Symptomatology

Symptomatology terms
General symptoms
Symptoms related to metabolic
Symptoms related to cardiovascular
Symptoms related to respiratory
Symptoms related to Gastrointestinal
Symptoms related to Dermatology
Symptoms related to neurology
Yoga therapy
Evidences supporting yoga in symptomatology

1. SYMPTOMATOLOGY 1 Dr. Satyendra Singh BNYS, MD

2. Contents Symptomatology terms General symptoms Symptoms related to metabolic Symptoms related to cardiovascular Symptoms related to respiratory Symptoms related to Gastrointestinal Symptoms related to Dermatology Symptoms related to neurology Yoga therapy Evidences supporting yoga in symptomatology 7/25/21 2

3. Symptomatology is the set of symptoms characteristic of a medical condition or exhibited by a patient The word symptom was derived from the word “ symptoma ” a Greek word which means “ any change that happens ”

4. Symptomatology terms Any deviation from health that can only be perceived or felt by the patient When a symptom has a physical manifestation that can be detected by others Set of symptoms & signs associated with & characteristic of any particular disease.

5. Types

6. Symtomatology outcomes

7. Symptomatology association

8. Why it is important ? The production of symptoms is always in according with natural physical laws and every sign and symptoms are expression of some internal deviation from normal physiology. It is the outward reflection of internal essence of the disease To understand the disease one must be able to distinguish the variation in the expression , from an actual deviation.

9. Elements of symptoms Location Sensation Character/ colour/odour Aggravation Amelioration Concomitants Causation Duration Extension Alternation Predisposition

10. FEVER It is a disorder of the thermoregulation centre causing an elevation of the body temperature due to elevation in the hypothalamic set point. Body temperature is regulated by THERMO REGULATORY CENTRE in the hypothalamus Thermoregulation achieved by maintaining Heat loss=Heat production Any imbalance leads to fever 10

11. NORMAL CONDITION Normal body temperature is 98.2 +/_ 0.7 degree Fahrenheit (36.8+/_0.4 degree Celsius) If the temperature is more than 1.5 degree F then it is called fever. VARIATION: Daily Variation =0.5/0.9degree Fahrenheit Rectal Temperature=0.4 degree Celsius more than oral(due to mouth breathing) 11

12. CAUSES PHYSIOLOGICAL: Exercise , high environmental temperature PATHOLOGICAL Infection, HIV/AIDS, Vascular, infective endocarditis , MI PYROGENS Substance that are released either from bacteria or viruses or from destroyed cells of the body and that causes fever. EXOGENOUS ENDOGENOUS- E.coli 12

13. MECHANISM Interleukin IL-1,IL-6,TNF,interferon acts on thermoregulatory centre ( organum vasculosum of the lamina terminalis ) Increase synthesis of prostaglandins- PGE2( which act as neurotransmitter) Increase cyclic AMP hypothalamic thermostat 13

14. Temperature remains elevated throughout the day with little variation Short febrile periods occur between one to several days of normal temperature Marked variation in the body temperature by atleast 2 degree F per day and temperature is normal for sometime in 24 hours Marked variation in body temperature by atleast 2 degree F and temperature does not reach normal REMITTENT INTERMITTENT CONTINOUS/ SUSTAINED RELAPSING TYPES 14

15. 15 EFFECTS OF FEVER

16. Accompaniments Myalgia 16 Headache Arthralgia malaise backache Chills and rigours

17. FATIGUE It is an excessive tiredness on exertion, occurring in organic and functional ill health. DIFFERENCE b/n TIREDNESS AND FATIGUE Tiredness is same as fatigue but occurs even at rest and weakness with loss of diminished muscle power. 17

18. MECHANISM Fatigue occurs due to the following mechanisms: Lactic acid accumulating in the muscles and in the blood Oxygen deficit Depletion of creatinine from muscles Deleterious effects of accumulated toxic substances 18

19. CAUSES PHYSIOLOGICAL: Insomnia, overwork , starvation PATHOLOGICAL: Anaemia, Nutritional deficiency, electrolyte imbalance Prolonged pyrexia and infections Malignancy and immunocompromised state Alcoholism, uremia Depression, sleep disorders Multiple sclerosis and myasthenia gravis 19

20. Localised neuromuscular disorders Poliomyelitis Myopathies Lung diseases Malignant encephalopathies LOCAL CCF Chronic lung diseases Chronic renal failure Obesity GENERALISED CLASSIFICATION 20

21. DIAGNOSIS Fatigue + muscle cramps + tremors + lethargy = ELECTOLYTE IMBALANCE Fatigue+ palpitation+ cardiomegaly = Heart disease Fatigue+ pallor + loss of weight+ malnutrition = Anemia Respiratory tract symptoms + cachexia + fatigue= Tuberculosis Polyuria + polydipsia + polyphagia = Diabetes mellitus Hypotension + pigmentation = Addisons disease 21

22. 7/25/21 22 METABOLIC

23. LOSS OF WEIGHT More than 10% decrease in the body weight in an individual is clinically significant provided an attempt has not been made to reduce weight. Extreme degree of loss of weight is called CACHEXIA. Loss of fluid content Loss of tissue mass of the body decrease appetite increased metabolism loss of calories combination of all other factor 23

24. CALORIE RESTRICTION Marasmus,PEM Poverty ENDOCRINOPATHIES : Diabetes mellitus Thyrotoxicosis Hyperthyroidism Adrenocortical insufficiency IMMUNO-COMPROMISED CONDITION AIDS CHRONIC INFECTION Tuberculosis Pernicious Anaemia Amoebic Liver Abcess MALIGNANCIES AND MAL ABSORPTION SYNDROME Ca.Stomach , Ca.Pancreas IBS, Steatorrhea 24 CAUSES

25. DIAGNOSIS Actual weight loss & period of time should be noted Information regarding the change of appetite/relation with loss of weight should be noted. 25

26. DIFFERENTIAL DIAGNOSIS Malnutrition Tuberculosis Malignancy Steatorrhea Thyrotoxicosis Diabetis mellitus Anorexia Nervosa Adrenocortical Insufficiency 26

27. Weight gain Weight gain  is an increase in body weight. This can involve an increase in muscle mass, fat deposits, excess fluids. 27

28. Fluid retention CHF Nephrotic syndrome Nephritic syndrome Liver cirrhosis Increase in tissue mass Heredity Calorie intake > energy expenditure Lifestyle Excess deposition of fat Increases in mass of tissue other than adipose tissue Drug induced Idiopathic Endocrinopathies Hypothyroidism Hypogonadism Cushingsyndrome Congenital disorders (Laurence Moon Biedl syndrome) CAUSES 28

29. 29 ASSESMENT Skin fold thickness: waist circumference mid arm circumference waist hip ratio Broca’s index Body- mass Index Weighing scale TREATMENT Behavioural modifications & diet Exercise

30. 7/25/21 30 CARDIO VASCULAR

31. CHEST PAIN One of the most commonest subjective symptoms that causes alarm to the patient(as a vision of organic disease of heart /lung) TYPES ACUTE CHRONIC Acute MI Pericarditis Aortic dissection Musculoskeletal disorder Acute pulmonary embolism Perforating Ulcer 31

32. CARDIAC ANGINA ANEURYSM OF AORTA DISSECTING ANEURYSM OF AORTA CAUSES AND PATHOGENESIS 32

33. PLEURITIC PAIN Pain felt due to inflammation of the pleura/ Due to spasm of intercoastal muscle PULMONARY HYPERTENSION PULMONARY EMBOLISM Pulmonary hypertension has same mechanism like that of chest pain 33 Due to increase in tension of the arterial wall

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35. TYPE OF PAIN RADIATION AGGREVATES ON RELIEVED ON ANGINA PECTORIS stabbing,crushing,squeezing Left pectoral medial aspect of left arm left shoulder& neck Exertion Emotion Eating heavily Sexual intercourse Exposure to cold Rest trinitroglycerin MYOCARDIAL INFARCTION Same location as before Pain associated with breathelessness, vomiting and sweating Not related to stress/exertion Not relieved by trinitroglycerin DISSECTING ANEURYSM Sudden onset,excruciating pain, sharp crushing/tearing pain To back, upper abdomen and neck Pressure on vessels PLEURITIC PAIN Sharp,knife like Back and abdomen Coughing,sneezing and inspiration By holding breath in expiration 35

36. TYPE OF PAIN RADIATION AGGREVATED WITH RELIEVED ON PERICARDITIS Substernal pain To left arm, back,epigastric by specific movement like turning over in bed by sitting and leaning forward MUSCULOSKELETAL Localised and associated with local tenderness Motion, respiration, violent coughing Immobilization of chest GASTRO-OESOPHAGEAL Midline associated with heart burn Upward to xiphoid process, jaw, back Recumbent position after food Belching, standing up antacids 36

37. PALPITATION Defined as an awareness of the beating of one’s heart brought by change in the rate, rhythm/ contractility of heart. If associated with dyspnoea / dizziness / chest pain /patient with a cardiac history then patient requires evaluation. 37

38. Exercise sexual or emotional outburst Anxiety PHYSIOLOGICAL Endocrine Cardiac Metabolic Drugs / toxins PATHOLOGICAL CAUSES 38

39. MECHANISM Catecholamine - tachycardia . stroke volume of ventricles . TREATMENT Tranquilizers Anxiolytic drugs 39

40. 7/25/21 40 RESPIRATORY

41. CYANOSIS It is the bluish discoloration of nail beds, lips, ears and tongue due to increased concentration of reduced haemoglobin. It becomes apparent when the concentration of reduced haemoglobin rises above 5g/dl. 41

42. CLASSIFICATION THERE ARE 2 MAIN CLASSIFICATION OF CYANOSIS. Central cyanosis Peripheral cyanosis 42

43. CENTRAL CYANOSIS PERIPHERAL CYANOSIS MECHANISM Diminished arterial Oxygen saturation Diminished flow of blood to the local parts SITES On skin and mucous membrane i.e. tongue,lips On skin only .doesnot affect the mucous memebrane TEMPERATURE OF THE LIMB warm cold CLUBBING Usually associated Not associated LOCAL HEAT Cyanosis remains Cyanosis abolished BREATHING PURE O2 FOR 10 MIN Cyanosis decreases Cyanosis persists 43

44. CENTRAL CYANOSIS PERIPHERAL CYANOSIS MIXED CYANOSIS EXAMPLES COPD, Pulmonary embolism Intestitial fibrosis Collapse of Lung Methemoglobinemia carboxyhaemoglobinemia Hypovolemic shock Cardiogenic shock Exposure to cold air or water Thrombophebitis Acute left ventricular failure 44

45. Dyspnoea Shortness of breath Word Meaning: dys -hard pnoea -breathing 45

46. Physiology of dyspnea Respiratory centres situated in medulla and pons Sensitive to changes in CO2 and H+ Concentration of blood and CSF Impulses are transmitted to the respiratory centres through VAGUS AND GLOSSOPHRAYNGEAL NERVE Information transmitted through intercostal , phrenic and vagus nerve to respective parts 46

47. TYPES EXERTIONAL DYSPNEA ORTHOPNEA PLATYPNEA PAROXYSMAL NOCTURNAL DYSPNEA TREPOPNEA 47

48. PHYSICAL ACTIVITY EXERTION GRADE 1 No limitation No symptoms with ordinary exertion GRADE 2 Slight limitation Ordinary activity causes symptom GRADE 3 Marked limitation Less than ordinary activity causes symptom GRADE 4 Inability to carry out daily activity Symptom at rest FUNCTIONAL CLASSIFICATION 48

49. Hypoxia and hypercapnea Fever/pyrexia Hypermetabolism PHYSIOLOGICAL Respiratory Cardiac Metabolic Functional Neurological PATHOLOGICAL CAUSES 49

50. 50

51. TREATMENT Beta 2 stimulant: salbutamol, terbutaline Methyl xanthine derivatives : aminophylline, theophylline Glucocorticoids : prednisolone, hydrocortisone 51

52. COUGH It is a physiological protective mechanism which is characterised by explosive expectoration against closed glottis following deep inspiration. Cough aims to clear the tracheobronchial tree of excessive expectoration foreign body 52

53. MECHANISM Voluntarily initiated mechanism AFFERENT LIMB CENTRE EFFERENT LIMB Trachea MEDULLA Glottis closure Larynx OBLONGATA Pharynx Contraction of thoracic Bronchi & abdominal muscle Pleura Contraction of diaphragm 53

54. PHASES 54

55. 55

56. CAUSES RESPIRATORY 56 TRACHEA AND BRONCHI 1.Cigratte smoking 2.Tracheobronchitis 3.Bronchogenic carcinoma LARYNX & PHARYNX Acute and chronic infection of larynx and pharynx LUNG 1.Pneumonia 2.Pulmonary Tb 3.Pulmonary edema 4.Abcess 5.Pulmonary infarction

57. CLASSIFICATION OF COUGH DRY COUGH: URTI , Pulmonary tuberculosis, Bronchogenic Carcinoma 2.COUGH WITH FOUL EXPECTORATION: Bronchectesis , Lung abscess, Fungal Infection 3.COUGH WITH MUCOID EXPECTORATION: Acute bronchitis, Bronchopneumonia 4.PAROXYSMAL COUGH: Asthma, Whooping cough 57

58. COMPLICATIONS COUGH FRACTURE COUGH SYNCOPE RUPTURE OF BULLAE 58

59. TREATMENT Avoid irritants Expectorants like steam inhalation and menthol Mucolytic agents to reduce the sputum viscosity and help in the removal Anti-histaminic decongestants 59

60. HEMOPTYSIS Expectoration of blood /blood stained fluids TYPES Haemorrhage from Haemorrhage from Lungs , bronchial tree nose,pharynx & and trachea larynx Results from vascular results from laceration rupture or ulceration of upper respiratory tract 60

61. CAUSES CARDIAC: aneurysm of aorta mitral stenosis pulmonary hypertension RESPIRATORY bronchogenic carcinoma lung abscess infection of lung IMMUNOLOGICAL haemorrhagic fever SLE BLEEDING DISORDER haemophilia thrombopenia leukemia IATROGENIC after bronchoscopy lung biopsy 61

62. HEMOPTYSIS HEMETEMESIS BLOOD COLOR Bright red and frothy Coffee ground mixed with food PRECEDING SYMPTOM Cough+ tickling sensation at throat vomiting ASSOCIATED SYMPTOM Cough+fever+ expectoration Abdominal pain+ vomiting+indigestion FOLLOWING STOOL Rusty sputum Tarry stools REACTION WITH BLOOD alkaline acidic DIFFERENCE BETWEEN 62

63. DIAGNOSIS It is respiratory- if it causes cough , chest pain ,expectoration and haemoptysis. Pulmonary oedema - pink sputum Lung abscess and bronchiectasis - foul smelling expectoration Consolidation- rusty sputum Bronchogenic carcinoma- clubbing & wasting It is cardiac if- it is associated with dyspnea on exertion, palpitation & syncope ,evidence of cardiac enlargement or failure If it is bleeding disorder: associated with bleeding at other sites and no respiratory/cardiovascular abnormality Pseudohemoptysis Condition obvious on examination of oral cavity/URT 63

64. POSTURE TREATMENT OF SHOCK PREVENT ASPIRATION TREATING THE CAUSES STOP BLEEDING TREATMENT 64

65. 7/25/21 65 GASTRO INTESTINAL

66. Vomiting It is the forceful expulsion of a part /whole of the stomach content through the oesophagus and mouth. NAUSEA: Indefinable and unpleasant sensation of vomiting 66

67. MECHANISM Vomiting centre is present in lateral reticular formation adjacent to medulla oblongata. There are 4 trigger zones that send afferent message to vomiting centre . They are Chemoreceptor trigger zone Higher CNS centre Vestibular system Afferent vagus fiber from GI 67

68. 1. abdominal muscles contract DURING VOMITING 2. diaphragm is voluntarily pushed downward 3.stomach wall contracts cardiac sphincter is elevated Straightening of the gastro-oesophageal junction Expulsion of the gastric content into the relaxed oesophagus with the help of the increased abdominal pressure 68

69. 7/25/21 69 CAUSES

70. CHARACTER OF VOMITING RED/COFFEE blood VOMITUS WITH FREE HCL Peptic ulcer GREENISH Presence of bile FECAL FOUL SMELLING- Peritonitis/ gastrocolic obstruction DIAGNOSIS 70

71. DIAGNOSIS Based on time of vomiting: 1.EARLY MORNING- pregnancy/ alcoholic gastritis 2.IMMEDIATELY AFTER MEALS-gastritis/ pylorospasm 3.4-6 HOURS AFTER MEALS-pyloric obstruction, gastric atony 71

72. ASSOCIATED SYMTOM Abdominal pain+ diarrhea /constipation=Abdominal causes Headache+ altered sensorium= increased intracranial tension Vertigo +tinnitus+ deafness=Labyrinthine Chest pain+ sweating+ dyspnea + palpitation=acute MI 72

73. CONSTIPATION It is the passage of hard stools with a reduced frequency of less than 3 times a week. When there is no passage of stools/ flatus it is called absolute constipation. ABNORMAL ACTION OF BOWEL 1. Defection may occur with insufficient frequency 2. Defecation may occur daily but insufficient quantity of stool 3.Occurs daily but faeces are hard and dry 73

74. PHYSIOLOGY Defecation reflex initiated by the acute distension of the rectum Supraspinal centres stimulate the sigmoid and rectal contractions and increase the pressure within the rectum Recto sigmoidal angle relax permit the evacuation of feces (aided by increasing the intra- abdominal pressure by glottal closure, descent of diaphragm and contraction of abdominal muscles) 74

75. CAUSES 7/25/21 75

76. OTHER CAUSES Drugs: Antibiotics, antidepressants Neurological disorders: Sacral nerve disorder, pudendal nerve damage 76

77. TREATMENT DIET EXERCISE - improves tone of abdominal muscles and colonic propulsion PSYCHOTHERAPY-relieve imaginary constipation 77

78. DIARRHOE is the frequent passage of unformed stools with an increase in daily stool weight of > 200 gms . ACUTE DIARRHEA is abrupt onset and short duration CHRONIC DIARRHEA is more gradual in onset and of longer duration. 78

79. PHYSIOLOGY NORMALLY, Most of the fluid is reabsorbed by jejunum and ileum & after this Caecum receives 1lt/day. Colon reabsorbs all the fluid load except about 100-150mlmwhich re- enters rectum. BUT IN DIARRHEA, it is prevented by the presence of non absorbable and osmotically active solutes from the diet and from bacterial action. 79

80. DIARRHEA Inhibition of ion absorption and stimulation of ion secretion( secretory diarrhea ) Osmotic diarrhea Deranged Intestinal motility PATHOPHYSIOLOGY 80

81. ACUTE DIARRHEA INFECTIONS: Salmonella, staphylococcus Aureus, Yersinia, E.histolytica , Rotavirus, Microsporodium GASTROINTESTINAL: IBS, sprue, amoebic colitis DRUGS: Sorbitol, laxatives MISCELLANEOUS: Thyrotoxicosis, Carcinoids 81

82. CHRONIC DIARRHEA INFLAMMATORY: Ulcerative colitis, Crohn’s disease, enterocolitis SECRETORY: medullary carcinoma, intestinal adenoma DERANGED INTESTINAL MOTILITY: Diabetic neuropathy, Thyrotoxicosis, neurological disorders OSMOTIC: Maldigestion of food, failure to absorb osmotically active DRUGS: Antacids, antibiotics 82

83. TREATMENT Fluid and electrolyte replacement Antibiotics Rehydration therapy 83

84. 7/25/21 84 DERMATOLOGIC

85. HAIR LOSS Is defined as the loss of hair which may be diffused or localized. Localised loss of hair or patchy loss of hair is known as ALOPECIA AREATA. SCARRING ALOPECIA is irreversible destruction of hair follicle and replacement by scar tissue . It is also associated with increased fragility of hair at all hair bearing sites. In NON SCARRING ALOPECIA, the hair follicles are preserved and therefore it is reversible. 85

86. HAIR TYPES Lanugo – fetal hair Vellum- found on face and arms of children which are fine and light colored hair Terminal hair- present on body of the males and hair bearing sites in females. 86

87. PHYSIOLOGY AND MECHANISM Non sexual hair is under the control of growth hormones found in both the sexes on the scalp , eye lashes , forehead and lower parts of the body. Ambisexual hair appears in both the sexes at the time of puberty under the influence of testosterone. 87

88. CAUSES OF ALOPECIA NON SCARRING ALOPECIA Congenital alopecia Male pattern baldness Drug induced alopecia Alopecia areata Nutritional-iron deficiency 88 SCARRING ALOPECIA : Inflammatory Lichen planus Herpes zoaster Scleroderma Radiation therapy

89. 7/25/21 89 NEUROLOGICAL

90. HEADACHE Is defined as any painful and non-painful discomfort extending from the orbits back to the suboccipital area either due to local pathology, disease due to the adjacent organs, a systemic disorder or psychological disturbances. 90

91. PHYSIOLOGY INTRACRANIAL Duramater , Cerebral arteries ,Cranial nerves 91 Pain may be extracranial or intracranial

92. CLINICAL PHYSIOLOGY A. Physiological headache Hunger, sleep and hangover B. Primary headache 1.Migraine and its variants 2. Tension headache 3.Cluster headache C. Secondary headache: Due to intracranial pathology(vascular traumatic ) Due to extra cranial pathology Systemic diseases 92

93. MECHANISM 1.ARTERIAL: Due to dilatation, traction, distension and dilatation of intracranial and extra cranial arteries 2.VENOUS: Due to traction and displacement of intracranial veins 3.NERVES: Inflammation and pressure on the trigeminal, vagus and glossopharyngeal nerve 4.MENINGEAL: Due to inflammation or irritation of the meninges 5. MUSCULAR: Due to spasm, inflammation or trauma to the cervical and cranial muscles 6.INTRACRANIAL TENSION: due to increase and decreasemin intracranial tension 7.REFERRED PAIN: Inflammation of special sense organs and sinuses 93

94. The greater the value of a symptom in a diagnostic sense , the less its value in therapeutic sense

95. Yoga therapy

96. Disturbances at manomaya level Percolate through pranamaya Manifestation of disease at annamaya kosha From adhi to vyadhi

97. Yoga mechanism stimulation of dermal and/or subdermal pressure receptors (innervated by vagal efferent fibers) limbic system and hypothalamic areas of cortisol secretion Enhanced vagal activity & reduced  cortisol Lowers stress

98. 7/25/21 98 Sudhakar RK, Babu VU, Nair PS. Effect of Pranayama on Level of Dyspnoea among Patients with Chronic Obstructive Diseases. COPD.;9:10. Naadi Sudhi Pranayama was given for the patients to perform twice daily for 25 days and then post test was conducted. The following conclusions were drawn Majority of the patients have moderate level of dyspnoea (grade 3 dyspnoea ) during the pre- test. The level of dyspnoea reduced to mild level (grade 2 dyspnoea ) for majority of the patients during the post test for the experimental group and the dyspnoea level remained the same in the control group. The Pranayama proved that it was one of the effective non pharmacological methods for reducing dyspnoea associated with Chronic Obstructive Pulmonary Disease.

99. 7/25/21 99 Latha DR, Kaliappan KV. Efficacy of yoga therapy in the management of headaches. Journal of Indian Psychology. 1992 Jan. Investigated the effect of yoga among 20 patients with tension or migraine headaches. Subjects were randomly assigned to 4 month of yoga therapy and no yoga therapy for control conditions. Subjects in both groups were assessed for headache activity (in terms of frequency, duration, and intensity), sources of stress, coping patterns, and somatic symptoms before and after the therapeutic intervention. There was significant reduction in the headache activity, medication intake, symptoms, and stress perception for the therapy group. They also showed significant improvement in coping behavior. 

100. 7/25/21 100 Kothari T, Jakhar S, Bothra D, Sharma N, Kumar H, Baradia M, Kothari TO, Jakhar SL, Kumar HS, Baradia MR. Prospective randomized trial of standard antiemetic therapy with yoga versus standard antiemetic therapy alone for highly emetogenic chemotherapy-induced nausea and vomiting in South Asian population. Journal of Cancer Research & Therapeutics. 2019 Jul 1;15(5). Randomly selected patients were those receiving highly emetogenic chemotherapy regimen grouped into yoga and standard antiemetic therapy (n = 50) just before receiving chemotherapy and continued for the following days and other group (n = 50) received only the standard antiemetic agent. In yoga arm, insignificant reduction in chemotherapy-induced nausea and but significant reduction in vomiting was observed as compared to the standard antiemetics only arm. There was a significant reduction in Grade 2 and 3 nausea and vomiting . This study concludes that yoga along with standard antiemetic medication should be a part of the management plan for the cancer patients receiving highly emetogenic chemotherapy.

101. 7/25/21 101 Manchanda SC, Narang R, Reddy KS, Sachdeva U, Prabhakaran D, Dharmanand S, Rajani M, Bijlani R. Retardation of coronary atherosclerosis with yoga lifestyle intervention. The Journal of the Association of Physicians of India. 2000 Jul;48(7):687. In this prospective, randomized, controlled trial, 42 men with angiographically proven coronary artery disease (CAD) were randomized to control and yoga intervention group and were followed for one year. The active group was treated with a user-friendly program consisting of yoga, control of risk factors, diet control and moderate aerobic exercise. At one year, the yoga groups showed significant reduction in number of anginal episodes per week , improved exercise capacity and decrease in body weight. Yoga lifestyle intervention retards progression and increases regression of coronary atherosclerosis in patients with severe coronary artery disease

102. 7/25/21 102   Bernstein AM, Bar J, Ehrman JP, Golubic M, Roizen MF. Yoga in the management of overweight and obesity. American Journal of Lifestyle Medicine. 2014 Jan;8(1):33-41. Thus, yoga appears promising as a way to assist with behavioral change, weight loss, and maintenance. Mechanisms by which yoga may assist with weight loss or maintenance include the following: energy expenditure during yoga sessions; allowing for additional exercise outside yoga sessions by reducing back and joint pain; heightening mindfulness, improving mood, and reducing stress, which may help reduce food intake; and allowing individuals to feel more connected to their bodies, leading to enhanced awareness of satiety and the discomfort of overeating.

103. 7/25/21 103 Bower JE, Garet D, Sternlieb B, Ganz PA, Irwin MR, Olmstead R, Greendale G. Yoga for persistent fatigue in breast cancer survivors: a randomized controlled trial. Cancer. 2012 Aug 1;118(15):3766-7 The authors conducted a 2‐group randomized controlled trial to determine the feasibility and efficacy of an Iyengar yoga intervention for breast cancer survivors with persistent post‐treatment fatigue. A targeted yoga intervention led to significant improvements in fatigue and vigor among breast cancer survivors with persistent fatigue symptoms.

104. REFERENCES Common medical Symptoms - By.P.J.Mehta Manipal Manual of Medicine 104

105. 7/25/21 105