Rheumatoid Arthritis – Introduction

Rheumatoid arthritis (RA) is a chronic disease of unknown cause affecting over 2 million adults in the USA . An inflammatory disease of the synovium, it results in pain, stiffness, swelling, deformity and, eventually, loss of function in the joints. Because there is currently no known cure or means of preventing RA, the American College of Rheumatology recommends the earliest possible diagnosis and treatment with disease-modifying anti-rheumatic agents to limit the degree of irreversible joint damage . Despite early detection, current treatment medications are limited in their efficacy and are frequently toxic.


Many patients look for complementary and alternative medicine (CAM) options in coping with this debilitating disease. Research has indicated that people suffering from chronic pain, as in RA, and those dissatisfied with current treatment are very likely to seek alternative treatments, and an estimated 60–90% of persons with arthritis use CAM . Among the most widely used treatments are chiropractic and herbal therapies . This growing interest in alternative medical practices clearly indicates the need for more thorough investigation into the safety and efficacy of CAM. An earlier review conducted in 2000 was limited in that it excluded trials of herbal preparations against active comparators.

Lifestyle Changes

Improving your diet using a combination of my nutritional guidelines and nutritional typing. There are some general principles that seem to hold true for all nutritional types and these include:

Eliminating sugar and most grains

Having unprocessed, high-quality foods, organic and locally grown if possible

Eating your food as close to raw as possible

Getting plenty high-quality animal-based omega-3 fats, such as krill oil

Incorporating regular exercise into your daily schedule.

Address Emotional Trauma

Having an effective method to address the nearly universal underlying emotional distresses that are present in virtually all autoimmune diseases like RA.
The emotional trauma typically occurs before the age the conscious mind is formed, which is typically around the age of 5 or 6, though it can occur at any point in your life.

If that specific emotional insult is not addressed with an effective treatment modality, then the underlying emotional trigger will not be removed, allowing the destructive process to proceed.

In some cases, RA appears to be caused by an infection, and it is my experience that this infection is usually acquired when you have a stressful event that causes a disruption in your bioelectrical circuits, which then causes an impairment in your immune system.

This impairment predisposes you to developing the initial infection and also contributes to your relative inability to effectively defeat the infection.

Therefore, it’s very important to have an effective tool to address these underlying emotional trauma which can be addressed by Meridian Tapping Technique (MTT).

If you already have RA, the emotional trauma is best treated by a professional.

Resolve Vitamin D Deficiency

Getting your vitamin D levels checked and, if necessary, taking a supplement if you can’t get daily sun exposure. In the thousands of patients I saw it was unusual where a severe vitamin D deficiency was not present.

For refill, contact Dr. Harish Kumar

Sushruta Ayurvedic Health Centre
# 2250. Bovaird Dr. E. Spring Dale Professional Building.
Suite No. 411. Brampton, ON, L6R 0W3. Canada.
email: drharishverma@gmail.com
Website: www.sushruta.com

Sandhivata (Osteoarthritis)

Osteoarthritis or OA is known as Sandhivaat in Ayurveda. It is also referred to by doctors as degenerative joint disease or degenerative arthritis. OA is a type of arthritis that is the result of the inflammation, degeneration and wearing out of the joint cartilage over time. In osteoarthritis, the top layer of cartilage breaks down and wears away. This allows bones under the cartilage to rub together. The rubbing causes pain, swelling, and loss of motion of the joint. People of all ages can develop osteoarthritis although people 50 years of age and above are the most likely one to acquire this disease. The joints most commonly affected are the knees, hips, and those in the hands and spine.

Getting older
Joint injury
Being overweight
Stresses on the joints from certain jobs and playing sports.

Osteoarthritis symptoms often develop slowly and worsen over time. Symptoms of osteoarthritis include:
Pain. …
Stiffness. …
Muscle weakness. …
Swelling. Osteoarthritis does not usually cause much swelling but may cause a little, especially in the knees.
Deformed joints. …
Reduced range of motion and loss of use of the joint. …
Cracking and creaking.


A combination of the following methods are used to diagnose osteoarthritis:

Clinical history
Physical examination

X rays—X-rays will help determine the form of arthritis and how much damage there is, including cartilage loss, bone damage, and bone spurs.
Magnetic resonance imaging It is used if there is pain, X-rays don’t show much, or there is damage to other joint tissues.

Ayurvedic Treatment of Sandhivaat(Osteoarthritis):

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• Reduce pain and inflammation of affected joints.
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For refill, contact Dr. Harish Kumar

Sushruta Ayurvedic Health Centre
# 2250. Bovaird Dr. E. Spring Dale Professional Building.
Suite No. 411. Brampton, ON, L6R 0W3. Canada.
email: drharishverma@gmail.com
Website: www.sushruta.com

Ayurvedic Treatment of Piles or Hemorrhoids

Piles, also known as “Hemorrhoids”, are lumps or swellings around the rectum and anus that contain enlarged and swollen blood vessels. Usually patients hesitate to discuss a lot about Piles therefore this problem keeps on increasing with time. It is better to seek for the solution in the beginning stages of any kind of disorder but if it has become critical you need to consult a health expert and discuss over the issue.

In women Hemorrhoids are very common, especially during pregnancy and after childbirth. They result from increased pressure in the veins of the anus. The pressure causes the veins to swell, making them painful, particularly when you are sitting.

The most common cause is straining during bowel movements. Hemorrhoids may be inside or outside the body.

• Internal hemorrhoids occur just inside the anus, at the beginning of the rectum.

• External hemorrhoids occur at the anal opening and may hang outside the anus.

Major symptoms of hemorrhoids is bleeding during or after bowel movements, itching, and rectal pain. Bright red blood in the toilet bowl or on toilet tissue is seen.

Other conditions with symptoms similar to hemorrhoids include anal fissures, anal fistulas, Anal abscess, inflammatory bowel disease (IBD).

Types of Hemorrhoids

Hemorrhoids can be divided into two types, internal and external. Internal hemorrhoids lie inside the anus or lower rectum, beneath the anal or rectal lining. External hemorrhoids lie outside the anal opening. Both kinds can be present at the same time.

Internal Hemorrhoids

The most common symptom of internal hemorrhoids is rectal bleeding. You may find bright red streaks of blood on the toilet paper or bright red blood in the toilet bowl after having a normal bowel movement. Blood also may be visible on the surface of the stool. Other symptoms of internal hemorrhoids may include Itching. This is a frequent complaint, because internal hemorrhoids often seep mucus, which can irritate the anal skin and cause itching, Skin irritation. Large hemorrhoids that bulge from the anus may secrete mucus, causing mild irritation.

Discomfort. You may still feel the urge to pass stool right after having a bowel movement. This uncomfortable feeling is caused by the bulging of the hemorrhoid in the end portion of the large intestine (anal canal). In general, the larger the hemorrhoid, the greater the discomfort.

Internal hemorrhoids are classified according to the degree of prolapse, although this may not always reflect the severity of symptoms.

Internal Piles / Hemorrhoids :

Internal hemorrhoids are those that occur above the dentate line. As this area lacks pain receptors, internal hemorrhoids are usually not painful and most people are not aware that they have them. Internal hemorrhoids, however, may bleed when irritated. These form in the back passage about 2-4 cm above the rim (opening) of the anus. Their severity and size are classified into grades 1 to 4:

Grade I: Grade 1 are small swellings on the inside lining of the back passage. They cannot be seen or felt from outside the anus. Grade 1 hemorrhoids are common. In some people they enlarge further to grade 2 or more. No prolapse.

Grade II: Grade 2 are larger. They may be partly pushed out (prolapse) from the anus when you go to the toilet, but quickly spring back inside again. Prolapse upon defecation but spontaneously reduce.

Grade III: Grade 3 hang out (prolapse) from the anus. You may feel one or more as small, soft lumps that hang from the anus. However, you can push them back inside the anus with a finger. Prolapse upon defecation and must be manually reduced.

Grade IV: Grade 4 permanently hang down from within the anus, and you cannot push them back inside. They sometimes become quite large. Prolapsed and cannot be manually reduced.
External Piles / Hemorrhoids :

External hemorrhoids are those which appear in the lower part of rectum. They protrude out of the anus or they may actually be concealed from view however. They are painful, and often accompanied by swelling and irritation. Itching, although often thought to be a symptom of external hemorrhoids, is more commonly due to skin irritation. The skin irritation may be brought about by the inflammation of the external hemorrhoid which in turn leads to a barely noticeable watery discharge and skin irritation.
Prolapsed Hemorrhoids (Thrombosed Piles)

Most internal hemorrhoids are not painful. But large hemorrhoids that bulge from the anus may become painful if they swell and are squeezed by the muscles that control the anus. Severe pain may be a sign that the blood supply to the hemorrhoid is being cut off (strangulated hemorrhoid). Emergency treatment is needed.
Causes of piles (Hemorrhoids)

Researchers have identified a number of reasons to explain hemorrhoidal swelling, including the simple fact that people’s upright posture places a lot of pressure on the anal and rectal veins. Aging, obesity, pregnancy, chronic constipation or diarrhea, excessive use of enemas or laxatives, straining during bowel movements, and spending too much time on the toilet are considered contributing factors. Heredity may also play a part in some cases. There is no reason to believe that hemorrhoids are caused by jobs requiring, for instance, heavy lifting or long hours of sitting, although activities of that kind may make existing hemorrhoids worse.
Symptoms of piles (Hemorrhoids)

The commonest symptom of internal hemorrhoids is bright red blood in the toilet bowl or on one’s feces or toilet paper. When hemorrhoids remain inside the anus they are almost never painful, but they can prolapse (protrude outside the anus) and become irritated and sore. Sometimes, prolapsed hemorrhoids move back into the anal canal on their own or can be pushed back in, but at other times they remain permanently outside the anus until treated by a doctor.

Small external hemorrhoids usually do not produce symptoms. Larger ones, however, can be painful and interfere with cleaning the anal area after a bowel movement.

When, as sometimes happens, a blood clot forms in an external hemorrhoid (creating what is called a thrombosed hemorrhoid), the skin around the anus becomes inflamed and a very painful lump develops. On rare occasions the clot will begin to bleed after a few days and leave blood on the underwear. A thrombosed external hemorrhoids are usually very painful.
Diagnosis of piles (Hemorrhoids)

Diagnosis begins with a visual examination of the anus, followed by an internal examination during which the doctor carefully inserts a gloved and lubricated finger into the anus. The doctor may also use an anoscope, a small tube that allows him or her to see into the anal canal. Under some circumstances the doctor may wish to check for other problems by using a sigmoidoscope or colonoscope, a flexible instrument that allows inspection of the lower colon (in the case of the sigmoidoscope) or the entire colon (in the case of the colonoscope).
Treatment of piles (Hemorrhoids)

Piles can often be effectively dealt with by dietary and lifestyle changes. Softening the feces and avoiding constipation by adding fiber to one’s diet is important, because hard feces lead to straining during defecation. Fruit, leafy vegetables, and wholegrain breads and cereals are good sources of fiber, as are bulk laxatives and fiber supplements such as Isabgol (Psyllium Husk).

Exercising, losing excess weight, and drinking six to eight glasses a day of water or another liquid (not alcohol) also helps.

Soap or toilet paper that is perfumed may irritate the anal area and should be avoided, as should excessive cleaning, rubbing, or wiping of that area. Reading in the bathroom is also considered a bad idea, because it adds to the time one spends on the toilet and may increase the strain placed on the anal and rectal veins.

After each bowel movement, wiping with a moistened tissue or pad sold for that purpose helps lessen irritation.

Hemorrhoid pain is often eased by sitting in a tub of warm water for about 10 or 15 minutes two to four times a day (Sitz Bath).

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There are two major steps you can take to minimize the symptoms of hemorrhoids. One is to increase the amount of fiber in your diet, a step that may also help hemorrhoids from developing. The other is to practice good anal hygiene. There are many other important factors and things you should know.

Since straining on the toilet, due to constipation, is the main cause of hemorrhoids, it follows that avoiding constipation is an important part of prevention and -in mild cases – relief. Many doctors consulted declared that adding fiber to the diet was the only treatment needed for about half of all cases of hemorrhoids. Fiber resists digestion and reaches the large intestine virtually unchanged. There, it speeds the passage of feces through the intestine, lessening the strain of bowel movement. Fiber also retains water and adds to the bulk, softness, and weight of stool, all factors in easing strain. Adding liquids to the diet contributes to the softening effect. The best way to increase the fiber intake is to eat fiber-rich foods such as fruits, vegetables, breads and cereals.

Good anal care can also help control irritation and itching, whether caused by hemorrhoids or not. The most important thing is to keep the skin around the anus clean and dry. Residual fecal matter keeps the area moist and can irritate the skin, but vigorously wiping with dry toilet paper may make things worse. Instead, swab the area after each bowel movement using toilet paper moistened with warm water, and then gently pat the area dry.

Soap residues can irritate, so always rinse off completely after showering or bathing. If soaps do cause irritation, you can clean the anal area with a product specially formulated for mildness, a perianal cleansing lotion. Perspiration can irritate the anal area, so avoid tight undergarments or pantyhose. Loose, cotton underwear is best. A light sprinkling of talcum powder in the area can help absorb moisture.

Avoid stress, excessive consumption of alcohol and seating for long periods without standing periodically to release the tension on the tissues around the anus. Exercise regularly, it will help you prevent hemorrhoids and many other ailments.

Hemorrhoids do not cause cancer and are rarely dangerous or life threatening.

Ayurvedic Treatment of Rheumatoid Arthritis

Rheumatoid arthritis is a chronic inflammatory disorder that typically affects the small joints in hands and feet.


Although rheumatoid arthritis can occur at any age, it usually begins between the age of 20 to 40 years. The disorder is much more common in women.
The most commonly affected joints are the small joints of the fingers, thumbs, wrists, feet, and ankles. However, any joint may be affected. The knees are quite commonly affected. Less commonly, the hips, shoulders, elbows, and neck are involved. It is often symmetrical. So, for example, if a joint is affected in a right arm, the same joint in the left arm is also often affected. In some people, just a few joints are affected. In others, many joints are involved. In addition to causing joint problems, rheumatoid arthritis sometimes can affect other organs of the body — such as the skin, eyes, lungs and blood vessels.


Rheumatoid arthritis occurs when your immune system mistakenly attacks the synovium — the lining of the membranes that surround your joints.

The resulting inflammation thickens the synovium, which can eventually destroy the cartilage and bone within the joint.

The tendons and ligaments that hold the joint together weaken and stretch. Gradually, the joint loses its shape and alignment.

Doctors don’t know what starts this process, although a genetic component appears likely. While your genes don’t actually cause rheumatoid arthritis, they can make you more susceptible to environmental factors — such as infection with certain viruses and bacteria — that may trigger the disease.


The common main symptoms are pain and stiffness of affected joints. The stiffness is usually worse first thing in the morning, or after you have been resting. The inflammation causes swelling around the affected joints.

Other symptoms

These are known as extra-articular symptoms of RA (meaning outside of the joints). A variety of symptoms may occur. The cause of some of these is not fully understood:

• Small painless lumps (nodules) develop in about 1 in 4 cases. These commonly occur on the skin over the elbows and forearms, but usually do no harm.
• Inflammation around tendons may occur. This is because the tissue which covers tendons is similar to the synovium around the joints.
• Anaemia and tiredness are common.
• A high temperature (fever), feeling unwell, weight loss, and muscle aches and pains sometimes occur.
• In a few cases, inflammation develops in other parts of the body, such as the lungs, heart, blood vessels, or eyes. This is uncommon but, if it occurs, can cause various symptoms and problems which are sometimes serious.

Blood Test

People with rheumatoid arthritis tend to have an elevated erythrocyte sedimentation rate (ESR), which indicates the presence of an inflammatory process in the body.

Other common blood tests

• Rheumatoid factor
• Anti-cyclic citrullinate d peptide (anti-CCP) antibodies.



Soft-tissue swelling and early erosions in the proximal

interphalangeal joints are usually seen in patients of RA.

Ayurvedic Treatment of Amavaat (Rheumatoid Arthritis)

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For refill, contact Dr. Harish Kumar

Sushruta Ayurvedic Health Centre
# 2250. Bovaird Dr. E. Spring Dale Professional Building.
Suite No. 411. Brampton, ON, L6R 0W3. Canada.
email: drharishverma@gmail.com
Website: www.sushruta.com

Ayurvedic Treatment of Cirrhosis of Liver

Cirrhosis is a serious condition where normal liver tissue is replaced with scar tissue, eventually preventing the liver from functioning properly. The scar tissue blocks the flow of blood through the liver and slows the processing of nutrients, hormones, drugs, and naturally produced toxins. It also slows the production of proteins and other substances made by the liver. It tends to progress slowly and often does not cause symptoms in its early stages.

Role of liver

The liver is in the upper right part of the tummy (abdomen). It has many functions which include:

• Storing fuel for the body (glycogen) which is made from sugars. When required, glycogen is broken down into glucose which is released into the bloodstream.
• Helping to process fats and proteins from digested food.
• Making proteins that are essential for blood to clot (clotting factors).
• Processing many medicines that you may take.
• Helping to remove or process alcohol, poisons and toxins from the body.
• Making bile which passes from the liver to the gut and helps to digest fats.

Causes of cirrhosis

There are many causes of ‘scarring’ of the liver (cirrhosis). The common causes are heavy alcohol drinking and infection with the hepatitis C virus. Less common causes include:

• Chronic infection with the hepatitis B virus. Worldwide, this is the most common cause of cirrhosis of liver.
• Autoimmune hepatitis The immune system normally makes antibodies to attack bacteria, viruses and other germs. In people with autoimmune diseases, the immune system makes antibodies against part(s) of the body. Something triggers the immune system to make these autoantibodies but the trigger is not known. In autoimmune hepatitis, the immune system makes antibodies against liver cells, which can lead to damage and cirrhosis.
• Diseases that cause blockage of the bile ducts can cause back pressure and damage to the liver cells. For example, primary biliary cirrhosis, sclerosing cholangitis, and congenital problems of the bile ducts.
• Non-alcoholic steatohepatitis (NASH) This is a condition which causes fat to build up in the liver. This can lead to scarring and cirrhosis. Being overweight/obese increases your risk of developing NASH.
• Severe reactions to certain medicines.
• Certain poisons and environmental toxins.
• Certain infections caused by bacteria and parasites which are usually found only in tropical countries. Parasites are living things (organisms) that live within, or on, another organism.
• Severe heart failure which can cause back pressure of blood and congestion in the liver.
• Some rare inherited diseases which can cause damage to liver cells. For example:
Haemochromatosis: This is a condition which causes an abnormal build-up of iron in the liver and other parts of the body.
Wilson’s disease.This is a condition which causes an abnormal build-up of copper in the liver and other parts of the body.
• Other rare disorders.

Symptoms of cirrhosis

In the early stages of the condition, often there are no symptoms. You can get by with a reduced number of working liver cells. However, as more and more liver cells die and more and more scar tissue (fibrosis) builds up, the liver:

• Fails to make enough proteins such as albumin that help to regulate the fluid composition in the bloodstream and body.
• Fails to make enough chemicals needed for blood clotting.
• Is less able to process waste chemicals in the body such as bilirubin. So, these may build up in the body.
• Is less able to process medicines, toxins and other chemicals which may then build up in the body.

Therefore, the symptoms that may develop include:

• Tiredness and weakness.
• Fluid which leaks from the bloodstream and builds up in the legs (oedema) and tummy (abdomen) – called ascites.
• Loss of appetite, feeling sick (nausea) and being sick (vomiting).
• Weight loss (although you may put on weight if you retain a lot of fluid).
• A tendency to bleed and bruise more easily.
• Yellowing of the skin or the whites of the eyes (jaundice) due to a build-up of bilirubin.
• Itch due to a build-up of toxins.
• Mental health changes which can develop in severe cases as toxins build up in the bloodstream and affect the brain. This can cause changes to your personality and behaviour, confusion, forgetfulness and difficulty concentrating. Eventually it can lead to loss of consciousness and hepatic coma. These changes are known as hepatic encephalopathy.

Also, the scar tissue restricts the flow of blood through the liver. As the cirrhosis becomes worse, this causes back pressure in the portal vein (known as portal hypertension). The portal vein is the vein that takes blood from the gut to the liver – it contains digested foods. Increased pressure in this vein can cause swellings (varices) to develop in the branches of the vein in the lining of the gullet (oesophagus) and stomach. These varices have a tendency to bleed easily into the gut. If a bleed occurs, you may vomit blood or pass blood with your stools (faeces).


A doctor may suspect, from your symptoms and a physical examination, that you have ‘scarring’ of the liver (cirrhosis). (For example, a doctor may detect that your liver is enlarged or that you are retaining fluid.) A doctor may especially think of cirrhosis as a cause of your symptoms if you have a history of heavy alcohol drinking or have had a previous episode of hepatitis.
Blood tests may show abnormal liver function. See separate leaflet called Liver Function Tests for more details. An ultrasound scan (or a CT scan or MRI scan) may show that you have a damaged liver. To confirm the diagnosis, a small sample (biopsy) of the liver may be taken to be looked at under the microscope. See separate leaflet called Liver Biopsy for more details. The scarring of the liver and damage to liver cells can be seen on a biopsy.

If the underlying cause of the cirrhosis is not clear, further tests may be done to clarify the cause. For example, to check for antibodies to hepatitis viruses, to check for autoantibodies that may have attacked your liver cells, to look in a blood sample for excess iron or copper, etc.

Treatment for cirrhosis

The first aim of treatment is to prevent further liver scarring or to slow the progression of the scarring process. Second step is to reverse the scarring process through Hepatoprotective Herbs.

Treatments that may be advised include the following.

Stop drinking alcohol

Whatever the cause of cirrhosis, you should stop drinking alcohol completely. Drinking alcohol will increase the rate of progression of cirrhosis from whatever cause.

Be cautious when taking medicines

Always tell your doctor or pharmacist that you have cirrhosis if you take any prescribed or over-the-counter medicines. Some medicines that are processed in the liver may need their dose adjusted if you have liver problems, or even should not be used at all.

Treatment for underlying causes

Some of the underlying causes of cirrhosis can be treated. This may slow down, or halt, the progression of cirrhosis. For example:

• Not drinking alcohol if alcohol is the cause.
• Interferon and other medication may be used to treat viral hepatitis.
• Steroid medicines or other immunosuppressant medicines may be used to treat autoimmune diseases causing liver damage.
• Regular removal of a pint or so of blood can remove excess iron which occurs in haemochromatosis.

Treatment to ease symptoms and prevent complications

Various treatments may be advised, depending on the severity of the cirrhosis and the symptoms that develop. For example:

• Adequate food intake (including calories and protein) and regular exercise are important to prevent excessive weight loss and muscle wasting.
• A low-sodium diet or ‘water’ tablets (diuretics) to reduce fluid accumulating in the body.
• Medicines to reduce itch.
Treatment of bleeding Varices
A bleed from swellings (Varices) is a medical emergency. Seek medical help immediately if you have cirrhosis and:
• You bring up (vomit) blood; or
• You pass blood in your stools (faeces); or
• Your faeces become black.

Various surgical techniques can be used to stop the bleeding and to help reduce the risk of further bleeds.

Ayurvedic Treatment of Ulcerative Colitis

Ulcerative colitis is a long-term condition that causes inflammation and sores (ulcers) in the lining of the large intestine and rectum. The inflammation usually begins in the rectum and sigmoid colon and spread upward to the entire colon. Ulcerative colitis rarely affects the small intestine. The severity of the symptoms varies, depending on how much of the rectum and colon is inflamed and how severe the inflammation is.

Ulcerative colitis occurs at the rate of approximately five cases per 100,000 people. The disease pattern is one of the remission and exacerbation. It can occur at any age but its onset is most common among people between ages of 15 – 40. Ulcerative colitis affects male and females equally and appears to run in some families.



The exact cause of Ulcerative Colitis is not known. Factors that have all been suggested are:
• Autoimmune factors
• Food allergies
• Collagen disorders
• Genetic factors
• Infection and Psychogenesis

One or some combination of these factors thought to trigger the inflammatory process. The theory of the involvement of the immune mechanism has been widely accepted because of concept that therapeutic agents like Corticosteroids and Azothiaprine exert their effect via the immuno suppressive mechanism.

The psychological factors of feelings like anger and anxiety of the degree of depression experienced by a sufferer are also important in modifying the course of the disease.


The main symptom of ulcerative colitis is frequent diarrhoea, which may be mixed with blood or mucus. Patient may also have lower abdominal (tummy) pain or cramps and need to rush to the toilet. Other symptoms include:

• feeling generally unwell
• loss of appetite
• weight loss
• having temperature
• feeling tired

If patient have proctitis, patient may not have diarrhoea, but still frequently feel an urgent need to have a bowel movement.

If patient has ulcerative colitis, there is a chance that he or she could develop problems in other parts of your body. These can include mouth ulcers, skin rashes and inflammation (redness or pain) in eyes, skin or joints. Problems outside the large bowel often occur during a flare-up but can also happen while patient is in remission.

About Crohn’s disease

Crohn’s disease is a condition that causes inflammation of any part of the gut i.e. from mouth to anus. Crohn’s disease is named after Dr Crohn, the person who first described the disease in the 1930s. In Crohn’s disease, one or more patches of inflammation develop in parts of the gut. Any part of the gut can be affected. However, the most common site for the disease first to start is the last part of the small intestine (the ileum). The ileum is affected in about half of cases. Other parts of the small intestine and the colon are also commonly affected. The mouth, oesophagus and stomach are affected much less commonly.

Symptoms of Crohn’s Disease

• Diarrhoea is the most common first symptom. It can vary from mild to severe. The diarrhoea may be mixed with mucus, pus or blood. An urgency to get to the toilet is common. A feeling of wanting to go to the toilet but with nothing to pass is also common (tenesmus).

• Pain occurs in about 7 in 10 cases. The site of the pain depends on which part of the gut is affected. The last part of the small intestine (ileum) is the most common site. Therefore, a common area of pain is the lower right side of the abdomen. When Crohn’s disease first develops it is sometimes mistaken for appendicitis. The severity of pain can vary from person to person. Also, a sudden change or worsening of pain may indicate a complication (see below).

• Weight loss that is not intentional is another common symptom.
• Ulcers. An ulcer is a raw area of the lining of the gut which may bleed. You may see blood when you pass stools (motions or faeces).
• Generally feeling unwell, which may include loss of appetite, fever, and tiredness.
• Anaemia may occur if you lose a lot of blood.
• Mouth ulcers are common.
• Anal fissures may occur. These are painful cracks in the skin of the anus. Skin tags (small fleshy wart-like lumps) may also appear around the anus.


Ulcerative Colitis diagnosis is done after carefully taking the history and physical examination of the patients, then the patients are subjected to sigmoidoscopy and colonoscopy examination.

The rectum and colon are seen through a flexible optical / camera tube which is inserted through anus. During this examination a sample of tissue from the lining of the colon is

taken to observe under a microscope. This is called a histopathology examination. A barium enema is helpful in determining the nature and the extent of the disease in patients.

Ayurvedic Treatment of Rakatatisaar (Ulcerative Colitis)

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For refill, contact Dr. Harish Kumar

Sushruta Ayurvedic Health Centre
# 2250. Bovaird Dr. E. Spring Dale Professional Building.
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email: drharishverma@gmail.com
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Viral hepatitis: Tackling a silent killer

Viral hepatitis is a major public health problem. In addition to causing loss of 250,000 lives annually, it also causes a huge financial burden due to repeated hospitalizations, particularly in cases of Hepatitis B and C.

BOTH hepatitis A and E are hyper endemic in India and are caused by drinking contaminated water. Both these viruses, in addition to causing sporadic cases of jaundice, also cause large epidemics, particularly during the monsoon, flooding and natural calamities like earthquakes and famine etc.

Global burden

Hepatitis A is the commonest cause of acute viral hepatitis in young children. Over 99 per cent of these children recover fully, acute liver failure can occur in a very small percentage of patients. Hepatitis A has the highest global burden at over 5.5 billion. The mortality of hepatitis A increases with increasing age. With mortality rates of 1 per 1,000 in children and 2 per 100 in adults, treatment is largely symptomatic and supportive.

Hepatitis E shares the same mode of transmission as hepatitis A. This virus affects both older children and adults. Hepatitis E is a more serious infection than hepatitis A, with incidence of acute liver failure exceeding 20 per cent in late stages of pregnancy. Globally hepatitis E causes annual mortality of over 300,000.

Hepatitis E has a global burden of 2.5 billion. Both hepatitis A and E have similar clinical presentation such as fever, loss of appetite, body, muscle and joint pain, weight loss, skin rash and jaundice.

Acute liver failure

Combined hepatitis A and E are the commonest cause of acute liver failure in India. When should one refer a patient to hospital? Rapidly increasing jaundice, severe headache and vomiting, bleeding from the nose or mouth, drowsiness, irrelevant talk and decreased urine output are symptoms that should require hospitalization.

Boiling and chlorination of water effectively kills hepatitis A & E viruses. We must ensure a 24 x 7, safe drinking water supply, repair of leaking sewerage pipes, which are often the main cause of fecal contamination of drinking water. Hepatitis A can effectively be prevented by two doses of hepatitis A vaccine, spaced six months apart. Hepatitis E vaccine has been available in China for almost two years now but this vaccine is still unavailable in India.

Common causes

Hepatitis B and C viruses are common causes of liver cirrhosis and liver cancer. Both are blood-borne viruses with a similar mode of transmission as the HIV/ AIDS virus. Hepatitis B and C rank as the ninth commonest cause of global mortality. Over 1.4 million people across the world die each year from hepatitis B and C. Hepatitis B is a hundred times more infectious than HIV/ AIDS virus. In Asian countries, mother-to-baby transmission (vertical transmission) is quite common, because of a shared mode of transmission, co-infection of hepatitis B, C and HIV/AIDS virus is not uncommon.

India and China combined have well over half-a-billion people chronically infected with hepatitis B; between 15 and 30 per cent of these will develop liver cirrhosis and/ or liver cancer during their lifetime. Hepatitis B causes over 50 per cent of all cases of liver cancer and over 30 of all cases of liver cirrhosis. Hepatitis C infects 2 per cent of the world’s population, with India having more than 14 million people infected with this virus. This is almost twice the burden of hepatitis C in Europe to 20 per cent of all patients of hepatitis C will develop liver cirrhosis and/ or liver cancer in 20 to 30 years.

Combined hepatitis B & C, contribute to 70 per cent of 750,000 new cases of liver cancer diagnosed globally. Liver cancer is a very serious disease with over one-third of patients dying within one year of diagnosis. However, if liver cancer is diagnosed early, curative treatment may be offered by surgery, radio frequency ablation or liver transplantation.

Hepatitis B and C are often referred to as “The Silent Killers”, because symptoms of liver disease appear at a very late stage. These symptoms include jaundice, swelling of feet and abdomen, vomiting of blood or passage of black stools, fatigue, anemia, memory disturbances, decreased urine output, fever etc. Both these can be diagnosed through appropriate blood tests.

In chronic hepatitis C, the risk of liver cancer increases 17-fold, with maximum risk in an elderly male patient who takes moderate to large amount of alcohol. Hepatitis C is responsible for maximum number of liver-related deaths, and is the leading indication for liver transplants in USA and Europe.
Blood tests & treatment

Hepatitis B and C can be diagnosed by blood tests. Chronic hepatitis B is diagnosed if hepatitis B virus persists over six months. Timely and appropriate antiviral therapy will improve patients’ survival, decrease liver-related deaths and improve the quality of life. Therapy for chronic hepatitis C has undergone a paradigm shift.

The standard of care which included prolonged injections with PEG interferon and daily ribavirin has been replaced by all-oral therapy where this standard therapy cannot be given or is ineffective. These all oral drugs are called DAA’s (Directly acting antivirals). These drugs are highly effective, given for a short duration, but are costly and are still unavailable in India. Sofosbuvir and ledipasvir are examples of such new drugs.

Hepatitis B can be prevented by three doses of an excellent vaccine given at day 0, 1 month and six months’ interval. These three doses give a 22 to 25 years protection against hepatitis B.

Safe surgical practices, avoidance of reusable syringes and needles, proper testing of blood and blood products to be transfused, banning of professional blood donors and taking universal precautions are some of the methods to control the spread of hepatitis B and C.

Delta hepatitis is a defective virus which is only seen in patients infected with hepatitis B. This is an extremely difficult-to-eradicate virus and leads to significant liver-related morbidity and mortality. Fortunately, delta virus is uncommon in India.

High-risk groups that must be tested and vaccinated against hepatitis B are:

• All new-born babies
• All pregnant females
• All children and adolescents not vaccinated at birth
• All HIV positive cases
• All patients of chronic liver disease (not caused by hepatitis B)
• All patients of chronic kidney disease with or without hemodialyses
• All healthcare professionals
• All patients being treated for sexually transmitted diseases
• All prison inmates
• All mentally challenged people requiring institutional care
• All intravenous drug abusers
• All spouses of patients who are suffering from hepatitis B.
• All people with high-risk sexual behavior
• All travelers visiting highly endemic areas
• Patients attending STD clinics
• Prison inmates
• All immigrants from highly endemic countries.
ABCDE of the silent killer
• Hepatitis A and E are spread by drinking faecally contaminated water.
• Hepatitis A is the commonest cause of viral hepatitis in children, with the global burden of 5.5 billion as per W.H.O.
• Hepatitis A can be prevented by two doses of vaccine.
• Hepatitis E is a more severe infection than hepatitis A, with mortality rates exceeding 20 per cent in late pregnancy.
• Hepatitis B and C are blood-borne and share a common mode of transmission.
• Hepatitis B and C cause liver cirrhosis and / or liver cancer
• Globally, over 400 million people are infected with hepatitis B and over 180 million with hepatitis C.
• India has over 40 million chronically infected patients of hepatitis B and over 14 million patients infected with hepatitis C.

Prevention & treatment of hepatitis B

HEPATITIS B virus affects over 40 million Indians, with a prevalence rate of 2 to 7 per cent. It shares the same route of transmission as HIV and hepatitis C virus. Hepatitis B can cause acute hepatitis with a 1 per cent mortality rate. Over 95 per cent of the people clear the virus from their blood, unlike 95 per cent infants and children who are unable to do so.

Persistence of hepatitis B for more than six months is defined as chronic hepatitis B. Both vertical and horizontal modes of transmission occur with this virus. About 15-30 per cent of all cases of chronic hepatitis B will develop liver cirrhosis and/or liver cancer.

Liver cancer is the most-dreaded complication of chronic hepatitis B. Liver cancer is invariably fatal as it is often diagnosed at a late stage. If it is diagnosed at an early stage, it may be cured by liver surgery, liver transplantation or radio-frequency ablation (RFA). Hepatitis B is truly an oncogenic (cancer-causing) virus.

The devastating complications of hepatitis B virus can be most effectively prevented with three doses of hepatitis B vaccine given intra-muscularly, in the arm, in three doses of 20 mcg on day zero, one month and six months.

The third dose gives a protection of 20-25 years. In India, less than 50 per cent of all vaccinated people receive their third dose. Globally, only one out of five babies will receive the third dose of this vaccine. A titer of 10 IU/ml is protective.

Hepatitis B immunoglobulin (HbIg) is also used for prevention of hepatitis B in special circumstances — in babies born to hepatitis B positive mothers, after needle-stick injury, and after liver transplantation to prevent re-infection of graft.

Other methods to prevent hepatitis B include testing of all blood and blood products, avoiding reused needles and syringes, practicing safe sex, avoiding the roadside barber, etc. This infection is not spread by casual contact.

Goals of treatment of hepatitis B include the reduction or slowing down of disease progression and prolongation of life. This includes the delaying or prevention of developing the dreaded complications of liver cirrhosis and liver cancer.

Two types of therapies are available

The first includes injections of pegylated interferons given for 48 weeks to patients with early liver cirrhosis and a moderate viral load. About one-third of patients respond to this therapy.

The other therapy used includes oral drugs like entecavir, tenofovir, adefovir, lamivudine and telbivudine.

The first two drugs have a high genetic barrier and are preferred in clinical practice. Therapy is generally continued for few years.

Over all, these drugs are safe but may cause lactic acidosis, kidney toxicity and bone changes.

Keep these in mind:

• Over 33 per cent of all liver cirrhosis is due to this virus.
• 15-30 per cent of all chronically infected people will develop liver cirrhosis and/ liver cancer.
• Three doses of hepatitis B vaccine are the most effective way to prevent hepatitis B.
• Hepatitis B vaccine is truly a cancer-preventive vaccine
• Injections of pegylated interferon are costly, given for 48 weeks, and cause side-effects.
• Oral drugs against hepatitis B are effective, can be given in advanced stages of liver cirrhosis, for long term.
• Testing of blood and blood products by nucleic-acid testing (NAT) is more effective, although costly.
• Hepatitis B and C cause over 50 per cent of all cases of liver cirrhosis and over 75 per cent of 750,000 new cases of liver cancer globally, annually.
• Hepatitis B and C-induced liver cirrhosis and/ or liver cancer is one of commonest indication for doing a liver transplantation.
• W.H.O. recommends universal Hepatitis B vaccination.
• Currently there is no vaccine available against hepatitis C
• Less than 5 per cent of people infected with hepatitis B and C are undergoing treatment.
• Hepatitis C infection can be cured by excellent all-oral drugs known as Directly Acting Antiviral (DAA’s). These drugs are still unavailable in India.