This document presents a case study of a 26-year-old male with multiple autoimmune disorders including spondyloarthropathy, plaque psoriasis, inflammatory bowel disease, and propriospinal myoclonus. He was treated with various allopathic medications with no success. He was then treated with Ayurvedic medications including Swarnavasant malati, Navaratna pishti, and Amar sundari vati along with a specialized diet. After 30 days of Ayurvedic treatment, his symptoms started improving and many modern medications were reduced or stopped. After 90 days, his symptoms had fully resolved and he was able to discontinue all modern medications except for Amarsundari v

1. Concept of Ama in light of Multiple
Autoimmune disorders
Vaidya Shrikrishna Sharma “Khandel”
Vaidya Madhaw Singh Baghel
Dr. Gunjan Garg
Dr. Manisha Talekar
1

2. Concept of Ama in light of Multiple
Autoimmune disorders
Vaidya Shrikrishna Sharma “Khandel”
MD Ay, PhD
Consultant Physician – Arogya Laxmi, Jaipur
Ex Professor – Rog Nidan
National Institute of Ayurveda, Jaipur
WHO fellow in Mental Health, Melbourne Australia
Sr. Editor- International edition of Charak Samhita Florida, USA
Visiting consultant – Naturafarm, Berlin, Germany
Email: drskhandel@gmail.com
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3. A case presentation-
Multiple autoimmune disorders
Vaidya Madhaw Singh Baghel
MD Ay, PhD
Consultant – Arogya Laxmi, Jaipur
Ex Professor – Kay Chikitsa – IPGT & RA, Jamnagar
Ex Director – IPGT & RA, Jamnagar
Ex I/C Vice Chancellor- Gujrat Ayurveda University, Jamnagar
Ex Chair Ayurveda – Deberson University - Hungary
Sr. Editor- International edition of Charak Samhita Florida, USA
Email: baghelayu@rediffmail.com
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4. A case presentation-
Multiple autoimmune disorders
Dr. Gunjan Garg
MD Ay, PhD
Consultant - Arogya Laxmi, Jaipur
Associate Professor- Swasthvritta
MJF Ayurveda College, Chomu, Jaipur
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5. A case presentation-
Multiple autoimmune disorders
Dr. Manisha Talekar
MD Ay, PhD – Rognidan
Research officer – cancer Unit
RRAP- CARIC, Worli, Mumbai
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11. 11

12. 12

13. Genesis of inflammatory disorders
• The inflammatory diseases also commence with Aamvisha at pre / early
pathological state.
• Additional secondary causes are required to trigger off the inflammatory
diseases, they are fairly mentioned in four long chapters. Like:
• Grahanidosha Caraka Chikitsa 15- for Aamvisha
• Trishotheeya - carak sutra 18 - for localized acute inflammations.
• Shotha - charak chikitsa 12- generalized chronic inflammations
• Trimarmeeya- charak chikitsa 26 -for advanced inflammations due to 3
most vital organs.
• Trimarmeeya – chraka siddhi 9 – for advanced inflammation at 107
more vital parts of the body 13

14. ‘Samprapti’ sequence of pathogenesis
• The word ‘Samprapti’ is an event by event sequence of any disease,
since an ignition of a pathogen from a producing cause up to the
Termination of pathology, either with / without disability, complication or in
a death.
• In regard to the inflammatory diseases the route chart is given very clear
in Ayurvedic texts, but it is scattered in many chapters listed above.
• This scattered knowledge need a compact picture to track the route of
disease.
• The concept of Samprapti is given by Caraka as fifth and concluding
aspect only for this purpose.
14

15. Sequence of inflammatory process - 1
• In this concerned subject the inflammations are begin with the few
predisposing causes like: incompatible food, suppression of natural
urges, erratic practices, and injudicious medications.
• These causes simultaneously deteriorate the physiological process in
many ways.
• At one end, where a normal digestive process transforming the food
into the bio matter, then in bio energy in three consecutive stages as:
• Phenabhoota Kapha: A pure subtle nutritive kapha
• Achha pitta: A pure enzyme as transformer of food
• Katubhava vata: efficient transporter of digested matter for general
circulation. 15

16. Sequence of inflammatory process - 2
• With effect of the above said causes, the digestion metabolisms
turn defective as:
• Nutritive Kapha turns into ‘Aama’ a sluggish, inert intermediate
product cause the loss of strength and vigor, loss of effortless
functioning.
• Transformer pitta turns in ‘Shukta’ a burning acidic product
• Transporting vata turns spreading force for ‘Aamvisha’ a potent
pathogen into general circulation and manifest as in next slide:
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17. A case of
Multiple autoimmune
disordersA young 26 year young male from
Ahmedabad came to our clinic
Arogya Laxmi center at Jaipur on
31 st May 2018, along with his
parents with multiple problems of
autoimmune disorders in nature
17

18. First
Diagnosing
date
His fever started in 2009 and
later blasting diorrhea was
continued and doctors
suspected Hodgkin’s
Lymphoma, Cancer, Enteric
fever, TB, HIV. Battery of
18

19. 19

20. Name xxxxxxxx
Age/Sex 26 years/Male
 Spondyloarthropathy
 Plaque Psoriasis
 Inflammatory bowel disease
 Abdominal pain and cramps
 Frequent diarrhea 17-18 times a day/night
 Early morning backache continued for 3-4 hours
 Knee joint effusion
 Myoclonic jerks horrible while trying to sleep for 3-4
hours
20

21. Name Xxxxxxxx Continued ….....2
Age/Sex 26 years/Male
Chief complaints
on the day when
he came to Our
Clinic
• Tender low back
 Tender sternoclavicular joints
 Generalized lymphadenopathy (inguinal,
mesenteric, posterior triangle of neck)
largest was 1.6 cm
 Blackouts for seconds while on bed trying
to sleep. 21

22. History
• It all initially started with a high grade
continuous fever for 20 days in 2009 which
was undiagnosed and all lab reports were
normal. Later on 2009 he was diagnosed
with Hepatitis A as a separate incident. In
2011 he also suffered with chicken pox.
22

23. Present history
• later on a sleep study was conducted
and it was found to be propriospinal
myoclonus (a kind of NREM
Parasomnia)
• Almost his every flare up was
associated with myoclonic jerks. As the
flare ups subsided the myoclonic jerks23

24. Present History contd….2
• Later, he had spells of syncope. Many a times he
used to get blackouts (Tamah pravesh) for seconds
while he was trying to sleep or resting. And he had
falls and syncope during micturition and at some
other occasions as well.
• The Cardiologist asked for Holter monitoring and Tilt
table test. His Holter testing report showed episodes
of sinus brady-tachycardia and marked sinus
arrhythmia with prolonged R-R interval in between
normal sinus rhythm suspecting of sick sinus 24

25. Present history – contd
…..3
• Gastroenterologist asked for a fecal
calprotectin test, whose report revealed 2250
IU which was raised more than 15 times the
normal range and it was said that it was Auto-
immune.
• After seeing fecal calprotectin test report, he
underwent a colonoscopy which showed
aphthous ulcer at terminal ileum and a biopsy 25

26. Present history –
contd…... 4• biopsy of a prominent lymph node in the triangle of
neck was done. The biopsy sample shows reactive
sinus histiocytosis and biopsy sample was run for
PCR for TB and it came out to be negative. During
the biopsy the surgeon iatrogenically cut his nerve
to Trapezius (Cervical spinal nerve-3), which led to
wasting of his right Trapezius, shoulder drooping
and later on he developed shoulder syndrom. for
which he has to go for nerve repair surgery
26

27. Tests Conducted
Tests
Condu
cted
CBC, LFT, RFT, ESR, CRP, Culture (Blood & Urine),
Widal, BM biopsy, Leukemia, Lymphoma panel, TB
gold test, Lymph node (LN) biopsy, LN biopsy
material for TB PCR, HLA B27 by RT-PCR method
which came out to be positive.
CECT abdomen, MRI (pelvis, knee, brain and spine),
Fecal calprotectin,
27

28. Diagnosis HLA B27 Spondyloarthropathy with Psoriasis & IBD, episodes of sinus
brady-tachycardia and marked sinus arrhythmia , propriospinal myoclonus (a
kind of NREM Parasomnia
Current
Developments
Knee joint effusion, abdominal pain diarrhea, myoclonic jerks,
tender low back and sterno-clavicular joint,
Treatment 1. Sodium valporate failed to respond
2. Methotraxte failed to respond
3. Infliximab- 5mg/kg every 2 month
4. Sulfasalazine- 4 gm/day
5. Budesonide-9mg/day
6. Clonezepam 3 to 4 mg
7. Etoricoxib 180 mg 28

29. 29

30. Ayurvedic
Treatment
given
Ayurvedic treatment started from June-2018 with allopath.
1. Swarnavasant malati for 20 days
2. Navaratna pishti for 20 days
3. Amar sundari vati- - continued
4. Shadanga paneeya (modified as Kalmegh + Vidang +Musta
+Parpatak + Amrita + Nagar 3 gms each ) 18 gms processed as
hima in 2.5 litres water for whole day (no plain water)
30

31. Pathya / Apathya 1. Whole moong 1 handful +fresh dadim seeds 1 handful, 1”
Ginger pc, Draksha 5 , almond 5, ½ tsf haridra, 2 tsf Goghrit, ½
tsf saindhav boiled in ½ ltr shadang paneeya in clay pot and
fried with ghee and cumin seed and hingu 1 pint
2. Dhanyak 25 gms +Ajwain 6 gms mildly fried in 15 ml Cow ghee,
added fine powdered sita 10 gms for morning break fast
3. Srikhand (Curd of go dugdha without water) with 3-4 leaves of
saffron and ½ tsf of nutmeg paste
4. 2-3 tsf freshly home made butter
5. Avoid milk and wheat and oils
31

32. Diet control & and
Recommendation by
allopaths
FODMAP (FODMAP is an acronym, derived from
"Fermentable Oligo-, Di-, Mono-saccharides And
Polyols" )diet.
Gluten and lactose free diet too. Continued
32

33. Results after 7 days
1.For initial 7 days following therapies and
medication used one by one but found of no
use
2.Nasya/ dhoopan/ abhyang/ swedan/ pottali/
anuvasana/ niruha/Found ineffective
3.Padabhyanga extremly intolerable and 33

34. Results after 15 days
1.Rambana rasa/ sanjivani all were ineffective
2.Kutaj was highly reactive and diarrhea increased
drastically
3.Above therapies and medicines withdrawn just
after one time 34

35. Results after 30 days
of ayurvedic medication
• After his treatment with above Ayurvedic, Allopathic medicines
and this diet chart
• After 1 month his stool started forming and frequency
started reducing
• By the end of July he had marked improvement both in
character of stool, abdominal pain and diarrhea.
• His myoclonic jerks came down, just with addition of
Etoricoxib 90 mg & chlonezepam 4mg in a period of 2
weeks. 35

36. Results after 45 days
• Without any modern medicine
support since last 15 days, Except
reduced dose of Choloronezepam 4
mg a day to 0.5 mg a day
• Stool become formed and 2-3 times a
day
• His myoclonic jerks came down to nil36

37. Results after 45 days
contd…...2
 Low back tenderness relived
 Joint tenderness are reduced to nil by end of
June (in 30 days of Tt.)
 Without use of Infliximab since last 4 months
or any high dose steroid. 37

38. Results after 45 days
contd…3• No any palpable lymphnode (inguinal, mesenteric,
posterior triangle of neck) even the largest which
was 1.6 cm
• 8-9 hours good sleep
 Early morning backache relieved
 No effusion in Knee joint
38

39. Results after 45 days contd…...4
• No abdominal pains and cramps
• No palpitations
• Appetite is good
• Body weight increased by 3 kg
• First time, felt himself energetic after long spell of 9
years
39

40. Results After 90 days
• Patient able to perform his 10-12 hrs hard duties
• Along with 2 hours workout like swimming and badminton
• Sleep is good without any medical support
• Digestion/ appetite and bowel movements are good
• No any pain, stiffness, effusion and feel energetic
• Without any supportive medicine since last 30 days
• Infliximab 5mg/ kg body weight not given since 5 months
• The last supportive medicine Chlorenezepam 0.5 mg has also
been withdrawn since 20 days
• Shadang panneya Hima is only being used as water
• Amarsundari vati 2 bd is continued 40

41. Reduction / Withdrawn in modern medical drugs
• Sulphasalazine (4gm/day) - have been removed
• Budesonide (9mg perday)- has been removed
• Prednisolone not required since ayurvedic treatment is
taken
• Etoricoxibe - have been withdrawn
• Medicine for Crohn’s is not required
• Clonozepam reduced 0.5 mg form 4 mg
• Inflixicab being taken (5mg/Kg body weight) IV every two
month has not been taken since last 4 months
41