MANAGEMENT OF SARVANGA SOTHA

WITH VARDHAMANA GUDAARDRAKA

PRAYOGA.

- A Pilot study.

Apr 14, 2023 K.C DEPARTMENT 1

Presented by ; Dr . Razimunnisa Begum .s k P.G. scholar, dept . of K.C

  INTRODUCTION

Apr 14, 2023 K.C DEPARTMENT 2

.EPIDEMIOLOGY

PREVALENCE

MORBIDITY & MORTALITY

GENDER&AGE

INTERNATIONAL RANKING

INTERNATIONAL DISTRIBUTION

CAUSITIVE FACTORS

OBJECTIVES &CLINICAL PLAN

OBJECTIVES OF THE STUDY

To assess the efficacy of

Vardhamana gudaardraka prayoga in the management

of sarvanga sotha.

CLINICAL PLAN;

5 PATIENTS

Apr 14, 2023 K.C DEPARTMENT 3

PARAMETERS

SUBJECTIVE

Utsedhana Ushma Gouravam Vivarnyam Chirottana prasamana Presence of Pitting

/Absence of pitting Measurement of girth

OBJECTIVE

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Hb% Serum electrolytesSerum creatininSerum albuminPlasma albuminBlood ureaX-ray

Ref.ch.chi 12/11 & M.ni

CLINICAL PLAN

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• Patients with sarvanga sotha• Both the gender• Any age group

INCLUSIVE CRITERIA

• Trauma• Heenabalasya sarvagah• Krisa• Sotha at trimarma stana• Upadrava yukta

EXCLUSIVE CRITERIA

• 1MonthDURATI

ON

DISEASE REVIEW

SOTHA NIDHANA

SAMPRAPTHI

S.SOTHA

TYPES

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MODREN VIEW

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DEFINITIONOedema results from the accumulation of excess fluid in the interstitial spaces or serous cavities.

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DEPENDING ON THE SITE OF COLLECTION

Generalized edema due to transudation of salt and water, as in

e.g- hypoproteinemic syndrome congestive cardiac failure acute glomerular nephritis nephrotic syndrome cirrhosis

Localized edema due to • increased permeability of small blood vessels, e.g, infection, trauma,

burns, allergy• lymphatic obstruction, e.g – malignancy, filariasis, chronic infection. • venous obstruction, e.g – thrombosis, malignant infiltration

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CAUSES OF EDEMA (MNEMONICS)

 THE LEAK OF VEINS

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CAN ANY ONE GUESS IT?

 THE LEAK OF VEINS

T umorH eart failureE nteropathy (protein-losing) L iver failureE ndocrine (hypothyroidism, aldosterones,diabetes)A ltitude sicknessK idney disease (renal failure, nephrotic syndrome) O bstruction of lymphaticsF ilariasis V enous thrombosisE clampsia / pregnancyI atrogenic N utritional deficiencyS epsis / capillary leakage (from Davidson Differential Diagnosis Mnemonics)Apr 14, 2023 K.C DEPARTMENT 11

General Principles in the formation of Interstitial Fluid

About 24 liters of fluid are filtered through the capillaries per day.

85% - reabsorbed into the capillaries. 15% - returned to the circulation via lymphatics

The formation of ISF is regulated according to the Starling hypothesis,

which incorporates 5 factors – capillary hydrostatic pressure, interstitial tissue pressure, plasma oncotic pressure, endothelial permeability and lymphatic function.

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Apr 14, 2023 K.C DEPARTMENT 14

A low plasma oncotic pressure or increased hydrostatic pressure at the venous end of capillary will tend to cause edema

GENERALISED OEDEMA /ANASARCA

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An important stimulus to Aldosterone release comes from Renin - Angoiotensin-Aldosterone system. (RAA)

Any fall in ECF volume

Stimulate Juxta glomerular apparatus of kidney

Renin secretion

(liver) (lung) ACE Angiotensinogen Angiotensin 1 Angiotensin2

CONT……….

Angiotensin II Stimulate "aldosterone" secretion from adrenal cortex

Vasoconstriction

Secretion of ADH by acting on hypothalamus.

Final result is salt & water retentions.Apr 14, 2023 K.C DEPARTMENT 16

Hypoproteinemic State

↓ Plasma protein level (esp. albumin)

↓oncotic pressure

transudation of solutes

EdemaApr 14, 2023 K.C DEPARTMENT 17

Heart Failure

↓Cardiac output

Accumulation of fluid in LV

Congestion of blood in LA

Congestion of blood in pulmonary veins

↑ Capillary hydrostatic pressure

Pulmonary edemaApr 14, 2023 K.C DEPARTMENT 18

Left Heart Failure

Right Heart Failure

↓ Contraction of RV

Congestion of RA

Congestion of SVC & IVC

↑Congestion in venules & capillaries

Generalized EdemaApr 14, 2023 K.C DEPARTMENT 19

Nephrotic Syndrome

Nephrotic Syndrome

Heavy Proteinuria

Hypoalbuminuria

Leaky glomerular capillary wall ↓Plasma oncotic pressure

Generalized edema

Fluid retention Hypervolemia

Salt & Water Retention RAA systemApr 14, 2023 K.C DEPARTMENT 20

WHAT IS REASON FOR THIS?

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CIRRHOSIS

Cirrhosis

Nodule & fibrosis plasma protein synthesis

Sinusoidal hypertension ↓ oncotic pressure Portal Hypertension Generalize Oedema Ascities Apr 14, 2023 K.C DEPARTMENT 22

Apr 14, 2023 K.C DEPARTMENT 23

Investigations of Generalized edema

Chest X-ray - sign of heart failure, cardiomegaly

Plasma albumin - low in nephrotic syndrome, cirrhosis, malnutrition

Blood urea and electrolytes - diminished GFR in renal disease or in severe cardiac failure

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DRUG REVIEW

Vardhamana gudaardraka prayoga

“Prayojayedaadrakanagara va tulyam gudenaardha palaabhi vridhaya maatraam param pancha palaani maasamjeerne payo yusha rasascha baktam”

ch.chi.12/47,48

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CONT………

Fresh ginger with equal quantity of

jaggery total of these 2 is ½

pala--- 1st day.

Increasing the dose by ½ pala per day to the maximum of 5

palas. It become the - (10th day).

This 5palas of dose should be

continued from -11th day to 30th

day.

Keeping on the diet of

milk ,vegetable soup( or) meat

soup &rice.

Apr 14, 2023 K.C DEPARTMENT 26

ANTI-INFLAMMATORY ACTIVTY of drugs

Malabar vaidyas hold that juice expressed from fresh ginger in gradually increasing doses,

is a strong diuretic in case of general dropy what ever the cause may be. Ref. Indianmateriamedica

Shogaol shows Triphasic effect on blood pressure. It induced contactile response in isolated guinea pigs. And showed Inotrophic &Chronotropic activities on isolated rats. Gingerols1&2 from rhizomes potentiated contractions induced

by Isolated blood vessels of mice &rats . Because of Prostaglandin related structure.Ref compendium of Indian

Medicinal plants.vol-4.Jaggery Combats excess kapha in blood system and hence effectively removes blocks in the channels and vessels aid free circulation of blood and nutrients.

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RESULTS

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GRADING

Utsedha ,Ushma, Gourvam ,Vivarnya and Presnce of pitting.

absent-0

Mild- 1

Moderate-2

Severe-3

Measurement of girth normal-0 5%above normal-110% above normal-2 More than 10%-3

Statistical analysis of results

 

Apr 14, 2023 K.C DEPARTMENT

SYMPTOMS B.T SCORE A.T SCORE

Utsedha 14 5

Ushma 12 7

Gouravam 16 6

Vivarnyam 18 11

Chirottana prasamana

10 4

Pitting 12 5

Measurement of girth

10 4

29

Apr 14, 2023 K.C DEPARTMENT 30

CONT…….

Intensity of swelling No . of patients Percentage

No swelling 3 60%

Mild swelling 2 40%

Moderate swelling 0 0

0 0Severe swelling

Results No. of Patients Percentage

Good/complete relief

3 60%

Moderate relief 2 40%

Poor/No relief 0 0

DISCUSSION

According to present Results 40% of patients belong to

smokers &alcoholics.

Out of 5Patients 2 female&3 are male having oedema in lower limbs& face.

It is observed clinically the incidence of the disease is more prevalent in the age group 40 to 59 yrs.

3 Patients got maximum relief & 2Patients got moderate relief.

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CONCLUSION

In this clinical study, the VARDHAMANA GUDAARDRAKA PRAYOGA shown highly significant anti inflammatory activity.

Puranaguda is having lagu guna ,vata hara ,pitta hara,patyakara, anabhishyandhi.Mutrala.

According to susrutha guda is adhikagunakari &atyantha patyakara.

Sunti is having katu rasa ,lagu,ruksha,teekshna guna,Ushna virya & madhura viaka.

Pharmacological action of sunti is kapha vata hara &sotha hara.

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