENT OF SPLENOMEGALY

In splenomegaly associated with vitiated vata and kapha, agnikarma i.e. fire cauterization should be done.

In splenomegaly associated with vitiated pitta, the below mentioned measures may be preferred –

• Oral use of ghee processed with Jivaniya group of herbs

• Enemas with milk processed with the decoction of pitta alleviating herbs

• Bloodletting

• Emesis

• Oral intake of milk

Soups which enhance the digestive power processed with herbs having sour, bitter and pungent herbs shall be used with easy to digest food. Alternatively similar food shall be served with meat soup.

8

DIAGNOSIS

The enlarged spleen is detected during a physical examination, especially when the doctor feels and taps the enlarged organ while examining the left upper abdomen. The diagnosis may be confirmed with blood tests, USG or CT scan and MRI. While the blood tests helps the doctor to figure out the number of red blood cells, white blood cells and platelets in the system, USG or CT scan helps determine the spleen size. MRI on the other hand helps to trace the blood flow through the spleen.

Liver function tests and bone marrow exams may be needed for diagnosis at times. A needle biopsy of spleen, though useful, is very rarely preferred because of the risk of bleeding.

Occasionally you may be recommended for a surgical removal of spleen. This is done especially when there is no identifiable cause for spleen enlargement.

Pathya(DO):

Sali chaval,java,mudga,jangam masa,dugdha, mahisa mutra, aasava,arista, madhu, sidhu, sura, dadima rasa, sarkara, takra

Virechana,langana, siravedha, dhumapana, anjana,udar pe kapda bandhna

Apathya(DON’T):

Audak,anupa jangam mamsa, saka, tila, ushna ,guru,patra saka, motha, tiksna vidahi

Snehana,jalapana,vamana,divaswapna,vyayama, maituna

1. USEFUL CLASSICAL MEDICINES

Pippalyadi Churna

Hapushadhya Churna

Vidangadi Kshara

Rohitakadi Yoga

Rohitaka Ghruta

Madhwadi yoga

Pippalyadi Lavana

2. FORMULATIONS FOR HEPATO-SPLENOMEGALY FROM YOGARATNAKARA

Sindhvadi Churna

Yavanyadi Churna

Laghu Hingwadi Churna

Shankhanabhi Churna

Vidangadi Churna

Rohitakadi Kalka

Sharapunkha mula kalka

Shalmali Pushpa Kwatha

Dravanti Nagavati

Kshara Bhavita Pippali

Chitrakadhya Ghrita

Maharohitakam Ghritam

Pippalyadi Ghrita

3. USEFUL CLASSICAL FORMULATIONS

• Arogyavardhini Rasa

• Sarvajwarahara Lauha

• Yakrutplihari Lauha

• Punarnavadi Mandura

• Punarnavadi Kashaya

• Saptasara Kwatha

• Rohitakarishta

• Kumaryasava

• Rajata Bhasma

• Loha Bhasma

• Kasisa Bhasma

• Yava Kshara

• Manibhadra Guda

• Dashamula Haritaki

• Dadimadi Ghrta

• Gandharvahastadi Taila

4. EFFECTIVE HERBS FOR ENLARGEMENT OF SPLEEN

• Apamarga – Achyranthes aspera

• Pippali – long pepper

• Kumari – Aloe vera

• Bhringaraja – Eclipta alba

• Trivrit – Operculina turpethum

• Punarnava – Boerhavia diffusa

• Common salt

• Aconitum heterophyllum

• Liatris spicata

• Chicory

• Eupatorium fortune

• Agarwood

• Asplenium falcatum

• Redroot

• Atractylodes lancea

• Indian snakeroot

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

- Jalodaradi rasa-(jayphala,tamra,snehusheera)

- Icchabhedi rasa-(kajjli,jayphala,sunthi)

- Narach rasa-(kajjali,trikatu,tankana)

- Loknath rasa-(kajjali,abhrak,loha,tamra)

- Mahabrahmi rasa-(parad,gandhak,haridra,triphala,nisoth,jayapala,manakshila)

- Treylokya sunder rasa-(parad,gandhak,tamra,abhrak,saindhav,vatsanabh,jeera,vidanga)

- Pippaliyadhya loha-(pippalimula,chitrak,abhrak,triphala,trikatu,trijata,loha)

- Pleehantak rasa-(tamra,rajat,abhrak,loha,gandhak,puskermula,trikatu,jayphala)

- Pleehari rasa-(parad,gandhak,tankan,trikatu,tripahala,jaypala,vatsanabh)

- Rohitak loham-(rohitak,triphala,trikatu,trinada,laha)

- Yakrutpalihari loha-(kajjali,loha,abhrak,loha,tamra,haridra,mankshila,jayphala)

VATI-(250-500MG WITH USHNA JALA)

- Abhaya vati-(snuhiksheer,tankan,haritakai)

- Arogyavardhani vati-(tamra,kutaki,abhrak)

- Agnitundi vati-(parad,gandhak,visa,ajmoda,kuchala)

- Bhedani vati-(gokshura,snehukshar,pippali curna)

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

- Narayan curna-(giloy kutaj,bilwa)

- Patoladhya curna-(patol,haridra,vidanga,triphala,nisoth,kampilaka)

- Shamundradhya curna-(samundri lavana,saindhav lavana,loha bhasma, trivrit)

- Punarnavadi curna-(punarnava,devdaru,haritaki)

- Rohitakadhya curna-(rohitak,yavakshar,chirayata,kutaki,motha)

- Arka lavana

KVATHA-(20-30ML WITH JALA)

- Punarnavadi kwatah-(punarnava,devdaru,kutaki)

- Punarnava asthak kvatha-(punarnava,bilwa,patol)

- Punarnavarista

- Dashamuladi kvatah-(dasamula,sunthi,punarnava)

- Punarnava asthak kvatha-(punarnava,bilwa,patol)

- Kumaryasava-(kumari,haritaki,loha,tamra)

- Arjunarista-(arjuna,draksha,madhuk)

- Abhayarista-(haritaki,vidang,draksha)

- Punarnavasava-(trikatu,triphala,gokshura,punarnava)

GHRITA/TAILA-(15-20ML WITH USNA JALA/MILK)

- Narach ghrita-(triphala,nisoth,snihiksheer,dantimula)

- Chitrak ghrita-(chitrak kvatha,ghrita)

- Pippali ghrita-(pippali,ghrita,sunthi,amlaki)

- Chitrak ghrita-(chitrak kvatha,ghrita)

AVLEHA/PAKA(20GM WITH DUGHDHA)

- Guda-pippali yoga-(guda,pippali,hinga,trikatu)