Jaundice– Ayurvedic Treatment, Diet, Exercises, Research Papers, Yoga & Pranayama

Jaunisse

The term Jaunisse came from the French word Jaune meaning yellow. Jaundice or icterus is a term used to describe yellowish discoloration of the skin, mucous membrane, body fluids, and sclera of the eye. It happens due to the increased amount of bilirubin in blood & body fluids and the colour may vary from yellow to brown. Though the term is familiar as Neonatal jaundice, which affects newborn babies, the disease can affect people of all ages. It is usually an indicator of an underlying issue like diseases of the liver, obstruction in the bile duct or an infection. Jaundice occurs when there is a derangement in the metabolism or excretion of bilirubin. Thus, jaundice itself is not only a disease but an indicator of an underlying issue.

Signs & Symptoms

  • Yellowish tinge to the skin, mucous membranes, body fluids and sclera.
  • Pale stools.
  • Dark or yellow coloured urine.
  • Itching of the skin, partial or all over the body.
  • Fatigue & weakness
  • Abdominal pain
  • Weight loss
  • Nausea& Vomiting
  • Fever & chills.
  • Loss of appetite.
  • Diarrhoea & rectal bleeding.
  • Headache.
  • Confusion.
  • Swelling in the extremities.
  • Swelling in the abdomen.

Causes 

It can be divided into three based on where the disruption/dysfunction occurs. 

  • Pre-hepatic or haemolytic

Haemolytic anaemia/Jaundice can happen due to diseases like:

    • Sickle cell anaemia
    • Glucose-6-phosphate dehydrogenase deficiency (G6PD)
    • Hereditary spherocytosis
    • Malaria
    • Thalassemia
    • Some drugs or toxins, and
    • Autoimmune disorders.
  • Hepatic

Conditions with a hepatic cause of jaundice include:

  • Acute or chronic hepatitis (commonly viral Hepatitis A, B, C, D, E] or alcohol-related)
  • Liver cirrhosis (caused by various conditions including alcohol toxicity)
  • Drugs or other toxins
  • Crigler-Najjar syndrome
  • Autoimmune disorders
  • Gilbert’s syndrome
  • Carcinoma of liver
  • Post hepatic

Conditions that can cause post-hepatic jaundice include

  • Cholecystitis
  • Carcinoma of the pancreas, gall bladder or bile duct
  • Stricture of the bile ducts
  • Cholangitis
  • Pancreatitis
  • Certain worms/parasites like liver flukes

Physiopathologie

Jaundice in adults is caused by various medical conditions that affect the normal metabolism or excretion of bilirubin. Bilirubin is normally formed from the daily breakdown and destruction of red blood cells in the bloodstream, which release haemoglobin as they rupture. The haeme portion of this haemoglobin molecule is then converted into bilirubin, which is transported in the bloodstream to the liver for further metabolism and excretion. In the liver, the bilirubin is conjugated and made more water-soluble, it is excreted into the gallbladder for storage and then eventually passed into the intestines, where a portion of the bilirubin is excreted in the faeces, while some are metabolized by the intestinal bacteria and excreted in the urine.

Jaundice with a pre-hepatic cause is due to the excessive destruction (haemolysis) of red blood cells. This causes a quick rise in bilirubin levels in the bloodstream which disturbs the liver’s capability to metabolize the bilirubin, and consequently the levels of unconjugated bilirubin increase.

Jaundice caused during the hepatic phase can arise from abnormalities in the metabolism and/or excretion of bilirubin. This can lead to an increase in both unconjugated and/or conjugated bilirubin levels. Jaundice caused during the hepatic phase can arise from abnormalities in the metabolism and/or excretion of bilirubin. This can lead to an increase in both unconjugated and/or conjugated bilirubin levels.

Jaundice from a post-hepatic cause arises from an obstruction in the normal drainage and excretion of conjugated bilirubin in the form of bile from the liver into the intestine. This leads to increased levels of conjugated bilirubin in the bloodstream. Jaundice from a post-hepatic cause arises from an obstruction in the normal drainage and excretion of conjugated bilirubin in the form of bile from the liver into the intestine. This leads to increased levels of conjugated bilirubin in the bloodstream.

Diagnostic

Diagnosis includes history taking, physical examination and laboratory tests.

All of them together will determine the cause of jaundice.

Blood tests to be done are,

  • Liver function tests
  • Total count or Complete blood count
  • Lipase levels

Blood tests for various Hepatitis infections

Depending on the results of initial blood tests, further studies may be needed to help diagnose the underlying disease. In certain cases, imaging studies like

  • Abdominal ultrasound
  •  CT scan
  • MRI
  • Cholescintigraphy (HIDA scan)

are taken to confirm the diagnosis.At times, further invasive tests like endoscopic retrograde cholangiopancreatography (ERCP) or a liver biopsy will be needed to determine the cause of jaundice.

Traitements

The treatment is decided according to the cause of jaundice and severity. Some patients will require hospitalization, whereas others can be managed as outpatients at home.

  • Mild viral hepatitis can be managed at home with care and rest.
  • Hepatitis C can be cured with medications now.
  • Alcohol consumption should be stopped.
  • Jaundice caused by drugs/medications/toxins requires discontinuation of the same. In cases of intentional or unintentional acetaminophen overdose, the antidote N-acetylcysteine is required.
  • Several medicines are used to treat jaundice, such as steroids in the treatment of jaundice due to some autoimmune disorders. Certain patients with cirrhosis will need diuretics and lactulose.
  • Antibiotics are required for infectious jaundice or the complications associated with certain conditions leading to jaundice (for example, cholangitis).
  • Blood transfusions may be required in individuals with severe anaemia from haemolysis or as a result of bleeding.
  • Individuals with carcinoma leading to jaundice will require consultation with an oncologist, and the treatment will vary depending on the type and extent of the disease.
  • Surgery and various invasive procedures like cholecystectomy or liver transplant may be required in rare cases of jaundice.

Pronostic

The prognosis of jaundice solely depends upon the cause or underlying condition. Some jaundice patients recover so well that they indicate an excellent prognosis whereas some severe cases can be fatal despite medicines and surgical invasion. The development and severity of complications will also determine an individual’s prognosis, as well as underlying comorbidities (other diseases present). Therefore, a case-by-case assessment is necessary to determine a more accurate prognosis. Some persons recover fully without any complications whereas some people carry a lifelong set of complications after a jaundice attack. It depends upon the general health of the person and the cause leading to jaundice.

Complications

A few of the potential complications include:

  • Electrolyte imbalance
  • Anémie
  • Bleeding disorders
  • Sepsis
  • Chronic hepatitis
  • Cancer
  • Liver failure
  • Kidney failure
  • Hepatic encephalopathy (brain dysfunction)
  • Death

Maladies et Ayurveda

Jaundice – Kaamala

Nidana

  • Excessive intake of ruksha(dry), Shita(cold), Guru (heavy to digest), and madhura(sweet) food items
  • Excessive intake of Paittika ahara & vihara by Pandurogi or a person with aggravated Pitta
  • Excessive exercise & physical exertion
  • Holding natural urges like urine, faeces etc.

Purvaaroopa

General poorvarupa mentioned under Pandu applied to kamala are;

  • Twacha: sphotanam-cracking of skin
  • Sthivanam-excess spitting
  • Gatrasada-Weakness of body
  • Mridbhakashana-tendency to eat soil/pica
  • Prekshanakootsotha-swelling of eyelids
  • Pitamutra&vit- Yellow urine and stools
  • Avipaaka-indigestion
  • Nissaara-decrease built&strength
  • Alparakta         – Anaemia
  • Alpamedasa    – Decrease in the fatty layer of skin and internal organs
  • Gatravaivarnya             – discolouration of body
  • Sithilendriya                  – Malfunctioned sense organs

Samprapti

  • Due to the nidanas, Vaata & Kapha prakopa
  • Vitiated Vaata & Kaha circulates through Pittavahasrotas
  • Avarodha of Pittavahasrotas by vitiated Kapha
  • Margavarodha of Pitta
  • Pitta starts to get accumulated in the liver, causing yellow discolouration of eyes, skin, nails etc.

Lakshana

  • Haridranetyra twak, netra, moothra- Yellow skin, eyes and urine
  • Swetavarchas  -Pale stools
  • Tilapishttanibhavarchas           – Stools like ground sesame paste
  • Atopa  – Gurgling sounds in the abdomen
  • Vishtambha     – Stiffness and dullness in the abdomen along with fullness.
  • Hrudayaguruta                            – Heaviness in chest
  • Daurbalya        – Fatigue
  • Alpagni              – Low appetite and digestive power
  • Parshva arti      – Pain in flanks
  • Aruchi                – Anorexia
  • Jwara                 – Fever
  • Arati(restlessness)
  • Tandra(giddiness)
  • Balakshaya(loss of strength)
  • Along with the symptoms of Paandu

Divisions

  • Koshthasrita kamala
  • Saakhasritakaamala
  • Kumbhakaamala

Pronostic

  • Sukhasadhya   – With minimal nidana, poorvaroopa and roopa
  • Asadhya            – When the disease is chronic and presented with complications like krishna-peeta malamutra, chardi, raktavid-mutra etc.

Chikithsa

Samana

  • Vaatakaphasamana
  • Pittahara
  • Yakridudwejaka(Liver stimulant)
  • Agnideepana (Digestive)
  • Rechana (Laxative)
  • Rakta-shodhana (Blood purifying)
  • Jwarahara (Anti-pyretic)
  • Sothahara (Anti-oedematous)

Sodhana

  • Snehana with tiktarasadravyas
  • Mrduvirechana
  • Daahakarma

Commonly used Medicines

Ayurvedic Supplements

Marques disponibles

  • AVS Kottakal
  • Vaidyaratnam Oushadhasala
  • SNA oushadhasala
  • AVP Coimbatore

Régime alimentaire

  • À éviter

Salt and oil as a part of the diet.

Les repas lourds et les aliments difficiles à digérer provoquent des indigestions.

Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine

Boissons gazeuses - rendent l'estomac plus acide et perturbent la digestion

Aliments réfrigérés et congelés - provoquent une digestion faible et paresseuse en affaiblissant Agni (le feu digestif).

Milk and milk products – increase Kapha and cause respiratory problems

Caillé - provoque le vidaaha et, par conséquent, de nombreuses autres maladies

  • A ajouter

Des repas légers et des aliments faciles à digérer

Green gram, soups.

Aliments fraîchement cuits et chauds traités avec des graines de cumin, du gingembre, du poivre noir, de l'ajwain, etc.

Comportement

Quit alcohol/smoking/narcotics.

Il est préférable d'éviter une exposition excessive à la lumière du soleil, au vent, à la pluie ou à la poussière.

Maintenir une alimentation et un sommeil réguliers.

Évitez de retenir ou de forcer les envies comme l'urine, les selles, la toux, les éternuements, etc.

Avoid day sleep.

postures de Yoga

Vigorous exercises are not allowed in jaundice.

Only stretching, moderate walking, and mild cardio exercises are advised. Also, specific yogacharya including Ardhamathsyentrasana, Dhanurasana, Gomukhasna and naukasana is recommended. Physical strength, Blood pressure, Haemoglobin level, Range of movement and flexibility must be considered while doing every exercise.

Sookshma sandhi vyayama (warming up small joints) is advised.

Regular exercise helps improve the bioavailability of the medicine and food ingested and leads to positive health.

Le yoga permet de maintenir l'harmonie à l'intérieur du corps et avec le système environnant.

Ardhamathsyentrasana

Dhanurasana

gomukasana

Naukasana

Tous les exercices et les efforts physiques doivent être décidés et effectués uniquement sous la supervision d'un expert médical.

 

Articles de recherche

https://pubmed.ncbi.nlm.nih.gov/28145671/

https://pubmed.ncbi.nlm.nih.gov/14515028/