A Case study of Ankylosing spondylitis

Miss.R.Karthika D/O.R.Rajendran,Age:15/F came to our OPD with complaints of pain in both the hip joints,pain in left ankle joint since two months.She was not able to walk due to pain.She came with the support of a walker. History No H/O Diabetics mellitus,hypertension,IHD,headache,vomiting, and fits. History of appendisectomy (child hood),piles(non bleeding). She was wrongly diagnosed as being infected with TB and she was under ATT.

Blood reports RA factor Anti TB IgG Anti TB IgM ESR S. uric acid HLAB27 HB -55 -32 u/l -2.1(positive) -33/70 -5.7 -Positive -10.6

MRI :- SI joints B/L Sacroiletis - RT>LT

O/E TMJ normal Neck -Normal

Shoulder joint Patricks

-Normal -RT Positive

Futher investigation T3 T4 TSH Anti ds(DNA) ANA AMA ATG Calcium -122 ng/dl -6.70g/dl -3.55 Iv/UL -33.33 (positive) -0.84 negative -14.68 V/M negative -313.56 IV/ML negative 10.18 (10 is N) -7.73 pg/ml (15 is N)

Intact parathyroid hormone Serum Protein Electrophoresis

Reduced alpha1 and Hypergamma globulinemia,No M-Band seen. TB Gold(Quantiferon) 0.15(negative). As TB feron was negative, ATT was stopped

Diagnosis Ayurvedic view Gambeera vata raktham ( Modern view Ankylosing spondylitis)

Dosham

Vatham

Dushyam Raktham Avastha Agni Chirakari

Samagni

Koshtam Madhyama koshtam Malam Normal

Treatment Phase I: Ama pachanam,Agni deepanam Indukantha kashayam Amritha aristhtam Nayopayam lehyam Indukantha ghrutam -50ml 4 times per day before food. -15ml bd after food. -1 tsp bd after food. - 1 tsp bd after food.

Phase II: Vataraktha haram Rasna erandadhi kashyam Aba guggulu Senthil Drakshadi rasayanam Tippili rasayanam - 50 ml 4 times per day before food. -1-0-1 after food. - 2-0-2 after food. -1tsp bd after food. -1 tsp bd after food.

Phase III: Raktha prasadhanam Manjishtadhi kashayam Senthil -50ml 4 times before food. -2-2-2 after food.

Sudharsanam Karisalai kalpam

-2-0-2 after food. -2-0-2 after food.

External Treatment

Phase I Phase II Phase III Phase IV Phase V Phase VI

Podi kizhi, Lepam Abyangam ,Dasamoola ksheera dhara ,lepam Virechanam(Nimbaamrutha erandam) Kaya sekam, Lepam, Avagaham Kayasekam, Lepam, Avagaham, matra vasti Kashaya Vasti (Guduci ksheera vasti)

Phase VII Phase VIII

Kayasekam, matra vasti, kati vasti Abyangam, kashaya dhara

2 days 5 days 1 day 2 days 4 days 4 days (alternative days) 3 days 1 day

Conclusion After 22 days of treatment, pain in the hip joints reduced. Patient was able to walk without the support of the walker.

Rasayana Karma Pippali vardhamana rasayanam 1 st day 2 nd day 3 rd day 4 th day 5 th day 6 th day 2 gms 4 gms 6 gms 8 gms 10 gms 12 gms

7 th day 8 th day 9 th day 10 th day 11 th day 12 th day 13 th day 14 th day 15 th day 16th day 17 th day 18 th day 19 th day

14 gms 16 gms 18 gms 20 gms 18 gms 16 gms 14 gms 12 gms 10 gms 8 gms 6 gms 4 gms 2 gms

Case Study-Lance Adams syndrome

N.Balamurugan,S/O G.Narayanasamy,Age 31/M attended the OP ward on 24.3.2011 with complaints of jerks(involuntary movements) in all four limbs,dysarthria since 3 years.He had involuntary movements during rest sleep and activity,but no fasciculations or wasting of the tongue was noticed. History A known case of bronchial astha, had acute asthmatic attack,was on ventilator support and developed continuous jerky involuntary movements on recovery. No DM,

No HT, No APD, No IHD/CVD, No TB, No jaundice No headeache No Vomitting No injury No Calculi History of Tracheotomy done. History of fits-Generalised tonic clonic seizures No History of attack for the past 6 months.

On Examination Comprehension Naming of objects Normal Normal.

Difficulty noticed in repetition of words. No spasticity of tongue No wasting DTR Power Plantar X chest taken MRI Brain -Normal -G4. -Flenor(B/V) -Normal -Normal with B/L martoiditis

EEG-Record is bilaterally abnormal with seizers activity of the clinically observed jerks are unrelated.

Electrolytes Peripheral smear Sputum-culture and sensitivity HIV I and II ANA TSH

Normal Normal Kleibsella grown in culture. Negative Negative Normal

Diagnosis Ayuvedic view Aakshepaka vatham (Modern view Lance Adams Syndrome)

Dosham Vatham Guna Dushti Dushyam Avastha Agni Chala gunam Majja Aashukari

Samagni

Koshtam Madhyama koshtam Phase I Astavarga kashayam +

Gandharva Hasthathi kashayam + Vaishvanara churnam Sahacharadi tailam External Mahakalyanaka kashayam

50ml two times a day before food.

- 1 tsp bd with kashayam 10 ml with milk at night after food.

Jeevanthyadi churnam(udvarthanam) for 5 days. Sahacharadi kulumbu (for abyangam,kaya sekam,mamsa kizhi) Talam Rasnadi churnam + Ksheera bala Nasyam Sahacharadhi thailam(pratimarsha nasyam)

Phase II Internal Vidaryadi + Badra darvadi kashayam Poorna chandrodayam Ashwaganda churnam Saraswatha churnam Bala churnam Sukumara lehyam Sahacharadi Vp + Rasa tailam -50 ml bd before food -1 - 0 1 after food -1 tsp with milk at night after food -1tsp bd with honey -1 tsp with milk bd after food - 1 tsp at night after food -1 tsp with milk bd after food

External Abyangam, Jambeerapinda swedam, pizhichal was given Niruha vasti Shiro vasti Chetasa ghrtam Dvipanchamooladhi --Sahacharadi VP 1 tsp bd after food

Danatanayanadi ksheera kashayam 50 ml at night(before food) Dhatu kalpam leoodhyam - 1 tsp bd after food Draksha +Balaaristam -15ml bd after food.