A case - Sthoulya- grade 1 Obesity.pptx

A case - Sthoulya- grade 1 Obesity & netra seka

1. CASE PRESENTATION Guided by: Dr. Ramya R V Assistant professor Department of Panchakarma

2. PRELIMINARY DATA Source of history - patient Name: XYZ Age: 26 years Gender: Male Address: Bangalore Occupation: Accountant Socio economic status: M iddle class Religion: Hindu Marital status: unmarried OPD No – 23030901 IPD No –IP2301467 DOA: 17/07/23 DOD:4/09/23

3. PRADHANA VEDANA Pt c/o g radual increase in weight around 10 kgs since 6 months Also c/o Heaviness in the body, excessive sweating and feeling of laziness since 2 months

4. ANUBANDHA VEDANA Patient c/o Burning sensation and mild blurred vision on exposure to system for more than 2 hours since 6 months

5. VEDANA VRITTANTA A male p atient aged 26 years was apparently normal six months ago, he gradually started gaining weight around 10 kgs from past 6 months and He noticed heaviness in the body, excessive sweating and feeling of laziness since 2 months He also noticed burning sensation and mild blurring of vision on exposure to system for more than 2 hours since 6 months for these complaints he got admitted in our hospital for further management.

6. POORVA VYADHI VRITTANTA K/c/o Myopia since 10 years ( Rt eye; -6 D and Lt eye; -7 D)

7. POORVA VYADHI CHIKITSA VRITTANTA Corrected with concave lens (spectacles)

8. KOUTUMBIKA VRITTANTA Father is a k/c/o Hypothyroidism Paternal uncle is a k/c/o obesity

9. VAYAKTHIKA VRITTANTA Ahara : Mixed ( non veg 2-3/week) Nidra : deep un disturbed sleep (9-10 hrs ) Mala pravrutti : Once daily ( no hard stools) Mutra pravrutti : 3-4 times in day / 1-2 times at night Vyasana : No habits

10. MANASIKA VRITTANTA No h/o stress, depression or anger issue UDYOGA PARISHAD VRITTANTA He is working as an accountant for past 3 years

11. SAMANYA PAREEKSHA Pulse rate: 81bpm Respiratory rate: 19cpm Blood pressure: 120/80mmHg Temperature: Afebrile Height: 160cm Weight: 82kg BMI: 32kg/m 2 cyanosis: absent Clubbing: Absent Pallor: Absent Icterus: Absent Lymphadenopathy: Absent Edema : Absent

12. ASTHA STHANA PARIKSHA Nadi : not elicited Mala: Once daily ( no hard stools) M utra : 3-4 times in day / 1-2 times at night Jihwa : Aliptata Shabda : Prakruta Sparsha : A nushnasheeta Drik : Vikruta ( myopia) Akruthi : Sthoulya

13. DASHA VIDHA PARIKSHA Prakriti : Vatakapha Vikruti : samana vata , kapha Saara : mamsa , meda Samhanana : Madhyama Pramana : Ht:160 cm ; Wt : 82kg BMI:32 kg/m2 ( sthoola ) Satmya : Sarvarasa satmya Satva : Madhyama Ahara shakti : abhyavarana shakthi-pravara jarana shakthi - avara Vyayama shakti : Avara Vaya : Madhyama

14. SAMSTHANIKA PARIKSHA CNS- conscious, well oriented to time, place and person CVS-S 1 S 2 heard, no added sounds GIT- Inspection- No added sounds Palpation- Soft, non tender Auscultation- Normal bowel sounds heard RS- Inspection- No chest deformity Palpation- Normal inspiration and expiration Percussion- Normal resonance heard Auscultation- NVBS heard

15. STHANIKA PAREEKSHA Hight – 160cm Weight – 82 kgs BMI-32kg/m 2 CC- 96cm MAC- 34cm MTC- 52cm WC- 98cm HC- 93cm

16. INVESTIGATIONS

17. NIDANA PANCHAKA NIDANA :- Ahara : excessive intake of junk food, dairy products, bekery items , fried items and non veg 2-3/week Vihara : not doing any exercise ( avyayama ) POORVAROOPA:- sleeping for long duration ROOPA:- weight gain , heaviness in the body, excessive sweating , feeling of laziness

18. SAMPRAPTI: due to nidana sevana ( meda and kaphakara ahara ) Amarasa ( jataragni mandya ) Medho dathu vriddi obesity srotorodha

19. medho datu nourishment and improper nourishment of uttarottara dhathus vimargagamana ( aggravation of vata ) Koshta sacharana (retaining of vata in abdomen) Teekshnata of agni Over appetite and thirsty

20. SAMPRAPTI GHATAKA Dosha : kapha pradana tridosha Dushya : rasa,meda ,and mamsa Agni : Jataragni , medadhatvagni mandya Ama ; agni mandyajanya ama Srotas : medovaha , mamsavaha , rasavaha Sroto dushti : Sanga , vimargagamana Udhbava sthana : Amashaya Sanchara sthana : Rasayani Vyakta sthana : whole body Adisthana : sarva shareera ( specially sthana , udara and sphik ) Rogamarga : Bahya Sadhya asadhya : Krucchra sadya Swabhava : Chirakari

21. SAPEKSHA NIDANA DISEASE INCLUSIVE CRITERIA EXCLUSIVE CRITERIA Hypothyroidism Weight gain Puffy face Constipation, hair loss, normal thyroid level DM-Type2 Weight gain, excessive sweating, blurred vision Burning feet, increased frequency of micturition, normal blood sugar levels Hypertension Weight gain, blurred vision Severe headache, normal blood pressure Nephrotic syndrome Weight gain Edema is absent, proteinuria is absent

22. DIFFERENTIAL DIAGNOSIS DISEASE INCLUDING CRITERIA EXCLUDING CRITERIA Cushing syndrome Weight gain, blur vision High blood pressure,purple striae , Obesity ( sthoulya ) Weight gain , heaviness of body, excessive sweating -

23. VYADHI VINISCHAYA Sthoulya - grade 1 Obesity

24. CHIKITSA GIVEN गुरु चातर्पणं चेष्टं स्थूलानां कर्शनं प्रति| कृशानां बृंहणार्थं च लघु सन्तर्पणं च यत्|| ( ch.su.21/20-21 ) शस्तमुल्लेखनं तत्र विरेकोरक्तमोक्षणम्| व्यायामश्चोपवासश्च धूमाश्च स्वेदनानि च||८|| सक्षौद्रश्चाभयाप्राशः प्रायो रूक्षान्नसेवनम्| चूर्णप्रदेहा ये चोक्ताः कण्डूकोठविनाशनाः||९|| ( ch. Su 23/ 8-9)

25. Netra seka with triphala Kashaya followed by tarpana with jeevantyadi gritha 2 days Sadyovamana Classical virechana Chakshushya basti ( yoga basti )

26. DATE TREATMENT MEDICINE 13/07/23--14/7/23 Netra seka Triphala kashaya 13/07/23 – 14/07/23 Tarpana Jivantyadi ghrita 17/07/23- 18/07/23 Deepana pachana Agnitundi vati 2-2-2 BF 19/07/23 Snehapana Varunadi Ghrita 150ml 20/07/23 Sarvanga Abhyanga , Swedana,Vamana Ksheerabala taila 21/07/23-23/07/23 Samsarjana Krama  

27. DATE TREATMENT MEDICINE 24/07/23 Normal Diet   25/07/23-27/07/23 Snehapana Varunadi Ghrita (40ml, 70 ml, 100ml) 28/07/23-29/07/23 Sarvanga Abhyanga , Bashpa Swedana , mahanarayana Taila 30/07/23 Sarvanga Abhyanga , Bashpa Swedana mahanarayana Taila, Trivrit Lehya -50g Triphala Kashaya -200ml

28. DATE TREATMENT MEDICINE 31/07/23-02/08/23 Samsarjana Krama   3/8/2023 08/08/23 Oral Medication Sitopaladi churna 1tsp with honey QID Lakshmi vilasa Rasa 1 BD 9/8/2023 21/08/23 Oral Medication Saptamrutha loha 0-0-1 a/f with milk Tab. Garcini 1-0-1 b/f 22/08/23-29/08/23 Chakshushya Basti Chakshushya Basti - 450 ml Honey 100ml, Saindavalavana 15g Triphala Ghrita 100ml Shatapushpa Churna 30g Eranda Mooladi Kashaya 200ml 4/9/2023 Oral Medication Saptamrutha loha 0-0-1 a/f with milk Tab. Garcini 1-0-1 b/f

29. S.No Samaya Pana Dravya Vega Vamita Dravya Pramana Other Symptoms 1 6:50 AM ksheera 1 madhyama   2 6:53 AM ksheera 1 madhyama   3 7:00 AM ksheera 2 madhyama   4 7:05 AM ksheera 1 bahu   5 7:13 AM ksheera 1 bahu Tiredness 6 7:18 AM madanaphala pippali       7 7:40 AM yastimadhu phanta 1 madhyama 8 7:46 AM yastimadhu phanta 1 madhyama   9 7:49 AM yastimadhu phanta 1 bahu Tiredness 10 7:53 AM yastimadhu phanta 2 bahu,madyama Tiredness ,burning sensation in throat 11 7:58 AM yastimadhu phanta 1 madyama Tiredness ,burning sensation in throat 12 8:05 AM yastimadhu phanta 2 madyama Tiredness ,burning sensation in throat 13 8:13 AM yastimadhu phanta 1 bahu Tiredness ,burning sensation in throat 14 8:20 AM lavanodaka 1 madyama Tiredness ,burning sensation in throat 15 8:30 AM lavanodaka 1 madyama Tiredness ,burning sensation in throat 16 8:34 AM lavanodaka 3 alpa Tiredness ,burning sensation in throat 17 8:41 AM lavanodaka 1 alpa Tiredness ,burning sensation in throat 18 8:49 AM lavanodaka 1 Total Vegas -5 Upavegas-17 madyama Tiredness ,burning sensation in throat VAMANA CHART

30. VIRECHANA CHART vegas Vega Samaya Matra of Mala Characters of Mala 1 9:40 AM madyama drava 2 9:49 AM madyama drava 3 9:55 AM madyama drava 4 10:15 AM madyama drava 5 10:33 AM madyama drava 6 11:02 AM madyama drava 7 11:30 AM madyama drava 8 11:40 AM madyama ati drava 9 12:30 PM madyama ati drava 10 1:10 PM alpa ati drava 11 1:45 PM alpa ati drava 12 2:55 PM alpa ati drava 13 4:10 PM alpa ati drava

31. BASTI CHART Date Basti Data Kala Pratyagamana Kala No. of Vegas 22/8/23 8:30am 8:38am 3 23/8/23 8:30am 8:37am 1 24/8/23 8:30am 8:41am 2 25/8/23 8:30am 8:42am 2 26/8/23 8:30am 8:43am 1 278/23 8:30am 8:40am 1 28/8/23 8:30am 8:39am 2 29/8/23 8:30am 8:38am 1

32. MEDICATIONS INGREDIENTS & IMPORTANCE REFERENCE Tab. Saptamruta loha yastimadhu , haritaki , vibhitaki , amalaki , loha basma , ghruta , madhu Indicated in timira , chardi,jwara , shotha , anaha bhaishajya ratnavali shoola rogadhikara 83-84 Lakshmivilasa rasa abhraka bhasma,shudda gandaka , shudda parada , karpoora , jatiphala , vriddhadaru,datura , bhanga,vidari , shatavari,nagabala,atibala,gokshura,nichula,nagavalli Indicated in hrid roga , prameha , kasa bhaishajya ratnavali jwara chikitsa 1223-1235

33. MEDICATIONS INGREDIENTS & IMPORTANCE REFERENCE agnitundi vati shudda parada,shudda gandaka,visha,ajamoda,triphala,yava kshara , vahni,saindava and samudra lavana , vidanga,tankana basma Indicated in agnimandya , ama jwara bhaishajya ratnavali agnimandya rogadhikara 93-94 Chakshusha Basti madhu,saindava lavana , Triphala Ghrita , Shatapushpa Churna,Eranda Mooladi Kshaya Help to reduce the refractive error   AH.KA.4/28 Varunadhi Ghrita Varuna,Sairyeka,Shatavari,Chitraka,Bilwa,Brahati,Karanja,Jaya,Pooti Karanja,Darbha,Vishanika Indicated for mandagni , medas , adyavata , shirashoola Ashtanga Hridaya Sutrastana 15/21-22

34. MEDICATIONS INGREDIENTS & IMPORTANCE REFERENCE Tab. Garcini Vrikshamla,shudda guggulu,triphala Uses to reduce the appetite   G. C PHARMA jeevantyadi gritha jeevanti,ksheera,gritha,prapundarika,pippali , lodhra,saindava lavana , shatahva,madhuka,draksha,sita,daruharidra,triphala , Bwnefits – chakshusya ashtanga Hridaya uttararastana 1/1-3 sitopaladi churna sitopala,vamshalochana,pippali,ela,twak Benefits- anti-inflammatory, appetizer, jwarahara , kasahara,shwasahara , charaka chikitsa sthana 8/134-137

35. ADVICE ON DISCHARGE Tab. Garcini 1-0-1 b/f for 1 month Saptamrutha loha -0-1 a/f with milk for 1 month Advised to avoid junk food and non veg Revisit advised after 1 month

36. OP FOLLOW UP REVISIT ON 11/10/23 c/o increased weight around 2 kgs Treatment T. Decrine plus 1-0-1 b/f T . Garcini 1-0-1 b/f Varunadi kashaya 15ml-0-15ml with 15ml of warm water in empty stomach for 15 days

37. OBSERVATION BEFORE TREATMENT AFTER TREATMENT Weight 82 kgs 73 kgs BMI 32 kg/m 2 28.5 kg/m 2 CC 96 cm 95 cm MAC 34 cm 33 cm MTC 52 cm 50 cm WC 98 cm 92 cm HC 93 cm 91 cm SYMPTOMS Excessive sweating, laziness and feeling of heaviness in body reduced sweating and laziness and no feeling of heaviness of body

38. RESULT BEFORE TREATMENT AFTER VAMANA AFTER VIRECHANA AFTER FOLLOW UP weight 82kgs 79 kgs 73 kgs 75 kgs BMI 32 kg/m 2 30.9kg/m 2 28.5kg/m 2 29.3Kg/m 2

39. CONCLUSION A male pt aged 26 years diagnosed with sthoulya (BMI-32kg/m 2 ) is compared to kaphamedo avrita as per ayurvedic classics and was treated with sadyovamana , virechana other shamana aushadi effectively . Patient was also having myopia since 10 years( Rt eye; -6 D and Lt eye ; - 7 D ) as a preventive measure tarpana was given before vamana chakhusya basti was given as virechanottara karma to prevent further damage to the eyes in this case Significant improvement was seen in the patients with respect to obesity and eyesight ie blurring and burning sensation .

40. ACKNOWLEDGEMENT I would like to express my special thanks of gratitude to Dr.Ramya.R.V Assistant professor, department of panchakarma and Dr.Harish gopal Assistant professor department of Shalakya tantra , of Sushrutha Ayurvedic Medical College and Hospital for valuable guidance during this case presentation

41. Before treatment After treatment