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