WhatsApp Discussion series:12- Balatisar {Infantile Diarrhea (RVD)} by Dr. Deepmala, Dr. Ravishankar Dr. Rakesh Nagar Dr. Anupama & Dr. Ankur Sharma and others

[24/05 1:13 PM] Dr Surendra A. Soni: 

Dr Ankur asked very good practical question that how should we manage Rota virus diarrhoea in infants by Ayurveda.

RVD is major killer of infants in South Asia.

Better to share experience and give guidance regarding that.

[24/05 1:20 PM] Haresh Soni Dr. Parul: 

1. Bilvadi Avleha

2. Kutajavleha

3. Sadya santarpan mantha  mentioned in last verse of santarpaniya adhyaya for rehydration.

[24/05 1:33 PM] Katoch sir: 

Considering the composition of Balchaturbhadra Churna and its antiviral ingredients, I think, it is the best option for RVD of Infants . For symptomatic relief, jaharmohra pishti with tandulodak or anar ras is recommendable.

[24/05 4:01 PM] Anupma Patra AIMS AYU:

 Rota virus diarrhoea in infant comes under visuchika. The principle of treatment is shadhan(vomiting can be done with mulethi) if it is in amavastha, if pt come immediately. But it usually never happen. Patient come after  waiting sometime because mild vomiting and simple diarrhoea are very common in infant. Simple digestive helps a lot in controlling such condition. Usually problem aggravated due to lack of proper ayurvedic knowledge. Pt should not take anything unless feel appetite. Even water also not digested at that time. So in atisaar also less water intake is advised. In this condition body never wants any thing even medicine in amavastha. If pain in abdomen is there then better to vomit for quick relief. Then give digestive like hinguastak churna, simple sunthi+ pippali churna with Luke warm water or balchaturbhadra. Diarex, mebarid etc all have good response.  we cannot do langhan in a infant, but we should stop food till appetite comes.  I doubt saline or intake of  profuse ors is saving life or aggravating the condition...? because it is reverse of ayurvedic principle. I never tried this case in infant . i ve seen simple Liv-52 or rochak syp is enough to handle simple diarrhoea and vomiting with a restricted diet in my family. Fever may occur due to avavastha for prolong time ,it diet given without digestive. So simple digestive can control vever also.sir for more detail knowledge we can go through text(su,ut.53 or charak or kashyap samhita) Research is needed in this field to check the iatrogenic aggravated condition of many such disease.

[24/05 4:49 PM] Anupma Patra AIMS AYU:



 thank u sir, please correct this- �Fever may occur due to  amavastha for prolong time or if diet given without digestive. So fever may control by digestive itself.

[24/05 5:03 PM] Anupma Patra AIMS AYU:

 Aaptopadesh is our literary teacher and patients are our practical teacher. Wheneved we ve time we should go detail about entire history of the disease, many thing we can learnt.

[24/05 7:04 PM] Dr Surendra A. Soni: 

Surprisingly....

Kaumaracharya in this group are silent....!

Very nice Anupama Ji....

Well explained...

The key is immunity as Katoch sir gave hint suggesting bal chaturbhadra...

[24/05 7:06 PM] Anupma Patra AIMS AYU:

 U r right medam . denitely we can give result through ayurveda.   Thinking about gara visa  is very important for this time. Through history of patient i realises many cases how they r converting to syndrome.  Medam u may also come to know it if go little detail about the progress of disease.

[24/05 7:12 PM] Dr Surendra A. Soni: 

I request to Dr. Deep mala Ji Dr. Rakesh Nagarji Dr. D. N. Mishra Sab. Dr. Dharmendra Sharma sab and other Bal Rog experts to through some light authentically on Rota virus cases.

[24/05 7:13 PM] ravi shankar khatri dr: 

The incubation period for rota virus is less than 48 hr it is purely a contagious disease. Treatment is nonspecific consists rehydration therpy

 It is very dangerous due to severe dehydration...

[24/05 7:18 PM] Dr Surendra A. Soni:

 What's your experience Dr. Ravi in management...?

[24/05 7:19 PM] ravi shankar khatri dr: 

Oral rehydration therapy

We can use peya yusha wich give starch and protein as well as rehydration also

If pt is able to take orally then continue , even we can use peya by nasogastric tube

But if there is no improvement in hydration status then immediately shift to IV line

[24/05 7:33 PM] Dr Surendra A. Soni:

 Thanks Dr. Ravi

Any Ayurveda perspective...?

[24/05 7:35 PM] Anupma Patra AIMS AYU:

 Ravi sir if u donot mind may i ask a question. Have u go through samhita and try to find out the treatment of it according to ayurveda?

[24/05 7:52 PM] Anupma Patra AIMS AYU: 

Donot take it otherwise sir. I just want to know the cause ,why we cannot utilizing the knowledge of our samhita?

[24/05 7:57 PM] radheshyam Soni dr: 

चरकोक्त 28 यवागू में से अतिसार में काम आने वाली यवागू का प्रयोग साधारण पेया की अपेक्षा अधिक उपयोगी हो सकता है।

[24/05 8:34 PM] ravi shankar khatri dr: 

In my opinion rota virus is aagantuk hetu for rota viral diarrhea that will affect the saaririk dosha because of its short incubation period

 Anupuma ! what abt ur ayurveda opinion abt polio wich also like rota virus... Vaccine preventable

[24/05 8:42 PM] Dr. deepmala kaumar: 

@ rotavirus post....As per Ayurveda , in आमातिसार we have  to manage it with  deepan , pachan & langhan and if its पक्वातिसार we should manage it with stambhan .

In rotavirus...there is profuse secretary diarrhoea and vomiting which eventually leads to severe dehydration and hence can b fatal. In rotavirus the pathophysiology changes so speedily that it can b considered always pakwatisaar and should manage it accordingly.

I have manage a couple of cases of severe diarrhoea with ORS, pre- Probiotics and ayurvedic drugs like bilwadi churna,chhrdiripurasa, tab & Syp diarex and zinc preparation if pt has mild vomiting.

[24/05 8:43 PM] Dr Surendra A. Soni: 

Thanks Madam...

[24/05 8:43 PM] deepmala kaumar: 

....then i prefer ORS And othrr homebased fluids

[24/05 8:45 PM] Dr Surendra A. Soni:

 Any specific investigation or sign or symptom that a General practitioner can identify the RVD...?

[24/05 8:49 PM] ravi shankar khatri dr: 

Severe watery diarrhea without faul smell. Rotavirus disease is characterized by vomiting and watery diarrhea for 3 to 8 days. Fever and abdominal pain also frequently occur. Additional symptoms include loss of appetite and dehydration. Symptoms of dehydraton include decrease in urination dry mouth and throat feeling dizzy when standing up

A dehydrated child may also cry with few or no tears and be unusually sleepy or fussy.

The incubation period for rotavirus disease is approximately 2 days.

Vaccinated and unvaccinated children may develo0p rotavirus disease more than once because neither vaccine nor natural infection provide full immunity (protection) from future infections. A child’s first infection with rotavirus tends to cause the most severe symptoms.

[24/05 8:52 PM] deepmala kaumar: 

Rarely mild, also infective/ contagious in association to vomiting... stool mostly greenish with content of undigested milk

[24/05 8:53 PM] ravi shankar khatri dr:

Diagnosis may be made by rapid detection of rotavirus antigen in stool specimens. Strains may be further characterized by enzyme immunoassay or reverse transcriptase polymerase chain reaction, but such testing is not commonly done.

[24/05 8:56 PM] deepmala kaumar:

 My daughter encounter the disease immediately after vaccination of rotavirus.asI was  aware ... the condition was managed accordingly.

[24/05 8:58 PM] ravi shankar khatri dr:

 it needs to be understood that diet is the most useful therapy in this case. Make the baby have smaller meals at more frequent intervals than normal. The amount of fluids need to be increased as compared to the solids. Oral rehydration solutions like Pedialyte should be given every 4-8 hours. The BRAT diet is famous as far as diarrhea is concerned. BRAT actually stands for Banana, Rice, Apple sauce and Toast without butter. It is important not to force feed the baby. Children on breast milk can continue to have it without any danger. Probiotics containing gut friendly bacteria like lactobacillus or acidophilus obtained from foods like yogurt may be helpful.

[24/05 8:59 PM] Dr Surendra A. Soni:

 Thanks very much Dr. Deepmala Ji and Ravishankar Ji for your appropriate guidance..... I hope that people like me and other juniors physicians would be able to help the affected infants certainly....

Thanks

[24/05 9:00 PM] ravi shankar khatri dr: Soni ji ..

[24/05 9:01 PM] Dr Surendra A. Soni:

 I understand that shadang paniya, jirodak ark shatpushpa ark yavani etc may be given...?

Correct...?

[24/05 9:01 PM] deepmala kaumar:

Never less  the fluid intake if there is watery loose stool until unless pt is unable to drink

[24/05 9:01 PM] deepmala kaumar:

Aabsolutely boss

[24/05 9:47 PM] Anupma Patra AIMS AYU: 

Thank u Deepmalaji and ravishaker sir for valuable information about rotavirus. I want to know one thing . The appro priate diagnosis of this infection is atisaar or visuchika?

[24/05 10:46 PM] Ankur Sharma Dr Delhi:

 Good discussion

[24/05 10:50 PM] rakesh nagar dr. NIA:

 In addition to Rota... all things very well explained by Dr Deepmala and Dear Ravi.. in the management you need diet therapy for proper rehydration and nutrition as per Ayurveda you can use Laagemand peya or super ORS. Laagemand peya should be fortified with panchkola, for sthambhan and deepen paachan.

[24/05 11:06 PM] Ankur Sharma Dr Delhi:

 Thanks to all members in participating this paediatric topic of rotaviral diarrhoea

But most of rotaviral infection require  hospitalization for i/ v line to prevent azotemia. Acute renal. Pt should be advised to keep eye on Urine output.

[24/05 11:08 PM] shekhar singh MP: 

What is the percentile of rotavirus infection, in India ?

 I am asking, because one of the senior paediatrician at Bhopal, says No to Rota Vaccine.

[24/05 11:09 PM] Ankur Sharma Dr Delhi:

 Oral Fluid should be given in such quantity that make kids to urinate  at least 3-4 hrly.

[24/05 11:10 PM] deepmala kaumar: 

@Anupama mam... while diagnosing RVD in Ayurveda, visuchika seems much closer but the most  distinguished character of it (pricking pain in whole body due to aamajeerna) is not observed in RVD..so in my opinion it should b  diagnosed as atisaar

[24/05 11:10 PM] Dr Surendra A. Soni:

 Antidiarrhoeal must be avoided....!

[24/05 11:11 PM] Dr Surendra A. Soni: Deepmala Ji

[24/05 11:11 PM] Ankur Sharma Dr Delhi:

 Yes sir antidiarrheal should be avoided as it prolongs viral stay

[24/05 11:13 PM] Ankur Sharma Dr Delhi:

Pomegranate juice & bilwa sharbat , diluted khichri, curd , banana are good therapeutic diet in rvd

[24/05 11:15 PM] Ankur Sharma Dr Delhi:

 Do anybody use sanjeevani vati in infantile diarrhoea cases??

[24/05 11:15 PM] deepmala kaumar:

 ....@ Dr. Ankur ...proven many a times

[24/05 11:16 PM] Ankur Sharma Dr Delhi: Yes madem

[24/05 11:17 PM] Dr Surendra A. Soni:

 संजीवनी with पुदीना...

Very effective.......

[24/05 11:17 PM] Dr Surendra A. Soni: Or अर्क पुदीना

[24/05 11:17 PM] Ankur Sharma Dr Delhi:

 Is rotaviral vaccines are sufficient to prevent rotaviral diarrhoea????

I have doubt

[24/05 11:19 PM] deepmala kaumar:

It only minimizes the disease risk.....as no vaccine can provide 100 %  immunity

[24/05 11:20 PM] Ankur Sharma Dr Delhi:

Can we use Swarn parpati in complicated rvd cases???

Sometimes all routine medicine do not give desirable results in immunocompromised kids.

[24/05 11:20 PM] Dr Surendra A. Soni:

 बालचातुर्भद्र must be useful to develop immunity...

I infer...

[24/05 11:21 PM] Ankur Sharma Dr Delhi:

 Even i saw measle & chikenpox vaccinated get these infections.

[24/05 11:21 PM] Dr Surendra A. Soni:

 May add kumar kalyan in that situation...

Right Dr. Deepmala Ji...?

[24/05 11:22 PM] Ankur Sharma Dr Delhi:

Swarn prashan is recommended in kids hence i am asking

[24/05 11:22 PM] Ankur Sharma Dr Delhi:

 Yes sir kumar kalyan ras is good choice

[24/05 11:22 PM] Ankur Sharma Dr Delhi: Of drug

[24/05 11:23 PM] deepmala kaumar:

Yes sir..we can use these drugs.

[24/05 11:25 PM] Daya Shnkrji Sir: पहले व्याधि  की चिकित्सा  तो करें !

[24/05 11:25 PM] deepmala kaumar:

Swarn is immunosuppressive...& i think swarn is the metal which must b satya like mother's milk..hence recommended from day 1

[24/05 11:25 PM] deepmala kaumar: Satmya...

[24/05 11:27 PM] Saroj Mishra Dr (Ankur):

How to diagnose rotavirus diarrhoea?

[24/05 11:27 PM] Ankur Sharma Dr Delhi:

Again thanks a lot.

[24/05 11:28 PM] Ankur Sharma Dr Delhi:

Clinically profuse watery diarrhoea preceded by vomiting episode.

No foul smell

[24/05 11:29 PM] Ankur Sharma Dr Delhi:

Hemogram lymphocytes may increased.

[24/05 11:30 PM] Ankur Sharma Dr Delhi: 

Stool

Hangings drop negative to dd cholera.

Ps no toxic granules 

If present then consider septicemia

[24/05 11:32 PM] Saroj Mishra Dr (Ankur): 

The same symptoms are prrsent in other gastroenteritis like zn and selenium deficiency diarrhoea,food poisoning,diabetic and immuncompromised patients diarrhoea,bacterial and fungal associated cases.Is it possible to find rotavirus in stool exam.

[24/05 11:32 PM] Ankur Sharma Dr Delhi:

 Generally it is diagnosed clinically by rule out others

[24/05 11:33 PM] Saroj Mishra Dr (Ankur):

 What is stool hangings dro

[24/05 11:34 PM] Ankur Sharma Dr Delhi: For cholera saroj

[24/05 11:40 PM] Anupma Patra AIMS AYU:

I think rvi can be compared with visuchika. Many other condition as mentioned above by Soraj sir (having symptom of loose motion ,vomiting, fever etc)can also included under this because here more 

emphasis given on langhan and pachan then sthambhan .

[24/05 11:49 PM] Anupma Patra AIMS AYU:

Pashni daha (agnikarma) has Been mentioned by sushruta as a emergency to stop severe condition. Have u any body here about that? Because some time occasionally patients come with history about such traditional treatment.

[25/05 6:01 AM] Katoch sir: 

Good morning everybody. Nice analysis and prospective treatment planning of Rota Virus Diarrhoea clarifying many doubts. I am concerned why Dr Deeya and Dr Shekhar have claimed Suvarn as Immunosuppressive, it is in fact immunity promoter/ booster proven Ayurvedically as well as by scientific studies.  Any comments on this observation?

[25/05 6:38 AM] deepmala kaumar:

 Good morning Sir

Immunosuppressive in relation to many autoimmune diseases ....ofcourse our classics has concrete references which which claim gold as medhya & immunity enhancer.

[25/05 6:50 AM] deepmala kaumar:

 In samhitas, suvarna yukta madhusarpi is recommended to give baby before initiating breastfeeding. Its very interesting madhu is a rich source of energy( may b allergy provoker as it is made by pollens), gold best medhya dravya ( immune reaction suppressor may cause due to madhu) & sarpi-vehicle to cross BBB.

[25/05 6:58 AM] deepmala kaumar:

 @ Katoch Sir....pls guide as your experience is above over our thinking

[25/05 7:06 AM] Ankur Sharma Dr Delhi:

 In Ayurveda the text honey is recommended to new born while modern science is against it due to solid reason ����

honey sometimes

contains dormant endospores of the bacterium

Clostridium botulinum, which can be dangerous to

babies, as it may result in botulism.

Let Md Kumarbhritya  keep opinions.

[25/05 7:12 AM] deepmala kaumar: 

I have expressed my views already... i recommend it &  i had followed it at the time of my daughter was born.

[25/05 7:16 AM] deepmala kaumar:

 Honey may b the allergy / gut allergy  testing aid. As initially newborn has sterile gut...by means of madhu we may induce to develope  gut flora.

[25/05 7:25 AM] Ankur Sharma Dr Delhi:

spores from Cl. botulinum or B. subtilis per 50 g honey

proved to be sterile after irradiation with a dose of 25

kGy. Honey was also spiked with Cl. botulinum at up to

5000 spores per 50 g honey, which is the upper limit of

natural contamination.

[25/05 7:28 AM] Ankur Sharma Dr Delhi:

 I want to say one thing new born get most of gut flora during  natural vaginal delivery in comparison to lscs.

[25/05 7:31 AM] Ankur Sharma Dr Delhi: 

It may be possible other herbs vacha or swarn + ghirt alongwith honey reduces the chances of botulism among kids.

Hence honey alone is not recommended in new borns. I think so.

Let correct me 

If i am wrong on this contexts.

[25/05 7:46 AM] Ankur Sharma Dr Delhi: 

Antibiotics resistances are emerging as opportunity to Ayurveda drs to show their talent in cases of infectious diseases.

Conditions are so deteriorated that in diarrhea sy oflox ornidazole of good pharmaceutical company is not working.

Yesterday 2 y kid has diarrhea since last 5 days inspite of taking syrup oflox ornidazole.

Attendant asked me why not kid is getting cure.

I told him antibiotics are getting resistance.

I gave bilwaadi churun 

Sanjeevani vati + ras pippari + ajwayan saunf daalchini ela powder.

Patients are accepting ayurveda as first line of treatment in common cases  rti uti fever diarrhoea.

This is motivating.

[25/05 7:48 AM] shekhar singh MP:

@ katoch sir,

I was also surprised to see swarn as immunosuppressive sir, that's why i put   ?? There

[25/05 7:51 AM] Ankur Sharma Dr Delhi:

Ayurveda swarn bhasm can't be immunosuppressive as per my little knowledge & experience.

Swarn bhasm in cases of autoimmune disorders may act by immunomodulator.

But not by immunosuppuresive.

 Swarn bhasm is rasayan

 Yogwahi

 It act as catalyst

 It act as  vishaghn.

Our swarn bhasm act by removing vish  & its harmful effects from body in cases of autoimmune disorders

[25/05 8:02 AM] Samta Tomar Dr Jmngr: 

@ankur sharma sir - antibiotic resistant also garavisha cases - suvarnbhasma is the best treatment . a person who take suvarn , nt a single particle of visha remains inside the body like on lotus no dew drops remain....totally depoisoned body ....ref. charak

[25/05 8:03 AM] Ankur Sharma Dr Delhi:

First step in pathogenesis of  autoimmune disorders is

Increase number of extracellular dna waste material of any allergen( peptides)/ virus/ bacteria.

 Yes dr samata ji i agree with you.

 I already kept reference regarding to swarn significance in cases of garvish shudhi.

My hypothesis ----

Antibiotics kills only bacteria but don't remove it's extracellular waste material dna , some people who are hypersensitive to it , have multifold increase in T memory cells which lead to recurring urticaria or in long term lead to autoimmune  disorders.

Hence in ayurveda routinely purification ( internal & external) with panchkarma followed by rasayan sewan likke swarn bhasm is the only solution of such problems.

Like in pc one has to empty recycle bin & refresh computer.

Even modern science believe that after viral infection some virus remain dormant in body, reactivate after some time

Example -- rabies, 

Chicken pox virus in adolescent time reinfect in elders as herpes.

HbSAg & hepatits c infection lead to hepatic carcinoma & liver cirrhosis in elders.

[25/05 8:18 AM] deepmala kaumar: 

Wowoo...Ankur Sir...u always have something for everything

[25/05 8:21 AM] Ankur Sharma Dr Delhi:

 Thanks madem

But it is not me who have Ayurveda tips , all Ayurveda drs have it.

Ayurveda text are wonderful it has solution of modern lifestyle related diseases.

But we shall have to  explore it

[25/05 8:29 AM] Katoch sir:

In Ayurveda, Kshetra (Field) is considered more important than Beej (Seed) in the disease process. Scientific reasoning for allergic/autoimmune diseases given by Dr Ankur is fully in consonance with this siddhant of Ayurveda. Promising results one can get in clinical practice if with this principle in mind Rasayan dravyas are recommended to the patients. Improving defence is the best offence against the intruders in the body systems.

[25/05 8:37 AM] shekhar singh MP:

"Modern treats disease, Ayurveda treats Patient"

[25/05 8:45 AM] rakesh nagar dr. jpr:

 Honey for Newborn- in Ayurveda on the very first day Honey is recommended as Prashan not as feeding article, Honey advised as feeding article with Ghee on fourth day.. if we use pure honey as first feed or as prelacteal feed, most of the time it create problems right from the stomach.

[25/05 8:47 AM] Katoch sir: 

Thanks Dr Ankur and Dr Shekhar. Suvarn is param rasayan ( Ojo Vardhak- Immunity Promoter) no doubt about this. By immunopromotive effects only, Suvarn along with other ingredients and sanskaras  combat autoimmune diseases. Calling suvarn formulations as Immunosuppressive agents is not acceptable when we know their pharmacotherapeutics in Ayurvedic perspective.

[25/05 8:47 AM] rakesh nagar dr. jpr:

With high sugar load it may cause gastritis,

[25/05 8:47 AM] Ankur Sharma Dr Delhi:

Yes sir yesterday i got a pt who have pain epigastric region was admitted for it + diarrhea in famous hospital, md medicine dr recommended her to take curd & avoid milk , take painkillers for pain abdomen.

After discharge she get better by diarrhea side but still has pain epigastrium.

She visted in my opd.

I just recommend her to take pitta shamak as milk coconut sitaphal bases kheer , 

Avoid curd & pain killer as it increase acid secretion which cause tender epigastrium.

She told me she continuously took curd -+ spicy brinjal + diclofenac + pcm for pain abdomen as advised by md medicine.

On behalf of usg report which reveal mild inflammatory changes in large bowel.

Pt asked me u are advising just opposite to md medicine doctor.

I told her i am seeing ur symptoms & site of pain at present which is upper abdomen (stomach ), 

My advice is according to ur complaints not according to previous  usg  findings which get settled.

I have to treat patient , not usg reports

[25/05 8:52 AM] Ankur Sharma Dr Delhi:

 Hence totally agree with u shekhar sir.

Modern drs  treat by blood reports radiological reports but missed patients actual complaints.

It happens mostly in hospitals  as specialists are senior doctors they are too busy to listen pts complaints.

But we don't follow them in this regard as every time pt visit his/ her complaints / physical examinations findings may vary.

Radiological & pathological findings are also variable.

[25/05 9:34 AM] Dr Surendra A. Soni: 

Anupama Ji

Great discussion...

Thanks to Kaumaracharyas Dr. Rakesh Dr. Ravi Dr. Deepmala and most active   Dr. Ankur and others for guidance...

*********************************************************************

Above discussion held on 'Kaysampraday" a Famous Whatsapp group  of  well known Vaidyas from all over the India. 

Compiled & edited by

Dr.Surendra A. Soni

M.D.,PhD (KC)

Associate Professor

Dept. of Kaya-chikitsa

Govt. Ayurveda College

Vadodara Gujarat, India.

EMAIL: surendraasoni@gmail.com

Mobile No. +91 9408441150