The Effect of Sira Vedha (Phlebotomy) at Right Elbow Joint in the Management of Non-alcoholic Fatty Liver Disease - Randomized Controlled Clinical Trial

Jump To References Section

Authors

  • Gaurav Sawarkar
     Department of Rachana Sharir, Mahatma Gandhi Ayurved College, Hospital and Research Centre, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha - 442001, Maharashtra ,IN
  • Priti Desai
     Department of Rachana Sharir, Sardar Patel Ayurvedic College And Hospital, Sardar Patel University, Dongariya - 481331, Balaghat, Madhya Pradesh ,IN
  • Punam Sawarkar
     Department of Panchakarma, Mahatma Gandhi Ayurved College, Hospital and Research Centre, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha - 442001, Maharashtra ,IN

DOI:

https://doi.org/10.18311/jnr/2023/30616

Keywords:

Blood Letting, Liver Disease, NAFLD, Phlebotomy

Abstract

Introduction: Sushruta stated that Sira Vedha (phlebotomy) at Right Elbow Joint was used as a cure for Liver Diseases. Modern science is likewise on the same page as phlebotomy treatment for some liver illnesses, although the specific location for phlebotomy has not been specified. Similarly, there is diversity in the amount of blood extracted and the time length, with each research study recommending a different amount to be removed and the gap between two sessions. Both of the previously listed things are mentioned in the context of Ayurveda. Nonetheless, due to a lack of clinical proof, it cannot be practiced reliably in normal exercise. As a result, clinical proof for liver illnesses is required to confirm Sushruta’s theory. Methodology: 111 eligible patients with Non-Alcoholic Fatty Liver Disease (NAFLD) Grade I/II were randomly assigned to the control (group A) or trial (group B) groups in the pilot research (group B). After obtaining written informed permission, blood samples from each patient were collected for LFT and lipid profile testing. The patients in Group A were then just counseled to make dietary changes. Group B patients underwent dietary changes as well as Sira Vedha (phlebotomy) with 65 cc blood three times in 15 days. Checked hemoglobin before each phlebotomy for safety considerations before discontinuing the patient. The blood sample was taken before enrollment in the study and after the final follow-up, which was on the 60th day. Results: The serum results from the first and last follow-ups were compared. This study found that group B considerably improved in liver enzymes and lipid profile (P<0.050) when compared to group A. As a result, we may infer that phlebotomy can enhance liver enzymes and lipid profiles in NAFLD patients.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Downloads

Published

2023-07-28

How to Cite

Sawarkar, G., Desai, P., & Sawarkar, P. (2023). The Effect of <i>Sira Vedha</i> (Phlebotomy) at Right Elbow Joint in the Management of Non-alcoholic Fatty Liver Disease - Randomized Controlled Clinical Trial. Journal of Natural Remedies, 23(3), 879–890. https://doi.org/10.18311/jnr/2023/30616

Issue

Volume 23 Issue 3 July 2023

Section

Research Articles

License

Copyright (c) 2022 Gaurav Sawarkar, Priti Desai, Punam Sawarkar

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Crossref
Scopus
Google Scholar
Europe PMC
Received 2022-07-05
Accepted 2023-06-26
Published 2023-07-28

 

References

Organisation mondiale de la Santé. Manuel d’investigation des flambées épidémiques d’étiologie chimique présumée : orientation pour l’investigation et la régulation [Internet]. Genève: Organisation mondiale de la Santé; 2022 [cited 2022 May 12].

Khodadoostan M, Zamanidoost M, Shavakhi A, Sanei H, Shahbazi M, Ahmadian M. Effects of phlebotomy on liver enzymes and histology of patients with nonalcoholic fatty liver disease. Adv Biomed Res. 2017; 6:12. https://doi. org/10.4103/2277-9175.200787 PMid:28299304 PMCid: PMC5343605 DOI: https://doi.org/10.4103/2277-9175.200787

Lainé F, Ruivard M, Loustaud-Ratti V, Bonnet F, Calès P, Bardou-Jacquet E, et al. Metabolic and hepatic effects of bloodletting in dysmetabolic iron overload syndrome: A randomized controlled study in 274 patients. Hepatol Baltim Md. 2017; 65(2):465–74. https://doi.org/10.1002/ hep.28856 PMid:27685251 DOI: https://doi.org/10.1002/hep.28856

Rawal M, Chudasma KM, Vyas RV, Parmar BP. Effect of vasantic vaman and other panchakarma procedures on disorders of various systems. Ayu. 2010; 31(3):319–24. https://doi.org/10.4103/0974-8520.77160 PMid:22131733 PMCid:PMC3221065 DOI: https://doi.org/10.4103/0974-8520.77160

Raval HN, Thakar AB. Role of raktamokshana by jalaukavacharana and siravedhana in the management of vicharchika (eczema). Ayu. 2012; 33(1):68–72. https://doi. org/10.4103/0974-8520.100314 PMid:23049187 PMCid: PMC3456867 DOI: https://doi.org/10.4103/0974-8520.100314

Raut SY, Rasale PL, Tambade AB. A study of changes in RBC indices after raktamokshana w.s.r. Siravedha. Int J Ayurvedic Med. 2013; 4(3). https://doi.org/10.47552/ijam. v4i3.263 DOI: https://doi.org/10.47552/ijam.v4i3.263

Vaneet Kumar J, Dudhamal TS, Gupta SK, Mahanta V. A comparative clinical study of siravedha and agnikarma in management of gridhrasi (sciatica). Ayu. 2014; 35(3):270–6. https://doi.org/10.4103/0974-8520.153743 PMid:26664236 PMCid:PMC4649569 DOI: https://doi.org/10.4103/0974-8520.153743

Rana J. Clinical evaluation of siravedha in the management of gridhrasi w.s.r to sciatica. World J Pharm Res. 2017; 1181–92. https://doi.org/10.20959/wjpr20177-8795 DOI: https://doi.org/10.20959/wjpr20177-8795

Sutrasthan AH. Chapter 27: Siravyadha Vidhi Venesetion (Blood Letting) 27/44, 316:352.

Beaton MD, Chakrabarti S, Levstik M, Speechley M, Marotta P, Adams P. Phase II clinical trial of phlebotomy for non-alcoholic fatty liver disease. Aliment Pharmacol Ther. 2013; 37(7):720–9. https://doi.org/10.1111/apt.12255 PMid:23441892 DOI: https://doi.org/10.1111/apt.12255

Burger HU, Gerlinger C, Harbron C, Koch A, Posch M, Rochon J, et al. The use of external controls: To what extent can it currently be recommended? Pharm Stat. 2021; 20(6):1002–16. https://doi.org/10.1002/pst.2120 PMid:33908160 DOI: https://doi.org/10.1002/pst.2120

Abenavoli L, Milic N, Peta V, Alfieri F, De Lorenzo A, Bellentani S. Alimentary regimen in non-alcoholic fatty liver disease: Mediterranean diet. World J Gastroenterol WJG. 2014; 20(45):16831–40. https://doi.org/10.3748/wjg. v20.i45.16831 PMid:25492997 PMCid:PMC4258553 DOI: https://doi.org/10.3748/wjg.v20.i45.16831

Fan JG, Cao HX. Role of diet and nutritional management in non-alcoholic fatty liver disease. J Gastroenterol Hepatol. 2013; 28(S4):81–7. https://doi.org/10.1111/jgh.12244 PMid:24251710 DOI: https://doi.org/10.1111/jgh.12244

Marchesini G, Petta S, Dalle Grave R. Diet, weight loss, and liver health in nonalcoholic fatty liver disease: Pathophysiology, evidence, and practice. Hepatology. 2016; 63(6):2032–43. https://doi.org/10.1002/hep.28392 PMid:26663351 DOI: https://doi.org/10.1002/hep.28392

Fernández T, Viñuela M, Vidal C, Barrera F. Lifestyle changes in patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis. Strnad P, editor. PLOS ONE. 2022; 17(2):e0263931. https:// doi.org/10.1371/journal.pone.0263931 PMid:35176096 PMCid:PMC8853532 DOI: https://doi.org/10.1371/journal.pone.0263931

Mahaling DU, Basavaraj MM, Bika AJ. Comparison of lipid profile in different grades of non-alcoholic fatty liver disease diagnosed on ultrasound. Asian Pac J Trop Biomed. 2013; 3(11):907–12. https://doi.org/10.1016/S2221- 1691(13)60177-X DOI: https://doi.org/10.1016/S2221-1691(13)60177-X

Khanal U, Paudel B, Gurung G, Hu YS, Kuo CW. Correlational study of nonalcoholic fatty liver disease diagnosed by ultrasonography with lipid profile and body mass index in adult nepalese population. J Med Ultrasound. 2019; 27(1):19. https://doi.org/10.4103/JMU.JMU_53_18 PMid:31031531 PMCid:PMC6445041 DOI: https://doi.org/10.4103/JMU.JMU_53_18

Ariya M, Koohpayeh F, Ghaemi A, Osati S, Davoodi SH, Razzaz JM, et al. Assessment of the association between body composition and risk of non-alcoholic fatty liver. PLoS ONE. 2021; 16(4):e0249223. https://doi.org/10.1371/journal. pone.0249223 PMid:33793621 PMCid:PMC8016222 DOI: https://doi.org/10.1371/journal.pone.0249223

Summart U, Thinkhamrop B, Chamadol N, Khuntikeo N, Songthamwat M, Kim CS. Gender differences in the prevalence of nonalcoholic fatty liver disease in the Northeast of Thailand: A population-based crosssectional study. F1000 Research. 2017; 6:1630. https:// doi.org/10.12688/f1000research.12417.2 PMid:29093809 PMCid:PMC5645706 DOI: https://doi.org/10.12688/f1000research.12417.1

Ahuja M. Age of menopause and determinants of menopause age: A PAN India survey by IMS. J -Life Health. 2016; 7(3):126. https://doi.org/10.4103/0976-7800.191012 PMid:27721640 PMCid:PMC5051232 DOI: https://doi.org/10.4103/0976-7800.191012

Hsieh SD, Yoshinaga H, Muto T, Sakurai Y, Kosaka K. Health risks among Japanese men with moderate body mass index. Int J Obes Relat Metab Disord J Int Assoc Study Obes. 2000; 24(3):358–62. https://doi.org/10.1038/sj.ijo.0801157 PMid:10757631 DOI: https://doi.org/10.1038/sj.ijo.0801157

Sookoian S, Pirola CJ. Systematic review with metaanalysis: Risk factors for non-alcoholic fatty liver disease suggest a shared altered metabolic and cardiovascular profile between lean and obese patients. Aliment Pharmacol Ther. 2017; 46(2):85–95. https://doi.org/10.1111/apt.14112 PMid:28464369 DOI: https://doi.org/10.1111/apt.14112

Godoy-Matos AF, Silva Júnior WS, Valerio CM. NAFLD as a continuum: From obesity to metabolic syndrome and diabetes. Diabetol Metab Syndr. 2020; 12(1):60. https:// doi.org/10.1186/s13098-020-00570-y PMid:32684985 PMCid:PMC7359287 DOI: https://doi.org/10.1186/s13098-020-00570-y

Cho JY, Chung TH, Lim KM, Park HJ, Jang JM. The impact of weight changes on nonalcoholic fatty liver disease in adult men with normal weight. Korean J Fam Med. 2014; 35(5):243–50. https://doi.org/10.4082/kjfm.2014.35.5.243 PMid:25309705 PMCid:PMC4192788 DOI: https://doi.org/10.4082/kjfm.2014.35.5.243

Vusirikala A, Thomas T, Bhala N, Tahrani AA, Thomas GN, Nirantharakumar K. Impact of obesity and metabolic health status in the development of non-alcoholic fatty liver disease (NAFLD): A United Kingdom populationbased cohort study using the health improvement network (THIN). BMC Endocr Disord. 2020; 20(1):96. https:// doi.org/10.1186/s12902-020-00582-9 PMid:32605642 PMCid:PMC7325099 DOI: https://doi.org/10.1186/s12902-020-00582-9

Weir CB, Jan A. BMI Classification Percentile And Cut Off Points. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021.

Lahsaee S, Ghazizade A, Yazdanpanah M, Enhesari A, Malekzadeh R. Assessment of NAFLD cases and its correlation to BMI and metabolic syndrome in healthy blood donors in Kerman. Gastroenterol Hepatol Bed Bench. 2012; 5(4):183–9.

Pak N, Allahverdi B, Moslemi S, Rostami P, Sayarifard F, Mehdizadeh M, et al. Relationship Between Body Mass Index, Fatty Liver, Lipids Profile, Carotid Intima-Media Thickness and Subcutaneous and Visceral Fat Determined by Ultrasound. Iran J Pediatr [Internet]. 2020; 30(1). https:// doi.org/10.5812/ijp.96605 DOI: https://doi.org/10.5812/ijp.96605

Fan R, Wang J, Du J. Association between body mass index and fatty liver risk: A dose-response analysis. Sci Rep. 2018; 8(1):15273. https://doi.org/10.1038/s41598-018-33419-6 PMid:30323178 PMCid:PMC6189125 DOI: https://doi.org/10.1038/s41598-018-33419-6

Francque SM, Marchesini G, Kautz A, Walmsley M, Dorner R, Lazarus JV, et al. Non-alcoholic fatty liver disease: A patient guideline. JHEP Rep. 2021; 3(5):100322. https://doi.org/10.1016/j.jhepr.2021.100322 PMid:34693236 PMCid:PMC8514420 DOI: https://doi.org/10.1016/j.jhepr.2021.100322

Shin SW, Jung SJ, Jung ES, Hwang JH, Kim WR, So BO, et al. Effects of a lifestyle-modification program on blood-glucose regulation and health promotion in diabetic patients: a randomized controlled trial. J Lifestyle Med. 2020; 10(2):77–91. https://doi.org/10.15280/jlm.2020.10.2.77 PMid:32995335 PMCid:PMC7502894 DOI: https://doi.org/10.15280/jlm.2020.10.2.77

Carneros D, López-Lluch G, Bustos M. Physiopathology of lifestyle interventions in non-alcoholic fatty liver disease (NAFLD). Nutrients. 2020; 12(11):3472. https:// doi.org/10.3390/nu12113472 PMid:33198247 PMCid: PMC7697937 DOI: https://doi.org/10.3390/nu12113472

Ennequin G, Sirvent P, Whitham M. Role of exerciseinduced hepatokines in metabolic disorders. Am J Physiol Endocrinol Metab. 2019; 317(1):E11–24. https://doi. org/10.1152/ajpendo.00433.2018 PMid:30964704 DOI: https://doi.org/10.1152/ajpendo.00433.2018

Severinsen MCK, Pedersen BK. Muscle–organ crosstalk: The emerging roles of myokines. Endocr Rev. 2020; 41(4):594–609. https://doi.org/10.1210/endrev/bnaa016 PMid:32393961 PMCid:PMC7288608 DOI: https://doi.org/10.1210/endrev/bnaa016

Papatheodoridis GV, Goulis J, Christodoulou D, Manolakopoulos S, Raptopoulou M, Andrioti E, et al. High prevalence of elevated liver enzymes in blood donors: Associations with male gender and central adiposity. Eur J Gastroenterol Hepatol. 2007; 19(4):281–7. https://doi. org/10.1097/MEG.0b013e328011438b PMid:17353691 DOI: https://doi.org/10.1097/MEG.0b013e328011438b

Facchini FS, Hua NW, Stoohs RA. Effect of iron depletion in carbohydrate-intolerant patients with clinical evidence of nonalcoholic fatty liver disease. Gastroenterology. 2002; 122(4):931–9. https://doi.org/10.1053/gast.2002.32403 PMid:11910345 DOI: https://doi.org/10.1053/gast.2002.32403

Sumida Y, Kanemasa K, Fukumoto K, Yoshida N, Sakai K, Nakashima T, et al. Effect of iron reduction by phlebotomy in Japanese patients with nonalcoholic steatohepatitis: A pilot study. Hepatol Res Off J Jpn Soc Hepatol. 2006; 36(4):315–21. https://doi.org/10.1016/j.hepres.2006.08.003 PMid:16971174 DOI: https://doi.org/10.1016/j.hepres.2006.08.003

Dongiovanni P, Fracanzani AL, Fargion S, Valenti L. Iron in fatty liver and in the metabolic syndrome: a promising therapeutic target. J Hepatol. 2011; 55(4):920–32. https:// doi.org/10.1016/j.jhep.2011.05.008 PMid:21718726 DOI: https://doi.org/10.1016/j.jhep.2011.05.008

Uche E, Adediran A, Damulak O, Adeyemo T, Akinbami A, Akanmu A. Lipid profile of regular blood donors. J Blood Med. 2013; 4:39–42. https://doi.org/10.2147/JBM.S42211 PMid:23717053 PMCid:PMC3663474 DOI: https://doi.org/10.2147/JBM.S42211

Bharadwaj RS. A Study of Lipid Profiles Among Male Voluntary Blood Donors in Chennai City. 2005; 30(1):2. 41. Meyers DG, Strickland D, Maloley PA, Seburg JK, Wilson JE, McManus BF. Possible association of a reduction in cardiovascular events with blood donation. Heart. 1997; 78(2):188–93. https://doi.org/10.1136/hrt.78.2.188 PMid:9326996 PMCid:PMC484902

van Jaarsveld H, Pool GF. Beneficial effects of blood donation on high density lipoprotein concentration and the oxidative potential of low density lipoprotein. Atherosclerosis. 2002; 161(2):395–402. https://doi.org/10.1016/S0021- 9150(01)00638-4 PMid:11888523 DOI: https://doi.org/10.1016/S0021-9150(01)00638-4

Clement ANJ, Vincent VS, Shey ND, Afoni BE, Marcelin NN. A cross-sectional study on the evaluation of the lipid profile of regular blood donors in the buea regional hospital, Cameroon. Cardiol Cardiovasc Res. 2017; 1(3):76.

Eshete EA, Weldemariam TZ. Hematological and lipid profiles of blood donors at red cross center in Addis Ababa. Ethiop Med J. 2016; 54(1):21–5.

Turankar SA, Turankar AV, Vaidya S, Balpande S. Effect of blood donation on lipid profile in healthy volunteers:A short-term pilot study. J Evol Med Dent Sci. 2018; 7(33):3670–4. https://doi.org/10.14260/jemds/2018/824 DOI: https://doi.org/10.14260/jemds/2018/824

Kumar H. Repeated blood donation effective in treating hyperlipidemia. J Assoc Physicians India. 1994; 42(6):468– 9.

Meyers DG, Strickland D, Maloley PA, Seburg JK, Wilson JE, McManus BF. Possible association of a reduction in cardiovascular events with blood donation. Heart Br Card Soc. 1997; 78(2):188–93. https://doi.org/10.1136/hrt.78.2.188 PMid:9326996 PMCid:PMC484902 DOI: https://doi.org/10.1136/hrt.78.2.188

Richmond W. Preparation and properties of a cholesterol oxidase from Nocardia sp. and its application to the enzymatic assay of total cholesterol in serum. Clin Chem. 1973; 19(12):1350–6. https://doi.org/10.1093/ clinchem/19.12.1350 PMid:4757363 DOI: https://doi.org/10.1093/clinchem/19.12.1350

Frei B. Reactive oxygen species and antioxidant vitamins: Mechanisms of action. Am J Med. 1994; 97(3A):5S-13S; discussion 22S-28S. https://doi. org/10.1016/0002-9343(94)90292-5 PMid:8085584 DOI: https://doi.org/10.1016/0002-9343(94)90292-5

Salonen JT, Korpela H, Nyyssönen K, Porkkala E, Tuomainen TP, Belcher JD, et al. Lowering of body iron stores by blood letting and oxidation resistance of serum lipoproteins: a randomized cross-over trial in male smokers. J Intern Med. 1995; 237(2):161–8. https://doi. org/10.1111/j.1365-2796.1995.tb01156.x PMid:7852918 DOI: https://doi.org/10.1111/j.1365-2796.1995.tb01156.x

McCord JM. Is iron sufficiency a risk factor in ischemic heart disease? Circulation. 1991 ; 83(3):1112–4. https://doi. org/10.1161/01.CIR.83.3.1112 PMid:1999020 DOI: https://doi.org/10.1161/01.CIR.83.3.1112

Sullivan JL. Blood donation may be good for the donor. Iron, heart disease, and donor recruitment. Vox Sang. 1991; 61(3):161–4. https://doi.org/10.1111/j.1423-0410.1991. tb00940.x PMid:1807057 DOI: https://doi.org/10.1111/j.1423-0410.1991.tb00940.x

M. Tabash A, M. Afana W, M. Elregeb A, Abu Eid S, M. AbuMustafa A. Assessment of Lipid and Hematological Profile among Blood Donors in European Gaza Hospital, Palestine. Cardiol Cardiovasc Med [Internet]. 2019; 03(04). https://doi.org/10.26502/fccm.92920063 DOI: https://doi.org/10.26502/fccm.92920063

Gebre-Yohannes A, Rahlenbeck SI. Coronary heart disease risk factors among blood donors in northwest Ethiopia. East Afr Med J. 1998; 75(9):495–500.

Tuomainen TP, Salonen R, Nyyssönen K, Salonen JT. Cohort study of relation between donating blood and risk of myocardial infarction in 2682 men in eastern Finland. BMJ. 1997; 314(7083):793–4. https://doi.org/10.1136/ bmj.314.7083.793 PMid:9080998 PMCid:PMC2126176 DOI: https://doi.org/10.1136/bmj.314.7083.793

Van Hoydonck PGA, Schouten EG, Hoppenbrouwers KPM, Temme EHM. Is blood donation induced low iron status associated with favourable levels of OxLDL, s-ICAM-1, sVCAM-1 and vWF-antigen in healthy men. Atherosclerosis. 2004; 172(2):321–7. https://doi. org/10.1016/j.atherosclerosis.2003.11.006 PMid:15019542 DOI: https://doi.org/10.1016/j.atherosclerosis.2003.11.006