Morbidity Management and Disability Prevention of Lymphatic Filariasis through Integrative Medicine

Dr. S.R. Narahari
Director IAD
Institute of Applied Dermatology
Kasaragod, Kerala, India PIN 671124
Contact: 9188763687 & 9895588735
www.iad.org.in
Email: srniad@gmail.com and iadorg@gmail.com
Morbidity Management and Disability
Prevention of Lymphatic Filariasis through
Integrative Medicine

Company Confidential Document
© Copyright 2020 Institute of Applied Dermatology, Kasaragod. All rights reserved.
Common cause of Lymphoedema: Lymphatic Filariasis
• Wuchereria bacrofti (90%)
• Brugia malayi (9+%)
• Brugia timori (+_ 1%)

3
Causes of lymphodema
Secondary:
Lymphatic Filariasis
Post surgery/Post breast/cervical
cancer
Phlebolymphodema
Traumatic
Systemic diseases
Podoconiosis
Primary: Familial/Genetic
Syndromes

Lymphoedema Grading System
International Society of
Lymphology (ISL Consensus)
• Stage I: Pitting oedema may be
present, completely resolve on
elevation (during overnight) and
normal skin.
• Stage II (early): Pitting oedema
manifests that does not resolve
completely on elevation
(overnight). Skin is normal.
• Stage II (late): Late stages of
grade II with non-pitting oedema
& thickened skin.
• Stage III: Oedema is not pitting
with trophic skin changes:
Acanthosis, Fat deposits, Warty
overgrowth.
WHO adopted Indian plastic surgeon’s
• Stage 1: Pitting oedema may be present, completely
resolve on elevation (during overnight) and normal
skin.
• Stage 2: Pitting oedema manifests that does not
resolve completely on elevation (overnight). Skin is
normal.
• Stage 3: Irreversible Lymphoedema with thickened
skin and shallow folds whose base is visible;
• Stage 4: Irreversible Lymphoedema with knobs
(bumps and lump);
• Stage 5: Irreversible Lymphoedema with deep folds
whose base is visible when separated by finger;
• Stage 6: Irreversible Lymphoedema with mossy foot;
• Stage 7: With irreversible Lymphoedema, disability to
do routine activities adequately grading

MMDP: Emerging public health programme in the world

INTEGRATED
TREATMENTTRADITIONAL
SKIN CARE
AYURVEDA ALLOPATHY
COMPRESSION
THERAPY
YOGA
PATIENT EDUCATION
HOME BASED-SELF CARE TREATMENT
Indian Treatment: Globally Acknowledged

Grade III :with non-
pitting oedema
Grade II early : with pitting
edema that is not resolved
completely on overnight
elevation
Integrated Medicine patient management: Overview
• We use allopathic structure for clinical studies combining ayurveda formulations
• Comparable biomedical terminology is identified by examining the patients as a
multi-system team
• Diagnosis and clinical outcomes are from allopathy (in case of lymphedema gold
standards of lymphology)
• PubMed’s MeSH term is Integrative Medicine
© IAD 2019
Grade II late : Oedema that
is not resolved during
overnight elevation
Skin Normal Skin Thickened Trophic Skin Changes
Indications for treatment

8
Contraindication:
Patients who are in acute
episodes of inflammatory
reaction (cellulitis / filarial
fever) of any cause
Do not to use this regimen during cellulitis

2004: First published in lymphology
Till date treated 4366 patients

10
Patient Preparation
Counseling
Case Taking
Outcomes recorded at the
baseline including
Photo Documentation
Steps of Integrative Medicine Treatment
Integrative Skin Care
Skin wash
Phanta soaking
Allopathy to treat bacterial
entry lesions
Lymph Drainage
Yoga asana
Breathing techniques
(Pre & post IMLD yoga)
IMLD(Massage)
Compression therapy

11
Measuring volume of lymphoedema
Volume measurement
by water
displacement method
‘Gold standard in
lymphology’

12
Volume estimation by measuring girth
Patellar
region
Maximal
bulk
Mid-foot
Metatarsal
Mid-thigh
Max. Bulk
End-of
calf bulk
Ankle
Sites of measurement

‘LymphaTech’ if you have money
• Fast, accurate, and
reliable 3D imaging
• Measurement: software
on iPad & scan the limb

Record all seven+
Bacterial Entry
points
14
Bacterial Entry points

With luke warm water
Use only the same brand of soap
15
SKIN WASH

AYURVEDIC CHURNA:
Herbal compound
powder
Dominant
DOSHA
Yastimadhu
(Glyceriza glabra)
Kapha
Manjista
(Rubia cordifolia)
Vata
Sariva
(Hemidesmus indicus )
Pitta
Thriphala
(Terminalia chebula etc)
Thridosha
Herbal drug (Phanta) soaking

Cotton cloth should be used.
Inter-digital clefts and folds should be properly dried.
17
DRYING

Nodal Drainage:
Locating Femoral/Popliteal pulse and massage
over the lymph nodes called nodal drainage
Inguinal nodal drainage Popliteal nodal drainage
18
Drainage of Lymph-nodes

19
Indian Manual lymph drainage-part 2
Herbal oil massage: below upwards

12/21/2020
Multi-layered Lymphoedema bandaging
Cotton cloth/ mouldsToe compression

21
Nurses require training for individualized compression therapy

22
Two yoga sessions

Alternate yoga positions

24
Family member assisted home based self care
• Pictures of farmers doing treatment at home after 14
days of intensive supervised regimen in the clinic

25
This protocol is used to manage Wide range of morbidity
Morbidity Management

LYMPOEDEMA TREATMENT PROTOCOL
In 2010, WHO acknowledged IAD as a lead lymphology clinic in the
world. 2018 onward, IAD is contributing to WHO publications on
neglected diseases
YouTube Channel: IAD Kasaragod: how we treat
lymphoedema and Filariasis in an integrated method :
https://www.youtube.com/channel/UCqBNL837KyrLqO
pFdV2zr5A

Outcome after 150 days
Baseline Discharge- after 21 days After 150 days

Response in severe cases
• Baseline (02-09-2017) • Follow up (02-01-2018)

Lymphatic Filariasis: Sustained treatment outcome

Outcome after 120 days
Baseline Discharge- after 21 days After 120 days

Upper limb lymphoedema(BCRL)
Baseline
After 120 days of integrative
treatment

Never Fear Filariasis
© IAD 2016
IAD is the designated ‘centre for integrated medicine and public health’ of
Government of Kerala, India’s first (2014 Feb) through a parliamentary process

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