A bunch of diseases-Psoriasis-Diabetes Mellitus-Hypertension


A bunch of diseases-Psoriasis-Diabetes Mellitus-Hypertension

Presenting Complaints with severity and episode duration

1. K/C/O DM
2.Bilateral knee pain more in left knee
3.Pain in toes a long with decreased strength
4.Scale skin lesions since 8 yrs high severity
5.Uncontrolled diabetes
6.HTN

Brief Relevant Medical History (Onset, Duration, Ag/Rel Factors, OTT, Prior Confirmed Diagnoses if applicable):

Patient k/c/o DM and HTN approached AyurVAID for Bilateral knee pain more in left knee,Pain in toes along with decreased strength,Psoriasis since 8 yrs high severity ,Uncontrolled diabetes and HTN

Family history:

Cancer Father's side

Current medication:
Glyconorm G 3 forte 1-0-1
Telmikind 0-0-1
Lipikind 10 0-0-1
Nurokind next0-0-1

Clinical Status
Allopathy Ayurveda
Vital Parameters

• BP:146/70mm of hg
• Pulse:60bpm

• Weight:89
• BMI:28.40
Asta Sthana Pariksha

• Nadi
• Malam:normal,nirama,regular,normal consistency
• Mutra:nlormal
• Jihva
• Shabda
• Sparsha
• Drik
• Akruti
Examinations

• GC:Fair
• CVS:NAD
• CNS:NAD
• RS:NAD
• PA:NAD

Knee joint examination:
Tenderness++(B/L)
Swelling-Absent
stiffness-Present
ROM restricted in supine posture

Foot examination:
tenderness +in fore foot(B/L) persistent.
Posture-Extended toes
Sensation-Normal
Numbness absent
Grip/strength:decreased
Sensation deep and light-normal
Eye examination:Early Retinopathy along with B/L immature cataract
Dasa Vidha Pariksha(from record)

• Prakriti:Kapha vatha
• Vikriti:Vatha kapha
• Sara:Madhyama
• Samhanana:Madhyama
• Pramana:Madhyama
• Satmya:snigdha and swadu
• Satva:Madhyama
• Aharashakti:Madhyama
• Vyayam Shakti:Madhyama
• Vaya:Madhyama
• Desha:Sadharana,madhyama
• Kala:10 yrs,greeshma,Vyaktha,Madhyama
Rogi Bala- Avara
Roga Bala- Madhyama
Not done

DSQ findings Rating

• ADRS Low/Med/High
• ADSS Low/Med/High
Nidana Panchaka

• Nidana:Beeja dosha
• Purvaroopa:
• Roopa:Shoola and sopha in janu sandhi,Sthamba in pada.twak rookshatha,khara sparsa
• Updrava
• Arishta Lakshana
• Samprapti
Dosha:vatha,pitha.kapha
Dushya:rasa,raktha,masa

Srotas:Rasa.Meda
Sroto Dushti Prakara:sanga
Screening MRI of whole spine on 15/10/14.
impression:Loss of cervical lordosis
Posterocentral protrusion of intervertebral disc noted at C4-C5 level causing significant compression of spinal cord and trversing nerve roots at right lateral recess.
Diffuse bulging of inter vertebral disc noted at C3-C4 level causing mild compression of spinal cord and transversing nerve roots at left lateral recess
Features suggestive of myelomalacia noted at C6-C7 level.
Normal plain MRI brain. 21/10/14
Acute pancreatitis
• Roga Samprapti Flow Chart
Differential Diagnosis with reasoning Differential Diagnosis with reasoning
Evidence Based Diagnosis with References

Psoriasis
Evidence Based Diagnosis with References

Kitibha kusta
Sandhigatha vatha
Chikitsa Vivechana:
Details of Allopathy medicine if continued

Glyconorm G 3 forte 1-0-1(on kashayavasthy days ie on 12/5/14 and 14/5/14 one tablet only)
Telmikind 0-0-1
Lipikind 10 0-0-1
Nurokind next0-0-1

Type – OPT/IPT/OPT-IPT
Duration –

Primary Treatments
Main Treatments
Post Treatments

Chikitsa Paddhati with details of dose of medicine.
Consulted Dr.Prasad on 24/6/12
Approached ayurvaid with complaints of Pain on knees more on left hight severity since 10 yrs
Psoriasis high severity since 8 yrs,Stomach pain high severity 39 yrs episode one year back,Lack of balance moderate severity 3 yrs,Pain left sole and left big toe moderate severity 3 yrs,Burning sensation on both soles

Medications given:
• Ashtavargam kashayam-15ml+Abhayaristam+Draksharistam+yogaraja guggulu-1 2times after food
• Mahamashathailam to apply over knee joint.

Review consulation with Dr.Mahadevan Iyer.

(19/4/14)-(16-6-14)

• Kathaka khadiradi kashayam-15 ml+Nisamlaki choornam 2 tsp+1/2 glass warm water at 7AM
• Aragwathadi kashyam 15 ml+Kaishoraguggulu 2+half glass warm water at 11 AM
• Tab.Mahanil 2BD 11 AM and 4PM
• Guggulu thikthakam kashayam 15 ml+Chandraprabha vati 2+half glass of warm water at 6 pm
• Panchathikthaka guggulu ghrutha 2 tsp gorochandai gugtika 2 tablet+Thriphala choorna 2 tsp at bed time followed by warm water.
• On 16/6/14-added saraswatha choorna

Pathya:
Timely meal,fresh food,warm food,gourd vegetables,cluster beans ,drumstick leaves ,Ginger pepper,jeera,turmeric,curry leaves in the cooking.Green gram,churned butter milk boiled and colled water to drink.

• Samyak Lakshanas achieved (Control Charts Summary to be Attached) Vathi chart

vasthy type and date MV 9/5/14 KV 10/5/14 MV 11/5/14 KV 12/5/14 MV 13/5/14 Kv 14/5/14 MV 15/5/14 MV 16/5/14
Time of Administration 1:00 pm 9:00 am 4:15 pm 8:30 am 1:30 pm 8:30 am 1:00 pm
Vasti pratyagama 3:00 pm 9:04 am 4:45 pm 8:33 am 3:30 pm 8:33 am 3:00 pm
Duration of retention 2 hrs 4 min 45 min 3 min 2 hrs 3 min 2 hrs
Number of vegas 1 1 1 3 3 2 2
Prasrushta vinmutra vata Yes Yes No Yes Yes Yes Yes
Shareera Laghava Yes Yes Yes Yes Yes Yes Yes
Ruchi Yes Yes Yes Yes Yes Yes Yes
Agni vruddi Yes Yes Yes Yes Yes Yes Yes
Bala vruddi No Yes Yes Yes Yes Yes Yes
Roga upashaya Yes Yes Yes Yes Yes Yes Yes
BP 120/80 mm hg 120/80 mm hg 120/80 mm hg 120/80 mm hg 120/80 mm hg 130/80 mm hg 130/80 mm hg

• Standardised Outcome Scales Used (Summary Table to be Attached)


PASI:


Before Treatment After Treatment
31.4 4

IKDC:


Before Treatment After Treatment
21.83 41.37

• Other outcomes

Outcome parameters
Pain in knee joint-right 19/4/14 7 23/4/14 7 27/4/14 6 7/5/14 4 11/5/14 0 15/5/14 0 16/6/14
Mild pain
Pain in knee joint -left 10 7 6 4 0 0
Itching(0-4) 4 2 1 1
Pain in right foot 10 5 4 3 3
Pain in left foot 10 5 4 3 3
BP at dawn 24/6/12 146/70 21/4/14 120/80 25/4/14 130/90 29/4/14 130/80 3/5/14 130/90 6/5/14 120/80 8/5/14 120/80 13/5/14 120/80 16/5/14 130/80 15/11/14 130/80 1/12/14 130/90 6/1/15 140/70
BP at dusk 120/80 120/80 120/90 120/80
Energy level moderate moderate moderate moderate moderate moderate moderate moderate
Motion clear clear clear clear clear clear clear clear clear
Urine count day >4-5 4-5 4-5 4-5 4-5 4-5 4 4
Urine count night 0 - - - - - - 0
Appetite normal Good Good Good Good Good Good Good Good
Sleep Quality Good Good Good Good Good Good Good Good Good
Hypoglycemia no no no no no no no no
FBS 110 130 106 111 90 97 91 104
RBS 189 270 231 183 132 218 159 157 134 175 163
Weight 89kg 85.6kg

Patient’s Outcome Scale

# Presenting Complaint Weightage Status_TSD Status_TED Status_1Week Status_1 Month Status_6 Months
1 Bilateral knee pain 60 1 3
2 Psoriasis 40 2 4
3
4
5
WEIGHTED AVERAGE SCORE-----> - - - - - -
IMPROVEMENT SCORE-----> 0.0 -2.0 -2.0 -2.0
IMPROVEMENT %ge-----> 0% -100% -100% -100%

Post ayurveda treatments patient shown their was significant improvement in the compliance of psoriasis and knee joint pain


* Outcomes may vary from person to person

Disclaimer: * Outcomes may vary from person to person