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May20
AYURVEDIC HOME REMEDIES
HOME REMEDIES FOR SOME COMMON PROBLEMS




URTICARIA


Ayurvedic Synonym : - Shitapitta

Main symptoms : –
1. Rash all over the body.

2. Itching.

3. Reddish patches.

Remedies :-
1. Piper nigrum (Marich) with cow’s ghee.

2. Curcuma longa (Haridra) powder with milk or hot water.

3. Application of bark of (Kapitha).

Ayurvedic Medicines : -
1. Brihat Haridra Khand Yoga.

2. Khadirarishta.

3. Mahamanjishthadi kwath.

4. Arogyavardhini.






CONSTIPATION


Ayurvedic Synonym : - Malavashtambha

Main symptoms : –
1. Irregular bowel evacuation.

2. Passage of hard stool in less quantity.

3. Flatulence.

Remedies :-
1. 10-15 pieces of Vitis vinifera (Black Grapes) kept over night in a glass of water and used at morning can relive constipation permanently.

2. Decoction of Zingiber officinale (Ardrak) added with 2 or three teaspoon of castor oil, taken at bedtime can be useful for chronic constipation.

3. Powdered Terminalia.chebula (Haritaki) processed in cow’s ghee in the dose of 1 teaspoon followed by lukewarm water is also proved as equal effective.

Ayurvedic Medicines : -
1. Avipattikar churna.

2. Gandharva Haritaki churna.

3. Argwadh kapila vati.

4. Abhayadi Modak







VOMITTING


Ayurvedic Synonym : - Chhardi

Main symptoms : –

1. Nausea

2. Ejection of stomach contents.

Remedies :-
1. Glycyrrhiza glabra (Yashtimadhu) + Pterocarpus santalinus(Raktachandan } paste prepared in milk.
2. Santalum album (Chandan) + Emblica officinals (Amalki) } with honey
3. Fresh juice of Punica granatam(Dadim)

4. Decoction of Coriandrum sativum (Dhanyak) with honey mixed.

5. Fresh juice of Zingiber officinale (Ardrak)+ Allium cepa (Palandu).

Ayurvedic Medicines : -
1. Sutshekhar ras

2. Pravalpanchamrit

3. Mayur-pichhamashi

4. Chandanadi loha.

5. Dadimavaleham.






INDIGESTION


Ayurvedic Synonym : - Ajirna

Main symptoms : –
1. Loss of appetite

2. Nausea with /without vomiting.

Remedies :-
1. Citrus acida (Nimbuk) + Zingiber officinale (Adrak) + Salt (Saindhav) + Allium sativum (Rason) } Mixture - before meals

2. Tea of Syzygium aromaticum (Lavang) is effective when there is nausea and loss of appetite.
3. Ferula narthex (Hingu) with cow’s ghee.

4. Carum roxburghianum (Ajmoda) and salt (Saindhav) with hot water.

5. Drinking of Hot water intermittently.

6. Cuminum cyminum (Jirak) with Buttermilk.

Ayurvedic Medicines : -
1. Hingvashtak churna.

2. Panchakolasav

3. Shankhavati

4. Lavanbhaskar churna.





HAIR LOSS


Ayurvedic Synonym : - Khalitya

Main symptoms : –
1. Progressive hair fall with or without dandruff.

Remedies : -
1. Gentle massage with

coconut oil.
Sesamum oil processed with Emblica officinals (Amalaki) and Bacopa monnieri (Brahmi).

2. Emblica officinals (Amalki) Cyperus rotundus (Musta) Sapindus trifoliatus (Arishtak) } Rinsing hairs with decoction of these herbs.
3. Triphala churna + Black Sesamum + Eclipta alba (Bhringaraj) } powder with hot water of internal use.

4. Massage with pulp of Aloe vera (Kumari) and Hibiscus rosa-sinensis (Japa-kusum).

Ayurvedic Medicines : -
1. Bhringaraj ghan vati

2. Asthiposhak vati

3. Arogyavardhini

4. Praval panchamrit.

5. Tikta ghrit.






JOINT PAIN


Ayurvedic Synonym : - Sandhigata Vata

Main symptoms : –
1. Painful joints with or without inflammation

2. Restricted movements of joints.

3. Increased local temperature in inflamed joints.

Remedies :-

Inflamed joints :-
1. Dry fomentation.

2. Apply poultice of smashed leaves of Allium sativum (Rason), Ricinus communis (Erand), Vitex negundo (Nirgundi) Mixed with salt.

3. Zingiber officinale (Ardrak) ,Curcuma longa (Haridra) in paste form for Local Application.

Non Inflamed joints :-
1. Gental massage with Sesamum oil followed by hot water fomentation.

2. Smashed Allium sativam (Rason) boiled in milk.

Ayurvedic Medicines : -

Inflamed joints :-
1. Sinhanad guggul

2. Punarnava guggul

3. Dashamularishta

4. Rasnasaptak kwath

5. Mahavishagarbha tail for Local application

Non inflamed joints :-
1. Mahayograj guggul.

2. Mahanarayan tail for Local Application

3. Ashwagandharishta.


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May20
The Science of Detoxification and Rejuvenation
Pancha Karma: The Ayurvedic Science of Detoxification and Rejuvenation

Ayurveda, which literally means the knowledge of life is the traditional healing science of India. Viewing disease as the natural end result of living out of harmony with our environment,

Ayurveda emphasizes reestablishing harmony and balance as the means of recreating a state of optimal health in our bodies and minds. While Ayurvedic methods utilize many therapies including herbs, diet, aromatherapy, color therapy, mantras, yoga, meditation and general lifestyle counseling, the most profound of all treatments is that of Pancha Karma.


Pancha Karma is the traditional form of detoxification of the body and mind that facilitates rejuvenation. It has been utilized for thousands of years as a method of staying healthy, young and vital.


"The value of Pancha Karma is that it offers systematic treatment for dislodging and flushing toxins from every cell, using the same organs of elimination that the body naturally employs -- sweat glands, blood vessels, the urinary tract and the intestines."


Pancha Karma is unlike any other detoxification program because it is fundamentally designed to remove a different form of toxin. While many toxins exist in our environment which accumulate and harm our bodies, Ayurvedic Pancha Karma addresses a special toxin called ama which is formed within our own bodies.


Ama is the by-product of inadequate digestion. It has the qualities of stickiness and heaviness. In our bodies it clogs our systems and damages our tissues. It is among the most damaging of forces in our bodies and contributes to disease.

Here is an analogy to help you understand how ama is formed. Imagine that there is a fire inside your stomach. Think of a campfire. If the fire is weak, it cannot burn up the wood put on it. Instead, the wood smolders and begins to smoke. In the end, charred bits are left and the wood is not efficiently turned into ash.


Poor digestive fire, or digestive strength, leads to food being improperly digested. This results in gas, bloating, burning indigestion, or constipation. In addition, a residue of this poorly digested food accumulates in your digestive tract and overflows into your bodily systems. This residue is called ama.


Ayurveda links the occurrence of ama in the body and a weak digestive system to the cause of such chronic conditions such as candida, chronic fatigue syndrome, migraine headaches, chronic respiratory disease and many other conditions. The process of Pancha Karma removes ama and clears the way for the body to re-establish an internal state of balance and harmony.


Ama may be present in the body if there is a coating on the tongue. A normal tongue appears pink throughout, but as ama accumulates in the digestive system, the tongue may appear with a white, yellow, green or gray film over it. In addition, in some cases the body and breath develop a strong odor and the stool becomes dense and sinks to the bottom of the toilet. (According to Ayurveda, the normal stool should float). If you have any of these signs, Pancha Karma treatment may be indicated.


The Process of Pancha Karma


Pancha Karma therapy begins with proper preparation. This includes several days or weeks of a special diet and herbs which begin the process of loosening up the ama and bringing it back to the digestive system for elimination. While the person is eating special foods and taking special herbs, oil and heat therapies are applied. These include the deeply relaxing therapies of Shirodhara, Ayurvedic massage, and Swedana.


Shirodhara is a unique therapy where the client lies down upon a massage table with their eyes covered. Then, a specially prepared warm herbal oil is poured in a thin steady stream through a spicket directly onto the forehead and sixth chakra. This blissful therapy purifies the mind, alleviates anxiety, reduces headaches and expands awareness. Shirodhara can be administered by itself or as part of a Pancha Karma regime.


During Ayurvedic massage two practitioners perform a choreographed hand dance upon the body. Using oils blended with special herbs, this form of massage specifically loosens up the ama stored in the tissues so that it can move back to the digestive system. Not only is it cleansing, but it is deeply relaxing. Ayurvedic massage can be administered by itself or as a part of Pancha Karma.


Swedana is a full-body steam therapy. Special herbs are fused into the steam and together the heat and herbs dilate the channel systems of the body allowing the stored ama to move back into the digestive system.


Once all of the ama is back in the digestive system, the next phase is to eliminate it from the body. This is achieved by the administration of a purgative to cleanse the small intestine and herbal enemas to cleanse the colon. A special form of cleansing is applied to the sinuses called nasya. Following the application of oil and heat over the sinuses, the herbal oils are administered directly into the nasal passages. This procedure not only eliminates ama but is helpful in the treatment of chronic allergic sinusitis and sinus headaches.


Rejuvenation

With the body clear of toxins and ama, it is much like a clean slate. Now the internal energy of the body can be rebuilt. The rebuilding process strengthens the digestive system and the immune system and entails taking additional special foods and herbs. These herbs are designed to enhance the strength of immune system and are revered for extending life.


The end result of Pancha Karma is an optimally functioning digestive system and renewed internal energy. After receiving Pancha Karma the mind is light and clear, the body is pure and the energy is high. For many it is a life-changing experience.



Pancha Karma is traditionally used in the healing of many diseases. It is an intensive therapy best performed at a time when the patient has adequate time to rest. Brief Pancha Karma programs last 7 days. This is followed by a period of rejuvenation which can be done at home. Extensive programs can be designed for up to one month.


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May20
Painkillers
Zingeber Officinale
Nux Vomica
Lycopodium
Apis
Withania Somnifera


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May20
Myopia, Hypermyopia, Conjuctivitis
MYOPIA - i.e., nearsighted. Objects farther than 6 meters from the eye are blurred. This condition is corrected by wearing spectacles with concave lenses. In some cases gradually the power of the concave lense has to increase and there may be chance of vision loss due to retinal detachment. This condition may be hereditary. Medicines: NITRIC ACID, PHOSPHORUS, PHYSOSTIGMA and PULSATILLA - GrI.

HYPERMETROPIA - or hyperopia i.e.,farsighted. Objects closer than 6 meters from the eye appeared blurred. Normal vision can be restored by wearing spectacles with convex lenses. It is normally seen after the age of 40 yrs. Medicines: ARGENTUM NITRICUM, CALCAREA CARBONICA, SEPIA and SILICEA

Conjuctivitis: Aconite 30, Euphrasia 30, Gels 30


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May20
homeopathy can work wonders in vitiligo
Vitiligo (often called as leucoderma) is a disorder where the skin loses its color in patches of irregular shapes and sizes. This is a pigmentation disorder which means that melanocytes (the pigment producing cells) in the skin get destroyed. This results in development of white patches on the skin.
The hairs which are growing in that area may loose their color and turn gray. This disorder also leads to psychological issues relating to appearances and at times in certain individuals (mainly the adolescents and the young) this stress can take enormous proportions particularly if Vitiligo develops on visible areas of the body, such as the face, hands, arms, feet, or on the genitals. They develop very strong emotions of being embarrassed, depressed, or worried about how others will react.
What causes Vitiligo?
The cause for Vitiligo is not very clear but doctors and researchers are beginning to believe that Vitiligo resembles an autoimmune disorder. Which means that the pigment (the matter that gives colour to our skin) producing cells of the skin are destroyed by the body?s own antibodies (defense cells).
In some cases it has been observed that the onset of Vitiligo is related to a psychologically stressful event in the patient?s life. People with a family history of Vitiligo are more prone to develop these white patches. Ninety five percent of all those who develop Vitiligo, start developing symptoms before their 40th year of their life.
Other factors that have been found to be more common with those suffering from Vitiligo are presence of other autoimmune disorders, history of sunburns, rashes and other skin disorders and hair turning grey before the age of thirty five.
What are the symptoms and how does it spread?
People with Vitiligo develop white patches on their skin of irregular shapes and sizes. Vitiligo is more common on the exposed areas for example hands face, neck and arms. It also occurs on covered areas too: - like genitals, breast and legs. In some patients the hair may also turn grey early and in the inside of the mouth, white discoloration may also occur.
The spread of Vitiligo cannot be determined. It may stop completely after the first patch but often these patches do spread. For some patients further development may takes years and for others the large areas can be covered in months. In some patients mental stress has been seen to increase the growth of these white patches.
How effective is homoeopathy?
Homoeopathy is able to give wonderful and miraculous cures in many cases of Vitiligo. This is due to the fact that homoeopathic treatment enhances the natural production of pigments. According to homoeopathic philosophy Vitiligo not a disease in itself but an expression of an inner disturbed state of the body. Thus, the cure should occur at a level where things have gone wrong. In order to archive this, the patient is analyzed on various aspects of mental and physical and familial attributes and also a complete study is done on the psychological-environment that the patient has gone through in his life. The prescription is then based at the deepest level of understanding of the patient?s disturbed inner force. Although many homoeopathic medicines Arsenic Sulph Falvus, Arsenic Album , Baryta Mur and Baryta Carb are known to give good results in Vitiligo; I would again reiterate the fact that real cure of Vitiligo occurs when the prescription is made according to the true principles of homoeopathic philosophy i.e. treating that ?deep causative factor ? which caused this inner disturbance. Also remember that Vitiligo is a chronic disorder and can take considerable time even with the best of the homoeopathic treatment, for it to be completely cured.


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May20
KNOW YOUR BODY PRAKRITI
While it is always most accurate to be fully evaluated by a trained Ayurvedic practitioner filling out the following questionnaire can give you insight into the balances of energies unique to your body.


As you fill out the following questionnaire, give yourself two points if a statement is clearly true for you. Give yourself one point is it is somewhat true. Give yourself no points if it is clearly not true.


Add up the total number of points for Vata, Pitta, and Kapha. This will give you the relative dominance of each of the forces in your constitution. You may not necessarily be dominant in one type but may be a unique blend of the three.


Vata Questions


1. I am thin and my body build is "slight."

2. I have a difficult time gaining weight or I am like a yo-yo going up and down.

3. My skin tends to be dry.

4. I feel cold often compared to others and I do not sweat very easily.

5. My complexion is dull gray or dusty.

6. When my digestion is not normal I tend toward constipation.

7. The shape of my face and jaw line is long and narrow.

8. When I am healthy I have a lot of energy and enthusiasm but focusing can be difficult.

9. I am prone to feeling nervous or anxious.

10. I tend to be a light sleeper and often suffer from insomnia.



Pitta Questions


1. I am of moderate weight and my build is moderate with good muscle tone.

2. My weight is steady and fluctuations are small.

3. My skin tends to be oily.

4. I often feel warm and sweat easily.

5. My complexion is rosy.

6. My digestion is not normal I tend toward diarrhea or burning digestion.

7. The shape of my face and jaw like is angular.

8. When I am healthy I have a lot of energy and I am very focused.

9. I am prone to feeling irritated, angry and resentful.

10. I sleep well and wake up easily. I may be awoken by dreams.



Kapha Questions


1. I am of "stocky" body build and I often carry some extra weight.

2. It is difficult to lose weight.

3. My skin tends to be oily.

4. I often feel cold and sweat easily.

5. My complexion is pale.

6. My digestion is generally good though I may occasionally have some constipation.

7. The shape of my face is round.

8. When healthy I move slowly and have a lot of endurance.

9. I am prone to feeling lethargic and depressed.

10. I sleep deeply and sometimes have a difficult time waking up.


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May18
A COMPREHENSIVE STUDY OF KAAS (Respiratory diseases) & ITS MANAGEMENT
Introduction

Respiratory Disease will afflict every human being at some time in their life. Whether it’s a cough associated with the common cold or respiratory distress associated with allergies and asthma, respiratory challenges are a constant source of irritation and misery for the afflicted.

Classical Ayurvedic Medicine categorizes respiratory challenges into two main categories. These are Kasa (cough) and Swasa ( dyspnea or difficulty breathing). From an understanding of ayurvedic knowledge, common conditions such as the common cold, asthma and bronchitis can be understood and managed. This article address the condition of kasa (cough).

Kasa (Cough)

In the Allopathic medicine, Cough are understood to be the result of either infection or irritation of the bronchial tissue and are known as bronchitis. Infectious bronchitis commonly accompanies the common cold but may occur separately and may or may not be associated with fever. Cough may be dry or productive. Irritative bronchitis is usually the result of pollutants, smoke, or chemicals and may have an allergic component.

Samprapti (Pathology)

Kasa occurs when apana vayu is obstructed resulting in an increase in upward motion. Vitiation of udana vayu propels the air upward and out of the body. Vata may however lodge in the chest, back, or head resulting in pain and repeated coughing.

All disease has its physicial origins in the digestive system. This is the site of accumulation and aggrevation of the doshas. Kasa begins with vitiation of apana vayu in the purishavaha srota (large intestine). Vata eventually overflows into circulation (raktavaha srota) and relocates to the pranavaha srota (respiratory system.) Additional doshas may mix with vata or become dominant in the pathology.

Purvarupa (Prodomal symptoms)

Cough are often preceeded by symptoms of the common cold such as a sore throat, and a decrease in appetite. Proper early management of the prodromal symptoms can prevent the onset of bronchitis.


Types of Kasa

Kasa (cough) is of five types; vata, pitta, kapha, ksataja and ksaya. Those of a vata, pitta and kapha nature represent different doshic manifestations of a cough. Ksataja type are due to chest injuries while ksaya type is due to disease that results in wasting of the bodily tissues such as tuberculosis.


Rupa (symptoms)

Cough due to vitiation of vata are called “vataja kasa”. They present as a dry cough with little mucous production. While small amounts of hard mucous may occasionally accompany a cough, the condition is for the most part dry. Examination of the mucous reveals it to be gray in color and ununctuous (not very sticky). The cough may be accompanied by a loss of voice and severe chest pain. The frequency of the cough is episodic and may occur in fits.

Cough due to pitta vitiation are called “pittaja kasa”. They present with a greater amount of mucous. Examination of the mucous reveals a yellow color and possible blood within the mucous giving it a “rusty” appearance. This latter appearance indicates that the infection has penetrated deeper in the respiratory system as is seen in pneumonia. Pittaja kasa is accompanied by fever. The cough is more continuous than that of vata type.

Cough due to kapha vitiation are called “kaphaja kasa.” They present with the greatest amount of mucous. Examination of the mucous reveals a cloudy, white color and the mucous is thick and sticky. The condition is often accompanied by a runny nose, nausea, and vomiting. Actual pain in the chest and head is mild. Kaphaja kasa is not associated with fever. Coughing is continuous.



Comparative Rupa (symptomatology) of Vataja, Pittaja and Kaphaja Kasa
Vataja Pittaja Kaphaja
Minimal mucous, hard mucous, grey in color Moderate mucous, sticky, yellow in color Large amounts of mucous, sticky, cloudy and white in color


Cough due to trauma, called “ksataja kasa” reveal a combination of symptoms related to vata and pitta types. Sputum may be red, yellow or black indicating infection and bleeding. While the mucous is abundant, it is ununctuous. Fever is probable and there may be joint pains as well. Due to trauma, blood may simulatanously appear in the urine. Cough due to trauma are described as resembling the cooing of a pigeon.

Cough due to ksaya occur with wasting disease such as tuberculosis. Tuberculosis is called “rajayaksmadi” literally the “kind of diseases” in the Ayurvedic literature. The condition results in a drying up and loss of tissue (ksaya). While vata dosha plays the most important role in this condition, the condition is sannipattika in nature (due to the vitiation of all three doshas).


Chikitsa: Treatment and Management

The management of kasa (cough) requires an understanding of the state of the patients agni, ama, and ojas as well as an appreciation of the doshic pathology present. In addition to treatment at the site of relocation in the pranavaha srota (respiratory system), treatment should also be directed toward the mahavaha srota (digestive system) as this is the physical root of the condition and the raktavaha srota (circulatory system) as the pathway of overflow.


Management of Vataja Kasa

The management of vataja kasa, at the site of relocation focuses on the application of oils and heat to the pranavaha srota (respiratory system). Sesame oil massaged into the chest followed by fomentation is recommended. Fomentation may be performed simply using hot water bottles, a heating pad or locally applied steam as in nadi svedana. Popular cough relieving herbs from India include kantakari (solanum xanthocarpum; VK-P+) and vamsa rochana (bamboo manna; VP-K+) . These are commonly used and may be prepared as ghrita (medicated ghee). Popular herbs used in the West include licorice (glycyrrhiza glabra; VP-K+) and wild cherry bark (prunis virginiana, prunia serotina; VP-K+).
Care of the digestive system requires dietary modification and the use of anuvasana basti (oil enema) or niruha basti (decoction enema). The diet, though nourishing should be taken in small quantities at first until the agni becomes strong. Nourishing soups are most beneficial. Patients should receive plenty of rest.

For both vataja and pittaja kasa, the classical formulation, Sitopaladi churna is commonly used. It may also be prepared in warm water or with honey. Sitopaladi churna is a combination of many herbs and spices with vamsa rochana as the chief herb in the formulation.


Management of Pittaja Kasa

The management of pittaja kasa, at the site of relocation focuses on herbal therapies. Oil and heat are not recommended. Medicated ghrita (ghee) may be prepared with cough relieving, expectorant herbs such as vamsa rochana (bamboo manna; VP-K+) and vasa (adhatoda vasica; PK- V+). Western herbal alternatives include licorice (VP-K+), mullein (verbascum thapus; PK-V+) and wild cherry bark (prunis virginiana, prunia serotina; VP-

K+). The classical Indian formulation, sitopaladi churna may also be used.
Virechana performed early in the condition is most beneficial to allieviate pitta at its root. The diet should emphasize a greater amount of the bitter taste as the bitter taste is cooling and purifies the rasa and rakta dhatu helping to destroy the infection. The diet should be light and and consist of easy to digest foods until improvement is noted. Stronger antimicrobial bitter herbs may be given to accompany the cooling, cough reducing herbs. These include kutki (Gentiana kuroo; PK- V+) and neem (Azadirachta indica; PK-V+) as well as well as Western alternatives such as goldenseal (Hydrastis Canadensis; PK-V+) and echinecea (Echinecea augustifolia, echinecea purpura; PK-V+). Patients should receive plenty of rest.



Management of Kaphaja Kasa

In the management of kaphaja kasa, treatment focuses on strong purification and may include vamana, virechana and niruha basti. Nasya is also recommended to purify the nasal passages and sinuses. An important herb from India is kantakari (solanum xanthocarpum; VK-P+). Kantakari alleviates cough and is a bronchodilator. Kantakari is one of the herbs in the famous ten roots formulation, dashmoola. Along with kantakari, additional herbs may be added to formulations such as vidanaga (embelia ribes; KV-P+) and chitrak (plumbago zeylancia; K-VP+). Dry, expectorant herbs may also be added to formulation or prepared for inhalation. Clove (caryophyllus aromatica) and bayberry (myrica nagi, myrica sapida, myrica cerifera) are commonly prepared in cigarette form or simply burned and inhaled. Western herbs that are beneficial include elecampane (inula helinum), eucalyptus (eucalyptus globulis) and black pepper (piper nigrum).

The diet of patients with kaphaja kasa should be very light and patients may fast for several days according to their strength. The diet emphasizes the pungent taste to support drying the lung tissues. Patients who are not experiencing great fatigue should remain active but should not overly exert themselves.



Managing Cough due to trauma requires referral to a medical specialist as the lung may be punctured. Until medical care can be administered, patients should take hemostatic herbs such as the Indian herbs manjishta and praval pisthi . Patients should also stay well hydrated.

Cough associated with wasting disease are difficult to treat and careful management is required. Weak patients usually require tonification to combat weight loss and increase strength. Medicated ghees with demulcent herbs such as bala rejuvenate the body and support repair of respiratory tissues. The dosage of the herbs is dependent upon the state of the patient’s agni. Anuvasana basti should also be administered to improve strength and can be prepared with nourishing herbs such as bala and ashwaganda in a sesame oil base. The diet should be nourishing. Meat and bone soups may be required to prevent continued weight loss.

Vegetarian patients may object, however they are strongly recommended if the patients life is in danger. The quantity of food taken should be proportional to the bodies abililty to digest it. Hence, dipanas to strengthen agni are required.


Sadhyasadhyata (Prognosis)

Doshic disturbances resulting in kasa are relatively easy to treat with vataja considered the easiest and kaphaja the most difficult. Those of mixed dosha pathology such as ksataja type are more difficult. Ksaya kasa is the most difficult of all. Ayurvedic texts state that kasa of any kind, if not treated properly can progress to ksaya type.


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May18
surgery for heart failure
SURGERY FOR HEART FAILURE

Generally heart failure is considered as totally a medical problem as the risks with surgery are high. However in selected patients, who are resistant to medical therapy, cardiac surgery can make medical treatment easier, improving quality of life to the patient. And there are surgeries like heart transplantation which have been proven to increase the longevity of these patients. Basically surgeries in these patients are:

- Those that identify and remove the primary insult that resulted in heart failure
- those that try to surgically reverse remodel the ventricle,
- using assist devices
- heart transplantation and
- Sometimes combination of the procedures.
.

Surgeries for removing the primary insult:

These include operations for coronary artery disease and valve diseases that resulted in heart failure and significant left ventricular dysfunction.

Coronary artery bypass surgery: Myocardial ischemia is probably the most important cause of heart failure and is associated with a 30% - 50% annual mortality. However reduced ventricular function may be reversible with ischemia. Restoration of function with correction of ischemia may take some time, on occasion, months. Identifying the presence of such hibernation is probably best achieved with labelled (F18 deoxyglucose uptake) positron emission tomographic (PET) metabolic studies. If it shows viable myocardium >20% of left ventricular mass, evidence is stronger. Viable myocardium can also be demonstrated by dobuatmine stressed echo and its characteristic bi-phasic response to increasing levels of inotrope. There is an initial improvement in contractility followed by a fall off in function as dobutamine levels reach values of 25 – 40g/Kg/min. Magnetic Resonance imaging (MRI) is showing promise too by revealing scar or viable muscle. Sometimes even 2D echo may give some suggestion of viability through the thickness of myocardium and subendocardial thickening. However one has to consider the clinical condition, evidence for significant viable myocardium and the high risks involved in these patients before advising surgery. Sometimes bypass surgery may have to be combined with mitral valve repair surgery or with left ventricular remodelling surgery.

Valve surgery: In India rheumatic heart disease still contributes to significant proportion of heart diseases. Today advances in surgery allow most valve disease patients with left ventricular dysfunction to be operated successfully although prognosis is still reduced in such patients. However surgery is likely to reduce number of hospital admissions with heart failure and improve their quality of life. Aortic stenosis patients with low gradient and low ejection fraction without inotropic reserve and mitral incompetence patients with ejection fraction of <30% in whom mitral subvalvar apparatus cannot be preserved constitute the small group in whom valve replacement surgery should probably not be performed.


Surgical procedures to improve cardiac output by reducing left ventricular size (“La Place surgery”):

Many modalities are being tried in the world today that aims at reducing an enlarged ventricular volume and reversing the forces that are driving further ventricular remodelling. Some of these are
(i) The Myo-splint.
ii) The CorCap® or Acorn device
iii) Left ventricular aneurysmectomy.
(iv) Mitral valve repair for secondary regurgitation.

One of the more accepted modalities is left ventricular aneurysmectomy when there is a left ventricular aneurysm causing heart failure. Dyskinetic segment of ventricle is removed reducing ventricular diameter and so reducing ventricular wall tension. However the segment removed here is scar and not ventricular muscle. The aim is to restore a more “normal” ventricular geometry increasing the efficiency of ventricular contraction..




Surgical strategies to re-power the failing heart:
These include surgeries like implanting ventricular assist devices and heart transplantation.

Ventricular assist devices (VAD): The intention here is to off-load the failing heart. This is achieved by the unloading of blood from the ventricle and delivering into the arterial tree (pulmonary for right ventricular assist or RVAD and systemic for left or LVAD). Both ventricles may be supported simultaneously with BIVADs. Total excision of a failing heart is occasionally undertaken followed by replacement with an artificial heart (Cardiowest, Abiocor).
Generally a potential VAD candidate presents with severe, refractory heart failure with deterioration despite intensive medical therapy. A VAD is selected and may be temporary or long–term. Some are designed for per cutaneous insertion into the systemic arterial tree lying across the aortic valve (Impella). More usually VADs are inserted via a sternotomy. Patients are often mortally ill with multi-system dysfunction. Bleeding, control of vascular resistance and multi-organ failure are early problems soon replaced by risks of infection and thrombo-embolism. Mostly these are used as bridge to transplantation in individuals who are on inotropes with haemodynamic instability and waiting for a suitable heart donor.. Interestingly some patients (often those with a short but aggressive history of failure or myocarditis) recover so that the VAD can be removed and heart transplantation avoided.

Heart Transplantation: Despite many advances in the management of chronic heart failure, many patients continue to progress to advanced end-stage heart failure. For those that are suitable, heart transplantation is the only proven therapy to offer improved survival and quality of life. Current survival for heart transplantation approaches 80-90% survival and 50-60% at 10 years. In addition to improving the longevity of life, it is associated with a marked increase in quality of life despite the need to take life long immunosuppressive medication and follow-up. In India now there are centres working to develop this transplantation facility.


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May16
LAPAROSCOPY
Anatomy and Physiology

Laparoscopic surgery is performed to diagnose and treat conditions affecting the organs and tissues of the abdomen and pelvis.

Traditional open surgery requires a relatively large incision. Laparoscopic surgery involves the creation of one or more tiny “keyhole” incisions, through which pencil–thin instruments are inserted to view the inside of the abdomen or pelvis, and to perform various procedures. This technique considerably reduces recovery time.

Reasons for Procedure

Laparoscopy is done to examine, diagnose, and treat problems inside the abdomen and/or pelvis. The procedure can: diagnose, and sometimes treat, causes of pain, retrieve a tissue sample, evaluate the presence of abnormal fluid, evaluate infertility, help determine if a cancer has spread, monitor previously treated cancer.

Treatments

Many surgeries that were traditionally performed through an open incision can now be performed laparoscopically. These include: appendectomy, ectopic pregnancy removal, egg retrieval for assisted reproductive technology, hernia repair, hysterectomy, certain surgeries of the gallbladder, stomach, colon, liver, spleen, adrenal gland, or kidney, biopsies, which entail retrieving a tissue sample, tubal ligation, and/or tumor removal In some of these cases, an open surgical procedure may still be required.

Procedure

In the days leading up to your procedure: Arrange for a ride to and from the hospital, and for help at home as you recover. The night before, eat a light meal and do not eat or drink anything after midnight. If you regularly take medications, ask your doctor if you need to temporarily discontinue them. Do not start taking any new medications before consulting your doctor.

Depending on the type of operation, laparoscopic surgery may be done under general, spinal, or local anesthesia. In general anesthesia, you will be asleep during the entire procedure. In spinal anesthesia, you will be rendered numb from the chest down. In local anesthesia, you will be numb at the site of the incision only.

To begin the procedure, your surgeon will insert a sharp instrument called a trocar through a small half–inch opening, usually just above or below your navel. The exact location of this opening will depend on the type of operation being performed.

In most cases, your surgeon will then pump carbon dioxide gas though this port in order to puff up your abdomen so its contents can be viewed more easily.

Next, your surgeon will insert the laparoscope. Images from its camera are magnified and projected onto a video monitor in the operating room. The surgeon will carefully examine your abdominal or pelvic organs and tissues, looking for signs of disease that might explain your symptoms.

Your surgeon may place other trocars through which surgical instruments can be inserted. These instruments may be used to: Move organs out of the way for better viewing Remove diseased or scarred organs or tissue Take tissue biopsies Sample and drain abnormal fluid Perform other surgical techniques

When the laparoscope is removed, all of the gas will be allowed to escape.

Each keyhole incision will be closed with just a few sutures or staples, and then covered with bandages.

Risks and Benefits

Possible complications of laparoscopy include: damage to blood vessels or organs in the surgical area, excessive bleeding Infection, anesthesia–related problems, during the laparoscopic procedure, your surgeon may need to switch to a traditional open procedure. This may occur if the area is damaged or it appears that the laparoscopic approach is not going to be successful.

Compared to traditional open surgeries, the benefits of laparoscopy include: smaller scars, shorter hospital stay or same–day discharge, fewer complications, less pain after the operation, and/or shorter recovery time.

However, these benefits are a tradeoff with the limited access available through the laparoscopic approach.

In a laparoscopy, or any procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it’s the most appropriate treatment choice for you.

After the Procedure

In most cases, patients are discharged within one to two days of their procedure. Depending on the reason for your laparoscopy, you may be able to leave the hospital the same day it was performed.

Proper care after your laparoscopy largely depends on the particular operation performed. In most cases, however, you will be advised to: remove the bandages the morning after surgery, return to your usual activities within a few days, avoid heavy lifting for several weeks.

Be sure to call your doctor immediately if you experience: severe nausea or vomiting. faintness or dizziness, coughing, shortness of breath, or chest pain, fever or chills, redness, swelling, increasing pain, excessive bleeding, or discharge from any of the incisions, difficulty urinating.


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May16
COLONOSCOPY
Anatomy and Physiology

Your colon, or large intestine, is a long muscular tube located in the last section of your intestines. After the stomach and small intestine digest food, the remaining material is passed through the colon, where water and electrolytes are absorbed. Formed stools are the end product of this process.

The colon is made up of: the cecum, the ascending colon, the transverse colon, the descending colon, the sigmoid colon, and the rectum.

Most of the conditions that are diagnosed or treated via colonoscopy affect the layer of cells that line the inside of the colon. A doctor can use the colonoscope to directly view this mucosal lining.

Reasons for Procedure

Conditions commonly diagnosed and/or treated with colonoscopy include: Colon cancer, colorectal polyps, colonic ulcers, colitis, or inflammation of the colon, diverticulosis.

Colorectal cancer, which initially occurs in the colon or rectum, is one of the most common types of cancer.

Essentially all colorectal cancers are believed to begin as polyps, which are abnormal growths of the mucosal lining. Detecting these polyps early is the key to preventing colorectal cancer.

In most cases, polyps cause no symptoms. colorectal cancer, however, can cause symptoms including: changes in bowel habits, blood in the stool, stools that are narrower than usual, abdominal discomfort, unexplained weight loss or fatigue.

Treatments

A colonoscopy is commonly used to screen for colorectal polyps. The purpose of a screening test is to detect a problem before it causes symptoms or serious harm. If left untreated, polyps may eventually develop into colorectal cancer. Colonoscopy is also used to treat polyps by completely removing them.

In a full colonoscopy, your doctor is able to see the entire colon, from the anus to the cecum, where it connects with the small intestine. In a sigmoidoscopy, your doctor is only able to see about half that distance, to the top of the descending colon. Either technique can be used to take a sample of tissue or remove a polyp.

Other screening tests for colorectal polyps or cancer include: fecal occult blood test, which is used to identify hidden blood in the stool; barium enema, which is a series of x–rays of the colon and rectum; digital rectal exam, which is a manual examination of the rectum; virtual colonoscopy, which uses a CT scan and computer to recreate a three–dimensional image of the colon lining.

The primary disadvantage of these tests is that they cannot be used to obtain a tissue sample or remove a polyp.

If you are diagnosed with colorectal cancer, your doctor will likely advise you to have other tests, such a CT scan of your abdomen.

Procedure

In the days leading up to your procedure: do not eat any solid food for 24 hours, or drink anything for 8–10 hours, before the procedure. Your doctor will recommend a preparation to clean the colon in order to make sure it is completely empty for the procedure. In addition to following a clear liquid diet, this may include taking laxatives, or performing an enema.

Also in the days leading up to your procedure: If you take medications, particularly nonsteroidal anti–inflammatory drugs such as aspirin, or blood thinners such as coumadin, ask your doctor if you need to temporarily discontinue them or change the doses. Do not start taking any new medications before consulting with your doctor. Be sure to arrange for a ride to and from the procedure.

A colonoscopy generally takes 15–60 minutes. Before the procedure, an intravenous line will be started, and you will be offered pain medication and a mild sedative to help you relax.

During the exam, you will lie on your left side with your knees bent. A colonoscopy is performed using an endoscope, which is a long, thin, flexible tube with a light and a tiny video camera attached to the end.

Your doctor will insert the endoscope into your rectum and slowly guide it to the point where your colon meets your small intestine. Your doctor will blow air through the endoscope into your colon to inflate it for better viewing.

The camera transmits an image to a TV monitor so your doctor can view the lining of your intestine.

If your doctor locates a polyp during the procedure, he or she may remove it using special instruments passed through the endoscope. The tissue obtained during this polypectomy is then sent to a laboratory for examination.

Risks and Benefits

Colonoscopy, with or without a polypectomy, is generally a very safe procedure. However, there is a chance you will experience some abdominal discomfort and/or distension. Other less common complications include: adverse reaction to medications, bleeding in the colon or rectum after a biopsy or polypectomy, a perforation, or tear, through the bowel wall, infection in the blood, heart and lung problems.

Benefits of a colonoscopy include: effective screening for colorectal cancer; both the diagnosis and treatment of colorectal polyps; diagnosis of other conditions such as colitis, or inflammation of the colorectal lining; diagnosis, and even treatment, of other causes of bleeding from the colon or rectum.

In a colonoscopy, or any procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it's the most appropriate intervention for you.

After the Procedure

Colonoscopy is an outpatient procedure, so you will be able to go home after your sedative wears off, which generally takes 1–2 hours. You should receive your results over the phone, by mail, or at a follow–up appointment.

Air that is left in your intestines after the procedure may cause some persistent abdominal discomfort and bloating, which usually is resolved when the trapped air passes. If you had a polypectomy, you may feel some additional abdominal discomfort for up to five days after the procedure, but symptoms usually clear within 48 hours.

Be sure to contact your doctor if you experience: signs of infection, such as fever and chills, severe or worsening abdominal pain, rectal bleeding.


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