Adverse drug reaction after application of Amapachana upanaha (~poultice application): An observation

It is the most common belief in Indians that herbal drugs are completely safe and do not produce any adverse effects. However, this belief is not always true. A case of Adverse Drug Reaction (ADR) after the application of an Ayurveda formulation is presented in this case report. An 82-year-old male patient, a resident of Belagavi, with a history of hypertension, presented to Ayurveda hospital with complaints of pain in bilateral knee joints for the last two months that aggravated since last week. As per Ayurveda parameters, he was diagnosed with a case of Sandhigata vata (~vitiated Vata dosha in joints; National Ayurveda Morbidity Code: AAE-16) comparable to osteoarthritis. He was admitted to the inpatient department on March 28, 2022, and after taking consent, Ayurveda treatment was started. Amapachana upanaha (~poultice application) over the bilateral knee joints was one among the treatment procedures followed in the case. On the second day of treatment (March 30, 2022), he suddenly developed reddish discoloration and the appearance of boils over the bilateral knee joint after the administration of Amapachana upanaha . The patient was managed with external application of Shatadhouta ghrita (~processed ghee) over the affected part along with internal administration of tablet Laghusootashekara vati (1600 mg) twice a day for three days for the suspected ADR. After three days of therapeutic intervention, blisters and discoloration were reduced and the patient was discharged on April 4, 2022, with internal follow-up medications for the next 15 days. This case report highlights the importance of preassessment and awareness toward the careful use of Ayurveda medicines like that of contemporary medications to address such ADRs.