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Case presentation
Dr. Amritha Edayilliam
Dept of PG studies in kayachikitsa
1
Management of Chronic Kidney Disease with
Rookshana involving Udwarthana and
Triphaladi lekhana basthi- A case study
2
VITAL DATA
• Name : Mrs. XYZ
• Age : 59 years
• Sex :Female
• Socio-Economic status : Rich
• Marital status :Married
• Edu...
•Pain and burning
sensation while micturition
since 1 month.
•Fatigue since 4 years
aggravated since 1month.
•Puffiness of...
ASSOCIATED COMPLAINTS
• Back pain
• Numbness over left lower limb on and off.
• Reduced appetite.
• Nausea on and off.
• I...
• Patient is a k/c/o hypertension since 10 years and CKD since 4
years. All relevant blood examination done showed raised ...
• Simultaneously patient developed complaints of tiredness through
out the day, needs support to get up from bed, walking,...
• H/o haemorrhage in right eye
treatment for the same 6 year
back.
• H/o cataract in left eye 4 yr back
operated for the s...
• Menarche at the age of 13.
• Menopause at the age of 45year (
2007).
• H/o severe menstrual bleeding,
for 6 years with d...
• H/o 3 D&C in between 2002-
2007.
• On medication
• Tab Twincal BD
• Tab Prazopress XL 2.5mg OD
• Tab Dytor OD
• Tab Alph...
• Diet - Mixed,
Nonveg – twice/week
• Appetite - reduced
• Sleep - disturbed
• Micturition – hourly once (10 times/day, 8 ...
• Prakruti - Vata-Pitta
• Vikruti- Pravara
• Sara -Avara
• Samhanana -Avara
• Pramana -Madhyama
• Satmya - Vyamisra
• Satv...
13
• A female patient obese built moderately nourished and afebrile, is
oriented to time place and in person
• P+ E0 N- tr...
Per abdomen
Inspection
• Shape of abdomen- Distended
• Umbilicus- inverted , centrally
placed
• Palpation
• Soft.
• Tender...
NIDANA
• Aharaja-
• Pradushta ahara,teekshna ahara,
• Atilavana,atikshara,
• Ati amla,katukahara,
• Masha,moolaka,
• Jalaj...
Aharaja
Viharaja
tridosha
prakopa
Rasa
Shonitha
dushti
Shirasoruk,Bhrama
,Rakta pradara,
vaivarnya,
agnisaada,tandra
Manas...
Doshaja basthi
marmaabhighatha
Further intake
of nidana
Akshiraga,visarpa
Gurugaatrata
Atidourbalya,Aruchi
Klama
Nidraathi...
• Dosha-
• Kapha Pitha pradhana tridosha
• Dushya -
• Rasa, rakta, mamsa, meda,
mootra
• Agni -Jataragni, dhatvagni
• Ama ...
• Previous investigation reports on 14/5/16
• Serum creatinine- 7.70 mg/dl
• Blood urea- 106.3 mg/dl
• GFR- 10
• Periphera...
• Ayurveda
• Kaphaja shotha
• Basthi marmaabhighatha
• Mootrakruchra
• Kaphaja prameha
• Modern science
• Chronic kidney d...
• Doshaja basthi
marmabhighata
• Vangshna shoola
• Mehana shoola
• Basthishoola
• Udavartha
• Jwara
• Mootrakruchra
• Moot...
• Sarvanga udwarthana with
triphala churna + manjishta
churna + kolakulathadi churna
followed by nadi sweda-(14 days)
• Sa...
•Tiredness
•Breathlessness
•Anorexia
•Nausea
•S. creatinine
•Blood urea
23
Assessment criteria
24
Tiredness Breathlessness Anorexia Nausea
0. no tiredness 0. No
breathlessness
0. Takes full diet and also
presence of p...
• OBSERVATION
• On 31/5/16
• S.creatine-7.6
• Blood urea- 87.6
• Puffiness of face reduced 50%,
• Tiredness reduced 40%,
•...
• Chronic kidney disease is progressive loss in renal function over a
period of months or years and is caused by any condi...
• Triphala is rich source of galic acid, tannins exhibits anti oxidant anti
inflammatoryand detoxification activities. It ...
Conclusion
• In this case Basthi is very much effective in improving the kidney
functions and basthi dravyas and shamanaou...
Thank you29
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chronic kidney disease case presentation

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chronic kidney disease

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chronic kidney disease case presentation

  1. 1. Case presentation Dr. Amritha Edayilliam Dept of PG studies in kayachikitsa 1
  2. 2. Management of Chronic Kidney Disease with Rookshana involving Udwarthana and Triphaladi lekhana basthi- A case study 2
  3. 3. VITAL DATA • Name : Mrs. XYZ • Age : 59 years • Sex :Female • Socio-Economic status : Rich • Marital status :Married • Education :Graduate • Occupation : housewife • Date of Admission :20/05/2016 • Date of discharge: 4/6/2016 • Address : Hyderabad 3
  4. 4. •Pain and burning sensation while micturition since 1 month. •Fatigue since 4 years aggravated since 1month. •Puffiness of face on and off since 4 years aggravated since 1 month. • Drowsiness • Feeling breathlessness while walking for short distance since 4 years, aggravated since 1 month. • Giddiness while getting up from bed, walking- since 10 years aggravated since 1 month. 4 CHIEF COMPLAINTS
  5. 5. ASSOCIATED COMPLAINTS • Back pain • Numbness over left lower limb on and off. • Reduced appetite. • Nausea on and off. • Incomplete evacuation. • Increased frequency of urine. Since 4 years aggravated since 1month. 5
  6. 6. • Patient is a k/c/o hypertension since 10 years and CKD since 4 years. All relevant blood examination done showed raised creatinine, low GFR. For which medication was started. 1 month back suddenly she developed fever with chills along with painful and burning sensation while micturition. It was a squeezing type of pain which develop prior, during and even after voiding the urine associated with burning sensation. She developed puffiness of face (no periorbital swelling)and swelling over bilateral feet persisting throughout the day and lasting up to 3 days or more. For which they consulted their physician and given symptomatic treatment. By which fever and swelling over feet subsided. Puffiness of face, burning sensation and painful micturition persisted. 6 HISTORY OF ILLNESS
  7. 7. • Simultaneously patient developed complaints of tiredness through out the day, needs support to get up from bed, walking, climbing steps, breathlessness while walking for short distances(from bed to till door) , feeling sleepiness after taking a little quantity of food, no interest to do any activities, reduced appetite and nausea. Pt also complaining of backpain(lumbar region) non radiating which she feels like originating from deep inside and numbness of left leg which will be during early mornining, sitting for long hours. • As she is undergoing regular checkup and taking treatment for CKD, her consultant advised to start with dialysis as the kidney function tests were much hampered. 7
  8. 8. • H/o haemorrhage in right eye treatment for the same 6 year back. • H/o cataract in left eye 4 yr back operated for the same. • H/o Asthma in the year of 1987 subsided in same year. • H/o headache for 20 yrs- used to take painkillers. • H/o Herpes 3 year back. • H/o chicken pox age of 7. • H/o UTI 1 year back • Not a k/c/o DM, Hypothyroidism, tuberculosis. 8 PAST HISTORY
  9. 9. • Menarche at the age of 13. • Menopause at the age of 45year ( 2007). • H/o severe menstrual bleeding, for 6 years with dysmenorrhea. For which she used to take Meftalspas continuously for 15 days in the dose of 3 tab/day for 1 and ½ year along with brufen occassionally(monthly thrice). • P8 A6 L2 D0. • All are induced abortions • P2- Female age- 37 year • P8- Female age-32 year. • No h/o tubectomy done. • H/o copper T contraception for 2 years. 9 Menstrual history Obstetric history
  10. 10. • H/o 3 D&C in between 2002- 2007. • On medication • Tab Twincal BD • Tab Prazopress XL 2.5mg OD • Tab Dytor OD • Tab Alpha ketoanalogue TID • Tab PTH cinacalcet OD • Tab Refil OD • Cap. Oferol 0.25mg OD • Epofit injection(weekly once) • Cap. Rencap OD • There was no family history pertaining to the present illness. 10 Treatment history Family history
  11. 11. • Diet - Mixed, Nonveg – twice/week • Appetite - reduced • Sleep - disturbed • Micturition – hourly once (10 times/day, 8 times/night),urgency + • Bowels - once/day, hard stools (No clear evacuation) • Habits- • Sleeping after lunch >2 hours. • Chilled softdrinks such Fanta, cococoala daily. 11 Personal history
  12. 12. • Prakruti - Vata-Pitta • Vikruti- Pravara • Sara -Avara • Samhanana -Avara • Pramana -Madhyama • Satmya - Vyamisra • Satva - Avara • Ahara sakthi- Avara • Vyayama shakthi - Avara • Vaya Madhyama(parihani) • Hetu - Shareerika- aharaja, viharaja, abheshaja Manasika nidanas • Dosha -Tridosha prakopa • Vata vikruti- Panchavata • Kapha vikruti- Kledaka, Avalambaka • Pitha vikruti- Pachaka • Desha - Jangala • Kaala - Rithu-Sharath, Greeshma • Bala -avara 12 ROGI PAREEKSHA
  13. 13. 13 • A female patient obese built moderately nourished and afebrile, is oriented to time place and in person • P+ E0 N- transverse lines C0 Io L0 • Tongue - non coated • Pulse - 75 BPM • B.P - 150/100 mmHg • Temp - 98.6° F afebrile • Respiratory rate - 18/min • Height -150 cm • Weight - 73kg • BMI - 32.4 General examination
  14. 14. Per abdomen Inspection • Shape of abdomen- Distended • Umbilicus- inverted , centrally placed • Palpation • Soft. • Tenderness – Epigastrium left Hypogastrium Umbilical Left iliac. • No rebound tenderness. • No organomegaly • Percussion and auscultation-NAD 14 Kidney &Urinary system Costovertebral tenderness-+ Urgency-+ Frequency-++ Dysuria + • RS- • Bilateral NVBS heard, • Crepitation heard over right and left lower zone. • CVS- • S1 & S2 heard, no added sounds • MSK Tenderness over L1,L2, L3.L4 SLR- -ve ROM- possible Systemic examination
  15. 15. NIDANA • Aharaja- • Pradushta ahara,teekshna ahara, • Atilavana,atikshara, • Ati amla,katukahara, • Masha,moolaka, • Jalaja anoopamamsasevana, • Dadhi,sura, • Virudhahara • Ati Snigdaahara • Guruahara • Sheetahara • Abhishyandi bhojana 15 • Viharaja • Divaswapna, avyayama • Abheshaja • Meftalspas 3 tab/day for 1 ½ year, • Brufen (monthly thrice) for 25 years • Painkillers for headache for 20 years • Manasika • Chintyanam cha atichinthanath ROGA PAREEKSHA
  16. 16. Aharaja Viharaja tridosha prakopa Rasa Shonitha dushti Shirasoruk,Bhrama ,Rakta pradara, vaivarnya, agnisaada,tandra Manasika AbheshajaMamsa medo dushti Mootra dushti 16 Sthoulya
  17. 17. Doshaja basthi marmaabhighatha Further intake of nidana Akshiraga,visarpa Gurugaatrata Atidourbalya,Aruchi Klama Nidraathiyoga Mehana shoola Basthishoola Mootraudavarta 17 Mootravaha sroto dushti Pandu Mootrakruchra
  18. 18. • Dosha- • Kapha Pitha pradhana tridosha • Dushya - • Rasa, rakta, mamsa, meda, mootra • Agni -Jataragni, dhatvagni • Ama - Tadjanya • Srothas Rasavaha, Raktavaha, Mamsavaha, Medovaha, Mootravaha. • Srotho dushti prakara – sanga • Udbava sthana Amapakwashaya • Vyaktha sthana- Basthi, Mootravaha srothas. • Adhishtana - Basthi. • RogaMarga - Madhyama • Sadhyasadhyatha - Yapya 18 Samprapthi ghataka
  19. 19. • Previous investigation reports on 14/5/16 • Serum creatinine- 7.70 mg/dl • Blood urea- 106.3 mg/dl • GFR- 10 • Peripheral smear test-Normocytic hypochromic • Parathyroid hormone-479pg/ml (raised) • Urine analysis • Appearance- clear, • Sp. Gravity- 1.005 • Protein- present, Sugar- present, pus cells- 15- 20 hpf • Epithelial cells- 6- 8 • RBC- nil, Cast- nil 19 INVESTIGATIONS
  20. 20. • Ayurveda • Kaphaja shotha • Basthi marmaabhighatha • Mootrakruchra • Kaphaja prameha • Modern science • Chronic kidney disease • Nephrotic syndrome • Pylonephritis • Cystitis 20 Vyavachedaka nidana
  21. 21. • Doshaja basthi marmabhighata • Vangshna shoola • Mehana shoola • Basthishoola • Udavartha • Jwara • Mootrakruchra • Mootrakruchra • Teevrarthi ruk vangshna, basthi • Swalpam muhu mootrayateeha • Sarujam, sadaaham,kruchram muhurmootrata. • CKD • Presence of markers of kidney damage> 3 months, • Functional abnormality of kidney with decreased GFR, anaemia, hypertension, raised PTH, nausea,reduced appetite, H/O peripheral oedema • Cystitis • Frequency, • Urgency, • Dysuria, • Burning micturition, pyuria, • Hypogastric discomfort. 21
  22. 22. • Sarvanga udwarthana with triphala churna + manjishta churna + kolakulathadi churna followed by nadi sweda-(14 days) • Sarvanga takradhara with musta,amlaki(5 days) • Triphala niruha (yogabasthi) • Anuvasana- triphala thaila(100ml) • Niruha - triphala kwatha • Honey-30ml • Saindhava- 5 gm • Triphala thaila-100ml • Katuki churna- 20gm • Triphala kwatha- 400ml • Internal medication • Pippalyasava+ Bringarajasava+Veeratharvadi kashayam+Varanaadi kashayam- 8tsp tid • Tab Chandraprabha vati 2-2-2. 22 TREATMENT ADOPTED
  23. 23. •Tiredness •Breathlessness •Anorexia •Nausea •S. creatinine •Blood urea 23 Assessment criteria
  24. 24. 24 Tiredness Breathlessness Anorexia Nausea 0. no tiredness 0. No breathlessness 0. Takes full diet and also presence of proper appetite at the next meal hour. 0. no nausea 1. occasional feeling of tiredness on activity 1. breathlessness on quick moving/upstairs 1. Presence of moderate apetite and proper appearance of appetite in next meal hour 1. less than 2 times 2. Constant feeling of tiredness on activity 2. breathlessness on light physical activity. 2. Presence of moderate apetite but delayed appearance of appetite in next meal hour 2. 2-5 times 3. Feeling tiredness all the time 3. breathlessness on bed 3. presence of low appetite and delayed appearance of appetite in next meal hour 3. >5 times
  25. 25. • OBSERVATION • On 31/5/16 • S.creatine-7.6 • Blood urea- 87.6 • Puffiness of face reduced 50%, • Tiredness reduced 40%, • No pain and burning sensation while micturition • Back pain reduced 95%. • Bowel- complete evacuation • Bladder- 6 times/day, 4 times at night.(complete evacuation) no urgency. • On 4/7/16 • Blood urea- 75.6mg/dl • S .creatinine – 7.4 mg/dl BT AT Tiredness 3 2 Breathlessn ess 2 1 Anorexia 3 1 Nausea 3 1 S.creatinin e 7.70mg/dl 7.4mg/dl Blood urea 106.3mg/dl 75.6mg/dl 25
  26. 26. • Chronic kidney disease is progressive loss in renal function over a period of months or years and is caused by any condition which destroys the normal structural properties possibly help to transport the drug molecules in the systemic circulation through mucosa. • The treatment modality adopted here based on the dosha dushya involvement. • Since the patient was mamsala medura and dosha involved was kapha pitha, rookshana was done in the fom of udwarthana , takradhara and lekhana basti was selected. • The drugs selected for lekhana basthi are capable of liquefying viscid matter and breaking into minuteminute particles ang helping in doshavilayana. Along with that Saindhava lavana helps in removal of doshas by its lekhana property. 26 Discusssion
  27. 27. • Triphala is rich source of galic acid, tannins exhibits anti oxidant anti inflammatoryand detoxification activities. It is rasayana, tridoshahara, amapachaka action which helps in rejuvenating damaged capillaries apart from improving blood circulation and GFR. • Katuki help to bring collective benefits for its pitha rechaka and kaphahara action. Varunadi Kashaya which mentioned as varunaadi gana which possess the quality of kapha medo hara and agnipradeepana, the contents of veeratharvadi Kashaya which mentioned as veeratharvadi gana possesses quality like mootrala and acts on mootrakruchra mootraghata rujahara. • Presence of pippali in pippalyasava enhances the bio availabilioty and thus allowing the faster penetration of phytomolecules. Bhringaraja in bringarajasava act as anti inflammatory antimicrobial activity thus pacifies chronic, non specific UTI with CKD 27
  28. 28. Conclusion • In this case Basthi is very much effective in improving the kidney functions and basthi dravyas and shamanaoushadis used in this case having srothovishodhana property. • This treatment approach is safe and effective in cases of CKD, Further studies to be conducted to establish the facts with more statistical and scientific strength. 28
  29. 29. Thank you29

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