Integrated Summary
| Allopathy | Ayurveda | ||||||
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Vital Parameters BP - 90/60 mm Hg Pulse - 62/min Weight - 59.8 Kg BMI - 23.5 Ht – 165 cms |
Asta Sthana Pariksha Nadi - Vata Kapha Pradhana Malam - Once in three days/ Vibadha, relieved by taking hot water in morning Mutra - 5-6 (D)/1 (N), Samyak Shabda - Prakruta Sparsha - Prakruta Drik - Prakruta Akruti - Madhyama |
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Examinations GC - moderate built PA- On Inspection-No flabby abdomen, Umbilicus – central O/ palpation-tenderness over Bilateral iliac regions O/percussion-normal tympanic abdomen O/Auscultation – Normal CVS- clinically NAD CNS- clinically NAD RS- clinically NAD |
Dasa Vidha Pariksha Prakriti- Vata kapha Vikriti- vata kapha Sara- madhyama Samhanana- madhyama Pramana- 59.8 kg, madhyama Satmya- avara Satva- pravara Aharashakti- avara Vyayam Shakti- madhyama Vaya- madhyama Desha- jangala Kala- sharad |
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RogiBala- Madhyama |
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Roga Bala- Balwan |
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NidanaPanchaka Nidana -Kapha Vriddikara Aharas like more oily foods, cheese, pizza Purvaroopa - Chronic constipation Roopa -pain in left side of the abdomen while lying, Pain during menstruation, Scanty menstruation with spotting for first 2 days, Hirsutism Updrava: NIL Arishta Lakshana: NIL Samprapti: Dosha: Kapha Vata Dushya: Rasa, Rakta, Meda Agni - Manda Ama - Rasa, Rakta & Medo dhatwagnimandyajanya Ama Srotas - Rasa, Rakta, Medo Artava vaha and Purisha vaha Sroto Dushti Prakara - Sanga , Vimarga Gamana |
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Differential Diagnosis with reasoning 1. Cushing syndrome 2. Androgen secreting tumor 3. Thyroid disorders PCOD (polycystic ovarian disease) Symptoms like Menstrual Irregularity Infertility Hirsutisn acne etc Obesity Symptoms present with Hirsutism, acne, obesity, Ovarian enlargement and Acantosis Nigricans confirms the PCOD which is supported by USG also. |
Differential Diagnosis with reasoning 1. Vataja Artava dushti 2. Anartava 3. Udavartini Yoni Vyapat Medavruta vata leading to arthava dusti 1. Arthava Kshaya 2. Shoola yukta arthava pravritti 3. Sthoulya 4. Vandhyatva All the bold marked above symptoms are present in the patient, so its diagnosed as Medavruta Vata leading to Arthava Dushti. |
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Evidence Based Diagnosis: - PCOD - Current medication |
Evidence Based Diagnosis: Medavruta Vata leading to Artava Dushti Chikitsa Vivechana: Type – OPT/IPT Duration – 8 days Primary Treatments: Deepana and Pachana: Panchakola Choorna 1tsp twice a day for 3 days Main Treatments: Snehapana: Guggulu Tiktaka Ghrita for 3 days in Arohana Karma, with 30ml on day 1 of Snehapana, 60ml, 90ml and 110ml on the consecutive days. Swedana: Sarvanga Abhyanga by Dhanwantara Taila and Bashpa Sweda for the next three days Virechana: On the third day of Swedana, Virechana Aushada with Mishraka Sneha 40 ml followed by Triphala Kashaya 150ml was given and advised patient to observe for the Vegas. Vegas: Pittanta virechana with 10 vegas. Post Treatments: - Lightness of body was observed - Apppettie was stabilized - Sukha prabhodana – patient used to feel enthusiastic once after waking up Samyak pravartana of vid mootra Weight was reduced after treatment to 57.8 kg i.e., around 2 kgs after virechana Chikitsa Paddhati with details of dose of medicine: After virechana - Kalyanaka kshara 2 pinch twice a day - Saptasara kashaya 15ml twice a day before food - Satavari gulum 1tsp, once at bed time - Guggulu tiktaka grita 10ml in empty stomach in morning followed by hot water. The above medicines were continued for a period of one month followed by virechana Later a rescan was adviced, the reports of which are attached. Arthava pravritti after treatment showed normal colour of arthava with no pain during menstruation , malabaddata was totally recovered with passing of stools once a day But no improvement in hirsutism was observed. |
Referral Opinion Sought if any: Patient after the rescan after one month was advised to take the opinion of the surgeon for the persisting endometrial cyst. For the same patient was advised to undergo laparoscopic excision of the same. The same was advised to be followed as the cyst was large enough.
Integrated View: PCOD is a disease which is said to be manifested as the result of medavruta vata leading to artava dushti manifested as a result of altered vata kapha and rasa rakta, artava and medovaha sroto dushti.
Outcome
- Specific Outcome scale used-
USG outcome before and after treatment:
| USG : BEFORE TREATMENT | AFTER TREATMENT |
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- Before treatment USG report: The uterus is normal in size and echo pattern The uterus, measures 59.4 *27.5* 38.1 mm
- The endometrium thickness is 5.9 mm hyperechoic - Both ovaries have polycystic ovarian pattern - Right ovary is bulky with hypoechoic, poorly vascular cyst approximate 54.18*40.9*51.3 mm and 59.4 cm3 vol - The right ovary measures 63.5* 51.4*59.0 mm and 100.8 cm 3vol - The left ovary measures 52.2*26.2*20.2 mm and 14.5cm3 vol - No free fluid is seen in the pelvis |
- The uterus is normal in size and echo pattern
- The uterus, measures 62.8 *24.7* 41.6 mm - The endometrium thickness is 4.4 mm trilaminar - Both ovaries have a polycystic ovarian pattern - Right ovary is bulky with large poorly vascular hypoechoic cyst? Endometriotic heamorrhagic corpus luteum? - Nature : measures approximate 78.5*58.3*78.2 mm and 187 cm3 vol Occupy entire ovary right side - The left ovary measures 26.8* 17.1*25.4 mm and 6.1 cm 3vol, has multifollicular pattern and is normal in size - No free fluid or mass is seen in the pelvis Inference: |
Specific Outcome scale used- USG outcome before and after treatment:
| # | Outcome Parameters / / Date-Time: | TSD 19/10/2014 | TED 24/10/2014 | R 8/11/2014 |
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1. |
Sleep (Nidra) |
Disturbed |
Sound |
Sound |
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2. |
Appetite (Agni) |
Manda |
Sama |
Sama |
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3. |
Bowels (Mala) |
Constipated |
Samyak |
Samyak |
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4. |
Urination (Mutra) |
Samyak |
Samyak |
Samyak |
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5. |
Stress (Manas) |
Low |
Low |
Low |
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8. |
BP |
90/60 |
110/70 |
120/80 |
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9. |
Pulse |
62/min |
70/min |
75/min |
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10. |
Weight, Kg |
59.8 |
57.8 |
57.5 |
Patient’s Outcome Scale
| # | Presenting Complaint | Status_TSD | Status_TED | Status_2 Month |
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1. |
Hirsutism |
present |
present |
present |
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2. |
Scanty menstruation |
Present for 4-5 days with spotting for first 2 days. |
present |
Absent |
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3. |
Painful menstruation |
present |
present |
Absent |
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4. |
Colour of the menstrual blood |
Black |
Dark red |
Normal |
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5. |
Hard stool |
Once in 3 days |
Regular, once daily |
Regular, once daily |
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5. |
Menstrual cycle |
4-5/50 days cylce |
- |
4-5/35 days cycle |
Attachments
| Lab Reports | At the start of Treatment 24/09/14 | Post treatment 24/11/14 |
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Lab Reports |
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Other reports Ca 125
ovarian cancer marker serum |
Nil |
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Conclusion
At the end of the classical Ayurveda treatments complete improvement in left ovary with multifollicular pattern and normal size restoration of the ovary was achieved. Clinically it was evident from the fact that the menstrual period was regular and normal – without pain, and normal in colour and amount. There was an improvement in meda dhatwagani which is evident from the fact that patient has lost 2kgs of weight during the course of treatment.