It is a work done by me to make comparision of modern science and ayurveda on tuberculosis.....
2. WELCOME WELCOME 3. RAJAYAKSHMA TUBERCULOSIS 4. Shree
Ganeshaya Namah.. 5.
- A Seminar by: Sandeep kumar sharma
- Guided by: Dr.Samir Bhadri
6.
7. Acc. to Ayurveda 8. Synonyms
9.
- Rajayakshma:Because King Chandra suffered this disease first
time.
- Kshaya : It Diminishes strength and activities.
- Sosa : Because it dries up Rasadi dhatus.
- Rogarat : It is a powerful disease. It is a disease which is
very difficult to treat.
10. King Chandra married 28 daughters of Dakshaprajapati but
unable to satisfy all except Rohini as he was more interested in
her. So remaining complaint to their father and Daksha Prajapati
became furious and his anger came out of his mouth through
expiration and King Chandra suffered by Rajayakshma. Mythological
history (charaka s.chi.8/3-12) 11. Due to occurrence of disease
first time in Raja so called as Rajayakshma. 12. Hetu
(c.s.ni.6/3 and s.s.u.41/9) 13. 1) Sahasa or (over exertion) 2)
Sandharana (suppression of natural urges 3) Kshaya (wasting) 4)
Vishamashana (irregular dieting) There are four etiological factors
Acc. To charaka 14. : :( . . .41/9 ) 15. There are four etiological
factors acc. To susruta
16. When a person does the work which is out of his capacity is
called as Sahasa. Acharya Charaka mentioned different examples of
Sahasa like: 1.Sahasa or aaghataja 17.
- - when a week person fights with a stronger person
- - perform exercise with big bow
- - swims for longer distance
- - subjected to forceful anointing therapy
- application of pressure by feet
- - running fast for longer distance.
- - Practices such other irregular regimens and physical exercise
in excess.
. 18. Samprapti
- As a result of these factors his chest becomes wounded
- the wounded chest gets saturated with Vata
- brings abnormality in both Pitta and kapha
- spreads upwards, downwards and sideways.
19.
- Due to injury to chest, patient constantly suffers from
coughing due to irregular movement of Vata and irritation of
throat.
- Frequent coughing leads to Haemoptysis and weakness and causes
Rajayakshma.
20. Lakshanas
- These vitiated doshas after entering the sandhis (joints)
cause:
- Angamarda (Pain in body parts) and
21.
- After entering the Amashaya causes:
- After entering the Kantha (throat) causes:
- Kanthodhwamsa (irritation of throat)
- Swara bheda (hoarseness of voice)
22.
- After entering the Pranavaha srotasas causes:
- After entering in head produces:
- Sira shula (distress in head)
23. 2)Sandharanaja or vega pratighataja(Suppression of natural
urges)
- Due to suppression of natural urges of Apana vata, mutra
(urine) and mala (flatus) because of:
- Attending the king or master
24.
- Attending meetings of gentleman
- Stree madhye (in b/w ladies)
- While travelling on uneven vehicle
- Prasanga or during Maithuna
- Ghruna (badboo utpanna hone ke dar se)
25. Samprapti ofsandharana janya Rajayakshma
- Due to above mentioned factors the Vata gets vitiated
- abnormality in Pitta and kapha
- after this vata moves downwards, upwards &sideways
- produces different symptoms.
26. Lakshanas of sandharana janyaRajayakshma
- Mala bheda (atisara) or hardness of stool
- Pain in ribs or sides of the chest, shoulder
- Irritation in chest and throat
27. 3. Kshaya hetu
- Excessive shoka (grief), chinta (worry), Irshya (envy ness),
Utkantha (anxiety), Bhaya, Krodha afflicts heart.
- Alpahar (less intake of food)
- Anahar (excessive fasting)
28.
- All above etiological factors leads to Rasa dhatu kshaya which
leads to manifestation of sosa Roga.
- Delay in management causes Rajayakshma.
29. Pratiloma kshayaja Hetu
30. - Ati Maithuna leads to Shukradhatu kshaya - after Shukra
kshaya if person indulges in sexual activity - no semen ejaculation
- vata enters the blood vesselsand causes blood dischargehaving
vata gunas from seminal passage. Samprapti of kshaya janya
Rajayakshma 31.
- vitiated vata spreading the entire body and aggravates Pitta
and kapha
- Pitta dries up the mamsa and rakta
32. Lakshanas
- Pain in the side of the chest and shoulders.
- Jwara, kasa, swarabhada, pratishyaya (due to pratiloma
vata)
33.
- Excess kasa leads to sputum along with rakta and due to rakta
kshaya further dhatu formation stops and person becomes weekend and
leads to Rajayakshma.
- Thats why one should protect his Shukra dhatu.
34. Vishamashana hetu
- Ifthe person adopts unhealthy dietetic pattern will lead to
Rajayakshma.
35. Samprapti of vishamashanaja Rajayakshma
- When a person does pana, ashana, bhakshya, lehya upayoga
opposite to the prakruti, karan, desha, kala, upayoga samstha and
upashaya then his doshas get vitiated
- these vitiated dosha obstructs the srotasas
- maximum part of the food turns into pureesh and mutra
- no rasadi dhatu formation
36.
- Here vitiated Vata leads to:
37.
- Here vitiated Pitta leads to:
38.
- Here vitiated kapha leads to:
39.
- In this case one should do pureesh rakshana because pureesh is
the one which supports the body.
- If a person suffers from constipation then he will not suffer
so much but if he is having atisara then it will suffer him
more.
40. Samprapti of Rajayakshma
41. Samprapti: Acc. To susruta
- Due to obstruction in rasavaha srotasas due to kapha or
- indulging more in maithuna leads to depletion of rasadi dhatus
due to shukra kshaya and leads to Rajayakshma.
42.
43. Sampraptiacc. To Vagbhata
- Aggravated vata produces increase of both pitta and kapha
- and spreads to all joints of the body and through siras goes
upwards, downwards and sidewards and obstructs or dilates the
srotasas and manifests Rajayakshma.
44. Rajayakshma Samprapti ghatakas
- Dosa : kapha pradhana tridoshas
- Vata (vyana, samana, udana, prana andapana)
- Pitta (pachaka and sadhaka)
- Kapha (kledaka, bodhaka, avalambaka)
- Dushya : Dhatus (rasa, raktadi all Dhatus)
- Upadhatus (sira and sandhi)
- Sharirika mala (mutra and pureesh)
- Dhatu mala (kapha, Pitta, sweda, kasha, loma, nakha)
45.
- Agni : Jatharagni, dhatwagni, bhutagni
- Srotas : annavaha, rasavaha, shukravaha mainly
- Later all the srotasas gets obstructed.
46.
- Srotodusti : sangha and vimarga gamana
- Udbhava sthana : amashaya and pakwashaya
- Adhisthana : sarva sharira
- Vyakta sthana : mukha and sarva sharira
- Sanchara sthana : rasa vahinis
47. Sadhya asadhyatva
48.
49.
50. Purvarupas
- Stree madya mamsa priyata
- Feeling of exhaustion during meal time
- Swelling on the face and feet
51.
- Frequent looking at the hands
- Excessive whitishness of eyes
52.
- deserted villages, towns, cities and countries
- dried, burnt, and destroyed forest.
- Riding over dog, camel, donkey and pig etc.
53.
54. Acc. To charaka
55.
- vaiswarya ( derangement of voice)
56. Acc. To susruta
57.
58. Acc. To charaka
59.
- shonita shtheevana (haemoptysis)
60. Acc. to susruta
61. Due to vata
62. Due to Pitta
63. Due to kapha
64. s
65. s acc. to charaka
66.
- Ati ksheena mamsa, bala and rakta
67. acc. to susruta
68.
- One who is having all ekadasha rupas, shadrupas and trirupas
along with loss of bala and mamsa
- Shoonmushkodara (swelling on testis and abdomen)
- Arista lakshanas are present.
69.
70.
- vardhakya (vriddhavastha)
71. Difference between sosa and Rajayakshma
- Madhava has given difference between shosha and
Rajayakshma.
- There should be presence of jwara and dandanu in Rajayakshma
but in shosha it is not compulsory.
72.
- Rajayakshma can be called shosha any time but shosha can not be
said as Rajayakshma every time.
- Shoka shoshi and jara shoshi will not be called as Rajayakshma
peedita.
73.
- Talisadi churna and gutika
74. Acc. To modern science.. 75.
Pulmonary 76. Some terms related to the topic
- Hilar - related to hilum or hilus.
- Lesions - discontinuation of tissues.
- primary focus- thestarting point of disease process.
- Tabes Mesenterica- a progressive wasting of the Intestine.
77.
- Caseous - cheesy appearance
- Erosion -destruction of tissue
- milliary TB- acute or generalised TB.
- Orthopnoea- discomfort in breathing in any position except
sitting or standing position.
78.
- Amyloidosis- it is disease in which amyloid is deposited
extracellularly
- Amyloid a glycoprotein resembling like starch
- Culture- to induce the propagation of micro organisms in
special media which are promoting their growth.
- Smear- a specimen for microscopic examination on slide.
79. Droplet infection
- Spreading of infection by fine infected particles as by
sneezing from the nose or by spitting from mouth.
80. Causative organism
- Tubercle bacillus or Kochs bacillus orMycobacterium
Tuberculosis.
- Organismis a strict aerobe and lives in the part where
theoxygen supplyis more,
- Mycobacterium Tuberculosis Bovisis mainly a causative factor by
theunpasturatedmilk from the animals.
81. Mycobacterium Tuberculosis hominis
- slender rod like bacillus.
- Neutral on gram staining.
- It can be demonstrated by:
- 1) Acid fast or ziehl neelson staining.
- 2) Fluorescent dye methods.
- 3) Culture of organism in sputum.
82.
- Tuberculosis is an infectious disease caused byMycobacterium
tuberculosis . The disease primarily affects lungs and
causesPulmonary Tuberculosis . It can also affect intestine,
meninges, bones and joints, lymph glands, skin and other tissues of
the body.
- The disease also affects animals like cattle and known asBovine
Tuberculosis .
83. Atypical or non tuberculous mycobacteria
- Atypical term is used for the other species of Mycobacteria
rather than Mycobacterium tuberculosis complex also called
asenvironmental Mycobacteria.
84. Mode of transmission
- Human beings acquire infectionwith tubercle bacilli by
following routes:
- 1)Inhalation :from cough droplets or dried sputum from an open
case ofPulmonary TB.
- 2) Ingestion :Leads to tonsillar or intestinal
tuberculosis.
- 3)Incubation :From infected post-mortem tissue or through
skin.
- 4)Trans placental route : Congenital Tuberculosis in foetus
from infected mother.
85. Incubation period
- Development of disease depends upon the closeness of contact,
extent of disease andsputum positivityof source or dose of
infection and host parasitic relationship.
- Thus the incubation period may be weeks, months or years.
- Normal incubation period - 3 to 6 weeks .
86. Spread of TB
- 1)Local spread :This takes place by macrophages carrying the
bacilli into the surrounding tissues.
- 2)Lymphatic spread :TB is primarily an infection of lymphoid
tissues. The bacilli may pass into lymphoid follicles of pharynx,
bronchi, intestines, regional lymph nodes.
- 3)Haematogenous spread : Because of the drainage of lymphatics
into vessel system.
87.
- 4)By the natural passages :
- (A) Lung lesions into pleura
- (B) Transbronchial spread into adjacent lung segments
- (C) Into peritoneal cavity (tuberculousperitonitis)
- (D) Infected sputum into larynx ( Tuberculous laryngitis )
- (E) Swallowing of infected sputum ( illeocaecal tuberculosis
)
- (F) Renal lesions into ureter
88. Evolutionof tubercle
- Tubercle bacilli invasion
- lodges in pulmonary capillaries
- due to tubercle bacilli coating ofopsoninwith in 12 hours
progressive infiltration by macrophages occurs
- phagocytosis by macrophages
- activation of T&B lymphocyte cells
- B cells produce antibodies but dont have any role in defence
against tubercle bacillus
- T helper cell(CD4+T) inactivation
89.
- without T helper cell no immune system stimulation
- Hard tubercle formation (due to absence of central
necrosis)
- central mass caseation (the process of conversion of necrotic
tissue into cheesy material)
90. Types of Tuberculosis
- Lungs are the main effected organ in TB. Depending upon the
type of tissue response it is of two types:
91. Primary TB
- The infection of an indivisual who has not been previously
infected or immunised is calledPrimary TBorGhons complexorchildhood
TB.
- Most probably involved tissues in Primary Tb are Lungs &
hilar (related to hilum or hilus) lymph nodes.
- Others are: tonsils, cervical lymph nodes.
- In the case of ingestion of bacilli lesions (discontinuation of
tissues) may be found in small intestine and mesenteric lymph
nodes.
92. This type of TB consists of 3 components
- 1 )Pulmonary component :Leisons in the lung is the primary
focus.
- It is more often in the upper part of the upper lobe of the
lung.
- 2)Lymphatic vessel component
- 3)Lymphatic component :Enlarged hilar and tracheobronchial
lymph nodes.
93. Note :
- In the case of Primary TB of the alimentary tract due to
ingestion of tubercle bacilli a smallprimary focus(the starting
point of disease process) is seen in intestine with enlarged lymph
nodes producingTabesMesentrica(a progressive wasting of the
Intestine).
- The enlarged and Caseous mesenteric lymph nodes may rupture
into peritoneal cavity and may causetuberculous peritonitis.
94. Fate of Primary TB
- 1) The lesions of lung may not progress but instead of healing
byfibrosis, calcificationandossificationmay occur.
- 2) Primary focuscontinues to grow and Caseousmaterial is sent
to the other part of the same lung or to another lung. It is called
asProgressive primary TB.
- 3) Bacilli may enter the circulation througherosion (
destruction of tissue) in blood vessels and may spread to various
tissues and organs. Thisis calledPrimary milliary TB.
- 4) Healed lesions of primary TB may be reactivated. It is
calledProgressive secondary TB.
95. Secondary Tuberculosis
- Infection ofan individual who has been previously infected is
called secondary or post primary or reinfection or chronic TB.
- The infection may be acquired from:
- (A)Endogenous source:such as reactivation of primary
complex.
- (B) Fresh dose of reinfection by tubercle bacilli.
96.
- Secondary TB occurs mainly in apex of the lungs.
- Other sites of infection are tonsils, pharynx, larynx, small
intestine and skin.
97. Fate of sec. pulmonary TB
- (A) Lesions may heal with fibrosis and calcification.
- (B) Lesions may join together to form larger area to involve in
disease.
- (D) Tuberculous caseous pneumonia
98. HIV associated tuberculosis
- HIV infected individuals are more prone to get TB and vice
versa.
- Rate of HIV infection in TB patient is very high.
- Extra pulmonary TBis more common inHIV patients.
99. Clinical features
- The clinical manifestations in tuberculosis may be variable
depending upon the location, extent and type of lesions.
- Usual clinical features are as under:
100. Referable to lungs
- Productive cough may be with blood(haemoptysis)
- Orthopnoea(discomfort in breathing in any position except
sitting or standing position)
- Chest X-ray may show Nodularity.
101. Systemic features
- Loss of weight and appetite
- Note:Untreated cases may developsystemic secondary amyloidosis
.
102. Diagnosis
- Tuberculin :The test material or antigen is known as
tuberculin. It is of two types:
- (b) Purified protein derivative(PPD)
- PPD has replaced OT due to its standardization in terms of its
biological reactivity astuberculin units(TU).
- For routine testing - 1 TUdose is used.
103. Milliary TB
- This disease is the result of acute diffuse tubercle bacilli
via bloodstream.
- It is difficult to diagnose.
- Because chest X-ray may be entirely normal
- Mantoux test may also be negative.
104. 1. Mantoux test
- It is carried out by injecting1 TU of PPD in 0.1 ml on the
flexor surface of forearm intradermally.
- WHO advocatesPPD-RT-23 with tween 80preparation for
testing.
- Result is read out after 72 hours of injection by seeing the
diameter of induration.
105.
- If the diameter is more than 10mm thenPositive case tests
.
- If the diameter is less than 6mm thennegative case test.
- If the diameter is in b/w 6 to 10 mm then doubtful case
test.
106.
- 2. Positive sputum for AFB (on smear or culture)
- 3. complete haemogram ( lymphocytosis )
- 5. Fibreoptic bronchoscopy
107. Causes of death in Pulmonary TB
- Sepsis (presence of micro organism in blood)
- Cor pulmonate orsecondary Amyloidosis .
108. Prevention or vaccination
- It is done by BCG(baccilae calmette Guerin)vaccination.
- A. liquid or fresh vaccine
109. Dosage
- Usual strength is 0.1mg in 0.1ml volume.
- In newborn baby below 4 weeks is 0.05 ml.
- Should be given at birth or at 6 weeks if not given at
birth.
110. Treatment
- Treatment given in TB is called aschemotherapy , which is
having drugs of:
111.
- Currently used drugs may be classified in to two groups:
- Bactericidal : These drugs kill the bacilli in vivo.
- Bacteriostatic:Inhibit the multiplication of the bacilli and
lead to their destruction by immune mechanism of the host.
112. The three basic conceptsin TB treatment are as follows:
- Regimens must contain multiple drugs to which the organism is
susceptible.
- Drugs must be taken regularly.
- Drug therapy must continue for sufficient time.
113. Antituberculous drugsare classified as.. 114. Firstline
antituberculosis drugs
- Superior in efficacy and posses an acceptable degree of
toxicity. these are:
- Isoniazid, rifampin, pyrazinamide, ethmabutol,
streptomycin.
115. Isoniazid
- Mechanism of action: It inhibits the synthesis of mycolic acid
(an essential factor for the formation of mycobacterial cell wall
synthesis)
- no growth of tubercle bacillus further.
116. Rifampin
- It inhibits the DNA synthesis
- no further growth of tubercle bacilli.
117. Pyrazinamide
- It is well absorbed from GIT
- penetrates tissues, macrophages, tuberculous cavities.
- It has excellent effect on intracellular mycobacteria due to
acidic environment.
- Half life: 9 to 10 hours.
118. Ethamabutol
-
- It also inhibits the DNA synthesis.
119. Streptomycin
120. Second line antituberculosis drugs .. 121. Second line
antituberculosis drugs
- More toxic and less effective and they are indicated only when
organisms are resistant to the first line agents. They are:
- Cycloserine, ethionamide, aminosalicylic acid, rifabutin,
quinolones, capreomycin, viomycin and pyridoxine.
122. Para-aminosalicylic acid (PAS)
- It is a Bacteriostatic drug.
- It penetrates tissues and stops the growth of tubercle
bacillus.
123. Ethionamide
- It is also bacteriostatic.
- Mechanism of action: By inhibiting the cell wall
synthesis.
124. Cycloserine
- It also acts by inhibition of bacterial cell wall
synthesis.
125.
- Quinolones:ciprofloxacin, levofloxacin, ofloxacin
126. Treatment for the Latent (inactive) TB infection.. 127.
Dots: directly observed therapy short course..
- Isoniazid 300mg given in combination 30minutes before
breakfast
128. Longer regimen
Isoniazid for 9 months daily or twice weekly OR Rifampin &
pyrozinamide O.D. for 2 months. Mainly in isoniazid resistant TB.
OR Rifampin O.D. for 4 months for one who cannot tolerate
pyrazinamide. 129. For active TB
- Most commonly used drugs are Isoniazid, rifampin and
pyrazinamide daily for two months followed by isoniazid and
rifampin B.D. or T.D. for 4 months.
- If isoniazid resistance is suspected than ethmabutol or
streptomycin.
- In HIV patient: 9 to 10 months.
130. THANK YOU.....