Eswara Sarma M P and Arathi P K / Int. J. Res. Ayurveda Pharm.

12 (4), 2021

Case Report
www.ijrap.net (ISSN:2229–3566)

AYURVEDIC MANAGEMENT OF PARTIAL EMPTY SELLA SYNDROME: A CASE REPORT

Eswara Sarma M P 1, Arathi P K 2*
1
Principal, PNNM Ayurveda Medical College and Hospital, Cheruthuruthy, Kerala, India
2
PG Scholar, Department of Kayachikitsa, Sri Jayendra Saraswathi Ayurveda College and Hospital, Chennai, India

Received on: 23/06/21 Accepted on: 25/07/21

*Corresponding author
E-mail: pkarathict@gmail.com

DOI: 10.7897/2277-4343.120498

ABSTRACT

Empty Sella Syndrome is a disorder that involves the presence of Cerebro-spinal fluid in Sella turcica in an excess amount. In empty Sella syndrome
the Sella turcica is either partially filled with cerebrospinal fluid and an atrophied pituitary gland lying in the floor of the Sella (Partial Empty Sella
Syndrome) or filled with cerebrospinal fluid which pushes the pituitary gland into a side of Sella turcica resulting in non-visualization of the gland.
(Completely empty Sella). A 37-year-old female diagnosed with partial empty Sella syndrome was managed with Pathyakshadhatryadi kashayam 15
ml twice daily in empty stomach with 45 ml lukewarm water, Rasnadi choornam tailam application, mahatraiphala ghritam 10 ml at night after food,
Kshirabala 7 Avarti tailam pratimarsha nasyam. After completion of the treatment, there was considerable relief in the primary complaint of the patient
which was a recurrent headache and the follow up MRI showed a marked change in the condition. This case report highlights the role of Ayurveda in
the management of partial empty Sella syndrome and sheds light for further study on the same.

Keywords: Partial empty Sella syndrome, Tarpaka kapha, Kledatva, Pathyakshadhatryadi kashayam

INTRODUCTION vitiated. Tarpaka Kapha is also correlated to the CSF4. Increased

inflow of the Cerebro spinal fluid can be considered as the
Empty Sella syndrome is caused due to a weakness of the abnormal function of Tarpaka kapha, which results in formation
diaphragm Sella resulting in its herniation into Sella turcica which of an Utkleda avastha in the mastishka. The aggravated kapha
leads to enlargement or malformation of Sella turcica.1 A partial obstructs the path of Prana vayu restricting its motion which
or apparently empty Sella syndrome is often an incidental MRI results in the manifestation of signs and symptoms like shirasula,
finding. chakshupeeda etc. Improper functioning of the Tarpaka kapha
also leads to regression of pituitary gland due to its inability to
Empty Sella syndrome is reported in up to 25% of the total nourish the gland properly.
population. Based on the cause there exists another classification
as well - Primary and Secondary Empty Sella syndrome. Primary Case report
empty Sella syndrome – happens when there is a combination of
(i) increased inflow of Cerebro spinal fluid causing a rise in A 37-year-old female patient visited our clinic “Santhwanam”
intracranial pressure or (ii) anatomical defect in the diaphragm Edarikode, Kottakkal with complaints of recurrent headache and
sellae, a membrane enveloping the pituitary. Pituitary masses at pain in bilateral eye for one year. The pain aggravated within the
times undergo a silent infarction with the development of a partial last 2 weeks after which she consulted a general physician and
or totally empty Sella by the cerebrospinal fluid. she was advised to take an MRI scan of brain, in which it was
revealed as Partial Empty Sella. Thereafter she went to Aravind
Secondary empty Sella syndrome - happens when the pituitary Eye Hospital at Coimbatore for further evaluation where she took
gland regresses after surgery primarily due to removal of a a fundoscopy of bilateral eyes which revealed there was no
pituitary tumor; or when radiation therapy is used to treat a tumor significant abnormalities. She came to our clinic for further
of pituitary gland. MRI scans are useful in evaluating empty Sella treatment of the same.
syndrome and identifying underlying disorders that may be the
cause of high fluid pressure and chronic headaches. Treatment is Past history: No H/O Diabetes Mellitus, Hypertension
based upon the complications diagnosed.
Family history: Nothing relevant
Clinically in severe cases the symptoms depend on the extent of
hormone deficiency. Likewise, GH deficiency causes growth Ayurvedic perspective
disorders in children. TSH and ACTH deficiency occurs in later
stage. PRL deficiency causes lactation failure etc. As partial empty Sella syndrome comes under rare diseases, it
Epidemiological studies have proven that long standing damage cannot be completely correlated to any specific disease condition
of pituitary causes an increase in mortality rate.2 elaborated in Ayurvedic classics. But, depending on the clinical
picture we can infer that Avarana has a role in the Samprapti of
Though there is no direct correlation of this disease in Ayurveda, the disease. Increase in kleda guna of kapha dosha leads to Marga
it can be considered as an Avarana janya vyadhi. Here, the Avarana of Prana vayu in addition to atyahara, vyayama,
Tarpaka kapha3 which in its unvitiated state provides nourishment abhighata, vegadharanam etc. which causes pranavayukopa5.
(Tarpana) and protection to centers of sense organs in the brain is Margavarodha is also a cause of vata prakopa. Here, the path of

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 Eswara Sarma M P and Arathi P K / Int. J. Res. Ayurveda Pharm. 12 (4), 2021

Prana Vayu is blocked by the increased kapha dosha specifically Investigations

the Tarpaka kapha. Aggravated vata and kapha dosha results in
the formation of a shopha or increase in the Kledatva. Primarily a MRI SCAN BRAIN- Partial Empty Sella. Increased perioptic
vatakaphahara kriya which checks the further inflammation in the fluid along intraorbital segment nerves on both sides.
Shiras must be done. In order to check the rukshata ghrita is also
needed to provide Tarpana side by side. Fundoscopy B/L eye: No optic disc protrusion

Intake of Ruksha, Snigdha ahara vihara, along with agantuja After careful evaluation of the condition of the patient treatment
nidana leads to Prana vayu and Tarpaka kapha prakopa was planned accordingly. Pathyakshadhatryadi kashayam (15 ml
(Kaphavataja vriddhi) which in turn leads to Shopha/Utkleda with 45 ml warm water in empty stomach at 6 am and 6 pm with
avastha Guda as anupana, talam with Ksheerabala 7 Avarti tailam and
Rasnadi choornam, Mahatraiphala ghritam (10 ml at bedtime was
administered).

List of polyherbal preparations (with their botanical names) used across Ayurveda treatment period and their prescribed quantity in the
formulation.

Each 10 ml prepared out of

Table 1: Pathyakshadhatryadi kashayam

Sanskrit Name Botanical Name Quantity

Pathya Terminalia chebula 2.645 g
Aksha Terminalia bellerica 2.645 g
Dhatri Phyllanthus emblica 2.645 g
Bhunimba Swertia chirayita 2.645 g
Nisa Curcuma longa 2.645 g
Nimba Azadirachta indica 2.645 g
Amrita Tinospora cordifolia 2.645 g

Manufacturer Aryavaidya Sala Kottakkal, A GMP certified company

Each 10 ml prepared out of

Table 2: Kshirabala 7 Avarti tailam

Sanskrit Name Botanical Name Quantity

Tailam Sesamum indicum 10.000 ml
Balamulam Sida cordifolia 45.000 ml
Balamulam Sida cordifolia 3.516 g
Kshiram Cow’s milk 180.000 ml

Manufacturer Aryavaidya Sala Kottakkal, A GMP certified company

Table 3: Rasnadi Churnam

Sanskrit name Botanical Name Quantity

Rasna Alpingia galangal 0.417 g
Amukkura Withania somnifera 0.417 g
Devadaru Cedrus deodara 0.417 g
Katuka Neopicrorhiza 0.417 g
scrophulariiflora
Chennyaya Aloe vera 0.417 g
Chenchilya Shorea robusta 0.417 g
Kottam Saussurea costus 0.417 g
Vayambu Acorus calamus 0.417 g
Gairika Kaolinum 0.417 g
Nisa Curcuma longa 0.417 g
Yashti Glycyrrhiza glabra 0.417 g
Bala Sida cordifolia 0.417 g
Musta Cyperus rotundus 0.417 g
Shunthi Zingiber officinale 0.417 g
Marica Piper nigrum 0.417 g
Pippali Piper longum 0.417 g
Puti Sterculia foetida 0.417 g
Sahasravedhi Ferula assafoetida 0.417 g
Jalam Plectranthus vetiveroides 0.417 g
Ushira Vetiveria zizanioides 0.417 g
Phenakam Sponge 0.417 g
Shreekhanda Santalum album 0.417 g
Tintrinidalasira Tamarindus indica 0.417 g

Manufacturer Kottakkal Aryavaidya Sala, A GMP certified company

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 Eswara Sarma M P and Arathi P K / Int. J. Res. Ayurveda Pharm. 12 (4), 2021

Each 10 ml prepared of
Table 4: Mahatraiphala Ghritam

Sanskrit Name Botanical Name Quantity

Krishna Piper longum 0.156 g
Amrita Tinospora cordifolia 0.156 g
Utpala Kaempferia rotunda 0.156 g
Draksha Vitis vinifera 0.156 g
Ghritam Ghee 10.625 ml
Ajakshira Goat’s milk 10.000 ml
Markava Eclipta prostate 10.000 g
Vasa Justicia beddomei 10.000 g
Sita Saccharum officinarum 0.313 g
Haritaki Terminalia chebula 0.833 g
Amalaki Phyllantus embelica 0.833 g
Vibhitaki Terminalia bellerica 0.833 g
Yashtimadhu Glycyrrhiza glabra 0.156 g
Dvikakoli Withania somnifera (sub) 0.312 g
Vyaghri Solanum virginianum 0.156 g

Manufacturer Kottakkal Aryavaidya Sala, A GMP certified company

Figure 1: Investigation before treatment (MRI) Figure 2: Investigation after treatment (MRI)

RESULT AND DISCUSSION Pathyakshadhatryadi kashayam mentioned under the name of

Pathya Shadangam Kashayam in Sharangadhara Samhita
The condition of the patient was monitored on an OPD basis and Madhyama Khanda6 was taken as the drug of choice as the
review of symptoms were assessed for a period of 1 year. On kashayam is effective in removing the kledarupa kapha and since
observation the patient was feeling symptomatically better after the kashayam is specifically indicated for shirasula,
taking medicines orally for two weeks. After a month of bhrushankasula and Chakshu peeda it was selected. Pathya,
treatments, the intensity and duration of headache with reduction Aksha, Dhatri - the renowned Triphala have various effects
of eye pain was noticed. 3 months later the patient reported to individually and in a synergistic action as well. According to
have considerable relief in all symptoms like pain in bilateral eye Sharangadhara they have excellent action in reducing the
and recurrent headache. Treatment continued, after a year on inflammation (Vata kapha) in nature as well as it is vatanulomana
taking MRI Scan, it revealed that no significant and sarvanetramaya hara. Along with anti-inflammatory
neuroparenchymal/intra-cranial abnormality was detected, and properties, it has antioxidant, anti-neoplastic activities
her bilateral orbits were normal. attributed.7,8 Bhunimba, Nimba and Guduchi are Tikta Rasa
Pradhana and are very helpful in decreasing the Utkleda and
Hormone replacement therapy is the existing mode of treatment normalizing the anubandha pitta dosha. Guduchi, Triphala all
in empty Sella syndrome depending on which function of the have Rasayana properties so it can be used for a long period of
pituitary gland is affected. Corticosteroids remain the widely used time.
drug for the management of the same. Ayurveda has a great role
in managing such conditions effectively and in checking the Talam with Ksheerabala 7 Avarti thailam9 and Rasnadi
further progression of the disease. Choornam was administered. Though there isn’t a reference of
talam mentioned in our classical texts, it’s an age-old concept
Depending on the signs and symptoms presented by the patient being followed by the traditional Vaidya’s in Kerala. Hence
and after careful evaluation of the condition the following Ksheerabala and Rasnadi choornam10 were taken as medicines
treatment was planned. since they both have kaphapittaghna properties and is very helpful
in reducing the inflammation because of its anti-inflammatory

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 Eswara Sarma M P and Arathi P K / Int. J. Res. Ayurveda Pharm. 12 (4), 2021

properties.11 Mahatraiphala ghritam12 mentioned in timira 2. Anthony Fauci et al. Harrisons Principle of Internal
pratisheda in Ashtanga Hridaya Uttara Sthana was chosen as Medicine, chapter 333, Disorders of the Anterior Pituitary
another drug. Taking into consideration the fact that ghrita acts as and Hypothalamus. p. 2199-2200.
Tarpana and it is very much beneficial in reducing rukshatva by 3. Vagbhata, Dr Sreekumar Ashtanga Hridayam Sutra Sthana,
increasing the snehamsham. Also, ghrita has the unique property English Commentary vol I, Doshabhediyam adhyayam
of crossing the blood brain barrier, it remains the ideal choice of 12/15-17. p. 315.
drug in diseases related to the brain as well as the eye. Kashayam 4. Kamath N and Patel Y. A Physiological Understanding on
and talam prayoga which was used for reducing the inflammation The Concept of Tarpaka Kapha. International Ayurvedic
may lead to increase the rukshata of the body. To reduce the Medical Journal (online) 2018 (cited August; 2018) Available
rukshatvam and to normalize the Tarpaka kapha thereby from:
providing proper nourishment to the dhatus, mahatraiphala http://www.iamj.in/posts/images/upload/1732_1736.pdf
ghritam was selected. 5. Srikantha Murthy KR. Ashtanga Hridayam, vol II, chapter 16.
p. 162.
CONCLUSION 6. Sharangadhara, Sharangadhara with the commentary of
Adhamalla’s Deepika and Kashiram’s Gudartha Deepika,
Management of Partial empty Sella syndrome involves long term Chaukhambha Varanasi, U P; 2002. p. 162.
usage of corticosteroids, depending on the level of atrophy of the 7. Peterson CT, Denniston K, Chopra D. Therapeutic Uses of
pituitary gland, results to the extent of the deficiency of Triphala in Ayurvedic Medicine. J Altern Complement Med.
hormones. Ayurveda has a great role in managing the condition 2017 Aug; 23(8): 607-614. DOI: 10.1089/acm.2017.0083.
effectively depending on the clinical picture presented by the Epub 2017 Jul 11. PMID: 28696777; PMCID: PMC5567597.
patient. Approaching the condition as being caused due to the 8. Bali Chouhan, Ramesh Chandra Kumawat, Mita Kotecha, A.
increased Kledatva of Tarpaka kapha causing prana vayu Kopa Ramamurthy, Sumit Nathani. Triphala: A comprehensive
by obstructing the normal passage of Prana vayu, the Ayurvedic review. Int. J. Res. Ayurveda Pharm 2013; 4(4):
management lies in reducing the Utkleda avastha, after which 612-617 http://dx. doi.org/10.7897/2277-4343.0443
Snehana (Tarpana) is done to bring back the Tarpaka kapha to its 9. Paradkar H editor (6), Sarvanga Sundara Vyakhyana of
normal function by nourishing the sense organs, the pituitary Arunadatta and Ayurveda Rasayana of Hemadri on Ashtanga
gland in this case. Though this is a single case report, a new Hridayam; 1939. p. 732-956.
concept can be evolved in effectively managing the condition 10. Dr R Vidyanath and Dr K Nishteshwar. Sahasrayogam,
which may shed some light and be helpful for further studies later. Central Council of Indian Medicine, Choorna Prakarana, 2nd
edition; p. 201.
Declaration of patient consent 11. Chithra G. Nair et al. A Comparative Study on the Anti-
Inflammatory Effects of Trividha Paka of Ksheerabala Taila.
The authors certify that they have obtained all patient consent Int. J. Res. Ayurveda Pharm 2015; 6(6): 692-95.
forms. In the form the patient has given her consent for her images 12. Vagbhatacharya. Ashtanga Hrudaya, Uttara Sthana, Timira
and other relevant clinical information to be used in the journal. pratisheda adhyaya. Chapter 13 verse, 12-14, Translated by
Srikantha Moorthy KR. p. 115.
REFERENCES
Cite this article as:
1. Jerome F.S, Robert L.B, Yen & Jaffe's Reproductive
Endocrinology (Seventh Edition), W. B. Saunders; 2014. p. Eswara Sarma M P and Arathi P K. Ayurvedic management of
909-942, https://doi.org/10.1016/B978-1-4557-2758- Partial Empty Sella Syndrome: A Case Report. Int. J. Res.
2.18001-1. Ayurveda Pharm. 2021;12(4):15-18 http://dx.doi.org/10.7897/
2277-4343.120498

Source of support: Nil, Conflict of interest: None Declared

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