कौमारभृत्य

PART B
CHAPTER I: Bala pariksha & samanya
chikitsa siddhanta

 बाल परीक्षाविवि

 विवििपरीक्षा
a) According to Charaka Samhita:
"त्रित्रिधं खलु रोगत्रिशेषत्रिज्ञानं भित्रि िद्यथाऽप्तोपदे शः प्रयक्षमनुमं चे त्रि ॥ ३ ॥"
i) Aptopadesha (च - त्रि - ४ / ३)
ii) Pratyaksha
iii) Anumana

b) According to Astanga Hridaya:

दशशनस्पशशनप्रश्नः परीक्षे ि च रोत्रगणम् । (अ.हृ. - सू - १ / २२)
i) Darshana
ii) Sparshana
iii) Prashna

 अष्टवििपरीक्षा
According to Yogaratnakara:
"रोगक्रान्तः शरीरस्य स्थानमष्टौ परीक्षयेि् ।
नाडीमू िमलत्रिह्वशब्धस्पशशदृकाक्रुत्रिः ॥" (योगरत्नाकर - १ / ३५)
i) Nadi
ii) Mutra
iii) Mala
iv) Jihva
v) Shabda
vi) Sparsha
vii) Drik
viii) Akruti
 दशवििपरीक्षा
a) According to Charaka Samhita:
"िस्मादािु रं परीक्षे ि प्रकृत्रििश्च त्रिकृिनिश्च सारिश्च संहननिश्च प्रमाणिश्च सात्म्यिश्च
सत्त्विश्चाहारशक्तििश्च व्यायामशक्तििश्च ियस्तश्चेत्रि बलप्रमाणत्रिशेषग्रहणहे िोः ॥ ९४ ॥"
i) Prakruti (च - त्रि – ८ / ९४)
ii) Vikruti
iii) Sara
iv) Samhanana
v) Pramana
vi) Satmya
vii) Sattva
viii) Aharashakti
ix) Vyayamashakti
x) Vaya

b) According to Astanga Hridaya:

"दू ष्यं दे शं बलं कालमनलं प्रकृत्रिं ियः ।
सत्त्वं सात्म्यं िथाऽऽहारमिस्थाश्च पृथक्तिधाः ॥" (अ.हृ. - सू - १२ / ६७)
i) Dushya
ii) Desha
iii) Bala
iv) Kala
v) Anala
vi) Prakriti
vii) Vaya
viii) Sattva
ix) Satmya
x) Ahara
िे दना अध्याय
- In Kashyapa Samhita, Sutra Sthana, Chapter 25 - िेदना अध्याय, Acharya Kashyapa has
explained the clinical manifestation of various diseases of children.
- By properly examining the clinical features, a physician can diagnose the disease
and assess its strength.
- Exmination of symptoms has great importance especially in small children because
they are unable to express themselves through speech.
- The features of the following diseases are described:
1) त्रशरोरुि
2) कणशक्ष्वेड
3) मु खमान्य
4) कण्ठिेदना & अत्रदशि
5) अत्रधत्रिह्वका
6) गलग्रह
7) कण्ठशोथ
8) ज्वर पूिशरूप
9) अत्रिसार पूिशरूप
10) उदरशूल
11) छत्रदश
12) श्वास
13) त्रहक्का
14) िृ ष्णा
15) आनाह
16) अपस्मार & उन्माद
17) मू िकृच्छ्र
18) प्रमे ह
19) अशश
20) अश्मरी
21) त्रिसपश
22) त्रिसूत्रचका
23) अलसक
24) चक्षु रामय
25) कण्डू आर्द्श अथिा शुष्क
26) पाण्डु & कामला
27) आम
28) मदात्याय
29) छत्रदश & उरोघाि
30) िन्तु कत्रदशिम्
31) ग्रह रोग

-> Refer to Kashyapa Samhita, Sutra Sthana, Chapter 25 for detailed description.
 सामान्य बालरोग विवित्सा वसद्धान्त
1) The dose of a drug should be strictly in accordance with the child’s age.
So, the principles of posology should be kept in mind.

2) Aushadha should be administered in divided doses throughout the day,

especially in children below 12 years.
According to Harita Samhita, the ideal औषधसेिनकाल in children is
प्राक्भि (before the meal).

3) The administration of Shodhanakarma should be avoided except in

emergency conditions. Shamanakarma is more suitable for children.
Langhana should not be performed during क्षीरप अिस्था.
Shoshana-karma is not at all suitable for an infant.

4) A. Charaka mentions to use Madhura Dravya for children which are

Mridu and generally liked by the child. Ksheerapaka Kalpana is the ideal
therapeutic form.

5) The following Guna & Rasa are unsuitable for children:

- अत्रित्रिग्ध (Causes Kapha Parkopa)
- अत्रिरूक्ष (Impairs growth & development)
- अत्रिगुरु (Causes Ajeerna)
- अत्यु ष्ण & अत्याम्ल (Intolerable for the child & causes Dhatupaka)
- कटु (Causes Vidaha)

6) The general guidelines for पथ्यापथ्य in each disease advocated for adults
are to be followed in pediatric cases also.

7) धािीशोधन & स्तन्यशोधन should also be considered if a child during क्षीरप

& क्षीरान्नाद अिस्था gets diseased.

8) Administration of Aushadha should be done in the following way:

- क्षीरप अिस्था Aushadha should be given to the mother.
- क्षीरान्नाद अिस्था Aushadha should be given to mother & child.
- अन्नाद अिस्था Aushadha should be given to the child.

9) During क्षीरान्नाद अिस्था, Aushadha Kalka can be applied on mother’s

breast just before breastfeeding for easy administration.

10) There are several hidden diseases in children caused by Grahas. So, the
physician should consider दन व्यव्यपाश्रय & युक्तिव्यपाश्रय त्रचत्रकत्सा.
 Examination of a diseased Child
Examination of a diseased child is essential primarily for diagnosis of the disease and
secondarily for determining the prognosis and planning the treatment protocol.
Examination should be done completely without upsetting the child.

 History Taking & General Examination

- Present complains with duration
- History of present illness
- Medical, Personal, Family, Social history
- Allergies, Vaccination, Aggrevating / Relieving factors, Current medication
- Diet, Micturation, Defication, Sleep pattern, Height, Weight, BMI, Pulse, BP
- Inspection of skin, mouth, tongue, jaw, ears, nasal cavities, eyes, neck,
clavicles, extremities.

 Systemic Examination
1) Cardiovascular System (CVS)
- Inspection: Skin & Nail colour
- Palpation: Brachial / Femoral pulse
- Percussion
- Auscultation

2) Respiratory System (RS)

- Inspection & Palpation: Size & shape
- Auscultation: Respiration, Respiratory rate
- Percussion

3) Gastro-Intestinal System (GI)

- Abdominal inspection, palpation (superficial & deep), percussion,
auscultation

4) Nervous System (NS)

- Behavior, Posture, Muscle tone, Movements, Reflexes

5) Genito-Urinary System (GUS)

- Male: Length of penis, Urethral posture, Foreskin, Testis, Scrotum,
Position & Appearance of anus
- Female: Clitoris, Labia, Hymen, Position & Appearance of anus
  Investigation
Investigations are targeted on the basis of history & examination and help
narrowing the differential diagnosis.
- Hb / Packed cell volume, CBC, Blood smear, Blood glucose, Blood culture,
Blood grouping, Microscopy of CSF, Urine analysis & microscopy, Stool
microscopy, HIV, LFT, Pulse oximeter, X-ray

 Differential Diagnosis
After assessment has been completed, consider the various conditions that
could cause the child’s symptoms and make a list of possible differential
diagnosis to avoid wrong assumptions and to choose the appropriate
treatment schedule.

 General Principles of Treatment in Children

According to Indian Academy of Pediatrics, following are the steps to be kept in
practice while applying a therapy in the diseases of children.

1) Reach an initial working diagnosis

The pediatrician can start the treatment on a working diagnosis. After
reaching a specific diagnosis, one can change the treatment scheme
accordingly.

2) Define therapeutic objectives

The doctor should specify what he/she intends to achieve through
therapy and in what time interval.

3) Assess effectiveness of therapies

Assessment of efficacy of a prescribed treatment has to be done
continuously and protocol can be changed accordingly.

4) Assess risk to the patient

Assessment of risk to the patient has to be done especially when
multiple pharmoclogical agents are used.
5) Plan strategies to ensure compliance
Compliance from the patient as well as the care taker is inevitable for a
good therapeutic practice. Most important factors to be considered are:
Flavor of drug, mode & frequency of administration, cost of the drug.

6) Enquire about previous experience

Previous therapeutic failures should be inquired. Questions about
hypersensitivity, adverse drug reactions, non-compliance & non-
effectivity should be asked.

7) Special aspects of pediatric pharmacology

Children are not small adults. According to their physiological difference,
size and stage of development, the drug has to be chosen by also
considering its absorption, distribution, metabolism & excretion in the
patient.

8) Pediatric drug dosages

By understaning a drug’s behavior in the body of a child, the doctor
should prescribe the medicine instead of going for a mere approximation
of pediatric dosage by calculation from an adult dose.

9) Methods of drug delivery and pediatric formulations

Drops, supensions, dry syrup, dispersible tablets, tablets and capsules
are used commonly for oral administration of children.

10) Drugs and breast feeding

Several drugs are excreting through the breastmilk, which may cause
harmful effects to the baby. So when a nursing mother is prescribed a
medication, its safety measures have to be kept in mind.
 CHAPTER II: Aushadha matra
nirdharana

 Introduction
The action of a drug is greatly influenced by its Matra (administration dose).
Matra should be chosen by considering following factors:
- Aim of the treatment (Shamana / Shodhana)
- Kalpana (therapeutic form)
- Agni, Bala, Satmya, Vaya & Kostha of the patient
- Prakriti of Rogi & Roga
- Ritu

 Aushada Matra for Children

 According to Acharya Kashyapa
- Aushadha Matra for a newborn baby = त्रिडङ्गफलमाि
(equal to the quantity of the fruit of Emblica ribes).
- Medicine should be given with मधु & सत्रपश.
- Aushadha Matra should gradually increase by each month.
- Maximum dosage should not exceed the quantity of आमलकमाि
(quantity of the fruit of Emblica officinalis).

 According to Acharya Sharangadhara

- 1st month = 1 Ratti (125 mg)
- This dose is increased by 1 Ratti in successive months.
- 12th month = 2 Masha (12 Ratti = 2 Masha = 1.5 gm)
- After that, the dose is increased by 1 Masha every year.
- 16 years = 17 Masha (12.75 gm); this constitutes the adult dose.
 Aushadha Matra depending on Kalpana
 Sneha Matra
It depends on Vaya of the child.

Vaya Matra Dose

Newborn कोलाक्तस्थ सक्तििम् 1/8 Kola
Upto 20th day कोलाधश सक्तििम् ½ Kola
Upto end of 1st month कोल सक्तििम् 1 Kola
2nd month १-२ कोल सम्मिति ् 1-2 Kola
3rd month त्रिकोल सक्तििम् 2 Kola
4th month शुष्कामलकमािम् Qty. = Dried
Amalaki fruit
5th & 6th month आर्द्ाश मलकमािम् Qty. = Fresh
Amalaki fruit

 Churna Matra
It depends on the desired Karma.

Karma Matra
दीपनीयम् 1 pinch
िीिनीयम् & संशमनम् 2 pinches
िमनम् & त्रिरे चनम् ½ pinch

 Kashaya / Kvatha Matra

It depends on the desired Karma.

Karma Matra
दोष शामकम् प्रसृि (96 ml)
िीिनीयम् & संशमनम् प्रसृि (96 ml)
िमनम् & त्रिरे चनम् त्रिप्रसृि (192 ml)

 Kalka Matra
It depends on the desired Karma.

Karma Matra
दीपनीयम् कषश (12 gm)
िीिनीयम् & संशमनम् कषश (12 gm)
िमनम् & त्रिरे चनम् अधश कषश (6 gm)
 Pediatric Dosage
- It is the correct amount of frequency and total number of doses of a medication to
be administered to a child. It depends on the age, weight, body surface area and
ability of the child to absorb, metabolize & excrete the medication. Also the potential
toxicity of medicine must be considered.

- Various formulas have been devised to calculate the pediatric dosage:

CHAPTER III: Panchakarma in children

 Introduction
- Panchakarma is generally not advised for children and most of Balaroga are curable
by Samshamana Karma.
- Acharya Kashyapa has discouraged especially Raktamokshana for children.
- Acharya Sushruta recommends all types of Panchakarma for children after some
years of growth & development.

 सामान्य पञ्चिमम क्रम

1) पूिशकमश = दीपन, पाचन, िेहन, स्वे दन
2) प्रधानकमश = िमन, त्रिरे चन, बक्तस्त, नस्य, रिमोक्षण
3) पश्चािकमश = संसिशनक्रम, धू मपान, गण्डूष, किल

 स्नेहन
- It aims to increase the त्रिग्धत्व (unctuous) & अत्रभष्यन्द (flowing) quality which helps
to return Doshas from Shakha to Kostha.
- िेहनकमश is optional in क्षीराद & क्षीरान्नाद अिस्थ because children at that age are
िेहत्रनत्य (always remain unctuous) by constant intake of स्तन्य & घृि.
- िेहनकमश becomes useful in lactation failure, feeding difficulites or other conditions
where nourishment & unctuousness of the child is decreased.

 भेद
1) अचपान (शोधन पूिशक)
2) त्रिचारण (शमन प्रयोग)

1) अचपान (शोधन पूिशक)

- Used as पूिशकमश
- ह्रस्व माि (small quantity) should be used because children are िेहत्रनत्य.

2) त्रिचारण (शमन प्रयोग)

- Used for शमनाथश
- अभ्यङ्ग, मािबक्तस्त, सभि िेह, नस्य, गण्डूष, मू धाश िनल, कणशपूरण, आश्चोिन
 स्वे दन
- It aims to at दोषपाक.
- It helps to relief stiffness, heaviness, constipation & pain.
- स्वे दनकमश is the transfer of heat energy to the body for a specified duration by using
material of different calorific value in a state of solid, semi-solid, liquid or gas.
- In children, Svedana should be of lesser duration with materials of lesser calorific
value (अल्पोष्णिा).
- Svedana is indicated for children who have हीन / मध्यम बल or if the disease is
originating due to शीि गुण त्रनदान.
- Svedana should be prerformed only after covering the eyes with leaves of Kumuda,
Utpala, Padma or a soft cloth.
- The cardiac region of the child should be constantly in contanct with Mukta,
Chrandrakanta, hand dipped in cold water or a pot filled with cold water.

 भेद
1) शोधन पूिशक
2) शमन प्रयोग

 भेद (िाश्यप सम्हिता)

1) हस्तस्वे दन
2) प्रदे हस्वे दन
3) नाडीस्वे दन
4) प्रस्तरस्वे दन
5) सङ्करस्वे दन
6) उपनाहस्वे दन
7) अिगाहस्वे दन
8) पररषेकस्वे दन

 हस्तस्वेदन
- It is the mildest form of Svedana used mainly for शमन प्रयोग.
- It can be performed from birth up to four months of age.
- It is done in a non-windy place by heating the hand of the practitioner
gradually with smokeless fire and then placing it on the child’s body.

 पटस्वेदन
- It is a unique form of Svedana described by Acharya Kashyapa.
- In this method, transfer of heat energy is mediated by warm cotton cloths
and is useful in children upto the age of 6 years.
 िमन
- According to Acharya Kashyapa, िमनकमश is contraindicated below the age of 6.

- Children, especially during क्षीरान्नाद अिस्थ, vomit spontaneously due to small

aggrevation of Doshas. So, generally they do not require forced vomiting.

- बालािस्थ has natural dominance of Kapha Dosha and Vamana can easily be induces
by Kapha-vardhakara Ahara such as Ksheera & Ghrita.

- The ideal drug for Vamana is Madanaphala. It is useful for सु कुमार (delicate)
individuals. Madanaphala and Pippali can be made into a paste and applied on
mother’s breast to induce Vaman in child if required.

 विरे िन
- त्रिरे चनकमश for children should be administered with extreme caution as there is
potential danger of dehydration which children are highly prone to.

- मृ दुत्रिरे चन is advised for children.

- Following Dravya can be used to induce मृ दुत्रिरे चन in children:

त्रििृि्, चिु रङ्गुल, दक्तन्त, षट् फला, कक्तिल्लक, िचा

 बम्हस्त
- Among all शोधनकमश , बक्तस्तकमश is the best treatment for children.

- It can be liberally used in children by keeping in mind the indicated administration

dose. It provides good complexion, strength & longevity.

- According to the Brhiat Trayee, Basti should be administered after the age of 1 year.

- According to Acharya Punarvasu, Basti should be administered only after the age of
4 months.

- According to Acharya Kashyapa, Basti should be administered after the child begins
to crawl.

- बक्तस्तकमश कृिं कालो बालानाममृिोपमम् ।

शीिव्यात्रधशरीररणां बालानां च त्रिशेषिः ॥ (का. स.)
Administration of Basti in children is just like Amrita (nectar).
It is especially useful in diseases of a child’s body due to Sheeta guna.
 नस्य
- नस्यकमश is generally contraindicated in children below the age of 8.
- Especially Dravya with Virechana & Shodhana properties should not be used.
- Consequently, प्रत्रिमशश नस्य is advisable in children.
- At birth, only maxillary & sphenoidal sinuses are present. Paranasal sinuses develop
throughout the childhood and attain full development after puberty only. The first
radiological evidence of paranasal sinues is possible at the age of 6.
- Nasya before the age of 8 may disturb the primary development of paranasal
sinuses, whereas support the same at a later stage.

 रक्तमोक्षण
- रिमोक्षणकमश is highly contraindicated in children as they have not attained proper
development of Dhatus.
- In unavoidable conditions, localized Raktamokshana can be useful in diseases such
as: Neelika, Mukhapaka, Charmadala.
- The safest and most comfortable mode of Raktamokshana in children is
िलौकािचारणम् (application of leech).
 CHAPTER IV: Prasava kaleena
abhighata / Birth injuries

 श्वासािरोि / Asphyxia Neonatorum

- It is a condition that occurs when a baby does not get enough oxygen during the
birth process may lead to long term complications or even foetal death.
- It is also known as perinatal asphyxia or birth asphyxia.

 Causes:
- Blocked airways
- Anemia
- Infection
- Longlastig or difficult delivery
- Insufficient oxygen supply of mother before or during delivery
- Mother’s BP is too high / too low during delivery.
- Placenta seperates too quickly from from the uterus
- Umbilical cord wraps around the baby

 Symptoms:
The length of time the baby goes without oxygen affects the severity of
symptoms. The longer a baby is without oxygen, the more likely they are to
experience symptoms:
- Pale or bluish skin
- Dypsnoea
- Weak muscle tone
- Slow heart rate
More severe symptoms can include injury or failure of:
- Lungs, Heart, Brain, Kidney

 Treatment & Precautions:

- The severity of symptoms influences the treatment. The timing of when the
diagnosis is made also affects their treatment.
- Mother may receive additional oxygen before delivery to boost a baby’s
oxygenation before birth.
- Cesarean delivery is a potential preventive measure in prolonged or difficult
deliveries.
- After birth, the baby may need ventilation to support respiration.
- Keeping baby warm reduces harmful effects.
- Monitoring of BP & fluid intake to make sure that the child is getting enough
oxygen.
 उपशीर्मि & Caput Succidanum / Cephalohematoma

उपशीर्मि
It is the condition in which Vata Dosha vitiates the कपाल (scalp) of the foetus and
causes शोफ.

 वनदान
िािप्रकोप due to:
- Prolonged difficult labour with increased pressure
- Trauma, Prolonged external pressure on foetal head

 लक्षण - शोफ, त्रनरुि, त्रििणश, रि संग्रह

 विवित्सा - िेहन, स्वे दन, त्रिम्लापन

Caput Succidanum / Cephalohematoma

- Caput Succidanum is a swelling of the newborn’s scalp occurring soon after delivery.
- Cephalohematoma appears as a lump on foetal head due to accumulation of blood
leading to hemorrhage between the skull & periosteum.

 Causes:
- Prolonged external pressure of dilated cervix or vaginal wall on the child’s
head.
- Prolonged difficult labour with increased pressure

 Symptoms:
- Swelling on foetal head
- Discolouration
- Cephalohematoma

 Treatment:
- Drain & collect the fluid from scalp.
- Usually resolves on its own within a few days.
 Facial Paralysis
It occurs due to physical injury to the facial nerve sustained during delivery.

 Causes:
- Forceps delivery
- Small pelvic diameter / Large infant size
- Abnormal attitude of foetal leading to difficult angle of presentation
- Trauma

 Symptoms:
- Asymmetrical sides of the face
- Eyelids may not close completely
- There is little or no movement on the affected side of the face.

 Treatment:
- Steroid therapy
- Antiviral therapy
- Facial exercise

 Erb’s Palsy
- It is a form of obstruction of brachial plexus.
- It occurs when the nerves in a baby’s upper arm are damaged.
- Erb’s Palsy is caused due to injury at Erb’s point, the area near the baby’s neck
where the 5th & 6th cranial nerves merge to create the upper joint of the brachial
plexus.

 Causes:
- Difficult labour; more common in cephalic presentation
- Excessive pulling of infant’s head and neck through the birth canal
- Infant with high birth weight
- Small pelvic diameter / Large infant size

 Symptoms:
- Weakness in affected arm
- Restricted movement
- Decreased ability to grip with hand
- Partial or full paralysis
- Loss of sensory function of upper arm
- Loss of motor function
- Impaired muscular & nervous development

 Treatment:
- Motor exercise
- Gentle massage on affected arm
 भग्ााः / Fractures
Broken bones and fractures can happen at any age, but especially to infants during
delivery, as their skin and bones are still extremely fragile. In many cases, light
bruising is a normal part of the delivery process, yet fractures and broken bones
typically indicate that something happened during the delivery process that could
have been prevented.

 Symptoms:
- Swelling around the broken bone
- Obvious signs of pain, such as constant crying
- Inability to move the broken limb

 Bone fractures during delivery:

1) Clavicle fracture
2) Humeral fracture
3) Femur fracture
4) Depressed skull fracture

1) Clavicle fracture:
Clavicle fractures are the most common injury sustained by newborns
during birth. It may occur as a result of a difficult delivery or trauma at
birth. Factors that may increase a risk for a clavicle fracture include the
newborn being large in size, the newborn’s shoulder getting stuck during
delivery, a narrow birth canal, or the use of tools to assist with the
delivery.

2) Humeral fracture:
The humerus is second to the clavicle as the most commonly fractured
bone associated with birth trauma. Neonatal humeral fractures result
from rotation or hyperextension of the upper extremity during passage
through the birth canal.

3) Femur fracture:
Femur fractures occur as the leg is awkwardly twisted during delivery.
The usual symptom is pain when the child is moved or their diaper is
changed.

4) Depressed skull fracture:

It is a rare condition, has been reported with an incidence of 1 in 10,000
births. These cases involve mostly temporo-parietal skull bones which
are soft, resilient, and flexible.
  Prevention
- Fractures and broken bones that occur during childbirth can usually be
prevented with diligent, careful medical care during the labor and delivery
period.
- One of the most preventable measures is for physicians to detect foetal
and/or maternal distress and schedule an emergency cesarean section (C-
section). The majority of babies who experience fractures and/or broken
bones were under great distress during delivery.
- Severe bruising and broken bones can happen during a normal delivery with
no fetal or maternal distress. Sometimes inexperienced medical
staff unnaturally pull on the baby even though there is no cause for concern
that the infant is in danger. Inexperienced medical staff members may also
attempt to pick up the baby from their arms instead of securely from the back
and neck.

 Treatment
- Medical intervention is always necessary if an infant experiences a broken
bone or fracture. In fact, if a fracture occurs at the end of a bone, it may affect
the growth of the bone. This requires immediate medical attention.

- In most cases, fractures and broken bones are treated with splints or casts,
medication, traction, closed reduction, and in severe cases, surgery.

 उल्वि / उल्बि
- It is the condition in which the newborn child does not properly expell गभोदक
(amniotic fluid) which leads to obstruction of Srotas by Kapha Dosha.
- It is also known as अम्बुपूणश.

 सम्प्राम्हि
त्रनदान -> कफ दोष प्रकोप -> स्रोिो त्रिरोध -> रसिहस्रोिो दु त्रष्ट -> हृदयस्थान त्रिकृत्रि
-> उल्बक

 लक्षण
कास, श्वास, आक्षे पक, ज्वर, छत्रदश

 उपद्रि
कास, श्वास, हृर्द्ोग

 विवित्सा
- अिामू िेण स्रोिोशोधन
- त्रिकटु , हरीिकी, हररर्द्ा कल्क दु ग्ध संयुिम्
 CHAPTER v: sahaja vyadhi

 सहज हृदय वििार & Congenital Heart Diseases

The diseases of the heart in a child present at birth are termed as congenital heart
diseases or congenital heart defects (CHD).
In Ayurveda, CHD can be compared as followed.

सहज हृदय वििार

 वनदान
- बीिदु त्रष्ट Vitiation of Shukra & Shonita of parents.
- आिश िदु त्रष्ट / शोत्रणिदु त्रष्ट Vitiation of Shonita is a main causative factor
because Hridaya is one of Matrija Bhava.
- रिदु त्रष्ट & कफदोष Hridaya is formed by Rakta & Kapha mainly, so
their vitiation during Garbhakala may lead to
permanent damage.
- गभाश शय दु त्रष्ट Improper intra-uterine environment
- अत्रहिाहार Unwholesome food intake of mother
- अत्रहित्रिहार Unwholesome regimen of mother
- काल Premature birth

 लक्षण
Symptoms are similar to कफि हृर्द्ोग.
श्वास, कास, हृदयशून्यत्व, अरुत्रच, ज्वर, अल्पत्रनर्द्ा, मोह, मू च्छ्ाश , भ्रम

Congenital Heart Diseases

 Causes:
- Single mutant gene, Chromosomal anomalies, Multifactorial inheritance
- Viral infections during 1st trimester of pregnancy
- Radiation, Alcohol
- Metabolic disorders of mother

 Symptoms:
Dyspnoea, Fatigue, Palpitation, Decreased appetite, Frequent infections, Sleep
disturbances, Cyanosis, Oedema, Syncope
 जलशीशमि & Hydrocephalus

जलशीशमि
It is the accumulation of Jala in Shira Pradesha.

 वनदान
अत्रि िल सेिन, मगाश िरोध, शोथ, रित्रिर्द्त्रध

 लक्षण
त्रिस्तृ ि त्रसरारन्द्र, त्रिस्तृ ि त्रशरः, त्रिसृि ललाट

 विवित्सा
शल्यकमश , मू िला र्द्व्य (पुष्करमू ल, अम्लिेिस, एला, त्रहङ्गु, अगुरु, िु लसी, भू म्यामलकी,
िीिन्ती, गोक्षू र)

Hydrocephalus
It is the enlargement of head due to accumulation of CSF in intracranial space.

 Causes:
- Increased production of CSF
- Obstruction of flow of CSF
- Birth trauma, head injury, intracranial hemorrhage
- Chemical hypervitaminosis

 Symptoms:
- Congenital hydrocephalus is present right at birth or appears in the first few
months of life.
- Enlargement of heard
- Wide and bulging fontanels
- Open sutures
- Protruding forehead
- Prominent scalp veins
- Sunset sign = visible sclera above the cornea
- Cracked-pot / Macewen sign = Percussion of head results in resonant sound.

 Diagnosis: CT Scan, Ultrasound

 Treatment:
Surgery: Shunt = insertion of drainage system
Endoscopic third ventriculostomy
 खण्डोष्ट & Cleft Lip

खण्डोष्ट
It is the condition in which the mouth and surrounding area is vitiated by Vata Dosha.
The lip is mainly affected.

 वनदान
रचनात्मक त्रिकृत्रि, िािदोष प्रकोप

 लक्षण
त्रिकृि ओष्ट, त्रिकृि दन्त, दन्तहीन, त्रिकृि नासा, त्रिकृि िालु

 विवित्सा
िेहन, स्वे दन, ले खन, सध्योव्रण त्रचत्रकत्सा, िािनाशक & मधु र गण त्रसद्ध िनल नस्य,
शल्यकमश

Cleft Lip
It is an opening or split in the upper lip that occurs when developing facial structures
in an unborn baby don't close completely.

 खण्डतालु & Cleft Palate

खण्डोष्ट
It is the condition in which the mouth and surrounding area is vitiated by Vata Dosha.
The palate is mainly affected.

 वनदान
रचनात्मक त्रिकृत्रि, िािदोष प्रकोप

 लक्षण
त्रिकृि िालु , त्रिकृि ओष्ट, त्रिकृि दन्त, दन्तहीन, त्रिकृि नासा

 विवित्सा
िेहन, स्वे दन, ले खन, सध्योव्रण त्रचत्रकत्सा, िािनाशक & मधु र गण त्रसद्ध िनल नस्य,
शल्यकमश

Cleft Palate
It is an opening or split in the palate that occurs when developing facial structures in
an unborn baby don't close completely.
 सविरुद्ध गुद & Imperforated Anus

सविरुद्ध गुद
It is condition in which vitiated Apana Vayu causes deformities of Guda Pradesha.

 वनदान
िािप्रकोप, अपानिाि दु त्रष्ट, मल िेगधारन

 सम्प्राम्हि
Due to Nidana sevana, Apana Vayu gets vitiated and located at Guda Pradesha
to cause improper development of Guda during intra-uterine life.

 लक्षण
No anal opening, Wrong location of anal opening, Difficulty in defecation,
Abdominal bulging

 विवित्सा
गुद ित्रिश प्रयोग, गुद त्रिस्तार (dilatation), त्रिग्धाहार, शल्यकमश

Imperforated Anus
It is a birth defect in which anus is improperly developed during intra-uterine life.

 Symptoms:
No anal opening, Wrong location of anal opening, Difficulty in defecation,
Abdominal bulging

 Diagnosis: X-Ray

 Treatment:
Surgery: Colostomy
 पाद वििृवत = Talipes Equanovarus & Valgus / Varus

Talipes Equanovarus
It is a congenital deformity in which the affected foot appears as if rotated internally
at the ankle joint.

 Signs:
- Foot faces inwards
- Soles of feet face each other
- Patient walks on their ankle
- Tendons of the leg are shortened

 Treatment:
- Ponseti method / Manipulative treatment
- Surgery: Achilles tenotomy

Valgus / Varus
Valgus is the condition in which a bone or joint is twisted outwards. The opposite
condition is called Varus. It may affect the upper or lower limbs.

 Treatment:
- Anti-inflammatory drugs
- Exercise
- Physiotherapy
- Surgery: Arthroscopy
 Spina Bifida
It is a birth defect or congenital malformation in which the vertebral column is
affected, leading to exposure of the spinal cord.

 Types:
1) Spina bifida occult / Spina bifida hidden
Gap of vertebral column, no other damage is present.

2) Meningocele
Bony defect in vertebral column through which spinal cord or meningeal
membrane may protrude.

3) Meningomyelocele
Abnormal protrusion of spinal cord and meningeal membrane through
congenital defect in the vertebral column and formation of swelling
under the skin. It causes severe neurological disturbances.

 Causes:
- Iron & Folic acid deficiency
- Anti-convulsant drugs
- Diabetes
- Obesity

 Symptoms:
- Bulge on spine
- Involuntary movements
- Urinary incontinence
- Numbness

 Diagnosis: CT Scan, X-Ray, MRI

 Treatment:
- Surgery: Meningocele repair
- Prevention: Supplementation of iron & folic acid, wholesome nutrition of
mother including grains, cereals, beans, green leaves, vegetables & fruits.
 CHAPTER vi: Genetic disorders

 Down Syndrome
It is a congenital disorder arising from a chromosome defect, causing intellectual
impairment and physical abnormalities including short stature and a broad facial
profile. It arises from a defect involving chromosome 21.

 Types:
1) Trisomy-21:
- It is the most common type of Down Syndrome (95%).
- Occurs when there are three, rather than two, number 21
chromosomes present in every cell of the body. Instead of the usual 46
chromosomes, a person with Down syndrome has 47. It is this additional
genetic material that alters the course of development and causes the
characteristics associated with the syndrome.

2) Translocation:
- 4% of all cases of Down Syndrome.
- Part of chromosome 21 breaks off during cell division and attaches to
another chromosome, typically chromosome 14. While the total number
of chromosomes in the cells remain 46, the presence of an extra part of
chromosome 21 causes the characteristics of Down Syndrome.

3) Mosaicism:
- 1% of all cases of Down Syndrome.
- Occurs when nondisjunction of chromosome 21 takes place in one –
but not all – of the initial cell divisions after fertilization. When this
occurs, there is a mixture of two types of cells, some containing the usual
46 chromosomes and others containing 47.

 Symptoms & Characteristics:

- Short stature, Flat facial features, Small head & ears, Short neck, Bulging
tongue, Poor muscle tone
- Impulsive behavior, Poor judgement, Short attention span, Slow learning
capability

 Complications:
- Loss of hearing, Poor vision, Cataract, Congenital heart defect, Dislocation of
hip joint, Leukemia, Chronic constipation, Congenital heart defect

 Treatment:
Therapy to improve sensory, motor, social, language & cognitive skills.
 Turner Syndrome (TS)
- It is a chromosomal disorder that affects only females.
- It occurs when one of the X chromosomes (sex chromosomes) is partially or
completely missing.

 Types:
1) Classical Turner Syndrome:
- One X chromosome is completely missing.
- It affects about half of all people with TS.

2) Mosaic Turner Syndrome:

- Also known as Mosaicism or Turner Mosaicism
- Abnormalities occur only in the X chromosomes of some of the body
cells.

 Symptoms & Complications:

During intra-uterine period:
- Thick neck tissue
- Cystic hyagroma
- Low weight

During infancy:
- Short stature / Delayed growth
- Lack of ovarian development
- Broad chest with widely spread nipple
- Low set ears
- Dropping eyelids
- Cubitus valgus
- Reduced birthweight

 Diagnosis: Ultrasound, Amniocentesis, Chorionic Villus Sampling (CVS)

 Treatment:
- There is no cure for turner syndrome.
- Treatment focuses to reduce symptoms & complications.
- Short stature: administration Growth hormone, alone or with androgen
- Lack of ovarian development: Estrogen replacement therapy to help with
development
- Psychological counseling
 Muscular Dystrophy
It is a group of diseases that cause progressive weakness and loss of muscle mass. In
muscular dystrophy, abnormal genes (mutations) interfere with the production of
proteins which are needed to form healthy muscles.

 Types:
1) Myotonic Muscular Dystrophy (MDD)
2) Duchenne Muscular Dystrophy (DMD)
3) Becker Muscular Dystrophy (BMD)
4) Congenital Muscular Dystrophy

1) Myotonic Muscular Dystrophy (MDD)

- Commonly appears in early childhood to adulthood
- Prolonged spams / stiffness of muscles
- Worsens in cold temperature.
- Affects CNS, CVS, GIT

2) Duchenne Muscular Dystrophy (DMD)

- Most common form of muscular dystrophy in children
- Appears only in male, between the age of 2-6 years
- Muscle wasting & weakness
- Arms, legs & spine become progressively deformed

3) Becker Muscular Dystrophy (BMD)

- Similar like DMD, milder symptoms, slower progression
- Appears between the age of 2-25 years

4) Congenital Muscular Dystrophy

- Present from birth
- Slow progression
- Shortening / Shrinking of muscles, joint problems

 General Symptoms:
- Muscle wasting
- Weakness of muscles
- Difficulty in climbing stairs
- Frequent tripping or falling
- Inability to walk or stand
- Tip-toe walking
- Pain in legs
- Facial weakness
- Inability to close the eyes

 Diagnosis: Genetic blood test, Muscle biopsy, EMG

  Treatment & Support:
There is yet no known care of muscular dystrophy.
- Physical therapy
- Medications
- Nutritional & Psychological counseling
- Personal caretaker

 Sickle-Cell Anemia
- It is a genetic disorder in which the body produces abnormal shaped RBCs which
slow down the blood flow and are unable to carry adequate oxygen.
- The RBCs are crescent or sickle-shaped; hence the name Sickle-Cell Anemia.

 Causes: Genetic

 Symptoms:
- Anemia: Pallor, Fatigue
- Yellowish skin, eyes & mouth
- Periodical episodes of pain in abdomen, chest, joints
- Hand-foot syndrome
- Frequent infections
- Delayed growth
- Vision problems
- Fever

 Complications:
- Stroke
- Acute chest syndrome
- Organ damage
- Blindness
- Skin ulcers

 Prevention of complications:
- Sufficient water intake
- Avoid too hot / too cold water
- Avoid high altitude (flying, mountains, etc.)
- Avoid places with low oxygen level
- Avoid activities which may cause low oxygen level

 Treatment:
- Blood transfusion
- Bone marrow transplant
- Gene therapy
- Oxygen supplementation
- Analgesics
- Antibiotics for infections
 Thalassemia
It is an inherited blood disorder characterized by abnormal hemoglobin production &
increased destruction of RBCs leading to anemia.

 Types:
1) Beta Thalassemia
2) Alpha Thalassemia
3) Thalassemia minor

1) Beta Thalassemia:
- Caused by changes in genes of beta globin component of Hb
- Inherited from both parents
- Usually causes severe anemia

2) Alpha Thalassemia:
- Caused by changes in genes of alpha globin component of Hb
- Inherited from both parents

3) Thalassemia minor:
- Inherited from one parent only
- Either alpha / beta thalassemia minor
- Causes minor anemia

 Symptoms:
- Pallor, slight icterus (jaundice), enlarged abdomen
- Spleenomegaly
- Growth retardation
- Infection
- Paralysis
- Bone deformity
- Irritability
- Dark coloured urine
- Abdominal distension

 Diagnosis: Bone marrow examination, Serum electrolytes, Serum irons, CBC

 Treatment:
- Blood transfusion
- Bone marrow transplant
- Corticosteroids
- Vitamin & Mineral supplementation (Ascorbic acid, folic acid, iron, etc.)
- Antipyretics, Analgesics
- Surgery: removal of spleen / gall bladder if required
 सहज मिुमेह / Juvenile Diabetes
- It is also known as Type I Diabetes or insulin dependent diabetes.
- It is a chronic autoimmune disease in which the body’s own immune system
destroys the β-cells of islet of Langerhans of pancreas which results in very less or no
production of insulin.

 Causes:
- Exact cause is unknown
- Possible causes: Genetic inheritance, Low immunity, Viral exposure

 Symptoms:
- Extreme weakness, fatigue, irritability
- Extreme dehydration, thirst
- Increased volume of urination or frequent urination
- Abdominal pain
- Nausea, Vomiting
- Blurred vision
- Impaired wound healing

 Complications:
- CVS diseases
- Neuropathy
- Nephropathy
- Retinopathy
- Foot damage

 Diagnosis:
- RBS (Random Blood Sugar) test
- PPBS (Post Prandial Blood Sugar) test
- HbA1C

 Treatment:
- Cannot be cured completely
- Treatment focuses on managing the blood sugar level by administering
insulin, wholesome diet & proper life style, which also prevent complications.
- The goal is to keep the blood sugar level as close to normal as possible.
Generally, FBS test should be between 80-130 mg / dl, and PPBS test should be
between 130-180 mg / dl.
CHAPTER ViI: prasavottara vyadhi /
Neonatal disorders

 निजात िामला / Neonatal Jaundice

- It is the condition in which the newborn child has a high bilirubin level which leads
to yellowish discoloration of eyes & skin.
- Bilirubin is a byproduct RBC breakdown. The liver processes the bilirubin and
excretes it into the stool.

 Causes:
Accumulation of bilirubin in blood due to increased production or decreased
ability to metabolize & process the bilirubin.

- Physiological Jaundice:
▪ Occurs on 2nd / 3rd day of life.
▪ Most common cause of jaundice in newborn
▪ Immature liver of the child is unable to excrete bilirubin, leading to
accumulation in the body due to breakdown of RBC which have a
shorter life span (70-90 days) than in adults (100-120 days).
▪ When liver matures, jaundice eventually disappears.

- Neonatal Jaundice:
▪ Occurs when mother & baby have non-compatible blood types.
▪ Mother’s blood produces antibodies which attack the blood cells of
the child leading to increased breakdown of RBC and therefore
bilirubin production.

- Breastmilk Jaundice
▪ Occurs in breastfed newborns, often at the end of first week of life.
▪ Exact cause is unknown. It is thought that certain chemicals of the
breastmilk prevent the infant’s liver from metabolizing the bilirubin.

- Breastfeeding Jaundice
▪ Occurs when the breastfed newborn does not receive adequate
breastmilk intake resulting in decreased bilirubin excretion.
▪ Causes may be delayed or insufficient milk production by the mother,
Poor feeding
 - RBC Membrane Defect:
▪ Abnormalities in the membrane & shape of RBCs can lead to
hemolysis and therefore increased production of bilirubin.

- RNC Enzyme Defect:

▪ Inherited genetic enzyme disorders can lead to hemolysis and
therefore increased production of bilirubin.

 Signs & Symptoms:

- Yellowish discoloration of eyes & skin
- Lethargy, Seizures
- Poor feeding, Light colored stool
- Changes in muscle tone, High pitched crying

 Diagnosis: Serum bilirubin level

- In a newborn, higher bilirubin level is normal due to stress of birth.
- 5.2 mg/dL within 24 hours after birth is normal.
- Many newborns have even higher bilirubin level which is the cause for
neonatal jaundice.

 Treatment:
- A newborn who develops jaundice within 24 hours after birth requires
immediate medical attention.
- Any newborn with a total serum bilirubin greater than 21 mg/dL should
receive phototherapy.
1. Bili Blanket Phototherapy
2. Single / Double / Triple Surface Phototherapy
 निजात ने िावभष्यन्द & Neonatal Conjunctivitis

निजात ने िावभष्यन्द
प्रस्रिणो अत्रभष्यन्दः ।
That which causes flowing is called अत्रभष्यन्द.
नििाि नेिात्रभष्यन्द is the condition in which the eyes of a newborn child are secreting
fluid.

 भेद & लक्षण

a) िािि स्राि, िोद, रूक्षिा, मल अभाि
b) त्रपत्ति उष्ण स्राि, दाह, पाक, रििणश
c) कफि त्रपक्तच्छ्ल स्राि, गुरुिा, शोथ, कण्डू
d) रिि स्राि, िाम्रिणश

 विवित्सा
- नेित्रपण्डी कमश with सनन्धि लिण, लोध्र, सौिीराञ्जन, मधु , घृि for कण्डू, दाह, िोद
- नेित्रपण्डी कमश with चन्दन, मधु क, लोध्र, िािीपुष्प, गनररक for दाह, स्राि

Neonatal Conjunctivitis
It is the watery or purulent oozing from the eyes of a newborn child.

 Causes:
- Bacterial or viral infection
- Chemical irritants

 Signs & Symptoms:

- Watery or purulent oozing (1st day - 2 weeks after delivery)
- Eyelids become puffy
- Reddish discoloration of conjunctiva

 Complications:
- Blindness
- Inflammation of iris

 Investigation: Culture of drainage from eye to detect bacteria or virus

 Treatment:
- Antimicrobial or antibiotic therapy: Ceftriaxone
- Eye drops: Tetracycline
- Gentle massage between eye & nasal area
 नावभरोग & Umbilical Disorders

नावभरोग
नात्रभरोग are various diseases related to the umbilicus of a newborn child.

i) नावभपाि
It is an infection leading to ulceration of umbilicus.
त्रचत्रकत्सा External application:
- अिा त्रिि् & दु ग्ध
- िन ल processed with लोध्र, मधु क, त्रप्रयाङ्गु, दे िदारु, हररर्द्ा

ii) नावभशोथ
It is the inflammation of umbilicus with discharge of puss & abscess.
त्रचत्रकत्सा - शल्यकमश
- अत्रिकमश

iii) नावभ व्रण / अनु ित नावभ

It is a wound of the umbilicus resulting as a complication after cutting of
umbilical cord.
त्रचत्रकत्सा घृि, अश्वगन्ध, अञ्जन, अिा त्रिि् , यष्टीमधु

iv) उित नावभ

It is the swelling of umbilicus resulting as a complication after cutting of
umbilical cord.
त्रचत्रकत्सा अिा त्रिि्

v) नावभ िुण्डल
It is the ring-like circular inflammation around the umbilicus.
त्रचत्रकत्सा िन ल processed with आश्वत्थ पञ्चाङ्ग क्वाथ.
Umbilical Disorders

 Classification:
a) Acquired (Delayed umbilical separation, Umbilical granulation)
b) Infectious (Omphalitis, Umbilical vein separation)
c) Congenital (Umbilical polyp, Paten urachus, Umbilical hernia)
d) Neoplastic (Teratoma)

i) Delayed Umbilical Seperation

- Umbilical cord usually gets separated after one week of birth.
- Persistence beyond 3 weeks is considered as delayed umbilical separation.
Treamtent: Manual removal - antiseptic precautions, cleaning around the
umbilicus & exposure to air.

ii) Umbilical Granuloma

- It is localized inflammation of the tissue.
- Most frequent cause is moistness / wet umbilicus.
- After umbilical cord separation, base of umbilicus becomes reddish-pink,
moist and measures 0.1-1 cm.
Treamtent: Repeated cauterization, Surgical excision

iii) Omphalitis
- It is an infection of umbilical cord stump & surrounding tissue.
- Onset: 5-9 days after birth
- Cause: Low Birth Weight (LBW)
- Erythematic, Oedema, Purulent drainage, Fever
Treamtent: Surgical debridement (removal of damaged tissue)

iv) Umbilical Phlebitis

- It is the inflammation of umbilical vein.
- Causes: Staphylococcus, Streptococcus
- Pain, Swelling, Redness
Treamtent: Antibiotis, NSAID

v) Umbilical Polyp
- It is a reddish mass at the base of umbilicus.
- It has a brighter reddish color and is slightly larger compared to umbilical
granuloma.
vi) Umbilical Urachus
- It is condition in which urachus remains a hollow tube connecting the urinary
bladder and umbilicus resulting in umbilical urinary fistula.
- Swelling, Abdominal pain, Erythematic, Urachal cyst
Treamtent: Surgical excision

-> Urachus is the part of allantois between apex of the bladder & umbilicus. > -
-> Allantois is a worm-shaped structure originating from the yolk sac of early
embryo and is associated with the development of urinary bladder & early
blood formation. Its blood vessels become umbilical arteries and veins.

vii) Umbilical Hernia

- It is a thick protrusion of the umbilicus with associated fascial defect.
- It may contain peritoneal fluid / peritoneal fat / intestine.
- Causes: Premature birth, LBW
Treamtent: Hernia repair

viii) Dermoid Cyst

- It is a sac-like growth on the umbilicus.
- It contains fluid, hair, skin glands, etc.
Treamtent: Surgical removal

ix) Teratoma
- It is a tumor composed of tissue from germ layers.
- It is rarely affecting the umbilicus.
Treamtent: Surgical removal
 निजात वशशु रक्त िै र्म्यता / Neonatal Septicemia
- It is a severe systemic infection of a newborn caused primarily by B. streptococcus.
- It affects the immune system of the child and is found in GIT & GUT.

 Causes:
- Bacteria: Streptococcus, E. Coli, Listeria
- Viruses: HSV (Herpes simplex virus)
- Infection from mother during delivery
- Infection of placental tissue

 Signs & Symptoms:

- Change of body temperature
- Breathing problem
- Diarrhoea
- Hypoglycemia
- Reduced sucking
- Reduced movements
- Seizures
- Brady- / Tachycardia
- Swollen belly
- Yellow or whitish eyes

 Investigations: Blood culture, Serum creatinine, CBC

 Treatment:
- Antibiotics: Ampicillin, Gentamycin
- Supportive treatment for RS, CVS & CNS
CHAPTER VIII: Dusta stanyapanajanya
vyadhi / disorders due to vitiated
breastmilk

 Lactose Intolerance
- It is the inability to digest lactose.
- Lactose is present in breastmilk, so babies having lactose intolerance can get
complication by drinking breastmilk.

 Causes:
- Genetic: lack of lactase since birth
- Disturbance of digestive system by illness

 Signs & Symptoms:

- Pain & swelling of abdomen
- Failure to gain weight
- Impaired growth
- Diarrhoea
- Deficiency of calcium, magnesium, zinc

 Diagnosis:
- Symptomatic examination
- Hydrogen breath test
- Elimination diet: Removing of food containing lactose and observing the
child’s health.

 Treatment:
- Nutritional supplementation
- Food advice
 क्षीरालसि
आलसक is a disease due to presence of आम. Food does not get digested, settles in
आिाशय and can neither move upwards or downwards.
In babies it may be caused due to दु ष्टस्तन्य भोिन, leading to the condition known as
क्षीरालसक.

 लक्षण
अरुत्रच, दु गशन्धयुि मल, ज्वर, िृम्भा

 विवित्सा
- िमन (mother & child)
- िचात्रद औषत्रध
- हररर्द्ात्रद गण औषत्रध
- पठात्रद गण औषत्रध

 िुक्कुणि
It is the condition in which Vata, Pitta, Kapha & Rakta, vitiate Stanya which, when
ingested by the baby, causes inflammation of conjunctiva (Neonatal conjunctivitis).

 वनदान
- धािी अत्रहिाहार सेिन - मधु राहार, मत्स्य, मां सरसपान, सुरा, अत्रभष्यन्द आहार
- त्रदिस्वप्न

 भेद
a) क्षीरदोषिन्य
b) दन्तोत्पत्रत्तिन्य

 लक्षण
ित्मश शोथ, नेि कण्डू, न क्षीित्रि, मनः अप्रसन्निा

 विवित्सा
- प्रक्षालन = आम्र, आमलकी & अश्मान्तक क्वाथ
- पररषेक = िरूण क्वाथ
- अश्चोिन = त्रसद्ध घृि
- िमन (for mother & child)
- त्रिरे चन (for mother)
- पथ्य आहार त्रिहार
 अवहपू तन & Napkin Rashes

अवहपू तन
- Improper cleaning after elimination of waste products.
- Vitiation of Rakta & Kapha Dosha leads to itching in anal region.

 वनदान
दु ष्ट स्तन्यपान, अशौच

 लक्षण
गुदप्रदे श िाम्रिणश िनिर्ण्श िा, कण्डू, व्रण, स्राि

 विवित्सा
- धािी स्तन्य शोधन
- त्रपत्तश्लेष्महर र्द्व्य - पटोल पि, त्रिफला
- त्रिफला / खडीर क्वाथ परक्षालन
- ले पन - कात्रसस, गोरोचना, िु त्थ, हरिाल, सनन्धि लिण

Napkin Rashes
It is an inflammatory reaction of the skin localized at the area which is covered by
napkin (diaper).

 Causes:
- Prolonged exposer to urine & feaces
- Moisture
- Friction & rubbing of diaper
- Contact with irritating chemical
- Infections

 Signs & Symptoms:

- Redness, shiny patches, pimply spot

 Treatment & Prevention:

- Cream / Ointments with zinc oxide and petroleum jelly
- Antifungal drugs
- Hydrocortisone steroid
- Timely exchange of diaper
- Proper cleaning & keeping the skin dry
CHAPTER Ix: kuposhanajanya vyadhi /
Nutritional disorders

 िाश्यम
- It is the condition in which the individual has strongly reduced Meda Dhatu.
- It comes under अष्ट त्रनक्तन्दि पुरुष.

 वनदान
- अत्रि रूक्ष अन्नपान सेिन, अल्प मािा आहार सेिन, उपिास
- िेगत्रिधारण, रात्रििागरण
- शारीररक मानत्रसक त्रक्रया अत्रियोग
- शोक, क्रोध, भय, त्रचन्ता

 लक्षण
- त्रनिम्बौ उदर ग्रीि कृशत्व
- त्रसरा धमनी दृश्यिे
- दौबशल्यत्वा

 विवित्सा
- बृंहण त्रचत्रकत्सा
- त्रनदान पररििशन
- मािृ बृंहण आहार सेिन
- त्रशशु पौत्रिक आहार सेिन
- गुरु शीि मधु र त्रिग्ध स्थूल त्रपक्तच्छ्ल आहार
- अभ्यङ्ग - लाक्षात्रद िन ल
- अश्वगन्ध घृि, त्रिडारीकण्ड चू णश
 फक्क
It is the disease in which the baby is unable to stand or walk even after 1 year of age.

 वनदान & भेद

a) क्षीरि - Breastmilk is vitiated with Kapha Dosha and afflicts the child.
b) गभश ि - If the lactating mother becomes pregnant again, then the
breastmilk decreases and nourishment for the first child is
insufficient for proper development.
c) व्यात्रधक - Affliction of other diseases may delay the child’s development
and cause फक्करोग.

 विवित्सा
- आभ्यन्तरिेहन - कल्याणक घृि / षत्फल घृि / अमृि घृि (upto 7 days)
- अभ्यङ्ग - राि िन ल
- कोि शोधन - त्रििृि् क्षीर
- बक्तस्त
- दु ग्ध पान
- क्षीरपाक - मधु क, पुननशिा, एकपत्रणश, एरण्ड, र्द्ाक्षा

 बाल शोर्
It is the condition in which the child gets emaciated due to dryness although Kapha
Dosha is the original causative factor.

 वनदान
- अत्रित्रनर्द्ा
- शीिाम्बु
- श्लनक्तष्मकास्तन्यसेिन

 लक्षण
अत्रिमन्द्द्य, अरोचक, प्रत्रिश्याय, ज्वर, कास, शोष, मु ख नेि त्रिग्धिा, श्वेििणश

 सम्प्राम्हि
त्रनदान सेिन -> कफ दोष प्रकोप -> कफेन रसिाहस्रोिात्रण अिरोध -> अरोचक,
प्रत्रिश्याय, ज्वर, कास -> बाल शोष

 विवित्सा
- सुिणशप्राशन अिले ह
- अश्वगन्ध अिले ह
- घृि - शालपणी, िचा, ककोली, त्रपप्पली, िगर, िलिेिस, कमला, पुननशिा
 पाररगवभमि & Protein Energy Malnutrition

पाररगवभमि
It is the nutritional deficiency of a child occurring due to abrupt stoppage of
breastfeeding or breastfeeding with milk which has poor nutrients.

 लक्षण
अत्रिमन्द्द्य, कास, िन्द्रा, अरुत्रच, छत्रदश, काश्यश, भ्रम

 विवित्सा
- अत्रिदीपन - त्रपप्पली, त्रचिक कल्क with काञ्जी
- ककोली, क्षीरककोली, मधु क with अिा दु ग्ध
- त्रिडारीकण्ड, यि, गोक्षू र, त्रपप्पली with अिा दु ग्ध

Protein Energy Malnutrition (PEM)

It is the consumption of protein & energy insufficient food. The diet fails to satisfy the
body’s nutritional needs which may lead to various complications.
Insufficient nutrients include protein, carbohydrates and fats.

 Causes for PEM:

- Chronic, very low energy and protein intake
- Exclusively breastfeeding for too long
- Unclean / Non-nutritive food
- Infections & diseases

 Types of PEM Disorders: - 2

a) Primary PEM disorders are directly caused due to lack of
nutrients; e.g.: Marasmus, Kwashiorkor
b) Secondary PEM complications; e.g.: Cancer, Renal failure, IBS

 Diagnosis:
- Physical examination
- History of eating habits
- BMI

 Treatment & Prevention:

- Nutritive & wholesome diet
- Macronutrient supplementation
- Micronutrient supplementation
- Treatment for infections & diseases
- Prevent hypothermia, dehydration
  Marasmus:
- It is caused by severe deficiency of nearly all nutrients, but especially
carbohydrates & proteins.
- Symptoms: Severe tissue wasting, emaciation, starvation, wrinkled
appearance, dry skin, no oedema

 Kwashiorkor:
- It is wet protein energy malnutrition.
- It is primarily due to severe protein deficiency.
- Extreme lack of protein causes an osmatic imbalance in GIT and causes
swelling of gut, diagnosed as oedema or retention of water.
- Reduced ability to reabsorb water. Improper functioning of lymphatic system.
- Symptoms: Oedema of hands & feet, Swollen abdomen, Irritability,
Dermatitis, Mental affliction, Hair discoloration, Fatty liver

 Failure to Thrive
- It is the failure to grow or to gain or maintain weight.
- It is the progressive decrease in weight and height.

 Causes:
- Acute or chronic disorders: Cleft lip / Cleft palate, GI reflux disorder
- Poor understanding of feeding technique
- Inadequate supply of breastfeeding

 Signs & Symptoms:

- Height, weight & head circumference does not match the standard growth
chart.
- Weight is lower than 3rd percentile of standard growth chart.
- Growth may be slow or stop completely prematurely.
- Excessive crying
- Constipation
- Lethargy
- Irritability

 Diagnosis:
- Frequent monitoring of height & weight
- Medical / Family / Social / Personal History
- Laboratory investigations: CBC, ESR, Serum electrolyte, HIV, TB

 Treatment & Prevention:

- Wholesome diet
- Increase of calories with fluid intake.
- Correction of any vitamin or mineral deficiency.
- Identification & treatment of associated disorders
  Vitamins, Vitamin Deficiency Disorders & Hypervitaminosis

 Vitamins
Vitamins are vital micronutrients which are essential for normal growth,
development & metabolic functions and are required to be acquired through
the diet because they cannot be synthesized by the body.

Types of Vitamins:
a) Fat soluble: 4 = A, D, E, K
b) Water soluble: 9 = B-Group & C

 Vitamin Deficiency
Vitamin deficiency is the condition in which the body has an insufficient
quantity of one or more of the vitamins required for normal health.

 Hypervitaminosis
Hypervitaminosis develops when a person has too much of a specific vitamin in
their system. It can be an acute or chronic condition it may lead to
complications in case of some vitamins.

Vitamin Chemical Name Function Source Deficiency Disorders Hypervitaminosis

A Retinol Vision, Buttermilk, Nyctalopia Dermatitis
Genetic regulation, Sweet potato, Xeropthalmia Hepatomegaly
Growth & Carrots, Papaya, Growth retardation Splenomegaly
Development Eggs, Fish, Meat Increased risk of
fractures
Recurrent infections

D Calciferol Calcium metabolism, Sunlight Rickets Nausea

Cell differentiation, Fish, Eggs Osteoporosis Excessive thirst
Immunity, Joint & muscle pain Severe itching
Maintenance of BMD

E Tocopherol Cholesterol balance, Sunflower seeds, IBS ---

Hormone balance, Wheat germs, Liver disease
Skin function, Mango, Butter, Pancreatic disease
Improves vision Tomato Impaired vision &
speech

K Phylloquinone Blood clotting Beans, Soybean, Delayed clotting time Hepatomegaly

Strawberries, leading to excessive Splenomegaly
Meat bleeding
B1 Thiamin Nerve & Heart Grains, Beans, Beriberi Restlessness,
functions, Nuts, Meat Chronic fatigue Convulsions,
Metabolism Heart complications Paralysis
Nerve damage

B2 Riboflavin Metabolism, Dairy products, Blurred vision Fatigue, Vomiting,

Skin functions, Vegetables, Inflammations of skin Itching, Numbness,
Anticoagulant Beans, Meat, Mood changes Burning or pricking
Eggs Slow metabolism sensation

B3 Niacin Metabolism, Sunflower seeds, Pellagra ---

Cholesterol balance Green peas, Rashes, Stomatitis,
Support brain, heart Mushrooms Mental disturbances
& skin

B5 Pantothenic Fat metabolism, Grains, Dairy Hypoglycemia, Diarrhoea, GIT

acid Production of RBC, products, Fatigue, Neurological problems, Water
Support GIT Sunflower seeds, problems, Abdominal retention leading to
Eggs cramps, Vomiting oedema

B6 Pyridoxine Immunity, Hormone Cereals, Green Cirrhosis, Skin diseases

balance, Metabolism, beans, Banana, Hyperthyroidism, Vomiting
Skin functions Cabbage, Dermatitis, Glossitis, GIT disorders
Carrots, Eggs Insomnia

B7 / H Biotin Synthesis of energy, Chocolate, Milk, Depression, Fatigue, Skin rashes

Breakdown of fat & Soybean, Yeast, Nausea, Muscular Increased blood
carbohydrate, Cereals, Eggs pain, Dermatitis sugar
Blood glucose Decreased Vitamin C
balance, Strengthens
nails, hairs & skin

B9 / M Folic acid Cell enhancement, Vegetables, Macrocytic anemia, Convulsions

Growth & Cheese, Anorexia, Loss of Sleep, stomach &
Development Cauliflower, memory, skin problems
Green peas, Osteoporosis
Mushrooms

B12 Cyanocobalamin RBC formation, Nerve Dairy products, Megaloblastic Liver & kidney
& DNA support, Fish, Meat, Eggs anemia, diseases
Growth & Neuropsychiatric
Development abnormalities

C Ascorbic acid Immunity Orange, Papaya, Scurvy Diarrhoea, Nausea,

Stress resistance Green pepper, Growth retardation Vomiting,
Skin functions Green peas, Decreased immunity, Heartburn,
Improves mineral Strawberries, Dry & splitting hairs Abdominal cramps,
absorption Pineapple Headache, Insomnia
 CHAPTER x: aupasargika vyadhi /
Infectious diseases

 िणममूलशोथ / Mastoiditis
- Mastoiditis is a serious infection in the mastoid process, which is the hard,
prominent bone just behind and under the ear.
- It is a rare condition, but can become life-threatening without treatment.
- Mastoiditis is most common in children younger than 2 years who have a history of
ear infections.

 Causes:
- Ear infections that people fail to treat cause most cases of mastoiditis.
- Bacteria from the middle ear can travel into the air cells of the mastoid bone.
- A person may have an abnormal growth of skin cells in the middle ear called a
cholesteatoma. This skin growth can cause a blockage in the ear that allows
bacteria to multiply, causing mastoiditis.

 Symptoms:
- Intense throbbing pain in or around the ear
- Pus or other fluids coming out of the ear
- Fever or chills
- Swelling / Redness behind or under the ear
- Bad smell coming from the ear
- An ear that appears to be sticking out or pushed forward
- Hearing problems or ringing in the ears

People should look out for the following signs in very young children who
might be unable to describe their symptoms:
Mood changes, Frequent crying, Hitting the side of the head, Pulling the ears

 Treatment:
- Regular hand-washing and avoiding people who are unwell can help reduce
the risk of contracting an ear infection.
- Without antibiotic treatment, the bacteria can continue spreading to the
bones of the skull. They may also travel to the blood and infect various organs.
- Antibiotics can usually treat mastoiditis. In most cases, a person needs
intravenous antibiotics. If the first antibiotic treatment does not work, a doctor
may take a culture of the infection to determine the type of bacteria and find a
different course of antibiotics.
- In some cases, a doctor may need to perform a mastoidectomy - removal of
the portion of the mastoid process that is infected.
 Mumps
Mumps is a viral infection that primarily affects saliva-producing (salivary) glands that
are located near your ears. Mumps can cause swelling in one or both of these glands.

 Causes:
Mumps is caused by a virus that spreads easily from person to person through
infected saliva. If you're not immune, you can contract mumps by breathing in
saliva droplets from an infected person who has just sneezed or coughed. You
can also contract mumps from sharing utensils or cups with someone who has
mumps.

 Incubation period:
Some people infected with the mumps virus have either no signs or symptoms
or very mild ones. When signs and symptoms do develop, they usually appear
about two to three weeks after exposure to the virus.

 Symptoms:
- Pain in the swollen salivary glands on one or both sides of your face
- Pain while chewing or swallowing
- Fever
- Headache
- Muscle aches
- Weakness & fatigue
- Loss of appetite

 Complications:
Complications of mumps are rare, but some are potentially serious.
Most mumps complications involve inflammation and swelling in some part of
the body, such as:
- Testicles. This condition, known as orchitis, causes one or both testicles to
swell in males who've reached puberty. Orchitis is painful, but it rarely leads to
sterility.
- Brain. Viral infections such as mumps can lead to inflammation of the brain
(encephalitis). Encephalitis can cause neurological problems and become life-
threatening.
- Membranes and fluid around the brain and spinal cord. This condition,
known as meningitis, can occur if the mumps virus spreads through your
bloodstream to infect your central nervous system.
- Pancreas. The signs and symptoms of this condition, known as pancreatitis,
include pain in the upper abdomen, nausea and vomiting.
 Other complications of mumps include:
- Hearing loss. Hearing loss can occur in one or both ears. Although rare, the
hearing loss is sometimes permanent.
- Heart problems. Rarely, mumps has been associated with abnormal
heartbeat and diseases of the heart muscle.
- Miscarriage. Contracting mumps while you're pregnant, especially early in
your pregnancy, may lead to miscarriage.

 Prevention & Management:

- The best way to prevent mumps is to be vaccinated against the disease. Most
people have immunity to mumps once they're fully vaccinated.
The mumps vaccine is usually given as a combined measles-mumps-rubella
(MMR) inoculation, which contains the safest and most effective form of each
vaccine. Two doses of the MMR vaccine are recommended before a child
enters school. Those vaccines should be given when the child is:
Between the ages of 12 and 15 months
Between the ages of 4 and 6 years

- College students, international travelers and health care workers in particular

are encouraged to make sure they've had two doses of the MMR vaccine. A
single dose is not completely effective at preventing mumps.

- Because mumps is a virus, it doesn’t respond to antibiotics or other

medications. However, symptomatic treatment can be done:
Rest in case of weakness & fatigue.
Analgesics & Anti-pyretics, such as acetaminophen and ibuprofen.
Ice pack can be applied on the swollen glands.

- Precautions:
Intake of plenty of fluids to avoid dehydration due to fever.
Sof diet like of soup and foods that aren’t hard to chew (chewing may be
painful when the glands are swollen).
Avoidance of acidic foods and beverages which may increase the pain.

- A person can usually return to work or school about one week or 10 days
after mumps is diagnosed and if the individual has recovered. At this point,
mumps is no longer contagious. Mumps usually runs its course in a couple of
weeks.

- People who get mumps can’t contract the disease a second time. Having the
virus once protects you against becoming infected again.
 रोमाम्हन्तिा & Measles

रोमाम्हन्तिा
It is the condition in which furuncles get formed due to aggravation of Kapha & Vata
Dosha as per Madhava Nidana, and Pitta & Kapha as per Charaka Samhita.
Formation of रोमाक्तन्तका is at the base of hair roots.
The furuncles are reddish in colour and devoid of secretions. Formation occurs all
over the body, but is dominant at face, back & abdomen.

 लक्षण
- सिश शरीर रि िणश त्रपडका
- ज्वर, दाह, िृ ष्णा, कण्डू, अरुत्रच, प्रसेक, क्लम, अिसाद, त्रिड् भेद, त्रशरोशूल

 उपद्रि
नेिरोग, रि िीिन, रिात्रिसार, गलशोथ

 विवित्सा
- लङ्घन, लघ्िाहार, फलरस पान, लक्षात्रनक प्रशमनौषत्रध, सुखत्रिरे चन
- काञ्चनार गुग्गुलु, खत्रदराररष्ट, अमृ िाररष्ट, कुिि सत्त्व

Measles
It is a highly contagious disease caused by measles morbillivirus / measles virus
(MeV). Humans are the natural host of this virus; no animal reservoir is known.

 Causes:
- Droplet infection
- Physical contact with an infected person

 Incubation period: 10-12 days

 Symptoms:
- Reddish-brown spotty rashes, spread all over the body, last for 5-7 days
- Fever, Cough, Coryza, Conjunctivits, Watery eyes, Body ache
- Koplik’s sports (very small greyish-white spots with bluish-white center in the
mouth within the cheeks & throat.

 Complications: Diarrhoea, Vomiting, Eye infection, Laryngitis, Pneumonia

 Treatment & Prevention: Symptomatic treatment, Antipyretics, Warm water,

Antibiotics for infected eyes, Isolation of contagions, Vitamin A supplements,
MMR (Measles, Mump, Rubella) vaccination
 Rubella
- It is also known as German measles / 3-days measles.
- It is caused by the rubeola virus and is an infection in which rashes appear on the
skin.

 Mode of transmission: Droplet infection

 Incubation period: 2 weeks

 Duration: 3 days

 Symptoms:
- Reddish-brown rashes all over the body
- Swollen lymph nodes
- Fever
- Sore throat
- Tiredness

 Complications:
- Testicular swelling
- Neuritis

 Investigations: Lymph node examination, Blood culture, Urine culture,

Antibody test

 Treatment & Prevention:

- There is no effective antiviral treatment for rubella.
- Antipyretics, Sufficient fluid intake
- MMR vaccine

 Congenital Rubella Syndrome:

It is an illness in infants that results from maternal infection by rubella virus
during pregnancy. When rubella infection occurs during early pregnancy,
serious complications such as miscarriage, still birth or birth defects may occur.
 मसूररिा & Chicken Pox

मसूररिा
It is the disease in which boils resembling the shape of a lentil seed are formed on the
body.

 वनदान
- लिण कटु अम्ल क्षार अत्रिसेिन-
- त्रिरुद्ध आहार सेिन
- अध्याशन
- ग्रह
- दु त्रष्ट िायु & िल

 सम्प्राम्हि
त्रनदान सेिन -> त्रपत्त प्रकोप -> रि दु त्रष्ट -> त्वक् दु त्रष्ट -> मसूररका

 पूिमरूप
ज्वर, कण्डू, अरत्रि, भ्रम, शोथ, अङ्गसाद

 लक्षण
दाह, ज्वर, रुि, कण्डू, अरत्रि

 उपद्रि
कास, त्रहक्का, प्रमोह, ज्वरािीव्र, प्रलाप, मू च्छ्ाश , िृ ष्णा, दाह,
मु खेन नासेन कणेन रिप्रसि

 भेद
i) िािि
ii) त्रपत्ति
iii) कफि
iv) सत्रन्नपािि
v) रिि

 विवित्सा
- लघ्िाहार, लङ्घन
- िमन, त्रिरे चन
- दे िदारु ििामां त्रस धू पन
- त्रनम्बपि उदक पान, खत्रदराररष्ट
- त्रिभु िनकीत्रिशरस
- त्रनम्ब चू णश, पटोलपि चू णश
- गुडूच्यात्रद क्वाथ, पटोलात्रदअ क्वाथ, काञ्चनार क्वाथ, िात्यात्रद क्वाथ
Chicken Pox
- It is also known as Varicella.
- It is a highly contagious disease caused by the initial infection with varicella zoster
virus (VZV). The disease results in a characteristic skin rash that forms small, itchy
blisters, which eventually scab over. It usually starts on the chest, back, and face;
then it spreads to the rest of the body.

 Causative organism: Varicella zoster virus (VZV)

 Mode of transmission: Droplet infection, Direct contact with the blisters of an

infected person

 Incubation period: 10-21 days

 Duration: 5-10 days

 Symptoms:
Prior to appearence of rashes:
- Fever
- Loss of appetite
- Headache
- Fatigue
- Malaise

Once the chickenpox rash appears, it goes through three phases:

a) Raised pink or red bumps (papules), which break out over several days.
b) Small fluid-filled blisters (vesicles), which form in about one day and then
break and leak.
c) Crusts and scabs, which cover the broken blisters and take several more
days to heal.

New bumps continue to appear for several days, so the infected person may
have all three stages of the rash - bumps, blisters and scabbed lesions - at the
same time.
Chickenpox can spread to other people by droplet infection for up to 48 hours
before the rash appears, and the virus remains contagious by direct contact
until all broken blisters have crusted over.

The disease is generally mild in healthy children. In severe cases, the rash can
cover the entire body, and lesions may form in the throat, eyes, and mucous
membranes of the urethra, anus and vagina.
 Complications:
- Brain damage (Encephalitis, Hydrocephaly, Aplasia of the brain)
- Eye damage (Optic stalk, Microphthalmia, Cataract, Optic atrophy)
- Skin disorders, skin lesions, hypopigmentation
- Hypoplasia
- Anal & bladder sphincter dysfunction
- Dehydration
- Pneumonia
- Death

 Treatment & Prevention:

- Most people diagnosed with chickenpox should be advised to manage their
symptoms while they wait for the virus to pass through their system. Parents
should keep their children out of school and day care to prevent spread of the
virus. Infected adults will also need to stay home.

- Antihistamine medications or topical ointments to relieve itching.

- Lukewarm baths, application of unscented lotion, wearing lightweight & soft
clothing to relive itching sensation.

- The chickenpox vaccine (Varivax) is the best way to prevent chickenpox.

Varivax is recommended for young children. The vaccine can be combined with
the measles, mumps and rubella vaccine, but for some children between the
ages of 12 and 23 months, the combination may increase the risk of fever and
seizure from the vaccine.

Children ages 7 to 12 years who haven't been vaccinated should receive two
catch-up doses of the varicella vaccine, given at least three months apart.
Children age 13 or older who haven't been vaccinated should also receive two
catch-up doses of the vaccine, given at least four weeks apart.

Unvaccinated adults who've never had chickenpox and are at high risk of
exposure. This includes health care workers, teachers, child care employees,
international travelers, military personnel, adults who live with young children
and all women of childbearing age.
Adults who've never had chickenpox or been vaccinated usually receive two
doses of the vaccine, four to eight weeks apart.
  रोवहणी & Diphtheria

रोवहणी
It is the condition which is characterized by abnormal growth in the throat region.

 भेद लक्षण विवित्सा

भेद लक्षण विवित्सा

I) िािि मु ख & कण्ठ शुष्किा, कणशशूल अभ्यङ्ग, चिु िेह, मृ दु स्वे दन, िमन,
प्रत्रिसारण, गण्डूष, शोथहर र्द्व्य,
कृत्रमघ्न र्द्व्य

II) त्रपत्ति ज्वर, दाह, िृ ष्णा, मू च्छ्ाश , स्पशशसंिेत्रददशशक शीि िन लयुि अभ्यङ्ग, िेहपान, मृ दु
स्वे दन, िमन, ले खन, गण्डूष, लकिल

III) कफि त्रपक्तच्छ्लत्व, कण्डू ले खन, रिमोक्षण, प्रत्रिसारण, गण्डूष

IV) सत्रन्नपािि िाि-त्रपत्त-कफि लक्षण ले खन, रिमोक्षण, प्रत्रिसारण, गण्डूष,

किल, धू मपान, नस्य

V) रिि त्रपडकम, कणशशूल, रििणश, त्रपत्ति लक्षण असाध्य

त्रपत्ति त्रचत्रकत्सा

Diphtheria
- Diphtheria is a serious bacterial infection that usually affects the mucous
membranes of the nose and throat.
- Diphtheria can be treated with medications, but in advanced stages, it can damage
the heart, kidneys and nervous system. Even with treatment, diphtheria can be
deadly, especially in children.
- People who are at increased risk of contracting diphtheria include:
Children and adults who don't have up-to-date vaccinations
People living in crowded or unsanitary conditions
Anyone who travels to an area where diphtheria infections are more common

 Causative organism: Corynebacterium diphtheria

 Mode of transmission: Droplet infection, Contaminated person or household

items

 Incubation period: 2-5 days

 Symptoms:
- A thick, grey membrane covering the throat and tonsils
- Sore throat & Hoarseness of voice
- Swollen cervical lymph nodes
- Difficulty in breathing / Rapid breathing
- Nasal discharge
- Fever & Chills
- Malaise
In some people, infection by corynebacterium diphtheria causes only a mild
illness - or no obvious signs and symptoms at all. Infected people who remain
unaffected of the illness are known as carriers of diphtheria because they can
spread the infection.

 Complications:
- Breathing problems
- Heart damage
- Nerve damage

Diphtheria is fatal 5% to 10% of the time, according to the World Health

Organization. Rates of death are higher in children.

 Treatment & Prevention:

- Antibiotics, such as penicillin or erythromycin, help kill bacteria in the body,
clearing up infections.

- The diphtheria vaccine is usually combined with vaccines for tetanus and
whooping cough (pertussis). The three-in-one vaccine is known as the DTaP
(Diphtheria, Tetanus, Pertussis) vaccine.

Vaccination consists of a series of five shots, typically administered in the arm

or thigh, given to children at these ages:
2 months, 4 months, 6 months, 15 to 18 months, 4 to 6 years

- Booster shots:
After the initial series of immunizations in childhood, the individual needs
booster shots of the diphtheria vaccine to help maintain the immunity.

Children who received all of the recommended immunizations before age 7

should receive their first booster shot at around age 11 or 12. The next booster
shot is recommended 10 years later, then repeated at 10-year intervals.

The diphtheria booster is combined with the tetanus booster - the tetanus-
diphtheria (Td) vaccine. This combination vaccine is given by injection, usually
into the arm or thigh.
 िुक्कुर िास / Whooping Cough
- Whooping cough (Pertussis) is a highly contagious respiratory tract infection. In
many people, it's marked by a severe hacking cough followed by a high-pitched
intake of breath that sounds like "whoop."

- Before the vaccine was developed, whooping cough was considered a childhood
disease. Now whooping cough primarily affects children too young to have
completed the full course of vaccinations and teenagers and adults whose immunity
has faded.

- Deaths associated with whooping cough are rare but most commonly occur in
infants. That's why it's so important for pregnant women — and other people who
will have close contact with an infant — to be vaccinated against whooping cough.

 Causative organism: Bordetella pertussis

 Mode of transmission: Droplet infection

 Incubation period: 7-10 days

 Symptoms:
- Runny nose
- Nasal congestion
- Red, watery eyes
- Fever
- Cough

After a week or two, signs and symptoms worsen. Thick mucus accumulates
inside the airways, causing uncontrollable coughing. Severe and prolonged
coughing attacks may:
- Provoke vomiting.
- Result in a red or blue face.
- Cause extreme fatigue.
- End with a high-pitched "whoop" sound during the next breath of air.

However, many people do not develop the characteristic whoop. Sometimes, a

persistent hacking cough is the only sign that an adolescent or adult has
whooping cough.
Infants may not cough at all. Instead, they may struggle to breathe, or they
may even temporarily stop breathing.
 Complications:
Teens and adults often recover from whooping cough with no problems. When
complications occur, they tend to be side effects of the strenuous coughing,
such as:
- Bruised or cracked ribs
- Abdominal hernias
- Broken blood vessels in the skin or the whites of your eyes

In infants, especially those under 6 months of age, complications from

whooping cough are more severe and may include:
- Pneumonia
- Slowed or stopped breathing
- Dehydration or weight loss due to feeding difficulties
- Seizures
- Brain damage

 Treatment & Prevention:

- Because infants and toddlers are at greatest risk of complications from
whooping cough, they're more likely to need treatment in a hospital.
Complications can be life-threatening for infants younger than 6 months old.

- Antibiotics, usually erythromycin; erythromycin is taken for 2 weeks.

- The best way to prevent whooping cough is with the pertussis vaccine, which
doctors often give in combination with vaccines against diphtheria and
tetanus; DTaP vaccine. Doctors recommend beginning vaccination during
infancy.
The vaccine consists of a series of five injections, typically given to children at:
2 months, 4 months, 6 months, 15 to 18 months, 4 to 6 years

- Booster shots
For adolescents: Because immunity from the pertussis vaccine tends to wane
by age 11, doctors recommend a booster shot at that age to protect against
whooping cough (pertussis), diphtheria and tetanus.

For adults: Some varieties of the every-10-year tetanus and diphtheria vaccine
also include protection against whooping cough (pertussis). This vaccine will
also reduce the risk of transmitting whooping cough to infants.

For pregnant women: Health experts now recommend that pregnant women
receive the pertussis vaccine between 27 and 36 weeks of gestation. This may
also give some protection to the infant during the first few months of life.
 िनुिाम त & Tetanus

िनुिाम त / िनु स्तम्भ

- It is the condition in which aggravated Vata Dosha afflicts the internal channels. As a
result, the body bends towards inner or outer side and experiences muscle spasms.
- It is a Vatavyadhi.

 भेद
a) अन्तरायम
b) बत्रहरायम

अन्तरायम िनुिाम त
Excessive aggravated Vata Dosha afflicts the मन्य leading to मन्यस्तम्भ.

 वनदान
- िािकर आहार त्रिहार
- ग्रह

 लक्षण
- ग्रीिा मन्या स्तम्भ
- दन्तानम् दम्शन
- लालास्राि
- पृि आयाम
- त्रशरोग्रः
- िृम्भा
- स्तब्ध हनू

 विवित्सा
- नस्य
- अभ्यङ्ग
- मृ दु त्रिरे चन
- बक्तस्तकमश
- रसत्रसन्धू र
- प्रिाल त्रपत्रष्ट
Tetanus
- It is a severe disease caused by a bacterial toxin which affects the central nervous
system. It leads to muscle pain, particularly in the jaw & neck region.
- It is also known as ‘Lockjaw’.

 Causative organism: Clostridium tetani

 Mode of transmission: Invasion by an injury, Pollution, Infected foreign body

 Symptoms:
- Stiffness of jaw, abdominal & back muscles
- Contraction of facial muscles
- Convulsions
- Rapid pulse
- Fever
- Sweating
- Painful muscle spasm near mucosal area which may affect the larynx and
chest, leading to dysphagia & dyspnoea.

 Complications:
- Vocal cord spasm
- Broken brones from severe muscle spasm
- Breathing difficulties
- Pneumonia
- Pulmonariy embolism

 Types:
i) Generalized tetanus (GT)
ii) Localized tetanus (LT)
iii) Cephalic tetanus (CT)
iv) Neonatal tetanus (NT)

 Treatment & Prevention:

- Tetanus antitoxins
- Antibiotics
- DTaP (Diphtheria, Tetanus, Pertussis) vaccine
 िृवमरोग & Worm Infestations

िृवमरोग (ि - वि - ७)
It is the disease in which visible or non-visible parasites are formed and live in various
body systems.

 भेद
“िद्यथा पुरीषिाः श्लेष्मिा शोत्रणििा मलिाश्चेत्रि ॥ ९ ॥“
a) पुरीषि
b) श्लेष्मि
c) शोत्रणिि
d) मलि

a) पुरीर्ज
i) त्रनदान = Ksheera, Guda, Tila, Matsya, Mamsa, Pistanna, Ajeerna, Puti,
Asatmya, Viruiddha Ahara Bhojana
ii) स्थान = Pakvashaya; upwards or downwars movement
iii) संस्थान = Sukshma, Deergha, Sthula, Vritta
iv) िणश = Shyava, Neela, Harita, Peeta
v) नाम = Kakeruka, Makeruka, Leliha, Sashulaka, Sausurada
vi) प्रभाि = Vidbheda, Karshya, Parushya, Lomaharsha, Toda, Kandu
vii) त्रचत्रकत्सा = Apakarshana, Prakriti vighata, Nidana parivarjana

b) श्लेष्मज
i) त्रनदान = Ksheera, Guda, Tila, Matsya, Mamsa, Pistanna, Ajeerna, Puti,
Asatmya, Viruiddha Ahara Bhojana
ii) स्थान = Amashaya; upwards or downwards movement
iii) संस्थान = Vrutta, Mamsa Peshi
iv) िणश = Shukla, Tamra
v) नाम = Antrada, Udarada, Hridayachahara, Churava, Darbhapuspa,
Saugandhika, Magaguda
vi) प्रभाि = Hrullasa, Lalaprasava, Arochaka, Avipaka, Jvara, Murccha,
Jrimbha, Kshavathu, Anaha, Angamarda, Chardi, Karshya,
Parushya
vii) त्रचत्रकत्सा = Apakarshana, Prakriti vighata, Nidana parivarjana
 c) शोवणतज
i) त्रनदान = Kustha Nidana
ii) स्थान = Raktavahini Dhamini
iii) संस्थान = Anu, Vrutta, without feet, invisible
iv) िणश = Tamra
v) नाम = Keshada, Lomada, Lomadvipa, Saurasa, Audumbara,
Jantumata
vi) प्रभाि = Kesha Shmashru Loma Nakha Patana, Harsha, Kandu, Toda,
Samsarpanani, Tvak Sira Snayu Mamsa Tarunasthi get eaten
vii) त्रचत्रकत्सा = Kustha Chikitsa

d) मलज
i) त्रनदान = Avoiding cleanliness of the body
ii) स्थान = Kesha, Shmashru, Loma
iii) संस्थान = Tila
iv) िणश = Krishna, Shukla
v) नाम = Yuka, Pipilika / Liksha
vi) प्रभाि = Kandu, Kotha, Pidika
vii) त्रचत्रकत्सा = Apakarshana, Prakriti vighata, Nidana parivarjana

 विवित्सा
- अपकषशण, प्रकृत्रित्रिघाि, त्रनदान पररििशन
- िेहन, स्वे दन, िमन, त्रिरे चन, बक्तस्त, त्रशरोत्रिरे चन
- भल्लािक िनल
- कृत्रमघ्न र्द्व्य
- कृत्रमघ्न रस

-> Refer to च - त्रि - ७ for detailed description.

Worm Infestations
It is the condition in which worms live as parasites in children in the GIT.

 Causes:
- Improper hygiene
- Consuming infected food or water

 General Symptoms:
- Abdominal pain
- Excessive crying in infants
- Nausea, Vomiting
- Diarrhoea
- Melena
- Fever
- Loss of appetite
- Itching rashes

 Common types of worm infestation:

a) Tape worm:
- Appearence: Flat & ribbon-like worm
- Size: 5-10 mtr
- Symptoms: Nausea, Vomiting, Jaundice, Loss of appetite

b) Round worm:
- Appearence: Resembles earth worm
- Size: 30-35 cm
- Symptoms: Fever, Dry cough

c) Pin / Thread worm:

- Appearence: Like a fine cotton thread
- Symptoms: Itching at anus, Sleep disturbances, Painful urination

d) Hook worm:
- Appearence: Hook-shaped
- Symptoms: Coughing, Sneezing, Anorexia, Fatigue

 Treatment & Prevention:

- Antiparasitic drugs
- De-worming therapy
- Prevention by maintaining hygiene, hand sanitizer, boiled water, sterzilized
toys, washing hands before eating
 आम्हिि ज्वर & Typhoid Fever

आम्हिि ज्वर / विर्म ज्वर

It is the fever which is critical to manage, very serious in nature and which develops
as a result of affliction of ghosts or supernatural powers.

 वनदान
- ग्रह
- साहस, मन थुन
- त्रिरुद्धाहार, त्रदिास्वप्न
- अध्याषन, मां स भोिन

 भेद
i) सन्ति
ii) सिि
iii) अन्येदुष्क
iv) िृ िीयक
v) चिु थशक

i) सन्ति
- Tridosha involvement, Vata dominance
- Vitiation of Sapta Dhatu & Tri-Mala; Rasa Dhatu is mainly afflicted
- Duration: 7 / 10 / 12 days
- May extend if vitiation of Dosha is extreme: 12 / 14 / 22 days
- Fever, Rise & fall of temperature, Weakness, Abdominal distension

ii) सिि
- Tridoshaja
- Rakta Dhatu is mainly afflicted
- Fever occurs twice in 24 hours
- Chills & sweating

iii) अन्येद्युष्क
- Tridoshaja
- Mamsa Dhatu is mainly afflicted
- Fever occurs once in 24 hours
 iv) िृ िीयक
- Meda Dhatu is mainly afflicted
- Fever sets in every 2nd day
- Sub-types: a) Vata-Pittaja Fever & pain in head
b) Vata-Kaphaja Fever & pain in the back & sacral are
c) Pitta-Kaphaja Fever & pain in sacral area

v) चिु थशक
- Masma, Meda, Asthi & Majja Dhatu are mainly afflicted
- Fever sets in every 3rd day
- Sub-types: a) Vataja Fever & pain in head
b) Pittaja Fever & burning sensation in Pittasthana
c) Kaphaja Fever & pain in calf muscles

 विवित्सा
- अनुिासन बक्तस्त
- त्रिरे चन
- िमन् षड् फला घृि
- सिश ज्वरहर ित्रट
- अमृ िाररष्ट
- षट् फला घृि
Typhoid Fever / Enteric Fever
It is an acute illness caused due to infection of salmonella typhi bacteria.

 Causes:
- Salmonella typhi bacteria; commonly found in food, contaminated water,
infected person

 Incubation period: 1-2 weeks; gradual onset

 Duration: 3-4 weeks

 Symptoms:
- Persistent high fever (39-40°C)
- Sore throat
- Fatigue
- Stomach pain
- Constipation
- Diarrhoea
- Headache
- Centrally coated tongue

 Complications:
- Severe weight loss
- Severe diarrhoea
- Becoming unresponsive
- Delirium
- Hallucination

 Treatment:
- Antibiotics
- Antipyretics
- Adequate rest
 मम्हस्तष्कािरणशोथ / Meningitis
It is an acute inflammation of the protective membranes covering the brain and
spinal cord.

 Causes:
- Most bacteria / viruses that live in our bodies; usually these germs stay in the
intestines, nose & throat, where they may or may not cause sickness; but if
they spread to the tissue that surround the brain and spinal cord, they can
cause inflammation.
- Viral organisms = Enterovirus, Herpes virus, Retrovirus (living in intestine)
- Bacterial organisms = Streptococcus, Neisseria
- Fungal, Candida, Cryptococcus, Parasytic

 Risk factors:
- Children under 5 years
- Teenagers & young adults; age 16-25
- Adults over 55 years

 Mode of transmission:
- Droplet infection
- Close & prolonged contact

 Incubation period: 2-10 days

 Symptoms:
- Infants younger than 3 months:
Poor feeding, Vomiting, Lethargy, Rashes, Neck stiffness, Irritability, Fever,
Seizures, Hypotonia, Jaundice
- Children older than 1 year:
Nausea, Vomiting, Headache, Increased sensitivity to light, Fever, Lethargy,
Seizures, Neck stiffness, Rashes

 Diagnosis:
- Kernig’s sign = When a thigh is flexed at the hip and knee at 90° angles, and
subsequently extension of the knee is painful.
- Brudizinki’s sign = Severe neck stiffness causes a patient’s hip and knee to flex
when the neck is flexed.
- Meningismus = Check for nuchal rigidity with passive neck flexion.
- Rashes = Purpuric rashes

 Investigations: Blood culture, Lumbar puncture sample test, CT scan

 Treatment: Steroids, Antibiotics, Antimicrobial drugs, Antifungal drugs

 AIDS
- AIDS = Acquired Immuno-Deficieny Syndrome
- HIV = Human Immunodeficiency Virus
- HIV is the virus that is responsible for causing AIDS. The virus destroys or impairs
cells of the immune system and progressively destroys the body's ability to fight
infections and certain cancers.
- 3.2 million children around the world are infected with HIV.

 Causes:
- In adults and adolescents, HIV is most commonly spread by sexual contact
with an infected partner.
- Nearly all HIV infections in children under the age of 13 are from vertical
transmission, which means the virus is passed to the child when they are in
their mother's womb or as they pass through the birth canal, or through
breastfeeding.

 Symptoms & Complications:

- Failure to thrive
- NS problems
- Seizures
- Difficulty with walking
- Poor performance in school
- Ear infection
- Cold
- Loss of appetite
- Stomach upset
- Diarrhoea

 Investigation: ELISA (Enzyme-Linked Immunosorbent Assay), HIV tests

 Treatment:
- ART (Anti-Retroviral Therapy)
- Keep the child comfortable
- In case of loss of appetite, offer a variety of foods.
- Avoid food such as fast food, soft drinks, etc.
- In case of diahorrea, give plenty of fluids, fruit juices, soups, ORS (Oral
Rehydration Solution)
 Dengue Fever
It is a debilitating viral disease transmitted by mosquitoes and causes sudden fever &
acute pain in joints.

 Causative organism: Dengue virus; it is spread by several species of

mosquitoes of the “Aedes Aegypti” type.

 Incubation period: 5-7 days

 Symptoms:
- Fever
- Headache
- Vomiting
- Muscle / Joint pain
- Skin rashes
- Abdominal pain
- Nausea
- Giddiness
- Weight loss
- Lethargy

 Investigations: WBC, Blood culture, Tourniquent test

 Management & Treatment:

- Anti-viral drugs
- IV fluids for rehydration
- Anti-pyretics
- NSAIDs
- Blood transfusion
- Papaya leaf extract: Caripill Tablets
- गड
ु ू चीसत्त्व
 Malaria
It is an intermittent and remittent fever caused by a protozoan parasite which
invades the red blood cells and is transmitted by mosquitoes in many tropical and
subtropical regions.

 Pathophysiology:
Infected mosquito bite with Plasmodia parasite -> Enters blood stream ->
Reaches the liver -> Matures after several days -> Infected matured parasite
enters the blood stream -> Infects RBCs within 48-72 hours -> Multiplication &
infection of RBCs -> Repetion of cycle every 2-3 days -> Malaria

 Incubation period: 18-40 days

 Symptoms:
- Fever
- Chills
- Profused sweating
- Headache
- Nausea
- Vomiting
- Abdominal pain
- Diarrhoea

 Complications:
- Swelling of veins
- Liver failure
- Anemia

 Diagnosis: Clinical examnation, Hepato- & Splenomegaly

 Treatment:
- Anti-malarial medication: Chloroquine, Hydro Chloroquine
- Antipyretic medication
 राजयक्ष्मा & Tuberculosis

राजयक्ष्मा
It is the condition in which Kapha Dosha along with association of Vata & Pitta,
vitiates Medha Dhatu leading to glandular swelling in axillae, shoulders & neck
region.

 पयामय
- शोष
- क्षय
- रोगराि

 वनदान
i) त्रिषमाशन
ii) िेगधारण
iii) साहस
iv) क्षय

 पूिमरूप
प्रत्रिश्याय, प्रस्राि, िनरस्य, अरुत्रच, अङ्गसाद, उत्क्क्लेश, छत्रदश, शोथ, मन थुनकामिा, कटु
मां स कामिा, नख केश िशीघ्र िृद्ध

 लक्षण
कास, श्वास, अरुत्रच, त्रशरोरुि, अत्रिमन्द्द्य, गलत्रशथ, िृम्भा, अङ्गसाद, अिीणश, पाश्वशशूल,
दाह, प्रस्राि, ज्वर, त्रिड् भेद, छत्रदश, गौरि, स्वरक्षय, क्षय, शोष

 सम्प्राम्हि
त्रनदान सेिन -> िाि त्रपत्त कफ प्रकोप -> स्रोिस् अिरोध -> अत्रिमन्द्द्य -> रसिह दु त्रष्ट
-> सिशधािु दु त्रष्ट -> क्षय / शोष -> राियक्ष्म
 भेद
A) हे िुभेद a) त्रिषमाशनि राियक्ष्म
b) िेगत्रिरोधि राियक्ष्म
c) साहसि राियक्ष्म
d) क्षयि राियक्ष्म

B) रूपभे द a) त्रिरूप राियक्ष्म

i) आम्स-पाश्वश-शूल
ii) हस्त-पाद-दाह
iii) ज्वर

b) षडूप राियक्ष्म
i) अत्रिमन्द्द्य
ii) अरुत्रच
iii) पाश्वशशूल
iv) स्वरभे द
v) ज्वर
vi) कास

c) एकदशरूप राियक्ष्म
i) अत्रिमन्द्द्य
ii) अरुत्रच
iii) आम्सदाह
iv) पाश्वशशूल
v) त्रशरोरुि
vi) िनस्वयश
vii) ज्वर
viii) कास
ix) श्वास
x) रि छत्रदश
xi) कफ छत्रदश)

 विवित्सा
- षडङ्गयूष, दशमू ल क्वाथ
- चू णश = सीिोफलात्रद, िालीसात्रद, लिङ्गात्रद, कपूशरात्रद, एलात्रद, अश्वगन्धात्रद, र्द्ाक्षात्रद
- घृि = दशमू ल, िासात्रद, बलात्रद
- अिले ह = िासािले ह, अमृ िािले ह
- आसि अररष्ट = त्रपप्पल्याररष्ट, खिूशरासि, र्द्ाक्षासि
- रसौषत्रध = िसन्तकुसुमाकर रस, लक्ष्मीत्रिलास रस, कनकत्रसन्धू र रस, अभ्रक भस्म
Tuberculosis
It is an infectious bacterial disease characterized by the growth of nodules (tubercles)
in the tissues, especially the lungs.

 Causes:
- Mycobacterium tuberculosis
- Low immunity
- Lack of nutrition & hygiene

 Mode of transmission: Droplet infection

 Incubation period: 2-12 weeks

 Symptoms:
Cough, Dyspnoea, Fever, Chills, Loss of weight, Fatigue, Night sweat

 Types:
i) Active TB
ii) Miliary TB
iii) Latent TB

i) Active TB:
Active TB is an illness in which the TB bacteria are rapidly multiplying and
invading different organs of the body.
A person with active pulmonary TB disease may spread TB to others by
airborne transmission of infectious particles coughed into the air

ii) Miliary TB:

Miliary TB is a rare form of active disease that occurs when TB bacteria find
their way into the bloodstream. In this form, the bacteria quickly spread all
over the body in tiny nodules and affect multiple organs at once. This form of
TB can be rapidly fatal.

iii) Latent TB:

Many of those who are infected with TB do not develop overt disease. They
have no symptoms and their chest x-ray may be normal. The only
manifestation of this encounter may be reaction to the tuberculin skin test
(TST) or interferon-gamma release assay (IGRA). However, there is an ongoing
risk that the latent infection may escalate to active disease. The risk is
increased by other illnesses such as HIV or medications which compromise the
immune system.
 -> TB can affect any structure of the body. Most commonly it affects the lungs.
It is called Extrapulmonary TB if it affects other organs.
Some of Extrapulmonary TB are:

▪ TB lymphadenitis TB lymphadenitis is the most common type of

extrapulmonary TB and involves the lymph
nodes. It tends to affect the the cervical lymph
nodes.

▪ Skeletal TB Skeletal TB, or bone TB, is TB that spreads to the bones

from the lungs or lymph nodes. It can affect any of the
bones, including the spine and joints.

▪ Genitourinary TB Genitourinary TB is the second most common type of

extrapulmonary TB. It can affect any part of the genitals
or urinary tract, but the kidneys are the most common
sites. It usually spreads to the area from the lungs
through the blood or lymph nodes.

▪ Liver TB Liver TB is also called hepatic TB. It occurs when TB

affects the liver. It accounts for less than 1 percent of all
TB infections. Liver TB can spread to the liver from the
lungs, gastrointestinal tract, lymph nodes, or the portal
vein.

 Investigations: Radiological examination, Tubercular test (Monteux

technique), Bacteriological examination (Sputum culture)

 Treatment:
- Isomiazid (H) 10 mg / kg – max. 300 mg / day
- Rifampacin (R) 15 mg / kg – max. 600 mg / day
- Pyrazinmide (Z) 35 mg / kg
- Ethambutol (E) 20 mg / kg
 जीिनुजन्य यिृत् शोथ / Hepatitis
It is an inflammation of the liver which can damage or destroy liver cells.

 Causes:
- Hepatitis A, B, C, D, E
- Cytomagalo virus
- Epstein-barr virus
- Varicella zoster
- Adenovirus
- Rubella

 Symptoms:
- Flu-like symptoms
- Fever
- Yellowish skin (Jaundice)
- Loss of appetite, Nausea, Vomiting, Stomach pain, Diarrhoea
- Join pain
- Clay coloured stool, Dark coloured urine

 Complications:
- Jaundice
- Liver failure
- Liver cancer
- Death

 Investigations: LFT, Blood Culture, CT scan, Ultrasound, MRI, Liver biopsy

 Treatment:
- It depends on the child’s symptoms, age & general health.
- Symptomatic treatment
- Antiviral drugs
- Supportive care by wholesome diet & rest
- Liver transplant
 CHAPTER xi: Srotas vikara

 प्राणिहस्रोतस्

 प्रवतश्याय & Common Cold

प्रवतश्याय
It is the condition in which Kaphadi Dosha get discharged by Vayu through
the nasal route.

 वनदान
धू म, शीि, संक्रमण, रिास् सेिन

 लक्षण
नात्रसके स्राििे , लाला प्रसि, कास, श्वास, दु बशल्य, मनसंिाप

 भेद
i) िािि
ii) त्रपत्ति
iii) कफि
iv) सत्रन्नपािि

 विवित्सा
▪ अपक्व प्रत्रिश्याय - दोष पाचन त्रचत्रकत्सा
▪ पक्व प्रत्रिश्याय - दोष त्रनहश रण त्रचत्रकत्सा

▪ नि प्रत्रिश्याय - मृत्युञ्जय रस, शृङ्यात्रद चू णश

▪ िीणश प्रत्रिश्याय - लक्ष्मीत्रिलास रस, पञ्चकोल चू णश
▪ दु ष्ट प्रत्रिश्याय - मकरध्वि ित्रट, अमृ ि सत्त्व, प्रिाल भस्म, सीिोफलात्रद चू णश,
च्यािन्प्राश अिले ह

▪ नस्य - अणुिनल, षड् त्रबन्द्दु िन ल, प्रधमन नस्य त्रिफला त्रिकटु चू णश

▪ योग - बालचिु भशर्द् चू णश, त्रचिक हरीिकी, अगस्त्य हरीिकी, सुरसात्रद क्वाथ, दशमू ल
क्वाथ
Common Cold
- It is a viral infection of the nose and throat (upper respiratory tract).
- Children younger than 6 are at greatest risk of colds.
- Most people recover from a common cold in a week or 10 days. Symptoms might
last longer in people who smoke.

 Causes:
- Many types of viruses can cause a common cold, rhinoviruses are the most
common.
- Droplet infection
- It also spreads by hand-to-hand contact with someone who has a cold or by
sharing contaminated objects; touching the eyes, nose or mouth after such
contact or exposure, likely leads to a cold.

 Risk factors:
- Age. Children younger than 6 are at greatest risk of colds, especially if they
spend time in child-care settings.
- Weakened immune system. Having a chronic illness or otherwise weakened
immune system.
- Time of year. Both children and adults are more susceptible to colds in fall
and winter.
- Smoking.

 Symptoms:
Symptoms usually appear one to three days after exposure to a cold-causing
virus. Signs and symptoms can vary from person to person:
Sneezing, Runny or stuffy nose, Sore throat, Cough, Congestion, Slight body
aches or a mild headache, Low-grade fever, Malaise

 Complications:
- Acute ear infection (otitis media). This occurs when bacteria or viruses enter
the space behind the eardrum. Typical signs and symptoms include earaches
and, in some cases, a green or yellow discharge from the nose or the return of
a fever following a common cold.
- Asthma. A cold can trigger an asthma attack.
- Acute sinusitis. In adults or children, a common cold that doesn't resolve can
lead to inflammation and infection of the sinuses (sinusitis).
- Other secondary infections. These include strep throat (streptococcal
pharyngitis), pneumonia, and croup or bronchiolitis in children.

 Treatment:
There's no cure for the common cold. Symptomatic treatment is adopted:
- Analgesics & Anti-pyretics (e.g.: Acetaminophen, Ibuprofen)
- Decongestant nasal sprays
- Cough syrups
 िास & Cough

िास
It is the condition in which Vata Dosha is forcefully expelled out from the mouth.

 वनदान
- रिसा धू मिाि
- शीिस्थान, शीिाम्बुसेिन
- रुक्षान्न त्रिषमान्न सेिन, मां स सेिन, िीक्ष्ण कटु क्षार आहार सेिन, अिीणश
- व्यायाम, मन थुन, िेगधारण, त्रदिास्वप्न, रात्रििागरण
- अपिपशण उपर्द्ि, पञ्चकमश उपर्द्ि
- भय, शोक, क्रोध, काम

 सम्प्राम्हि
त्रनदान सेिन -> अपान िायु प्रकोप -> प्राण & उदान िायु प्रकोप -> उदान िायु
त्रिमागशगमन -> प्राण & उदान िायु दु त्रष्ट -> कास

 पूिमरूप
कण्ठे कण्डू, भोज्यानामिरोध, अरोचक, स्वरभे द, अत्रिसाद

 लक्षण
कास, उर कण्ठ नास कणश त्रशरो िेदना, कण्ठे कण्डू, भोज्यानामिरोध, अरोचक, स्वरभे द

 उपद्रि
हृर्द्ोग, श्वास, छत्रदश, पीनस, पाश्वशशूल, राियक्ष्म, त्रहक्का, गुदभ्रं श, योत्रनभ्रं श

 भेद
i) िािि
ii) त्रपत्ति
iii) कफि
iv) क्षिि
v) क्षयि

 उपिार
- त्रिश्रम
- त्रनदान पररििशन
- दीपन, ले हन, घृि, क्षीरपाक, धू मपान
Cough / Tussis
- It is a voluntary or involuntary act that clears the throat and breathing passage of
foreign particles, microbes, irritants, fluids, and mucus; it is a rapid expulsion of air
from the lungs.
- Coughing can be done deliberately or as part of a reflex. Although coughing can be a
sign of a serious illness, more often, it will clear up on its own without the need for
medical attention.

 Causes:
a) Acute (short-term) cough
In most cases, the infection is in the upper respiratory tract and affects the
throat, this is known as a URTI or URI (upper respiratory tract infection).
- Influenza
- Common cold
- Laryngitis

If it is an LRTI (lower respiratory tract infection), the lungs are infected, and/or
the airways lower down from the windpipe.
- Bronchitits
- Pneumonia

b) Chronic (long-term) cough

- Smoking
- Mucus dripping down the throat from the back of the nose (post nasal drip)
- GERD (gastro-esophageal reflux disease)
- Asthma
- Tuberculosis
- Lung cancer

 Symptoms:
In most cases, there will not be anything serious underlying the cough, but in
rare cases, a long-term cough can be a sign of something that needs treating,
such as lung cancer or heart failure.
Other reasons to seek medical advice include:
- The cough is getting worse.
- There are swelling or lumps present in the neck region.
- Weight loss
- Severe coughing
- Difficulty swallowing
- Permanent changes in the sound of the voice
- Coughing up blood
- Difficulty breathing
- Chest pain
- Fevers that are not getting better
 Treatment:
- The best way to treat a cough caused by a viral infection is to let the immune
system deal with it - generally, such coughs clear up on their own.
- Codeine, dextromethorphan, and other cough suppressants are often used by
people with coughs.

- According to the National Health Service (NHS), United Kingdom, a

homemade remedy with honey and lemon is as good, if not better than most
over-the-counter (OTC) products sold in pharmacies.

- Honey coats the throat, resulting in less irritation and possibly less coughing.
Honey is a demulcent (something that soothes).

- Cough suppressants suppress the cough reflex and are generally only
prescribed for a dry cough. Examples include pholcodine, dextromethorphan,
and antihistamines.

- Expectorants help bring up mucus and other material from the trachea,
bronchi, and lungs. An example is guaifenesin (guaiphenesin), which thins the
mucus and also lubricates the irritated respiratory tract, helping to drain the
airways.
 श्वास & Respiratory Distress Syndrome

श्वास
It is the condition in which vitiation of Prana & Udana Vayu causes difficult and
strenuous breathing.

 वनदान
- रिसा धू मिाि
- शीिस्थान, शीिाम्बुसेिन
- व्यायाम, मन थुन, भय, शोक
- रुक्षान्न त्रिषमान्न सेिन, मां स सेिन, अिीणश
- अपिपशण उपर्द्ि, पञ्चकमश उपर्द्ि

 सम्प्राम्हि
त्रनदान सेिन -> आम -> कफ प्रकोप -> प्राणिहस्रोिस् त्रिरोध & दु त्रष्ट -> क्लेदक
कफ प्रकोप -> प्राण & उदान िायु त्रिमागशगमन -> श्वास

 पूिमरूप
आनाह, पाश्वशशूल्, हृदयस्य पीडन, िनरस्य, त्रशरोशूल

 लक्षण
कृच्छ्रश्वासन

 उपद्रि
स्वरभे द, कास, हृर्द्ोग, नेिरोग

 भेद
i) महा श्वास (असाध्य)
ii) ऊध्वश श्वास (असाध्य)
iii) त्रछन्न श्वास (असाध्य)
iv) िमक श्वास (कृच्छ्रसाध्य / याप्य)
v) क्षु र्द् श्वास (सुखसाध्य)

 उपिार
- त्रिश्रम
- त्रनदान पररििशन
- पुराण घृि + लिण ले पन
- श्वासकुटार रस, श्वास त्रचन्तामत्रण रस
- िात्रलसात्रद चू णश
- कण्टकारी अिले ह
- र्द्ाक्षाररष्ट, कनकासि
Respiratory Distress Syndrome (RDS)
- It is a common breathing disorder that affects newborns. RDS occurs most often in
babies born preterm, affecting nearly all newborns who are born before 28 weeks of
pregnancy. Less often, RDS can affect full term newborns.

- RDS is more common in premature newborns because their lungs are not able to
make enough surfactant. Surfactant is a foamy substance that keeps the lungs fully
expanded so that newborns can breathe in air once they are born.
Without enough surfactant, the lungs collapse and the newborn has to work hard to
breathe. He or she might not be able to breathe in enough oxygen to support the
body's organs. Most babies who develop RDS show signs of breathing problems and a
lack of oxygen at birth or within the first few hours that follow. The lack of oxygen
can damage the baby's brain and other organs if not treated promptly.

 Risk factors:
Following factors may increase the risk that your newborn will have RDS:
- Infection
- Premature delivery
- Problems with the baby’s lung development
- Stress during delivery; especially in case of excessive blood loss
- Juvenile diabetes
- Emergency cesarean delivery before the baby is full term.
- Planned cesarean deliveries that occur before a baby's lungs have fully
matured can also increase the risk for RDS.

 Symptoms:
- Grunting sounds
- Rapid, shallow breathing
- Sharp pulling inward of the muscles between the ribs when breathing
- Widening of the nostrils, or flaring, with each breath
- Apnea - the newborn also may have pauses in breathing that last for a few
seconds.

 Complications:
- Many babies who are born with RDS develop bronchopulmonary dysplasia
(BPD). If babies born with RDS still require oxygen therapy by the time they
reach their original due dates, they are diagnosed with BPD.

- Depending on the severity of a newborn's RDS, he or she may develop other

medical problems.
Bleeding in the brain, Blood and blood vessel complications, Bowel disease,
Impaired vision; including blindness, Kidney failure, Lung complications
 Treatment:
- Treatment for RDS usually begins as soon as a newborn is born, sometimes in
the delivery room.

- Surfactant replacement therapy, breathing support from a ventilator or nasal

continuous positive airway pressure (NCPAP) machine.

- Most newborns who show signs of RDS are quickly moved to a neonatal
intensive care unit (NICU). There they receive around-the-clock treatment
from healthcare professionals who specialize in treating premature newborns.

- Surfactant helps keep the lungs open so that a newborn can breathe in air
once he or she is born. Babies who have RDS get surfactant until their lungs
are able to start making the substance on their own. Surfactant is usually given
through a breathing tube. The tube allows the surfactant to go directly into the
baby's lungs.
Once the surfactant is given, the breathing tube is connected to a ventilator, or
the baby may get breathing support from NCPAP.
Surfactant often is given right after birth in the delivery room to try to prevent
or treat RDS. It also may be given several times in the days that follow, until
the baby is able to breathe better.

- Some women are given medicines called corticosteroids during pregnancy.

These medicines can speed up surfactant production and lung development in
a foetus.
 तमि श्वास & Bronchial Asthma

तमि श्वास
- It is the condition in which the individual feels as if sinking in darkness.
- Total obstruction by Kapha Dosha of Pranavaha Srotas along with occlusion of
mouth and nose produces the feeling of darkness. Vata Dosha aggravates by all its
qualities and takes the abnormal upward direction, moving speedily all over the
Pranavaha Srotas to form Tamaka Shvasa.

 वनदान
- कुक्कुर कास
- संक्रमण
- श्रम, व्यायाम, साहस
- िािािरण
- क्रोध, भय, मन संिाप

 लक्षण
- कास
- श्वास कष्टिा
- िम प्रिेश अनुभूत्रि
- मू च्छ्ाश
- दु बशलिा

 विवित्सा
- पुराण घृि + लिण ले पन
- श्वासकुटार रस, श्वास त्रचन्तामत्रण रस
- िात्रलसात्रद चू णश
- कण्टकारी अिले ह
- र्द्ाक्षाररष्ट, कनकासि

Bronchial Asthma
- It is a medical condition which causes the airway path of the lungs to swell and
narrow. Due to this swelling, the air path produces excess mucus making it hard to
breathe, which results in coughing, short breath, and wheezing.
- The disease is chronic & curable. Inhalers help overcome asthma attacks. Bronchial
Asthma can affect any age or gender and depends upon environmental and
hereditary factors at large.
- When ignored, the disease proves fatal claiming lives in many cases.
 Causes:
Though the root cause of bronchial asthma is unclear, it occurs largely due to
environmental or genetic factors. Factors that trigger an asthma reaction are:
- Exposure to substances such as pollen, dust, animal fur, sand, and bacteria,
which triggers allergic reactions.
- Viral Infection like cold and flu, or pneumonia
- Air Pollution, smoke, fumes from vehicles, etc.
- Stress and anxiety
- Physical activity or exercise
- Medications like aspirin, Ibuprofen, beta-blockers, etc.
- Acid reflux or gastroesophageal reflux disease (GERD)
- Perfumes and fragrances
- Weather, especially extreme changes in temperature
- Food additives

 Risk factors:
- Family history (parent or sibling) of bronchial asthma.
- Allergic reaction such as atopic dermatitis or hay fever.
- Habits which cause overweight.
- Smoking, or passive smoking.
- Exposure to chemical fumes or pollution, and irritants from hair sprays or
perfumes.

 Symptoms:
The symptoms may vary from individual to individual and depends on
environmental factors. A person may show regular symptoms of the disease or
periodic symptoms that may prompt at a certain time. The most common signs
of asthma are:
- Breathlessness or short breath while talking, laughing, or running.
- Chest pain or tightness.
- Sleep apnea or trouble while sleeping caused by breathlessness.
- Coughing or wheezing
- Cold and flu due to viral infection

 Treatment:
- Anti-inflammatory drugs:
Drugs like corticosteroids (mometasone, flunisolide, etc.) are long-term
medications and need time to reach maximum benefits. In cases of an asthma
attack, oral medications like Accolate and Zyflo can provide relief for the day.
- Inhaled bronchodilators:
They act rapidly to ease symptoms of an attack.
- Ipratropium (Atrovent):
When inhaled, it reacts quickly to relax the bronchi airways, thus restoring
easy breathing. The medicine is used to treat chronic bronchitis and severe
asthma attacks.
 श्वसनि ज्वर / उत्फुल्लीिा & Pneumonia / Pneumonitis / Bronchiolitis

श्वसनि ज्वर / उत्फुल्लीिा

- In Yogaratnakara, श्वसनक ज्वर is called as उत्फुल्लीका.
- It is an infectious disease.
- It is the condition in which Kapha & Vata Dosha cause inflammation of the lower
respiratory tract.

 वनदान
- संक्रमण
- अत्रि कफकर िािकर आहार त्रिहार
- त्रनदानाथश रोग (कास, श्वास, िमक श्वास)

 लक्षण
श्वास, कास, ज्वर, अरुत्रच, पाश्वशशूल, रििीिन, दु बलिा, प्रलाप

 उपद्रि
िीव्रसंिाप, सज्ञानाश, कि

 विवित्सा
- त्रिभु िानकीत्रिश रस
- श्वासकासत्रचन्तामत्रण रस
- कुमारयाणक रस
- बालपञ्चभर्द् रस
- बालचिु भशर्द् चू णश
- त्रपप्पल्यात्रद चू णश
Pneumonia
- It is an infection that inflames the air sacs in one or both lungs. The air sacs may fill
with fluid or pus (purulent material).
- Pneumonia can range in seriousness from mild to life-threatening. It is most serious
for infants and young children, people older than age 65, and people with health
problems or weakened immune systems.
- Children who are 2 years old or younger & people who are age 65 or older are at
higher risk to develop pneumonia.

 Causes:
- Bacteria, Viruses, Fungi
- Hospital-acquired pneumonia
Some people catch pneumonia during a hospital stay for another illness.
Hospital-acquired pneumonia can be serious because the bacteria causing it
may be more resistant to antibiotics and because the people who get it are
already sick.
- Health care-acquired pneumonia
Health care-acquired pneumonia is a bacterial infection that occurs in people
who live in long-term care facilities or who receive care in outpatient clinics.
- Aspiration pneumonia
Aspiration pneumonia occurs by inhalation of food, drink, vomit or saliva into
the lungs.

 Symptoms:
- Shortness of breath
- Cough, which may produce phlegm
- Chest pain while breathing & coughing
- Confusion or changes in mental awareness (in adults age 65 and older)
- Fever, sweating & shaking chills
- Lower than normal body temperature (in adults older than age 65 and people
with weak immune systems)
- Nausea, Vomiting, Diarrhea, Fatigue
- Newborns and infants may not show any sign of the infection. Or they may
vomit, have a fever and cough, appear restless or tired and without energy, or
have difficulty breathing and eating.

 Complications:
- Bacteremia; bacteria that enter the bloodstream from the lungs can spread
the infection to other organs, potentially causing organ failure.
- Fluid accumulation around the lungs (pleural effusion)
- Lung abscess

 Prevention:
Vaccination, Good hygiene, Avoid smoking or secondhand smoking,
Maintenance of the immune system
Pneumonitis
- It is a general term that refers to the inflammation of lung tissue.
- Technically, pneumonia is a type of pneumonitis because the infection causes
inflammation. Pneumonitis, however, is usually used to refer to non-infectious
causes of lung inflammation.

 Causes:
- Pneumonitis occurs when an irritating substance causes the tiny air sacs
(alveoli) in your lungs to become inflamed. This inflammation makes it difficult
for oxygen to pass through the alveoli into the bloodstream.
- Many irritants, ranging from airborne molds to chemotherapy drugs, have
been linked to pneumonitis. But for most people, the specific substance
causing the inflammation is never identified.
- Pneumonitis causes may include:
Drugs. A variety of drugs can cause pneumonitis, including some antibiotics,
several types of chemotherapy drugs and medications that keep the heartbeat
regular. An overdose of aspirin can cause pneumonitis.
Molds and bacteria. Repeated exposure to some molds and bacteria can cause
the lungs to become inflamed.
Birds. Exposure to feathers or bird excrement is a common cause of
pneumonitis.
Radiation treatments. Some people who undergo radiation therapy to the
chest, such as for breast or lung cancer, may develop pneumonitis.
Pneumonitis also can occur after whole-body radiation therapy, which is
needed to prepare a person for a bone marrow transplant.

 Symptoms:
- Shortness of breath
- Dry cough
- Fatigue
- Loss of appetite
- Weight loss

 Complications:
- Irreversible lung damage
- In normal lungs, the air sacs stretch and relax with each breath. Chronic
inflammation of the thin tissue lining each air sac causes scarring and makes
the sacs less flexible. They become stiff like a dried sponge. This is called
pulmonary fibrosis. In severe cases, pulmonary fibrosis can cause right heart
failure, respiratory failure and death.

 Treatment:
- Corticosteroids
- Oxygen therapy
- Bronchodilators
Bronchiolitis
- It is a common lung infection in young children and infants.
- It causes inflammation and congestion in the bronchioles of the lung.
- Bronchiolitis is almost always caused by a virus. Typically, the peak time for
bronchiolitis is during the winter months.

 Causes:
- Viral infection
Respiratory Syncytial Virus (RSV). RSV is a common virus that infects just about
every child by 2 years of age. Outbreaks of RSV infection occur every winter,
and individuals can be reinfected, as previous infection does not appear to
cause lasting immunity.

- Droplet infection
- Touching eyes, nose & mouth after direct contact with objects affected by
the virus.

 Risk factors:
- Bronchiolitis typically affects children under the age of 2 years. Infants
younger than 3 months of age are at greatest risk of getting bronchiolitis
because their lungs and immune systems are not yet fully developed.

- Other factors that are linked with an increased risk of bronchiolitis in infants
and with more-severe cases include:
Premature birth, Underlying heart or lung condition, Depressed immune
system, Exposure to tobacco smoke, Never having been breast-fed, Contact
with multiple children, Crowded environments

 Symptoms:
- Rhinorrhoea
- Nasal congestion
- Cough
- Slight fever (not always present)
- Dyspnoea or wheezing.
- Many infants also develop an ear infection (otitis media).

 Complications:
- Cyanosis, Apnea
- Dehydration
- Low oxygen levels & respiratory failure

 Treatment:
- Symptomatic care; there is no cure for bronchiolitis, so treatment is aimed at
the symptoms.
 गलशोथ & Pharyngitis / Larnygitis

गलशोथ
It is the condition in which vitiated Kapha & Pitta Dosha affects the throat (गल) and
produces inflammation (शोथ).

 वनदान
- अत्रि कफकर त्रपत्तकर आहार त्रिहार सेिन
- संक्रमण
- िायु पररसर मात्रलन्य
- स्तन्यदोष (कफि & त्रपत्ति स्तन्यदोष)

 लक्षण
शोथ, दाह, रुि, ज्वर, िृ ष्णा, श्वास, कास, अन्निे ष

 विवित्सा
- कल्याणक आिले ह + िङ्कन भस्म + मधु
- प्रिाल त्रपत्रष्ट + यशद भस्म + मधु
- प्रत्रिसारण & ग्रहधू म with कटु र्द्व्य
- नस्य - िन ल processed with अपामागश बीि दक्तन्त त्रिडङ्ग सनन्धि लिण
- गन्धक रसायन
- त्रिफला गुग्गुलु

Pharyngitis
It is the inflammation of pharynx.

 Causes:
- Bacterial / Viral infection
- Droplet infection
- Pollution, Secondhand smoking

 Symptoms:
- Sore throat, Hoarseness of voice, Cough
- Odynophagia
- Rhinorrhoea, Itching or watery eyes
- Fever & Headache
- Tender, whitish or yellowish patches in the back of the throat
- Nausea, Vomiting, Stomach pain

 Treatment:
Analgesics, Antipyretics, Antibiotics, NSAID’s
 Laryngitis
- It is the inflammation of larynx.
- The larynx is also known as the ‘voice box’.
- When functioning normally, the vocal cord opens and closes smoothly to produce
the sound for the voice. When the individual has laryngitis, the vocal cord becomes
inflamed, changing the flow of air.

 Causes:
- Viral /Bacterial / Fungal / Parasitic infection
- Pollution
- Common cold
- Asthma
- Secondhand smoking

 Symptoms:
- Dysphagia, Odynophagia
- Dry cough, Fever
- Rhinorrhoea, Dyspnoea
- Sore / Dry throat, Vocal cord weakness

 Treatment:
Analgesics, Antipyretics, Antibiotics, NSAID’s

 तालुिण्ठि / Tonsillitis
- It is the inflammation of the tonsils.
- Tonsils are two oval-shaped pads of tissue at the back of the throat.
- They are part of the immune system.

 Causes:
- Bacterial infection (Streptococcus)
- Viral infection (Epstein barr virus)
- Droplet infection

 Symptoms:
- Sore throat, Hoarsness of voice
- Fever, Cough, Rhinorrhoea
- Yellowish / white patches at the back of the throat
- Halitosis (bad breath)

 Treatment:
- Analgesics, Antipyretics, Antibiotics, NSAID’s
- Tonsillectomy
 अििहस्रोतस्

 अजीणम & Indigestion

अजीणम
It is the disease in which food remains undigested in Amashaya for a prolonged
period of time.

 वनदान
- अत्यम्बुपान, शीिाम्बु
- त्रिषमाशन, अकाले भोिन, अत्रिमाि भोिन
- िेग धारण, त्रदिास्वप्न, रात्रििागरण
- क्रोध, शोक, भय, त्रचन्ता, काम
- स्तन्य दोष, अत्रि स्तन्यपान

 लक्षण
अत्रिमन्द्द्य, त्रशरोरुि, मू च्छ्ाश , भ्रम, िृम्भा, अङ्गमदश , िृ ष्णा, ज्वर, छत्रदश, अरोचक,
उदरगौरि, ग्लात्रन, मारुिमू ढिा, त्रिबन्ध

 भेद
i) आमािीणश
ii) त्रिदग्धािीणश
iii) त्रिष्टब्धािीणश
iv) रसशेषािीणश
v) त्रदनपाकािीणश

 विवित्सा
- उष्णोदक, िमन
- लघुभोिन, लङ्घन
- दीपन पाचन चू णश
- लिण भास्कर चू णश, महाशंख चू णश, त्रहङ्गु चू णश, शुण्ठी चू णश
- अकश ित्रट, त्रहङ्िात्रद ित्रट, बालसञ्जीित्रन ित्रट
- बालचिु भशर्द् रस
Indigestion / Dyspepsia
- It is a general term that describes discomfort in the upper abdomen. Indigestion is
considered as a disease, but rather as a symptom.
- Indigestion can be a symptom of another digestive disease. Indigestion that isn't
caused by an underlying disease may be eased with lifestyle changes and medication.

 Causes:
Indigestion has many possible causes. Often, indigestion is related to the
lifestyle and may be triggered by food, drink or medication. Common causes of
indigestion include:
- Overeating or eating too quickly
- Fatty, greasy or spicy foods
- Too much caffeine, alcohol, chocolate or carbonated beverages
- Smoking
- Anxiety
- Certain antibiotics, pain relievers and iron supplements

Sometimes indigestion is caused by other digestive conditions, including:

- Inflammation of the stomach (gastritis)
- Peptic ulcers
- Celiac disease
- Gallstones
- Constipation
- Pancreatitis
- Stomach cancer
- Intestinal blockage

 Symptoms:
- Early fullness during a meal
- Uncomfortable fullness after a meal
- Discomfort in the upper abdomen
- Burning in the upper abdomen
- Bloating in the upper abdomen
- Nausea

 Treatment:
- Avoiding foods that trigger indigestion
- Eating five or six small meals a day instead of three large meals
- Reducing or eliminating the use of alcohol and caffeine
- Avoiding certain pain relievers, such as aspirin, ibuprofen and naproxen
sodium
- Controlling stress and anxiety
 अवतसार & Diarrhoea

अवतसार
- It is the frequent elminiation of loose watery stool through the downward passage.
- It is a very acute condition which affects the body quickly.

 वनदान
स्तन्य दोष, ग्रह, संक्रमण, अत्रिभोिन, त्रिषम आहार, कृत्रम

 पूिमरूप
त्रिबन्ध, आनाह, हृद् नात्रभ पाश्वश रुि, अिीणश, दु बशल्य

 लक्षण
अत्रिर्द्ि मल प्रिृत्रत्त, उदरशूल, श्रम, श्वास, रूक्षिा, रसधािु क्षय लक्षण

 सम्प्राम्हि
त्रनदान सेिन -> िाि दोष प्रकोप -> कोिे आप धािु संचय -> अत्रिमन्द्द्य -> पुरीष
त्रनमाश न दु त्रष्ट -> अत्रिसार

 भेद
i) िािि
ii) त्रपत्ति
iii) कफि
iv) सत्रन्नपात्रिक
v) आगन्तु ि

 विवित्सा
- बालचिु भशर्द्
- अिसी चू णश + मधु
- त्रपप्पली + मत्रञ्जि + मधु
- िात्रिफल चू णश + मधु
- िीरक चू णश + िक्र
- शुण्ठी चू णश + िक्र
- लक्ष्मीनारायण रस
- कुटिाररष्ट
- त्रबल्वाररष्ट
- त्रबल्वािले ह
- सिाश ङ्गसुन्दर रस
Diarrhoea
- It is the frequent passage of loose, fluid undigested stool.
- The definition of diarrhoea is passing loose or watery bowel movements 3 or more
times in a day (or more frequently than usual).
- Diarrhoea occurs when the lining of the intestine is unable to absorb fluid, or it
actively secretes fluid.

 Causes:
Diarrhoea may have many different causes, including the following:
- Infection with a virus, bacteria or parasite. Infectious diarrhoea is most
commonly caused by viruses passed from person to person, or by consuming
food or water contaminated with viruses, bacteria, parasites.
- Change of diet
- Food intolerance
- Drinking excess alcohol
- Bowel conditions such as inflammatory bowel disease
- Malabsorption
- Some medicines can cause diarrhoea as a side effect.

 Symptoms:
In addition to frequent, watery bowel movements, the stool may also contain
mucus, pus, blood or excessive amounts of fat.
Diarrhoea can be accompanied by:
- Painful abdominal cramps, Nausea, Fever, Bloating, Generalised weakness

Diarrhoea can cause dehydration, especially in young children and older

people. Symptoms of dehydration in adults can include:
- Thirst, Lack of energy, Passing less urine than normal, Dizziness or light-
headedness, Decreased skin turgor

 Treatment:
- Many cases of diarrhoea are self-limiting and do not need specific treatment.
However, it is important in any case of diarrhoea to stay hydrated by drinking
plenty of liquids.
- Water - However, if dehydration is severe, water alone is inadequate.
- Oral rehydration fluids contain not only the water replacement, but also
important electrolytes that must be replaced. Available products include
Gastrolyte, Hydralyte, Pedialyte and Repalyte.
- Diluted soft drink or juice (1 part juice or soft drink to 5 parts water).
(Do not drink undiluted lemonade or other undiluted soft drinks, as the high
glucose content may draw fluid into the gut, causing more diarrhoea.)
 छवदम & Vomiting

छवदम
- It is the elimination of aggravated Doshas through the mouth which creates pain in
the body.
- It is also known as ित्रम, िमन, िमथु , त्रनिीिन.

 वनदान
नििािा त्रशशु त्रनदान
गभोदक पान, संक्रमण, प्रसिकाल रि पान, क्षीरलसक, स्तन्यदु त्रष्ट

बालािस्था त्रनदान
अत्रिभोिन, ग्रह, स्तन्य दोष, अकाले भोिन, अत्रिमाि भोिन, त्रिरुद्ध आहार,
अत्रिर्द्ित्रिग्ध लिण आहार, अत्रिव्यायाम, कृत्रम, अन्निहस्रोिस् अिरोध, आम, त्रिष्टाथश

 सम्प्राम्हि
त्रनदान सेिन -> उदान & व्यान िायु प्रकोप -> कफ त्रपत्त प्रकोप -> कफ त्रपत्त
ऊध्वश गत्रि -> छत्रदश

 पूिमरूप
ह्रल्लास, उद्गार, प्रसेक, अन्निे ष, िालु ओष्ट मु ख शुष्किा, दाह, अत्रिरोदन

 लक्षण
छत्रदश + पूिशरूप

 भेद
i) िािि
ii) त्रपत्ति
iii) कफि
iv) सत्रन्नपात्रिक
v) त्रदष्टाथश ि

 विवित्सा
- छत्रदशत्रनग्रहण र्द्व्य
- कण्टकारर + फलस्वरस + पञ्चकोल चू णश + मधु + घृि
- त्रपप्पली + मररच + शकशरा + त्रनम्बुस्वरस
- बालाकश रस, एलात्रद चू णश, पञ्चकोल चू णश, कटु त्रक चू णश
Vomiting / Emesis
- It is the forceful expulsion of gastric or intestinal contents through the mouth along
with increased intra-abdominal pressure.
- It is most commonly a symptom of an underlying disease or may be a side effect of
a therapy or medications.

 Causes:
Food poisoning, Infections, Pneumonia, Bowel obstruction, Chemotherapy,
Radiation therapy, Over eating, Irritation of throat, Lactose intolerance,
Hepatitis, etc.

Medical attention should be provided if nausea and vomiting are accompanied

by other warning signs, such as:
Chest pain, Severe abdominal pain or cramping, Blurred vision, Confusion,
High fever and stiff neck, Fecal material or fecal odor in the vomit, Rectal
bleeding, Severe headache, Dehydration - excessive thirst, dry mouth,
infrequent urination, dark-colored urine and weakness, or dizziness or
lightheadedness upon standing, Vomit with blood

 Treatment:
- Anti-emetic drugs
- Intake of large amount of clear liquids
- Rehydration
- Oral Rehydration Salts (ORS)
- IV fluids
 विबन्ध & Constipation

विबन्ध
- It is the condition in which hard and dry stool is passed only with difficulty or
infrequently; commonly occurring due to vitiation of Vata Dosha.
- It is also known as मलबद्धिा, कोिबद्धिा, मलािरोध.

 वनदान
- अल्पमाि िलपान दु ग्धपान, अत्रिमाि आहार, रूक्ष शीि आहार, त्रिरुद्धाहार
- भय, क्रोध, शोक, मन संिाप

 लक्षण
मलबद्धिा, क्लम, अरुत्रच, आनाह, अशश, शूल, आलस्य, त्रशरोरुि

 विवित्सा
- त्रनदान पररििशन, अनुलोमन र्द्व्य, िेहन, स्वे दन, बक्तस्त, गुदित्रिश
- एरण्ड िेहपान, त्रिफला चू णश, त्रििृि् चू णश
- व्यायाम

Constipation
- It is the condition in which stool is passed only with difficulty or infrequently.
- It is generally described as having less than three bowel movements a week.

 Causes:
- Withholding or ignoring the urge of defecation
- Change of diet; insufficient fibres, insufficient fluid intake
- Medication (especially antidepressants)
- Metabolic or digestive disorders
- Stress, anger, fear, etc.

 Symptoms:
- Less than 3 bowel movements a week
- Stool which is dry, hard & difficult to pass
- Pain while defeciation, Unsatisfactory evacuation of feaces
- Abdominal pain, abdominal distension, bloating, flatus

 Complications:
- Anal fissure
- Rectal prolapse

 Treatment:
- Laxatives, Suppositories, Enema, Exercise
- Increase intake of water & dietary fibres
 मु खपाि & Stomatitis

मु खपाि
- It is the condition in vitiated Dosha causes Vrana inside the mouth.
- According to A. Sushruta, it is the disease which causes Vrana inside the whole oral
cavitiy and is therefore called सिशसर.

 वनदान
- संक्रमण, ग्रह
- दू त्रषि अन्नपान
- दू त्रषि स्तन्यपान

 भेद
i) िािि
ii) त्रपत्ति
iii) कफि

 लक्षण
िोद, अत्रिलालास्राि, अत्रिरोदन, अरुत्रच, स्तन्यिे ष

i) िािि अरुण िणश, पीड

ii) त्रपत्ति लालिणश, दाह
iii) कफि श्वेि िणश, कण्डू, अल्पिेदना, शोफ

 विवित्सा
- मधु युि प्रक्षालन
- त्रिफला / पाठा / र्द्ाक्षा / िात्रि / मृ त्रिका / लोध्र / यत्रष्टमधु क्वाथ – पानाथश / गण्डूषाथश /
किलाथश
- आम्र चू णश + लोहभस्म + गनररक + मधु + रसाञ्जन - लेपन
- त्रसद्ध घृि / िनल – किलाथश
- पौत्रष्टक आहार
Stomatitis
It is an inflammation and soreness of mouth or lips which is affecting the mucous
membrane with or without ulceration.

 Causes:
- Lack of immunity
- Emotional stress
- Deficiency of iron, folic acid or vitamin B12
- Food allergies
- Herpes virus type 1

 Symptoms:
- Pain & discomfort in affected area
- Open sore / ulcer
- Fever
- Blisters
- Swollen gums
- Difficulty in swallowing
- Foul smell

 Treatment:
- Analgesics like Tylenol / Ibuprofen
- Gargling with cool water
- Rinsing with salt water
- Topical anesthetics like Lidocaine / Xylocaine
- Topical corticosteroid like Triamcinolone
- Lidex Gel, Aphthasol anti-inflammatory paste, Peridex mouth wash
- Supplementation of Vitamin B12, Folic acid, Iron
 गुदपाि & Proctitis

गुदपाि
It is the condition in which vitiated Pitta and Vata Dosha causes Vrana in
Gudapradesha.

 वनदान
- अत्रि त्रपत्तकर िािक आहार
- त्रिषम आहार
- मत्रलन िस्त्र धारण
- अशौच

 लक्षण
िेदना, दाह, अत्रिरोदन

 विवित्सा
- रसाञ्जन + उदक - पानाथश & ले पनाथश
- शंखभस्म + यत्रष्टमधु + रसाञ्जन चू णश - ले पनाथश
- रसाञ्जन + िीरक चू णश + िात्रिपि -> स्वरस + अिदु ग्ध - पानथश

Proctitis
It is the inflammed lining of the tissue of the inner rectum.

 Causes:
- Irritable Bowel Syndrome (IBS)
- Anal trauma
- Infection (salmonella, shigella)

 Symptoms:
- Pain in rectum, anus, abdomen
- Bleeding from rectum
- Passing of rectal mucosa
- Loose stool / Water diarrhoea

 Treatment:
- Anti-inflammatory drugs
- Antibiotics
- Antifungal drugs
 पररिवतम िा & Anal Fissure

पररिवतम िा
- It is the condition in which there is severe pain in Gudapradesha.
- It is also known as गुद त्रिकार, गुद चीर, क्षि गुद.

 वनदान
- त्रिबन्ध, अत्रिसार
- कृत्रम, क्षि
- अत्रधक शौच
- अत्रिसार, बक्तस्त, त्रिरे चन उपर्द्ि

 लक्षण
- िीव्रशूल, रोदन, अरुत्रच, ज्वर
- गुद नात्रभ मे ढर बक्तस्त त्रशर प्रदे श दाह

 विवित्सा
- अत्रिसार त्रिबन्ध त्रचत्रकत्सा
- मृ दु त्रिरे चन, दीपन
- िात्रि घृि
- अभयाररष्ट
- गुग्गुलासि

Anal Fissure
- It is a painful linear ulcer at the margin of the anus.
- It appears as a crack / slit in the mucous membrane of the anus.

 Causes:
- Constipation
- Mucous spasm

 Symptoms:
Severe pain, Itching, Bleeding, Pus discharge

 Diagnosis:
Physical examination, Rectal examination, Colonoscopy, X-ray abdomen

 Treatment:
- Laxatives to soften the stool, Diatery fibres
- NSAID’s
- Steroid ointment
- Surgery; Sphincterectomy, Dilatation, Fissurectomy
 उदरशूल & Infantile Colic

उदरशू ल
Vitiated Dosha enter in कौमार उदर and cause उदरशूल.

 वनदान
- दु ष्टस्तन्य पान
- अत्रहि आहार त्रिहार
- संक्रमण

 लक्षण
- स्तन्यिे ष
- त्रचत्त चञ्चलिा
- अत्रिरोदन
- उदर स्तब्धिा

 विवित्सा
- मात्रणक्य रसात्रद ित्रट
- सनन्धि लिण + भारत्रङ्ग चू णश + उष्णोदक
- एलात्रद ित्रट
- मात्रदफल रसायन
Infantile Colic
- It is severe abdominal pain, often caused by spasm / obstruction / distension of
hollow viscera.
- It is defined as episodes of crying for more than three hours a day, for more than
three days a week, for three weeks in an otherwise healthy child. Often crying occurs
in the evening.

 Causes:
The cause of colic is unknown. It may result from numerous contributing
factors. Possible contributing factors that have been explored include:
- Digestive system that isn't fully developed
- Imbalance of healthy bacteria in the digestive tract
- Food allergies or intolerances
- Overfeeding, underfeeding or infrequent burping
- Early form of childhood migraine
- Family stress or anxiety

 Symptoms:
- Intense crying that may seem more like screaming or an expression of pain
- Crying for no apparent reason, unlike crying to express hunger or the need
for a diaper change
- Extreme fussiness even after crying has diminished
- Predictable timing, with episodes often occurring in the evening
- Facial discoloring, such as reddening of the face or paler skin around the
mouth
- Bodily tension, such as pulled up or stiffened legs, stiffened arms, clenched
fists, arched back, or tense abdomen
- Aversion for feeding & food
- Vomiting (Red flag sign; yellowish / bloody)

 Treatment:
- Dicyclomine drugs
- Antiemetic drugs
- Antispasmodic drugs
- Oral Rehydration Salts (ORS)
- Dietary changes
 प्रिावहिा & Dysentry

प्रिावहिा
It is the condition in which vitiated Vata and Kapha Dosha cause disturbance in
formation of Mala, which will only be expelled by laberous effort and with pain.

 वनदान
- अत्रहि आहार त्रिहार
- िाि कफ दधश क आहार त्रिहार
- अत्रि उष्ण िीक्ष्ण आहार त्रिहार
- स्तन्य दोष
- संक्रमण
- अत्रि त्रिल त्रपष्टान्न सेिन

 सम्प्राम्हि
त्रनदान सेिन -> िाि कफ प्रकोप -> अत्रिमन्द्द्य -> अन्त्र दु त्रष्ट -> प्रिात्रहका

 लक्षण
- अल्प माि मल
- अत्रिकफ त्रमत्रश्रि मल
- रि त्रमत्रश्रि मल
- शूल, आनाह, अरुत्रच, दु बशल्य

 विवित्सा
- बालित्रट 1-2 vati with Stanya
- बालचिु भशर्द् 2 ratti with Madhu / Stanya
- बालाकश रस 1 vati with Madhu / Stanya
- बालरोगान्तक रस 1 vati with Madhu / Stanya
Dysentery
It is an intenstinal inflammation affecting mainly the colon.

 Types: - 2
i) Bacillary dysentery (Shigella / Salmonella bacterium)
ii) Amoebic dysentery (Entemeba histolytica)

 Causes:
- Poor hygiene
- Contaminated food
- Contaminated water and other drinks
- Poor hand washing by infected people
- Swimming in contaminated water, such as lakes or pools
- Physical contact

 Symptoms:
- Severe diarrhea with (3 to 7 days)
- Abdominal cramps or pain
- Nausea, Vomiting
- Fever (38°C or higher)
- Dehydration, which can become life-threatening if left untreated
- Weight loss
- Fatigue

 Treatment:
- Antispasmodic drugs
- Antibiotics like Ciprofloxacin, Ofloxocin
- Oral Rehydration Salts
- Prebiotic sachet
- IV fluids
- Metranidazole injection
 गुदभ्रं श & Rectal Prolapse

गुदभ्रं श
It is the condition in which गुदप्रदे श comes out.

 वनदान
रूक्ष दु बशल रोगी - अत्रिसार / प्रिात्रहका

 लक्षण
- गुदन्नगशच्छ्त्रि
- अत्रि रोदन
- अत्रिसार / प्रिात्रहका / त्रिबन्ध

 विवित्सा
- िेहन, स्वे दन
- गोफणाबन्धान
- बृहत्पञ्चमू ल + दु ग्ध + िन ल + िािघ्न र्द्व्य - ले पनाथश & पानाथश
- पञ्चकोल

Rectal Prolapse
It is the protrusion of either the rectal mucosa or the entire wall of rectum.

 Causes:
- Diarrhoea
- Constipation
- Rectal parasites
- Neuromuscular pelvic disorders
- Myelomeningocele
- Anorectal malformation
- Cystic fibrosis
- Rectal polyps

 Types: - 3
i) Type 1: False prolapse - it involves only part of the rectal mucosa, usually
accompanied with hemorrhoids.
ii) Type 2: Incomplete rectal prolapse - it involves only the rectal mucosa.
iii) Type 3: Complete rectal prolapse - it involves all layers of the rectal wall.

 Treatment:
- Treatment of diarrhoea / constipation; mild rectal prolapse usually resolves
when stoll returns to normal condition.
- Suppositories, Enemas, Bulking agents, Stool softeners
- Surgery is needed in case of necrosis
 आमिात ज्वर / Rheumatic Fever
- It is an inflammatory disease that can develop when strep throat or scarlet fever
isn't properly treated. Strep throat and scarlet fever are caused by an infection with
streptococcus bacteria.
- Rheumatic fever most often affects children who are between 5 and 15 years old.

 Causes:
- Rheumatic fever can occur after a throat infection from a bacteria called
group A streptococcus.
- The strep bacteria contain a protein similar to one found in certain tissues of
the body. The body's immune system, which normally targets infection-causing
bacteria, attacks its own tissue, particularly tissues of the heart, joints, skin and
central nervous system. This immune system reaction results in swelling of the
tissues (inflammation).

 Symptoms:
The onset of rheumatic fever usually occurs about two to four weeks after a
strep throat infection. Symptoms may include:
- Fever, Painful and tender joints - most often in the knees, ankles, elbows and
wrists, Pain in one joint that migrates to another joint, Red, hot or swollen
joints, Small, painless bumps beneath the skin, Chest pain, Heart murmur,
Fatigue, Flat or slightly raised, painless rash with a ragged edge, Jerky,
uncontrollable body movements (Sydenham chorea) - most often in the hands,
feet and face, Outbursts of unusual behavior, such as crying or inappropriate
laughing, that accompanies Sydenham chorea

 Complications:
Inflammation caused by rheumatic fever can last a few weeks to several
months. In some cases, the inflammation causes long-term complications.
Rheumatic fever can cause permanent damage to the heart (rheumatic heart
disease). It usually occurs 10 to 20 years after the original illness, but severe
cases of rheumatic fever can cause damage to the heart valves while the child
still has symptoms. Problems are most common with the valve between the
two left chambers of the heart (mitral valve).
- Narrowing of the valve. This decreases blood flow.
- Leak in the valve. A leaky valve causes blood to flow in the wrong direction.
- Damage to heart muscle. The inflammation associated with rheumatic fever
can weaken the heart muscle, affecting its ability to pump.

 Treatment:
- The goals of treatment for rheumatic fever are to destroy remaining group A
streptococcal bacteria, relieve symptoms, control inflammation and prevent
the condition from returning.
Antibiotics, Anti-inflammatory treatment, Anticonvulsant medications
रसिहस्रोतस्

 ज्वर & Fever

ज्वर
"ज्वरप्रत्याक्तत्मकं त्रलङ्गं सन्तापो दे हमानसः ।" (च - त्रच - ३ / ३१)
The cardinal feature of Jvara is increased body temperature & irritation / anguish of
the mind.

 पयाम य
- व्यात्रध
- आिङ्क
- त्रिकार

 वनदान
- अत्रहिकर आहार त्रिहार
- गुरु शीि त्रिग्ध आहार
- अत्रधक चङ्क्रमण
- स्तन्य दोष
- संक्रमण
- अिीणश
- दन्तोद्भि काल
- ऋिु सक्तन्ध

 सम्प्राम्हि
त्रनदान -> िाि त्रपत्त कफ प्रकोप -> आमाशय & ग्रहणी स्थान संचय -> अत्रिमन्द्द्य ->
पाचक त्रपत्त दु त्रष्ट -> आहारस िनषम्य -> सिशशरीर -> रसधिु दु त्रष्ट -> स्वे दिह स्रोिस्
अिरोध -> संिाप -> ज्वर

 पूिमरूप
- क्लम, त्रििणशिा, िनरस्य
- िृम्भा (िािि)
- अत्रक्षदाह (त्रपत्ति)
- अरुत्रच (कफि)

 लक्षण
- संिाप
- अरुत्रच, िृ ष्णा, रोदन, स्तन्य िे ष, आहार िे ष, दु बशल्य, अङ्गसाद
 भेद
i) िािि
ii) त्रपत्ति
iii) कफि
iv) िाि-त्रपत्ति
v) िाि-कफि
vi) त्रपत्त-कफि
vii) सत्रन्नपात्रिक
viii) आगन्तु ि a) अत्रभगािि (due to external injury)
b) अत्रभषङ्गि (कामि, भयि, शोकि, क्रोधि, त्रिषि,
भू िात्रभषङ्गि)
c) अत्रभचारि (due to black magic, hatred or rivelry of
other people)
d) अत्रभशापि (due to curse)

 विवित्सा
- बालचिु भशर्द् रस + िु लत्रस स्वरस / मधु
- बालाकश रस
- बाल ज्वराङ्कुश रस
- बाल रोगान्तक रस
- बाल सञ्जीित्रन ित्रट
- कटु त्रक चू णश + मधु
Fever / Pyrexia
It is defined as having a temperature above the normal range.

 Symptoms:
- Increased body temperature above the normal range
- Sweating, Chills, Shivering, Headache, Muscle pain, Loss of appetite,
Irritability, Dehydration, General weakness

 Types:
i) Continuous fever
ii) Intermittent fever

i) Continuous fever:
Temperature remains above normal throughout the day and does not flactute
more than 1°C in 24 hours.
E.g.: Lobar Pneumonia, Typhoid, Meningitis, UTI

ii) Intermittent fever:

The temperature elevation is present for a certain period after which it returns
back to normal.

a) Quotidian fever
Duration of fever = 24 hours
E.g.: Plasmodium falciparum / Plasmodium knowlesi malaria

b) Tertian fever
Duration of fever = 48 hours
E.g.: Plasmodium vivax / Plasmodium ovale malaria
c) Quartian fever
Duration of fever = 72 hours
E.g.: Plasmodium malariae malaria

d) Remittent fever
Temperature remains above normal throughout the day and fluctuates
more than 1°C.
E.g.: Infective endocarditis, Brucellosis
 Treatment:
- Antipyretics
- Antibiotics
- IV fluid
- Maintenance of hygiene
- Adequate resting

 Hyperpyrexia:
Hyperpyrexia is a fever with an extreme elevation of body temperature –
greater than 106.7°F / 41.5°C.
It is considered as a medical emergency as it may indicate a serious underlying
condition or lead to significant complications.

 Hyperthermia:
Hyperthermia is an example of a high body temperature that is not a fever.
It may occure due to several reasons such as heartstroke, neuroleptic
malignant syndrome, malignant hyperthermia, cocaine, etc.
 पाण्डु & Anemia

पाण्डु
It is the condition in which the body and colour of the skin becomes pale.

 वनदान
"क्षाराम्ललिणात्यु ष्णत्रिरुद्धासात्म्यभोिनाि् ।
त्रनष्पािमाषपुर्ण्ाकत्रिलिन लत्रनषेिणाि ॥
त्रिदग्धे ऽन्ने त्रदिास्वप्नाद्व्यायामान्मन थुनात्तथा।
प्रत्रिकमश िुशिनषम्यािे गानां च त्रिधारणाि् ॥
कामत्रचन्ताभयक्रोधशोकोहिचेिसः ।" (च - सू - १६ / ७-९)

 सम्प्राम्हि
त्रनदान सेिन -> त्रपत्त दोष प्रकोप -> हृदयस्थान -> रसधािु दु त्रष्ट -> रिधािु दु त्रष्ट ->
पाण्डु

 पूिमरूप
हृदयस्पन्दन, त्वक् रूक्षत्वा, श्रम, मृ द्भक्षण, त्रपपास, अरुत्रच, ह्रल्लास, दाह, अङ्गगौरि

 लक्षण
- पाण्दु त्व, श्वेििणश नख अक्ष मु ख ओि िालु
- ओिोक्षय, दु बशल्य, रि & मे द क्षय, अरुत्रच, त्रनसार, श्वास, नात्रभ प्रदे श शोथ, अत्रिसाद

 भेद
i) िािि
ii) त्रपत्ति
iii) कफि
iv) सत्रन्नपात्रिक
v) मृ द्भक्षणिन्य

 विवित्सा
- बालचिु भशर्द् रस
- मण्डूर भस्म
- पुननशिा मण्डूर
- सप्तामृ ि ले ह
- लोह आसि
Anemia
- It is the decrease of total amount of RBC or Hb in the body.
- It can also be defined as a lowedered ability of the blood to carry oxygen.

 Causes:
- Decrease in RBC production: Vitamin B12 / Iron / Folic acid deficiency,
Renal failure, Bone marrow disease

- Increase in RBC destruction: Jaundice, Genetic disorders, Stress

- Vitiated RBC / Hb: Thalassemia, Sickle cell anemia

- Blood loss: Trauma, Surgery, GI bleeding

 Symptoms & Complications:

- Pallor, Weakness, Fatigue, Malaise, Poor concentration, Dyspnoea, Dizziness
- Splenomegaly, Angina, Palpitations, Jaundice, Tachycardia, Heart failure
- Repeated stomatitis may be due to folic acid deficiency.
- Angular stomatitis may be due to iron deficiency.

 Classification of anemia:
i) Iron deficiency anemia:
It is caused due to insufficient dietary intake or absorption of iron.
Infants, toddlers and pregnant women have higher requirement of iron and
are therefore easier prone to develop iron deficiency anemia.
It may cause angular stomatitis.

ii) Megaloblastic anemia:

It is due to either Vitamin B12 or Folic acid deficiency, or both. Deficiencymay
occure due to inadequate intake or insufficient absorption.
 iii) Pernicious anemia:
It is caused by a lack of intrinsic factor which is required to absorb Vitamin B12.
Lack of intrinsic factor may be due to an automminue disease which targets
the intrinsic factor directly or the parietal cells that produce instrinsic factor.

iv) Macrocytic anemia:

It can be caused by removal of the functional portion fo the stomach, such as
during gastric bypass surgery, leading to reduced Vitamin B12 absorption.
Other causes may be hypothyroidism or alcoholism.

v) Normocytic anemia:
It occurs when the overall Hb level is decreased, but the RBC size (Mean
Corpuscular Hemoglobin - MCH) remains normal.

vi) Aplastic anemia:

It is an autoimmune disease in which the bone marrow is affected and the
body fails to produce blood cells in sufficient numbers. Blood cells are
produced in the bone marrow by stem cells. Aplastic anemia causes a
deficiency of all blood cell types: red blood cells, white blood cells, and
platelets.

vii) Hemolytic anemia:

It is anemia due to hemolysis, the abnormal breakdown of red blood cells
(RBCs), either in the blood vessels (intravascular hemolysis) or elsewhere in
the human body (extravascular, usually in the spleen).

viii) Sickle cell anemia:

RBC with normal Hb can easier be transported through the blood stream due
to rounded shape & flexibility. In sickle cell anemia, RBC are sickle shaped,
sticky and more stiff. Due to decreased flow of blood, oxygen supply decreases
as well which results in anemia.

 Investigations: Blood smear examination, Serum iron level, Hb test, Bone

marrow aspiration and biopsy

 Treatment:
- Treatment depends on the causative factor.
- Iron drops for infants; Liquids / Tablets for older children
- Vitamin B12 & Folic acid supplementation
- Blood transfusion
- Medicine for infections
- Medicine for bone marrow stimulation
 मृ द्भक्षणजन्य पाण्डु & Pica

मृ द्भक्षणजन्य पाण्डु
It is one typed of पाण्डु which is specifically caused due to consumption of मृ त्रत्तका
(mud / soil / clay / earth).

 लक्षण
- िनिर्ण्श
- दु बशल्य
- इक्तन्द्रयदु बशल्य
- ओिोक्षय
- अत्रिमन्द्द्य
- कृत्रम

 सम्प्राम्हि
मृ त्रत्तका भक्षण -> आहाररस दु त्रष्ट -> स्रोिो त्रिरोध -> धािु पोषण अभाि ->
इक्तन्द्रय-बल-िणश नाश, अत्रिमन्द्द्य, ओिोक्षय -> रि-मां स-त्वक् दु त्रष्ट ->
मृ द्भक्षणिन्य पाण्डु

a) कषाय मृ त्रत्तका -> िाि प्रकोप

b) क्षार मृ त्रत्तका -> त्रपत्त प्रकोप
c) मधु र मृ त्रत्तका -> कफप्रकोप

 विवित्सा
- त्रनदान पररििशन
- त्रसद्धघृि - पाठ, त्रिडङ्ग, हररर्द्ा, मु स्त, भरङ्गी, पुननशिा, त्रबल्व, त्रिकटु , घृि
- त्रसद्धघृि - नागकेशर, यत्रष्टमधु , त्रपप्पली, दू िश, घृि
- पाण्डु त्रचत्रकत्सा
Pica
It is an eating disorder typically defined as persistent ingestion of non-nutritive
substances for at least one month.

 Causes:
- Mineral deficiency in blood
- Malnutrition
- Hookworm infections

 Symptoms:
Appetite for substances such as mud, faeces, urine, vomit, raw potatoes, glass,
ice, etc.

 Types:
- Amylophagia (Intake of purified starch)
- Gemelophagia (Intake of raw potatoes)
- Coniophagia (Intake of feaces)
- Urophagia (Intake of urine)
- Emptophagia (Intake of vomit)
- Hyalophagia (Intake of glass)
- Plumbophagia (Intake of lead)
- Pagophagia (Intake of ice)

 Complications:
- Anemia, Intestinal obstruction, Poisoning, Malnutrition, Autism, Vomiting,
Diarrhoea
- Impairment of mental & physical development

 Treatment:
- Supplementation of deficient nutrients
- Wholesome diet
- Deworming therapy
 रक्तिहस्रोतस्

 िामला & Jaundice

िामला
It is the condition in which Kapha Dosha along with association of Vata & Pitta,
vitiates Medha Dhatu leading to glandular swelling in axillae, shoulders & neck
region.

 भेद
a) अल्पत्रपत्त / शाखात्रश्रि (त्रपत्त-कफ प्रधान)
b) बहुत्रपत्त / कोिशाखात्रश्रि (त्रपत्त-िाि प्रधान)

 वनदान
a) अल्पत्रपत्त / शाखात्रश्रि ▪ रूक्ष शीि गुरु स्वादु आहार, व्यायाम, वेगनिग्रहण
b) बहुत्रपत्त / कोिशाखात्रश्रि ▪ कटु िीक्ष्ण उष्ण आहार, पाण्डु रोग

 पूिमरूप
a) अल्पत्रपत्त / शाखात्रश्रि ▪ आध्मन, अन्न िे ष, मलाप्रिृत्त
b) बहुत्रपत्त / कोिशाखात्रश्रि ▪ ज्वर, त्रिदाह, त्रिभ्रम

 लक्षण
a) अल्पत्रपत्त / शाखात्रश्रि
b) बहुत्रपत्त / कोिशाखात्रश्रि
▪ शुक्ल शकृि् , पीििणश नेि, मु ख, नख, मू ि, बौबशल्यिा,
अरुत्रच, त्रिबन्ध, ज्वर
▪ पीििणश नेि, मु ख, नख, मूि, शकृि् , अत्रिमन्द्द्य,
बौबशल्यिा, अरुत्रच, त्रिबन्ध, ज्वर

 सम्प्राम्हि
a) अल्पत्रपत्त / शाखात्रश्रि
त्रनदान सेिन -> िाि-कफ दोष प्रकोप -> कफेन त्रपत्तत्रिरोध -> पाचक त्रपत्त सम्बन्धन
-> िािे न त्रपत्तप्रसर -> अल्पत्रपत्त कामला

b) बहुत्रपत्त / कोिशाखात्रश्रि
पाण्डु रोग -> त्रनदान सेिन -> त्रपत्त-िाि प्रकोप -> रि-मां स दु त्रष्ट -> बहुत्रपत्त कामला

 विवित्सा
- पञ्चामृ िलोह, धािी लोह
- कुमारकल्याण रस, कामलाहर रस
- रोत्रहिक्याररष्ट, कुमायाश सि
- महात्रििकघृि
Jaundice
- It is the yellowish discoloration of skin, mucus membrane and sclera caused by
increased amount of bilirubin in blood.
- It is also known as hyperbilirubinemia.

 Causes:
- Liver diseases
- Sepsis (Blood infections)
- Abnormalities of RBC
- Blockage of bile duct
- Hemolytic anemia

 Symptoms:
- Yellowish discoloration of skin, mucus membrane, sclera
- Pale or yellow colored stool, dark yellow urine
- Itching, Loss of appetite, Nausea, Weight loss, Fever

 Diagnosis: Urine examination, Serum bilirubin, CBC, Physical examination

 Treatment:
- Iron supplementation, Blood transfusion, Antiviral drugs, Phototherapy
- Surgery in case of obstruction of bile duct
 रक्तवपत्त & Hemophilia

रक्तवपत्त
It is the acute condition in which morbid Pitta Dosha mixed with vitiated Rakta Dhatu
is expelled from the body apertures without any specific cause such as trauma or
injury.

 वनदान
- कटु िीक्ष्ण क्षार अम्ल लिण उष्ण आहार अत्रिसेिन
- मां स, घमश
- शोक, क्रोध
- अत्रिव्यायाम-व्यिाय
- संक्रमण

 भेद
a) ऊध्वश ग (त्रपत्त-कफ प्रधान)
b) अधोग (त्रपत्त-िाि प्रधान)
c) उभय / त्रियशक् (त्रिदोषि)

 पूिमरूप
त्रशरो गौरि, अन्नात्रभलाषा, त्रिदाह, शीिे च्छ्ा, छत्रदश, कास, श्वास, श्रम, स्वरक्षय, अत्रिसदन

 लक्षण
a) ऊध्वश ग = Bleeding from eyes, nose, ears, mouth
b) अधोग = Bleeding from urethra, anus
c) उभय / त्रियशक् = उभय - bleeding from all upper & lower orifices,
त्रियशक् - bleeding from hair follicles

 सम्प्राम्हि
त्रनदान सेिन -> त्रपत्त दोष प्रकोप -> रि दु त्रष्ट -> यकृि् & प्लीहा अत्रधिान ->
प्रकुत्रपि रि िृक्तद्ध -> ऊध्वश / अधो / त्रियशक् गत्रि -> रित्रपत्त

 विवित्सा
- रिस्थम्बन
- प्रिाल भस्म
- लोह भस्म
- लोहपपशत्रट
- स्वणशमात्रक्षक भस्म
- नस्य, िमन, त्रिरे चन
Hemophilia
- It is an inherited bleeding disorder in children.
- Excessive bleeding occurs due to lack of clotting factors.

 Types
a) Hemophilia A (lack of factor 8)
b) Hemophilia B (lack of factor 9)
c) Hemophilia C (lack of factor 11)

 Symptoms:
- Bruising: Occurs on small accidents resulting in accumulation of blood
under the skin causing swelling (Hematoma)
- Bleeding: Tendency to bleed from nose, mouth easily
- Hemo-arthritis: bleeding into join cavity
- Bleeding into muscle causing pain & redness
- Bleeding into brain due to injury leading to death
- Hematuria, Melena

 Diagnosis: CBC, CT Scan, BT

 Treatment:
- Replacement of missing clotting factor
- Preventing dental & gum problems with proper oral hygiene
- Special care before surgical treatment is required
- Surgery to resolve damage done by internal bleeding
- Anti-fibrinolytic protein: Desmopressin for Hemophilia A
 यिृतोदर & Hepatomegaly

यिृतोदर
- It is one type of उदर रोग.
- It is a disease of the abdomen which mainly afflicts the liver. It is compared with
hepatomegaly in modern medicine.

Hepatomegaly
- It is the enlargement of the liver.

 Causes:
- Viral hepatitis
- Heart failure in children
- Decreased backflow of blood from hepatic vein

 Signs & Symptoms:

- Fever, Fatigue
- Abdominal enlargement, tenderness & pain
- Jaundice

 Diagnosis: Serum bilirubin, Abdominal ultrasound, CT scan, MRI

 Treatment:
- Radiation therapy
- Steroids
- Symptomatic treatment
- Vaccination

 विवित्सा
- िेहन, स्वे दन, त्रिरे चन, बक्तस्त
- षट् फल घृि, रोत्रहिकात्रद घृि
- अभया with गुड
- त्रपप्पली, नागर, दन्ती, त्रचिक, अभया, त्रिडङ्ग with उष्णोदक
 प्लीहोदम र & Splenomegaly

प्लीहोदम र
- It is one type of उदर रोग.
- It is a disease of the abdomen which mainly afflicts the spleen. It is compared with
splenomegaly in modern medicine.

Splenomegaly
- It is the enlargement of the spleen.
- 10% of children normally have a palpable spleen.
- A pathologically enlarged spleen is often firm and may have an abnormal surface.

 Causes:
- Viral, bacterial, fungal infection
- Neoplasia
- Obstructed venous drainage
- Accumulation of lipids

 Signs & Symptoms:

- Failure to thrive
- Pallor, Jaundice, Itching, Rashes
- Dynspnoea, Fatigue, Anemia, Poor vision
- Abdominal swelling & tenderness
- Joint pain, bone pain

 Diagnosis: CBC, CT Scan, LFT, MRI, USG

 Treatment:
- Hemophilia influenza vaccine
- Antibiotics: Penicillin
- Surgery: Splenectomy in sickle cell anemia

 विवित्सा
- िेहन, स्वे दन, त्रिरे चन, बक्तस्त
- षट् फल घृि, रोत्रहिकात्रद घृि
- अभया with गुड
- त्रपप्पली, नागर, दन्ती, त्रचिक, अभया, त्रिडङ्ग with उष्णोदक
 मांसिहस्रोतस् & मेदोिहस्रोतस्

 अपिी & Lymphadenitis

अपिी
It is the condition in which there is chronic presence of गण्डमाला, glandular swelling
in axillae, shoulders & neck region. The lumps start suppurating and discharging pus.
The swelling disappears and recurs at another location in the body.

Lymphadenitis
It is an inflammation of lymph nodes, resulting in swelling & tenderness of the
affected area.

 Causes:
- Streptococcal infection
- Viruses
- Protozoa
- Fungi

 Symptoms:
- Swelling, tenderness
- Fever with chills
- Loss of appetite
- Heavy perspiration
- Rapid pulsation
- General weakness

 Diagnosis: WBC, Blood culture, Biopsy of lymph nodes

 Treatment:
- Antibiotics: Penicillin, Erythromycin, Clindamycin
- NSAIDs (Nonsteroidal Anti-Inflammatory Drugs)
 गलगण्ड & Goiter

गलगण्ड
The swelling which hangs like scrotum in the throat region is called गलगण्ड.
Kapha Dosha along with Vata Dosha localize at throat region to vitiated Meda Dhatu
and causes गलगण्ड.

 भेद & लक्षण

a) िािि िनरस, िालु -गल-शुष्कत्व, िोद, श्याि िणश, परुष, अपाक
b) कफि कण्डू, त्रचरिृक्तद्ध, मन्द रुिा, मधु यशिा
c) मे दोि त्रिग्ध, गुरु, पाण्डु िणश, कण्डू, अल्प रुिा

Goiter
It is an abnormal enlargement of the thyroid gland.

 Causes:
- Auto-immune system variation
- Iodine deficiency

 Symptoms:
- Swelling at the base of the neck
- Tight feeling in throat
- Coughing, Hoarseness of voice, Pain
- Dysphagia, Dyspnoea

 Treatment:
- Observation: Self-resolution or worsening
- Thyroid hormone replacement
- Symptomatic treatment for pain
- Surgery: Removal of inflamed portion
- Radioactive iodine
 गण्डमाला & Cervical Lymphadenopathy

गण्डमाला
It is the condition in which Kapha Dosha along with association of Vata & Pitta,
vitiates Medha Dhatu leading to glandular swelling in axillae, shoulders & neck
region.

 वनदान
त्रदिास्वप्ना, मे द िृक्तद्धकर आहार, दु ष्ट अम्बुपान

 विवित्सा
- िमन, त्रिरे चन, नस्य, रिमोक्षण
- गण्डूष, मे द नाशक धू म
- काञ्चनार गुग्गुलु
- गण्ङमाला खण्डन रस
- भल्लािकात्रद ले प, गन्धकात्रद ले प

Cervical Lymphadenopathy
- It is the enlargement of lymph nodes at cervical region.
- It is an acute condition, common in children.

 Causes:
- Staphylococcus infections
- Streptococcal pharyngitis
- Cat scratch diseases: Bartonella henselae bacteria
- Vital respiratory infections
- Chickenpox

 Symptoms:
- Swollen lymph nodes
- Fever, Pain, Runny nose
- Sore throat
- URT infections

 Diagnosis: CBC, CT Scan, PET, Lymph node biopsy, Chest radiography

 Treatment:
- Antibiotics: Clindamycin, Trimethoprim, Sulfamethoxazole, Amoxicillin
- Symptomatic treatment for pain, fever, etc.
 मूििहस्रोतस्

 िृ क्क शोफ / Glomerulo Nephritis

It is an inflammation of the glomeruli, which are structures in the kidneys that are
made up of tiny blood vessels.
Glomeruli help to filter blood and remove excess fluids. If they are not functioning
properly, it may lead to kidney failure.

 Causes:
- Streptococcal infections, Vasculitis, Hepatitis

 Symptoms:
- Dark brown colour of urine, Decreased urine
- Fatigue, Lethargy, Dyspnoea, Headache, Weight loss
- Seizures, Rashes over buttocks & legs, Joint pain, Sore throat
- Oedema, Pale skin complexion

 Diagnosis: Ultrasound, Chest X-Ray, Urine microscopy, Urine analysis

 Treatment:
- Diuretic drugs, Fluid restriction
- Low protein diet & less salt intake
- Antibiotics, Steroids to decrease inflammation

 Nephrotic Syndrome / Nephrosis

It is a kidney disease characterized by oedema and the loss of protein from the
plasma into the urine due to increased glomerular permeability.

 Causes:
- Idiopathic (relating to or denoting any disease or condition which arises
spontaneously or for which the cause is unknown)
- Genetic changes, Kidney infection

 Symptoms:
- Oedema, Albuminuria, Hematuria, Hyper-lipedema, Hypertension
- Fever, Lethargy, Irritability, Abdominal pain, Diarrhoea

 Diagnosis: Family history, Physical examination, Signs & Symptoms, Urine test,
Blood test, Ultrasound, Kidney biopsy

 Treatment:
- Control of immune system by cortico-steroids
- Removal of excessive fluid, Antibiotics
 CHAPTER XII: anya bala vikara /
miscellaneous pediatric disorders

 अपस्मार & Epilepsy

अपस्मार
It is the condition in which memory is lost for a short period of time.
It associated with loss of consciousness and abnormal body movements due to
vitiation of बुक्तद्ध & मन.

 वनदान
- अत्रहिकर आहार त्रिहार
- िेगधारण
- काम, क्रोध, शोक, भय, त्रचन्ता
- इक्तन्द्रयाथश अत्रियोग / हीनयोग / त्रमथ्ययोग
- सत्त्वगुण दु बलिा, रिोिमोगुण महात्मिा

 सम्प्राम्हि
त्रनदान सेिन -> शरीररक & मनत्रसक दोष प्रकोप -> मनोिहस्रोिस् दु त्रष्ट ->
मनो त्रिभ्रम -> स्मृत्रि त्रिभ्रम -> अपस्मार

 भेद
1) िािि
2) त्रपत्ति
3) कफि
4) सत्रन्नपािि

 पूिमरूप
मनो त्रिभ्रम, बुक्तद्ध त्रिभ्रम, हृदय शून्यत्व, त्रशरशूल, स्वे द, इक्तन्द्रयदु त्रष्ट, मू च्छ्ाश , भ्रम

 लक्षण
- हस्त-पाद-त्रिक्षे प
- फेन िमन
- नेि त्रिकृत्रि
- दन्त खादत्रि
- मू छाश
- सज्ञानाश
 बालापस्मार / स्कन्दापस्मार / विर्ािाग्रह
It is a specific type of अपस्मार which is only seen in children.

लक्षण
- सज्ञा नाश मु हुः
- शकृण्मू ि मु हुः
- रोमहषश
- फेन िमन
- ज्वर
- त्रिह्वा सन्दम्श

 विवित्सा
- दन िव्यापाश्रय त्रचत्रकत्सा
- मृ दु शोधन, ब्रह्मी घृि नस्य, त्रिफलात्रद प्रधमन नस्य
- ब्राह्मी स्वरस, रसोन चू णश, श्तािरी चू णश, दशमूल क्वाथ, पञ्चकोल घृि, महापञ्चगव्य घृि,
ब्राह्मी घृि
Epilepsy
It is a neurological disorder in which nerve cell activities in the brain are disrupted,
leading to convulsions or loss of consciousness.

 Causes:
- Injury to the brain
- Lack of oxygen supply to the brain
- Meningitis / Hydrocephalus
- Genetic
- Fever, Severe headache, Difficulty in breathing, Stress or other mental
afflictions may lead to seizures.

 Symptoms:
- Seizures, Convulsions
- Loss of awareness, Unconsciousness
- Repetitive movements like clapping, chewing, lip smacking

 Investigation: EEG

 Treatment:
- Anti-convulsion drugs: Carbanazepine, Phenytoin, Valporate, Valproic acid
- Antiviral drugs
- Antibiotics
- Antipyretics

 Stages of Epilepsy in Children:

1) Aura stage:
- Prior actual epileptic seizures.
- Signs: Abnormal sensation, Dizziness, Headache, Nausea,
Numbness, Altered taste, smell & sound

2) Ictus stage:
- Actual epileptic seizure
- Phases: i) Tonic phase: ▪ 20-30 sec, Muscle spasm,
Loss of consciousness
ii) Clonic phase: ▪ 30 sec, Powerful interrupted
jerky movements, Frothy mouth

3) Post-ictus stage:
- Post-seizure stage
- Recover phase, may take 2 min - 30 min
- Confusion, Headache, Loss of consciousness, Loss of bowel control,
Numbness, Partial paralysis
 आक्षेप & Convulsions

आक्षेप
It is the condition in which vitiated Vata Dosha causes Shuskatva (dryness) in
Dhamani, affecting Hasta, Pada, Sira, Snayu & Khandara leading to contraction &
relaxation.

 वनदान
- नात्रभ नाल किश न िन्य उपर्द्ि
- उल्बक रोग, अपस्मार, ज्वर, उदर कृत्रम
- त्रिष, रिक्षय
- मक्तस्तष्कािरण शोथ
- क्रोध, शोक, भय, त्रचन्ता

 विवित्सा
- त्रनदान पररििशन, त्रिश्राक्तन्त
- िािकुलान्तक रस, सरस्विाररष्ट
- पञ्चगव्य घृि, शड् धौि घृि, अभ्यङ्ग

Convulsions
It is a condition where body muscles contract and relax rapidly and repeatedly,
resulting in uncontrolled shaking of the body.

 Causes:
- Sudden abnormal electrical activity
- Fever > 38° C
- Epilepsy
- Brain tissue scarring

 Symptoms:
- Sudden stiffness of the body
- Unconsciousness
- Uncontrolled jerking
- Eyes rolling backwards

 Investigations: Blood culture, Chest X-Ray, EEG

 Treatment:
- During convulsions, place the child on a soft surface, lying on his side or back.
- If convulsion continuous for more than 5 minutes, call ambulance or take the
child to hospital care.
- Treatment mainly depends on the causative factor.
 वनरुद्धप्रिाश / वनरुद्धमवण / Phimosis
It is the condition in which the head of penis is covered by constriction of prepuce
(foreskin) leading to obstruction of urinal flow. Prepuce cannot be pulled back to
expose the complete glans penis.

मत्रण = Glans penis

त्रशश्ण चमश = Prepuce

 Causes:
- Foreskin is too narrow to pass over glans penis
- Inner surface of foreskin is fused with glans penis
- Frenulum is too short to allow complete retraction of foreskin
(Frenulum is an elastic band of tissue under foreskin that connect to the glans
penis.)

 Signs & Complications:

- Prepuce cannot or only slightly be retracted
- Slow urination with mild pain
- Swelling due to urine
- Greater risk of inflammation of glans penis

 Treatment:
- िेहन = घृि ले प, िािहर िन ल त्रप्रषेक
- Dilatation of preputial meatus
- Topical steroid creams like Cortisone
- Surgery: Circumcision - complete removal of foreskin
 Cerebral Palsy
It is a disorder that affects the muscle tone, movements and motor skills. It is
generally caused due to brain damage occurred before / during delivery or 1-3 years
of age.

 Causes:
- Exact cause is unknown
- Brain damage during intra-uterine life or delivery
- Improper development of brain, Premature birth
- Genetic, Infection

 Signs & Complications:

- Visual impairment / Blindness
- Loss of hearing
- Difficulty in speech
- Dysphagia
- Tooth decay, Sleeping disorders
- Osteoporosis
- Behavioral problems
- Developmental delay

 Types:
1) Spastic Cerebral Palsy
2) Athetoid Cerebral Palsy
3) Ataxic Cerebral Palsy
- Stiffness, restricted movements
- Involuntary & uncontrolled movements
- Disturbance of balance & depth
perception

 Treatment:
- Wholesome diet
- Calcium, Vitamin D supplementation
- Medicines & surgery can improve muscle function
- Individual schooling
- िेहन, स्वे दन, मािबक्तस्त
CHAPTER xIII: behavioral disorders of
children

 Breath Holding Spell (BHS)

- BHS are brief periods in which young children stop breathing for up to one minute.
- It may cause unconsciousness.
- BHS usually occurs when a child is angry, frustrated, in pain or afraid.
- Common in children between 6-18 months, usually not present after 5 years of age.

 Classification:
1) Simple Breath Holding Spell (SBHS)
2) Cyanotic Breath Holding Spell (CBHS)
3) Pallid Breath Holding Spell (PBHS)
4) Complicated Breath Holding Spell (CBHS)

1) Simple Breath Holding Spell (SBHS)

- Aspiration
- Usually triggered by frustration or pain.

2) Cyanotic Breath Holding Spell (CBHS)

- Forced expiration, sometimes leads to cyanosis & loss of
consciousness.
- Usually triggered by frustration, anger or pain.

3) Pallid Breath Holding Spell (PBHS)

- Loss of consciousness
- Child turns pale
- Commonly triggered by sensation of pain.

4) Complicated Breath Holding Spell (CBHS)

- Very severe condition of BHS
- Similar like CBHS & PBHS associated with seizures.

 Investigation: EEG

 Treatment:
- Piracetam drugs
- Iron therapy
 शय्यामू ि & Nocturnal Enuresis (Bed Wetting)

शय्यामू ि
It is the repeated inability to control urination during night time.

 वनदान
- मनत्रसक = भय, क्रोध, शोक, त्रचन्ता, मू ि िेगधारन, पयाश प्त त्रशक्षण (excessive
learning), अनुत्रचिा त्रशक्षण (improper education)
- शारीररक = संक्रमण (infection), कृत्रम

 लक्षण
शय्यामू ि

 विवित्सा
- मनत्रसक =त्रशक्षण, संरक्षण
- शारीररक =मृ दु त्रिरे चन, त्रििङ्ग भस्म, बहुमू िान्तक रस, चन्द्रप्रभािटी, त्रशलाििु
रसायन, त्रशग्रु क्वाथ, दशमू ल् क्वाथ

Nocturnal Enuresis (Bed Wetting)

It is urinary incontinence during night time in a more than 5-year-old child.

 Causes:
- Low bladder capacity, Prolonged sleep
- Under development of brain, Bladder control problem
- Spina bifida, Ectopic ureter, Disturbed vesico-urethral reflex
- Increased production of ADH (Anti-diuretic hormone) during sleep
- Anxiety

 Symptoms:
- Uncontrolled urination during sleep.

 Treatment:
- If child sleep excessively, it should be woken timely.
- Desmopressin drug: reduces production of urine during night.
- Anticholinergic drugs like Oxybutynin: reduces contraction of bladder and
increases bladder capacity.
 Pica
It is an eating disorder typically defined as persistent ingestion of non-nutritive
substances for at least one month.

 Causes:
- Mineral deficiency in blood
- Malnutrition
- Hookworm infections

 Symptoms:
Appetite for substances such as mud, faeces, urine, vomit, raw potatoes, glass,
ice, etc.

 Types:
- Amylophagia (Intake of purified starch)
- Gemelophagia (Intake of raw potatoes)
- Coniophagia (Intake of feaces)
- Urophagia (Intake of urine)
- Emptophagia (Intake of vomit)
- Hyalophagia (Intake of glass)
- Plumbophagia (Intake of lead)
- Pagophagia (Intake of ice)

 Complications:
- Anemia, Intestinal obstruction, Poisoning, Malnutrition, Autism, Vomiting,
Diarrhoea
- Impairment of mental & physical development

 Treatment:
- Supplementation of deficient nutrients
- Wholesome diet
- Deworming therapy
 उन्माद
It is the condition in which there is vitiation or impairment of मन, बुक्तद्ध, ज्ञान, स्मृत्रि,
भक्ति, शील (temperament), चे ष्ट & अचर (conduct).

 वनदान
- त्रिरुद्ध, दु ष्ट, अशुत्रच आहार सेिन
- दे ि, गुरु, ब्राह्मण त्रनदन
- भय
- त्रिषम चे ष्ट

 सम्प्राम्हि
त्रनदान सेिन -> त्रिषमात्रि & रि-िम त्रिकृत्रि -> मनोिहस्रोिस् दु त्रष्ट ->
मनो त्रिभ्रम -> उन्माद

 भेद
5) िािि
6) त्रपत्ति
7) कफि
8) सत्रन्नपािि
9) आगन्तु ि

 पूिमरूप
मनो त्रिभ्रम, बुक्तद्ध त्रिभ्रम, मन चञ्चलत्व, हृदय शून्यत्व, असम्बद्ध भाषण

 लक्षण
- General symptoms are similar as premonitory symptoms.

1) िािि = असम्बद्ध िात्रण, अङ्ग चे ििा, नख श्याििा, गीत्रि

2) त्रपत्ति = नेि लालिा, पीि िणशिा, अत्रधक क्रोध, अत्रधक स्वे द
3) कफि = लालास्राि, अल्प चे ििा, श्वेि िणशिा, आलस्य
4) सत्रन्नपािि = िािि-त्रपत्ति-कफि लक्षण
5) आगन्तु ि = अलौत्रकक िात्रण, असम्बद्ध िात्रण, इक्तन्द्रयदु बशल्य, मू च्छ्ाश ,
नेि लालिा, श्यि िणशिा

 विवित्सा
- िेहन, स्वे दन, पञ्चकमश
- दे ि व्यपाश्रय त्रचत्रकत्सा
- ब्रात्रह्म, शङ्खपुष्पी
- सारस्वि चू णश
- पुराण घृि, कल्याणक घृि, महाकल्याणक घृि, लशुन िन ल, त्रशि िनल
- त्रनम्ब पि धू पन
 Autism
It is a neurobehavioral disorder of children characterized by impaired
communication, emotional detachment, repetitive behavior and restricted range of
interest. It typically occurs at the age of 1-3 years. Sometimes it may be present from
birth.

 Causes:
- Genetic
- Infections during pregnancy
- Seizures
- Pica

 Symptoms:
- Impaired communication
- Emotional detachment
- Repetitive behavior
- Lack of interest, sharing, enjoyment
- Parents may be confused about their child’s hearing ability.

 Treatment:
- Behavioral therapy
- Management of seizures

 Attention Deficit and Hyperactivity Disorder (ADHD)

It includes a combination of persistent behavioral problems such as difficulty in
sustaining attention, hyperactivity and impulse behavior.
It is a chronic condition that affects millions of children and often continuous into
adulthood.

 Causes:
- Alcohol, tobacco or infections during pregnancy
- Premature birth

 Symptoms:
- Restlessness, hyperactivity, constant movements
- Continuous talking & interrupting
- Inattentiveness, Boredom
- Short memory

 Treatment:
- Behavioral therapy
- Education for parents regarding physical exercise, meditation, etc.
- Brain stimulant drugs such as Dopamine
 जडत्व / Mental Retardation
It is a mild intellectual disability in which children are able to develop social and
communication skills in a delayed manner and their motor skills are slightly impaired.
It appears in children under the age of 18 months.

 Causes:
- Alcohol or tobacco consume of mother during pregnancy
- Infections during pregnancy
- Birth defect, Malnutrition
- Complication of Hydrocephalus, Chicken pox or Environmental pollution

 Symptoms:
- Sitting, crawling, walking milestones are delayed
- Talking is delayed, difficulty in speaking
- Difficulty in remembering
- Trouble in understanding social rules
- Trouble in thinking logically

 Treatment:
- Behavioral therapy

- Individualized education
- Skill training
 CHAPTER xIv: prana raksha vidhi

 Shock
 Introduction:
- It is a condition of acute circulatory failure.
- It is characterized by prolonged hypotension leading to inadequate tissue
perfusion.
- All forms of shock result in reduction in effective blood flow (hypo-perfusion).
It leads to reduced delivery of oxygen and nutrients, consequently to
dysfunction of cells.

 Signs & Symptoms:

- Paleness, cold & moist skin
- Fast & thread pulse
- Shallow respiration
- Decreased BP
- Oliguria
- Hypo-perfusion
- Alteration of mental status

 Types & Treatment

a) Hypovolemic shock
- Hypovolemia is a total decrease in blood or fluid volume.
- It may be caused due to severe hemorrhage or fluid loss.
- Treatment: Airway asses, Isotonic fluid, Fluid bolus, Dopamine

b) Cardiogenic shock
- Decreased cardiac output due to myopathy, myocardial infarction, cardiac
arrhythmia, pump failure, etc.
- Treatment: Airway asses, Administration of 02, Mechanical ventilation,
Vaso-active drugs

c) Anaphylactic shock
- Due to hypersensitivity
- Death may occur due to bronchial spasm or laryngeal oedema.
- Treatment: Airway asses, Corticosteroids

d) Septic shock
- Presence of sepsis in the body leading to organ hypo-perfusion, further to
multi-organ failure resulting in acute respiratory distress syndrome.
- There can be necrosis of liver, pancreas.
- Treatment: Airway asses, Antibiotics, Assessment of immunity
 Anaphylaxis
 Introduction:
- It is a severe, potentially life-threatening allergic reaction.
- It can occur within seconds or minutes of exposure to the antigen due to
hypersensitivity.

 Causes:
- Food: Milk, eggs, peanuts, wheat, fish, etc.
- Insects: Wasps, fire ants, etc.
- Medicines: Penicillin, Sulfa drugs, Insulin, etc.

 Signs & Symptoms:

- Skin itching & rashes
- Swelling of lips, tongue, throat
- Shortness of breath, wheezing, Dizziness, fainting
- Abdominal pain, Vomiting, Diarrhoea

 Treatment:
- Corticosteroids: Methyl prednisolone, Prednisolone

 Poisoning
 Introduction:
- It is a condition of being exposed to a substance that is injuries to health and
even can cause death.
- It is a major issue for children, especially in case of accidental poisoning due
to household products.

 Types of poisoning:
a) Accidental (common in children below the age of 5)
b) Homicidal
c) Suicidal

 Treatment / Management:
- Removal of source of poison
- Removal of poison from skin by washing with soap.
- Initial resuscitation & stabilization: Access the airway, adequate breathing,
papillary size, blood glucose concentration,
temperature control
- Removal of unabsorbed poison from GIT: Stomach wash, Gastric lavage,
Activated Charcoal, Whole bowel irrigation
- Elimination of absorbed poison: Forced diuretic, peritoneal dialysis,
hemodialysis, hemofiltration
- Symptomatic treatment: Hypertension, Arrhythmia, Convulsions,
Hypothermia, Pain
 Foreign Body in Respiratory Tract
 Introduction:
- Most air way foreign body aspirations occur in children.
- Children aged 1-3 years are most susceptible.

 Causes:
- Lack of molars for proper grinding of food
- Putting small objects in mouth
- Risk factors: hard food, peanuts, grapes, beans, seeds

 Phases:
a) Initial phase: Chocking, gasping, coughing

b) Asymptomatic phase: Lodging of the object with relaxation of reflexes that

often result in a reduction or cessation of symptoms.

c) Complication phase: Foreign body causes obstruction leading to pneumonia

or abscess.

 Foreign body in the nose:

Symptoms:
- Difficulty in breathing through the affected nostril
- Foul smelling
- Bloody nasal discharge
- Irritability
- Pain

Treatment / Management:
- Rhinoscopy
- Removal of foreign body

 Foreign body in the larynx:

Symptoms:
- Croup
- Strider
- Cough
- Dyspnoea
- Hoarsness of voice

Treatment / Management:
- Bronchoscopy
- Removal of foreign body
  Foreign body in the tracheo-bronchial tree
Symptoms:
- Episodes of coughing
- Intermittent or continuous dyspnoea
- Cyanosis
- Pain
- Hoarseness of voice

Treatment / Management:
- Bronchoscopy
- Removal of foreign body

 Hemorrhage
 Introduction:
- It is a condition in which there is escape of blood.
- Bleeding may occur externally or into hollow viscera, serous cavities or tissue.

 Causes:
- Traumatic injury: abrasions, excoriation, hematoma, laceration, incision,
puncture wound, crushing injury, contusion, etc.
- Medical condition: intravascular changes, intramural changes, extracellular
changes, deficiency of clotting, etc.

 Symptoms:
- Symptoms depend on loss of blood and speed of loss.
- General symptoms and reactions of the body in successive order:

a) Vasovagal syncope: sweating, pallor, giddiness, decreased BP & PR,

ischemia, emotional stress, anxiety, fear

b) Cardiovascular changes: Increased breathing, tachycardia due to secretion

of adrenaline, selective vasoconstriction to increase BP.

c) Reaction of blood: Increased platelet count, fibrinogen and ESR.

d) Restoration of blood volume: There will be withdrawal of fluid &

electrolytes from interstitial compartment to plasma compartment. Decrease
in lymphatic flow, water is drawn from dense connective tissue. Haemo-
dilution occurs.

e) Late changes: After 48 hours – Regeneration of lost blood. Stimulation of

secretion of erythropoietin, which stimulates bone marrow to produce RBCs.
Stimulation of erythropoietin is due to diluted blood & a result of anorexia.
 Treatment / Management:
- Treatment / Management depends on type causative factor or wound,
area of bleeding, presence of foreign objects, etc.

- Management of internal bleeding:

It is beyond first aid and is life threatening.
Surgical treatment or doctor may suggest Vitamin K, Plasma or Blood
transfusion.

- Key points of wound management:

a) Elevation
b) Direct pressure
c) Pressure points

a) Elevation:
- Keeping the wound above the level of the heart to decrease pressure at
injury point and therefore reduce bleeding.
- This mainly applies to limbs and head.
- Does not apply for broken limbs as elevation may worsen the injury.

b) Direct pressure:
- Placing pressure on the wound will constrict the blood vessels manually.

c) Pressure points:
- Constriction of major artery which carries blood towards the injury.
- Performed at a place where a pulse can be found.
- Only used when Elevation or Direct pressure do help sufficiently.
- Use 4 fingers to detect the pulse, apply firm pressure with the heel of the
hand / 4 fingers along the path of the artery to compress it against the
underlying bone.
 Acute Renal Failure (ARF) / Acute Kidney Injury (AKI)
 Introduction:
- Abrupt decline in renal function
- Sudden and temporary loss of kidney function
- It an acute condition which is potentially reversible.

 Causes:
- Deceased blood flow to the kidneys; hemorrhage, surgery, shock
- Obstruction or blockage in urinary tract
- Infection
- Kidney toxicity due to medications, heavy metals
- Glomerulonephritis

 Signs & Symptoms:

- Fever, Rashes, Severe vomiting, Bloody diarrhoea, Hemorrhagae
- Abdominal pain, paleness, inflammation of eyes
- No or excessive urine output

 Treatment / Management:
- Hospitalization
- History & physical examination to identify the cause
- Stop all nephrotoxic drugs
- Fluid & electrolyte management
- Diuretic therapy or medication to increase urine output
- Medications to control BP
- Specific diet = Proteins: 0.6-1 gm /kg/day
Calories: 50-100 cal/kg/day
Glucose containing fluids
Salt restriction if hypertensive
Calcium supplementation if needed
 Febrile Convulsion
 Introduction:
- Febrile convulsion / Febrile seizure is associated with high body temperature
but without any underlying CNS infection.
- Febrile convulsions are usually due to fevers with body temperature >38°C.
- Commonly occurs in children between the age of 6 months to 5 years.
- Febrile seizure generally lasts for less than 5 minutes.
- Complex febrile seizure is the condition in which the seizure lasts longer than
15 minutes or multiple episodes occur within 24 hours. The child should be
shifted to a hospital.

 Signs & Symptoms:

- Body stiffness
- Twitching of extremities
- Loss of consciousness, eyes remain open
- Irregular breathing
- Vomiting
- Body temperature >38°C

 Treatment / Management:
- During convulsion: IV diazepam, maintain free airway with periodic
suction, protect child from injuries, semi-prone
position
- Before / After convulsion: Antipyretic treatment
- Further management: Counselling of parents, long term prophylaxis
with anticonvulsant drugs
 Status Epilepticus (SE)
 Introduction:
- It is a medical emergency associated with significant morbidity and mortality.
SE is defined as a continuous seizure lasting more than 30 min, or two or more
seizures without full recovery of consciousness between any of them.

 Treatment / Management:
a) Stabilization of airway, breathing & circulation:
- Keep the child in left lateral decubitus position.
- Suck out the secretions from the airway
- Decompress the stomach by orogastric or nasogastric aspiration.
- Administer 100% oxygen by face mask or nasal catheter.
- Secure IV line

b) Control of seizures:
- IV diazepam
- IV phenytoin
- IV phenobarbitone

 Status Asthmaticus
 Introduction:
It is a severe attack of bronchial asthma with extensive bronchial obstruction
from the beginning or during the course of an asthmatic attack.
It is a progressive worsening condition that leads to pulmonary insufficiency.
Status asthmaticus / severe acute asthma is unresponsive to the usual
appropriate management with adrenergic drugs.

 Causes:
- Excessive exposure to allergens
- Infections
- Psychogenic stress
- Inadequate therapy
- Excessive or inappropriate use of aerosol, tranquilizers, etc.

 Treatment / Management:
- Beta agonist: Terbutaline, Epinephrine, Isoproterenol – Stimulates beta
receptors on bronchial smooth muscles and mediate muscle relaxation.
- Humidified oxygen
- IV infusion for rehydration
- Mechanical ventilation
- Intubation
- Antibiotics are contraindicated
 Fluid & Electrolyte Management
 Introduction:
Electrolytes play a vital role in maintaining homeostasis within the body.
They help to regulate heart and neurological functions, fluid balance, oxygen
delivery, acid base balance, etc.

Electrolyte imbalance can develop due to:

- Excessive electrolyte ingestion
- Diminished electrolyte elimination
- Excessive electrolyte elimination

Chronic laxative abuse, severe diarrhoea or vomiting may lead to disturbances

of electrolyte level along with dehydration.
The most common electrolyte disturbances involve abnormality in the level of
sodium, potassium & calcium.

At 24 weeks of gestational age, a baby’s total body water content is close to

80% of total body weight. This slowly decreases until the child is around 1 year
of age, when total body water content is about 60% of total body weight.

 Examination of child:
- Skin = Dry skin, poor turgor, decreased skin elasticity, shrunken eyeballs,
paleness, no tears

 Treatment / Management:
- ORT (Oral Rehydration Therapy)
- TPN therapy (Total Parenteral Nutrition): It is a method of feeding that
bypasses the gastrointestinal tract. Fluids are given into a vein to provide most
of the nutrients the body needs. The method is used when a person cannot or
should not receive feedings or fluids by mouth.
- Intravenous infusion
- Intraosseous infusion: It is the process of injecting directly into the marrow of
a bone. This provides a non-collapsible entry point into the systemic venous
system. This technique is used to provide fluids and medication when
intravenous access is not available or not feasible.
 CHAPTER xv: balagraha

 Introduction
- बालग्रहरोगाः are a separate entity of disorders related to children because their
pathogenesis, severity of clinical features, complications and management are
entirely different.

- "ग्रहणाि् ग्रह इत्यु च्यिे ।"

The one which captures / seizes is known as Graha.

- In Ayurveda, the term ग्रह refers to an unseen & unknown power which captures or
seizes children to produce various complications.

- In modern medicine, ग्रह can be correlated to the term ‘idiopathic’ which is relating
to or denoting any disease or condition that arises spontaneously or for which the
cause is unknown. Sometimes, it is also correlated to pathogenic microorganisms as
they cannot be seen by the naked eyes.

 संख्या
ग्रन्थ ग्रह संख्या
Kashyapa Samhita 20
Astanga Hridaya 12
Sushruta Samhita 9
Harita Samhita 8

 िगीिरण
भेद सुश्रुत सम्हिता अष्टङ्ग हृदय
पुरुर् ग्रह 1. स्कन्दग्रह 1. स्कन्दग्रह
2. स्कन्दापस्मार 2. स्कन्दापस्मार
3. ननगमे ष / त्रपिृ ग्रह 3. मे ष / ननगमे ष त्रपिृ ग्रह
4. श्वग्रह
5. त्रपिृ ग्रह
स्त्री ग्रह 4. शकुनी ग्रह 6. शकुनी ग्रह
5. पूिन ग्रह 7. पूिन ग्रह
6. शीिपूिन ग्रह 8. शीिपूिन ग्रह
7. अन्धपूिन ग्रह 9. अदृष्टपूिन ग्रह
8. मु खमक्तण्डका ग्रह 10. रे ििी ग्रह
9. रे ििी ग्रह 11. शुष्करे ििी ग्रह
12. मु खमक्तण्डका ग्रह
 ग्रहरोग िारण
- Although the specific causative agents for ग्रहरोग are unclear, A. Sushruta has
mentioned some factors which may provoke affliction of the disease.

▪ अत्रहिकर आहार त्रिहार (Unwholesome food & regimen)

▪ त्रहम्सा (Violence)
▪ अपचार (Wrong or improper actions)
▪ शौचकमश ििशन (Not cleaning oneself)

 सामान्य लक्षण
- िृम्भा (yawning)
- उध्वश दृत्रष्ट (upwards rolling of eyes)
- अत्रिरोदन (excessive crying)
- स्वरिनकृि (debility of voice)
- फेनस्राि (frothy discharge)
- दन्तकूिन (clenching of teeth)
- स्तन्यिे ष (aversion of breastmilk)

 सामान्य विवित्सा
- 3x/day washing with water

- कुसुम्भ पि & सषशप बीि should be placed in the 4 corners of the home.

- पररषेक with सुखाम्बु or decoction prepared from: िरुण, त्रचिक, नल, त्रचरत्रबल्व,
आरत्रिगन्ध, पाररभर्द्

- रक्षोघ्न कमश – गृह & गि धू पन: घृि, करञ्ज, दशाङ्ग, सषशप, िचा, भल्लािक, यिनी, कुष्ट

- अभ्यङ्ग: पुराण घृि

 विवशष्ट लक्षण

1. स्कन्दग्रह त्रशरो त्रित्रक्षपिे मु हु, स्तब्धिा, स्वे द, मलािरोध

2. स्कन्दापस्मार फेन िमन, शकृण्मू िप्रििश न, केश लुञ्चन, कन्धरानपी, ज्वर,

स्तन्यत्रिह्वसन्दं श

3. ननगमे ष / मे ष आध्मान, फेन िमन, िृ ष्णा, अत्रिसार, छत्रदश, त्रििणशिा, स्तनकूिन, ज्वर

4. श्वग्रह आक्षे प, रोमहषश, स्वे द, त्रिह्वदं श

5. त्रपिृ ग्रह रोमहषश, ज्वर, कास, अत्रिसार, छत्रदश, आक्षे प, शोष, त्रििणशिा

6. शकुनी ग्रह अत्रिसार, त्रिह्विालु गले व्रणः, भय, ज्वर

7. पूिन ग्रह छत्रदश, आक्षे प, त्रनर्द्नाश, त्रहक्का, आध्मन, अत्रिसार, िृ ष्णा

8. शीिपूिन ग्रह आक्षे प, िृ ष्णा, अत्रिसार, शीित्व उष्णत्व

9. अन्धपूिन ग्रह छत्रदश, अत्रिसार, कास, ज्वर, त्रनर्द्नाश, शोष, दृष्टे सादः अत्रिरुक्

10. रे ििी ग्रह श्यानीलत्व, कणशनासात्रक्ष मदश न, कास, आक्षे प, ज्वर, शोष, पुरीषं हरीर्द्ं

11. शुष्करे ििी ग्रह शोष

12. मु खमक्तण्डका ग्रह त्रसरात्रभ उदरिा, ज्वर, अरोचक, दु बशल्य