Volume I
About the Author
Dr L Mahadevan is one of the foremost luminaries among the clinicians of Ayurvedic field Through his teaching he has inspired, guided and enlightened many Ayurvedic seekers He has the most talented style and vigorous exactitude of expressions
Dr L Mahadevan is a contemporary clinical teacher He writes with timeless and uncomplicated clarity of the clinical medicine and imparts a simple yet profound message
He has got amazing ability to distil ancient tridosha theory into contemporary usable practical guidelines This book brings hope and light to the people, who are confused with diagnosis
With intense and compiling clarity, Dr Mahadevan’s guidance gives the promise of leading the students to their best and highest place in clinical medicine to resonate with and reflect the energy of true tridosha theory
Students will find new discoveries on the way To read his book, is to make a journey where falsely created concepts will whither away The journey is very challenging, interesting and complete
In this book, he presents a clinical protocol for a Ayurvedic student community and a clear strategy for siddhanta based treatment This book also explains the possibilities and limitations of our science More than students have studied in his Ayurvedic gurukulam and he has indirectly taught more than students all over India
Preface
There was no pressure to write a text book of medicine It was a causal outburst as a result of demand from my students Today I remember the words of my teacher Dr B Vaidyanathan In he told me not to teach anybody until I have treated cases independently He told me to practice rigorously for years and then start teaching I started teaching from During my early years of clinical carrier, I got a student from Coimbatore Ayurveda College I got ample time and I was updating my knowledge and sharing that with her at that period There was a continuous urge to learn, update the knowledge in modern medicine and to refer internet about new information At the same time I was very consistent in reading Astanga sangraha regularly During my association with PG students, I developed interest to read later texts like Vangasena, Siddha yoga, Bhaisajya ratnavali etc I am reading these books regularly for the past five years and using the drugs mentioned in the texts This interest was created in me by Dr Manoj, who is a Scholar in this field During my PG studies, my knowledge was limited to Caraka Samhita and Astanga Hrdayam and Sangraham In Trivandrum Ayurveda College there was no trend to read the latter texts I found very good yogas in later texts which are handy and useful
Clinically I am influenced directly by Dr B Vaidyanathan, Dr M R Vasudevan Nampoothiri, DrPS Sreekumar and Dr G Shyamakrishnan Indirectly I was highly inspired by Dr P Rajagopalan and Dr Sankaran Sir The principle oriented treatments of Dr Sankaran has produced a great impact in my thinking, so I am much thankful to him During the last ten years of practice, lakhs of patients were successfully treated or managed with the knowledge base we have developed in our center
I have personally trained more than students and taught them the guna based tridosha thinking and indirectly taught more than students all over India Students from Tamilnadu, Kerala, Karnataka, Maharashtra, Nagaland, Himachal Pradesh and other places are regularly visiting and staying with me in our gurukulam and observing what I am doing I usually teach them with the case in front of me
Theory is valued only when it is applied Ayurveda is a great science But it has its own limitations A science cannot be static, especially the medical science I advise my students to be thorough with Mula Siddhanta and Astanga Samgraha Then after getting confidence in our own science, I ask them to read clinical methodologies which helps in the diagnosis These clinical methodologies are mostly adravya Now it has become difficult for me to practice without a Knee hammer Many doctors do not do this Because they are not trained or exposed or did not get an opportunity to test the glory of these methodologies I really feel sorry for those people who hesitate to use these technology in medicine Diagnosis is an art I feel very few Ayurvedic doctors' diagnose properly
To diagnose a hidden pathology, you need a special skill During my early years I have seen many vaidyas missing cases of Intestinal Tuberculosis, pancreatitis, pulmonary hypertension, fallopian tube blocks, endometrial TB etc Then there was an urge in me to develop the diagnostic skill Nowadays I do not treat a patient until the diagnosis is perfect Some days the diagnosis will be over with in a few minutes or it will take three, four days
We have found luekemias, space occupying lesions, hidden metabolic conditions, mitochondrial cytopathties with our skills and we were able to interpret everything as guna dusti and treat We can tell the truth about the incurable nature of certain diseases correctly, so that the patient need not waste their money here and there So far in my life, I have never hidden anything from students Students with me see what I am doing There is no secret at all They are allowed to observe what I am doing They are allowed to question me regarding my diagnosis Most of the time diagnosis and treatment will be spontaneous So what I write is from my experience which vary from person to person You can read it and you can always change your medicine, based on your own yukti and availability of the drugs Based on avasta you have to change the medicines Recently I have done a survey with Ayurvedic students None of them have seen an acute MI or a pulmonary embolism in their life They have got to years of practical experience also Probably they would have seen that, and they would have missed it out We have also seen the same cases seen by many higher institutions We are also using the same medicines There is no difference between us and higher centres
Only thing is we diagnose better
Of course I understand that everyone may not respond favorably to my writing Many people who are influenced by nonclinical teaching are still deeply entrenched Anybody who is still totally identified with text book consciousness will inevitably fail to see what my work is all about Some of my enthusiastic students discuss about these concepts to their ayurvedic colleges and they are surprised and disappointed when the recipient found it difficult and could not get beyond few ideas Many have reacted with ego, resistance and strong criticisms Despite all these, the response what I personally receive from all over the country is overwhelmingly positive
Without diagnosis you can not plan a good therapy This book is a source reference for practitioners, UGs, and PGs who have hospital and private clinical settings I am planning to update it annually and more outputs will be given on diagnosing and management In this book, you can get an over view of diagnosis, therapeutic modalities, and everyday usefulness in inpatients care No book can replace the expertise of an experienced teacher or practitioner, but it is a supplement This is a ready reference and refresher text I am planning to update topics regularly as my experience grows The treatment recommendations are given based on my own understanding of the science I have to write more about geriatrics, dermatology, opthalmology, pulmonary disorders, nervous system, nutritional disorders, infectious disorders, in the future volumes We have to write about cancer, HIV because we have treated those cases We are planning to give cost information’s also in later editions I wish to thank all my students for making this possible I am grateful to Mr Saju and Miss Usha for their services I am grateful to my patients, and students We continue to welcome comments and recommendation, in the future editions I am always reachable through email for my students who follow our tradition
The following persons may have difficulty in using this book
People who have complete aversion towards BP apparatus, blood tests, clinical methodologies etc
People who talk but do not treat much
People who feel they can diagnose everything through "Nadi Pafiksa"
People who feel their prescriptions are superior to any other prescription in the world
Whenever we talk about a great physician, we always talk about what cases he has treated successfully We should also talk about the diagnosis he has missed and the results because of the wrong diagnosis This is also very much needed in our science
I realize that there is a community who believe in us, our work and our views and we have to write for them I feel confident that in the years to come, thousand & thousands will be drawn to the "Guna" based thinking, impregnated with modern views and this will continue to make vital contribution to the rising of new ayurvedic community with a clear enlightenment oftridoshic and clinical awareness
Contents
1
Gastroenterology
21
2
Liver
119
3
Circulatory System
162
4
Renal Diseases
224
5
Bone Disorders
273
6
Diet Regulations
367
7
General Treatments
371
8
Usage of medicines and their critical analysis
381
9
Bio chemical test & their normal values
436
10
Testing Blood Glucose Level at home
482
11
Other important Investigations
483
12
Medicines and their references
493
13
X-ray
513
14
Disease index
521
15
Investigation index
531
16
Medicines index
537
Volume II
There are not much valuable literature available in clinical medical practice in Ayurveda. Those available, are written by physicians who know theory and having good clinical practice. To my dismay, I find that communication and patient interaction is not still taught in Ayurvedic colleges. Even now, there is no organized help in the area of ayurvedic education and training. There is a deficiency in Ayurvedic curriculum and in my view this is the cause for clinical Ayurvedic stress. There is a definite deficiency, which the population suffers in seeking the medical help. This is also a cause for poor clinical image. There are more than 300 Ayurvedic colleges in the country today. Every year more than thousand Ayurvedic graduates add to the already existing Ayurvedic community. What a student expects from the hospital is not taught nowadays.
Clinical neurology is an art. I can tell, clinical neurology is equal to basic anatomy plus Mula siddanta plus Yukti. It is like mathematics. Reading a sloka of Pakshagata may not help you to treat it. We know that you have to do sneha, sveda, sodhana, virecana in pakshagata. Everybody can chant this sloka. But in management so many things we have to learn. How can you learn? You should be able to see cases (at least a few) acute and chronic cases, and you should sit with a master, who can teach all these things. Even in brain there is vata area, pitta area and kapha area. Frontal cortex is a vata area. Occipital cortex is a pitta area. Temporoparietal is the area of kapha. This is not textual, but experience. You cannot randomly do the same treatment for everybody. You cannot start with udvartanam and finish with lasuna rasayanam in all the cases. This work is an anastamoses between professionals and students. You have to conduct more research in some cases as I have done a few. In some areas we have done a lot. It is very difficult to use modern research methodology in Ayurvedic practice, because we are going on changing the medicines based on avasta. I accept that there are a few lapses which produce sleepless nights in clinical practice also. What I have not seen in my clinical career during curriculum I will miss. I have to work a lot to correct this mistake and grow clinically. Many people think, using knee hammer is modern medicine. I tried my level best to convey that knee hammer is an instrument. They don't believe it. Even in the reflexes you are able to see vata pitta kapha. To see vata pitta kapha in natural and in ill health is a vision. It is a beautiful clinical vision.
INTRODUCTION
17
1.
HEADACHE
43
2.
BELLS PALSY
56
3.
TRIGEMINAL NEURALGIA
64
4.
MENIERE'S DISEASE
71
5.
TEMPORAL ARTERITIS
76
6.
OPTIC NEURITIS
82
7.
APHASIA
88
8.
DYSARTHRIA
101
9.
INSOMNIA
109
10.
SLEEP APNEA
118
11.
DEMENTIA
124
12.
ORTHOSTATIC HYPOTENSION
138
13.
SPINAL CORD COMPRESSION
144
14.
THORACIC OUTLET SYNDROME
152
15.
BRACHIAL PLEXOPATHY
157
16.
SCIATICA
163
17.
CAUDA EQUINA SYNDROME
172
18.
MERALGIA PARESTHETICA
179
19.
RESTLESS LEGS SYNDROME
184
20.
MONONEURITIS MULTIPLEX
190
21.
DIABETIC NEUROPATHY
195
22.
BURNING NEUROPATHY
205
23.
ENTRAPMENT NEUROPATHIES
210
CUBITAL TUNNAL SYNDROME
212
RADIAL TUNNAL SYNDROME
213
24.
WILSON'S DISEASE
217
25.
POST HERPETIC NEURALGIA
222
26.
MENINGITIS
229
27.
ENCEPHALITIS
237
28.
HYDROCEPHALUS
242
29.
ESSENTIAL TREMORS
251
30.
ATAXIA
255
31.
DYSTONIA
263
32.
MYOCLONUS
271
33.
NEUROMYOTONIA
278
34.
CHOREA
283
35.
HUNTINGTON'S DISEASE
289
36.
URINARY INCONTINENCE
291
37.
GUILLAINBARRE SYNDROME
301
38.
MULTIPLE SCLEROSIS
307
39.
PARKINSON'S DISEASE
316
40.
TRANSVERSE MYELITIS
328
41.
SYRINGOMYELIA
336
42.
REFLEX SYMPATHETIC DYSTROPHY
345
43.
CHRONIC FATIGUE SYNDROME
353
44.
STROKE (CVA)
359
45.
WALLENBERG SYNDROME
382
46.
EPILEPSY
389
47.
MOTOR NEURON DISEASE
401
48.
SPINAL MUSCULAR ATROPHY
413
49.
MYASTHENIA GRAVIS
420
50.
TICS
424
51.
AUTISM
428
52.
MENTAL RETARDATION
435
53.
CEREBRAL PALSY
441
54.
MUSCULAR DYSTROPHY
446
55.
ALCOHOLIC MYOPATHY
451
56.
ALCOHOLIC NEUROPATHY
456
57.
MORTON'S NEUROMA
462
58.
SYPHILITIC MYELOPATHY (TABES DORSALIS)
465
59.
STIFFPERSON SYNDROME
467
60
MYOTONIA CONGENITA
471
61.
CHARCOTMARIETOOTH DISEASE
474
62.
MARCHIAFAVABIGNAMI SYNDROME
477
63.
POSTCONCUSSION SYNDROME
479
64.
ATTENTIONDEFICIT HYPERACTIVITY DISORDER (ADHD)
65.
COMPLEX REGIONAL PAIN SYNDROME
186
66.
ARNOLD CHIARI MALFORMATION
491
67.
POEMS SYNDROME
497
68.
CHRONIC MOTOR TICS DISORDER
503
69.
AMNESIA
506
70.
HORNER SYNDROME
511
71.
VOCAL CORD PARALYSIS
514
72.
POSTTRAUMATIC STRESS DISORDER (PTSD)
518
73.
SLEEP WALKING
522
74.
SLEEP TERROR DISORDER
526
75.
NIGHTMARE DISORDER
529
NEUROLOGICAL EXAMINATION
530
HIGHER MENTAL FUNCTIONS
CRANIAL NERVES
536
MOTOR
542
REFLEXES DEEP AND SUPERFICIAL
545
CEREBELLUM
548
MENINGES
550
SENSORY COLUMN
551
BLADDER
553
SEIZURES
554
ANS (AUTNOMIC)
OTHER PHYSICAL EXAMINATIONS AND SIGNS
RELATED TO NEUROLOGICAL CONDITIONS
555
BLOOD TESTS RELATED TO NEUROLOGY
565
GUIDELINES FOR CHOOSING THE IMAGING
MODALITY IN NEUROLOGICAL DISORDERS
575
CRITICAL ANALYSIS OF YOGAS USED IN THIS TEXT
585
Volume III
I am really very happy and bring out the handbook of medicines 3rd volume of clinical practice series. When we started writing we never expected that the demand from student community and practitioners will be so overwhelming. We used to receive calls everyday asking for copies from all over India, even some of the parts I don't know where it is?
When I realize that there is a big cap in clinical diagnosis and management especially in teaching which I am fulfilling.
It is a great pleasure to write the 3rd volume of my Clinical Practice series. When I started writing I did not expect such a response from my fellow colleagues, students, doctors, lecturers, and colleges in India and abroad. I realised at one point that I am a teacher and it is my duty to teach and share what I know to others without expecting anything. Many students used to come and stay with me in Derisanamcope or in Chennai. Many from Rajasthan, Gujarat and Kashmir often tell that they were unable to be with me and they call all the time when difficult cases visit them. So I have promised them long back that whatever I do I will give it in writing in the form of a book. So it is the students who motivate me to write further and further. In spite of all difficulties, heavy practice, busy schedule and travel I could do this because I am interested in the subject matter and because of the team work. Many students have contributed for this work. Dr. Vaishali H. Sugavanam my clinical assistant who has done honest work in taking notes from my classes and observing me in my clinics has helped me in writing this book. I asked her to be my eo author for this book and I bless her for all prosperity. I wish the doctors to read this book and I hope this will be a beneficial guide for their practices. This in no way a substitute to our traditional texts. This is for an additional reading which will boost their medical practice. My pranams to all of you.
I.
ONCOLOGY
BENIGN OESOPHAGEAL TUMOURS
23
STOMACH CANCER
28
SMALL INTESTINE CANCER
33
COLORECTAL CANCER & ANAL CANCER
36
PANCREATIC CANCER
42
HEPATOCELLULAR CARCINOMA
44
LARYNGEAL CANCER
57
CANCER OF THE MOUTH AND THROAT
63
TONGUE CANCER
66
SALIVARY GLAND NEOPLASM
69
OTIC TUMORS
70
SKIN CANCER
BONE TUMORS
79
KAPOSI'S SARCOMA
89
THYROID CANCER
91
GLIOMA
93
LUNG CANCER
99
BLADDER CANCER
104
SPECIAL FORMULATION OF DR. L.MAHADEVAN FOR PATIENTS UNDERGOING CHEMOTHERAPY
107
SPECIAL FORMULATION OF DR. L.MAHADEVAN FOR PATIENTS UNDERGOING RADIATION THERAPY
II
HEMATOLOGY
ANEMIA
113
CLASSIFICATION
116
JAUNDICE DUE TO HEMOLYTIC ANEMIA
123
TREATMENT FOR MEGALOBLASTIC ANEMIA
TREATMENT FOR APLASTIC ANEMIA
ANEMIA ASSOCIATED WITH OTHER DISEASES
126
IRON DEFICIENCY ANEMIA
127
VITAMIN DEFICIENCY ANEMIA
131
HEREDITARY HEMORRHAGIC TELANGIECTASIA
136
ALLERGIC PURPURA
THROMBOCYTOPENIA
139
VON WILLEBRAND DISEASE
142
HAEMOPHILIA
143
THROMBOPHILIA
146
WHITE BLOOD CELL DISORDERS
148
MULTIPLE MYELOMA
159
ACUTE LYMPHOCYTIC LEUKEMIA (ALL)
165
ACUTE MYELOCYTIC LEUKEMIA (AML)
169
HODGKIN'S LYMPHOMA
NON-HODGKIN LYMPHOMA
175
POLYCYTHEMIA VERA
MYELOFIBROSIS
182
THROMBOCYTHEMIA
SPLEEN DISORDERS
III
ENDOCRINOLOGY
CUSHING SYNDROME (HYPERCORTISOLlSM)
191
PORPHYRIAS
196
ACUTE PORPHYRIAS
CUTANEOUS PORPHYRIAS
202
PORPHYRIA CUTANEA TARDA
THYROID GLAND
HYPOTHYROIDISM
209
SUB -CLINICAL HYPOTHYROID
GOITRE
HASHIMOTO'S THYROIDITIS
216
HYPERTHYROI DISM
219
GRAVES DISEASE
POST-PARTUM THYROIDITIS (PPT)
SIMPLE NONTOXIC GOITER (EUTHYROID GOITER)
226
PARATHYROID HORMONE
PARATHYROID PROBLEMS
PRIMARY HYPERPARATHYROID HORMONE
230
SECONDARY HYPER PARATHYROIDISM
231
HYPOPARATHYROIDISM
233
OSTEOPOROSIS
235
DIABETES
245
260
267
ERECTILE DYSFUNCTION IN DIABETES
272
DIABETIC RETINOPATHY
274
DIABETIC HEART DISEASES
CARDIOMYOPATHY
281
METABOLIC SYNDROME
284
OBESITY
288
DYSLIPIDAEMIA
293
IV
ANDROLOGY
MALE REPRODUCTIVE SYSTEM
297
PHYSIOLOGICAL STAGES OF FORMATION OF SHUKRA
MALE INFERTILITY
303
DISEASES OF THE SHAFT
BALANITIS
331
PRIAPISM
334
NON-ISCHEMIC PRIAPISM:
337
PEYRONIE'S DISEASE (CURVATURE OF THE PENIS)
338
ORCHITIS
344
PROSTATE DISORDERS
347
BENIGN PROSTATIC HYPERPLASIA
PROSTATITIS
352
SEXUAL DYSFUNCTIONS
357
EJACULATION DISORDERS
358
PREMATURE EJACULATION
DELAYED OR IMPAIRED EJACULATION
364
RETROGRADE EJACULATION
ERECTILE DYSFUNCTION
370
HYPOACTIVE SEXUAL DESIRE DISORDER (REDUCED LIBIDO)
374
MALE REPRODUCTIVE CANCERS
PENILE CARCINOMA
377
TESTICULAR CANCER
379
PROSTATE CANCER
V
GYNAECOLOGY
FEMALE REPRODUCTIVE SYSTEM
387
MENSTRUAL ABNORMALITIES AND COMPLICATIONS
390
AMENORRHOEA
PREMATURE MENOPAUSE
395
DYSMENORRHEA
402
DYSFUNCTIONAL UTERINE BLEEDING [DUB]
405
PREMENSTRUAL SYNDROME [PMS]
408
PREMENSTRUAL DYSPHORIC DISORDER [PM DD]:
409
POLYCYSTIC OVARY SYNDROME
415
ENDOMETRIOSIS
418
PELVIC INFLAMMATORY DISEASE [PID]
422
PELVIC FLOOR DISORDERS/ PELVIC RELAXATION SYNDROME
425
CYSTOCELE AND CYSTOURETHROCELE
VAGINAL INFECTIONS
OTHER GYNAECOLOGICAL PROBLEMS
432
DYSPAREUNIA
434
FEMALE SEXUAL AROUSAL DISORDER
LOW SEXUAL DESIRE DISORDER
437
FEMALE INFERTILITY
HABITUAL ABORTION
459
UTERINE GROWTHS
UTERINE FIBROIDS
463
ADENOMYOSIS
464
UTERINE POLYP
ENDOMETRIAL POLYP
ADENOMYOMATOUS POLYPS
PLACENTAL POLYPS
472
UTERINE CANCER
411
CERVICAL CANCER
VAGINAL CANCER
484
OVARIAN CANCER
489
BREAST CANCER
BREAST CANCER IN FEMALE
MALE BREAST CANCER
500
VI
ANTENATAL CARE
PRECONCEPTION CARE
DIAGNOSIS OF PREGNANCY
PROBABLE SIGNS AND SYMPTOMS OF PREGNANCY
501
LABORATORY EVIDENCE OF PREGNANCY
502
MANAGEMENT OF NORMAL PREGNANACY
504
OTHER IMPORTANT ANTENATAL SCREENINGMONTHLY
REGIMEN FOR PREGNANT WOMEN
509
NUTRITION OF THE PREGNANT WOMAN
IMPORTANCE OF NUTRITION IN PREGNANACY
LOSS OF MATERNAL IRON IN A NORMAL PREGNANCY
515
RECOMMENDED DAILY INTAKE OF
SIX CRITICAL NUTRIENTS IN PREGNANCY
DIETARY ADVISE FOR PREGNANT WOMEN
DISEASES AND DISCOMFORTS OF PREGNANT WOMEN
GASTRO INTESTINAL DISEASES AND PREGNANCY:
520
NAUSEA, VOMITING AND HYPEREMESIS GRAVIDARUM
FOOD DISLIKES AND FOOD CRAVINGS
525
GASTRO OESOPHAGEAL REFLUX
LIFESTYLE MODIFICATIONS
528
PEPTIC ULCER DISEASE
DIARRHOEA
CONSTIPATION
534
ACHES AND PAINS
BACK PAIN
IN SACROILIAC PAIN
538
IN NOCTURNAL BACK PAIN
539
JOINT PAIN
540
LEG CRAMPS
ABDOMINAL CRAMPS IN EARLY PREGNANCY
543
HEADACHES AND MIGRAINES
VARICOSE VEINS
HAEMORRHOIDS
OTHER MINOR DISORDERS
FREQUENCY OF URINATION
549
VAGINAL DISCHARGE
DYSPNOEA (SHORTNESS OF BREATH)
DIFFICULTY IN GETTING UP AND DOWN
CHLOASMA (THE MASK OF PREGNANCY)
CHANGING FEELINGS AND EMOTIONS
COMPLICATIONS OF PREGNANCY
557
ANAEMIA IN PREGNANCY
IRON DEFICIENCY ANAEMIA
ANEMIA DUE TO VITAMIN B AND FOLIC ACID DEFICIENCY
558
HAEMOGLOBINOPATHIES
562
THALASSAEMIAS
SICKLE CELL ANAEMIA
HYPERTENSIVE DISORDERS OF PREGNANCY
563
GESTATIONAL HYPERTENSION
CHRONIC HYPERTENSION
564
PREECLAMPSIA
ECLAMPSIA
VII
POST NATAL CARE
568
LACTATION
572
SUBSTITUTE OF MOTHER'S MILK
574
ANNEXURE
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