Article by Dr Raghuram Y.S. MD (Ay) and Dr Manasa, B.A.M.S
Elevated ESR – Erythrocyte Sedimentation Rate is a hematological finding in many diseases. In may go up or go down. Generally it is raised in inflammatory conditions and autoimmune diseases.
The variations of ESR will settle down and come to normal range once the disease behind it is addressed effectively.
But in some conditions like autoimmune diseases the values remain high in spite of comprehensive treatment and medicines being administered.
Even in long standing ailments which are waxing and waning due to compromised immunity and improperly treated infections will show high values of ESR for a pretty long time.
Many times elevated or decreased ESR does not cause any illnesses. It only reflects some persisting conditions.
In my clinical experience I have seen many patients who complain that their ESR values are varied and thus they are worried.
Erythrocyte Sedimentation Rate (ESR)
Erythrocyte means red blood cells. ESR is the rate at which the RBC or red blood cells sediment in a period of one hour.
It is a non-specific measure of inflammatory process taking place in the body.
When there is inflammation in the body, the high proportion of fibrinogen in the blood causes the red cells to adhere to each other. The red cells thus form stacks called ‘Rouleaux formation’. This formation settles faster because of having increased density.
Conditions with increased ESR
Conditions wherein ESR is increased – Inflammation
- Autoimmune disorders, example – Rheumatoid Arthritis, Lupus
- Some kidney diseases
- Few cancers like lymphoma and multiple myeloma etc
Conditions with decreased ESR
Conditions wherein ESR is decreased –
- Congestive heart failure (CHF)
- Hyper-viscosity of blood
- Sickle cell anemia
- Low plasma protein (caused by kidney disease or liver disorders) etc
ESR in diagnosis
ESR is useful in diagnosis of –
- Auto-immune diseases
- SLE (Systemic Lupus Erythematosus)
- Rheumatoid Arthritis
- Inflammatory Bowel Disease
- Chronic Kidney Diseases
- Multiple myeloma
- Polymyalgia Rheumatica
- Infective endocarditis
- Sub-acute Thyroiditis etc
The normal range is 0-22 mm/hr for men and 0-29 mm/hr for women.
Note – ESR tends to rise with age and is generally higher in women. Values are increased in anemia and in black populations. The values are generally studied in correlation with clinical findings (signs, symptoms and other reports).
Ayurvedic management of high ESR
These suggestions and recommendations are based on my clinical experience and observations.
Role of Deepana (carminative) Pachana (digestive) medicines
Sarve Api Mande Agnau (Madhava Nidana, Udara Roga)
All diseases are caused by disturbance of internal fire or agni, unless proved otherwise. Sluggish agni causes weak metabolism and indigestion. This leads to production of ama or intermediate products of wrong digestion.
The contaminated rasa (digestive juice) or immaturely formed digestive juice in the stomach due to weak agni is called ama. This type of immature essence of digestion is incompatible with body cells. When ama is put into circulation, it combines with the doshas and dhatus (tissues) and further contaminates them. They block and clog the srotases (channels carrying various tissues and important components of the body from one place to other) and cause deficit supply of nutrition and essential elements to the tissues.
Agnimandya and Ama are the main causes for many systemic disorders. They are also the main culprits causing metabolic disorders, inflammatory diseases and auto-immune disorders. Most of these diseases present with elevated values of ESR.
Deepana – Appetite enhancing medicines, herbs and formulations which correct errors of agni and rectifies metabolic disturbances, medicines used for kindling the core fire
Pachana – Herbs or formulations or treatment measures which help in expelling ama, help in digesting and destroying the immature digestive juices and endo-toxins
When ESR is elevated due to inflammatory and auto-immune process or due to anemia, the role of agnimandhya and ajeerna and also involvement of ama should be first thought of and addressed accordingly by administering Deepana and Pachana medicines.
The symptoms of low digestion, not feeling hungry, aversion towards the food etc are the symptoms of agnimandhya and ajeerna as said by patients. Formation of ama and circulating ama causes body pains, fatigue, fever, swelling of joints and muscles, tiredness, feeling to sleep, etc symptoms in addition to loss of appetite and indigestion in the backdrop.
Best Deepana medicines –
- Pippali – Piper longum
- Pippalimula – Root of Piper longum
- Chavya – Piper retrofractum
- Chitraka – Plumbago zeylanica
- Shunti – Zingiber officinale
- Maricha – Piper nigrum
- Ajamoda – Trachyspermum ammi
- Mishreya – Bishop’s weed
- Shatapushpa – Anethum sowa
- Jeeraka – Cumin seeds
- Krishna Jeeraka – Black caraway etc
The first 5 herbs are called Panchakola
Best Ama-pachana medicines –
- Maricha – Piper nigrum
- Shunti – Zingiber officinale
- Musta – Cyperus rotundus
- Pippalimula – Roots of Piper longum
- Dhanyaka – Coriander
- Haridra – Turmeric
- Daruharidra – Berberis aristata
- Haritaki – Terminalia chebula
- Amalaki – Emblica officinalis
- Bibhitaki – Terminalia bellirica
- Kushta – Saussurea lappa
- Vacha – Acorus calamus
- Katuki – Picrorrhiza kurroa
- Ativisha – Aconitum heterophyllum
- Chitraka – Plumbago zeylanica
- Guduchi – Tinospora cordifolia
Role of Langhana
यत् किञ्चित् लाघवकरं देहे तत् लङ्घनं स्मृतम्। (च.सू.२१/९)
Langhana therapy brings lightness to the body and gets rid of heaviness. It has similar role to play like deepana and pachana. Langhana too destroys ama and cures the pathological conditions caused by excessive circulating ama. Upavasa or fasting is one of the best known and practiced types of Langhana.
Among 10 types of Langhana, those which cure the diseases causing elevated ESR and also bring back the elevated ESR to normal are –
- Upavasa – fasting (means partial or complete)
- Pachana aushadha – medicines which help in digestion, to destroy ama
- Vamana – therapeutic emesis
- Virechana – therapeutic purgation
- Niruha Vasti – decoction enemas
- Vyayama – exercise
The other forms of Langhana are –
- Shiro-virechana – nasal medications
- Maruta – exposure to wind
- Aatapa – exposure to heat of Sun
- Pipasa Nigrahana – controlling thirst or urge to take water
- Read related: Langhana Therapy – A Unique Ayurvedic Treatment Principle
Role of Panchakarma in reducing ESR:
Among the Panchakarma measures,
Vamana (therapeutic emesis),
Virechana (therapeutic purgation) and
Vasti (medicinal enemas) are highly beneficial in reducing ESR, whilst curing the causative diseases.
These treatments flush away the morbid doshas causing inflammation and disturbing the immunity in the body. They detoxify the body and re-establish health.
Pathological increase of kapha leads to accumulation and stagnation of unwanted wastes and toxins in the cells. Like ama, morbid kapha too blocks the body passages and cause deficit supply of nutrients and essential commodities needed for proper functioning to the cells. Likewise, pathological increase of pitta leads to inflammatory reactions in the body and pathological increase of Vata leads to degenerative effects. All these conditions lead to compromise of immune system and can lead to autoimmune disorders. Vamana is the best treatment for morbid kapha and pitta. Virechana is the best remedy for morbid pitta. Vasti is the best remedy for morbid Vata. These treatments not only cure the diseases and damages caused by the vitiated doshas but also will bring back the increased ESR to the normal levels.
Role of Rasayanas to decrease ESR:
Rasayanas are the herbs or formulations which enhance the quality and quantity of the tissues, thereby enhancing the overall immunity of the body. They also help as disease-modifying and anti-ageing agents. The role of Rasayanas in the management of diseases and also in maintenance of health is unparalleled.
After effectively curing the inflammatory or autoimmune disorders with effective Deepana, pachana measures and also with the help of Panchakarma treatments, Rasayana shall be given to avoid the recurrence of the diseases.
Rasayanas are very effective in disease conditions which are recurring and tend to be involved with increased values of ESR. They not only avoid the recurrence of the diseases but also keep the ESR levels in control, within normal limits.
In my clinical experience I have seen the below mentioned Rasayanas having a good effect in immune-modulation role and in preventing diseases and checking the inflammatory and auto-immune processes occurring in the body, while keeping the ESR values at bay.
- Chaitanya Rasayana (proprietary)
- Ashwagandha Rasayana
- Kushmanda Rasayana
- Amalaki Rasayana
Important formulations which help in reducing ESR
- Dashamula Kashayam
- Amrutottaram Kashayam
- Rasnaerandadi Kashayam (Cheriya Rasnadi Kashayam)
- Maharasnadi Kashayam
- Guluchyadi Kashayam
- Punarnavadi Kashayam
- Rasnasaptakam Kashayam
- Guggulutiktakam Kashayam / Ghritam
- Varanadi Kashayam / Ghritam
- Drakshadi Kashayam
- Nayopayam Kashayam
- Dashamulakadutrayadi Kashayam
- Simhanada Guggulu
- Kaishora Guggulu
- Chandraprabha Vati
- Punarnavadi Mandura
- Giloy Satwa
- Ardraka Satwa
- Nimbamritadi Eranda Tailam
- Gandharvahastadi Eranda Tailam
Just Before Finishing
Elevated ESR, what one needs to understand is that it is just a part and representative of a disease. Once the disease gets controlled or cured, the ESR comes back to its normal levels. Therefore there is no need to panic about the numbers that the raised ESR shows. The culprit disease causing it should be addressed. This article covers the effective Ayurvedic solutions for bringing back the elevated ESR to normal whilst combating the disease or diseases causing it.