Mrs. Mangala, age 36, presented with pain in multiple joints and morning stiffness for 45 days. She reports an initial fever 45 days ago which subsided with medication, but joint pains developed over the next few weeks in her ankles, knees, wrists, and fingers. On examination, she had tenderness and warmth in all joints with reduced range of motion. Based on her symptoms and family history, she is assessed as having Amavata involving multiple joints likely due to vitiation of vata and pitta doshas leading to accumulation of ama. Blood investigations are proposed to further evaluate inflammatory markers.

1. RAJESH.K
I I YEAR PG SCHOLAR
DEPT., OF PG STUDIES IN KAYACHIKITSA
SKAMCH&RC, BANGALORE
1
CASE DISCUSSION

2. 2
 Name : Mrs. mangala
 Age : 36 Years
 Sex : female
 Religion : Hindu
 Socio economic status : middle class
 Marital status : Married
 Education status : MBA
 Occupation : house wife
 Date of admission :24/07/15
 Date of discharge :

3. 3
 Ward : female General Ward
 Source of history : Patient
 Case taken on : 29/07/15
 Consultant doctor : Dr. Byresh.A
 O.P No : 16678
 I.P. No : 2867/15
 Address : # 12 ,3rd cross kallappa
compound,AD halli
Bangalore - 79

4. PRADHAN VEDANA
4
 Pain in multiple joint associated with morning stiffness
since 45 days.

5. VEDANA VRUTTANTA
5
Patient was apparently normal 45 days ago. She had an
attack of raised body temperature along with chills
tiredness, & body ache. The same day she consulted a
physician and was prescribed with medication(details of
which are not available). After taking that medication
she found relief in fever (chills, tiredness & body ache
persisted) . After 6-7 days she started to get pain in her
both ankle joints which was localised in nature. Pain got
aggravated during early morning and used to resolve as

6. 6
the day progresses. Gradually she developed pain in
her both knee joints ; with morning stiffness persisting
nearly 2-3hrs.There was no complaints of crepitus in
joints and pain was always localised in nature. On
22/6/2015 she consulted SKAMCH & RC OPD and
was prescribed with medications. She started to get
pain in her both wrist joints, inter phallengeal joints;
disturbing her daily activities. So on her consulting
physician’s advice she got admitted in FGW on
24/7/15.

7. 7
Bowel and Bladder habits are said to be regular and under
control.

8. POORVA VYADHI VRUTTANTA
8
 Patient is not a k/c/o Diabetes Mellitus,
Hypertension, Tuberculosis, Rheumatoid
Arthritis.

9. TREATMENT HISTORY
9
On 22/6/15
 Amruthottharam kashayam
3tsp tonic + 9tsp water @7am-6pm
 Simhanada guggulu 2-2-2 A/F .
 Kottam chukkadi taila
Warm & apply to joints daily
 T . Amla parimala 1-1-1 A/F

10. 10
ON 29/6/15
 Tab .kaishora guggulu
 Kokilaksha kashayam
2tab powdered + 3tsp of tonic+9 tsp of water @
7Am & 6pm.
 pinda taila warm and apply to legs twice daily.

11. KAUTAMBIKA VRUTTANTA
11
 Father and mother are suffering from Diabetes
mellitus.
 Father-in-law also had fever along with her & got
subsided after taking medications .
 Patient is married and has one son aged 10 years.

12. VYAKTIKA VRUTTANTA
12
 Diet : Mixed (non- veg once in a week)
 Appetite : good.
 Bowel : once in a day , regular , complete evacuation.
 Bladder : 4 to 5 times/day night.
 Sleep : sound .
 Habit : Tea – 5 to 6 per/day.

13. MENSTRUAL HISTORY
13
 Menarche at age of 13 yrs
 Cycles 3-4/28-30 days regular.

14. GENERAL PHYSICAL EXAMINATION
14
 General Condition : Fair.
 Temperature : a febrile
 Built : Moderately built.
 Nourishment : Moderately Nourished.
 Pallor : Absent.
 Edema : absent
 Nails : No clubbing
 Cyanosis : Absent.
 Icterus : Absent.
 Lymphadenopathy : Absent.
 Pulse :74 bpm.

15. 15
 BP :120/80 mmHg.
 R/R :18/minute.
 Tongue :un coated.
 Height : 1.46 m
 Weight : 64 Kgs
 BMI :

16. PER ABDOMEN EXAMINATION
16
INSPECTION
 Shape – Scaphoid
 Umbilicus inverted
 No visible peristalsis, No scars.
 No redness
PALPATION
 Soft, no organomegaly.
 Tenderness at right and left lumbar region

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PERCUSSION
 Tympanic sounds heard except the area of Liver
dullness.
AUSCULTATION
o Bowel sounds heard.

18. RESPIRATORY SYSTEM
18
INSPECTION
 Shape of chest - Bilaterally symmetrical
PALPATION
 Trachea - Centrally placed
 Tactile Vocal Fremitus -Normal
PERCUSSION
 Resonant sounds heard except the cardiac dullness.
AUSCULTATION
 Normal Vesicular Breath Sounds heard

19. CARDIO VASCULAR SYSTEM
19
INSPECTION - No scar, No swelling .
PALPATION - Non tender, Apex Beat felt at 5th
intercostal space 9 cm from the mid sternal line.
PERCUSSION - Defined Area of cardiac dullness.
AUSCULTATION - S1 and S2 heard.
No added sounds heard.
No murmurs heard.

20. LOCOMOTOR SYSTEM EXAMINATION
20
Joints Tenderness Warmth Swelling Measurments Range of movements.
Ankle
joints &
foot
Rt- +++
Lt- +++
Rt-
present
Lt-
present
Rt- present
Lt- present
Rt – 11.8 inch
Lt – 9.4 inch
Flexion-Rt- painful, Lt-
painful
Extension-Rt- painful, Lt-
painful
Inversion – Rt- painful, Lt-
painful
Eversion- both normal
Knee
joints
Rt- ++
Lt- ++
Rt-
present
Lt-
present
Rt- present
Lt- present
Rt – 14.8 inch
Lt – 14.1 inch
Flexion- both normal
Extension-both normal
Internal rotation- both
painful
External rotation- both
painful

21. 21
Joints Tenderness Warmth Swelling Range of movements
Hip joints Rt- ++
Lt- ++
Rt-
present
Lt-
present
Rt- present
Lt- present
Flexion- both painful
Extension- both painful
Abduction-both painful,
Adduction- both Normal
Int.Rotation- both painful
Ext Rotation- both normal
Thumbs Rt- ++
Lt- ++
Rt-
present
Lt-
present
Rt- present
Lt- present
Flexion- both painful
Extension-both normal
Abduction- both normal
Adduction- both normal
Opposition- Rt-normal, Lt- painful

22. 22
Joints Tenderness Warmth Swelling Measurments Range of movements
Wrist joints Rt- +++
Lt- +++
Rt-
present
Lt-
present
Rt-
Present
Lt- Absent
Rt – 7.5 inch
Lt – 6.9 inch
Flexion- painful
Extension-painful
Adduction-painful
Abduction- painful
Hand grip – Normal
Elbow
joints
Rt- ++
Lt- ++
Rt-
present
Lt-
present
Rt-
Present
Lt- Absent
Rt – 10 inch
Lt – 9.5 inch
Flexion- painful
Extension-normal
Supination- normal
Pronation- normal

23. 23
B/L
Joints
Tenderness Warmth Swelling Measurements Range of movements
Shoulder
joints
Rt- ++
Lt- ++
Present
on both
Rt - Present
Lt – Absent
Rt – 14 inch
Lt – 12.8 inch
Flexion- Rt- upto 90
degree, Lt- upto 50 degree,
painful
Extension- both upto 20
degree, painful
Int Rotation- both painful.
Ext Rotation- not possible
in both.
Neck /
cervical
joint
- Present Absent Flexion- normal
Extension- painful
Rotation- Painful
Lateral Bending- painful

24. SUMMARY OF LMS EXAMINATION
24
 Pain in all the joints
 Tenderness & warmth in all the joints.

25. DASHAVIDHA PARIKSHA
25
1) प्रकृ ति: –: Vata Pittaja.
2) सारतः –: Madhyama.
3) संहनि –: Madhyama.
4) प्रमाणतः –: Height -
- : Weight - kgs.
5) सात्म्यि –: Madhyama.

26. 26
6) सत्मवि –: Madhyama
7) आहर शक्ति -: अभ्यवहरण शक्ति – Avara
-: जरण शक्ति – Avara
8) व्यायाम शक्ति –: Avara
9) वयः –: Madhyama
10) ववकृ ति –: Pravara

27. Nidana panchaka
27
NIDANA :
SAMPRAPTI GHATAKA:
Dosha :
Dushya : Rasa,Mamsa, Snayu, Asthi.
Srotas : Rasavaha, mamsavaha, astivaha
Sroto dusti :
Agni : Jatharagni, Dhatvagni
Ama :Jatharagni & Dhatwagni mandhya janya ama
Udbhava sthana : Amashaya.
Sanchara sthana :
Vyakta sthana : Sandhi.
Roga marga : Madhyama

28. 28
Vyadhi Svabhava : Chirakari.
Sadhya asadhyata : Krichra sadhya.

29. 29
 Nidana sevana Agnimandya + Vata Dusti
Ama utpatti
Pravruddha ama propelled by vitiated vayu
 Undergoes Vidhagdha and Results in Tridosha
Prakopa and Enters Dhamani

30. Lodges in sandhi, amashaya causing srotoavarodha
Produces symptoms like Angamarda, gourava, dourbalya,
jwara, shotha, shoola, stabdhata
Amavata
30

31. 31
POORVAROOPA -
ROOPA
 Pain
 Sotha in sandhi .
 Pricking type of pain in joints .
 Aruchi, agnimandya, gaurava, anaha,
 Stabdhata in sandhis.
 Jwara.
UPASAYA :
 ANUPSAYA: .

32. 32

33. PROPOSED INVESTIGATION
33
 Blood – CBC
Platelet count
ESR
RA factor
CRP
SERUM CREATININE
URIC ACID
 Urine - routine

34. 34