Splenomegaly – Ayurveda Concept, Symptoms, Causes, Remedies

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Splenomegaly is a condition in which there is enlargement of spleen, an abdominal organ located in the left upper portion of your abdomen, below the ribcage. This condition is explained in Ayurveda treatises in the name of Plihodara.

Plihodara

Pleehodara, according to Ayurveda is one among the eight types of Udara Roga i.e. abdominal enlargement. When spleen enlarges beyond normal dimensions, it presents as an abdominal enlargement. Pliha means spleen. Udara means abdomen. Therefore Plihodara means enlargement of spleen in the abdomen causing its enlargement. It is often called as just Pliha.
Read – Charaka Udara Roga Chikitsa – 13th Chapter

If the word Pliha is used in the context of explanation of disease it means ‘enlargement of spleen’. Else, the word just means the ‘organ spleen’.

Spleen along with liver is considered as roots of origin of channels of formation and transportation of blood. It is said that the rasa tissue on reaching the liver and spleen get colored red by the action of ranjaka pitta and transformed into blood tissue.

Home remedies

Aloe vera – 2 tablespoon of pulp of Aloe added with pinch of turmeric powder
Read – Aloe Vera Benefits, Research, Home Remedies, Side Effects

Achyranthes aspera – 2 tablespoon of fine powder of dried plant of Achyranthes aspera should be mixed with beaten yoghurt and taken twice daily.

Achyranthes aspera powder – should be mixed with equal parts of powder of rock salt, dry ginger, long pepper, black pepper, mixed in honey and taken orally.
Read – Apamarga – Achyranthes aspera – Uses, Dose, Side Effects

Apple – apple should be eaten on empty stomach or fresh apple juice should be consumed

Beetroot – fresh beetroot slices or grated beetroot should be taken in slad

Bitter gourd – half spoon of powder of dried bitter gourd seeds should be taken with lukewarm water

Black plum – 2 teaspoon of Jamun vinegar should be taken daily

Bombax malabaricum – flowers, roughly 20 grams should be boiled in ¼ liter of water. Soak it overnight. Filter it early in the morning, add 2-3 pinches of mustard powder and consume it daily

Cinchona – decoction of cinchona plant should be consumed

Cow urine – 1 pinch of crystal salt powder mixed in 50 gm of cow urine and take early in the morning for 40 days.

Drumstick – half tablespoon of ground root of drumstick tree mixed with black pepper, impure carbonate of potash and honey should be taken twice daily.

Drumstick tree bark – 20 grams is boiled in half liter water until ¼ of it remains. Filter the decoction. Add 1 gm of powder of Plumbago zeylanica, 2 gm long pepper powder and 3 gm of rock salt powder. This decoction should be consumed daily.

Eclipta alba – juice of crushed plant of Eclipta should be consumed in 20ml quantity.

Fig – 2 figs soaked in vinegar for 6 days should be consumed daily

Ginger – eating 2-3 small pieces of fresh ginger will help. Alternatively decoction of ginger should be taken.

Hibiscus – tree root powder and rock salt should be mixed in equal quantity and ground in water into a paste and balls of pea nut size prepared, dried and stored. 1 pill should be taken with water before food twice a day for 4 weeks.
Read – Hibiscus Benefits, Usage, Dose, Remedies, Side Effects

Jojoba leaves – decoction of fresh leaves of jojoba boiled in 2 cups of water until it remains half should be taken daily.

Lemon juice – 10 gm should be mixed with 10 gm onion juice and consumed early in the morning.

Mango – juice of ripe mangoes added with one spoon of honey is helpful when taken daily.

Papaya – Raw pieces of papaya soaked in cup of apple cider vinegar should be left overnight. It should be eaten early in the morning adding little rock salt to it. Alternatively 1 tablespoon of papaya raw milk should be taken on empty stomach. 

Plumbago zeylanica – root powder should be ground with water and small pills of pea nut size should be prepared, dried and stored. 1 pill placed in the middle of banana piece and swallowed. This shall be taken for 3 days.

Pomegranate juice – Juice of dried pomegranate root mixed in 1 cup of milk should be taken.
Read – Pomegranate Benefits, Home Remedies, Side Effects

Trachyspermum ammi – soaked in Aloe vera juice should be placed in a mud pot over night. Next day, it should be kept in sunshine and mixed. Repeat this for 3 days. Dry the powder and store it. This should be taken in ¼ spoon quantity with water before food for 40 days.

Vitex negundo – paste of leaves of Vitex negundo should be applied externally on painful spleen.
(read more here)

Lifestyle advice

Avoid contact sports like hockey, football and soccer.
Limit other physical activities as recommended by your doctor.
Don’t forget to wear seat belt while driving. This can prevent injury to your spleen in case you meet with an accident.
Keep taking your vaccinations post-surgery to avoid the risk of infection.

Causes, Pathogenesis

The entire body and body parts getting stimulated and agitated (jerk, shake violently) following one of the below mentioned events –

• Riding on animals immediately after taking food
• Getting indulged in many kinds of physical activities immediately after intake of food

Extreme emaciation of the body occurring due to one or more of the below mentioned factors –

• Excessive sexual intercourse
• Lifting heavy weights
• Excessive walking
• Suffering from vomiting or other diseases for long duration
  Read – Vomiting: Causes, Complications, Pathophysiology, Treatment

Due to the above said etiological factors, the spleen located in the left side of the abdomen will get displaced from its place and undergo excessive growth. Alternatively the increased quantity of rasa tissue will lead to the formation of excessive blood tissue. This increased blood will cause enlargement of spleen.

Texture of enlarged spleen

• Hard on touch
• Stony appearance
• Initially / proximally gets enlarged
• Raised and appears similar to the shell of tortoise
• If it is not treated early, the enlarged spleen will encroach over the entire abdomen, over the stomach, pancreas and causes enlargement of the abdomen
  Read – Fullness Of Abdomen – Ayurvedic Approach And Treatment

Signs and Symptoms of Plihodara

• Weakness
• Disinterest in food, tastelessness
• Indigestion
• Obstruction to passage of urine and feces
• Feeling as if enveloped by darkness
• Thirst
• Body aches
• Vomiting
• Fainting
• Weakness of the body
• Cough
• Dyspnea
• Mild fever
• Flatulence
• Sluggish digestion
• Emaciation
• Awkward tastes in the mouth
• Pain in small joints of the hands
• Vata type of pains in the abdomen
• The abdomen appears reddish / reddish brown color or is colorless
• Elevated lines of blue, green or turmeric color on the abdomen
  Read – Gulma- Abdominal Tumor- A Unique Disease In Ayurveda

Dosha symptoms of enlargement of spleen

• In vata predominant splenomegaly upward movement of vata, pain in the abdomen and flatulence can be found.
• In pitta predominant splenomegaly burning sensation, confusion, severe thirst and fever are the symptoms.
• In kapha predominant splenomegaly heaviness in the abdomen, tastelessness and hardness of belly can be found.
• In splenomegaly associated with association of all three vitiated doshas, the symptoms of all three doshas are present in mixed proportions.
• In splenomegaly caused by vitiated blood, the symptoms of vitiation of blood explained in Vidhishonitiya Adhyaya i.e. 24^th chapter of Sutra Sthana section are available.
  Read – 24th chapter of Charaka Samhita Sutrasthana – Vidhi Shoniteeya Adhyaya

Yakrutodara

Yakrutodara means enlargement of liver. If there is similar (to spleen enlargement) enlargement on the right side of the abdomen, with the above said signs and symptoms, it will be called as Yakrutodara.

The causes, signs and symptoms and treatment of enlargement of liver is said to be similar to that of enlargement of spleen. Therefore there is no separate description of enlargement of liver in Ayurveda texts. The explanation is clubbed in the discussion of plihodara itself.

Types of Plihodara

1. Sankshobhadi chyutasya pliha vriddhi – enlargement due to displacement caused by sudden jerks or violent shaking of abdomen caused by riding vehicles or doing excessive physical activities immediately after taking food. This is of 5 sub-types and are called Pancha Pliha Doshas i.e. 5 kinds of spleen morbidities.

• Vataja Pliha – caused by vitiated vata
• Pittaja Pliha – caused by vitiated pitta
• Kaphaja Pliha – caused by vitiated kapha
• Sannipataja Pliha – caused by simultaneous vitiation of all three doshas
• Raktaja Pliha – caused by vitiated blood

2. Rakta vriddhi janya pliha vridhhi – enlargement of spleen taking place due to increased blood tissue. Blood tissue is formed from rasa tissue in spleen and liver. If more quantity of rasa tissue is formed, more quantity of blood too is formed in the spleen. Due to this there is enlargement of spleen.
Read – Rasa Dhatu: Definition, Formation, Circulation, Imbalance Diseases, Treatment

Treatment of Plihodara

1. Principles of Treatment

The below mentioned therapies shall be done in enlargement of spleen –

• Snehana – oleation
• Swedana – sudation
• Virechana – purgation
• Niruha – decoction enemas
• Anuvasana – oil / fat enemas

Siravedha – Bloodletting – If all the above said treatments are not able to cure splenomegaly then bloodletting through venesection of the vein located in the left arm should be done.
Read – Siravyadha Method Of Bloodletting: Procedure, Precautions, Benefits

Alternatively the below mentioned shall be used –

• Shatphala Sarpi ghee mentioned in the chapter dealing with treatment of Rajayakshma i.e. tuberculosis
• Combination of jaggery and Terminalia chebula
• Use of alkalis
• Use of Arishtas

2. Dosha wise treatment of splenomegaly

In splenomegaly associated with vitiated vata and kapha, agnikarma i.e. fire cauterization should be done.

In splenomegaly associated with vitiated pitta, the below mentioned measures may be preferred –

• Oral use of ghee processed with Jivaniya group of herbs
• Enemas with milk processed with the decoction of pitta alleviating herbs
• Bloodletting
• Emesis
• Oral intake of milk
  Read – Chardi Roga Chikitsa: Ayurvedic Treatment For Vomiting, Limitations

Soups which enhance the digestive power processed with herbs having sour, bitter and pungent herbs shall be used with easy to digest food. Alternatively similar food shall be served with meat soup.

3. Useful classical medicines  

Pippalyadi Churna

Powder of the below mentioned ingredients should be taken with hot water to treat abdominal disorders including splenomegaly –

• Pippali – Piper longum – 1 part
• Ginger – Zingiber officinale – 1 part
• Danti mula – roots of Baliospermum montanum – 1 part
• Chitraka mula – roots of Plumbago zeylanica – 1 part
• Vidanga – Embelia ribes – 1 part
• Terminalia chebula – twice the quantity of the above said

Hapushadhya Churna

Powder prepared from the below mentioned ingredients shall be used either with juice of sour pomegranate, decoction of Triphala, meat soup, urine of cow or hot water. It is also used as purgative.

• Hapusha – Juniperus communis
• Swarnakshiri mula – Root of Argemone mexicana
• Amalaki – Emblica officinalis
• Bibhitaki – Terminalia bellirica
• Haritaki – Terminalia chebula
• Katuki – Picrorrhiza kurroa
• Nilini – Indigofera tinctoria
• Trayamana – Gentiana kurroo
• Saptala – Euphorbia dracunculoides
• Trivrit – Operculina turpethum
• Vacha – Acorus calamus

Vidangadi Kshara

Alkali prepared by burning together in an earthen saucer should be given with milk –

• Vidanga – Embelia ribes
• Chitrakamula – roots of Plumbago zeylanica
• Ginger
• Rock salt
• Vacha – Acorus calamus
• Ghee

This formulation cures splenomegaly and abdominal tumors.

Rohitakadi Yoga

Coarse powder of Rohitaka stem (Aphanamixis polystachya) is dipped in decoction of Terminalia chebula or urine of cow for 7 days. Later it is rubbed with hands and filtered. This should be taken for drinking. After the medicine has got digested, food should be taken along with the meat soup of animals and birds living in desert like land.

Rohitaka Ghruta

Decoction of Bark of Aphanamixis polystachya – 1200 grams and sour Ziziphus mauritiana – 1296 grams should be prepared. To this, paste prepared with 48 grams each of powders of Piper longum, Piper nigrum, Piper retrofractum, Plumbago zeylanica and Ginger and 240 grams of Aphanamixis polystachya should be added. In this 648 grams of ghee should be produced. This formulation cures enlargement of spleen apart from wide array of disorders.

Madhwadi yoga

Below mentioned ingredients should be mixed in buttermilk and consumed to cure spleen enlargement –

• Honey
• Sesame oil
• Vacha – Acorus calamus
• Ginger
• Shatahva – Anethum graveolens
• Kushta – Saussurea lappa
• Rock salt

Pippalyadi Lavana

Powder of the below mentioned ingredients should be prepared –

• Pippali – Piper longum
• Lodhra – bark of Symplocos racemosa
• Hingu – Ferula narthex / asafetida
• Ginger
• Gajapippali – Scindapsus officinalis
• Bhallataka – Semecarpus anacardium
• Drumstick fruits
• Haritaki – Terminalia chebula
• Bibhitaki – Terminalia bellirica
• Amalaki – Emblica officinalis
• Katuki – Picrorrhiza kurrooa
• Devadaru – Cedrus deodara
• Turmeric
• Daruharidra – Berberis aristata
• Sarala – Pinus roxburghii
• Ativisha – Aconitum heterophyllum
• Vacha – Acorus calamus
• Kushta – Saussurea lappa
• Musta – Cyperus rotundus
• Five types of salt

To this curds, muscle fat, bone marrow and sesame oil are added and burnt. The salt thus prepared should be consumed with wine or supernatant water of curds or water. Apart from other disorders, this formulation is highly effective in curing splenomegaly.

Shigru Kwatha (Chakradatta, Udara Chikitsa Prakarana, 44)

In the decoction of drumstick, powder of long pepper, black pepper, rock salt and Garcinia pedunculata. This decoction when consumed will cure splenomegaly.
Read – Moringa Benefits, Medicinal Usage, Complete Ayurveda Details

Indravaruni Mula utpatana (Chakradatta, Udara Chikitsa Prakarana, 45)

The root of Citrullus colocynthis should be de-rooted by taking the name of the patient who is suffering from splenomegaly. It should be split / torn apart into two parts and thrown away at far distance. By doing this the patient’s enlargement of spleen will be cured.
Read – Colocynth: Citrullus colocynthis Uses, Dosage, Side Effects

4. Formulations For Hepato-Splenomegaly From Yogaratnakara

Sindhvadi Churna

The powder of the below mentioned herbs shall be taken with water –

• Rock salt
• Long pepper – Piper longum
• Chitrakamula – roots of Plumbago zeylanica
• Roots of drumstick – Moringa oleifera
• Cumin seeds

Yavanyadi Churna

The powder of the below mentioned herbs shall be taken mixing with hot water, supernatant water of curds or medicated wine. More details about this medicine here

Kushtadi Churna

12 grams of the powder of the below mentioned herbs is taken with hot water –

• Kushta – Saussurea lappa
• Vacha – Acorus calamus
• Ginger – Zingiber officinale
• Chitrakamula – Roots of Plumbago zeylanica
• Kutaja Phala – fruits / seeds of Holarrhena antidysenterica
• Patha – Cissampelos pareira
• Ajamoda – Trachyspermum ammi
• Long pepper

Laghu Hingwadi Churna

The powder of the below mentioned herbs should be taken with juice of Matulunga (Citrus medica) –

• Shuddha Hingu – purified asafetida
• Ginger
• Maricha – black pepper
• Pippali – long pepper
• Kushta – Saussurea lappa
• Yava Kshara – alkali of barley
• Rock salt

Shankhanabhi Churna

12 grams of ash of Shankhanabhi, a kind of shell should be taken mixing with juice of ripened Citrus limon.

Vidangadi Churna

The powder of the below mentioned herbs shall be taken with hot milk or urine of cow –

• Vidanga – Embelia ribes
• Yavani – Trachyspermum ammi
• Chitraka mula –roots of Plumbago zeylanica
• Devadaru – Cedrus deodara
• Ginger
• Punarnava – Boerhavia diffusa
• Trivrut – Operculina turpethum

Rohitakadi Kalka

Paste of equal quantity of Rohitaka (Aphanamixis polystachya)and Haritaki (Terminalia chebula) triturated with urine of cow should be taken orally with water.

Sharapunkha mula kalka

Paste of roots of Tephrosia purpurea should be taken with buttermilk.

Shalmali Pushpa Kwatha

Flowers of Bombax ceiba should be steamed and left overnight in the water. When it gets stale in the morning, it should be mixed with powder of Brassica juncea / brown mustard and used to drink. This cures splenomegaly and hepatomegaly.

Dravanti Nagavati

The tablets are prepared with the below mentioned ingredients  

• Alkali of sesame – 1 part
• Alkali of castor plant – 1 part
• Dravanti kshara – Alkali of Jatropha curcas – 1 part
• Shuddha Bhallataka – Purified Semecarpus anacardium – 1 part
• Pippali – Piper longum – 1 part
• Old jaggery – 6 parts

Kshara Bhavita Pippali

Pippali i.e. Piper longum should be triturated with decoction of alkali of Butea monosperma and consumed.

Shuktikadi Yoga

Ash / alkali of shell of pearl oyster and powder of long pepper should be taken with milk.

Ksharadi Yoga

Alkali of barley plant, Vid salt and powder of long pepper should be taken with juice of Caesalpinia bonduc made warm.

Shobhanjanadi Yoga

Decoction of drumstick tree bark should be taken with one of the below mentioned–

• Rock salt, Roots of Plumbago zeylanica and powder of long pepper
• Alkali of Butea monosperma
• Alkali of barley plant

Lashunadi Yoga

Powder of garlic, roots of long pepper and Terminalia chebula should be eaten and cow’s urine should be consumed as after drink.

Rohitakadi Yoga

The powder of the below mentioned should be consumed with cow’s urine as after drink cures enlargement of spleen and liver –

• Rohitaka – Aphanamixis polystachya
• Haritaki – Terminalia chebula
• Ginger – Zingiber officinale

Lavanadi Takram

240 grams each of rock salt, turmeric and brown mustard should be thoroughly mixed in 4800 grams of buttermilk. This should be kept in an earthen vessel or mud pot, a lid is closed, sealed and left in place for 3 days. Later it should be taken in 240 grams dose for 21 days.

Vajra Kshara

1. The powder is prepared with equal quantity of the below mentioned ingredients–

• Sauvarchal lavana – Souchal salt
• alkali of barley plant
• Sea salt
• Kacha lavana – glass salt
• Rock salt
• Pure borax
• Sarji kshara – Carbonate of soda

2. This powder should be triturated in heat of the sun with latex of Arka – Calotropis gigantea and Snuhi – Euphorbia neriifolia, 3 days with each of the latex and dried.

3. Leaves of Calotropis gigantean should be taken in equal quantity as that of the quantity of powder. Half of the leaves should be placed above and half of the leaves below the powder in an earthen crucible. Its lid should be closed and concealed at the joint.

4. The platter should be heated with fuel of cow-dung in Gajaputa method. When it is totally burnt the ingredients are removed and pounded. To this, the powder of the below mentioned ingredients should be mixed properly –

• Ginger
• Long pepper
• Black pepper
• Vidanga – Embelia ribes
• Mustard
• Haritaki – Terminalia chebula
• Bibhitaki – Terminalia bellirica
• Amalaki – Emblica officinalis
• Chavya – Piper retrofractum
• Hingu – asafetida fried in ghee

The final preparation is called as Vajra Kshara. This should be taken with buttermilk as after drink.

Agnimukha Lavana

1. The powder of the below mentioned ingredients taken in equal quantity–

• Chitrakamula – roots of Plumbago zeylanica – 1 part
• Trivrit – Operculina turpetum – 1 part
• Danti mula – roots of Baliospermum montanum – 1 part
• Amalaki – Emblica officinalis – 1 part
• Haritaki – Terminalia chebula – 1 part
• Bibhitaki – Terminalia bellirica – 1 part
• Ruchaka lavana – type of salt – 1 part
• Rock salt – 8 parts
  Read – Salt Taste – Types, Qualities, Health Benefits, Side Effects

2. The above said powder should be triturated with latex of Snuhi – Euphorbia neriifolia. This should be dried.

3. The dried powder should be filled inside the branches of Euphorbia neriifolia from which the pulp has been removed. The ends of the branches are sealed and burnt in the fire. When they are properly burnt they should be pounded and the powder collected.

This is called Agnimukha lavana. It should be taken with buttermilk to cure enlargement of spleen and liver.

Chitrakadhya Ghrita

Ghee processed with the below mentioned ingredients is useful in curing enlargement of spleen and liver.

Ingredients –

1. Decoction of roots of Chitraka – Plumbago zeylanica – 4800 grams
2. Ghee – 648 grams
3. Aranala – fermented medicinal liquid – 1296 grams
4. Dadhi manda – supernatant water over the curds – 2592 grams
5. Buttermilk – 2592 grams
6. Paste of the below mentioned – 24 grams each

• Long pepper
• Roots of long pepper
• Chavya – Piper retrofractum
• Chitraka – Plumbago zeylanica
• Ginger
• Talisa patra – leaves of Abies webbiana
• Yava Kshara – alkali of whole plant of barley
• Sarji kshara – Carbonate of soda
• Rock salt
• Souchal salt
• Vida lavana – Vida salt
• Sea salt
• Audbhida lavana – Salt prepared from alkaline soil
  Read – Ghee Benefits, Usage, Side Effects, Contra Indications

Maharohitakam Ghritam

Ghee is prepared with below mentioned ingredients

1. Bark of Rohitaka – Aphanamixis polystachya – 4800 grams
2. Badara – jujube fruit – 1296 grams

These two should be pounded and boiled in 10,368 grams of water till one fourth of it remains. The decoction is filtered.

To this, the below mentioned ingredients are added in mentioned quantity and ghee is processed –

3. Ghee prepared from cow’s milk – 648 grams
4. Goat’s milk – 1296 grams
5. Paste of below mentioned ingredients taken in 24 grams each –

• Ginger
• Long pepper
• Black pepper
• Amalaki – Emblica officinalis
• Haritaki – Terminalia chebula
• Bibhitaki – Terminalia bellirica
• Shuddha Hingu – purified asafetida
• Yavani – Trachyspermum ammi
• Tumburu – Zanthoxylum alatum
• Vida – Vida salt
• Vidanga – Embelia ribes
• Chitraka – Plumbago zeylanica
• Hapusha – Juniperus communis
• Chavya – Piper retrofractum
• Vacha – Acorus calamus
• Cumin seeds
• Krishna Lavana – Black Salt
• Pomegranate
• Devadaru – Cedrus deodara
• Punarnava – Boerhavia diffusa
• Vishala – Citrullus colocynthis
• Alkali of barley plant
• Pushkaramula – Roots of Inula racemosa
  Read – Goat Milk Benefits According to Ayurveda

Pippalyadi Ghrita

Consumed to cure especially enlargement of liver. More details here

4. Useful classical formulations

• Arogyavardhini Rasa
• Sarvajwarahara Lauha
• Yakrutplihari Lauha
• Punarnavadi Mandura
• Punarnavadi Kashaya
• Saptasara Kwatha
• Rohitakarishta
• Kumaryasava
• Rajata Bhasma
• Loha Bhasma
• Kasisa Bhasma
• Yava Kshara
• Manibhadra Guda
• Dashamula Haritaki
• Dadimadi Ghrta
• Gandharvahastadi Taila

5. Patent Medicines useful in curing splenomegaly and hepatomegaly

• Tab Stimuliv
• Syrup Retoliv
• Syrup Livol-S
• Cap Livol
• Tab Livlon
• Syrup Livion Forte
• Tab Livfit
• Tab Liverson
• Cap Livcare Forte
• Syrup Liv-50
• Syrup Kalamegha Strong
• Syrup Heptovit S.C.G
• Cap Heptoliv
• Cap Hepaten

Sanskrit verses

Splenomegaly

Splenomegaly means enlargement of spleen, measured by size or weight. It gets enlarged due to various causes including infections, liver disease and some cancers.
Read – Liver Diseases: Causes, Symptoms, Treatment, Home Remedies

The enlarged spleen is diagnosed during a routine physical examination. A normal spleen cannot be felt by the doctor during abdominal examination. But when it is enlarged it can be felt while palpation and percussion of abdomen is being carried out. To make a diagnosis, the doctor may recommend you to get blood tests and imaging done.

Definition

Definition of splenomegaly by weight and size – A normal spleen weighs approximately 150 grams. It is approximately 11 cm in craniocaudal length. A spleen weight of 400-500 grams indicates splenomegaly. When the spleen weighs more than 1000 grams, it is labeled as massive splenomegaly. Poulin et al defined splenomegaly as moderate if the largest dimension is 11-20 cm and severe if the largest dimension is greater than 20 cm. (read more)

Treatment of splenomegaly is usually done based on the underlying condition that is causal. Surgical removal of spleen may be advised if other treatments fail.

Functions of Spleen

Spleen is a soft and spongy organ, which filters out old and damaged blood cells, prevents infection by producing white blood cells, stores red blood cells and platelets which are helpful in clotting of blood. When the spleen enlarges these vital functions are hampered. As it becomes larger, the spleen filters even normal red blood cells and traps too many platelets. Excess blood cells and platelets will eventually clog your spleen and afflict its normal functioning. Its own blood supply will be hampered with time. As a result some portions of the spleen may get damaged or even destroyed.
Read – Involvement Of Doshas In Formation Of Organs

Chief functions of spleen –

• Clearance of microorganisms and particulate antigens from blood stream
• Synthesis of IgG (Immunoglobulin G), properdin and tuftsin
• Removal of abnormal red blood cells
• Extramedullary hematopoiesis in certain diseases

Causes of Splenomegaly

Below mentioned are some of the common infections, diseases and conditions which cause enlargement of spleen –

Condition	Example
Viral infections	Mononucleosis
Bacterial infections	Syphilis, Endocarditis (infection of inner layer of heart) Read – Upadamsha – Treatment For Sexually Transmitted Disease
Parasitic infections	Malaria
Liver diseases	Cirrhosis of liver etc
Anemia	Various kinds of hemolytic anemia
Blood cancers / neoplastic	Leukemia, Myeloproliferative neoplasms, Lymphomas (example – Hodgkin’s disease)
Metabolic disorders	Gaucher’s disease, Niemann-Pick disease
Venous problems / congestive	Pressure on splenic veins or liver veins or blood clot in these veins, spleen vein thrombosis, portal hypertension, Banti disease
Infiltrative	Sarcoidosis and some neoplasms
Myeloproliferative	Chronic myeloid metaplasia
RBC destruction work hypertrophy	Hereditary spherocytosis and thalassemia major
Immune response work hypertrophy	Sub-acute bacterial endocarditis or infectious mononucleosis

Read – Fatty Liver: Symptoms, Ayurvedic Treatment, Remedies, Tips

Other causes –

• Hemangiomas
• Metastasis
• Trauma
• Cysts
• Giant abscess
• Certain drugs
  Read – Recurrent Abscess Ayurvedic Treatment Options

Symptoms

In some cases, splenomegaly will be symptomless. Below mentioned symptoms may be found when the spleen gets enlarged –

• Pain or fullness in the left upper part of your abdomen, the pain may spread to your left shoulder
• Having a feeling of fullness without eating food or even after eating small quantity of food (this happens due to pressure of enlarged spleen over your stomach)
• Anemia
• Fatigue
• Frequent infections
• Easy bleeding

When you have severe pain in your left upper abdomen or if the pain gets worse when you take deep breathe, you have to see your doctor without delay.

Types of splinomegaly

1. Inflammatory splenomegaly – caused due to various infections or inflammatory processes. It results from an increase in the defense activities of the organ. Example – enlargement of spleen occurring from lupus and Felty syndrome and from viral infections like EB Virus induced mononucleosis.

2. Hyperplastic splenomegaly – Caused due to removal of abnormal blood cells from circulation. It is also caused due to extramedullary hematopoiesis, as in myeloproliferative disease.(read more)

3. Congestive splenomegaly – It is caused due to one or more of –

• cirrhosis with portal hypertension,
• splenic vein thrombosis,
• congestive heart failure with increased venous pressure
  Read – Ayurvedic Treatment For Heart Diseases – Hridroga Chikitsa

4. Infiltrative splenomegaly – occurs in sarcoidosis, Gaucher disease, amyloidosis or metastatic malignancy due to engorgement of macrophages with indigestible materials.

5. Infectious splenomegaly – This happens due to formation of multiple abscesses in the spleen. This happens due to splenic filtering of blood-borne pathogens especially encapsulated organisms.

6. Acute Splenic Sequestration Crisis (ASSC) – is a major cause of morbidity and mortality in children with sickle cell disease and other hereditary hemolytic anemias. It is characterized by –

• sudden enlargement of spleen due to trapping of a significant proportion of blood volume
• rapid drop in hematocrit with hypovolemia
• thrombocytopenia

This condition is rare in adults with sickle-beta thalassemia. But splenomegaly is common in these patients.

Complications

Infection – frequent infections occur when you have splenomegaly because your enlarged spleen can reduce the number of healthy red blood cells, platelets and white blood cells in your bloodstream. There is also a possibility of increased bleeding to occur and consequential anemia. Both these conditions also give base for infections.

Rupture of spleen – the enlarged spleen may easily rupture. This will eventually cause life threatening bleeding into your abdominal cavity.

Risk Factors

Spleen enlargement can take place in anyone at any age but certain groups of people are at highest risk. They are –

• Children and young adults with infections, such as mononucleosis
• Those having Gaucher’s disease, Niemann-Pick disease and many other inherited metabolic disorders affecting the liver and spleen
• People living in or traveling to areas wherein malaria is common
  Read – Bleeding Disorders: Ayurveda Treatment, Diet, Home Remedies

Diagnosis

The enlarged spleen is detected during a physical examination, especially when the doctor feels and taps the enlarged organ while examining the left upper abdomen. The diagnosis may be confirmed with blood tests, USG or CT scan and MRI. While the blood tests helps the doctor to figure out the number of red blood cells, white blood cells and platelets in the system, USG or CT scan helps determine the spleen size. MRI on the other hand helps to trace the blood flow through the spleen.

Liver function tests and bone marrow exams may be needed for diagnosis at times. A needle biopsy of spleen, though useful, is very rarely preferred because of the risk of bleeding.

Occasionally you may be recommended for a surgical removal of spleen. This is done especially when there is no identifiable cause for spleen enlargement.
Read – 10 Factors Of Patient Examination – Dasha Vidha Atura Pareeksha

Treatment

Treatment of enlarged spleen totally depends on the underlying problem. Example, if there is an underlying bacterial infection; the infection shall be promptly treated with antibiotics. Similarly any other disease which has caused spelnomegaly shall be promptly addressed.

Watchful waiting – Your doctor may suggest you to wait while carefully watching when you have an enlarged spleen but do not have related symptoms. This may also be suggested when the exact cause cannot be found. You might have to see the doctor for reevaluation in 6-12 months or sooner if you develop any symptoms.
Read – Ayurvedic Home Remedy For Liver Diseases

Splenectomy – is a surgery for removing enlarged spleen. If an enlarged spleen causes serious complications or when its cause cannot be found out or when the condition cannot be treated, splenectomy will be the only option. In chronic or critical cases, surgery may offer best hopes for recovery. Doctors may consider elective spleen removal. This is because if total spleen is removed, you may suffer from serious and life threatening infections after its removal. Many times radiation can help shrink your spleen so that you may avoid its surgical removal.

Role of patient education – Patient education would decrease the risk of splenic trauma and rupture. They should be advised to avoid contact sports or any other activities that may increase intra-abdominal pressure, to use seat belts while driving or riding a motor vehicle, and education about signs and symptoms of post-splenectomy sepsis comes in handy. Education helps in preventing overwhelming post splenectomy infection (OPSI). Asplenic patients should be encouraged to wear a medical alert bracelet. They should carry a wallet card explaining their lack of spleen. Patients should know the need of notifying their physician if they suffer from acute febrile illness, especially if it is associated with rigors or systemic symptoms.
Read – Roga, Rogi Pareeksha: Examination Of Disease And Patient

Effective herbs for enlargement of spleen

• Apamarga – Achyranthes aspera
• Pippali – long pepper
• Kumari – Aloe vera
• Bhringaraja – Eclipta alba
• Trivrit – Operculina turpethum
• Punarnava – Boerhavia diffusa
• Common salt
• Aconitum heterophyllum
• Liatris spicata
• Chicory
• Eupatorium fortune
• Agarwood
• Asplenium falcatum
• Redroot
• Atractylodes lancea
• Indian snakeroot

Epidemiology

Reports in US showed palpable spleen in 2% patients and another report showed the same in 5.6% patients.

Tropical splenomegaly syndrome / hyperactive malarial syndrome – occurs most often in people indigenous to malarial belt of tropical Africa and visitors to that region. This condition has a female-to-male ratio of 2:1. Apart from this no sex prediction is documented for splenomegaly.

Splenic injury is more common in elderly persons.

Prognosis

The prognosis of splenomegaly is usually excellent. It is impacted by the state of underlying disease rather than presence of enlargement of spleen or post-splenectomy state.

Morbidity and mortality

This depends on the states of associated disease or surgical procedures. Rates are highly variable and relate to presence of absence of co-morbidities, hemorrhage and organ failure. Splenomegaly patients more likely have splenic rupture from blunt injury of abdomen or lower thorax.

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Yogas mentioned in Sahasra Yoga text book

Sukumara ghritha
Dhanvantari Ghrita
Trikatvadi choorna
Hapushadi choorna
Taleesa patradi choorna
Hingu vachadi choorna
Arka patradi bhasma
Ketakidala bhasma
Indrasani choorna
Kalyana kshara
Vidangadi kashara
Punarnavasava
Lohasava
Manibhadra Guda
Ellum tippalyadi lehaym
Danti hareetaki Lehya
Dasamoola hareetaki Lehya
Dasamooladi Lehya
Chitrakadi Guda
Gudardraka
Matala Rasayana
Kukkuta Rasayana
Yogaraja guggulu
Mandoora vataka
Marichadi Gutika
Sleepadantaka gutika