Abstract of Re-Orientation Course for Ayurvedic Doctors

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Department of Roga Nidana, Govt. Ayurveda College Kannur, Pariyaram Faculty Dr. R. Sreekumar MD (Ay) H.O.D & Reader in charge of Professor Dr. S. Gopakumar MD (Ay) Tutor P .G . Scholars Dr. K.S. Nandalal Dr. K.N. Ajithkumar Dr. Prabha. M. Kawna Dr. Sunil Babu P.P Dr. Madhu P.M Dr. S. Gopikrishna Dr. Mukesh E Dr. Viswanath K Dr. Preetham Pai Dr. Shobha Bhat

Transcript of Abstract of Re-Orientation Course for Ayurvedic Doctors

Page 1: Abstract of Re-Orientation Course for Ayurvedic Doctors

Department of Roga Nidana,Govt. Ayurveda CollegeKannur, Pariyaram

FacultyDr. R. Sreekumar MD (Ay)H.O.D & Reader in charge of Professor

Dr. S. Gopakumar MD (Ay)Tutor

P.G. ScholarsDr. K.S. NandalalDr. K.N. AjithkumarDr. Prabha. M. KawnaDr. Sunil Babu P.PDr. Madhu P.MDr. S. GopikrishnaDr. Mukesh EDr. Viswanath KDr. Preetham PaiDr. Shobha Bhat

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CONTENTS

1. CLINICAL RELAVANCE OF DASAVIDHA PAREEKSHA

DR. R. SREEKUMAR

2. HYPERTENSION

DR. BALAKRISHNAN VALLIOT

3. RADIOLOGICAL FINDINGS IN ARTHRITIS

DR. MAHESH

4. ELECTRO CARDIOGRAM (ECG)

DR. AJITH KUMAR M.K

5. CLINICAL RELEVANCE OF AGNI

DR. K. MURALI

6. NON - TRAUMATIC DISEASES OF THE SHOULDER JOINT

DR. NARESH

7. SAMPRAPTHI Vs SAMPRAPTHI VIKHATANA

DR. GOPAKUMAR .S

8. CEREBRAL PALSY

DR. T.K.UMA

9. SPINAL DISORDERS

DR. K.B.SUDHIKUMAR

10. ENTAMOLOGY - ENVIRONMENT AND DISEASE

DR. VENUGOPALAN. A.K

11. KAAMALA - DIAGNOSTIC APPROACH

DR. R. SREEKUMAR

12. OCULAR MANIFESTATIONS IN SYSTEMIC DISEASES

DR. SREEJA SUKESAN

13. DYSFUNCTIONAL UTERINE BLEEDING

DR. RASIYA MONY

14. CONCEPT OF AVARANA

DR. MANOJ KUMAR A K

15. FUNDAMENTALS OF ONCOLGY

DR. V N BHATTATHIRI

16. STROKE - DIAGNOSIS

DR. SUDEEP

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Desam - Bhoomi & Athura desha:Here bhoomi pareeksha is about the land in which the patient lived.Athura desha pareeksha is the DASHA VIDHA ATHURA PAREEKSHA.Kalam - Samvathsara & Athuravastha:In samvathsara the 6 ritus are considered.In aturavastha ama-niramavastha, nava-puranavastha etc are considered.Pravruthi - Karma samarambha:Is the proper functioning of bhishak,aushada,atura & paricharaka.Upayam - Pada sampath:Bhishak,dravya,atura & paricharaka having all their required qualities forms theupayam.

DASAVIDHA PAREEKSHASPrakruthi:

Some ualities which help to assess the various prakrutis are:KAPHA: Snigdhanga, Sukumara avadata gaatra, Sthira shareera, Manda chesta, Sheegravikara, Prasanna darshana, Balavantha, VidhyavantaPITTA: Ushna asha, Kshut pipasa vanta, Has more vali, palita,khalitya, Has less &kapila varna smashru, roma,kasha, Klesha asahishnu, Prabhuta ashana pana, Adhikaswed, mootra,purisha etcVATA: Alpa shareera, Swara rooksha, jarjara, Chapala gati,chesta etc., Excess talk,Prominent s i ra kandara, Grasps th ings soon but forgets very fast e tc ,The knowledge of prakriti helps to assess:1)The prognosis2)Rogi bala3)to know the mental status of the patient.

Vikruthi:Here the changes taking place in the patients body must be noticed with due importanceto:Hetu: the causative factor.♦ Dosa.♦ Dooshya♦ Prakriti♦ Desham♦ KalamBy considering all these we can frame a proper samprapti of the disease, which in turnhelps for proper treatment.

Saram:The lakshanas of the 8 saras are watched out in the patient and a grading is done depending

on the maximum qualities noticed as: PRAVARA, MADYAMA OR AVARA.SARA.Sara also represents the ojus or the bala of the patient.

Samhananam:(compactness of the body)a compact body is characterized by symmetrical & well divided bones,well knit joints

and well bound mamsa & rakta.Pramanam:

Here the patient is examined with reference to the measurement of his bodily organs. thisis determined by measuring the height, length & breadth of the organs by taking the fingerbreadth of the individual as the unit of measurement.Sathmyam:

Satmya(homolagation)stands for such factors as are wholesome to the individuals.evenwhen continuously used..

Pravaram - sarvarasa, ghritha, ksheera etc

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HYPERTENSIONDR. BALAKRISHNAN VALLIOT

-Leading cause of death in developed countries (70-75% of total deaths)-Hypertension is a hard pounding of blood and it exists in an adult when the brachial

artery readings persistently exceed 140/90 mm of Hg.-Systolic pressure- Pressure exerted on the arterial walls when the heart contracts.-Diastolic pressure is the pressure exerted on the arterial wall when the heart relaxes.

Increase in diastolic pressure would lead to aneurysm of the arteries and this conditioncannot be treated efficiently.

300 billion-hospital visit• Increase in 33% from 1992 studies• 1/5th above 160—65• 50% in Framingham study 140/90• 95% primary hypertension• 5% secondary hypertension• Urban India– 60/1000• Rural India– 35/1000• Increase in both areas

MEASUREMENTS AND ERRORS• Sitting ideal, avoid drinks, smoking 30mts, rest for 5 minutes, mercury preferred, SBP

and DBP to be recorded• 2-3 reading 1wk apart ideal, disappearance of korokoff phase 5

Potential errors in measurements• Inaccurate manometer, improper cuff size, arm not supported, not keeping arm at

heart level, not taking SBP by palpatory, inflating/deflating fast, misinterpret auscultationgapSelf measurement

White coat HTN, assessment anti hypertensive, improving compliance, reducing cost

RISK FACTORS• Smoking, obesity, dyslipidemia, diabetes mellitus, age more than 60 years, men, family

history, woman more than 65, target organ damage, stress• Type A personality

Secondary hypertension1. Renal causes• UTI, renal calculi, polycystic kidney, AGN, liddle syndrome2. Endocrine causes• Acromegaly, Cushing syndrome, Thyrotoxicosis, pheochromocytoma, Conns syndrome,

hypothyroidism, PCOD, carcinoids3. Drugs• Adrenalin, isporenalin, ephedrine, cyclosporin, carbenoxolone• Corticosteroid, erythropoeitin, ergotamine

CLASSIFICATION A* 1) Systemic - i. Primary or essential – unknown causes.

ii. Secondary or where the cause is known.2) Portal hypertension - i. Intra hepatic portal hypertension.

ii. Post hepatic portal hypertension.iii. Pre hepatic portal hypertension.

3) Pulmonary hypertension - i. Primary (Unknown Causes)ii. Secondary (Known Causes).

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PHYSICAL EXAMINATION• Polycythemia, radio femoral delay, vasculitis• Edema, Cushing, acromegaly, cardiomegaly, palpable kidney, bruite,AR murmur, collapsing pulse, retinopathy

INVESTIGATIONUrine, CBC, electrolytes, BUN, FBS, lipid profile, ECG, x-ray chest

OptionalCreatinine clearance, micro albuminuria, 24hr protein, uric acid, TFT, echocardiogram,test for secondary HTN

DIAGNOSIS· Early diagnosis is essential.· Recording blood pressure routinely.· Investigations for the cause.

DIFFERENTIAL DIAGNOSISCommon Causes-

1. Chronic pyelonephritis2. Chronic glomerulonephritis.3. Coarctation of aorta.4. Renal artery stenosis.5. Middle aortic syndrome.

MANAGEMENTDrug therapy, diuretics, vasodilators, beta blockers, ace inhibitors, calcium channelblockers

Supportive therapylife style modification, rest and relaxation, exercise, wt reduction programme, yoga &meditation

Lack of responseHigh cost, poor education, side effect of drugs, inconvenient dose, inadequate dose,poor compliance, concomitant drug use, Excess salt, alcohol, smoking, poor drugselection, co morbidity

Hypertensive emergencyEncephalopathy, ICH, AMI, IVF, eclampsia

UrgencyUnstable angina, diabetic nephropathy, pre eclampsia, drug intoxication

COMPLICATIONSRelated with affected parts- Heart, Brain, Kidney, Eye, etc.

JNC VII• 50 years 140 SBP more risk than DBP

• Every 10/20 rise in BP double the risk

• Individual SBP 120-39 and 80-89 is pre hypertensive

• Thiazide diuretic is to be combined

• Many need two drugs to control

• Motivation improve compliance and stress given

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ANKYLOSING SPONDYLITISUsually occurs in younger individuals. X-ray findings are erosion of joint, joint narrowing,

fusion and periostitis.

Another common condition that we come across is periarthritis of shoulder joint. Thisincludes supraspinatous tendonitis, rotator cuff injury, frozen shoulder and subacromialbursitis. X-ray findings are osteopenia, bony spur or osteophytes and soft tissue calcification.Joint space will be normal.

Chronic arthritisOSTEOARTHRITIS

Usually it occurs in old age and in most of the cases it is monoarticular.the joints subjectedto stress are mainly affected like hip , knee, ankle and wrist. X-ray findings are jointnarrowing which is asymmetric , subchondral sclerosis and osteophytes. In chronic casesthere will be late destruction of articular margins.RHEUMATOID ARTHRITIS

Most common in younger females and is polyarticular. The most frequently involved jointsare metacarpophalangeal joints, proximal interphalangeal joints and wrist . feet is moreinvolved than hand. X-ray findings are soft tissue edema, osteopenia, erosions of jointmargins, symmetric joint narrowing and fusion in some cases.

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CLINICAL RELEVANCE OF AGNIDR. K. MURALI

In the process of Srushti, the Panchamahabhootas are having the main role to createa body. So each mahabhootas are given some qualities for the creation, such as Prithwi-Dhriti, Jala- Samgraha, Thejus- Paka, Vayu- Vyuha, Akasha- Avakasha. In this, Thejus ishaving the role of Agni. As we know in our body the role of Thejus or Agni is mainly donein the Koshta as Pachaka Pitha with the help of distinct factors like Samana Vayu and KledakaKapha.

In the conversion of food materials to a human body the agni plays a major role. So thePachaka Pitha – commonly known as Kayagni acts on the food materials directly and it isfirst converted to Sara & Kitta. From that Sara the Bhoothagni divides the Bhoothas. It isabsorbed to the body for the Dhathus by the effect of Dhathwagni. This is postulated bythree main nyayas like Ksheera dadhi nyaya, Khale kapotha nyaya, & Kedara kulya nyaya.In this stage some malas are formed inside the body. They are Kapha, Pitha, Kheshu malas,Sweda, Nakha, Roma, Sneha in netra, twak vit, & Ojus. The other malas excluding Ojus areexcreted within intervals. As Ojus is termed mala it is not excreted. It is the mala of SuklaDhathu & is retained in the body and is passed over to next generation through pregnancy.

Coming to the importance of agni in the samprapthi of roga - the agni is having somevitiated properties like Vishamagni, Mandagni, & Theekshnagni. These agnees cause theindigesion of food causing Ajeerna. By the difference of agnees we are getting three typesof Ajeerna.

1. Mandagni – Ama. 2. Theekshnagni – Vidagdha, 3. Vishamagni – VishtambhaThe common symptoms of Ajeerna are: Vitbandha, athipravrithi, glani, moodha vayu,

vishtambha, gourava, bhrama etc.1. AMA

There are various views about the concept of Amaa. Apakwa annarasa itself as Amab. Formation of Ama from Dosha moorchanac. Formation of Ama from Mala sanchayad. Formation of Ama in the early stage of Dosha dushti

Definition of Ama: it is Avipakwa, Asamyuktha, Durgandha, PichilaIn the primary manifestation of Ama with body we are getting some symptoms like srotho

rodha, dourbalya, gourava, moodha vayu, alasya, ajeerna, nishteeva, vitbandha, aruchi, klamaetc.

In the secondary manifestation of Ama with different Doshas we are getting Saama Doshalakshanas. If the Ama is manifested with Vatha dosha we get – Tandra, sthaimithya, gourava,snighdhathwa, aruchi, alasya, saithya, sopha, agnimandya etc. If it is with Pitha we get –Durgandha, haritha – syavatha, amla, amlika, hrith daha, etc. and If it is with Kapha we get– Avila, thandula, sthyana, durgandha, vibandha etc

By this manifestation the doshas may be in an avastha called Utklishta (moving) orAnutklishta (non moving).

Eg. In Rajayakshma (agnimandya – upalepa- srotho rodha – dhathu kshaya)In Arsas (vyadhi hethuka nidanas + agnimandya)In Athisara (utklishta – Ama)In Udara (sroth rodha in udakavaha srothus)In Amavatha (Ama in madhyama roga marga)In Prameha (error in Sara kitta vibhajana)

So considering the treatment principles we have to give the most importance to protectthe Agni. Eg. In Utklishta avastha we have to give Upeksha (negligence), Pachana & Upadravachikitsa In Anutklishta avastha we have to give Pachana, Deepana, Snehana, Swedana, &Sodhana

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NON-TRAUMA TIC DISEASES OF THE SHOULDER JOINTDR. NARESH

Shoulder pain is the most common musculoskeletal complaint in men & women over theage of 40 yrs.

Common causes of shoulder pain:A) EXTRA CAPSULAR:Rotater Cuff Lesions:

1) Supra spinatous tendonitis or tear:It results from impingement of the tendon on the acromion.It is charecterised by a painful

arc on abduction of the arm which can be abolished by external rotation, as well as by localtenderness over the greater tuberosity & pain on resisted abduction. Partial tears areassociated with identical symptoms & signs. In some case there is radiographic evidence ofcalcific deposits . rupture of calcific material into the sub acromial bursa occationly resultsin acutely painful gout like attack of inflammatory subacromial bursitis. Fluid aspiratedfrom the bursa contains crystals of calcium hydroxyapatite.TREATMENT:

Local injection of steroids.2) Bicipital tendonitis:It can be recognized by pain & tenderness in the bicipital groove aggravated by resisted

flexion of the elbow.3) Infra spinatus tendonitis:it is associated with pain on resisted external rotation.4) Subscapularis lesions cause pain on resisted internal rotation of the arm.

B) ACROMIO-CLAVICULAR: It includes conditions like arthritis.

C) GLENO HUMERAL: CAPSULITIS/ FROZEN SHOULDER:

It is a common and disabling condition in which severe spontaneous shoulder pain isinitially associated with capsular tenderness & painful restriction of all shoulder movemens& later with restriction of all shoulder movements alone. A frozen shoulder may be a lateconsequence of a rotator cuff lesion & sometimes follows a M.I, hemiplegia, herpes zoster,etcTREATMENT:

With analgesics and local corticosteroid injection in the early phase, and mobilizingexercises after the pain has resolved.D) REFERRED:

Cervical nerve rootIschemic heart diseaseSub diaphragmatic pathologyPolymyalgia rheumatica etc

SHOULDER HAND SYNDROME: This syndrome is charecterised by burning pain, vasomotor changes, & severe limitation

of the movement of the hand in association with restriction of the shoulder movements. Aradiogtraph of the hand shows patchy osteoporosis after some weeks or months.TREATMENT:

Is aimed at mobilizing the affected limb. Analgesics, a short course of systemic corticosteroids, sympathetic nerve block & physiotherapy can also be opted.

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In sanga - of mild degree, dosha pachana is sufficientEg. Shadharana choorna in Amavatha.If sanga is of moderate or severe degree, Vathanulomana, koshtagamana and sodhana are

the treatments.Eg. pithanirharana in Sakhashritha kamala.In athipravritti - SthambhanaEg. Kutaja in Athisara and Vasa in Rakthapittha.If atipravritti and sanga exists together, anulomana is the treatment Eg. Hareetakhi in

Amathisara.In vimargagamana - srothorodhahara and Vatha anulomana chikitsa should be combined

followed by shodhana e.g. gomoothra hareetaki in udara.In siragranthi, soshana is the treatmentEg. Guggulu panchapala choorna in varicosity.

VYADHI - AVASTHAIn Amavatha, first treatment is for Ama by langhana, swedana , deepana etc.It is followed

by treatment for Vatha by snehana, virechana and vasthi.In vatharaktha - acute stage (Utthana) – lepana, abhyanga, parisheka should be done.

Vatha - fluctuation in joint swelling – Nagaradi lepa – Bala taila.Pittha - tenderness in joints - Jatamayadi lepa - Pinda taila.Kapha - stiffness of joints - Kottamchukkadi lepa - Kottamchukkadi taila.

In Gambheera Vatharaktha- snehapana, virechana, and vasthi are the treatment, which isfollowed by rasayana- Vardhamana pippali or Chyavanaprasha.

In Amavatha and Vatharaktha Vatha is the main dosha hence vasthi is the main treatmentbut vasthi is different in both occasions i. e. Kshara vasthi in Amavatha and Ksheera vasthiin Vatharaktha. In Amavatha itself if vatha is more, Kshara vasthi is done with Ksheera andif kapha or ama is more Kshara vasthi is done with gomoothra.

In Athisara, with blood and mucous – Ksheera prayoga or Piccha vasthi which is applicableto conditions related to ulcerative colitis also. All the treatment in arshas should aimvathanulomana and that is why almost all arshohara drugs contain hareetakhi, which is bestVatha anulomana Silajathu with chedana, and kiedasoshaka property is a drug of choice inperipheral vascular disease as Rasayana. Generally when ojus is to be enhanced Rasayana isthe right measure after doing the sodhana.

In manasikarogas along with vitiated thridoshas Rajus and Thamus are to be normalizedby Harshana,Santhwana,and other forms of Daivavyapasraya chikitsa and Sathwavajayachikitsa.UNEXPLAINED DISEASES IN AYURVEDA - APPROACH

1) Identify the signs and symptoms 2) Understand the doshas involved 3) Realise themodern pathogenesis 4) Apply the dosha-dooshya concept 5) Formulate a new samprapthi6) Derive the treatment principle as per the new samprapthi 7) Do the upasaya to test thehypothesis 8)Make changes if needed.How to win the battle?

Use the right tool at the right time as discussed above.In Alpadosha-langhana,in madhyadosha-langhana and pachana,in prabhootha dosha-

sodhana is the general principle.Apply it according to the situation.CONCLUSION

To be an effective physician…1) Read the screenplay of the disease very well 2) Identify the important scenes 3)

Anticipate the turnings and climax 4) Select the proper artists and technicians 5) Now it isthe time for ACTION… You are starting the BATTLE against SAMPRAPTHI…

Best of Luck…………

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DIAGNOSTIC METHODSDelay in attaining motor milestonespersistance of moros grasppersistance of primitive reflexes after the age of three monthsCripplingFeeding difficultyDroolingBad teethConstipationBehavioral problems etc.CT scan reveal areas under developed,

ABNORMAL CYSTSMRI – gives better pictures of abnormal areasULTRA SONOGRAPHY – used in infants before the closure of skull bones,to detectcysts and structures in brainEEG – to detect brains electrical activity that suggest a seizure disorder

DIFFERENTIAL DIAGNOSIS* PSEUDOMUSCULAR DYSTROPHY* KWASHIORKOR* MARASMUS* RICKETS* POLIO MYELITIS* PSEUDOMUSCULAR DYSTROPHY

DIAGNOSTIC METHODS* Difficulty in standing, walking, climbing stairs, arising from the pelvis* Gower sign – succession of movements involving arising from bed to an upright

position.The child appears to be climbing up in his own thighs

* Remarkable bulky calf muscle * Waddling gait

MARASMUSInfantile atrophy in early age.Remarkable wasting of muscles and subcutaneous fat, face is wizened and shriveledIrritable and hungry in the early stage.

* LATE STAGERefuses foodBecomes miserable and apatheticLate walking due to lack of energy

RICKETS* Head-macrocephaly* sweats easily* fontenella – slow closing* skin – pasty looking* Thorax- ricketic rosary* abdomen- disteded* legs – bow legs

PARALYTIC POLIOSpinal form paralysis of legs (frog position) phantom hernia

BULBAR FORMParalysis of muscles supplied by cranial nerves (dysphgia, nasal speech, dyspnoea,

facial paralysis), mild hypertensionBULBOSPINAL – combination of both bulbar and spinalENCEPHALITIS – changes in sensorium, irritability, drowsiness, unconciousnessPREVENTION

Vaccination to the mother in pregnancyBetter antinatal,natal and postnatal careAdequate neonatal careA special serum after each child birth to avoid rh incompatibility

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SPINAL DISORDERSDR. K.B.SUDHIKUMAR

Back pain may be due to Intrinsic or extrinsic reasonsIntrinsic causes-

1) Congenital - Spina bifida, Spondylolestheis.2) Traumatic - Lumbosacral strain, IVDP, Vertebral fracture3) Functional - Kyphosis, scoliosis.4) Inflammatory – Arthritis, Fibrositis.5) Degenerative – Spondylosis, osteoporosis6) Neoplastic - Primary, secondary.

Extrinsic causes-1)Abdominal – Pancreatitis, cholecystitis2)Pelvic - Inflammation of ovary/tubes3)Genitourinary - Renal calculi, prostitis.4)Vascular - Ischemic from occluded arteries.

Psychogenic causesSPINA BIFIDA

Congenital defect in the posterior bony wall of the spinal canal involving the lacunae.Spina bifida occulta, Meningocoel, Meningomyelocele, Syringomyelocele, Myelocele- Most common

Spina Bifida Occulta - It is the improper fusion of neural archesNo protusion of cord or membrane, No projection on surface, Impairment of nervefunction may be caused in some such cases by tethring of the dura, and through thisthe spinal cord, to the skin surface by a fibrous membrane.- Clinically, the common manifestation of nerve involvement is muscle imbalance inthe lower limb-foot drop, backache.

SPONDYLOLISTHESIS-Deformity of lumbosacral region produced by gradual slipping forward of luimbar spine

over sacrum.-Four varieties

1)Spondylolitic - familial - spondylolysis in pedicle.2)Congenital – superior facet defect.2)Degenerative - Degeneration of facet joint and disc L4 L53)Traumatic - Hyperextension injuries (Fracture of pedicle).Nerve root may becompressed by the defective narrowed intervertebral foramina.

CLINICAL FEATURESBack ache - Gradual onset long duration, Usually intermittent, Aggrevates afterexercise, Movements - restrictedPhysical signs- Shortened trunk, Deep transverse furrows, Prominent sacrum

LordosisX-ray - AP – 5th transverse level with upper border. Lateral – Ullman’s sign, Oblique

LUMBOSACRAL STRAINCommonest variety of acute back ache, usually caused by strain, stretching or tearing of

ligamentsLumbosacral joint is forced beyond the normal range of movement.

CLINICAL FEATURES· Localised pain and tenderness· All movements restricted.· Rarely radiates

Chronic· Occurs in individuals with poor musculature· Insidious onset

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ENTAMOLOGY - ENVIRONMENT AND DISEASEDR. VENUGOPALAN. A.K

TYPE OF MOSQUITOES & DISEASES TRANSMITTEDAnopheles - Malaria, Filaria (not in India)Culex - Bancroftian filariasis, Japanese encephalitis, West Nile fever, Viral arthritis

(epidemic / poly arthritis)Aedes - Yellow fever (not in India), Dengue, Dengue haemorrhagic fever, Chikungunya

fever, Chikungunya haemorrhagic fever, Rift valley fever, Filaria (not in India)Mansonoides - Malayan (Brugian) filariasis, Chikungunya feverHousefly - Typhoid, Paratyphoid fever, Diarrhoea, Dysentery, Cholera, Gastro- enteritis,

Amoebiasis, Helminthic Infestations, Poliomyelitis, Conjunctivitis, Trachoma, Anthrax, Yaws.etc

Sand fly - Kalaazar, Oriental sore, Sand fly fever, Oraya feverTsetse fly - Sleeping sicknessLouse - Epidemic typhus, Relapsing fever, Trench fever, PediculosisRat flea - Bubonicplague, Endemic typhus, Chiggerosis, Hymenolepis diminutaBlackfly - OnchocerciasisReduviid bug - Chagas diseaseHard ticks - Tick typhus (Rocky Mountain Spotted fever)

Viral encephalitis (e.g., Russian Spring - summer encephalitis)Viral fevers (e.g., Colorado tick fever)Viral haemorrhagic fever (e.g. KFD in India)Tularaemia, Tick paralysis, Human babesiosis

Soft ticks - Q fever, Relapsing fever, KFDTrombiculid mite - Scrub typhus, Rickettsial - poxItchmite - ScabiesCyclops - Guinea- worm disease, Fish tapeworm (D. latus)Cockroaches - Enteric pathogens

TRANSMISSION OF ARTHROPOD – BORNE DISEASES1 DIRECT CONTACT e.g., Scabies and Pediculosis2 MECHANICAL TRANSMISSION e.g., Diarrhoea, Dysentery, Typhoid, Food poisoning

and, Trachoma by housefly3 BIOLOGICAL TRANSMISSION

PROPAGATIVE e.g., Plague bacilli in rat fleasCYCLO - PROPAGATIVE e.g., Malaria parasite in AnophelineCYCLO - DEVELOPMENTAL e.g., Filarial parasite in culex, Guinea worm embryoin Cyclops

PRINCIPLES OF ARTHROPOD CONTROL1 Environmental control2 Chemical control3 Biological control4 Genetic control

MOSQUITO CONTROL MEASURESAnti - larval Measures

Environmental ControlChemical ControlBiological Control

Anti - adult MeasuresA) Residual SpraysB) Space SpraysC) Genitic Control

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KAAMALA - DIAGNOSTIC APPROACHDR. R. SREEKUMAR

NIRUKTHI• Nidana sambandhi –EòºªÉ VɱɺªÉ +É̈ÉÉƶÉÆ ±ÉÉÊiÉ <ÊiÉ EòÉ̈ɱÉÉ **EÖòÎiºÉiÉÆ +É̈ÉÆ ±ÉÉÊiÉ <ÊiÉ EòÉ̈ɱÉÉ **• Lakshana sambandhi –EòÉ̈ÉÆ EòÉÏxiÉ ±ÉÖhÉÊiÉ <ÊiÉ EòÉ̈ɱÉÉ **

BHEDA• KOSHTA SAKHASRITHA (BAHU PITHA KAAMALA)• SAKHASRITHA(ALPA PITHA KAAMALA)

NIDANAS – KOSHTA SAKHASRITHA• Pithaprakopa Nidanas

Madya, Amla lavana athibhojanam, etc..• Raktha prakopa Nidanas

Dadhyamlam, masthu, suktham, virudhanna, poothi anna etc.Causes Pitha and Raktha vitiation

NIDANAS - SAKHASRITHARooksha, Sheetha, Guru, Athivyayama etc..Vatha and Kapha vitiates

SAMPRAPTHIKoshta Sakhasritha

• Pitha prakopa nidanas, Agni dushti & pitha dushti, Agni mandya & amotpathiCirculation of Saama dosha with Raktha, Raktha vaha srotho dushti, Adhika rakthamala utpathi, Circulation of Raktha mala with Raktha, Raktha Mamsa dushti, Kaamalanirvrithi

Sakhasritha• Kapha & Vatha prakopa nidanas, Agni mandya, Amotpathi & dosha vridhi, Pithamarga gamana, Mala ranjaka pitha margaavarodha, Vatha prakopa & vimarga gamanaof Pitha, Kaamala nirvrithi

LAKSHANASKoshta Shakashrita

Haridra netra, twak nakha, mukha, Daha, Avipaka, Daurbalya, Anga sada, Aruchi, Durbalaindriyata, BalakshayaShakashrita

Haridra mootra, netra, twak, Sweta pureesha, Vishtamba, Gaurava, Parshva vedanam,Hikka, Swasa, JwaraTREATMENT

Kosta shakashrita PittaharaShakashrita Kapha vatahara

JAUNDICE It is a symptom complex charecterised by the yellow discolouration of the skin, sclera,

mucous membranes & other tissues due to exess of bilirubin in the blood. In simple wordsit is the disturbance in the synthesis, manufacture, secretion or excretion of bile.NORMAL BILE PIGMENT METABOLISM1) BREAK DOWN PHASE:

Haemoglobin break down occurs in the reticulo endothelial system forming the bilepigment bilirubin which is tranceported in the blood stream attached to albumin. This is notwater soluble.2) CONJUGATION PHASE:

Unconjugated bilirubin is lipid soluble & cannot be excreted from the kidney. Forelimination it is transportedto the liver, taken up into the hepatocytes, conjugated with

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OCULAR MANIFEST ATIONS IN SYSTEMIC DISEASESDr. SREEJA SUKESAN

1. DIABETES MELLITUSRetinal changes rarely develop in a diabetic (less than 3 years)Ocular changes seem to depend more upon duration rather than on theInadequate control. Common age group is 50 – 60 and male-female ratio is 2: 3Those who are having hereditary tendency are at risk.

Structure Wise Ocular Lesions Are1. Lids

Xanthelasma. White patches on the medial aspect, can be because of either DM or hyperlipidemia.

Recurrent Stye.Internal Hordeolum.

2. ConjunctivaTelangiectasia.Subconjuctival hemorrhage.

3. CorneaDecreased corneal sensitivity (Due to Trigeminal neuropathy) which may lead to traumaPunctate KeratopathyHigher incidence of infective corneal ulcers and delayed epithelial healing due to

abnormality in epithelial basement membrane.4. Iris

Rubeosis iridis.5. Retina

Characteristic Fundus lesion consists of: Dot & Blot hemorrhages – Exudates - Obliteration of Pre-capillary arterioles - Results

in focal areas of Retinal anoxia. – Neovascularization – Vitreous hemorrhage - Retinaldetachment - Increased Intra ocular pressure.6. Lens: Cataract.7. Vitreous: Vitreous hemorrhage - Fibro vascular proliferation.8. Optic Nerve: Optic neuritis.9. Extra Ocular Muscles: Ophthalmoplegia due to Diabetic neuropathy.10. Changes In Refraction: Myopia - Decreased Accommodation.2. HYPERTENTION

The factors which play role in the pathogenesis of Hypertensive Retinopathy are –1. VasoconstrictionHyper tonus – followed by hypertrophy .Hyperplasia of tunica media2. Arteriosclerosis3. Increased Vascular Permeability

Abnormalities in the fundus:· Attenuation of arterioles· Arterio venous crossing changes· Segmental calibre variation in the arterioles· Hemorrhage· Exudates

Hard - in chronic hypertensionSoft - in malignant hypertension

· Papilloedema - malignant hypertension3. DEMYELINATING DISEASES

From ophthalmologic point of view three of them deserve special attentionØ Multiple (disseminated) sclerosisØ Disseminated myelitis with optic neuritisØ Diffuse sclerosis

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DYSFUNCTIONAL UTERINE BLEEDINGDR. RASIYA MONY

MENSTRUATIONThe visible manifestation of the-cyclic -physiologic -uterine bleeding - out of shedding

of the endometrium,-due to invisible interplay of hormonesMainly through -hypothalamo - pituitory ovarian axis.

CONTENTSDark Altered Blood, Desquamated Endometrial Cell Debris, Fragments Of Endometrium,

Cervical Mucous, Vaginal Epithelial Cells, Calcium, BacteriaBlood Clots In Uterine Cavity- By Its Thromboplastic Property-Clots Are Dissolved By-The Fibrinolysinec - Released From The Endometrium

Dysfunctional Uterine BleedingExcessive Uterine Bleeding Where No Organic Cause [Systemic, Haematological Or Pelvic

Can Be DetectedNature Of Bleeding

o Menorrhagiao Metrorrhagiao Polymenorrhoeao Countinuous Bleeding Preceded By Amenorrhoea

MenorrhagiaExcessive Menstrual Loss In Amount Or DurationOr Both CausingMore Than 80 Ml Of BloodE G:-Fibroid , Ca Of Endometrium, Endometrial Hyperplasia,Pcod With Tonic Estrone

And Lh Effect, Obesity With Tonic Estrone & Lh Effect,HypothyroidismMetrorrhagia

“Inter Menstrual Irregular Uterine Bleeding”E G:- Carcinoma Of The Cervix Or Endometrium, Fibroid

PolymenorrhoeaEpimenorrhoea

Too Frequent Menstruation At Regular Intervals Of 2 WeeksBut Less Than 3 Weeks

Ø Can Be Normal In AmountØ When Becomes Heavy -EpimenorrhagiaØ May Occur At Any TimeØ Temporarily Develop At Perimenopause, After Abortion And Child Birth

Classification* REGULAR (OVULAR)* IRREGULAR (ANOVULAR)

Regular [Ovular]Menorrhagia, Polymenorrhoea Polymenorrhagia

Aetiology* No Menstrual Endocrinal Disorder• Excessive Endometrial Secretion Of Pge2* Excess Prostacyclin In Endometrium & Myometrium• Excess Fibrinolysis With Failure Of Secondary Thrombotic Plug* Defect In The Spiral VesselsEndometrial Vascular System Affected By Sympathetic Nervous System

Irregular [Anovular ]Seen In Puberty,Premenopause,Obesity ,Pcod ,Corpus Luteal Abnormalities

AETIOLOGY

Page 16: Abstract of Re-Orientation Course for Ayurvedic Doctors

CONCEPT OF AVARANADr. MANOJ KUMAR A K

TRANSPORTATION• Jalasandhanavat• Agnisandhanavat• Sabdasandhanavat

Avarana ……• Srotas• Anulomana• Significance• Definition• Mechanism• Diagnosis• Classification• Fate• Complications• Prognosis• Treatment• Avarana in Pakshaghata

SROTASAvyahata gati, Lives 100 yrs. With no diseaseSrotodushti

Decrease in sizeIncrease in size

Anulomana• All movements• All direction• For health• Dosha dhatu agni samatam….

SIGNIFICANCEBetter patient management

DEFINITIONAvarana: Doshanam samsarga:

• Avarana: gatinirodha:• Avarana: margarodha:• Avarana: sanga:

EFFECT• Temporary condition• A disease

DIAGNOSIS• Mode of onset• Symptomatology• Site of onset• No evidence of Dhatu kshaya

CLASSIFICATION• Dosha• Dhatu• Anna• Mala• Mootra

Page 17: Abstract of Re-Orientation Course for Ayurvedic Doctors

FUNDAMENT ALS OF ONCOLGYDR. V N BHATTATHIRI

What is Cancer ?• Abnormal, uncontrolled growth of cells• Ability to invade adjacent structures• Produce metastasis• Is of self origin

Disease of heritable, somatic mutations affecting cell growth and differentiation,characterized by abnormal, uncontrolled growth.ONCOGENESIS

Multistep process1 Gene mutation: genotoxic agents

Activation of OncogeneInactivation of suppressor genes

2. Alteration inSignal transductionLoss of cell cycle controlNo apoptosis

3. Acquire features of malignancyImmortalGreater growthAbsent cell cell interactionsinvasion and metastasis

CANTER——>CANCERGrowth of a tumour

Three phases to its growth.1. Exponential phase: Nutrition from interstitial fluid.

1->2->4->8->16, etc.2. Lag phase occurs: Insufficient nutrition

Slow growth3. Plateau phase Neovascularisation; Tr. VEGF

Cell death tooAbout 40 doublings to clinical size

Aetiological factors: VirusesRNA and DNA viruses (retroviruses)Adenoviruses: Cell cultures transformedHepatitis B and C: Hepatocellular carcinomaHerpesviruses: Epstein Barr (EBV)Burkitt’s lymphoma, Immunoblastic lymphomaNasopharyngeal carcinomaKSHV (AIDS too): Hodgkin’s disease, Kaposi’s sarcoma, body cavity based lymphomaPapillomaviruses: Anogenital, upper airway cancers, Skin cancerPolyomavirus: Neural tumors, Insulinomas, Mesotheliomas

Retroviruses:HTLV I : Adult T cell leukemia, lymphomaHTLV II: Hairy cell leukemia

Aetiological factors: ChemicalsGenotoxic or nongenotoxic

Tobacco: Many cancersDiethylstilbestrol: transplacental: Ca vagina in childOccupational carcinogens: vinyl chloride, benzene, aromatic amines, bis

(chloromethyl) etherDietary factors: enhance or inhibit

Page 18: Abstract of Re-Orientation Course for Ayurvedic Doctors

Gross type: Growth, ulcer or indurationInvasion: Bleeding, ulcer, bone/cartilage necrosisTr. secretions: Biochemical effects, functioning tumoursparaneoplastic syndromesNutritional effects: Cancer cachexiaSecondary effects: Infection, fever

Common SymptomsGrowth or Ulcer: Oral cancerHemoptysis, cough: Lung cancerBleeding mole: MelanomaHaemetemesis: Stomach cancerDysphagia: Stomach cancerAbdominal pain, ascites: Intra-abdominal tumoursHead ache, vomiting: Brain tumourPersistent fever, anemia, weakness: LeukemiasSwellings: Commonest; Lymphnode mets, lymphomas, breast cancer, sarcomasVaginal Bleeding: cervical cancerBlood in stools: Colorectal cancerHematuria: Bladder cancerParalysis: spinal/vertebral tumours

All these more often due to other causesINVESTIGATIONS

• DIAGNOSTIC• STAGING• PROGNOSTIC• ASSESSMENT• TREATMENT EVALUATION

Types - Imaging, Endoscopy, Tumour markersIMAGING

Radiological: CommonestX-rays: Plain, Barium Swallow and meal, IVPCT Scan: Whole body spiral CT; Contrast

MRI Scanning: Dynamic contrast enhanced brain, spine and head & neckFunctional Imaging: PET; P M R SpectroscopyUltrasonography: superficial; transrectal, transvaginalRadionuclide imaging, Machines: Gamma camera, SPECTIndirect or non-specific scans: Perfusion Bone, LiverDirect or specific: Gallium 67 Citrate Scans: Lymphomas, lung, high ferritintumours Thyroid, Adrenal

Endoscopy: Inspection and collection of cells bybiopsy, scraping, washing, etc .cytology,

Video - endoscopiesNasopharyngoscopyOesophagoscopy,Gastro-duodenoscopyColonoscopy, CystoscopyLaparoscopy, ColposcopyBronchoscpy, Thoracoscopy, mediatinoscopy

Tumour markers• Carcinoembryonic antigen: Stomach, colon, liver• Alpha fetoprotein: Teratomas• CA125: Ovary• BetaHCG: Choriocarcinoma• PSA: Prostate

Page 19: Abstract of Re-Orientation Course for Ayurvedic Doctors

Remote afterloading: Moderate and High dose rate machinesAction of ionosing radiation

Interaction with matterPhysical: Ionise atomsPhysicochemical: Free radical formationChemical: Damage to DNA, Cell membraneBiological: Cell death: apoptosis or necrosis

Affect tumour as well as normal tissues. In normal tissues unaffected cells repopulate,but if unaffected cancer cells repopulate, tumour recurs.RADIOTHERAPY: COMPLICATIONS AND HAZARDS

*Complications to patientsHigh treatment doses

Depend on site/organ/tissue as well as volume of tissue irradiatedProliferating: Easily damaged; repairable Mucositis, dermatistis, diarrhoea, etc.Non-Proliferating: Resistant, permanent Fibrosis, necrosis

Radiation hazards to staff: Risk of Germ cell damageRisk of somatic cell damage: Cancer

Radiotherapy: Role Limitation: Number of tumour cells, disease extent RT as single modality: Many solid

tumours Head & neck cancers, Cervix, Oesophagus, Early Hodgkins DiseasePart of Combined modality Breast, Lung, Many Advanced solid tumours

Palliative: Pain relief: Bone mets, Brain secondariesSurgery: Limitation: Extent of tumour

Simple excision and closureResection and plastic repairResection and anastomosis

Morbidity: Cosmetic: Plastic repairLoss of function: Prosthesis

Surgery: Role inSkin, Head & neck cancers, Breast, Lung, Salivary gland, Stomach, Intestines, Brain,Soft tissues, Uterine, ovary, Kidney, Prostate

Chemotherapy: Use drugsLimitation: Number of tumour cells, but not extent

Drugs ClassifiedCell cycle dependent

Phase specificPhase nonspecific

Cell cycle IndependentChemotherapy

• Single drug or Combination chemotherapy• Route

SystemicIntra-arterial: Tr perfusionIntrathecal: into CSFInstillation: BladderIntra-cavitary: Pleural, peritoneal

• Single Modality• Combined Timing• Neoadjuvant• Concurrent with radiation• Adjuvant

Chemotherapy: Drugs

Page 20: Abstract of Re-Orientation Course for Ayurvedic Doctors

STROKE - DIAGNOSISDR. SUDEEP

-Stroke is one of the leading causes of the death and disability throughout the world.

-It is rapidly developed clinical signs of focal or global disturbance of cerebral function;

lasting more than 24 hours or leading to death, with no apparent cause other than vascular

origin. The 24 hours threshold in the definition excludes transcient ischaemic attacks(TIA).

-The disturbance of cerebral function is caused by three morphological abnormalities,

i.e. stenosis, occlusion, or rupture of the arteries.

RISK FACTORS

Hypertension, cardiac abnormalities e.g. left ventricular hypertrophy, diabetes, elevated

blood lipids, obesity, smoking, blood clotting and viscosity, oral contraceptives, etc.

-Stroke includes a number of syndromes with differing aetiologies, prognosis and treatment

e.g. Subarachnoid hemorrhage, Cerebral hemorrhage, Cerebral thrombosis or embolism,

Occlusion of pre cerebral arteries, TIA, ill defined cardiovascular disease, etc.

Dysfunction of the brain manifests by various neurological signs and symptoms that are

related to extent and site of the area involved and to the underlying causes. These include

coma, hemiplegia, paraplegia, monoplegia, multiple paralysis, speech disturbances, nerve

paresis, sensory impairment, etc.

PROGNOSIS

there is and enormous variation in the prognosis for stroke depending upon the presence or absence of

continuing risk factors.

INVESTIGATIONS

· CT Scan – Seen as areas of low attenuation.

· MRI- as zones of high signal.

· Angiography.

· Arteriography.

H

Page 21: Abstract of Re-Orientation Course for Ayurvedic Doctors

Dr Pretham PaiKulyadi houseKadbattu,Udupi,Karnataka;Pin – 576101Ph – 0820 2521489

Dr K Shobha bhat,KRISHNA KRUPA,Chantar, Brahmawar,Udupi,Karnataka,Ph – 0820 2560815

Dr. S PriyaTutor, Govt. Ayrveda college,TrippunitharaErnakulam

SREEVASPalace road,Vakkam P.O

Thiruvananthapuram.Pin – 695308

Ph – 04702 654368Mob – 9847390543

Dr. Sanila V.K.Pallikkulam,Chirakkal P.OKnnurPin - 670011Ph – 04972746619

Dr M JayarajJaya nivas,Thiruvizha junction (NH)Mahithara market P.OCherthala,Alappuzha.Pin – 688539Ph – 0478 2814259, 94472 91152

Dr P Mohanan,Padmalayam, Irinav P.O.Kannur Pin – 670301Ph – 0497 2867373 (res)Mob – 9447448956

Senior physician,Asoka pharmacy,

Kannur – 1Ph – 0497 2707112, 2712696

Dr Ebey AbrahamMoongamakelPayam P.O.Edoor,Kannur,Ph – 0490 2450398Mob – 9847853991

Arya Vaidya Sala ( Publications)Kottakkal P.O.

Malappuram,Kerala

Ph – 0483 2742226

Dr V. Thrivikraman,Veluthat manaKavanchery P.OMangalam, Tirur.Pin – 676561Ph – 0494 2566212

Arya Vaidya SalaKottakkal P.O.

Malappuram,Kerala

Ph – 0483 2742216

Dr.Mini.K.VTutor, Nangelil Ayurveda College,Kothamangalam

Nangelil House,Pulluvazhi P.O

Perumbavoor, Ernakulam Dt.Ph: 9847314407

Dr.Sreekala Nambiar,Meleth House,Near Olachery kavuTalap Kannur 670002Ph: 0497 2700748.

Dr.Anija S.Aiswarya,Mangalamkunnu,Palakkad – 679514Ph: 0466 – 2260131Mobile : 9847673808.

Dr. Shini K.KShinshal,Maruthonkara P.O.Kavilumpara ViaKozhikkode 673513Ph: 0496 2565182Mob: 94474 70199

Page 22: Abstract of Re-Orientation Course for Ayurvedic Doctors