Zollinger-Ellison Syndrome: Ayurvedic Treatment, Remedies

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
We do not find any disease explained in Ayurvedic treatises which exactly matches resembles ZE Syndrome. But following the symptoms and presentation of Zollinger Ellison Syndrome, we can try to correlate and included some conditions explained in Ayurvedic texts under ZES. This would help us to frame a treatment protocol with Ayurvedic perspective. 

Treating Zollinger Ellison Syndrome on the lines of Parinama Shoola Chikitsa and Annadrava Shoola Chikitsa

Zollinger Ellison Syndrome (ZES) is a disease closely related to Peptic ulcers or acid reflux diseases in terms of its presentation and symptoms.
Related reading – Zollinger Ellison Syndrome

Peptic Ulcers fall under the category of ‘Shoola’ explained in Ayurveda, mainly Parinama Shoola and Annadrava Shoola. Shula means pain or colic often used to describe pain abdomen.
Read related: Parinama Shoola : Definition, Types, Treatment, Medicines

Due to close resemblance of ZES with Parinaama and Annadrava Shoola, it makes sense to treat ZES on the line of treatment explained for these 2 conditions.
Read related: Annadrava Shoola: Definition, Treatment, Remedies



Treatment of ZES on the lines of shula
Controlling Vata
All Shoolas immaterial of the type and dosha involved are linked with Vata vitiation. In short, Vata is the prime culprit and is vitiated in all types of Shoola. Controlling Vata is an important strategy in managing pain related to Shula vis-à-vis ZES or Peptic Ulcers. The best way of controlling Vayu is to avoid the causative factors leading to vitiation of Vata (Vata vitiating factors). If the shoola has been manifested, vata alleviating medicines and treatments shall pacify vata. We have already discussed the curative part as far as Vata is concerned in the above said passages. Now let us enlist the Vata vitiating factors which can be avoided by all those who are susceptible to develop Shoola or are suffering from the mentioned condition.

Treatment of other associated symptoms of ZES
Having taken care of the primary symptom of ZES i.e. Pain, it is also necessary to have a look at other important symptoms of the disease. Most of the formulations and treatments explained above in the context of Shula or pain will also take care of the associated symptoms like diarrhea, loss of appetite and vomiting since most of the medicines explained above are multi-dimensional.

Treating associated diarrhea and steatorrhea in ZES
Anti-diarrhoeal foods, medicines and remedies mentioned here are useful

Treating associated Nausea, Vomiting and bloody vomiting in ZES
Anti emetic treatment methods that are explained here are useful. 

Treating Loss of Appetite associated with ZES
Deepana (appetite enhancing medicines and foods) and
Pachana (medicines and foods which help in enhancing digestion and expelling ama, the immature essence of nutrition in circulation which is toxic for the body) are the best strategies to combat loss of appetite associated with ZES. Along with this, many formulations mentioned in the above mentioned passages (treating pain, diarrhea and vomiting) will also enhance appetite and set right the metabolism.

Deepana and pachana medicines help improve the digestion, destroys ama, expel krimis (micro-organisms, infection) and thus reduce the gut inflammation and irritability. Thus, indirectly these medicines will be acting as anti-diarrhoeal medicines.

These are also the medicines which will cure ajeerna (indigestion)

The best herbs used for Deepana are –

  • Pippali – Piper longum
  • Pippalimula – Root of Piper longum
  • Chavya – Piper retrofractum
  • Chitraka – Plumbago zeylanica
  • Shunti – Zingiber officinale
  • Amlavetasa – Garcinia pedunculata
  • Maricha – Piper nigrum
  • Ajamoda – Trachyspermum ammi
  • Bhallataka – Semecarpus anacardium
  • Hingu – Ferula foetida
  • Ativisha – Aconitum heterophyllum
  • Mishreya – Bishop’s weed
  • Shatapushpa – Anethum sowa
  • Jeeraka – Cumin seeds
  • Krishna Jeeraka – Black caraway etc

Ama-pachana – The best medicines which can get rid of ama are –

  • Dhanyaka – Coriander
  • Musta – Cyperus rotundus
  • Pippalimula – Roots of Piper longum
  • Maricha – Piper nigrum
  • Shunti – Zingiber officinale
  • Lavanga – Syzygium aramaticum
  • Haridra – Turmeric
  • Daruharidra – Berberis aristata
  • Haritaki – Terminalia chebula
  • Amalaki – Emblica officinalis
  • Bibhitaki – Terminalia bellirica
  • Kushta – Saussurea lappa
  • Katuki – Picrorrhiza kurroa
  • Ativisha – Aconitum heterophyllum
  • Chitraka – Plumbago zeylanica
  • Patola – Trichosanthes dioica
  • Guduchi – Tinospora cordifolia etc

Useful formulations for Deepana-Pachana –

  • Decoction of Vacha (Acorus calamus) and Ativisha (Aconitum heterophyllum)
  • Decoction of Musta (Cyperus rotundus) and Parpataka (Fumaria indica)
  • Decoction of shunti (ginger), ativisha (Aconitum heterophyllum), Musta (Cyperus rotundus),
  • Paste of Shunti, ativisha and musta mixed in hot water
  • Powder of Haritaki (Terminalia chebula) mixed in hot water
  • Powder of shunti (ginger) mixed in hot water

Treating Malnourishment associated with ZES
The malnourishment associated with ZES can be combated with the food preparations mentioned in the treatment of diarrhea and vomiting associated with ZES in the above mentioned passages i.e. yushas, mamsarasas, peya, avaleha etc. The below mentioned also can be included –

  • Sarpiguda (explained in kshataksheena chapter, treatment of chest injuries)
  • Kalyana ghrita (explained in treatment of unmada or insanity)
  • Tryushana ghrita (explained in the treatment of kasa or cough)
  • Jeevaneeya ghrita (explained in the treatment of vatarakta or gout)
  • Vrushya yoga (aphrodisiac formulations mentioned in vajikarana)
  • Mamsarasa (meat soups)
  • Avaleha (confections)

Treating ZES on the lines of treating Granthi (cysts), Arbuda (tumors) and Shotha (swelling, inflammation, edema) –
We have seen that ZES is a disease which presents with acid producing gasrinomas or tumors in the stomach, which in few cases may be a part of multiple tumors manifesting in various parts of the body. The basic intention of Ayurvedic treatment is to address high acid output and provide relief from related symptoms. Many medicines and formulations mentioned above in the context of treatment of pain, diarrhea and vomiting may also be effective against these gastrinomas. To be more specific, treatment principles of granthi, arbuda and shotha can be adopted in treating ZES.
Read related: Granthi: Cystic Swelling, Types, Features, Ayurvedic Treatment

Role of Panchakarma in ZES
Vamana (therapeutic emesis) and Virechana (therapeutic purgation) are exceptional and effective remedies (among the Panchakarma therapies) in tackling ZES. They have a great role in local and systemic cleansing and detoxification. They expel excessive and vitiated pitta and kapha from the stomach, which are responsible for causing high acidity, triggering pain and other associated symptoms found in ZES. Vamana and Virechana are proved remedies in peptic ulcers, of which ZES is a variant. The medicines and formulations explained above (as remedies for ZES) yield best results when administered after giving Vamana and or Virechana.

My experience in treating ZES
I had only a couple of cases of diagnosed ZES which I happened to come across in my 20 year clinical practice. My role was to give those patients some effective medicines so as to combat excessive pain abdomen and gastritis, for which the patients had consulted me. Of all the cases of peptic ulcers and gastritis which I have successfully treated in my lengthy span of clinical practice, many might have been cases of ZES which had escaped diagnosis. I personally feel that many cases of ZES might not go to get graduated by that name, since many cases of pain abdomen which come to the clinics would be diagnosed either as gastritis or peptic ulcers (as indicated by their classical signs and symptoms) and remedies offered for the same. A few cases which are stubborn to the ‘ulcer care’ might go to the screening in which few may be diagnosed as ZES. Diagnosed cases of ZES are diverted to the ‘tumor care and ulcer care’ specializations of modern medicines as people want quick relief. Therefore I feel most patients diagnosed with ZES might not knock the doors of an Ayurvedic doctor and many more go undiagnosed.

Limitations of treating ZES with Ayurvedic remedies
I feel research works should be done on documented and diagnosed cases of ZES through Ayurvedic medicines. This will give us a clear picture of the limitations of Ayurvedic treatment or remedies on ZES. Even the modern medicine addresses this disease symptomatically. The main aim of treating ZES is treating the peptic ulcers and associated symptoms effectively which gives solace to the ailing patients. Ayurveda has best remedies to combat peptic ulcers and associated symptoms. Since Ayurveda has an effective tool in the form of Panchakarma treatments, we can infer that these treatments may halt the progression of the disease and also afford a possible cure in mild to moderate cases, in cases of ZES not associated with complications of severe degree.

Just before Finishing –
Zollinger Ellison Syndrome is a condition which resembles peptic ulcers in terms of clinical presentation. The only thing which differentiates them is the presence of gastric tumors called gastrinomas in ZES. This article is to figure out the various options and possible remedies available in Ayurveda to tackle the symptoms related to ZES.
Click to Consult Dr Raghuram Y.S. MD (Ayu)

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