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→Kumbha Kamala
Both types of ''kamala'', if not treated convert into difficult to treat and hardened skin. ''Kumbha kamala'' could also refer to the presentation of the patient having distended abdomen i.e. ascitis, which is one of the important clinical feature of liver diseases, which are also the main cause of jaundice.
Both types of ''kamala'', if not treated convert into difficult to treat and hardened skin. ''Kumbha kamala'' could also refer to the presentation of the patient having distended abdomen i.e. ascitis, which is one of the important clinical feature of liver diseases, which are also the main cause of jaundice.
Liver is the main seat for a number of functions and when it gets severely deranged the liver functions are affected. The clinical picture of ''kumbha kamala'' corresponds to these as observed below.
Liver is the main seat for a number of functions and when it gets severely deranged the liver functions are affected. The clinical picture of ''kumbha kamala'' corresponds to these as observed below:
*The production of majority of proteins as albumin, few globulins, cerulo-plasmin etc., is hampered leading to edema in the various body parts (''Bhrusham Shoonam cha Manavaḥ'') and dryness in the body.
*The coagulation profile gets affected leading to increased prothrombin time, the presentation of esophageal varices, bleeding per rectum etc. Here the same features have been described as ''sarakta akshi mukha, chhardi vida mootra'' meaning blood seen or coming out of the eyes, mouth or in the vomitus (esophageal varices), through the stool (haemorrhoids) or through the urine.
*The derangement of liver structure in these diseases leads to some presentation of obstructive jaundice with yellow urine (''peeta mootrata'').
*The stage of altered consciousness has also been described as ''tandra moha samanvita'' (acting as if sleepy or having altered perception - semiconscious state).
*The stage of hepatic coma has also been described as ''nashta sangya'' means the person is not able to recognise and perceive anything – unconscious state (''Sangya Nama Grahanena'').
*The excessive dryness (''kharibhuta'') is generally due to increased bile salts deposition leading to pruritus and dryness of skin. This dryness further leads to the hardness.
*As liver disorders progress, coagulatory defects begin leading to upper G.I. track bleed causing black stools/''malena''(''Krishna shakrita''). Secondly conjugated bilirubin which does not enter intestine becomes urobilinogen giving urine dark color (''krishna mutra'').
*Excessive edema is observed all over body. Cirrhosis of the liver is a condition that causes reduction in plasma protein concentration. Cirrhosis means development of large amounts of fibrous tissue among the liver parenchymal cells. One result is failure of these cells to produce sufficient plasma proteins, leading to decreased plasma colloid osmotic pressure and the generalized edema that goes with this condition. Another way that liver cirrhosis causes edema is that the liver fibrosis sometimes compresses the abdominal portal venous drainage vessels as they pass through the liver before emptying back into the general circulation. Blockage of this portal venous outflow raises capillary hydrostatic pressure throughout the gastrointestinal area and further increases filtration of fluid out of the plasma into the intra-abdominal areas. When this occurs, the combined effects of decreased plasma protein concentration and high portal capillary pressures cause transudation of large amounts of fluid and protein into the abdominal cavity, a condition referred to as ascites.
*Hematemesis/bleeding in eyes,per rectum, hematuria (''Sarakta akshi mukha chhardi vinamutra'') explains the bleeding disorders which begin in late hepatic disorders.
*Fainting (''tamah pravesha'') is due to reduced cerebral perfusion due to various causes like gastrointestinal bleed, electrolyte or metabolic disturbance.
*Drowsiness (''tandra''), confusion (''moha'') are further symptoms of hepatic encephalopathy. Neuropsychological findings are experienced in all phases of hepatic encephalopathy. It is experienced as forgetfulness, mild confusion and irritability, inversed sleep pattern followed by lethargy and personality changes. The third stage is marked with worsened confusion and in fourth stage is coma. ''Mada, Murchha'' and ''sanyasa'' are mentioned earlier as disorders due to vitiated blood in [[Vidhishonitiya Adhyaya]].
==== Current clinical practices in treatment of ''pandu'' and ''kamala'' ( referred from Chikitsa Pradeep) ====
==== Current clinical practices in treatment of ''pandu'' and ''kamala'' ( referred from Chikitsa Pradeep) ====