vata rakta case.pptx gouty arthritis case

PRESENTING BY-
DR.VARSHINI.HR
1ST YEAR PG
DEPT.OF KAYACHIKITSA
SAMC&H
BANGALORE
CASE PRESENTATION

TABLE OF CONTENTS
Prelimnary data
History
Examination
Investigations
Diagnosis
Treatment
23/06/2023
Case presentation-Dr.Varshini
2

PRELIMNARY DATA
Source of history-Patient OP NO-23022867
Name-XYZ IP NO- IP2301117
Age-54 years Bed no-79
Gender-Male Ward-Atreya
Qualification-6th std DOA-24/5/2023
Occupation-Farmer DOD-7/6/2023
Religion-Hindu
Socio-economic status-lower middle class
Marrital status-Married
Address-Bommanahalli,Bangalore
23/06/2023
3

PRADHANA VEDANA
Pain in lateral aspect of bilateral lower limbs from
thighs to legs since 2 ½ years aggravated since 1
year.
23/06/2023
4

ANUBANDHA VEDANA
C/O Low back pain since 3 years .
C/O Pain in Right shoulder on and off increases
while lifting heavy weight since 2 years.
23/06/2023
5

VEDANA VRUTTANTA
o Male patient aged 54 years N/K/C/O HTN/DM was
apparentely normal before 25 years.
o In 1998 ,while working in the farm he had fallen down
from the tree, had mild to moderate pain with no
external injuries in the lower back,taken treament at
local hospital and got relieved.
23/06/2023
6

o But was having on and off lower back pain while
working in the farm, as the pain was mild and not
disturbing his work didn’t paid much attention to
that.
o From past 2 ½ years from 2020 he gradually started
to experience right lower limb pain from lateral aspect
of thigh to leg.
23/06/2023
7

o After 2 months of onset of right leg pain he started to
feel numbness in the same leg while walking.
o Within the duration of 1 month, he started to feel left
lower limb pain from calf to ankle and also
numbness to the extent that he was not aware of his
foot wear also.
23/06/2023
8

o Pain increases on walking ,could not walk for more
than 0.25 km, after taking rest for sometime and
then can walk again.
o He also complains of right shoulder pain from past 2
years which increases on working and relives after
taking some rest.
23/06/2023
9

o In 2022 in the month of November he had consulted
local hospital for the same and undergone
physiotherapy found relief to some extent but was
having on and off pain.
o With this increase in pain he visited SAMC&H and
got admitted for further management.
23/06/2023
10

POORVA VYADHI VRUTTANTA
H/O Snake bite in 2021.
23/06/2023
11

POORVA VYADHI CHIKITSA VRUTTANTA
Treated with Antivenom for snake bite in 2022
Undergone physiotherapy for lower limb pain at
local hospital.
23/06/2023
12

 KOUTUMBIKA VRUTTANTA: Nothing relevant.
 VYAVASAYIKA VRUTTANTA: Farmer by occupation from
past 30 years.
 SAMAJIKA-ARTHIKA VRUTTANTA: Nothing relevant.
MATERNAL PATERNAL
Diabetes - -
Hypertension - -
Vata rakta - -
23/06/2023
13

PERSONAL HISTORY
 Ahara-Mixed type,Samashana,sama pramana
Rasa-lavana-katu pradhana.
 Vihara-
• Nidra- usually sound/regular-8 hrs
• Vyayama-only routine work
nature of work-Heavy
• Abhyasa-Alcohol-occasionally-once in 15 days-from
20 years
Smoking (stopped 20 years back)
Tobacco chewing weekly once.
23/06/2023
14

 Vyasana-Tea 4-5 /D
 Mala pravrutti-regular-1-2times/day
 Mutra pravrutti-4-5times/day and 1/night
23/06/2023
15

SAMANYA PAREEKSHA
 Built-Moderately built
 Nourishment-Moderate
 Ht:Wt-137cm:65kg
 Pallor-Absent
 Icterus-Absent
 Clubbing-Absent
 Cyanosis-Absent
 Lymphadenopathy-Absent
 Edema-Absent
23/06/2023
16

VITALS
 Temperature-98 degree F
 Pulse rate-78 bpm
 Respiratory rate-22 per min
 Blood pressure-130/80 mmhg
 BMI-23.7
23/06/2023
17

ASHTA STHANA PAREEKSHA
नाडि वात डित्तानुबन्ध
मल प्राक
ृ त
मूत्र प्राक
ृ त
डिह्व आडलप्त
शब्द प्राक
ृ त
द्रुक
् प्रथम िटलगत डतडमर
स्पशश अनुष्ण शीत
आक्र
ु डत मध्यम
23/06/2023
18

DASHA VIDHA PAREEKSHA
प्रक्र
ु डत वात-डित्ति
डवक्र
ु डत वात-डित्त
सार मध्यम
संहनन सुसंडहत शरीर
प्रमाण मध्यम
सात्म्य कटु रस प्रधान
सत्व मध्यम
आहर शक्ति
व्यायाम शक्ति िूवश कालीन-मध्यम
अध्यतन कालीन-अवर
वय मध्यम
अभ्यावहर शक्ति मध्यम
िरण शक्ति मध्यम
अभ्यावहर शक्ति मध्यम
िरण शक्ति अवर
िूवश कालीन
अध्यतन कालीन-
23/06/2023
19

SYSTEMIC EXAMINATION
• CNS- Patient is oriented to self, time and place
Higher mental functions: Intact
Sensory perception: Intact
Motor functioning: Intact
Cranial Nerves: NAD
• CVS-S1,S2 heard,no murmurs
23/06/2023
20

RS- : Inspection : Shape of chest – bilaterally symmetrical
Palpation : Trachea – centrally placed
Auscultation : RR : 22 cycles/min
Normal Vesicular Breath Sounds Heard b/l
No Added Sounds.
23/06/2023
21

• P/A: Inspection : no scar marks, umbilicus inverted
and central.
Palpation : Soft, no tenderness, no
organomegaly.
Auscultation: Bowel sounds heard.
23/06/2023
22

LOCAL EXAMINATION
 Check for individual pulses-
Femoral artery + +
Popliteal artery absent diminished
Posterior Tibial artery absent diminished
Dorsalis pedis artery absent diminished
ARTERIES RIGHT LEG LEFT LEG
23/06/2023
23

23/06/2023
24
Skin-Pallor, ulcers- absent
smooth and shiny
skin(+)
 Claudication distance-0.25km

NIDHANA PANCHAKA
डनदान :
o Ahara: Ati katu amla lavana ahara sevana-mamsahara,
ruksha bhojana-chapathis
madya sevana-occasionally-once in 15 days-from
20 years
Dhumapana- Smoking (stopped 20 years back)
o Vihara: Diwaswapna, Ratri jagarana, akala bhojana.
o Manasika: Ati chinta, shoka, krodha.
23/06/2023
25

िूवशरूि :
 Swedo atyartha-excess perspiration.
 kshate atiruk-excessive pain if there is any injury.
 Gurutva and supti in jaanu,uru,pada, pindikodgama.
रूि:
 Sandhi stabdhata,manda ruja in sandhi.
 Ruksha kathina twak.
 Supta.
23/06/2023
26

उिशय:
Vishrama
अनुिशय:
o Excessive physical strain.
o Stressful situations.
o Alcohol and smoking
23/06/2023
27

SAMPRAPTI
Vata kara
nidhana
sevana
Rakta
dushtikara
nidhana
sevana
Vata prakopa Rakta dushti
Obstruct marga of vata
Vata gets aggravated
severely
23/06/2023
28

Further vitiates rakta
Similarly pitta and kapha is
also vitiated
Combined with dushta rakta
Vata rakta
23/06/2023
29

SAMPRAPTHI GHATAKA
दोष वात प्रधान डत्रदोषि
दू ष्य धातु-रस,रि,मांस
उिधातु-डसर,कण्डरा,सक्तन्ध,स्नायु,त्वक
्
अडि िाठराडििन्य
अडि दुडि मन्दाडि
आम मन्दाडििन्य
स्रोतस् वातवह,रसवह,रिवह
स्रोतो दुडि संघ
अडधष्ठान िानु,िंघ,उरु,कडट,धमडन,हस्त-िदांग सक्तन्ध
उद्भव स्थान िक्वाशयोत्त,आमशयोत्त
व्यक्थ स्थान िानु,िंघ,उरु,कडट,धमडन,हस्त-िदांग सक्तन्ध
संचार स्थान रसवह,रिवाडहन्य
स्वभाव आशुकरर
रोग मागश मध्यम
साध्यसाध्यत याप्य 23/06/2023
30

INVESTIGATIONS
NOTHING AVAILABLE
23/06/2023
31

DIFFERENTIAL DIAGNOSIS
DISEASE INCLUSION CRITERIA EXCLUSION CRITERIA
Deep vein
thrombosis
Affecting the blood vessels
of lower extremities, leg
pain,numbness
Occlusion of veins by
atherosclerotic plaques,no
symptoms of paresis,
Chronic
compartment
syndrome
Pain,
numbness,pulselessness,
Skin discoloration
Affecting group of
muscles,nerves,blood
vessels covered by fascia
Reynaud’s disease Constriction of blood
vessels causing Pallor,pain
numbness,
Involves
fingers,toes,ears,nose tip
23/06/2023
32

DISEASE INCLUSION CRITERIA EXCLUSION
CRITERIA
Takayasu’s
Arteritis
Weak or absent pulse,
Claudication in limbs
Fever,muscle pains,weight
loss,hypertension.
Thromboangiitis
obliterans
Limb
ischemia,pulselessness,h/o
smoking and tobacco
chewing
Non atherosclerotic
Inflammatory
vasculopathy affecting
both arteries and
veins,triad of claudication
of affected extremity
absent.
Acute arterial
occlusion/PAD
Limb
ischemia,numbness,pulseles
snes,progressive pain in
lower limbs.
23/06/2023
33

VYAVACHEDAKA NIDANA
DISEASE INCLUSION CRITERIA EXCLUSION
CRITERIA
AMAVATA Sandhi stabdhata,alasya,
Gaurava,
shotha,daha,ama
pradhanya,jwara
SIRA GATA VATA Manda ruk, sopha Sira shoonya,supti
SNAYU GATA VATA Manda ruk,suptata, Khalli,bahya abhyantara
ayama
23/06/2023
34
VATA RAKTA Suptata,manda ruk
sandhi stabdhata

VYADHI VINISHCHAYA
o Uttana Vata rakta.
o Peripheral arterial disease.
23/06/2023
35

TREATMENT GOALS
Short term goals:
o To minimise pain
o To make patient comfortable.
Long term goals:
o To attempt to manage the disease or condition.
o To improve quality of living.
23/06/2023
36

CHIKITSA
Treatment given-
Maha manjishtadi kashaya-15 ml BD with warm
water after food.
Kaishora guggulu: 1-0-1 with warm water after
food.
Dashamoola kashaya dhara to adho shaka for 7 days.
Kati abhyanga with Ksheera bala taila and nadi
sweda for 7 days.
23/06/2023
37

DATE TREATMENT OBSERVATION
24/5/23 1. Tab Kaishora guggulu 1-0-1 ( A/F) with
warm water.
2. Maha manjishtadi kashaya
3tsp-0-3tsp( A/F )with warm water
3. Abhyanga with Ksheera bala taila f/b
Dashamoola kashaya dhara to B/L lower limb.
Pain in lateral aspect of
bilateral lower limbs from
thighs to legs.
warm water.
3tsp-0-3tsp( A/F )with warm water.
Dashamoola kashaya dhara to B/L lower limb.
All lakshanas persists.
23/06/2023
38

26/05/23 to
28/05/23
1. Tab Kaishora guggulu 1-0-1 ( A/F) with
warm water.
Dashamoola kashaya dhara to B/L lower
limb.
Reduction in LL pain, patient
feels better.
warm water.
Dashamoola kashaya dhara to B/L lower
limb.
Reduction in LL pain,increase
in claudication distance.
23/06/2023
39

31/05/23 Continue 1 and 2
3.stopped
4.Kati abhyanga with ksheera bala taila
and nadi sweda
Lower limb pain reduced
low back pain persists.
1/06/23 Continue 1 and 2
4.Kati abhyanga with ksheera bala taila
and nadi sweda
Low back pain persists.
2/06/23 to
7/06/23
Continue 1,2 and 4 Considerable reduction in
low back pain.
23/06/2023
40

ADVICE ON DISCHARGE
Long term therapy-
Kaishoora guggulu –
1-0-1 –after food with warm water.
 Maha manjishtadi kashaya-
3tsp-0-3tsp-with warm water after food.
(Duration-2 month)
23/06/2023
41

PATHYA APATHYA
Ahara: Yava, Godhuma,shashtika
shali, mudga, adaki, chanaka,
ksheera, ghrita, jangala mamsa rasa,
amalaka, guduchi, shatavari,
mitahara, pranayama,yoga.
Vihara :
Abhyanga,parisheka,proper nidra
Ahara:Amla, katu,lavana ahara,
ruksha bhojana, adhyashana,akala
bhojana, ushna ahara, guru bhojana,
kshara, dadhi, madhya, mulaka.
Vihara: Ratrijagarana,
diwaswapna, ati vyayama, ati chinta,
shoka, krodha, manodwega,
dhoomapana
23/06/2023
42

CONCLUSION
Kaishora guggulu-(Sharangadhara samhita M.K-7/70-81).
• Indicated in vatarakta and kushta along with manjishtadi
kashaya.
• Acts as rakta shodhaka,shoola and shotha hara
• Balances Vata and pitta.
Maha manjishtadi kashaya-(Sharangadhara samhita M.K-
2/137-142)
 Indicated in kushta ,vata rakta, supta, pakshaghata,
medodosha…
 Acts as rakta shodhaka and prasadaka.
23/06/2023
43

Dashmoola kashaya dhara-
 Tridosha hara , reduces shoola and shota.
 Stimulates metabolism,vasodilation and corrects
sweda vaha sroto dushti.
23/06/2023
44

23/06/2023
45

23/06/2023
47

23/06/2023
59

23/06/2023
60

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