Excerpts from experience

[SAISAVAM - QUARTERLY NEWS LETTER] April-June 06 issue No.6 Vol.2 / Page No.19-27 Department of Kaumarabhritya felt honored when Dr. L. Mahadevan, Director of Sri Sarada Ayurvedic Hospital, Derisanamcope, Kanyakumari District who is a devoted practitioner in the field of Ayurveda, heartily accepted to share his experiences in Pediatric practice with us. Bonafied post graduate student from the Thiruvananthapuram Ayurveda College, Dr. L. Mahadevan, has established his own reputation in the field of Ayurveda especially in neurological disorders with specialized interventional Panchakarma techniques. He has authored many books including the much appreciated book on Principles and Practice of Vasti. Here are the glimpses of his v aried clinical experiences that he shared with the department. Common pediatric illnesses met in the practice Usually the villagers around this hospital bring children as soon as they are born. Two things they themselves name it. One is called Sikappu denotes some erythema type of problem. The only thing is that one should not miss cyanosis, septicemia or a blue baby syndrome in the name of sikappu. So when they bring neonates with Sikappu, I examine the lesion, auscultate the heart and rule out congenital anomalies like tetralogy of Fallot, Patent ductus arteriosus, etc. Another one what the mother brings for is called pirali. Pirali looks like gulma form of entity, a moodhavata or a krura koshta. Sometimes they attribute the pseudomonas infection and diarrhea also as pirali. Few cases of milk allergy, lactose intolerance are also called as pirali. I see upper respiratory infections, lower respiratory infections, adenoids, tonsillitis, tension headache, worms and indigestion, scabies impetigo. In chronic form of cases, I see a lot of primary muscle disease. Recently I saw a boy who is 4 years old and the mother told that he could not walk well. He was little bit obese and he was able to sit and stand. I examined the deep tendon reflexes, they were absent and plantar was one time flexor and the other time equivocal. So I suspected Hypothyroidism in that case and TSH was surprisingly within normal limits. CPK was more than 20000IU/dl. So when I enquired them, they told that there was a history of viral fever. Probably that was a case of post viral myositis. Other than that, I have seen one or two cases of dextrocardia, two or three cases of Perthes disease. I have come across dyslexia, colour blindness, retinitis pigmentosa, autism, attention deficit hyperactive disorder and disorders of post meningitis squeal very commonly. Some children come with pain in the tibial tuberosity. That is OSD Osgood Schlatter Disease which is common in Active adolescents. The frequency of Rheumatic fever is coming down. But still I have seen a lot of cases. I have seen acute demyelination, guillain- barre syndrome also. I have come across hepatitis, para typhoid fevers, typhoid, etc.

Most commonly indigestion, poor appetite, lack of growth, lack of attention, which the mother commonly complains of, is seen. When we examine them thoroughly sometimes we could not find anything and sometimes we will find very positive sign. Diseases like Down syndrome can be easily diagnosed just by seeing the typical Mongoloid facies, nose, the hands and most of them will be having congenital heart problems also. Rare cases are documented include infantile hemiplegia, paralysis, stills disease etc. Pneumonia and acute diarrhea are seen. But mostly once I diagnose, I refer them to near by allopathic hospitals. These are a spectrum of disorders seen by me. Conditions needing modern casualty care When children come to you with high fever more than 103 F and especially with neck stiffness you are afraid. When the patient vomits and there is diarrhea and oral intake is not possible, then you can do nothing. Diarrheas, breathing difficulties, childhood bronchial asthmas cannot be managed in acute condition. Even in these things a little bit relief can be given. But I feel modern medicine with nebuliser, bronco dilators, broad spectrum antibiotics treat well. It is very difficult to treat typhoid also. Acute conditions that Ayurveda can manage Only certain acute conditions need allopathic help. Other conditions we can manage very well. For ex: viral fever. A 7 year old boy comes to you with fever and there are no other symptoms except headache. If you are not finding any respiratory signs, ASO, ESR, TC, DC is normal, chest X-Ray is normal and there is fever still. If you are sure that it is viral, it can be managed very well with Amritha Shadangam kashayam, Svarnamalini vasantha rasam, Amritharishtam, Parpatakarishtam, Gorochanadi vati, etc. Laghu ahara sevana is also very effective. Some of the cases like measles we can manage without allopathic help. If you find that it is chickenpox then you can give Shadangam without Sunti, Sudarsanavati, Nimbadi kashayam, Daruharidra paneeyam, Amirtharishtam. Most of the fever like conditions of children is very well managed with Guducyadi kashayam, Sudarsana vati, Amritharishtam, Svarnamalini vasantha rasam. Surya prabha gulika which contains vatsanabi also reduces fever very quickly and tepid sponging is also effective. In diarrhea, we can always give oral rehydration and support the therapy. In respiratory infections child comes to you with tonsillitis. Older child with tonsillitis can be managed very well. For example giving Dasamulakatuthrayam kashayam, Kanchanara guggulu and application of some upanaha lepas below the mandibular region, gargling with Sapthachadadi kashayam or Saraswatha churnam, taking Khadiradi vati as Mukhadharanam are very effective. After that phase is over, to promote the immunity Shadphala ghrita or Indukantha ghrita along with vyoshadi vatakam is useful. Most of the children take milk. So processing milk with Tulasi, Panchakola and Kantakari can also be done. Other than that, we have lot of drugs like Sithopaladi, which the children, can take easily. I have managed lactose intolerance very well which can be considered as Kapha ajeerna or Kaphaja grahani. When they cannot take milk, you advice them to stop milk. In that condition you can give Madhukasavam and Vilwadi gulika. Ashta churnam and Gangadhara churnam are found to be very effective. In intestinal colic, you can use drops of vacha which is available as vachan drops now a day. Applications of Dhanwantara tailam+Karpura tailam over the abdomen, giving Tapasveda, giving Dhanwantara gutika with Jeerakadi kashayam are very effective. Nayopayam kashayam is also very effective in reducing the spasm of abdomen. Taking the history from the mother in these cases is very important. You should ask whether the flatus is passed,

stools are passed because you should not miss a case like intussusceptions. You can even auscultate the abdomen to confirm the presence of Borborygmi in the abdomen. Palatability of medicines Palatability is a big problem when it comes to the case of children. So we should be open to the patent medicines manufactured by good companies. Mentat syrup, Shankapushpi syrup are very much liked by children. We must be open to that and we must adopt them when and where possible. Nowadays, many of the companies are making pediatric syrups. Recently I got to know a big allopathic company making Amritham extract in the name of immune syrup. It is an immuno modulator and can be given for skin infections. It is a very nice way they have made. All big companies are coming with very good syrups. Usually children take lehyas. Kashayam can be given with honey or with gudam. Only with churnas like sudarsana they have problem in taking. Basis of pediatric dosage You know, following the text is very difficult. First we have to classify the age group as up to 6 months, 6 months baby to 2 years to 5 years and so on. So in case of a small baby, we have to give arishta in drops like 20 to 25 drops and kasthuri gulika which is about 50 mg (1 gulika). After 6 months, it will become 3.5 ml to 7 ml of arista. Kashayam can be given up to 15 ml. Churnas you can give 1 gm. After 7 years you can almost give adult dosage with little bit of adjustment. All the bhasmas can be given 125 mg and madhu can be considered as the best anupana for children. Management of worm infestation and enuresis Most of the worm infestation responds very well to Ashta churnam. In ashtachurnam some people are adding Vidanga churna and call it as maha ashta churnam. Krimikutara rasam is very effective and also Vidangarishtam. For adult, I feel Manibadra rasayanam is a better drug. Manibadra rasayanam contains vidanga as well as trivrt. So it is anthelmentic and a little laxative also. Even though texts mention different forms of krimis like kakerukam, Makerukam, Romaadveepam, Romavidvamsam, etc., this a generalized prescription. We have not worked upon the different krimis yet. So, the general krimi prescription is given. Some people are giving puthikaranja churnam which is a very good anthelmintic. In enuresis, both mind and body have to be treated. Apana has to be controlled and mind has to be treated. Here giving abdominal pichu with dhanwantara taila, Avagaha sweda, anuvasana vasti with 50 to 60 ml of dhanwantara taila are very effective. Vasthyamayantaka ghrita along with Nisamalaki churnam and abhraka bhasmam is found to be effective in these cases. Keeping siro pichu and giving Manasamithram is also very effective. Karappan/Skin diseases Skin diseases are very much common. People use the word Karappan which is the Tamil word for kushta. Scabies is one of the common forms of skin diseases. So in those conditions Pamari tailam, Nimba tailam processed with maricha, krishnajeeraka, etc are very effective. Nyagrodham, Udumbaram, Aswatham, Plaksham, Parisam, Nimbam, Triphala are taken and boiled with water and used for bath. Then internally manjishtadi, nimbadi kashayam, Aravindasavam, khadirarishtam can be given. For external application, if there is kapha srava usually no tailam is applied. When there is no sravam, in pitta conditions nalpamaradi keram is applied. Working on Doshas based on symptoms and selecting drugs is easy in kushtas.

Developmental disorders All types of developmental disorders come to Ayurveda. Attention deficit hyper activity disorder (ADHD) has to be treated like a prakopa in sirasthana. So all vata samana, medhya, and brimhana Rasayana like Kalyanaka ghrita have to be given after agni deepana. In pitta pradhana rogas, pancharavindam, kuvayalachatushkam are given. There is a ghrita called ashtadasa kooshmanda ghrita that is also very effective in pitta type. In kapha pradhana conditions, panchagavyam is given. Then aswagandharishtam, aswagandhadi churnam, smriti sagara rasam are also very effective. In ADHD, the hyperactivity definitely comes down after Ayurvedic treatment. In Autism, I am unable to tell if our drugs are effective or not. Children with CP respond well to various forms of massages given. Endocrinological disorders Commonly, I feel what we can manage is hypothyroidism. Once you know that it is hypothyroidism, kaphamedohara oushadas like varunadi kashayam, punarnavadi kashayam, kanchanara guggulu, and trikatu churnam, given for 3 to 6 months will definitely bring down TSH. Other than the hypothyroidism, I have not seen any endocrinal disorders. Insulin dependent diabetes usually comes with complications or when they come they would have reached diabetic ketoacidosis. So we may be forced to send them for modern management. I think Hypothyroidism is the only condition which I have treated successfully with Ayurveda in pediatric practice. Once TSH crosses 7 to 8 we have to treat. I have seen it going up to 50 or 60 and then responding very well. It is the dhatu parinama which is affected. In childhood, dhatu parinama can be corrected well. After correcting the agni and the bhutagni, you correct the ama present in the rasa dhatu. The medo dhatvagni also has to be corrected in hypothyroidism you can see the application of sthoulya chikitsa for hypothyroidism. More than that, you have to work on the ama affecting the agni of the rasa dhatu. The rasa kashayam in hypothyroidism is very important. Myopathies I have not seen any improvement in any of the Myopathies cases. I have never cured any Myopathy case before. Usually the treatment starts with brimhana as all the kashayas are to be treated by brimhana. So for brimhana I do start with udwartana. I select jeevanthyadi churna yogam present in the last verses of kshayas chikitsa. We do it for 10 days and then treat with oils like sahacharadi, Lakshadi tailam, swedam and then mild anulomanam is given. Then pizhichil, njavara kizhi are done which usually worsen the condition or give a pseudo effect of good feeling. I have tried Bhallatakam also. It is also not effective. Nowadays, I am treating it in the line of dushi visha. So I am giving Kalyanaka kashayam, dushivishari agadam, etc. Kalyanaka kashayam is whole and complete because it has the phalasruti of rasa, rakta, mamsa, medo, asthi, majja, sukra, arthava, visha and unmade vikaras. So I feel it is broad spectrum yoga. If you have a kshaya chikitsa. The soup Sa pippalikam sayavam sakulattham sanagaram is highly useful in pediatric practice. Rasayana In some of the frequent respiratory infections usually we give vasa kantakari lehyam, ela ajamodha rasayanam told as sarpirguda yoga in kshatakshina prakaranam. In pediatric rasayana, the vacha rasayana, indukantha ghrita, kooshmanda rasayana can be given because they are specifically indicated in the paeduatruic conditions. Brahma Rasayana is a ayushkamiya rasayana and can be given because the phalasruti is dosha pratyanika. There are kalyanaka ghrita, kumara kalyanaka ghrita which are specific paediatric rasayanas. There are saraswatha ghritam, laghu saraswatha ghritam, maha

saraswatha leukemia. But the bone marrow aspiration report was that it is not chronic myeloid leukemia. So when they called me, I just told them to give vasaguducyadi kashayam, vasa (cheriya adalodakam)-Panchangam paneeyam. After two weeks they came here yesterday and told that TC and everything came dawn. Hemoglobin became 11, platelet became 7 Lakhs. Previously I have treated ITP-Idiopathic Thrombocytopenic Purpura in a boy and at that time too, I gave the same medicines considering that Pittam vidagdham sonitham. One is vrddhi avastha of rakta and another one is kshaya avastha. So we have never treated the vrddhi avastha or kshaya avastha, we have treated only the vidagdha dushti of pittam and raktham. Now, I feel vidagdha dusti of the dhatu is very important. This was a very interesting experience. So what I wanted to share with you is that, in pediatric practice, you should be aware of hemophilia, acute lymphatic leukemia etc. Management of Acute Rheumatic Fever An 8 year old boy came with polyarthralgia. His temperature was 1020 F. There was dyspepsia also. The pulse rate was 120 per minute. He had sore throat for the past 5 days. Dysuria was also there. Shifting type of joint pain was also noted. There was no neck stiffness. Kerning sign negative, no vomiting, no diarrhea, Hemoglobin was 9.TC was 12000 cells per cu.mm, polymorphs 70%, Lymphocytes 25%, Eosinophils 5%, ASO positive 1:1200, CRP positive, RA Negative, CPK within normal limits (To rule out stills disease / DMD / Post Viral Myositis). ECG taken showed sinus tachycardia. Ayurvedic diagnosis vata kapha jvaram, Amavastha, Prescription: So katu rasa pradhanya, agni dipana, sroto sodhana, ama pacana medicines were selected. I had given the following medicines: Pathyakusthumbaradi kashayam, Gorochanadi vati, Svarnamuktadi vati, pippalyasavam, sunti-dhanyaka panam strict kanji diet was advised. Within 5 days fever came down. Echo was taken to rule out carditis and valvular changes. Then, we reduced the intensity of katu rasam and started treating with tikta rasa and snigdha guna. Later pippalyadi ghritham 15ml bd, Guduchyadi kashayam were given. After a week, as there was agni deepti, vata samana and brimhana medicines were selected. The patient was prescribed laghu panchamula kshira kashayam for 10 days. Usually in jvara pachyamana avastha upanaham is contra indicated. Sometimes it may produce stagnated synovitis. In mono articular problems, upanaham can be tried. In multi joint involvement which is of shifting nature, upanaham is avoided. Pathyakusthumbaradi kashayam is very effective in beta hemolytic streptococcus. Medicines useful in pediatric practice For allergies, I have found vilwadi gulika, Nimbadi kashayam, varatika bhasmam, Kamadugha rasam as very effective. Udvartanam with bhasmam (Vibhuti) is also effective in allergic skin. For nutritional support, Drakshadi rasayanam is very effective. If the child is suffering from anorexia, Ashta churnam, Vilwadi lehyam, Ajamodadi arkam are very effective. Ajamodadi arkam has got anthelminthic properties also. Madhukasavam, Vilwadi lehyam, vilwadi gutika, Kaidaryadi churnam are effective in lactose intolerance (managed like kaphagrahani). Babularishtam, Ganghadhara churnam are effective in amoebic dysentery. Sukumara Ghritam with vaishwanara churnam and abhayarishtam are very effective in constipation in children. Jambeeradi panakam, Dhanwantara gutika, Lajaphanta kashayam, vilwadi lehyam are very good in managing nausea.

For upper respiratory infection Bharangi gudam, svasakutara rasam, Kanakasavam, Dhanwantara gutika, Drakshadi churnam,Gorochanadi vati, Kooshmanda rasayanam are widely used. For tonsillitis gargling with arimedadi tailam is very effective. Once the amavasta has passed. Children usually come with Epistaxis. In that condition, nasyam with vasa svarasam, keeping cold pack are useful. Drakshadi churnam, Kooshmanda rasayanam, Laksha pal kashayam are given as supportive therapy. Triphaladi danta dhavanam is very effective. All the children are to be taught to do gum massage with Trivarga trayam at least three times a week. Saribadyasavam is effective in bacterial skin infections like impetigo when given for conditions like tailam can be given for conditions like impetigo. Pravala bhasmam and kamadudha rasam are the best sources of natural calcium. Amirthaprasa ghritam is usually given to promote growth. Before prescribing it proper agni dipana, langhana has to be done. Brihat chagaladyam ghritam, vidariyadi rasayanam help in the promotion of growth. Maha masha tailam and laksha tailam are usually selected in the paediatric practice to promote muscle strength. For urinary infection in girls Laghu Panchamulakashayam, Chandanasavam, Chandanadi vati, Gokshuraprayogam are very effective. In glomerulo nephritis, usually albuminuria is seen. There gudichiyadi kashayam + Punarnavadi kashayam, Chandanadi vati, Gokshuradi guggulu are very effective. x---------x ---------x ---------x ---------x ---------x ---------x ---------x ---------x