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
AllopathyAyurveda
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 reasoningDifferential 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 dateMV 9/5/14KV 10/5/14MV 11/5/14KV 12/5/14MV 13/5/14Kv 14/5/14MV 15/5/14MV 16/5/14
Time of Administration1:00 pm9:00 am4:15 pm8:30 am1:30 pm8:30 am1:00 pm
Vasti pratyagama3:00 pm9:04 am4:45 pm8:33 am3:30 pm8:33 am3:00 pm
Duration of retention2 hrs4 min45 min3 min2 hrs3 min2 hrs
Number of vegas1113322
Prasrushta vinmutra vataYesYesNoYesYesYesYes
Shareera LaghavaYesYesYesYesYesYesYes
RuchiYesYesYesYesYesYesYes
Agni vruddiYesYesYesYesYesYesYes
Bala vruddiNoYesYesYesYesYesYes
Roga upashayaYesYesYesYesYesYesYes
BP120/80 mm hg120/80 mm hg120/80 mm hg120/80 mm hg120/80 mm hg130/80 mm hg130/80 mm hg

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


PASI:


Before TreatmentAfter Treatment
31.44

IKDC:


Before TreatmentAfter Treatment
21.8341.37

• Other outcomes

Outcome parameters
Pain in knee joint-right 19/4/14 723/4/14 727/4/14 67/5/14 411/5/14 015/5/14 016/6/14
Mild pain
Pain in knee joint -left 1076400
Itching(0-4) 4211
Pain in right foot 105433
Pain in left foot 105433
BP at dawn24/6/12 146/7021/4/14 120/8025/4/14 130/9029/4/14 130/803/5/14 130/906/5/14 120/808/5/14 120/8013/5/14 120/8016/5/14 130/8015/11/14 130/801/12/14 130/906/1/15 140/70
BP at dusk120/80120/80120/90120/80
Energy levelmoderatemoderatemoderatemoderatemoderatemoderatemoderatemoderate
Motionclearclearclearclearclearclearclearclearclear
Urine count day>4-54-54-54-54-54-544
Urine count night0------0
AppetitenormalGoodGoodGoodGoodGoodGoodGoodGood
Sleep QualityGoodGoodGoodGoodGoodGoodGoodGoodGood
Hypoglycemianononononononono
FBS110130106111909791104
RBS189270231183132218159157134175163
Weight89kg85.6kg

Patient’s Outcome Scale

#Presenting ComplaintWeightageStatus_TSDStatus_TEDStatus_1WeekStatus_1 MonthStatus_6 Months
1 Bilateral knee pain 60 13
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