Monday, July 20, 2009

A CASE STUDY ON PRIMARY OPEN ANGLE GLAUCOMA

PERSONAL DATA
w NAME: MR. R. VENKATRAMANI
w SEX:MALE
w AGE:63
w OCCUPATION: RETIRED BANK OFFICIAL
PRADHANA VEDHANA
w REDNESS,
w WATERING OF EYES,
w PAIN (OCCASIONALLY, BUT INTENSE)
w GRITTINESS IN EYES(PAMSHU POORNABHAM),
w LACK OF PROPER VISION SINCE 3 YEARS
ANUBHANDHA VEDANA
w FREQUENT ALLERGIC EPISODES
w OCCASIONAL PAIN IN LEGS
w DISTURBED SLEEP
w ANXIETY
w BRONCHIAL ASTHMATIC
PERSONAL HISTORY
w FOOD HABBITS- VEGETARIAN, FOND OF MADHURA, KATU RASA, FRIED ITEMS
w NON ALCHOHOLIC, NO SMOKING HISTORY
w SLEEP- DISTURBED
w STATUS- MARRIED, DEPENDENT
w NO RELAVANT FAMILY HISTORY WAS OBSERVED
HISTORY OF PAST ILLNESS
n 11 YEARS- SUFFERED FROM HEAD INJURY
n 30 YRS- HAD A MAJOR ACCIDENT AND MALLEOLUS WAS REMOVED FROM THE RIGHT LIMB.
n 44YRS- VIPER BITE( ANTI VENOM WAS GIVEN)
n 48YRS- B/L HYDROCELE OPERATION WAS PERFORMED
n SUFFERING FROM BRONCHIAL ASTHMA SINCE 10 YRS
n ALLERGIC TO PENCILLIN
n ALLERGIC TO SMOKE, DUST AND SOME FOOD ITEMS.
n RECENTLY BEFORE 2 YEARS HAD A DOGBITE AND PROPHYLACTIC MEASURES WERE TAKEN
OPTHALMIC HISTORY
DEGENERATIVE PROGRESSIVE MYOPIA
IN 1984 LEFT EYE CATARACT WAS DONE- A FAILURE, AND RESULTING IN COMPLETE LOSS OF VISION DUE TO IATROGENIC REASONS.
IN 1990 CATARACT OPERATION CARRIED OUT IN RIGHT EYE

n IN 1998- SYMPTOMS OF GLAUCOMA WERE PRESENTED AND WAS DIAGNOSED AS POAG, AND OPERATION WAS ATTEMPTED WITHOUT SUCCESS, RESULTANT VISION BEING 2/60
n IN 2005 ANTI GLAUCOMA OPERATION (TRABECULOTOMY ) WAS DONE SUCCESSFULLY, RESULTANT VISION -1/60
n UNDER CONTINUOUS TREATMENT OF PILOCARPINE DROPS TO MAINTAIN IOP
n IOP BEFORE AND AFTER OPERATION ARE 29 AND 19 mm OF Hg RESPECTIVELY.
AKSHI PAREEKSHA
n VARTHMA- STHANIKA, PRAKRUTHA
LACRIMAL GLANDS AND DUCT ARE NORMAL AND PATENT
n SUKLA MANDALA- A CYST ( WHITE ) IN COLOUR WAS SEEN OVER THE SCLERA OF RIGHT EYE, THE EXACT NATURE OF THE CYST WAS UNKNOWN, THE OPTHAMOLOGIST HAVE OPINED THAT , THIS CYST IS A COMPENSATORY MECHANISM FOR HIGHER IOP.
n KRSHNA MANDALA- BILATERALLY BOTH EYES ARE APHAKIC( ABSENCE OF LENS)
n THARA MANDALAM- DIMINISHED PUPILARY REFLEX TO LIGHT, BLACK IN COLOUR
n DRSTI MANDALA- IN LEFT EYE NO VISUAL ACTIVITY, IN RIGHT EYE VERY MINIMAL VISUAL ACTIVITY
n PAIN, REDNESS, SWELLING OF RIGHT EYE WAS SEEN.
n IOP PRIOR TO 2005 WAS 29 AFTER THAT THE LAST IOP VALUE DURING FEB 2008 WAS 19
n FINGER COUNTING ONLY UPTO 1 FEET B4 TREATMENT.
SAMANYA PAREEKSHA
n JIHVA- DRY
n R.R- 20/MIN
n H.R- 80/MIN
n B.P- 138/88 mm hg
n MALA- NORMAL BOWEL MOVEMENTS,
(2/ DAY) NORMAL CONSISTENCY.
P.R- 78/MIN
WEIGHT- 66 KGS
MOOTRA- D/N -5-6/2
SATWA- PRAVARA.

APPROACH IN AYURVEDA
n THOUGH MOST OF THE SYMPTOMS BORE CLOSE SIMILARTITY WITH KAPHAJA ADHIMANTHA, BUT VATA DOSHA INVOLEVEMENT IS ALSO UNDERSTOOD THROUGH RUJA, CHRONICITY AND OTHER FEATURES. PITHA INVOLVEMENT IS CRUCIAL IN ANY AKSHI VIKARA, AND SAME HOLDS HERE TOO.
n SYMPTOMS ALSO RESEMBLE THOSE OF SA SHOPHA AKSHI PAKA, TIMIRA TOO.
n HENCE RATHER THAN TRYING TO FIND EXACT AYURVEDIC NAME OF THE CASE IT IS BETTER TO ANALYSE THE DOSHA AWASTHA AND UNDERSTAND THE DISEASE.
n DOSHA INVOLVED- KAPHA PRADHANATHAMA, VATHA SECONDARY, AND PITHA ALSO.
n SROTHA- RAKTHA AND RASA
n SROTHO DUSHTI- SANGA AND VIMARGA GAMANA , ATHI PRAVRUTHI.
n ROGA MARGA- MADHYAMA
n SADHAY SADHYAM- YAPYAM
n ROGA AWASTHA- BHEDA
NIDANA PANCHAKAM
n NIDANAM- VIPERBITE, ABHISYANDHI AHARA,
n POORVAROOPA- RAGA DAHADI IN MILDER FORM, PAIN IN FREQUENTLY IN HEAD
n ROOPA- RAGA, SHOTHA, DAHA, RUJA, SRAVA, LOSS OF VISION.
n UPASAYA, ANUPASAYA-MORNING SYMPTOMS ARE MORE, AND AS TIME GOES ON SLIGHTLY BETTER.
n SAMPRAPTHI- NIDANA CAUSES KAPHA DUSHTI, BECAUSE OF SANGA I.E MARGA AVARODHA OCCURRED AND ULTIMATELY PITHA AND RAKTHA BECOMES DUSHITHA RESULTING IN THE ILLNESS.
CHIKITSA
n ON JUNE 2008 WHEN HE WAS FIRST ATTENDED,
HE WAS GIVEN
DHANWANTHARA AND MAHATHIKTHA KASHAYAM IN B.D DOSE IN EMPTY STOMACH( 5ML EACH WITH 30 ML HOT WATER)
LATER DHANWANTHARAM WAS DISCONTINUED,
AMRTHA PRASHA GHRTHAM 5G B.D WITH KSHEERA A/ FOOD
w RUMORID TABLETS- NAGARJUNA PREPARATION CONTAINING, GUGGULU, SHALLAKI, ERANDA, PARADHA, GANDHAKA WAS GIVEN IN 2 B.D DOSE AFTER FOOD
w MANASAMITRAM WAS ALSO ADMINISTERED TO REDUCE ANXIETY AND TO INDUCE GOOD SLEEP. 1 H/S.
w PATIENT WAS INSTRUCTED NOT TO DRINK HUGE AMOUNT OF WATER MORE THAN 1 LTR AT A TIME, AS IT WOULD INCREASE THE IOP!!
AUSHADA NIRNAYA

w MAHA TIKTHAKAM- PREDOMINANTLY KAPHA PITHA SHAMAKA, BRINGS PITHA TO SWASTHANA.
w AMRTHA PRASHA GHRTHAM- ACTION MAINLY IN GAMBHEERA VYADHIS, A VATHA PITHA SHAMAKA, VERY EFFECTIVE FOR ANY CHRONIC CASES.
w RUMORID- NAGARJUNA PATENT- GUGGULU, SHALLAKI, ERANDA, PARADHA, GANDHAKA- SYMPTOMATICALLY TO REDUCE INFLAMATORY SIGNS AND PAIN
w MANASAMITRAM- REDUCES ANXIETY AND INDUCES GOOD SLEEP
TARPANA KARMA
w IT WAS DECIDED TO PROCEED WITH THARPANAM FOR THIS CASE, AS THERE WAS SOME IMPROVEMENT WITH MEDICATION.
w 1ST COURSE OF THARPANAM WAS CARRIED OUT FOR 7 DAYS BETWEEN 20-9-08 TO 27-9-08
w MAHA THRIPHALA GHRTHAM WAS USED
w THE MESSAGE IS THOUGH THE ACTUAL KALA NIRNAYA IS TOLD IN TEXT, ONE HAS TO ASSESS THEM TO FIND OUT EXACTLY WHAT AMOUNT OF TIME IS NEEDED FOR A PARTICULAR PATIENT.
w AFTER THARPANA THE GHRTHAM IS COLLECTED AND WAS ADMINISTERED INTERNALLY AT NIGHT WITH USHNODAKAM.
w A PART OF GHRTHAM WAS USED FOR PADABHYANGAM BEFORE SLEEP
w THEN AFTER A BRIEF PERIOD , SECOND COURSE OF THARPANAM WAS RESUMED FROM 25- 10-08 TO 31-10-08.
w THARPANAM WAS FOLLOWED BY A BRIEF SWEDANAM WITH PICHU AND USHNODAKAM.
PROGRESS
n BEFORE THARPANA
w FINGER COUNTING 1 FEET
w IOP 19 mm of hg
w CYST IN SCLERA
w REDNESS, EPIPHORA,
w BURNING SENSATION
w VISION 1/60
AFTER THARPANA
AFTER 1ST COURSE OF THARPANAM
w FINGER COUNTING UP TO 3 FEET
w REDUCTION IN REDNESS ETC
w THE CYST SPONATEOUSLY
DISAPPEARED, AFTER 10
DAYS FROM THARPANAM.
AFTER 2ND COURSE OF THARPANAM
w IOP 6 mm of hg (remember diurnal
variations are very high in POAG)
w FINGER COUNTING UP TO 5 FEET
w VISION 5/60
w NO REDNESS, BURNING
w SENSATION ETC,
w REDUCTION IN SWELLING OF EYE

INFERENCE
v THUS THROUGH THIS CASE IT COULD BE UNDERSTOOD THAT IN A CASE OF POAG OUR AYURVEDIC THERAPEUTIC MEASURES COULD GIVE BETTER RESULT AND COULD HELP IN PARTIAL RESTORATION OF VISION, IMPORTANTLY IT CAN INFLUENCE THE IOP .
DISCLAIMER
THE MOTIVE OF THIS PRESENTATION IS NOT TO BOAST OFF WITH THE SUCCESS , BUT TO SHARE THE JOY AND TO MAKE OUR FRIENDS TO BELIEVE THAT THEY COULD TAKE AND HANDLE SUCH A CASE IN FUTURE. THIS FORMULA MAY NOT BE WORKING IN ALL CASES, OR EVEN SOME BETTER MEASURES AND MEDICINES COULD HAVE PRODUCED BETTER RESULTS, WE ARE PRESENTING HERE HOW WE UNDERSTOOD AND HOW WE REAPED THE FRUIT.

40 comments:

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俊楊凱 said...

期待你的下次更新喔^____^..................................................

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睇完之後覺得有d頓悟..感謝大大分享..˙ 3˙............................................................

ELIXIR OF LIFE said...

Was this your own case, or is it an excerpt