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 Table of Contents 
CASE REPORT
Year : 2020  |  Volume : 9  |  Issue : 5  |  Page : 2487-2491  

Role of Kalpa Chikitsa in the management of Lynch syndrome- A case report


1 MD Scholar, All India institute of Ayurveda, New Delhi, India
2 Assistant Professor,Department of Kayachikitsa, All India institute of Ayurveda, New Delhi, India

Date of Submission25-Jan-2020
Date of Decision13-Mar-2020
Date of Acceptance08-Apr-2020
Date of Web Publication31-May-2020

Correspondence Address:
Dr. Pooja Sharma
Department of Kayachikitsa, All India Institute of Ayurveda, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_161_20

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  Abstract 


Lynch syndrome (hereditary non-polyposis colorectal cancer) is an autosomal dominant condition and it is caused by germline mutations in the DNA mismatch repair genes. The present case report was conducted to evaluate the efficacy of Madhuyasti (Glycyrrhiza glabra) Ksheerpaka kalpa in Lynch syndrome. A 28-year-old male was diagnosed with Lynch syndrome in 2016. The patient was operated three times followed by chemotherapy. In 2019, he was diagnosed with adenocarcinoma and advised for surgery. But despite getting surgery patient prefer to take Ayurvedic consultation considering his miserable condition after previous surgeries. It is decided to give the kalpa method of therapy prescribed in Ayurveda for rejuvenation and overall improvement of health. After the 15 days of treatment with Madhuyasti (Glycyrrhiza glabra) Ksheerpaka Kalpa chikitsa, the patient showed significant improvement in quality of life (P < 0.001 for SPF) and CT abdomen showed a reduction in circumferential thickening from 2.8 to 1.5 cm (~50% improvement) with no worsening complications. Although the pathogenesis cannot be revert back to the normalcy as the patient already had resection of the total colon, it can be concluded that with the help of Ayurveda, the appearance of complications can be delayed and the quality of life can be improved in such patients. It is further suggested that better result may obtained if the Ayurvedic therapy starts at earlier stage.

Keywords: Kalpa chikitsa, Lynch syndrome, Madhuyasti Ksheerpaka


How to cite this article:
Sharma P, Kajaria D. Role of Kalpa Chikitsa in the management of Lynch syndrome- A case report. J Family Med Prim Care 2020;9:2487-91

How to cite this URL:
Sharma P, Kajaria D. Role of Kalpa Chikitsa in the management of Lynch syndrome- A case report. J Family Med Prim Care [serial online] 2020 [cited 2020 Sep 19];9:2487-91. Available from: http://www.jfmpc.com/text.asp?2020/9/5/2487/285080




  Introduction Top


Lynch syndrome is one of the most common cancer susceptibility syndromes. Individuals with Lynch syndrome have a risk of developing colorectal cancer, endometrial, stomach and intestine cancer.[1],[2],[3] A lack of effective screening methods and the relative paucity of presenting symptoms contribute to a high percentage of cases at the advanced stage at the time of diagnosis in small bowel cancer.[4] Small bowel adenocarcinoma has a poor prognosis at all stages, with a 5-year overall survival rate ranging from 14% to 33%.[5]


  Case History Top


A 28-year-old male was brought by his wife to the OPD of Kayachikitsa, All India Institute of Ayurveda hospital, New Delhi in July 2019 in a severe condition with an orogastric tube in his mouth. The chief complaints of the patient is increasing the frequency of stool 9-10 times/day with blackish and green loose stool, pain in abdomen after eating food, whatever he used to eat, he vomits out each and everything, bilateral legs mild swelling, difficulty in sitting and walking, loss of appetite and gradual weight loss since last 6 months. History of the present illness revealed that the patient was normal till 2009, and then he gradually noticed constipation since followed by bleeding per rectum for 2 years. Thus he took some local treatment, and after 1 year, he noticed mass per rectum then he underwent treatment of colonoscopic polypectomy in May 2012 at a private hospital but they told him to consult at some higher center. Hence, he went to AIIMS in New Delhi for consultation and was diagnosed with sigmoid and descending colon carcinoma by CT scan and biopsy, for which subtotal colectomy with ileorectal anastomosis was done on July 2012 at AIIMS and 8 cycles of chemotherapy was done on March 2013. He was apparently fine for the last 2 years, and then suddenly he developed vomiting 7-8 times in a day with a loss of weight and appetite. Again he went to AIIMS on November 2015 and was evaluated for these complaints and found to have a large growth in the duodenum and diagnosed with carcinoma of the duodenum with the involvement of ampulla of vater, pancreatic head with metastasis to para aortic mesenteric nodes for which Whipple's pancreaticoduodenectomy with segmental jejunal resection was done and again he received adjuvant chemotherapy that was completed in July 2016, on follow-up upper gastrointestinal endoscopy was done and he was found to have jejunal polyp for which polypectomy was done followed by a biopsy, CECT chest which suggested adenocarcinoma, the final diagnosis was made as Lynch syndrome with jejunal adenocarcinoma on December, 2016 and for this jejunal resection, anastomosis was done. Again the patient was fine for the last 2 years and suddenly he noticed increase frequency of motion 9-10 times in a day and vomiting. again he went to AIIMS in July 2019, was evaluated for these complaints and CECT abdomen revealed that asymmetric circumferential wall thickening (2.8 cm) distal body, gastrojejunostomy site and proximal jejunum-biopsy proven adenocarcinoma.

General examination revealed that bilateral hands and foot nails black due to chemotherapy, bilateral foot planter fascia removed, his teeth color was mild brown blackish, and his weight was 40 kg, blood pressure 90/60 mmHg, pulse rate 70/minute, temperature − 98.2

°F, pallor- (+++), clubbing grade (1), icterus and cyanosis both are absent. Personal history of the patient showed that appetite was good, micturition regular, sleep decrease, dreams – he was seen dead persons in the dreams.

Systemic examination revealed that he had a very large scar mark of a surgery over the abdomen and tenderness in the whole abdomen. A family history of malignancy revealed that his mother died at the age of 35 years with endometrial carcinoma and brother died of some biliary malignancy at the age of 25 years.

The following laboratory studies was done before treatment started; hemoglobin 8.5 g/dl, total RBC 3.10 × 106/cumm, platelet count 143 × 103/cumm, TLC 5.9 × 103 cumm, neutrophils 86%, lymphocytes 07%, Eosinophil 01%, Monocytes 01%, ESR 44 mm/h, total protein 5.15 gm/dl, albumin 2.18 gm/dl, ECG revealed that poor R wave progression (V2), stool routine and microscopic investigation showed that no RBCs in the stool.

Madhuyasti (Glycyrrhiza glabra) Kalpa therapy is mentioned in Ayurvedic classics. According to the principle of kalpa chikitsa, the broad-spectrum activity of MadhuyastiKsheerpaka was given for 15 days.

Ksheerpaka of Madhuyasti in vardhamana karma, starting the dose from 6 gm on the first day was given. It was increased by 6 gm daily up to a maximum dose of 48 gm then it was tapered by 6 gm daily to a dose of 6 gm. The patient was kept on, mudga yusha and takra with Trikatu churna.

After completion of treatment, results were assessed which shows the frequency of stool was improved 2 times/day, semisolid stool with normal in color, bilateral legs swelling reduced within 4 days, a patient can walk 20 minutes morning and evening daily. Mild significant changes in blood investigation after the treatment. CECT abdomen revealed that asymmetric heterogeneously enhancing wall thickness 15 mm (1.5 cm) of the body of the stomach, gastrojejunostomy site, proximal jejunal loops [Figure 1] and [Figure 2] better improvement was seen in Agni bala,Deha bala, Satva bala and SPFas mentioned in [Table 1].
Figure 1: (a) and (b) Before treatment

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Figure 2: (a) and (b) After treatment

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Table 1: Assessment before and after treatment

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  Discussion Top


In Ayurvedic concept, according to ‘Charaka’ and ‘Sushruta’ cancer is described as inflammatory or non-inflammatory swelling and mentioned either as ‘Granthi’ (minor neoplasm) or ‘Arbuda’ (major neoplasm).[6] The modern cancer therapy that is known to burdened by drug-induced toxic side effects hoping the perfect cure of disease form the complementary and alternative medicine system. The main goal of Ayurvedic therapy is to find the ultimate cause of illness while the therapeutic approach of Ayurveda is divided into four categories as Prakritisthapani chikitsa (health maintenance), Rasayana chikitsa, (restoration of normal function), Roganashani chikitsa (disease cure) and Naishthiki chikitsa (spiritual approach).[7]

It was very difficult to correlate Lynch syndrome with any Ayurvedic disease, some of the features of Vataja grahani[8] were found in this patient. The symptoms indicated totally dhatu (~body tissues) Kshaya, on the basis of Madhuyast i (Glycyrrhiza glabra) Ksheerpaka kalpa chikitsa was decided.

Ayurveda kalpachikitsa is a distinctive approach of therapy, where a specific drug is administered in a gradually increasing dose and decrease inverse order to the level of the initial dose.[9]

Glycyrrhiza glabra has various pharmacological activities like antibacterial activity, antithrombotic effect, hepatoprotective effect, anticonvulsant effects, cerebroprotective effect, anti dyslipidaemic activity, memory-enhancing activity, antioxidant potential activity, hair growth-promoting activity, etc.[10] Madhuyashti (glycirrhyza glabra) has been mentioned in medhya Rasayana,[11] jivaniya mahakashaya[12] group of drugs. Madhuyashti[13] being a cost-effective drug, holding rasayana property and capable of alleviating many disorders proves beneficial in attaining dhatusamya in the body and resulting in a complete state of wellbeing through different modes of action. It strengthens and promotes the swasthbhava or the dhatusamya. He got significant relief in overall health and quality of life was improved.

Madhuyasti Ksheerpaka, it is very beneficial in primary care, as it is easily available and cheapest medicine, a lot of research has been done on it, which proved it has anti-cancer property and can be given in cancer patient as an adjuvant with chemotherapy.


  Conclusion Top


Madhuyasti Ksheerpaka has the capabilities to address the manifestation of Lynch syndrome. A good result was obtained in this case. Informed consent was taken from the patient for this case report. This approach may be useful for clinical practices and further studies on treating Lynch syndrome.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Coco D, Leanza S, Boccoli G. Small bowel adenocarcinoma (SBA) three years after colonic adenocarcinoma in an elderly patient: Case report in a National Institute of Health and Aging (INRCA) and review of the literature. Int J Surg Case Rep 2014;5:939-43.  Back to cited text no. 1
    
2.
Chaaya A, Heller SJ. Introduction to small bowel tumors. Tech Gastrointest Endosc 2012;14:88-93.  Back to cited text no. 2
    
3.
Tanyi M, Olasz J, Tanyi JL, Tóth L, Antal-Szalmás P, Ress Z, et al. MLH1 and MSH2 mutation screening in HNPCC families of Hungary-Two new MMR gene mutations. Eur J Surg Oncol 2014; 40:1445-52.  Back to cited text no. 3
    
4.
Koornstra JJ, Kleibeuker JH, Vasen HF. Small-bowel cancer in Lynch syndrome: Is it time for surveillance? Lancet Oncol 2008;9:901-5.  Back to cited text no. 4
    
5.
Delaunoit T, Neczyporenko F, Limburg PJ, Erlichman C. Small bowel adenocarcinoma: A rare but aggressive disease. Clin Colorectal Cancer 2004;4:241-51.  Back to cited text no. 5
    
6.
Bhishagratha KL. Sushruta samhita. Sushruta samhita. Varanasi: Choukhamba Orientalia; 1991.  Back to cited text no. 6
    
7.
Thatte U, Dhahanukar S. Ayurveda, the natural alternative. Sci Today 1991;2001:12-8.  Back to cited text no. 7
    
8.
ByadgiPS. Ayurvediya Vikriti-Vijnana & Roga Vijnana. 2nd Part. Varanasi: Chaukhambha Publication; 2009. p. 114-6.  Back to cited text no. 8
    
9.
Singh NK, Singh RH. The kalpa method of therapy in chronic diseases. Anc Sci Life 1989;9:7-10.  Back to cited text no. 9
    
10.
Prajapati S. Therapeutic Potential of Yashtimadhu in Bruhat-Trayi and Laghu-Trayi. Res Rev: J Ayurvedic Sci, Yoga Naturopathy 2015;2: p26–33 10.  Back to cited text no. 10
    
11.
Agnivesha, Caraka Samhita, Chikitsasthana 1/3/30-31 ed. Jadavji Trikamaj Acharaya Chowkhambha Surbharati Prakashan, Varanasi, 2008;385.  Back to cited text no. 11
    
12.
Agnivesha, Caraka Samhita, Sutrastahna 4/9 ed. Jadavji Trikamaj Acharaya Chowkhambha Surbharati Prakashan, Varanasi, 2008;32.  Back to cited text no. 12
    
13.
Mukti Manki Mita S, Prashant R, Shailza B. Clinical evaluation of rasayana effect of madhuyashti churna in apparently healthy individuals. World J Pharm Res 2019;8:1130-5.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]



 

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  Introduction
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