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Case-presentation: Yakridudar/Jalodar (Liver-cirrhosis) by Prof. Vd. Arun Rathi

[12/24, 2:35 PM] Dr. Arun Rathi, Akola:

 *Case Presentation :*

 *A Case of Cirrhosis of Liver (Non-Alcoholic) Esophageal Varices (EVL DONE) with Early Hepatic Encephalopathy  with Parkinsonism with HTN with DM and its Ayurvedic Management :*

*रुग्ण लिंग : पु.   वय : 67 वर्ष.*
*ऊंचाई : 5.5 ft. वजन : 73.4 kg.*
*व्यवसाय : Electrical Wholesale Shop.*
*जाति : हिन्दू*

*रुग्ण इतिहास : ∆ c/o  HTN, DM on Western Rx.*
*In Nov.19 C/o Pain and Tenderness in Abdomen, Anorexia, Vomiting, Hiccup, Constipation, slightly yellow Eyes, Oedema over feet. Thoroughly Investigated and ∆ c/o suffering from Cirrhosis of Liver.*
*Grade III X 3 columns with RCS, Portal HTN - High Risk Esophageal Varices. Six EVL Bands applied on 12th Nov.19 and discharge on 13th Nov.19 and was on western Rx.*
*Again admitted 21st Nov.19 with c/o sleeplessness, slow response to commands, slurred speech. Now the patient was ∆ c/o as having Early Hepatic Encephalopathy and was discharge  on 23rd Nov.19.*
*On 28th Nov.19 patient and family explain about disease, treatment, options & prognosis and was advice Liver Transplant.*
*On 7th Dec.19 evening again patient was admitted and discharge on request on 9th Dec.19. & was shifted to Amravati where EVL was done by a Gastroenterologist & Hepatologist. Pts was admitted and 3 points of Albumin was given - again shifted to Akola on 11th Dec.19 and was admitted on the same day in ICU.*

*From 12th Dec.19 Ayurvedic Rx. was started while pt. was in ICU.*
*c/o : sleeplessness, slow response to commands with altered behaviour, oedema over feet and hand, ⬇ urine output, constipation,  on Abd. examination shifting dullness and transmitted fluid wave present. (जलतरंग प्रतिती)*

 *रोग विनिश्चय : उदर (जलोदर)*

*दोष : त्रिदोष*

*दुष्य : रसरक्तादि सप्तधातु*

*मल : मल, मूत्र, स्वेद, असृजा पित्तम्।*

*अग्नि :  जठराग्निमांद्य*

*व्याधि उद्भव स्थान : कोष्ठ.*

*स्रोतस दुष्टी : स्त्रोतोरोध*

*रोग हेतु : स्निग्ध आहार, अव्यायाम, आचार और पापड़ का अतिसेवन, untreated Splenomegaly*

*संप्राप्ति : रुद्ध्वा स्वेदाम्बुवाहिनी दोषाः स्त्रोतांसि संचिताः।*
*प्राणग्न्यपानान् संदुष्य जनयन्त्युदरं नृणाम्।।*
च.चि.१३/२०.

*रोग मार्ग : त्रिविध ।*

*साध्यासाध्यत्व : कृच्छ्रसाध्य > याप्य > असाध्य ।*

*चिकित्सा सूत्र : दोषातिमात्रोपचयात् स्त्रोतोमार्ग निरोधनात्।*
*संभवत्युदरं तस्मान्नित्यमेव विरेचयेत्।।*
च. चि. १३/६१.

*नित्य विरेचन, पिप्पली, हरितकी, क्षार, मंजिष्ठा, रोहितक आदि द्रव्यो से दिपनपाचन, दुग्धपान और लधु द्रव्यों से युक्त भोजन.*

*Blood Invesigation*
*Before t/t on 12/12/19.*
Bilirubin Total : 3.44 mg/dl.
Bilirubin Direct : 0.79 mg/dl.
Bilirubin indirect : 2.65 mg/dl.
Creatinine : 2.14 mg/dl.
Na               : 128.3 mEq/l.
K                  : 3.98 mEq/l.
*Serum Ammonia : 207.5 Ug/dl.*
*Hb               : 7.7 gm/dl.*

*After t /t on 14 /12/ 19.*
*Serum Ammonia : 121.5 Ug/dl.*
Total Proteins : 6 gm/dl.
Albumin           : 3.6 gm/dl.
Globulin           : 2.4 gm/dl.
Urine Protein  : Traces.

*On 15th Dec.19 pts was discharged from Hospital, Conscious with Ambulatory Condition.*
*On 17th Dec.19 catheter was removed.*
*On 19th Dec.19 Western Direutics were discontinued.*
*On 22nd Dec.19 USG Abd.& pelvis done.*
*Impression : # Mildly altered Liver Parenchymal Echotexture.*
*# Minimal free fluid is noted.*
*# Borderline splenomegaly.*
*On 23rd Dec. 19 Bld. Investigation:*
Bilirubin Total : 0.96 mg/dl.
Bilirubin Direct : 0.30 mg/dl.
Bilirubin Indirect : 0.66 mg/dl.
Total Protein : 6 gm/dl.
Albumin         : 3.5 gm/dl.
Globulin         : 2.5 gm/dl.
*Creatinine     : 1.2mg/dl.*
Na                  : 122 mEq/l.
K                     : 3.6 mEq/l.
*Hb                  : 9 gm/gl.*
Urine             : Bld.Traces.
*At present*
*Wt.  = 71.3 kg ⬇ 2kg.*
*⬆ Urine output 1.3 to 1.4 L/24hrs.*
*Motion : 2 to 3, first one semisolid, 2nd & 3rd watery.*
*No edema over feet, Abd. girth reduce by 1.5 inches.*
*slight gripping pain in Abd., GC fair, Conscious & well behaved, doing his own daily routine.*

*चिकित्सा :*

१). *मंजिष्ठादि चुर्ण  ५ ग्राम*

 नियमित रात में *शरपुंखा, माका, त्रिफला, रोहितक, कुटकी और जटाँमांसी समप्रमाण मे मिश्रित ८ ग्राम चुर्ण से* निर्मित क्वाथ से.

*२). *पुनर्नवा मंडूर  500mg*
        *यकृतपिप्पली योग 500 mg.*
        *मुक्तापिष्टी 125mg.*
         *स्वर्णमालिनी वसन्त 60 mg.*
         *स्वर्णब्राम्ही वटी 50 mg*
प्रातः सायं शहद से

*आहार व्यवस्था :*

*500 to 1000 ml तक चौ. प्रहरी पिप्पली (250 to 500 mg) सिध्द गो दुग्ध.*
*मुली स्वरस 30 to 50 ml + 3 to 5 ml निंबुरस + अजवायन + सैधानमक / 24 hrs*
*फालसा शर्बत 30 ml + जल 70 ml /24hrs*
*खस और नागरमोथा सिध्द जल 700 to1000 ml / 24 hrs.*

*15/12/19 के बाद*
👆🏻 *उपरोक्त के साथ*

*प्रातःकाल गुलकन्द 20- 25 ग्राम / 1 नग आँवला मुरब्बा / 1 नग आगरे का पेठा.*

*दोपहर मे मूंगदाल + पुराने चावल से निर्मित पेया गोघृत से तडका लगा कर 150 ml तक + मुली की सब्जी के साथ सेवन करने को कहा गया.*

*सायंकाल में आनार के दाने 100 gm  काली मिर्च और सैधानमक के साथ या पपीता 100 gm तक सेवन करने को कहाँ गया.*

*रात मे क्षुधा लगने पर मुनक्का,अंजीर, खजूर, मामरा बादाम, अखरोट से निर्मित पानक 150 ml तक या 25 - 30 gm Questa Pro.(Protein powder from Himalaya) दुध या जल से.*

*विहार :*
*यथा संभव ढिले और सूती कपड़े पहनने को कहा गया.*
*अपने नित्म कर्म स्वयं को करने को कहा गया.*
*ज्यादा शारीरिक श्रम करने से बचने को कहा गया.*
*सुबह धुप मे बैढने को कहा गया.*




























[12/24, 3:13 PM] Dr. Ajay Gopalani: 👏🏻👏🏻👏🏻👌🏻👌🏻👌🏻🙏🏻🙏🏻🙏🏻

[12/24, 3:35 PM] Dr Pradeep Mohan Sharma: Great job

[12/24, 3:37 PM] Dr. Ashok Rathod, Oman: 👍🏽👍🏽👍🏽💐

[12/24, 4:20 PM] Dr Jayshri Kulkarni, Latur: 🙏🏻💐💐

[12/24, 4:42 PM] Dr Shekhar Singh Rathoud: 

Excellent 👌🏻👌🏻👌🏻
 Miraculous 🌹🌹🌹

[12/24, 4:53 PM] Dr. Digvijay Singh: Wonderful👌🏻👌🏻

[12/24, 4:54 PM] Dr Rajvir Agad: 🙏🏼🙏🏼👌🏻👌🏻

[12/24, 4:55 PM] Dr Shashi Jindal: 👏👏👏👏💐💐💐💐💐🙏🏼🙏🏼🙏🏼

[12/24, 5:25 PM] Dr Divyesh Desai: 🌺🌺 marvelous

[12/24, 5:34 PM] Dr. Sadhana Babel, Pune: 👌🏻👌🏻💐great

[12/24, 6:14 PM] Dr. Satish Jaimini Choumu, Jaipur: 

सराहनीय अत्यंत प्रसंशनीय आयुर्वेद शास्त्र की संपत्तियों को बढ़ाने हेतु बधाई !

[12/24, 6:15 PM] Dr. Rituraj Verma: अतिउत्तम गुरुवर

[12/24, 6:33 PM] Prof. Surendra A. Soni: 

Excellent management Arun Sir !
When principles Charak samhita applied with the help of Ras drugs, miracles does happen. Your case is proving this.
Thanks for sharing a great case.

नमो नमः ।। 👌🏻👍🏻🌹🙏🏻

[12/24, 6:39 PM] Dr. R S. Soni, Delhi: 

👏👏👏🙏🌹
अद्भुत परिणाम। बहुत बहुत आभार सुस्पष्ट प्रस्तुतिकरण हेतु👌👌👍🏻🌹🌹

[12/24, 6:52 PM] Prof. Surendra A. Soni: 

What a beautiful way to present a case !!

Excellent presentation Sir !!

Your case will be a mile stone in presentation sequence like as honourable Subhash Sir does in his post.
Your case has enough potential to be learnt by beginners/juniors.

🙏🏻🌹😌

[12/24, 6:55 PM] Prof. Surendra A. Soni: 

Use of ras preparation gave you daring to ignore the principal of "nirjal-niranna-nirlavan-chikitsa & Ksheer-vritti" ?

Is it so ?

🍁🌹🙏🏻

[12/24, 7:03 PM] Dr. Arun Rathi, Akola: 

Thanks Dear.
🙏🏻🙏🏻🙏🏻

[12/24, 7:19 PM] Dr. Arun Rathi, Akola: 

As far *nirjal* is concerned, the reports regarding *Renal Function* are gradually rising ,  ⬆ *Creatinine Level*. 

*So my thing was minimum water  700 to 1000 ml can be given.*

Regarding *niranna* after starting Ayurvedic Rx pt. was kept on only *चौ. प्रहरी पिप्पली सिध्द दुग्ध* for initial 5 day.


Last one *nirlavana* pt.was already on *western Diuretics* & had  ⬇ levels of Na . So I was of view सैधव लवण should be given.

In last bld investigation report on 23rd Dec. 19 *Na levels are around 122 mEq / l.*
So सैधव लवण is continued.

🙏🏻🙏🏻🙏🏻


[12/24, 7:21 PM] Prof. Surendra A. Soni: 🙏🏻🌹👏🏻

[12/24, 7:44 PM] Prof. Mrinal Tiwari, Pune: 

चिकित्सा करते समय आपने सही निर्णय लिया । 👍
Sir I have seen pts being on Dugdhahar for 6mn continuously and without water during my PG.What was the dravya for nitya virechana.

[12/24, 7:49 PM] Prof. Surendra A. Soni: 

किसके निर्णय की ओर ध्यान आकर्षित कर रही हैं ?
6 महीने दुग्धाहार का परिणाम ?
नित्य विरेचन प्रश्न किससे है ?

प्रोफेसर मृणाल जी !!🙏🏻🌹

[12/24, 7:53 PM] Prof. Surendra A. Soni:

Diuretics were continued during Ayu. Management ?
If it is so then chances of reoccurrence may be there because charak advocates milk therapy for 3 months. Can't say anything that ras drugs compensate enough permanent type of dhatu-soushthav or not ?

Arun Sir !!

🙏🏻🌹

[12/24, 7:54 PM] Prof. Mrinal Tiwari, Pune: 

Regarding niranna and nirjala Sir took right decision to start light diet,siddha jala.
For nitya Virechana triphala and kutaki were enough or he had to add more ?

[12/24, 7:55 PM] Prof. Mrinal Tiwari, Pune: 

I shared my experience of Jalodhar pts kept on dugdha for 6 mn.They were never allowed to have diet .

[12/24, 8:38 PM] Dr. Arun Rathi, Akola: 

After 5 days of Ayu. Rx. catheter was removed and 7 days western Diuretic were stopped.

Dr. Soni !

[12/24, 8:39 PM] Prof. Surendra A. Soni: Thanks Arun Sir !!🙏🏻

[12/24, 9:41 PM] Dr Ashwini Kumar Sood, Ambala: 

Wonderful achievement on AUURVEDA lines of treatment , liver and kidney functions became normal .👌🏼
One simple query can NASH cause so much havoc or was some other contributing factor responsible for so  much of hepato- renal  insufficiency.

[12/24, 11:03 PM] Dr. Arun Rathi, Akola: 

What I think *Non  Alcoholic Steatohepatitis (NASH)* doesn't cause so much havoc.

*The patient is father of a Well Known & Established MDS Surgeon from Akola.*
*Pt. was entangled in VVIP Syndrome and the contributing factors were Anxiety of pts & his relatives for such a Havoc.*
*Yes of course there are some contributing factor for the disorder such as*

*1. Seating job for 8 to 10 hrs. daily.*

*2.. पापड और आचार अतिसेवन.*
*3. No t/t for mild Splenomegaly since last 2 to 3yrs.*
*Factor 1 to 3 are हेतु for उदर (जलोदर) according to Ayurvedic रोग संप्राप्ति.*

🙏🏻🙏🏻🙏🏻


[12/24, 11:07 PM] Dr. Ravikant Prajapati M. D, BHU.: 👌👌🌹🌹🙏🙏💐

[12/24, 11:08 PM] pawan madan Dr:

 Very nice Arun ji.
Thanks a lot for sharing.
🙏💐🙏

[12/24, 11:10 PM] pawan madan Dr: 

माका शायद आयुर्वेदिक herb नई है
ये किस रूप में प्राप्त होती है?

और यकृत पिप्पली तो आपका स्पेशल योग है।



[12/24, 11:21 PM] Dr Sanjay khedekar: 

Yes Maka is Bhringraj !!

[12/25, 7:37 PM] Vaidyaraj Subhash Sharma, Delhi: 

*excellent presentation Dr Arun Rathi ji*


               👌👍👏🌹🌺








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




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. Congratulations and a grwat job Dr Arun

    ReplyDelete
  2. Excellent thinking & pin point medicine management.
    Hats off sirj

    ReplyDelete
  3. Nice presentation Sir.. Hats off to u.... 🙌

    ReplyDelete
  4. Nice presentation Sir.. Hats off to u.... 🙌

    ReplyDelete
  5. Excellent case presentation by Vs.Arunji. It shows how to utilise the modern investigations to treat the case with pure Ayurveda medicines.

    To my opinion, this case is an eye opener for new and young practitioners who left or not treated the case which is untreated by modern experts.

    We must remember Acharya Vagbhata's quotation where he says, if a physician is not able to name a perticular disease , he should not feel ashamed on that account because it is not always possible to name all types of diseases in definite terms (A.H.Su.12/64)

    According to Vagbhata, a physician who minutely examine the patient on Ayurveda parameters like Dashvidh Pariksha never go wrong in doing treatment.

    Hearty congratulations to Vd.Arunji for your in-depth knowledge and courage in treating this case.

    ReplyDelete
  6. Very nicely and meticulously presented,it may be an eye opener but more no of cases and long term follow up require to come on any conclusion along with control group

    ReplyDelete
  7. Superb sir it was really inspiring the learning juniors

    ReplyDelete
  8. Very practical and knowledge full case presentation sir, Niranna advise is very important for fast clinical recovery

    ReplyDelete
  9. Sir yakrutpipali yog kay he?? Ref?

    ReplyDelete

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[14/08 21:17] Amol Jadhav Dr. Ay. Pth:  What should be our approach towards... Headache with cranial nerve palsies.... Please guide... [14/08 21:31] satyendra ojha sir:  Nervous System Disorders »  Neurological Disorders Headache What is a headache? A headache is pain or discomfort in the head or face area. Headaches vary greatly in terms of pain location, pain intensity, and how frequently they occur. As a result of this variation, several categories of headache have been created by the International Headache Society (IHS) to more precisely define specific types of headaches. What aches when you have a headache? There are several areas in the head that can hurt when you have a headache, including the following: a network of nerves that extends over the scalp certain nerves in the face, mouth, and throat muscles of the head blood vessels found along the surface and at the base of the brain (these contain ...

WhatsApp Discussion Series:18- "Xanthelasma" An Ayurveda Perspective by Prof. Sanjay Lungare, Vd. Anupama Patra, Vd. Trivendra Sharma, Vd. Bharat Padhar & others

[20/06 15:57] Khyati Sood Vd.  KC:  white elevated patches on eyelid.......Age 35 yrs...no itching.... no burning.......... What could be the probable diagnosis and treatment according Ayurveda..? [20/06 16:07] J K Pandey Dr. Lukhnau:  Its tough to name it in ayu..it must fall pakshmgat rog or wartmgat rog.. bt I doubt any pothki aklinn vartm aur klinn vartm or any kafaj vydhi can be correlated to xanthelasma..coz it doesnt itch or pain.. So Shalakya experts may hav a say in ayurvedic dignosis of this [20/06 16:23] Gururaja Bose Dr:  It is xantholesma, some underline liver and cholesterol pathology will be there. [20/06 16:28] Sudhir Turi Dr. Nidan Mogha:  Its xantholesma.. [20/06 16:54] J K Pandey Dr. Lukhnau:  I think madam khyati has asked for ayur dignosis.. [20/06 16:55] J K Pandey Dr. Lukhnau:  Its xanthelasma due to cholestrolemia..bt here we r to diagno...

WhatsApp Discussion Series 47: 'Hem-garbh-pottali-ras'- Clinical Uses by Vd. M. Gopikrishnan, Vd. Upendra Dixit, Vd. Vivek Savant, Prof. Ranjit Nimbalkar, Prof. Hrishikesh Mhetre, Vd. Tapan Vaidya, Vd. Chandrakant Joshi and Others.

[11/1, 00:57] Tapan Vaidya:  Today morning I experienced a wonderful result in a gasping ILD pt. I, for the first time in my life used Hemgarbhpottali rasa. His pulse was 120 and O2 saturation 55! After Hemgarbhapottali administration within 10 minutes pulse came dwn to 108 and O2 saturation 89 !! I repeated the Matra in the noon with addition of Trailokyachintamani Rasa as advised by Panditji. Again O2 saturation went to 39 in evening. Third dose was given. This time O2  saturation did not responded. Just before few minutes after a futile CPR I hd to declare him dead. But the result with HGP was astonishing i must admit. [11/1, 06:13] Mayur Surana Dr.:  [11/1, 06:19] M gopikrishnan Dr.: [11/1, 06:22] Vd.Vivek savant:         Last 10 days i got very good result of hemgarbh matra in Aatyayik chikitsa. Regular pt due to Apathya sevan of 250 gm dadhi (freez) get attack asthmatic t...

DIFFERENCES IN PATHOGENESIS OF PRAMEHA, ATISTHOOLA AND URUSTAMBHA MAINLY AS PER INVOLVEMENT OF MEDODHATU

Compiled  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

UNDERSTANDING THE DIFFERENTIATION OF RAKTAPITTA, AMLAPITTA & SHEETAPITTA

UNDERSTANDING OF RAKTAPITTA, AMLAPITTA  & SHEETAPITTA  AS PER  VARIOUS  CLASSICAL  ASPECTS MENTIONED  IN  AYURVEDA. Compiled  by Dr. Surendra A. Soni M.D.,PhD (KC) Associate Professor Head of the Department Dept. of Kaya-chikitsa Govt. Ayurveda College Vadodara Gujarat, India. Email: surendraasoni@gmail.com Mobile No. +91 9408441150

Case-presentation- Self-medication induced 'Urdhwaga-raktapitta'.

This is a c/o SELF MEDICATION INDUCED 'Urdhwaga Raktapitta'.  Patient had hyperlipidemia and he started to take the Ayurvedic herbs Ginger (Aardrak), Garlic (Rason) & Turmeric (Haridra) without expertise Ayurveda consultation. Patient got rid of hyperlipidemia but hemoptysis (Rakta-shtheevan) started that didn't respond to any modern drug. No abnormality has been detected in various laboratorical-investigations. Video recording on First visit in Govt. Ayu. Hospital, Pani-gate, Vadodara.   He was given treatment on line of  'Urdhwaga-rakta-pitta'.  On 5th day of treatment he was almost symptom free but consumed certain fast food and symptoms reoccurred but again in next five days he gets cured from hemoptysis (Rakta-shtheevan). Treatment given as per availability in OPD Dispensary at Govt. Ayurveda College hospital... 1.Sitopaladi Choorna-   6 gms SwarnmakshikBhasma-  125mg MuktashuktiBhasma-500mg   Giloy-sattv...

Case-presentation: 'रेवती ग्रहबाधा चिकित्सा' (Ayu. Paediatric Management with ancient rarely used 'Grah-badha' Diagnostic Methodology) by Vd. Rajanikant Patel

[2/25, 6:47 PM] Vd Rajnikant Patel, Surat:  रेवती ग्रह पीड़ित बालक की आयुर्वेदिक चिकित्सा:- यह बच्चा 1 साल की आयु वाला और 3 किलोग्राम वजन वाला आयुर्वेदिक सारवार लेने हेतु आया जब आया तब उसका हीमोग्लोबिन सिर्फ 3 था और परिवार गरीब होने के कारण कोई चिकित्सा कराने में असमर्थ था तो किसीने कहा कि आयुर्वेद सारवार चालू करो और हमारे पास आया । मेने रेवती ग्रह का निदान किया और ग्रह चिकित्सा शुरू की।(सुश्रुत संहिता) चिकित्सा :- अग्निमंथ, वरुण, परिभद्र, हरिद्रा, करंज इनका सम भाग चूर्ण(कश्यप संहिता) लेके रोज क्वाथ बनाके पूरे शरीर पर 30 मिनिट तक सुबह शाम सिंचन ओर सिंचन करने के पश्चात Ulundhu tailam (यह SDM सिद्धा कंपनी का तेल है जिसमे प्रमुख द्रव्य उडद का तेल है)से सर्व शरीर अभ्यंग कराया ओर अभ्यंग के पश्चात वचा,निम्ब पत्र, सरसो,बिल्ली की विष्टा ओर घोड़े के विष्टा(भैषज्य रत्नावली) से सर्व शरीर मे धूप 10-15मिनिट सुबज शाम। माता को स्तन्य शुद्धि करने की लिए त्रिफला, त्रिकटु, पिप्पली, पाठा, यस्टिमधु, वचा, जम्बू फल, देवदारु ओर सरसो इनका समभाग चूर्ण मधु के साथ सुबह शाम (कश्यप संहिता) 15 दिन की चिकित्सा के ...