🔘 Typhoid Fever (Antarika Jwara)

TYPHOID FEVER (ANTRIKA JWARA):-

💫 ACCORDING TO MODERN:- TYPHOID

👉🏻 Introduction:-

- Typhoid fever is due to systemic infection mainly by Salmonella typhii.

- The disease is clinically characterised by a typical continuous fever for 2-3 weeks.

- In Ayurveda it is correlated with  'Enteric fever, आन्त्रिक ज्वर or मन्थर ज्वर.

👉🏻 Causitive organism:-

- Salmonella typhii (Gram -ve, anaerobic bacilli)

👉🏻 Incubation period:-

- 10-14 days

👉🏻 Source of infection:-

√ The primary source of infection are:-

- Contaminated food, milk and water

- Pollution of drinking water supplies

- Open air defecation and urination

- Low standards of food

- Low personal hygiene and health ignorance

√ Transmission :- Feco-oral route

√ Carrier :- House flies

👉🏻 Risk factors:- 

- Typhoid fever is a serious worldwide threat and affects about 27 million or more people each year.

- The disease is established in India, Southeast Asia, Africa, South America and many other areas.

- Worldwide, children are at greatest risk of getting the disease, although they generally have milder symptoms than adults do.

√ If you live in a country where typhoid fever is rare, you're at increased risk if you:-

- Work in or travel to areas where typhoid fever is established

- Work as a clinical microbiologist handling Salmonella typhi bacteria

- Have close contact with someone who is infected or has recently been infected with typhoid fever

- Drink water polluted by sewage that contains Salmonella typhi.

👉🏻 Pathogenesis:-

- Due to contaminated food, milk and water, salmonella typhi bacilli enters and reaches to the intestine.

- In intestine, it penetrate the mucosa of intestine and reaches to the intestinal lymphatic through peyer's patches.

- From peyer's patches it enters in blood stream.

- In blood stream, the bacteria is disseminated throughout body via blood and intracellular multiplication occurs.

- The organism enters intro the blood stream and producing bacteremia when all organs are repeatedly exposed.

- It affect different body organs.

• Brain:- Encephalitis

• Heart:- Cardiac failure

• Lungs:- Pneumonia, Bronchitis

• Liver:- Hepatomegaly

- 3rd week is most critical phase.

👉🏻 Clinical features:-

✓ 1st week (Prodromal stage):-

- Mild fever (99-100° F)

- Malaise

- Headache

- Generalised bodyache

- Cough

- Sore throat

- Often with abdominal pain

- Constipation

- Stepladder fashion (pattern) fever

- Relative lynohocytosis with leucopenia.

✓ 2nd week:-

- High grade fever (Temperature gradually rise upto 107° F)

- Fever reaches at peak and patient looks toxic appearing exhausted.

- Marked abdominal tenderness

- Mild hepatospleenomegaly

- Relative bradycardia

- Diarrhoea:- Pea soup like stool

- Red rose spots or red spots may seen on chest and abdomen, disappeared within 2-3 days

- Constipation:- Caused by swelling on lymphoid tissue around ileocaecal junction.

✓ 3rd week (Stage of complication):-

- Intestinal perforation and haemorrhage

- Meningitis

- Pneumonia, bronchitis

- Cardiac failure

- Encephalitis

👉🏻 Diagnosis:-

- CBC:- Leucopenia - 1st week

- Antigen:- WIDAL test - 2nd week

- WIDAL test detects O and H Antigen of Salmonella typhii.

- Culture:- Stool, Urine - 3rd and 4th week

- Typhi DOT:- More accurate than WIDAL, shows early result on 2nd or 3rd day

👉🏻 Diffrential diagnosis:-

- Pneumonia

- Dengue fever

- Malaria

- Cerebrospinal fever

- Tuberculosis

- Relapsing fever

👉🏻 Management:-

1) For prevention:-

- Providing clean water to public

- Proper excreta disposal

- Protection of water from contamination

2) For treatment:-

- Bed rest

- Fluid management:- Oral / IV

- Antibiotics

- Steroid therapy

- Surgical intervention:- 3-5%

✓ Antibiotics:-

1. Chloramphenicol:- 3-4 gm/day 

(Continues with 2gm/day for 18 days)

2. Amoxicillin:- 4-6 gm/day (In 4 divided doses)

3. Ciprofloxacin:-:500-750mg BD

4. Ampicillin

5. Ceftriaxone:- 75 mg/kg/day

6. Cefexine:- 400mg BD

7. Azythromycin:- 1gm, once in a day for 5-7 days

✓ Steroid:-

1. Dexamethasone:- 1mg/kg every 6hrs

💫 ACCORDING TO AYURVEDA:- ANTRIKA JWARA Or MANTHARA JWARA

👉🏻 Introduction:-

- There are presence of Pidakas or manthari in this type of jwara, hence named as Manthara jwara.

- It is also known as Antrika Jwara, because this fever widely affect intestine.

- In this type of Jwara, all tridosha lakshana are present. 

- In modern it is correlated with Typhoid fever.

👉🏻 Samanya Nidana:-

• "बह्वध्व क्लान्ततनवस्तथाऽनश्नकर्षिताः। 

दुर्गन्धिपूर्णभूमौ वा नित्यमेव निवासिनः॥

आंत्रिककेत्यभिधानं चापरमस्यैव कथ्यते। 

सामस्य कारणं प्रोक्तं विशिष्टं तु निगद्यते॥"

(मा.नि. परि. मंथर ज्वर 1-4)

- Ati margagamana

- Ati upavasa

- Durgandha purna, dushita sthana nivasa

- Intake of food and drinks contaminated with dushita mala etc.

👉🏻 Vishista Nidana:-

- Agantuja karana:- Bacterial infection

👉🏻 Samprapti:-

• कीटाणवो बेसिलस टाइफोसस नामकाः । 

दण्डाकाराः कृतावासा रक्ते मूत्राशये मले।

स्वेदे पित्ताशये प्लीह्नि पिडिकास्वान्त्रिकव्रणे। 

जनयन्ति नृणां देहे ज्वरं प्रोक्तं विशेषतः॥"

(मा.नि.परि.)

• मलमूत्रस्वेदजात दोष संसर्ग दूषिते। 

भक्ष्यपेयादिभिद्रव्यैर्नाना संक्रमणकारणैः ॥

लक्ष्येत यदि रक्तस्थस्रावो भिन्नान्त्रता तदा॥" 

(मा.नि.परि.मन्थर ज्वर 7/11)

- Due to nidana sevana and Bacterial infection (Jivanu sankramana) jivanu (bacteria) enters into antra (intestine).

- After entering, it produces swelling in sntra granthis.

- Due to swelling doshas, rasa and rakta dhatu exists in intestine are aggravated and producing kshata (injury) to the intestine.

- After some time kshata (injury) increases and produces chhidra in antra (perforation of intestine) and causes continuous blood flow in intestine.

- It creates Manthara (antrika) jwara, and this condition is Asadhya when antra is perforated.

👉🏻 Samprapti ghataka:-

- Dosha:- Tridosha

- Dushya:- Rasa, Rakta

- Srotasa:- Annavaha, Rasavaha

- Srotodushti:- Sanga

- Adhisthana:- Antra

- Swabhava:- Chirakari

- Sadhyasadhyatva:- Kruchrasadhya

👉🏻 Purvaroopa:-

• शिरोव्यथा स्यादरुचिस्ततोऽरतितमोऽवसादौऽपि च बिड्बद्धता।

सप्ताहपर्यन्तमिति स्फुटास्फुटं ज्वरेऽग्ररुपं नियंत सदाऽऽत्रिके॥

 (मा.नि.परि.)

- Shirovyatha (headache)

- Aruchi (anorexia)

- Restlessness

- Darkness in front of eyes

- Depression

- Malabaddhata (constipation)

👉🏻 Lakshana (Clinical features):-

• तदग्ररुपं च ततोऽष्मेऽहनि भवेदभिव्यक्तिमवाप्यलक्षणम्।

ज्वरोऽथ नित्यं क्रमश: प्रवर्द्धते सहापरैमर्थरेकऽत्र लक्षणैः ।।

भवेत्तदा तु ज्वरजाप सीमा चतुर्भुतं पञ्चमुतं शतं वा॥

उपद्रवसमाधिक्यं सप्ताहितं सेविन:।

(मा.नि. परिशिष्ट)

- It is similar to Pittolbana Sannipataja jwara.

- It is explained by Acharya Gananath sena in Siddhanta nidana, which are similar to Typhoid fever in modern.

✓ 1st week:-

- Jwaradhikya (Hyperpyrexia)

- Pleehavriddhi (Spleenomegaly)

- Jihva malina evum rakta varna (Tongue coated and reddish)

- Adhmana (Flatulence)

- Vibandha (Constipation)

- Red spots on neck, abdomen and chest area

✓ 2nd week:-

- Jwaradhikya (Hyperpyrexia)

- Pralapa (Delirium)

- Tandra (Drowsiness)

- Kasa (Cough)

- Furrowed tongue, dry with reddish coloration

- Durbalata (weakness)

- Mukhashosha (Dryness of mouth)

- Arati (Restlessness)

- Adhmana (Flatulence)

- Dicrotic pulse

- Blood mixed stool

👉🏻 Asadhya Lakshana:-

- Ati raktasrava (Excessive bleeding)

- Increased pulse rate

- Acute pain in abdomen

- Tendency of raised body temperature during morning hours and night

- Generalized peritonitis

- Excessive weakness

- Tremora in hands and feet

- Intestinal bleeding

👉🏻 Upadrava:-

- Antra kshaya (Intestinal tuberculosis)

- Vishaktata (Toxaemia)

- Raktasrava (Haemorrhage)

- Peritonitis

- Antra vidarana (Intestinal perforation)

- Vrukka Shopha (Nephritis)

👉🏻 Chikitsa sutra:-

- Firstly Langhana should be done for dosha pachana.

- In Sannipataja jwara, when there is ugra vega of jwara; first treat pitta then treat kapha and vata dosha respectively.

• कफस्थानानुपूा तु सन्निपात ज्वरं जयेत्।" (च.चि. 3)

- In lakshana Manthara jwara is similar to Sannipataja jwara so its treatment should be done according to Kapha sthana

- Firstly done Kapha and Amadosha pachanaz then treat aggravated vata and pitta.

- In case of constipation sramsana aushadha should be used for koshtha shodhana according to Bala of rogi.

- In antra pradhaha sheeta, tikta and madhura rasatmaka dravya should be used.

- If Trishna present, then use Shadangapaniya.

- Pathya Palana

- Pushtikaraka, balaprada and supachya drava ahara should be taken.

👉🏻 Chikitsa:-

1. Samshodhana Chikitsa:-

√ Same as Sannipataja jwara treatment:- 

 a) Langhana

 b) Swedana :- Baluka, Sandhava sweda, Snigdha sweda

 c) Shirovirechana:-

- Trikatu churna pradhamana nasya

- Kataphala twak churna pradhamana nasya

- Shwara kuthara rasa nasya

 d) Anjana prayoga

2. Samshamana Chikitsa:-

a) Rasa / Bhasma / Pishti:-

• Matra:- 125-250 mg

• Anupana:- Ushnodaka / Madhu

- Sutashekhara rasa

- Pravala pamchamrita

- Karpura rasa

- Ramabana rasa

- Yogendra rasa

- Bola parpati

- Navayasa lauha

 b) Vati:-

• Matra:- 250-500 mg

• Anupana:- Ushna jala

- Madhurantaka vati

- Saubhagya vati

- Samshamani vati

c) Churna:-

• Matra:- 3-6 gm

• Anupana:- Koshna jala

- Sitopaladi churna

- Yavani shadava churna

d) Kwatha / Asava / Arishta:-

• Matra:- 10-20 ml

• Anupana:- Jala

- Chandanadi kwatha

- Mustadi kwatha

- Kiratadi kwatha

- Chandana kiratadi kwatha

- Lohasava

- Draksharishta

e) Anya yogas:-

- Lavanga:- 7 

- Jatiphala:- 2gm

- Sunthi:- 2gm

- Ela:- 2

- Tulasi:- 5 patra

• These all should be added with 400 ml water and boiled until 50 ml is remained and given with madhu.

👉🏻 Pathya-Apathya :-

1) Pathya:-

- Ahara:- 

Kurchika, dadima, draksha, munnaka, godugdha, mudga, yava manda, laja manda, Purana shali, peya, vilepi, patola, lavangodaka, Shadangapaniya etc.

- Vihara :- 

Langhana, Vishrama, avoid vega dharana

2) Apathya:- 

- Ahara :- 

Guru, Abhishyandi, tikshna bhojana, pizza, burger, samosa, kachori, halva, malpuva etc.

- Vihara :- 

Adhyashana, Vyayama, Vyavaya, Shrama, Chinta, Jagarana etc.

🔘 Hysterectomy

Hysterectomy :-

Introduction:

• Hysterectomy is an operation in which the uterus is removed.

• The cervix, ovaries and/or fallopian tubes might also be removed.

• It may be done abdominally or vaginally.                                

• Vaginal hysterectomy usually done for some cases of uterine prolapse.

Indications:

• Fibroids

• Endometriosis

• Uterine prolapse

• Cancer of the uterus, cervix, or ovaries

• Vaginal bleeding, dub 20%

• Uncontrollable PPH

• Adenomyosis

• Rupture or injury to uterus

• Vaginal bleeding

• Pelvic inflammatory disease

• Severe pelvic adhesions

• Bilateral ovarian pathology

• Pelvic congestion syndrome

• Uterine anomalies

• Recurrent intrauterine polyps

• Uterine perforation

• Mentally retarded patient with no hygiene control

• Pregnancy 

• Placenta increta, percreta, or acreta

• Atonic uterus 

• Uterine perforation

Types/routes for Hysterectomy:

1) Abdominal hysterectomy(AH):

 Total

 Subtotal

 Radical

2) Vaginal Hysterectomy (VH)

 Laparoscopically-Assisted Vaginal (LAVH)

 Totally Laparoscopic Hysterectomy

3) Laparoscopic Hysterectomy

4) Caesarean Hysterectomy

1) Abdominal Hysterectomy:

Patient Preparation:

• For patients at risk, thromboembolism prophylaxis is begun preoperatively, or pneumatic compression boots are applied in the procedure

• Prophylactic antibiotic agent should be given as a single dose 30 minutes prior to the incision.

Incision Choice:

• Transverse or Vertical

• Need for exploration of The Upper abdomen

• Size of the Uterus

• Presence of prior incisions

• Desired cosmetic results

Procedure:

• Hysterectomy through abdomen, an incision is given over the lower abdominal skin. 

• The incision is about 5 inches, and it may be given vertically or horizontally. 

• Abdominal muscles, fascia and blood vessels are carefully separated. 

• The ligaments holding the uterus are cut. 

• Care is taken to avoid damage to adjoining healthy organs, nerves and blood vessels.

• The uterus is removed. Muscles and other organs are positioned as before and the surgical incision is closed with a suitable, medically designed thread. 

• For enlarged uterus, this route of hysterectomy is more preferred, as the surgical incision is big enough to remove the uterus without much hassles.

Post-operative care:

• Not necessary to leave a bladder catheter in place postoperatively

• IV fluids for the first 24 hours to ensure that the patient remains well hydrated

• Early feeding of a regular diet can stimulate the bowel and decrease the length of hospitalization

• Deep breathing to prevent atelectasis

• Ambulation is encouraged

• Intermittent compression boots

• Adequate control of postoperative pain

Advantages of subtotal Hysterectomy:

• It is easier and quicker than total hysterectomy 

• There is less danger of injuring the bladder. 

• Less danger of pelvic infection. 

• The cervix left to act as a support for vagina. 

• The cervix discharge lubricates the vagina

Advantages of total Hysterectomy:

• Provides better drainage of the operation area. 

• If the cervix is lacerated or infected, the source of irritant discharge is removed.

Postoperative complications of abdominal Hysterectomy:

• Shock. 

• Hemorrhage can cause anemia 

• Infection, wound dehiscence 

• Intestinal complications as acute gastric dilatation

• Pulmonary complications e.g. bronchitis, pneumonia, pulmonary collapse. 

• Venous thrombosis (DVT, SVT.) 

• Post-operative anesthetic complications e.g. cyanosis, vomiting. 

• Remote complications e.g. vaginal discharge (infection), vaginal vault prolapse, low back ache

• Menopausal symptoms e.g. sadness, irritability (in younger female). depression or sexual dysfunction 

• Incisional hernia

2) Vaginal Hysterectomy:

Introduction:

• The uterus is removed through the vagina. 

• Less invasive than abdominal hysterectomy 

• Incision site at inner vagina 

• Hospital stay 1-3 days 

• Recovery time 4-6 weeks 

• Cervix cannot be preserved

Indications of vaginal Hysterectomy:

• Some cases of uterine prolapse

• Some cases of dysfunctional uterine bleeding

• Some cases of cancer body

Vaginal Hysterectomy procedure:

• A prophylactic antibiotic agent should be given as a single dose 30 Minutes prior to the first incision for vaginal hysterectomy – cefazolin, Cefoxitin, and cefuroxime – metronidazole (500 mg IV) may be used in patients with cephalosporin allergies 

• A course of appropriate preoperative antibiotics in women with bacterial Vaginosis can reduce the frequency of cuff infection

• Patient positioning - dorsal lithotomy 

• Bimanual pelvic examination is performed – assess uterine mobility and descent – confirm that no unsuspected adnexal pathology is found 

• A bladder catheter may be inserted – some surgeons believe that a distended bladder helps with recognition of a bladder injury and thus do not use a catheter.

Advantages of vaginal Hysterectomy:

• Absence of an abdominal scar. 

• Lower incidence of intestinal complication

• An associated genital prolapse can be treated at the same time

Disadvantages of vaginal Hysterectomy:

• It is unsafe and difficult in the presence of pelvic adhesions

• The ovaries cannot be removed in some cases

• It cannot be done if the size of the uterus is larger than a 14 weeks pregnant uterus.

3) Laparoscopic Hysterectomy:

• The uterus is removed in sections through small incisions using a

• Laparoscope 

• Hospital stay 1-3 days 

• Recover time is 4-6 weeks 

• Longer duration of procedure 

• Requires greater surgical expertise 

• Urinary tract injuries are more likely 

• Fewer abdominal wall infections or febrile episodes 

• Less blood loss

Risks and side effects:

• Earlier onset of menopause 

• Greater risk of cardiovascular disease 

• Increased chance of osteoporosis and bone fractures 

• Uncontrolled urination 

• Reduced libido 

• Vaginal dryness

4) Caesarean Hysterectomy:

After Hysterectomy:

• Most women don’t need pap smears except those who had previous CIN >2 ,ca cervix or ca corpus uterus 

• Oestrogen only HRT (ERT) is an option  except when BSO was performed for oestrogen responsive cancer or severe endometriosis 

• Symptoms control in these patients can be a real problem 

• Current research suggests that ERT has many benefits and few risks.

🔘 Astha Vidha Shastra Karma

ASHTA VIDHA SHASTRA KARMA: 

👉🏻 Introduction:-

तच्चशस्त्रकर्माष्टविधं तद्यथा छेद्यं, भेद्यं, लेख्यं, वेध्यम्, एष्यम्, आहार्य, विस्राव्यं, सीव्यमिति ।

(Su. su. 5/3-4)

The surgical activities (sastra karmas) are of eight kinds viz, Chedya (excision), bhedya (incision), lekhya (scraping), vedhya (puncturing), eshya(probing), aharya (extracting), visravya (draining) and seevya (suturing).

1. Chedana:- excision-ectomy

2. Bhedana:- incision-otomy

3. Lekhana:- scraping

4.:Eshana:- probing

5. Aaharana:- extraction

6. Vedhana:- Puncturing-ostomy

7. Visravana:- draining

8. Seevana:- Suturing 

9. Paatana:- Breaking

10. Pracchana:-multiple incisions

11. Utpaatana:- elevation and extraction

12. Kuttana:- multiple pricking

13. Mandhana:- churning and drilling

14. Grahana:- catching

15. Dahana:- cauterization

👉🏻 Sastra karmas according to different Acharyas:-

✓ According to Sushruta--

1. Chhedana

2. Bhedana

3. Lekhana

4. Eshana

5. Aharana

6. Vedhana

7. Visravana

8. Seevana

✓ According to Charaka:-

1. Paatana

2. Vyadhana

3. Chhedana

4. Lekhana

5. Pracchana

6. Seevana

✓ According to Vagbhatta:-

1 to 8. All the 8 of Sushruta

9. Uthpaatana

10. Kuttana

11. Mandhana

12. Grahana

13. Dahana

1) Chhedana (Excision):-

👉🏻 Indications:

• छेद्या भगन्दरा ग्रन्थिः श्लैष्मिकस्तिलकालकः |

व्रणवमार्बुदान्यशश्चर्मकीलोऽस्थिमांसगम् ||

शल्यं जतुमणिर्माससङ्घातो गलशुण्डिको |

स्नायुमाससिराकोथो वल्मीकं शतपोनकः ||

अध्रुषश्चोपदंशाश्च मांसकन्द्यधिमांसकः ।

(Su. su.25/4)

• The rogas that require excision (chedhana karma) are:-

- Bhagandhara (Fistula ano) 

- Kapha grandhi (lymphadenitis)

- Tilakalam (black mole) 

- Wound (ulcers)

- Arbudas of the eyelids (benign tumours)

- Haemorrhoids (piles) warts of the skin

- Foreign body lodged in the bones and muscles

- Jatumani (birth mark pigmented patch/elevated mole)

- Mamsa sanghata, (benign tumor of palate fibromyoma)

- Galasundika (enlargement of uvula/fibrosed tonsils)

- Valtmeekam (actinomycosis or madhura foot)

- Sataponaka (a variety of rectal fistula/multiple fistula)

- Adhrusa, upadamsa (lympho granuloma venerium or inguinal lymphadenitis due to syphilis or gonorrhoca)

- Mamsasksnda adimamsa (muscular hypertrophy, myomas, gingivitis) - these diseases require excision (cutting and complete removal).

 2) Bhedana (Incision):- 

👉🏻 Indications:-

•भेद्या विद्रधयोऽन्यत्र सर्वजाद्ग्रन्थयस्त्रयः |

आदितो ये विसपश्चि वृद्धयः सविदारिकाः |

प्रमेहपिडकाः शोफः स्तनरोगोऽवमन्थकाः |

कुम्भीकानुशयी नाड्यो वृन्दौ पुष्करिकाऽलजी |

प्रायशः क्षुद्ररोगाश्च पुप्पुटौ तालुदन्तजौ |

तुण्डिकेरी गिलायुश्च पूर्वं ये च पाकिणः |

बस्तिस्तथाऽश्मरीहेतोर्मेदोजा ये च केचन ।।

(Su. su.25/6-8)

- All vidrathi (abscess) except that produced by tridosha

- Three kinds of granthi from the beginning (vataja, pittaja and kaphaja)

- The first three kinds of visarpa (erysipelas-vataja, pittaja, kaphaja)

- Antravrudhi (enlargement of scrotum-hernia),

- Vidarika (pustule in groin and axilla)

- Diabetic eruptions, diabetic carbuncle,Shopha

- Diseases of the breasts,

- Avamanthaka (a disease of the penis, suppurated veneral warts)

- Kumbhika vartma (follicular conjunctivitis/ sty)

- Anusayi (abscess of the foot)

- Nadee vrana (Sinus ulcer)

- The two kinds of vrindha (vrindh and ekavrindha- small tumour of throat)

- Pushkarika (adisease of the penis)

- Alaji (inflammation of penis)

- Generally all kshudra rogas (minor disease)

- Talupupputa (tumor of the palate)

- Danta pupputa (gingivitis)

- Tundikeri (tonsilitis)

- Gilayu (tonsillar abscess)

- Those diseases which suppurate mentioned earlier such as fistula in ano etc. under chedya rogas)

- The urinary bladder due to formation of calculus

and Some diseases produced by fat tissue

👉🏻 Incision planning-General Principles:-

1. An incision should always be planned way that it gives ready and direct access to the part to be operated upon.

2. Incision planed should allow for any change in the scope of surgery i.e. extensible in a direction which would allow for any changes in the plan of operation.

3. Cosmetically good incision is another hallmark of good surgery.

👉🏻 Method of making Good Incision:-

1. Incision should be made clearly with firm and controlled stroke of knife. The knife should be kept perpendicular to the skin

2. Incision should be made with a single firm stroke. Repeated strokes usually give rise to an incision with jagged margins.

3. If skin is loose over the operative area then it should be stretche in turn by traction as the incision is made.

4. Healing is usually good if the incision is given parallel to the crease line and across the line of pull of underlying muscles.

👉🏻 Qualities of Incision:-

- Adequate in length

- Extensible

- Regular & uniformly cut edges

- All layers cleanly incised

- Independent

👉🏻 Correct technique:-

- First decide the line & depth wanted

- Always use sharp knife

- Use the belly of the knife, except if a short stab wound is required

- Cut at one stroke

- Control bleeding

- Straight pointed blade is used only to make small incisions

- Curved blade-designed to allow smooth incision

- For minor surgical work a No: 11 blades will be ideal

- For finer work the small No 15 blades may be used.

- The physician should cut with his instrument well sharpened, should anuloma direction, avoiding vulnerable parts etc. deep enough till the pus is seen.

- The incision upto two angula (4 cm Aprox.)

- If need more space, do another insicion near 2 to 3 angulas

👉🏻 Instruments used in Incision Making:-

- Scalpel is the most important instrument.

- There are two types:

(a) Scalpel handle combined with blade

(b) Scalpel handles with detachable blade

✓ Different Methods of Holding a Scalpel:-

(1) Dinner knife position:-

- This position is used while making a long incision and when separating muscle from bone.

(2) Writing or Dissecting or Pen holding position:-

- This position is used while doing delicate and fine dissection such as during separation of a delicate structure like artery, vein or nerve or which separating the growth from surrounding

tissues.

(3) Fiddle-bow position:-

- This position is used to make incisions with minimal pressure over delicate structures. The main disadvantage of this position is that the grip is neither firm or controlled.

👉🏻 Direction of incision:-

- Should be done in the direction of hairs

- Incision should be oblique in-eye brow, cheek, temple, forehead, eyelid, lip, gum,axilla, belly & groin.

- Make incision like full moon in the upper & lower limbs.

- Half moon incision in anus & penis.

👉🏻 Counter incision:-

- Done if first incision is not enough to drain pus

ie, if the most prominent part is not the most dependent part.

👉🏻 Extension of incision:-

- Incision should be made on whichever direction the tracks lead & where ever pockets are present so that no offencive materials should be left.

- Incision should be made 2 or 3 angula deep

3) Lekhana (Scraping):-

👉🏻 Indications:-

• लेख्याश्चतस्रो रोहिण्यःकिलासमुपेजिह्निका ।

मेदोजो दन्तवैदर्भो ग्रन्थिर्वाधिजिलिका ।।

अर्शांसि मण्डलं मांसकन्दी मांसोन्नतिस्तथा ।। 

(Su.su. 25/8-9)

- Four kinds of rohini (vataja, pittaja, kaphaja, sannipataja)

- Kilasa (leucoderma)

- Danta vaidarbha of fat origin (gingivitis)

- Medaja granthi (fatty tumor)

- Medaja vartma (fatty tumor of eyelids)

- Adhijihvika (adenoids)

- Arshas (haemorhoids)

- Mandalakushta (a variety of leprosy)

- Mamsakanda (small tumor of muscles) and

- Mamsonnati (thickening of the muscle)

4) Vedhana (Puncturing):-

👉🏻 Indications:-

• वेध्याः सिरा बहुविधा मूत्रवृद्धिर्दकोदरम् । 

(Su.su. 25/10)

- Siras (veins) to be punctured in many diseases

- Mutra vrddhi (enlargement of scrotum - hydrocele)

- Jalodara (ascitis)

 5) Eshana / Yeshya rogas (Probing):-

👉🏻 Indications:-

• एष्या नाड्यःसशल्याश्च द्रणा उन्मार्गिणश्च ये ।। 

(Su.su. 25/10)

- Nadi (sinus ulcers)

- Sasalya vrana (wound with foreign body inside) 

- Inmargi vrana (sinus ulcer which spread sidewards).

6) Aharana (Extraction):-

👉🏻 Indications:-

• आहार्याः शर्करास्तिस्रो दन्तकर्णमलोऽस्मरी ।

शल्यानि मूढगर्भाश्च वर्चश्च निचितं गुदे ।।

(Su.su. 25/ 11)

- Three kinds of sarkara (vataja, pitaja, kaphaja- urinary gravel)

- Dantamala (tartar of the teeth)

- Paada sarkara(coms in the foot)

- Karnamala (ear wax)

- Antah shalyas (Internal foreign bodies)

- Asmari (urinary calculii)

- Shalya (all kinds of foreign bodies)

- Mudha garbha (abnormal presentation of foetus)

- Mala sanga (faeces accumilated in the rectum)

7) Visravana (Draining):-

👉🏻 Indications:-

• स्राव्या विद्रधयः पञ्च भवेयुः सर्वजादृते ।

कुष्ठानि वायुः सरुजः शोफो यश्चैकदोषजः ।।

पाल्यामयाः श्लीपदानि विषजुष्टश्च शोणितम् । 

अर्बुदानि विसर्पाश्च ग्रन्थयश्चादितश्च ते ।।

त्रयस्त्रयश्चोपदंशाः स्तनरोगा विदारिका । 

सुषिरो गलशालूकं कण्टकाः कृमिदन्तकः ।।

देन्तवेष्टः सोपकुशः शीतादो दन्तपुप्पुटः । 

पित्तासृक्कफजाश्चौष्ठ्याः क्षुद्ररोगाश्च भूयशः ।।

(Su.su. 25/12-15)

- Five kinds of vidradhi (abscess) except that born from all the dosas together.

- Vataja kustha sa ruja (leprosy of vata origin having pain)

- Ekadesaja sopha (inflammatory oedema confined to one place)

- Pali amaya (diseases of the earlobe)

- Shlipada (filariasis)

- Visha justa sonita (blood vitiated by poison)

- All kinds of arbuda (malignant tumors)

- All kinds of visarpa (erysepelas)

- The first three kinds of grarithi (vataja, pittaja and kaphaja-benign tumor)

- Three kinds of upadamsa (vataja, pittaja. kaphaja- syphillis)

- Stanaroga (diseases of the breast)

- Vidarika (pustule in groin and axilla)

- Sausira (small sinus of the tooth)

- Gala saluka (epiglotitis)

- Kantaka (jihvakantaka/ inflammation of tongue)

- Krimidanta (caries of the teeth)

- Danta vesta (gingivitis)

- Upakusa (ulcerative gingivitis)

- Sitada (spongy gums/scurvy)

- Danta pupputa (gingivitis)

- Ostha kopa arising from pitta, rakta and kapha (inflammation of the lips)

- Ksudra rogas (minor diseases)

8) Seevana (Suturing):-

👉🏻 Indications:-

• सीव्या मेदः समुत्थाश्च भिन्नाः सुलिखिता गदाः । 

सद्योव्रणाश्च ये चैव चलसन्यिव्यपाश्रिताः ।।

(Su.su. 25/16)

- Pralamba mamsa (a hanging cut muscle)

- Suddha vranas (clean uninfected wounds)

- Diseases arising from fat such as tumors etc

- Cut Incised wounds (such as tumors etc)

- Well scrape wound

- Sadyo Vrana (traumatic wound)

- Diseases localised on moveable joints

- Cut wounds on karnapali (ear lobe), sira's (head), netra gola (eye ball), nasa, oshtha, kantha, kapola, Ooru, bahu. greeva, and udara

- Vitpaatita vrana (deep seated wound)

👉🏻 Contraindication for suturing:-

- Kshara and agnidahaya vranas

- Pavana vai vranas (gas gangrene)

- Madhumehaja vranas (diabetic ulcers)

- Kakshaha vranas (tension wounds)

- Alpa mamsa yuktha vranas (gaping wounds)

👉🏻 Seevanam / suturing:-

- Sutures or stitches are the materials used to close a wound

- Used in an attempt to improve and speedy healing

- Used to close skin, internal tissues, organs and blood vessels

- Suture material may be absorbable and non absorbable

👉🏻 Suturing - Introduction:-

1. To produce accurate apposition with minimal dead space

2. Avoid suturing in septic conditions

3. Suture should not be put neither too far nor too near.

👉🏻 Types of suture:-

1. Continuous suture (Vellitak)

2. Interrupted suture (Ruju granthi)

3. Blanket or button hole suture (Gofanika)

4. Matress suture

5. Buried subcuticular suturing (Tunnasevani)

🔘 Chardi (Vomiting)

CHARDI (VOMITING) 

👉🏻 Introduction :-

- Chardi is also mentioned as ‘adhaaraneeya vega’, a natural urge expressed by the body. 

- This means to tell that we should not control or suppress vomiting because it is a process in which the body is trying to throw out the unnecessary contents, contaminants and toxins out of the body, which would otherwise prove to be harmful when left alone in the body. 

- Stomach identifies the incompatible foods and rejects them in the form of expulsion through vomiting. 

- Chardi as roga or disease – Chardi is a disease when the pathology is head by the vitiated doshas. 

- Even here too, if the patient is strong enough, the vomiting process should be allowed until the unwanted things have been ejected out of the system. 

- When comes to treating vomiting, the pathology should be addressed and treated only after the unnecessary things have been thrown out of the body.

👉🏻 Defination of Chardi:-

1. "छादयति मुखम् अर्दयति चाङ्गानीति छर्दिः।" (विजय रक्षित)

- Combination of Mukha achhadana and Ardana of anga is called as chardi.

2. "उर्ध्वातिदोषप्रवृत्त रुपा छर्दिरुच्यते।" (च.चि. 20/1 चक्रपाणि)

- When aggravated doshas expelled from urdhwa marga, it is called as Chhardi.

3. "छादयन्नाननं वेगैरर्दयनङ्गभञ्जनैः निरुच्यते छर्दिरिति।" (सु.उ.49/6)

- After achhadana of Mukha ashrita doshas and anga peedana when the doshas are removed, it is called as Chhardi.

👉🏻 Types of chardi :-

- दोषैः पृथक्त्रिप्रभवाश्चतस्रो  द्बिष्टार्थयोगादपि पञ्चमी स्यात्| 

(Cha.Chi.20/6)

1) Vataja Chardi – Vomiting caused by vitiated Vata.

2) Pittaja Chardi – Vomiting caused by vitiated Pitta.

3) Kaphaja Chardi – Vomiting caused by vitiated Kapha.

4) Sannipataja Chardi – Vomiting caused by vitiation of all 3 doshas

5) Drushtartha Samyogaja (Agantuja Chardi) – Vomiting caused due to consumption or sight or exposure to incompatible   foods and things.

👉🏻 Samanya Nidana (Causitive factors):-

- अतिद्रवैरतिस्निग्धैरहद्यैलवणरति ।

अकाले चातिमात्रैश्च तथाऽसात्म्यैश्च भोजनः ।

श्रमात् क्षयात्तथोद्वेगादजीर्णात् कृमिदोषतः ।

नार्याश्चापन्नसत्त्वायास्तथाऽतिद्रुतमश्नतः ।

अत्यन्तामपरीतस्य छर्देर्वे संभवो ध्रुवम ।

बीभत्सर्हेतुभिश्चान्यैर्दुतमुत्क्लेशितो बलात् ।।                                       (Su.U.49/3-5)

- Ati drava – excessive consumption of liquid foods or liquids.

- Ati snigdha– excessive consumption of unctuous or oily foods, fried foods.

- Ahrudhyaihi – excessive consumption of incompatible or unsuitable (unwholesome) foods.

- Ati lavana – excessive use of salt or salty foods.

- Akala bhojana – untimely intake of food.

- Ati matra bhojana – eating in excess.

- Asaatmya bhojana – incompatible foods

- Shramaat – exhaustion

- Bhayaat – fear, panic

- Udwega – high end emotions

- Ajeernaat – indigestion

- Krimi dosha – infection

- Naaryaha aapanna satva – pregnancy

- Ati drutam ashnataha – eating food in hurry.

- Beebhatsa hetu – anything which creates an awkward feel.

👉🏻 Vishesha Nidana:-

1) Vataja Chhardi:-

-व्यायामतीक्ष्णौषधशोकरोगभयोपवासाद्यतिकर्शितस्य ।                                               (Cha.Chi.20/7)

- Vyaayaama – excessive exercise.

- Teekshna aushadha – strong medicines.

- Shoka – grief.

- Jeerna roga – chronic diseases.

- Bhaya – fear.

- Upavasa – excessive fasting.

 2) Pittaja Chhardi:-

- अजीर्णकट्वम्लविदाह्यशीतैरामाशये पित्तमुदीर्णवेगम्|                                             (Cha.Chi.20/10)

- Ajeerna bhojana – indigestion.

- Katu – excessive consumption of pungent foods.

- Amla – excessive consumption of sour foods.

- Vidahi – excessive consumption of corrosive foods.

- Ushna – excessive consumption of hot foods.

3) Kaphaja Chhardi:-

- स्निग्धातिगुर्वामविदाहिभोज्यैः स्वप्नादिभिश्चैव कफोऽतिवृद्धः|                                        (Cha.Chi.20/12)

- Snigdha – excessive consumption of unctuous, oily and fried foods.

- Guru – excessive consumption of heavy ‘to digest’ foods.

- Ama – excessive consumption of unprocessed and immature / improperly prepared (cooked) food components.

- Vidahi – excessive consumption of corrosive foods.

- Swapna – excessive sleeping, sedentary life, rest prone etc.

4) Sannipataja Chhardi:-

- समश्नतः सर्वरसान् प्रसक्तमामप्रदोषर्तुविपर्ययैश्च|

                                              (Cha.Chi.20/14)

- Constant indulgence in diet consisting of wholesome and unwholesome diet together, having all categories of taste together because of ama-dosha (ailments caused by improper digestion) and because of seasonal perversions.

 5) Dvistartha Samyogaja Chardi:-

- द्विष्टप्रतीपाशुचिपूत्यमेध्यबीभत्सगन्धाशनदर्शनैश्च|                                          (Cha.Chi.20/18)

√ Smells, food or things which are:

- Dwishta – repulsive to the mind

- Prateepa – against the need of mind.

- Ashuchi – untidy, clumsy, unwholesome, unclean.

- Puti – putrid, decayed,

- Amedhya – disturbs the mind.

- Beebhatsa – horrifying, scary.

👉🏻Samprapti (Pathogenesis):-

- वायुर्महास्रोतसि सम्प्रवृद्ध उत्क्लेश्य दोषांस्तत ऊर्ध्वमस्यन्|

आमाशयोत्क्लेशकृतां च मर्म प्रपीडयंश्छर्दिमुदीरयेत्तु|                                               (Cha.Chi.20/7)

- On getting provoked by the above said causative factors, the doshas get immediately vitiated.

- They quickly move upwards and fill up the mouth. In the process they cause serious discomfort, bends and twist the body parts. 

- The condition in which there is quick movement of doshas towards the mouth is called Chardi.

👉🏻 Poorvarupa :-

- तासां हृदुत्क्लेशकफप्रसेकौ द्वेषोऽशने चैव हि पूर्वरूपम्||                                            (Cha.Chi.20/6)

- Hrudaya utklesha – feeling of discomfort in the region of the heart, nausea (repeated).

- Kapha praseka / Hrillasa – filling of mouth with watery secretions, water brash, excessive salivation.

- Ashana dwesha – aversion or lack of interest in food.

- Udgara rodha – obstruction to belchings

Tanu, lavana srava – thin salty secretions in the mouth.

👉🏻 Samanya Lakshana:-

- Vegapurvaka Anna pravrutti from mukha pradesha

- Angamarda (Bodyache)

- Mukha vairasya

👉🏻 Vishesha Lakshana:-

 1) Vataja Chhardi:-

- हृत्पार्श्वपीडामुखशोषमूर्धनाभ्यर्तिकासस्वरभेदतोदैः|

उद्गारशब्दप्रबलं सफेनं विच्छिन्नकृष्णं तनुकं कषायम्|

कृच्छ्रेण चाल्पं महता च वेगेनार्तोऽनिलाच्छर्दयतीह दुःखम्||                                                    (Cha.Chi.20/8-9)

- Hrit parshva peeda – Pain in the cardiac region and sides of the chest

- Mukha shosha – Dryness of the mouth

- Murdha nabhya arti – Pain in the head and umbilical region

- Kasa – Coughing

- Swara bheda -hoarseness of the voice 

- Toda – pricking pain

- Udgara shabda prabala – Eructation with loud noise

- Sa phena, vicchinna, krshna, tanu kashayam – Vomiting of material which is frothy, scattered, black in color, thin and astringent in taste.

- Krchrena alpam – The urge for vomiting is forceful, but the patient vomits only in small quantities with pain and The patient feels miserable.

 2) Pittaja Chhardi:-

- मूर्च्छापिपासामुखशोषमूर्धताल्वक्षिसन्तापतमोभ्रमार्तः|

पीतं भृशोष्णं हरितं सतिक्तं धूम्रं च पित्तेन वमेत् सदाहम्||                                             (Cha.Chi.20/11)

- Moorcha – Fainting

- Pipasa – Morbid thirst

- Mukha shosha – dryness of the mouth

- Santapa – Burning (or heating) sensation in the head, Palates and eyes

- Tamo pravesha- A feeling as if the entering into darkness

- Bhrama – Giddiness

- Pitam bhrsoshanam haritam satiktam dhumram-Vomiting of material which is yellow, excessively hot, green, bitter and smoky in appearance

- Sa daham – Vomiting takes place with burning sensation.

3) Kaphaja Chhardi:-

- तन्द्रास्यमाधुर्यकफप्रसेकसन्तोषनिद्रारुचिगौरवार्तः|

स्निग्धं घनं स्वादु कफाद्विशुद्धं सलोमहर्षोऽल्परुजं वमेत्तु|                                           (Cha.Chi.20/12-13)

- Tandra – Drowsiness

- Madhura aasya – sweet taste in the mouth

- Kapha praseka –  excessive salivation

- Santosha – Sense of satisfaction

- Nidra – sleep

- Aruchi – anorexia 

- Gauravam – heaviness of the body

- Vomiting of material which is Snigdha – unctuous, Ghana – thick, Svadu – sweet and free from any undesirable smell

- Loma harsha – Horripilation and Alpa ruja – less of pain

4) Sannipataja Chhardi:-

- शूलाविपाकारुचिदाहतृष्णाश्वासप्रमोहप्रबला प्रसक्तम्|

छर्दिस्त्रिदोषाल्लवणाम्लनीलसान्द्रोष्णरक्तं वमतां नृणांस्यात्|                                                (Cha.Chi.20/15)

- Shula – Colic pain

- Avipaka – indigestion

- Aruchi – Anorexia

- Daha – burning sensation

- Trishna – morbid thirst

- Shwasa – dyspnoea and fining which are of serious nature and persistent.

- Vomiting of material which is Lavana – saline, amla-sour, Anila – blue, Sandra -dense, Ushna -hot and Rakta – red (mixed with blood).

5) Dvistartha Samyogaja Chardi:- 

- शूलहल्लासबहला कृमिजा च विशेषतः ।

कृमिहद्रोगतुल्येन लक्षणेन च लक्षिता ।।                                   (Su.U.49/14)

- Udarashoola - Pain in abdomen

- Hrillasa Bahulata - Excessive nausea

- Similiar Lakshana of Krimija hridroga

👉🏻 Sadhyasadhyatva :-

- क्षीणस्य या छर्दिरतिप्रवृद्धा सोपद्रवा शोणितपूययुक्ता|

सचन्द्रिकां तां प्रवदन्त्यसाध्यां साध्यां चिकित्सेदनुपद्रवां च||                                             (Cha.Chi.20/19)

- Ksheena – person is emaciated or has tissue depletion.

- Ati pravrudda vamana – severe vomiting occurring repeatedly

- Sa upadrava – vomiting associated with complications.

- Shonita yukta – blood mixed vomitus.

- Pooya yukta – pus mixed vomitus.

- Sa chandrika – vomitus having shiny materials.

These type of Chhardi is Asadhya.

- The chhardi without above mentioned symptoms are Sadhya.

👉🏻 Complications:-

- Kasa:- Cough

- Shwasa:- Dyspnoea

- Jwara:- Fever

- Hikka:- Hiccough

- Trishna:- Polydypsia

- Vaichitya:- Restlessness

- Hridroga:- Cardiac disorders

- Tama:- Darkness infront of eyes

👉🏻 Chikitsa Sutra:-

- आमाशयोत्क्लेशभवा हि सर्वाश्छर्द्यो मता लङ्घनमेव तस्मात्|

प्राक्कारयेन्मारुतजां विमुच्य संशोधनं वा कफपित्तहारि||                                                 (Cha.Chi.20/20)

- As all the types of vomiting are considered originating from the agitations of the doshas in the stomach, fasting therapy should first be prescribed or purificatory procedure curative of kapha and pitta should be administered except in cases of vata dominance.

- Patient may also be given emetic therapy prepared of the drugs of the valliphala (group of cucurbitaceous fruits), etc. or if the patient is weak, then he should be treated with pacification therapy through delicious soups and light as well as dry food articles for diet along with various kinds of drinks.

👉🏻 Vataja Chardi chikitsa:-

- The well sizzled soup of the meat of Tittiri, Barhi and Lava.

- Vegetable soup of Kola, Kulattha, Dhanya, Bilva (Shyonaka, Gambhari, Patala), Mulamla (sour drink prepared of radish) and yava.

- Ghee with rock- salt (cooked with rock salt). This recipe is given to the patient of Vatika Chardi, associated with the palpitation of the heart.

- Ghee cooked with Dhanyaka Nagara, Yogurt and the juice of Dadima 

- Ghee added with the powder of Sunthi, Pippali,  Maricha and Saindhava, Sauvarchala and Vida type of salt.

- The patient of Vataja Chardi is given food which is unctuous and pleasing to the heart along with meat- soup, vegetable- soup, yogurt and sour pomegranate.

👉🏻 Pittaja Chhardi Chikitsa:-

- The powder of Trivruta along with the juice of Draksha, Vidari and sugarcane for causing Anulomana or downward movement of the morbid matter, i.e purgation. 

- When Pitta is over- aggravated in chest (in the region above the abode of kapha- stomach), then (emetic therapy with the help of) drugs having sweet taste is administered.

- After the body is cleansed from the morbid matter, the patient is given during meal- time the Laja-mantha (flour of popped- rice, Diluted in water) or Laja-Peya (thin gruel made of popped- rice) along with honey and sugar. 

- The patient may also be given boiled Shali- rice along with the soup of Mudga or the soup of the meat of animals inhabiting an arid zone.

- Kulmasha, Masura,  Laja, Yava, Saktu, Grnja (boiled barley along with its scum), or the pulp of Kharjura,  Coconut, Draksha or Kola is made to a linctus by adding Sitopala (sugar having big crystals), honey and Pippali.

- These recipes are given to the patient suffering from Paittika type of vomiting.

- The powder of Srotonjana Laja (popped paddy), Utpala and Abhaya is made to a linctus by adding honey, and given to the patient. 

- Similarly the seed- pulp of Kola, Anjana, and stool of fly, Laja (popped paddy), sugar and grains of Pippali mixed with honey may be given to the patient.

- The patient may drink cooled juice of Draksha or the leaves of jambu and Amra by adding honey (after the decoction is cooled).

- Water is added with the powder of mudga, Pippali, Ushira and Dhanya and kept overnight. In the morning the powder is strained out and the filtered water is taken by the patient. 

- Similarly the water added with the powder of chanaka or Gavedhuka- root or Guduchi and kept to overnight can be given to the patient.

- The patient may be given sugarcane juice or milk to drink.

👉🏻 Kaphaja Chhardi Chikitsa:-

- The patient is given the decoction of Pippali, Sarsapa and Nimba  added with the powder of Pinditaka and rock salt. This cleanses (eliminates) Kapha from Amashaya (stomach).

- The patient is given wheat, rice and barley which are old (more than 6 months old after harvesting) as food. 

√ Along with this food, he is given the following side –dishes and drinks:-

- Vegetables soup of Patola, Amrta and Chitraka.

- Butter-milk cooked by adding Sunthi, Pippali and Maricha.

- Butter- milk cooked by adding Nimba.

- Soup of sour fruits along with pungent drugs

- Soup of the meat of animals inhabiting arid zone (Jangala). The spit-roasted meat these animals may also be given along with food.

- Old honey, Sidhu (alcohol prepared of sugar-cane- juice) and Arishta (a type of alcoholic drink) and

- Raga (condiments), sasava (pickles) and Panaka (syrup) prepared of Draksha, Kapittha and Phala- Puraka (bija-Purakaa)

👉🏻 Sannipataja Chhardi Chikitsa:-

- Various types of treatment suggested by me (by Atreya) for the treatment of different types of Chardi,(Viz, Vatika,pattika and Kaphaja Chardi) is appropriately and judiciously combined, and given by the physician to the patient suffering from Sannipatika type of Chardi. 

- The physician well versed in ayurvedic scriptures is (specially) vigilant (with regard to the Sannipatika type of Chardi) keeping in view the relative preponderance of the Doshas involved, the season when the disease has occurred, the stage of the disease and the power of digestion of the patient.

👉🏻 Dvistartha Samyogaja Chardi Chikitsa:-

- For the treatment of vomiting caused by the mental disgust or affliction of the mind (Manobhighata), the following steps are taken:-

• Mano anukula – The patient is made to hear pleasing talks.

• Ashvasana – He is consoled and encouraged.

• Loka prasiddha sruta – He is made to hear reputed folk tales including mythological stories.

• He is attended to by congenial companions and he should resort to amorous and wholesome regimes (games).

• He is made to smell various types of pleasing perfumes emanating from the earth, flowers, Sukta (vinegar) and Sour fruits.

• He is given to eat well prepared vegetables, eatables, syrups, Shadavas (Pickles), raga (condiments) and Lehas (preparations in the form of linctus or jam).

• Eatables like vegetable- soup, meat- soups, Kambalika (sour curry of fish and meat), Khada (sour drinks prepared of fruits), meat preparations, popped cereals, different food preparations, fruits and roots having pleasing smell, color and taste cure vomiting caused by mental disgust.

• In general, whatever smell, taste, touch, sound or vision is pleasing to such patients is administered even though some of these might be unwholesome, because the aliments caused by such unwholesome contacts can be treated easily.

👉🏻 Treatment of Chronic Chhardi:-

- In persistent vomiting vata invariably gets aggravated because of loss of tissue elements. 

- Therefore, in case of chronic vomiting medications that are bulk promoting, vata pacifying, upastambhana (astringents) and brimhana (nutritive) should be administered.

√ The following recipes are useful in chronic type of vomiting.

- Sarpirguda 

- Kshira-vidhi 

- Kalyanaka Ghrita

- Tryushana Ghrita

- Jeevaniya Ghrita

- Vrishya recipes

- Mansarasa.

- Lehya like chyavanprasha

 

👉🏻Upadrava Chikitsa (Management of complication) :-

- छर्द्युत्थितानां च चिकित्सितात् स्वाच्चिकित्सितं कार्यमुपद्रवाणाम्|

अतिप्रवृत्तासु विरेचनस्य कर्मातियोगे विहितं विधेयम्||                                       (Cha.Chi.20/45)

- Complications associated with the disease (vomiting) are treated on the lines suggested in respect of each of these ailments. 

- If there is excess of vomiting, then the therapeutic measures to be suggested in Siddhi 6 is administered to the patient.

👉🏻 Yoga for chardi :

1) Samshodhana Chikitsa:-

- *Vamana* :- Madanaphala or other Vamana drugs

- *Virechana* :- Haritaki + Madhu churna

2) Samshamana chikitsa:-

a) Rasa / Bhasma / Pishti:-

- Chardi Ripu rasa

- Sutasekhar rasa

- Mayurpichha bhasma

- Rasendra yoga

- Manashiladi yoga

- Vamanakuthara rasa

b) Vati:-

-  Eladi Vati

- Lavangadi Vati

c) Churna:-

- Eladi Churna

- Vidangadi churna

- Lajadi churna

- Avipattikara churna

d) Kwatha:-

- Jamvadi kwatha

- Guduchyadi Kwatha

- Parpataka kwatha

- Chandanadi kwatha

e) Ghrita:-

- Padmakadi Ghrita

- Sarpiguda

- Jeevaniya Ghrita

- Kalyanaka Ghrita

f) Paka / Avleha:-

- Jatyadi leha

- Kolamajjadi leha

- Haritaki churna leha

👉🏻 Pathya-Apathya: 

1) Pathya:-

√ Ahara:-

- Purana tava. Godhuma, shali, mudga, chanaka, green vegetables, godugdha, nimbu, mansa rasa of lava, tittira and bater, jeeraka, sunthi etc.

√ Vihara:-

- Vamana, Virechana, Snana, Sharira Shuddhi, lepa prayoga, agnikarma above nabhi etc.

2) Apathya:-

√ Ahara:- 

- Viruddha ahara, bimbi phala, Sarshapa, drava padartha etc 

√ Vihara:-

- Vyayama, Nasya, Basti, Swedana, snehapana, dushita jala, bibhatsa Darshana, raktamokshana, bhaya, udwega etc 

👉🏻MODERN CORRELATION:- VOMITING

- In modern on the basis of symptoms Chhardi is known as 'Vomiting'.

✓ Defination:-

- Vomiting, or throwing up, is a forceful discharge of stomach contents.

✓ Causes of Vomiting:-

- Vomiting is common. 

- Eating too much food or drinking too much alcohol can make a person throw up.

- This generally isn’t a cause for concern. 

- Vomiting itself is not a condition. It’s a symptom of other conditions. Some of these conditions include:

• food poisoning

• indigestion

• infections (associated with bacterial and viral illnesses)

• motion sickness

• pregnancy-related morning sickness

• headaches

• prescription medications

• anesthesia

• chemotherapy

• Crohn’s disease

- This condition can cause vomiting episodes several times throughout the year when left untreated. 

- It can also have serious complications that include:

• dehydration

• tooth decay

• esophagitis

• a tear in the esophagus

✓ Complications:-

- Dehydration is the most common complication related to vomiting. 

- Vomiting causes your stomach to expel not only food but fluids, too. Dehydration can cause:

• dry mouth

• fatigue

• dark urine

• decreased urination

• headache

• confusion

- Dehydration is especially serious in infants and young children who vomit. 

- Younger children have smaller body mass and thus have less fluid to sustain themselves. 

- Parents whose children show symptoms of dehydration should talk to their family pediatrician immediately.

- Malnutrition is another complication of vomiting. 

- Failure to keep down solid foods causes your body to lose nutrients. 

- If you’re experiencing excessive fatigue and weakness related to frequent vomiting, seek medical attention.

✓ Management:-

- To treat the main cause first like Gastritis, Hyperacidity, Poisoning etc.

- Antacids

- Anti emetic drugs

- Patient should be advised to take light food.

Avoid Tea, Coffee, Alcohol & Cigarrete smoking.

- Avoid overeating & lying down for 3 hour's after eating.

- Maintain Fluid/Electrolyte balance of body.

🔘 Trachoma (Pothaki)

TRACHOMA (Pothaki) 

According to Ayurveda: 

Pothaki is a Kaphaja Lékhana Sadhya Vyadhi. It is one of the Pilla roga. 

खाविण्यः कण्डुरा गुब्यों रक्तसर्षपसन्निभाः। 

पिडकाच रुजावत्यः पोथक्य इति संज्ञिता: ll (S.U.3/11) 

It is a vartmagata roga in which the pidakas resemble red mustard seed. The pidakas are hard (heavy). painful, associated with itching and discharge. The condition having the above features is called as Pothaki. 

पोथक्यः पिटिका: श्वेता: सर्पपाभा घनाः कफात् । 

शोफ उपदेह रुकू कण्डू पिच्छिलाश्रु समन्विताः ।

(A.H. U. 8/9) 

Pothaki is a condition in which hard follicles with coating, resembling the seeds of white mustard originates in vartma due to vitiation of kapha dosha. The associated symptoms are oedema, sticky discharge, pain and itching. 

Chikitsa: 

Two methods of treatments are indicated in pothaki: 

1. Blood letting 

2. Scraping. 

Initially blood letting is indicated. This is to be followed by scraping the part slowly. 

According to Acharya Vagbhata; 

The management of Pothaki is as follows 

1. Lekhana. 

2. Pratisarana with shunti, saindhava and pippali. 

3. Prakshalana with ushnambu. 

4. Sechana with kashaya prepared out of khadira, adhaki and shigru. 

5. Aschótana with kashaya prepared out of haridra, daruharidra and yashtimadhu mixed with honey. 

6. Aschótana with decoction of tender leaves of amra and jambu. 

7. Anjana prepared from vidanga, laksha, daruharidra, twak, haratala, manashila and honey. 

According to Modern: 

Definition: 

It is a chronic keratoconjunctivitis primarily affecting the superficial epithelium of 

conjunctiva and cornea simultaneously. 

It is characterized by a mixed follicular and papillary response of conjunctival tissue. 

Etiology: 

(1) Causative organism- Bedsonian organism, Chlamydia trachomatis belonging to PLT (Psittacosis Lymphogranuloma Trachoma) group.

It is epitheliotrophic and forms intracytoplasmic inclusion bodies called H.P. bodies 

(Halbertstaedter Prowazeke) 

(2) Predisposing factorsa.

Age – usually infancy & childhood

b. Sex – female

c. Race – more in jews and less in negroes

d. Climate – dry and dusty

e. Socio-economic status – poor class owing to unhygienic condition, over crowding etc.

f. Environmental factors – exposure to dust, smoke, sunlight etc. 

(3) Source of infection- conjunctival discharge of the affected person. 

(4) Mode of infection 

a.Direct spread through contact by air borne or water borne modes.

b. Vector transmission through flies.

c. Material transfer through contaminated fingers of doctors, nurses and contaminated 

tonometers, common towel, hanker chief, bedding and surma rods. 

Incubation period: 5-21 days 

Pathology: 

It is a chronic inflammatory disease which involves epithelial and subepithelial layer of 

conjunctiva. 

In early stage – epithelial hyperplasia of palpebral conjunctiva. 

Lymphocytic infilteration in subepithelial layer

Increased vascularisation and formation of follicles and papillae. 

In the healing stage, it is initiated by cicatrization which is directly proportional to the extent of secondary infection. 

Results of cicatrization on the following:

(1) Subconjunctival tissue – shallowing of fornix, symblephron.

(2) Bulbar conjunctiva – dryness, keratinization of conjunctival surface

(3) Limbus – Herbert’s pit

(4) Cornea – scarring of corneal tissue, corneal astigmatism (curvature of cornea disturbe)

(5) Angle of A.C. – secondarily rise of IOP. 

After Trachoma:

The conjunctiva can never be reformed.

(1) Herbert’s pits are always present.

(2) Palpebral conjunctiva looses its transparency.

(3) Ghost vessels are present – these are remainant of blood vessels formed during the active stage of disease. These are empty vessels with no blood inside. 

Symptoms: 

(1) In absence of sec. infection –

a. mild F.B. sensation, 

b. occasional lacrimation, 

c. slight stickiness of the lid, 

d. scanty mucoid discharge. 

(2) In presence of sec. infection – symptoms of muco-purulent conjuncitivitis develop. 

Signs: 

(A) Conjunctival sign 

a.Congestion of upper tarsal and fornix conjunctiva. 

b. Conjunctival follicles – look like sago grains (common on upper tarsal conjunctiva and 

fornix, sometimes even on bulbar conjunctiva)

Follicles – scattered aggregation of lymphocytes and other cells in the adenoid layer

Central part – mononuclear histocytes + few lymphocytes + Leber cells 

(large multinucleated cells)

Cortical part – actively proliferating lymphocytes.

Most peripheral part – blood vessels.

Presence of Leber cells + signs of necrosis makes confirmation of Trachoma. 

c. Papillary hyperplasia- reddish, flat top raised areas and give red and velvery appearance 

to tarsal conjunctiva.

Central part- numerous dilated blood vessels.

Cortical part- lymphocytes and conjunctival hypertrophic epithelium. 

d. Conjunctival scarring – irregular, star shaped or linear. 

Arlt’s line – linear scar present in sulcus subtarsalis. 

e. Concretions due to accumulation of dead epithelial cells and mucus in the depressions 

called glands of Henle. 

(B) Corneal signs: 

a. Superficial Keratitis in upper part. 

b. Herbert follicles – follicles present in Limbal area. 

c. Pannus – infilteration of cornea associated with vascularisation seen in upper part. 

Vessels are superficial and lie between epithelium and bowman’s membrane. Later on 

Bowman’s membrane is also destroyed.

i. Progressive pannus – infileration of cornea is ahead of vascularisation.

ii. Regressive pannus – (pannus siccus) vessels extend a short distance beyond the 

area of infilteration. 

d. Corneal ulcer 

e. Herbert pits – oval or circular shaped pitted scars left behind healing of Herbert follicles 

in the limbal area. 

f. Corneal opacity – it is the end of trachomatous corneal lesions. May involve the papillary area. 

Grading of Trachoma:

Mc Callan’s classification (1908) – 

Stage I – Incipient trachoma or stage of infilteration (hyperemia of palpebral conjunctiva + immature follicles) 

Stage II- established trachoma or stage of floride infileration(mature follicles, papillae, progressive corneal pannus) 

Stage III- cicatrizing trachoma or stage of scarring(scaring of palpebral conjunctiva) 

Stage IV- healed trachoma or stage of sequel

(disease is quiet and cured but sequel due to cicatrization give rise to symptoms.) 

Complication: 

(1) Trichiasis – forward, upward, downward direction of eyelashes is normal, but in trichiasis it turns into forward, downward, backward. (infection when affects the hair follicles or cicatrization may distort the direction of cilia.) 

(2) Entropion – inward rolling of the lid margin. (inner surface of tarsal plate affected and thickened due cicatrization leads to entropion.) 

(3) Symblepheron and shallowing of fornix. 

(4) Corneal haze and astigmatism. (cornea get flattened – astigmatism, and vessels – haze) 

(5) Corneal vascularization – pannus 

(6) Conjunctival xerosis – keratinization of bulbar conjunctiva leads to dryness. 

(7) Exposure keratitis – eyelid shortening (inflammation of cornea upto 1/6 of cornea) 

(8) Trachomatous ptosis – due to follicles, papillae lid becomes heavy and drop 

(9) Dacryocystitis, dacryoadenitis – inflammation of lacrimal sac or gland. 

(10) Corneal ulcers and corneal opacities – exposure keratitis and follicles rub the corneal surface due to blinking. 

(11) Degenerative changes – concretion formation (calcified degeneration) in palpebral conjunctiva. 

Treatment: 

(1) Prophylaxis at family level –

a. Don’t use same surma stick without washing. 

b. Don’t use saree to wipe tears.

c. Avoid doping children with opiates (fly control) 

(2) Prophylaxis at school level

a. Prevent the child from going to school.

b. Proper sanitary measure, avoiding flies etc. 

(3) Endemic area- tab. Azithromycin single dose of 2 gms orally. 

Treatment- 

(1) 20% Sulphacetamide (Phenosulf) drops Q.I.D. for 2-3 months.

(2) 1% tetracycline/ 1% erythromycin eye ointment at night.

(3) systemic – tetracycline tab / tab. Erythromycin 500 mg O.D. for 3 days

Tab. Doxycyline 100 mg B.I.D.

Tab. Azithromycin 1 gms O.D. 

In complication – go for surgical treatment.

🔘 Kati Basti

KATI BASTI

 Introduction :

In Sanskrit, ‘Kati’ means lower back and ‘Basti’ means to retain.

It is a type of local snigdha sweda where warm oil is kept at the kati pradesha for a prescribed time. 

The patient lies in prone position and the katipradesha is encircled with thick black gram paste for retention of the oil.

It acts effectively as it is applied at the site of lesion.

It is a samana procedure.  

 Indication :

Chronic Backache

Degenerative spine changes

Compressed discs and spinal nerves

Disc prolapse

Osteoporosis

Osteoarthritis of the hip

Rheumatic arthritis

Sciatica

Spondylolisthesis

Lumbar spondylitis

 Contra Indication :

Acute inflammatory condition

In a patient who are unable to lie in prone position for 30 minutes.

 Commonly used medicated oil:

Mahanarayana taila

Dhanvantara taila

Vishagarbha taila

Karpasastyadi taila

Nirgundi taila

Muriveena taila

Bala ashwagandha taila

Bala taila

Sahacharadi taila

 Materials required:

Black gram flour- 250g

Suitable oil- 150-250ml

Vessel- 3

Spoon-1

Cotton- Q.S.

Hot waterbath-1

Attendent-1

 Pre-operative procedure:

The black gram flour is well mixed with sufficient quantity of warm water into a thick paste. 

It is then made into flat slab-like structure having length about 45 - 60 cm, thickness of 3 cm and height of 5 cm or Steel or plastic rings can also be used.

Patient should lie in comfortable prone position exposing the kati. 

The prepared dough is fixed to the area in circular shape, taking care not to cause any leakage of oil. 

 

 Procedure:

The oil should be warmed over the hot water bath and poured slowly inside the ring. 

Its temperature must be maintained at 40oC - 45oC, by replacing a small quantity after reheating. 

After the prescribed time, oil should be removed with the help of cotton. 

 

 Post-operative procedure:

After removing the dough, the body part is cleaned with lukewarm water and the patient is allowed to take rest.

 

 Duration: 

30 minutes usually it is done for 7 days.

 

 Precautions:

Leakage is to be prevented by pasting the dough firmly over the area.

Uniform temperature must be maintained throughout the procedure.

Be cautious about the temperature of the oil while reheating to avoid burns.

 Complications and management:

 

Burns - Stop the procedure and do agni dagdha chikitsa like application of aloe vera gel, haridra mixed ghruta, shatadhoutha ghruta.

 Conclusion:

Kati  Basti  is  most  often  recommended  in  condition  like chronic  back  pain,  arthritis, stiffness of the joints and even muscle pain. 

In these conditions Kati Basti may help to increase blood circulation to the affected area, gets rid of Dosha imbalances, strengthens the muscles in the area, helps the release of toxins and reduces inflammation. 

This also helps to tone muscles and improve the working of tissues within the body.

🔘 SNAKE BITE

SNAKE BITE:

👉🏻 Introduction:-

- India estimates approx 2,00,000 bites and 35-50,000 snake bite deaths/year

- No reliable National statistics are available

- Males bitten almost twice as often as females.

- Majority of the bites being on the lower extremities.

- 50% of bites by venomous snakes are dry bites, result in negligible envenomation.

👉🏻Snake bite An occupational disease:-

- Farmers

- Snake charmers

- Plantation work

- Hunter

- Workers at site

- Fisherman

👉🏻 Classification of snakes:-

1) Poisonous

2) Non-Poisonous

1. Poisonous:-

a) Elapids:-

- Cobra

- King cobra

- Common krait

- Banded krait

- Coral

b) Vipers:-

- Common green pit

- Russell's viper

- Saw scaled viper

c) Sea snakes:-

- Hydrophiids

- Laticaudids

- Acrochordids

- Homalopsids

- Natricids

2. Non-Poisonous

👉🏻Type of snake:-

- In India, >200 species of snakes, only 52 are Poisonous.

- The bites of saw scaled viper and Russel's viper are of 70-80% Hemotoxic/Vasculotoxin

- Common krait and Indian cobra bites are mostly Neurotoxic(20-30%).

👉🏻 Venomous and Non venomous snakes:-

1) Venomous:-

- Triangle shaped head

- Elliptical pupil

- Pit

- Fangs

2) Venomous:-

- Rounded head

- Round pupil

- No fangs

👉🏻Local Sympotoms and signs in the bitten part:-

- Fang marks

- Local pain

- Local Bleeding

- Brushing

- Lymphangitis

- Lymph node enlargement

- Inflammation (swelling, redness, heat)

- Local infection, abscess formation

- Necrosis

👉🏻Haematological sign:-

- Necrosis of muscle tissue.

- Muscle tissue will begin to die throughout the body, a condition known as rhambdomyolysis.

- Dead muscle cells may even clog the kidney which filters out proteins. This, couoled with hypotension, can lead to acute renal failure, and if left untreated eventually death.

👉🏻Neurotoxic envenoming - Examination:-

- Ask the patient to look up and observe whether the upper lids retract fully.

- Test eye movements for evidence of early external ophthalmoplegia.

- Check the size and reaction of the pupils.

- Krait can cause fixed, dilated non reactive pupils simulating brain stem death - however it can recover Fully.

- The muscles flexing the neck may be paralyzed.

- A common symptom of a bite from a venomous snake is the presence of two puncture wounds from the animal's fangs.

👉🏻Do's and Don'ts:-

1) Do's:-

- Immobilize the affected limb.

- Apply basic first aid (wash the wound with soap and water).

2) Don'ts:-

- Take the patient to a tantrik or a snake charmer for treatment

- Suck the wound

- Cut the wound open

👉🏻 Medicolegal:-

- 39 code of Criminal procedure under:- Constitution of India article 21

- MLC to be initiated.

👉🏻Fatal dose and period:-

1) Fatal dose:-

- Dried form:-

Cobra:- 15mg

Krait:- 6mg

Viper:- 20mg

Saw scaled viper:- 8mg

- Quantity injected in one bite:-

Cobra:- 200-350mg

Krait:- 20mg

Viper:- 150-200mg

Saw scaled viper:- 25 mg

2) Fatal period:-

- Cobra:- Few minutes to few hours

- Viper:- Few day

- Sea snake:- Not fatal

👉🏻ASV:-

- ASV is Ig purified from the serum/plasma of a horse/sheep immumised with the venoms of one or more species of snake

- Monovalent/Polyvalent

- The ASV in India is a polyvalent type which is active against the commonly found snakes in India including the four.

- Average dry weight of venom injected:- 63+/-7 mg by Russell's viper or cobra

- Each vial neutrilises the venoms of:-

• 6 mg cobra

• 6 mg Russell's viper

• 4.5 mg of Krait

• 4.5 mg of Saw scaled viper

- Initial dose should be 8-12 vials

- Snake inject same amount of venom into children dose of ASV is same as adults.