fungal sinusitis in ayurveda a case presentation

1. CASE
PRESENTATION
DR. GURMEL SINGH
2nd YEAR P.G. SCHOLAR
DEPARTMENT OF PG STUDIES IN KAYACHIKITSA
SKAMCH&RC
VIJAYANAGAR
BENGALURU
1

2. ATURA VIVARANA
2
 Name : Mr. Raghunath
 Age : 58 Years
 Sex : Male
 Religion : Hindu
 Socio economic status : Middle class
 Marital status : Married
 Education status : Diploma in Electronics
 Occupation : Weighing & Auto machine
dealer

3. 3
 Address : # S.R.S. Road, 3rd Main
4th Cross Behind P.E.S
School, Peenya
Bengaluru - 58
 Source of history : Patient, Wife, Son
 O.P No : D26955
 I.P. No : 3769/16
 Ward : Semi Special Ward 3
 Bed No : 35

4. 4
 Date of admission : 03/09/16 @ 11:30 AM
 Date of discharge :
 Case taken on : 18/09/16
 Consultant doctor : Dr. Vijayalakshmi S

5. PRADHANA VEDANA
5
Headache since 3months aggravated since 2 weeks
General weakness / tiredness since 1 year aggravated
since 2 weeks
Loss of vision and complete closure of right eye lid since
1month

6. ANUBANDHA VEDANA
6
Constipation since 3 months
Reduce appetite since 3 months
Disturbed / loss of sleep 3months
Blurred vision in left eye 1 month
Dizziness since 15 days
Pain & swelling in right side of face and around the eyeball
since 15 days

7. VEDANA VRITTANTA
7
 Patient is a K/C/O DM type 2 since 18 years, HTN since 15
years and on medication .
 Patient was apparently healthy before 3 months. Gradually
he developed pain over right side of face and head (on & off )
for which he consulted physician at Columbia Asia Hospital
during his regular check up on 01/07/16.
Cont…..

8. 8
He was given medication for 5 days but the patient noticed
aggravation of headache after two days of medication .
Headache was present all over the head, persisting through
out the day and aggravated at night time, associated with
increased tiredness, reduced appetite, constipation and
unable to perform daily activities due to general debility and
pain, no history of vomiting, cough, cold, discharges from
nose, eyes, ears. Cont….

9. 9
Since the complaints aggravated again he consulted his
physician in Columbia Asia hospital on 03/07/16.
He referred him to neurologist & ENT / head and neck
surgeon and there he was advised certain investigations and
diagnosed with Right side fungal sinusitis and performed
ENDOSCOPIC MEDIAL MAXILLECTOMY /
MEDIOSCOPIC ORBITAL DECOMPRESSION under
general anaesthesia on 08/07/16. Cont….

10. 10
Followed by surgery a course of anti fungal treatment was
administered. On 17/7/16 he again developed severe
headache at mid night & disturbed sleep for which he
consulted ENT / head and neck surgeon and prescribed
medication for 5 days and from this he didn’t get any relief.
On follow-up on 25/7/16, he was prescribed medication for
next15 days .
Cont….

11. 11
During this period patient’s son noticed gradual drooping of
right eye lid and complete loss of vision in right eye and
blurred vision in left eye .
For all the persisting complaints and new complaints he
consulted the neurologist . He advised to take CT- PNS
(Report enclosed) and on seeing the reports, further referred
the patient to E.N.T specialist in Chord Road Hospital for
needful. Cont…

12. 12
Along with CT-PNS he was advised ENDOSCOPIC
BIOPSY under general anaesthesia on 11/8/16 and
prescribed medicine for 15 days. Patient didn’t find any
differences from these medications, during this period
patient also developed pain & swelling over right periorbital
region associated with dizziness while getting up from bed
& while walking along with frequent headache.
Cont….

13. 13
On follow-up he was informed as the anti fungal treatment
was nephrotoxic, if the medicines are continued it will have
adverse effects on his kidney function.
Hence patient refused to continue medicines and was looking
for alternative approach. One of his relative suggested
SKAMCH & RC for further management .

14. POORVAVYADHI VRITTANTA
14
 Patient is a k/c/o
 IHD since 18 years
 B/L Cataract since 7 years
 B/L Diabetic retinopathy since 3 years

15. CHIKITSA VRITTANTA
1
 Angioplasty done 18 years back.
 Oral hypoglycemic agent since 13 years, since 2 years he is
on Insulin .
 B/L Cataract surgery 7 years back.
 B/L Laser treatment 3 years back for diabetic retinopathy.
 Coronary artery bypass graft (CABG) ON 12/02/2016
 8 time dialysis done during the hospitalization for CABG.

16. 16
On Medication
1) Tab Sibelium 5mg 0-0-1
2) Tab Moxavas 0.2mg 1-0-0
3) Tab Coralan 7.5 mg 1-0-1
4) Tab Flavedon MR 35mg 1-0-1
5) Tab Cardivas 25mg 1-0-1
6) Tab Ketohunt 1-0-1
7) Human actrapid and Insugen

17. KAUTUMBIKA VRITTANTA
17
SON DAUGHTER
PATIENT wife
 All family members are said to be healthy.
 No one in the family is having similar type of complaints.

18. VAIYAKTIKA VRITTANTA
18
 Ahara : Vegetarian.
 Mala Pravrutti : Once in 2 days (Irregular, hard)
Incomplete evacuation.
 MutraVisarjana : 4-5 times / day
1-2 times / night
 Nidra : Disturbed
 Vyasana : Coffee (4-5 time /day) & during
night in case of headache.

19. ROGI PAREEKSHA
19

20. ATURA BHOOMI DESHA PAREEKSH
20
 Jatatah : Sadharana
 Samvardhitah : Sadharana
 Vyadhitah : Sadharana

21. ASTHA STHANA PARIKSHA
21
 Nadi :78bpm / min
 Mutra :4-5 times / day, 1-2 times / night
 Jihva : Alipta
 Mala : Once in 2 days (irregular, hard ) incomplete
evacuation.
 Sabdha : Vikruta (hearing loss in right ear)
 Sparsha : Prakruta
 Druk : Vaikruta
 Aakruti : Madhyama

22. DASHVIDA PAREEKSHA
22
1) Prakriti : Vata – Kapha
2) Saara : Avara
3) Samhanana : Madhyama
4) Pramana : Madhyama (Height:165 cm, Weight : 73 kg)
5) Saatmya : Madhyama
6) Satva : Avara
7) Aahara Shakti :
Abhyavaran Shakti : Avara
Jarana Shakti : Avara Cont…

23. 23
8) Vyayama Shakti : Avara
9) Vaya :Madhyama
10) Vikriti : Pravara
Hetu : Aaharaja & viharaja nidaana, Vyadhi karshana.
Dosha : Tridosha
Dooshya : Rasa, Rakta, Mamsa, Meda, Majja
Purisha, Mootra .
Desha : Sadharana
Bala : Avara
Kala : varsha, sharad
Prakriti : Vata kapha

24. SAMANYA PARIKSHA
(GENERAL PHYSICAL EXAMINATION)
24
Patient is conscious, alert, oriented to time, place and
Person.
 General Condition : Fair
 Built : Moderately -Built
 Nourishment : Moderately -Nourished
 Pallor : Present ++
 Cyanosis : Absent
 Nail :Pale white, no clubbing or koilonychia
 Icterus : Absent.

25.  Lymphadenopathy : Absent.
 Swelling : B/L pitting Pedel oedema
(dependent )since 3 days
25
SITE LEFT (cm) RIGHT (cm)
 Thigh 48 47.5
 Calf 33 33
 Ankle 25.5 25.5
 Foot 25.5 24.5

26. 26
 Temperature : Afebrile
 Pulse : 78 bpm.
 BP : 140 / 90mmHg.
 R/R : 18 /minute.
 Tongue : Uncoated
 Height : 165cm
 Weight : 73Kg
 BMI : 28.67

27. VISHISHTA PARIKSHA
(SYSTEMIC EXAMINATION)
27
 PER ABDOMINAL EXAMINATION
Inspection - Shape- distended
Umbilicus- Centrally placed, inverted
Scar mark seen in Epigastric region
Auscultation - Bowel sounds heard .
Palpation - Soft
Tenderness : Over epigastric region
No organomegaly
Percussion - Tympanic

28. 28
 RESPIRATORY SYSTEM
Inspection –
Nasal septum deviated to right side
Pale nasal mucosa
Shape of chest –B/L symmetrical
Chest movements- Symmetrical
Healed scar mark seen
Respiratory rate-18/min
Palpation - Trachea - Centrally placed
Chest Expansion - Symmetrical
Tactile vocal fremitus - Normal
Percussion - B/L Resonant
Auscultation - B/L Normal Vesicular Breath Sounds heard

29. 29
 CARDIO VASCULAR SYSTEM
Inspection – JVP seen- 6cm
Palpation - Apex beat felt @ 5th intercostal space lateral to
left mid-clavicular line
Percussion – Cardiac dullness noted
Auscultation - S1, S2 heard, No added sounds

30. 30
 CENTRAL NERVOUS SYSTEM
1. HMF
Consciousness - Conscious
Orientation to - Time, place, person- Intact
Memory - Recent - Not affected
Remote - Not affected
Intelligence - Intact
Hallucination & Delusion - Absent
Speech disturbance - Absent
Handedness - Right

31. CRANIAL NERVE EXAMINATION
CRANIAL
NERVES
LEFT SIDE RIGHT SIDE
CN I- Olfactory
a) Nasal passage
b) Smell sensation
Intact
Intact
DNS
Affected
CN II- Optic
a)Visual acuity
b)Visual field
c)Light reflex
CF from 3 metres
Not affected
Normal
Complete drooping
of upper eye lid
Couldn’t elicit
Sluggish
31

32. CN III Occulomotor Nerve
CN IV Trochlear Nerve
CN VI Abducens Nerve
A) (Pupil- Position, Size,
Shape, Symmetry)
B) Eye ball Movements
Normal
Normal
Normal
Not able to
perform
32

33. 33
CN V Trigeminal Nerve
A) Sensory –Touch, pain
and pressure sensation
B) Motor -
a) Clenching of teeth
b) Jaw movement against
resistance
c) Jaw jerk
d) Corneal reflex
Intact
Possible
Possible
Normal
present
Intact
Possible
Possible
absent
33

34. 34
 CN VII Facial
Nerve
a)Forehead frowning
b) Eyebrow raising
c) Eye closure
d) Teeth showing
e) Blowing of cheek
f) Nasolabial fold
Possible
Possible
Possible
No deviation of
angle of mouth
Possible
Equal on both
sides
Possible
Possible
Possible
No deviation of
angle of mouth
Possible
34

35. 35
 CN VIII
Vestibulo
Cochlear Nerve
a) Rhinne’s test
b) Weber’s test
AC>BC
Equal on both sides,
no, lateralisation
AC present,
BC absent
35

36. 36
 CN IX, CN X
Glossopharyngeal
and Vagus nerve
a) Position of uvula
b)Taste sensation
c) Gag reflex
Centrally placed
Intact
Normal
36

37. 37
 CN XI Accessory
Nerve
a) Shrugging the
shoulder
b) Neck movement
Possible against
resistance
Possible against
resistance
Possible against
resistance
Possible against
resistance
 CN XII
Hypoglossal Nerve
a) Protrusion of tongue
b)Tongue movements
Possible
Possible

38. MOTOR SYSTEM
38
Muscle Bulk Right (in cms ) Left (in cms)
Upper limb
Arm 24 24
Forearm 21 21
Lower limb
Thigh 46 47
Leg 32 31

39. 39
Muscle power Left Right
Upper limb 4/5 4/5
Lower limb 4/5 4/5
DEEP TENDON REFLEX
Biceps jerk ++ ++
Triceps jerk ++ ++
Supinator jerk ++ ++
Knee jerk ++ ++
Ankle jerk ++ ++

40. 40
 Muscle tone
B/L Upper limb and lower limb- Normal
 Co-ordination
Gait - Conscious while walking
Upper limb
• Finger to nose test - Possible
Lower limb
• Heel shin test- Possible
• Rhomberg’s sign- Negtive

41. SENSORY SYSTEM
• Superficial
a) Touch - Intact
b) Temperature - Intact
c) Pain - Intact
• Deep
a) Vibration sense- intact
b) Joint position sense- intact
41

42. 42
• Cortical
a) One point localization - Intact
b) Two point discrimination - Intact
c) Stereognosis - Present
d) Graphesthesia - Present

43. 43
EXTERNAL
OCULAR
EXAMINATION

44. STRUCTURE EXAMINATION RIGHT EYE LEFT EYE
 Eye Lids
Position & Movements
Lid margin
Normal
Whitish scales are
seen
Normal
Normal
 Lacrimal
Apparatus
Lacrimal sac & puncta
Regurgitation test
Normal
Patent
Normal
Patent
 Conjunctiva
Bulbar conjunctiva
Palpebral conjunctiva
Chemosis is seen in
Bulbar conjunctiva
No abnormalities
No abnormalities
 Sclera
Discolouration,
Inflammation
Normal
Normal
Normal
Normal
 Cornea Reflex absent Normal
44

45. VISUAL FIELD EXAMINATION
• Confrontation Test was performed:
45
O/E RE LE NORMAL
VALUES IN
DEGREES
Above
- 50
50 degree
Below
- 70
70 degree
Medial(Nasal side)
- 60
60 degree
Lateral (temporal
side)
- 90
90 degree
45

46. 46
EXAMINATION OF NOSE

47. 47
 Nasal passage :- Narrow passage on right side wider
passage on the left side, whitish yellow plugs
appreciated blocking the passage.
 Septum :- C shaped septal deviation to right side in the
cartilaginous part and wider passage in left nostril
 Floor of nose :- Not appreciated on Right and Left no
defects.

48. 48
 Lateral wall
• Nasal mucosa :- Congested nasal mucosa on right side
• Turbine and meati :- Mild swollen inferior turbinate on
the right side
• Discharge :- Absent
Patency of nose
 Spatula test :- Area of mist formation is reduced on
both sides and more on the right side

49. 49
Cotton wool test :- Movement was more appreciated on
left side when compared to right side
Sense of smell :- Reduced in right side

50. EXAMINATION OF PARANASAL
SINUSES
50
Tenderness :- On the right maxillary, frontal, & ethmoidal
sinus areas.
Swelling and tenderness present on Peri-Orbital area.
Local rise of Temperature :- Felt on Right MaxillarySinus

51. EXAMINATION OF THE EAR
51
Otoscopic examination
External Ear: Both ears normal
EAC: Normal
Tympanic membrane: Congestion and
retraction pockets seen in both the ears

52. INVESTIGATIONS
52

53. 53
53

54. 54
54

55. 55
55

56. 56
5
6

57. 57 5
7

58. 58 5
8

59. 59
59

60. 60
60

61. 61 6
1

62. 62 62

63. 63 6
3

64. 64
64

65. 65
65

66. 66
66

67. 67 67

68. 68 6
8

69. 69
69

70. 70
impression: soft tissue attenuation mucosal thickening in the right
maxillary ,Right sphenoidal and ethmoidal sinuses .The mucosal
thickening is eroding the medial and inferior wall of right orbit
,infiltration of the medial and inferior recti muscles as well as mild
proptosis of right eye globe- likely invasive fungal sinusitis

71. 71
71

72. 72 72

73. 737
3

74. ROGA PAREEKSHA
74

75. NIDANA PANCHAKA
75
Nidana – Adhayasana, Virudhasana, Avayama,
Divaswapna, Athiseetla ahara, Masha anna, Pishtana,
Parnshakha, Madhura dhadi with lavana, aasyasukham,
Vegadharana. Vyadhi swabhava, Vyadhi karshana
Purvaroopa :- unable to elicit

76. 76
 Roopa – Shiro shola, dourbalya, tandra, linganasha
dakhshina netra, vaat hata vartma dakshin netra , badha
shakruth, mandaagni, nidraanaasha , Timira vama netra ,
bhrama, shoona akshikoota and dakshina bhaaga vadana.
Upsaya : Sedatives, Pain killers
Anupsaya

77. 77
SAMPRAPTI
Aharaja & viharjaVyadi karshana Madhumeha,
hrudroga
(kleda pradhanta)
Kapha pradhana tridosha
Krimi utpathi
Shiro roga? (kapha krimi )
Vata parkopa
Badha purisha
Udavartha
Avrutha vata
upadrava-
HRUDROGA,
MADHUMEHA
Dushta
prathishyaya
Badhirya, andha,
ghrana shakthi
naasha, nayana
Amaya, shopha,
agnisaada.
aprathikriya

78. SAMPRAPTI GHATAKA
78
Dosha – Tridosaja
Dushya – Rasa, Rakata, Mamsa, Meda, majja, Purisha
Mootra.
Srotas –Rasa, Rakata, Mamsa, Meda, Majja, Purisha
Mootra vaha
Sroto dushti - Sanga, Vimarga gamana.
Agni - Jathraagni , Dhatwaagni
 Ama – Jataraagni & dhatwaagni mandya janya

79. 79
Udbhavasthana – Aamashaya and pakwashaya
Sancharasthana – Rasayani
Vyaktasthana – Sarva sharira especially in Indriya
and shiras
Adhishtana – Shiras, Indriya
Rogamarga – Madhyama
Sadhya asadhyada - kruchrasadhyata

80. VYAVCHEDAK NIDAANA
(DIFFERENTIAL DIAGNOSIS)
80
 Madumeha upadrava
 Tridoshaja krimija shiro roga
 Udavarta
 Ardhaavabhedaka
 Ananthavata
 Dushtapratishyaya

81. 81
Disease Inclusion Exclusion
Ananta vata Shirashoola, netra vikara Greevapradesha ruja
Hanugraha
Ganda parshwa kampa
Ardhavabhedaka Shirashoola, bhrama,
Athivrudha nayana
shravanam vinasha
Ardhe tu murdhna,
pakshaath, dashaat,
akasmaath ardha bhedam.
Madhumeha and upadrava Hrudaya, netra,shravana
indriyaupalepa, shayyasana
swapnasukha,
sheethapriyatwam,
prathishyaya, hrudroga,
udavartha, shoola

82. 82
Disease Inclusion Exclusion
Tridoshaja krimija
shiroroga ?
Aruchi, shoola persisting dina and rathri,
tantra, shoonakshikoota,vadana,
balakshaya, nidana as krimi, nistudhyade
shira.
Udavarta Mala bandha, shiroroga, hrudroga, andhya,
badhirya, mandagni,
Dushtaprathishyaya Praklidhyadi puna naasa parishushyathi.
Muhuraahanyathe cha api muhur vivriyate
thata, agnisada, shodha, krimiutpathi-
krimija shirorogavat linga.
Indriyathapanam-
Gandha na vethi cha
Badhirya, aandhya, nayanamaya. 82

83. 83
DIFFERENTIAL DIAGNOSIS
 Fungal sinusitis
 Diabetes mellitus and its complication
 Migraine
 Trigeminal neuralgia
 Cluster headache

84. 84
Disease Inclusion Exclusion
Cluster headache Pain and swelling
localised orbital,
temporal region,
Ptosis .
Unilateral
headache,Onset and
offset rapid, burning
pain,
Here the cause is
Fungal infection.
Migriane
Headache Aurra , unilateral
headache, episodic,
aggravated by loud
noise
Trigeminal neuralgia Pain unilateral
opthalmic,maxillary
division
Trigger factors such as
washing ,shaving,
combing hair, blowing,
nose talking, eating
84

85. 85
Disease Inclusion Exclusion
Diabetes mellitus
complication
Diabetic retinopathy,
cataract, coronary artery
disease, hearing loss,
neohropathy
Fungal sinusitis Diagnosis based on Ct
PNS, endoscopic biopsy,
persistent headache, loss of
smell sensation. Facial
swelling,
85

86. VYADHI NIRNAYA / DIAGNOSIS
86
 Vyadhi sankara
Madumeha – upadravastha
Udavarta
Shiroroga – Krimija?
Dushta prathishyaya
 Right Fungal sinusitis.

87. 87
DATE CHIKITSA OBSERVATION
03/09/16 •Haridra dhuma dipping in triphala taila 3
time per day- 1st day
Planed For Virechana
•Tab chitrakadi vati 1-1-1 (B/F)
•Tab Shirashula Vajra rasa 1-1-1 (A/F)
•Cap Step 1-1-1 (A/F)
•Inj dynapar im @ 10:00 pm
•Haridra dhuma stopped
•Syp vidangarishta3tsp- 3tsp- 3tsp (A/F)
Headache on right side increased at night.
Perorbital swelling persisting
General weakness increased
Walking with support
Giddiness while walking
Appetite reduced
Bowel- passed.
04/09/16 •Haridra dhuma dipping in triphala taila 3
time per day - 2nd day
•Tab chitrakadi vati 1-1-1 (B/F)
•Tab Shirashula Vajra rasa 1-1-1 (A/F)
•Cap Step 1-1-1 (A/F)
•Syp vidangarishta-3tsp- 3tsp- 3tsp (A/F)
•Inj Dynapar im @ 04:40 pm
•Inj Dynapar im @ 11:00 PM
Headache on right side increased at night.
Perorbital swelling persisting
General weakness increased
Walking with support
Giddiness while walking
Appetite reduced
Bowel- passed- no complete evacuation.
87

88. 88
DATE CHIKITSA OBSERVATION
05/09/16 •Haridra dhooma stopped
•Tab chitrakadi vati 1-1-1 (B/F)
•Tab Shirashula Vajra rasa 1-1-1 (A/F)
•Cap Step 1-1-1 (A/F)
•Syp Vidangarishta 3tsp- 3tsp- 3tsp (A/F)
•Inj Dynapar im @ 03:30 pm
Headache persisting
Appetite- improved
Bowel : not passed today
Sleep disturbed due to pain
06/09/16 •Snehapana with varunadi ghrita (not given today
due to patient had breakfast)
•Tab chitrakadi vati 1-1-1 B/F
•Tab Shirashula Vajra rasa 1-1-1 (A/F)
•Cap Step 1-1-1 (A/F)
•Syp Vidangarishta -3tsp- 3tsp- 3tsp (A/F)
•Tab Anuloma DS stat
•Refferred to shalakya dept, to Dr Mamtha for
further evaluation and treatment protocol.
•Tab Anuloma DS 0-0-2
Headache increased at night.
Appetite- patient wants to take
food more frequently
Bowel : not passed.
C/S/B
Dr Mamtha.
Advice : cst with rsanadi +
karchooradi choorna lepa L/A
on forehead
88

89. 89
DATE CHIKITSA OBSERVATION
07/09/16 •Snehapana with varunadi ghrita 30 ml 1st
day(not given)
• Tab chitrakadi vati 1-1-1 (B/F)
•Tab Shirashula Vajra rasa 1-1-1 (A/F)
•Cap Step 1-1-1 (A/F)
•Syp vidangarishta 3tsp- 3tsp- 3tsp (A/F)
•Tab Anuloma DS 0-0-2
•Rasnadi + Karchuradi churna lepa (l/A) on
forehead
Headache reduced in the
morning.
Appetite- increased
Bowel- passed/ once clear
evacuation
Snehapana : not given today
due to patient had more
tiredness
08/09/16 •Snehapana with varunadi ghrita 30 ml- 1st
day siven 7:20 am
•Advice : Ganji with jeera power and
pepper power
•Inj dynapar im @10:10 am, 10:10 pm
Headache- increased
morning
Appetite- increased
Bowel- once passed clear
evacuation
Increased tiredness
Kshuda pravruthi@8:45 am
89

90. 90
DATE CHIKITSA OBSERVATION
09/09/16 Snehapana with varunadi ghrita
70 ml 2nd day given
@ 07:00 am
Headache in the morning, able to
tolerate
Disturbed sleep due to pain at night
No injection given
Appetite increased
Kshuda pravruthi@ 12.00 pm
Bowel : 3 times passed
10/09/16 Snehapana with varunadi ghruta
130 ml @ 07:10 AM
Inj Dynapar IM @ 07:30 Am
Headche reduced 30%
Headache increasing in the evening
time.
Appetite- moderate
Bowel- asamhata varchas, passed 3
times
Kshudha pravrutti @ 02:30 PM
Peri orbital swelling reduced 10%
90

91. 91
DATE CHIKITSA OBSERVATION
11/09/16 Sarvanga abhyanga with
dhanwantaram taila followed
by ushna jala snana 1st day
Inj Dynapar IM @ 03:00 PM
Headache in the morning reduced
Disturbed sleep due to pain at night
Appetite modererate
Bowel : not passed.
Headache persisting
12/09/16 Sarvanga abhyanga with
dhanwantaram taila followed
by ushna jala snana 2nd day
Inj Dynapar IM @ 09:30 Am
Headache increased in the morning
Appetite- reduced
Bowel : not passed since 1 days
Disturbed sleep
13/09/16 Sarvanga abhyanga with
dhanwantaram taila followed
by ushna jala snana 3rd day
Inj Pan 40 mg iv bd
Headache in the morning+
Abdominal discomfort
Appetite- reduced
Headcache reduced at night
Bowel : passed
Inj Pan 40 mg given @ 11:00 am
91

92. 92
DATE CHIKITSA OBSERVATION
14/09/16 Sarvanga abhyanga with dhanwantaram taila
followed by Baspa sweda
Virechana karma : -
Trivrut Avaleha 60 gm followed by ushana jala
@ 09;30 AM
C/S/B Dr Sunitha G S
Opinion from Dr. Shankarlingiah
Inj Sedcef 1.5 gm bd iv
Infusion PCT 100 ml iv bd
Tab Montair-Lc 0-0-1
Tab Wykoril 1-0-1
Continue medicine for IHD/HTN/DM
CT scan brain advised.
[no treatment b/c of samsarjana krama]
Tiredness+
Headache reduced
One episode of vomiting
No of vegas 10
First vega started @ 12:30
pm
advice to take ganji @ 2;30
pm
15/09/16
16/09/16
Samsarjana Krama, Inj dynapar given @ 8 pm
Samsarjana krama,Inj dynapar given @ 8 pm
Headache reduced at night
Apepetite moderate
Bowel- not passed
sleep disturbed
•Bowel- passed 9
2

93. 93
DATE CHIKITSA OBSERVATION
17/09/16 Inj Dynapar @ 05:00 pm
C/S/B Dr Mamtha
• Nasya karma-1st
•Mukha abhyanga with karpasahastayadi taila-1st
•Kavala with triphala & tankana churna-1st
Apamarga moola + vidanga + shunthi 3 gram
powder each + 20 ml boiling water, soak over night,
filter in the morning, 4 drops in each nostrils.
•Tab stessrcom 1-0-1
•Bruhat haridra khanda 1 tsp powder + 1 glass warm
milk @ bed time
•Cap Infex 2-0-2 a/f
•Patola katurohinyadi kwatha 3tsp tonic with 6 tsp
water twice daily before food.
•Kachooradi choorna + rasnadi churna lepa (E/A)
morning.
•K.M lepam (E/A) Evening.
•Nimbamrutha eranda thailam
2tsp tonic+1/2 cup warm milk @bed time
Last night nose block
Headache reduce 50 %
Right side nasal block since
night
Peri orbital swelling reduced
30%
Appetite-reduced
Bowel- not passed
Headache increasing at
night.
93

94. 94
DATE CHIKITSA OBSERVATION
18/09/16 Inj Dynapar @ 05:00 pm
Nasya karma -2 day
Mukha abhyanga -2nd
Kavala -2nd
•Tab stessrcom 1-0-1
•Bruhat haridra khanda 1 tsp powder + 1
glass warm milk @ bed time
•Cap Infex 2-0-2 a/f
•Patola katurohinyadi kwatha 3tsp tonic
with 6 tsp water twice daily before food.
•Kachooradi choorna + rasnadi churna
lepa (E/A) morning.
•K.M lepam (E/A) Evening.
•Nimbamrutha eranda thailam
2tsp tonic+1/2 cup warm milk @bed time
Headache reduced
Apetite- improving
Bowel-passed once
Pedel oedema – noticed
Pitting type.
94

95. 95
19/09/16 •Continued same treatment
•inj dynapar not given
b/l pedal oedema
Pus formation and scaly lashes of rt eye
associated with pain
Appetie- reduced
Bowel not passed
Refered to shalakya department for
detail examination of ear eye nose.
20/09/16 Continued same treatment
Tab anuloma ds 2 stat with warm
water
Haridra dumapana dipping in
triphla taila 3 times per day
Headache reduced in the morning,
difficulty in breathing while walking.
Pedel oedema- persisting
Bowel not passed since 2 days

96. 96
21/09/16 Continued same treatment Headache reduced at night
No injection have taken at night
Bowel 3 times yesterday night passed
22/09/16 Continued same treatment
Started seka with
panchavalkala kwatha for 5
days
Bidalaka with triphala+
yashtimadhu+ haridra for 5
days.
Pedel oedema reduced 30%
Headache reduced 60%
No scaly lashes , no pus collection in right
eye
Peri orbital swelling persisting
Rt eyeball pain reduced 30%
Frequency of taking painkillers reduced.