Gridhrasi - A Case presentation

By Dr. Maanas. A1st year PG scholar

Guided byDr. Rajarajeshwari N MAssociate ProfessorDept of samhita samskruta and siddhanta

CASE PRESENTATION

CASE HISTORY Name: abc Age: 55 Sex: Female Occupation: Farmer [worker] Address: Signahalli, Hassan IPD- 004104-2014 OPD- 023862-2014 D.O.A- 30-06-2014 D.O.D- 09-07-2014

CHIEF COMPLAINT Pain in the lower back region

radiating to the posterior aspect of Left leg since 3 months.

The pain has increased from 15

days.

ASSOCIATED COMPLAINTS

Unable to walk properly due to pain since 15 days.

Pulling type of pain in left calf and thigh region.

HISTORY OF PRESENT ILLNESSPatient was apparently normal 3 months back. She developed pain in lower back region ,which started gradually radiating to posterior aspect of left leg within two days and was not able to do her occupational work. She consulted an allopathic doctor who prescribed her with medications and rest. The treatment gave her temporary relief, but pain recurred which was continuous in nature and used to aggravate after strenuous work. She came to a stage were she was unable to do her household work also.15days back she came to know about our hospital and started taking medications for the same which gave her relief, so for further improvement she got admitted in our hospital.

PAST HISTORY

No H/O DM or HTN No surgical history

FAMILY HISTORY

Nothing Significant

PERSONAL HISTORY AAHARA: MIXED DIET. Morning-Dosa, rice

items Afternoon-Ragi Mudde, curd and buttermilk, Night rice curd, non veg once in a week

VIHARA: FARM WORKER she sits in same position for almost 5-6 hr since 30 yr, controls her thirst and urge to micturate.

APPETITE: Decreased appetite, but takes food regularly

BOWELS: Since 3 months Hard, straining MICTURITION: Normal SLEEP: DISTURBED since 5 yr, DUE TO PAIN

since 3 months HABITS : NIL

Gynecological historyMenarche : 15yrMenopause : 50yr Disturbed sleep since thenObstetric history : P3A0L3D0

General examination B.P-130/80 mm Hg PR-78/Min R.R-20/Min Height -5ft 2inches Weight - 48kg Edema/lymphadenopathy/pallor/icterus/

clubbing/cyanosis - absent

SYSTEMIC EXAMINATION RS - NVBS CVS - S1 S2 heard P/A - Soft, non tender CNS-Conscious and well

oriented

Musculo-skeletal system Gait - limping with support Upper limb - Normal Lower limb - Stiffness: Stiffness in the calf and thigh region. Redness and Warmth / Weakness / Swelling / Deformity : Absent Examination of spine - Inspection : No visible deformity Palpation : Tenderness - L5 S1 S2 region Movements : Cervical/Thoracic : NAD Lumbar : Flexion Restricted Lateral flexion Lt-Not possible Rt – Restricted Extension- restricted

SLRT-Positive at 30 degree LASEGUES SIGN- Positive

INVESTIGATIONS Hb:11gm% E.S.R :20 mm/hr Platelets: 3.31 lakhs/CMM FBS: 82 mg/dl Blood urea: 15 mg/dl Urine sugar: absent

ASTA STHANA PARIKSHA NADI-78/min JIHVA-Alipta MALA-Twice/day MUTRA- 4-5 times/day SHABDA-Prakrita SPARSHA-Sama sheetoshna DRIK – Gati- Vikruta AKRITI- Madhyama

DAShA VIDHA PARIKSHA PRAKRITI- Vata - Pitta VIKRITI-

o Hetu- Long hours of sitting and working, lifting heavy weight, vegadharana, Nidrahaani

o Dosha- Vatao Dooshya- Asthi, Sandhi, Mamsao Prakriti - Mriduo Desha – Bhumi -Anupa Sadharana o Atura – Kati, Vama sakthio Kala – Ritu- Varsha ritu Kriyakaala- Vyakta

avasthao Bala –Rogi - Avara ; Roga - Madhyama

DAShA VIDHA PARIKSHA CONTd.. SARA SAMHANANA SATVA SATMYA AHARA SHAKTI VYAYAMA SHAKTI VAYAH PRAMANA

Madhyama Madhyama Madhyama Madhyama Abhyavaharana Shakti- Madhyama Jarana Shakti- Madhyama Avara Madhyama Madhyama

NIDANA PANCHAKA Nidana - Long hours of sitting and working,

lifting heavy weight, vegadharana, Nidrahaani

Purvarupa – Purvarupa not elicited. Rupa - Low back pain, radiating pain from

Left buttock region to posterior side of the leg, difficult to walk, pain aggravating while walking and while turning from one side to other on lying down.

Upashaya – Resting in supine position with legs fl

Anupashaya - walking, bending, working.

SAMPRAPTINIDANA

VAYAH DHATU KSHAYA

VATA PRAKOPA

KHA VAIGUNYA IN KATI

DOSHA - DUSHYA SAMMURCCHANA

SIRA, SNAYU AFFECTED

GRIDHRASI

VYADHI VYAVACHEDANAVATAJA

GRIDHASIVATA-KAPHAJA

GRIDHRASI URUSTAMBHA KHALLI

STAMBHA STAMBHA RUK IN URU PADA,

JANGHA,URU & URU

MOOLA PEEDA

RUK GAURAVA SHOTHA,AYASA,SANKOCA

MARDANAVAT PEEDA

TODA AROCHAKA ANGAMARDA SPANDATE

MUHUHU TANDRA GURUTWA

DEHA VAKRATA TANDRA

ARUCHI, STAIMITYA, SUPTI

VYADHI VINISHCHAYA

VATAJA GRIDHRASI

OP basis Treatment Sahacharadi Kashaya 3tsf BD Rasna Guggulu 2 TID Hingvashtak Churna ½ tsf TID * 1 week

TREATMENT 30-6-2014 TO 9-7-

2014

चि�कि�त्सा सूत्र अस्थ्याश्रयाणाम् व्याधीनाम् पं��मा�णिण भेषजम् । बस्तयः क्षीरसप%किष कितक्त�ोपकि(ताकिन � । �. सू .२८/२८

�ेवलम् किनरुपस्तंभमादौ स्ने(ैरुपा�रेत् । �. चि�. २८/७५

01-07-14

Kati Basti with Dhanwantara taila Sarvanga Abhyanga (Dhanwantara Taila) + Bashpa

Sweda Matra Basti with Pancha Tiktaka Ghrita 80ml Katilepa with Jadamayadi Churna + Dhanwantara

Taila Rasna Guggulu 2-0-2 Physiotherapy

LOW BACK ACHE RADIATING TO LT Leg +++APPETITE – GOODBOWEL-REGULARSLEEP- DISTURBEDSTIFFNESS- PRESENT

Kati Basti with Dhanwantara Taila Sarvanga Abhyanga with Dhanwantara Taila + Patra

Pinda Sweda Matra Basti with Pancha Tiktaka Ghrita Katilepa with Jadamayadi Churna + Dhanwantara

Taila Rasna Guggulu 2-0-2 Physiotherapy

PAIN – REDUCEDAPPETITE – GOODBOWEL-REGULARSLEEP- DISTURBEDSTIFFNESS- PRESENT

02-07-14

Kati basti with Dhanwantara taila Sarvanga Abhyanga + Patra pinda sweda Matra Basti with Pancha Tiktaka Ghrita Katilepa with Jadamayadi Churna + Dhanwantara

Taila Rasna Guggulu 2-0-2 Physiotherapy

PAIN - REDUCEDAPPETITE – GOODBOWEL-REGULARSLEEP- DISTURBEDSTIFFNESS- PRESENT

Ksheera vaitarana Basti- Guda Paka 30ml, Chincha Rasa 50ml,

saindhava Lavana-12gm, PTG-40ml, Ksheera 200ml

03-07-14

Pain reduced, No pain while getting up from bedAPPETITE – GOODBOWEL-REGULARSLEEP- DISTURBEDSTIFFNESS- PRESENT

Ksheera vaitarana Basti Kati basti with Dhanwantara taila Sarvanga Abhyanga (Dhanwantara Taila) + Patra

pinda sweda Matra Basti with Pancha Tiktaka Ghrita 80ml Katilepa with Jadamayadi Churna + Dhanwantara

Taila Rasna Guggulu 2-0-2 Physiotherapy

04-07-14

Pain reduced/ Able to walkAPPETITE – GOODBOWEL-REGULARSLEEP- DISTURBEDSTIFFNESS- PRESENT

Kati basti with Dhanwantara taila Sarvanga Abhyanga (Dhanwantara Taila) + Patra

pinda sweda Ksheera vaitarana Basti Matra Basti with Pancha Tiktaka Ghrita 80ml Katilepa with Jadamayadi Churna + Dhanwantara

Taila Rasna Guggulu 2-0-2 Physiotherapy

05-07-14

PAIN REDUCED, PERSISTS ON WALKINGAPPETITE – GOODBOWEL-REGULARSLEEP- DISTURBEDSTIFFNESS- PRESENT

Kati Basti with Dhanwantara taila Sarvanga Abhyanga (Dhanwantara Taila) + Patra

pinda sweda Ksheera vaitarana Basti Katilepa with Jadamayadi Churna + Dhanwantara

Taila Rasna Guggulu 2-0-2 Physiotherapy

06-07-14

C/O PAIN WHILE WALKINGAPPETITE – GOODBOWEL-REGULARSLEEP- DISTURBEDSTIFFNESS- PRESENT

Kati Basti with Dhanwantara taila Sarvanga Abhyanga (Dhanwantara Taila) + Patra

pinda sweda Ksheera vaitarana Basti Matra Basti with Pancha Tiktaka Ghrita 80ml Katilepa with Jadamayadi Churna + Dhanwantara

Taila Rasna Guggulu 2-0-2 Physiotherapy

07-07-14

Kati basti with Dhanwantara taila Sarvanga Abhyanga (Dhanwantara Taila) + Patra

pinda sweda Matra Basti with Pancha Tiktaka Ghrita Katilepa with Jadamayadi Churna + Dhanwantara

Taila Rasna Guggulu 2-0-2 Physiotherapy

O/E PAIN ON PRESSURE. PAIN REDUCED APPETITE – GOODBOWEL-REGULARSLEEP- DISTURBEDSTIFFNESS- PRESENT

08-07-14

Treatment Chart01/0

702/0

703/0

704/0

705/0

706/0

707/0

708/0

7KATI

BASTI x x x x x x x xS.A. + B.S. x

S.A.+ PPS x x x x x x xBasti chart01/07 02/07 03/07 04/07 05/07 06/07 07/07 08/07

x x N N N N N xA A A A A A A A

DISCHARGE ADVISE Rasna Guggulu 2-2-2 Sahacharadi Kashaya 4tsf-4tsf-4tsf Dhanwantara Taila (E/A)

REVIEW AFTER 15 DAYS

Pathya

Sarpi, Swadu, amla, lavana rasa ahaara, Godhuma, Masha, Shali, Kulattha, Mamsa rasa, Gramya - audaka, mamsa, Dadim, Jambir, Draksha, etc. Daily Abhyanga

Tikta, Katu, Kashaya Rasa Ahaara atisevana, late night food,Chinta, Vegadharana, Shrama- Especially Bharadhwa, Anashana etc.

Apathya

ACCORDING TO PATIENTS SATISFACTION SCALE

PAIN C/O PAIN No C/O PainOnly O/E Pain

SLR +ve at 30 o +ve at 70o

LASEGUESSIGN +ve +ve

APPETITE Decreased Good

SLEEP Disturbed Can sleep Better

PROGNOSIS

THANK YOU

अस्थ्याश्रयाणाम् व्याधीनाम् पं��मा�णिण भेशजम् । ब्स्तयः क्षीरसप%किष कितक्त�ोपकि(ताकिन � । �. सू .२८/२८ �ेवलम् किनरुपस्तंभमादौ स्ने(ैरुपा�रेत् । �. चि�. २८/७५