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Books > Ayurveda > Ayurvedic Clinical Practice (Set of 3 Volumes)
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Ayurvedic Clinical Practice (Set of 3 Volumes)
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Description

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

 

Preface

 

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.

 

Contents

 

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)

482

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

1.

HIGHER MENTAL FUNCTIONS

530

2.

CRANIAL NERVES

536

3.

MOTOR

542

4.

REFLEXES  DEEP AND SUPERFICIAL

545

5.

CEREBELLUM

548

6.

MENINGES

550

7.

SENSORY COLUMN

551

8.

BLADDER

553

9.

SEIZURES

554

10.

ANS (AUTNOMIC)

554

 

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

 

Preface

 

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.

 

Contents

 

I.

ONCOLOGY

21

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

71

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

109

II

HEMATOLOGY

ANEMIA

113

CLASSIFICATION

116

JAUNDICE DUE TO HEMOLYTIC ANEMIA

123

TREATMENT FOR MEGALOBLASTIC ANEMIA

124

TREATMENT FOR APLASTIC ANEMIA

124

ANEMIA ASSOCIATED WITH OTHER DISEASES

126

IRON DEFICIENCY ANEMIA

127

VITAMIN DEFICIENCY ANEMIA

131

HEREDITARY HEMORRHAGIC TELANGIECTASIA

136

ALLERGIC PURPURA

138

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

169

NON-HODGKIN LYMPHOMA

175

POLYCYTHEMIA VERA

179

MYELOFIBROSIS

182

THROMBOCYTHEMIA

184

SPLEEN DISORDERS

186

III

ENDOCRINOLOGY

CUSHING SYNDROME (HYPERCORTISOLlSM)

191

PORPHYRIAS

196

ACUTE PORPHYRIAS

196

CUTANEOUS PORPHYRIAS

202

PORPHYRIA CUTANEA TARDA

202

THYROID GLAND

205

HYPOTHYROIDISM

209

SUB -CLINICAL HYPOTHYROID

212

GOITRE

212

HASHIMOTO'S THYROIDITIS

216

HYPERTHYROI DISM

219

GRAVES DISEASE

219

POST-PARTUM THYROIDITIS (PPT)

222

SIMPLE NONTOXIC GOITER (EUTHYROID GOITER)

226

PARATHYROID HORMONE

229

PARATHYROID PROBLEMS

229

PRIMARY HYPERPARATHYROID HORMONE

230

SECONDARY HYPER PARATHYROIDISM

231

HYPOPARATHYROIDISM

233

OSTEOPOROSIS

235

DIABETES

245

DIABETIC NEUROPATHY

260

BURNING NEUROPATHY

267

ERECTILE DYSFUNCTION IN DIABETES

272

DIABETIC RETINOPATHY

274

DIABETIC HEART DISEASES

278

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

347

PROSTATITIS

352

SEXUAL DYSFUNCTIONS

357

EJACULATION DISORDERS

358

PREMATURE EJACULATION

359

DELAYED OR IMPAIRED EJACULATION

364

RETROGRADE EJACULATION

367

ERECTILE DYSFUNCTION

370

HYPOACTIVE SEXUAL DESIRE DISORDER (REDUCED LIBIDO)

374

MALE REPRODUCTIVE CANCERS

PENILE CARCINOMA

377

TESTICULAR CANCER

379

PROSTATE CANCER

381

V

GYNAECOLOGY

FEMALE REPRODUCTIVE SYSTEM

387

MENSTRUAL ABNORMALITIES AND COMPLICATIONS

390

AMENORRHOEA

390

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

425

VAGINAL INFECTIONS

428

OTHER GYNAECOLOGICAL PROBLEMS

432

DYSPAREUNIA

434

FEMALE SEXUAL AROUSAL DISORDER

435

LOW SEXUAL DESIRE DISORDER

437

FEMALE INFERTILITY

456

HABITUAL ABORTION

459

UTERINE GROWTHS

459

UTERINE FIBROIDS

463

ADENOMYOSIS

464

UTERINE POLYP

464

ENDOMETRIAL POLYP

464

ADENOMYOMATOUS POLYPS

464

PLACENTAL POLYPS

472

UTERINE CANCER

411

CERVICAL CANCER

483

VAGINAL CANCER

484

OVARIAN CANCER

489

BREAST CANCER

489

BREAST CANCER IN FEMALE

493

MALE BREAST CANCER

500

VI

ANTENATAL CARE

ANTENATAL CARE

PRECONCEPTION CARE

500

DIAGNOSIS OF PREGNANCY

500

PROBABLE SIGNS AND SYMPTOMS OF PREGNANCY

501

LABORATORY EVIDENCE OF PREGNANCY

502

MANAGEMENT OF NORMAL PREGNANACY

504

OTHER IMPORTANT ANTENATAL SCREENINGMONTHLY

506

REGIMEN FOR PREGNANT WOMEN

509

NUTRITION OF THE PREGNANT WOMAN

513

IMPORTANCE OF NUTRITION IN PREGNANACY

514

LOSS OF MATERNAL IRON IN A NORMAL PREGNANCY

515

RECOMMENDED DAILY INTAKE OF

SIX CRITICAL NUTRIENTS IN PREGNANCY

515

DIETARY ADVISE FOR PREGNANT WOMEN

515

DISEASES AND DISCOMFORTS OF PREGNANT WOMEN

GASTRO INTESTINAL DISEASES AND PREGNANCY:

520

NAUSEA, VOMITING AND HYPEREMESIS GRAVIDARUM

520

FOOD DISLIKES AND FOOD CRAVINGS

525

GASTRO OESOPHAGEAL REFLUX

525

LIFESTYLE MODIFICATIONS

528

PEPTIC ULCER DISEASE

528

DIARRHOEA

530

CONSTIPATION

534

ACHES AND PAINS

536

BACK PAIN

536

IN SACROILIAC PAIN

538

IN NOCTURNAL BACK PAIN

539

JOINT PAIN

540

LEG CRAMPS

542

ABDOMINAL CRAMPS IN EARLY PREGNANCY

543

HEADACHES AND MIGRAINES

543

VARICOSE VEINS

543

HAEMORRHOIDS

545

OTHER MINOR DISORDERS

548

FREQUENCY OF URINATION

549

VAGINAL DISCHARGE

550

DYSPNOEA (SHORTNESS OF BREATH)

551

DIFFICULTY IN GETTING UP AND DOWN

553

CHLOASMA (THE MASK OF PREGNANCY)

554

CHANGING FEELINGS AND EMOTIONS

554

INSOMNIA

555

COMPLICATIONS OF PREGNANCY

557

ANAEMIA IN PREGNANCY

557

IRON DEFICIENCY ANAEMIA

557

ANEMIA DUE TO VITAMIN B AND FOLIC ACID DEFICIENCY

558

HAEMOGLOBINOPATHIES

562

THALASSAEMIAS

562

SICKLE CELL ANAEMIA

562

HYPERTENSIVE DISORDERS OF PREGNANCY

563

GESTATIONAL HYPERTENSION

563

CHRONIC HYPERTENSION

564

PREECLAMPSIA

565

ECLAMPSIA

565

VII

POST NATAL CARE

568

LACTATION

572

SUBSTITUTE OF MOTHER'S MILK

574

ANNEXURE

575

 

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Ayurvedic Clinical Practice (Set of 3 Volumes)

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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

 

Preface

 

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.

 

Contents

 

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)

482

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

1.

HIGHER MENTAL FUNCTIONS

530

2.

CRANIAL NERVES

536

3.

MOTOR

542

4.

REFLEXES  DEEP AND SUPERFICIAL

545

5.

CEREBELLUM

548

6.

MENINGES

550

7.

SENSORY COLUMN

551

8.

BLADDER

553

9.

SEIZURES

554

10.

ANS (AUTNOMIC)

554

 

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

 

Preface

 

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.

 

Contents

 

I.

ONCOLOGY

21

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

71

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

109

II

HEMATOLOGY

ANEMIA

113

CLASSIFICATION

116

JAUNDICE DUE TO HEMOLYTIC ANEMIA

123

TREATMENT FOR MEGALOBLASTIC ANEMIA

124

TREATMENT FOR APLASTIC ANEMIA

124

ANEMIA ASSOCIATED WITH OTHER DISEASES

126

IRON DEFICIENCY ANEMIA

127

VITAMIN DEFICIENCY ANEMIA

131

HEREDITARY HEMORRHAGIC TELANGIECTASIA

136

ALLERGIC PURPURA

138

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

169

NON-HODGKIN LYMPHOMA

175

POLYCYTHEMIA VERA

179

MYELOFIBROSIS

182

THROMBOCYTHEMIA

184

SPLEEN DISORDERS

186

III

ENDOCRINOLOGY

CUSHING SYNDROME (HYPERCORTISOLlSM)

191

PORPHYRIAS

196

ACUTE PORPHYRIAS

196

CUTANEOUS PORPHYRIAS

202

PORPHYRIA CUTANEA TARDA

202

THYROID GLAND

205

HYPOTHYROIDISM

209

SUB -CLINICAL HYPOTHYROID

212

GOITRE

212

HASHIMOTO'S THYROIDITIS

216

HYPERTHYROI DISM

219

GRAVES DISEASE

219

POST-PARTUM THYROIDITIS (PPT)

222

SIMPLE NONTOXIC GOITER (EUTHYROID GOITER)

226

PARATHYROID HORMONE

229

PARATHYROID PROBLEMS

229

PRIMARY HYPERPARATHYROID HORMONE

230

SECONDARY HYPER PARATHYROIDISM

231

HYPOPARATHYROIDISM

233

OSTEOPOROSIS

235

DIABETES

245

DIABETIC NEUROPATHY

260

BURNING NEUROPATHY

267

ERECTILE DYSFUNCTION IN DIABETES

272

DIABETIC RETINOPATHY

274

DIABETIC HEART DISEASES

278

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

347

PROSTATITIS

352

SEXUAL DYSFUNCTIONS

357

EJACULATION DISORDERS

358

PREMATURE EJACULATION

359

DELAYED OR IMPAIRED EJACULATION

364

RETROGRADE EJACULATION

367

ERECTILE DYSFUNCTION

370

HYPOACTIVE SEXUAL DESIRE DISORDER (REDUCED LIBIDO)

374

MALE REPRODUCTIVE CANCERS

PENILE CARCINOMA

377

TESTICULAR CANCER

379

PROSTATE CANCER

381

V

GYNAECOLOGY

FEMALE REPRODUCTIVE SYSTEM

387

MENSTRUAL ABNORMALITIES AND COMPLICATIONS

390

AMENORRHOEA

390

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

425

VAGINAL INFECTIONS

428

OTHER GYNAECOLOGICAL PROBLEMS

432

DYSPAREUNIA

434

FEMALE SEXUAL AROUSAL DISORDER

435

LOW SEXUAL DESIRE DISORDER

437

FEMALE INFERTILITY

456

HABITUAL ABORTION

459

UTERINE GROWTHS

459

UTERINE FIBROIDS

463

ADENOMYOSIS

464

UTERINE POLYP

464

ENDOMETRIAL POLYP

464

ADENOMYOMATOUS POLYPS

464

PLACENTAL POLYPS

472

UTERINE CANCER

411

CERVICAL CANCER

483

VAGINAL CANCER

484

OVARIAN CANCER

489

BREAST CANCER

489

BREAST CANCER IN FEMALE

493

MALE BREAST CANCER

500

VI

ANTENATAL CARE

ANTENATAL CARE

PRECONCEPTION CARE

500

DIAGNOSIS OF PREGNANCY

500

PROBABLE SIGNS AND SYMPTOMS OF PREGNANCY

501

LABORATORY EVIDENCE OF PREGNANCY

502

MANAGEMENT OF NORMAL PREGNANACY

504

OTHER IMPORTANT ANTENATAL SCREENINGMONTHLY

506

REGIMEN FOR PREGNANT WOMEN

509

NUTRITION OF THE PREGNANT WOMAN

513

IMPORTANCE OF NUTRITION IN PREGNANACY

514

LOSS OF MATERNAL IRON IN A NORMAL PREGNANCY

515

RECOMMENDED DAILY INTAKE OF

SIX CRITICAL NUTRIENTS IN PREGNANCY

515

DIETARY ADVISE FOR PREGNANT WOMEN

515

DISEASES AND DISCOMFORTS OF PREGNANT WOMEN

GASTRO INTESTINAL DISEASES AND PREGNANCY:

520

NAUSEA, VOMITING AND HYPEREMESIS GRAVIDARUM

520

FOOD DISLIKES AND FOOD CRAVINGS

525

GASTRO OESOPHAGEAL REFLUX

525

LIFESTYLE MODIFICATIONS

528

PEPTIC ULCER DISEASE

528

DIARRHOEA

530

CONSTIPATION

534

ACHES AND PAINS

536

BACK PAIN

536

IN SACROILIAC PAIN

538

IN NOCTURNAL BACK PAIN

539

JOINT PAIN

540

LEG CRAMPS

542

ABDOMINAL CRAMPS IN EARLY PREGNANCY

543

HEADACHES AND MIGRAINES

543

VARICOSE VEINS

543

HAEMORRHOIDS

545

OTHER MINOR DISORDERS

548

FREQUENCY OF URINATION

549

VAGINAL DISCHARGE

550

DYSPNOEA (SHORTNESS OF BREATH)

551

DIFFICULTY IN GETTING UP AND DOWN

553

CHLOASMA (THE MASK OF PREGNANCY)

554

CHANGING FEELINGS AND EMOTIONS

554

INSOMNIA

555

COMPLICATIONS OF PREGNANCY

557

ANAEMIA IN PREGNANCY

557

IRON DEFICIENCY ANAEMIA

557

ANEMIA DUE TO VITAMIN B AND FOLIC ACID DEFICIENCY

558

HAEMOGLOBINOPATHIES

562

THALASSAEMIAS

562

SICKLE CELL ANAEMIA

562

HYPERTENSIVE DISORDERS OF PREGNANCY

563

GESTATIONAL HYPERTENSION

563

CHRONIC HYPERTENSION

564

PREECLAMPSIA

565

ECLAMPSIA

565

VII

POST NATAL CARE

568

LACTATION

572

SUBSTITUTE OF MOTHER'S MILK

574

ANNEXURE

575

 

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Artwork received today. Very pleased both with the product quality and speed of delivery. Many thanks for your help.
Carl, UK.
I wanted to let you know how happy we are with our framed pieces of Shree Durga and Shree Kali. Thank you and thank your framers for us. By the way, this month we offered a Puja and Yagna to the Ardhanarishwara murti we purchased from you last November. The Brahmin priest, Shree Vivek Godbol, who was visiting LA preformed the rites. He really loved our murti and thought it very paka. I am so happy to have found your site , it is very paka and trustworthy. Plus such great packing and quick shipping. Thanks for your service Vipin, it is a pleasure.
Gina, USA
My marble statue of Durga arrived today in perfect condition, it's such a beautiful statue. Thanks again for giving me a discount on it, I'm always very pleased with the items I order from you. You always have the best quality items.
Charles, Tennessee
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