SUVARNAPRASHAN

Empower Baby’s health with Ayurvedic ‘SUVARNAPRASHAN’

Prof. Dr. Usha Deshmukh
M.D., D.C.H. (Ayu)
Prof. & H.O.D. Pediatrics
R.A. Podar Medical College, Worli, Mumbai
+919423107039
drusha1954@gmail.com

Children are wealth of the nation. Health of this new generation is a major concern towards the development of the country. Hence empowering future generation in terms of physical fitness and intellectual abilities is of immense importance. Children constitute about 40% of the total population of the country. Considering this scenario, undoubtedly, future of the country is solely dependent on supreme health and dynamic brains of the children. Swami Vivekanand said “A model man is one who possesses creative brain, skillful hand and an affectionate heart”. Hence it’s high time to execute skilful, safe and scientific plan to achieve this goal of a model man.

Looking through the medical angle, genetically inherited qualities and environmental factors contribute equally in making a model personality. Exceptionally intelligent and smart child is a daydream of every parent. Due to several social factors, the family size is restricted to one or two children only.  During infancy the body system and tissues are like clay which can be molded in proper shape by advocating optimum care, appropriate nutrition and natural wellness regimens. Keeping this goal in mind, Ayurveda an ancient health science was unfurled and a formulation elaborated for infants and children to enlighten their future was discovered.

While understanding the need and importance of this issue, the topic was discussed with various departmental heads including Medicine, Gynecology & Obstetrics, Pharmacy etc. along with associate faculties in my own Pediatric department. The project was blessed and guided by Hon. Dr. Kuldeep Raj Kohali, Dean, M. A. Podar Hospital. Way back in 2010, we initiated massive brainstorming in focused direction and concluded with a concrete formula with all best inputs from concerned authorities.

The study was as deep to recognize even the particle size of Suvarna Bhasma in the composition. The use of ‘Brahmi Ghruta’ instead of plain Cow ghee was yet another added feature to excel the therapeutic value of this formula. The dosage recommended in the original text as “स्वपाणितल” (quantity which fills the palm of baby) was found to be pretty expensive and hence we used only 4 drops per subject. As on date, at Podar Hospital, Mumbai, over 100,000 children are immunized with Suvarnaprashan and have benefited to restructure their immunity and have gained outstanding health profile.

During deep thinking on the project from various angles, a new dimension of therapeutic role came forward. As the foundation of entire Nervous System sets during embryonic stage, it will be wise to initiate Suvarnaprashan from third gestational month up to completion of sixth months. This view was reestablished with textual references and was supported by Prof. Dr. Subhash Marlewar from the Dept. of Gyn and Obs. Hence I strongly recommend that Suvarnaprashan should be advocated from the beginning of 3rd gestational month till the completion of 6th month. Further, it should be initiated since birth and to be continued till 5th birthday on daily basis.

In the recent past, Suvarnaprashan has gained vast popularity in the country. Many companies have started manufacturing and marketing numerous brands and variety of authentic and many substandard formulations for commercial interest. The concept of advocating this treatment only on the “Pushya Nakshatra” is rather misleading. The development of physiological elements in the body is an ongoing process and need not be governed by any such barrier. It is rather misinterpreted because purchase of Gold is considered auspicious on this day. I am of an opinion that it will be obviously inadequate dosage if given only on a particular day of a month.

Considering the benefits of Suvarnaprashan, we were looking forward to popularize it on wider platform which was not possible due to the organizational structure. It is indeed a pleasure that Akshay Pharma Remedies; Mumbai, have shown keen interest in this project. We were happy to share the formulation and technical details to them. Now Akshay Pharma Remedies has introduced this authentic Suvarnaprashan under the brand name “HemPrash”.

This text summarizes the observations of Suvarnaprashan in brief:

The central nervous system develops far ahead of the other systems. First spurt of development is during the prenatal period, around third trimester. Further, a significant amount of brain building is happening during the first 2 – 3 years of childhood, wherein the foundations for intelligence region and language is established. The groundwork for brain development begins at the day one of conception.

According to the developmental pattern, prenatal spurt and postnatal spurts depend upon the nutrition. Children are most vulnerable to infections owing to low immunity and maturity with risk factors like poor hygiene and nutritional inadequacies. Nuclear family structure, busy professional commitments and competitive educational system also contributes a lot to stress related problems in children. These eventually result in poor health profile and performance. Thus, promotion of overall health and intelligence is the need of this hour. Ayurveda always emphasizes on promotion of health and disease prevention.

“Suvarna-Prashan, is one of a splendid methods, specially mentioned for newborn babies and infants. It is also useful in early prenatal period with the aim to boost their immunity and overall health including higher mental health. Acharya Kashyap was the first ancient pediatrician in the world. He has advised Suvarna-Lehena with honey and ghee. Charaka Samhita and Ashtang Sangraha has also described Suvarna-lehana after birth.

आमथ्य मधुसर्पिर्भ्यां लेहयेत् कनकं शिशुम् l सुवर्णप्राशनं ह्येतन्मेधाग्निबलवर्धनम् ll
आयुष्यं मङ्गलं पुण्यं वृष्यं वर्ण्यं ग्रहापहम् l मासात् परममेधावी व्याधिभिर्न च धृष्यते ll
षड्भिर्मासैः श्रुतधरः सुवर्णप्राशनाद्भवेत् l काश्यप – सूत्रस्थानम् १८

Development is a constant process from birth to maturity which begins at the gestational phase. It depends upon maturation and myelination of brain which continues up to two years of age. Myelin acts as insulation, making it possible for the nerves to carry information from one part of the brain or body to another. DHA and Omega 3 fatty acids are vital for growth, development and maintenance of the brain tissue. Cow ghee, prepared by traditional Indian method is identified as natural and rich source of DHA and Omega 3 fatty acids along with many other nutritional assets for the brain. Hence, Ghee provides the right substance for manufacturing myelin i.e. the fatty sheath that surrounds nerve fibers. It is a part of diet which improves texture and radiance of the skin, termed as OJA in Ayurveda.

Ayurveda has mentioned the properties of cow ghee as follows.

शस्तं धीस्मृतिमेधाग्निबलायुः शुक्रचक्षुषाम् । बालवृद्धप्रजाकान्तिसौकुमार्यस्वरार्थिनाम् ॥ क्षतक्षीणपरीसर्पशस्त्राग्निग्लपितात्मनाम् । वातपित्तविषोन्मादशोषालक्ष्मीज्वरापहम् ॥
स्नेहानामुत्तमं शीतं वयसःस्थापनं घृतम्।

As mentioned earlier, we have used Brahmi Ghruta in place of plain Cow Ghee of which the properties are described as below:
Consuming Cow ghee processed with Brahmi, Siddharthak, Vekhand, Anantamool, Kushtha, Saindhav and Pippali improves voice, intellectual ability and memory. It also extends the life span, corrects vision defects, uplifts immunity against microorganisms, attains mental stability. The property of correcting vision defects may probably nullify the childhood vision errors.

ब्राह्मीसिद्धार्थकवचासारिवा कुष्ठसैन्धवैः । सकणैः साधितं पीतं वाङ्मेधास्मृतिकृद् घृतम् ।।
आयुष्यं पाप्मरक्षोघ्नं भूतोन्मादनिबर्हणम् ।  अष्टांगहृदय, उत्तरस्थान १/४३

Suvarna (Gold) is cool in action; possess aphrodisiac, strength promoting, heavy, tonic properties. The taste is sweet along with bitter and astringent with sweet after-taste (Vipaka), slummy property, auspicious, anabolic, improving vision, memory and intellect promoting, good for heart muscle, imparts longevity, skin texture, stability, antitoxic and recommended for treating tuberculosis, achieves balancing of all the three doshas, good for treating fevers and hoarseness of voice. Gold bhasma prepared by authentic Ayurvedic manufacturing process has numerous health benefits.

The textual verses are as follows.

सुवर्णं शीतलं वृष्यं बल्यं गुरु रसायनम् । स्वादु तिक्तं च तुवरं पाके च स्वादु पिच्छिलम् ।।
पवित्रं बृंहणं नेत्र्यं मेधास्मृतिमतिप्रदम् । हृद्यमायुष्करं कान्तिवाग्विशुद्धिस्थिरत्वकृत् ।।
विषद्वयक्षयोन्मादत्रिदोषज्वरशोषजित् । . . . . भावप्रकाश, धात्वादिवर्ग १०, ११

Honey is a food item containing more sugar, iron and Vitamin A.
आजन्मसात्म्यात्कुरुते धातूनां प्रबलं बलम् l बालवृद्धक्षतक्षीण वर्णकेशेन्द्रि यौजसाम् ll
प्रशस्तो बृंहणः कण्ठ्यः स्तन्यसन्धानकृद्गुरुः l आयुष्यो जीवनः स्निग्धः पित्तानिल विषापहः ll अहृ.सू १०/८

It does SadyaTarpana (Instant nutrition). Its use in initiating active immunization is well studied. Honey is cooling, easily digestible, sweet in taste, useful in diarrhoea, weight reducing, vision improving, appetizer, voice cleanser, wound cleansing and antiseptic, imparts luster, promotes rapid assimilation, astringent after-taste, imparts pleasant feeling, improves skin radiance, accelerates memory, improves vigor, possesses cleansing property and improves the taste. It is recommended in various illnesses like skin diseases, piles, cough, diseases of Pitta, blood borne diseases, diseases of Kapha, Prameha, weakness, worms, obesity, dryness of throat, vomiting, hiccup, diarrhoea, indigestion, burns, bronchiectasis and acts as a catalyst to increase the efficacy of the formulation.

The properties of Honey mentioned in Ayurveda are –
मधु शीतं लघु स्वादु रूक्षं ग्राहि विलेखनम | चक्षुष्यं दीपनं स्वर्यं व्रणशोधनरोपणम ||
सौकुमार्यकरं सूक्ष्मं परं स्रोतोविशोधनम् | कषायानुरसं ह्लादि प्रसादजनकं परम् ||
वर्ण्यं मेधाकरं वृष्यं विशदं रोचनं हरेत् | कुष्ठार्शःकास पित्तास्र कफ मेह क्लमकृमीन् ||
मेदस्तृष्णा वमिश्वास हिक्काऽतीसारविड्ग्रहान् | दाहक्षतक्षयांस्तत्तु योगवाह्यल्पवातलम् || भावप्रकाश, मधुवर्ग २/५

Summary of the project -
"Suvarnaprashan" consists of brain boosting compounds which ensures the babies intellectual upliftment and provide supreme immunity. Multi-point heat treated Ghee, Suvarna and Honey i.e. Suvarnaprashan are rapidly distributed throughout the intra-and extracellular spaces.

In 1890, the German bacteriologist Robert Koch discovered that compounds made with gold inhibited growth of the bacillus that caused tuberculosis and he was awarded the Nobel Prize in medicine for his discovery. Some researchers are placing Gold on critical conditions. Every day the unique qualities of Gold are helping millions of people live longer, healthier and productive lives. Over 5000 years ago, Egyptians ingested gold for mental, bodily and spiritual purification. It is used in surgery to patch damaged blood vessels, nerves, bones and membranes and noticed that it has direct effect on cardiac health by improving coronary blood circulation.  It is beneficial for rejuvenating the sluggish organs, especially the brain. In newborn baby, circulatory system is established first. It is used to improve mental attitude and emotional status. Gold increases mental supremacy and the ability to concentrate. Gold is thought to strengthen mental function by increasing the conductivity between nerve endings in the body and on the surface of the brain.

Benefits of SUVARNAPRASHAN:
1) Medha-janana – (Promotion of memory, intellect and talent). The properties of honey, Ghee and Gold are equally favorable to the mental progress of a child. Honey, ghee are rich sources of carbohydrates and fat respectively, these may provide energy to the child even used in small quantity.
2) Ayushya – (For longevity): It is for ensuring a long, healthy and happy life for the child.
3) Strength – (For physical strength to the newborn). Physician may observe for routine in terms of improved sucking and swallowing reflexes of neonate.
4) Immune system - (To improve Rog Pratikar Shakti). Immune systems towards diseases become very powerful.
5) Recall memory becomes very strong (ShrutaDhara).
6) Improves digestion power.
7) Tones up skin colour (Fair and radiant skin)
8) Growth of Mind and body faster than usual.
9) Anti-toxic power increases.
10) Imparts strong protection against variety of infections.
11) It provides a protection shield during seasonal changes and diseases attributed to these changes.

PCOS (Classification)

Dr Rupali Mahadik.
MD ( Streerog )
Amrutwel Women's Clinic Kharaghar.
Ex Prof and HOD streerog Dept.
D.Y.Patil Ayu College Nerul

PCOS (Classification )

Polycystic Ovary Syndrome (PCOS)  is an incompletely understood enigmatic disease.

It is usually, but not necessarily ; characterized by
- Oligomenorrhea
- obesity
- hyperandrogenaemia
- infertility

Although pathogenesis is unclear , chronic hyperandrogenaemia either due to

-Erratic high LH levels
  or
- insulin resistance with compensatory hyperinsulinaemia,
Is a predominant feature of this syndrome.

Both LH and Insulin act at the Thecal compartment of Ovary to stimulate hyperandrogenaemia.

Moreover the small and intermediate follicles predominate the PCOS scenaria and they gradually proceed to atresia rather than follicular dominance.

* Classification of PCOS -
Based on Endocrine and Sonographic  landmarks following classes of PCOS subjects are arbitrarily identified with gradation of hyperandrogenism , individual approach of treatment is needed.

1- PCO

Normoandrogenic, normoestrogenic and non obese subjects.

Do not exhibit usual manifestation of hyperandrogenaemia,
menstrual delay/ Oligomenorrhea ,

But anovulation is present.

These subjects have bilateral active ovaries with no evidence of follicular dominance or ovulation .

No significant alteration is expected in the hormonal profile.
Constitutes 80% of PCOS subjects and form the link between normal and significantly androgenised PCOS subjects.

2- PCOD

These are definitely hyperandrogenic and relatively obese.
Oligomenorrhea
anovulation are almost certain.
Evidence of high LH to FSH ratio
Higher testosterone levels
Ovaries large  with evidence of homogeneous polyfollicular enlargement with significant Thecal hyperplasia .
Necklace pattern in USG

20% of PCOS Pt gave the typical features of PCOD.

3. - Hyperinsulinaemia

Picture same like PCOD with Endocrine difference of hyperinsulinaemia instead of high LH levels.

4- Hyperthecosis

These subjects with Ovarian Hyperthecosis are much more androgenised, with testosterone levels bordering that of tumor range( > 1 ng/ml).

Sonographically they present with sparse Ovarian follicles and predominant thecal excess.

These patients could manifest insulin resistance and acanthosis Nigerians.
Hence condition is known as Hairan syndrome.

Less then 5 % among PCOS population .

5- Hyperprolactinaemia

Borderline Hyperprolactinaemia and hypodopaminergic state could co exist in nearly 5% PCOS subjects.

They may or may not be galactorrhoeic and may not evidence significantly high prolactin levels.
Represents like type 1 PCO case but with borderline/ Hyperprolactinaemia.

6 - High DHEAS

Few pts may present with Congenital adrenal hyperplasia, a genetic defect in 21- hydroxylase enzyme in adrenal cortex.
Only 3% have this defect and they present with high DHEAS levels ( between 250 and 800 ng/ml), .
They are usually thin , hirsute with ovulatory dysfunction, and an alternate presentation is that a thin adolescent subject with symptomatology of hirsutism.

7 - Tumour

Occasionally a Virilizing ovarian or adrenal tumours present with features of virilism , and  these subjects have serum testosterone (1.5 ng/ml or more) or DHEAS ( 9000 ng/ml or more) respectively.
Easily spotted at routine sonographic study of ovaries and adrenal in all PCOS subjects.

According to this the treatment protocol differs.

Vātaśonita

वातशोणित ;
Vātaśonita is the disease produced by vitiated vāta dośa and rakta which impede the gati of each other causing the disease. This disease is also renamed as ādhyaroga i.e. mainly affluent people are affected by the disease as said by Chakrapāni.1 Very detailed aetiological factors had been mentioned in Caraka Samhita which were in practice during that very time and now has become either out dated or localized to very remote places in India, like pinyaka (in ancient time, the residue of oil seeds were eaten after oil had been extracted), madya like arnāl, sauvir, sukta, surā, āsava like alcoholic beverages which were in use which have been replaced by refine alcoholic drinks like beer, wine etc. Again during old time horse, camel and yāna (carts) were used for travelling which may be co related with travelling means of modern era. The disease is predominant among the people who in general are not habitual to physical activity rather they have more sedentary lifestyle. People of pitta prakriti (pitta constitution) are prone to develop vātaśonita, sukumāratwa (delicate personality) is the characteristic feature of pitta prakriti.
Each of the three dośa, which are physiological entity can be subdivided into three types depending on the mode of action which each of the three execute in the normal and pathological stages, a) normal physiological activities of the body are dhātu dośa (normal dośa), b) abnormal physiological activities of dośa in the body- (vitiated dośa) and c) by products of abnormal physiology will be the mala dośa (waste product) only which have anatomical entity and are removable from the body. All normal micro and macro movemental activities in the body are dhātu vāta, all the activities responsible for heat production and regulation are dhātu pitta and all the synthesis or productive activities of the body are dhātu kapha. Dośa (normal physiological activities) are very essential for the body so in that context they are called as dhātu, but when they are prone to vitiation they are called as dośa. All abnormal movemental (macro and micro) activities in the body are caused by vitiated vāta dośa, abnormality in heat production and regulation in the body are caused by vitiated pitta dośa and abnormal synthesis in the body are caused by vitiated kapha dośa and by products of abnormal activities (pathological activities) are mala dośa, they tarnish (malini karnat) the body so called mala.
In case of vāta śonita there should be abnormality in movemental activity (vāta dośa) as well as abnormality of rakta. Due to metabolic disturbances (dhātwāgni vaishamya) there is overproduction of metabolites like uric acid, calcium pyrophosphate, etc. High concentration of these metabolites in blood should be considered as raktaduśti, high concentration of uric acid and other metabolites in blood slows the propulgation of blood in capillaries and hence there is stagnation of it near the joints and dependent parts of the body. Uric acid escapes and enters into the joints and other tissues from the stagnated hyperuricemic blood, and the same time there may be reduced excretion of uric acid through kidneys, these all disturbed movemental activities are considered as vāta duśti and over production of uric acid during metabolism of nucleoproteins and through de novo pathway may be considered as agniduśti. It is observed that patients suffering from vātaśonita also have visamāgni (disturbed digestive capability), it is a rule that if the jatharāgni (digestive capability) is disturbed the other types of agnī (metabolism) will also be disturbed. It is the beauty of Ayurvedic science that has mentioned all and very different etiological factors responsible for a) agni vaisamya b) dośa prakopa and c) dhātu dushti directly or indirectly.
Inflammation of joints may also occur by some other metabolites like calcium pyrophosphate crystal deposition which is also a by product and resultant of agni dushti (disturbed metabolism).

Prof. Dr. Satyendra Narayan Ojha ,
MD (KC), Ph.D.
Director , Yashawant ayurveda college , Post graduate teaching and research center ,
Kodoli ,Panhala , Kolhapur.. 

drsnojha@rediffmail. com   

- See more at: http://infoayushdarpan.blogspot.in/#sthash.1vieGQdO.dpuf

Obesity

Some Basics –

“Let thy FOOD be thy Medicine
Let thy medicine be thy food”
-Hippocrates

“Eat to live and not live to eat”

“Health is made or marred in the Kitchen ”

Now a days , menstrual abnormalities incidence have gone high,
we see only two types of young girls- one very lean with zero figure and others maximum in no a very Obese.

Obesity –
Obesity is a condition wherein the body weight is 20% or more above the ideal body weight.
Excessive accumulation of adipose tissue in relation to lean body mass.

Causes-
1. Overeating- and Fast food
This leads to excessive consumption of energy, which is stored in the body as fat. Consumption of high fat diet leads to increased triglycerides levels. Excess of Carbohydrate and Protein in food,which are not utilized,are stored as fat.

2. Physucal inactivity-
Lack of adequate exercise leads to a decreased energy requirements.Thus ,an imbalance between the energy intake and energy expenditure occurs.

3. Emotional disturbance-
During anxiety, frustration,tension or insecurity some people tend to overeat to allay their tension. Thus, they see food as a model of comfort resulting in overeating.

4. Heredity-
Studies indicate that if both parents are obese,there is an 80% chance of the child also becoming obese.

In postmenopausal women, estrogen levels are decreased, leading to the deposition of fat in abdominal region,thereby contributing to abdominal obesity.

MANAGEMENT OF OBESITY:

Behaviour modification together with diet and exercise help in prevention and treatment of obesity.
*Diet:
Do’s-
● High fibre foods like whole wheat flour, bajra,jowar, oatmeal etc
● Pulses,especially whole pulses and Sprouts.
●Use Skimmed milk
●More of Vegetables in raw or cooked form such as leafy vegetables, cabbage, gourds etc.
● Fruits like apple,Papaya,Orange,Sweetlime,guava,peach etc
● 8_10 glasses of water per day.
●Cut down on fruits like banana, chikoo,mango,custard apple and Vegetables like potatoes, sweet potatoes, yam etc.

Don’t-
● cut off sugar.
●Avoid refined products such as Maida,white bread,khari ,pasta etc.
● Reduce Consumption of Chocolates, Pastries,aereated drinks.
●Reduce /stop smoking,alcohol,tobacco chewing.

*Behaviour Modification
●Eat slowly -savour each bite.
● Regular meal pattern with frequent intervals
● Never skip meal
● Eat wisely and learn to say ‘No’ to temptation.

*Exercise-

Aim to increase your physical activity at least thirty minutes per day.

Exercise is excellent to burn calories out and improve both mental and physical health.

Dr.Rupali Mahadik

MD Streerog
Amrutwel Women’s Clinic
Kharghar

Neoplasm of the Lung

Neoplasm of the Lung ;
The incidence of lung cancer peaks between ages 55 and 65 years. Lung cancer accounts for 29% of all cancer deaths (31% in men, 26% in women). Lung cancer is responsible for more deaths in the United States each year than breast cancer, colon cancer, and prostate cancer combined; more women die each year of lung cancer than of breast cancer.

Aetiology
Most lung cancers are caused by carcinogens and tumor promoters inhaled via cigarette smoking etc.

Clinical Features
Although 5–15% of patients with lung cancer are identified while they are asymptomatic, usually as a result of a routine chest radiograph or through the use of screening CT scans.
Most patients present Central or endobronchial growth of the primary tumor which may cause cough, hemoptysis, wheeze and stridor, dyspnea, and postobstructive pneumonitis (fever and productive cough).
Peripheral growth of the primary tumor may cause pain from pleural or chest wall involvement, dyspnea on a restrictive basis, and symptoms of lung abscess resulting from tumor cavitation.
Regional spread of tumor in the thorax (by contiguous growth or by metastasis to regional lymph nodes) may cause tracheal obstruction, esophageal compression with dysphagia, recurrent laryngeal nerve paralysis with hoarseness, phrenic nerve paralysis with elevation of the hemidiaphragm and dyspnea, and sympathetic nerve paralysis with Horner’s syndrome (enophthalmos, ptosis, miosis, and ipsilateral loss of sweating).
Malignant pleural effusion often leads to dyspnea.
Pancoast’s (or superior sulcus tumor) syndrome results from local extension of a tumor growing in the apex of the lung with involvement of the eighth cervical and first and second thoracic nerves, with shoulder pain that characteristically radiates in the ulnar distribution of the arm, often with radiologic destruction of the first and second ribs. Often Horner’syndrome and Pancoast’s syndrome coexist.
Other problems of regional spread include superior vena cava syndrome from vascular obstruction; pericardial and cardiac extension with resultant tamponade, arrhythmia, or cardiac failure; lymphatic obstruction with resultant pleural effusion; and lymphangitic spread through the lungs with hypoxemia and dyspnea.
Common clinical problems related to metastatic lung cancer include:-
Brain metastases with headache, nausea, and neurologic deficits;
Bone metastases with pain and pathologic fractures;
Bone marrow invasion with cytopenias or leukoerythroblastosis;
Liver metastases causing liver dysfunction, biliary obstruction, anorexia, and pain;
Lymph node metastases in the supraclavicular region and occasionally in the axilla and groin;
Spinal cord compression syndromes from epidural or bone metastases.
Adrenal metastases are common but rarely cause adrenal insufficiency

Investigation:
Chest x-ray
CT scan of chest and abdomen
CT or MRI scan of brain and radionuclide scan of bone if any finding suggests the presence of tumor metastasis in these organs
Tumor tissue can be obtained by a bronchial or transbronchial biopsy during fiberoptic bronchoscopy; by node biopsy during mediastinoscopy; from the operative specimen at the time of definitive surgical resection; by percutaneous biopsy of an enlarged lymph node, soft tissue mass, lytic bone lesion, bone marrow, or pleural lesion; by fine-needle aspiration of thoracic or extrathoracic tumor masses using CT guidance; or from an adequate cell block obtained from a malignant pleural effusion.

Ayurved treatment by Panchkarma: (Purificative Procedure) especially Vaman is very useful. Associated therapy with following procedures may also be helpful.
Ura- basti
Lepa

Internal Medicine may be used:
Pushkarmula, (Inula racemosa), janjabilsami
Bharangi, (Clerodendron serratum)
Ashwagandha kshar (Withania somnifera), Winter cherry
Haridra, (Curcuma longa), Turmeric
Daruharidra, (Berberis species), Indian berberry
Bhallataka, (Semecarpus anacardium) Marking nut
Vansha, (Bambusa arundinacia), Bamboo manna
Shirish, (Albizzia lebbeck)
Pippali, (Piper longum), long pepper
Tulasi, (Ocimun sanctum), Holy basil
Brihat panchmula: It is group of 5 herbal drugs viz; Bilwa,{(Aegle marmelos), Bengal Quince}, Gambhari, {(Gmelina arborea)}, Patala, (Stereospermum suaveolans), Agnimantha, (Premna integrifolia), Syonaka, (Oroxylum indicum).

Prof. Dr. Satyendra Narayan Ojha ,
MD (KC), Ph.D.
Director , Yashawant ayurveda college , Post graduate teaching and research center ,
Kodoli ,Panhala , Kolhapur.. 

drsnojha@rediffmail. com   

SKIN CANCER

SKIN CANCER

Clinical Characteristics:
There are four types of cutaneous melanoma. In three of these—superficial spreading melanoma, lentigo maligna melanoma, and acral lentiginous melanoma—the lesion has a period of superficial (so called radial) growth during which it increases in size but does not penetrate deeply. It is during this period that the melanoma is most capable of being cured by surgical excision. The fourth type— nodular melanoma —does not have a recognizable radial growth phase and usually presents as a deeply invasive lesion, capable of early metastasis.
When tumors begin to penetrate deeply into the skin, they are in the so-called vertical growth phase. Melanomas with a radial growth phase are characterized by irregular and sometimes notched borders, variation in pigment pattern, and variation in color. An increase in size or change in color is noted by the patient in 70% of early lesions.
Bleeding, ulceration, and pain are late signs and are of little help in early recognition. Superficial spreading melanoma is the most frequent variant observed in the white population.
The back is the most common site for melanoma in men. In women, the back and the lower leg (from knee to ankle) are common sites.

Nodular melanomas are dark brown-black to blue-black nodules. Lentigo maligna melanoma is usually confined to chronically sun-damaged, sun-exposed sites (face, neck, back of hands) in older individuals. Acral lentiginous melanoma occurs on the palms, soles, nail beds, and mucous membranes.

While this type occurs in whites, it is most frequent (along with nodular melanoma) in blacks and East Asians.

A fifth type of melanoma, the desmoplastic melanoma, is recognized. This tumor type is associated with a fibrotic response to the tumor, neural invasion, and a higher tendency to local recurrence.

Occasionally, melanomas can be amelanotic, in which case the diagnosis is established histologically after biopsy of a new or changing skin nodule or because of a suspicion of a basal cell carcinoma. Sites appear to be the forearm and leg (excluding feet), while unfavorable sites include scalp, hands, feet, and mucous membranes.
In general, women with stage I or II disease have a better survival than men, perhaps in part because of earlier diagnosis; women frequently have melanomas on the lower leg, where self-recognition is more likely and prognosis is better.

Lymphadenectomy may control early regional disease. Liver, lung, bone, and brain are common sites of hematogenous spread, but unusual sites, such as the anterior chamber of the eye, may also be involved.

Biopsy: The recommended technique is an excisional biopsy, as that facilitates pathologic assessment of the lesion, permits accurate measurement of thickness if the lesion is melanoma, and constitutes treatment if the lesion is benign.
For large lesions or lesions on anatomic sites where excisional biopsy may not be feasible (such as the face, hands, or feet), an incisional biopsy through the most nodular or darkest area of the lesion is acceptable; this should include the vertical growth phase of the primary tumor, if present. Incisional biopsy does not appear to facilitate the spread of melanoma.

In ayurveda one can opt for Panchkarma: (Purificative Procedure) such as:
Vaman
Virechan
2. Associated therapy
Lepa
Snehan especially various abhyanga
3. Internal Medicine
Manjistha, (Rubia cordifolia), Indian madder
Haridra, (Curcuma longa), Turmeric
Daruharidra, (Berberis species), Indian berberry
Bakuchi, (Psoralea corylifolia), Malaya tea
Chakramarda, (Cassia tora), Fetid cassia
Nimba, (Azadirachta indica), Neem tree..

Prof. Dr. Satyendra Narayan Ojha ,
MD (KC), Ph.D.
Director , Yashawant ayurveda college , Post graduate teaching and research center ,
Kodoli ,Panhala , Kolhapur..
 drsnojha@rediffmail. com   - 

Eladi Choornam (Eladi Churna)

 Eladi Choornam (Eladi Churna) is herbal powder formulation containing Elaichi (cardamom) as a main ingredient. It has different formulations based on ingredients and each formulation has unique benefits and medicinal uses. Generally, all formulations are beneficial for nausea, vomiting, anorexia, excessive thirst etc.

ELADI CHOORNAM FORMULATION NO. 1 Ingredient Name Quantity

Elaichi (cardamom) 10% 

Laung (Cloves) 10% 

Kushta (Indian Costus Root) – Saussurea Lappa 10% 

Nagkesar – Mesua Ferrea 10% 

Ber (Indian Jujube) fruit pulp 10% 

Lajja 10% 

Priyangu 10% 

Mustak 10% 

Chandan 10%

 Kapoor – Cinnamomum Camphora 10% 

Reference: SAHASRAYOGAM, CHURNA PRAKARANA, ELADI CHURNA (26) 

Medicinal Properties

 1. Antiemetic Therapeutic Indications 1. Nausea 2. Vomiting Benefits & Uses This formulation of Eladi Choornam has antiemetic action. It is specially specified for Kapha, Vata ad Pitta type of vomiting. It has very balanced proportion according to Dosha, so it can be given without consideration of humours. It is generally found effective in vomiting with sour and burning vomitus. It also improves digestion and increases appetite. Dosage & Administration The general dosage of Eladi Choornam formulation No. 1 is as follows. Children 250 to 500 mg * Adults 1 to 1.5 grams * Pregnancy Contraindicated due to presence Kapoor * Twice or thrice a day with honey When to Take: before food Safety Profile The short-term use of Eladi Choornam formulation No. 1 is considerably safe and has no side effects when used in prescribed dosage. If unnatural camphor is added in the formulation, then its higher dosage may cause vertigo and camphor poisoning.

 ELADI CHOORNAM FORMULATION NO. 2 Ingredient Name Quantity Elaichi (cardamom) 2.4% Dalchini (Cinnamon) 4.7% Nagkesar – Mesua Ferrea 7.1% Kali Mirch (Black Pepper) 9.5% Pippali (Long pepper) 12% Sonth (dried ginger) 14.3% Misri (Sugar) 50% Reference: SAHASRAYOGAM, CHURNA PRAKARANA, ELADI CHURNA (29) Medicinal Properties 1. Digestive Stimulant 2. Appetizer 3. Anti-spasmodic 4. Anti-emetic 5. Liver stimulant Therapeutic Indications 1. Excessive Salivation 2. Loss of Appetite 3. Nausea and Vomiting 4. Pleuritic chest pain 5. Throat irritation or discomfort Benefits & Uses The effect of Eladi Choornam formulation No. 2 is on KAPHA and VATA imbalance. Excessive Salivation Eladi Choornam formulation No. 2 reduces salivation, so it is beneficial in excessive salivation. It helps digesting and eliminating AMA toxins. It works in excessive salivation when patient has any of following condition: 1. Excessive starch intake 2. Infections of oral cavity 3. Enlarged tonsils with white patches 4. White coating on the surface of the tongue 5. Loss of Appetite However, the most common cause of excessive salivation is acid reflux, GERD or hyperacidity, but in such cases, Eladi Choornam may not help well. In such cases, remedies that work on Pitta Dosha should be used. Eladi Churna formulation No. 2 works mainly on Kapha and Vata dosha. Loss of Appetite Eladi Choornam formulation No. 2 contains high amount of Sonth, Pippali, Kali Mirch and Dalchini in addition to cardamom. All these ingredients are well known appetizers and digestive stimulant. Nausea and Vomiting Eladi Choornam formulation No. 2 is good medicine for nausea and vomiting when vomitus is not sour, but it may be sweet, salty or tasteless. It digests AMA and improves digestion food. It is also effective in vomiting due gastroenteritis or food poisoning. It should not be used in vomiting with sour vomitus, burning sensation, gastritis and epigastric tenderness. Pleuritic chest pain Eladi Choornam formulation No. 2 is also used for pleuritic chest pain. It reduces inflammation of pleura and exerts smoothening effect, which reduces chest pain. Dosage & Administration The general dosage of Eladi Choornam formulation No. 2 is as follows. Children 250 to 500 mg * Adults 1 to 3 grams * * Twice or thrice a day with water When to Take: After food Safety Profile Eladi Choornam formulation No. 2 can cause burning sensation, heartburn, and gastric irritation in some people with PITTA body type or people suffering from GERD, gastritis, ulcers etc.

ELADI CHOORNAM FORMULATION NO. 3 Ingredient Name Quantity

Elaichi (cardamom) 4%

Nagkesar – Mesua Ferrea 4%

Dalchini (Cinnamon) 4%

Tejpata (Indian Bay Leaf) – Cinnamomum Tamala 4%

Talispatra (Indian Silver Fir) – Abies Webbiana 4%

Vanshlochan (Tabashir) – Bamboo Manna 4%

Munakka (Raisins) – Vitis Vinifera 4%

Anardana – Pomegranate seeds 4%

Dhania (Coriander) 4%

Kala Jeera (Black Cumin) 4%

Safed Jeera (White Cumin) 4%

Pippali (Long Pepper) 2%

Piplamool – Long pepper Root 2%

Chavya – Piper Retrofractum 2%

Chitrakmool – Plumbago Zeylanica 2%

Sonth – Zingiber Officinale 2%

Kali Mirch (Black Pepper) 2%

Ajwain (Carom Seeds) – Trachyspermum Ammi 2%

Tintidika – Rhus Parviflora 2%

Amalvet 2%

Ajmoda (Celery) 2%

Ashwagandha – Withania Somnifera 2%

Kaunch Beej (Velvet bean) – Mucuna Pruriens 2%

Misri (Sugar) 32%

Reference: Ayurved Sar Sangrah

Medicinal Properties

1. Strong Antiemetic Therapeutic Indications 1. Nausea 2. Vomiting 3. Dry mouth or throat 4. Excessive Thirst Benefits & Uses The effect of Eladi Choornam formulation No. 3 is on PITTA imbalance. Dosha action is major difference between Eladi Choornam formulation No. 2 and No. 3. Excessive Thirst Eladi Choornam formulation No. 3 helps reducing mouth dryness and reduces excessive thirst. Mainly, PITTA dosha is found in excess in people with excessive thirst. Eladi Choornam formulation No. 3 balances PITTA and reduces thirst. Nausea and Vomiting Eladi Choornam formulation No. 3 has potent antiemetic effects in vomiting with burning and sour vomitus. It reduces nausea and vomiting with PITTA dominance. Dosage & Administration The general dosage of Eladi Choornam formulation No. 3 is as follows. Children 1 to 3 mg * Adults 3 to 6 grams * * Twice or thrice a day with Misri (Sugar) and honey or water When to Take: before food or as required Safety Profile Eladi Choornam formulation No. 3 is considerably safe even from chronic patients suffering with nausea. It can also be used on long-term basis without any side effects

Dr. Atul Dnyanadeo Sanap

Mauli Ayurveda chikistalay panchkarma and research center

D 25 sidhivinayak complex

Sahayognager

Beed 9403330067 9890065637

BREAST CANCER

BREAST CANCER
Breast cancer is a malignant proliferation of epithelial cells lining the ducts or lobules of the breast. Epithelial malignancies of the breast are the most common cause of cancer in women (excluding skin cancer), accounting for about one-third of all cancer in women.

Aetiology
Increased caloric intake contributes to breast cancer risk in multipleways: earlier menarche, later age at menopause, and increased postmenopausal estrogen concentrations reflecting enhanced aromatase activities in fatty tissues.
Moderate alcohol intake also increases the risk by an unknown mechanism. Folic acid supplementation appears to modify risk in women who use alcohol but is not additionally protective in abstainers.
Breast cancer is a hormone-dependent disease. Women without functioning ovaries who never receive estrogen-replacement therapy do not develop breast cancer.
Breast Examination
Women should be strongly encouraged to examine their breasts monthly.
Breast examination by the physician should be performed in good light so as to see retractions of nipple and other skin changes.
The nipple and areolae should be inspected, and an attempt should be made to elicit nipple discharge.
All regional lymph node groups should be examined, and any lesions should be measured.
Physical examination alone cannot exclude malignancy.
Lesions with certain features are more likely to be cancerous (hard, irregular, tethered or fixed, or painless lesions).
A negative mammogram in the presence of a persistent lump in the breast does not exclude malignancy.
Palpable lesions require additional diagnostic procedures including biopsy.
In premenopausal women, lesions that are either equivocal or nonsuspicious on physical examination should be reexamined in 2–4 weeks, during the follicular phase of the menstrual cycle. Days 5–7 of the cycle are the best time for breast examination.
A dominant mass in a postmenopausal woman or a dominant mass that persists through a
menstrual cycle in a premenopausal woman should be aspirated by fine needle biopsy or referred to a surgeon.
If nonbloody fluid is aspirated, the diagnosis (cyst) and therapy have been accomplished together.
Solid lesions that are persistent, recurrent, complex, or bloody cysts require
mammography and biopsy, although in selected patients the so-called triple diagnostic techniques (palpation, mammography, aspiration) can be used to avoid biopsy.
Ultrasound can be used in place of fine-needle aspiration to distinguish cysts from solid lesions.
Not all solid masses are detected by ultrasound; thus, a palpable mass that is not visualized on ultrasound must be presumed to be solid
Better mammographic technology, including digitized mammography, routine use of magnified views, and greater skill in mammographic interpretation, combined with newer
diagnostic techniques (MRI, magnetic resonance spectroscopy, positron emission tomography, etc.) may make it possible to identify breast cancers even more reliably and earlier. Screening by any technique other than mammography is not indicated; however, younger women who are BRCA-1 or BRCA-2 carriers may benefit from MRI screening where the higher sensitivity may outweigh the loss of specificity.

Not Recommended Test in Breast Cancer
Complete blood count
Serum chemistry studies
Chest radiographs
Bone scans
Ultrasound examination of the liver
Computed tomography of chest, abdomen, or pelvis
Tumor marker CA 15-3, CA 27-29
Tumor marker CEA

Ayurvedic Treatment that can be recommended in breast cancer is as follows:

Panchkarma: (Purificative Procedure) especially Vaman (Vomiting induced by medicine) will be very useful as a preventive as well as curative therapy.

Internal Medicines which havea role in Breast Cancer are as follows:
Vacha (Acorus calamus), Sweet Flag
Kutki (Picrorrhiza kurroa), Picrorrhiza
Shilajit (Bitumen),
Guduchi (Tinospora cordifolia), Tinospora
Bhallataka ghrit, (Semecarpus anacardium) Marking nut

External Application in the form of paste following drugs may be used:
Kombadnakhi ,
Shigru (Moringa pterygosperma), Drumstick tree.

Prof. Dr. Satyendra Narayan Ojha ,
MD (KC), Ph.D.
Director , Yashawant ayurveda college , Post graduate teaching and research center ,
Kodoli ,Panhala , Kolhapur..
 drsnojha@rediffmail. com   -

Infertility - Emotional impact

        Most people take their fertility for granted.
Infact a common complaint from individuals and couples when they have difficulty conceiving is " we were so careful to avoid pregnancy until we were ready."

         Couple go in short order from an assumption of assured fertility to one of absolute dismay at what is experienced as unfair and wholly unexpected Infertility.

          The intensively painful experience of finding oneself defined as infertile leads to feelings of isolation and guilt and the inevitable questions: " why me ?" .

           Guilt may b as a primary response common to many couples diagnosed with infertility : guilt about waiting too long to start a family, guilt about previous life events such as pregnancy termination.

In addition to the emotional impact of Infertility are the rigorous, expensive and often humiliating demands of medical treatment.

        Some patients jokingly say , " I have learned more about the reproductive system than I ever imagined I would need to," whereas for others the treatment regimens are confusing and difficult to understand.
All results in stress depression and anxiety , loss of self confidence , loss health etc.
Dr Rupali Mahadik

MD ( Streerog )
Amrutwel Women's Clinic
9322187726

Infertility Treatment Current Scenario

Infertility Treatment Current Scenario-

It involves an initial evaluation of the

First step

-History ,
-Physical examination,
-Semen Analysis
-Hormone evaluation in 35% of patients

Second step

- Female Factor

One third of patients are thought to have disorders of Ovulation -this problem is treated by correcting body weight, and / therapy with Clomiphene citrate, bromocriptine, or prednisolone for 6 cycles .

No pregnancy results , 30% of the patients undergo Diagnostic and Operative Hysteroscopy and Laparoscopy

Half are thought to have a good prognosis. They attempt pregnancy for 6 months ; if no pregnancy results approximately 40% undergo 3 cycles of IVF.

If poor prognosis ( Tubal diseases ) they undergo 3 cycles of IVF.

-Male factor

If male factor is present out of total diagnosed 80% are oligospermic and varicocele- medicines and operated for varicocele , if no pregnancy occurs following surgery , 3 cycles of IVF are attempted.

The Azoospermic Pt undergoes 6 cycles of therapeutic donor insemination. If no pregnancy results, 2 cycles of IVF are attempted.

 Dr Rupali Mahadik
MD Streerog
Amrutwel Women's Clinic
Kharghar
9322187726

Shat-kriyakala - modern time review

Shat-kriyakala - modern time review ;

 Acharya Sushruta has described the concept of Kriyakala which seeks to explain the incident of vrana in terms of dosha disturbance. Vrana in modern parlance may be described as inflammatory process which may lead on to suppuration and ulceration. The concept of Kriyakala describes the mode and stages of the development of diseases. A good understanding of Kriyakala is very essential for early diagnosis, prognosis and for adopting preventive and curative measurement.
The term Kriyakala means the time of action. Kala or time in this context signifies the avastha or stage of the process of diseases.
Kalo hi nityaga avasthika; tatra avasthika vikaram apekshate ||
Ca.Vi.1/229(6)
Kriya or action refer to the resort to measure-aushadha, ahara and charya-with a view to eliminate and correct the doshic disturbance.
Kriyakala therefore, means the (early) recognition of the avastha or the stage of the process of disease and the resort to appropriate measures to correct the same.
As described above shatkriyakala are explained in vrana prashna adhyaya where Dalhan the commentator clarifies vrana in this content is not wound but vatadi humor (dosha) which themselves are cause for dehotpatti (responsible for structural and functional activity of body). They are the one who maintain normalcy. They physiologically go through the phase of chaya prakopa and prashama. This 3 step process is essential for sharira dharan.
The same dosha when get vitiated are cause for destruction of sharir.
Ta eva cha vyapanna pralaya hetava ||
Su.Su.21/3
Destruction (vyapanna) in case of sharir refers to vikruti or disease which undergoes evolution in 6 phase viz chaya, prakopa, prasara, sthanasansraya, vyakti and bhedha.
Inflammation is the local physiological response to tissue injury. It is not in itself, a disease, but is usually a manifestation of disease. Inflammation may have beneficial effect such as the destruction of invading micro-organisms and the walling-off of an abscess cavity to prevent spread of infection. However, may also produce diseases; for example, an abscess in the brain wound act as space occupying lesion compressing vital surrounding structure, or fibrosis resulting from chronic inflammation may destroy tissue permanently.
Inflammation is a protective response that involves immune cells, blood vessels and molecular mediator. It is one among the reason why Acharya Sushruta in this context has accepted rakta (shonita) as fourth dosha. Inflammation is a generic response, and therefore it is considered as a mechanism of innate immunity as compared to adopted immunity specific for each pathogen/hetu. Thus one hetu can cause many diseases and many hetu can cause one disease.
Sanchayam ca prakopam ca prasaram sthana sansrayam II
Vyaktim bhedam ca yo vetti doshanam sa bhaveda bhisaka II
SANCHAYA: It is the first phase of shat kriyakala; it is the stage of accumulation or the stage which represents the inceptive phase of the disease wherein the dosha are stated to have accumulated and stagnated in its own place (Dosha sthanani yesu sanchiyate II Su. Su 21/28), instead of freely circulating as in its normal avastha or phase.
Dosha in this condition are in compact form (Samhati rupa vridhi chaya II Dalhan Su. Su. 21/18). Samhata or compactness can be understood by symptom of vata dosha, vata dosha chaya which is manifested as stabdha purna kostha i.e. stabdha kostha (sense of dullness in abdomen/ sense of reduced intestinal motility) and purna kostha (sense of fullness/ sense of heaviness in abdomen). To fill up the space is normal function of vata which is manifested in excess in sanchaya avastha.
Pitta chaya is manifested with yellow tinge (pittavabhasata). Yellow is normal colour of pitta which is manifested as excess.
Kapha manifest as low body temperature/ reduce temperature (manda ushmata), heaviness of a part or full body (anga gaurav) and languor (alasya). These symptoms are seen in sthan (seat) where chaya rupa vridhi is seen.
The process of acute inflammation is initiated by resident immune cells (sthanik dosha) already present in the involve tissue mainly resident macrophages, dendritic cells, histiocytes, Kupffer cells and mastocytes. Receptors named pattern recognition receptors (PRRs) recognize generic molecules that are broadly shared by pathogens but distinguishable from host molecules, collectively referred to as pathogen associated molecular pattern (PAMPs). Thus cells undergo activation and recognize non self and mechanism of opposition is initiated which is manifested as pradvesho vridhi hetusu i.e. aversion towards similar and attraction towards contraries.
In case of fever it is the pyrogen which may be exogenous (bacterial substance lipopolysaccharide (LPS) present on bacterial cell wall) or endogenous (cytokines, Interleukin-1 and Interleukin-6 etc). These pyrogens enter the body and activate the immune cells (antigen presenting cell) for the formation of cytokines and other factors or due to endogenous cause too activation of immune system takes place.
Atherosclerosis, formally considered a bland lipid storage disease, actually involves an ongoing inflammatory response. Recent advances in basic science have established a fundamental role for inflammation in mediating all stages of this disease from initiation through progression and ultimately, the thrombotic complications of atherosclerosis. Oxidised levels of LDL, increased level of VLDL are the initiation or triggering factor of atherogenesis.
Sanchaya is the early initiation of marker C-reactive Protein which prospectively defines risk of atherosclerotic complications, thus adding to prognostic information provided by traditional risk factors.
Thus new insights into inflammation in atherosclerosis not only increase understanding of disease but also have practical clinical application in risk stratification and targeting of therapy for this scourge of growing worldwide importance rightly said by Dalhan as prathama kriyakala aadya karmavasara.
PRAKOPA: In this stage dosha gets vitiated or aggravated or the dosha previously accumulated/ stagnated get swollen and excited. Vilayan rupa vridhi prakopa (Dalhan). Vilayana here means bonding (samhata) is loss and dosha gets released.
In case of acute inflammation release of inflammatory mediators responsible for the clinical signs of inflammation takes place.
In case of fever Exogenous factors contain immunological protein called lipo-polysaccharide binding protein (LBP) which binds to LPS. The LBP-LPS complex then binds to the CD14 receptors of a nearby macrophage. It causes synthesis and release of various endogenous cytokines factors such as IL-1, IL-6, Tumour Necrosing Factor alpha (TNFα).
In atherosclerosis C- Reactive Protein is elevated and noted in the blood test. Increased level of LDL, VLDL and intermediate lipoproteins activate inflammatory functions of vascular endothelial cells. During atherogenesis, inflammatory cells (eg, monocyte-derived macrophages) accumulate in arteries, releasing growth factors/cytokines (eg, platelet-derived growth factor [PDGF], transforming growth factor-beta [TGF-β], granulocyte-macrophage colony-stimulating factor). Whereas PDGF may stimulate cholesteryl ester (CE) hydrolysis in cells, TGF-β appears to cause a decrease in lysosomal CE hydrolysis. The latter could lead to a transient reduction in intracellular free cholesterol.
In case of Allergens pre-sensitized mast cells respond by degranulating, releasing vasoactive chemicals such as histamine.
Clinical knowledge of Acharyas is saluted by significant and pertinent observation made by Sushruta to rakta as the medium (or substrate) for the spread or dissemination of the morbific factors of the disease. The aggravation of the dosha goes together with the disturbed or agitated state of rakta.
Yasmad rakta……..
Dalhan says alone dosha are unable to get prakopita whereas they are always dependent (paratantra) on rakta. Therefore Acharya have mentioned vata, pitta and kapha dushita rakta. Modern Science too explains release of inflammatory mediators in blood. Vasodilation and its resulting blood flow cause the redness (rubor) and increased heat (calor), (paridaha).
Acute inflammation is an immune-vascular response to an inflammatory stimulus. Vascular response is compared with rakta prakopa and cellular/ immune response to vata, pitta and kapha.
Similarly upon contact with PAMPs, tissue macrophages and mastocytes release vasoactive amines such as histamine and serotonin, as well as eicosanoids such as prostaglandin E2 and leukotriene B4 to remodel the local vasculature. Macrophages and endothelial cells release nitric oxide. These mediators vasodilate and permeabilize the blood vessels, which results in the net distribution of blood plasma from the vessel into the tissue space.
PRASARA: The third phase signifies to spread which generally takes place with help of vata and rakta. Dosha are stated to spread over and extend to other parts of the body.
TESHAM VAYUGATIMATVAT PRASARAN HETU SATYA API ACHAITANYA I
RAJASCA PRAVARTANA SARVABHAVANAM II
The biomotor or motive force which keeps the rakta moving all over the body, through its own channels-srotas- is vata.
The doshas which have become prakupita expand and overflow the limits of their respective locations. This is explained with two analogues viz the overflow which occurs during the process of fermentation in which ferments rises acquiring new and unseen qualities and the later analogy refers to the overflowing in water dam due to an increased accumulation of water in it, resulting in the two sides of the dam being connected into one vast and continuous sheet of water. It explains the various pressure gradients which enable the vimargagaman of inflammatory mediators from vascular tract into another tissue space, organ system or tract. Pressure gradient cause permeability of srotas/ channels and due to unknown reason dosha do the dusti of rakta and prasar of dushit rakta takes place through 15 different ways as mentioned by Acharya Sushruta.
In case of fever the cytokine factors are released into general circulation, where they migrate to the circumventricular organs of the brain due to easier absorption caused by the blood–brain barrier's reduced filtration action there. The cytokine factors then bind with endothelial receptors on vessel walls, or interact with local microglial cells. When these cytokine factors bind, the arachidonic acid pathway is then activated. Prostaglandin E2 (PGE2) is released which is mediated by the enzymes phospholipase A2 (PLA2), cyclooxygenase-2 (COX-2), and prostaglandin E2 synthase.
In acute inflammation the inflammatory mediators molecules alter the blood vessels to permit the migration of leukocytes, mainly neutrophils and macrophages, outside of the blood vessels (extravasation) into the tissue. Vimargagaman as explained by Sushruta. The neutrophils migrate along a chemotactic gradient created by the local cells.
Increased permeability of blood vessels results in the net distribution of blood plasma from the vessel into the tissue space.
Vasodilation occurs first at the arteriole level (prakopa) progressing to the capillary level, and brings about and increase in the amount of blood present causing the redness and heat of inflammation. Thus paridaha symptom is present in Prakopa and prasar stage of shatkriyakala.
In allergy vasoactive chemicals like histamine propagate an excessive inflammatory response characterized by blood vessel dilation and cytokine release into the blood which move alongwith blood.
Acharya Sushruta analogues that the manner in which rain loaded clouds downpour in specific area where they are taken with help of wind similarly dosha whether permeating the entire body or a part of it- ardha sharira or become confined to a particular part or a member of the body, may give rise to disease in the site of their transportation.
Further Sushruta has also explained how sometime simple cause trigger exacerbarated symptoms of disease. Sushruta says prakupita doshas when not sufficiently excited may remain quiescent, coating (lina dosha) the internal pathways- margas- of the body and exacerbate to cause disease, when they are subsequently excited by appropriate exciting factors.
The above quiescence can be easily understood when patient says previous night he had egg and from next day he started with bloody stools with increased frequency which was later on diagnosed as Ulcerative Colitis, an inflammatory bowel disease. Here egg is exciting factor whereas in patient body the dosha/ inflammatory mediators were already prakopita and waiting for exciting causes.
Allergic rhinitis, urticarial etc are example of lina dosha wherein vascular response secrete histamine which excitingly stimulates cellular immunity to show up sudden (achaya purvak) symptoms.
STHANASANSRAYA: It is prodromal phase or the phase of purvarupa wherein disease is yet to be manifested fully. The excited dosha having extended to other parts of the body become localized and it marks the beginning of specific diseases pertaining to those sthan/ structures. It is also known as the stage of disease augmentation. Sthana samshraya means taking shelter in a place.
In case of fever PGE2 is the ultimate mediator of the febrile response. PGE2 acts on neurons in the preoptic area (POA) through the prostaglandin E receptor 3 (EP3). EP3-expressing neurons in the POA innervate the dorsomedial hypothalamus (DMH), the rostral raphe pallidus nucleus in the medulla oblongata (rRPa), and the paraventricular nucleus (PVN) of the hypothalamus. Fever signals sent to the DMH and rRPa lead to stimulation of the sympathetic output system, which evokes non-shivering thermo-genesis to produce body heat and skin vasoconstriction to decrease heat loss from the body surface. It is presumed that the innervations from the POA to the PVN mediates the neuroendocrine effects of fever through the pathway involving pituitary gland and various endocrine organs.
In case of atherosclerosis sthansansraya takes place in myocardial vessel leads to angina/ myocardial ischaemia/ infarct. If it takes place in brain it leads to Cerebro Vascular Event and if it takes place in peripheral vessel it leads to peripheral vessel disease.
If the inflammatory mediators attack the component of muscle it leads to myopathy whereas if intestine are involved it leads to Inflammatory Bowel Disease.
With respect of atherosclerosis when plasma LDL concentrations become elevated, the vessel wall eventually becomes lipid-engorged because it is unable to traffic the large amounts of endocytosed LDL-CE. In addition, lipoprotein entrapment by the extracellular matrix can lead to the progressive oxidation of LDL because of the action of lipoxygenases, reactive oxygen species, peroxynitrite, and/or myeloperoxidase found in oxidized LDL particles. A range of oxidized LDL species is thus generated, ultimately resulting in their delivery to vascular cells through several families of scavenger receptors. These “molecular Trojan horses” and “cellular saboteurs,” once formed or deposited in the cell, can contribute to, and participate in, formation of macrophage- and smooth muscle–derived foam cells.
The accumulation of the WBCs is termed "fatty streaks" early on because of the appearance being similar to that of marbled steak. These accumulations contain living, active WBCs (producing inflammation) and remnants of dead cells, including cholesterol and triglycerides. The remnants eventually include calcium and other crystallized materials within the outermost and oldest plaque. The "fatty streaks" reduce the elasticity of the artery walls. However, they do not affect blood flow for decades, because the artery muscular wall enlarges at the locations of plaque. The wall stiffening may eventually increase pulse pressure; widened pulse pressure is one possible result of advanced disease within the major arteries.
Atherosclerosis is therefore a syndrome affecting arterial blood vessels due to a chronic inflammatory response of WBCs in the walls of arteries. This is promoted by low-density lipoproteins (LDL, plasma proteins that carry cholesterol and triglycerides) without adequate removal of fats and cholesterol from the macrophages by functional high-density lipoproteins (HDL). It is commonly referred to as a "hardening" or furring of the arteries. It is caused by the formation of multiple atheromatous plaques within the arteries
Thus depending on srotovaigunya or khavaigunya or depending on organ/ system disease is caused.
In acute inflammation, after resultant movement of plasma into the tissue which lead to resultant stasis due to increase in the concentration of the cells within blood. Stasis allows leukocytes to marginate (move) along the endothelium, a process critical to their recruitment into the tissues.
VYAKTI: This stage may be stated to be that of manifestation of the fully developed disease- the resultant dosha dushya samurchana.
In case of fever the brain ultimately orchestrates heat effector mechanisms via the autonomic nervous system. It causes increased heat production by increased muscle tone, shivering and hormones like epinephrine (adrenaline) and also prevents heat loss by way of vasoconstriction.
In acute inflammation the increased collection of fluid into the tissue causes it to swell (edema). The main symptoms of the inflammatory response are as follows.
The tissues in the area are red and warm, as a result of the large amount of blood reaching the site.
The tissues in the area are swollen, again due to the increased amount of blood and proteins that are present.
The area is painful, due the expansion of tissues, causing mechanical pressure on nerve cells, and also due to the presence of pain mediators.
Specific patterns of acute and chronic inflammation are seen during particular situations that arise in the body, such as when inflammation occurs on an epithelial surface, or pyogenic bacteria are involved.
Granulomatous inflammation: Characterized by the formation of granulomas, they are the result of a limited but diverse number of diseases, which include among others tuberculosis, leprosy, sarcoidosis, and syphilis.
Fibrinous inflammation: Inflammation resulting in a large increase in vascular permeability allows fibrin to pass through the blood vessels. If an appropriate procoagulative stimulus is present, such as cancer cells, a fibrinous exudate is deposited. This is commonly seen in serous cavities, where the conversion of fibrinous exudate into a scar can occur between serous membranes, limiting their function. The deposit sometimes forms a pseudo-membrane sheet. During inflammation of the intestine (Pseudo-membranous colitis), pseudo-membranous tubes can be formed.
Purulent inflammation: Inflammation resulting in large amount of pus, which consists of neutrophils, dead cells, and fluid. Infection by pyogenic bacteria such as staphylococci is characteristic of this kind of inflammation. Large, localized collections of pus enclosed by surrounding tissues are called abscesses.
Serous inflammation: Characterized by the copious effusion of non-viscous serous fluid, commonly produced by mesothelial cells of serous membranes, but may be derived from blood plasma. Skin blisters exemplify this pattern of inflammation.
Ulcerative inflammation: Inflammation occurring near an epithelium can result in the necrotic loss of tissue from the surface, exposing lower layers. The subsequent excavation in the epithelium is known as an ulcer.
Atherosclerotic lesions, or atherosclerotic plaques, are separated into two broad categories: Stable and unstable (also called vulnerable). The pathobiology of atherosclerotic lesions is very complicated but generally, stable atherosclerotic plaques, which tend to be asymptomatic, are rich in extracellular matrix and smooth muscle cells, while, unstable plaques are rich in macrophages and foam cells and the extracellular matrix separating the lesion from the arterial lumen (also known as the fibrous cap) is usually weak and prone to rupture. Ruptures of the fibrous cap expose thrombogenic material, such as collagen, to the circulation and eventually induce thrombus formation in the lumen. Upon formation, intraluminal thrombi can occlude arteries outright (e.g. coronary occlusion), but more often they detach, move into the circulation and eventually occluding smaller downstream branches causing thromboembolism. Apart from thromboembolism, chronically expanding atherosclerotic lesions can cause complete closure of the lumen. Chronically expanding lesions are often asymptomatic until lumen stenosis is so severe (usually over 80%) that blood supply to downstream tissue(s) is insufficient, resulting in ischemia.
BHEDA: It is the stage in which the disease may become sub-acute and chronic or incurable. Different types or variant of disease gets manifested.
In case of fever signs like increased blood pressure, neck stiffness, headache, giddiness, unconsciousness etc are seen in this phase.
In case of inflammation the outcome is manifested as:
Fibrosis: Large amounts of tissue destruction, or damage in tissues unable to regenerate, cannot be regenerated completely by the body. Fibrous scarring occurs in these areas of damage, forming a scar composed primarily of collagen. The scar will not contain any specialized structures, such as parenchymal cells, hence functional impairment may occur.
Abscess Formation: A cavity is formed containing pus, an opaque liquid containing dead white blood cells and bacteria with general debris from destroyed cells.
Chronic inflammation: In acute inflammation, if the injurious agent persists then chronic inflammation will ensue. This process marked by inflammation lasting many days, months or even years, may lead to the formation of a chronic wound. Chronic inflammation is characterized by the dominating presence of macrophages in the injured tissue. These cells are powerful defensive agents of the body, but the toxins they release (including reactive oxygen species) are injurious to the organism's own tissues as well as invading agents. As a consequence, chronic inflammation is almost always accompanied by tissue destruction.
The importance of the scheme of kriyakala in early diagnosis and for adopting preventive and curative measures can be appreciated better by taking into consideration some of the recent trends in the modern medicine relating to the pathogenesis of disease.
Avoid hetu which are caused of dosha vridhi. Natural antioxidants (i.e. β-carotene, vitamin C, and vitamin E) have been used as a potential strategy to reduce damage caused by oxidized LDL in patients with or at high risk for CHD, but the majority of clinical trials have not shown reductions in CHD events with this approach. More clinically reliable markers of oxidative stress or the development of more effective antioxidant therapies might make this strategy more useful.
Rakta should always be given importance in all diseases. The mode of prasar should be assessed and managed at the same level.
Elevated values of circulating inflammatory markers such as CRP, serum amyloid A, IL-6, and IL-1 receptor antagonist commonly accompany ACS. Such elevations correlate with in-hospital and short-term adverse prognosis and may reflect not only a high prevalence of myocardial necrosis, ischemia-reperfusion damage, or severe coronary atherosclerosis but also a primary inflammatory instigator of coronary instability.
Non communicable disease are the main concerned in the 21st century, Metabolic Syndrome is among the main factor thus early diagnosis and prevention taken by changing the lifestyle can improve the health of society.
Study can be made by using specific antibiotics or specific medicine for each stage of evolution of disease. It will surely reduce the chances of drug resistancy and also control the vigorous use of drugs.
Study of shatkriyakala specifically sthanasansraya will help to understand kha vaigunyakar causes and help prevention of such hetus from causing the disease.
Conclusion: The utility of this shatkriyakala is to enable the treating physician to recognize the disturbances in its early formative stages and to enable to take necessary steps in time, to correct and eliminate the offending factors before they have caused sufficient damage.

Prof. Dr. Satyendra Narayan Ojha ,
MD (KC), Ph.D.
Director , Yashawant ayurveda college , Post graduate teaching and research center ,
Kodoli ,Panhala , Kolhapur..
 drsnojha@rediffmail. com   - See more at: http://infoayushdarpan.blogspot.in/2016/02/ginger.html#sthash.p9onK67z.dpuf