DEPTT.

OF PG STUDIES IN KAYACHIKITSA,JIAR
CASE DISCUSSION ON THE TOPIC

GUIDED BY:
AMAVATA PRESENTED BY:
 Dr.Sharada (Principal and H.O.D) Dr.Rajni Rani
 Dr.Nitin Mahajan(Associate
Final Year
Professor)
 Dr. Poonam Gupta(Assistant PG Scholar
Professor)
 Dr.Sukhdev Khatotra(Assistant
Professor)
 Dr.Aabha Sharma(Assistant
Professor)
 Dr.Shrey B Shah(Assistant
Professor)
 PATIENT’S DATA
NAME – Renu Sharma
AGE- 49 Years
GENDER- Female
RELIGION-Hindu
SOCIO-ECONOMIC STATUS- Middle Class
MARITAL STATUS- Married
OCCUPATION- Housewife
ADDRESS- Akhnoor
CONSULTANT DOCTOR- DR. Sharada
 PRADHANA VEDANA

C/O - Pain in elbow, wrist, knee, shoulder,

metatarsophalangeal ,
metacarpophalangeal joints.
- Swelling in both knees, elbow, wrist
and metacarpophalangeal joints.
- Morning Stiffnes
Since 5 years
 ANUBANDHA VEDANA

C/O - Decreased Appetite

- General
weakness
- Difficulty in walking
- Limping was present while walking
Since 2 years
 VEDANA VRITTANTA
 As per the patient she was normal 5 years back.
 One day she developed pain in metacarpophalngeal
joints bilaterally.
 After a week she noticed stiffness in the fingers.
 Later pain started in the elbow joints.
 Gradually pain started in wrist, shoulder, knee and
metatarsophalangeal joints bilaterally.
 Severity of the pain started increasing and associated
with swelling.
 Later stiffness in the body during morning hours started.
 POORVA VYADHI VRITTANTA

 No history of HTN
 No history of DM
 Or any other major illness
 CHIKITSA VRITTANTA

 Firstly patient took allopathic medicine –

no relief
 Then homeopathic medicine- Moderate
relief
 Then Ayurvedic medicine from Dehradun-
no relief
 KOUTUMBIKA VRITTANTA

No one in the family is said to have similar

complaints.
 VAIYAKTIKA VRITTANTA

 DIET – Veg
 APPETITE – Decreased
 SLEEP-Normal
 MICTURITION- Normal
 BOWEL- 1 Time/Day,Normal Stool
 ADDICTION-Nil
 MENSTRUAL HISTORY-Towards menopause(at
the interval of 2-3 months for the duration of 2-3
days)
 GENERAL EXAMINATION

 BUILT - Moderate
 PALLOR- Present
 ICTERUS - Absent
 CYANOSIS- Absent
 CLUBBING- Absent
 LYMPHADENOPATHY- Absent
 EDEMA - present (in both Knees and
Metacarpophalangeal joints)
 PULSE - 92/min
 B.P - 130/90mmhg
 TEMP - 98.6 F
 RESPIRATORY RATE - 18 breath/min
 HEIGHT - 5 feet
 WEIGHT - 47 kgs
 ASHTAVIDHA PARIKSHA

Nadi – 78/min , Regular

Mutra- 4-5 times daily
Malam-Once in a day
Jihwa-Normal
Shabda- Prakrit
Sparsha- Ushna in affected areas
Drik- Prakrit
Akriti- Samanya
 DASHAVIDHA PARIKSHA
 Prakruti – Vata-Pitta
 Sara-Madhyama
 Samhanana – Madhyama
 Pramana- Ht-5feet , Wt-47 kgs
 Satmya- Madhyama
 Satva- Madhyam
 Ahara shakti :-Jarana Shakti and Abvyavarana
shakti- Madhyam
 Vyayama Shakti- Avara
 Vaya- Madhyam
 SYSTEMIC EXAMINATION
CVS-
On Auscultation S1 , S2 heard. No murmurs heard.

 CNS-
Consciousness - Fully conscious , cooperative
Orientation - well oriented to time , place , person

 RS-
Respiratory rate – 18 times/min
Normal Vesicular Breath Sound heard

PER ABDOMEN –
No Abnormality Detected on Inspection , Palpation , Percussion
Auscultation
Musculo Skeletal System-
On Inspection -
 Difficulty in extension and flexion of fingers
 Difficulty in lifting arms
 Swelling in multiple joints

On Palpation-
 Rise in temperature in joints
 Tenderness in joints
 ASSESSING PAIN USING ‘SOCRATES’
S SITE Multiple joints B/L
knees,elbow,wrist, shoulders,
metacarpophalangeal

O ONSET Rapid
C CHARACTER Symmetric pain
R RADIATING Radiating
A ASSOCIATED SYMPTOMS Stiffness, Swelling ,
tenderness
T TIMING Mostly after waking up from
the bed.
E EXACERBATING AND Morning3-4 hrs and relievied
RELIEVING FACTORS after taking pain killers

S SEVERITY 6
VISUAL ANALOGUE SCALE
 GENERAL ASSESSMENT OF
LOCOMOTOR SYSTEM (GALS)
 GAIT –On inspecting the patient there was pain on knee joints while
movements and limping was present while walking.

 ARMS - when asked to put hands behind head , it was noted that the shoulder
and elbow movements were not proper , when asked to put hands and fingers
straight , there was swelling seen in metacarpals and the grip was also not
normal.

 LEGS- When the patient lying , it was seen there was swelling and warmth
over knees , rotation and movements were not normal and crepitus recorded
on left side .On palpation over the feet there was pain over proximal
interphalangeal joint of the greater toe .

 SPINE- On inspecting the spine, it was found the curvature was normal , the
joint movements and rotation was not normal and there was tenderness.
 LOCAL EXAMINATION OF JOINTS

 Tenderness +++
 Localised swelling +++
 Temperature at site – raised
 Movement of joint – reduced and painful
 LABORATORY EXAMINATIONS

 Serum uric acid – 4.70mg/dl

 E.S.R -78mm/hr
 RA – Earlier it was said to be +ve ,but later
on it was -ve
 Hb – 9.3gm%
 NIDANA
 Ahara nidana : Excessive intake of food i.e rice in every meal,
madhura, amla and lavana rasa intake.
 Intake of food which is Guru, Ruksha, Abhishyanda and
Snigdha in properties tends to cause Amavata.
 Ajeerna Bhojana, Virudhahara these haibits of food intake is said
to cause illness
 Intake of Rice, Masha, Matsya Dadhi, and Madhura aharas all
tends to cause the illness
 Viharaja nidana : working after taking food, supression of
urges, taking bath immediately after heavy work and
supression of natural sleep.
 Mansika Nidana – Chinta, Bhaya and Vegavrodha causes Vata
Vruddhi
 PURVA RUPA

• Gatraruja (bodyache)
• Alasya ( Laziness )
• Daurbalaya (weakness)
• Gurutwa ( heaviness )
• Sandhi ruk ( Pain in joints )
• Aruchi (anorexia)
• Shopha ( Swelling )
 RUPA

Sandhishoola
Sandhishotha
Stabdhata
Sparshasahatva
Aruchi
Angamarda
 SAMPRAPTI
Hetu Sevana

Vataprakopaka hetu Sevana kaphaprakopaka hetu Sevana

Vataprakopa kaphaprakopa

Sarva sharir Sancharan through Dhamnis

Dushita Ama in all sleshma sthanas(trika,ura,amashya,hridya,sandhi)

Sandhishoola, Shotha, Stabdhata, Gauravta ,hridya daurbalya

Amavata
 SAMPRAPTI GHATAK
 Dosha -Tridosha, mainly vata and kapha
 Dushya -Rasa, Mamsa, Asthi ,Sandhi , Majja
 Agni - Jatharagni , Dhatwagni
 Srotas - Rasavaha , Asthivaha , Majjavaha Srotas
 Sroto dushti - Sanga
 Udbhava Sthana - Amashaya, Pakwashaya
 Adhisthana - Sarva sharira sandhi
 Vyakta Sthana - Sandhi
 Roga Marga - Madhyama
 Vyadhi Swabhava- Ashukari / Chirkari (mainly)
 VYAVACHEDAKA NIDANA

• Aamavata
• Sandhivata
• Vatarakta
• Kroshtuka shirasha

• These diseases usually attack in different joints of the body

and few of the lakshanas seem common to each other.
However, some symptoms are specific for each disease. The
lakshanas of Aamavata , Sandhivata , Vatarakta , kroshtuka
shirasa can be seen as :
 VYAVACHEDAKA NIDANA
Vatarakta Sandhivata Kroshtuka shirasha Amavata

At first greater toe is At first bigger joints Only knee joints are At the first smaller
effected are effected effected joints are effected

Mild fever Present Absent Absent Mild fever present

Swelling over Pain over the effected Pain and swelling Swelling over the
effected joints joint over knee joint effected joints
followed by pain followed by pain
Tridoshaja mainly Vata predominant Tridoshaja mainly Tridoshaja mainly
vatarakta vata predominant vata kapha
predominant disease predominant disease

Dushya -Rakta Rasa Rasa Rakta Rasa

Relief by blood Nil Nil No relief by blood
letting letting
 DIFFFERENTIAL DIAGNOSIS
Osteo Arthritis Gouty Arthritis Rheumatoid Arthritis
• Onset is slow • Onset is Sudden •Onset is Slow

•Family history –ve • Family history +ve •Family history +ve

• Weight bearing joints •Metatarsophalangeal joints •Polyarticular joints

involved mainly knees involved involved

•Symptoms include Pain and • Symptoms include •Symptoms include

swelling on major weight Polyarticular pain , inflammation in multiple
bearing Joints , Stiffness , swelling , inflammation and joints , morning stiffness
Crepitations , tenderness tenderness that last for around half and
hour

• Xray shows narrowing of •Serum uric acid levels •Auto immune disease , rise
joint space raised in temperature is seen and
anemia

•ESR is raised
 CRITERIA ACCORDING TO AMERICAN
RHEUMATISM ASSOCIATION 1987
1. Morning stiffness Stiffness in and around the joints lasting
one hour before maximal improvement.

2. Soft tissue swelling At least 3 or more joint areas observed by

a physician.
3. Arthritis of hand joint Arthritis of wrist , meta carpophalangeal
joint or proximal interphalangeal joint.

4. Symmetric Arthritis Simultaneously involvement of same joint

areas on both sides of body .

5. Rheumatoid nodule
6. Serum Rheumatoid Factor RA factor by any method for which the
result is positive.
7. Radiological changes Erosions or periarticular osteopenia in
hand or wrist joint.
 VYADHI VINISHCHAYA

AMAVATA- JEERNA AVASTHA

 CHIKITSA

 At initial stage of treatment foremost goal is to

relieve the intensity, severity of pain, once pain
is controlled other movements could be restored.
 In this patient,the treatment protocol was
followed to slowdown the progress of samprapti,
so that full - fledged deformities are not further
seen.
 Treatment plan Shamana Chikitsa

Shodhana Chikitsa
 SHAMANA AUSHADHI ADMINISTERED

AUSHADHI DOSE ANUPANA

1.AGNITUNDI VATI 3 T.I.D LUKEWARM WATER BEFORE FOOD

2.VISHATINDUKA VATI 2T.I.D LUKEWARM WATER AFTER FOOD

3.SINHANAD GUGGULU 3 B.D WITH R.E.KASHAYA AFTER FOOD

4.PATHYADI CHURNA 5GM B.D LUKEWARM WATER AFTER FOOD

5.RASNA ERANDADI ½ TSF 5TSF OF WATER BEFORE FOOD

KASHAYA

6.ERANDADI KWATHA 25ML B.D BEFORE FOOD

 PANCHKARMA PROCEDURES
T/T T/T DRUG USED DOSAGE DAYS
PERIOD MODALITY
FIRST BALUKA HEATED SAND 3
WEEK SWEDA DAYS
NADI SWEDA NIRGUNDI AND 2
ERAND LEAVES DAYS

SADHYO GANDHARVAHA 100ML 1

VIRECHANA STADI DAYS
TAILA+VIRECHA
N
YOGA(trivrit+danti
+triphala)
 VIRECHAN VEGA

DRUG VEGA TIMING

ADMINISTERED

10.38AM 1 11:30AM
2 1:00PM
3 1:30PM
4 2:53PM
5 4:00PM
6 5:30PM
TOTAL=6
T/T PERIOD T/T DRUG USED BASTI DAYS
MODALITY
THIRD WEEK ABHYANGA VISHAGARBHA CONT.
TAILA
NADI ERAND AND CONT.
SWEDA NIRGUNDI LEAVES

KAALA SAINDHAVADI ANUVASAN CONT.

BASTI TAILA BASTI (16
days)
ERANDAMOOLADI NIRUHA
NIRUHA BASTI BASTI
 BASTI PRATYAGAMANA KALA

BASTI DOSE PRATYAGAMANA

KALA
ANUVASAN 60ML 4HRS
BASTI
NIRUHA BASTI 600ML 6MIN
ANUVASAN 60ML 3HRS
BASTI
NIRUHA BASTI 800ML 2MIN
 PATHYA-APATHYA

 Pathya Ahara :
Puranayava , Shastika Shali , Godhuma, Mudga ,
Shali ,Kultha, Tikta, Katu rasa
Ahara ,Vastuka ,Karvelaka, gokshura,Adraka ,
Nimbapatra , Lashuna , Shunthi and Eranda taila .

 Pathya Vihar :
Ruksha sweda, Baluka potali ,Langhana , pollution free
environment and warm weather
 Apathya Ahara :
Guru ,Snigdha, sheeta ,dushta and Abhishyandhi
bhojana, masha , pishtaka, , dadhi , kshira , matsya,,
ikshu and anoopa mamsa.

 Apathya Vihara :
Divaswapna , viruddha chesta, snigdha abhyanga, ratri
jagrana , Vegavarodha.
PROPOSED LINE OF TREATMENT

SHODANA CHIKITSA
• Langhana –Laghu bhojana (mudga yusha)
• Swedana –Saindhav lavana sweda
• Deepana pachana- Sunthi –jeerak kwatha 20 ml bd
• Nitya Virechana – Eranda taila with
Gomutra/Godudgaha-15ml at bed time for 1 month
• Niruha Basti- Vaitarana basti -Chincha, Guda,
Saindhava, Gomutra, Taila-
• Anuvasana Basti- with Brihatsaindhava taila -50-100 ml
SHAMANA CHIKITSA
• Ras yoga-Amavatari Rasa-125mg BD After meal
• Chitrakadi vati-1BD After meal
• Triphaladi Lauha- 2tab BD Before meal
Sinhanada Guggulu- 2BD After meal
Rasnasaptaka Kwatha- 20 ml BD after meal
Lepa-Nirgundi patra lepa L/A
Shunthi sadhita jala
 OBSERVATIONS

After the BALUKA SWEDA patient’s pain

aggravated and was unable to sleep.
After NADI SWEDA patient got relief.
After ANUVASAN BASTI patient felt better and the
pain was reduced.
But, after NIRUHA BASTI patient complained that
the pain was aggravated
When the dose of NIRUHABASTI was increased to
800ml patient complained of loose motions(4-5
times) in a day.
 Patient was unable to come next day for ANUVASAN
BASTI because of weakness by loose motion.
But the pain was reduced and she felt better.
Treatment is still continued….
FOR YOUR ATTENTION