CASE HISTORY CASE HISTORY

Name : xxxxxx

Age : 22 yrs

Gender : Female

Present Complaints: Distension of abdomen Burning sensation over throat, epigastric region along with

belchings Nausea and vomitings 5 to 6 times after taking food Pain in abdomen(On and off)

since 4yrs (aggravated 6 month before)

Associated Complaints :• Increased weight since 5 years.

HISTORY OF PRESENT ILLNESS

The patient was apparently healthy before 4 yrs. She developed distension of abdomen, pain in abdomen, burning sensation over throat, chest region and epigastric region along with belchings. She was feeling nausea after taking food along with regurgitation of ingested food particles. She vomits the food daily 5-6 times. She had consulted an allopathic physician and was advised with antacids for the above complaints and got temporary relief. The symptoms got aggravated since 6 month before.

PAST HISTORY: NOTHING SIGNIFICANT

PERSONAL HISTORY

Aahara : mixed

Vihara : household works(habit of skipping meals)

Appetite : Decreased

Bowels : 1time /day

Micturition : regular

Sleep : disturbed

Addiction : nil

GENERAL EXAMINATION

• B.P - 130/90 mm of Hg• PR -68 bpm

• R.R - 16 /minute• Ht -153.2cm• Wt -78 kg• BMI -33.2 kg/m² (Sthoulya)33.2 kg/m² (Sthoulya)• Family history -Family members also obese

• RS - NVBS

• CVS - S1 S2 heard

• CNS - conscious and well oriented

• GIT - Distension of abdomen

• No tenderness, gas is present

SYSTEMIC EXAMINATION

CBP- Normal but ESR 17mm/hr CUE- Normal Thyroid profile- Normal Diabetic profile- Normal Lipid profile- Normal C-XR-PAv- Normal ECG - Normal Upper GI Endoscopy(1/7/14)- Antral Gastritis, laxed L.E.S

INVESTIGATIVE HISTORY

ROGI PAREEKSHAROGI PAREEKSHA1.DASAVIDHA1.DASAVIDHA2.ASTAVIDHA2.ASTAVIDHA

Prakruthi - kapha vata Vikruthi - Dosha - tridosha Dooshya - rasa, mamsa Sara - madhyama Samhanana - madhyama Satva - madhyama Aahara sakthi - abhyavahara - madhyama jarana sakthi - madhyama Vyayama sakthi - madhyama Satmya - madhyama Vaya - Madhyama Pramana - madhyama

ASTA VIDHA PAREEKSHA

1. Nadi - 68/minute

2. Jihva - Liptha

3. Mala - 1 time in a day

4. Moothra - 4-6 times in a day

5. Sabdha - praakrutha

6. Sparsha - anushna sheeta

7. Drik - praakrutha

8. Aakruthi - madhyama

• ROGA PAREEKSHAROGA PAREEKSHA• 1.NIDHANA PANCHAKA

• 2.SAPEKSHA NIDHANA

• 3.VYADHI VINISCHAYA

EXAMINATION OF ROGA

NIDANA PANcHAKA

Nidana – िविषमाशन, कुलत्थ, रूक्षाहार 1.All foods containing beans, fried food, oily food, combinations like milk with sour fruits

2.She takes incompatible, unhygienic, sour and heart burn producing and pitta vitiating foods and drinks(tea 4 times /day, excessive intake of masala items, chitranna, dosa, paanipuri, gobi manchuri, non veg,kulatha,maasha etc)

• Purvarupa – Not elicited

• Rupa – आनाह, उदर शलू,हृल्लास,मन्दािग,छर्दिद, उरोदाह,अम्लोद्गार

• Upashaya – Aushadha

• Anupashaya – गुरु भोजन, अम्ल कटु लविण सेविन

• SAAPEKSHA NIDANA

• Anaha • Adhmana

Atopa

• • Amlapitta

Pittaja grahani

• Ama Anaha

Purisha anaha

• Urdhwaga

Adhoga

•AMA ANAHA:

•Accumilation of gas in the abdomen with or without abdominal sounds due to formation of ama in the GI tract.•PURISHA ANAHA:•Due to accumilation of feces or severe constipation , they may be pain in the lower abdomen,back ache, uneasiness and vomiting

ADHMANA:

•Accumilation of gas in GI tract is usually associated with colicy type of pain

ATOPA:•Accumilation of gas in GI tract is usually associated with sounds and pain

URDWAGA AMLAPITTA

Passes different types of fecesThirstSkin eruptionBurning sensationPoor appetiteFaintingHorripilationSweatingGiddinessConfusionYellow complexion of bodyNausea

• Vomiting with vomitus containing green, yellow, blue,black,blood or red colour.

• Vomitus is sour with watery or slimy or clear or associated with mucus constituents or ingested irritating food particles, bitter or sour contents.

• Bitter or sour eructation• Burning throat, heart &

epigastrium.• Headache• Burning sensation of hand &

feet• Raised temperature• Anorexia• Fever.

ADHOGA AMLAPITTA

PITTAJA GRAHANI

Nidana – Pitta get aggravated by intake of food ingredients- pungent, heavy, vidahi, sour, alkaline. Aggravated sa drava pitta suppresses agni.

Lakshanas• Loose stools containing undigested food material

• Colour of stools – bluish –yellow or yellow in colour• Eructation having fowl smell and sour taste• Burning sensation in cardiac region and throat.• Anorexia .

• Distention of abDomen :• CliniCal Diagnosis (fff)• fat(obese)..usually sunken umbliCus,

Dullness to perCussion

• fluiD(asCites)..bilateral bulging flanks,shifting Dullness,fluiD thrill

• flatus(gas).. milD Distention, early vomiting , upper abD pain , resonant perCussion

VYADHI VINISCHAYA VYADHI VINISCHAYA • AMAANAHA

• WITH

• LAKSHANAS OF

URDWAGA AMLAPITTA

•

AMAANAHAAMAANAHA

SAMPRAPTISAMPRAPTI

• SAMPRAPTI GATAKAS• Dosa - Pitta Pradana Tridosa• Vata- Samana

• Pitta-pachaka

• Kapha-kledhaka• Dushya - Rasa• Agni - Jataragni• Agni Dusti - Mandhagni• Srotas - Rasavaha,annavaha

• Srothodusti - Vimargagamanam, Sanga• Adhistana - Amasaya• Udhbavasthana - Amasayottha• Vyaktasthana - Amasaya, Kanta, Hridaya• Rogamarga - Abhyantara

CHARDI OBSERVED IN CHARDI OBSERVED IN DIFFERENT DISORDERSDIFFERENT DISORDERS

• Parinamashoola• Annadravashoola

• Ajeerna• AmlapittaAmlapitta• AnahaAnaha• Visoochika• Udavarta

• Kaasa

• Krimi

FURTHER UNDERSTANDING

AMAANAHA• All foods containing beans, fried foods, oily foods, fermented

foods, combinations like milk with sour fruits can create gas in the abdomen

• Accumilation of gas in the abdomen with or without sounds,and is a common digestive disturbence due to ama.

• Symptoms:abdominal distension ,thirst, belching or passing of gas through the anus.

• Sometimes gas and pain can even be felt as mild pressure or pain in the chest

CHIKITSA CHIKITSA • AMAANAHA:• Oleation and laxatives are the treatment of choice• PREPARED MEDICINES:• Avipattikara churna 1gm should be given at night for laxative

effect• Hingwataka churna 1gm :twice a day for 15days.these should be

given with warm water or wiyh buttermilk

• Jirakadhyarista\ abhayarista 15ml 3 times a day for 3 wks are also indicated

• To relieve gas and colic immedietly, tab shanka vati should be given with warm water 2 to 3 times a day

• PATHYA : Warm water, laaja sakthu, godugdha, aamalaki, dadima,

kharjura, draaksha, patola, moolaka, mugdayoosha ,tikta rasa+

shashtika shaali vilepi, no worry( keeping calm and quiet)

• APATHYA : Guru bhojanam, tila, kulatha, dadhi, matsya, teekshna

–ushna aahara,alcohol,smoking, tobacco, worry.

CONCLUSION

DUE TO NIDHANA

MANDHAGNI

AMAANAHA

INTRA ABDOMINAL PRESSURE

ACCUMILATION OF GAS COMES OUT THROUGH

BELCHINGS(URDWAGA AMLAPITTA)

BURNING SENSATION IN EPIGASTRIC

THROAT REGION

GAS WITH FOOD(CHARDHI)

ANTRAL GASTRITIS

PYLORIC INCOMPITENCE

LAXED L.E.S

OBESITY