Effect of Trikatukadi Pratisarana in Tundikeri (Tonsillitis)-A case

study

Presented By Dr.Panchajanya kumar Deevi,

Final year PG Scholar.Under the Guidance of

Dr.Ch.Ramadevi, M.D, PhD, Asso.Prof. Dept. Of. Shalakya, DR BRKR GAC,

S.R Nagar, Hyderabad.

Contents

Introduction

Tundikeri

Tonsillitis

Pratisarana

Case study

Conclusion

Introduction

• The (palatine) tonsils are a pair of soft tissue masses located at the rear of the throat (pharynx).

• The tonsils are part of the lymphatic system, which helps to fight infections.

• According to Acharya Susruta Tonsillitis can be compared with Tundikeri.

Tundikeri

Nidana: “Anupa pisitah Ksheera dadhi matsya ati sevanath”

(Ma.Ni.56/1) -by taking in excess of meat of marshy animals, curd and fish.

• “Sothah sthalustodadaha prapaki praguktabhyam tundikeri mata tu” (Su.Ni.16/42,1/2)

• “Hanu sandhyasritah kante karpasi phala sannibhah pichilo manda ruk sophah kantinah tundikerika”. (AH.Ut.21/47).

• Acharya Susruta and Madhavakara consider it as talu gata roga.

• Acharya Vagbhata considered it as kantha roga.

Contd...

• Tundikeri means the tonsilar mass look like karpasi phala.

Dosha: Kapha, Rakta, Vata and Pitta.Lakshana:• Patient suffers with tonsilar inflammation, mild

pricking pain, sliminess and fever.

Contd...

Treatment: “Tundikeri adhrusha kurme sanghate talupupputake

esha eva vidhih karyo viseshah sastrakarmani” (Su.chi.22/57)

The Tundikeri etc. “4” diseases can be treated like Galasundika, i.e. pratisarana, kavala graha, dhooma varti, kshara sidha mudga yusha sevana etc. they differ only in type of surgery.

Tonsillitis

Tonsillitis is inflammation of (palatine)tonsils , caused by staphylococci or streptococci.

It may be acute or chronic.Acute tonsillitis is characterised by enlargement,

redness and inflammation.Chronic tonsillitis is caused by repeated attacks of

acute tonsillitis, in which the tonsils are small and fibrosed.

Contd….

Symptoms:• Discomfort in throat• Difficulty in swallowing• Generalised body ache• Fever, Ear ache and Thick speechSigns:• Swollen congested tonsils with exudates• Enlarged tender Jugulo-diagastric lymph nodes

Treatment: Antibiotics, Anti inflammatory, Antipyretics

according to the condition of the patient. If the tonsillitis is sever, altering the speech,

swallowing of food and difficult in breathing is opted for surgery -Tonsillectomy.

Pratisarana

Pratisarana is of “4”types “Kalka, Rasakriya, Kshaudra, Churna” forms can

be used according to place and condition of the disease.

• Pratisarana has to be done with the tip of the finger –Angulyagra pranitamtu.

• Doshaghna and Anabhishyandi diet should be taken after pratisarana. (Su.chi.40/62-63)

Trikatukadi – “Trikatu+vacha+saindhava+kshaudra”I) Trikatu 1.Maricha- Vata Kapha samaka, raktothklesaka,

lekhana and sroto sodhana. 2. Pippali- Kapha Vata samaka, raktotklesaka and

jantughna. 3. Sunti- Kapha Vata samaka, sheeta prasamana, shotha hara, vedana sthapana.

Contd….

II) VachaKapha Vata samaka, pitta vardhaka, shotha hara, vedana sthapana, lekhana.

III) Saindhava Tridosha samaka, sukshma sroto sodhana.IV) Kshaudra

Rakta pitta hara, Kapha samaka, Vata vardhaka, chedana, sandhaniya.

Contd….

Case study Patient: ‘x’ aged 15yrs Female ,selected from OPD of

Shalakya ENT unit GAH Erragadda-Hyderabad. Chief complaint: complaining of on-off fever along

with difficult in swallowing since 15 days. On examination with the help of torchlight, she has

enlargement of (palatine) tonsils with congestion of pharynx and uvula and slight raise temperature.

Investigations: Advised for Hb,TC,DC,ESR- Report-Hb-10g/dl,TC-8500 cells/cu.mm, D C Neutrophils  60% Lymphocytes 30 % Eosinophils2 % Monocytes2% Basophils 0 % ESR-10 1st hr 20 2nd hr.

After all investigations patient was explained about the procedure (pratisarana).

Primarily she was kept under medication for 5 days for the control of fever and congestion. 1.Kanchanaraguggulu 2 tab BD, 2. Tribhuvana keerthi ras 1 tab BD, 3. Lavangadi vati 2tab TID, 4. Subhra bhasma for gandusha.

Contd….

After getting relived from the fever and congestion patient was given pratisarana with Trikatukadi.

Patient was advised not to take any diet before pratisarana.

Patient was approached with the tip of index finger by the sides of the mouth after wearing gloves.

Pratisarana was done for each tonsil “5” applications one time/day.

After that patient was given 15 minutes gap and advised to do gargling with luke warm water mixed with Saindhava lavana.

Contd….

Patient was given the same treatment for 15 days. During this 15 days patient doesn’t use any internal

medicine. Result: patient doesn’t get any fever since last 15

days after the treatment, difficulty in swallowing was relived and the size of the tonsils was decreased.

Contd….

Conclusion

Pratisarana is one of the Para surgical procedure before going for surgical management.

This particular case study was done with Trikatukadi, which is formulated according to condition of the patient .

The result what we get from this clinical study was encouraging by avoiding surgery.

ReferencesSusrutha Nidana and chikitsa by kaviraj kunjan lal

bhishag ratna.Madhava Nidana with madhukosa vyakya by sri

yadunandan upadhyaya.Ashtanga hridaya uttara tantra by sri brahmanand

tripati.Text book of Pathology by Harsha mohan .

Aknowledgement

I express my deep sense of gratitude to mentors Prof.& HOD PG Dept.of.S.S.P: Dr. M.Guru murthy. M.D ,Professor: Dr. T. Praveen kumar.M.D, Associate professor Dr. CH.Rama Devi . M.D,Ph.D., Assistant professor: Dr. B.Badrinath Benarji.M.D, for encouraging me. And I'm thankful to whole Faculty and Scholars of Dept.of.S.S.P.