This document discusses the Ayurvedic approach to managing epilepsy (Apasmara). It begins with an overview of epilepsy and its features in Ayurveda. Treatment involves assessing causative factors and dosha involvement to determine a clinical approach. Management includes vega kalina treatment during seizures and vegantara kalina treatment between seizures, with a focus on removing triggers, snehana, basti/virechana/vamana, and shamana medicines tailored to the dosha imbalance. The goal is to pacify the doshas, clear channels, and normalize brain function without reliance on long-term medications.
astasthana pareeksha-
1.Nadi -The pulse
2.Mootram – The urine
3.Malam --The faeces
4.Jihwa – The tongue
5.Sabda – The voice
6.Sparsa – Examination by palpation
7.Drik -- The eyes
8.Akriti – Dimentions of the body
astasthana pareeksha-
1.Nadi -The pulse
2.Mootram – The urine
3.Malam --The faeces
4.Jihwa – The tongue
5.Sabda – The voice
6.Sparsa – Examination by palpation
7.Drik -- The eyes
8.Akriti – Dimentions of the body
Gridhrasi is defined as Stambha (stiffness), Ruk (pain), Toda (pricking pain) in a radiating manner along with Spandana (tingling sensation) starting from Kati Pradesha (low back) to Prushtha (back), Janu (knee joints), Jangha (calf muscles) and Pada (dorso lateral aspect of feet) of either one side of the lower limb or may involve both lower limbs. This condition makes raising of the affected leg difficult.
Swasa Roga is a typical respiratory problem mentioned in classical Ayurveda texts. This presentation has tried to include classical as well as modern perspectives of respiratory problems that has difficulty in breathing/dyspnoea as the major symptom.
Gridhrasi is defined as Stambha (stiffness), Ruk (pain), Toda (pricking pain) in a radiating manner along with Spandana (tingling sensation) starting from Kati Pradesha (low back) to Prushtha (back), Janu (knee joints), Jangha (calf muscles) and Pada (dorso lateral aspect of feet) of either one side of the lower limb or may involve both lower limbs. This condition makes raising of the affected leg difficult.
Swasa Roga is a typical respiratory problem mentioned in classical Ayurveda texts. This presentation has tried to include classical as well as modern perspectives of respiratory problems that has difficulty in breathing/dyspnoea as the major symptom.
Application of Satvavajaya (Psychotherapy) techniques in Madatyaya (Alcoholis...Dr. Prabhakar Manu
Madatyaya is a disorder due to excess of alcoholism results because of its continuous consumption without having any limitation to its quantity.Madakari Dravya is that by the intake of which produces disturbance of the intellect faculty by its virtue of Tamoguņa like Madya, Sura etc.Intake of excessive alcohol which is Tikshņa, Ushņa, Amla and Vidahi in guna makes the Annarasa Utkleda and will be digested improperly which ultimately turns Kshara and causes Antardaha (burning sensation in the interior of the body), Jvara (fever), Trishņa (morbid thirst), Pramoha (loss of orientation), Vibhrama (completely deranged mental faculty) and Mada (intoxication).The Dosha incited by alcohol causes obstruction to the movement of Vayu in the Srotas (channels of circulation) because of which the patient suffers from excruciating pain in the head, bones and joints. The best approach to achieve the goal of Satvavajaya chikitsa is to restrain mind from desire for unwholesome objects, is through Jnana (knowledge of self), Vijnana (professional analytical knowledge), Dhairya (confidence), Smriti (scriptural wisdom) and Samadhi (concentration) according to Charaka .
JOINT DISEASE
A combination of pain and stiffness , leading to loss of function, is a classic feature of joint disease.Usually one component will predominates as stiffness in inflammation, and pain in mechanical joint problem.Therefore specific questions will establish whether symptoms are mechanical (e.g. degenerative joint disease & mechanical tear) or inflammatory(e.g. rheumatoid arthritis or gout).
POST COVID MANAGEMENT –an ayurvedic approach by Dr soumya Patil.pptxDr Soumya Patil
POST COVID MANAGEMENT AN AYURVEDIC APPROACH
A COMPREHENSIVE INITIATIVE TO UNDERSYTAND THE PATHOLOGY OF COVID AND TRY TO BREAK ITS PATJHOLOGY THROUGH AYURVED AAND GOIVE SYMPTOMATIC RELIEF AS WELL AS HELP PPL IN REGAINING THE IMMUNITY AND STOPPING THE RECURRENCE OF COVID .
AIMS AND OBJECTIVES:
To Understand The Post COVID Symptoms And Their Management Through Ayurvedic Treatment Modalities.
INTRODUCTION:
COVID- 19, the recent virus outbreak declared as Pandemic by WHO threatened the world by its fast spreading nature and is yet creating an alarmed situation throughout the world by Post Covid Symptoms
A recent study on Post-COVID manifestation of symptoms showed that about 72 percent of participants had major complaints, only 10.8 percent of survivors assessed in the study had no symptoms or manifestations post COVID.
Depending on the Immunity of a person, COVID-19 can differ in its impact on different people.
Similarly, Post-COVID conditions, which has become a grave issue in recent times, have also taken a major toll on people's lives.
Post covid manifestations can be understood as Agnimandya avasta and Dhatukshaya avastha in individual .
Hence modalities like Agnivardhaka and Rasayana property medication can be choosen .
Rasayana therapy is the one which brings the normalcy in Immune system by improving fundamentals like dhatu, agni, srotas. And ultimately fights against Post Covid Symptoms.
DEFINATION OF POST COVID
A/C to NICE :
"Signs and symptoms that develop during or after an infection consistent with COVID‑19, continue for more than 12 weeks and are not explained by an alternative diagnosis. It usually presents with clusters of symptoms, often overlapping, which can fluctuate and change over time.
CONCLUSION:
Much about the aftermath of the illness remains unclear or unknown, and there is even uncertainty about the term "recover" in the coronavirus context
According to Ayurveda concepts, there will be Dhatu-Kshaya & AgnimandyaAvastha Post COVID infection.
Hence, Dhatuposhana and Rasayana sevana drugs for at-least 45 days and to combat the residual effects of the virus on the body and to combat toxicity produced from antiviral drug therapy.
Deepana Pachana drugs may be used in case of abdominal discomfort .
Depending upon individuals Agni status and availability of medicine following drugs may be prescribed.
Ayurveda has enormous potential and treatment options which are available for enhancing the immunity and systemic illness and positively influence mental health , thus helpful in combating Post covid symptoms .
Hence Ayurveda should be used as main treatment modality for Heath restoration and Prevention of recurrence, rather than a adjuvant therapy in treating post COVID symptoms .
A comparative clinical study to evaluate the efeect of Drakshaadi avleha and ...DrBakhtyar Asharafi
This is my pre thesis Seminar of my post graduation thesis.
I had used Two of the ayurvedic preparation in asthma and got really good results over both subjective as well as objective criteria.
This will help you to make your pre thesis seminar and also provide you the some information of asthma with both modern and ayurvedic prospective.
Concepts of Rasayan and Deerghayushkara rasayana drug by Dr. RASHMI SRIVASTAVA MD. Ph.D. READER, DEPT. OF DRAVYAGUNA RGGPG AYURVEDIC COLLEGE, PAPROLA, H.P.
MANAGEMENT OF GUILLAIN BARRE SYNDROME THROUGH AYURVEDA-A CASE STUDY Dr Amritha Edayilliam
Guillain-Barré syndrome (GBS) is an acute, rapidly evolving are flexic motor paralysis with or without sensory disturbance. It occurs year around at arate of between 1 and 4 cases per 100,000 annually. Age is an important factor determining outcome, and prognosis.Direct correlation of GBS with Ayurvedic terminology is difficul. Here a case of 7 year old female child presented with sudden onset of loss of power in lower limb, unable to get up, walk and stand with a past history of fever brought to OPD of SKAMC&HRC Bangalore. She was provisionally diagnosed as a case of acute inflammatory demyelinating polyneuropathy (AIDP-type of GBS). As per Ayurvedic classics, this condition we have taken as Sarvangavata (Vata affecting the whole body) which precedes Jwara (H/O fever before onset of symptoms). Hence, the line of treatment we have adopted Jwara Chikitsa and Vatavyadhichikitsa which included Aamapachana as well as Brihmanachikitsa along with Shamanoushadhis. The outcome was very remarkable with the patient able to walk on her own.
A Randomised Controlled Trial to Evaluate the Efficacy of Sheravydha and Jalo...ijtsrd
The aim of the entire human is to attain happiness. To achieve this, a healthy state of physical, emotional, intellectual and spiritual plans is necessary. Ayurveda is the science of life has an aim of preservation of health of a healthy person and cures the diseases. It has eight branches, which comprises of kaya chikitsa, shalya tantra, shalakya tantra, bhutavidhya, kaumarabrithya, agada tantra, rasayana and vajikarana chikitsa. Dr. Santhosh S Pujari "A Randomised Controlled Trial to Evaluate the Efficacy of Sheravydha and Jaloukaacarana in Ardhavabhedaka with Special Reference to Migraine" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-7 | Issue-1 , February 2023, URL: https://www.ijtsrd.com/papers/ijtsrd52650.pdf Paper URL: https://www.ijtsrd.com/medicine/ayurvedic/52650/a-randomised-controlled-trial-to-evaluate-the-efficacy-of-sheravydha-and-jaloukaacarana-in-ardhavabhedaka-with-special-reference-to-migraine/dr-santhosh-s-pujari
A case study on Bibrachial amyotrophy, with special correlation to 'Bahusosham' (in Ayurveda) was treated for a period of 21 days . The treatment response was assessed and documented.
Concept of balya and brimhana (immunity and micronutrients) in ayurvedaKopila Adhikari
according to ayurveda many diseases arises due to lack of immunity powder. proper nutrition and herbal preparation helps to boost up energy and to relief malnutrition.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Ocular injury ppt Upendra pal optometrist upums saifai etawah
AYURVEDIC APPROACH TO CLINICAL MANAGEMENT OF EPILEPSY (APASMARA)-ICAUST 2016
1. 4th International Conference on
Ayurveda, Unani, Siddha & Traditional Medicine 2016
“Indigenous Knowledge for Health Challenges”
08th – 10th December 2016
organized by
Institute of Indigenous Medicine
University of Colombo
Rajagiriya, Sri Lanka
1
2. AYURVEDIC APPROACH TO CLINICAL
MANAGEMENT OF EPILEPSY
(APASMARA)
PRESENTOR: Dr PRABHAKAR MANU, PG SCHOLAR
GUIDED BY : Dr SUHAS KUMAR SHETTY & Dr SAVITHA H P
DEPARTMENT OF MANO VIJYAN EVAM MANASA ROGA
SDM COLLEGE OF AYURVEDA & HOSPITAL
HASSAN-573201,
KARNATAKA, INDIA 2
3. CONTENTS
INTRODUCTION TO EPILEPSY (APASMARA)
CAUSATIVE FACTORS
IMPORTANT FEATURES OF EPILEPSY (APASMARA)
CLINICAL APPROACH
VEGA KALINA APPROACH
VEGANTARA KALINA APPROACH
UNDERSTANDING THE SAMPRAPTI
DISCUSSION
CONCLUSION 3
4. OVERVIEW OF EPILEPSY (APASMARA)
Chronic neurological disorder characterized by
episodic unprovoked seizures
Causes: brain injury, stroke, brain tumour,
infections of the brain, and birth defects.
Approx. 50 million people worldwide have epilepsy
- WHO.
स्मृतेरपगमं प्राहुरपस्मारं भिषग्विदः|
तमःप्रिेशं बीित्सचेष्टं धीसत्त्िसम्प्लिात्|| Cha. Chi. 10/3 4
5. तमःप्रिेशं
Pre-ictal phase
बीित्सचेष्टं
Ictal phase
धीसत्त्िसम्प्लि
Post-ictal phase
Loss of consciousness
(entering into darkness)
Convulsions with
Teeth biting
Altered state of
consciousness
Aura,
Deviation of the eyes
Dribbling of
Frothy saliva
Drowsiness
Salivation and
Nasal discharge
Expiratory dyspnoea Confusion
Sensation of spasm Involuntary speech or
murmuring
Nausea
Congestion of heart Head retraction
To one side
Headache
Giddiness Constriction of the
fingers, unstable
movements of the limbs
Epilepsy ‘Apasmara’
6. MANAGEMENT THROUGH AYURVEDA ?????
• Consumption of AED
• Adverse effects
• Chances of relapse
• Shodhana and Shamana
treatment
• Decreased frequency of
attack
• Less chances of relapse
and less side effects
6
MODERN MEDICINE AYURVEDA
7. CAUSATIVE FACTORS
AHARA- DIET VIHARA- LIFESTYLE MANASIKA-
PSYCHOLOGICAL
Heavy for digestion(guru
ahara)
Suppression of thirst and
appetite (vega-
kshutvega dharana)
Persistent grief, passion
and anger, Mental
irritation(chinta)
Incompatible food
(viruddhahara)
Excess work
(ativyayama)
Timid personality
Alcohol (madya),
Nicotine
Unethical activities
(abhichara)
Insult of teachers and
elders (guru-
vriddhapachara)
Fish (matsya) Impaired Sleep wake
cycle
Intellectual blasphemy
Tiredness (shrama)
Prajnaparaadh
7
10. FEATURES VAATAJ PITTAJ KAPHAJ SANNIPATAJ
FROTH AND
COLORS
Vomiting froth
Yellowness of
the foam, limbs,
face and eyes
White colour of
the foam from
the mouth,
body, face and
eyes
Pain in the
heart, thirst and
nausea
AURA
Gets visual aura
of forms which are
rough, pink or
black in color
Aura of yellow
or blood- red
objects
Visualizes the
whole world as
if set in flames
Aura of white
objects
MIXED AURA
OTHER
FEATURES
Rigorous
breathing
Gnashing of teeth
Trembling
Morbid thirst
and heat
Horripilation
Feeling of
heaviness and
cold
Delirious talk
and the making
of indistinct and
moaning
sounds
10
15. TREATMENT -BEFORE SEIZURES - 1*
ON EXPERIENCING AURA, HALLUCINATIONS-
Get away from water, fire, height, sharp objects, climbing
trees, riding vehicles
Move towards flat large space area
Inform someone nearby if possible
15
16. DURING SEIZURES - 2*
Prevent injuries by placing the patient on flat surface
Head in lateral position to prevent obstruction in breathing
Placing mouth gag if possible so as to avoid tongue and
cheek bite
16
19. SNEHAPANA - HIGH INTAKE
Brahmi Ghrita-
Polyherbal formulation ( Bacopa monneri, Evolvulus
alsinoids, Acorus calamus, Saussurea lappa and Cow’s
ghee) – Motor Coordination, Behaviour, Sleep, Convulsions,
Locomotion and analgesia was evaluated in mice using
standard procedures and results showed that Brahmi
Ghrita protected mice from maximum electroshock and
pentylenetetrazole induced convulsion.
-Achliya GS, Wadodkar SG, Dorle AK. Evaluation of CNS activity of
Brahmi Ghrita. Indian J Pharmacol 2005;37:33-6.
http://dx.doi.org/10.4103/0253-7613.13853
19
20. SNEHAPANA – CONT….
Panchagavya Ghrita-
Panchagavya ghrita as Arohana Matra Sneha
followed by Virechana provided significant and
better relief in most of the symptoms of epilepsy.
Chitrangana CN et al/ Int. J. Res. Ayurveda Pharm. 5(6), Nov-Dec
2014
20
21. TANTU PASHAN
Sanskrit Name
Botanical
Name
Quantity
Maricha
Piper nigrum
berry
180 mg
Chavya
Piper chabab
stem
80 mg
Tantu Pashan
Bhasma*
Magnesium
Silicate
140 mg
Sudhakar Pemminati et al. / Journal of Pharmacy Research 2010,
3(5),1178-1180
On chronic administration, the test
drug significantly reduced the
duration of tonic hind limb
extension and also the clonus
phase in MES induced seizures.
But, in PTZ induced seizures,
neither it reduced the duration of
clonic convulsion nor protected the
animals from death. Results
indicates that Tantu Pashan has
protective effect against MES, but
not against PTZ induced seizures.
25. PRANAYAMA OR DEEP DIAPHRAGMATIC BREATHING
In this method, as a person slips into a seizure state and is
trained to reflexively catch and hold their breath as if
startled or frightened. This causes changes in metabolism,
blood flow, and oxygen levels in the blood.
The practice of pranayama, i.e., controlled deep
diaphragmatic breathing, helps restore normal respiration;
this can reduce the chances of going into a seizure or stop
the seizure before it becomes full blown.
25
26. DISCUSSION
o Modern antiepileptic drugs suppress the seizure, but do
not cure the disorder from root. The main drawbacks are
adverse effects , contraindications and sometimes lifetime
treatment.
o Ayurveda believes in balancing humours (dosha) to
remove the root causes of the disorders and normalize the
brain activity.
o In the context of apasmara, The main aim of treatment is to
pacify the doshas and to clear the occlusion of sanjna vaha
srothas.
26
27. DISCUSSION
Ketogenic diet (Ghrita) is a safe and effective
treatment for intractable epilepsies; it has been
recommended since 1921. The diet induces ketosis,
which may control seizures.
Ayurveda includes shamana, tikshna sanshodhan,
rasayan chikitsa, sattvavajaya chikitsa.
27
28. CONCLUSION
Apasmara is a neuropsychiatric disease & has
episodic manifestation.
Etiopathogenesis should be properly understood to
diagnose & manage the cases of apasmara.
Apasmara has sthayi & vega kalina samprapti.
Management of apasmara is divided into vega
kalina & vegantara kalina chikitsa.
28
29. Duration of the treatment should be planned
according to chronicity, severity etc. of the
disease & response to the treatment.
29