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CASE PRESENTATION

By
Dr.  Maanas.  A
15‘ year PG scholar

Guided by

Dr.  Rajarajeshwari N M

Associate Professor

Dept o...
Efifia

 

ififiififiw

« Name:  Lakshmamma
« Age:  55
~/  Sex:  Female

~/  Occupation:  Farmer [worker]
« Address:  Signahalli...
CHIEF l: lIl1I'I. II| I'IT

~/  Pain in the lower back region radiating to
the posterior aspect of Left leg since 3
months...
IISSIIBIIITEII ClIHP| .IIII'| TS

J Unable to walk properly due to pain since
15 days. 

J Pulling type of pain in left ca...
tifififilw 8% t§5?? §E§Ea'1a“W llflifififi

Patient was apparently normal 3 months back.  She
developed pain in lower back region...
Film MSWW

N0 I-I/  C DIX/ J; no 1‘ N

No surgical liistory
FlIl1|I. Y IIISTIIIIY

~/  Nothing Significant
§E%§%ii%§%i E*§%$? §fi? 

AAHARA:  MIXED DIET.  Morning-Dosa,  rice items
Afternoon-Ragi Mudde,  curd and buttermilk,  Nigh...
Gynecological history
Menarche :  l5yr
Menopause :  50yr

Disturbed sleep since then
Obstetric history :  P3A0L3D0
EEWEESQE,  §§§@i“i'iis“iE5.i7'§: 'E@i%

B. P-130/80 mm Hg
PR-78/Min
R. R-20/Min
Height -5ft Zinches
Weight - 48kg

Edema/1...
SYSTEMIC EIIIINIHIITIIIII

« RS - NVBS
« CVS - S1 S2 heard
« P/ A - Soft,  non tender

« CNS-Conscious and well oriented
Musculo-skeletal system

6) Gait - limping with support
<9 Upper limb - Normal
Lower limb - Stiffness:  Stiffness in the c...
« SLRT-Positive at 30 degree
w LASEGUES SIGN- Positive
IIIIIESTIIIIITIIIIIS

J Hb: l1gm°/ o

J E. S.R :20 mm/ hr

J Platelets:  3.31 lakhs/ CMM
J FBS:  82 mg/ dl

J Blood urea: ...
SSW §T%§§i“i% 

J NADI-78/ min

J JHIVA-Alipta

J MALA-Twice/  day

J MUTRA- 4-5 times/  day

J SHABDA-Prakrita

J SPARSHA...
Efigilfi iii

J PRAKRITL Vata - Pitta
J VIKRITI-

Hetu- Long hours of sitting and working,  lifting heavy
weight,  vegadhara...
IIIISIIII IIIIIIIII PIIIIIIISIIII l3lIIIT. .

J SARA r Madhyama
J SAMHANANA r Madhyama
J SATVA r Madhyama
J SATMYA r Madhy...
lg

 Efigrigiélfilitifi

J Nidana - Long hours of sitting and working,  lifting
heavy weight,  vegadharana,  Nidrahaani

J Pu...
,‘
»x
[1

VATA
PRAKO PA

     
  

NIDANA ~

DHATU
KSHAYA

t

,  KHA _,  
- .  VAIGUNYA 

IN KATI

VAYAH

DOSHA - DUSHYA
S...
Vfizlillfll l’i’1M’. LM3MlEll1%M11ll. 

VATAJA VATA-KAPHAJA _
GRIDHASI GRIDHRASI URUSTMIBHA - KHALLI
J PADA,  JANGHA, 
J STA...
Wfilfili QENESEESSPS

q‘ -. ._‘_~IVT. —.r. , .  ,fi. ,-
" .  - at’

‘I.71&}~. ri: ‘1&i*-O‘1&, ‘- : ..: .Q"‘i. ... ..J; --_Ji-...
OP basis Treatment

<9 Sahacharadi Kashaya 3tsf BD
<9 Rasna Guggulu 2 TID
<9 Hingvashtak Churna ‘/2 tsf TID

* 1 week
TIIEIITPIEIIT
30-S-2014 T0 S-T-2014
1%'rEb’c<“FR‘l§l

tEfififlfifiIfiuGF{| 
® ? rmw wT H Ia.  1=, L.? (,/ Q6

fit.  Qc/ Lek
 I El. 
oafiailfigqfi
LOW BACK ACHE RADIATING TO LT Leg +++

O1_O7_1 4 APPETITE — GOOD
BOWEL-REGULAR

SLEEP- DISTURBED
STIFFNESS- PRESENT

<9 Ka...
PAIN — REDUCED

O2_O7_1 4 APPETITE — GOOD
BOWEL-REGULAR

SLEEP- DISTURBED
STIFFNESS- PRESENT

<> Kati Basti with Dhanwanta...
PAIN - REDUCED

APPETITE — GOOD

i 03-07-14 . ... w.. -m. ... ... .

SLEEP— DISTURBED

STIFFNESS- PRESENT

<9 Ksheera vait...
Pain reduced,  No pain while getting up from bed
04 O 7 1 4 APPETITE — GOOD
- - BOWEL-REGULAR
SLEEP- DISTURBED
STIFFNESS- ...
Pain reducedl Able to walk
O5_O7_14 APPETITE — GOOD
BOWEL-REGULAR
SLEEP- DISTURBED
STIFFNESS- PRESENT

<9 Kati basti with ...
PAIN REDUCED,  PERSISTS ON WALKING
O6_O7_ 1 4 APPETITE — Goon
BOWEL-REGULAR
SLEEP- DISTURBED

STIFFNESS- PRESENT

<9 Kati ...
C/ O PAIN WHILE WALKING

O7_O7_1 4 APPETITE — Goon
BOWEL-REGULAR

SLEEP- DISTURBED

 

STIFFNESS- PRESENT

<9 Kati Basti w...
O/ E PAIN ON PRESSURE.  PAIN REDUCED
O8_O7_1 4 APPETITE — Goon
BOWEL-REGULAR
SLEEP- DISTURBED
STIFFNESS- PRESENT

<9 Kati ...
Treatment Chart
-

M W flflflllllflllfl

 +  EIIIIIII
 -Ilflflllllflfl

Basti chart

01/07 02/07 03/07 04/07 05/07 06/07 07/07 08/07
DISCHARGE ADVISE

<9 Rasna Guggulu 2-2-2
<9 Sahacharadi Kashaya 4tsf-4tsf-4tsf
<9 Dhanwantara Taila (E/  A)

REVIEW AFTER ...
i Pathya J
<9 Sarpi,  Swadu,  amla,  lavana rasa ahaara,  Godhuma, 
Masha,  Shali,  Kulattha,  Mamsa rasa,  Gramya -

auda...
PROGNOSIS

ACCORDING TO PATIENTS SATISFACTION SCALE

No C/ O Pain
Only O/ E Pain

+ve at 30 ° +ve at 70°

LASEGUES
SIGN

A...
41%‘-. 

~SII. ‘§”.3.| [2I¥! IIll| I‘ ‘r: »*J; |iIf:3.‘| “."= ‘~‘| _meéiaigasungili

I
 *. §iIfI"-P{! §Ii'7iI If, I'l7’; '...
Gridhrasi - A Case presentation
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Ayurvedic Management of Gridhrasi -
Under the able guidence of Dr. Rajarajeswari mam

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Gridhrasi - A Case presentation

  1. 1. CASE PRESENTATION By Dr. Maanas. A 15‘ year PG scholar Guided by Dr. Rajarajeshwari N M Associate Professor Dept of samhita samskruta and siddhanta
  2. 2. Efifia ififiififiw « Name: Lakshmamma « Age: 55 ~/ Sex: Female ~/ Occupation: Farmer [worker] « Address: Signahalli, Hassan ~/ PH. NO: 8453266593 « IPD- 004104-2014 / OPD- 023862-2014 ~/ D. O.A- 30-06-2014 ~/ D. O.D- 09-07-2014
  3. 3. CHIEF l: lIl1I'I. II| I'IT ~/ Pain in the lower back region radiating to the posterior aspect of Left leg since 3 months. / The pain has increased from 15 days.
  4. 4. IISSIIBIIITEII ClIHP| .IIII'| TS J Unable to walk properly due to pain since 15 days. J Pulling type of pain in left calf and thigh region.
  5. 5. tifififilw 8% t§5?? §E§Ea'1a“W llflifififi Patient 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 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. 1 5days 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.
  6. 6. Film MSWW N0 I-I/ C DIX/ J; no 1‘ N No surgical liistory
  7. 7. FlIl1|I. Y IIISTIIIIY ~/ Nothing Significant
  8. 8. §E%§%ii%§%i E*§%$? §fi? 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 l/ IICTURITION: Normal SLEEP: DISTURBED since 5 yr, DUE TO PAIN since 3 months HABITS : NIL
  9. 9. Gynecological history Menarche : l5yr Menopause : 50yr Disturbed sleep since then Obstetric history : P3A0L3D0
  10. 10. EEWEESQE, §§§@i“i'iis“iE5.i7'§: 'E@i% B. P-130/80 mm Hg PR-78/Min R. R-20/Min Height -5ft Zinches Weight - 48kg Edema/1ymphadenopathy/ pa1lor/ icterus/ clubbing / cyanosis - absent
  11. 11. SYSTEMIC EIIIINIHIITIIIII « RS - NVBS « CVS - S1 S2 heard « P/ A - Soft, non tender « CNS-Conscious and well oriented
  12. 12. Musculo-skeletal system 6) Gait - limping with support <9 Upper limb - Normal Lower limb - Stiffness: Stiffness in the calf and thigh region. Redness and Warmth / Weakness / Swelling / Deformity : Absent é> Examination of spine - Inspection : No visible deformity Palpation : Tendemess - L5 S1 S2 region Movements : Cervical/ Thoracic : NAD Lumbar : Flexion Restricted Lateral flexion Lt-Not possible Rt — Restricted Extension- restricted
  13. 13. « SLRT-Positive at 30 degree w LASEGUES SIGN- Positive
  14. 14. IIIIIESTIIIIITIIIIIS J Hb: l1gm°/ o J E. S.R :20 mm/ hr J Platelets: 3.31 lakhs/ CMM J FBS: 82 mg/ dl J Blood urea: 15 mg/ dl J Urine sugar: absent
  15. 15. SSW §T%§§i“i% J NADI-78/ min J JHIVA-Alipta J MALA-Twice/ day J MUTRA- 4-5 times/ day J SHABDA-Prakrita J SPARSHA-Sama sheetoshna J DRIK — Gati- Vikruta J AKRITI- Madhyama
  16. 16. Efigilfi iii J PRAKRITL Vata - Pitta J VIKRITI- Hetu- Long hours of sitting and working, lifting heavy weight, vegadharana, Nidrahaani Dosha- Vata Dooshya- Asthi, Sandhi, Mamsa Prakriti - Mridu A Desha — Bhumi -Anupa Sadharana ‘Stilt Filfiliifiiifi r 5 Atura — Kati, Vama sakthi Kala — Ritu- Varsha ritu Kriyakaala- Vyakta avastha Bala —Rogi - Avara ; Roga - Madhyama
  17. 17. IIIISIIII IIIIIIIII PIIIIIIISIIII l3lIIIT. . J SARA r Madhyama J SAMHANANA r Madhyama J SATVA r Madhyama J SATMYA r Madhyama J AHARA SHAKTI r Abhyavaharana Shakti— Madhyama , Jarana Shakti- Madhyama J VYAYAMA SHAKTI r Avara J VAYAH r Madhyama J PRAMANA I Madhyama
  18. 18. lg Efigrigiélfilitifi J Nidana - Long hours of sitting and working, lifting heavy weight, vegadharana, Nidrahaani J Purvarupa — Purvarupa not elicited. J 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. J Upashaya — Resting in supine position with legs fl J Anupashaya - walking, bending, working.
  19. 19. ,‘ »x [1 VATA PRAKO PA NIDANA ~ DHATU KSHAYA t , KHA _, - . VAIGUNYA IN KATI VAYAH DOSHA - DUSHYA SAMMURCCHANA SIRA, SNAYU *5 GRIDHRASI AFFECTED
  20. 20. Vfizlillfll l’i’1M’. LM3MlEll1%M11ll. VATAJA VATA-KAPHAJA _ GRIDHASI GRIDHRASI URUSTMIBHA - KHALLI J PADA, JANGHA, J STAMBHA J STAMBHA J RUKINURU URU&URU MOOLA PEEDA SHOTHA, AYASA, MARDANAVAT J TODA AROCHAKA ANGAMARDA ‘ v’ SPANDATE NIUHUHU TANDRA GURU I WA / DEHA VAKRATA TANDRA ARUCHI, STAIMITYA, SUPTI
  21. 21. Wfilfili QENESEESSPS q‘ -. ._‘_~IVT. —.r. , . ,fi. ,- " . - at’ ‘I.71&}~. ri: ‘1&i*-O‘1&, ‘- : ..: .Q"‘i. ... ..J; --_Ji-“~.1LL. LJi.
  22. 22. OP basis Treatment <9 Sahacharadi Kashaya 3tsf BD <9 Rasna Guggulu 2 TID <9 Hingvashtak Churna ‘/2 tsf TID * 1 week
  23. 23. TIIEIITPIEIIT 30-S-2014 T0 S-T-2014
  24. 24. 1%'rEb’c<“FR‘l§l tEfififlfifiIfiuGF{| ® ? rmw wT H Ia. 1=, L.? (,/ Q6 fit. Qc/ Lek I El. oafiailfigqfi
  25. 25. LOW BACK ACHE RADIATING TO LT Leg +++ O1_O7_1 4 APPETITE — GOOD BOWEL-REGULAR SLEEP- DISTURBED STIFFNESS- PRESENT <9 Kati Basti with Dhanwantara taila <9 Sarvanga Abhyanga (Dhanwantara Taila) + Bashpa Sweda <> Matra Basti with Pancha Tiktaka Ghrita 80ml <9 Katilepa with Jadamayadi Churna + Dhanwantara Taila <9 Rasna Guggulu 2-O-2 <> Physiotherapy
  26. 26. PAIN — REDUCED O2_O7_1 4 APPETITE — GOOD BOWEL-REGULAR SLEEP- DISTURBED STIFFNESS- PRESENT <> Kati Basti with Dhanwantara Taila <9 Sarvanga Abhyanga with Dhanwantara Taila + Patra Pinda Sweda <9 Matra Basti with Pancha Tiktaka Ghrita <> Katilepa with Jadamayadi Churna + Dhanwantara Taila é> Rasna Guggulu 2-0-2 <9 Physiotherapy
  27. 27. PAIN - REDUCED APPETITE — GOOD i 03-07-14 . ... w.. -m. ... ... . SLEEP— DISTURBED STIFFNESS- PRESENT <9 Ksheera vaitarana Basti- Guda Paka 30ml, Chincha Rasa 50ml, saindhava Lavana-l2gm, PTG-40ml, Ksheera 200ml <9 Kati basti with Dhanwantara taila <9 Sarvanga Abhyanga + Patra pinda sweda <9 Matra Basti with Pancha Tiktaka Ghrita <9 Katilepa with Jadamayadi Churna + Dhanwantara Taila <9 Rasna Guggulu 2-0-2 <9 Physiotherapy
  28. 28. Pain reduced, No pain while getting up from bed 04 O 7 1 4 APPETITE — GOOD - - BOWEL-REGULAR SLEEP- DISTURBED STIFFNESS- PRESENT <9 Ksheera vaitarana Basti <9 Kati basti with Dhanwantara taila <9 Sarvanga Abhyanga (Dhanwantara Taila) + Patra pinda sweda <9 Matra Basti with Pancha Tiktaka Ghrita 80ml <9 Katilepa with Jadamayadi Churna + Dhanwantara Taila <9 Rasna Guggulu 2-0-2 <9 Physiotherapy
  29. 29. Pain reducedl Able to walk O5_O7_14 APPETITE — GOOD BOWEL-REGULAR SLEEP- DISTURBED STIFFNESS- PRESENT <9 Kati basti with Dhanwantara taila <9 Sarvanga Abhyanga (Dhanwantara Taila) + Patra pinda sweda <9 Ksheera vaitarana Basti <9 Matra Basti with Pancha Tiktaka Ghrita 80ml <9 Katilepa with Jadamayadi Churna + Dhanwantara Taila <9 Rasna Guggulu 2-0-2 <9 Physiotherapy
  30. 30. PAIN REDUCED, PERSISTS ON WALKING O6_O7_ 1 4 APPETITE — Goon BOWEL-REGULAR SLEEP- DISTURBED STIFFNESS- PRESENT <9 Kati Basti with Dhanwantara taila <9 Sarvanga Abhyanga (Dhanwantara Taila) + Patra pinda sweda <9 Ksheera vaitarana Basti <9 Katilepa with Jadamayadi Churna + Dhanwantara Taila <9 Rasna Guggulu 2-0-2 <9 Physiotherapy
  31. 31. C/ O PAIN WHILE WALKING O7_O7_1 4 APPETITE — Goon BOWEL-REGULAR SLEEP- DISTURBED STIFFNESS- PRESENT <9 Kati Basti with Dhanwantara taila <9 Sarvanga Abhyanga (Dhanwantara Taila) + Patra pinda sweda <9 Ksheera vaitarana Basti <9 Matra Basti with Pancha Tiktaka Ghrita 80ml <9 Katilepa with Jadamayadi Churna + Dhanwantara Taila <9 Rasna Guggulu 2-0-2 <9 Physiotherapy
  32. 32. O/ E PAIN ON PRESSURE. PAIN REDUCED O8_O7_1 4 APPETITE — Goon BOWEL-REGULAR SLEEP- DISTURBED STIFFNESS- PRESENT <9 Kati basti with Dhanwantara taila <9 Sarvanga Abhyanga (Dhanwantara Taila) + Patra pinda sweda <9 Matra Basti with Pancha Tiktaka Ghrita <9 Katilepa with Jadamayadi Churna + Dhanwantara Taila <9 Rasna Guggulu 2-0-2 <9 Physiotherapy
  33. 33. Treatment Chart - M W flflflllllflllfl + EIIIIIII -Ilflflllllflfl Basti chart 01/07 02/07 03/07 04/07 05/07 06/07 07/07 08/07
  34. 34. DISCHARGE ADVISE <9 Rasna Guggulu 2-2-2 <9 Sahacharadi Kashaya 4tsf-4tsf-4tsf <9 Dhanwantara Taila (E/ A) REVIEW AFTER 15 DAYS
  35. 35. i Pathya J <9 Sarpi, Swadu, amla, lavana rasa ahaara, Godhuma, Masha, Shali, Kulattha, Mamsa rasa, Gramya - audaka, mamsa, Dadim, Jambir, Draksha, etc. Daily Abhyanga Apathya <9 Tikta, Katu, Kashaya Rasa Ahaara atisevana, late night food, Chinta, Vegadharana, Shrama- Especially Bharadhwa, Anashana etc.
  36. 36. PROGNOSIS ACCORDING TO PATIENTS SATISFACTION SCALE No C/ O Pain Only O/ E Pain +ve at 30 ° +ve at 70° LASEGUES SIGN APPETI'I'E Good Can sleep Better
  37. 37. 41%‘-. ~SII. ‘§”.3.| [2I¥! IIll| I‘ ‘r: »*J; |iIf:3.‘| “."= ‘~‘| _meéiaigasungili I *. §iIfI"-P{! §Ii'7iI If, I'l7’; 'T~TF: ;l'-f5Pf= ,IiPi: II. -i’; l,IT'~. a’ ? 'e! I T1 3PI‘mIéi, I : f6‘; . 2.‘ ‘ - '. .»_. ‘.'“~: . *“ 2: . '; IF: ~|F%‘m ? l,i"". .I°: ‘i’E. ;_ I «go.
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Ayurvedic Management of Gridhrasi - Under the able guidence of Dr. Rajarajeswari mam

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