Prameha pidakas.pptx MADE BY AMITA SINGH BAMS

Prameha pidakas.pptx MADE BY AMITA SINGH BAMS/ M56BOOKSTORE - JOIN US ON TELEGRAM - THANKS

1. Prameha pidaka Presented by : Amita Singh guided by : dr nirupama bhat

2. Contents References in classics
Origin of the disease
Definition
Nidana
Samprapti Purvarupa
Rupa Characteristic feature
Types according to different Acharyas Types in detail Prognosis Complications Management Single drug usage
Useful formulations
Pathya
Apathya

3. References Sushruta Samhita Nidana Sthana chp 6 Sushruta Samhita Chikitsa Sthana chp 12 Charaka Samhita Sutra Sthana chp 17 Charaka Samhita Nidana Sthana chp 4 Charaka Samhita Chikitsa Sthana chp 6 Ashtanga Hridaya Nidana Sthana chp 10 Ashtanga Hridaya Chikitsa Sthana chp 12

4. Origin of the disease In case of urinary disorders, due to long persisting Dosha imbalance, the body gets deteriorated owing to vitiated Medo Dhatu (fat / adipose tissue) and Kleda (metabolic waste / moisture). Ultimately, aggravated Doshas exhibit their symptoms on the surface of the skin. They are usually elevated or discoloured in nature. Usually, they are present in muscles, joints or vital parts (such as groin, kidney, heart, head, face etc). These are known as Prameha pidakas (diabetic carbuncles).

5. Definition The word Prameha can be defined as a condition where there is excess urine flow. The word Pidaka means ‘Yat Peedayanti Tat Pidak’. That which causes Peeda or Vyatha or Vedana. ‘Spota Visheshaha Pidak’. The suppurative lesion is also called as Pidaka.

6. Nidana Etiological factors specified in the context of Prameha (urinary disorders) if continued further or followed excessively, results in Prameha pidaka.

7. Samprapti The aetiopathogenesis of Prameha Pidaka also follows the same path as that of the Prameha. When the Vasa and Meda Vyapta Pramehi consumes the Nidaanarthakara Bhavaas, Kapha Dosha vitiates and further vitiate Pitta and Vata. These vitiated Doshas settles in the Meda Dhatu and Vasa i.e. Sneha ofMamsa and manifestes the Prameha Pidakas in the Pramehi.

8. Characteristic feature The uncured or long persisting blisters with discoloured spots is the characteristic feature.

9. Types

10. Types according to different Acharyas Acharya sushruta Acharya charaka Acharya vagbhata Sharavika Sharavika Sharavika Sarshapika Sarshapika Sarshapika Kacchhapika Kacchhapika Kacchhapika Jalini Jalini Jalini Vinata Vinata Vinata Putrini ------ Putrini Masurika ------ Masurika Alaji Alaji Alaji Vidarika ------ Vidarika Vidradhi Vidradhi Vidradhi

11. Sharavika शरावमात्रा तद रूपा निम्नमध्या शराविका | Sharava means disc or earthen pan in Sanskrit. The carbuncles or boils which are convex in the margins and concave (dipped) in the centre, similar to an earthen pan are termed as ‘Sharavika’. It has elevated borders and a depressed the centre, grey in colour and associated with slough and pain.

12. Sarshapika गौरसर्षपसंस्थाना तत्प्रमाणा च सर्षपी । Sarshapa means mustard. Such types of boils appear similar to white coloured mustard and possess the same size too.
It is not very big, suppurates quickly, is very painful and associated with carbuncles of the size of mustard seeds is known as Sarshapi.

13. Kacchhapika सदाहा कुर्मसंस्थाना ज्ञेया कच्छपिका बुधैः । Kacchapa means tortoise. The carbuncles which are elevated like the tortoise shell, with rough surface and causing burning sensation are called Kacchapika kind of Prameha pidakas.
As per Charaka, it is deep seated and painful combined with splitting type of pain; it has a very big base, it is smooth and resembles the back of the tortoise. (Kacchapa means tortoise).

14. Jalini जालिनी तीव्रदाहा तु मांसजालसमावृता । Jala means mesh. The carbuncles which cause severe burning sensation and appears like anetwork of fibre occurring in the even surface of skin are termed as Jalini pidakas.
It is hard; it has a network of vessels on its surface; is sticky; it has a very big base: it is very painful with splitting type of pain having subtle openings.

15. Vinata महती पिडका नीला पिडका विनता रमना | Word meaning of vinata is sunken or bent inside. Here, the boils are deep rooted, large, painful, moist and appear in the back and abdomen. They are blue in colour and occupy larger area.
It is also deep-seated; it is associated with slough; it occurs either in the back or abdomen; it is big in size, blue in colour and has a depression in the centre.

16. Putrini महत्यल्पाचिता ज्ञेया पिडका सा तु पुत्रिणी । The blisters which are spread over a large surface area where small multiple blisters are found in the middle are termed as Putrini pidakas.

17. Masurika मसूरसमसंस्थाना ज्ञेया सा तु मसूरिका । Masura means lentils. The blisters appear similar to lentils.

18. Alaji रक्ता सिता स्फोटवती दारुणा तु अलजी भवेत् । Red or white coloured vesicles which appear as if they are about to rupture and cause severe pain are called ‘Alaji’ prameha pidaka.
It causes burning sensation during eruption; when fully manifested, it causes thirst, unconsciousness, fever; it always spreads and is very painful due to burning sensation like fire.

19. Vidari विदारिकन्दबद्धता कठिना च विदारिका । ‘Vidari’ is a herb and its botanical name is Ipomea tuberosa. The carbuncles which are having the shape of the tuber of Vidari are termed as Vidari pidakas. They are usually hard and round in shape.

20. Vidradhi विद्रधे लक्षणैर्युक्ता ज्ञेया विद्रधिका बुधैः । The carbuncles possessing the features of abscess are called as Vidradhi pidakas.
Abscess is of two types- the external and the internal.
The external one arise out of the skin, ligaments and muscles. In shape and size it resembles tendons and it is exceedingly painful.

21. Dosha – dhatu involvement Shravika, Kachhapik & Jalini - Kapha and Meda
Sarshapi & Alaji - Pitta Pradhana
Vinata & Vidradhi Alpa Meda

22. Prognosis

23. According to Ayurveda, Sharavika, Kacchapika, Jalini, Putrini and Vidarika are difficult to cure. Other five varieties namely Sarshapika, Masurika, Alaji, Vinata, and Vidradhi are easy to cure.
Acharya Sushuta opines that the carbuncles which are associated with severe burning sensation, spread all around with red or black discoloration, exhibiting complications like thirst, hallucination, fever etc are difficult to cure. As per Charaka –
Sarshapi, Alaji, Viinata and Vidradhi types of carbuncles are on the other hand dominated by Pitta and occur in the case of such patients who have food in less quantity. These are curable.
A diabetic patient who suffers from abscesses occurring in vital organs, shoulder, anus, hands, breasts, joints and feet seldom survive.

24. Complications Acharya Charaka referred following features under the heading of complications:
1. Trit (severe thirst)
2. Kasa (chronic cough)
3. Mamsa sankocha (contractures / gangrene)
4. Moha (fainting)
5. Hikka (hiccough)
6. Mada (intoxication)
7. Jwara (fever)
8. Visarpa (erysipelas) and
9. Mamsarodha (infarction in vital organs or blood vessels)

25. Treatment

26. Management At first, all efforts are carried out to control the particular type of Prameha (urinary disorder).
In general, matured carbuncles should be subjected to incision and drainage (patana and shodhana).
In case, if it is immature, Raktamokshana (blood letting) is carried out preferably by leech application (jaloukavacharana).
According to the dosha dominance purification also can be undertaken.
Then, Shamana Aushadha (curative medicaments) are administered internally as well as externally.

27. Purvarupa Avastha Apatarpana V anaspati Kashaya Basta Mutra Dhanvantara Ghrita

28. Rupa avastha Teekshana virechana
Dhanvantara ghrita Utsadana – aragvadadi kwatha Parisheka – saalasaradi gana dravyas Pana – pipplayadi gana dravyas Saalasaradi leha Navaysa loha

29. Single drug usage Nimba
Guggulu
Patola
Guduchi
Manjishta
Khadira
Haritaki
Trivrit
Sariva
Mamajjaka

30. Useful Formulations Triphala guggulu
Panchatiktaghrita guggulu
Aragwadhadhi kashaya
Patola katukarohinyadi kashaya
Amrita guggulu
Swayambhuva guggulu
Kaishora guggulu
Gandhaka rasayana
Mamajjaka ghana vati
Mahatiktaka kashaya

31. Pathya Shigru
Haridra Amalaki Shyamaka
Kodrava
Yava
Godhuma
Mudga Kulattha Patola
Karavellaka Maricha Lashuna
Jambu
Vyayama

32. Apathya Kanda moola
Ikshu
Taila
Ghrita
Guda
Kanjika
Madya Pishtanna
Anupa mamsa
Dadhi Navanna
Diwaswapna

33. Modern view
DIABETIC CARBUNCLES

34. Contents Definition Sites Causes
Pathology Clinical feature
Types in detail
Complications
Differential diagnosis Treatment Conclusion

35. Definition It is an infective gangrene of the subcutaneous tissue due to staphylococcal (staphylococcus aureus) infection. Gram negative bacilli & streptococci may be found coincidentally.

36. Sites Carbuncles are mostly seen on the back, in the nape of the neck where the skin is coarse & vitality of the tissues is less. Rare sites are the shoulders, the cheek, dorsum of the hand etc. Hirsute portions of the chest & abdomen may also be involved.

37. Causes Staphylococcus aureus infection Infective gangrene of subcutaneous tissue Men above 40 yrs of age who are diabetic

38. Pathology Staphylococci invasion Penetrate deeper layers of skin & subcutaneous fat
Carbuncle is formed which consists a series of communicating abscesses, which discharge by separate openings on the surface due to which surface is sieve like. Individual compartments in the carbuncle are maintained through persistence of fascial attachment to the skin. Carbuncle may be more extensive than they appear. There is central slough, surrounded by a rosette of small areas of necrosis. In untreated cases infection may extend widely with fresh openings appear on the surface, which coalesce with those previously formed. Under treatment when the central slough is drained off, fibroblastic reactions start from the surrounding granulation tissue & carbuncle heals with a characteristic induration.

39. Clinical feature Commences as painful & stiff swelling which spreads rapidly with marked induration. Overlying skin becomes red, dusky, oedematous. Central part softens & multiple vesicles appear on skin. Later vesicles transform into pustules. Pustules burst allowing discharge to come out through several openings in the skin producing sieve like or cribriform appearance. These openings enlarge & ultimately coalesce to produce an ulcer. At the floor of the ulcer lies the ash grey slough. Finally slough separates leaving an excavated granulation tissue, which heals by itself.

40. Venous ulcer Patients with venous ulcers may complain of tired, swollen, aching legs. These ulcers may be painful but not as severe as those seen with ischemic ulcers. The legs will typically be edematous, often with hyperpigmentation of the lower legs from chronic venous stasis. The skin around the ulcer is hyperpigmented. These ulcers are usually on or near the malleoli, usually the distal medial leg. The margins of the ulcers are irregular, with a shallow base. Lipodermatosclerosis may be present, a condition of the skin whereby it becomes indurated and fibrotic in a circumferential pattern, resembling an inverted champagne bottle.

41. Treatment Prevention Elevation of the legs above the level of the heart for 30 minutes three or four times daily may reduce edema and improve the cutaneous microcirculation.11 Elevation of the legs while sleeping at night also reduces swelling. Compression therapy is believed to exert its positive effect on venous ulcers by increasing fibrinolysis, reducing venous hypertension, and improving the cutaneous microcirculation Diuretics

42. Folliculitis Infection of one or more of the pockets from which hair grows (follicles).
Folliculitis may be more common among those with acne. Shaving and use of topical steroid creams can also increase the risk of developing this condition. Small, white-headed pimples appear around the hair follicles. They may itch or be painful. Severe infections can cause permanent hair loss and scarring.

43. Treatment Mild cases often clear on their own. Antibiotics or other drugs may be required for severe cases.
Antibacterial soap, Avoid shaving affected area, Warm compress and Moisturizer Antibiotics, Penicillin and Topical antiseptic

44. Acanthosis nigricans A skin condition characterised by dark, velvety patches in body folds and creases. Acanthosis nigricans typically occurs in people who are obese or have diabetes. Dark, velvety patches of skin often appear in the armpits, groin and neck.

45. Treatment Treating underlying conditions, such as obesity or a tumour, may restore the skin.

46. Diabetic dermopathy Diabetic dermopathy refers to small lesions or spots on the skin. This diabetic skin condition can form anywhere on the body, but tends to develop on bony parts, such as the shins. This condition is fairly common for people with diabetes. The appearance of diabetic dermopathy can vary from person to person.
The skin condition is characterized by reddish-brown, round or oval, scar-like patches that are usually a centimeter or less in size. It’s typically asymptomatic, meaning it usually doesn’t present any symptoms.

47. Treatment There’s no specific treatment for diabetic dermopathy.
Some lesions may take months to resolve, while others may take more than a year. There are other instances where lesions may be permanent.

48. Necrobiosis lipidica diabeticorum Necrobiosis lipoidica (NL) is a rare, chronic, idiopathic, granulomatous disease of collagen degeneration with the risk of ulceration, classically associated with diabetes mellitus, usually, type 1. There is thickening of the walls of the blood vessels, and deposition of fat. The major complication of the disease is the formation of ulcer, mainly occurring after trauma. Uncommonly, infections can also occur. Moreover, if necrobiosis lipoidica becomes chronic it may rarely turn into squamous cell carcinoma.

49. Treatment No treatment has proven to be effective. In patients with diabetes mellitus, control of blood glucose usually does not have a significant effect on the course. In the absence of ulceration or symptoms, it is reasonable not to treat necrobiosis lipoidica given that up to 17% of lesions may resolve spontaneously. Compression therapy controls edema and promotes healing in patients with associated venous disease or lymphedema
When ulcerations are present, proper wound care principles are important.
Inflammatory type – uv therapy

50. Diabetic blisters Diabetic blisters can occur on the backs of fingers, hands, toes, feet, and sometimes on legs or forearms. These sores look like burn blisters and often occur in people who have diabetic neuropathy. They are sometimes large, but they are painless and have no redness around them.

51. Treatment Blisters may be treated with antibiotic cream or ointment and bandaged to protect them from further injury. E.g. Bacitracin & Neosporin.

52. Eruptive xanthomatosis Eruptive xanthomatosis is a skin condition that causes small yellow-red bumps to appear on the body. It can occur in people who have very high blood fats (lipids). These patients also frequently have diabetes. Eruptive xanthomas usually appear on the buttocks, shoulder, arms, and legs. However, people may notice the bumps and lesions all over the body, including on the face and inside the mouth.

53. Treatment Treat the cause as well as prescribe medications, healthful dietary changes and increased physical activity can help treat eruptive xanthomas.

54. Diabetic bacterial infection Bacterial infections commonly affecting the skin spreads quickly in diabetic individuals. Bacteria viz., Staphylococcus are more common and more serious in people with uncontrolled diabetes

55. Treatment Antibiotics

56. Diabetic scleroderma One of the diabetic skin conditions is the scleroderma-like syndrome. Its prevalence, according to various authors, ranges from 8% to 50%.
These changes consist in thickening and hardening of skin of the dorsal part of hands, in particular fingers, with limited joint mobility and contractures, and are defined as diabetic sclerodactyly. Another skin complication of diabetes is diabetic scleroderma.The skin hardening involves the skin of face, nape, shoulders, upper parts of the trunk, upper arms. It occurs in approximately 2.5–3% of patients with diabetes.

57. Treatment The treatment is to bring blood sugar level under control. Lotions and moisturizers may help soften skin.

58. Abscess Abscess is a localised collection of pus in the cavity lined by granulation tissue, covered by pyogenic membrane. Patients with diabetes mellitus are more likely to have a pyogenic liver abscess with gas forming infection; a gas forming pyogenic liver abscess carries a higher morbidity and mortality than the non-gas forming group. People with diabetes have an increased risk of developing skin abscesses.

59. Treatment Incision & Drainage Wound care

60. Complications Diabetic retinopathy Diabetic neuropathy Diabetic nephropathy Abscess to brain, skin, spinal cord, or organs such as kidney etc Endocarditis Osteomyelitis Permanent scarring of skin Sepsis
Spread of infection to other areas

61. Differential diagnosis Cystic acne
Hidradenitis suppurativa
Infected epidermal inclusion cyst
Cellulitis Osteomyelitis Anthrax
Herpetic whitlow
Orf

62. Treatment Improvement of the general health of the patient
Proper antibiotic should be started immediately from the culture & sensitivity test.

63. If the surface openings have not formed, a synthetic penicillin e.g. Erythromycin may be used. At this time a paste of anhydrous magnesium sulphate & glycerine may be applied or S.S. Mag sulph powder is used on a moisten cotton & placed on the affected area. This will exercise a valuable osmotic affect & will not only reduce oedema but also will help to burst the carbuncle. Hot compress is helpful before bursting. It may be supplemented by infrared or short wave diathermy.

64. Operation It may be required When toxaemia & pain persist even after a course of antibiotics When the carbuncle is more than 2 ½ inches in diameter. It must be remembered that incision is never made unless there is softening in the centre.

65. Technique A large cruciate incision is made extending upto the margin of the inflammatory zone. Sloughs should be cleared with a piece of gauze. Epices of the four skin flaps are generously excised. The wound is covered with Vaseline gauze or sofratulle dressing. The part should be kept in perfect rest for a week & antibiotic is continued till resolution.

66. Conclusion The subject matter shows that priority should be given in checking the disease (particular type of urinary disorder / diabetes) in early stage itself.
Further, diabetic carbuncles must be treated with utmost care and diet restriction becomes mandatory.
If neglected, surely irreversible loss will occur. Is it not worth to understand the graveness of the disease and act accordingly instead of undue repenting thereafter!