Uncategorized / Dixit Ayur Care
Signs and symptoms of Utthana Vatarakta For Gambhira Vatarakta: Introduction:
Etiological factors:
• Excessive intake of salty, sour, spicy and alkalis food, also dry, unctuous and ushna content food
• Consumption of dry leafy vegetables and flesh of aquatic animals
• Excessive consumption of alcohol
• Adhyashana – Eating before the complete digestion of previous food
• Vishamashana – irregular meals
Viharajam:
• Sleeping during day time
• Lack of physical exercise and excessive physical exercise
• Excessive sexual indulgence
• Trauma
• Keeping late hours or not sleeping during nights
• Walking long distances
• Suppression of natural urges
• Fasting
Seasonal and climatic factors
• Cold
• Cloudy & windy day
• Winter and rainy seasons Types of Vatarakta
➢ Gambhira Vatarakta : in which the disease is situated in the remaining dhatus of shakhas.
• Itching sensation
• Burning sensation
• Pain and swelling
• Pricking pain
• Throbbing pain
• Slight flexure of the joint
• Red and bluish red discoloration of skin over joints
Signs and symptoms of Gambhira Vatarakta
• Pain in the joints is severe that felt in the Uttana veriety
• Swelling and stiffness of joints
• Swelling like nodules which are hard and painful, covered by dark or copper colored skin. There is a burning sensation, pricking pain, throbbing sensation and these swellings are likely to inflame and suppurate also Treatment:
Snehanam, Swedanam, Siravyadha, Upanaha and Samshamana Chikitsa are advocated
Snehanam, Swedanam, Siravyadha, Basti and Samshamana Chikitsa advocated.Case report:
This study is on a female patient aged about 59 years suffering from severe pain and stiffness of the both knee, (left knee more than right). Patient had shown Orthopaedician for the same, and was advised for surgery in 2011. She did not undergo surgery and underwent Ayurvedic treatment for the Osteoarthritis of knee in the same year. Post Ayurvedic treatment she was able to walk, perform her daily activities without any difficulties till 2016. Finally in 2016, (her age 64 old), while walking she slipped in park, and then suddenly developed severe pain, swelling and restricted movement of the knee joint. All the conservative line of treatment failed to reverse the condition. So patient underwent Total Knee Replacement on 23/12/16. Image 1 & 2: Shows Janu Sandhi Lepam and Janu Basthi
Image 3:Shows Sthanika Janu Patra Pinda Sweda.
Image 4: x ray of left knee AP & Lateral view before surgery.
Image 5: x ray left knee AP & Lateral view after surgery.
Image 6: Shows Degenerated articular cartilage of left knee.
Image 7: Shows left knee with prosthesis.
2. Ch.321.15th edition 1987. Harrison’s Principles of Internal Medicine. 3. Orthoinfo, The American Academy of Orthopaedic Surgeons, Total Knee Replacement, page4/11. 4. Durability of Knee Implants: How Long Do Knee Replacements Last?, BoneSmart, Knee Replacement & Hip Replacement Patient Advocacy & Online Community.ABSTRACT
So Ayurvedic treatment postponed her total knee replacement surgery for about 5 years. With this postponement, she would be able to avoid revision Total Knee Replacement surgery in future.
KEYWORDS: Osteoarthritis of knee, TKR, Ayurvedic treatment, Replacement surgery.INTRODUCTION
In vridhavastha all dhatus undergo kshaya, thus leading to vata prakopa and making the individual prone to many diseases. Among them, Sandhigata vata stands top in the list. The incidence of Osteoarthritis in India is a high as 12%. It is estimated that approximately four out of 100 people are affected by it. Osteoarthritis is the most common articular disorder which begins asymptomatically in the 2nd and 3rd decades and is extremely common by the age 70. Almost all persons by the age of 40 have some pathologic change in weight bearing joints2, 25% female & 16% males have symptomatic Osteoarthritis.
Each and every system of medicine has its own limitation in managing this disease. They can provide either conservative or surgical treatment and are highly symptomatic and with troublesome side effects. Whereas such type of conditions can be better treated by the management and procedures mentioned in the Ayurvedic classics. So with the help of Ayurveda line of management, one can postpone the Total Knee Replacement Surgery.CASE REPORT
DISCUSSION
When there is severe knee pain or stiffness that limits the everyday activities, including walking, climbing stairs, and getting in and out of chairs.
One finds it hard to walk more than a few blocks without significant pain and may need to use a cane or walker.
Moderate to severe knee pain while resting, either day or night. Chronic knee inflammation and swelling that does not improve with rest or medication.
Knee deformity a bowing in or out of the knee.
Failure to substantially improve with other conservative treatments3.
Knee Prosthesis / implant
Knee replacements eventually wear out. Unfortunately, an artificial knee is not as durable as one’s own knee. Because the knee replacement implants are made of metal and plastic, over time, these materials begin to wear, just like the rubber on the car tires.
In 1960s and 1970s, most believed that total knee implants would last about 10 years. This was one of the reasons that knee replacement procedures were confined to older patients. As time passed, it became apparent that the great majority of knee implants would last approximately 20 years and even longer. Improvements in surgical techniques, materials, implant designs and fixations have escalated over the past two decades resulting in an increased durability of knee implants well beyond even 20 years4.
According to the manufacture of prosthesis there are two varieties, Indian prosthesis and western prosthesis. Durability of the implant is in accordance to the manufacturer. The Indian prosthesis is valid for 8 to 10 years and western / imported prosthesis is valid for 10 to 12 years. This should be kept in mind before doing the surgery. Considering this case, if Total Knee Replacement surgery was done in 2011, then she would have had to undergo revision replacement surgery in 2022 that is at the age of 71 years. Now that her age is 64 year, and surgery is done with imported prosthesis, it will be valid till she will be 76 years or even more. Here, if we compare her activity at ages 71 and 76, at 76 years less activity is done and that will promote prosthesis to be valid for longer, and can prevent revision replacement surgery for life time. So if we postpone Total Knee Replacement surgery as much as possible it will help to avoid revision replacement surgery.
In this case with Ayurvedic line of treatment for Osteoarthritis of Knee we could postpone the surgery for about 5 years, and also might be able to prevent revision replacement surgery for life time. Thus, Ayurvedic treatment has an important role in postponement of Total Knee Replacement surgery.CONCLUSION
REFERENCES
After confirming that the fracture healed well, the cast was removed and patient was advised to mobilize the distal interphalengeal joint of the left thumb. It was observed that the healing occurred at a good rate and also movements were restored faster. Abha guggulu, a medicine described in Bhaishajya Ratnavali of Govind Das in the chapter Bhagna chikitsa adhyaya. It is said to speed up the fracture healing. Present study is carried out to confirm and re- establish the efficacy of Abha guggulu in the management of Angushtha Asthi Bhagna. The fracture was reduced anatomically and cast was applied to the region of hand and thumb for immobilization. The patient was advised to take Abha guggulu two tablets twice daily after food with milk during the treatment for three weeks. The follow –ups to observe the healing of the fracture was clinically and radiologically done at an interval 7days till the 21st day (After application of cast). After confirming that the fracture had healed well, the cast was removed on the 21st day. Then, patient was advised to mobilize the distal interphalengeal joint of the left thumb. The process of fracture healing to regain the usual structure pertaining to it, usually takes about six weeks. In this case the fracture healed within three weeks; with only Abha guggulu as the oral medication. Image 1&2. X-ray left thumb AP & oblique view before treatment
Image 3&4. X-ray left thumb AP & oblique view after 7th day of treatment
Image 5&6. X-ray left thumb AP & oblique view after 14th day of treatment
Image 7&8. X-ray left thumb AP & Lateral view after 21st day of treatment
Image 9&10. X-ray left thumb AP & Lateral view after treatment
Image 11, 12, 13 & 14. Images of left thumb after treatment
1. It accelerates the fracture healing Thus, this medicine enhances the healing power. So, it is highly recommended in the treatment of fractures. More than 200-300 of angulation in the latral plane produces an IP joint extensor lag thus one has to undertake reduction in these patients. Less than 200 of angulations in the lateral plane is acceptable. Transverse fractures usually are stable with closed reduction. Displaced fracture of proximal phalanx may require operative intervention. Displaced spiral or oblique fracture may be treated either with inter fragmentary screws (ORIF) or percutaneous pinning with kirschner wires (K-Wire). Another option is intra medulary kischner wire insertion, retrograde through the distal aspect of the thumb across the thumb IP joint3. In this case, though the fracture was comminuted intra-articular fracture, displaced fracture was reduced anatomically and cast was applied for three weeks to immobilize the thumb. Patient was advised to take Abha guggulu two tablets twice daily after food with milk during treatment. Fractured site was observed clinically and Radiologically at an interval 7days to till 21st day (After application of cast). Then the patient was advised to mobilize the distal interphalengeal joint of thumb. During each observation, an angle of 50 in the lateral plane was seen which is within acceptable range. The conservative oral medication used i.e. Abha guggulu, a medicine described in Bhaisjyaratnavali of Govind Das in the chapter Bhagna chikitsa adhyaya was selected for the management. Abha guggulu contains following ingredients4, 1. Babula twak (Acacsia Arabika)- 1 part Dose: 3 grams, in divided dose. The administration of Abha guggulu was done as described in Bhaisajyaratnavali. It acts as a natural bone healing agent with anti inflammatory and analgesic effects. Owing to the miraculous healing abilities of this medicine “Abha Guggulu”, it can be tried in most fracture cases, either as the main line of management or as supplement during follow-ups, irrespective of closed or open reduction (with/without internal fixation) of the fractures. 2. Abha Guggulu ingredients, brnrfits, uses and side effects by Dr Jagadev Singh. 3. Thumb fracture and dislocation treatment and management Donald.R.Laup. et. All. 4. Baishajyaratnavali of Shri Govind Das, by Bhisagratna Shri Brahmashankar Mishra, edited by Kaviraj Ambikadatta Shastri, published by Chaukamba Prakashana, Varanasi. ABSTRACT
The probable mode of action of the medicine may be therefore understood by its ability to speed up the fracture healing, its ability to facilitate the repair of bone fracture by hastening the proliferative physiological process in the body and its ability to increase the rate of regeneration of the bone. Thus, this can be recommended for the treatment of other fractures. INTRODUCTION
CASE REPORT
2. It is likely to facilitate the repair of fracture by hastening the proliferative physiological process in the body.
3. In addition, it also improves the appetite, absorption of nutrients from the food, and bio-availability of the minerals which are beneficial in bone healing2.DISCUSSION
2. Triphala – 1 part
3. Trikatu – 1 part
4. Guggulu (Commiphora mukul)- 3 parts
5. Ghrita – QS
Its anti osteoporotic and anti arthritic effects can protect the bones against several diseases. Usually fracture healing process will take about 6 weeks. In this case the fracture healed within three weeks with the help of Abha gugggulu as oral medication. CONCLUSION
REFERENCES
