A bunch of diseases-Hypothyroid-Diabetes Mellitus-Knee pain-Skin lesions

A bunch of diseases-Hypothyroid-Diabetes Mellitus-Knee pain-Skin lesions

Presenting Complaints with severity and episode duration

1. C/o pain in both the knee joints since last 5 years, associated with stiffness, grating sound in knee when climbing stairs, restriction of knee movement while flexing.

2. C/o pain in low back region since last 2 years.

History of present illness( vedana vruttanta) patient was apparently normal before 5 years. Gradually she developed pain in right knee joint later involved the left knee also which was associated with stiffness, grating sound in knee when climbing stairs, restriction of knee movement while flexing.pain was more during the evening hours and on standing for long hours. Patient used to find relief with symptoms by relaxing for few hours. But now the pain doesn’t subside even with rest and for which patient had taken symptomatic treatment with allopathic medicines.As she didn’t observed considerable improvement she has consulted here.

Past history:

Patient is a known case of Diabetes Mellitus since 20 yrs, and hypothyroidism since 8 yrs and is on medication for the same

Current medication :

For Diabetes Mellitus :

  • Glycomet GP 2 forte 1-0-1

along with Ayurvedic medications

  • i.e Shiva gutika 1-0-1
  • Asanadi kashayam + Shadanga kashayam – 15ml -0-15ml before food

For Hypothyroidism : Thyronorm tab 50 mcg once daily in morning.

Clinical Status
Allopathy Ayurveda
Vital Parameters

• BP-130/60
• Pulse-76/min
• Weight-63.4 kgs
• BMI-26.6
• WHR-

Asta Sthana Pariksha

• Nadi- vaata pitta
• Malam- prakruta
• Mutra- 5-6/day, 2/night.
• Jihva- prakruta
• Shabda-prakruta
• Sparsha-prakruta
• Drik- prakruta
• Akruti- sthoola

• GC- fair
• PA- No organomegaly.
• Locomotor system examination:
Inspection: alignment while standing- no genuvulgus or varus deformity.
gait- antalgic gait present
No inflammatory signs are seen.
No deformity, no muscle wasting, no signs of trauma, surgery,scars, lesions.
Muscle bulk and symmetry- normal
Palpation: Temperature change- absent
Tenderness over knee joint area- present.
Crepitus in both the knee joints- grade 3 where patient hears the grating sound in the knee joint while walking
Patellar tap: negative in both the knee joints.
ROM: All movements are possible but painfull.
Rogi Bala- Madhyama
Roga Bala- balawan
Not done

DSQ findings Rating

• ADRS Med
• ADSS Med
Nidana Panchaka

• Nidana- ati vyayama, ati chankramana,
• Purvaroopa- NIL
• Roopa- jaanu shoola, sthamba, prasarana akunchanayo vedana.
• Updrava- NIL
• Arishta Lakshana- NIL
• Samprapti
  • Dosha- kledaka kahpha kshaya, vyana vaaata vruddi
  • Dushya- rasa, rakta, mamsa asthi
  • Agni- dhaatvagni mandhaya
  • Ama- jaataragni mandhya
  • Srotas- rasavaha, raktavaha, mamsavaha, asthivaha.
  • Sroto Dushti Prakara- sanga, vimarga gamana
Differential Diagnosis
Infectious arthritis


1. Morning stiffness lasting for more than 30 mins to 1 hr and present for atleast 6 weeks
2. swelling of 3 or more joints atlaest for 6 weeks
3. Sweeling of small joints of the hands, feet, cervical spine and also larger joints of shoulder and knee associated with increased warmth and pain
4. Symmetrical joint involvement , sometimes asymmetrical in presentation.
5. Hand x-ray showing erosion or bony decalcification
6. Presence of rheumatoid nodule is characteristic of RA.
7 Serum rheumatoid factor positive

Other: Deformities include ulnar deviation, boutonnieres deformity, swan neck deformity and Z- line deformity.

Require at least four positive criteria


1. more than 1 attack
2.maximal inflammation developed within 1 day
3. attack of monoarticular arthritis
4. joint redness observed
5.first MTP joint painful and swollen
6.unilateral attack involving first MTP joint
7. suspected tophus first
9.x-ray with sub cortical cyst without erosion
10. asymmetrical swelling within the joint

Presence of 6 or more features.

Here it causes an attack of sudden burning pain, stiffness, sweeling in a joint usually a big toe. Nocturnal attack of presentation , foot, ankle and knee. Attack can last for few days to many weeks before pain goes away. Symptom free period between the attacks. Raised uric acid levels.

Osteoarthritis -

Classic Clinical Criteria

  • knee pain plus at least 3 of 6 characteristics:
    • > 50 yrs - yes
    • Morning stiffness < 30 min-no
    • Crepitus - yes
    • Bony tenderness-yes
    • Bony enlargement- no
    • No palpa ble warmth - yes

Differential Diagnosis with reasoning


In this case there is no morning stiffness for more than half an hour and pain and swelling involiving multiple joints, symmetrical joint involvement present but no other positive signs and symptoms.


As the acute onset of pain, redness, burning sensation are not there suggestive of Gout so excluded.

Osteoarthritis -

Almost all the criteria suggestive of Osteoarthritis are present in patient, Thus diagnosed as Osteoarthritis

Lab test: Nil
Evidence Based Diagnosis

Evidence Based Diagnosis

Current medication:

1. Shiva gutika 1-0-1
2. Asanadi kashayam and shadanga kashayam- 15ml-0-15ml with 60ml of warm water twice daily before food.
3. Bhadradarvyadi kashyam and prasarinyadi kashayam- 15ml-0-15ml with 60 ml of warm water twice daily after food.
4. Gandha tailam- 6drops-0-6drops with ½ cup of warm water twice daily after food.
5. Yogaraja guggulu 1-0-1 after food.
6. Triphala choorna and nalpamaradi choorna for yoni dhavana.
7.Sahacharadi taila for external application.
8. Chandraprabha DS 1-0-1
9. Saraswatha ghritam 10ml in the morning on empty stomach followed by drinking warm water.
Chikitsa Vivechana – stahnika vata niyamana by jaanu vasti because of the snighdha vatahara properties of taila. Matra vasti is an effective treatment in managing astigata vyadhis. As asthi is the ashraya sthana of vaata tiktaka ghrita would help in contracting the pathology at the level of asthi, because of its vaatahara properties

Type – OPT Duration – 8 days

Primary Treatments- Jaanu basti- to bilateral knee with sahacharadi kulumbu, karpooradi taila and dhanwantara taila followed by stanika abhyanga over knee and naadi sweda.

Main Treatments- Maatra basti- with guggulu tiktaka ghtrita 60ml after sthanika abhayanaga over prushta and udara.

Post Treatments- Taadana over paada and swikh for basti retainment. Pratyagamana kaala was observed. Advised to take hot comforts during treatment period.

Chikitsa Paddhati with details of dose of medicine:

Mode of action of Matrabasti:


• Specific Outcome scale used- WOMAC osteoarthritis index

• Samyak Lakshanas achieved (Reference- Control Charts)

# Outcome Parameters / / Date-Time N TSD T TED R-T
7/1/15 11/1/15 15/1/15 19/1/15 31/1/15
1 Sleep (Nidra) 6 6 8 9 9
2 Appetite (Agni) 7 7 8 8 8
3 Bowels (Mala) 8 8 9 9 9
4 Urination (Mutra) 9 9 9 9 9
5 Stress (Manas) 7 8 8 8 8
6 Vitality (Ojus) 7 7 8 8 8
7 Wellbeing (0-10) 6 6 7 8 8
8 BP 130/60 130/70 130/80 130/80 130/90
9 Pulse 76/min 74/min 75/min 77/min 76/min
10 Weight, Kg 63.4 63.4 63 63 63
11 W-U, cm 90cms 90cms 89cms 89cms 89cms
12 Diet (Ahara) 96cms 96cms 95cms 95cms 95cms
13 Exercise (Vyayama) NIL Walking Walking Walking Walking
14 Lifestyle (Vihara) Fair Fair Fair Fair Average
15 FBS 105mg/dl 145 ----- 116 136
16 PPBS 145mg/dl 185 ---- 160 185
17 CBG --- 292 ---- --- -----

Patient observed improvement in the scorring of Womac scale which showed improvement from a score of 57.6 before treatment to 81.8 after treatment. The significant improvement is due to the effect of janu basti and matra basti together along with the given internal medications. The review done after 15 days of treatment showed no relapse and maintainance of health condition of the patient.