WhatsApp Discussion Series:19- (Case Discussion 1-) Kamala by Prof. Ramakant Sharma "Chulet", Prof. Satyendra Ojha, Dr. Dinesh Katoch, Dr. Radheshyam Soni & Others.

[02/07 10:14] J K Pandey Dr. Lukhnau:

 Respected gurujan and seniors..I just want ur valuable views on a case..

a girl 14yrs came to me with detected jaundice 10 days back..her billirubin was 4.75

sgpt 4784

sgot 6543

alk.phosphate 470

...

I gave her faltrikadi kwath plus sarvkalp kwath(patanjali)

arogyavardhini

punarnavadi mandoor

kumariasav, punarnavasav

after one week..

her billirubin5.75

sgpt 474

sgot 345

alph..477

I want to know ..abt increase in billirubin level reason?

and any thing else shud be done?

[02/07 10:20] Dr. Radheshyam Soni: 

सर मेरे विचार से आपको आसव अरिष्ट को उपचार में से हटा कर, प्रवाल या मुक्ता पिष्टी और गिलोय सत्व जोड़ देना चाहिए, और रात्रि में पित्त विरेचनार्थ कुटकी का प्रयोग करना चाहिये

[02/07 10:22] J K Pandey Dr. Lukhnau:

 Soni sir...this is topic of discussion and point of my great confusion,.

should asav arisht be given in liver diseases or not?

infact I cud hv given many liver tonic syp like liv 52.livimyn,amlycure etc..bt I tried to give classical medicine only..

[02/07 10:24] radheshyam soni  dr: 

पुनर्नवासव के स्थान पर यदि उदरशूल या शोथ हो तो अर्क पुनर्नवा का प्रयोग कर सकते हैं।

[02/07 10:24] J K Pandey Dr. Lukhnau: 

Sir is asav contraindicated in kamla ?

[02/07 10:25] Singh Vinod Dr: 

Obstructive jaundice bhi ho sakti hai

[02/07 10:25] Dr. DC Katoch sir: 

Dr JK Pandey, please mind to add bhringraj, amalaki, guduchi and chandan to facilitate elimination of bilirubin and normalization of liver function.

[02/07 10:27] J K Pandey Dr. Lukhnau: 

Thanks katoch sir..

[Vinod sir..sgot sgpt were too raised ..so chances of infective jaundice is more

direct billirubin was 4.25 

indirect 1.50

that too indicates infective pathology

[02/07 10:29] Singh Vinod Dr: 

Yes but alkline phosph. Bhi jyada hai

Vaise pahale asav arishta hata kar dekho

[02/07 10:30] radheshyam soni dr: 

सर मेरे विचार से कामला पैत्तिक व्यधि है, और आसव या संधान आधारित औषध अम्लता के कारण पित्त वर्धक हैं, साथ ही शोथकारक भी हैं, तीक्ष्ण भी हैं। अतः इस कारण कामला में विरुद्ध होनी चाहिए।

[02/07 10:32] Singh Vinod Dr: Ha sahi hai ...

[02/07 10:32] J K Pandey Dr. Lukhnau: 

Soni sir

charak has indicated गौड़अरिष्ट,बीजकारिष्ट,धात्र्यारिष्ट in pandu kamla

[02/07 10:32] Katoch sir: 

Yes, asava arisht not advisable in deranged liver function condition. Treatment of Ashraye is more important than the agantuj.

Dr Pandey, those asava arishtas are recommendable for pre-hepatic or posthepatic causes of jaundice not for hepatic cause.

[02/07 10:36] J K Pandey Dr. Lukhnau: 

Sir charak has indicated पथ्य  in kamla ..as रूक्ष।अम्ल,कटु रस सिद्ध मांस या शुष्क मूली यूष

[Ok katoch sir..got the point..

[02/07 10:36] Janardan Hebbar Dr: 

I have not used asava / arishta in kamala. But the concept of ushna being contra indicated in Kamala...., Even katuki, pippali, Guduchi, Vasa are also ushna but are used its treatment. 

[02/07 10:36] J K Pandey Dr. Lukhnau: 

Hebbar sir..thats the point

[02/07 10:37] radheshyam soni dr: 

पाण्डु रसज व्याधि है, तब तब आसव ठीक है किन्तु *पाण्डु रोगी तु यो अत्यर्थः पित्तलानि निषेवते* की सम्प्राप्ति को विघटित करने की दिशा में ये न देना ठीक रहेगा मेरे विचार से

[02/07 10:38] pawan madan Dr: 

The choice of asava arisht may not depend on vyaadhi. 

IT depends on what type of the person is.....

if the girl is a kapha predominant person asav arisht may be a good choice.

Chikitsa sutra may depend on observing the hetus also.

[02/07 10:38] Katoch sir: 

Hitting the cause of jaundice not the bilirubin level only is the principle of Ayurvedic treatment.

[02/07 10:38] Janardan Hebbar Dr: Makes sense.

[02/07 10:42] radheshyam soni dr: 

सर मद्य और मद्य आधारित औषध अधिक तीक्ष्ण और दग्धकर्म करने में सक्षम है, साथ ही अम्लता के कारण शोथ कारक है इस लिए उक्त औषध क्वाथ या चूर्ण रूप में देना ठीक रहेगा।

[02/07 10:42] Trivendra Sharma Jpr: 

रूक्ष।अम्ल,कटु रस सिद्ध मांस या शुष्क मूली यूष.   useful only for shakhashrit kamla .      putlrpose dosh ko shakha se kosth Mein Lana .    esliye vardhan , vishyandan etc karte hain.  Vridhya vishyandnay  pakat...........

 Vishyandnat

[02/07 10:42] Katoch sir: 

Understanding the nature of vikriti, which causes kamala, may be more relevant than the hetus who have already induced the disease. Nidan parivarjan is essentially required irrespective of the stage of vikriti and it's manifestation.

[02/07 10:42] pawan madan Dr: 

Sir.....kya ye har case me jaruri hai ??

[02/07 10:44] pawan madan Dr: 

Sir here.......nature of vikriti ...may be directly or indirectlt proportional to the hetus........and that may help to dcide which sutra to be applied........

[02/07 10:47] Katoch sir: For example ? Dr Pawan

[02/07 10:53] pawan madan Dr: 

Sir...for example ...

....if pitta vardhak hetus resulting in kamla with a history of paandu......aggresive pittashamak and rakashodhak chikitsa may work.......like with chandan etc as u said...

.....but if vaata vardhak hetus are qorking from ling time but the vyadhi is kaamla in a vaata predominant person.....a vaata pitta shaamak, anulomaka and mridu pitta virechaka medicine like amaltaas, haritaki etc may work better.

Rest sir...you are the authority.......pls corrct wherever wrong.....this is what I experienced only.....may be wrong......

[02/07 10:57] Katoch sir: 

Chikitsa of vyadhi is done keeping in mind the psychophysical condition of vyadhit, not the hetus. But hetu parivarjan is important while treating the vyadhit.

Because hetus produce the disease and are not in part of the body system. So practitioner can advise for Nidan Parivarjan but can not treat the hetu. It is to manage the disease by understanding vikriti (morbid complex)  and prakriti (constitution) which exist in the same body system.

[02/07 11:04] Trivendra Sharma Jpr: 

Nice sir.      swabhavoparamvaad, Pravrittirheturbhavanam n nirodheasti kaaranam.  .............heturhetoravartanam.

[02/07 11:05] pawan madan Dr: 

Sir aap meri baat samjhe nahi.

We are nt treating hetus.

We are going to decide line of treatment based on hetus + sampraptis + laxans

As I explained above....

...to do dosh shaamak only

....to act for aavaran etc

[02/07 11:06] Sanjay Lungareg Dr:

 

पाण्डुरोगप्रशान्त्यर्थमिति प्रोक्तं महर्षिणा।

विकल्प्यमेतद्भिषजा पृथग्दोषबलं प्रति।

वातिके स्नेहभूयिष्ठं पैत्तिके तिक्तशीतलम्।

श्लेष्मिके कटुतिक्तोष्णं विमिश्रं सान्निपातिके।

[02/07 11:07] pawan madan Dr: 

Thank U sir....

[02/07 11:11] Trivendra Sharma Jpr: 

For kamla

[02/07 11:11] radheshyam soni dr: 

मेरे विचार से कामला की स्थिति में हर व्याधित में मद्य आधारित औषध निषेध है।

[02/07 11:16] Trivendra Sharma Jpr: 

Lekin shakhashrit kaamla Mein denge aasav arisht.  Jo avrodh k kaaran hai . Kyuki usme kapha avrodhak kaaran hai ya nahi denge ?

[02/07 11:21] Katoch sir: 

Kamala mein madya ka nishedh ho sakta hai, par asava arishta jahan avashyakta hai vahan dene chahiyein.

[02/07 11:32] Trivendra Sharma Jpr: 

Thanks sir.

[02/07 12:32] lokdeep sharma dr: 

Dr Pandey ji .

advise USG abd n start 1gm sphatic bhasm in banana for 3-5 day empty stomach.slit a banana n put 1gm bhasm ,keep for a night n use in morning.

[02/07 12:49] shekhar singh MP: 

पुनर्नवाष्टक क़्वाथ is very good to reduce S. Bilirubin.

[02/07 12:50] J K Pandey Dr. Lukhnau:

Ji

Thanks all

[02/07 12:50] radheshyam soni dr: 

 और मार्केण्डेयादि हिम भी

[02/07 12:53] Sukhvir Verma J. KC: 

We are using Devdali Phala Nasya in Kamla 

Good results within 2 days

[02/07 12:58] Trivendra Sharma Jpr: 

Yes boss.  Markandeyadi best hai. 

[02/07 13:01] Trivendra Sharma Jpr:

 Ok

[02/07 13:10] Rameshwar Rao Rane Mu: 

Pandurogi yo atyartham with this sutra acharya have explained kosthashrayi kamala samprapti.here pittavrudhi is so much that it is burning rakta and mansa . Acharya have used word dagdhva.with my little knwiledge we can use chikitsasutra in madadatyay ie ksharohi yati shighram amlopasamhita to justify use of aasava arishta in kamala.but hetu of pittalani nishevate and symptoms of pittavrudhi daha trushna should be there.

[02/07 13:10] Ramakantji Chulet Sir Nia: 

Kamala mein madya ka nishedh ho sakta hai, par asava arishta jahan avashyakta hai vahan dene chahiyein.

------very right ----in 

Shakhasrit shakhasrit Kamal this is line of treatment to give ushnateekshna bhrishamlai chapyupakrama,nivrittopadravasy syad purvo kam limo vidhi --- but for a limited period , can b identified easily - aa pittaragat shakrato - up to purush ran jan and vat prasham --after that as stated by dr lungare sir

[02/07 13:37] Dr Surendra A. Soni:

 Perfect 

Katoch sir 

[02/07 13:38] Dr Surendra A. Soni: 

आपित्तरागात्....

ramakant Sir...

[02/07 13:49] Dr Surendra A. Soni: 

Dr. Pandeji

Atleast you are to establish the condition as *koshthaashrita / Shakhashrita / Ubhayaashrita*.

What did you think in this regarding...?

Great inputs from all honourable members.

As per my understanding you missed the mild periodic purgation in your Rx like Aaragwadha, Nishoth, kutaki draksha etc So the *Malaroopa Pitta* could not be expelled out. Thus  Inspite of improvement in hepatic function bilirubin level didn't respond.

Use of Aasavaarishta is justified in SK and may not in Koshthaashrita Kamala.

[02/07 13:56] Katoch sir:

 Even now Dr Pandey you can start Kumaryasav + Punarnavasav to expel bilirubin through gastrointestinal and urinary tracts.

Overproduction and accumulation of bilirubin in the case seems to have stopped. Now expulsion of accumulated bilirubin can be done by pittavirechak and mutrarechak fast acting asavas mentioned above. Must avoid pittavardhak Aahar Vihar.

[02/07 14:04] Ankur Sharma Dr Delhi: 

I want to know 

Can pitta be removed from urinary system by using  mutra virchanya dravya ( pitta shamak + virechak)???

Which pitta ??

Pachak pitta ???

We always try to remove pitta through virechan ( by kostha )

Is urinary system also considered as part of kostha ?

[02/07 14:09] Chulet Sir Nia: 

This is the real purpose of group .

[02/07 14:09] Katoch sir: 

Dr Ankur, here Pitta is malaroop Pitta I.e. Bilirubin and to expel its conjugated form through urinary system. Otherwise Pitta ( Bile etc) is normally expelled by Virechana only.

[02/07 14:11] J K Pandey Dr. Lukhnau: 

Soni sir ! Are contents of faltrikadi kwath not sufficient for virechan too?

I think most medicine indicated for kamla r pitt virechniya or virechniya

Here trifala patol chirayata r pittvirechak too

[02/07 14:14] Dr Surendra A. Soni: 

Again 

you gave in what dose..? Quality .?

How many motions were there...?

If PTK would have been induced virechana then bilirubin level would not increased..

Pandeji

[02/07 14:14] J K Pandey Dr. Lukhnau: 

Or I should give more potent medicine for virechan?

[02/07 14:15] J K Pandey Dr. Lukhnau: 

Ok soni sir

Got the point

Thank u

[02/07 14:15] Dr Surendra A. Soni: 

Exactly in proportion to vyadhita Bala.

[02/07 14:16] Katoch sir: 

Dr Pandey , please check. Phaltrikadi is more kosthashodhak than pittavirechak. Chirayata is pittashamak or pittaprasadak not pittavirechek.

[02/07 14:18] Ankur Sharma Dr Delhi: 

Thanks but i want to know what is the pitta swaroop in urinary system??

Dushit pitta may be conjugated bilirubin , pus , etc.

My hypothesis-- Pitta can be removed  from virechan, vaman, mutravirechan.

I don't know is this right or not but clinically it seems appropriate.

As in uti  mutravirechaniya dravya provide  sufficient relief.

[02/07 14:20] Katoch sir: 

Phaltrikadi has helped to correct the liver function but not enabled expulsion of accumulated malapitta. Now specific medicines for expelling bilirubin are required, phalatrikadi may not work so switch over to kumaryasava/rasanjan vati/ daruharidra Churna etc

[02/07 14:28] Ranga prasad Ji Vd. Chennai: 

Sir, just check this comparative tabulation from the link provided, whether your query gets answered. 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC545762/table/t2-28/

[02/07 14:35] priy rnjan tiwari Dr. j: 

in kosthasrit kamla  phaltrikadi kwath plays good virechan karm as triphala and panchtikt contents

[02/07 14:40] Dr Surendra A. Soni: 

                           [02/07 14:04] Ankur Sharma Dr Delhi: I want to know 

Can pitta be removed from urinary system by using  mutra virchanya dravya ( pitta shamak + virechak)???

*{{{Yes by Mutravirechana drugs in some extend...}}}*

Which pitta ??

Pachak pitta ???

*{{{mainly ranjak pitta}}}*

We always try to remove pitta through virechan ( by kostha )

Is urinary system also considered as part of kostha ?

*{{{Yes}}}*

Thanks but i want to know what is the pitta swaroop in urinary system??

*{{{as I remember physiologically there is no clear cut concerne of Dosha and Mutra just like Purish}}}*

Dushit pitta may be conjugated bilirubin , pus , etc.

My hypothesis-- Pitta can be removed  from virechan, vaman, mutravirechan.

I don't know is this right or not but clinically it seems appropriate.

As in uti  mutravirechaniya dravya provide  sufficient relief.

*Dr. Ankur* 

My reply in  {{{....}}}

[02/07 16:46] pawan madan Dr: 

Ankur ji...good points..

What we are refering to Pitta...is the important point?

Pitta is a group of स्नेहम उष्णम तीक्षणम द्रवम अम्लम सरम.कटु gunas.

So in a sense any dravya possesing these gunas in excess can be called pitta or pitta vargiya ......or......... any process which is increasing these gunas can be called Pittaj or pittalaa.

So if this grouo of gunas (which are dooshita gunas in this case) are being decreased through the process of mutravirechaniya then surely it is decreasing or removing or evacuating the pitta .......otherwise not.

More maargadarshan is needed by Gurujan..

[02/07 17:32] Harish Verma Canada: 

Dr Katoch Ji, I have gone through Today's post. In my opinion the patient of Dr Pandey has improved a lot. He should continue the same line of treatment. Serum Billirubin will take long time to become normal. But look at Sgpt & sgot from 4784 & 6543  it has come down to 474 &  345. What else he wants. Patient is improving. From my experience I can tell general condition of patient must be fine. Only glucose can be added to his diet.

I advise Dr Pandey to keep eye on billirubin, even it futher escalate, he should not worry. Please post further developments, His patient will recover 100%

[02/07 18:00] J K Pandey Dr. Lukhnau:

 Thanks harish sir

[02/07 18:09] radheshyam soni dr: 

शाखाश्रित कामला में मूत्र पीत वर्णी और पुरीष तिल पिष्ट निभ अर्थात् पीत नहीं होता, और चिकित्सार्थ प्रयास यही होता है कि मूत्र का वर्ण पीताभ और पुरीष का वर्ण पीत हो जाये, अर्थात् बजाय मूत्रविरेचनीय के पित्तरेचक द्रव्यों का प्रयोग हो जो पुरीष के साथ पित्त का रेचन करें न कि मूत्र के साथ। यही कामला से मुक्ति का लक्षण भी माना जाता है।

[02/07 18:17] satyendra ojha sir: 

आचार्य चक्रपाणि ; आपित्तरागात् शकृत इति यावत् कोष्ठमार्गस्थो मलो न रञ्जते तावत् पित्तवर्धनम्..।

[02/07 18:21] J K Pandey Dr. Lukhnau:

 

[02/07 18:26] satyendra ojha sir: 

एरंडपत्र स्वरस , कालमेघ , दार्वी , एवं कुटकी .

पुनर्नवाष्टक.. फलत्रिकादि... महासुदर्शन...।

[02/07 18:29] J K Pandey Dr. Lukhnau: 

Thanks sir..pranaam

[02/07 18:30] radheshyam soni: 

तो फिर शाखाश्रित कामला को स्थानसंश्रित पैत्तिक व्याधि के रूप में देखना चाहिये

[02/07 18:31] satyendra ojha sir: नहीं..

[02/07 18:31] satyendra ojha sir: 

कफ वात ... फिर पित्त...

[02/07 18:32] radheshyam soni: 

[02/07 18:36] satyendra ojha sir:

 कफहरं पित्तवृद्धिकरं च समं चिकित्सितं प्राह , यतः शाखाश्रयदोषस्य वृद्धिः कोष्ठानयार्थम् ; उक्तं हि... वृद्ध्या.....

[02/07 18:44] radheshyam soni dr: 

आचार्य चक्रपाणि के इस सन्दर्भ में पित्त वर्धन की युक्ति पर मुझे संशय है।

जब शाखा से कोष्ठ में लाने के उपायों में वृद्धि के अतिरिक्त अन्य उपाय भी हैं तो फिर सम्प्राप्ति कारक घटक का वर्धन ही क्यों?

और इस कार्य हेतु बताये गए द्रव्यों में प्रधानतः तिक्त रस वाले द्रव्य है, जो रस से पित्त का शमन करते हैं न की वर्धन।

तो फिर यहाँ पर वर्धन की अपेक्षा पाक क्यों नहीं, या श्रोतोमुख विशोधन क्यों नहीं, जबकि कुटकी, दरुहरिद्रा, चिरायता, गिलोय आदि तिक्त और उष्ण हैं और आम पाचक भी।

यदि पित्त वर्धन ही कार्य था तो कटु उष्ण यथा कृष्ण मरिच जैसे द्रव्यों का प्रयोग क्यों नहीं बताया

[02/07 18:46] satyendra ojha sir: 

I appreciate ;  रुक्ष शीत गुरु स्वादु व्यायामैः वेगनिग्रहैः । कफसंमूर्च्छितो वायुः स्थानात् पित्तं क्षिपेत् बली.।।चरक..

[02/07 18:48] Harish Verma Canada: 

Please post about general condition of patient and weekly repeated LFT. Thanks

[02/07 18:49] satyendra ojha sir: 

Refer ch.chi .16/130 ; कटुतीक्ष्णोष्णलवणैर्भृशाम्लैः च अपि उपक्रमः..।

[02/07 18:50] satyendra ojha sir:

 Ch.Chi.16/128-131

[02/07 18:51] Prof. Daya Shankarji Sir: 

शाखाश्रित कामला में त्रिकटु चूर्ण बिजोरा नीबू रस एवं शहद के साथ चरक ने लिखा  है

[02/07 18:51] radheshyam soni: 

ओझा सर, निश्चय ही चरक संहिता देख कर आगे कुछ कहूँगा

[02/07 18:52] Chulet Sir Nia: 

Radhey JI "til pist nibham" vala sutra bhi padhna

[02/07 18:52] satyendra ojha sir:

 I appreciate the use of trikatu with honey.. no doubt ..

[02/07 18:53] satyendra ojha sir: 

Yes guru ji. Prof. D S Mishra sir..

 

[02/07 18:53] radheshyam soni : 

दूसरे कोष्ठश्रित और शाखाश्रित का विभेद पुरीष के वर्ण पर ही आधारित है, न की मूत्र। वर्ण पर अतः यहाँ पर मूत्र मार्ग को कोष्ठ नहीं माना।

[02/07 18:54] radheshyam soni dr: 

अवश्य सर

[02/07 18:54] satyendra ojha sir: 

R S Soni ji Please see charak samhita with Acharya Chakrapani..

[02/07 18:57] Prof. Daya Shankarji Sir: 

पित्त प्रमाथि हिम का प्रयोग दोनो प्रकार के कामला  में लाभदायक है

[02/07 18:59] satyendra ojha sir: 

[02/07 19:21] radheshyam soni dr: 

जी सर , चरक संहिता में पित्तवर्धन और कफ क्षपण हेतु कटु उष्ण अम्ल द्रव्यों के उपयोग हेतु ही निर्दिष्ट किया है शाखाश्रित कामला में

[02/07 19:28] satyendra ojha sir: 

[02/07 21:34] Shantanu Das Prof KC: 

I think ....kamalaa is sudha paitrik vyadhi ...only pitta hara chikitsa is essential.sakhasrita kaamala....pitta is covered by kapha ...for this....paachan...nd niharana nd use of mild katu...tikshna,lavan,nd amla dravyas intake is need,....Apitta ragachhikruto vayoscha prasamanam .(.chk)''.dosa should come from saakhaa to kosta...mrdutikta nd virechana need...

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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

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