KUPOSHANA JANYA

VYADHIS
 CONTENTS
• PHAKKA
• PARIGARBHIKA
• BALASHOSHA
• PROTEIN ENERGY MALNUTRITION
 INTRODUCTION
• in infancy, breast milk is the main diet.
• after annaprashana samskara child
consumes other food articles.
• In this period growth and development is
very fast.
• Any quantitative or qualitative defect in diet
cause various nutritional disorders.
 PHAKKA
• It is a unique disease of children mentioned
only in kashyapa samhitha.
• It is defined as inability of a child to walk
even by the age of one year.
Classification:
• Ksheeraja phakka
• Garbhaja phakka
• Vyadhija phakka
 KSHEERAJA PHAKKA
• Breast milk vitiated by kapha dosha is
known as phakka dugdha.
• Child consuming this milk get affected by
ksheeraja phakka.
• Initially child suffers from many diseases.
• Later develops phakka due to emaciation.
 GARBHAJA PHAKKA
when nursing mother conceives

Early caesation of breast milk

Breast fed child gets emaciated & even dies

garbhaja phakka
 PREDISPOSING FACTORS
• Ignorance of alternatives for breast milk
• Negligence of child
• Poverty
• Early weaning
• Insufficient weaning foods
• Immaturity of GIT
 VYADHIJA PHAKKA
If child is not cared properly

Suffers from various diseases

If proper care and treatment is not provided

malnutrition

vyadhija phakka
 CLINICAL FEATURES
• Decrease in flesh,strength and luster
• Emaciation of hips and arms
• Protuberant abdomen
• Appears as skeleton
• Over powered by flies, insects and worms
• Foul smell
• Abnormal thick nasal discharges
 TREATMENT
SHODHANA
• Snehana with kalyanaka ghritha,shadphala
ghritha,amritha ghritha for seven days
• Swedana
• Virechana with trivrith ksheera
• Vasthi
 Shamana
Includes:
Abhyanthara
• Deepana with ghritha medicated with rasna,
madhuka etc
• Pachana
• Srotoshodhana
• Brumhana- mamsa rasa and ksheera
medicated with rasna, madhuka
Bahya
• Abhyanga with raja taila
• Physiotherapy for disabilities
• Using phakka ratha,child is trained to walk
properly
 PARIGARBHIKAM
• Baby feeding on a pregnant mothers milk
will catch this disease.
• In this baby shows features of malnutrition.
• Pregnancy will either stop or reduce breast
milk.
• If baby is exclusively dependent on breast
for food,he will develop malnutrition.
 LAKSHANA
• kasa
• agnisada
• vamathu
• tantra
• karshya
• aruchi
• brama
• koshtavridhi
 TREATMENT
• Here functions of agni are reduced
• Main aim of treatment is to keep agni in
normal state
• Deepana pachana
• Highly brumhana diet – food made of
vidari,yava,godhuma,pippali with ghritha
• Anupana should be milk – boiled and
cooled mixed with madhu or sugar.
 BALA SHOSHA
• Reduced growth and development in
children as a result of general dhatu kshaya
can be attributed to different reasons
• In kaumarabhrithya it is known by the term
balashosha
NIDANA
• Divaswapna
• Sheethambu sevana
• Kapha dushta sthanya pana
 SAMPRAPTHI
Nidana kapha kopa ama

Mandagni rasa kshaya

Sarvadhatu kshaya bala shosha

 LAKSHANA
• Arochaka
• Prathishyaya
• Jwara
• Kasa
• Snigdha,shukla mukha and netra
 TREATMENT
1. Deepana pachana with ushna and teekshna
drugs like panchakola
2. Brumhana and srotoshodhana
• Bahya – abhyanga with lakshadi taila
• Abhyanthara:
i. Shringyadi and yashtyahwa ghritha-
brumhana property
ii. Sthiradi and brahmyadi ghritha- brumhana
and sroto shodhana
3. Symptomatic managment:
• Choorna of saindhava,triphala,patha etc
with madhu and ghritha.
• In associated features like kasa,jwara and
chardi – lehana with athivisha,shunti and
pippali with honey.
 PEM

Term applied to class of clinical condition

consisting of classifiable and non
classifiable manifestations of protein lack
and energy inadequacy
 CLASSIFICATION
• Kwashiorkor – results from gross
deficiency of protiens with associated
energy inadequacy
• Marasmus - results from gross deficiency of
energy associated with protien deficiency.
• Marasmic – kwashiorkor – overlap of
clinical picture of kwashiorkor and
marasmus
 Cont...

• Pre – kwashiorkor
• Nutritional dwarf
 MARASMUS
• Age – usually in children less than three
years
• Peak incidence – first year of life
General features
• Gross waisting of muscle , hypotonia
• Prominant bones uncovered by fat and
muscles
• Large head , staring eyes, shrunken buttocks
• Premature baby look , hollow cheeks and
temples – monkey facies
• Distended abdomen
• Hypothermia
• Classically oedema will be absent
 Skin and hair changes
• Dry, loose and wringled skin
• Patchy hypo pigmentation
• Scaling and purpura
• Hair will be sparse , dry and lighter
 Psychological changes
• At first child may be lively and playful
• Later become irritable
• Always cry due to hunger
• Become inactive and refuses everything
Growth failure
• motor retardation in sitting and standing
• Marked difference in weight and to a lesser
extent in height also
 GIT
• Early stage – constipation
• Later – reccurent diarrhoea
• Due to condition of skin , features of
dehydration is difficult to elicit
• Uncommon hepatomegaly
• Vitamin and mineral deficiency
 Features of complication
• Broncho pneumonia
• Hypothermia
• Hypoglycemia
• Electrolyte imbalance
 KWASHIORKOR
• Age – common in older infants and pre -
school children
General features:
• Oedema – unique feature, pitting in nature
• Muscle wasting, hypotonia with diminished
or absent DTR.
• Facies – moon face or baggy face
 Skin changes
• Seen in 60% of cases
• Crack dry and scaly skin

a) Dermatosis
• Areas of hyper pigmentation mainly over
pressure points and flexors of extremities
• These are similar to peeling of paint hence
called ‘flaky point dermatosis’,reticular
dermatosis,enamel paint dermatosis,crazy
pavement dermatosis
b) petechiae & ecchymosis
c) pyoderma & scabies
 Hair changes
• Light coloured
• Painless easy pluckability
• Alternate bands of light and dark colour-
flag sign
 Psychomotor changes
• Irritability
• May lead to permanent physical and mental
retardation
Growth failure
• Under weight inspite of oedema
• May be due to damage of anterior pituitary
there will be permanent growth failure
 GIT
• Moderate hepatomegaly
• Diarrhoea because of lactose intolerence
 Cardiovascular
• Cyanosis
• Hypotension
• Feeble pulse
• Tachycardia
• CCF due to severe anemia
• Myopathy
• Electrolyte imbalance
 Features of complication
• Vitamin and mineral deficiencies
• Congestive cardiac failure