SANKRAMAKA JWARA CHIKITSA.pptxAccording_to_ncism

KAYACHIKITSA SYLLABUS FINAL YEAR ACCORDING TO LATEST NCISM SYLLABUS

1. KAYACHIKITSA 3 rd PROF. PAPER 1 POINT 5 1

2. SANKRAMIKA JWARA CHIKITSA PRESENTED BY… DR. AABHA SHARMA, MD (AYU) ASSOCIATE PROFESSOR, DEPARTMENT OF KAYACHIKITSA 2

3. SANKRAMAKA JWARA EVAM JEEVANU JANYA VYADHI Sankramaka roga / infectious/ communicable diseases are manifested by microbial transmissions, from one person to another, animals to humans or through environment, spread via air, water, saliva, food, blood, etc. Sankraman means “ability to spread”, Roga means “disease”. Hence, Sankramika roga emphasizes the role of infectious agents in causing these diseases and pyrexia caused during these infections are termed as Sankramika Jwara . In Charaka Samhita, description is found regarding different micro-organisms which leads to illness in various parts, channels of body or skin. Among those some are: Kasheruka janya vyadhi (infections originated from vertebrate animals- zoonotic diseases) eg. Rabies, Dengue…. 3

4. VISHAMA JWARA (MALARIA) Vishama means “irregular”, Jwara means “pyrexia”, when Jwara has an irregular pattern [ vishama arambha / kala/ kriya/ avadhi ….] it is termed as VISHAMA Jwara . Terms like Preta/ Bhoota / Graha were also used for micro-organism. In these conditions, the fever has never gone off, it (vitiated dosha/ jeevanu ) is deep seated in Dhatu at latent ( suptavastha ) state. After remission period (fatigue, heaviness…) it again appears, at different times in different types of Vishama Jwara . Durbala/ Alpa Dosha after remission of Jwara due to Vikruta Aahara -Vihara aggravates once again, lodged in any Dhatu and manifests the type of Vishama Jwara . Malaria , an infectious disease caused by plasmodium parasite (malariae) and transmitted through infected female anopheles mosquito bite. Commonly, observed in hot and humid places (tropical area) like Africa and parts of Asia. Fever, chills, headache, muscle ache, sweating, fatigue, difficulty breathing are common features. In some cases chest pain, diarrhoea, nausea, seizures are also recorded. In worst condition: Anaemia, Jaundice. [I.P.- a wk - month] recurrence can also be observed after a year. 4

5. If, left untreated : organ failure, coma, death. Diagnosis : sign/ symptoms, travel history, blood sample for Malaria parasite (species too). Management/ treatment : Antimalarial drugs [chloroquine, doxycycline, quinine,…] Antipyretic drugs [acetaminophen….] Rehydration [I/V, O], if, needed blood transfusion Symptomatic management [antiemetic, anti diarrhoeal…] Preventive measures [mosquito repellent- DEET, mosquito nets- permethrin, full clothing] Chikitsa : Dosha+ Bhoota [ Daivyavaipashraya - Yuktivaypashraya chikitsa] In context of treatment of Vishama jwara only Tritikyaka - Chaturthaka - Chaturthaka viprayaya is included, which means for remaining 3 types general treatment and medicine should be adopted. Vata : Anuvasana Vasti, ushna aushadha sadhita ghruta or oil orally; Pitta : Virechana , dugdha - ghruta ; Kapha : Vamana- Shatapala ghruta , ushna kapha shamaka aushadha orally administered. Aushadha yoga : Triphala kwatha , giloya swarasa , panchagavya , pippali , mamsa rasa, Mahasudarshana churna , Amrutarishtam , Tribhuvanakirti rasa, AYUSH 64 by CCRAS, fruit juice, coconut water… {REST IN PREVIOUS JWARA PPT} 5

6. ANTRIKA JWARA (TYPHOID) Antrika means “intestinal” features like intestinal bleeding or its perforation are common Upadrava observed in this Jwara after the Snataap is at its peak. After Upadrava body temperature falls down making it a bad prognosis. No direct corelation is observed between typhoid and other fever, some comparisons are- Pittolbana Vishama Sannipataja Jwara [vitiated tridosha in unequal proportion  Antardaha - Bahirdaha ] Hikka , Atisara , Shwasa , Atinidra , Atisweda , Atidaha , Atitrushna , Raktasrava some of its features seen in typhoid too. Santata jwara / continuous fever a feature that resembles to typhoid and 7,10,12 days Jwara persists indicated dominating vitiated Dosha involvement. Jwaratisar mentioned in Madhava nidana with similar Hetu, Poorvarupa , Rupa, Samprapti (common jwara with pitta pradhana vikruti ), prognosis in varying combinations indicating Jwara and Atisara coexist in this illness. It is a condition with fever and intestinal symptoms (diarrhoea), so can be compared with typhoid. Cause : Pittapradhana Sannipataja Hetu Chikitsa : balancing Tridosha , Udbhavasthana Chikitsa ( aamashaya ), Pittashamaka Chikitsa, Santata Vishama Jwara Chikitsa (general), Virechana , Tikta - Sheeta Aushadha sevana , Sudarshanaghana Vati, Avipatti Churna , Vishamajwarantaka Vati,…. { REST IN PREVIOUS JWARA PPT } 6

7. Typhoid / enteric fever is a bacterial (Salmonella typhi) infection, that infects small intestine due to the consumption of contaminated food-water by this bacterium. Similar type of typhoid with milder features is Paratyphoid , caused by S. Paratyphi . [I.P.- 5-14 days] Commonly, seen in children and areas with poor hygiene. Person can be a carries for more than a year. Features : high fever (step ladder), chills, rose spot rash (chest, stomach), abdominal pain, nausea, diarrhoea, vomiting, muscle ache, headache…. Diagnosis : 1 st week widal + ve in blood, 2 nd week bacterium multiplies in peyer’s patch causing gut symptoms stool/ urine + ve and rose spot rash, 3 rd week if not treated cause complication like internal bleeding, encephalitis, 4 th week body temperature starts falling but typhi can live in gallbladder. Travel history, X Ray, bone marrow test. Management/ Treatment : Antibiotic of different groups [ofloxacin, cefixime, azithromycin,….] Severe case [steroids- dexamethasone…] Symptomatic [NSAIDs- ibuprofen; anti diarrhoeal, etc….] Antipyretic drugs [acetaminophen….] Maintaining hygiene…. 7

8. VATA-SHLAISHMIKA JWARA (INFLUENZA) Jwara caused by the vitiation of Vata Kapha Dosha mainly out of Tridosha . Some consider it to be caused by predominance of Kapha and some due to Vata. But, as the nature of Vata ( chala ) it is the provoking factor here that vitiates Kapha, later both have association to manifest Vatashalaishmika Jwara . Features of Vata and Kapha are visible here, but inspite of Pitta being involved its features are not predominantly evident in this Jwara . Management/ treatment : Samanya Jwara Chikitsa; Vata- Kapha- Vatakapha Chikitsa [ both already mentioned in JWARA PPT ]; Shotha Chikitsa [Bala, Dosha, Kala considered for treatment. In Amavasta  Langhana , Pachana followed by Shodhana Chikitsa administered according to the site of the Dosha located. In Snehakaraka Shotha  Aushadha having Rooksha guna are used and vice-versa. In Vibandha  Niruha Vasti. In Pitta-Vata dominance  Tiktaka Ghruta . Kapha pradhanta  Takra , Kshara , Ushna aushadha - Trikatu , Trivruta …. Triphaladyarishta , Gudardraka , Chitrakadi Ghruta …..] 8

9. Influenza , common viral infection of respiratory tract that can be fatal in risk group caused by influenza viruses. Features like running nose, sore throat, cough, fever, headache, body ache observed which can be severe. [I.P.-1-3 days] It may progress to Pneumonia, by subsequent viral/ bacterial infections. Cause/ Type : A [seasonal epidemic, evolves quickly, transmitted through respiratory route. IAV  H1N1 swine flu/ avian flu; H3N2 can infect birds/ mammals] {its an orthomyxovirus having Haemagglutinin clumps the RBC binds to infected cells and Neuraminidase helps move virus through infected cells} B [does not have subtypes like type A, contributes to seasonal epidemic] C,D [usually remains asymptomatic, primarily affects children, have slower evolution rate] Diagnosis : symptoms, nasal- throat swab test (URT), sputum (LRT), virus culture (RT-PCR), serological Prevention : infection control, sanitization, vaccination Treatment : Antipyretic drugs, Rehydration therapy, Antiviral drugs [peramivir, oseltamivir, zanamivir…], if required Antibacterial drugs for secondary infection [amoxycillin, cefixime….] 9

10. SHWASANAKA JWARA (PNEUMONIA- COVID- H1N1) Jwara present in Shwasanaka jwara is predominantly associated with Kapha. Features of Kapha Vikruti are observed more due to Dosha and Sthana involved here are Kapha pradhana . Vitiated Kapha- Ama generates the Avorodha in Srotas , resulting spread of Jatharagni throughout the body causing Jwara along with the symptoms of Pranavaha Srotas - Shwasa , Kasa (with mucous), Urahashoola , temperature rises upto 103̊-104̊F, pulse upto 101-103/min.…. Paryaya : Phuphuspaak , Phuphuspradaha , Raktashathivana sannipata …. Chikitsa : Kapha chikitsa (kapha nashaka - nihsaraka - vilayankaraka ) trikatu , pippali , tribhuvankirtirasa …, Vata chikitsa ( bruhata vatachintamani rasa,…) Hrudaya ( draksha , madhu ,…), Santaphara ( giloya , Sanjivani vati ,…) 10

11. Pneumonia an infectious disease of one or both lungs, caused by bacteria, fungi, viruses spread through airborne route, causing inflammation of alveoli (filled up with fluid/ pus) making lungs difficult to breath . Fungal pneumonia attracted through environment not from people. Thick- persistent phlegm with cough, high fever, shortness of breath even at rest along with chest pain, wheeze are some of the major features observed in it. Stages : Bronchial [often localized, can affect areas throughout both lungs] Lobar [affects one or more lobes. Congestion- lungs alveoli filled with fluid appears heavy and congested. Red hepatization - lung appears red and solid because of RBC and immune cells Gray hepatization - RBC breakdowns, immune cells remain causing colour to change. Resolution- immune cells clears infection, productive cough eject out remaining fluid.] Diagnosis : crackles on auscultation, consolidation seen on X-ray, blood- sputum culture, CT- MRI scan…. Treatment : Antibacterial, Antiviral, Antifungal, Antipyretic, Analgesic, Rehydration, Hospitalization [I/V administration; Respiratory therapy- breathing exercise; Oxygen therapy- ventilator, nasal tube] 11

12. COVID-19 is an infectious disease caused by SARS-CoV-2 virus, spread worldwide in January 2020 resulting in pandemic. Dominant features : fever, loss of taste- smell, shortness of breath, nausea, etc. Complications : pneumonia, ARDS, respiratory failure, sepsis, brain damage, etc. Diagnosis : symptoms, RT-PCR Prevention : face mask, vaccination, hygiene, ventilation Treatment : symptomatic, supportive [fluid therapy, Neb.(D+B), oxygen therapy, Zn, Vit.C ] 12

13. DANDAKA JWARA (DENGUE) Vishama jwara mentioned in ayurveda shows clinical features like seen in dengue, correlated with Dandaka Jwara means “joint pain/ breakbone fever” cardinal feature. As mentioned under Vishama Jwara indicating vitiation of Tridosha Pitta dominance. Chikitsa : Langhan, Deepana, Pachana , Mrudu Swedana , Jwaraghna Aushadha , Bala- Vyadhikshamatva Vardhaka Aushadha , [Sudarshana Churna , Sootashekhara Rasa, Vasantakusumakar Rasa, Kalamegha , Papaya leaves….] Dengue is a mosquito borne viral (DENV-1,2,3,4) disease, transmitted via the bite of a female mosquito Aedes aegypti, also known as breakbone fever and direct person to person transfer is not possible, except pregnant mother to child. Primary host humans [I.P.- 1 week] Symptoms : Mostly don’t cause symptoms, if so then high fever (104̊F), rashes, retro orbital pain, nausea, joint/ muscle pain, Febrile phase - 104F saddle back fever, petechiae do not disappear, rash; Critical phase - plasma accumulation in abd . thorax, GIT bleeding, Dengue haemorrhagic fever / Dengue shock syndrome usually appears within 24-48 hrs; Recovery phase - reabsorption of plasma, fluid overload may happen causing seizures, improvement Diagnosis : sign-symptoms, blood investigation (CBC, ↓platelets, LFT, PCR, IgM- important in 1 st week), [DHF-grade I- fever, minor brusing , tourniquet + ve test; grade II- random haemorrhage; grade III- shock symptoms; grade IV- weal pulse acute shock DSS] Treatment : antipyretic, stay hydrated (oral/ IV, electrolyte replacement, platelet transfusion), loop diuretics, (avoid NSAIDs to reduce risk of haemorrhage), rest, symptomatic management…. 13

14. SANDHIGATA SANNIPATA JWARA ( CHIKungunyA ) According to Ayurveda imbalance and vitiation in Tridosha due to viral infection causing disease and accumulation of vitiated dosha especially Vata-Kapha in joints, exacerbated by body’s weakened state post infection (following multiple features in its acute state like fever, nausea, flu-like symptoms). Vata causing pain, stiffness, dryness and Kapha joint inflammation. Due to this cardinal feature it is related to Sandhigha Sannipataja Jwara . Chikungunya is a viral (CHIKV) fever spread by the bite of infected Aedes aegypti/ albopictus mosquitoes, symptoms of dengue resembles it like fever, joint pain, rashes, vomiting, photophobia, haemorrhage but in dengue platelet depletion sets-in in later stages. However, the most painful aspect of chikungunyna is the extended period of pain and swelling in joints following recovery from pyrexia due to own immune response to parts of virus which resembles joints. Post chikungunya arthritis affects multiple joints for a very long period causing debility. Diagnosis : CBC, ↓lymphocytes, verimia , CRP, ESR, ELISA In this condition Ayurvedic formulations and therapies help to modulate the immune response against viral antigens affecting joints causing synovial membrane inflammation. 14

15. Chikitsa : [For Chikungunya] Shotha-Vedanahara Chikitsa - Yogaraja guggulu+Shallaki ; Jwaraghana chikitsa - Nimbadi Kashaya+Amrutarishta ; Balavardhana - Ashwagandha+Balarishta + Ksheerabala Tailam [Post disease Arthritis] Ama chikitsa - Langhan, Pachana , Deepana, Vata chikitsa ; Ushna Virya- Sookshma - Tikshna Guna Aushadha for Vata [Simhanada guggulu , eranda taila ] No specific treatment is there, only supportive care is suggested  Antipyretic, Analgesics [PCM not Aspirin- ↑bleeding], NSAIDs, no corticosteroids [immunosuppressant], fluid therapy [oral, I/V],  Arthritis [ribavirin, methotrexate x2 wks ] 15

16. MASTISHKAvarana shotha JWARA (MENINGITIS) Mastishka Jwara / Mastishka aavarna shotha is manifested due to the vitiation of Kapha-Pitta Dosha mainly along with Vata, Bhootabhishanga (micro-organism infestation) causing Jwara , Shirashoola , Manyastambha (neck stiffness), Gatracheshtha (seizures). Chikitsa : Jwara Chikitsa; Shotha Chikitsa [ navayasa churna , yogaraj guggulu , dashmoola ]; Sthana vishesha Kapha Chikitsa [ trikatu , triphalaguggulu ]; Sankramana involves Pitta Chikitsa; CNS involves Vata Chikitsa Meningitis is an acute inflammatory disease of brain and spinal cord three layers (meninges) caused by infectious (viral, bacterial, fungal, parasitic, amoebic) or non-infectious (injury, surgery, cancer) cause leading severe damage to nervous system, can be fatal if not treated. Features like meningeal rash , high fever, nervous issues, light sensitivity, headache, vomiting are observed. Condition mainly found in children (high fever, crankiness, over sleepy, bulge on fontanel). Diagnosis : symptoms, Glass test, blood investigation- CBC, ESR, CT scan, MRI, lumbar puncture Treatment : ac/t cause- Antibacterial, Antiviral, Antifungal, Antiparasitic; antipyretic Complication : brain damage, memory-vision-hearing loss, gangrene, hydrocephalus…. 16

17. Mastishka shotha (ENCEPHALITIS) Dosha imbalance give rise to number of diseases, same happens in case of nervous system and diseases related to brain, majorly Vata vitiation is responsible for it and association of Pitta leads to condition. It may be due to Bahya Nidana ( Jiwanu ) or Antaha Nidana (Dosha). In common practice it is k/as Chamki Jwara . Encephalitis is a brain tissue inflammation as a result of infection (bacteria, virus, fungus) or autoimmune process. Causing symptoms like headache, confusion, body weakness, personality changes, seizures, high fever, vomiting etc. commonly seen in children ↓15 years. Diagnosis : symptoms, neurological examination, CBC, CT scan, MRI, Lumbar puncture,… Treatment : Jwarahara Aushadha , Vata chikitsa, Shothahara Chikitsa, Sankramana hetu Aushadha [ giloya , neemadi ]….. Shadanga paniya , Kumarakalyana rasa, Ratnagiri rasa.… - Antipyretic, Rehydration [O/ IV], Antiseizures [zonisamide, clonazepam], Antibacterial, Antiviral, Speech therapy, Plasmapheresis- Immunoglobins for autoimmune issue, mechanical ventilators. 17

18. DHANURVATA (TETANUS) Dhanurvata / dhanurastambha , seen as an imbalance of Vata Dosha and a manifestation of aggravated Prana Vata that governs nervous system. The toxins produced by Vishaanu blocks the flow and cause Vata Vikruti Lakshana, especially muscle spasm. Chikitsa : Body detox, Vata Chikitsa, Immune strengthening, Jwara Chikitsa,…. Tetanus/ lock jaw is a nervous system disorder caused by bacterial infection causing muscle tightening throughout the body, muscle contractions often in jaw and neck eventually to rest of the body [generalized, neonatal, localized, cephalic tetanus]. Preventable through vaccination, require immediate treatment or else life threatening. Caused by bacteria Clostridium tetani spores present in dust and animal drooping, enters blood stream via cuts, wounds and spread to CNS. [I.P.- 3-12 days] Major symptoms - difficulty swallowing, spasm- stiffness of muscle, high blood pressure-heart rate, fever Diagnosis : wound evaluation, immunization history, CBC, muscle rigidity-stiffness-spasm, tetanus antibody test, + ve gag reflex, ELISA, CSF evaluation Treatment : wound cleaning, Antibiotic, Antipyretic, Muscle relaxant, Tetanus Immunoglobin, Vaccination [TT booster/ DPT] Complication : pneumonia, convulsion, laryngospasm, secondary infection, ↓ brain oxygen 18

19. GRANTHIKA SANNIPATA JWARA (PLAGUE, LEPTOSPIROSIS) Granthi formation in plague indicates the involvement of Rasa dhatu in the disease as it forms in the lymph, even for Jwara . Vikruta Rasa Dhatu further affects Vata Dosha for the spread of the disease. Chikitsa : management Jwara Chikitsa, Visha Chikitsa (body detox for rasa dhatu), Balavardhana , Lakshanika Chikitsa. Plague is an infectious disease caused by bacterium Yersinia pestis (vector- rat fleas), manifesting features like fever, headache, swelled lymphs (bubonic form), tissues turn black ( septicemic form), shortness of breath (pneumonic form). [Onset 1-7 days after exposure] [Diagnosis- buboes fluid aspiration, blood test, mucus test] Treatment : Antibiotics, Antipyretic, rehydration, symptomatic,…. Leptospirosis / weil’s is a rare infectious disease ( krumi roga ) disease, mostly non-life threatening bacterial (Leptospira interogans ) disease spread through the urine of infected animals especially pets. Often found in warm climate. Infection cause Tridosha imbalance along with toxin/Ama accumulation. Patient may not have symptoms but can be a carrier. Re- occurance is observed if disease turned severe and need hospitalisation. Symptom hit fast with fever 104̊F, muscle ache, chills, red conjectiva in this initial phase focus on balancing Dosha and removing Ama; in advanced phase disease affects organs and management is done according to the Dosha associated with the organ/ disease. 19

20. BEEJANU JWARA (ANTHRAX) Beejanu Jwara Sthana evam Lakshana anusar is Kapha-Pitta Pradhana Jwara , where features like Kasa, Urahashoola , Atisara , Kandu, Udara Shoola etc are observed. Anthrax/ woolsorter’s / ragpicker’s disease is a rare but serious infectious illness caused by microbe bacillus anthraceis residing in soil, where domestic animals gets infected first then spread in humans (inhale, ingest). Without treatment its fatal. [I.P.- 7 days] Symptoms : depends on mode of contact [SKIN- small raised sore with itch turn to blister/ ulcer] [PULMONARY- sore throat, cough, chest pain, haemoptysis…] [INGESTION- nausea, appetite loss, abd . pain, bloody diarrhoea…] [INJECTION- contracted through illegal drug, local redness- swelling…] Diagnosis : sign-symptoms, blood test (CBC, bacterial culture), skin test (serum testing), stool test, spinal tap, chest X-Ray, CT scan, endoscopy Complication : haemorrhagic meningitis, death Treatment : Krumi chikitsa, Kandu- Shotha chikitsa, Jwara chikitsa, Kapha-Pitta chikitsa Antibiotic, Corticosteroid, Antipyretic, Antitoxin therapy, Anthrax vaccine, Surgical removal of infected tissues. 20

21. PEETA JWARA (YELLOW FEVER) Peeta Jwara is caused by Pitta Dosha imbalance/ aggravation along with Vata, which leads to yellowish discolouration, bitter/ sour taste, excessive thirst/ sweating, by entering stomach blocks Rasavaha Srotas and spreading through out the body causing Jwara . Chikitsa : pacify Pitta, Jwarahara Chikitsa, balancing Tridosha , lakshanik chikitsa…. Yellow fever / yellow plague/ yellow jack/ bronze john is a serious viral (Flavivirus) haemorrhagic disease, potentially deadly flu-like disease spread by Aedes aegypti mosquitoes(dengue/ zika spreaders). Characterized by high fever, jaundice. [I.P.-3-6 days] Symptoms : initially similar to influenza. Acute phase- head muscle joint pain, flu, reduced appetite, fever; Remission phase- as the phase over symptoms goes away some develop serious version; Toxic phase- abd pain, seizures, arrhythemia , internal bleeding, organ damage, jaundice/ hepatitis… Diagnosis : features, history, PCR, blood test (IgM, virus detection), LFT.. Treatment : I/V fluids, oxygen therapy, Antipyrexia , Antiviral, symptomatic management, blood transfusion for renal failure…. 21

22. SHLEEPADA (FILARIASIS) Shleepada / hastipaad is termed so because here foot swelled up like stone and appears like foot of an elephant. Comparative to other body parts it is more seen in foot. It is Kapha pradhana Tridoshaja sankramaka vyadhi . Vankshana peeda - shotha , jwara chills are some of its lakshana and sravayukta , Valmik vat shikhra granthi yukta , puraan shleepada is asadhya . Chikitsa : Kaphanashaka Chikitsa, Jwara Chikitsa, Langhana , Virechana , Sarshapa taila mardana, Siravedhana [V- gulpha sandhi urdhva , P- gulpha sandhi adho , K- angushtha Sameep],Nitya lahsuna sevana . Filariasis / elephantiasis is a parasitic diseases caused by roundworm and spread by mosquito (lymphatic/ sub cutaneous/ serous cavity filariasis). Symptoms are oedema in lower limb, rash, urticarial papules, arthritis, swelling of other body parts. Diagnosis : PCR, finger prick test for larvas (detected at resting phase in swollen region), CT, MRI…. Treatment : Antipyretic, Antiparasitic, symptomatic management… 22

23. THANKYOU !!! 23