EMISSARY VEINS

Emissary veins -

1-These are veins which link the intracranial venous sinuses with veins out side the cranial cavity.

2-an old surgical axiom stats that if it were not for emissary veins wounds of the scalp would lose half their significance.

3- They are of importance in that they are channels along which infected thrombosis may reach the interior of the cranial cavity from infections out side it.

The following are recognized emissary vein -

-Vein of the foramen caecum

-Ophthalmic veins

-Parietal emissary 

-Mastoid vein 

-Veins of the hypoglossal canal 

-Veins of the foramen ovale 

-Middle meningeal vein 

LEECH

Acne vulgaris(MUKHDUSHIKA)

v Skin disease common during adolescence. For other acne form skin diseases, Acne vulgaris.

v Acne in a 14-year-old male during puberty.

v Acne vulgaris is a long-term skin disease that occurs when hair follicles become clogged with dead skin cells and oil from the skin. Acne is characterized by areas of blackheads, whiteheads, pimples, and greasy skin, and may result in scarring. The resulting appearance can lead to anxiety, reduced self-esteem and, in extreme cases, depression or thoughts of suicide.

Acne primarily affects skin with a greater number of oil glands, including the face, upper part of the chest, and back. During puberty, in both sexes, acne is often brought on by an increase in androgens such as testosterone..

Acne occurs most commonly during adolescence, affecting an estimated 80–90% of teenagers in the Western world.

Classification

Acne is commonly classified by severity as mild, moderate, or severe. This type of categorization can be an important factor in determining the appropriate treatment regimen.

Mild acne is classically defined as open (blackheads) and closedcomedones (whiteheads) limited to the face with occasional inflammatory lesions.

  Acne may be considered to be of moderate severity when a higher number of inflammatory papules and pustules occur on the face compared to mild cases of acne, and acne lesions also occur on the trunk of the body.

 Lastly, severe acne is said to occur when nodules (the painful 'bumps' lying under the skin) are the characteristic facial lesions, and involvement of the trunk is extensive.

Large nodules have been referred to as cysts in the past, and the term nodulocystic has been used in the medical literature to describe severe cases of inflammatory acne.  However, since true cysts are rare in those with acne, the term severe nodular acne is now the preferred terminology.

Signs and symptoms-

Typical features of acne include

v seborrhea

v  Microcomedones

v comedones

v papules,

v pustules,

v Nodules (large papules), and in many cases scarring. The appearance of acne varies with skin colour. It may result in psychological and social problems. 

AYURVEDIC TREATMENT -

1-VAMANA 

2- LEECH APPLICATION

3- VIRECHANA 

4-KAISHOOR GUGGULU 

5-MAHAMANJISTHADI KASHAYA

6-TRIPHALA CHURNA 

MYASTHENIA GRAVIS

1-A paralytic condition.

2- An Autoimmune disease.  

3-serious condition in late day.

4-Inhibition of N.M.J (neuromuscular junction).

5-Antibody against ACH. Receptor proteins are formed and destroy the receptors. 

6- morning is good time for patients as concentration of ACH IS VERY HIGH.

SIGN AND SYMPTOMS

Ø Painless weakness of specific muscles, not fatigue. 

Ø The muscle weakness becomes progressively worse during periods of physical activity, and improves after periods of rest.

Ø Typically, the weakness and fatigue are worse towards the end of the day.

Ø MG generally starts with ocular (eye) weakness; it might then progress to a more severe generalized form, characterized by weakness in the extremities or while performing basic life functions

Gridhrasi. (sciatica)

                                  

Definition

The term sciatica describes a symptom rather than a specific disease. Some use it to mean any pain starting in the lower back and going down the leg. Others use the term more specifically to mean a nerve dysfunction caused by compression of one or more lumbar or sacral nerve roots from a spinal disc herniation. Pain typically occurs in the distribution of dermatome and goes below the knee to the foot. It may be associated with neurological dysfunction, such as weakness. The pain is characteristically of shooting type, quickly traveling along the course of the nerve.

As per Ayurveda, gridhrasi (sciatica) is explained as one among 80 types of Vata imbalance disorders (neurological / neuro-muscular disorder). The word ‘Gridhrasi’ is derived from the root word – ‘Gridhra’. Which means the bird ‘vulture’.

It is observed that in this disease, the patient’s gait is altered as his legs become tense, and slightly curved due to pain. Ultimately, the patients walk similar to the walk of the vulture (gridhra). Hence the name Gridhrasi.

According to another saying, sciatica is characterized by severe pain experienced by the patient and it is similar to the pain one experienced by the prey of vulture, while being eaten up.

Epidemiology

Depending on how it is defined, 2% to 40% of people have sciatica at some point in time. It is most common during peoples 40s and 50s and men are more frequently affected than women.

The condition where back pain and radiating pain of the legs are found together it is called Sciatica syndrome. In older times, as per Ayurveda system of medicine, it was named as Gridhrasi.

Causes -

1-About 90% of the time sciatica is due to a spinal disc herniation pressing on one of the lumbar or sacral nerve roots.  

2- The straight-leg-raising test is often helpful in diagnosis. The test is positive if, when the leg is raised while a person is lying on their back, pain shoots below the knee. In most cases medical imaging is not needed.

3-Sciatica is generally caused by the compression of lumbar nerves L4, or L5 or sacral nerves S1, S2, or S3, or by compression of the sciatic nerve itself.

Sciatica is typically caused by irritation of the sciatic nerve.

4-Spinal disc herniation.

Spinal disc herniation pressing on one of the lumbar or sacral nerve roots is the primary cause of sciatica, being present in about 90% of cases.

5- Spinal stenosis.

6-Piriformis syndrome.

7-Pregnancy.

8-Spondylolisthesis: If a vertebra slips forward over the vertebra below it, it’s                  called spondylolisthesis. This slip can pinch the nerve root and cause sciatica.

9-Trauma:

Cardinal features:

Radiating pain in the affected leg/legs is the typical characteristic feature of this illness. Due to this, the patient walks with the gait of the bird, vulture.

Diagnosis

Straight Leg test sometimes used to help diagnose a lumbar herniated disc.

Imaging tests such as computerised tomography or magnetic resonance imagingcan help with the diagnosis of lumbar disc herniation.The utility of MR neurography in the diagnoses of piriformis syndrome is controversial.

Management

When the cause of sciatica is lumbar disc herniation, most cases resolve spontaneously over weeks to months. Initially treatment in the first 6–8 weeks should be conservative. There does not appear to be a significant difference in outcomes between advice to stay active and recommendations of bed rest. Similarly, physical therapy (exercises) has not been found better than bed rest.

Medication

Although medicines are commonly prescribed for the treatment of sciatica, evidence for analgesics is poor. Specifically, low-quality evidence indicates that NSAIDs do not appear to improve immediate pain and all NSAIDs appear about equivalent. Evidence is also lacking in use of opioids and muscle relaxants. In those with sciatica due to piriformis syndrome, botulinum toxin injections may improve pain and or function. There is little evidence for steroids, either epidural or by pill. Low-quality evidence supports the use of gabapentin for acute pain relief in those with chronic sciatica.

Ayurvedic view -

Etiological factors:

All etiological factors of Vata imbalance disorders are the exclusive reasons of sciatica too.

Common causes for sciatica-

v Intake of Vata aggravating eatables like- adhaki (pigeon pea), chanaka (Bengal gram), kalaya (peanut), masura (red lentil), nishpava (flat bean), uddalaka  etc

v Excess intake of dry, light and cold food

v Excess intake of pungent, bitter and astringent food

v Heavy weight lifting, long walk, improper lie or sitting positions

v Suppression of urine, feces etc

v Improper practice of enema, purgation etc

v Fall or injury etc.

Symptoms of Sciatica:

Pain starting from hip area and radiating to the thigh, back, sacral region, popliteal area, calf muscles and foot.

Pricking sensation in those parts

Altered gait

Rarely stiffness or pulsation etc. are mainly found.

Types:

 Sciatica ( gridhrasi) is two type-

1.       Vataja Gridhrasi

2.       Vata-kaphaja Gridhrasi

Vata sciatica-

Curved posture (altered gait) due to pain . severe stiffness, pulsation in back, hip, thigh, knee and foreleg.

Vata-kaphaja sciatica-

Along with the above features, indigestion, drowsiness, nausea, anorexia, heaviness of the leg and freezing sensation in the lower limbs are complained.

Line of treatment:

Snehana -

Swedana - tub bath, pizichil, sudation with oil added medicated herbal pastes (patrapinda sweda), application of poultice (upanaha sweda) etc. are beneficial.

Mridu samshodhana– mild purgation (Mridu Virechana) is preferred.

Basti (medicated enema)

Shiravyadha/ Rakta-mokshana ( blood letting) – It is advised to perform 4 angula (3inch) above or below the knee joint.

Agni karma (cautery)-  is carried in the severe painful area or near the little toe of the leg, using a metallic rod.

Herbs useful in gridhrasi :

       i.            Nirgundi –  Vitex negundo

     ii.            Bala –     Sida cordifolia

  iii.            Punarnava – Boerhavia diffusa

iv.            Eranda – Castor root – Ricinus communis

     v.            Shigru – Moringa oleifera

  vi.            Rasna –  Pluchea lanceolata .

vii.            Masha – Black gram

Formulations useful in Gridhrasi (Sciatica):

v Yogaraja guggulu                                                

v Kaishora guggulu                               

v Vishtinduk vati                 

v Sahacharadi kashaya                                            

v Punarnavashtaka kashaya                                       

v Ekangaveera Rasa  

v Dasmoola Kwatha

v Ashwagandha Churna

v Triyodashanga Guggulu

v Rasnaerandadi kashaya

v Rasnasaptaka kashaya etc

Panchkarma procedures

1-    Matra Basti

2-    Agni karma

3-    Snehana Swedana

4-    Vaman

5-    Rakatmokchana

6-    Basti karma

      7-Kati Basti

Wholesome diet and habits in Sciatica:

Masha (black gram)

Kulath (horse gram)

Godhuma (wheat)

Raktashali (red rice)

Amlaphala (sour fruits)

Dadima (pome granate)

Draksha (raisins)

Shigru (drum stick)

Patola (snake gourd)

Kshira (milk)

Ghrita (ghee)

Mamsarasa (meat soup)

Dhanyamla (sour gruel)

Eranda taila (castor oil)

Tila taila (sesame oil)

Avagaha (tub bath)

Abhyanga (oil massage)

Ushnodakasweda (warm water bath) etc

Unwholesome diet and habits in Sciatica:

Kalaya –  peanut (Lathyrus sativus Linn.)

Chanaka  – Bengal gram (Cicer arietinum Linn)

Rajamasha (Raj maa)

Vegadharana (suppression of urges)

Vyavaya (sexual indulgence)

Vyayama (heavy exercise)

Diva swapna (day sleep)

Prajagarana (sleepless nights)

CARPAL TUNNEL SYNDROME.

Carpal tunnel syndrome (CTS) is a medical condition in which the median nerve is compressed as it travels through the wrist at the carpal tunnel and causes pain, numbness and tingling, in the part of the hand that receives sensation from the median nerve. Pain may extend up the arm leading to discomfort extending to the shoulder and forearm. The mechanism of injury is compression; there are a variety of contributing factors. Some of the individual predisposing factors include: diabetes, obesity, pregnancy, hypothyroidism, and a narrow-diameter carpal tunnel. CTS may also result from an injury that causes internal scarring or mis-aligned wrist bones. Occupational causes involve use of the hand and arm, such as heavy manual work, work with vibrating tools, and highly repetitive tasks even if they involve low force motions.

The main symptom of CTS is intermittent numbness of the thumb, index, and middle fingers and the radial (thumb) side of the ring finger. The numbness often occurs at night, with hypothesized reasons related to sleep position, such as the wrists being held flexed during sleep or sleeping on one's side. It can be relieved by wearing a wrist splint that prevents flexion. Long-standing CTS leads to permanent nerve damage with constant numbness, atrophy of some of the muscles of the thenar eminence, and weakness of palmar abduction.

Pain in carpal tunnel syndrome is primarily numbness that is so intense that it wakes one from sleep. Pain in electrophysiologically verified CTS is associated with misinterpretation of nociception and depression

Conservative treatments include use of night splints and corticosteroid injection. The only scientifically established disease modifying treatment is surgery to cut the transverse carpal ligament.

TREATMENT
1-ANTI INFLAMMATORY DRUGS
2- DASANG LEPA
3-LEECH APPLICATION
4- KAISHOR GUGGULU
5-SHNEHAN SHWEDANA.

Secret of life: a central dogma in Urdu language

JINDAGI KYA HAI JUHURE TARTEEBE ANASIR,MOUT KYA HAI ANASIR KA PASHEMAN HONA.

wish you happy new year to all my dear friends .

HARITIAKI (HARAD)

                                                 HARITAKI

                 a)  Latin name  -  Terminalia chbula

                                 Terminalia –Proceding from the extremity

                                 Chebula -    Retz

                  b)  Family  -  Combrataceae (caffer butterfly)

                  c) Gana  - Triphala, Amalakyadi, Parushakadi, Trivruttadi,                                      Prajasthapana, Jwaraghna, Kushthaghna,                                                Arshoghna.

                 d)  Names

                             Sanskrit- Shiva, Pathya, Avyatha, Abhaya, Chetena,                          Rohini, Putana, Amrua, Jeevpriya, Pranada.

                              Hindi- Harre, Harad

                              Marathi- Hirada

                              Bengali- Haritaki

                              Gujarathi- Harad

                              Tamil-   Kandakai

                               English- Myrobalan, Chebulic myrobalan

        e) Types – 7 types

                     "विजया रोहिणी चैव पूतना चामॄताभयाम्।

                          जीवन्ती चेतकी चेति पथ्यायाः सप्त जातयः॥  "

Vijaya	Vindhta	Lambagola
Rohini	All over	Rounded
Putana	Sindhu	Small, less fleshy
Amruta	Champaranya	Fleshy
Abhaya	Champadesh	Used in netra roga and Having 5 lines on fruit
Jivanti	Saurashtra	Yellow colour
Chetaki	Himalaya	Three lines on fruit

        f) Parts used ­-  Fruits

        g) Ayurvedic Properties –

                "कषायं दीपनं चाम्लं चक्षुष्यं चाभयाफलम्॥"    सु. सु.४६

                        "हरितकी पंचरसा अलवणा तुवरा परम्।

                         रुक्षोष्णा दीपनी मेध्या स्वादुपाका रसायनी॥

                         चक्षुष्या लघुरायुष्या बॄंहणी चानुलोमनी। "   भा. प्र.

                        Rasa – Madhur, Amla, Katu, Tikta, Kashaya

                                 Kashaya rasa prominent

                        Guna – Laghu, Ruksha.

                        Veerya – Ushna

                        Vipaka – Madhur

                        Prabhav – Tridoshahara

        g) Doshaghnata – Tridoshaghna

        h) Rogaghnata -  Netravikara, Drushtimandya, Mulvyadhi, Shoola,   Anaha, Gulma, Vibhanda, Udara, Grahani,  Shwasa,  Shukrameha, Shwetpradara, Mutrakrucch  Murtaghata, Ashmari, Jwara.

        i)  Karma – Dahashamana, Chakshushya, Rasayana, Krumighna,              Vedanasthapana, Vranashodhana, Vranaropana, Medhya,                         Balya, Dipana, Pachana, Yakruta-uttejaka.

        j) Dosage - Shodhana purpose -3 to 6 gms

                       rasayana purpose – 1 gms

                       Balaharitaki – 1 to 3 gms

        k) kalpas – Abhayadi Modaka, Abhayarishta, Pathyadi vati,     Pathyadi kadha, Vyaghriharitaki, Agastiharitaki, Gandharvaharitaki,                           Haridra khanda.

        l) Strotogamitwa -  Rasavaha, Majjavaha, Raktavaha, Medovaha.

        m) Chemical composition-

           Phenolic acid, terpenoids, tannins, luminol-which is an                            antioxidant, vaniline, l-ascorbic acid, poly-l lycine                     hydrobromide,cupric sulphate, analogs of vitamin E,                              vitamin E- fat soluble antioxidant, Vitamin E- water soluble               antioxidant, l- glutamine which prevent cataract, gallic acid.                 

·         luminol-which is an antioxidant.

·         lycine, glutamine and vaniline are essential amino acids.

·         Gallic acid acts as hypoglycemic, hypolipidemic, anti-fungal, antioxidant. It is helpful in albuminourea and showed regeneration of beta cells of pancreas. Gallic acid restores total protein, albumin, and total body mass of diabetic patient to near normal.