By Dr. Maanas. A 1 st year PG scholar Guided by Dr. Rajarajeshwari N M Associate Professor Dept of samhita samskruta and siddhanta CASE PRESENTATION
By Dr. Maanas. A1st year PG scholar
Guided byDr. Rajarajeshwari N MAssociate ProfessorDept of samhita samskruta and siddhanta
CASE PRESENTATION
CASE HISTORY Name: abc Age: 55 Sex: Female Occupation: Farmer [worker] Address: Signahalli, Hassan IPD- 004104-2014 OPD- 023862-2014 D.O.A- 30-06-2014 D.O.D- 09-07-2014
CHIEF COMPLAINT Pain in the lower back region
radiating to the posterior aspect of Left leg since 3 months.
The pain has increased from 15
days.
ASSOCIATED COMPLAINTS
Unable to walk properly due to pain since 15 days.
Pulling type of pain in left calf and thigh region.
HISTORY OF PRESENT ILLNESSPatient was apparently normal 3 months back. She developed pain in lower back region ,which started gradually radiating to posterior aspect of left leg within two days and was not able to do her occupational work. She consulted an allopathic doctor who prescribed her with medications and rest. The treatment gave her temporary relief, but pain recurred which was continuous in nature and used to aggravate after strenuous work. She came to a stage were she was unable to do her household work also.15days back she came to know about our hospital and started taking medications for the same which gave her relief, so for further improvement she got admitted in our hospital.
PAST HISTORY
No H/O DM or HTN No surgical history
FAMILY HISTORY
Nothing Significant
PERSONAL HISTORY AAHARA: MIXED DIET. Morning-Dosa, rice
items Afternoon-Ragi Mudde, curd and buttermilk, Night rice curd, non veg once in a week
VIHARA: FARM WORKER she sits in same position for almost 5-6 hr since 30 yr, controls her thirst and urge to micturate.
APPETITE: Decreased appetite, but takes food regularly
BOWELS: Since 3 months Hard, straining MICTURITION: Normal SLEEP: DISTURBED since 5 yr, DUE TO PAIN
since 3 months HABITS : NIL
Gynecological historyMenarche : 15yrMenopause : 50yr Disturbed sleep since thenObstetric history : P3A0L3D0
General examination B.P-130/80 mm Hg PR-78/Min R.R-20/Min Height -5ft 2inches Weight - 48kg Edema/lymphadenopathy/pallor/icterus/
clubbing/cyanosis - absent
SYSTEMIC EXAMINATION RS - NVBS CVS - S1 S2 heard P/A - Soft, non tender CNS-Conscious and well
oriented
Musculo-skeletal system Gait - limping with support Upper limb - Normal Lower limb - Stiffness: Stiffness in the calf and thigh region. Redness and Warmth / Weakness / Swelling / Deformity : Absent Examination of spine - Inspection : No visible deformity Palpation : Tenderness - L5 S1 S2 region Movements : Cervical/Thoracic : NAD Lumbar : Flexion Restricted Lateral flexion Lt-Not possible Rt – Restricted Extension- restricted
SLRT-Positive at 30 degree LASEGUES SIGN- Positive
INVESTIGATIONS Hb:11gm% E.S.R :20 mm/hr Platelets: 3.31 lakhs/CMM FBS: 82 mg/dl Blood urea: 15 mg/dl Urine sugar: absent
ASTA STHANA PARIKSHA NADI-78/min JIHVA-Alipta MALA-Twice/day MUTRA- 4-5 times/day SHABDA-Prakrita SPARSHA-Sama sheetoshna DRIK – Gati- Vikruta AKRITI- Madhyama
DAShA VIDHA PARIKSHA PRAKRITI- Vata - Pitta VIKRITI-
o Hetu- Long hours of sitting and working, lifting heavy weight, vegadharana, Nidrahaani
o Dosha- Vatao Dooshya- Asthi, Sandhi, Mamsao Prakriti - Mriduo Desha – Bhumi -Anupa Sadharana o Atura – Kati, Vama sakthio Kala – Ritu- Varsha ritu Kriyakaala- Vyakta
avasthao Bala –Rogi - Avara ; Roga - Madhyama
DAShA VIDHA PARIKSHA CONTd.. SARA SAMHANANA SATVA SATMYA AHARA SHAKTI VYAYAMA SHAKTI VAYAH PRAMANA
Madhyama Madhyama Madhyama Madhyama Abhyavaharana Shakti- Madhyama Jarana Shakti- Madhyama Avara Madhyama Madhyama
NIDANA PANCHAKA Nidana - Long hours of sitting and working,
lifting heavy weight, vegadharana, Nidrahaani
Purvarupa – Purvarupa not elicited. Rupa - Low back pain, radiating pain from
Left buttock region to posterior side of the leg, difficult to walk, pain aggravating while walking and while turning from one side to other on lying down.
Upashaya – Resting in supine position with legs fl
Anupashaya - walking, bending, working.
SAMPRAPTINIDANA
VAYAH DHATU KSHAYA
VATA PRAKOPA
KHA VAIGUNYA IN KATI
DOSHA - DUSHYA SAMMURCCHANA
SIRA, SNAYU AFFECTED
GRIDHRASI
VYADHI VYAVACHEDANAVATAJA
GRIDHASIVATA-KAPHAJA
GRIDHRASI URUSTAMBHA KHALLI
STAMBHA STAMBHA RUK IN URU PADA,
JANGHA,URU & URU
MOOLA PEEDA
RUK GAURAVA SHOTHA,AYASA,SANKOCA
MARDANAVAT PEEDA
TODA AROCHAKA ANGAMARDA SPANDATE
MUHUHU TANDRA GURUTWA
DEHA VAKRATA TANDRA
ARUCHI, STAIMITYA, SUPTI
VYADHI VINISHCHAYA
VATAJA GRIDHRASI
OP basis Treatment Sahacharadi Kashaya 3tsf BD Rasna Guggulu 2 TID Hingvashtak Churna ½ tsf TID * 1 week
TREATMENT 30-6-2014 TO 9-7-
2014
चि�कि�त्सा सूत्र अस्थ्याश्रयाणाम् व्याधीनाम् पं��मा�णिण भेषजम् । बस्तयः क्षीरसप%किष कितक्त�ोपकि(ताकिन � । �. सू .२८/२८
�ेवलम् किनरुपस्तंभमादौ स्ने(ैरुपा�रेत् । �. चि�. २८/७५
01-07-14
Kati Basti with Dhanwantara taila Sarvanga Abhyanga (Dhanwantara Taila) + Bashpa
Sweda Matra Basti with Pancha Tiktaka Ghrita 80ml Katilepa with Jadamayadi Churna + Dhanwantara
Taila Rasna Guggulu 2-0-2 Physiotherapy
LOW BACK ACHE RADIATING TO LT Leg +++APPETITE – GOODBOWEL-REGULARSLEEP- DISTURBEDSTIFFNESS- PRESENT
Kati Basti with Dhanwantara Taila Sarvanga Abhyanga with Dhanwantara Taila + Patra
Pinda Sweda Matra Basti with Pancha Tiktaka Ghrita Katilepa with Jadamayadi Churna + Dhanwantara
Taila Rasna Guggulu 2-0-2 Physiotherapy
PAIN – REDUCEDAPPETITE – GOODBOWEL-REGULARSLEEP- DISTURBEDSTIFFNESS- PRESENT
02-07-14
Kati basti with Dhanwantara taila Sarvanga Abhyanga + Patra pinda sweda Matra Basti with Pancha Tiktaka Ghrita Katilepa with Jadamayadi Churna + Dhanwantara
Taila Rasna Guggulu 2-0-2 Physiotherapy
PAIN - REDUCEDAPPETITE – GOODBOWEL-REGULARSLEEP- DISTURBEDSTIFFNESS- PRESENT
Ksheera vaitarana Basti- Guda Paka 30ml, Chincha Rasa 50ml,
saindhava Lavana-12gm, PTG-40ml, Ksheera 200ml
03-07-14
Pain reduced, No pain while getting up from bedAPPETITE – GOODBOWEL-REGULARSLEEP- DISTURBEDSTIFFNESS- PRESENT
Ksheera vaitarana Basti Kati basti with Dhanwantara taila Sarvanga Abhyanga (Dhanwantara Taila) + Patra
pinda sweda Matra Basti with Pancha Tiktaka Ghrita 80ml Katilepa with Jadamayadi Churna + Dhanwantara
Taila Rasna Guggulu 2-0-2 Physiotherapy
04-07-14
Pain reduced/ Able to walkAPPETITE – GOODBOWEL-REGULARSLEEP- DISTURBEDSTIFFNESS- PRESENT
Kati basti with Dhanwantara taila Sarvanga Abhyanga (Dhanwantara Taila) + Patra
pinda sweda Ksheera vaitarana Basti Matra Basti with Pancha Tiktaka Ghrita 80ml Katilepa with Jadamayadi Churna + Dhanwantara
Taila Rasna Guggulu 2-0-2 Physiotherapy
05-07-14
PAIN REDUCED, PERSISTS ON WALKINGAPPETITE – GOODBOWEL-REGULARSLEEP- DISTURBEDSTIFFNESS- PRESENT
Kati Basti with Dhanwantara taila Sarvanga Abhyanga (Dhanwantara Taila) + Patra
pinda sweda Ksheera vaitarana Basti Katilepa with Jadamayadi Churna + Dhanwantara
Taila Rasna Guggulu 2-0-2 Physiotherapy
06-07-14
C/O PAIN WHILE WALKINGAPPETITE – GOODBOWEL-REGULARSLEEP- DISTURBEDSTIFFNESS- PRESENT
Kati Basti with Dhanwantara taila Sarvanga Abhyanga (Dhanwantara Taila) + Patra
pinda sweda Ksheera vaitarana Basti Matra Basti with Pancha Tiktaka Ghrita 80ml Katilepa with Jadamayadi Churna + Dhanwantara
Taila Rasna Guggulu 2-0-2 Physiotherapy
07-07-14
Kati basti with Dhanwantara taila Sarvanga Abhyanga (Dhanwantara Taila) + Patra
pinda sweda Matra Basti with Pancha Tiktaka Ghrita Katilepa with Jadamayadi Churna + Dhanwantara
Taila Rasna Guggulu 2-0-2 Physiotherapy
O/E PAIN ON PRESSURE. PAIN REDUCED APPETITE – GOODBOWEL-REGULARSLEEP- DISTURBEDSTIFFNESS- PRESENT
08-07-14
Treatment Chart01/0
702/0
703/0
704/0
705/0
706/0
707/0
708/0
7KATI
BASTI x x x x x x x xS.A. + B.S. x
S.A.+ PPS x x x x x x xBasti chart01/07 02/07 03/07 04/07 05/07 06/07 07/07 08/07
x x N N N N N xA A A A A A A A
DISCHARGE ADVISE Rasna Guggulu 2-2-2 Sahacharadi Kashaya 4tsf-4tsf-4tsf Dhanwantara Taila (E/A)
REVIEW AFTER 15 DAYS
Pathya
Sarpi, Swadu, amla, lavana rasa ahaara, Godhuma, Masha, Shali, Kulattha, Mamsa rasa, Gramya - audaka, mamsa, Dadim, Jambir, Draksha, etc. Daily Abhyanga
Tikta, Katu, Kashaya Rasa Ahaara atisevana, late night food,Chinta, Vegadharana, Shrama- Especially Bharadhwa, Anashana etc.
Apathya
ACCORDING TO PATIENTS SATISFACTION SCALE
PAIN C/O PAIN No C/O PainOnly O/E Pain
SLR +ve at 30 o +ve at 70o
LASEGUESSIGN +ve +ve
APPETITE Decreased Good
SLEEP Disturbed Can sleep Better
PROGNOSIS
THANK YOU
अस्थ्याश्रयाणाम् व्याधीनाम् पं��मा�णिण भेशजम् । ब्स्तयः क्षीरसप%किष कितक्त�ोपकि(ताकिन � । �. सू .२८/२८ �ेवलम् किनरुपस्तंभमादौ स्ने(ैरुपा�रेत् । �. चि�. २८/७५