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Case-presentation: Tiryak-raktapitta (ITP) by Vd. Arun N. Rathi

*Case Presentation :*

*Chronic Idiopathic Thrombo- cytopenia (Ch-ITP) and its Ayurvedic Management :*

*रुग्ण लिंग : पु.   वय : 36 वर्ष.*
*ऊंचाई : 5.7 ft. वजन :  102.3 kg.* 
*व्यवसाय : प्राध्यापक.*
*व्याधि काल : 4 वर्ष. जाति : मुस्लिम*

*रुग्ण इतिहास : सप्टेंबर 2012 में अचानक रुग्ण को संपूर्ण शरीर पर यत्र तत्र नील रक्तवर्ण के धब्बे दिखाई दिए, परीक्षण करने पर ज्ञात हुआ कि platelet count reduced to 3000 / cu mm. Dengue test was negative. Patient was hospitalized at Akola, stat dose of 40 mg. Omnacortil was given in evening platelet count was 7000 / cu mm. 2nd day patient was shifted to higher Centre for investigation at Nagpur. Patient was throughly investigated and diagnosed as suffering from ITP and was kept on 100 mg of Omnacortil for 15 days. Since last 4 years patient was given steroids on and off, in mean time patient gain 9 kg of weight and have renal dysfunction.*

 *रोग विनिश्चय :  रक्तपित्त* 
*दोष : त्रिदोष पित्तप्रधान*
*पित्त : पाचक, रंजक, भ्राजक.*
*वायु : व्यान, समान*
*कफ : क्लेदक, अवलम्बक.*
*दुष्य : रस, रक्त, मज्जा*
*मल : असृजा पित्तम्।*
*अग्नि :  जठराग्नि, रसाग्नि, रक्ताग्नि,मज्जाग्नि*
*व्याधि उद्भव स्थान : आमाशय एवं ग्रहणी,(षष्ठी पित्तधरा कला -  मज्जाधरा कला )*
 *एवं एव पित्तधरा व मज्जधरेति षष्ठे।* सू.कल्प. 4 / 40 - 41 पर डल्हणाचार्य.
*डल्हणाचार्य ने विषबाधा और चिकित्सीय महत्व को दर्शाने के लिए पित्तधरा कला को मज्जाधरा कला कहा है*
*स्रोतस दुष्टी : रस, रक्त, मज्जावह स्त्रोत* 
*व्याधि अधिष्ठान : त्वचा, रक्त और मांस.*
*रोग हेतु : यदा-कदा गोवंश का मांस, मछली और दही युक्त मांस बिरयानी सेवन करना, कभी कभी colddrinks, आचार और पापड़ का सेवन*

*लक्षण : उदर प्रदेशी त्वचा पर रक्त वर्ण पीटिका, बाहु प्रदेशी त्वचा पर नीलकृष्ण वर्ण धब्बे, सर्वांग मेदवृद्धि, नख एवं नेत्र पांडूता.*

*संप्राप्ति : पित्त प्रधान त्रिदोष द्वारा रस,रक्त और मज्जा धातु को दूषित कर त्वचा रक्त और मांस धातु में स्थानसंश्रय कर रोग उत्पत्ति*।

*रोग मार्ग : त्रिविध ।*
*साध्यासाध्यत्व : कृच्छ्रसाध्य > याप्य > असाध्य ।*

*चिकित्सा सूत्र :  

मार्गौः दोषानुबन्धं  च निदानं प्रसमीक्ष्यच ।*
*लङ्गनं रक्तपित्तादौ तर्पणं वा प्रयोजयेत्।।*
 च. चि. 4/30.

 *मृदुविरेचन, आम दोष पचनार्थ लंघन, तर्पण, स्निग्ध, मृदु, मधुर, शित,तिक्त और कषाय गुण एवं रस प्रधान औषधी और आहार द्वारा चिकित्सा*

१). *गंधर्व हरीतकी चूर्ण 4 ग्राम*
 नियमित रात में जल से.

 २). *पंचतिक्त घृत 10 -10 ग्राम*
 *प्रातः सायं. - बकरी के दूध के साथ* 

३). *पुनर्नवा मंडूर  250 mg*
       *भूमीवया घन 500 mg.*
        *गिलोय सत्व 250 mg.*
        *प्रवाल पिष्टी 250 mg.*
         *चौ. प्रहरी पिपली 60 mg*
प्रातः सायं जल से

*पहले 4 माह तक नियमित दो बार - दूर्वा, वासा और पपीता पत्र को स्विन कर निकाला हुआ 30ml स्वरस + गिलोय स्वरस 30ml में आंवला मुरब्बा पीसकर पीने को कहा गया ।*

*जलपान : खश और नागरमोथा से सिद्ध जलपान करीब 4 माह तक । 4 माह बाद सादा पानी उबालकर सेवन करने को कहा गया।*
*चार माह तक उपरोक्त औषधी दी गई।*

*4 माह बाद उपरोक्त औषधी के साथ स्वर्णमालिनी वसंत 60 mg.+ सहस्त्र पुटी अभ्रक भस्म 30 mg. +  मुक्ता पिष्टी 60 mg. शुरू की गई।*

*पंचतिक्त घृत को बंद कर, बकरी के दूध के साथ 3 से 6 ग्राम तक मज्जापान रात में एक बार सेवन करने को कहा गया।*
 *दुर्वा,वासा आदि से निर्मित स्वरस को प्रातः काल अभूक्त अवस्था में लेने को कहा गया।*

*8 माह बाद स्वर्ण मालिनी वसंत के जगह लघुमालिनी वसंत 125 mg दिया गया + पुनर्नवामण्डुर आदि सभी औषधी एक बार कर दी गई ।*
*मज्जापान और बकरी का दूध बंद कर दिया गया।*
*दुर्वा,वासा आदि का स्वरस प्रातः काल एक बार शुरू रखा गया।*
*15 माह बाद सभी औषधी बंद कर दी गई।*

*आहार व्यवस्था :

 मूंगदाल खिचड़ी, गेहूं की रोटी, देशी घी से तडका दी गई मूंगदाल, पुराना चावल।*
*बकरे के पैर से निर्मित देशी घी में तड़का दिया हुआ मांस रस ।*

*सब्जी - परवल, ढेमसा ( टिण्डा ), तुरई, लौकी, काशीफल, गाजर, बीट, टमाटर, पालक, मेथी - देशी घी में छौंका लगाकर खाने को कहा गया।*

*फल - अनार, जाम, संतरा मौसंबी, सेंधा नमक डालकर लेने को कहा गया। गर्मी में फालसा और खिरनी ।*

*दोपहर में भूख लगने पर - मुनक्का, अंजीर, खजूर से निर्मित पानक, गुलकंद, आंवला मुरब्बा, फालसा शरबत, आगरे का पेठा, ताल मखाना आदि कोई भी एक पदार्थ सेवन करने को कहा गया।*

*विहार  : विशेषता गर्मी के मौसम में रूह खस का अत्तर कर्ण पाली में धारण करने को कहा गया, यथा संभव ढिले और सूती कपड़े पहनने को कहा गया। ज्यादा शारीरिक श्रम करने से बचने को कहा गया ।*

https://drive.google.com/file/d/10CQh2n1u-Pc5Ucw1QUSPp3hIetnRJhB2/view?usp=sharing















































































*विशेष सूचना :  विगत 2 वर्षों से औषधी बंद होने पर भी रुग्ण का Platelet Count Normal है और किसी भी तरह की कोई तकलीफ नहीं है।*

*मै भुमिआमलकी यह क्वाथ रुप मे ज्यादा देता हुँ।*

*एक sy. LIVWEL बनाता हूँ, इसके मुख्य घटक द्रव्यों मे भुमिआमलकी है।*

*भुमिवया घन:*
*भुमिआमलकी ८ भाग*
*गिलोय              ४ भाग*
*आमलकी          २ भाग*
*माका                  १ भाग*
*यह घन रसवह, रक्त वह स्त्रोतस और Autoimmune disorders मे रसायन के तौर पर उपयोग मे लेता हूँ।*

*Thrombocytopenia*

 *Formation of platelet* :

In the bone marrow are cells called *pluriopotential hemopoietic stem cells ( PHSCs)*, from which all the cells in the circulating blood are derived.
Growth and reproduction of the different stem cells are controlled by multiple proteins called *growth inducers* 
The growth inducers promotes growth but not differentiation of the cells.
Instead this is function of another set of protein called *differentiation inducers*
Platelets are fragments of seventh type of white cells found in the bone marrow, the *Megakaryocytes* which are very large polypoid bone marrow cells produced by the process of *endomitosis* 
After leaving the marrow space approximately one third of the platelets are sequestered in the spleen.While the other two third circulates for 7 to 10 days.Normally only a small fraction of platelet mass is consumed in the process of *hemostasis*, so most platelets circulate until they become senescent and are removed by phagocytic cells.
The formation of platelets from megakaryocytes is regulated by *thrombopoietin (TPO)*.
The platelets in the blood are totally replaced approximately once every 10 days. In other words about 30000 platelets are formed each day for each microliter of blood.

*Thrombocytopenia :*
 Thrombocytopenia means the presence of a very low quantity of platelets in the circulatory system.
Platelets are especially important for repair of minute breaks in capillaries and other small vessels.
Ordinarily bleeding does not occurs until the number of platelets in the blood falls below a value of approximately 50,000 per microlitre. *Levels as low as 10000 per microlitre are frequently Lethal*
The skin of such a person displays many small purplish blotches, giving the disease the name *Thrombocytopenic Purpura*. Most person with thrombocytopenia have the disease known as *Idiopathic Thrombocytopenia* which means simply thrombocytopenia of *unknown cause* 
ITP -  is a common explosive onset of severe thrombocytopenia following recovery from a viral exanthem or upper respiratory illness common in children and accounts for 90% of Pediatric cases of immunologic thrombocytopenia. This syndrome is usually called *acute ITP*.Of these patients 60% recover in 4 to 6 weeks and over 90% recover within 3 to 6 months.
Acute ITP is a rare in adults and accounts for more than 10% of post pubertal patients with *immune thrombocytopenia*.
Most adults presents with more indolent form of thrombocytopenia that may persist for many years and is referred as *chronic ITP*. Women aged 20 to 40 are afflicted most commonly and out number men by ratio of 3 : 1.
Chronic ITP usually can be controlled with glucocorticoid, but in rare cases may requires *temporary phagocytic blockade with intravenous immunoglobulin ( IVIG )*. IVIG is effective form of therapy but it is quite expensive and gives temporary relief. Emergency splenectomy is usually reserved for patients with acute or chronic ITP who are desperately ill and have not responded to any medical or any measures design to improve hemostasis.
High doses of glucocorticoids - 60 mg prednisone is administered for 4 to 6 weeks and then decreased slowly over another few weeks. Approximately 50% of patients normalise their platelet count on high doses of prednisone. However the majority will have a fall in platelet count after steroid withdrawal and and after received variety of immunosuppressive drugs, these chronic ITP patients are eligible for *elective splenectomy*

 *Although each of these drugs and measures designed may be beneficial, it is important to use some restraint because they have serious side effects*.


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




Above case presentation & discussion held in 'Kaysampraday" a Famous WhatsApp group  of  well known Vaidyas from all over the India. 





Presented by-



















Prof. Vd. Arun N. Rathi
 H. O. D. 
Dept. of Kriya Sharir
Dr. V. J. D.Gramin Ayurved College, 
Patur, Dist. Akola, Maharashtra India.

Member :-
Pre Clinical Board, Faculty of Ayurveda, Maharashtra University of Health Sciences, Nashik.

Clinic : -
Ayurleela Panchkarma Chikitsalaya, Pohare Complex, Tapadiya Nagar Akola,  444005 ( MS ).

Time  : -
Mon. to Sat. 7:00 p.m. to 9:30 p.m.
Sunday 10:00 a.m. to 2:00 p.m.
Mob. :  094 23162 555

email : vaidyaarunrathi@ gmail.com

Comments

  1. Great, Dr. Arun,Shadangodak Water used for drinking may be used, I would have preferred Hartaki with Aragwadh.
    Probably I would not have used Suvarna Yoga,as you used.

    ReplyDelete
  2. ��������������

    ReplyDelete
  3. Wonderful treatment protocol and very good result

    ReplyDelete

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