Dhatura Patra Lepa in Sthana Vidradhi Vis-À-Vis Mastitis - A Case Report

Introduction

Mastitis is an inflammatory condition of the breast, which may not be accompanied by infection. If it is associated with lactation, then it is called as lactational mastitis or puerperal mastitis. Breast abscess, a localised collection of pus within the breast, is a severe complication of mastitis.1 About 10% of breastfeeding women are affected with mastitis. Mastitis typically develops when the milk is not properly removed from the breast. Milk stasis can lead to the milk ducts in the breasts becoming blocked. In lactation mastitis, frequent emptying of both the breasts by breastfeeding is essential. Also essential is adequate fluid supply for the mother and the baby.² 

If despite all efforts at prevention, mastitis occurs, it must be treated promptly and adequately. If treatment is delayed or incomplete, recovery is less satisfactory. There is an increased risk of breast abscess and relapse. The main principles of treatment of mastitis are: supportive counselling, effective milk removal, antibiotic therapy, symptomatic treatment according to modern science. As per Ayurveda, this condition may be co-related to Sthana Vidradhi; it is of five types namely Vataja, Pittaja, Kaphaja, Sannipataja and Abhighataja.³ By seeing the lakshanas of the present case, it can be said as, it belongs to Kaphaja type of Sthanavidradi.4 It has to be treated like Vruna. In Pachyamana avastha, suppuration should be enhanced by oral use of appropriate drugs or diet. In Pakwa avastha, Shastra karma should be done protecting the Dugdhaharininadis (lactiferous ducts), areola and nipples. Repeated milking at all the stages of Vidradhi, Jaloukavacharana, Lepa with different dravyas is also advised. Shotha (inflammation) chikitsa like Lepa, Abhyanga, Pariseka, Vimlapana etc can be adopted in sequential order.⁵

Case Report

A 25-year-old woman who had delivered one month ago came to the OPD of Dhanvantari Ayurveda College and Hospital, Siddapur (Uttara Kannada), with the complaint of pain, tenderness, swelling and hardness in the lower, outer quadrant of right breast for 8 hours. No history of similar complaints, fever, or local rise in temperature and any other illness was noted.

On general examination, patient weighted 54 kg, pulse rate was 86 beats/min and rate of respiration was 18/ min. On local examination, patient presented with swelling, tenderness and hardness on the lower, outer quadrant of the right breast. No history of smoking or alcohol consumption was given. Patient belongs to Kapha-Vataja prakruti.

Methodology of the study

The material required for the study is fresh Dhatura patra.

Preparation of lepa

Fresh leaves of Dhatura were collected and cleaned properly to get rid of dust. Sufficient quantity of leaves were taken and made into fine paste without adding water. This paste was slightly warmed before applying to the patient.

Mode of administration

Local application of warm paste of Dhatura leaves on lower, outer quadrant of right breast leaving nipple region was done two times a day.

Duration of treatment

Lepa was retained over the breast until it completely dries off. Application was done for three days.

Results

Reduction in pain was seen on the first day itself, while swelling and hardness gradually reduced by three days of application (Table 1).

Dhattura⁶

Synonyms: Unmatta,Kanaka, Maatula, Shivapriya

Latin name: Dhatura metel Linn.

Rasa: Tikta, Katu

Guna: Laghu, Ruksha, Vyavayi, Vikasi

Veerya: Ushna Vipaka: Katu

Prabhava: Maadaka.

Doshaghnata: Kapha-Vata shamaka.

Samsthanika Karma (Bahya): Janthugna,Vedanasthapana, Twakdoshahara. 

Discussion

The present case with the complaint of pain, tenderness, hardness and swelling shows that there was an involvement of Vata-Kapha dosha. Dhatura being VataKapha shamaka, paste from its leaves was applied to subside aggravated doshas. Apart from that, Dhatura plant is an important medicinal plant as it is well known source of different phytochemicals. Its leaves contain flavonoids, phenols, alkaloids & steroids that act as analgesics as well as anti-inflammatory. In Bhava Prakasha Guduchyadi varga, we get the reference of Dhatura patra lepa in Sthana shotha.7 Because of Katu rasa, Laghu-Ruksha guna and Ushna Veerya, it acts as Vrana avasadana (stops excess growth of wound) and Shwayathu hara (reduces swelling). As involvement of Rakta can be seen in Vidradhi, Raktashodhaka (blood purifying) Shamana medicines can be given internally for the purpose of Raktashodhana and to prevent the recurrence of Vidhradhi. 

Mode of action of Dhatura patra lepa on Sthana Vidradhi

Dhatura leaves contain high amounts of alkaloids known as Daturine and albumen in addition to mucilage and ash. It is also used as anodyne as the plant as a whole has anodyne i.e., pain relieving. Dhatura leaves when applied on breast in mastitis, reduces inflammation and pain associated with it. As the present condition of Sthana Vidradhi is in aama avastha, Dhatua patra being Katu-rasa, Laghu-Ruksha guna and Ushna veerya, it does aama pachana and brings Sthana Vidradhi to Niraama avastha.

Conclusion

Sukoshna Dhatura patra lepa provides better results in a short period in the management of acute condition of Sthana vidradhi, by reducing the symptoms like pain, tenderness, swelling and hardness in an effortless way. The acute stage of Sthana Vidradhi can be co-related to mastitis as there is no complete involvement of Mamsa and Meda dhatu. Here, acute condition refers to aama avastha of vidradhi, the signs and symptoms of acute state of abscess are similar to the signs and symptoms of mastitis, which is an inflammatory condition. 

Scope for further study

As it is a single case study, to know the efficacy of Dhatura patra lepa in Sthanavidradhi, research can be conducted in larger group of patients. Further, the same formula is mentioned for reducing lactation in feeding women and it can be used to stop lactation after still birth or miscarriage. This formula will decrease the milk supply gradually.  

Author Contributions

CKN, SG and LB contributed equally in study design, conducting analysis and writing of manuscript.