Magaj ane Gyantantu na Rogo

Author(s): Sudhir V Shah
Publisher: Chetna Sudhir Shah
Catalog link: https://jainqq.org/explore/004950/1

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magaja ane jJAnataMtunA rogo (svAsthya prazikSaNa mArgadarzikA) DaoN. sudhIra vI. zAha Jain Education frontal lobe Dendrite frontal eye field prefrontal area Axon Broca's area (in left hernisphere) Synaptic terminal temporal lobe sensorimotor area auditory Exceed ****** Res auditory association (including Wernicke's arces, in left hemisphere) *A* Agleto ~* parietal lobe rivate & Personal Use Only Neurons in younger brain Des visual visual association \W/Levw/\/\/\/\/ Sleep Cake

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magaja ane jJAnataMtunA rogo (svAdhya prazikSaNa mArgadarzikA) DISEASES OF THE BRAIN & NERVOUS SYSTEM . (A Health Education Guide ) DaoN. sudhIra vI. zAha ema.DI., DI. ema., (nyurolaoNjI) kansalTanTa nyurophijhiziyana * onararI prophesara enDa heDa opha DipArTamenTa opha nyurolaoNjI - ke.ema.skUla oNpha posTagrejyueTa meDisina enDa risarca, amadAvAda. - ena.eca.ela. myu.meDikala kaoNleja, amadAvAda * DirekTara oNpha nyurosAyansIjha - sTarliMga haoNspiTala, amadAvAda 7 onararI nyurophijhiziyana - hijha ekselansI, dha gavarnara oNpha gujarAta - vI. esa. janarala hospiTala, amadAvAda - DaoN. jIvarAja mahetA heltha phAunDezana, amadAvAda klinikaH nyurolojI senTara, 206-7-8, saMginI kaoNpleksa, parimala relave kraoNsiMga pAse, elisabrija, amadAvAda - 380006 phonaH (079) 26467052, 26467467 website: www.sudhirneuro.org

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MAGAJ ANE GYANTANTUNA ROGO DISEASES OF BRAIN AND NERVOUS SYSTEM (A Health Education Guide) by Dr. Sudhir V. Shah prathama AvRtti H I.sa. 2000 nakala : 1,500 * dvitIya AvRtti H I.sa. 2005 nakala : 2,500 tRtIya AvRtti H I.sa. 2009 nakala : 1,000 * caturtha AvRtti : I.sa. 2009 nakala : 2,000 paMcama AvRtti : I.sa. 2010 nakala : ,OOO pRSTha saMkhyA : 16 + 296 * kula nakala : 9,000 kaoNpIrAITa All rights reserved. No part of this book, including design, cover design, and icons, may be reproduced or transmitted in any form, by any means (electronic, photocopying, recording or otherwise) without the prior written permission of the publisher / author. * mUlya : rU. 200/ISBN : 978-93-80065-12-0 prakAzaka : cetanA sudhIra zAha nyUraoNlaoNjI senTara, 206-7-8, saMginI kaoNpleksa, parimala relave kraoNsiMga pAse, elisabrija, amadAvAda-380 006 phona : (079)26467052, 26467467 e-mail : sudhirshah@hotmail.com viketA : gUrjara ejansI ratanapoLa nAkA sAme, gAMdhI mArga, amadAvAda - 380 001 e-mail : goorjar@yahoo.com mudraNa saMskAra : mudraza purohita, sUryA oNphaseTa, AMbalI gAma, seTelAiTa-bopala roDa, amadAvAda-380 058 phona : (02717) ra301 12 e-mail : suryapress@gmail.com

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ooooooooooooooooooooooooooooooooooooooo aNa jemane madadanI kharekhara jarUra che apcocococococococococoducesesta. ane eNttttttttttttttttttttttttttttN je anyane madada karavA sadAya tatpara che te sahune ..... DaoN. sudhIra vI. zAha

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S khAsa sUcanA = A pustaka magajanA vividha rogonI jANakArI mATe che. A tabIbI pAThyapustaka (Medical Textbook) nathI. vAcakone vinaMtI che ke A pustaka vAMcIne koI paNa davA laI svaupacAra karavAnI bhUla na kare. tamArA DaoNkTaranI salAha pramANe ja davA laI, upacAra karavo.

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coseconocessed soot AbhAra mArA vaDIlo, gurujano, kuTuMbIjano tathA zubhecchako ane mitrono 9 B C DaoN. sudhIra vI. zAha

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GODDESS OF CURE C kRti : DaoN. vI. je. zAha 5. pU. pitAzrI sva. DaoN. vI. je. zAha

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FOREWORD DR. B. S. SINGHAL M.D. (BOM.), F.R.C.P. (LONDON), F.R.C.P. (EDIN), F.A.M.S. PROFESSOR & HEAD DEPARTMENT OF NEUROLOGY Bombay Hospital Institute of Medical Sciences Neurologist - Bombay Hospital ENGLISH EDITION, 2002 Diseases of the Brain and Nervous System (A Health Education Guide) Bombay Hospital MEDICAL RESEARCH CENTRE 12, Marine Lines, MUMBAI 400 020 Clinic (9122) 206 4747, 206 7676 Res. (9122) 363 0639, 363 7788 Neurological illnesses account for nearly 20% of the burden of illnesses in the community. Sadly, there is not much awareness about the neurological illnesses and the patient and the family members are suddenly overcome with anxiety and apprehension, and do not know how to cope with neurological problems. Dr. Sudhir Shah's book serves to give the necessary information required. The original book was in Gujarati language, but he has taken pains to bring out this English edition. It is a fairly comprehensive book, dealing with all practical problems faced in neurology. It gives the description of the illness along with the management. I am confident that the reader will find it extremely useful and it will help the patients and relatives to cope with various neurological problems. He has also emphasized on preventive aspects of the illness and side effects of the commonly used drugs and in particular care to be taken for drugs used for prolonged periods. This book should be useful not only for the patient and the caretakers but also for the medical students and the physicians and those involved in the management of neurological illnesses. I enjoyed reading the book and I am confident that it will have a wide reception. I should compliment Dr. Sudhir Shah for having spared his time from his busy practice and academic work to write this book. Za bloshe B. S. Singhal Professor & Head Department of Neurology Bombay Hospital Institute of Medical Sciences Mumbai. April 10, 2002. vii

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Amukha bahArathI akharoTa jevuM dekhAtuM magaja asaMkhya cetAtaMtuonuM baneluM che. eka sekanDanA 16mA bhAgamAM tvarita nirNayo letuM magaja samagra zarIranuM saMcAlanakendra che. AvA supara kampyuTara karatAM paNa caDhiyAtA evA magaja ane cetAtaMtra aMge ghaNAM saMzodhano thayAM che. samagra zarIramAM magaja cetAtaMtra eka ati saMvedanazIla taMtra che ane temAM kyAMya paNa kSati thAya to samagra zarIrane asara pahoMcI zake che. aDhAra varSathI amadAvAdamAM mArA klinika 'nyuraoNlaoNjI senTara'mAM, vikhyAta vI. esa. janarala haoNspiTala ane sTarliMga haoNspiTala ane jIvarAja mahetA haoNspiTalamAM gujarAta tema ja anya prAMtanAM vividha sthaLethI AvelAM mArAM dardIonI sAravAra karatAM jaNAyuM ke dardIo tema ja temanAM svajano magajanAM dardI aMge mAhitI meLavavA ati Atura hoya che. prAdezika bhASAmAM A aMge koI eka ja pustakamAMthI upayogI mAhitI maLe tema na hatuM; tethI magaja ane cetAtaMtuone lagatA rogo vize kAMIka lakhavuM evI sphuraNA thaI. samayanA abhAve A vAta tyAra bAda visAre paDI gayelI. AkAzavANI parathI sapTembara 1999 daramiyAna savAre 'paheluM sukha' kAryakrama tathA dUradarzana para 'svAsthyasudhA' kAryakramamAM magajanA keTalAka rogo aMge mArAM pravacano goThavAyAM. temAMthI magajanA mukhya rogo vize lakhavAnI preraNA thaI. Ama A pustakano prAdurbhAva thayo. prathama A pustaka meM mArI mAtRbhASA gujarAtImAM lakhyuM, pachI aMgrejI AvRtti 2002mAM pragaTa karI. A baMne AvRttione sAro pratisAda maLatAM khUba ja TUMkA gALAmAM bIjI be AvRttio pragaTa karI ane tyAra bAda 2008mAM savistara mAhitI sAthe hindI AvRtti bahAra pADI. temAMthI A navI gujarAtI AvRtti taiyAra thaI. A gujarAtI AvRtti taiyAra karavAmAM khAsa protsAhana tathA sahakAra mATe gujarAta rAjyanA mAnanIya zikSaNamaMtrI mu. zrI ramaNabhAI vorAe ananya rasa dAkhavyo te badala temano huM atyaMta RNI chuM. gujarAta rAjya pAThyapustaka maMDaLe paNa pustaka taiyAra karavAmAM yathocita sahayoga Apyo che, temano sauno paNa AbhAra. viii

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A pustaka dvArA janatAnA svAthyajJAnanI vRddhi tema ja rogo aMgenI jAgRti ANavAno namra prayAsa hoI temAM tabIbI vijJAnanI daSTie UMDANabharI ane tajajJatApUrNa mAhitI ApelI nathI, tema chatAM sAmAnya vyaktine jarUrI tema ja yogya tamAma mAhitI temAM maLI raheze tevI AzA che. joke Aja sudhInAM navAM saMzodhano ane davAone A pustakamAM AvarI levAno prayatna karyo che, paraMtu navI davAonuM rojabaroja saMzodhana cAlatuM ja rahe che tenI noMdha levI joIe. ApameLe akhatarA karavA nahi, paraMtu tabIbI mArgadarzana aMtargata ja davAo levAnuM ucita lekhAze. khAsa to ekAda sAmAnya lakSaNa jaNAtAM vAcake pote nyurolojikala bImArIno bhoga banyo che tevA bhramamAM AvI javuM nahi. bIjI khAsa vAta e che ke gujarAtInI prathama AvRtti prakAzita karI tyAre dardI ane tenAM svajanone roganI jANakArI maLI rahe te ja Azaya hato, paraMtu loko sudhI A pustaka pahoMcatAM saue mane saharSa jaNAvyuM ke phemilI DaoNkTarsa, meDikala TuDanTsa, phijhiyotherapisTa, narsisathI laIne sAva sAmAnya mANasa mATe - ema dareka mATe A pustakamAM kaMIka ne kaMIka agatyanI tathA upayogI vAta jarUra che. A jANIne mane khUba khuzI thaI che. - A pustaka taiyAra karavAmAM mArA guruvarya DaoN. zrI guNavaMtarAya ojhA tathA DI.ena.bI. nyurolojInI mArI vidyArthinI DaoN. raIsA vorAe mane khUba madada karI che. sAthe ja mArA klinikanA sahAyaka phijhiziyana DaoN. amita bhaTTa tathA mArI suputrI ci. helI zAha (meDikala TuDanTa) paNa vizeSa dhyAna ApyuM che. te mATe huM emano paNa RNI chuM. DaoN. atula paTele (ema.DI.) prakaraNa 13mAM eIsa roganI mAhitI vize keTalAMka salAha-sUcano ApyAM che. nyuraoN-reDiyolaoNjI prakaraNa dvArA DaoN. hemaMta paTele (ema.DI. reDiyolojI) sI.TI. skena, ema.Ara.AI. aMge suMdara mAhitI ApI te badala temano AbhAra. A uparAMta nyurosarjarI prakaraNamAM vizeSa mAhitI ApavA badala nyurosarjana DaoN. parimala tripAThIno paNa AbhAra. uparAMta mArAM ardhAginI cetanA zAhano phALo paNa agatyano rahyo che ane temanA sahayogathI ja samayano abhAva hovA chatAM temanA cokasAIbharyA TAima-maeNnejamenTathI A badhuM vistRta ane vyavasthita

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lakhI zakAyuM che. A uparAMta, zrI mudreza purohita (sUryA ophaseTa), jemaNe vyaktigata rasa laI suMdara mAvajata ane sahakArathI A pustakanI caturtha AvRtti taiyAra karI che te badala temano ghaNo AbhAra. sAthe sAthe, A pustakanA prerakabaLa evAM mArAM dardIone huM kema bhUlI zakuM? A pustaka thakI jo thoDIka vyaktio paNa roga pratikAra aMge jAgRta thaze ane samayasara roganidAna thavAthI kaMI nahi to thoDAka mANasonI paNa jiMdagI bacI zakaze to mane AnaMdAnubhUti thaze, paritoSanI prApti thaze. sAthe ja dardIne roga vize jarUrI jANakArI maLavAthI DaoNkTara ane pezanTanA saMbaMdhomAM A pustakathI prema ane vizvAsa vadhaze evI mane zraddhA che. mane A prakAzanamAM preraNA ane mArgadarzana arpanAra saunuM bhAvabhInuM smaraNa karI kRtArthatAnI lAgaNI anubhavuM chuM. khAsa karIne mArA guruvarya DaoN. harSadabhAI joSI, DaoN. pI. ema. dalAla, DaoN. aruNa zAha, DaoN. bhIma siMghala, DaoN. pravINa zAha, DaoN. phrenka yAtsu (hyusTana), DaoN. nAyala kvIna (laMDana), tathA DaoN. zimona zoravona (laMDana), jemaNe mane nyuraoNlojInuM zikSaNa ApyuM e saune huM natamastake praNAma karuM chuM. ApaNA svAtaMtrya dine A gujarAtI AvRtti rASTrane arpaNa karatAM huM gaurava anubhavuM chuM. aMtamAM, paramakRpALu paramAtmA sarvanuM kalyANa kare tevI zubhecchA saha... tA. 15 oNgasTa, 2009 DaoN. sudhIra vI. zAha svAtaMtrya dina ema.DI., DI.ema. (nyuraoNlaoNjI) amadAvAda,

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prastAvanA (bhojana pUrve epeTAIjharanuM je mahattva che tevuM ja mahattva prastAvanAnuM pustaka vAMcatAM pahelAMnuM che. baMnenuM kAma che bhUkhane pradIpta karavAnuM, utsukatA jagADavAnuM ane sabaLa pUrvabhUmikA racavAnuM. A samajaNa ane saMdarbhamAM tamAre A prastAvanA vAMcavI ja rahI !) mAMdagI AvI paDe tyAre svAbhAvika che ke dardI ane tenAM sagAMo moTI vimAsaNamAM mukAI jAya che. "have thaze? kaMIka ajugatuM to nahIM bane ne ? jIvanabharanI paravazatA to nahIM Ave ne?' AvA prANaprazno dardI tathA tenAM sagAMone hacamacAvI mUke che. roganI asara dhIme dhIme thatI dekhAya tyAranI vAta judI che paNa lakavA jevo roga humalA (eTeka) svarUpe acAnaka trATake tyAre dardI ane sagAMonA jIvanamAM bhAre asthiratA AvI paDe che ane keTalAMya bihAmaNAM praznArthacino UpasI Ave che. roga vizenI ajJAnatA ane khAsa karIne, roga vizenA khoTA, bhrAmaka khyAlo, mAnyatAo tathA "mane to kaMI thAya ja nahIM', "huM kadI mAMdo paDuM ja nahi tevo chUpo huMkAra paristhitine vadhAre vaNasAve che. temAM dardI-sagAMono vAMka paNa nathI kAraNa ke ApaNI zikSaNa paddhati tathA sAmAjika mALakhAmAM svAthyanI saMbhALa kevI rIte rAkhavI, tenuM rakSaNa kevI rIte karavuM tema ja rogo vizenI samaja-mAhitI, gaMbhIra rogonAM zarUAtanAM lakSaNo-cihano kevo hoya ane temane gaNakArIe nahi to tenAM kevAM duHkhada pariNAmo AvI zake tathA roga AvI paDe tyAre te mATenA Avazyaka mAnasika-Arthika Ayojana bAbata zALAmahAzALAomAM ke bIjA koI mAdhyama dvArA zIkhavavAno koI saMgaThita, buddhigamya ane pariNAmalakSI prayatna thayo nathI tathA te mATe kaMI ja samajAvavAmAM-zIkhavavAmAM AvatuM nathI (atyAre

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ApaNA rASTranA kula bajeTano phakta eka TakA jeTalo bhAga svAththarakSA mATe phALavavAmAM Ave che) roga AvI paDe tyAre DaoNkTara pAse doDI jaIe tenA karatAM roga thAya ja nahIM ane thAya to tene prAraMbhika kakSAe ja oLakhI laIne yogya sAravArathI tene dUra karIe tevI sUjha sAmAnya mANasamAM tema ja kahevAtA bhaNelA-gaNelA mANasamAM kema nathI hotI? te mATe ApaNI keLavaNI saMsthAo, samAja jAgRtisaMsthAo potAnI javAbadArI barAbara nibhAve che kharI? samAcArapatro tathA sAmayiko rogo vize vAcakone mAhitagAra karavA prayatna karatAM hoya che paNa ghaNI vAra tenAM UlaTAM pariNAmo jovA maLe che ! (koI vartamAnapatra ke sAmayikamAM svAthyalakSI lekho mATe niSNAta tabIba kAyamI dhoraNe saMpAdaka ke salAhakAra tarIke nimAyA hoya tevuM sAMbhaLyuM ke joyuM nathI !) AvI paristhitimAM, vividha rogo vizenI mAhitI pustikAo upalabdha hoya to eka moTI samAjasevA thaI gaNAya; tethI ja jANItA nyuraoNphijhiziyana DaoN. sudhIrabhAI vI. zAhe lakheluM "magaja ane jJAnataMtunA rogo' nAmanuM A pustaka eka AzIrvAda samAna che tema kahevAmAM mane koI atizayokti jaNAtI nathI. jyAre jUnA rogo pharIthI mAthuM UMcakI rahyA hoya ane navA rogono pagapesAro thaI cUkyo hoya tevA samaye je tabIbane dardI ane sagAMonI ciMtA hoya ane jenA haiye dardIo tathA sAmAnya janatAnuM hita vasyuM hoya te tabIba ja potAnI vyasta dinacaryAmAMthI pustaka lakhavA mATe samaya kADhe ane rAtaujAgarA karIne paNa potAnuM lakhANa pUruM kare ane vaLI potAne kharce tene prasiddha kare. 'huM ekalo zuM karI zakuM?" tevA nakArAtmaka, nirAzAvAdI valaNane badale "ekalo jAne re' e siddhAMte DaoN. sudhIrabhAIe A dizAmAM prathama pagaluM mAMDyuM che. A pUrvabhUmikA samajyA pachI putakanI vAta karIe. eTaluM to vinAsaMkoca kahevuM ja joIe ke vizeSajJa DaoN. sudhIrabhAI

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dardIo, tenAM sagAMo tathA samagra janasamudAyane magajajJAnataMtuonA vividha rogo bAbata jarUrI jJAna pIrasavAmAM dhArI saphaLatA meLavI zakyA che. bhojananI vAnagIo jema pauSTika hovI joIe tema supAcya ane svAdiSTa paNa hovI joIe. lekhakoe paNa AvuM dhyAna rAkhavuM ja paDe ane te bAbatanI DaoN. sudhIrabhAIe cokasAI rAkhI che te pustaka vAMcatAM jaNAI Ave che. rajUAtanI saraLatA, mAhitInI pracuratA, lakhANanI lokabhogya zailI ane bhASA paranI pakaDa jevI bAbatonI gUMthaNI addabhuta rIte thaI che. binajarUrI pAMDityano bhAra nahIM hovAne lIdhe keTalAka jaTila - sAmAnya mANasane na samajAya tevA - rogo paNa vAMcI-samajI zakAya te rIte nirUpavAmAM AvyA che, je eka moTI siddhi gaNI zakAya. Ama to dareka prakaraNa kuzaLatAthI, sakSamatAthI lakhAyuM che chatAM mUrchA, lakavo, smRtibhraMza, vAI ane tanAvanAM prakaraNo mokhare che. sAthe sAthe e paNa noMdhavuM paDe ke A pustaka koI sAmAnya pustaka nathI paNa lekhakano vividha rogo vizeno anubhava ane te vizenA jJAnano paripAka che ane sAmAnya janatA mATenI lekhakanI asAmAnya anukaMpA, lAgaNI, ciMtA ane zubhabhAvanAnuM pratibiMba che. gujarAtamAM, kadAca bhAratabharamAM, A viSayane lagatuM sAmAnya janatA mATe lakhAyeluM A viSaya paranuM A prathama pustaka che. A pustaka jeTalA premathI lakhAyuM che teTalA ja premathI dardIoe, temanAM sagAMoe, tabIbI tathA narsiMga vyavasAyanA sabhyoe tathA gujarAtanI gujarAtamAM, anya prAMtomAM tathA paradezamAM vasatI jAgRta, buddhijIvI prajAe tene vadhAvI levuM joIe. 'DaoNkTaro mAtra paisA kamAI jANe che' tevI TIkA karanArA mahAnubhAvoe temano abhiprAya badalavo paDaze tema lAge che! dardIonA svAsthyanI vividhalakSI saMbhALa ane zreyanI ciMtA na hota to A pustaka lakhavAnI DaoN. sudhIrabhAIne koIe pharaja nahotI pADI chatAM potAnI svayaMbhU zubhabhAvanAthI na

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prerAIne A suMdara, saphaLa, upayogI pustaka prasiddha karavA badala Do. sudhIrabhAIne hArdika abhinaMdana pAThavatAM AnaMda anubhavuM chuM. chatAM, rasoInAM ekapakSI vakhANa karavAno koI artha nathI. chevaTe to bhojananI A vAnagI ArogyA pachI vAcake ja tenI guNavattA nakkI karavAnI che. huM to mArA taraphathI eTalI khAtarI ApI zakuM ke tame nirAza nahIM thAva, balake kaMIka pAmyAno saMtoSa jarUra anubhavazo. makarasaMkrAMti tA. 14-1-2001 amadAvAda-380 007 DaoN. guNavaMtarAya jI. ojhA ema.DI.

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anukramaNikA ......... 1. cetAtaMtra (Nervous system) viSe prAthamika mAhitI (Preliminary Information about Nervous System)......... 9 2. nyuroreDiyolojI-magajanI eksa-re tapAsa (Neuroradiology) ............ 3. mUcha (komA) (Coma) .. vAI, AMcakI, kheMca (epilepsI) (Epilepsy) lakavo (perelisisa) - pakSAghAta (Stroke). 6. magajamAM raktastrAva - hoina hemareja (Brain Hemorrhage) ...... 7. AdhAzIzI (mAigrena) ane mAthAnA anya dukhAvA tathA varkiMgo (Migraine, other headaches and vertigo) ..................... 8. mUvamenTa DisorDarsa ane DisTonIA (Movement disorders and dystonia).. 9. kaMpavAta (pArkinsonijhama) (Parkinsonism)... 10. smRtibhraMza (DimenziA) ane yAdazakti vadhAravAnA upAyo (Dementia and tips to improve memory) . 110 11. nidrA-vikAra ane sAravAra (Sleep Disorders) 131 12. magajanA cepI rogo : meninajAiTisa, ensephelAITisa (CNS Infections) 13. eiDjha (tenI cetAtaMtra para asara) (AIDS-its effects on Nervous System) .... ........................... 165 ***** .. 1oo 14pa XV

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ar. .... 180 - , , , , 14. magajamAM thatI gAMTho (voina TyUmara). (Brain Tumour).... 103 15. serila pAlsI (sI.pI.) (Cerebral Palsy)..... 109 16. karoDarajjunA rogo (mAyalopathI) (Myelopathy) . 10. malTipala klerosisa (Multiple Sclerosis) ............. 19o 18. moTara nyurona DisIjha . (Motor Neuron Disease).... 205 19. nyuropathI (e.Ai.DI.pI. tathA anya) (Neuropathy) 211 20. mAcestheniyA grevisa (Myaesthenia Gravis) .. 220 21. nAyunA rogo (Myopathies) 22. tanAva (sTresa) (Stress) ..... 23. magajanI zastrakriyA - nyurosarjarI (Neurosurgery)... 259 24. lAMbA samaya sudhI vAparavI paDe tevI davAo aMge mAhitI (Neurological Medicines to be used for longer duration). ........... 269 25. davAkhAnAmAM dAkhala karela dardI aMge jarUrI sUcano (Tips for a hospitalised patient)... 209 dardIo mATe mAhitI mArgadarzikA Patient Information Guide .... 235 24o ....... 288 xvi

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(1)(cetAtaMtra (Nervous system) viSe prAthamika mAhitI) magaja, karoDarajju ane temAMthI nIkaLatI cetAo, snAyuo tathA anya avayavo sAthenuM temanuM joDANa - e AkhI kAryaracanAne cetAtaMtra eTale ke "narvasa sisTama' (Nervous system) kahe che. manuSya bIjAM prANIo karatAM viziSTa che ane utkRSTa che, tenuM kAraNa mAnavanI cetAtaMtranI racanA ane tenI paddhati che. khAsa karIne magajanuM kaoNrTeksa (magajanI sapATI paranuM jhAMkhA bhUkharA raMganuM paDa) je ativikasita ane jaTila che. joke manuSyanAM bIjAM aMgo anya prANI jevAM athavA temanA karatAM UtaratAM che paNa kaoNrTeksane lIdhe tene ananya buddhicAturya, tarkazakti, smaraNazakti ane zabdazakti prApta thayela che. A korTeksamAM Azare so abaja nyuraoNnsa (cetAkoSo) AvelA che. eka aMdAja mujaba sAmAnya manuSya potAnA magaja pAsethI tenI zaktinA Azare 3thI 5 TakA jeTaluM ja kAma le che, madhyama manuSya Azare 5thI 10 TakA jeTaluM kAma le che paraMtu jIniasa eTale ke vilakSaNa manuSya tenAthI vizeSa kAma le che. A uparathI samajAya che ke manuSya potAnA magaja pAsethI jema vadhu kAma letAM zIkhe tema te vadhu sarvoparI thaI zake. pukhta vayanA mANasanA magajanuM vajana Azare 1200thI 1400 grAma jeTaluM hoya che. Ama ApaNuM magaja zarIranA kula vajanano mAMDa 1thI 2 TakA jeTalo ja hisso dharAve che. paNa zarIrane maLatA prANavAyuno Azare 25 TakA jeTalo puravaTho ane gyukojhano 70 TakA jeTalo phALo magajane vAparavA joIe che. nIcI kakSAnAM karoDavALAM prANIone magaja jevuM vikasita aMga na hovAthI temanAM kAryo preraNA-AdhArita hoya che, tethI temane saMvedanA hotI nathI, jema ke mAkhI vagere. moTuM mAthuM eTale buddhipratibhA vadhAre hoya tevuM nathI, kada karatAM magajanI racanA vadhAre agatyanI che.. magajanI bahAranI sapATI bhUkharA raMganI che jene korTeksa kahe che ane aMdaranI sapATI sapheda che jene vhAITa meTara kahe che.

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magaja ane jJAnataMtunA rogo magaja khoparImAM surakSita rIte sacavAyeluM che ane gharSaNa na thAya ane kaMIka aMze rakSaNa thAya te mATe vacce traNa AvaraNo hoya che jene meninjIjha kahe che, te che, dura mater (bahAranuM), arachnoid mater (vacaluM) ane pla mater (cheka aMdaranuM). AnA cepane maeNninjAiTisa kahe che, jema ke TI.bI. maeNninjAiTisa. magajanI aMdara AvelI kothaLIone ventricles kahe che. be lateral ventricles, eka third ventricle ane eka fourth ventricle ema kula cAra kothaLIo hoya che. D AG Pituitary Gland piTyUiTarI graMthi Cerebrum C // cerebrum - moTuM magaja D - DyUrA meTara A - erekanaoNIDa meTara SA - saba erekanaoNIDa spesa AG - erekanaoNIDa TraeNnsyUlezana C - nAnuM magaja SA AS 4. CC - kaoNrpasa kelojhama LV - laeNTarala venTrikala v3 - trIjuM venTrikala v4 - cothuM venTrikala As - ekviDakTa oNpha silviana

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cetAtaMtra (Nervous System) viSe prAthamika mAhitI 3 A kothaLIomAM rahelA pANI jevA pravAhIne c.S.E. (serIbro spAInala phalyuIDa) kahe che. te magajathI karoDarajjumAM vacce uparathI nIce sudhI ane magaja tathA karoDarajjunAM bahAranAM AvaraNomAM raheluM che jene kAraNe magajamAM thato cepa ke breina haeNmareja vagere karoDarajjumAMthI pANI kADhIne lumbar puncture dvArA paNa sahelAIthI jANI zakAya che. A C.S.FnuM kAma magajanA cayApacaya (metabolism)mAM madada karavAthI mAMDIne magajamAM gharSaNa ghaTADavA sudhInuM che. magajanA koSonI ati bhAre ane jaTila kAmagIrIne lIdhe temane adhika poSaNa ane prANavAyunI jarUra paDe che; tethI lohIno jhaDapI ane adhika puravaTho jarUrI rahe che. jo lohI tathA prANavAyunuM bhramaNa kaoNrTeksamAM pAMca miniTathI vadhu samaya mATe bilakula aTakI jAya to tenI kAmagIrI haMmeza mATe samApta thaI jAya che ane jIvana paNa samApta thaI zake che. magajanA traNa bhAga pADI zakAya (1) khoparInA moTA bhAgane rokatuM moTuM magaja (Cerebrum) jenA be bhAga che, jamaNuM ane DAbuM. A baMne vaccenuM joDANa kare che te kaoNrpasa kelojhama che. (2) nAnuM magaja (Cerebellum) je khoparInA pAchalA bhAgamAM hoya che, te paNa DAbuM ane jamaNuM ema be bhAgamAM vaheMcAyeluM hoya che. tenuM kAma mukhyatve zarIranuM samatolana jALavavAnuM che. (3) baMne magajanI vaccethI joDatI paTTI ke kaDI te breinasTema kahevAya che. jemAM mld brain, pons (majjAsetu), ane medulla oblongata (laMbamajjA) AvelAM che, jenuM karoDarajjumAM sIdhuM parivartana thAya che. kAryaracanAnI dRSTie moTA magajanA cAra bhAga paDe che H (1) phranTala (AgaLano bhAga) loba (2) perAiTala(bAjuno u52no) loba (3) Temporala (bAjuno nIceno) loba (4) oNksipiTala (pAchaLano) loba

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magaja ane jJAnataMtunA rogo ] ] B E If : ' '' kaDaka ka DA , . .. mIDabreIna che pITyuTarI graMthI moTuM magaja che majAsetu che korpasa kelojhama, laMbamajA (4) thelemasa karoDaraDablyu ) hAIpothelemasa 1 nAnuM magaja jamaNuM magaja zarIranA DAbA bhAganAM aMgonI kAryazIlatA mATe javAbadAra hoya che te ja rIte DAbuM magaja jamaNAM aMgo tema ja vizeSamAM bhASA dvArA abhivyaktinI kSamatA mATe javAbadAra hoya che. phranTala loba mahad aMze viruddha bAjunA hAthapaganA halanacalana mATe tathA manuSyanA vyaktitva ane vartaNUka mATe javAbadAra hoya che. perAITala loba zarIranI sAmI bAjunI saMvedanAnuM vizleSaNa kare che tathA gaNita vagere zaktio sAthe saMkaLAyeluM che. Temporala loba ane limbika sisTama manuSyanI smaraNazakti tema ja svAbhAvika - mULabhUta vRttio (instincts), saMvedanA

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cetAtaMtra (Nervous system) viSe prAthamika mAhitI (emotions) mATe jarUrI che. ane keTalAkanA mate te chaThThI indriya sixth sense vagere gUDha zaktinuM sthAna hoI zake. vaLI zravaNazaktinuM sarvoparI kendra paNa tyAM che. oNksipiTala loba e dRSTinuM magajanuM vizleSaNa kendra che. jamaNA hAthe kAma karanAra (lakhavuM, khAvuM, pheMkavuM vagere) vyaktinuM DAbuM magaja prabhAvI hoya che ane temAM mukhyatve bhASA tema ja bIjAM anya agatyanAM kendro hoya che, jethI karIne DAbuM magaja e mahad aMze Tekanikala breina (taMtrika magaja) kahI zakAya. jamaNuM magaja saMvedanazIlatA, sarjanAtmakatA vagere sAthe saMkaLAyeluM che. e eka samajavAno viSaya che ke vicakSaNa manuSyo jamaNA magaja pAsethI paNa vizeSa kAma kaDhAve che. phranTala loba magajanuM vANI kendra che. A bhAga che Temporala loba perAiTala loba -magajanuM vANI kendra rIte bhAga 2 , jo ha - oNksipiTala komara | loba che nAnuM magaja karoDarajju I majjAsetu laMbamajjA magaja ) magajamAM mana kyAM AveluM che te vize koI ekamata nathI. eka mata mujaba dareka koSamAM mana che, bIjA mata dvArA Temporala loba, limbika sararkiTamAM ke pInIala graMthimAM mananuM prasthApana karavAmAM Avela che. kharekhara to mananuM koI eneTomikala - bhautika prasthApana nathI paNa te eka jaivika-rAsAyaNika (bAyokemikala) ane ilekTromaeNgneTika jaTila prakriyA che ane tenA vizenuM yathAyogya jJAna ApaNane nathI, te vijJAnanI eka maryAdA che. chatAM, vicAro, vRttio, icchAo, ahaMkAra ane vartaNUka e mananAM kAryo gaNI zakAya. AtmAnA astitvanI bAbatamAM to ghaNA vaijJAniko zaMkAzIla che.

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6 magaja ane jJAnataMtunA rogo A sivAya magajamAM caeNlemasa (thalamus) tathA bejhala gengalIA (basal gangla) nAmanAM agatyanAM koSakendro AvelAM che ane temAM thatAM rAsAyaNika asaMtulanane laIne pArkinsonijhama ke tethI viruddha koriA, DisToniA vagere rogo thAya che. tenI vistRta jANakArI prakaraNa 8 ane 9mAM ApI che. - te ja rIte hAIpothelemasa e eka agatyanuM aMga che je simpatheTika (sympathetic) tema ja perAsimpatheTika cetAtaMtranuM sarvoparI aMkuza rAkhanAruM sthAna che. A maMtra ApaNAM anaicchika snAyuo tema ja tanAva vagere bhautika kriyAo sAthe saMkaLAyeluM che. hRdaya, AMtaraDAM, AMkhanI kIkI, blaDaprezara, zvAsocchavAsa vagere aneka atyAdhika mahattvanI kriyAonuM niyamana A prakAranuM cetAtaMtra kare che, je svayaMsaMcAlita (oTonomika) che. - aMtaHstrAva graMthionuM sarvoparI sthAna te piyUTarI graMthi che ane te magajamAM Avela che. te zarIranI tamAma aMtaHstrAva graMthio (hormonasisTama)nuM addabhuta niyamana kare che. A uparAMta magaja ane cetAtaMtramAM saMdezAonI Apa-le mATe DopAmina, noraeDinAlina, gAbA, siroTonina, esiTAIla kolina, enDorphina, ensephelina jevAM atyaMta agatyanAM nyuroTrAnsamITara ane temanAM risepTaranuM adbhuta neTavarka prasthApita thayeluM che. | magajamAMthI pratyeka bAjue bAra (eTale ke bAra joDa) cetAo (Nerves) nIkaLe che tene kenIala narsa (Cranlal Nerves) kahe che. te atyaMta mahattvanI kAmagIrI saMbhALe che, jemake gaMdha, dRSTi, caherAnA snAyuo ane jIbhanuM halanacalana. * prathama cetAne Offactory nerve kahe che je gaMdha saMbaMdhI mAhitI magajane pUrI pADe che. * bIjI cetAne optic nerve kahe che - je dRSTi saMbaMdhI jJAna magajane pahoMcADe che, ane tenuM udbhavasthAna AMkhano paDado (reTInA) che. tene nukasAna thAya to daSTinA rogo thAya che ane aMdhatva paNa AvI zake che.

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cetAtaMtra (Nervous system) viSe prAthamika mAhitI * traNa, cAra ane cha naMbaranI cetAne anukrame okyulomITara (Oculomotor), Elscll242 (Trochlear) 2477 ROSYZY-34 (Abducens) kahe che. A traNeya cetAo AMkhanA DoLAne pharato rAkhavAnA snAyuone cetAnvita kare che, jemAMnI eka paNa cetAne asara thAya to AMkha trAMsI bane athavA ekane badale babbe (Dabala) dazyo dekhAya. * pAMca naMbaranI-cetAne TrAIjeminala (Trigeminal) kahe che, jenI kAmagIrImAM muzkelI sarjAya to moDhAnA-jaDabAnA snAyu kamajora thAya athavA mastaka paranI saMvedanAonuM yogya pRthakkaraNa na thAya athavA khoTI vedanA thAya, jene TrAIjeminala nyurAsjiA kahe che. (juo prakaraNa-7). jIbha parathI svAda A cetA dvArA ja magajane pahoMce che. * sAta naMbaranI cetAne phesiala (Facial) narva kahe che. teno lakavo thAya to moTuM vAMkuM thAya che, te bAjunI AMkha baMdha thaI zakatI nathI. A jANItA rogane "belsa pAlsI' kahe che. 0 ATha naMbaranI nasa (Vestibulocochlear) vesTIbyulo kokalIara che. tene nukasAna thAya to baherAza athavA zArIrika asaMtulananA rogo thAya che. varTigo (cakkara AvavAM) sAmAnya rIte A cetAmAM thatI garabaDathI thAya che. * nava ane dasa naMbaranI nasane anukrame (Glossopharyngeal) glosophenziala ane vegasa (Magus) kahe che. temanuM mukhya kAma khorAka gaLavAnuM tathA svarapeTInA snAyuone yogya rIte kAryarata karavAnuM che. vizeSamAM vegasacetA zarIranI aneka anaicchika kriyAo para niyaMtraNa karatI hoI, te autonomic nervous systemnuM khUba agatyanuM aMga che. * agiyAra naMbaranI cetA eksesarI (accessory) cetA kahevAya che. te gaLAnA aicchika snAyuo para niyaMtraNa kare che, jyAre bAra naMbaranI hAyapoglosala (Hypoglossal) cetA jIbhanA snAyuonA halanacalana mATe kAryarata che.

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magaja ane jJAnataMtunA rogo A bAreya naso-cetAo magajamAM yogya sthAne - cokkasa sthAnethI nIkaLe che ane niyata sthAne pahoMce che. je naso saMvedanA laI jAya te sensory nerves che ane te nizcita aMga (jemake kAna, AMkhomAMthI nIkaLI magajamAM pahoMce che. jyAre magajamAMthI cetA je AjJA snAyuo para laI jAya (jemake DoLAnA snAyuo, moDhAnA snAyuo) tene motor nerves kahe che. zarIranA halanacalananI gatividhio traNa cetAsamUha (systems) dvArA thAya che, je prakaraNa 8mAM vistRta rIte darzAvyuM che. magajane eneTomI (zarIraracanA)nI dRSTie to ApaNe joI gayA paNa tenI keTalIka addabhuta viziSTatAo-khAsiyato che je manuSyane sarva prANIomAM sarvazreSTha banAve che. magajanA koSomAM eka jAtano sUkSma vidyutapravAha uddabhavyA karato hoya che jemAM eka sAtatya che, laya che. A eka vijanika prakriyA che. A pravAha rAsAyaNika rIte eka koSamAMthI bIjA koSamAM pahoMce che ane AkhA cetAtaMtramAM nyuroTrAnsamITara ane risepTaranuM ajabanuM neTavarka che je sekaMDanA 1000mA bhAgamAM eka mAhitI eka bhAgathI bIjA bhAgane pahoMcADI zake che. A eka jaivika-rAsAyaNika prakriyA che. magajanA koSo anya koSonI jema potAnuM cayApacaya saMbhALe che. A eka jaivika (bAyolaoNjikala) prakriyA che. AhAra, nidrA, bhaya vagere mULabhUta svAbhAvika vRttio (instincts) magaja pAse che. uparAMtamAM, vicAra, buddhi, vivekazIlatA, yAdadAsta ane sarjanAtmakatA jevAM ativikasita upakaraNo-avadhAno magajane maLelAM che ane sAthe lAgaNI, gusso, gamo-aNagamo, prema jevI vividha prakAranI saMvedanazIlatA ApaNA magajane maLelI che. dRSTi, svAda, gaMdha, sparza ane zravaNa jevI jJAnendriyo magajanI tahenAtamAM che. bhASA dvArA ApaNe ekabIjA sAthe sahelAIthI vicAronI Apale karI zakIe chIe.

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cetAtaMtra (Nervous system) viSe prAthamika mAhitI jene ApaNe "mana" kahIe chIe te paNa magajano ja bhAga nathI zuM? joke bhautika rIte hadaya(dila) chAtImAM AveluM che paNa kavio je saMvedanAtmaka hRdayanI vAta kare che te viSe vicAratAM ema jaNAya che ke te kharekhara to magajano ja ullekha che. manuSyasarjita koI paNa supara kamyuTaramAM kadIya AvI badhI apekSA ApaNe rAkhI zakIzuM kharAM? Azcarya e vAtanuM che ke ApaNA magaja viSe ApaNuM magaja je vicAra karI zake che, vizleSaNa karI zake che, joke ApaNane koNe banAvyA te viSenI kalpanAone ghaNI ja maryAdAo che. magajamAM pedA thatA vidyuta-taraMgone I.I.jI. dvArA noMdhI zakAya che. magajanA pAchalA bhAgamAMthI jAgRta avasthAmAM AMkho baMdha rAkhIne je vIjaLika prakriyA noMdhI zakAya che tene AlphAtaraMga kahe che. tenI taraMgasaMkhyA 8thI 13 Hz hoya che. cheka AgaLanA phranTala kaoNrTeksa parathI sAmAnya rIte bITA taraMga 14thI 40 HTa jeTalI noMdhI zakAya che. thITA taraMga 4 thI 7Hz kyAreka Temporala bhAgamAM maLI Ave che ane bALakomAM te vadhu vikasita hoya che. DelTA prakriyA e pukhta vyaktimAM jAgRta avasthAmAM haMmezAM rogasUcaka (ebnormala) hoya che ane kyAreka nidrAmAM te bALakomAM noMdhI zakAya che. bAkI, sAmAnya rIte DeTA prakriyA e magajanI koI mAMdagInI nizAnI hoya che. je lokone vivaraNa pasaMda che emanA mATe nIcenI mAhitI rasaprada thaI paDaze. prAthamika ghaTaka - cetAkoSa ane cetAonuM saMyojana AgaLa jaNAvyuM tema cetAtaMtramAM magaja, karoDarajju, emAMthI nIkaLatI cetAo ane snAyuone saMdezo pahoMcADatI nasono samAveza thAya che. (central and Peripheral Nervous system) manuSyanA magajanuM vajana lagabhaga 1200thI 1400 grAma hoya che, paNa emAM lagabhaga

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10 Dendrites magaja ane jJAnataMtunA rogo 100 abaja cetAkoSikAonuM neTavarka hoya che. cetA koSikAonI saMkhyA bhale AkAzagaMgAnA tArAo jeTalI hoya paNa phakta ane phakta e ja magajanI jaTilatAno nirdeza kare che. evuM nathI. A jaTilatAmAM cetAkoSonI vividhatAonuM paNa Cell Body agatyanuM yogadAna che, jenA vize jANItA nyurAeneTaoNmisTa remana vAya. kejale sAcuM ja kahyuM che ke, "The Mysterious Butterflies". cetAkoSikA magajanuM prAthamika ghaTaka che. cetAkoSikAonA mukhya traNa bhAgo che. - koSa ane koSakendra, DenDrAITsa ane ekSonsa ke je anya cetAkoSikAone saMdezo pahoMcADe che. cetAkoSikA (nyuraoNna) uttejita thaIne vIjaLika taraMgo dvArA bIjA nyuraoNnsane saMdezo pahoMcADe che, jene ekzana poTenziyala kahe che. A saMdeza taraMgo ekjhona para AgaLa vadhe che ane be koSo vaccenA sAMdhA (Synapse - sAyanepsa) para rAsAyaNika saMdezanA svarUpe parivartita thAya che. jyAre taraMgo prisAyanepTika nyuraoNnanA ekjhona para pahoMce che tyAM nyuraoNTrAnsamITara (rAsAyaNika padArtha)no srAva thAya che, je AgaLa prasare che ane DenDrAITsanI posTasAyanepTika membrenamAM risepTara sAthe joDAya che. jenA kAraNe Ayana cenalo khule che ane posTasAyanepTika cetAkoSikAomAM ekzana poTenziyala utpanna thAya che. saMkSiptamAM kahIe to A rIte cetAkoSikAo saMdezAnI Apa-le kare che.

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cetAtaMtra (Nervous System) viSe prAthamika mAhitI cell body axan dendrite Chemical synapse 05 ponse SUND aa. 000 synapt vesicle dendrite neuro. transmiter Contro postsynaptic receptor tooer of a #mapot Ketan & mor dendrites cell body p myeti1 sheath magajamAM vividha prakAranA nyuraoNTrAnsamITara maLI AvyA che ane A vividhatAnuM magajanAM kAryamAM ghaNuM yogadAna che. A staranuM - sAyanepTika levalanuM pRthakkaraNa mukhyatve mAnasika ane magajanA rogomAM ghaNuM upayogI che, je magajanAM kAryo para prakAza pADe che. 11 vicAravAnA ane anya koI viziSTa prakAranA vartananuM rAsAyaNika AdhAranuM adhyayana cetAonA saMgaThananA vividha staronI vistRta jANakArI prApta karavAthI thaI zake che, je magajathI laIne vividha starothI AgaLa vadhIne aNuo sudhI pahoMce che. AnA dvArA ApaNe e paNa samajI zakIe chIe ke ApaNe je kaMI paNa vicArIe chIe, je paNa zabda bolIe chIe, je paNa vartana karIe chIe, e dareka vAta magajamAMthI utpanna thAya che ane darekanI samagra zarIranAM tamAma taMtro ane koSo para kaMIka ne kaMIka asara jarUra thAya che. mATe ja sArAmAM sAruM vicAravuM joIe, sArAmAM sAruM bolavuM joIe ane ucca prakAranuM kalyANakArI vartana ApaNe karavuM joIe.

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1 2 magaja ane jJAnataMtunA rogo 'cetAtaMtranA vividha staro | vartana Behaviour ( taMtra taMtra System jALAkAra vinyAsa Network | cetA Neuron | sAyanesa Synapse rAsAyaNika padArtha Molecules Molecules | janIna Genes A tamAma saMzodhanonA stare mukhya zodhonA kAraNe je anusaMdhAno thayAM che enAthI cetAvijJAna druta gatie AgaLa vadhyuM che, je eka tarapha manocikitsAthI mAMDIne bIjI tarapha ANvika cetAvijJAna (Molecular neurobiology) ane cetA janInavidyA (Neuro-genetics) sudhI vistRta che. A tamAma saMzodhana mAnasika (Psychological) ane cetAtaMtranA (Neurological) rogonI sAravAramAM vizeSa upayogI thayAM che. | ATaluM samajyA pachI ApaNe magaja tathA cetAtaMtranA rogonA vargIkaraNa viSe vicArIe: (1) magajanI sabhAnatAmAM vikSepa-pheraphAra thavo : (Altered consciousness) komA (bebhAnapaNuM) vagere.

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13 cetAtaMtra (Nervous system) viSe prAthamika mAhitI (2) magajamAM vadhu paDato athavA vikRta vijanika pravAha pedA thavo: epilepsI (3) magajamAM lohIno puravaTho baMdha thavo sTroka : perelisisa magajamAM lohInI naLI phATavI : hemareja (raktastrAva) (4) magajane thatI IjAo H IjA, TromA jema ke kankazana, kayUjhana. (5) magajamAM thatI gAMTho : breina TyUmara magajamAM cepa (infection) lAgavAthI thatA rogo : meninjAiTisa, parunI gAMTha magajamAM thatA vAirasanA rogo ensephelAITisa, eiTsa (AIDS) magajanA hAITa meTaranA rogo : DimAIlineTiMga DijhIjha dA.ta., malTipala skulerosisa (M.s). magajanA poSaNane lagatA tathA aMtastrAvo athavA cayApacayanA rogo : meTAbaoNlika ensephelopathI (10) magajanI janmajAta khoDane lagatA rogo : janInothI vahana thatA vArasAgata rogo (11) magajanA koSonA vinAzaka, vikRti, ghasArAne lIdhe thatA rogo pArkinsonijhama, Albamara DimenziA tathA AvA anya roe (12) karoDarajjunA rogo (13) yuropathI yAne jJAnataMtuonA rogo (14) snAyunA rogo (15) mAyaspeniA grevisa vagere * 6 ka

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14 magaja ane jJAnataMtunA rogo magajanA uparyukta rogo e cetAtaMtranA rogo (nyurolojikala DisaoNrDasa) kahevAya. tenI sAravAra nyurolojisTa athavA koI paNa sakSama phijhiziyana karI zake. mananA rogone mAnasika rogo eTale ke, (sAikiATrika DisaorDarsa) kahevAya, jemAM mukhyatve Diprezana, ekjhAiTI, sAIkosisa, nyuraoNsisa, parsanAliTI praoNblema ane manodaihika (sAyakosomeTIka) rogo vagere Ave. A badhA rogonI sAravAra niSNAta sAIkAyaTrisTa pAse karAvavI joIe. sAmAnya rIte sAIkAyaTrika rogomAM sI.TI. skena, I.I.jI. ane lambara paMkyara vagere tapAsa normala Ave. keTalIka vAra be judA judA rogamAM ekasarakhAM cihno AvI zake, jema ke mANasanI prakRtimAM pheraphAra Avyo hoya eTale ApaNe mAnI laIe ke Diprezana thayuM che, paNa kvacit te breina TyUmara (phranTala athavA kaoNrpasa kelojhalamAM gAMTha) paNa hoI zake. Ama, nidAnamAM gaMbhIra bhUla thaI jaI zake; tethI khUba UMDANamAM dardIne rogalakSI puchAtI vigato-vistRta tabIbI itihAsa (History) laIne, laMbANathI zArIrika tapAsa karavI dareka mAnasika kesamAM jarUrI hoya che. kvacit zaMkA paDe to be tapAsa jema ke sI.TI. skena, I.I.jI. karavI, vadhAre sArI paraMtu utAvaLe mAnasika roganuM lebala mAravuM khoTuM ema kahI zakAya. sadbhAgye AvI paristhiti javalle ja thAya che. e ja rIte mAthAmAM thatI tamAma prakAranI IjAo-jema ke mArgaakasmAta, UMcAI parathI paDavAne lIdhe vAgavuM, mAthAmAM koI ojArathI thayelI IjA mahad aMze tAtkAlika sAravAra - kaTokaTInI sAravAra mAgI letI bInA che. temAM saheja paNa samaya gumAvyA sivAya dardInA hitamAM sAcI vAta e che ke tene tarata ja sArvajanika ke khAnagI haoNspiTalamAM dardIne khaseDI tAtkAlika nyurosarjana dvArA sAravAranI vyavasthA karavI joIe. vaLI, magaja tathA karoDarajjune lagatA tamAma oparezana mATe nyurosarjananI . jarUra paDe.

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cetAtaMtra (Nervous system) viSe prAthamika mAhitI - 15 magaja aMge ATalI sAmAnya mAhitI meLavyA bAda have pachInAM prakaraNomAM ApaNe magajanA A badhA prakAranA rogo aMge savizeSa jANavAno prayatna karIzuM. upara jaNAvela mAnasika rogo ApaNA pariprekSyanI bahAra hoI tenI carcA karela nathI. chelle eka sauthI agatyanI vAta - anubhavathI eka vAta to nizcita rUpe jaNAya che ke dardInA sAjA thavAnAM paribaLomAM DaoNkTara dvArA sAcuM ane samayasaranuM nidAna ane yogya davAonuM saMyojana to anivArya che ja paraMtu teTalAM ja agatyanAM keTalAMka paribaLo che tene kamanasIbe AjanI upacArapaddhatimAM eTaluM mahattva ApavAmAM AvatuM nathI. | dardIne jhaDapathI ane saMpUrNa rIte svastha thavA mATe tenI DaoNkTara pratyenI zraddhA, vizvAsa, teno hakArAtmaka abhigama ane niyamita ane sAdagIbharI jIvanazailI ati mahattvanAM che. A uparAMta DaoNkTaranI dardI pratyenI hamadardI, DaoNkTaranI potAnA vyavasAya pratyenI pratibaddhatA-niSThA tathA vorDamAM narsiMga sTApha dvArA kALajIbharI sAravAra tema ja haoNspiTalanuM vAtAvaraNa vagere paNa eTalo ja mahattvano bhAga bhajave che. vizeSamAM dardInAM sagAMvahAlAMnI dardI mATenI hUMpha ane kALajI, prArthanA-duA, gharanuM sAmAjika vAtAvaraNa tema ja roga viSenI yogya mAhitI paNa dardInA ArogyamAM sudhAro lAvanArAM mahattvanAM paribaLo che. A sarvanI yogya noMdha levI ghaTe.

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16 magaja ane jJAnataMtunA rogo ATaluM jarUra jANo manuSyanA magajamAM lagabhaga 100 abaja cetAonuM neTavarka hoya che. magajanuM vajana 1200 thI 1400 grAma hoya che ane... evuM mAnavAmAM Ave che ke, sAmAnya manuSya magajano 3thI 10 TakA jeTalo ja upayoga kare che. magajamAM moTuM magaja (cerebrum), nAnuM magaja (cerebellum) ane breIna sTema (Brain stem) ema traNa mukhya bhAga che. ane 12 cetAo magajanI baMne bAjuthI nIkaLe che. DAbI bAjunuM magaja zarIranI jamaNI bAjunAM aMgonuM saMcAlana kare che ane jamaNI bAjunuM magaja zarIranI DAbI bAjunAM aMgonuM saMcAlana kare che. jo magajamAM lohI ane oNksijananuM paribhramaNa pAMca miniTa karatAM vadhu samaya mATe rokAI jAya athavA saMpUrNapaNe baMdha thaI jAya to manuSyanuM mRtyu thaI zake che. magajanI nIcenA bhAgamAM rahelI piTyuTarI graMthi zarIranAM badhAM aMtaHstrAvonuM niyamana kare che. magajanA cetAkoSomAMthI eka prakArano layabaddha vidyutApravAha nIkaLe che. jeno abhyAsa I.I.jI. (EEG) nAmanA TesTa dvArA thaI zake che.

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( nyuraoNreDiyolaoNjIH magajanI eksa-re tapAsa) sAmAnya rIte magajanA ke anya roganuM nidAna DaoNkTara dardInA bAhya avalokana-cihno ane pUchaparacha vagere dvArA karatA hoya che. keTalIka vAra roganAM kAraNo jANavA mATe zarIranI aMdara kevI, kyAM ane keTalI takalIpha che tenI tapAsa karavI jarUrI bane che tyAre reDiyaoNlaoNjInyuraoNreDiyolaoNjI mA~de Ave che, jemAM eksa-re, sonogrAphI, sI.TI.skena ane ema.Ara.AI. vagereno upayoga karavAmAM Ave che. * eksa-re - kSa-kiraNo : zarIranI aMdara joI zakanArAM A eNksa-re (kSa--kiraNo) "camatkArika kiraNo"nI zodha I.sa. 1895mAM jarmanInA DaoN. ronTajane karI hatI. tyAra bAda tabIbI kSetre A kiraNono vadhAre ne vadhAre kalpanAzIla rIte upayoga thato rahyo che, je mAnavajIvana mATe eka mahAna AzIrvAda rUpa nIvaDyo che. sUryaprakAza, kSa--kiraNo, mAIkroveva ane reDiyotaraMgo A badhA vaijJAnika dRSTie vIjacuMbakIya taraMgo che. temAM pharaka che mAtra A taraMgomAM rahelI zaktino. reDiyo ane TelivijhananAM mojAM-taraMgomAM jhAjhI zakti nathI tethI ApaNI cAre tarapha AvA asaMkhya taraMgo prasarelA hovA chatAM ApaNe svastha jIvana-jIvI zakIe chIe. kSa--kiraNonI UrjA prakAza karatAM 1015 hajAra gaNI vadhu che eTale e vastuo-cIjonI ArapAra jaI zake che. kudaratanI karAmata e che ke ApaNI AMkhone phakta sUryaprakAza ja dekhAya che. sAmAnya eksa-renI madadathI magajanA bAhyAvaraNanuM ekaparimANIya citra maLe che jenAthI koI cIjanI UMDAI keTalI che te khabara paDatI nathI dA. ta., magajanI aMdara gAMTha hoya to te cokkasa kaI jagyAe ane keTalI UMDAImAM che te jANI zakAtuM nathI. * sI.TI.skena (c.T.scan) : eksa-reno upayoga zarIranA vividha avayavonAM citro meLavavA mATe thAya che paraMtu ApaNI carcA ahIM magajanA rogomAM eNksa-re

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18 magaja ane jJAnataMtunA rAgA vagerenA upayoga aMgenI che. ApaNe agAunA prakaraNamAM joyuM tema magaja khoparInA mALakhAmAM surakSita sacavAyeluM che tethI sAmAnya eksa-re dvArA ApaNane khoparInA bAhyAvaraNanI jANakArI maLI zake che paNa magajanA aMdaranA bhAga ane baMdhAraNa vagerenI spaSTa mAhitI maLI zakatI nathI. A samasyAno upAya briTiza vaijJAnika hoMsaphilDa dvArA banAvAyela sI.TI.oNna mazInathI maLI Avyo. sI.TI. skena (c.T.Scan) athavA to keTa skena eTale kamyuTeDa eziala TomogrAphI (computed Axial Tomography). - sI.TI. skenamAM paNa eNksa-reno ja upayoga thAya che paraMtu ahIM kapyuTaranI madadathI kapyuTara gaNatarIdvArA zarIranA dareka aMganuM ane tenA ghaTakonuM triparimANIya citra laI zakAya che. magajanI aMdara gAMTha hoya to UMDAInI dRSTie kaI jagyAe che te jANavA magajanA breDanI slAisa jevA kAlpanika bhAga pADI te pratyeka bhAganA vividha khUNethI eksa-re levAya che. tyAra bAda kamyuTaranI madadathI gaNatarI karI magajanuM triparimANa (thrI-DAImenzana) citra taiyAra karI zakAya che, jethI gAMThanI UMDAI ane kada vagere bAbato cokkasapaNe jANI zakAya che. Ama, sI.TI. skena dvArA magajanI aMdaranI sUkSma kSatio vize paNa jANI zakAya che. sI.TI. skenanI madadathI phoTA kevI rIte levAmAM Ave che te nIcenA citra dvArA samajI zakAya che. sI.TI. skenanI kAmagIrI Working of CT Scan TI.vI. moniTara eksa-re TyUbA TV Monitor X-ray Tube DiTekaTaro Detector 4 Computer sayez

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19. nyuraoNreDiyolaoNjIH magajanI eksa-re tapAsa sI.TI.skena mazIna sI.TI. skenanuM mazIna corasa ghanAkAra peTI jevuM hoya che jene enTrI (Gantry) kahevAmAM Ave che. A ghanAkAranI vacce goLa Tanala jevo Azare 2 phUTa jeTalo bhAga hoya che. daradIne uparanIce, AjubAju ane AgaLapAchaLa khasI zake tevA sTrecara jevA Tebala para suvADavAmAM Ave che. zarIranA je bhAganI tapAsa karavAnI hoya te bhAga A TanalanA madhyabhAgamAM lAvavAmAM Ave che. eksa-renI TyUba A goLa TanalanA madhyabhAgamAM vartuLAkAre pharatI hoya che je dvArA magajanA athavA je te avayavanA dareka khUNethI phoTA laI zakAya che. A chabI DiTekTarI para pratibiMbita thAya che ane kamyuTaranI madadathI cokkasa prakAranI gaNatarI karIne agAu joyuM tema breDanI slAisanI jema avayavane kamyuTaranA maoNniTara para joI zakAya che tathA lesara kemerAnI madadathI tenI chabI laI zakAya che. A samagra prakriyAmAM Azare 15thI 30 miniTano samaya lAge che je daramiyAna daradIe sthira sUI rahevAnuM hoya che. navA adyatana mazInathI to have phakta be ja miniTano samaya lAge che. Ga Generator Table sI.TI. skena mazIna

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magaja ane jJAnataMtunA rogo sAmAnya rIte eNksa-renI 14" x 17nI philma 52 20 chabI levAmAM Ave che jenuM niSNAta reDiyolaoNjisTa dvArA arthaghaTana karavAmAM Ave che ane teno riporTa taiyAra thAya che. sI.TI. skenathI magajathI mAMDIne karoDarajjunI ane phephasAMthI mAMDIne peTanA avayavonI pUratI mAhitI maLI zake che. tethI je bhAgano skena joIe te pramANe sUcanA lakhavI paDe. sI.TI. skenathI koI jAtano dukhAvo thato nathI, sivAya ke thoDIka vAra mATe sthira sUI rahevuM paDe. 20 magajanA rogo jevA ke gAMTha ane cepa(inphekzana)mAM khAsa jAtanI davA (contrast Agent) nasamAM injekzanathI ApavAmAM Ave che jethI lohInA paribhramaNa vize jANI zakAya che. A AyoDinayukta (lodinised Contrast) davA jyAre nasa dvArA ApavAmAM Ave tyAre keTalIka vAra zarIramAM garamI lAge athavA UlaTI thavA jevI lAgaNI thAya che paraMtu eka ke be miniTamAM ApoApa sAruM thaI jAya che. tethI ja Contrast C.T. Scan mATe sAmAnya rIte 3 kalAka bhUkhyA peTe rahevAnuM kahevAmAM Ave che. je vyaktine eNlarjI, dama (asthamA), kiDanI ke thAiraoNiDanI takalIpha hoya temane riekzana AvavAnI zakyatA rahe che. AvA kesamAM nonaAyonika DAi vAparavAthI riekzana nivArI zakAya che. sagarbhA strIe sagarbhAvasthA bAbata DaoNkTarane agAuthI jANa karavI jarUrI che. sI.TI. skenanI koI khAsa ADaasara hotI nathI, sivAya ke reDiezana; tethI daradInA mitra ke saMbaMdhIne sI.TI. rUmamAM hAjara rahevA devAtA nathI ane daradInA zarIranA bIjA bhAgane DhAMkI rAkhavAmAM Ave che. sI.TI. skena have magajanI prAthamika tapAsa jevuM thaI gayuM che ane gujarAtanAM tathA anya rAjyonAM jillA kakSA sudhInAM lagabhaga badhAM zaheromAM A sagavaDa upalabdha che. sAmAnya rIte eka vAra sI.TI. skena karAvavAno kharca Azare rU. 1000thI 1500 sudhI Avato hoya che.

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2 1 jAka nyuraoNreDiyolaoNjIH magajanI eksa-re tapAsa ema.Ara.AI. (M.R..) : sI.TI. skena dvArA cetAtaMtuo, magajanI aMdarano bhAga (hAiTa meTara) ane karoDarajju jevAM aMgo mATe maryAdita mAhitI maLI zake che. sana 197ramAM DAmaDiyana nAmanA vaijJAnike cuMbakIya pravAho mAnavazarIranI ema.Ara.AI.mazIna tapAsa mATe vAparI zakAya che tevI zodha karI. kapyuTaranA AdhunikIkaraNathI zaktizALI cuMbakIya pravAho dvArA magajanI chabI levAmAM Ave che jene maeNgneTika rejhonansa imejiMga (Magnetic Resonance Imaging) (ema.Ara.AI.) tarIke oLakhavAmAM Ave che. magajanI gAMTha, lakavo, hAiTa meTaranA roga ane janmajAta khoDakhAMpaNa, cetAtaMtranA malTipala skUlaeNrosisa jevA rogo, AMkha tema ja kAnanA aMdaranA bhAganA atyaMta sUkSma bhAga vagerenI tapAsa - nidAna mATe ema.Ara.AI. atyaMta mahattvanuM sAbita thayuM che. - ema.Ara.AI.nuM mazIna eka naLAkAra lohacuMbaka (megneTa) hoya che. tenI madhyamAM daradIne suvADavA mATe Tanala hoya che. A maeNgneTanI cuMbakIya kSamatA pRthvInA cuMbakIya kSetra karatAM eka hajAra gaNI vadhAre hoya che... mazInanI kSamatA tenA TeslA (Tesla) dvArA nakkI thatI hoya che. sAmAnya rIte 0.2, 0.3T, 0.5, 1.0T, 1.5nAM mazIno AvatAM hoya che. jema TeslA vadhAre tema mazInanI cokasAI, bArIkAI ane jhaDapa vadhAre hoya che. have 3.0TnA zaktizALI mazIno AvI javAthI thoDIka ja miniTomAM khUba ja jhaDapathI bArIka ane spaSTa nidAna thaI zake che.

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2 2 magaja ane jJAnataMtunA rogo ucca kakSAnAM mazInomAM cuMbakIya kSetra - maeNgneTika philDa jALavI rAkhavA heliyama gesano upayoga thAya che jethI ema.Ara.AI. mazInane vAtAnukUlita rAkhavuM paDe che. ema.Ara.AI. paNa sITI skenanI mAphaka magaja, karoDarajju, peTanA avayavo, kiDanI, phephasAM, hADakAM ane snAyu ema vividha aMgonI cokasAIpUrvakanI vistRta jANakArI mATe vAparI zakAya che. daradInA je bhAganI tapAsa karavAnI hoya che te A mazInanA madhyabhAgamAM Ave te rIte dardIne suvADavAmAM Ave che. ahIM eNksa-reno upayoga thato nathI paraMtu reDiyo-taraMgo karoDarajuno ane tIvra cuMbakIya kSetrano upayoga karavAmAM ema.Ara.AI. Ave che jethI reDiezanano bhaya raheto nathI. zarIramAM puSkaLa pramANamAM pANImAM rahelA hAiDrojananAM proTonsa hoya che ("H" fH40). ema.Ara.AI.nA siddhAMta pramANe reDiyotaraMgo ane cuMbakIya kSetranI madadathI A proTonsa uttejita avasthAmAM jAya che ane greDiyanTsa (Gradients)nI madadathI temane prasthApita avasthAmAM lAvavAmAM Ave che. dareka koSamAM rahelA judA judA proTonanI saMkhyA ane reDiyosignalanA AdhAre kamyuTaranI Adhunika gaNatarInI madadathI bahu ja cIvaTapUrvaka temane alaga tAravavAmAM Ave che ane lesara kemerAnI madadathI 14"x17nI phoTophilma para dareka khUNethI phoTA laI zakAya che. A kAraNasara magajanAM hAITa meTara ane gre meTara AsAnIthI alaga

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nyuraoNreDiyolaoNjI : magajanI eksa-re tapAsa 23 pADI zakAya che. eka phoTo plaeNTamAM lagabhaga 16thI 20 phoTA Ave che ane samagra ema.Ara.AI. daramiyAna AvAM cArathI pAMca sikavansa levAmAM Ave che. dareka sikavansa pAMcathI ATha miniTa cAle che. Ama 30thI 45 miniTamAM magajamAM vividha khUNethI (x,Y,z dharIthI) 80thI 100 phoTA levAmAM Ave che jenA parathI niSNAta tabIba-reDiyolaoNjisTa arthaghaTana karIneM riporTa Ape che. Adhunika tabIbIzAstranI mAnavajAtane A adbhuta bheTa hI zakAya. ema.Ara.AI.nI tapAsa daramiyAna mazInanA greDiyanTsano avAja Avato rahe che. paraMtu kAnamAM rUnAM pUmaDAM, iyara plaga ke iyara phonanA upayogathI te najIvo saMbhaLAya che. ghaNI vAra saMgIta paNa A rUmamAM vagADavAmAM Ave che. amuka dardI baMdha naLAkAramAM sUtAM gabharAI jAya che jene klaoNsTrophobIA (Claustrophobia) kahe che. tevA daradIne ghenanI davA ApavAmAM Ave che. navI zodha pramANenA ema.Ara.AI. mazInanAM maeNgneTanI DijhAina khullI hoya che (opana maeNgneTa) jethI gabharAmaNa ochI thAya che. ema.Ara.AI.mAM paNa amuka roganI lAkSaNikatA jovA mATe khAsa davA (contrast) ApavI paDatI hoya che jenI ADaasaro bahu ja najIvI hoya che. ema.Ara.AI.nI tapAsa sI.TI. skena karatAM ghaNI rIte caDiyAtI che. sau prathama to ahIM eNksa-reno upayoga thato nathI. sagarbhAvasthA daramiyAna AvI tapAsa sI.TI. skena karatAM bahu ochI jokhamI hoya che. sI.TI. saeNnamAM ApaNe agAu joyuM tema mAtra ADA (Axial), breDanI slAisa jevA kaTsa maLe che, jyAre ema.Ara.AI.mAM triparimANIya (X, Y ane z) eTale ke saMpUrNa ghanatvanI mAhitI maLe che. taduparAMta ema.Ara.AI. dvArA karoDarajju-spAinalakorDa khUba ja bArIkAIthI joI zakAya che. atyaMta zaktizALI cuMbakIya kSetranA kAraNe ema.Ara.AI. rUmamAM ghaDiyALa, kreDiTa kArDa, pena ane vIMTI jevI dhAtunI vastu sAthe

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magaja ane jJAnataMtunA rogo pravezavAnI manAI hoya che. jemanA hRdayamAM pesamekara mukAvela hoya ke zarIramAM AvuM koI ilekTronika upakaraNa hoya temane mATe ema.Ara.AI. dvArA tapAsa karI zakAtI nathI. navI zodhakhoLonA pariNAme Diffusion ane Perfusion ema.Ara.AI. zakya banyuM che. jenA kAraNe magajanA je bhAgamAM lohInuM paribhramaNa ochuM thayuM hoya tenuM jhaDapathI, miniTomAM ja nidAna karI zakAya che ane tAtkAlika sAravArathI lakavA jevI bImArIthI dardIne bacAvI zakAya. 24 phaMkzanala ema.Ara.AI. (E.M.R..) eka evI zodha che ke jemAM magajamAM rahelAM halanacalana, yAdazakti, vANIzakti ane saMvedanAo vagerenAM uddbhavasthAnone judAM tAravI zakAya che. Ano mahattvano phAyado sarjarI ane reDiyotherApInA Ayojana-plAniMgamAM thAya che. A udbhavasthAnone bacAvIne sarjarI karavAthI daradIne kAyamI khoDakhAMpaNathI bacAvI zakAya. ema.Ara.AI.no kharca sAmAnya rIte rU. 3000thI 5000 sudhI Ave che ane have gujarAtanAM tathA dezanAM moTAM zaheromAM ema.Ara.AI.nI sagavaDa upalabdha che. enjiogrAphI (Angiography) : enjiogrAphI eTale lohI laI jatI naLIo-dhamanIonI tapAsa. hRdayanI enjiogrAphI aMge sAmAnyapaNe dareka vyakti jANatI hoya che. magajanI naLIonI paNa A rIte ja tapAsa thAya che = magajanA ghaNA rogo - jevA ke lohInI naLI kaThaNa-sAMkaDI thaI javI ke temAM kSAra jamA thavo, naLI para phuggo thaI javo (Aneurysm), naLIonAM gUMcaLAM thaI javAM (A V Malformation) vagerenA nidAna mATe DijiTala sabasTrekzana enjiogrAphI(DSA)nI madadathI magajanI enjiogrAphI thAya che. sauprathama sAthaLamAM AvelI lohInI dhamanImAM

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nyurArADavAlAjI : magajanA eksa-2 tapAsa IA ECA RICCAVBALT CCA ema.Ara.AI. enjiogrAphI naLI (ketheTara) mUkavAmAM Ave che jene lohInA pravAha sAthe AgaLa dhapAvavAmAM Ave che. eNkasa-re ane kamyuTara maoNniTaranI madadathI tene magajanI naLI sudhI pahoMcADavAmAM Ave che. tyAra bAda temAM khAsa prakAranI davA (konTrAsTa miDiyama - contrast dye) ijekzananI madadathI ApavAmAM Ave che. A davA jema jema AgaLa prasare tema jANe ke jIvaMta prasAraNa'nI jema tapAsavAmAM Ave che ane jarUra paDye jude jude khUNethI eNksa-re dvArA dhamanIone saraLatAthI joI zakAya che. DijiTala sabasTrekzana enjiogrAphImAM prathama mAthAno-magajano phoTo - eNksa-re - levAmAM Ave che. tyAra bAda davA (contrast) ApyA bAda eksa-re karavAmAM Ave che. Ama mAthA ane magajanA vividha bhAganI tathA tyAra bAda naLIonI taphAvatabharI bArIkAIthI tapAsa karI nidAna karavAmAM Ave che.

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magaja ane jJAnataMtunA rogo magajane lohI pUruM pADatI gaLAmAMthI pasAra thatI grIvA dhamanI (keroTIDa ArTarI) sAMkaDI thatI hoya ke temAM kSAra jAmI jAya to tene phuggAnI madadathI phulAvI A kSArane toDI zakAya che, jene keroTIDa enjioplAsTI kahe che. 26 hRdayanI enjiogrAphInI jema ja magajanI enjiogrAphImAM paNa amuka najIvAM paNa cokkasa jokhamo rahelAM hoya che paraMtu A jokhamanI paNa sAravAra karavI zakya che. koI paNa jokhama vagara paNa naLIonI tapAsa karI zakAya. dA.ta., kalara Doplara, sI.TI. enjiyogrAphI, ema.Ara.AI. enjiyogrAphI vagerethI maLatI mAhitI DSAnI tulanAmAM 5-10 TakA UtaratI hoya che. kalara DoplaranI madadathI gaLAnI keroTIDa ArTarI aMge bahu ja saraLatAthI sAdI sonogrAphI dvArA mAhitI maLI zake che, je dvArA dhamanIno parIgha, lohInuM prezara, lohInA kSAranI mAtrA joI zakAya che. ema.Ara.AI. enjiogrAphImAM, kaeNtheTaranI madada sivAya dhamanI tema ja zirAnI bahu ja jhINavaTabharI tapAsa thaI zake che ane A parIkSaNa-tapAsa bahu ja jhaDapathI naLIonI prAthamika tapAsa tarIkenuM sthAna laI rahela che. te mATe dardIe ema.Ara.AI.nI jema ja jaIne tapAsa mATe Tebala para sUI javAnuM hoya che. sI.TI. enjiogrAphI AnAthI paNa sAruM pariNAma Ape che. vijJAna, TeknolaoNjI ane kampyuTaranA AdhunikIkaraNanI madadathI reDiyolaoNjImAM bahu ja jhaDapabhera navI zodho AvI rahI che. paeNTa skena (PET Scan-Positron Emission Tomography)nI madadathI tathA paeNTa-sI.TI.skenathI amuka rogonI AthI paNa vizeSa mAhitI maLI zake che, jethI daradInI vadhAre sArI rIte sAravAra thaI zakaze, joke te AsAnIthI upalabdha nathI. SPECT Scan dvArA magajanI cayApacayanI mAhitI ke magajanI kAryadakSatAnI mAhitI maLI zake che. magajanI gAMTha, magajamAM cepa tathA amuka anya rogomAM spaSTa nidAna mATe M.R.Spectroscopy nAmanA khAsa parIkSaNano vyApa AjakAla vadhato jovAmAM Ave che.

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27. nyurArADayAlAjI: magajanA aksa-re tapAsa eksa-re ane vikiraNonI zodho mAnavInA svAthya uparAMta anya kSetre paNa ati mahatvanI che. atyAra sudhI 15 jeTalAM nobela prAijha eksa-reno upayoga karatI vividha zodhone maLyAM che. mAnavInA jIvanamAM eksa-renA pradAnanI A pArAzIzI gaNAya. haju paNa navI zodho ane saMzodhano thatAM rahe che. ApaNe AzA rAkhIe ke navI TekanolaoNjIno mahattama lAbha mAnavazarIra, svAthya tathA sukhAkArI mATe vadhAre ne vadhAre upalabdha thAya.

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28 magaja ane jJAnataMtunA rogo ATaluM jarUra jANo * sI.TI. skenanI tapAsa magajanA rogonA nidAna mATe prAthamika tapAsa banI gaI che. ema.Ara.AI. skena viziSTa jANakArI tathA sUkSma jANakArI mATe che. magajanA pAchalA bhAganI tapAsa mATe, magajanA aMdaranA bhAganI tapAsa mATe tathA karoDarajajunA rogonA nidAna mATe ema.Ara.AI.nI tapAsa sI.TI. skena karatAM vadhu upayogI che. magajamAM lohI pahoMcADatI dhamanIonI tapAsane enjiyogrAphI kahe che, je sITI skena, ema.Ara.AI. tathA DI.esa.e. dvArA karI zakAya. tenAthI paNa ghaNA badhA rogonuM nidAna thaI zake che. kalara DoplaranI madadathI DokanI sonogrAphI dvArA magajane lohI pahoMcADatI keroTiDa ArTarInI jANakArI saraLatAthI maLI zake che. peTa-sITI.skena reDiyolojInI sauthI Adhunika tapAsa che. paraMtu te saraLatAthI upalabdha nathI. jaivika rAsAyaNika prakriyA jANavA mATe peTa ane spekTa khUba ja upayogI che. te AvanArA divasomAM navI TeknolojInA vikAsane lIdhe magajanA rogonA nidAnamAM vadhAre suvidhA prApta thaze.

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3 gAMTha mUrchA (komA) mUrchAnAM keTalAMka mahattvanAM kAraNo hemareja ke lohI gaMThAvuM lohInI naLIonuM gUMcaLuM akasmAtamAM magajane ijA cepa : purunI gAMTho janmajAta ane vArasAgata roga mULa grIka bhASAmAMthI UtarI Avela zabda che komA. bebhAnAvasthA, ardhabehozI, mUrchA, taMdrA, pralaMba gADha nidrA - A badhA magaja tathA zarIranA judA judA staranI saMvedanAtmaka avasthA jaNAvavA mATe vaparAtA zabdo che. tabIbIvijJAnanI bhASAmAM komAnI vyAkhyA ApavI hoya to ema kahI zakAya ke magaja evI sthitimAM mukAI jAya jyAre tenI satarkatA nAza pAme. zarIranI aMdaranI ke bahAranI koI paNa saMvedanAne pratibhAva ApavAnuM ke AMtarika jarUriyAtane paNa anubhavavAnuM baMdha thaI jAya tene komA kahe che. AvI sthiti thoDI, vadhu ke mRtyuparyaMta cAle tevA dardIne komA-pezanTa kahI zakAya. komA zabdae jeTalo hAu Ubho karyo che tevo ane teTalo te khataranAka nathI. sAthe sAthe A rogane haLavAzathI paNa nahIM levAnI khAsa salAha che. Adhunika jIvananI vyastatA ane tanAvane lIdhe vadhatA jatA blaDaprezara, DAyAbiTIsa tathA mArgaakasmAtane lIdhe tema ja cepa, gAMTha tathA anya aneka kAraNosara komA game tene, game tyAre thaI zake.

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30 magaja ane jJAnataMtunA rogo kAraNo H (1) mArga-akasmAta : (magajane IjA) breina TraoNmA H kankazana, kayUjhana, haeNmareja (sabaDyUrala, ekasTrADyUrala) (2) magajamAM lohInA paribhramaNanA rogo : thraoNmbosisa, (dhamanI athavA zirAmAM lohI gaMThAvuM), embolijhama, raktasrAva (haeNmareja), sabaerekanaoNIDa haeNmareja (3) magajanA cepathI thatA rogo athavA inphekzana (saMkramaNa) : maeNninjAiTisa, TI.bI., vAyarasa ensephelAiTisa, jherI maeNleriyA, eiDsa tathA anya oNporcyunisTika (takavAdI) rogo, phangasa (phUga), peresAiTa inphekzana, siphilisa vagere. (4) breina TyUmara : kaeNnsaranI (prAimarI athavA sekanDarI) gAMTha, jevI ke glAyomA ke meTAsTesisa, sAdI gAMTho jevI ke maeNninjiomA. A badhAmAM mAthuM dukhavuM, cakkara AvavAM, kheMca AvavI, UlaTI thavI, eka ke be bAjunAM aMgomAM lakavAnI asara AvavI tevAM lakSaNo cihno hoya che. DaoNkTarI tapAsa ane sI.TI. skena, ema.Ara.AI. dvArA sacoTa nidAna thaI zake che. (5) cayApacayanA (meTAbaoNlika) rogo : jemAM DAyAbiTika komA mukhya che. AmAM dardInI jIvanazailI, mAnasika tanAva ane vyastatA vagere agatyano bhAga bhajave che. oNksijananI UNapa, zarIramAM zarkarA-zugaranuM aniyaMtrita pramANa (vadhaghaTa), livara, kiDanInA rogo ane zvAsanA rogo vagerethI judAM judAM aMgonI kAryakSamatAne dhakko pahoMcavAthI aMte magajanI kAryakSamatA khoTakAvAthI komA thAya che. (6) poSaNanI UNapathI ke DihAIDrezana thavAthI paNa komA thaI zake che. zarIrane upayogI ghaTako jevAM ke viTAmina bI-1, bI-12 vagere dravyo bahu ghaTI javAthI paNa komA thaI zake che. soDiyama (mIThuM) ghaTavAthI thatA komAne hAiponeTrImika komA kahevAya che.

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mUcha (komA). 31 (7) hormonsanuM asaMtulana : thAiraoNiDa, perethAiroiDa, eDrinala, piTyUiTarI graMthiomAMthI nIkaLatA (haoNrmona) aMta:strAva vadhavA/ghaTavAthI komA thaI zake. (8) vAIDa epilepsInA eka athavA uparAchAparI humalAne aMte. (9) aljhAimara DijhIjha : aMta bhAgamAM chevaTanA tabakkAmAM roga praveze tyAre. (10)jhera (poIjhana) : ApaghAta ke hatyA mATe vaparAtAM o.pI.poijhaniMga ke bhAre dhAtuo (hevI meTalsa) jema ke Arsenika, pAro sIsuM (leDa), UMghanI goLIono ovaraDojha. (11) nazIlAM dravyo : madirA (dArU), heroIna, tamAku vagere. (12) sAIkojenika komA : AmAM dardI sAcesAca komAmAM hoto nathI. Glassgow Coma Scale : I.sa. 1974mAM DaoN. TesaDela ane DaoN. jeneTe glAsago nAmanA zaheramAM dardInI jAgRtatA (behozI)no mApadaMDa nakkI karavA mATe glAsago komA skela nAmanI sarvasvIkRta paddhatinI zodha karI, jemAM mULabhUta traNa saMjJAonuM vizleSaNa karavAmAM AvyuM che. je nIce mujaba che : (1) AMkhono pratibhAva (2) halanacalanano pratibhAva (3) vAcAno pratibhAva Ano laghutama AMka 3 ane mahattama AMka 15 che. A AMka jo 8thI nIce hoya to dardInI hAlata gaMbhIra gaNAya che. komA (behozI)nA dardInI paristhiti jANavA mATe ke enI sthitimAM thayela sudhAro-ke bagADo samajavA mATe A bahu ja saraLa ane asarakAraka paddhati che. emAM najIvI saMdigdhatA jarUra che chatAM e sarvasvIkRta che.

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magaja ane jJAnataMtunA rogo komAnA dardInI sAravAra saMpUrNa kALajIthI, paddhatisara (sisTemeTika) karavAmAM Ave che. A mATe dardInA tabIbI itihAsa-hisTrI, palsa(nADI), zArIrika uSNatAmAna, zvAsa, AMkhanI tapAsa ane cetAtaMtranI tapAsa karIne zarIra tathA magajanAM keTalAMka khAsa parIkSaNo - TesTa karAvavAma Ave che. A mATe lohInI vividha prakAranI tapAsa, ema.Ara.AI.. sI.TI. skena, I.I.jI. ane jarUra paDye kamaramAMthI pANI paNa levAma Ave che. dardI komAmAMthI jyAre kyAreka breinaDetha (glAsago komA skela 3)nI paristhitimAM Ave tyAre te jAhera karatAM pahelAM khUba ja dhyAna rAkhavuM paDe che ane te mATe nakkI thayelAM cokkasa dhArAdhoraNone AdhAre ja breinaDethanI paristhiti jAhera karAya che. breinaDetha pachI kyAreya magajanI satarkatA pAchI AvatI nathI tethI Avo dardI hRdaya baMdha paDavAthI mRtyu pAme te pahelAM kiDanI, yakRta vagere aMgonuM dAna karavAthI koI anya vyaktinI jiMdagI bacAvI zakAya. 32 sAravAra : komAnI sA2vA2nA mukhya muddA nIce mujaba che H (1) paristhitinI gaMbhIratA mujaba dardIne 1.c.i.mAM dAkhala karI ghaniSTha sAravAra zarU karI devI. (2) oNksijana,zvAsocchvAsa, lohInuM paribhramaNa, blaDaprezara jevAM mahattvanAM kAryone jhaDapathI rAbetA mujabanAM karavAM. (3) tvarita kAraNa na khabara paDe tevA komAmAM tarata ja glukojha, B1 viTAmina ane Nalorphine Injection pahelAM ApavAmAM Aveche. (4) lohInA riporTa dvArA tathA jarUra paDe to I.I.jI., sI.TI.skena, lambara paMkcara dvArA komAnuM kAraNa kAraNo jANI sAthosAtha te aMgenI sAravAra jhaDapathI zarU karavAmAM Ave che, jema ke magajanuM inphekzana hoya to eNnTibAyaoNTika, TI.bI.(kSaya)nI davA, thraoNmbosisa hoya to lohI pAtaLuM karavAnI davA vagere vAparavAmAM Ave che.

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- 33 mUcha (komA) (5) zarIramAM DihAiDrezana thayuM hoya to nasamAM (.V) pravAhI ApavAmAM Ave che athavA to eNsiDa-beijha saMtulana bagaDyuM hoya to tenI sAravAra saghana rIte karavAmAM Ave che. pUratI kelarIvALo khorAka ApI poSaNa saMtulita karavAmAM Ave che. (6) yakRta, kiDanI vagere je te aMgo bagaDavAthI komA thayo hoya to enI athavA DAyAbiTIsa ane thAiroiDa vagerenI garabaDa hoya to tenI tatkALa sAravAra karavAmAM Ave che, jemake vAyarasathI yakRta acAnaka bagaDI gayuM hoya (Acute liver failure) to anya sAravAranI sAthesAthe ena-esiTAIla sisTina ane meniTola ApI zakAya che. jo yakRta dArU pIvAnA kAraNe dhIredhIre bagaDyuM hoya (Chronic liver failure) to ela-ornithina ela-espArkeTa (Heparmerz) apAya che. baMne prakAranI kharAbImAM lekTayUlojha enimA apAya che. bAdamAM dardInI paristhiti sudharI hoya tyAre yogya kesamAM livara pratyAropaNa-TrAnsaplAnTano vicAra paNa karI zakAya che. (7) kheMca AvatI hoya ke soDiyama vagere dravyo ghaTI gayAM hoya to tenI davA tAtkAlika ApI sAravAra zarU karavAmAM Ave che. (8) magajamAM sojo hoya tevuM komAnA dardIomAM ghaNIvAra bane che, khAsa karIne breIna hemareja ke vAIrasanA ke magajanA cepI inphakazananA kesamAM pezanTanI meDIkala tapAsa ke magajanA sI.TI. skena ke ema.Ara.AI.mAM tenI khabara paDe. AvA kesamAM dardIne yogya sthitimAM (30deg mAthuM UMcuM) sUvADavo joIe (jo BP ochuM hoya to temane karAya). davAomAM Inj. Mannitor, Lasix tathA anya davAo sojo utAravAmAM madadarUpa thAya. koIvAra nyUro sarjananI madada laI suyogya oparezana (hemIkenIekTamI) dvArA jiMdagI bacAvI zakAya.

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34 magaja ane jJAnataMtunA rogo (9) ghaNI vAra koI jherIlI davAnuM sevana, UMghanI goLIono vadhAre paDato Dojha ke pachI jherI kemikalanI ADaasara paNa komAnuM kAraNa banI zake che. A mATe rakta ane pezAbamAM A davAonuM pramANa (Toxic Drug Screening) jANavuM komAnA tamAma anirNita kesomAM khUba jarUrI bane che. pezanTane komAmAM dhakelatA sTrakcarala ane meTAbolika paristhitikanDizana vacce paNa pharaka che. breina TyUmara, lakavA tema ja akasmAtane kAraNe thatA breina haeNmarejano sTrakcarala kAraNomAM samAveza thAya che, jemAM dardInA magaja para ja zArIrika pratikULatAnI sIdhI asara thAya che, jyAre meTAbaoNlikamAM magaja sivAyanAM zarIranAM anya aMgomAM prathama asAmAnyatA vartAya che. eTale ke darda zarIramAM UbhuM thAya che jenI asara pachI magaja para thAya che. dA.ta. zugara, kIDanInI bImArI. joke komAnA 2thI 8 TakA kesa evA paNa hoya che jemAM dardI komAmAM gayAnuM kAraNa jANI zakAtuM nathI. mAthAno asahya ke anapekSita athavA haThIlo du:khAvo thato hoya to tene haLavAzathI na letAM tapAsa karAvI levI hitAvaha che. lakavAvALA dardIne haoNspiTalamAM tAtkAlika dAkhala karavo joIe jethI samaya bacI jAya ane sI.TI. skena karAvI anya sAravAra ApI zakAya. A sAthe lakavA ane tene kAraNe komA pezanTanI vadhatI saMkhyA tyAre ja ghaTaze jyAre bI.pI., DAyAbiTIsanI sAravAra yogya rIte levAmAM Ave ane jIvanazailI sudhare, sthULatA ghaTe vagere. chellA keTalAka samayamAM komAnA pezanTanA vadhelA pramANanuM kAraNa bI.pI., DAyAbiTIsa, tamAku, dArU, kephI dravyo, mArgaakasmAta, poijhaniMga ane eiDsanuM vadhatuM pramANa che. keTalIka davAonI ADaasarathI paNa komA thaI zake, jema ke insyulinanI mAtrA vadhu paDe to lohImAM zarkarAzugara jokhamI pramANamAM ghaTI jAya ane dardI komAmAM sarI jAya che.

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mUrchA (komA) 35 komAmAM sarI paDelA dardIne keTalA samayamAM sAruM thaI jaze te nakkInizcita hotuM nathI. dareka dardInA kissAmAM A samaya alaga-alaga hoI zake che. keTalAka dardIomAM ekasarakhA, agocara prakAranA kissA temanI taMdrAvasthAmAM anubhavAyA hovAnuM rasaprada rIte noMdhAyuM che, jene Near-death experience kahe che. komAmAMthI bahAra Avelo dardI pharIthI paNa komAmAM jaI zake che. komAnA pezanTanI sArasaMbhALa ane sAjo karavAmAM davAo sAthe dardInI dekhabhALa, khorAka, prArthanA ane premabharI lAgaNI paNa jAduI asara karI zake che. dardInI sAravAra sAthe DaoNkTaranI sAttvikatA tathA dardInuM acetana avasthAmAM paNa pradIpta raheluM manobaLa paNa sAjA thavAmAM agatyano bhAga bhajave che. be divasa, aThavADiyuM, mahino-nA ke lAMbA samaya sudhI komAmAM sarI paDyA pachI sAjA thayelA dardI keTalAka saMjogomAM koI vAra ADaasara rUpe mUMgA paNa thaI jAya che, koIka yAdadAsta - magajazakti paNa gumAvI bese che, keTalAka breinaDetha tarapha dhasI jAya che. komAnA kesamAM mRtyunuM pramANa sarerAza 10thI 20 TakA che.

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magaja ane jJAnataMtunA rogo ATaluM jarUra jANo zarIranI aMdara ke bahAranI koI paNa saMvedanAno pratibhAva nahi devAnI avasthA athavA AMtarika jarUriyAtono anubhava jato rahevAnI avasthAne komA (dIrdha bebhAnAvasthA) kahe che. magajanA rogo sivAya bebhAnAvasthAnAM vividha kAraNo hoya che, jema ke mUtrapiMDa, yakRtanI garabaDathI thatAM cayApacayanA rogo, jherI dravya, zarIramAM pANInI kamI, aMtaHstrAvonuM asaMtulana, kSAro (dA.ta., soDiyama)nI garabaDa vagere. AvA dardIone sAmAnya rIte AI.sI.yu.mAM dAkhala karavAmAM Ave che. bebhAnAvasthAnAM kAraNo jANavAmAM ghaNI vakhata DaoNkTaranI kSamatAnI parIkSA thaI jatI hoya che. AyojanapUrvaka ane tAtkAlika sAravArathI ghaNAM dardIonA jIva bacAvI zakAya che. tema ja temane thatuM nukasAna paNa ghaTI zake che.

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vAI, AMcakI, kheMca (epilepsI) epilepsI arthAt vAraMvAra AvatI vAI, kheMca athavA phiTa. eka ja vAra AvelI kheMcane epilepsI kahevAya nahIM. A magajano eka prakArano roga che jemAM magajamAM thoDA samaya mATe vIjaLika taraMgo vadhu utpanna thavAthI zarIsmAM dhrujArI athavA jhATakA Ave che. Azare 100mAMthI 1 vyaktine AvI epilepsInI bImArI hoI zake che. e hisAbe ApaNA zamAM lagabhaga eka karoDa loko A bImArIthI pIDAya che. paraMtu eka tAraNa mujaba 100mAMthI 4 vyaktione jiMdagImAM eka vAra to kheMca khAvI ja hoya che, jema ke tAvamAM kheMca AvavI. epilepsInA 70%thI 75% dardIomAM A bImArI nAnapaNathI ja thatI hovAnuM jovA maLyuM che. e samaye tenI yogya sAravAranA abhAve dardIne bhaviSyamAM zArIrika ane mAnasika kSati paNa pahoMcI zake che. epilepsInA dardIo yogya sAravAra le to svAsthyapUrNa (naoNrmala jIvana) jIvI zake che. pa0% jeTalA dardIone to davAo levAthI be thI traNa varSa pachI kheMca kAyamI baMdha thaI jatI hoya che. epilepsInAM mukhya kAraNoH (1) bALakanA janma vakhatanI IjA athavA oNksijananI UNapa (2) mArgaakasmAta ane anya prakAranI mAthAnI IjA (3) magajanI gAMTha eTale ke breinaTyUmara (4) magajamAM lohInuM paribhramaNa ochuM thavuM (5) magajano tAva, magajamAM cepI roga thavo (jema ke TI.bI. ke nyuraoNsisTisa2kosisa) (6) vArasAgata kAraNo (7) rAsAyaNika tattvanuM asaMtulana (Na+, K+, Ca++, Mg++ vagere) (8) cayApacayanI garabaDa

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38 magaja ane jJAnataMtunA rogo (9) lohImAM khAMDanuM pramANa ghaTavuM (10) upara darzAvela kAraNomAMthI eka paNa kAraNa lAgu paDatuM na hoya evA kissAmAM paNa epilepsI jovA maLe che (Idiopathic epilepsy). kheMcanA mukhya cAra prakAro che : (1) vitarita - vistRta prakAranI kheMca (janaralAijhUDa sIjhara) (2) sImita - AMzika prakAranI kheMca (pArziyala sIjhara) (3) anirNita - (unclassified) (4) sTeTasa epilepTIksa janaralAIjhaDa sIjhara, pArziyala sIjhara A cAreya prakAranI khecanA peTAprakAra : (1) janaralAIjhUDa sIjhara H () grAnDamAla epilepsI arthAta AkhA zarIranI kheMcaH A prakAramAM mANasa bebhAna thaI jAya, kyAreka cIsa pADe, moDhethI phINa Ave, zarIramAM jhATakA Ave, koIka vAra jIbha kacarAya to kyAreka kapaDAMmAM jhADo-pezAba paNa thaI jAya che. A prakAranI kheMcane moTI kheMca kahe che. bhAnamAM AvyA pachI paNa dardI thoDI vAra ardhajAgrata ke taMdrAmAM rahe che athavA UMdhI jAya che. thoDA samaya mATe lakavo thaI zake che. keTalIka vAra

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vAI, AMcakI, kheMca (epilepsI) 39 kheMca AvatAM pahelAM dardIne saMketa maLI jato hoya che jene oNrA (Aura) kahe che. (ii) peTiTamAla (ebasansa) : A prakAranI kheMcamAM dardI amuka paLo mATe kSubdha, stabdha, zUnyamanaska ane vikSipta banI jAya che, jANe ke blekaAuTa thayo na hoya. AnA be prakAra che. (1) Typical (2) Atypical (II) mAryoonika sIjhara : A prakAranI kheMcamAM dardIne hAtha-pagamAM kSaNika jhATakA Ave che ane hAthamAMnI vastu paDI jAya che, dardI hozamAM rahe che. (iv) A sivAya Tonika, klonika ane ekAineTika evA keTalAka prakAro janaralAiDsa sIjharamAM Ave. (2) pArziyala sIjharanA be peTAprakAro (i) simpala pArziyala sIjhara : A prakAramAM dardI sabhAna avasthAmAM hoya che ane zarIranuM eka bAjunuM aMga kheMcAya che athavA jhaNajhaNATI thAya che vagere. (ii) kaoNmpleksa pArziyala sIjhara : jyAre simpala pArziyala sIjhara jevAM lakSaNo sAthe dardI kSaNika paNa bhAna gumAve to tene kaoNmpleksa pArziyala sIjhara kahe che. A prakAramAM dardI kSaNabhara mATe bhAna gumAvI de che to kyAreka vicitra vartaNUka kare ane pachI tarata bhAnamAM AvI jAya che. A paristhitine nAnI kheMca paNa kahe che. (3) anirNita (Unclassified) (4) sTeTasa epilepTIksa (Status epilepticus - Continuous Seizures) jyAre dardIne lagAtAra aDadhA-aDadhA kalAkathI paNa vadhAre samaya kheMcanA humalA cAlu rahe athavA vAraMvAra thatA kheMcanA humalAo vacce

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40 magaja ane jJAnataMtunA rogo che. dardI bebhAna raheto hoya e gaMbhIra paristhitine sTeTsa epilepTIksa kahe A eka meDikala ImarajansI che. dardIne tAtkAlika hospiTalamAM (ICUmAM) dAkhala karIne sAravAra zarU karI devI joIe. tAtkAlika sAravAra chatAM 15thI 20 TakA dardIonuM mRtyu thatuM hoya che. sAikojanika : hisTIriyAH epilepsI jevAM lakSaNo dharAvato bIjo eka roga hisTIriyA che. A eka mAnasika roga che ane temAM magajamAM takalIpha hotI nathI. A roga strIomAM savizeSa jovA maLe che. mAnasika rogonA DaoNkTaranI sAravArathI A roga maTI zake che. phebrAila kanvaTjhana athavA tAvaprerita kheMca : koI vAra nAnAM bALakone tAvamAM kyAreka sAmAnya kheMca AvatI hoya che. sAmAnya rIte bALaka pAMca varSa pUrAM kare pachI AvI kheMca ApoApa maTI jAya che. AmAM magajamAM koI nukasAna thayeluM nathI tenI khAtarI karI levI joIe. jemane tAvamAM kheMca AvatI hoya tevAM bALakone tAva Ave ja nahi tenI pUrI takedArI rAkhavI joIe. tAva Ave to tarata ja paeNrAsiTemaoNla jevI davAo temaja klobAjhAma nAmanI davA ApI devI joIe. gudAmAM mUkavAnI DIREC-2, Juniz ke tevI koI bIjI davA AvI kheMca aTakAvavAno sacoTa upAya che ane kheMca cAlu thAya to paNa tenAthI tarata aTakI paNa jAya che. A davA bAra kalAke pharI ApI zakAya. ke pachI dAMta ke jIbha para Midazolam nAmanI davA Dropara ke siriMja dvArA ApavAthI vAInA humalA aTakAvI zakAya che. AvI kheMco aTakAvavI jarUrI che, kema ke vAreghaDIe kheMca Ave to bhaviSyamAM 1% dardIomAM kaoNmpleksa pArziyala athavA janaralAijhDa sIMjharanA humalA zarU thaI zake che.

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41 vAI, AMcakI, kheMca (epilepsI) epilepsIno eNTeka eTale ke kheMca Ave tyAre ATalI bAbato acUka dhyAnamAM rAkho: 1. dardIne eka paDakhe suvADIne kapaDAM DhIlAM karavAM. jIbhane IjA na thAya te mATe moDhAmAM dhImethI rUmAla athavA gaoNjhapIsa mUkavo paNa A mATe paNa bahu jora na karavuM. tarata ja DaoNkTaranI sAravAranI vyavasthA karo. dardIne IjA thAya athavA vAraMvAra kheMca Ave to DaoNkTarI 'salAha levI joIe. jarUra paDye nasamAM Lorazepam athavA DiazepamnuM ijekzana ApavAnI vyavasthA karavI athavA dardIne tAtkAlika davAkhAnAmAM dAkhala karavo. epilepsInA dardI svAthyapUrNa jIvana jIvI zake che, lagna karI zake che ane mahilAdardIo garbha paNa dhAraNa karI zake che. garbhAvasthA samaye kheMca mATenI amuka davAonA upayogathI AvanAra bALakane moTe bhAge kSati pahoMcatI nathI, jema ke kArlAmejhepina, lemoTrijhina ane lIvATIrAsiTAma. paraMtu jo davA baMdha karI devAthI kheMca Ave to temAM oNksijana(prANavAyu) na maLavAthI bALakane thatuM nukasAna vadhu kharAba puravAra thAya che tethI sagarbhAe davA avazya levI paDe. epilepsInI tapAsa : tapAsa mATe kheMcano savistara ahevAla taiyAra karavo joIe. jeNe kheMca joI hoya te vyaktinI pAsethI tamAma jhINavaTabharI mAhitI ekatrita karavI joIe. pachI kheMcano prakAra, sAravAranI paddhati ane roga vizenI vadhu mAhitI jANavA mATe magajano grApha (I.I.jI.), magajano phoTo (eTale ke sI.TI. skena) ane mukhyatve ema.Ara.AI. nAmano skena paNa jarUrI bane che. A uparAMta lohInI tapAsa, magaja ane chAtInA sAdA phoTA jevI anya tapAsano paNa yathAyogya samAveza thaI zake.

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42 magaja ane jJAnataMtunA rogo epilepsInI sAravAra : epilepsInuM kAraNa jANI tenI yogya rIte sAravAra thavI jarUrI che. A sivAya A roga vadhu vakare tevI vAMdhAjanaka paristhitiothI dUra rahevuM joIe. tethI ujAgarA, tanAva, bhUkhyA rahevuM ke vadhu paDatA mAnasika athavA zArIrika zramane TALavo joIe. yogya davA lAMbA samaya sudhI levAthI A roga cokkasapaNe kAbUmAM laI zakAya che. niyamita pholaoNapa (pheratapAsa) bahu jarUrI che. jyAre jyAre jarUra paDe tyAre DaoNkTarano tarata ja saMparka karavo joIe. kheMcanI mukhya davAo : (1) phinobAbiTona : dA.ta. gArDinAla, bITAla (2) phenIToIna : dA.ta. epToina, DAilenTina, epsolIna (3) kArbomejhepina (4) vAlaproyeTa : dA.ta. jhepTaoNla, TegreTaoNla, kArbATaoNla, mejheTola, jhena : dA.ta. vAlaperina, enkoreTa, epileksa, TaoNraveTa kArbomejhepina ane vAlaproyeTamAM have navI TeknolaoNjI anusAra slo-rIlIjha (dhIme ane lAMbA samaya sudhI asara rahenArI) phaoNrmyulA paNa maLe che, jema ke TegreTaoNla-sI.Ara., vAlTeka-sI.Ara. vagere. AnAthI divasa daramyAna davAnuM lohImAM pramANa samabhAge jaLavAI rahe che ane divasamAM be 4 vA2 davA levI paDe che. vAlaproyeTanI navI phormyulA DAyavAlaproyeTa (dA.ta. velensa, divA) hAla vadhAre pracalita che. kheMcanI mukhya davAonI ADaasara aMge prakaraNa 24mAM vizeSa mAhitI ApelI che.

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vAI, AMcakI, kheMca (epilepsI) 43 roganAM lakSaNo ane prakAra uparathI DaoNkTara yogya davA nakkI kare che. chellAM keTalAMka varSomAM A roga aMge ghaNAM navAM saMzodhano thayAM che, roganivAraka navI davAo paNa zodhAI che. navAM saMzodhanone davAo tathA sarjarI ema mukhyatve be bhAgamAM vaheMcI zakAya. navI davAo (sekanDa janarezana) paikI gAbApenTIna, lemoTrijina, vigAbeTrIna, TIgAbIna, phelbameTa, TopIrAmAiDa ullekhanIya che. A davAo amerikAnA epha.DI.e. (pheDarala Dragjha oNthoriTI) dvArA kaDaka cakAsaNImAMthI pasAra thaI hoIne bajAramAM vAInI davA tarIke svIkRta thayelI che. sAmAnyataH A davAo pramANamAM moMghI paDe che. agAu jaNAvelI mukhya davAonI asara je te kaeNsamAM lAgu paDI na hoya to ja A navI davAo vAparavAmAM Ave che. moTA bhAge A davAonI ADaasaro ochI hoya che tema chatAM paNa keTalAka kesamAM vicitra ADaasaro jovA maLe che, jema ke TopIrAmAiDathI Azare 2 TakA dardIone kiDanImAM patharI thAya che. A davAonI khUba lAMbAgALAnI asaro mATe haju ocho anubhava che paraMtu sagarbhAvasthAmAM A davAo kadAca salAmata-(safe) che. eTale ke janma lenAra bALaka upara A davAonI ADaasara nahivat haze tema jaNAyuM che. Ama suyogya kesamAM jyAre mukhya davAo saphaLa na hoya athavA to tenAthI ADaasara thatI hoya tevA kesamAM A navI davAo jarUrathI vAparavI joIe. taddana navI davAomAM mukhyatve okSakAbUjhepina, lIvATIrAsITAma tathA jhonIsemAiDa Ave. A davAo hajI ghaNI navI che. tene tharDa janarezana davAo paNa kahI zakAya. svAbhAvika rIte ja A davAono anubhava ocho che paraMtu atyAra sudhImAM te asarakAraka jaNAI che. tenI ADaasaro taddana najIvI che ane keTalIka jUnI davAone sthAne te ArAmathI goThavAI jaze tema jaNAya che, jema ke kArbomejhepinane sthAne okSakAbejhepina.

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44 magaja ane jJAnataMtunA rogo jyAre mukhya davAo yogya tabIbI mArgadarzana (GuidelineProtocol) mujaba vAparI cUkyAM hoIe ane davAonAM yogya saMyojano (Polytherapy), yogya mAtrAmAM, yogya samaya sudhI vAparavA chatAM paNa kheMca-vAInuM saMtoSakAraka niyamana thAya nahIM to tene aniyaMtrita kheMca (Refractrory Epilepsy-Intractable Epilepsy) kahevAya. AvuM nakkI karatAM pahelAM nIcenI bAbato pharIthI cakAsI jovI joIe. (1) A darda kheMcanuM ja che ne? nidAnamAM koI bhUla (Diagnostic Error) to nathI ne ? bhaLato ja koI roga jema ke sInkopa, hisTIriyA ane zugara ghaTI javI vagere to nathI ne? kheMcano prakAra barAbara nakkI thayo che ne? kheMcanuM koI kAraNa zodhavAmAM to bhUla thaI nathI ne ? A bAbatonuM pharIthI vizleSaNa karI nakkI karavuM joIe. (2) tene lagatI yogya davA, yogya mAtrAmAM apAI to che ne ? je te prakAranI kheMcamAM alaga davA ApavAmAM Ave che. khoTI davA (Inappropriate drug)thI kheMca vakarI paNa zake che, jema ke kArbonejhepina ApavAthI mAyoklonika prakAranI kheMca vakarI zake. (3) ayogya Dojha-mAtrA athavA to ayogya saMyojano to nathI ne? lohImAM davAnuM pramANa je te vyaktimAM barAbara jaLavAyuM to che ne ? A uparAMta dardInI badhI yogya tapAsa thaI cUkI che ke nahIM, jema ke I.I.jI., sI.TI. skena ane ema.Ara.AI. vagere dvArA tapAsIne yogya kAraNa zodhavAmAM AvyuM che ne ? (4) dardInA saMdarbhamAM koI paribaLa nathI ne ? jemake dardI kharekhara yogya davA niyamita rIte le che ke nahIM? koI bIjo mAnasika ke zArIrika roga to nathI ne? bIjI koI davAo bIjA roga mATe cAlatI hoya tenI koI viparIta asarathI

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vAI, AMcakI, kheMca (epilepsI) 45 kheMca vadhatI to nathI ne ? magajamAM koI prakAranI gAMTha, janmajAta khoDa ke evI koI garabaDa to nathI ne ? jarUra paDye viziSTa prakAranAM I.I.jI., vIDiyo I.I.jI., Deptha ilekTroDathI I.I.jI., spekTasTaDI ane 3-DI athavA epha. ema.Ara.AI. karAvavA paDe che. uparanAM kAraNonI yogya saMbhALa levAI gaI hoya ane te kAraNo to nathI ja tenI cokasAI thaI jAya te A tabakke ati mahattvanuM che, kema ke A kAraNo mahadaMze nivArI zakAya tema hoI kheMcanuM suyogya niyamana AvI jAya. Ama karyA chatAM ane vaijJAnika mArgadarzana heThaLano be alaga-alaga mukhya davAo (monotherapI)no pratyeka 6 mahinAno yogya Dojhano korsa tathA ochAmAM ochuM eka saMyojanayukta davAo (paoNlItherapI)no 6 mahinAno korsa (jarUra paDye AvA be korsa) ajamAvI jovA chatAM jo dara mahine ekathI be kheMca be varSa sudhI AvyA ja kare to tene aniyaMtrita kheMca' kahevI joIe tevo eka sAmAnya mata che, joke A vyAkhyA dareka dardI mATe alaga hovI joIe. (koI koI kaeNsamAM janInanI vikRti javAbadAra hoI zake). dardInAM sAmAjika, Arthika tathA rojagArInAM paribaLo tathA dardInI uMmara, tenAM mAnasika ane zArIrika lakSaNo athavA maryAdAone lakSyamAM lIdhA pachI ja A dardI '"aniyaMtrita kheMca'' (Refractory Epilepsy)thI pIDAya che tevuM nidAna karI zakAya. kheMcanA tamAma dardIomAM Azare 15thI 22 TakA dardIo AvA hoya che. AvA dardIo mATe nIcenAM pagalAM - (steps) laI zakAya : (A) navI davAo ajamAvI zakAya. niSNAta DaoNkTara sAmAnyataH mukhya davAo uparAMta vizeSa davA tarIke (Add-on drug) sekanDa athavA tharDa janarezananI davA yogya prakAranI kheMcamAM vAparatA hoya che. kvacit navI davAne mukhya davA (First-line drug) tarIke paNa vAparI zakAya.

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46 magaja ane jJAnataMtunA rogo (B) oNparezana : jyAre davAonA raste pariNAma na maLe ane kheMcanA kAraNarUpa koI ilekTrikala ke sTrakcarala phokasa (kendra bindu) maLI Ave to yogya sarjarI dvArA kheMcanA praznano nikAla lAvI zakAya. kheMcanI sarjarIkSetre chellA dAyakAmAM saMtoSajanaka pragati thaI che ane tenA pariNAma rUpe je kissAomAM kheMcanuM phokasa (kendra) maLyuM hoya tevA phokasanA oNparezana mATe lAyaka evA dardIonA 30thI 35 TakA dardIomAM kheMcanuM pUrNa niyamana Ave che. AvAM oNparezana ApaNA dezamAM tathA videzamAM paNa thAya che ane te khAsa jokhamI paNa nathI. judAM judAM senTaromAM rU. 20 hajArathI rU. 2 lAkha sudhInA kharcamAM thaI zake che, joke AvAM senTaro ApaNA dezamAM tenI jarUriyAta karatAM ghaNAM ochAM che. kheMca mATe nIce mujabanAM oNparazano upalabdha che. kayA kesamAM kayuM oNparezana karavuM te to epilepsI senTaranA anubhavI nyuraoNlaoNjisTa-nyuraoNsarjananI TIma ja nakkI kare che. (a) (b) Resective Surgery Functional Surgery Resective Surgery - kApakUpa karavI (a) (b) (1) mAikroskaoNpika Disekzana (2) Temporala loba sarjarI (3) ekasTrA Temporala sarjarI (4) lIjhanekaTomI (5) lobekaTomI (6) malTI lobara sarjarI (7) hemI sphIarekTomI Nonresective/Functional Surgery (1) korpasa kelojhoTomI (2) malTIpala sabapAyala TrAnjhekzana (3) sTIrIoTeTika prosijara

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vAI, AMcakI, kheMca (epilepsI) (4) AyonAIjhiMga reDIezana (5) kamIsoTomI 47 (c) sTimyulezana - stimulation - uttejita karavuM (1) vegasa (cetA) sTimyulezana (2) thelemika sTimyulezana (3) serIbelara sTimyulezana (a) koSa pratyAropaNa - selaTrAnslalAnTa (Cell Transplant) (C) vegasa narva sTimyulezana - (VNS) : sane 1980mAM jaoNsepha jharabArA dvArA zodhAyela ane paradezamAM Azare rU. 8thI 10 lAkhanA kharce thatI A viziSTa prakAranI sarjikala prakriyA che, jemAM kampyuTara paddhatithI ilekTrika rIte vegasa narva (magajamAMthI nIkaLatI 10 naMbaranI cetA)ne uttejita karavAmAM Ave che jenAthI vAInI kheMcanA humalA-eNTeka 50 TakAthI paNa vadhu pramANamAM ochA thaI jAya che. tenI sAthe davAo paNa laI zakAya. vaLI dardIne vAIno humalo AvI rahyo che tevI jANa (jene oNrA kahe che) thaI jatI hoya to te pote ja ilekTroDane uttejita karIne AvatI kheMcane baMdha paNa karI zake che. na A paddhatino vyApa vadhato jAya che. A salAmata paddhati che. tenAM mApadaMDa-perAmITarsa badalI zakAya che. je dardIono kesa sarjarI mATe yogya na hoya, jemAM vAInI kheMcanuM udbhavasthAna kendra-phokasa na maLyuM hoya athavA jeoM sarjarI mATe rAha jotAM hoya te sahumAM A paddhati ghaNI sArI che. khAsa karIne je kesamAM davAo khAsa upayogI nIvaDI na hoya tevA kesamAM A prakAranI sAravAra upayogI che. bhAratamAM rU. 2thI 3 lAkhamAM have A sAravAra thaI zake che. (D) kITojenika DAyeTa : 80% carabIyukta khorAka levAthI kheMcanuM pramANa sArA evA pramANamAM ghaTe che tevA saMzodhana pachI A paddhati pracalita thaI che. A paddhati khAsa karIne aniyaMtrita kheMcavALA bALakomAM vizeSa upayogI jaNAI che, jenAthI Azare 30 TakA bALako

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magaja ane jJAnataMtunA rogo kheMcamukta thayelAM jaNAyAM che ane eTalA ja bIjA dardIonI kheMca ghaNI ghaTI hoya tevuM jaNAyuM che. zarUAtamAM bALakone A prakArano khorAka levo agharo lAge che paraMtu dhIre dhIre bALaka TevAI jAya che, jo ke amuka anya rogomAM A prakArano khorAka ApI ja na zakAya. - Azare 1thI 2 varSa sudhI DaoNkTaranI dekharekha heThaLa Avo khorAka levAthI sAruM pariNAma maLe kharuM. AmAM mAtA-pitAe paNa agatyano bhAga bhajavavAno hoya che. sarjarI ke VNS jevI A kharcALa paddhati nathI. dardIne zarUAtamAM rathI 3 aThavADiyA DaoNkTaranI dekharekha heThaLa hospiTalamAM rAkhavo hitAvaha che. yogya kesamAM A prakAranI sAravAra jarUra ajamAvI zakAya. samaya jatAM navI zodhakhoLa, navI paddhatio (jema ke TArageTeDa Draga DilivarI), navI sarjikala Tenika, koSa pratyAropaNa vagere dvArA kheMcanA dardInuM bhaviSya badalAI jaze te niHzaMka che. kheMcanA dardIe nirAza thavAnI jarAye jarUra nathI. kheMca e pracalita roga hovAne lIdhe ATalI carcA karavI jarUrI lAgyuM che jethI karIne dardIne-parivArajanone A roga vize pUratI mAhitI maLI rahe. vAIsaMbaMdhI keTalIka geramAnyatAo hajI paNa pravarte che; tethI keTalIka vAra dardI yogya sAravArathI vaMcita rahI jAya tevuM paNa jovA maLe che (1) vAI e mAnasika bImArI che. A satya nathI. (2) vAIno humalo cAlu hoya tyAre dardInA hAthamAM lokhaMDano TukaDo dabAvI rAkhavo athavA DuMgaLI ke jUtAM (caMpala) suMghADavAM. A mAnyatA khoTI che. hakIkatamAM moTe bhAge ekathI pAMca miniTamAM vAIno humalo jAte ja aTakI jato hoya che.

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49 vAI, AMcakI, kheMca (epilepsI) (3) vAI vArasAgata che. vAI sAmAnyataH vArasAgata nathI paraMtu mAtA-pitA bemAMthI koIne paNa vAI hoya to alpa pramANamAM bALakane vAI thavAnI zakyatA vadhI zake. (4) vAInA dardI mATe TaoNnika sArAM - A eka geramArge doranArI mAnyatA che. (5) vAI kAyamane mATeno roga che. nA ema nathI. 70thI 75% kesamAM davA levAthI 100% rAhata thAya che. keTalAkane jiMdagImAM eka ja vAra kheMca Ave che. epilepTika dardIo sAva normala che. temanA pratye aNagamAnI ke tiraskAranI bhAvanA rAkhavI joIe nahIM tema ja A dardI khoDakhAMpaNayukta che tema mAnavuM joIe nahIM. AvA dardIoe roga kAbUmAM AvyA pachI amuka varSa sudhI DrAiviMga na karavuM, svimiMga na karavuM ane agnithI dUra rahevuM joIe. juliyasa sijhara, nepoliyana, AphreDa nobela, vinsenTa vAna gaoNga, jahonTI rhoTsa jevA vikhyAta mANaso vAInI takalIpha dharAvatA hatA, chatAMya teo temanA kSetramAM saphaLa thaI zakyA. Ama sAmAjika ane vyavasAyika vagere pravRttiomAM mahAnatA meLavavA vAInI takalIpha baMdhanarUpa thatI nathI. kheMcanA dardInI sarvAgI madada mATe, inDiyana epilepsI esosIezananI zAkhA amadAvAdamAM cAle che, jemAM roganI mAhitI, Arthika savalata, samUha-kAryakramo vagere rAkhavAmAM Ave che. dardI tathA svajanone mAnasika sAMtvanA maLe ane samAjamAM temane svIkRti maLe tevI pravRttio niSNAta DaoNkTaronI dekharekha heThaLa hAtha dharavAmAM Ave che. A uparAMta rASTrIya kakSAe inDiyana epilepsI sosAyaTI tathA inDiyana epilepsI esosIezananI zAkhA jevI AMtararASTrIya mAnyatA dharAvatI saMsthAo paNa ghaNI sakriya che.

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50 magaja ane jJAnataMtunA rogo ATaluM jarUra jANo magajamAM acAnaka vidyuta taraMgonuM asaMtulana thavAthI zarIramAM jhATakA Ave che, jene kheMca (tANa) kahe che. vizvamAM lagabhaga 1 TakA lokomAM (5 karoDathI paNa vadhu) A roga vyApta che. 70thI 75 TakA dardIomAM A bImArI nAnapaNathI hoya che. kheMca vividha prakAranI hoya che, ane tenA prakAra anusAra alaga alaga prakAranI davA ApavAmAM Ave che. khAsa karIne strI dardIne kheMca che ke hisTIriyA (mAnasika roga) teno nirNaya tapAsa dvArA thaI zake che. kheMca eka nyuraoNlojIkala bImArI che, jyAre hisTIriyA eka mAnasika bimArI che. tenI jANakArI dardInAM parivArajanone hovI joIe. kheMcanI davA DaoNkTaranI sUcanA pramANe mukhyatve be athavA traNa varSa athavA vadhAre samaya sudhI levI paDe che. davAnI ADaasara thAya athavA to strI dardImAM garbhAvasthA hoya to DaoNkaTaranuM tarata dhyAna doravuM joIe. kAraNa ke AvI paristhitimAM davA badalavI paDe che. kheMcanA keTalAka haThIlA kesomAM oparezana dvArA paNa sArI rIte sAravAra thaI zake che. navI-navI davAo, sarjarI, navA saMzodhanonI jhaDapI gatithI kheMcanAM dardIonuM bhaviSya AzAspada che.

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( lakavo (perelisisa) - stroke lakavo ApaNA dezamAM pracalita-jANIto roga che. mRtyu thavAnAM agatyanAM kAraNomAM hRdayaroga, kensara ane mArgaakasmAta pachI lakavo eka mahattvanuM kAraNa che. lakavAnA mukhya be prakAra che - (1) magajane rakta pUratA pramANamAM na maLavuM (Brain ischemia) ane (2) magajamAM raktasrAva thavo (Brain hemorrhage). A roga vize janajAgRti tema ja mAhitI AmajanatAmAM atialpa che te eka Azcaryajanaka tema ja duHkhada bAbata che vizeSa to A roga aMgenAM jokhamI paribaLonI sAcI jANakArIthI hRdayaroganI mAphaka ja tene mahadaMze aTakAvI zakAya che ane sAvacetInAM cihnone oLakhIe to moTA humalAthI paNa bacI zakAya che. A roga thayA pachI tvarita nidAna ane sAravAra maLe to khoDakhAMpaNomAMthI paNa bacAva thaI zake che ane tema thavAthI vaiyaktika, kauTuMbika, Arthika, sAmAjika ane rASTrIya hita bRhad pramANamAM sacavAya to eka moTI sevA thaI gaNAya. atre lakavA(breIna eTeka ke sTroka)nI ati vistRta mAhitI ApavAnuM e ja prayojana che. ApaNI carabI ane gaLapaNayukta khorAkapaddhati, beThADu jIvana, kasaratano abhAva, peTa paranI carabI, vArasAgata kAraNo, lohImAM vadhu paDatI carabI.... A badhAne laIne AkhA vizvamAM bhAratIyo ane temAMya khAsa karIne gujarAtIomAM hRdayaroga ane lakavAnuM pramANa mokhare che. lakavo eTale zarIranI jamaNI athavA DAbI bAju para acAnaka pakSAghAtano humalo thavo - aMga rahI javuM. AmAM vizeSamAM bolavAnI, samajavAnI ane / athavA jovAnI zaktine asara thAya che. lakavAnA prathama prakAra eTale ke breIna IzcamIA thrombosIsamAM magajanI amuka dhamanIomAM lohInA paribhramaNamAM rukAvaTa UbhI thavAthI magajanA koSone poSaNa tema ja oNksijananI UNapa sarjAya che, jenA kAraNe A koSo kAma karatA aTakI jAya che, tethI AvI takalIpha UbhI thAya che. pakSAghAtanA bIjA prakAra eTale ke breIna hemareja bAbate ApaNe vizeSa carcA AgaLanAM prakaraNamAM karIzuM.

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para magaja ane jJAnataMtunA rogo keTalAka nasIbadAra lokone kSaNika pakSAghAtanI asara pachI 24 kalAka sudhImAM saMpUrNa rAhata thaI jAya che te tabIbI bhASAmAM TI.AI.e. (Transient Ischemic Attack) kahe che. joke AvA dardIomAMnA 30 TakAne e pachInAM pAMca varSamAM moTA pakSAghAtanI asara thatI jovA maLe che. AthI kSaNika pakSAghAtanI sthitine cetavaNIno sUra samajIne kALajI rAkhavI hitAvaha che. lakavAnA prakAra ane tenAthI thatI asaranI tIvratA magajanA kayA bhAgane keTalI kSati pahoMcI che tenA parathI niSNAto nakkI karatA hoya che. jo magajanA DAbI bAjunA bhAgamAM asara thAya to jamaNI bAju lakavAnI asara dekhAya che temaja bolavAnI zakti ochI thAya che. e ja rIte magajanA jamaNA bhAgane asara thAya to zarIranA DAbI bAjunA aMga para lakavAnI asara dekhAya che. perIkelosala, mIDala serebrala posTIrIcara serebrala supIrIcara serebelara " . . enTirIyara serebala posTIrIcara serebralaenTirIyara komyunIkeTIMga - * inTarnala keroTIDa, - enTiriyara inphIrIara serebelara posTIrIyara inphIrIara serekala - varTibrala .. 1 posTIrIyara - inTarnala keroTIDa ekSaTarnala keroTIDa -komana keroTIDa tojalara - 1 komyunIkeTIMga varTikala - (magajamAM lohI pahoMcADatI mukhya naLIomAM. rudhirapravAha baMdha thavAthI lakavo thaI zake che.)

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lakavo (perelisisa) - Stroke 53 (keroTiDa ArTarI - 3 kaeNiroTiDa ArTarI - 4] INTERNAL CAROTID A. bijhIlara ArTarI (dhorI nasa) (dhamanI) varTibrala ArTarI -1) varTibrala ArTarI - 2) (magajamAM lohI pahoMcADatI mukhya naLIo) magajane lohI mukhyatve cAra dhamanIo pUruM pADe che. DokamAM AgaLanA bhAge baMne bAjue AvelI be keroTiDa naLIo ane pAchaLanA bhAge AvelI be varTibrala naLIo magajane ekadhAruM lohI pUruM pADe che. pAchalI be naLIo bhegI thaI "bejhIlara ArTarI bane che jene ApaNe sAmAnyataH dhorI nasane nAme oLakhIe chIe je sauthI agatyanI naLI che. magajanI dhamanIo athavA magajane lohI pahoMcADatI dhamanI (ArTarI)mAM saMkocana thavAthI ke rudhira gaMThAvAne lIdhe pravAha baMdha thaI javAthI magajamAM lohInA paribhramaNane kSati pahoMce che. amuka miniTa mATe hRdaya baMdha thaI javAthI paNa magajane nukasAna pahoMce che. kyAreka zirAmAM lohI jAmI javAthI paNa lakavo thaI zake che. uMmara vadhatI jAya tema, zarIranI kSati pAmelI dhamanIonA AMtarika paDamAM vRddhi thatI hoya che, jene pariNAme lohInuM paribhramaNa aTake che athavA ochuM thAya che. A paristhitine etheroklerosisa kahe che.

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pa4 magaja ane jJAnataMtunA rogo - breIna IzcamIAnI paristhitimAM magajanA koSone be rIte kSati thaI zake che. eka to lohInI snigdhatA vadhavAthI lohIno gaThTho thaI jAya che (thrombosisa). bIjuM lohIno gaThTho hRdayamAMthI ke anya sthaLethI rudhiramAM pravAhita thaI magajanI anya dhamanImAM (Artery) aTakI jaI lohInuM paribhramaNa aTakAve che jene embolijhama kahe che. Azare 20 TakA kesomAM magajanI naLI blaDaprezara vadhI javAthI ke anya kAraNe phATavAthI paNa lakavo thAya che jene breIna hemareja kahe che. lakavA jevAM ja lakSaNo bIjA kayA rogomAM thaI zake? : magajano cepa, breIna TyUmara, parunI gAMTha, malTipala skulerosisa, hisTIriyA, mAthAnI IjA vageremAM eka bAju ke baMne bAjuno lakavo thaI zake paraMtu te A pakSAghAta karatAM judo hoya che ane te anya lakSaNo parathI parakhAI zake che. 0 lakavo thavA aMgenAM javAbadAra jokhamI paribaLo : (1) vadhu paDatuM lohInuM dabANa eTale ke hAI blaDaprezara (ra) madhuprameha eTale ke DAyAbiTIsa (3) lohImAM carabInuM asaMtulita pramANa (dyslipidemia) (4) vadhAre vajana (obesiTI) (5) dhUmrapAna, tamAku athavA dArUnuM sevana (9) hRdayaroga (HD), vAlvanA rogo athavA aniyamita nADI dA.ta. Atrial Fibrillation (AF) (7) jUno lakavo athavA TI.AI.e. (8) garbhanirodhaka goLIonuM sevana (9) saMgharSapUrNa jIvanapaddhati, tanAva-sTresa, beThADu jIvana ane kasaratano abhAva (10) vArasAgata - jineTika - kAraNo

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- 55 lakavo (perelisisa) - Strole (11) lohInA ghaTakone lagatI bImArIo ke je lohI jADuM kare (12) keTalAka zArIrika rogo jema ke kolejanI DijhIjha, enTIkArDiyolIpina sinDroma (13) cayApacayanI keTalIka garabaDo jema ke hAyapara homosisTinemIA (14) kokeIna vagere DragsanuM baMdhANa A paikI moTA bhAganAM jokhamI paribaLo lakavo tema ja hRdayaroga baMne mATe javAbadAra che. ane niyamita yogya sAravArathI A paribaLone kAbUmAM laI zakAya che. Ama paNa 40 varSa uparanI dareka vyaktie niyamita tabIbI tapAsa karAvavI jarUrI che. temAMya kuTuMbamAM koI vyaktine hRdayaroga ke lakavo thayela hoya to vadhu sAvaceta rahI lakavo aTakAvavAnAM yogya pagalAM anya kuTuMbIjanoe levAM joIe. A sivAya keTalAMka ochAM jANItAM paNa saMbhavataH lakavo karavAmAM kAraNabhUta evAM paribaLonI paNa noMdha laIe. zarIramAM cepI roganI hAjarI, ilekTrolAITa (soDiyama-poTeziyama)nI garabaDa, himoglobinanI UNapa, vAtAvaraNa-pradUSaNa, pANInI sakhatAI.... vagere. A badhAM paribaLo vize hajI vaijJAnika sarvasaMmati sthapAyela nathI. eka vAta e paNa dhyAnamAM rAkhavI joIe ke Azare 40 TakA dardIomAM koI paNa agatyanuM jokhamI paribaLa maLatuM nathI je lavA (athavA hRdayaroga) mATe kAraNabhUta hoya. * lakavAnI cetavaNInAM cihno (TI.AI.e)H (1) eka bAjunA eTale ke aDadhA aMga para azakti jaNAya - e bAjunA hAthapaga kAma karatA aTakI jAya athavA khAlI caDyAnuM jaNAya. (2) kSaNika eka athavA baMne AMkhamAM ochuM dekhAvuM. (3) thoDA samaya mATe bolavAnI athavA samajavAnI takalIpha thavI, mUMjhavaNa UbhI thavI.

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56 magaja ane jJAnataMtunA rogo (4) cakkara AvavAM, dhUMdhaLuM dekhAvuM, bevaDuM-Dabala dekhAvuM, mAthuM acAnaka dukhavuM, UlaTI-UbakA AvavA, baMne pagamAM kamajorI thavI, lathaDayAM AvavAM, acAnaka kSaNika bebhAna thavuM, kheMca AvavI athavA paDI javuM, AvuM amuka kSaNominiTo-kalAko sudhI rahe. upara mujabanAM cihno daramyAna magajano sI.TI. skena athavA ema.Ara.AI. normala Ave to tene TI.AI.e. kahe che. AvAM cihno avagaNyAM hoya to pachIthI zakya che ke AkhA aMgano lakavo Ave, vAcA jatI rahe ane dardI bebhAna paNa thaI zake. jiMdagInuM jokhama thaI jAya. lakavo tema ja hRdayaroga Avato aTakAvavAnA upAyo : etherosklerosisa khUba ja dhImI gatie uttarottara vadhato roga che jemAM AgaLa sUcavelAM jokhamI paribaLo gati tathA kSatimAM vadhAro karI zake che. tene aTakAvavA mATe prathama to vajana samatola rahe tevo sAttvika ane chatAM pauSTika khorAka levo joIe. tamAku athavA dhUmrapAnanI Adata hoya to teno tyAga karavo. 1 sigareTathI Azare 7 miniTa AyuSya ghaTe. 20 varSanI uMmare tamAku choDavAmAM Ave to 9 varSa AyuSya vadhe. koIpaNa rIte tamAkunuM sevana vizvamAM baMdha thAya to 25 thI 30% lakavA, hRdayaroga ane kensara nAbUda thAya. blaDaprezara : A eka khUba jokhamI paribaLa che. blaDaprezara niyamita ceka karAvavuM ane jo vadhu jaNAya to yogya davA laIne kAbUmAM rAkhavuM. dareka taMdurasta vyaktie paNa samayAMtare te ceka karAvatA rahevuM jarUrI che. temAMya jo mAthuM duHkhe, cakkara Ave, aMdhArAM Ave, becenI thAya to bI.pI. mapAvavuM ja joIe. eka AdhArabhUta mAhitI (nezanala sTroka eNsosiezana) mujaba dareka mulAkAta-vijhiTamAM DaoNkTare tenA

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57 lakavo (perelisisa) - stroke dardInuM blaDaprezara jotAM rahevuM joIe. bhale dardI koI paNa bIjI bImArInI sAravAra mATe kema na Avyo hoya. Ama karavuM e tabIbanI pavitra pharaja che. blaDaprezaranA yogya upacAra ane niyamanathI hRdayaroga, lakavo ane kiDanInI bImArI aTakAvI zakAya che. sisTolika (uparanuM) blaDaprezara lagabhaga 120 ane DAyasTolika (nIcenuM) blaDaprezara 80-85 rAkhavuM e ja zreSTha upAya che. mAtra blaDaprezaranA sacoTa ane AjIvana niyamanathI 40thI 50 TakA lakavA tathA hRdayaroga cokkasapaNe aTakAvI zakAya tevuM vakhatovakhata puravAra thayuM che tethI blaDaprezaranA niyamana viSe jeTaluM kahevAya teTaluM ochuM che. khorAkamAM uparathI mIThuM bhabharAvavAnuM ane pApaDa-athANAM khAvAnuM baMdha karavAmAM Ave to 10thI 15 mi.mI. blaDapresara ghaTe ane to 20thI 25% lakavA tathA hRdayaroga aTakAvI zakAya. sAmAnya janatAmAM blaDaprezara viSe aneka geramAnyatAo che. jema ke keTalAka dardIo potAne blaDaprezara hoI zake te mAnavA ja taiyAra nathI hotA. temanuM kahevuM ema hoya che ke "mane mAthuM du:khatuM nathI, cakkara paNa AvatAM nathI" vagere. paraMtu badhA ja blaDaprezaranA dardIone AvAM lakSaNo hotAM nathI. vaLI, amuka dardIo thoDo vakhata davA laI ema mAnavA prerAya che ke have blaDaprezara kaMTrola thaI gayuM che. davA sAthe mapAvavAthI prezara normala rahetuM hoya eTale teo davA baMdha karI detA hoya che. teo ema mAne che ke temane prezara maTI gayuM paraMtu A eka ati bhayajanaka gerasamaje che.*davA baMdha karatAM thoDAka samayamAM ja blaDaprezara pharIthI vadhavA mAMDe che ane aMte dardI lakavA ane hRdayarogano humalo thAya tyAre DaoNkTara pAse pahoMce che. AvuM rojeroja amArA jovAmAM Ave che tethI atizaya duHkha thAya che.

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58 magaja ane jJAnataMtunA rogo DAyAbiTIsa jevuM blaDaprezaranuM che tevuM ja DAyAbiTIsanuM che. banne eka bIjAnAM bhAI jevA che. DAyAbiTIsa paNa mahAbhayaMkara roga che. chupAIne pravezI ghaNI khAnAkharAbI karato A roga che. A roga hoya to teno svIkAra karI yogya sAravAra dvArA tenuM saMpUrNa niyamana ati jarUrI che. vakhatovakhata blaDazugara tapAsatAM rahevuM joIe, jethI blaDazugaranA pramANano khyAla Ave. DAyAbiTIsanA tathA bI.pI.nA dardIe davAonI sAthe jIvanazailI tathA AhAramAM paNa khUba kALajI rAkhavI jarUrI che. khorAka : lakavo Avato aTakAvavA khAsa to khorAkamAM carabInuM pramANa khUba ghaTADI (20%) devuM ati mahattvanuM che. ghI, mAkhaNa, taLelI cIjo-pharasANa, AIsakrIma ochAM karI devAM. bhAratabharamAM ane temAMya gujarAtIomAM to AIsakrIma khAvAnuM pramANa khUba vadhAre che. tene badale, khorAkamAM salADa, phaLo-zAkabhAjI vadhArI devAM lAbhakAraka che. niyamita kasarata: dararoja 30 miniTa cAlavAthI cokkasa phAyado thaI zake. vajana ghaTADavuM hoya to 60 miniTa ke tenAthI vadhAre cAlavuM joIe. yogAsano tathA zarIrane anurUpa anya kasarata paNa niyamita karI zakAya. aThavADiyAmAM pAMca divasa to kasarata thavI ja joIe. ciMtAyukta tema ja saMgharSapUrNa jIvanazailImAM sudhAro karI AnaMdita jIvana jIvavuM. IrSA, dveSa to nakArAtmaka abhigama dUra karI "sarvamitra' banavuM joIe, je sAce ja suMdara pariNAma Apaze ane lakavo tathA hRdayaroga dUra raheze. strIoe, khAsa karIne, ke jemane A roganAM jokhamI paribaLo hoya temaNe garbhanirodhaka goLIno upayoga laghutama karI, garbhanirodhana mATe bIjI paddhatio apanAvavI joIe.

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lakavo (perelisisa) - stroke pa9 jemane agAu hadayaroga ke lakavo eka vAra thaI cUkyo hoya tevA dardIone lohI pAtaLuM rAkhavAnI davAo jema ke espirina, klopIDojUla, DAipAirIDemola, TIklopIDIna vagere DaoNkTarI sUcanA ane dekharekha heThaLa levAnI rahe che. tenAthI lakavo ke hRdayarogano eNTeka AvavAnI zakyatA Azare 13thI 45% jeTalI ghaTI jAya che. Ane sekanDarI privenzana kahevAya. paraMtu agAu hRdayaroga ke lakavo na thayo hoya, chatAM paNa upara jaNAvela anya jokhamI paribaLo hoya temane espirina vagere davAo ApavI ke nahi te vize hajI ekamata nathI, chatAM jene vadhAre jokhama hoya tene ApI zakAya. je dardIomAM homosisTIna dravya lohImAM vadhu hoya temane mithAIla kobAlAmIna (viTAmIna B12) tathA anya poSaka ghaTako ApavAthI lohInI naLIo gaMThAtI aTake che. lohImAM carabInuM pramANa (khAsa karIne kolesTarola ke ela.DI.ela. prakAranI carabI) vadhu hoya aneathavA eca.DI.ela. prakAranuM kolesTarola ochuM hoya, tevA dardIone sImavAsTeTIna, eToryAsTeTIna jevI sTeTIna prakAranI davA tathA jemanAmAM TrAiglisarAIDjha vadhAre mAtrAmAM hoya temane phAIbreTsa prakAranI davA niyata mAtrAmAM lAMbo samaya ApavAthI hArTaeTeka tathA lakavo ghaNe aMze nivArI zakAya che tevuM vaijJAnika satya ghaNuM pracalita thayuM che. AvI davAonA vaparAzathI hArTane lagatI ke keroTiDa naLIne lagatI ghaNI badhI sarjarI ke enjiyoplAsTI nivArI zakAze temAM bemata nathI. Ama blaDaprezara, DAyAbiTIsa, kolesTarolanI yogya davA karavAmAM Ave, khorAkamAM mIThuM, ghI-tela tathA gaLapaNa tadana niyaMtrita karavAmAM Ave, tamAku-dArUthI dUra rahevAmAM Ave,

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magaja ane jJAnataMtunA rogo homosisTInanuM yogya pramANa jALavavAmAM Ave, kasarata niyamita karavAmAM Ave, tanAvathI dUra rahI sarvamitra banavAmAM Ave ane yogya kissAmAM lohI pAtaLuM pADavAnI yogya davA dardI niyamita le, to 70% lakavA-hRdayaroga dUra thAya. nidAna : lakavo e magajanA rAga hovAthI anubhavA phAjhAzayana athavA magajanA roganA niSNAta (nyuraoNphijhiziyana) pAse satvare (vinAvilaMbe) yogya sAravAra levI joIe. A niSNAto magajanA kayA bhAge, keTale aMze kSati pahoMcI che te jANavA sAru jarUrI zArIrika tapAsa tathA keTalIka saMlagna tapAsa karAvatA hoya che. moTe bhAge magajano sI.TI. skena athavA ema.Ara.AI. TesTa karAvI sAravArano yogya nirNaya levAmAM Ave che. lakavo thayAnA zarUAtanA ja kalAkomAM sI.TI. skena karAvavAno hetu dardIne thromboembolijhama che ke hemareja che te jANavAno che. hemareja to sI.TI. skenamAM tarata ja jaNAI Ave. thrombosisanA kesamAM sI.TI. skena zarUAtanA keTalAka kalAko sudhI normala Ave che. tethI hemareja nathI tenI khAtarI thatAM ja lakavAnA kesomAM thrombosisanI sAravAra pleIna sI.TI. skenanA AdhAre sAmAnya rIte tarata ja zarU karI devAmAM Ave che. jyAre 24-36 kalAka pachI kaoNnTrAsTa DAI nAkhIne pharI vAra sI.TI. skena karAvavAthI magajanA keTalA bhAgamAM thrombosisanI asara che te spaSTa jaNAya che, jenAthI dardInA bhaviSya aMgenI aTakaLa karI zakAya. koI vakhata lakavA jevAM lakSaNo bIjA koI rogane kAraNe hoya to te paNa sI.TI. skenathI jaNAI AvatAM gaMbhIra bhUla thatI aTakI jAya che. - A uparAMta lohInI keTalIka vizeSa tapAsa, bAyokemisTrI (zugara, 'kiDanInA TesTa vagere). i.sI.jI. tathA anya jarUrI tapAsa dvArA dardInI zArIrika sthiti jANavAmAM Ave che. yogya samaye lohInI carabIno TesTa karAvavAmAM Ave che. hRdayanI tapAsamAM ra-DI Iko (driparimANIya Iko) vagere dvArA roganAM kAraNo ane mAhitI paNa meLavAya che.

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lakavo (perelisisa) - Stroke 61 L ApaNe AgaLa joyuM tema je jokhamI paribaLo lakavo kare che te ja paribaLo hRdayaroga paNa kare che. hRdayaroga to lakavA karatAM paNa vadhAre phelAyela che. tethI ja lakavAnA dardIomAM hRdayanA roganI tapAsanuM ati mahattva che jethI hRdayaroga aTakAvI zakAya. bIjI rIte jotAM, lakavAnA dardIonuM mRtyu lakavAthI thAya che te karatAM vadhAre pramANamAM hRdayarogathI thAya che tevuM vaijJAnika tAraNa che. zreSTha hospiTalomAM sITI enjiogrAphI tathA sITI paraphayujhana skenanI madadathI miniTomAM saMpUrNa nidAna thaI zake che. nAnI uMmaranA lakavAnA daradIone blaDaprezara ke DAyAbiTIsa to nathI ne ! tenI pUrI khAtarI karIne keTalIka viziSTa tapAsa karAvavI joIe, je niSNAta DaoNkTaro sUcavatA hoya che. A tapAsamAM enTikArDIolIpIna TesTa, homosisTIna TesTa tathA amuka kesamAM kaoNlejana roganA TesTa vagereno samAveza thAya che. lohInI naLIomAM keTalI kharAbI che te jANavA mATe keroTiDa-varTibala Doplara tathA ema.Ara.eNnjIogrAphI (kyAreka DI.esa.e. ke sI.TI. eNnjIogrAphI) karavAmAM Ave che. kayA daradIne kaI tapAsa karAvavI te to DaoNkTara ja nakkI karI zake. * lakavAnI sAravAranI vistRta mAhitI : lakavAnI asara ke cihno dekhAyA pachI tarata ja yogya haoNspiTalamAM niSNAta phijhiziyana athavA nyuraoNlaoNjisTanA mArgadarzana heThaLa sAravAra zarU karavI joIe. vilaMbanAM phaLa mAThAM hoya che. zakya hoya to haoNspiTalamAM dAkhala karAvavA laI jatI vakhate jyAM sagavaDa hoya tevAM zaheromAM dardIne sI.TI. skena karAvIne laI jevuM vadhu hitAvaha che. dardI vadhu gaMbhIra hoya to tene tAtkAlika 1.C.U, ke saghana sAravAra kendramAM laI javo joIe.

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magaja ane zAMnataMtunA rogo gaMbhIra kakSAnA dardIne lakavAnI sAthe magajamAM sojo jaNAya to tene bebhAna thato aTakAvavA sojAnI sAravAranI davAo I.C.U.mAM ApavI joIe. tenI nADI, bI.pI. ane zvAsa vagere barAbara TakI rahe te mATe yogya pagalAM levAM joIe. kheMca Ave to tene kAbUmAM lAvavI joIe ane blaDaprezara, DAyAbiTIsa vagere hoya to tenI paNa tAtkAlika sAravAra sAthosAtha zarU karI devI joIe. 62 lakavAnI sAravAranA mukhya cha bhAga che : (1) thraoNmboliTika phaeNrapI (2) enTIthromboTika phaeNrapI (3) nyuroproTekTiva therapI (4) kaoNmplikezana mATenI phaeNrapI (5) nyuraoNsarjarI (6) TekArUpa (saporTiva) tha2pI; phijhiothaeNrapI (1) thraoNmboliTika phaeNrapI : e have nirvivAda satya che ke thraoNmboembolijhamathI thatA lakavAnA kesomAM jo saghana, taddana navI viziSTa sAravAra lakavo thayAnA 1thI 6 kalAkamAM temAMya khAsa to 1thI 41/2 kalAkamAM ApI devAmAM Ave to ghaNA kesomAM (a) AkhIye avaruddha naLI khUlI jAya che. (ba) naLInI aMdarano gaThTho (thraoNmbasa) ogaLI jAya che ane (ka) magajanA koSonuM nukasAna aTakI jAya che ane tethI AvanAra lakavo ane tenAM pariNAmomAMthI dardI bacI jAya che. AmAM mukhyatve saMzodhana thromboliTika therapI para thayuM che. jemAM Ara.TI.pI.e. nAmanuM auSadha lakavo thayAnAM mAtra 1thI 41/2 kalAkamAM hAtha ke paganI zirAmAM ApavAmAM Ave che tene inTrAvInasa thrombolisIsa kahe che. A paddhati pramANamAM saraLa che jemAM vadhu upakaraNo ke viziSTa

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lakavo (perelisisa) - Stroke anubhavanI jarUra nathI. jayAre inTrAArTIrIala paddhatimAM keroTIDa ke varTIbala dhamanImAM Ara.TI.pI.e., yurokAInejha ke proyurokAInejha auSadha sIdhesIdhuM thrombosisanI jagyAe lakavo thayAnA 1thI 6 kalAkamAM (kvacit 24 kalAka sudhImAM) ApavAmAM Ave che. A paddhati jaTila che, anubhavI TImanI tathA adyatana sAdhanonI temAM jarUra che. AvAM thrombosisa - lohInuM jAmI javuM bIjAM paNa keTalAMka auSadho saMzodhana heThaLa che. te mATe viziSTa upakaraNo (sI.TI. skena, eNnjiyogrAphInI suvidhA)thI sajja haoNspiTala hovI joIe. vizeSamAM A baMne sAravAra ghaNI moMghI che (hAlamAM Azare 60thI 90 hajAra kharca Ave) ane 4thI 7 TakA dardIomAM tenI ADaasara rUpe breina haeNmareja thAya che, joke mRtyuno dara tenAthI UMco jato nathI ane badhI rIte vicAratAM hAlanAM vaijJAnika pramANone anusarIe to A sauthI zreSTha upacArapaddhati che. paradezamAM lakavAnAM cihno aMge janajAgRti ati uttama che tethI ghaNI vAra dardI 1thI 2 kalAkamAM to haoNspiTalamAM hAjara thaI zake che. vaLI tyAM insyaoNransaprathA ati pracalita che jethI yu.esa.e. tathA yuropamAM AvI upacArapaddhati ghaNI jhaDapathI sarvavyApaka thaI rahI che. AzA rAkhIe ke ApaNA dezamAM paNa A roga mATenI janajAgRti vadhe ane loko insyaoNransaprathA aMge abhigama sudhAre to vadhu phAyado thAya. inTrAArTIrIala thrombolisisa : upara jaNAvyA pramANe, A paddhatimAM paganI ke hAthanI naLImAMthI magajanI dhamanI - keroTIDa ke varTibala ArTarImAM - ketheTara dvArA gAIDavAyara pahoMcADavAmAM Ave che. pachI DijiTala sabasTrekazana enjIogrAphI (DSA) dvArA kaI naLImAM thrombosisa (gaThTho)che ke sTInosIsa (avarodha) che, te zodhavAmAM Ave che. tyAM jo thrombosisa hoya 63

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64 - magaja ane jJAnataMtunA rogo to tyAM ja te naLImAM (ArTarImAM) sIdhesIdhuM auSadha ApavAmAM Ave to ghaNI vAra, pariNAma kharekhara saMtoSakAraka AvI zake che. proyukorAInejha, yurokAInejha athavA Ara.TI.pI.e. auSadha sAmAnya rUpe vAparavAmAM Ave che. joke have ghaNAM navAM auSadho paNa ArTarImAM ApavA mATe vikasyAM che. A paddhati inTrAvInasa thrombolisisa karatAM vadhu asarakAraka che, kema ke auSadha sIdhuM thrombosisanI jagyAe ja ApavAnuM hoya che. tenAM duSpariNAmo (complications) paNa ochAM che, kema ke niyata jagyAe ja auSadha ApavAnuM hoI ghaNI ochI mAtrAmAM jarUra paDe ane tethI hemareja thaI javAnuM pramANa ochuM hoya che. vaLI opareTaranI AMkha sAme 'DSAthI ja ApavAnuM hovAthI gaThTho tarata ogaLI jAya to tarata ijekzana baMdha paNa karI zakAya. gaThTho ogALavAmAM muzkelI jaNAya to gAIDavAyara dvArA gaTTAnI aMdara pahoMcI gaThTho toDavAno prayatna paNa anubhavI opareTara karI zake. sAmAnya rIte zarIramAM anya aMgamAM paNa A paddhatimAM duSpariNAma rUpe hemareja na thAya. khAsa phAyado to e che ke A paddhati pramANe to ghaNI vAra 6thI 24 kalAka pachI paNa gaTTA ogaLI zake che, jyAre inTrAvInasa paddhatimAM to sAmAnya niyama pramANe lakavo thAya tenA mAtra 41/3 kalAka sudhImAM ja auSadha ApavAnuM rahe - te pachI te kAragata na paNa nIvaDe. InTrAvInasa paddhatimAM khAsa mazIno ke vadhu khAsa anubhava ke moTI haoNspiTala vagerenI jarUra na hovAthI, te nAnAM senTaromAM paNa thaI zake che, temAM mAtra Ara.TI.pI.e. auSadha ja vAparavuM paDe. tArkika rIte ane prayogAtmaka rIte e siddha thayuM che. ke lakavAnA dardIne tAtkAlika rIte inTrAvInasa thrombolisisa zarU karAvI pachI tarata jayAM inTrAArTIala paddhati maLI zake tevAM moTAM senTaramAM mokalavo -tema karavAthI baMne paddhatinA lAbha je te dadIrne maLe ane pariNAma bevaDuM sAruM AvI zake. inTrAArTIrIala paddhatimAM navI zodhakhoLo navAM navAM sAdhano have vaparAvA mAMDyA che. paradezamAM tathA bhAratanAM adyatana kendromAM masa (MERC Retriever) riTrAivara ke penabrA dvArA AvA gaTTA kheMcI laI

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65 lakavo (perelisisa) - stroke zakAya ke ogALI zakAya che. vizeSamAM jyAM zakya hoya tyAM sTroka - lakavo thayAnA gaNatarInA kalAkomAM ejIoplAsTI karI sTenTa paNa mUkI zakAya. thrombolisisa sAthe marsi, athavA sTenTa - ema be paddhatio joDI zakAya che. lakavA vize ATaluM vistRta lakhANa janajAgRti mATe che jethI lakavAnA dardIone suyogya sAravAra tAtkAlika maLe ane zreSTha prakAranI maLe to AyuSya laMbAya ane jhaDapI saMpUrNa sudhAro thAya to mAro A namra prayatna saphaLa thaze. ApaNA dezamAM vividha prakAranI muzkelIone lIdhe A paddhati ApaNA keTalA loko sudhI pahoMcaze ane keTalAne mATe camatkArika bacAva thaI zakaze te to AvanAra samaya ja kahI zake, joke ApaNA DaoNkTarone have AnA vize yogya mAhitI che ema kahI zakAya. atyAra sudhInAM zodhAyelAM A badhAM auSadho 6 kalAka pachI lakavAne rokI zakatAM nathI, maTADI zakatAM nathI, kema ke tyAM sudhImAM lohI ane oNksijananI UNapathI magajanA keTalAya koSo nAza pAmI gayA hoya che. (2) eNnTithromboTika gherapI : - ApaNA dezamAM A gherapI khUba saraLatAthI upalabdha che ane teno hetu lohInI naLImAM thayelo gaThTho AgaLa banato - vadhato aTakAvavAno che, jemAM hIperIna, lo molekyulara hIperIna jevI eNnTikoegyulanTa davAo tathA espirina, klopIDojela, DAIpAIrIDemola, ensAkSImeba jevI enTipleTaleTa grUpanI davAo tathA eNnkorDa jevI phAibrInoliTika grUpanI davAo vAparavAmAM Ave che. Ama karavAthI nukasAna AgaLa vadhatuM aTake che paNa tenI ADaasara rUpe kvacit hemareja paNa thaI zake, tethI A davAono yogya mAtrAmAM, jarUrI, niyamita karAtA TesTane AdhAre upayoga karavo joIe. TIklopIDIna ke klopIDojela davAono lakavAnA zarUAtanA kesomAM koI khAsa upayoga jaNAyo nathI paraMtu A davAo lakavo pharIthI thato aTakAvavAmAM cokkasapaNe vizeSa upayogI che.

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magaja ane jJAnataMtunA rogo Azare 10thI 15 TakA dardIone sTroka-ina-ivolyuzana nAmanI viziSTa paristhiti hoya che. viziSTa eTalA mATe ke cihno zarU thayAnAM rathI 4 divasa sudhI davAo karavA chatAM lakavo paNa kramazaH vadhato jAya ane aMte AkhuM aMga rahI jAya. tema thavAnuM kAraNa e che ke AkhI naLI dhIme dhIme avaruddha thaI rahI hoya che ane enTithromboTika ke enTipleTaleTa davAo roganI mAtrA sAme pUratuM kavaca pUruM pADI zakatI nathI. davAo ApavA chatAM lakavo vadhe te paristhiti dardI-DaoNkTara vacce gerasamaja UbhI karI zake. jo lakavo vadhato jAya to, have hemareja to nathI thayuM ne te pharIthI sI.TI. skena dvArA jANI levuM joIe. vizeSamAM, thrombosisanA kesomAM zarUAtanA thoDA divaso sudhI amuka mAtrAmAM blaDaprezara TakAvI rAkhavuM joIe; ekadama jhaDapathI utArI devuM joIe nahIM. B.R. ekadama ghaTADI devAthI magajane lohI ochuM maLavAthI lakavo vadhI zake che. uparanuM (sisTaoNlika) bI.pI. Azare 200 ane nIcenuM (DAyAsTaoNlika) Azare 110 hoya tyAM sudhI blaDaprezaranI koI davA (thrombosisanA kesomAM lakavo thayAnA zarUAtanA 7 divasomAM) nyurolojisTa DaoNkTaro ApatA nathI (sivAya ke tAjo hArTaeTeka ke enjAInA Dya athavA koI viziSTa kAraNa jaNAtuM hoya). (3) nyuraoNproTekTiva davAo: lakavAnA kesamAM saiddhAMtika rIte koSono nAza (lohI tathA baoNksijananI UNapane lIdhe) thato aTakAvavA evAM tattvo-jaivika rasAyaNo pakavo thavAnAM prathama 6thI 24 kalAka ApavA joIe ke je koSone lAMbA samaya sudhI poSaNa pUruM pADe athavA oNksijana pahoMcADe athavA cayApacayanI samasyA dUra kare ke koSonA AvaraNane saMrakSita karI, koSone tUTatA aTakAve. AvI Azare 30thI 40 jAtanI davAo (nImoDIpIna, eDeverona, sITIkolIna, pIrAsITAma, emake-801, eravejhela) prayogAtmaka parIkSaNamAMthI saphaLatAthI pasAra thaI cUkI che paraMtu koNa jANe

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lakavo (perelisisa) - stroke kema vAstavika rIte jayAre A davAo dardIone ApavAmAM Ave che tyAre dhAryo sudhAro karI zakatI nathI. tenAM keTalAMka vaijJAnika kAraNo paNa che. tethI temAM sudhAro karI navI davAo vikasAvAI rahI che, je tarata ja ApavAmAM Ave to koSone lohI tathA oNksijananI khAmI hovA chatAM paNa bacAvI zakAya athavA lAMbA samaya sudhI jIvita rAkhI zakAya. AjakAla sITIkolIna ane IDarAvo (erevona) nAmanI davAo vadhu vaparAzamAM che. (4) kaoNmplikezansa (ADaasaro): lakavAnA humalA daramiyAna keTalAka dardIone amuka kaoNmplikezansa thatA hoya che je roganI gaMbhIratA vadhArI mUke che, jema ke magajamAM sojo Avavo, bebhAna thavuM, kheMca AvavI, tAva Avavo, bhAThAM paDavAM, nyumoniyA thavo, zarIramAM pANI vadhI ke ghaTI javuM, peTa phUlI javuM, pezAba baMdha thaI javo, zarIramAM soDiyama, poTeziyamanI mAtrAmAM vadhaghaTa thavI vagere. sAravAra karanAra phijhiziyane rojeroja jhINavaTathI kesa joI, dararoja A badhAM pAsAMo paratve lakSya ApavuM joIe jethI sAravAranuM pariNAma sAruM Ave, dardI jIve ane jaladIthI sudhAro thAya. jyAre dardIne zvAsamAM takalIpha thAya athavA magajano sojo khUba vadhI jaI dardI komAmAM jato rahe tyAre tene venTileTara para mUkI jiMdagI bacAvavAnI koziza karI zakAya. (5) nyurosarjarI lakavAnA keTalAka kesomAM (Azare 4thI 5 TakA) nyurosarjananI jarUra paDatI hoya che je imarajansI oparezana dvArA dardInI jiMdagI bacAvI zake athavA magajanA koSonuM nukasAna ochuM karI zake. AmAM krenIeNkaTamI, kenI ekaTamI vrAplAsTI, ImarajansI keroTiDa bAyapAsa athavA eNmbolekaTamI vagere oNparezano hoya che. hemarejanA kAraNe thatA lakavAmAM kyAreka khoparI kholI lohIno gaTTo kheMcI levAmAM Ave che (jo davAothI kesa na sudhare ane hemareja kheMcI zakAya tevuM hoya to).

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68 magaja ane jJAnataMtunA rogo (6) saporTiva (TekArUpa) therapI : sAravAra sAthe dardIne pUratuM poSaNa tathA pravAhI maLe, tenA zarIranAM dravyo jaLavAI rahe ane yogya viTAmino maLI rahe te jovAnuM rahe che. yogya vakhate eNnTibAyoTika ApI zakAya. A badhI TekArUpa sAravAra kahevAya. lakavo thayAnA 1-2 divasamAM DaoNkTara phijhiyotherapisTane bolAvatA hoya che. te hAthapaganI kasarato tathA phephasAMnI kasarato zarU karAve che. roja 4thI 6 vAra 20thI 40 miniTa sudhI cAlatI A kasarato dardInA samajadAra sagAe zIkhI laIne pote dardIne karAvavAnI hoya che jenAthI aneka phAyadA thAya che. khAsa to aMgonuM halanacalana jhaDapathI sudhare che ane chAtImAM kapha jamA thato nathI ane aMgo kaThaNa (kaDaka) thaI jatAM nathI. eka vAra lakavAnI zarUAtanI sAravAra maLe eTale lakavo pharIthI na Ave te mATe enTIpleTaleTa grUpanI davAo jema ke espirina, klopIDojela, DAyapAraDemola temaja TiklopIDIna vagere ghaNo lAMbo samaya ApavAmAM Ave che. kayA dardIne AmAMthI kaI davAo, keTalI (eka ke be jAtanI), keTalA pramANamAM ApavI te dardInI tAsIra ane roga pharI thavAnI saMbhavitatA parathI DokTara nakkI kare che. koI koI dardIne enTIkoegyulanTa davAo paNa (ke je thoDI jokhamI paNa che) dA.ta vaoNraphe rIna, esITroma vagerenI goLIo ApavI paDe che. - suyogya kesomAM gaLAmAM AvelI lohI laI jatI naLIo (keroTiDa ane varTibala ArTarIne) asTrAsAunDa Tekanika DoplarathI keroTiDa enTiMga tapAsavAmAM Ave che ane jo keroTiDa

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69 lakavo (perelisisa) - Stroke naLI 60-70% jeTalI avaruddha jaNAya to DI.esa.e. athavA ema.Ara.e. jevI eNnjiogrAphI dvArA tenI khAtarI karavAmAM Ave che. eNnjiogrAphImAM jo A lohI laI jatI naLIo 70%thI vadhAre pramANamAM avarodhAyelI mAlUma paDe to anubhavI nyuraoNsarjana ke vAskyulara sarjana pAse keraoNTiDa naLI para sarjarI karI avarodha dUra karavAmAM Ave che. keraoNTiDa enDa ArTarekTamI nAme oLakhAtI A sarjarI ApaNe tyAM hajI paradeza jeTalI pracalita nathI paNa hamaNAMthI teno vyApa vadhato jAya che ane tenAM pariNAmo sArAM che. tenuM jokhama 1thI 2 TakAthI vizeSa hovuM joIe nahIM. bAyapAsa sarjarIne badale jema hRdayamAM eNnjioplAsTI thAya che tema ghaNA kesomAM have keraoNTiDa enjioplAsTIe eNnDaArTarekTamI sarjarInI jarUriyAta ochI karI nAkhI che. sTenTa sAthe enjioplAsTI karavAthI lAMbA samaya sudhI lakavAthI bacI zakAya che. Ama davA, oNparezana, kasarata ane lakavo thavAnAM kAraNo zodhI tenI sAravAra (dA.ta., blaDaprezara, DAyAbiTIsa) ema vividha saMyojanothI ja lakavAno tAkIdano tema ja kAyamI upacAra thaI zake che. vizeSamAM AvA dardInuM mAnasika, sAmAjika, Arthika ane vyavasAyika ema vividha rIte yogya punaHsthApana thAya to ja sAravAra saMtoSakAraka thaI gaNAya. je dardIne lakavA pachI hAtha, paga kaDaka thaI jAya (spAsTisITI) ane aMgo amuka ja sthitimAM jakaDAI jAya (fixed postion) evA dardIne sakhata kasarata, aMgo DhIlAM karavAnI davAo (lIyorIsAla, TIjhAnIDIna, benjhoDAyAjhapIna) yogya mAtrAmAM ApI zakAya. hAtha ane paganA viziSTa prakAranA paTTA (splint) vAparI zakAya. vizeSamAM boTulInama ToksIna (boToksa | DisporTa) nAmanAM ati Adhunika IMjekzana cokasAIpUrvaka gaNelI mAtrAmAM (yuniTsa), je te snAyumAM anubhavI nyurolojisTa pAse levAthI cokkasapaNe phAyado thAya che, je pachI kasarata dvArA aMgone zithila banAvI haju paNa vadhAre sAro phAyado meLavI aMgone mahadaMze kAryarata

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70 magaja ane jJAnataMtunA rogo banAvI zakAya. A ijekazana kayA dardIne phAyado karI zakaze ke kema te jANavA mATe ezavartha skora (Ashworth score) tathA tevA anya phijhiotherApI skoranI madada levAmAM Ave che. A sAravAra moMghI hovA chatAM amuka kesamAM atyaMta lAbhadAyI nIvaDe che. lakavAnA dardIne sAravAra uparAMta ArogyanAM badhAM pAsAMonI yogya samajaNa ane mArgadarzana ApavAnI sAthosAtha cetavaNInAM cihno (TI.AI.e.), prAthamika sAravAra, tAtkAlika sAravAranI agatya vagere vize samajAvavuM e tabIbanI pahelI pharaja che. lakavAnA dardInA phemilI DaoNkTaranI bhUmikA paNa keTalI agatyanI che, te A parathI sahelAIthI samajAze. sAthe sAthe dardIe tenI jIvanapaddhatimAM pheraphAra karavA joIe. beThADu jIvana tyajI kasarata ane vyAyAma-yoga karavo joIe. DaoNkTaranAM salAhasUcana mujaba yogya davA-upacAra karavA joIe ane sAduM jIvana apanAvavuM joIe tathA tanAva dUra karavo joIe. mananA valaNamAM (atitude) jarUrI hakArAtmaka pheraphAra karavA joIe. A badhuM samajavuM ane AcaraNamAM mUkavuM ghaNuM lAbhakAraka thaI zake. aMtamAM, niyamita jIvana, mAnasika svasthatA, pramANasarano zrama, niyamita kasarata tathA yogAsano tema ja jarUrI davAo ane khAsa to blaDaprezara ane DAyAbiTIsanA custa niyamanathI lakavo (ane hRdayaroga paNa) mahad aMze nivArI ja zakAya ane te mATe janajAgRti ati jarUrI che. tema karavAthI vyaktinuM, kuTuMbanuM, samAjanuM tathA dezanuM ghaNuM ghaNuM nukasAna (ghaNA prakAranuM) aTakAvI zakAya. A aMge TUMka samayamAM eka ativistRta Preventive Programme for stroke and heart attack zarU karavA vicArAyela che.

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lakavo (perelisisa) - Stroke ATaluM jarUra jANo magajanA cetAkoSone poSaNa ane oNksijana ochA pramANamAM maLavAthI cetAkoSa kAma karavAnuM baMdha karI de che, ane zarIranAM DAbI ke jamaNI bAjunAM aMgo kAma karavAnuM baMdha karI de che, jene pakSAghAta (lakavo) kahe che. mRtyunAM vividha kAraNomAM hRdayaroga, kensara ane mArga - akasmAta pachI cothA naMbaramAM pakSAghAta che. blaDa prezara, DAyAbiTIsa, kolesTerola, kasaratano abhAva, medasvIpaNuM, AhAramAM carabIyukta ghaTakono atireka, vyasana, AnuvAMzika kAraNa vagere pakSAghAta mATe tema ja hRdayaroga mATe javAbadAra paribaLo che. magajanI raktavAhinIomAM lohIno pravAha ghaTavAthI, thoDAka samaya mATe (kSaNa, miniTa, 24 kalAkathI ocho samaya) bolavAmAM takalIpha, hAtha-pagamAM jhaNajhaNAhaTa, sUnnapaNuM athavA eka bAju lakavAnI asara jovA maLe ane 24 kalAkathI ochA samayamAM dardI bilakula ThIka thaI jAya to tene TI.AI.e. (Transient Ischemic Attack) kahe che. magajanI raktavAhinImAM lohI gaMThAI jAya to tene Thrombosis kahe che. anya jagyAe gaMThAyelA lohImAMthI koI gaThTho chUTo paDI magajanI naLImAM pahoMce tene Cerebral Embolism kahe che. A badhA karatAM breIna hemareja vadhu gaMbhIra paristhiti che, je jiMdagI chInavI zake. hemareja (Hemorrhage) moTebhAge naLI phATavAthI thAya che. moTe bhAge (80-85%) pakSAghAta thrombosIsa athavA embolIjhamathI thAya che, bAkInA pakSAghAtanuM kAraNa hemareja hoya che. 31

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72 magaja ane jJAnataMtunA rogo nidAna mATe sI.TI. skena, ema.Ara.AI., enjiogrAphI, Doplara vagere TesTa karavAmAM Ave che. thrombosisamAM magajanA koSonuM mRtyu prathama 6 kalAkamAM, lohI temaja oksijana na maLavAthI thAya che. eTalA mATe jeTaluM bane teTaluM jaldI, 1thI 3 kalAkamAM dardIne haoNspiTalamAM lAvIne TrITamenTa karAvavI paDe. adyatana sAravAra paddhati thrombolisIsa che. - jemAM Ara-TIpIe nAmanuM auSadha lakavo thatAM ja, pahelA 3 kalAkamAM (vadhumAM vadhu 41/2 kalAkamAM) ApavAnuM rahe che. A uparAMta enTIthromboTika therapI, nyuraoNproTekTiva davA, komplIkezanonI davA, nyuraoNsarjarI, saporTIva (TekArUpa) davAo, phijhIotherapI vagere dvArA pakSAghAtanA dardInI sAravAra karI zakAya.

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magajamAM raktasrAva-breina hemareja magajanI naLIomAM thatI vikRtine kAraNe thatA paeNraeNlisisa-pakSAghAtanA kesomAM Azare 20% breina haeNmareja (magajanA raktasrAva)nA keso hoya che. bAkInA thraoNmboembolijhamathI thatA hoya che. S magajanA ati gaMbhIra roga tarIke jANItA evA A rogamAM, sAmAnya bhASAmAM kahIe to lohInI naLI phATavAthI athavA evA koI kAraNathI magajamAM lohInuM khAbociyuM bharAya che ane AmAMnA ghaNA dardIo miniTomAM behoza thaI jAya che ane samayasara sAravAra na maLe to keTalAka mRtyu paNa pAme che. breina haeNmarejane be bhAgamAM vaheMcI zakAya : (1) inTrAserebrala haeNmareja : mukhyatve blaDaprezara vadhI javAthI paNa javalle emAyalaoNiDa nAmanuM dravya naLIomAM jamA thavAthI (emAyalaoNiDa eNnjiopathI)thI magajamAM je haeNmareja thAya te. (2) sabaeNrekanaoNIDa haeNmareja : lohInI naLI para akudaratI rIte phuggo (sekyulara enyurijhama) banI jaI tenA phATavAthI athavA magajanI lohInI naLIonuM vicitra gUMcaLuM (e-vI mAlaphaoNrmezana) phATavAthI thatuM haeNmareja breIna hemareja e sivAya eNnTikoegyulanTa nAmanA - lohI pAtaLuM karavA vaparAtA - auSadhonI ADaasarathI, mAthAnI IjAthI, lohInA pAtaLA paDI javAnI bImArIthI, magajanI kaeNnsaranI gAMTha phATavAthI lohI jamA thavAthI, magajamAM cepa lAgavAthI - ema keTalAMya anya kAraNosara paNa breina haeNmareja thAya che.

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magaja ane jJAnataMtunA rogo (1) inTrAserebrala haeNmareja : blaDaprezarane lIdhe magajanI aMdara AvelI keTalIka naLI phATavAthI A haeNmareja thatuM hoya che. moTe bhAge A haeNmareja magajanI keTalIka cokkasa jagyAe (jema ke puTAmena, thelemasa, seribelama) cokkasa rIte thatuM jovA maLe che ane pezanTane tapAsatAM ja phijhiziyanane khyAla AvI jAya che ke haeNmareja magajanA kayA bhAgamAM thayuM haze. 74 emAyalaoNiDa eNnjiopathI e moTe bhAge vayaska lokomAM thatI moTA magajanI aMdaranI haeNmarejanI bImArI che je kvacit pharIpharIne paNa thaI zake. A badhA haeNmarejanuM tAtkAlika nidAna karI 1.C.U.mAM sAravAra zarU karavAmAM Ave - khAsa karIne bI.pI.ne kAbUmAM laI magajanA sojAnI yogya sAravAra samayasara maLI jAya to haeNmarejanA kesomAM mRtyunuM pramANa cokkasapaNe ghaTADI zakAya, je hAlamAM Azare 50thI 60% jeTaluM UMcuM che. thoDA kesomAM, jema ke nAnA magajamAM thatuM haeNmareja (serebelara haeNmareja) athavA moTA magajanA Temporala laoNba athavA puTAmenamAM thatA haeNmarejanA amuka dardIomAM yogya samaye nyuraoNsarjana pAse sarjarI karAvavAthI paNa jiMdagI bacAvI zakAya. paNa A badhA mATe jarUrI che roga pratyenI jAgRti, tAtkAlika nidAna, yuddhanA dhoraNe sAravAra ane niSNAta tathA tvarita nirNaya laI zake tevA phijhiziyana ane nyuraoNsarjana tema ja badhI suvidhAo (vaeNnTileTara mazIna, oNparezana thiyeTara vagere) pUrI pADI zake tevI sArI haoNspiTalonI. cihno : kAma karatAM acAnaka jorathI mAthuM duHkhavuM, UlaTI thavI, cakkara AvavAM, AMkhe aMdhArAM AvavAM (A badhAM hAI blaDaprezaranAM lakSaNa hoI zake). dardIne kheMca paNa AvI zake, laDathaDiyAM Ave, lakavo thAya, miniTomAM dardI behoza thavA mAMDe ane zvAsa jhaDapathI cAlavA mAMDe . sAmAnya rIte A badhAM cihno breina haeNmarejanAM hoya che. 1

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* magajamAM raktastrAva - breIna hemareja * nidAna ane tAtkAlika sAravAra : sI.TI. skena athavA ema. Ara. AI. dvArA tvarita nidAna karavuM atyaMta jarUrI che. sAthe sAthe hemareja kyAM che, keTaluM lohI jamA thayuM che, magajamAM sojo che ke kema tathA tenuM kAraNa zuM hoI zake tenI tathA bIjI mAhitI paNa ghaNI vAra A TesTa dvArA maLI jatI hoya che. jo dardIno zvAsa vyavasthita (normala) hoya ane blaDaprezara atizaya vadhu na hoya to, kharI rIte to dardIne haoNspiTalamAM khaseDatAM pahelAM, jo zaheramAM sI.TI. skenanI suvidhA upalabdha hoya to magajano sI.TI. skena karAvIne ja haoNspiTalamAM laI javuM vadhu hitAvaha che, kema ke keTalIka vAra hemarejanI zaMkA hoya paNa sI.TI. skenamAM thrombosisane lagatAM cihUno Ave athavA gAMTha, sabaDyurala hemareja ke magajano cepa evuM koI nidAna Ave to AkhI sAravAramAM mULabhUta pharaka paDI jAya che. paraMtu, dardInI hAlata gaMbhIra hoya to tAtkAlika sAravAra haoNspiTalamAM apAvyA pachI sI.TI. skena mATe laI javuM joIe. zreSTha to e che ke sITIskena hoya tevI hospiTalamAM ja dAkhala karavuM. koI paNa prakAranA gaMbhIra nyuraoNlaoNjikala kesamAM ghaNI vAra niSNAta DaoNkTarane ghare bolAvavAno Agraha sevI samaya veDaphavo te karatAM phemilI DaoNkTaranI madadathI eNbyulansa dvArA dardIne tAtkAlika haoNspiTalamAM khaseDavuM, athavA zakya hoya to pahelAM sI.TI. skenamAM laI javuM e bAbata pratye pUratI jAgRti keLavavI khUba jarUrI lAge che. niSNAta DaoNkTara tAtkAlika ghera AvI zake to sArI vAta che paNa sAmAnya rIte temane ApavAmAM 2-4 kalAkano ati mUlyavAna samaya veDaphAI jato hoya che ane tenAthI sAravAramAM thayelA vilaMbathI dardIne kadI bharapAI na thaI zake tevuM magajanuM nukasAna thatuM hoya che. jo phemilI DaoNkTara paNa kvacit jaladI na AvI zake tema rokAyelA hoya to zreSTha rasto e che ke dardIne tAtkAlika najIkanI sArI haoNspiTalanA imarjansI vaoNrDamAM laI javuM ane tyAM sudhImAM yogya DaoNkTarane sIdhA bolAvI levAnI goThavaNa karI devI. A vAta ati vistArathI lakhavAnI pAchaLa eka cokkasa hetu e che ke moTe bhAge AnAthI viruddha ja thatuM jovAmAM Ave che. imarjansI meDisina,

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76 magaja ane jJAnataMtunA rogo kriTikala kera, A meDisinanA taddana alaga evA suparasonika ke kaoNnpharDa vimAno jevA vibhAgo che. temAM mAtra mAnavatAne dhoraNe, eka eka sekanDa bacAvI ati mahattvanA nirNayo niSNAta DaoNkTaro letA hoya che ane jiMdagI bacAvavAnI temanI tAlIma - TreniMga - eti upakAraka thatI hoya che. mATe A kAma A rIte ja thavuM joIe. koI paNa dalIla ke hastakSepa AmAM calAvI na levAya.. - dardIne ghera tapAsatI vakhate bI.pI. vadhu hoya to hemarejanA kesamAM bI.pI. tAtkAlika nIce lAvavA phemilI DaoNkTara jarUrI sAravAra karatA hoya che. jo thrombosisa dhAratA hoIe to zarUAtamAM blaDaprezarane ekadama ghaTADavAmAM AvatuM nathI. tema karavAthI hakIkate nukasAna thatuM hoya che. tema chatAM thrombosisanA kesomAM blaDaprezara atizaya vadhu hoya to athavA sAthe hRdayaroga hoya ke lohI pAtaLuM karavAnI davA cAlu hoya to avazyapaNe blaDaprezarane naoNrmala karavuM joIe. | magajano sojo vadhu lAgato hoya to ghera paNa tAtkAlika sojo utAravAnAM ijekzana (niTola, lesiksa) phemilI DaoNkTara ApI zake, tyAM sudhImAM dardIne haoNspiTalamAM khaseDI zakAya. kheMca AvatI hoya to tenI sAravAramAM paNa rAha na jovAya. - sI.TI. skena uparAMta kvacit nidAna mATe lambara paMkyara paNa karavAmAM Ave che. paraMtu jo magajamAM sojo vadhu hoya to A tapAsathI ghaNI vAra dardIne vadhu takalIpha thaI zake che tethI bahu gaMbhIra hAlatanA (siriyasa) dardImAM te na karavuM. haoNspiTalamAM AvA dardIne svAbhAvika rIte ja AI.sI.yu. I.c.U)mAM ja rAkhavuM hitAvaha che. temAM yogya sAravAra sAthe saghana moniTariMga karavAmAM Ave che. jarUra paDye eNnjiogrAphI vagere tapAsa yogya samaye karavAmAM Ave che ane kvacit jarUra paDye agAu jaNAvyA mujaba sarjarI karAvI magajamAMthI lohI kheMcI levAmAM Ave che. lohImAM khAmI UbhI thavAthI lohI pAtaLuM paDIne hemareja thayuM hoya to lohInI je te UNapo pUrI karavAmAM Ave che. davAnI ADaasara (jema ke vorDa athavA

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magajamAM raktastrAva - breIna hemareja esITroma davA hRdayanA vAlvanA kesomAM cAlatI hoya che)thI jo hemareja thayuM hoya to plAjhamA tathA bIjA yogya lohInA ghaTako ApIne hemareja baMdha karavAno prayatna karavAmAM Ave che. meDikala sAravAranI keTalIka gaMbhIra ADaasaromAM AvatI A mukhya paristhiti che. AvA tathA blaDaprezarathI thatA hemarejanA keTalAka kesomAM novo sevana davA (koegyulezana phekTara 7) asarakAraka sAbita thAya che. enTIkoyuelanTa davAo ke je lohIne gaMThAtuM aTakAve che te amuka kesomAM hemareja paNa kare che. tethI A davA cAlatI hoya te dardIne asaraADaasara viSe vigatavAra jhINavaTabharI mAhitI ApavI atyaMta Avazyaka che. vaLI dara 7thI 15 divase Prothrombin time - PT/INR nAmano blaDaTesTa karI lohI keTaluM pAtaLuM rahe che tenI niyamita cakAsaNI karavI paDe che. jo vyavasthita takedArI rAkhavAmAM Ave to hajAro dardIone koI paNa takalIpha vagara varSo sArAM jatAM hoya che. A davAo letA dardIone breIna hemareja (ke anya prakAranuM hemareja) ADaasara rUpe na thaI jAya te mATe A mudA samajavA jarUrI che. A davA letA dardIne koIpaNa prakAranA raktastrAva (dA.ta. pezAba lAla thavo) thAya to teNe tarata ja DaoNkTarano saMparka sAdhavo joIe. jema isyulina jevI mahattvanI davAthI hajAro jiMdagI sudharatI jovA maLe che te ja isyulinanI mAtrA vadhu paDavAthI zugara ghaTI javAthI akasmAta mRtyu thaI zake, tevuM ja A davAonuM paNa che. Ama, blaDaprezaranuM niyamana, magajanA sojAnI davA, yogya narsiMga ane je gUMcavaNa-kaoNmplikezana thayA hoya tenI davA karavAthI tathA jarUra paDye sarjarI karAvavAthI AvA InTrAserebrala hemarejanA dardIne mahaddaaMze ugArI zakAya che. jiMdagI bacyA bAda jo lakavo rahI gayo hoya to kasarata tathA yogya davA-upacAra dvArA te bhAgane punaH kAryarata karavA mATenA prayatno lAMbA samaya sudhI cAlu rAkhavA joIe. e vAta sAcI ke hemarejanA kesomAM mRtyuno dara thrombosisanA keso karatAM jarUra UMco che paraMtu eka vAra jiMdagI bace to lakavAmAM sudhAro paNa thrombosisanA daradI karatAM vadhu jhaDapathI thato hoya che.

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78 magaja ane jJAnataMtunA rogo (2) sabaeNrekanaoNIDa hemareja : A hemareja inTrAserebrala hemareja karatAM sAva juduM paDe che. AmAMnA moTA bhAganA daradIone hAI blaDaprezara hotuM nathI. ghaNAkharA yuvAna hoya che ane temAMnA moTA bhAganAne lohInI naLInI janmajAta vikRti athavA kamajorIne lIdhe phuggo thayo hoya che (sekyulara enyurijhama) athavA lohInI naLIonuM gUMcaLuM hoya che (jane e-vI. mAlaphaoNrmezana kahe che) je amuka uMmare acAnaka zramathI ke ApoApa ja phATI jaI temAMthI lohI magajanAM AvaraNonI vacce sabaeNrekanaoNIDa spesamAM prasaratuM hoya che. tene sabaeNrekanoIDa hemareja kahe che. mahattvanI vAta e che ke eka aMdAja mujaba dara 100 vyaktimAM Azare eka jaNane magajanI naLIomAM Avo kabbo hoI zake ane janmathI ja hovA chatAM te kyAre phATe te nakkI hotuM na ane chatAM jiMdagIbhara na paNa phATe tevuM ghaNA badhA kesomAM bane che athavA ekavAra te phATe eTale 100mAMthI Azare 4pathI 60 daradI eka mahinAmAM ja mRtyune zaraNa thaI jAya che. Avo bhayAnaka A roga che ane tene samajavo jeTalo jarUrI che tenAthI vizeSa agatya che tenA nidAna tathA sAravAranI. AzcaryanI vAta e che ke ghaNAne koI pUrvaciDDano ja hotAM nathI ane acAnaka ja hemareja thaI jAya che paraMtu mAthAnI eka ja bAjuno (jema ke mAtra jamaNI bAju, kAnanI upara, AMkhanI pAchaLa) AdhAzIzI jevo duHkhAvo, je bIjI bAju na jAya ane avAranavAra AvIne jato rahe to niSNAta DaoNkTaronA eka jUthanA mata pramANe kamasekama magajanI ema. Ara. enjiogrAphI (MRA-Brain) nAmano TesTa karAvI levo joIe magajanA A TesTa dvArA magaja ane khAsa karIne lohInI naLIomAM koI paNa jAtanI Akramaka (invejhiva) prakriyA vagara Azare 95-98% khAtarIthI AvA phuggA jene enyurijhama kahe che te che ke nahIM te kahI zakAya che. A TesTano kharca Azare 4thI 6 hajAra rUpiyA Ave ane AvA badhA kesomAM A TesTa karavo ke kema te aMge hajI ekamata nathI. paraMtu mArA mata ane anubhava pramANe satata, mAtra eka ja bAju rahetA AdhAzIzInA dukhAvAmAM A TesTa karavo hitAvaha che.

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magajamAM raktastrAva - breIna hemareja A roganAM cihnomAM dhyAna kheMce tevI mukhya vAta e che ke dardIne jiMdagImAM kadI pahelAM anubhava na thayo hoya evI bhayaMkara tIvratAthI -jorathI mAthuM duHkhe che. kyAreka sAthe ca paNa Ave ane dardIne magajamAM sojo AvavAthI te kSaNika bebhAna paNa thaI jAya. sAmAnya rIte thoDI vAramAM dardI bhAnamAM Ave ane pachI thoDIka vAra pachI kAM to pharI bebhAna thavA mAMDe. dardIne lakavo thAya athavA jhaDapathI zvAsa caDe, bI.pI. ane hRdaya vagere agatyanAM kAryo bagaDe ane AmAMnA ghaNA dardIo tAtkAlika athavA najIkanA 14thI 30 divasamAM mRtyu pAme che. AthI jayAre dardI ema kahe ke "AvuM bhayaMkara mAthuM mane jiMdagImAM kyAreya dukhyuM nathI ane khAsa to sAthe uparokta jaNAvela eka paNa lakSaNa-cihna hoya to acUkapaNe nyuraoNlaoNjikala tapAsa karAvI levI joIe jethI samayasara nidAna ane sAravArathI jiMdagI bacAvI zakAya. * magajanI naLIonI tapAsa - jene eNnjiogrAphI kahe che te Ano mukhya TesTa che. ema. Ara. eNnjiyogrAphI e evI tapAsa che sI.TI. enjiogrAphI AgaLanI serebrala dhamanImAM (ACA) phuggA jevuM enyurijhama

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magaja ane jJAnataMtunA rogo jemAM ema. Ara. AI.nA maeNgneTa dvArA naLIonI tapAsa thAya che. temAM koI ketheTara zarIranI nasomAM nAkhavuM paDatuM nathI. e rIte binaAkramaka (nona-invejhiva) TesTa kahevAya. koronarI enjiogrAphI mATe haMmezAM ketheTara koI naLImAM nAkhavuM paDe ane tenuM thoDuM jokhama paNa hoya che. AmAM evuM nathI. A rIte karelA TesTamAM 90thI 95 % jeTalI khAtarI karI zakAya che. tethI tene skriniMga TesTa tarIke vAparI zakAya. sauthI vadhu khAtarIthI nirNayabharyo TesTa to kanvenzanala phora-vesala eNnjiogrAphI athavA DijiTala sabasTrekzana eNnjiogrAphI (USA) kahI zakAya. sI.TI. enjiogrAphI eka navI paddhati che jemAM 4 mi.mI.thI vadhAre kadanA phuggAone (Aneurysm) DNA jeTalI kSamatAthI joI zakAya che. eNnjiogrAphImAM enyurijhama (phuggo) hoya to tarata dekhAya che. AvA 15 TakA kesomAM ekathI vadhu enyurijhama hoya che; tethI haMmezAM magajanI cAreya naLInI eNnjiogrAphI karavI joIe, jethI oNparezananI jarUra AvI paDe to badhA enyurijhamane lakSyamAM laI TrITamenTa karavI saraLa paDe. *evI mAlaphormezana (naso gUMcaLuM) eNnjiogrAphImAM A sivAya lohInI naLInuM gUMcaLuM paNa hoya to dekhAya che jene ArTarIo-vInasa mAlaphormezana (e-vI mAlaphaoNrmezana) kahe che. AvA dardIomAM pUrve mAthuM duHkhatuM hovAnI mAhitI - vigata maLe che, kyAreka kheMca AvI hoya che, keTalAkane pahelethI eka aMgano lakavo hoya che.

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magajanA jAtrA - mR01 na sabaeNrakenaoNIDa hemarejanA keTalAka kesomAM DI.esa.e. (eNnjiogrAphI) paNa naoNrmala Ave che. AmAMnA keTalAya kesomAM ekadama nAnuM evurijhama hoya athavA ekadama nAnuM lohInI naLInuM gUMcaLuM hoya (kriTika evI mAlaphaoNrmezana) athavA naLI saMkocAI hoya (vAjhospAjhama) to paNa eNnjiogrAphI naoNrmala Ave. tethI AvA kesamAM sAmAnya rIte 3 mahine pharIthI enjiogrAphI karAvavI joIe. te pachIthI ja khAtarIthI kahI zakAya ke hemareje mATe AvuM kazuM kAraNa nathI, eTale ke A iDiyopethika sabaeNrakenaoNIDa hemarejano kesa che. * komplIkezansa : A rogamAM eka vAra lohInI naLa phATe te pachInA eka mahinAmAM te pharIthI game tyAre phATI zake che (jene Rebleeding kahe che) ane tevA kissAmAM dardInuM bacavuM atyaMta duSkara thaI jAya che. A ja rIte hemareja thavAnA divasa 4thI 1ranI vacce phuggA pachInI naLI saMkocAvA mAMDe che jene vAsotpAjhama (Vasospasm) kahe che. temAM lakavo Ave ane bhAna ochuM thAya evAM lakSaNo cihno jovA maLe che. davAothI mahad aMze Ane aTakAvI zakAya. tyAra pachI lohImAM ghaNI vAra soDiyama tattva ghaTI jAya che (tene sIADH kahe che.) tene lIdhe kyAreka kheMca Ave tevuM paNa bane che. eka vAra khAtarIthI nidAna thayA bAda, tamAma suyogya kesomAM magajanI naLInI sarjarI karI enyurijhamane klIpa karavAmAM Ave che. koI vAra tenI cAre bAju pharatuM snAyunuM AvaraNa karavAmAM Ave che. athavA plAsTikanuM koTiMga karavAmAM Ave che. koI vAra gaLAmAM keroTiDa ArTarIne bAMdhIne paNa TriTamenTa karavAmAM Ave che. sarjarI jevI ja bIjI sAravAranI paddhatimAM koIlsa (coils)no upayoga karavAmAM Avato hoya che. emAM dhAtunI spriMga jevI cIjathI phuggAne bharI devAmAM Ave che, jethI phugAmAM lohI jamA na thAya. A samagra prakriyA raktavAhinImAM clot (go) utpanna kare che. A koIlsanI paddhati saMpUrNataH oparezana rahita (Non-Invasive)

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82 magaja ane jJAnataMtunA rogo che. eno kharca keTalI koilsa vaparAya che tenA para AdhAra rAkhe che. lagabhaga 3thI 4 lAkha rUpiyA thaI zake. A badhA dvArA Rebleeding saMpUrNa rIte aTakAvI zakAya ane mRtyuno dara ghaNo ghaTADI zakAya. upara nirdezita anya prakAranI sarjarIno kharca Azare rU. 1thI 1.5 lAkha Ave ane tenuM sarjikala jokhama 1thI 5 TakA ja hoya che. tamAma ucca prakAranA kendronA niSNAta nyurosarjana pAse AvI sarjarI zakya che. - e-vI mAlaphormezana mATe bloka risekzana athavA lAIgezana Tenika vAparavAmAM Ave che athavA proTonabImathI tene bALavAmAM Ave che. hamaNAMthI gAma nAIphano upayoga vadhu pracalita che, jemAM kobAlTanA srotathI gAmA nAIpha dvArA kendrita karelAM gAmA kiraNothI cokasAIthI A mAlaphormezanane bALI zakAya che. jo sarjarI zakya na hoya to pleTinama kaoNila dvArA embolAIjhezana karavAmAM Ave che. magajanAM bahAranA bhAgamAM thayelA nAnA ke madhyama kadanA evI mAlaphormezana mATe oparezana ja zreSTha che. magajamAM agatyanI jagAe athavA magajanA erika (aMdaranA bhAgamAM thatAM 3 mi.mI. ane enAthI nAnA kadanA e.vI.ema. mATe sTirioTekTika reDiyo sarjarI (esa.Ara.esa.- gAmA nAipha) zreSTha che, jyAre embolAIjhezana dvArA 15thI 20 TakA lokone rogamukta karI zakAya che. kyAreka kyAreka embolAIjhezanano upayoga moTI sarjarI mATe rAha joI rahelA dardI para karI zakAya che. A Tekanika enyurijhama ane e-vI. mAlaphormezana ema baMnemAM vAparI zakAya che. (c) korTikala vInasa thrombosisaH magajanI zirAomAM kyAreka-kyAreka raktapravAha baMdha | zithila thaI jAya che. kyAreka mukhya zirAno bhaMDAra (Venous sinus) rUMdhAI jAya che tyAre magajanA raktano pravAha avyavasthita thaI jAya che. hemareja ane zombosisa baMne prakAranI vikriyA thAya che. sakhata mAthuM duHkhavuM, (UlaTI thavI, kheMca AvavI, behoza thaI javuM, lakavAno humalo thavo ane gaMbhIra kissAomAM mRtyu thavA sudhInI A roganI lAkSaNikatAo che.

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magajamAM raktasrAva-breIna hemareja badanasIbI e vAtanI che. moTA bhAganA dardIomAM nidAna bahu moDuM thAya che. sAmAnya DaoNkTaronI jANakArI paNa A bAbatamAM TUMkI paDe che. AmAM nyurolojI vizeSajJanI jarUra paDe che. khAsa karIne vicitra prakAranA mAthAnA duHkhAvAmAM nyurolojInA vizeSajJanI salAha laIne jo jarUra jaNAya to ema.Ara.AI. breIna (MR), ema.Ara.AI. vInogrAma (MR) karAvI levuM joIe. moTA bhAganA kesomAM enAthI nidAna pakaDAtuM hoya che. bIjI badanasIbI e che ke sagarbhA mahilAone suvAvaDa pachI ke pahelAM ekathI cAra aThavADiyAmAM A roga vadhAre thAya che. nAnAMnAnAM gAmaDAMomAM ajJAnatA ane meDikala suvidhAnA abhAvanA kAraNe mRtyudara paNa vadhAre rahe che. rakta jADuM-ghaTTa (Thick) thaI javAthI (Hypercoagulable state), uzlzui uisl ezuel (Dehydration etc), zarIramAM kensaranI utpatti thavAthI tathA lyupasa, hAIpara homosisTInemiA, enTI-phospholipiDa sinDroma vagere prakAranI raktanI vikRtiothI paNa A roga thaI zake che. mAthAnA dukhAvAne, khAsa karIne vadhatA jatAM mAthAnA dukhAvAne, UlaTI, kheMca vagerene najaraaMdAja na karavAM joIe. sagarbhAvasthA daramiyAna ke tarata pachI AvAM cihno ke kheMca Ave to dardIne tarata ja sArAmAM sArI suvidhAjanaka hospiTalamAM laI javuM joIe. MRI MRS karAvI levuM joIe. rakta pAtaLuM karanArI davA, (Heparin, wartarin etc), magajanA sojAnI davA, kheMca, mAthAnA dukhAvAnAM cihna dUra karanArI davA vagere dvArA tAtkAlika sAravArathI dardI svastha thaI zake che. kyAreka Venous Thrombolysis thrombolisIsa tathA sarjarI dvArA dardIne bacAvI zakAya che. paNa enTIkoegyulanTa (Warfarin, Acitrom) Eqi nell zzril sal di 244 till dal paDe che.

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magaja ane jJAnataMtunA rogo { ATaluM jarUra jANo raktavAhinI phATavAthI athavA evA koI kAraNathI magajamAM lohI bheguM thAya che; ane kSaNavAramAM dardI bebhAna thaI jAya che, tene breIna hemareja kahe cheH moTA bhAganA kesomAM acAnaka ja blaDa prezara vadhI javAthI breIna hemareja thAya che. AthI BPnI yathAyogya ane kAyamI sAravAra karavI jarUrI khUba ja tIvratAthI mAthuM duHkhavuM, UlaTI thavI, cakkara AvavAM, AMkhe aMdhArA AvavAM, kheMca AvavI, laDakhaDAvuM athavA lakavo thaI javo, kSaNavAramAM bebhAna thaI javuM ane khUba ja jhaDapI gatithI zvAsa cAlavA vagere breIna hemarejanA cihno che. upara mujabamAMthI koIpaNa lakSaNa gaMbhIra rUpe dekhAya to, dada mATe niSNAta tabIbane ghera bolAvavAne badale, turaMta ja phemilI DaoNkTaranI sahAyathI dardIne haoNspiTalamAM khaseDavuM joIe. sI.TI. skena ane enjiogrAphI nAmanAM TesTa A roganAM nidAna mATenAM mukhya mAdhyama che ane amuka dardIomAM sarjarInI paNa AvazyakatA UbhI thaI zake che. korTikala vInasa thrombosisa eka khataranAka roga che, jemAM nidAnanI prakriyA jaTila che. samayasara mAthAnA dukhAvAnI tapAsa ane sAravAra karavI khUba ja Avazyaka che.

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AdhAzIzI (mAIgrena) mAthAnA anya dukhAvA (ziradardI) tathA varkiMgo - mAthAno dukhAvo e magajanA rogomAM sauthI vizeSa jovA maLato roga che. evuM kahevAya che ke dareka vyaktine kyAreka to mAthuM dukhe ja, koIne vAraMvAra. moTA bhAge dareka vyaktie ekAda vAra mAthAno dukhAvo anubhavyo haze paNa kyAreka te gaMbhIra paNa hoI zake che. ekAda TakA vyaktine mAthAnA dukhAvAnA mULamAM magajamAM gAMTha hoI zake. koI vyakti dara thoDA divase ke mahine eka bAjunuM mAthuM dukhe evI phariyAda kare che, je AdhAzIzI hoI zake che. ( jo chellA thoDA divasathI mAthuM dukhavAnuM zarU thayuM hoya to sau prathama rojiMdI jIvanapaddhati jevI ke kAmagIrI, khorAka, ArAma vageremAM koI pheraphArane kAraNe to tema thayuM nathI ne te jovuM joIe. agara thoDA mahinAothI dukhAvo thato hoya to zA mATe ATalA vakhata pachI sAravAranI jarUra paDI te paNa vicAravuM joIe. keTalIka strIone garbhanirodhaka goLInA upayogathI paNa mAthAno dukhAvo thaI zake che. blaDaprezara vadhavAthI paNa mAthuM duHkhatuM hoya tevuM bane. tethI mAthAnA dukhAvAnA dareka dardIe saMpUrNa zArIrika tathA magajanI tapAsa karAvavI joIe. jo mAthAnA dukhAvAnI sAthe kvacit bebhAnapaNuM Ave, vastuo hoya tenA karatAM bamaNI-Dabala dekhAya, kheMca Ave, lathaDiyAM, cakkara ke aMdhArAM Ave to vizeSa sAvaceta thaIne tAtkAlika sI.TI. skena vagere tapAsa karI levI joIe, kadAca te breina TyUmara agara sAdo sojo hoI zake che. - mAthAnA dukhAvAnAM ciMtAkAraka kAraNomAM maeNninjAiTisa, breIna hemareja, breIna TyUmara, ArTarAiTisa, magajano sojo, lohInA vahanamAM khAmI vagere hoI zake che. joke mAthAnA dukhAvAnA bahu ochA kesomAM AvI gaMbhIra bImArI jovA maLe che ke jemAM uparanAM lakSaNo mAthAnA dukhAvAnI sAthe hoI zake. mAthAnA dukhAvAnAM sAmAnya, ciMtA na upajAve tevA kAraNomAM AdhAzIzI mukhya bImArI che jene sAmAnyataH mAigrenanA nAme oLakhavAmAM

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86 magaja ane jJAnataMtunA rogo Ave che. A sivAya bIjAM sAdAM kAraNomAM Tenzana, davAonI ADaasara, 'klasTara heDeMka' vagere che. A prakAranA dukhAvAmAM magajanI tapAsa sAmAnyataH naoNrmala hoya che ane dardIne koI khoDakhAMpaNa ke paeNraeNlisisa thavAno sAmAnya rIte bhaya raheto nathI. A uparAMta Diprezana, dAMrUnuM vyasana, DokanA maNakAnI bImArI, zaradI-sAInusAITIsa, AMkhonI nabaLAI ke jhAmaranI bImArI athavA nyurAlphiA vagerethI paNa mAthAno dukhAvo thaI zake che. A badhAMmAMthI vadhAre jovA maLatAM kAraNomAM AMkhonI nabaLAI, Tenzana heDeka, sAInusAITIsa, blaDa prezara, AdhAzIzI vagereno samAveza thAya che, paNa vyaktigata kesamAM koIpaNa kAraNa hoI zake. (1) AdhAzIzI (mAigrena) mAigrena-AdhAzIzI e khuba jANIto roga che. tanA aTaka (humalA) daramiyAna dardI khUba ja paravaza, parezAna ane lAcAra thaI jato hoya che. pukhtavaya dharAvatI vIseka TakA vyaktione A roga vatteoche aMze thaI zake che. A rogamAM mahinAmAM Azare 1thI 6 vAra (kvacit roja) mAthAno dukhAvo thaI zake, je dukhAvo mAthAnI eka ke banne bAju (jamaNI ane DAbI) paNa thato hoya che. A dukhAvo tIvra, labakArA mAratA hoya te prakArano nADIbaddha saNakA jevo hoya che, je kAma ka2vAthI vadhe che; ghaNI vAra UbakA Ave, UlaTI thAya, AMkha sAme jhabakArA, aMdhArAM AvI zake ane prakAza sAme bahu joI na zakAya tathA avAja paNa sahana na thAya. A dukhAvo 4 kalAkathI 72 kalAka sudhI paNa cAle tevuM banI zake. AvA pAMca jeTalA eNTaeNka Ave to dardIne mAigrena che tevuM nidAna thaI zake. sAmAnya rIte UlaTI thaI gayA pachI athavA ArAmathI athavA yogya davA levAthI dukhAvo zamI jAya che. AdhAzIzI (mAigrena)nA prakAro : (1) kaoNmana mAigrena (2) klAsika mAigrena (jemAM AMkha-dRSTine lagatAM lakSaNo hovAM jarUrI che.) (3) mAigrenanI sAthe kSaNika lakavo thavo. (4) klasTara heDeka (5) kaoNmplikeTeDa mAigrena

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AdhAzIzI (mAIgrena) ane mAthAnA anya duHkhAvA (ziradarda). khorAka tathA jIvanazailImAM thayelA pheraphArathI paNa AdhAzIzI thaI zake che. tethI AhAravihAramAM niyamitatA, mananI zAMti ane pUratA ArAmanI AvazyakatA rahe che. kabajiyAta na thAya tenuM dhyAna rAkhavuM joIe. taDakAmAM pharavuM nahi athavA taDakAmAM javuM ja paDe to gogalsa paheravAM tevI sUcanAo DaoNkTaroe haMmezAM ApavI joIe. caoNkaleTa, cIjha, kaoNphI, cAinijha phUDa, khATAM phaLo, reDa vAina vagere aneka prakAranA khorAkathI AdhAzIzIno humalo thaI zake che. keTalIka vAra bhUkhyA rahevAthI ke zarIramAM pANI ghaTI javAthI ujAgaro karavAthI ke mAnasika TenzanathI paNa mAigrenano humalo AvI zake. kvacit jAtIya samAgamathI to kyAreka vAtAvaraNamAM pheraphArathI avAja-ghoMghATathI tema ja strIone garbhanirodhaka goLIo levAthI ke menopojha daramiyAna mAIgrena vadhI zake che. AvA tamAma prakAranA mAIgrenanA dardIonI vigatavAra zArIrika tapAsa thavI jarUrI che. keTalAka dardIomAM sI.TI. skena ke ema.Ara.AI. dvArA paNa nidAna-sAravArano nirNaya levAmAM Avato hoya che. yogya davAo tathA upara jaNAvyA mujaba AhAravihAranA niyamanathI ja roga kAbUmAM AvI jaI zake. | mukhya auSadho : (1) humalA daramiyAne levAnAM auSadhoH humalo thAya te samaye tarata levAnI davAmAM peresiTemola, UlaTInI goLI, pIDAnAzaka davAo jema ke Ibuprophena prakAranI davA athavA keTalAka kesamAM aragaTomAina nAmanI davA moDhethI, Ijezana dvArA ke gudAmAM sapojhiTarI dvArA ApavAthI ja humalo khALI zakAto hoya che athavA humalAnI mAtrA ghaTe che. navI davAmAM sumATriAna (goLI athavA Invekzana), rIjhATriAna, nArATriAna vagere asarakAraka sAbita thaI che. kalasTara heDekamAM sumATriTAna sAthe 100% oksijanano prayoga paNa karAya che.. humalAne Avato aTakAvavA mATenAM auSadho : anya prakAranAM auSadho jema ke bITAblokara athavA phalunArijhina davA. athavA emiTriSTilIna davAo jo lAMbo samaya levAmAM

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88 magaja ane jJAnataMtunA rogo Ave to AdhAzIzInA humalA AvatA ochA thaI jAya che. atyAre TopIrAmeTa (TOPAMAC), vAlaproyeTa, vagere davAo vadhAre pracalita che. kyAreka boTokSanAM injekzano paNa mAthAmAM jyAM du:khatuM hoya tyAM ApavAthI lAbha thAya che. kalasTara heDekanAM kesomAM verApAmila, lithiyama, ane preDanIsolonano prayoga karAya che. enI sAthosAtha agAu jaNAvyA mujabanI AhAravihAranI kALajI rAkhavI jarUrI che. (2) spAsTika heDeka A dukhAvo AdhAzIzI jeTalo ja athavA tethI paNa vadhAre pracalita che. nAma mujaba snAyuonA kheMcANa athavA Tenzanane lIdhe A prakArano dukhAvo thAya che. A dukhAvo 'mAthAne pharate koI paTTo bAMdhyo hoya' tevo tathA ekadhAro, beTTo ane dhImo hoya che ane lagabhaga roja athavA mahinAnA moTA bhAganA divasomAM te thato hoya che. A badhI rIte te mAigrenathI ghaNo judo paDe che. zArIrika tapAsa tathA eNksa-re, sI.TI. skena AmAM paNa naoNrmala ja Ave che. tenI sAravAra paNa AdhAzIzIthI alaga paDe che. sau prathama to dardIne zI bAbatano tanAva che te zodhI tene dUra karavAno prayAsa karavo joIe. sAmAnya rIte kauTuMbika, sAmAjika, mAnasika, Arthika ke zArIrika bImArInAM kAraNo agrabhAga bhajave che tenI dardI tathA tenAM sagAsaMbaMdhI joDe mukta mane carcA karavI ane tene dUra karavA upAyo karavA te muddAnI vAta che. vizeSamAM AgaLa tanAvanA prakaraNamAM lakhyA mujaba mAnasika zAMtinA tamAma upAyo karavAthI ghaNo ja phAyado thAya che. kasarata, dhyAna, Asano ane yoganuM AnI sAravAramAM agatyanuM pradAna che. jarUra paDye hipnosisa, oNTosajezana, bAyophiDabeka paddhationo upayoga karI zakAya. nyuraoNlojisTa, phijhiziyana ane jarUra paDye sAikAyaTrisTa DaoNkTaranI madada laI A rogamAM yogya davA upacAra tathA sAikortherapI karavAthI phAyado thAya. udAsIpaNuM tathA aticiMtAgrastapaNuM dUra karavAnI davAonI sAthe,

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AdhAzIzI (mAIgrena) ane mAthAnA anya duHkhAvA (ziradardI) 89 vyaktino mUDa sudhare, paristhitino sAmano karavAnI zakti vadhe tevI davAono upayoga karavAmAM Ave che. sAthe snAyuonI taMga avasthA ane kheMcANa ochuM thAya tevI davAo umeravAmAM Ave che. vizeSamAM AhAravihAramAM yogya pheraphAro to kharA ja. AmAM dukhAvAnI davAo ochI levI te upara khAsa bhAra mUkavAmAM Ave che. dukhAvAnI davAonA aniyaMtrita upayogathI AvA duHkhAvA vakaratA jAya che ane pachI dukhAvAnI davAnI asara thatI nathI, ane davAonI ADaasara yakRta tathA mUtrapiMDa para thavA mAMDe che, lohInA koSo para ADaasara Ave che. koI vakhata AvA dardIne davAnI Adata-baMdhANa thaI jAya che (Headache of drug abuse). tethI DaoNkTaroe AvA dardInI sAravAramAM khUba kALajI levI joIe ane dhIrajathI kAma levuM joIe ane dardazAmaka davA sivAyanA upara jaNAvelA bIjA upAyo para dhyAna ApavuM jarUrI bane che. (3) mAthAnA dukhAvAnAM anya kAraNo agAu jaNAvyA mujabanA magajanA dukhAvAnAM anya kAraNomAM magajamAM cepa ane meninjAiTisanA kissAmAM tAtkAlika sAravAra karavAthI dardInI jiMdagI bacI zake che. breina TyUmaranuM nidAna sI.TI. skena athavA ema.Ara.AI. dvArA thaI zake che ane te yogya sAravAra, sarjarIthI te maTI zake che. tevI ja rIte hemarejanI yogya saghana sAravArathI moTA bhAganA kesomAM jiMdagI bacAvI zakAya che. dukhAvo maTADavAnI vadhu paDatI davAonA sevanathI ke Teva paDI javAthI mAthAno dukhAvo vaNasato jAya che. kyAreka mAthAnA dukhAvAmAM eka karatAM vadhu kAraNo hoya che, jema ke sAInusAITIsa ane mAigrena. sAInusAITIsa, AMkhanI takalIpho vagere mAthAnA duHkhAvAnA saraLatAthI maTI zake tevA prAthamika rogonuM nirAkaraNa ati jarUrI che. mAthAnA dukhAvAnA gaMbhIra kesomAM nIcenAM cihno sAmAnyataH saMkaLAyelAM hoya che. AvA kesomAM tAtkAlika tapAsa tathA sAravAra maLe to jiMdagI bacI zake che je A prakaraNano mukhya saMdeza che.

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magaja ane jJAnataMtunA rogo mAthAnA dukhAvAnI sAthe sAthe : (1) kheMca AvavI, cakkara ane aMdhArAM AvavAM, cAlatAM laDiyAM AvavAM ke ekAda bAju lakavAnI asara thavI athavA yAdadAsta ke bolavAnI zakti jatI rahevI ke behoza thavuM. (2) tAva Avavo. (3) UMghamAMthI UThavAnA samaye mAthuM dukhavuM, chIMka ke khAMsI khAtI vakhate duHkhAvo vadhavo. (4) ekadama ja thoDIka miniTo mATe atizaya dukhAvo thavo. (5) bALakomAM thato mAthAno dukhAvo. 90 (6) 50 varSathI uparanAM vyaktiomAM kramazaH vadhato jato mAthAno dukhAvo (7) davA levAthI paNa duHkhAvo niyaMtraNamAM na Avavo. mAthAnA dukhAvAnI sAthe sAthe AvAM badhAM cihno hoya to cetI javuM paDe. tenA mULamAM kadAca magajamAM sojo, gAMTha ke cepa hoI zake che. agara AvAM koI ja cihna-lakSaNo na hoya to dardIe gabharAvAnI khAsa jarUra nathI. 50 varSa vaTAvI cUkela vyaktine zarU thayelo vadhato jato duHkhAvo. AmAM lamaNA paranI lohInI naLI sojAne kAraNe jADI thatI hoya athavA duHkhAvo karatI hoya temaja sAthe zarIramAM thAka, jhINo tAva, azakti hoya to Temporala ArTarAiTisa hoI zake. temAM ESR ane CRP (blaDa TesTa)nI mAtrA vadhAre Ave che. bAyopsIthI tenuM nidAna thAya che ane sTIraoNiDa davAthI te maTI zake. I.I.H. mAthAnA duHkhAvAnA anya asAmAnya kAraNomAM eka che 1.1.H. eTale ke Idiopathic Intracranial Hypertension, AmAM magajamAM koI kAraNasara sojo vadhI jAya che paraMtu magajano sI.TI. skena, ema.Ara.AI., kamaranAM pANInI tapAsa vageremAM kAraNa pakaDAtuM nathI.

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AdhAzIzI (mAIgrena) ane mAthAnA anya dukhAvA (ziradarda) paraMtu AMkhanI tapAsa eTale ke phanDoskopI tapAsamAM AMkhano sojo pepiloiDimA (Papilloedema) jovA maLe che. je nidAna mATe jarUrI che. A rogamAM mAthuM duHkhavuM, jhAMkhu dekhAvuM evuM sAmAnya che ane jo lAMbo samaya sudhI sAravAra na thAya to dardIne aMdhApo paNa AvI zake che. A roga strIomAM, khAsa karIne jene mAsika aniyamita AvatuM hoya ane vajana vadhAre hoya temAM vadhu jovA maLe che. magajanI zirAomAM lohInuM paribhramaNa dhImuM thaI gayuM hoya tevA dardIomAM paNa A roga jovA maLe che. keTalIka davAonI ADaasarathI paNa A roga thato jovA maLe che. magajano sojo ocho karavA mATe esiTAjholAmAiDa nAmanI davA ane niyamita samayAMtare kamaramAMthI pANI kADhavuM upayogI che. jo dardInI dRSTi javAno bhaya hoya ane upara jaNAvela sAravAra kAragata na nIvaDe to sarjarI (thIkoperiToniyala zanTa) paNa karavI paDe che. TrAijeminala nyurAjUiA jurAsjiA zabdano sAdo artha che nasamAM du:khAvo. je te nasanI (narvanI) saMvedanAno jeTalo vibhAga zarIramAM hoya, eTale ke je te nasa zarIramAM jyAMthI saMvedanA grahaNa karI magaja sudhI pahoMcADatI hoya, teTalA bhAgamAM nasa amuka prakAranuM darda pedA kare tene jurAsjiA kahe che. sAmAnya rIte amuka nasomAM AvuM bahu sAmAnya rIte jovA maLe che, jema ke mastiSkanI 5 naMbaranI, 9 naMbaranI nasa.... vagere. AvA nyurAsjika dardI chAtImAM, peTamAM, cAmaDI para, hAthapaganI cetAomAM paNa thaI zake che. e vAta khAsa noMdhavI joIe ke cAmaDI para thato harpIsa jhosTara-- vAIrasano roga je te nasa para sojo kare che ane moTe bhAge atyaMta pIDAjanaka nyurAsjiA pedA kare che. TrAijeminala e mastiSkanI 5 naMbaranI nasa che ane temAM thatuM AvuM darda TrAijeminala nyurAjiA kahevAya che. A darda jANe karaMTano jhATako lAgyo hoya tevuM TUMkuM paNa atizaya bhAre pIDAdAyaka hoya che ane te vakhatovakhata thayA kare che. divasamAM 1-2 vakhatathI 100-200 ke

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magaja ane jJAnataMtunA rogo tethI vadhu vakhata AvA karaMTa jevA dardanI pIDA dardIne lAcAra banAvI de che. tene kazuM ja game nahIM. ThaMDuM pANI aDe ke te khorAka khAvA moTuM khole ke ThaMDA pANI-pavananI lahera Ave to paNa darda cAlu thaI jAya. TrAijeminala nasa traNa bhAgamAM vaheMcAyelI hovAthI prathama bhAgamAM takalIpha thAya to kapALa para darda thAya che, bIjA bhAgamAM takalIpha thAya to gAla para ane trIjA bhAgamAM takalIpha thAya to haDapacI para Avo dukhAvo thAya che. sAmAnya rIte A roga pa naMbaranI catA para koI nAnakaDI raktavAhinInA dabANane kAraNe thato hoya che. sAmAnya rIte nyurolaoNjikala tapAsamAM koI khAmI jaNAtI nathI paNa jo sAthe je te bhAgamAM saMvedanA ghaTI gaI hoya athavA sAthe bIjI naso (dA.ta., sAthe 6 ke 7 naMbaranI nasa) para garabaDanAM cihano hoya athavA dardInI uMmara 40thI nIce hoya to, ema.Ara.AI.breina (kaoNnTrAsTa sAthe ane kyAreka ema.Ara.eNnjiogrAphI) karAvI levuM joIe, kema ke A prakAranA keTalAka kesamAM pa naMbaranI nasa para athavA tenI AjubAju gAMTha hoI zake athavA malTIpala klerosisa (A roga ApaNA dezamAM eTalo badho jovA maLato nathI) nAmano vicitra roga hoI zake. TrAijeminala nyurAsjiAnI TriTamenTa prathama to meDikala eTale ke davAothI karavI joIe. mukhya davA che kAbUmejhepIna (TagreTola, kArmeTola, jheTola vagere). tenI asara 80% jeTalA dardImAM ghaNI sArI hoya che. bAkInA dardIomAM phInAiToina, gAbApenTIna, klojhapAma ane beklophena vagere davAo vAparI zakAya. - dardane haLavuM karavA dukhAvAnI goLI paNa umerI zakAya. AlkoholanuM lokala Invekzana te nasamAM ApavAthI 3-4 mahinA sudhI du:khAvAmAM rAhata thaI zake. TrAijeminala nyurAbruiAmAM RFTC eTale ke reDiyo phrikvansI tharmokoegyulezanathI nasane zAMta karavAmAM Ave che. A upAya sacoTa che ane ghaNAkharA dardIone o.pI.DI. prosijara tarIke karI

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AdhAzIzI (mAIgrena) ane mAthAnA anya duHkhAvA (ziradardI) ApavAmAM Ave che ane tenAthI 90thI 95% saphaLa pariNAma Ave che. je dardIomAM davAo asarakAraka na thAya tevA keTalAka kesamAM sarjarInI madadathI (rAijhoTomI, nyurekaTamI) nasane kApI nAkhavAmAM Ave che. joke sauthI zreSTha upAya to mAIkrovAkyulara Dikojhezana sarjarI che, jemAM upara darzAvelI raktavAhinIne 5 naMbaranI cetAthI alaga karIne vacce jelaphaoNma mUkavAmAM Ave che. have to boTokSanA ijekzana paNa AmAM kAragata jaNAyAM che. A badhI sAravAra paddhati gujarAta, muMbAI tathA tamAma moTAM senTaromAM upalabdha che. * varTigo (cakkara AvavAM) : eka sarvekSaNa pramANe o.pI.DI.mAM batAvavA AvatAM dardIomAM cakkara, zarIranI asaMtulitatA e chAtInA duHkhAvA ane zArIrika thAka - nabaLAI pachInuM trIjuM sauthI pracalita lakSaNa che. uMmaralAyaka vyaktiomAM Azare 50 TakAne kyAreka to A takalIpha thAya che. jyAre vyaktine potAnI AjubAjunI vastu ghUmatI lAge, goLa pharatI lAge athavA vyakti pote ja pharatI hoya tevuM tene lAge, potAnuM saMtulana te na jALavI zake tyAre tene "varTigo-cakkara AvyAM che tema kahevAya. sAmAnya kSaNika aMdhArAM AvavAM, azakti lAgavI, kSaNika asaMtulana jevuM lAgavuM, becenI lAgavI te badhAMne kharA arthamAM varTigo na kahevAya, tenI khAsa kALajI rAkhavI. varTigonAM mukhya kAraNo che : (1) zArIrika sthitinA pheraphArathI AvatAM cakkara (Benign Positional Vertigo) (2) kAnanI aMdaranA aMta:karNamAM Avela saMtulana saMbaMdhI nAjuka ...34949Hitect (Vestibular disturbance) (3) nAnA magajane lagatI bImArI (4) mInIarsa Dijhijha (5) magajamAM lohI ochuM pharavuM (6) anya kAraNo

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94 magaja ane jJAnataMtunA rogo AmAM keTalAkane acAnaka AvatAM tathA thoDA samaya mATe rahetAM cakkara hoya che. keTalAkane cakkara lAMbo samaya cAle ane keTalAkane thoDI miniTo mATe pharI pharIne cakkara Ave. A saumAM aMtaHkarNamAM thayelI muzkelIvALA cakkara vadhu agatyanA che. e kyAM to vesTibyulara nyuronAiTisathI thAya jemAM vAirasathI (dA.ta. zaradIthI) aMtaHkarNamAM sojo Ave athavA to lebirinthAiTisathI thAya jemAM cakkaranI sAthe kAnamAM baherAza ane vicitra jhanajhanATI-sisoTIvALo avAja Ave. banne prakAramAM sAthe sAthe UlaTI paNa thaI zake. cakkara sAthe baherAza hoya to harpisa, lebirinthAiTisa, nAnA magajamAM lohI ochuM pharavuM ke gAMTha hovI evAM kAraNonI tapAsa karavI joIe. gAMTha sAmAnya rIte ekosTika nyuraoNmA nAmanI hoya che, jemAM cakkara, baherAza, asaMtulana, nAnA magajane lagatAM lakSaNacihna vagere hoya che, sAthe mAthAno dukhAvo - UlaTI paNa thAya. e ja rIte mInIarsa DijhIjhamAM aMtaHkarNamAM sojo Ave, pANI bharAya, jenAthI cakkaranI sAthe kAnamAM sisoTIno avAja Ave, kAna bhAre lAge, baherAza Ave ane UlaTI paNa thaI zake. A badhuM thoDA kalAkathI mAMDI thoDA divasa cAle ane pachI dardI sAjo thAya. AvA vAraMvAra humalA thAya ane pachI baherAza vadhatI thAya tyAre sisoTI ghaTatI jAya. AvA dardIoe mIThuM ochuM levuM joIe ane kaoNphI, cokaleTa na levAM joIe. vayaska vyaktione vizeSa thatA cakkaranuM kAraNa Benign Paroxysmal PositionalVertigo che, jemAM UbhA thatAM, besatAM ke sUtAM, paDakhuM pharatAM, amuka ja pojhIzanamAM thoDIka sekaMDo mATe ja cakkara Ave. temAM sAmAnya rIte magajamAM koI gaMbhIra takalIpha hotI nathI. uMmaralAyaka vyaktiomAM UbhA thavAthI blaDaprezara ghaTI javAthI paNa cakkara ke asaMtulanatA AvatI hoya che jene othostaticHypotension kahe che. cakkaranA dardInI sAravAra agAu joI gayA tema alaga alaga kAraNone zodhI teno yogya upacAra karavAnI che. cikkara mATe

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AdhAzIzI (mAIgrena) ane mAthAnA anya duHkhAvA (ziradarda) enTihisTAminika, enTiensAyaTI, enTikolinarjIka, phInothAyAjhina davAothI mAMDIne DAiyureTika temaja navI davAo jevI ke onDenaseTrona vAparavAmAM Ave che. sAthe yogya kesomAM khorAkanI sUcanA ApavAmAM Ave. dA.ta., mIThuM ochuM levuM. vizeSamAM cakkarane lagatI keTalIka kasarato paNa keTalAka kesamAM zIkhavavAmAM Ave che. A badhuM karavA uparAMta kyAreka viziSTa prakAranI sarjarI paNa lAMbA samaya cAlatAM cakkaramAM upayogI nIvaDe. gAMThavALA kesamAM to gAMTha kaDhAvavI ja paDe. magajamAM rudhirAbhisaraNanI khAmI hoya to tenI paNa yogya sAravAra karavI paDe. 95 A badhI upacAra paddhatiothI cakkaranA cakkaramAMthI chUTI zakAya, rAhata meLavI zakAya. nAnA magajane lagatI bImArIo (Cerebellar disorders) viSe sthaLa saMkocane lIdhe vadhu vivaraNa thaI zakyuM nathI. paNa TUMkamAM temAM paNa gAMTha, cepa, lohI jAmI javuM, hemareja thavuM tevA rogo thatA hoya che ane nAnuM magaja sukAvAnI bImArI (Cerebellar degeneration) prauDha ke vRddha vyaktine thatI ghaNI vAra jovA maLe che. vadhu paDatA dArUnA sevanathI ke AgaLa prakaraNa 17mAM jaNAvelI malTipala sklerosisa nAmanI bImArIthI ane koI vAra koI dhAtunA jherathI (jema ke pArAnuM sevana) paNa nAnuM magaja bagaDI zake. nAnuM magaja (Cerebellum) bagaDe tA asatulana, cakkara, lathaDiyA Ave, vAcA aspaSTa bane tathA hAthanuM saMtulana paNa bagaDe. jema ke pyAlo hAthamAMthI chUTI jAya athavA koLiyo moDhA sudhI laI javAne badale hAtha tene nAka para aDADI de, baTana baMdha karavAnI ke tevI nAnI paNa cokasAIvALI kriyAo na thaI zake. akSaro bagaDe.... vagere. moTA magajane nukasAna thAya to lakavo Ave, nAnA magajane nukasAna thAya to asaMtulana Ave ane vadhumAM kriyAo cokasAIvALI na rahe.

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magaja ane jJAnataMtunA rogo ATaluM jarUra jANo ghaNI vyaktiomAM dara thoDA divase athavA aThavADiye eka bAjuno mAthAno dukhAvo thAya che, je AdhAzIzI hoI zake che. A dukhAvo kAma karavAthI vadhe che. ghaNIvAra UbakA-oDakAra AvavA, UlaTI thavI, AMkhe aMdhArA AvavA, prakAza sahana na karI zakavo jevAM lakSaNo paNa sAthe jovA maLe che. AhAra ane jIvanazailImAM parivartananA kAraNe paNa AdhAzIzIno roga thaI zake che. jyAre cetA zarIramAM jeTalAM bhAgamAM saMvedanA pahoMcADe che, teTalAM bhAgamAM amuka prakAranuM darda utpanna kare che, tyAre tene nyUrAsbiyA kahe che. magajanI pAMca naMbaranI cetA jene TrAIjeminala kahe che, temAM thatAM A prakAranAM darzane TrAIjeminala nyUrolkiyA kahe che. A pIDA vIjaLInA karaMTa jevI alpa samaya mATe thAya che, paraMtu atyaMta pIDAdAyaka hoya che. mAIgrena-AdhAzIzI ane TrAIjeminala nyUrAjiyAnI saMtoSakAraka-asarakAraka davAo upalabdha che. jyAre vyaktine potAnI AsapAsanI vastuo pharatI hoya tevuM lAge, athavA vyakti potAne ja pharatI mahesUsa kare potAnuM saMtulana na jALavI zake, tene varTigo kahe che. zArIrika mudrAmAM badalAva, kAnanI aMdaranA saMtulanamAM garabaDa, nAnA magajanI bImArI, mInIarsa DisIjha, magajamAM lohInuM paribhramaNa ghaTI javuM... A badhAM kAraNothI varTigo thaI zake che. AhAramAM jarUrI badalAva ane yogya davA levAthI A bImArI mahadaaMze kAbUmAM AvI zake che.

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mUvamenTa DisorDarsa ane DisTonIA manuSyanA zarI2nuM halanacalana ane gatividhi je mahadaaMze icchAvartI che, te mukhyatve traNa prakAranA jJAnataMtuonA samUha para avalaMbe che, jene taMtra athavA system kahI zakAya. (1) piAmiDala sisTama (2) pepirAmiDala sisTama (3) eksTrApirAmiDala sisTama A traNeyamAM eka naMbara mukhya che. tenI kAryavAhImAM avarodha Ave tene ApaNe lakavo kahIe chIe eTale ke je te jJAnataMtuonI kAryavAhI bagaDatAM teTalAM aMgo kAma karatAM aTake ane temAM haLave haLave kaDakapaNuM (spAsTisiTI) pedA thAya. (1) A pirAmiDala sisTama magajanA phraMTala lobanA pAchalA bhAgamAM ane thoDeka aMze perAiTala lobanA AgalA bhAgamAM AvelA koSasamUhomAMthI pedA thaI, koronA reDIeTA banAvI pachI bejhala gejhlIAnI vacce AvelI inTarnala kaeNpsyUlanA pAchalA bhAgamAMthI pasAra thaI seribrala pIDankalamAMthI nIce UtarI pirAmiDala TrekTsa banAve che. pachI be bAjunA magajanI naso kraoNsa karIne potAnAthI sAmenI bAjue meDyulAmAM UtarI koTirkospAinala TrekTanA nAmathI karoDarajjumAM nIce Utare che ane karoDarajajumAM AvelA spAinala koSo ke je hAthapaganI halanacalananI prakriyAne kaMTrola kare che tene maLe che. A spAInala koSo (loara moTara nyuraoNna) magajamAMthI nIce AvatI AjJAo sUcanAone spAinala cetAo dvArA snAyuone pahoMcADe che ane tethI je te kriyA mATe tenA upara magajanAM spaMdano, magajanI AjJAo mokale che. jethI je te kriyAno halanacalanano udbhava thAya che. A kAmamAM sekaMDano kSaNika bhAga lAge che. Ama magajano phrUTala loba AkhI sisTamano mukhya bhAga che. sAthe sAthe magajano bIjo eka bhAga jene saplimenTarI moTara kaoNrTeksa kahe che, te halanacalana pUrve keTalAka saMdezA pedA kare che. teno paNa agatyano phALo che. pirAmiDala sisTamamAM kSati thAya to lakavo thAya.

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magaja ane jJAnataMtunA rogo (2) perApirAmiDala sisTamamAM mukhyatve brospAinala, TekTospAinala, reTIkyulospAinala, vesTIbyulospAinala vagere cetAsamUho AvelA che. temanuM kAma pirAmiDala sisTama para potAno prabhAva batAvavAno che jethI icchAvartI kAryo-kriyAo amuka rIte nizcita krama pramANe ja thAya. AmAM reDa nyuklIsa, TekTama ane nAnuM magaja ema magajanA aneka avayavo saMkaLAyelA che. AmAM, kSati thAya to asaMtulana ane dhrujArI vagere lakSaNo-cihno Ave. . (3) A prakaraNamAM je rogo viSe vAta karavAnA chIe, tene mUvamenTa DisaoNrDarsa (halanacalananI khAmIo-kSatio) kahe che. A rogomAM mukhyatve bejhala gengalIA nAmanA magajanA madhya bhAgamAM AvelA koSasamUho agatyano bhAga bhajave che ane A sisTamane esTrApirAmiDala sisTama kahe che. AkRtimAM jaNAvyA mujaba te phaMTala loba, globasa paeNlIDasa, puTAmena, kaoNDeTa nyuklIasa, klosTrama tathA emAyaDelA nAmanA koSonA bejhala geglIyA kaoNDeTa nyukliyasa - - InTaranala kempala - - no, * * thelemasa magajano ADacheda globasa paeNlIDasa yuTAmena samUhonA banelA che. e pirAmiDala sisTamane potAnI rIte kaMTrola kare che. paNa A sisTamanI kAryavAhImAM rukAvaTa Ave to lakavo eTale ke paeNraeNlisisa na thAya paraMtu nIce jaNAvelI be jAtanI takalIpho thAya, jene ApaNe lakSaNa-cihnasamUha ke sinDroma nAme oLakhIzuM.

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mUvamenTa DisaorDarsa ane DisTonIA 99 - (a) ekAIneTika rIjIDa sinDroma jema ke kaMpavAta (pArkinsonijhama - jenA vize ApaNe have pachInA prakaraNamAM vigate joIzuM, jemAM hAthapaga kaDaka thavA mAMDe, dardInI badhI kriyAo dhImI thaI jAya, hAthapagamAM dhrujArI Ave ane badhI halanacalananI samagra prakriyAo ochI thaI jAya. DopAmIne nAmanuM rasAyaNa magajamAM ghaTI javAthI AvuM thAya che. (b) hAIparakAineTika DisuoNrDarsaH AmAM dardInA magajamAM DopAmIna tattva vadhI jAya che tevuM saMkSepamAM kahI zakAya. svAbhAvika rIte tenAthI potAnA aicchika niyaMtraNa bahAranI vadhArAnI kriyAo thayA kare, jema ke DisTonIA, korIA, DiskAinejhIA, hemIbelIsamasa. (A) DiTonIA (Dystonia) : jyAre koI kriyA lAMbA samaya sudhI eka ja zArIrika abhaMgamAM eTale ke sthiti(posTara)mAM rahe tene DisTonIA kahe che dA.ta. garadana eka bAju kheMcAIne vaLelI rahevI tene sarvAikala DisTonIyA (TorTIkolisa) kahevAya. AMkha ane moDhAnA snAyuo vAraMvAra eka bAju kheMcAyA kare tene hemIphesIala spAjhama kahevAya. AMkho anaicchika rIte baMdha rahyA kare, khAsa karIne sAmI vyakti sAthe AMkha meLavIne vAta karavAmAM paNa muzkelI paDe tene blepherospAjhama kahevAya. moDhAnI AjubAjunA ke jIbhanA snAyuo vicitra rIte paNa kaMIka kramabaddha rIte hAlyA kare tene phesIyala DisTonIA athavA mIgsa sinDroma kahe che. khUba pracalita evo eka bIjo roga che jene rAiTarsa kaeNmpa (Writer's cram) kahe che. temAM dardInI lakhavAnI prakriyAmAM garabaDa UbhI thAya che. prathama to akSara bagaDavA mAMDe che, jhaDapathI lakhI zakAtuM nathI. chevaTe potAnI sahI karavAmAM paNa dardIne muzkelI thAya che. kArakuna, zikSaka vagere jeno lakhavAno nokarI-dhaMdho hoya tene keTalI muzkelI paDe te samajI zakAya che, dA.ta., koI ekjhikyuTiva ke jene sahI karavAmAM muzkelI paDe, tenA ceko pAchA phare, kaoNnTrAkTamAM sahIno phera paDavAthI gaMbhIra muzkelIo thAya vagere.... jovAnI vAta e che ke A dardIne phakta lakhavAmAM ja takalIpha paDe. tene khAvAmAM, vastu pakaDavAmAM koI muzkelI na hoya ke lakavAnAM koI lakSaNo na hoya. evuM ja bIjA DisTonIAnuM che jemAM avAja tINo thaI jAya, avAja nIkaLavo baMdha thaI jAya. tene vokala korDa DisTonIA kahe che.

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100 magaja ane jJAnataMtunA rogo eka mata pramANe AvA kamase kama 100thI vadhAre prakAranA DisTonI che. vAyolina vagADanArane AMgaLIno DisTonI thAya to bicArA vAyolinavAdakane tenuM nAma-kAma ane AjIvikA gumAvavAM paDe. tabalAM vagADanAranI AMgaLI DisTonIAmAM jhaDapAya to tabalAMno tAla ja badalAI jAya. AvA aneka prakalpa-vikalpo kalpanAthI samajAI jaze. - A DisTonI thAya che, bejhala gengalIAnI kAryavAhImAM garabaDa thavAthI. temAM DopAmIna tattva vadhI jAya che, jethI dardInI kriyAo vadhI jAya che athavA amuka cokkasa snAyuo satata kheMcANamAM jatA rahevAthI layabaddha kriyAo aTakI jAya che ane upara jaNAvela muzkelI thAya che. upara jaNAvelA moTA bhAganA DisTonIA prAimarI hoya che ane mukhyatve yuvAna vayamAM thAya che. AvuM kema thAya che, te jANI zakAyuM nathI. mAnasika tanAvathI mAMDIne ekanuM eka kAma vizeSa karavAthI (jema ke lakhavuM) AvA DisTonIA thaI zake. paNa to pachI AvuM karanArI asaMkhya vyaktiomAMthI koIkane ja kema thAya che ? zakya che ke AnuvaMzika (jineTika) ke vArasAgata kAraNo ane e vIronmenTala eTale ke paryAvaraNanAM paribaLo tema ja dardInI jIvanazailI, AhAra ane mAnasika paribaLo vagerenA saMyojanathI AvA rogo thatA haze. - e je hoya te, tenI TriTamenTa paNa eTalI ja muzkela che. tenI je davAo che te paNa aMdAje ja ApavAmAM Ave che, kema ke tenuM kAraNa paNa khabara nathI. dA.ta., TrAIhelIphenI DIla, helIperIDola, benjhoDAijhapIna (jema ke klonApIna), TeTrAbenAjhIna vagere anekAneka davAo ekAkI ke saMyojananA rUpamAM ApI zakAya che. dardInI prakRti pramANe Dojha paNa badalAya che. paNa A badhI davAo phakta 30% thI 40% kesomAM ja asara kare che ane te paNa madhyama prakAranI davA le teTalo vakhata dardIne sAruM rahe. samaya jatAM davAnI asara paNa ochI thatI jAya che. paNa sauthI vizeSa to yuvAna dardIone mATe A davAnI ADaasaro ciMtAjanaka hoya che. tethI DaoNkTaroe AvI davA vadhu paDatI na vAparatAM dardInI takalIka mujaba amuka hada sudhI ja vAparavI joIe. . tene badale navA prakAranI TrITamenTa jene boDhulInIyama iMjekzana (boToksa | DispoTa) kahe che te je te snAyumAM yogya mAtrAmAM vAparavAthI A badhA prakAranA DisTonIAmAM saMtoSakAraka pariNAma lAvI zakAya.

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mUvamenTa DiorDarsa ane DisTonIA 101 AthI upara jaNAvelA sarvAMikala DisTonIA (TorTIkolIsa)thI mAMDIne blepherospAjhama, hemIphesIyala DisTonIA, rAiTarsa kraeNmpa vageremAM A auSadha jAdui rIte aksIra ane upakAraka mAlUma paDyuM che. A iMjekzana ApavA mATenI yogya TreniMga pAmela nyuraoNlaoNjisTa DaoNkTaro bhArata dezamAM muMbAI, amadAvAda, kolakAtA ane dilhI tathA anya zaheromAM che. A iMjekzana kayA snAyumAM keTalI mAtrAmAM ApavuM te tabIba nakkI kare che jethI tenI ADaasara na thAya dA.ta., je snAyu vadhu kheMcAyelo raheto hoya temAM A iMjekzana ApavAthI snAyumAM saMtulana AvI jAya che, kriyAo barAbara thAya che ane kheMcANathI darda rahetuM hoya to te paNa jatuM rahe che. kaoNsmeTika rIte paNa dardIne sAruM rahe che ane te vyavasAya, nokarI pharIthI yathAvat karI zake che. A iMjekzana moMghuM hoya che jeno kharca hemIphesIala spAjhamanA mATe Azare 4thI 5 hajAra rU. thAya. blepherospAjhama mATe rU. 6 hajAranI AjubAju thAya. dara 4thI 6 mahine tenI asara sAmAnya rIte nAza pAmatI hovAthI pharI ApavuM paDe che. kyAreka kayA snAyumAM injekzana ApavuM e sacoTa rIte jANavuM agharUM paDe to i.ema.jI. nAmanA snAyuonA TesTanI madadathI te snAyu zodhavo paDe che ane kvacit jo koI Dojha vadhu paDI jAya to te snAyunI kAmagIrI thoDA divaso mATe nabaLI paDI jAya, jema ke AMkhanuM popacuM DhaLI javuM (blepherospAjhama mATe popacAmAM iMjekzana apAya che). AthI A iMjekzana phakta niSNAta nyuraoNlaoNjisTa athavA evI rIte yogya TreniMga pAmelA phijhiziyana pAse ja levuM joie. A boTyulinIyama IMjekzana je boToksa, DisporTa vagere nAmathI maLe che, te be cetAtaMtu jyAM bhegA thAya te sAyanepsanA prisAyanepTika kolInarjika Tarminala para evI rIte baMdha (baoNnDa) banAve che ke jethI cetAtaMtuthI kaMTrola thayela snAyupezIonuM phaMkzanala Dinardezana kare che ane tethI te snAyunI pezIone kamajora banAve che. A kamajorI pachIthI dhIre dhIre jatI rahe che. A boToksa IMjekzana sAravArano vyApa ati jhaDapathI vistarato jAya che, jethI DisTonIA sivAya jyAM paNa snAyuo kheMcANa anubhavatA hoya athavA snAyumAM darda UbhuM thatuM hoya tyAM vAparavAmAM Ave che. lakavA pachI snAyuomAM AvatuM kaDakapaNuM (spasticity) ane tenI sAthe aMgomAM thatI vicitra

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102 magaja ane jJAnataMtunA rogo sthiti(Posture)mAM boToksa iMjekzanathI ghaNo phAyado thAya che. paraMtu 4thI 6 mahine tenI asara pharI ochI thaI jAya che. serIbrala pAlsIthI kaDaka thayelA hAthapaganI sAravArathI laIne snAyuonA dukhAvA ane uMmarane chupAvavA karacalInI TrITamenTa sudhI A badhAmAM boDhulInIyama iMjekzana upayogI che tevuM siddha thayuM che. teno Dojha nAnA snAyumAM 2 yuniTathI mAMDIne kula 150-200 yuniTa sudhI hoI zake. davAo tema ja khAsa karIne boDhulInIyama TokSinanA upacArathI moTA bhAganA AvA DisTonIyA kAbUmAM rahe che paNa kyAreka jarUra paDye sarjarI paNa karAvI zakAya che. sarjarImAM rAIjhoTomI, Dinarvezana prosijara vagerethI sAravAra karAya che. kyAreka spAInala kaoNrDa sTimyulezana karavAmAM Ave che. DisTonIAnA koI kesamAM cAmaDI para lagAvelA paTTA (plinTa) vAparI zakAya che. DisTonIAnA keTalAka kesone sekanDarI DisTonI kahe che. temAM magajamAM koIne koI prakAranI khAmI hoya che, jema ke koSonA cayApacayanI vArasAgata bImArI, vilsana Dijhijha, AnuvAMzika DisTonIyA (DisTonI A makyulophormansa), magajanI gAMTha, lohInI khAmI, keTalIka davAonI ADaasara vagere. AmAMnA keTalAkamAM kAraNane dUra karavAthI DisTonIAmAM rAhata thAya che. keTalAkamAM kAraNane sArI rIte kAbU karI zakAtuM nathI. | DisTonIA sivAyanA keTalAka anya mUvamenTa DisaoNrDarsa paNa atyaMta agatyanA che. (B) sizl24.1 (Chorea) : bejhala geglIAmAM AvelA kaoNDeTa nyuklIyasanI kAmagIrImAM muzkelI sarjAvAthI, hAthapaga-garadana-moDhAnuM vicitra, ahetuka halanacalana ke je ghaNI vAra kramabaddha rIte punarAvartita thAya che. (1) rumeTika phIvara tarIke oLakhAtA sAMdhAnA rogathI thato korIA (2) haMTigTana korIA(vArasAgata) (3) senAIla korIA (4) DipleriyA, jupiMga kapha (kAlI khAMsI, uTAMTiyuM) rubelA tathA ensephelAITisa vagere rogomAM thato korIA (5) thAiraoNiDanA srAva vadhI javAthI thato korIA (6) vilsansa Disijha, nyuro ekenyosIsa korIA

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mUvamenTa DiorDarsa ane DisTonIA 103 (7) davAonI ADaasarathI thato korIA - khAsa karIne mAnasika rogonI davAo, garbhanirodhaka goLIo, lithiyama, UlaTInI davAo, pArada jhera, A badhAM kAraNothI korIA thaI zake che. korIAmAM agAu jaNAvyA mujaba DopAmIna tattva vadhI jAya che, tethI DopAmInane avarodhe tevI heloperIDola, klopromejhIna, TeTrAbenAjhIna ane resarpIna vagere davAo vAparavAmAM Ave che. (C) dhrujArI-kaMpana Tremara (Tremor) : hAthapaganAM AMgaLAMnI ke kyAreka garadana-hoThanI kramabaddha, parivartita ane ekasarakhI dhrujArIne Trema2-kaMpana kahe che. A sauthI vadhu pracalita mUvamenTa DisUoNrDara che. ghaNI vAra svastha mANasone paNa thAka, kaMTALo, davAnI asara, kaoNphI, garbhAvasthA jevI paristhitimAM paNa dhrujArI jaNAya che. davAomAM sTIraoNiDa, damanI (sAlabyuTAmola, thIophAilIna) davAo, lithiyama, TrAisAiklika tathA enTisAyakoTika jevI mAnasika roganI davAo ane kheMca mATe vaparAtI vAljhoeTa davA mukhya che. thAiraoNiDa hormonanuM pramANa vadhavAthI paNa Tremara Ave. keTalAka kissAomAM Tremara vArasAgata hoya che, jene phaeNmilIala -esenzIala Tremara kahe che. keTalAkane uMmarane lIdhe Tremara Ave, vaLI pArkinsonijhamanA mukhya lakSaNamAM Tremarano samAveza thAya che. vilsansa DisijhamAM paNa dhrujArI AvI zake. Ama alaga alaga kAraNothI thatA TemaramAM alaga alaga davAo vaparAya che, jema ke bITA blokara (propenolola), DAyAaepAma, klonAjhapAma, gAbApenTIna, prImIDona, pArkinsonijhama mATe DopAmInarjIka davAo. to keTalAka kesamAM sarjarIthI paNa phAyado thaI zake. (D) Tiksa (Tics) : jhaDapI, parivartita Teva jevI lAgatI halanacalananI prakriyAne Tiksa kahe che. pAMca TakA bALakone AvI 'Teva' hoya che, je taruNAvasthAmAM jatI rahe che dA.ta. koI davAnI ADaasara ke vAirasanA rogathI paNa Ama thAya che. paNa je kharAba jAtanI Tika che, te Gilles de la Tourettee Syndrome mAM jovA maLe che jemAM TiksanI sAthe sAthe vartaNUkamAM pheraphAra, (ADHD, OCD) tathA kharAba bhASA jovA maLe che. AnI yogya TriTamenTa karavI joie.

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1 /4 magaja ane jJAnataMtunA rogo vilsansa Disijha : have ApaNe eka agatyanA roga -- vilsansa DisijhanI - vAta karIe. te ApaNA dezamAM khUba pracalita che ane samayasara nidAna karIne sAravAra karavAmAM Ave to dardI lAMbo samaya sAro-sAjo rahI zake che. A AnuvaMzika roga eTIpI 7bI nAmanA proTInanI khAmIthI thAya che, jenuM kArya khorAkamAMthI zarIramAM AvatA tAMbAnuM (copper Metal) pramANa jALavI rAkhavAnuM che ane te vadhArAnI dhAtuno nikAla kare che. A proTInanI khAmIthI zarIramAM vadhAre pramANamAM tAMbu (Copper Metal) jamA thAya che. temAM yakRta ane magaja mukhya che. A roganI zarUAta sAmAnya rIte taruNAvasthAmAM yakRtanA roganAM lakSaNo (jema ke kamaLo)thI thAya che ane dhIme dhIme temAMthI yakRtamAM cAMduM paDe che (sIrosIsa-cirrhosis) ane kamaLI paNa thaI zake che. magaja upara tenI asara vizeSa rIte jovA maLe che. temAM kaMpavAta eTale ke dhrujArI AvavI, korIA, DisTonIA jevA peja naM. 99mAM jaNAvyA mujaba ekAineTika rIjIDa sinDroma athavA hAIparakAineTika DisUorDasa baMne prakAranAM lakSaNo jovA maLe che. anya lakSaNomAM bolavAmAM ane khAvAmAM asaMtulana thavuM, kheMca AvavI, buddhino kSaya thavo vagere..... ghaNIvakhata pezAba ane maLabhAganuM niyaMtraNa na rahevuM, bI.pI. ghaTI javuM ane parasevo na thavo vagere jevA anaicchika cetAtaMtranAM lakSaNo paNa jovA maLe che. mAnasika roganAM lakSaNo jevAM ke asAmAnya vartana, raDavuM, Diprezana, vadhAre paDatuM halana-calana vagere paNa jovA maLe che. jo roga AgaLa vadhe to vizeSa rIte hADakAMnI khAmI, mUtrapiMDanI kSati, lohImAM vikAro jema ke enimiyA vagere paNa jovA maLe che. A roganA nidAna mATe sauthI sAdI chatAM mahattvanI, AMkhanI tapAsamAM (salt-lamp mAM) bhUkharA raMganI ke. epha. rIMga jovA maLe che. vizeSamAM lohImAM ghaTatuM sirama serayuloplAjhamina ane vadhatuM tAMbAnuM pramANa, ane covIsa kalAkamAM pezAbamAM tAMbAnuM pramANa vagere mahattvanAM che. yakRtamAM cAMduM paDe to madaaMze peTanI sAdI sonogrAphIthI pakaDAI zake che. sacoTa nidAna yakRtanI bAyopsI (soyathI tapAsa) dvArA ja karI

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mUvamenTa DisaorDarsa ane DisTonI 105 zakAya che. A roganI sAravAra mATe jhiMka (jasatanA kSAra), penisilAmAina, TrAyenTina vagere mahattvanI davAo che, paraMtu kaI davA kyAre ane keTalA DojhamAM levI te to DaoNkTara ja nakkI karI zake, kAraNa ke davAnI ADaasara paNa che. A ja rIte hADakAMnI, mUtrapiMDanI kSati, lohInA vikAro vagerenI lagatI sAravAra paNa jarUrI che. jo yakRta vadhu paDatuM bagaDI gayuM hoya tevA saMjogomAM yakRta badalavAnI sAravAra apAya che, je atizaya kharcALa che. Ama mUvamenTa DisoNrDasUno koI paNa dardI khAsa karIne taruNAvasthA ane yuvAvasthAmAM hoya to teno roga vilsansa Disijha che ke nahi te jovuM atyaMta jarUrI che. A chelle, keTalIka elopethika davAnI ADaasarathI thatAM mUvamenTa DisaorDarsanI noMdha karIzuM : (1) DiskAinesIA : phInothAyejhInsa, lIvoDopA vagere davAthI thatA korIA, DisTonIyA (2) DisTonIA : nyurolepTika grUpanI davAothI thatI hAthapaganI vicitra kheMcANabharI avasthA (3) ekIthIsIyA : enTisAyakoTika davAothI thatI eka prakAranI ajaMpAbharI paristhiti (4) pArkinsonijhama : dA.ta., heloperIDola, mAnasika rogonI davAothI thato kaMpavAta (5) korIA : dA.ta., garbhanirodhaka davAo (6) nyuraoNlepTika melignanTa sinDroma : enTIsAyakoTika davAonI ADaasarane pariNAme thaI zake, jemAM tAva Ave, zarIra jakaDAI jAya. lohImAM sI.pI.ke. enjhAIma vadhI jAya. (7) TArTiva DiskAIsIA : nyuraoNlepTika davAonA lAMbA gALAnI vaparAzathI thatA korIA, DisTonI vagere. (8) sIroTonIna sIndroma : hatAzA-DiprezananI sAravAramAM vaparAtI sIroTonIna vadhAravAnI davAothI dhrujArI, gabharAmaNa tathA tAva, asaMtulana jevAM lakSaNo-cihno thAya.

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106 magaja ane jJAnataMtunA rogo ATaluM jarUra jANo magajanAM ekasTrA pirAmiDala sisTamamAM bejhala gengaliyAna kAryavAhImAM rukAvaTa AvavAthI kaMpana, DisTonIA, korIA jevAM mUvamenTa DisaorDasa thAya che je DopAmIna nAmana tattvanAM asaMtulanathI thAya che. sarvAIkala DisToniyA, hemiphasIyala spAjhama, blephero spAjhama, rAITarsa kempasa vagere DisTonIAnA prakAra che. mUvamenTa DisaorDaramAM DisTonIAnI sAravAra mATe vaparAtI davAnI ADaasaro vadhu hoya che, eTalA mATe eka navA prakAranI sAravAra jene boTulInama injakazana kahe che, te AjakAla vadhu pracalita che. A IjekazananI koI khAsa ADaasara nathI. bejhala gengaliyAmAM rahela koDeTa nyuklIyasanI kAryapraNAlImAM samasyA thavAthI hAtha-paga, garadana, mukha vagerenuM vicitra ardha-hetupUrvaka halana-calana kramabaddha rIte punarAvartita thayA kare che, jene korIA kahe che. hAtha-paganI AMgaLIonAM athavA garadana, hoTha vagerenAM kramabaddha parivartita athavA eka sarakhAM kaMpanane Trekara kahe che. zIgha parivartita, Adata jevI lAgatI halana-calana prakriyAne Tiksa kahe che. keTalIka elopathI davAnI ADaasarathI paNa mUvamenTa DisaorDarsa thaI zake che.

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kaMpavAta (pArkinsonijhama) sane 1817mAM DaoN. jemsa pArkinsane sau prathama magajanA A roganAM lakSaNonI vistRta mAhitI ApI hatI tethI A roga temanA nAme oLakhAya che. vayaska lokono A mUMjhavato ane pracalita roga che, jemAM magajanA sasTensiyA nAyagrA' nAmanA koSo koI kAraNasara kSatigrasta thaI nAza pAmatA jAya che tyAre 'DopAmina'nAmanuM breinanuM agatyanuM jaivika rasAyaNa banatuM ochuM thaI jAya che. tenAthI halanacalana dhImuM ane maMda thaI javuM, dhrujArI (kaMpana), snAyuonuM kaDakapaNuM vagere lakSaNo udbhave che. tenI zarUAta moTe bhAge zarIranI eka bAju eTale ke jamaNA ke DAbA aMgathI thAya che. amuka dardIomAM AgaLa jatAM thoDAM varSomAM te baMne aMgomAM prasarI jAya che. 9 lakSaNo : (1) ArAmanI paLomAM ke beThAM beThAM paNa hAtha-paganI AMgaLIonI viziSTa prakAranI (pIlaroliMganI jema athavA nANAnI noTo gaNatA hoya tevA prakAranI) layabaddha dhrujArI (Tremors) (2) saheja namIne nAnAM-jhaDapI pagalAM bharI cAlavuM tathA cAlatI vakhate hAthanuM halanacalana ochuM thavuM. (3). aicchika snAyuonI badhI ja kriyAo ochI thavI ane dhImI thavI (bradykinesia) (4) hAtha-paga tathA caherAnA snAyuo kaDaka thatA javA (rigidity) (5) akSara nAnA thaI javA. (6) cAla dhImI paDI javI, cAlatAM calatAM sthagita thaI javuM. (7) yAdadAstamAM ghaTADo thavo, Diprezana AvavuM, khUba parasevo thavo, zarIre kaLatara thavI, avAja dhImo ane kaMTALAjanaka (monotonous)

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108 magaja ane jJAnataMtunA rogo thaI thavo, caherAnA hAvabhAva ochA thavA-adazya thavA, moDhAmAMthI lALa paDavI ane AMkhonI pAMpaNonI ughADabaMdha thavAnI prakriyA maMda, ochI thavI. AvAM lakSaNo jaNAya to DaoNkTarane maLI roganuM nidAna karAvavuM jarUrI bane che. tabIbI dRSTie A rogane judI judI pAMca avasthAmAM (stages) vaheMcI zakAya che. A roga uMmarathI thatA magajanA ghasAro (wear and tear) sAthe saMkaLAyelo-joDAyelo che paraMtu tenAM cokkasa kAraNo hajI saMpUrNapaNe jANI zakAyAM nathI. keTalIka vAra davAonI ADaasarathI, mAthAmAM IjA thavAthI, jherI gesa ke jaivika rasAyaNothI thatA nukasAnathI ke vAyarasathI, vilsansa DisijhathI ane asAmAnya saMjogomAM vArasAgata kAraNothI paNa A roga thAya che. joke moTA bhAganA dardIomAM koI paNa samajI na zakAya tevA ajJAta kAraNathI ja (IDiyopethika) A roga thAya che. kyAreka A roga bIjA koI moTA roganA bhAgarUpe paNa jovA maLe che, jema ke malTIsisTama eTrophI athavA progresiva suprAnyukliyara pAlsI. temAM agAu jaNAvelI dhrujArI sivAya paNa ghaNAM anya lakSaNo jaNAya che. Azare dara 500mAMthI eka vyaktine pArkinsonijhama thaI zake che. 60 varSathI vadhu vayanA Azare 1.pa% loko A rogathI pIDAya che. keTalIka vAra yuvAnImAM paNa A roga thato jovA maLe che. jyAre "DopAmina' nAmanuM magajanuM rasAyaNa utpanna karanAra 80 TakA jeTalA koSo nAza pAme tyAre pArkinsonijhamanAM lakSaNo dekhA de che. Ama to pArkinsonijhama roganI tapAsa mATe koI viziSTa tapAsanI jarUra nathI hotI chatAM paNa jyAre nidAnamAM koI zaMkA hoya ke pArkinsana plasa sinDromanI zakyatA hoya (jenA vize ApaNe AgaLa jANIzuM) to ema.Ara.AI. ke spekTa ke phaMkzanala ema.Ara.AI. karAvavuM joIe.

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kaMpavAta (pArkinsonijhama) 109 A koSone nAza pAmatA aTakAvavAnI koI cikitsA ke davA nathI. tethI A rogane jaDamULamAMthI nAbUda karI zakAto nathI. paraMtu niyamita rIte davA, sAravAra karavAthI tenA ghaNAM lakSaNo para mahad aMze kAbU jarUrathI meLavI zakAya che. Adhunika cikitsA paddhati tathA vyAyAma ane yoga dvArA A rogamAM rAhata meLavI zakAya che. sAravAra tabIbI upacAra mATenI davAomAM mukhyatve livoDopA, DopAmina egonisTa (ropInIrola, premIpekSola, bromokriSTina), enTAkaeNpona ane enTikolinajIka davAo (pesiTena) vagere davAo vaparAya che. A paikI livoDopA e mukhya davA che, te magajamAM DopAmina nAmanuM tattva sIdhesIdhuM dAkhala karAvI de che je tattvanI kamIne lIdhe ja A roga thato hoya che. jeTalA pramANamAM lakSaNo tene anusAra DaoNkTara davAnI mAtrA nakkI karI ApatA hoya che. jarUra paDye niSNAta DaoNkTaranuM mArgadarzana jarUrI hoya che, kema ke A davAnI ADaasara paNa vadhu hoya che. A davA judA judA pramANamAM, judA judA saMyojanamAM tema ja goLI, pravAhI ane pampanI madadathI paNa dardIne ApI zakAya che. ghaNA niSNAta tabIbo A davAne badale roganA prAraMbhika tabakkAmAM pesiTena, emenTiDIna, bromokiSTina, premIpekSola ane DrAIvAsTAla vagere davAothI calAve che ane jyAre roga bIjI ke trIjI avasthAmAM (zarIramAM baMne bAju asaro kare) hoya tyAre ja livoDopA ApatA hoya che, jenAthI dardI davAnI ADaasara sivAya lAMbuM jIvI zake che. navA saMzodhana pramANe selijelIna (DopAmIna egonIsTa) nAmanI davA paNa jo zarUAtanA tabakkAmAM ApavAmAM Ave to roganI AgaLa vadhavAnI gati jarUrathI thoDIka dhImI paDI zake. tabIbI daSTie A roga pAMca avasthAo (stages)mAM vaheMcAyelo che. dA.ta., prathama tabakkAmAM zarIranI eka ja bAju dhrujArI

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110 magaja ane jJAnataMtunA rogo ke kaDakapaNuM Ave, jyAre aMtima tabakkAmAM dardI-pathArIvaza hoya. je te avasthAmAM dardIne kaI davA ApavI te nyuraoNphijhiziyana nakkI karatA hoya che. ahIM e spaSTatA jarUrI che ke koI paNa be dardInI sAravAra mATe davAo ekasarakhI ja hoya tevuM nizcita nathI hotuM. chellAM keTalAMka varSomAM A roganA nirmulana mATe atyaMta mahattvapUrNa zodhonA kAraNe tabIbo tathA dardIomAM AzAnuM kiraNa jaNAyuM che. premiprekSaoNla, ropInIrola, TaoNlakepona, eNnTAkepona jevI davAo atiasarakAraka chatAM ochI ADaasaravALI jovA maLe che jenAthI dardIne khUba ja rAhata thaI zake. atyAra sudhI A davAo ApaNA dezamAM na banatI hovAthI te ghaNI kharcALa hatI paraMtu tAjetaramAM ropInIrola (Ropark), uulumet (Premirole, Remipax) 247 24-21suly (Entacom, Alcapone) bajAramAM upalabdha thaI che. viTAmina I tathA bIjAM keTalAMka dravyo levAthI paNa A roganI mAtrA kadAca ghaTe che evuM keTalAka mAne che paraMtu A bAbatamAM hAla sarvasaMmati nathI. sarjarI : vizeSa camatkArika vAta to navI sarjarInI che. dAyakAo pUrve pArkinsonijhama sarjarInI zodha karavAmAM AvI hatI paraMtu livoDopA davAnA AviSkArane lIdhe rogamAM camatkArika phAyado thatAM sarjarIno yogya vikAsa thaI zakyo nahi. livoDopAnI davAnI lAMbegALe thatI ekadhArI ADaasaro vize tabIbonuM dhyAna jatAM pharIthI pArkinsonijhamane lagatI sarjarIno vikAsa chellA dAyakAmAM thayo ane have to temAM dinapratidina anubhava umerAto javAthI sarjarI salAmata ane svIkArya thatI jAya che. sarjarI kayA kesamAM kyAre karavI tema ja kayA prakAranI karavI te vAta paNa AjakAla tabIbI parikRdono mahattvano mudo banI rahela che je AnaMdanI vAta che. pArkinsonijhamanA kesamAM traNa prakAranI sarjarI thaI zake.

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kaMpavAta (pArkinsonijhama) 111 (1) eblezana sarjarI: AmAM pArkinsonijhama thavAnA kAraNabhUta magajanA koSonI sarakiTamAM yogya jagyAe cheda-ghA (Ablation) karavAmAM Ave che. cheda mATe sTirioTeksInI paddhatino upayoga karavAmAM Ave che. Avo cheda thelemasamAM, pelIDamamAM ke sabathelemika nyukliyasamAM karavAmAM Ave che. te mujaba tene thelemoTaoNmI, pelIDoTaoNmI vagere nAma ApavAmAM Ave che. thelemoTomI mukhyatve dhrujArI jenuM lakSaNa hoya ane dardI yuvAna hoya temAM karavAmAM Ave che. livoDopA davAne lIdhe thatI ADaasaro jema ke DiskAinejhIyA vagere dUra karavA pelIDoTaoNmI karI zakAya. A sarjarIthI dhAryuM pariNAma maLe kharuM paNa eka vAra cheda karyo te bhAga kAyama mATe chedagrasta rahevAno. vizeSamAM, kyAreka oNparezanane lIdhe lohI jamA thavuM (hematoma), cepa lAgavo vagere vikriyA paNa thaI zake, joke AnuM pramANa ochuM hoya te jarUrI che. A sarjarIno kharca 30thI 60 hajAra rUpiyA jeTalo thaI zake. A sarjarI baMne bAju karavI jokhamI thaI paDe che tethI sAmAnyataH eka bAju karavAmAM Ave che. (2) sTimyulezana TekanikaH koI paNa bhAga kAyamI chedagrasta na karavo hoya ane ilekTrika paddhatithI jarUra pramANe ja niyaMtraNa karavuM hoya to je te bhAgane khUba vadhu (sTimyuleTa) uttejita karavAthI te bhAganI kAryazakti kuMThita thaI jAya che. A vaijJAnika satyane AdhAre A paddhati vikasAvavAmAM AvI che. magajanA uparanI eblezana sarjarImAM jaNAvelA bhAgone ahIM Hyperexciteatiuttejita karavAmAM Ave che. te mATe sTimyuleTara - ilekTroDa ane sarkiTa mUkavAmAM Ave che. " Ama, zailemika sTimyulezana, pelIDala sTimyulezana ane sabavaeNlemika sTimyulezana ema traNeya paddhati vikaselI che. paraMtu hAlanA tabakke sabathelemika sTimyulezana TekanikanAM pariNAmo sauthI sArA jaNAyAM che.

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112 magaja ane jJAnataMtunA rogo - A paddhatino eka phAyado e che ke te bhAgone kAyamI nukasAna thatuM nathI. vaLI uttejanA ochIvattI karavAthI pariNAma badalI zakAya che. tenI ADaasaro paNa ochI hoya che paraMtu te atikharcALa che. eka bAjunI sarjarIno sTimyuleTara sahitano kharca rU. 4thI 5 lAkha Ave. A mazIna baMne bAju paNa mukAvI zakAya. keTalAka kesomAM kharca ghaTADavA ane bIjAM kAraNosara eka bAju sTimyuleTara ane bIjI bAju eblezana sarjarI karavAmAM Ave che. Ama karavAthI zarIranI baMne bAju roga prasarelo hoya to temAM sArI rAhata maLe che. A badhI sarjarI ApaNA sArA nasIbe ApaNA dezamAM paNa amuka senTaromAM upalabdha che ane teno vyApa vadhato jAya che. paradezamAM to vImAnA (meDikala inzyoransanA) pracalanane kAraNe sarjarI vadhu jhaDapathI vistaratI jAya che. koSa pratyAropaNa- sela TrAplAnTezana sarjarI : A sarjarI hajI prAyogika tabakkAmAM che tema kahI zakAya. AmAM eDrinala graMthinA koSone dardInA magajamAM prasthApita karavAmAM Ave che. thoDA samaya pahelAM, ardhavikasita garbhanA koSonuM pratyAropaNa paNa khUba pracalita thayela paraMtu temAM keTalAka tabIbI-kAyadAkIya tema ja naitika prazno Ave che. A badhAM kAraNone laIne AvI TrAnsaplAnTa sarjarI joIe teTalI pracalita nahIM thaI zake tema mAruM mAnavuM che. meDikala tathA sarjikala prakAranI A sAravAra uparAMta niyamita vyAyAma karavo, AnaMdamAM rahevuM, samUhamAM maLavuM ane yogopacAra karavo vagere paNa saphaLa sAravAranAM upayogI paribaLo che, je cokkasapaNe dardInI sAravAramAM agatyano bhAga bhajave che.

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kaMpavAta (pArkinsonijhama) 113 TUMkamAM, pArkinsana rogathI have gabharAvAnI bilakula jarUra nathI. zakya teTaluM vaheluM nidAna, sacoTa sAravAra, niSNAta phijhiziyana athavA nyurophijhiziyananuM mArgadarzana, samUha cikitsA, cUpa therapI, kasarata-yoga ane jarUra paDye sarjarI vagere dvArA A rogane mahad aMze nAthI zakAya che. amadAvAda muMbAI jevA zaheromAM pArkinsonijhamathI pIDAtA dardIonuM eNsosiyezana (saMgaThana-maMDaLa) che je A dardIone upayogI mAhitI pUrI pADe che grUpamAM yoga-dhyAna, kasarata zIkhave che ane suMdara sevAo pUrI pADe che. pArkinsana-plasa sinDromsa : - pArkinsana jevAM lakSaNovALA nignalikhita rogomAM samayasara nidAna karAvavuM khUba jarUrI che kAraNa ke A rogomAM pArkinsananI davA jhAjhI upayogI sAbita thaI nathI ane jo jaladIthI nidAna karIne yogya sAravAra na apAya to A roga bahu jhaDapathI AgaLa vadhI jAya che ane dardI pathArIvaza thaI jAya che. (1) malTIsisTama eTrophI (MSA) : A rogamAM pArkinsananAM thoDAMka lakSaNo to hoya ja che. sAthe sAthe (a) zArIrika asaMtulana, paDI javuM, bolavAmAM takalIpha tathA hAthanI kriyAomAM paNa takalIpha udbhave che. nAnA magajanuM kArya bagaDavAne kAraNe AvuM thatuM hoya che. (ba) anukaMpI - parAnu kaMpI taMtra (autonomic system) bagaDavAthI ekadama UbhA thaI jatAM blaDaprezara ghaTI jAya che. pezAba aTake che athavA kapaDAmAM ja thaI jAya che. AmAM pArkinsana sivAya paNa be bIjAM taMtramAM musIbata udbhavatI hovAnA kAraNe Ane malTIsisTama eTrophI kahe che.

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114 (2) Diphyujha levI boDI DisIjha (DLB) : AmAM roganI zarUAtamAM ja yAdadAsta ghaTavI, azakti lAgavI, bhramaNA thavI, sabhAnatAmAM noMdhapAtra vadha-ghaTa thavI vagere jevAM lakSaNo dekhAya che ane tyAra bAda pArkinsananAM lakSaNo udbhave che. cittabhrama mATenI davAonI moTA bhAge AmAM ulaTI asara thatI hoya che ane zarIra jakaDAI jAya che. (3) progresiva suprAnyukliara pAlsI (PSP) : magaja ane jJAnataMtunA rogo zarUAtamAM pArkinsana jevA lAgatA A rogamAM kaDakapaNuM mukhyatve chAtI ane pIThamAM udbhave che (axial rigidity), je pArkinsana DisIjhamAM hAtha-paganA snAyuomAM uddabhave che. AMkhonA snAyuonuM halanacalana ghaTe che (supranuclear palsy). vizeSa to A roganI zarUAtamAM dardI cAlatAM-cAlatAM vAraMvAra paDI jato hoya che ane enA avAjamAM pharaka paDI jAya che. (4) korTikobejhala Dijanarezana (CBD) : AmAM kaMpavAta sAthesAthe eka bAjunA hAthanuM vicitra halanacalana paNa thAya che, (alien limb movements) ane emAMthI saMvedanA paNa nAza pAme che. hAthamAM tAkAta hovA chatAM e hAthathI kArya nathI thatuM (apraxia).

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kaMpavAta (pArkinsonijhama) ATaluM jarUra jANo magajamAM rahela sabasTenziyA nAyagrA nAmanA koSo koI kAraNaveza kSatigrasta thaIne naSTa thAya che tyAre DopAmIna nAmanA magajanA mukhya jaivika rasAyaNanuM utpAdana ghaTI jAya che, jenA kAraNe kaMpavAta (pArkinsonIjhama)nI bImArI thAya che. * moTAbhAganAM dardIomAM Tremara (dhrujArI) paheluM lakSaNa hoya che. anya lakSaNomAM snAyuonuM kaDaka thaI javuM, kArya karavAnI gati ghaTI javI, yAdazakti ghaTI javI, Diprezana thavuM, caherAnA hAvabhAva adRzya thaI javA, moDhAmAMthI lALa TapakavI vagere jovA maLe che. AgaLa jatAM dardI eka pUtaLA jevo thaIjAya che. paraMtu sabhAnatA ane buddhicAturya chellA zvAsa sudhI TakI rahe che. livoDopA, DopAmIna egonisTa ane pesiTena vagere davAothI A roganAM lakSaNo ThIka thaI zake che. 0 A roganAM upacAra mATe have ghaNI sArI navI davAo upalabdha che ane sarjarI jema ke eblezana, sTImyulezana ane sela TrAnsaplAnTezana vagere paNa upayogI che. eTale ke A roganAM dardIone davA athavA oparezanathI ghaNuM sAruM thaI zake che, paraMtu davA kAyama levI paDe che. 115

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116 magaja ane jJAnataMtunA rogo pArkinsonIjhama jevA lakSaNovALA anya cAra roga MSA, DLB, PSP ane CBD che, jemAM pArkinsonijhamanI davA eTalI sacoTa nIvaDatI nathI, ane A cAreya rogamAM dardI khUba jaladI parAvalaMbita thaI jAya che.

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(10) - Rtiza - matibhraMza (DimenziyA); yAdazakti vadhAravAnA upAyo DimenziyA : jene ApaNe sAmAnya zabdomAM smRtibhraMza tarIke oLakhIe chIe tene mATe matibhraMza nAma vadhAre yogya lAge che (mati=buddhi). temAM vyaktinI yAdazakti, vicArazakti, bhASA samajavAnI ane samajAvavAnI zakti) tathA vartanamAM UNapa Ave che. dardInAM vANI, vartana, vyaktitva ane vyavahAramAM AvatA noMdhapAtra pheraphAra sAthe tenI cetanA paNa ochI thayela jaNAya che. Ama buddhimattAnI UNapanA kAraNe vyavahArika jIvanamAM keTalAka prazno udbhave che. DimenziyAnAM kAraNo : Ama to DimenziyA thavAnAM ghaNAM badhAM kAraNo hoI zake. Azare 80 TakA dardIomAM AnuM kAraNa AljhAImarsa roga athavA to vAkyulara DimenziyA hoya che. A uparAMta phranToTemporala DimenziyA, levI baoNDIjha, normala prezara hAIDrosiphesala, jekaba kujhaphelDaTa-DisIjha,korTiko bejhala DisIjha, hanTiMgaTana DisIjha, sabakorTIkala bhUkoensephelopathI, e.ela.esa. jevA rogomAM paNa DimenzimAM jovA maLe che. viTAmina BnI UNapa, thAiroiDa, perAthAIroIDa ane DAyAbiTIsa jevA rogo tathA keTalAMka jherI dravyo ane bhAre dhAtuonI viSama asara.... Ama, aneka kAraNosara DimenziyA thaI zake. (1) Alzeihmer's Dementia : (AjhAimarsa DimenziyA)nAM lakSaNo-cihano A roganI zarUAtamAM nIce jaNAvyA pramANenAM lakSaNo jovA maLe che : * bhASAnI takalIpha (samajavAnI ane arthapUrNa bolavAnI - takalIpho UbhI thAya che.

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118 magaja ane jJAnataMtunA rogo yAdazakti (tAjetaranI athavA bhUtakALanI vAto yAda rAkhavAnI zakti)mAM ghaTADo. ghaNA vakhata sudhI jUnI yAdadAsta ThIka-sArI rahe. dardI rojabarojanI ghaTanAo ane paricita vyaktionAM nAma bhUlavA mAMDe che. sagAMsaMbaMdhI, mitro ane ciraparicita vastuo oLakhavAmAM thApa khAya ane cIjavastuo ADIavaLI mukAI jAya. sthaLakALanuM bhAna ochuM thavuM. nirNayazakti ghaTavI. nIrasatA vadhavI, Diprezana AvavuM, atizaya krodha Avavo. roga AgaLa vadhatAM, A dardIone temano rojiMdo krama nibhAvavAmAM tathA rojabarojanAM kAmakAjamAM paNa takalIpha paDavA lAge che. sAphasUphI, rasoI ke kharIdI jevI bAbatomAM paravaza thaI jAya che. nahAvA, dhovA ane vastraparidhAna mATe paNa tene madadanI jarUra paDe che. rasto na jaDavo, ghara na jaDavuM, bAtharUma zodhavAmAM muzkelI. vAtacIta karavAmAM ane haravApharavAmAM paNa muzkelI paDavA lAge che. jAtajAtanA bhrama thavA lAge. dardIne khAvApIvAmAM takalIpha thAya. saMjogonuM vizleSaNa karavAmAM akSama thaI jAya. haravA pharavAmAM takalIpha UbhI thAya. vyaktitvamAM parivartana AvavAthI dardI AptajanothI vikhUTo paDI jAya che. *

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smRtibhraMza - matibhraMza (DimenziA) yAdazakti vadhAravAnA upAyo jhADA-pezAbanuM bhAna gumAve. jAheramAM ajugatuM-vicitra vartana kare. tabIbI cikitsAnI STie traNa tabakkAmAM vaheMcAyelA A roganA chellA tabakkAmAM dardI saMpUrNapaNe parAvalaMbI banI jAya che. kAraNo tathA upacAra 119 AlajhAimarsa thavAnuM cokkasa kAraNa jANI zakAyuM nathI paraMtu dardInAM vicAra, yAdadAsta ane bhASA para niyaMtraNa rAkhatA magajanA koSo nAza pAme che. Ama thavAnA kAraNamAM lohInuM ghaTeluM paribhramaNa, koI cepa (inphekzana) ke vadhatI uMmara ema nathI hotuM. Ama to keTalIya vizvavikhyAta vyaktione A roga lAgu paDela che te eka jagajAhera vAta che, jema ke amerikAnA bhUtapUrva pramukha ronAlDa rIgana, riTA hevartha, zugara re robinsana, I.bI.vhAiTa tathA anya... A roganI koI cokkasa davA hajI sudhI zodhAI nathI. roganAM lakSaNonI tIvratA ghaTADavAnI navatara davAonI zodhakhoLa cAlI rahI che. ema thaze tyAre, davAo dvArA A dardIo mATe madada karI zakAze. rojabarojanI jiMdagImAM AvatI aDacaNo nivAravA dardI tathA tenAM sagAMo pAse paddhatisaranI mAhitI ane tAlIma hovAM jarUrI che. nidAna * AgaLa jaNAvela lakSaNo uparAMta dardInI sabhAnatA, yAdazakti, grahaNazakti ane bhASAkIya samatulAne cakAsatAM aneka parIkSaNo (Cognitive Test)thI dardIne DimenziA hovAnI vAtanuM samarthana thaI zake che: mini menTala sTeTasa ekjhAminezana, varDa lisTa memarI TesTa, varka rikaoNla TesTa, koga TesTa, eNDanabruksa TesTa jevA vividha nyuraoNsAyakolaoNjikala mApadaMDa dvArA roga ane tenI tIvratAnuM mApa nIkaLI zake che.

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120 magaja ane jJAnataMtunA rogo * lohInA TesTa, blaDazugaranuM pramANa, thAiraoNiDa TesTa, perAthAiroiDa TesTa, yakRta tathA kiDanInA TesTa, viTAmina bI-12 tathA pholika eNsiDanuM pramANa vagere paNa nidAnamAM sahAya kare che, je A roganA dardIomAM naoNrmala hoya che. * I.I.jI dvArA jekaba-phruTjhapheTa DisIjha tathA phranToTemporala DimenziyA jevA roganA nidAnane samarthana maLe che. * sI.TI. skena, ema.Ara.AI. uparAMta ema.Ara.eNnjio, spekTa (Spect), paeNTa (Pet) jevI nyuraoNimejiMga paddhationI paNa nidAnamAM kyAreka jarUra paDe che. navatara zodhakhoLa AljhAimarsanAM kAraNo ane upacAra mATe zodhakhoLa cAlu che. Azare 5%thI 10% kesomAM A roga vArasAgata hoya che. dAkhalA tarIke dardInA 19mA raMgasUtra para eNpolAipoproTIna I-4 janIna hoya to dardInA saMtAnone AljhAimarsa thavAnI zakyatA vadhu rahe che. magajanA nyuraoNnsa (koSomAM) nyuraoNphIbrilarI Tengalsa banavA, koSonI bahAra bITA emAyaloiDsa nAmanA proTInanA pleksa jamA thavA tema ja tenA lIdhe magajanA nAjuka koSone nukasAna thavuM ane sojo Avavo te A roganI eka paeNtholaoNjikala prakriyA che. paNa AvuM kema thAya che ? te hajI sudhI zodhAyuM nathI. paNa zakya che ke APOE nAmanA proTIna ane TAU nAmanAM bIjAM jaivika rasAyaNa A badhI prakriyAo mATe javAbadAra hoI zake. navuM saMzodhana A badhAMne aTakAvavAnI davAo zodhvA para kendrita thayeluM che. AljhAimarsanA dardIomAM Dojhila (Donep, Alzil, Aricep) nAmanI davA thoDI ghaNI asarakAraka che. navI vaparAtI davAmAM rivAsTizmina (Rivamer) ane tene lagatI bIjI davAonAM pariNAma vadhu sArAM che. yuropamAM gelenTemAina (Galamer) vadhu pracalita che. bhAratamAM memenTAIna (Admenta, Mentra) nAmanI davA saraLatAthI

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121 smRtibhraMza - matibhraMza (DimenziA) yAdazakti vadhAravAnA upAyo upalabdha che. prathama vadhu vaparAtI TekrIna (kogneksa) davA tenI ADaasarane lIdhe have ochI vaparAya che. sTeTIna grUpanI davAo (Atorvastatin vagere)no upayoga sAmAnya rIte lohInI carabI ghaTADavA mATe thAya che. paraMtu A davAo aljhAImara DimenziyAmAM paNa upayogI jaNAI che. bIjI navI davA/paddhati jemAM jineTika enjiniyariMga tathA kloniMgano upayoga karavAmAM Ave che te hajI prAyogika kakSAmAM che. AljhAimarsa roga mATe rasI (vekasIna) paNa taiyAra karavAmAM AvI rahI che. ApaNA dezamAM A badhI kharcALa paddhatio hajI vikasI nathI. pirAsiTAma (nAmabreiIna, ropIla) jinko bIlobA tathA aragaTa grUpanI davAo ApaNe tyAM vadhu pracalita che. (2) Frontotemporal Dementia : (iMToTemporala DimenziyA) 'vismRtinA rogomAM AljhAimaranA roga pachI A eka mahattvano roga che. AmAM phranTala laoNba ane Tembaporala lobanA koSo kramazaH nAza pAme che. tenAM lakSaNone mukhyatve be samUhomAM vargIkRta karI zakAya. vyavahAranAM lakSaNo ke vyaktitvamAM badalAva tathA Executive (netRtva) Function saMbaMdhita samasyAonAM lakSaNa. - vyavahAranAM lakSaNomAM ALasa-sustI, ayogya vartana, udAsInatA tathA potAnI jAtanI dekhabhALa nA rAkhI zakavI vagereno samAveza thAya che. jaTila kauzalya (Complex Executive Tas) darzAvavAmAM dardI asakSama bane che. A rogamAM dardInI bhASA para paNa asara thAya che. ghaNA dardIono vApravAha sAmAnya hoya che paNa teo koI cIjavastuonAM nAma ane zabda samajavAmAM muzkelI anubhave che. jyAre keTalAMka dardIonI bhASAmAM vAkyAtmaka truTi Ave che. aljhAImara roga jevA ja lAgatA A rogamAM mukhyatve nIceno taphAvata che.

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122 magaja ane jJAnataMtunA rogo mANasanI netRtvazakti, nirNayazakti tathA vizeSa buddhimattAne pahelAM asara thAya che. enA vyaktitva ane vartanamAM bahu badalAva AvI jAya che. evuM lAge jANe pahelAM hato e A mANasa ja nathI. aljhAImara rogathI judI bIjI eka vAta e che ke A rogamAM yAdadAsta saMgraha (Memory storage) ane rastAonI parakha ghaNA samaya sudhI barAbara rahe che. A roganA traNa prakAra che. (1) Frontal variant. (2) Primary progressive aphasia (3) Semantic dementia A roganAM samUha lakSaNo-cihno sahita ema.Ara.AI. nAmanI tapAsa dvArA A roganuM nidAna thaI zake che. jemAM phranTala loba ane/athavA Temporala lobanuM saMkocana (atrophy) dekhAya che. A saMkocananuM pramANa dardInA roganI gaMbhIratA mujaba hoya che. paraMtu keTalAMka dardIomAM roganI zarUAtamAM ema.Ara.AI. normala paNa hoya che. A rogamAM janInanI khAmI paNa jovA maLI che, jemAM MAFT janInamAM myuTezana athavA 17 naMbaranA raMgasUtramAM progrenyulinamAM myuTezana jovAmAM AvI che. A roganI koI cokkasa sAravAra nathI. (3) Vascular Dementia : vAkyulara DimenziyA - malTi inphArkaTa DimenziyA (MID): magajanA nAnA nAnA bhAgamAM lohInuM paribhramaNa ghaTavAthI te bhAgonA koSo nAza pAme che tyAre A sthiti utpanna che. lohInuM dabANa vadhavAthI, nAnI nAnI raktavAhinIo tUTavAthI ane lohInA jhINA gaThThA dvArA nAnI raktavAhinIomAM avarodha pedA thavAthI magajanA keTalAka bhAgomAM lohInuM paribhramaNa ghaTe che athavA baMdha thaI jAya che. aneka jagAe AvI kSatione kAraNe MID thAya che. hAI blaDaprezara (High B.P)nA kAraNe dhamanIo kSatigrasta ke sAMkaDI thaI jAya che. emAM lohInA ochA paribhramaNane kAraNe paNa A roga thaI zake che. (Deep white matter changes)

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smRtibhraMza - matibhraMza (DimenziA) yAdazakti vadhAravAnA upAyo 123 - A roganI zarUAta acAnaka thaI zake athavA temAM dhIme dhIme uttarottara (stepwise) vadhAro thaI zake. zarUAta moTe bhAge yAdazakti (khAsa karIne najIkanA bhUtakALane lagatI) ghaTavAthI thAya che. roganAM lakSaNo ane dardInI mAnasika sthitimAM vadhaghaTa thatI rahe che. Ama chatAM roga vizenI sabhAnatA, AljhAimarsa DimenziAnA dardIo karatAM vadhAre hoya che. dardInuM mULabhUta vyaktitva paNa vatteoche aMze jaLavAI rahe che. paNa roga AgaLa vadhatAM dardInI hAlata ghaNI kathaLI jAya che. sAthe lakavAnI asara paNa hoI zake, paraMtu kaI naLIo para asara che tenA para A bAbata AdhArita che. dardInAM upara jaNAvyA mujabanAM lakSaNo uparAMta sI.TI. skena, ema.Ara.AI., ema.Ara.eNnjio dvArA nidAna khUba sacoTa rIte thaI zake che. A rIte AljhAimarsanI sarakhAmaNImAM nidAna khUba saraLa che. te uparAMta lohImAM carabInuM pramANa, DokanI nasonuM keroTiDa Doplara, hRdayano dviparimANI (Tu-DI) Iko vagere parikSaNo nidAnamAM vizeSa sahAyabhUta thatAM hoya che. lohI pAtaLuM pADavAnI davAo uparAMta A rogane thato aTakAvavA mATe blaDaprezara, DAyAbiTIsanuM kaDaka niyaMtraNa tathA khorAkanuM niyamana ane niyamita kasarata vagere anivArya banI rahe che. kyAreka kyAreka AljhAimarsa ane vAkyulara DimenziA sAthe paNa thaI zake che. matibhraMza-smRtibhraMzanA dardIonI sAra-saMbhALa : * A roganA dardIo mATe temane saraLa paDe ane bane eTalA svAvalaMbI rahI zake tevI dinacaryAnuM Ayojana karavuM joIe. * sAthesAthe dardInI surakSA mATe paNa pUratAM pagalAM bharavAM paDe. * nahAvuM, dhovuM ane kapaDAM paheravAM, bhojana levuM jevA nityakramomAM dardInI avasthA anusAra yogya madada karavI paDe. * yAdazaktimAM madadarUpa thaI zake tevI bAbato zodhI dardIne bane tyAM sudhI avaDhavamAMthI ugArI zakAya, jema ke lakhavA mATe DAyarInoMdhapothI ApavI.

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1 24 magaja ane jJAnataMtunA rogo * dardI joDe vAtacItano vyavahAra rAkhavo atyaMta jarUrI che, jethI dardInI saMvedanAo jaLavAI rahe. haravA-pharavA ane ArAma mATe dardIne khAsa baMdhana na lAge te rIte nityakrama goThavI Apavo paDe. A uparAMta navI davAo jema ke rivAsTizmina, gelanTAmIna ane Donepejhila vAparI zakAya. te uparAMta enTipleTaleTa prakAranI davA dardInA roganA kAraNa mujaba ApI zakAya. vArasAgata rIte AvatAM AljhAimara ke bIjA DimenziyAmAM temanAM najIkanAM sagAMo (putra, putrI, bhAIbahena vagere.) eTale ke svastha vaMzajonI pahelethI tapAsa karavI keTale aMze vAjabI ke vyavahAru che te eka vicAra mAgI le tevo prazna che. paraMtu keTalAka dezomAM AvI savalato upalabdha che ke janInonI tapAsa (AnuvaMzika lakSaNo-cihnonI tapAsa) dvArA A roga A vyaktine bhaviSyamAM vArasAgata rIte thaze ke nahi te pramANamAM sacoTa rIte jANI zakAya. ghaNI vAra DimenziyA jevAM lakSaNo mAnasika tanAvanI sthitimAM thAya che jemAM kharekhara to Diprezana ke sTresa ja kAraNabhUta hoya che tene suDoDimenziyA kahe che. yogya nyurolaoNjikala tapAsathI ja te jANI zakAya che; tenI cikitsA pramANamAM saraLa che. A roga kAbUmAM AvI zake che eTale ke tenI asaro lAMbo samaya rahetI nathI ane vadhatI jatI paNa nathI. keTalAka meDikala rogomAM paNa vatteoche aMze yAdadAsta, vyavahAra, vyaktitva vageremAM asara AvI zake che. tyAre keTalIka vAra bhUlathI AljhAimaranuM nidAna thatuM jovAmAM Ave che dA.ta. thAIroIDanI kSamatA ghaTavI (hAipothAiraoNiDIjhama), viTAmina BjhanI UNapa, keTalAMka kolejana Dijhijha jema ke esa.ela.I. vagere. * davAoH dardInA roganA kAraNa mujaba yogya davAo ApI zakAya, jema ke : (1). enTiplesleTa : vAkyulara DimenziyAmAM

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1 25 smRtibhraMza - matibhraMza (DimenziA) yAdazakti vadhAravAnA upAyo (2) aragoTa jUthanI davAo jema ke sarmiana, hAIDarajina, serelaoNiDa (3) navI viziSTa davAo jevI ke rivAsTimina, Donepejhila, gelAmara memenTIna kogneksa...vagere.. Aljhaimara DimenziAmAM ApI zakAya. (4) pirAsiTAma jema ke normAbreina, nyuTropila, seresiTAma athavA ensephebola davAo * smRtibhraMzana aTakAva ane magajanI kAryazaktinuM rakSaNa-vardhana evuM mAnavAmAM Ave che ke moTI uMmare mANasanA magajanA koSo ghasAya che ane yAdazakti magajazakti ochI thatI jAya che paraMtu A vAta saMpUrNa sAcI nathI. saMzodhano dvArA have evuM zodhI kaDhAyuM che ke jo yogya vAtAvaraNa pUruM pADavAmAM Ave to pukhta ke vRddha vyaktionA magajamAM paNa navA cetAkoSo ane koSikAono vikAsa thaI zake che. yAdazakti cheka sudhI sArI rAkhI zakAya che. magajane kAryAnvita karavA mATe raktano saMcAra jarUrI che. te mATe zarUAta savArathI ja karo, thoDuM jaoNgiMga karo, jethI zarIramAM lohIno pravAha jhaDapI bane che. pariNAme magajane lohI ane oNksijanano puravaTho vadhAre maLaze ane cetAtaMtra jAgRta thaze. kasarata bAda nAsto levAmAM kALajI rAkho. carabIvALA padArthonA badale kArbohAiDreTavALA (lUkojha beIjhavALA) padArtho vadhu pasaMda karo. oNphisa ke kAmakAjanA sthaLe dara ekathI doDha kalAka kAma karyA pachI thoDI miniTo mATe vizrAma karo, laTAra mAro. satata eka ja prakAranuM kAma karatA magajane ociMtA ja bIjI dizAmAM vALo je magajane vadhu saceta banAve che. - baporanA bhojanamAM paNa kArbohAiDreTa bharapUra lo. carabI ane proTInavALo AhAra pramANasara levo. khorAka lIdhA pachI magajane lohIno puravaTho ocho maLato hoya che jethI UMgha AvavA lAge che, tethI jarUra pUrato ja khorAka levo. samayAMtare haLavI kasarata karI levI. zarIra beThADu rahe to sthULa thaI jAya tema magajane paNa evuM ja che. kekyuleTara ane

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126 magaja ane jJAnataMtunA rogo kamyuTaranA yugamAM magajane bahu mahenata karavI paDatI nathI. tethI memarI geima ke zabdabUha racanA ke suDoku jevI magajane kasatI (nyurobiksa) ramata ramavAnI Teva pADo. yAdazakti vaparAya nahIM to nakAmI che mATe yAdazaktino upayoga karo. dA.ta., kharIdI karavA jAva tyAre lisTa banAvavAnuM TALo, Teliphona naMbaro yAda rAkho ane mitro-saMbaMdhIonI janmatArIkha yAda rAkhavAnI Teva pADo. ochAmAM ochuM tamArA kuTuMbanA sabhyonI janmatArIkha yAda rAkho. e hakIkata che ke yAdazakti vadhAravA mATeno koI rAmabANa ilAja nathI. magaja ane zarIrane vyAyAma pUro pADavAthI magajanI zakti vadhe che. sAMjanA khANAmAM paNa carabIvALA padArtho ochA levA. zarIrane kelziyama vadhu maLe tevuM Ayojana karo. dUdha-keLAM ane sUkA mevAne prAdhAnya Apo. magajane vyAyAmanI jarUra che teTalI ja ArAmanI paNa jarUra che. pUratI UMgha maLe te ati jarUrI che. UMgha daramiyAna paNa magaja sakriya hoya che. divasa daramiyAnanA anubhavomAMthI guDanAITa-zubharAtri mATenAM kAraNo zodhI, pojhiTiva vicAro karI nirAMte sUI javuM. Ama karavuM kaMI agharuM nathI. A uparAMta yoga ane dhyAnathI magajanI kAryakSamatA vadhe che te to eka vaijJAnika satya che ja. * magajanI kAryazakti vadhAravA ATaluM avazya karo: * tanAvanuM niyaMtraNa karo, tanAvathI cetAkoSomAM hAnikAraka rasAyaNo pedA thAya che; tethI magaja pratye premALa kumaLuM vartana rAkho. dhyAna ane yoga magajanI kAryakSamatA acUka vadhAre che; tethI te avazya karo. * pUratI UMgha meLavo. ochI UMghathI lAMbAgALe magajanI kAryazakti ane yAdazakti ghaTe che. * tamAku, zarAba ane davAonA ravADe caDazo nahIM, nazo magaja mATe hAnikAraka che. For

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smRtibhraMza - matibhraMza (DimenziA) yAdazakti vadhAravAnA upAyo mitro banAvo, sAmAjika saMbaMdho keLavo. sarjanAtmaka abhigama-pojhiTiva thiMkiMga apanAvo. * * niyamita zArIrika-mAnasika vyAyAma karo. viTAmino ane khanijatattvothI samRddha samatola AhAra lo. vadhAre paDato carabIyukta AhAra TALo. vidhArthIo mATe smaraNazaktimAM vRddhi karavAnI saraLa paddhati H 127 abhyAsa karatI veLA tamAre jarUrI pAThyapustaka, pena, noTa, anya sAhitya sAthe ja rAkhavuM, jethI vAraMvAra UbhA thavuM paDe nahIM. zakya hoya tyAM sudhI vAcananI jagyA eka ja rAkhavI. vAcanarUma havAujAsavALo ane zAMtibharyo hoya te jarUrI che. tyAM TI.vI. ane TaeNparekaoNrDara vagere khalelajanaka sAmagrI na hoya tenuM dhyAna rAkhavuM. abhyAsa daramiyAna ekAgratA jALavavA mobAIla, Teliphona vagerethI paNa zakya hoya tyAM sudhI dUra rahevuM. kyAreya sUtAM-sUtAM ke ADI avaLI aMgamudrAmAM vAMcazo nahIM, palAMThI vALIne besavuM athavA TebalakhurazIno upayoga karavo. niyamita abhyAsa mATe samayapatraka banAvI tene Tebala para ke bhIMta para rAkho. abhyAsa samaye tamane koI khalela na pahoMcADe te mATe mAtApitA tathA mitrane tenI jANa karo. manathI utsAhapUrvaka abhyAsa karo. abhyAsa zarU karatAM pahelAM ane abhyAsa karyA bAda eka miniTa AMkho baMdha rAkhI dhIme dhIme UMDA zvAsa lo. khAsa karIne agharA viSayanA abhyAsa bAda pAMca miniTa mATe UMDA zvAsa lo, jethI mananI ekAgratA vadhaze.

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128 magaja ane jJAnataMtunA rogo rIbojhomala memarInA siddhAMta mujaba nIcenAM sUcanothI phAyado thAya ? eka dhyAnathI dareka peregrApha vAMco ane temAM lakhela mudA barAbara yAda rAkho. te rIte bIjo peregrApha vAMco ane thoDuM vAMcyA bAda pAThyapustaka bAjue mUkI vAMceluM yAda karo. agatyanA mudAo yAda karI lakho tathA anya sAthe vAMcelA muddAonI carcA karo ane tyAra bAda vAMcelA mudAone yAda karelA mudAo sAthe sarakhAvo. dareka navuM prakaraNa vAMcatAM pahelAM rathI 5 miniTamAM AgaLanuM vAMceluM prakaraNa UDatI najare yAda karI levuM. 24 kalAke, 7, 15 ane 30 divase pharIthI TUMka samaya mATe je te vAMcelA viSayo rathI 15 miniTa mATe phakta mudAsara yAda karavAmAM Ave to koI paNa nabaLA vidyArthIne paNa te sacoTa rIte lAMbo samaya yAda rahe che temAM koI zaMkA nathI. jyAM zakya hoya ane jarUra hoya (dA.ta. koI eka praznanAM aneka kAraNa ke mudAo yAda rAkhavA hoya) to emoniksa ke joDakaNAno prayoga karI zakAya. dA.ta.ABcp. keTalAMka loko vaLI citrathI (grAphika memarI) ke saMgItamaya rIte (melaDIthI) paNa yAda rAkhatAM hoya che. A ane AvA prayogo lAMbA lisTanI jagyAe jAte goThavIne vAparI zakAya. pAThyapustakamAM agatyanAM vidhAnonI nIce pILA raMganI rekhA doro jethI binajarUrI mAhitI vAMcavAmAM - yAda rAkhavAmAM samaya vyartha jato nathI ane jarUrI mAhitI magajamAM goThavAI jAya che. amuka vAcana bAda AMkhone paTapaTAvo jethI AMkhono thAka UtarI jAya. AMkho baMdha karI, hAthanI hatheLI vaDe haLavethI dabAvo. hatheLInI uSmA ane zakti AMkhane tAjagI Ape che.

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smRtibhraMza -matibhraMza (DimenziA, yAdazakti vadhAravAnA upAyo 129 * ekadama thAkI javAya tyAM sudhI eka ja sthitimAM rahIne vAMcavuM nahIM. zakya hoya to rUmamAM ekabe AMTA mArI UMDA zvAsa laI jarUrI phUrti meLavI zakAya. parIkSAkhaMDamAM mUMjhavatA prazno Ave tyAre AMkho baMdha rAkhI vAMcelI mAhitI yAda karo, jethI tarata smaraNazakti jAgRta thaze. agAu jaMNAvyuM che tema yAdazakti vadhAravAno koI cokkasa rAmabANa ilAja nathI paraMtu upara darzAvela upAya mujaba jo vAcana-abhyAsa karavAmAM Ave to mAtra vidyArthIone ja nahIM paraMtu dareka vyaktine cokkasa phAyado thaze ja tema kahI zakAya.

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130 magaja ane jJAnataMtunA rogo ATaluM jarUra jANo * matibhraMza-smRtibhraMza rogamAM vyaktinI yAdazakti, vicAra-zakti ane bhASA tathA vyavahAramAM khAmI utpanna thAya che. smRtibhraMzanAM kAraNo aneka che, paraMtu moTA bhAganAM (80%) dardIomAM AljhAimarsa ane vAskayulara DimenziyA jovA maLe . AljhAImarsa DimenziyAmAM bhASAnI takalIpha, yAdazaktino ghaTADo, Diprezana, rojabarojanA vyavahAra karavAmAM asamarthatAthI roga vadhIne aMtamAM dardI saMpUrNapaNe parAvalaMbI banI jAya che. A roganI nizcita davAonuM saMzodhana haju sudhI saMpUrNataH saphaLa thayuM nathI, paraMtu roganAM lakSaNonI tIvratA ghaTADI zake tevI davAo upalabdha che. * magajanI kAryakSamatA vadhAravA mATe taNAvanuM niyaMtraNa karavuM, dhyAna ane yoganI sAdhanA karavI, pUratI UMgha levI, nazIlA padArtho (dravyonuM sevana baMdha karavuM. zArIrika ane mAnasika vyAyAma karavo, samatola AhAra levo ane hakArAtmaka abhigama apanAvavo khUba ja jarUrI che.

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(11)( nidrA-vikAra ane sAravAra ) nidrA eTale ke UMgha e dareka prANInI khorAka, prajotpatti vagere jevI eka mULabhUtavRtti/prAthamika jarUriyAta che. ApaNe ApaNA jIvanano Azare trIjo bhAga UMghamAM pasAra karIe chIe. nidrA thakI ApaNA zarIrane ArAma, zakti ane utsAhano saMcAra thAya che, zarIranA je koSo ghasAyA hoya tenI marammata navasarjana thAya che, yAdazakti daDha bane che ane ApaNI zArIrika svasthatA jaLavAI rahe che. Ama nidrA e ApaNane kudarata taraphathI maLelI amUlya bakSisa paNa gaNAvI zakAya. svapna e nidrAnI ja eka gUDha sthiti che jene adhikRta rIte hajI sudhI pUrepUrI samajI zakAI nathI. Ama to nidrA e sabhAnatA ane bebhAnapaNuM e beyathI judI avasthA che. paNa prayogo, leboreTarI TesTa ane nidrA aMgenA abhyAso parathI jaNAya che ke nidrA e sabhAnAvasthAnuM ja anya rUpa che. ApaNA jIvanamAM nidrAnuM sthAna atyaMta mahattvanuM che, chatAM paNa mahad aMze tenI avagaNanA thayelI che. nidrAnA vikAro-rogonuM yogya nidAna thatuM nathI tethI AvA rogInI saMpUrNa sAravAra paNa yogya rIte thatI nathI. AthI samagra janasamudAyanI kAryakSamatA tathA svasthatAmAM noMdhapAtra ghaTADo thAya che. sArI UMgha ApaNane rogothI dUra rAkhe che, nidrA nAdurasta tabiyata vakhate ApaNane ArAma pradAna kare che ane tanAvanA samayamAM bhAvanAzIla rAhata Ape che. nidrA vikArane kAraNe, divasa daramiyAna taMdrAvasthAmAM hovAne kAraNe ghaNA saDaka mArga akasmAto paNa thAya che, e jANItI vAta che. jo dardInI nidrA aMgenI takalIphonAM varNanane vadhAre dhyAnathI sAMbhaLavAmAM samajavAmAM Ave to tenA moTA bhAganA vikArone samajI zakAya che ane tenI yogya sAravAra karI zakAya che. jyAre dardIne nidrA daramyAna, zvAsamAM gUMgaLAmaNa thatI hoya athavA UMghamAM kheMca AvatI hoya tyAre ja khAsa leboreTarImAM vadhAre cIvaTabharI tapAsanI jarUra paDe che. A prakaraNamAM nidrA ane tene lagatA vikAronI saMkSipta jANakArI ApavAno. A prakaraNamAM prayatna karyo che.

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132 magaja ane jJAnataMtunA rogo nidrAnuM baMdhAraNa-taMgaAyojana ane tenA tabakkA(Organisation and Stages of Sleep) : nidrAnuM taMtra Ayojana tathA tenI judI judI avasthAo : nidrA-UMgha e 24 kalAkanI daihika-jaivika ghaDiyALa (circadian rhythm) AdhArita mULabhUta prakriyA che. eka divasamAM navajAta zizune 16thI 20 kalAka nidrAnI jarUra hoya che. bAlyAvasthAmAM eka divasamAM 10thI 12 kalAka nidrAnI jarUra paDe. dasa varSanA bALakane eka divasamAM 9thI 10 kalAka nidrAnI jarUra paDe. pukhta vayanI vyaktine eka divasamAM 7thI 71, kalAkanI nidrA jarUrI che. vRddha vyaktine eka divasamAM 61, kalAkanI nidrA jarUrI che. rasco que a HURMA) NREM (Non-Rapid Eye Movement) Sleep dell REM (Rapid Eye Movement) Sleep aeis quia nidrAnA zarUAtanA samayamAM ja vyakti ochAmAM ochI eka vAra NREMnI eka evI avasthAmAMthI pasAra thAya che ke je samaye AMkhanI halanacalananI gati bahu jhaDapI nahIM tevI hoya che. NRHM nidrAnI kula cAra avasthAo hoya che. NREM sthiti pachI REM avasthA jovA maLe che. je daramiyAna AMkhonI gati bahu jhaDapI hoya che. NREM ane REM avasthA nidrA vakhate 4thI 6 vAra vArApharatI pharI pharIne thatI hoya che NREM avasthA samaye AMkho paTapaTe che. pAMpaNo thoDI DhaLelI hoya che ane AMkhanI kIkI jhINI thaI jAya che. REN avasthAmAM zarIranA snAyuo zithila bane che, paraMtu AMkhanA DoLA jhaDapathI gatizIla bane che, ane zvAsanI kriyA aniyamita thAya che. nidrAnI prakriyAnuM jevika-rAsAyaNika pRthakkaraNa : keTalAka prayogomAM jaNAyuM che ke nidrA lAvavAnAM uddIpaka tarIke sIroTInIna nAmanuM tattva kAma kare che, jyAre keTekolAmAIna nAmaka tattva jAgRta avasthA mATe javAbadAra che. REM tabakkAnI nidrA mATe kolInarjika

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133 nidrA-vikAra ane sAravAra nyuroTrAnsamizana mahattvano bhAga bhajave che. A avasthAmAM smRti daDha thAya che. te uparAMta prosTAglenDIna-DI-ra, melATonIna vagere jevA nidrAprada uddIpako oLakhAyelAM che. A uddIpakonI asara sAmAnya rIte nidrAnAM NREM tabakkA sudhI maryAdita hoya che. keTalAMka nidrA prada-udIpaka rogapratikAraka paNa hoya che, temanA roga-pratikAraka kArya tathA nidrAjAgRta avasthA vacce saMbaMdha hovAnuM jaNAyuM che. rAtre piniyala graMthimAMthI melATonIna nAmanA tattvano strAva thAya che, joke melATonInanA strAvano AdhAra UMgha AvavAnI sAthe hoto nathI. rAtre jAgRta vyaktimAM paNa teno sAva thAya che. prakAzanI hAjarImAM reTInAnA uttejananI paristhitimAM te ghaTe che. (melATonInanI vRddhi nidrA vadhAre) - hAyapokreTIna tattva jAgRta avasthA mATe mahattvano che. enI kamIthI nArkolepsI ane divase vadhAre UMgha AvavAnI bImArI thAya che. ratsaldi fasizl-(Sleep Disorders) : (1) ayogya nidrA (Dyssomnias): anidrA, atinidrA vagere (2) vikSipta athavA vikRta nidrAnI paristhiti (Parasomnias) (3) daihika/mAnasika rogonA kAraNe thatA nidrAnA vikAra (4) anya vikAro. (1) anidrA-(Insomnia) : anidrA zabda ja pUratI sagavaDo hovA chatAM gADha nidrA na AvavAnI sthitino nirdeza kare che. Ama anidrAmAM UMgha na AvavI, UMghanI avadhi pahelAM jAgI javuM, vAraMvAra jAgI javuM - jAgavuM athavA pUratI ane gADha nidrA na Ave te athavA to A traNeya prakAranI paristhitino samAveza thAya che. 1pathI 25 TakA pukhta lokomAM A takalIpha hoya che. Azcarya ane duHkhanI vAta e che ke moTA bhAganA loko AnI sAravAra mATe jAgRta nathI hotA ! A anidrAnA nIce mujaba mukhyatve traNa prakAra hoya che : (1) mULabhUta rIte ja anidrA hovI jemAM Diprezana, nyurosisa, mAnisaka kAraNo hoya ke koI roga na hoya chatAM paNa lAMbA samaya sudhI UMgha na AvavI.

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134 magaja ane jJAnataMtunA rogo (2) khAdya padArthanI elarjI, sthaLa phera, vAtAvaraNanI pherabadala ke UMghanI zarUAta na thavI jevAM bAhya paribaLonA lIdhe anidrA. (3) ziphTamAM kAma karavuM, TAIma jhonamAM pheraphAra ke UMghavA-jAgavAnI - aniyamita paddhatinA kAraNe anidrA. anidrAnI ADaasaro : jo anidrAnI bImArI lAMbA samaya sudhI cAle to navAM saMzodhano mujaba dardIne zArIrika ane mAnasika ghaNuM nukasAna thaI zake che, jemake aticiMtA, nIrasatA (Diprezana), DAyAbiTIsa, medasvitA, blaDaprezara, hRdayaroga thavo, kheMcanA humalA zarU thaI javA ke vadhavA, AtmahatyAnI icchA thavI ke nazIlI davAonI lata paDI javI. tethI ja anidrAnI yogya sAravAra khUba jarUrI che.' anidrAnI sAravAra : sAmAnya rIte mAMdagI ke anya asAmAnya saMjogomAM alpa samaya mATe mukhya davAnI sAthe upazAmaka ke nidrAprada davA sAravAra mATe sUcavavAmAM Ave che. je dardIone UMgha na AvatI hoya ke UMdha jaLavAI rahetI na hoya temane jhaDapI asara kare tevI UMghanI davA upayogI che (jholpIDema, phalurAjhapAma, TrAyajholAma). je dardIo lAMbA samayathI anidrAthI pIDAtA hoya temane nidrAprada upazAmaka davAo lAMbA samaya sudhI ApavI joIe nahIM, paraMtu anidrAnuM kAraNa zodhI kADhavuM joIe. A prakAranAM dardIone sUvAnA samaya sAthe dinacaryAnuM suAyojana karavA tathA divasamAM zArIrika rIte sakriya rahevA tathA sUtAM pahelAMnA traNa kalAka pahelAM thoDo vadhAre zrama-vyAyAma karavA mATe protsAhita karavA joIe. tanAvathI mukta rahevAno prayatna karavo joIe. anidrAnI sAravAra mATe nidrA ghaTADI de tevAM paribaLomAM pheraphAra karavo joIe jema ke : - kephInayukta pINAM, sTIroIDa tathA magajane uttejita karanArI davAono upayoga TALavo joIe. - tamAku tathA bIDI-sigAreTanuM sevana paNa anidrA karI zake che.

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nidrA-vikAra ane sAravAra - 135 gaMbhIra zArIrika bImArIo jevI ke hRdayaroga, lakavo, kensara vagere thaI jaze tevI akAraNanI ciMtA ane bhaya dUra karavA joIe. - sAthe dhyAna, bhrAmarI vagere prANAyAma, haLavuM saMgIta-vAcana UMgha mATe madadarUpa che. keTalIka vAra anidrAnI sAravAra karyA bAda jyAre davAo baMdha karavAmAM Ave che tyAre mULa roga hoya te karatAM paNa vadhAre vakarI zake che te bAbatanuM dhyAna rAkhavuM joIe. (2) asthira paga ane paganuM halanacalana : (Restless legs syndrome and periodic leg movement) : asthira (restless) paganAM lakSaNo tarIke jaNAto vikAra haMmezAM samayasaranI UMghamAM vikSepa kare che. A prakAramAM dardI 'ghUMTaNIe cAlavAthI thatA dukhAvA jevo dukhAvo paganAM sAthaLa ane pIMDIomAM thAya che tevI phariyAda kare che. A lakSaNomAM paganA sthAnanI herapherathI thoDo samaya rAhata paNa thAya che. A lakSaNa Ama to kudaratI che paNa kyAreka perIpherala nyuropathI (nyurAITIsa)no nirdeza kare che. AnA jevo ja bIjo vikAra anidrAmAM vakhatovakhata paganI asthira herapherathI thAya che, je divasa daramiyAna vadhu paDatI UMgha mATe kAraNabhUta che. lohatattvanI UNapa (enimiyA)thI pIDAtA dardIomAM A roga vadhu paDato jovA maLe che. AvAM dardIomAM enimiyAnI sAravAra ghaNI upayogI sAbita thAya che. upacAra : DopAminarjika davAo, oNksikoDona, gAbApenTina, tathA lohatattvanI UNapanI sAravAra (3) UMghamAM zvAsa rUMdhAvo : (Sleep Apnea Syndrome) enA mukhyatve be prakAra che : (a) OSA (b) CSA (a) Obstructlve Sleep Apnea : UMghamAM nasakorAM bolavA; UMghamAM zvAsa rokAI javo ane divase vadhAre paDatI UMgha

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136 magaja ane jJAnataMtunA rogo AvavI AnAM mukhya lakSaNo che. agAu joyuM tema nidrAnAM REM tabakkAmAM zvAsa aniyamita hoya che. keTalIka vAra 10 sekaMDa sudhI paNa zvAsa rUMdhAyelo jaNAya che. nidrAnA zarUAtanA tabakkAno zvAsano Avo avarodha e koI roga na gaNAya paraMtu keTalIka vyaktiomAM Avo zvAsAvarodha vAraMvAra thato hoya che ane te 10 sekaMDa karatAM paNa vadhAre samaya raheto hoya che. zvAsocchavAsa levAnA kAryamAM rukAvaTa, zvAsocchavAsa baMdha thaI javo ke A baMnenA lIdhe AvuM thaI zake che. uparI zvasanamArga (nasopharyngeal airway) nAno ke dabAyelo hoya to paNa A roga thaI zake che. UMdhyA pachI zvAsAvarodha thAya che jemAM lohImAM prANavAyu ghaTI jAya che ane kArbana DAyoksAIDa vadhI jAya che, jethI UMghamAMthI saphALA jAgI javAya che ane pachI zvAsocchavAsa saraLa thatAM pharIthI UMgha Ave che. AvuM ghaNI vAra bane che tethI gADha nidrAmAM vikSepa paDe che, jenA kAraNe dardI divasa daramiyAna vadhu paDato nidrAdhIna rahe che. lAMbA gALe anidrAthI magajamAM kAryavikSepathI buddhimAM, vyaktitva ane vartaNUkamAM pheraphAra thaI zake che. kvacita hRdaya baMdha paDI jAya, UMghamAM ja na samajI zakAya tevuM mRtyu thaI zake ke blaDaprezara paNa thaI zake. sthULa zarIravALI vyaktione AvAM lakSaNo thAya tene pIkavIkIana sinDroma (Picwickian syndrome) tarIke oLakhAya che. prauDha puruSomAM A roga vadhAre thAya che. sthULa zarIravALAM loko jo UMghamAM jora jorathI nasakorAM bolAvatAM hoya to A roga vize vicAra karavo joIe. A roganA nidAnamAM polIsomnogrAphI TesTa mukhya che. sAravAra : * dArU jevAM kephI pINAM ane nazo karatI vastuono tyAga karavAthI zvasanamArga saraLa thAya che. vajana

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nidrA-vikAra ane sAravAra 137. ghaTADavuM joIe. cattA sUI javAnI Teva choDavI ane moDhAmAM jIbha aMdara jatI na rahe te mATe yogya sAdhana moDhAmAM mUkI rAkhavAthI zvAsa levAmAM saraLatA rahe che; nAkathI zvAsa levAnI Teva pADavI joIe. jamaNe ane DAbe paDakhe vArApharatI sUvAthI rAhata maLI zake. keTalI vAra sarjarI dvArA paNa zvAsAvarodha ghaTADI zakAya che. (b) keTalIka vakhata zvAsocchavAsanA mazIna(cPAP)nI tathA zvAsanaLImAM chedanI paNa jarUra paDe che. moDAphInIla jevI davAthI divasanI UMgha ochI thaI zake che. gADha nidrAmAM zvAsAvarodha : (Central sleep Apnea) kAraNo : (1) ajJAta kAraNosara (2) magajano roga (Brain stem dysfunction) (3) zvAsocchavAsamAM aniyamitatA (CheyneStokes breathing) (4) oksijananI UNapa (UMcAIe, phephasAMno roga) (5) hRdaya ane phephasAMne lagatI takalIpha sAravAra : - kAraNa mujaba sAravAra karavI : davAo tathA jarUra paDe to zvAsocchavAsanAM mazIna BIPAP ke CPAPno upayoga karavo joIe.

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138 (4) atinidrA H divasanI nidrA sahita jarUratathI vadhAre uMgha AvavI, jenAM kAraNo nIce mujabanA che H (1) nidrApada davAo, cakkaranI davAo, DiprezananI davAo ke pachI niyamita kephI padArthonA sevanathI. (2) gaMbhIra mAMdagI (3) oNparezana pachI ane enesthesIyAnI asara (4) Diprezana-hatAzA (5) cayApacayanI garabaDa, hAipothAIroIDIjhama, eDIsana DisIjha (6) magajano cepI tAva, vAyarasa; kSAratattvanI khAmI (7) taMdrAvasthA (8) divasanI atinidrA-(Narcolepsy) magaja ane jJAnataMtunA rogo aniyaMtrita nidrA : grIka zabda Narken eTale ke jhokAM khAvAM, Leptos eTale kabajo karavo tenA uparathI rokI na zakAya tevI nidrA ke taMdrAvasthA tenAM mukhya cAra prakAra A mujaba che - divase vadhAre sUvuM, keTApleksI, UMghamAM kSaNika lakavo thavo ane vicitra sapanAM AvavAM. A uparAMta rAtanI UMgha bagaDavI ke ayogya vyavahAra karavo e paNa agatyanuM lakSaNa che. ghaNA dardIomAM A roga AnuvaMzika hoya che ane jiMdagIbhara rahe che. (1) divase atinidrA (Narcolepsy) : 15thI 35 varSanI uMmaramAM atinidrAno vikAra thAya che. rokI zakAya nahIM tevI UMdha AvyA karavI. nidrAno gALo 15 miniTathI vadhAre nathI hoto ane avAja ke sparza karavAthI dardI jAgI jAya che.

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nidrA-vikAra ane sAravAra 139 * divasamAM AvuM keTalIka vAra thAya che. * A roga mukhyatve hAyapokreTina nAmanA tattvanI khAmInA lIdhe thAya che. (2) keTapleksI-(Cataplexy) : keTalIka sekanDa mATe bhAvuktAne lIdhe athavA bhAre zrama karavAthI athavA koI vore koIka paNa jAtanA kAraNa vagara sabhAna avasthA hovA chatAM snAyuo zithila thaI javAM. paDI javuM. keTalIka vAra AvI paristhiti kalAko sudhI rahe. keTalIka vAra snAyuo AMzika rIte paNa zithila thaI gayA hoya tevuM banI zake dA.ta., jaDabuM laTakI paDavuM. (3) nidrA AvatAM ke jAgI jatAM vicitra bhramaNA thavI (Hypnagogic Hallucination) : (4) amuka dardIomAM UMghamAM alpajIvI lakavo paNa thaI zake che. (Sleep Paralysis) : * polisoznogrAphI - malTIpala slIpa leTansI TesTa dvArA yogya nidAna thaI zake che. sAravAra : (1) 15thI 20 miniTa mATe divasamAM rathI 3 vAra niyata samaye sUI javuM. (2) magajane uttejita karatI davAo-mithAIla phenIDeTa, emphaTemAIna, moDAphInIla jevI davAono yogya pramANamAM upayoga karavo. (3) TrAisAyakalIka enTIDipresanTa davAo, esa.esa.Ara.AI. tathA esa.ena.Ara.AI. davAo vAparI zakAya. (5) vikSipta-nidrAvasthA-(Parasomnia): ahIM evA keTalAka nidrAnA vikArone samAvI zakAya ke jemAM mAtra nidrAmAM ja asAmAnya vartaNUka ke asAmAnya prakAranI zarIranI hilacAla

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140 magaja ane jJAnataMtunA rogo thatI jovA maLe che. A roganAM lakSaNo REM nidrAvasthA tathA NREM nidrAvasthAmAM alaga-alaga hoya che (A), UMghamAMthI UThatI vakhate/jagADatI (Arousal) vakhate thatA vikAroH . - nidrAmAM cAlavuM. - (B) ardhanidrA daramiyAnano vikAra : - UMghamAM jarka/jhaTakA AvavA. = - UMghamAM vAto karavI, bakabaka karavuM. hAtha-paganI zreNIbaddha hilacAla thavI. - nidrAmAM bhaya-Dara lAgavo. (C) nidrAnAM REM tabakkA sAthe saMkaLAyela vikRti : bIka lAge tevAM svapna. D - nidrA daramiyAna alpajIvI lakavo. - (D) vikSipta nidrAvasthAnA anya vikAra - UMghamAM dAMta kacakacAvavA. - - UMghamAM pezAba thaI javo. - nasakorAM bolAvavAM. - - nidrAmAM bALakanu mRtyu thavuM. (SIDS) UMghamAM cAlavuM-(Sleep Walking, Somnambulism) : - A roga moTA bhAge bALakomAM jovA maLe che. - dardI pathArImAM beTho thaI jAya che athavA palaMganI kinAre besI jAya che ke gharamAM AMTA mAre che. A roganI zarUAta bALapaNamAM thAya che ane uMmara vadhatAM sAruM thaI jAya che.

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nidrA-vikAra ane sAravAra 141 vayaska vyaktimAM A vikAra asAmAnya hoya che ane te koI mAnasika bImArI ke pachI koI davAnI ADa asara hoI zake. kvacita nidrAmAM cAlavA daramiyAna paDI javAthI vAgI jAya athavA mRtyu thAya tevI durghaTanA paNa banI zake athavA to dardI ajANapaNe gunAhita pravRttimAM paNa phasAI jAya tevuM paNa banI zake. koI lAgaNIzIla banAva ke bhaya athavA to hiMsaka vartana thaI zake, koI vAra Dara lAge ane hRdayanI dhaDakana vadhI jAya. sAravAramAM 0.5 ke 1.00 mi.grA. klonAjhepAma ApI zakAya. UMghamAM bIka lAgavI-(Sleep Terrors) : - bALapaNamAM thAya che. - nidrAnAM 3 ke 4thA tabakkAmAM AvuM thAya che. bALaka ekadama ja jhabakIne jAgI jAya che ane tenAM zvAsocchvAsa UMDA tathA jhaDapI banI gayelA hoya che; sAthesAthe bALaka DarI gayeluM hoya che. AvA bALakamAM 'UMghamAM cAlavAnuM' lakSaNa paNa hoI zake che. DAyAjhepAma tathA anya keTalIka davAo A rogane aMkuzamAM rAkhavA mATe madadarUpa thaI zake che. UMghamAM-jarka/jhaTakA AvavA-(Sleep Starts) : UMgha Ave che tyAre ke keTalAMka calana-biMduo sateja/uttejita thAya che, jethI moTA pramANamAM zArIrika jarkas/jhaTakA Ave che ane vyakti jAgI jAya che. duHsvapna/bihAmaNAM svapna AvavAM (Nightmares) : ', nidrAmAM REM tabakkAmAM Ave che. khAsa karIne jyAre dArU ke anya nidrAprada davAo baMdha karavAthI, REM tabakko niyaMtrita karAyo hoya tyAre AvAM prakAranAM svapna Ave che. AvAM svapna koI ekAkI ghaTanAne anurUpa paNa hoI zake che.

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magaja ane jJAnataMtunA rogo kAraNo : tAva AvavAthI cayApacaya kriyA barAbara na hoya to, DarAmaNI vAto sAMbhaLavAthI athavA to DarAmaNI Telivijhana siriyala ke sinemA jovAthI, vAraMvAra mAthAno duHkhAvo thaI Avato hoya tevA kesamAM, bITA blokara prakAranI davAnI ADaasara rUpe vagere 142 UMghamAM dAMta kacakacAvavA (Sleep Bruxism) : rAtre UMghamAM ja dAMta kacakacAvAya che. - te ApoApa ja thAya che. UMghamAM pezAba thaI javo (Nocturnal Enuresis) : -- - bAlyAvasthAmAM tathA kizorAvasthAmAM UMghamAM pezAba thaI jAya che. - divasa daramiyAna pezAba rokI rAkhavAthI AvuM thAya che ane pukhtAvasthAmAM paNa cAlu rahe che. - saiddhAMtika dRSTie-mUtrAzayanI athavA tenuM niyamana karatA jJAnataMtuonI (spina bifida) vikRti hovI. sAmAnya vyakti karatAM mUtrAzayanI kAryazakti ochI hoya che. AvA dardIomAM mUtrAzayamAM thatuM dabANa sAmAnya karatAM vadhAre hoya che. sAravAra-dA : rAtre sUtI vakhate imiprAmIna. mUtrAzayane Teva pADatI kasarata karavI. - - gaMbhI2 kissAmAM nAkamAM chAMTavAnI davA-DesmopresIna spre (spray) -- (6) mAnasika tema ja daihika paristhiti sAthe saMkaLAyela nidrAnAM vikAro : (A) mAnasika vikRti, manorogI, ciMtA, ucATa, dArU sAthe saMkaLAyela. (B) magajanI vikRtio, unmAda, pArkinsanano roga, epilepsI, smRtibhraMza sAthe saMkaLAyela.

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* 143 nidrA-vikAra ane sAravAra (C) anya : anaicchika rIte UMdhI javAnI bImArI (Sleeping sickness), phephasAMnI bImArI, asthamA, jaTharamAM cAMdu hovuM, annanaLInI takalIpho vagerenAM lIdhe nidrAmAM vikSepa paDavo. (0) anya prakAranA nidrA-vikAra : (A) ochuM UMdhanArA (B) lAMbo samaya UMdhanArA (C) ardhajAgRta/taMdrAavasthAvALAM (D) nidrAmAM jhaTakA AvavA (E) UMghamAM atyaMta parasevo thavo (F) mAsikasamaya sAthe saMkaLAyela vikAra (G) sagarbhAvasthA sAthe saMkaLAyela (H) A uparAMta nidrA daramiyAna thatI anya takalIphomAM zvAsa - rUMdhAvo, zvAsa vadhI javo, avAja Avavo vagere kahI zakAya. Ama, UMghanA ATalA badhA vikAro hovA chatAM nidrA e rogonI jananI che tema mAnavAnI bhUla karavI joIe nahIM. nidrA to manuSyane kharekhara ja hakArAtmaka svAcya ApanArI, zarIrane ArAma ApanArI tema ja zaktino punaHsaMcAra karanArI che. paramAtmAe ApaNane nidrArUpe ApelI A uttama bheTa che. tenuM yogya jatana karavuM joIe ane ApaNe agAu joyuM tema nidrAnAM ghaNAM kharAM rogo sAmAnya che, gaMbhIra nathI ane maTI zake tevAM che. tenuM samayasara nidAna thaI zake te mATe jAgRti ANavA A prakaraNa lakhyuM che. AzA che ke tenAthI lokonI nidrA-pravRttimAM yogya sudhAro thaze ane te aMgenA rogonuM yogya ane samayasara nidAna thaze.

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144 magaja ane jJAnataMtunA rogo ATaluM jarUra jANo 'manuSyanA jIvanamAM nidrAnuM sthAna atyaMta mahattvapUrNa che. navajAta zizune 16-20 kalAka, bALakane 10-12 kalAka, yuvAna vyaktine 7-7.5 kalAka ane prauDha vyaktine 6.5 kalAkanI UMghanI AvazyakatA hoya che. anidrA, UMghamAM paganuM asthira halana-calana, pragADha nidrAmAM zvAsamAM avarodha thavo, atinidrA, keTApleksI, vikSipta nidrA, UMghamAM cAlavuM, UMghamAM bIka lAgavI, UMghamAM jhATakA AvavA, kharAba svapna AvavuM, UMghamAM dAMta kacakacAvavA, UMghamAM pezAba thaI javo, mAnasika vikRti, unmAda, smRtibhraMza, anaicchika nidrAnI bImArI vagere nidrA sAme joDAyelA vikAra che. moTA bhAganA nidrAnA roga sAmAnya che, gaMbhIra nathI ane samayasara sAravAra karAvavAthI dardI svastha thaI zake che.

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(12)(magajanA cepI rogo meninjAiTisa, ensephelAITisa) magaja zarIranAM bIjAM aMgo, jevAM ke hRdayanI sarakhAmaNImAM ati jhaDapathI ane ghaNI vAra cepI rogono bhoga bane che. khAsa karIne magajano TI.bI., magajano pAyojanika eNninjAiTisa, magajamAM parunI gAMTha (eksesa), magajano ensephelAITisa (vAirasane lagato), magajamAM thato jherI meleriyA tathA anya paropajIvI jaMtuothI thato cepa, jema ke sisTisarakosisa, magajamAM thatI phUga, jAtIya cepI rogo jevA ke eiTsa vagere. Ama aneka jAtanAM sUkSma jaMtuothI magaja cepI rogano zikAra bane che. | mukhyatve kAnamAM ke nAkamAM saDo thayo hoya ke paru AvatuM hoya, gaLAmAM cepa lAgyo hoya, moDhA upara cepI phoDalIo thaI hoya, zarIranA anya bhAgo jema ke chAtImAM paru thayuM hoya athavA sepTisamiA thayuM hoya to magajamAM cepa lAgavAnI zakyatA rahe che. te uparAMta heDa InjarI eTale ke mAthAmAM vAgyuM hoya ane vizeSa karIne kAna, nAkamAMthI lohI nIkaLyuM hoya ke khoparInA hADakAmAM phrekTara thayuM hoya ane temAMthI magajanuM pANI (CSF) nAkamAMthI bahAra AvatuM hoya (jene sI.esa.epha. rUhAInorIA kahe che) athavA to magajanuM koI kAraNasara oNparezana thayuM hoya (jema ke magajanI gAMThanuM) ane zarIranI rogapratikAraka zaktimAM ghaTADo thayo hoya tyAre magajamAM cepa lAgavAnI zakyatA vadhAre rahe che. Ane lIdhe mAthuM duHkhavuM, tAva Avavo, prakAza sahana na thavo, kheMca AvavI jevAM lakSaNothI mAMDIne lakavo, bebhAna thavuM ke mRtyu thavuM jevAM khataranAka pariNAmo paNa AvI zake che. A badhA ja rogo vize lakhavuM zakya nathI paraMtu je khUba agatyanA roga che evA keTalAka vize joIzuM. (1) magajano TI.bI. sAmAnya rIte magajano TI.bI. zarIranA bIjA bhAgamAMthI (jema ke phephasAMno ke AMtaraDAno TI.bI.) phelAIne Ave che. evuM bane ke chAtIno TI.bI.

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magaja ane jJAnataMtunA rogo ghaNA vakhata pahelAM thayo hoya paraMtu have zarIrane ghasAro paDyo hoya, zarIranI rogapratikArakazakti ghaTI gaI hoya tyAre phephasAMno ane te pachI magajano TI.bI. ekadama bahAra Ave. ApaNA dezamAM TI.bI. eTalo badho pracalita che ke ApaNAmAMnA moTA bhAganA lokomAM TI.bI.nAM jIvANuo kyAreka to havA ane javalle dUdha vagere dvArA zarIramAM pravezI cUkyAM hoya che, magajano TI.bI. suSupta avasthAmAM chupAyelA hoya che ane tenI sAmenI eNlarjI zarIramAM hoya ja che. AmAMthI jyAre koI kAraNathI zarIranI rogapratikArakazakti ochI thAya ke zarIra kamajora paDe tyAre roganI zarUAta thAya che. eiDsavALA dardIne TI.bI.no roga (navesarathI athavA suSupta jaMtuo pharIthI sakriya thavAthI) noMdhanIya pramANamAM jovAmAM maLe che. 146 magajanAM AvaraNomAM TI.bI.no cepa lAge tene TI.bI. maeNninjAiTisa kahevAya. magajamAM TI.bI.nI gAMTha thAya tene TyUbarakyulomA kahevAya, magajamAM kaoNrTeksane cepa lAge tene ensephelAiTisa (ensephelopathI) kahevAya. A roganAM lakSaNomAM mAthuM duHkhavuM, jhINo tAva Avavo, UlaTI thavI, bhUkha na lAgavI, khUba azakti ke becenI thavI evAM zarUAtanAM lakSaNo thAya che. pachIthI kheMca Ave, ekAda ke tethI vadhu aMgamAM lakavAnI asara thAya ane roga vadhI jAya to magajamAM sojo AvavAthI dardI bebhAna thAya ane dardI mRtyu paNa pAmI zake che. te sivAya magajamAM nAnI ke moTI lohInI nasa baMdha thAya to tene TI.bI. ArTarAiTisa kahe che, jenAthI lakavo thaI zake. magajanA pravAhI (C.S.F-sI.esa.epha.)nI kothaLIomAM pravAhIno rasto avaraddha thAya to hAIDrosIphelasa thAya, jenAthI kothaLIo phUlI jAya ane dardI bhAna gumAvato jAya agara AMkhanI

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147. magajanA cepI rogo meninjAITisa, ensephelAITisa daSTi gumAve tevuM paNa bane. kyAreka karoDarajajumAM ane karoDanA maNakAmAM TI.bI.nI asara Ave to pagano lakavo thaI zake. nidAnaH A roganuM nidAna karavA dardInI laMbANapUrvakanI tabIbI tapAsa uparAMta kamaranA pANInI tapAsa (lambara paMkyara) e magajanA cepI rogonA yokkasa nidAnanI lagabhaga anivArya jevI tapAsa che. kamaranA pANInI tapAsamAM proTIna vadhu, khAMDa zugara) ochI ane limphosAITa nAmanA zvetakaNo vadhu mAtrAmAM Ave che. lohInA jarUrI evAM sAmAnya (rUTIna) TesTa karavAmAM Ave che. te uparAMta keTalAka gUMcavADAbharyA kesamAM sI.esa.epha.-pI.sI.Ara, sI.esa.epha.- sI.Ara.pI., sI.esa.epha.e.DI.e. vagere TesTa dvArA paNa nidAnamAM cokasAI lAvI zakAya che. AvI cokasAI eTalA mATe jarUrI che ke eka vAra magajanA TI.bI.nuM nidAna karyuM eTale dardIne ochAmAM ochI doDhathI be varSanI sAravAranI jarUra paDe che. kyAreka-kyAreka sITIskena ane ema.Ara.AI. paNa karAvavuM paDe che, je TyubarakyulomA tathA hAIDrosephelasanA nidAna mATe khAsa jarUrI che. roganI zarUAtamAM kamaranA pANInA riporTamAM keTalIka vAra vAIrasa athavA parunAM jaMtuo kAraNabhUta hoya tevuM citra paNa UpasatuM hoya che ane jo traNemAMthI koInI paNa yogya sAravAra karavAmAM DhIla thaI jAya to bhayajanaka pariNAmo AvI zake ane tethI ja A badhA cepI rogonI vyavasthita tapAsa atizaya jarUrI che. Azare-Azare nidAna na karavuM tema tamAma niSNAta DaoNkTaro mAne che paraMtu magajamAM khUba sojo hoya, AMkhanA paradA para sojo (Papilloedema) dekhAya, zvAsa vadhu hoya, dardInI sAmAnya paristhiti sArI na hoya tevA saMjogomAM kamanuM pANI kADhavuM kharekhara jokhamI bane che ane tethI teve vakhate sI.TI. skena, ema.Ara.AI. tathA bIjA sahAyaka purAvAonA AdhAre davA zarU karI devI joIe.

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148 magaja ane jJAnataMtunA rogo davAo : magajanA TI.bI.nI davAo mukhyatve sTrepTomAIsina (SM)nAM Ijezana, AIsosAyAjhIDa (INH), riphASpIsIna (RF), pAyarejhInAmAiDa (PZ) tathA IthAkyUTola (EMB) che jene prAimarI (prathama caraNanI) davAo kahe che. keTalAka haThIlA kesamAM sporaloklAsina ke siprophaloklAsina athavA kenAmAIsina ijekzana, IthionemAIDa athavA sAIkloserina nAmanI davAo paNa vAparavAmAM Ave che jene sekanDarI (bIjA caraNanI) davAo kahe che. paraMtu A badhI ja davAonI koI ne koI ADaasara hoya che jene mATe dardInAM lakSaNo uparAMta leboreTarI tapAsathI vakhatovakhata jovAmAM Ave che, jema ke INH, RF athavA PzthI yakRta (lIvaramAM) kyAreka sojo AvI zake ane kamaLAnI asara paNa dekhAya. tethI DaoNkTara s.G.P.T. vagere mATe lohInI tapAsa vakhatovakhata karAvatA rahe che ane jo AmAM garabaDa Ave to je te davA thoDo vakhata baMdha karavAmAM Ave che. koI kesamAM RFthI lAgalagATa UlaTI thayA kare athavA bhUkha sAva ja jatI rahe to RF davA baMdha karavI paDe che. paraMtu tenAthI lAla pezAba thAya to davA baMdha karavAnI jarUra nathI. 4thI 6 aThavADiyAMmAM dardIne sAro sudhAro thavA mAMDe che. magajamAM sojo hoya athavA cs" tapAsamAM proTIna vizeSa hoya to khAsa karIne sTiroIDa davAo 4thI 6 akvADiyA mATe ApavAmAM Ave che ane jo magajamAM khUba moTI gAMTho thaI hoya to kvacita moTuM oNparezana karavAmAM Ave che athavA navA ja sTIrioTeksIka bAyopsInA nAnA oNparezana dvArA bAyopsI sAthe nAnI gAMTha hoya to te paNa kADhI zakAya che. sAmAnya rIte gAMTho mATe oNparezananI jarUra bhAgye ja hoya che. davAthI ja gAMTho ogaLavA mAMDe che, jene mATe rathI 3 mahine sI.TI. skena ke ema.Ara.AI. tapAsa karAvatA rahI sudhAro jotA rahevuM paDe che. kamaranA pANInI tapAsa (csF) bhAgye ja vAreghaDIe karavI paDe che paraMtu haThIlAM dardomAM kamaranA pANI dvArA amuka vAra davAo ApavAmAM Ave che jene InTrAthikala rUTathI davAo ApI tema kahevAya che.

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149 magajanA cepI rogo : meninjAITisa, ensephelAITisa jyAre magajanI kothaLIomAM (ventricles) pANIno rasto avaruddha thAya ane kothaLIomAM pANI bharAvA mAMDe tyAre dardI bhAna gumAvavA mAMDe, bolavA-cAlavA, samajavAmAM takalIpho vadhI zake, AMkhonI daSTiochI thAya tevuM bane athavA mAthuM duHkhavuM, UlaTIo thavI tevI takalIpho thAya, jene hAIDrosIphelasa kahe che teve vakhate tenI sI.TI. eNna dvArA sacoTa rIte khAtarI karI zakAya. jo tema hoya to nAnI TyUbakhoparImAM thaIne magajanI kothaLImAM pasAra karavAmAM Ave che, jenA dvArA magajanAM pANIne peTamAM cAmaDInI nIce Tanela karIne TyUba mAraphate pasAra karavAmAM Ave che. Ane "zanTa mUkyo'tema kahe che. A eka taddana sAduM oNparezana che ane tenAM pariNAma sArAM hoya che paraMtu zanTa avaruddha thAya to takalIpha thaI zake. TI.bI.nAM jaMtuo davAothI kaMTrolamAM na Ave ane roga vadhato ja jAya tema paNa bane, jene Draga rejhisTansa kahe che ane temAM prAraMbhika davAo niSphaLa jAya to bIjA caraNanI davAo vAparI zakAya. chatAM kvacit koI kesamAM dardInI rogapratikArakazakti taddana ja khatama thaI gaI hoya, jema ke eiTsa ke cepI jaMtuo haThIlAM hoya to tevA dardIne khAsa madada thaI zakatI nathI. ereknoDAITisanA keTalAka haThIlA kesomAM theliDomAIDa nAmanI davA sArA pariNAmo Ape che. (2) pAyojanika meninjAiTisa : - TI.bI. sivAyano A agatyano ane jokhamI evo bIjo meninjAiTisa keTalAMka cepI jaMtuothI thAya che je magajamAM paru banAve che. A paru magajanI sapATI paranAM AvaraNomAM jhaDapathI bane che ane phelAya che; tethI TI.bI. karatAM khUba jhaDapathI eTale ke amuka divaso ke kalAkomAM dardInI hAlata bagaDatI jAya che ane khUba jorathI tAva Avavo, atizaya, asahya mAthuM du:khavuM, UlaTIo thavI ane DokanI pAchaLa dukhAvo thavo, prakAza sahana na thaI zakavo ema zarUAta thaI khUba TUMkA gALAmAM behozI AvavI, kheMca AvavI ke yogya sAravAra, nidAnanA abhAve mRtyu paNa thAya tevuM jovA maLe che.

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150 magaja ane jJAnataMtunA rogo A jaMtuomAM meningokokasa, sTephilokoksa, nyumokoksa, sTrepTokokasa, lIsTiriA, eca. InphalyuenjhA, suDomonAsa, proTIasa, I. kolAI evAM jAtajAtanAM grAma-pojhiTiva,ane grAma-negeTiva prakAranAM baeNkTariyA hoya che, je magajane jhaDapathI ane vividha prakAranuM nukasAna kare che paNa jo tAtkAlika nidAna ane sAravAra thAya to moTe bhAge koI paNa jAtanI dUragAmI khoDa ke asara vagara dardI taddana sAro thaI zake che. tethI koI paNa jAtanA mAthAnA bhAre dukhAvAmAM jo sAthe tAva hoya to magajanA cepanI eka gaNanApAtra zaMkA rahe che. sAthesAthe jo dardInuM bolavA-cAlavAnuM badalAI gayuM hoya, kheMca AvatI hoya ke bhAna gumAvavAnuM zarU thayuM hoya to tAtkAlika aDadhI rAtre paNa sI.TI. skena karAvI, dAkhala karI, jarUra paDye tAtkAlika kamaranuM pANI (cs) sAvacetIpUrvaka kaDhAvI, tenI tAtkAlika tapAsa karAvIne nidAnanI khAtarI karavI atizaya mahattvanI banI rahe che. A tapAsa sakSama DaoNkTara pAse ane sArI leboreTarImAM karAvavI ati Avazyaka che, kema ke csnA riporTa parathI, yogya eNnTibAyoTikanI pasaMdagI karavAmAM Ave che, jenA dvArA dardInuM bhaviSya nakkI thAya che. AmAM koI paNa jAtanuM samAdhAna calAvI levAya nahIM. kamaranA pANI (cs)nI tapAsamAM A prakAranA meninjAiTisamAM sAmAnya rIte seMkaDothI mAMDI hajAro nyuTrophilsa (zvetakaNono eka prakAra) hoya che, proTIna thoDuM vadhe che ane pANInI sugara (glakaoNjha) atyaMta ochI thaI jAya che ke nahivat thaI jAya che. TI.bI., meninjAiTisanA kamaranA pANInA riporTathI A riporTa judo paDe che. te uparAMta grAma sTeina dvArA mAikroskopamAM ghaNIvAra jaMtuo paNa cokkasapaNe dekhAI Ave che. A badhI bAbato para dhyAna ApIne tAtkAlika kaI davAo zarU karavI teno nirNaya levAmAM Ave che. dareka kesamAM csF kalcara enDa sensiTiviTI TesTa karAvavA joIe jenuM pariNAma 48thI 72 kalAke maLe ane te mujaba agAu pasaMda karelI davAomAM pheraphAra karavAnI jarUra che ke nahIM te nakkI karavAmAM Ave che.

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magajanA cepI rogo : meninjAITisa, ensephelAITisa 151 A uparAMta jarUra mujaba CSF Lactate, CSF CRP, Latex Particle agglutination, sirolaoNjikala TesTa phaoNra siphilisa, vAirasa Aisolezana TesTa, ImyUnoese, phangasa mATenA TesTa ane TI.bI. mATenA PCR TesTa paNa sAthe sAthe karavAmAM Ave che. Ama badhI rIte A pAyojanika maeNninjAiTisa ja che tenI khAtarI karavAmAM Ave che ane kayA jaMtuo che te nakkI karI te mujaba davAo cAlu karavAmAM Ave che. davAo jarUra paDye A davAomAMthI eka ke tethI vadhu davA jevI ke sirphalosporina, penisilIna, venkomAIsina, lAInejholiDa, meropenama, Imipenama, piparAsilina, TAjhobekTama, jenTAmAisina, kelorAmyuMnikola ane meTronirDajhola vAparavAmAM Ave che. A badhI uttama ane saphaLa pariNAmalakSI davAo che ane tvarita rIte, yogya mAtrAmAM, yogya saMyojanavALI davAo vAparavAthI 80thI 85 TakA kesa sArA thaI jatA hoya che. sAmAnya rIte A davAo 10thI 14 divasa ekasarakhI rIte vAparavAmAM Ave che ane kalcaranA riporTa mujaba jarUra paDye vacce pheraphAra karavAmAM Ave che ane chevaTe bIjI vAra kamaranAM pANI(CSF)nI tapAsa karIne khAtarI karavAmAM Ave che ke jaMtuo nAza pAmyAM che ane A pANI have para batAvatuM nathI, te pachI ja davA baMdha karavI joIe. jo magajanI aMdara thoDo paNa cepa rahI gayo hoya ane davA baMdha karavAmAM Ave to zakya che ke roga TUMka samayamAM pharIthI Uthalo mAre ane te vakhate kadAca A davA dhArI asara na paNa kare jene Draga rejhisTansa kahe che. magajamAM sojo vadhAre hoya, eka bAju kheMca ke lakavAnI asara hoya (phokala simpaTama - sthAnika nukasAnasUcaka lakSaNa-lakSaNo) to avazya tvarita sI.TI. skena karAvI levuM joIe. kadAca purunI gAMTha hoya. AvA kesamAM ghaNI vAra kamaranuM pANI na kADhatAM yogya davAo zarU karavAmAM Ave che ane jarUra paDye sakSama nyuraoNsarjana dvArA gAMThamAMthI paru kheMcI kADhavAmAM Ave athavA oNparezana karavAmAM Ave che, jenAthI dardInI jiMdagI bacI zake.

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magaja ane jJAnataMtunA rogo magajano sojo vadhato javo (raised intracranial tension), kheMca AvavI, kothaLIno rasto avaruddha thavo (hAiDrosikelasa), sabaDyUrala ephyUjhana ke sabaDyUrala empAyamA magajanA AvaraNanI vacce paru thavuM.) ke breina eksesa (magajanI aMdara paranI gAMTha), baherAza, magajanI zirAo avaruddha thavI (vinasa thraoNmbosisa) ane vAskyulAiTisa - A badhI ochA pramANamAM thatI paNa maeNninjAiTisathI thatI cokkasa jANItI evI samasyAo che ane tenuM paNa yogya nidAna karI tvarita sAravAra karavI joIe. A uparAMta AvI badhI bhAre davAo paNa kyAreka koI ne koI ADaasara karI zake, mATe tenI paNa sAvacetI rAkhavI joIe. (3) phangala maeNninjAiTisa 152 magajamAM thatA phUganA rogane phangala maeNninjAiTisa kahevAya. phUga aneka prakAranI che jema ke krIpTokoksa, kokaMsIDIosIsa, kenDIDA, esparagIlasa, hisToplAjhamA, phAyakomAyaseTisa vagere. kamaranA pANIno riporTa TI.bI.ne maLato ja hoya che paNa vadhu cokasAIthI mAikroskopamAM jotAM temAM phangasa maLI Ave che (e.g. India ink preparation in cryptococcus). A roga paNa jhINA tAva, mAthAnA duHkhAvA ane azakti temaja becenIthI zarU thAya che ane tethI ghaNIvAra tenuM nidAna zarUAtanI kakSAe thatuM nathI hotuM ane te daramiyAna roga vadhI javAthI bebhAna thavuM tathA kheMco AvavI vagere thAya che. sAmAnya rIte je vyaktinA zarIranI rogapratikArakazakti sAva ghaTI gaI hoya, temane phangasano roga thAya, jema ke kaeNnsara, limphomA, eiDsa, nazAyukta davAonuM baMdhANa, vadhu paDato dArU, vadhu paDatI eNnTibAyaoNTika davAonuM sevana, harpisa, kaeNnsa2nI kemothaeNrapI temaja vadhu paDato DAyAbiTIsa athavA sTIroIDa - A badhA saMjogomAM phangasa zarIramAM phelAvA mAMDe che. kvacit dardI haoNspiTalamAM bIjA roganI sAravAra mATe gayo hoya ane TI.bI, phangasa (phUga) ane bIjA parajanya roga laIne Ave tevuM paNa bane. arvAcIna tabIbI sAravArapaddhatinI A eka ADaasara che.

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magajanA cepI rogo meninjAITisa, ensephelAITisa 153 phUgane mATe mukhyatve emphoTeresIna, phalUsAyaTosIna, phalUkonAjhola, vorIkonAjhola ane spAranaoNksa jevI vagere davA vAparavAmAM Ave che. A davAonI kiDanI (mUtrapiMDa), yakRta ane kAna vagere upara ghaNI ADaasara thatI hoya che tethI tene khUba sAvacetIpUrvaka vAparavI joIe. (4) vAirasa ensephelAiTisaH A ekajhaDapathI thatI bImArI che jemAM dardIne tAva Ave, mAthuM dukhe, ekAeka vartaNUkamAM pheraphAra thavA mAMDe ke Diprezana Ave, prakAzathI Dara lAge. pachI kheMco zarU thAya, lakavo thAya ke dardI bebhAna thAya. magajanA kaoNrTeksane UdhaInI jema jhaDapathI korI khAto A roga koSono nAza kare che ane ghaNI vAra tenI kAyamI rahI jatI asaro choDI jAya che, jema ke yAdadAsta ochI thavI, kheMco AvyA karavI AP -13 ant ane vartana badalAyeluM rahevuM. | vAyarala ensephelAITisa moTA bhAge gAlapacoLiyAno vAirasa (mamsa), harpisa sipleksa vAirasa, (Asv-1), Arbo vAirasa ane kyAreka veriselA, esTina bAra, enTaro vAIrasa - AmAMno koI vAirasa koI kAraNasara magajamAM praveze to vAirasa ensephelAITisa thAya. eiTsano vAirasa paNa Avo ensephelAITisa kare. kvacit keTalAka vAirasa phakta magajanAM AvaraNone asara kare che jene vAirala meninjAiTisa kahevAya. A bImArI pramANamAM haLavI che.

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154 magaja ane jJAnataMtunA rogo vAirasanA rogo atizaya khataranAka nIvaDI zake, jema ke harpisa ensephelAITisanA rogamAM yu.esa.e.mAM paNa Azare 10thI 40 TakA dardIo mRtyu pAme che ane eTalA ja pramANamAM temane roganI agAu jaNAvelI khoDa-asaro rahI jAya che. * nidAna : - kamaranA pANI(cs)nA riporTamAM proTIna thoDA vadhelA hoya che, sugara lagabhaga normala hoya che ane limphosAiTsa nAmanA zvetakaNo vadhu hoya che. imyunolaoNjikala TesTa dvArA ghaNI vAra vAirasanI hAjarI jANI zakAya che, jemake csFHsv TesTa; kyAreka cs-PCR TesTa dvArA AnI khAtarI karI zakAya. yogya kesamAM ema.Ara.AI. ke sI.TI. skena athavA I.I.jI. karavAmAM Ave che. jo A roganuM yogya nidAna thAya to tAtkAlika keTalIka davAo jiMdagI bacAvI zake ane khoDakhAMpaNathI dUra rahI zakAya dA.ta. harpisa ensephelAITisamAM esAiklovira (jhovIrekSa, vIra, esIvIra)nAM iMjekzana vAparavAmAM Ave che. dareka davAnI jema A davAnI rojanI mAtrA ane te keTalI vAra vakhata levI te je te niSNAta DaoNkTara nakkI kare che. tenI ADaasaro joke bahu nathI paNa te bAbatanuM dhyAna rAkhavuM paDe. A sivAya sI.ema.vI. jevA aneka bIjA vAirasa magajane eka yA bIjI rIte takalIpha karI zake jenuM nirUpaNa sthaLasaMkocane kAraNe ahIM karavuM zakya nathI. e ja rIte magajanA keTalAka vAiraso jene slo-vAIrasa kahe che te dhIme dhIme mahinAo-varSomAM magajanA koSono nAza kare che AmAM esa.esa.pI.I. (sabaekyUTa skulerojhiMga pAnaensephelAITisa), jekoba-krUjhaphekTa DIsIjha mukhya che. kamanasIbe, AmAMnA koI roganI davAo upalabdha nathI. thoDI rAhata thAya teTalI davAothI ja calAvavuM paDe che ane moTA bhAganA AvA slovAirasanA kesamAM dardI aMte mRtyu tarapha dhakelAI jAya che.

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155 magajanA cepI rogo meninjAITisa, ensephelAITisa (5) phAlsiperama maleriyA : maleriyAnA jaMtuo sUkSma jIvasRSTimAM che paraMtu teo baeNkTariyA ke vAirasathI taddana alaga evA proTojhoA samUhanAM che. A maleriyala paisAITa eka prakAranuM paropajIvI jaMtu che. A jaMtunA kula cAra peTAprakAra che paraMtu temAM vAIreksa ane phAlsiperama mukhya che. phAlsiperama vize jotAM pahelAM ApaNe A ati pracalita roga viSe vistArathI joIzuM. A maleriyala paresAiTanuM jIvanacakra be tabakkAomAM thAya che? (1) eka tabakko mAdA enophilisa maccharamAM thAya che. A tabakko prajanana avasthA tarIke oLakhAya che. (2) bIjo tabakko mANasanA yakRta-livaranA koSo ane lohImAM rahelA raktakaNomAM thAya che. A tabakko vikAsa, vibhAjana ne vRddhino tabakko kahI zakAya. enophilisa mAdA macchara manuSyane karaDe che tyAre tenA DaMkha sAthe maleriyala paisAiTanA "sporojhoisa" lohImAM bhaLe che ane thoDI vAramAM livaranA koSomAM dAkhala thAya che. tyAM teno vikAsa, vibhAjana ne vRddhi thAya che. chevaTe livaranA koSo tUTe che ane asaMkhya "merojhoITsa" lohImAM bhaLe che, je lohImAM taratA raktakaNomAM praveze che. A tabakke keTalAka merojhoITsanuM nemeTosAITsa(nara ane mAdA)mAM rUpAMtara thAya che. gemeTosAiTsa e prajanananI avasthA che. enophilisa mAdA macchara jyAre maleriyAnA dardIne karaDe ane lohI cUse te sAthe A gemeTosAiTsa paNa tenA peTamAM pahoMce che ane temAMthI chevaTe navAM sporojhoinTsa pedA thAya che, je maccharanA DaMkha dvArA mANasanA lohImAM bhaLe che. raktakaNomAM pravezelA bAkInA merojhoITsa vikAsa, vibhAjana ane vRddhino krama cAlu rAkhe che. pariNAme, A raktakaNo paNa tUTe che ane asaMkhya merojhoiTrasa pharIthI lohImAM bhaLe che ane vaLI pAcho

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156 magaja ane jJAnataMtunA rogo bIjA raktakaNomAM dAkhala thAya che. vAiveksa maleriyAmAM A cakra lAMbo samaya cAlyA kare che. phAlsiperama prakAramAM mAnavazarIramAM eka ja cakra hoya che. hakIkatamAM asaMkhya raktakaNonuM eka sAthe tUTavuM-phATavuM e maleriyAnA rogamAM ThaMDI vAya ane tAva caDhe tenuM mukhya kAraNa che. vAraMvAra maleriyA thavAnA kAraNe je enemiyA (lohInI phikAza - ochuM lohatattva (hImoglobina) thAya che tenuM paNa A ja kAraNa che. Ama, mAdA enophilisa macchara ane mANasa vacce potAnI Ava-jA cAlu rAkhI maleriyala paeNraeNsAiTsa potAnuM ane sAthe sAthe maleriyAnA roganuM astitva TakAvI rAkhe che. cepI macchara karaDyA pachI 8thI 14 divasa pachI ja maleriyAno tAva Ave che. maleriyAnAM lakSaNo maleriyAnA humalAnA traNa tabakkAo che. (1) zarUAtamAM dardI kaMpArI ke sakhata dhrujArI (khATalo paNa dhruje tevI dhrujArI) anubhave che. (2) dhrujArI zAMta thatAM tAva caDhe che ne garamI lAge che. (3) thoDA samaya pachI khUba parasevo vaLI tAva UtarI jAya che. dardI khUba nabaLAI anubhave che. da2 trIjA divase Avo ja humalo thAya che. A sAthe mAthAno dukhAvo, zarIramAM kaLatara, UbakA ane UlaTI paNa thAya che temaja lUkhI khAMsI rahe che. keTalAka kesomAM hoTha para phollA nIkaLe che (haripasa simpleksa, lebIAlIsa) khAsa karIne phAlsiperama nAmano maleriyA bIjAM ghaNAM asAmAnya lakSaNo-cihno sAthe thaI zake che. tAvano laya aniyamita hoya che. phAlsiperama maleriyAne jherI maleriyA paNa kahe che. A prakAranA maleriyAnA jIvANu

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magajanA cepI rogo : meninjAITisa, ensephelAITisa 157 dareka avasthAnA raktakaNone cepa lagADe che (vAiveksa mAtra navA (yuvAna) raktakaNone ja cepa lagADe che). 1-2 TakA raktakaNo para asara thatI hoya che. tethI A maleriyAno cepa dharAvatA raktakaNonI saMkhyA vadhI jAya che ane sAthe sAthe enimiyA paNa vadhAre thAya che. cepa dharAvatA raktakaNo lohInI nAnI naLIo (capillaries)mAM jamA thaI naLI baMdha karI de che. Ane lIdhe dardI bebhAna thaI jAya che (serebrala maleriyA) ke kiDanI bagaDI jAya che, jhADA thaI jAya che. kamaLo thAya, zvAsamAM takalIpha paDe ane blaDaprezara khUba ghaTI jAya tevI jIvaleNa takalIpho paNa thaI zake che. sAmAnya rIte vAiveksa maleriyAmAM klorokvInanI goLIo vaparAya che. kvinAina e phAlsiperama maleriyAnI sAravAranI akasIra davA che. te 10 miligrAma/kilo dara 8 kalArka 10 divasa sudhI ApavAmAM Ave che. A davAnI ADaasaro paNa hoya che, khAsa karIne hRdaya para. A davA haMmezAM DaoNkTaranI salAha pramANe ane temanI dekharekha nIce ja levI joIe. gaMbhIra kesamAM zarUAtamAM kvinAina nasamAM glukojha sAthe ApavAmAM Ave che. dardI moDhethI goLIo laI zake tyAre goLIono upayoga karavAmAM Ave che. phAlsiperama maleriyAmAM A davAnI asara na thAya tevuM paNa jovA maLela che. te mATe mephalokvina, ArTisTraneTa, ArTethara jevI davAo vAparavI paDe che. A sivAya pAIrImethemAina, TeTrAsAiklina ane DaoNksisAiklina davAo paNa ochA gaMbhIra keso mATe vAparI zakAya che. nidAnanI khAtarI mATe lohInI tapAsa * kALajIpUrvaka lohInI tapAsa karavAmAM Ave to sAmAnya rIte raktakaNomAM maleriyala paeNraeNsAiTsa (ema.pI.) jovA maLe che. phAlsiperamamAM maleriyala paeNraeNsAiTanI saMkhyA vadhAre hovAthI te lohInI tapAsathI moTe bhAge ane sahelAIthI jovA maLe che, paNa vAiveksa prakAramAM ema.pI. ochA hovAthI te na paNa dekhAya tevuM bane. kyU.bI.sI. prakAranI tapAsathI vadhu saphaLatA maLI zake. A mATe tAva hoya tyAre ja lohI levuM vadhu

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- AkSita wAIkara 11 ) 158 magaja ane jJAnataMtunA rogo icchanIya che paraMtu te pachI paNa laI zakAya. keTalIka vAra klorokvinanI 2-4 goLI laIne Avela dardInA lohInI tapAsamAM kAMI maLatuM nathI. AvA kesamAM lakSaNone vadhu mahattva ApI sAravAra pUrI karavI paDe che. lakSaNo parathI maleriyAnI saMbhAvanA vadhu lAge to tenI pUrI sAravAra ApavI paDe ane chatAM tAva na maTe to tAvanuM kAraNa zodhavA vadhu tapAsa karavI ane je kAraNa nIkaLe tenI davA karavI te vadhu hitAvaha che. (6) nyurosisTisarakosisa : magajamAM thatA paeNraeNsAiTika rogomAM eka atijANIto ane tabIbone mUMjhavato A evo roga che ke jemAM magajanA sI.TI.skenamAM TI.bI.nA jevI gAMTho (ringenhancing lesions) dekhAya che. ema kahevAya che ke ApaNA dezamAM yuvAna vyaktione kheMca (phiTa) nyurosisirakosisa AvavAnuM sauthI agatyanuM kAraNa A sisTisaraksa nAmanuM paeNraeNsAiTa che, je mAMsa ke dhoyA vagaranA salADa khAvAthI thaI zake che. AmAM kheMca (phiTa) aTakAvavAnI davA uparAMta roga maTADavA mATe AlbanDejhola ke prejhikvonTAla nAmanI davAo jarUrI mAtrAmAM nyurolaoNjisTa Ape che. mAMsa na levuM ane salADa dhoI-sApha karI, zakya hoya to kAcuM na khAtAM, thoDA dhImA tApe garama karIne khAvuM e A atipracalita rogane phelAto aTakAvavA mATe pUratuM che. (0) TITenasa (hanu): A roga klosTrIDIyama TITenI nAmanA grAmapojhiTiva jaMtuthI udbhavatAM jherI dravyothI thAya che ane A jaMtu zarIranA ghAmAMthI aMdara praveze che. . ' ' ke A www.j

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magajanA cepI rogo : meninjAITisa, ensephelAITisa 159 A jherI dravya (ekjhoTokSina) snAyu ane cetAo-nasonI uttejanA kare che ane tenAthI TITenasa roga thAya che. temAM snAyu jakaDAI jAya che, jaDabuM barAbara khUlI zakatuM nathI (lock jaw). moDhuM, garadana ane pIThanA tathA anya aicchika snAyuo jakaDAI-jhalAI jAya che. zarUAtamAM sAmAnya takalIphathI mAMDIne chevaTe kalAko ke divasomAM evI paristhiti sarjAya che ke snAyuo satat uttejita rahe che ane jhATakA (spasm) Ave che ane aMte zvAsanA tathA gaLAnA snAyuo upara asara thAya che. kyAreka phakta ghA pUrato ja TITenasa sImita rahe che; temAM dardIne sudhAro thavAnI vadhu zakyatA rahe che, paNa agAu jaNAvyA pramANe za2I2mAM badhe prasarelA TITenasamAM mRtyuno dara TrITamenTa karavA chatAM Azare 60 % sudhI pahoMce che. * sAravAraH enTITITenIka sIrama (3,000thI 10,000 yuniTa)thI TrITamenTanI zarUAta karavAmAM Ave che. ghAne barAbara sApha karIne AjubAju sarjikala DresiMga karavAmAM Ave che ane jo zakya hoya to DresiMga khulluM rAkhavuM joIe. penisilIna A roga mATe akasIra eNnTibAyaoNTika che je 10thI 14 divasa ApavAmAM Ave che. penisilInanI eNlarjI hoya tene irIthromAyasIna athavA TeTrAsAyaklina ApI zakAya. dardIne aMdhArA rUmamAM rAkhI, jhATakA aTakAvavA satata I.V. (inTrAvenasa) DAyAjhApama bATalAmAM auSadharUpe yogya mAtrAmAM ApavAmAM Ave che. kyAreka vaeNnTileTara para mUkIne nyuraoNmaskyulara blaoNkiMga paNa karavAmAM Ave che. anaicchika sisTamanI aniyamitatAne lIdhe blaDaprezaranI vadhaghaTa, tAva ane hRdayanI takalIpho paNa thaI zake to tenI kALajIpUrvaka sAravAra karavI paDe. sAravAra karatAM aTakAva (prevention) vadhAre saraLa ane icchanIya che. TITenasa rokavA mATe rasIkaraNa : A eka bahu ja mahattvanI ane jarUrI prakriyA che jenAthI aneka jiMdagIo bacAvI zakAya che.

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160 magaja ane jJAnataMtunA rogo be mahinA uparanI dareka vyaktine tathA jeNe TITenasanuM rasIkaraNa barAbara lIdhuM nathI tema ja je dardI tAjetaramAM ja TITenasanA rogamAMthI hemakhema bahAra Avyo che teone TITenasa TophoiDa .(T) dvArA paddhatisara saMpUrNa rasIkaraNa karavuM joIe. TInuM paheluM iMjekazana lIdhA pachI 1 mahine iMjekazanano bIjo Dojha levAno hoya che ane te pachI cha mahine trIjo Dojha levAno hoya che. tyAra pachI dara dasa varSa TTno eka busTara Dojha levAno hoya che. sagarbhA strIne vadhArAnA Dojha ApavA paDe che. A rIte, rasIno Akho korsa karavAthI TITenasa sAme pratikArazakti Ave che. jyAre ghA thAya tyAre TTno eka busTara Dojha pharI apAya che ane jo ghA gaMdo, kharaDAyelo, asvaccha hoya to hyumana TITenasa imyunoglobyulinano eka Dojha (250 Units/I.M.) apAya che. TITenasanA aTakAva (prevention) mATe A to sAmAnya mArgadarzana ja che kAraNa ke dareka vyakti | kesamAM judAM judAM paribaLone lakSyamAM laIne nirNaya to sAravAra karatA DaoNkTare ja levAnA hoya che. ApaNA dezamAM A roga ocho thayo che paNa chatAM hajI paNa ThIka ThIka pracalita che kemake ajJAnatA khUba che, gaMdakI ghaNI ja che ane tabIbI taMtrano gAmaDAMo sudhIno pracAra apUrato che; tethI AvA aTakAvI zakAya tevA rogamAM paNa varSe ApaNe seMkaDo nAgarikone gumAvIe chIe. (8) poliyomAyalAiTisa : vAirasano A roga enTarovAirasathI thAya che ane karoDarajajunA enTiriara haoNrna koSo (cells)no nAza kare che jethI zarIranA vividha aMga-aMgonA aicchika snAyuone jhaDapathI pAMgaLA thaI jAya che. ekadama tAva Ave ane thoDA divasomAM ja paga ke hAtha ke pIThanA ke bIjAM snAyuomAM duHkhAvo thAya ane te zithila thaI jaI sukAvA mAMDe ane tethI khoDa Ave. joke sadnasIbe, rasIkaraNanI jhuMbezathI A roga have vizvamAMthI adazya thaI rahyo che. ane bhAratamAMthI paNa te lagabhaga nAbuda thaI gayo che. tenI TrITamenTa khAsa karIne pUraka sAravAra ja hoya che. koI khAsa davA hotI nathI. nAnAM bALakomAM tAva daramiyAna snAyumAM iMjekzana ApavAnuM TALavuM joIe to poliyonA keso ghaTI jAya.

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161 magajanA cepI rogo meninjAITisa, ensephelAITisa palsa polIyo kAryakrama : dareka navajAta zizune polIyonI rasIno saMpUrNa korsa karAvavAnA pariNAma svarUpe dezamAMthI A rogane saMpUrNapaNe dUra karavAnA kAryamAM ApaNe ghaNAMbadhA saphaLa thayA chIe. svAthya vibhAga ane tabIbI vijJAnanI A mahattvanI upalabdhi gaNI zakAya. chatAM paNa dezanAM dUra-dUranAM aMtariyALa gAmaDAomAM game tyAre polIyonA samAcAra vartamAnapatromAM AvatA rahe che. svAcyavibhAge A rogane haMmezA mATe mULamAMthI ukhADI pheMkavAnA udezyane paripUrNa karavA mATe palsa polIyo abhiyAna AraMbhya che ane pariNAma svarUpe A bImArIne saMpUrNapaNe dUra karavAnI dizAmAM ApaNe maMjilathI basa hAthaveMta ja cheTA chIe evuM kahI zakAya. (9) rebIsa (haDakavA) kUtaruM, vAMdaro, ziyALa tathA garama lohIvALAM anya prANIo ane cAmAcIDiyuM vagerenA karaDavAthI thato ane acUka mRtyu lAvato magajano vAirasathI thato A ati bhayaMkara roga che. prANI karaDyA pachI 30 divasathI 60 divasamAM ane kyAreka 6 mahinA sudhImAM zarIramAM A roga pragaTa thaI jAya che. zarUAtamAM vartaNUkamAM pharaka dekhAya che ane dardI uttejita thaI jAya che ane pachI kheMca-lakavA vagere Ave. mukhyatve pANIne joIne te habakI jAya (hydrophobia, pANI jovAnI-pIvAnI bIka) ane TUMka samayamAM zvAsa baMdha thavAthI athavA hRdayanI gati bagaDavAthI mRtyu thAya che. zreSTha sArasaMbhALa ke davAo chatAM bhAgye ja koI dardI bace che. tethI nivAraNa vadhu jarUrI che. rebIsanI rasI ane enTIsIrama, prANInA karaDavAnA dareka kesamAM vAparavuM AthI hitAvaha che. joke jUnI rasI(sIrama)nI keTalIka ADaasaro che tethI have navI zodhAyela riphAInDa rasIo (je thoDI moMghI che) je HDcy nAmathI oLakhAya che te ApavI hitAvaha che. A mATe DaoNkTaranI salAha tarata ja levI joIe. upasaMhAra: magajanA A tamAma cepI rogo paranI carcA parathI jaNAI Ave che ke magajanA (tathA zarIranA) AvA jAtajAtanA cepI roga thavA mATe

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162 magaja ane jJAnataMtunA rogo nabaLI rogapratikAraka zakti eka agatyanuM kAraNa che tethI rogapratikArakazakti vadhe tevA prayatno karavA joIe. yogya pauSTika khorAka levo, vyAyAma karavo, svacchatA jALavavI, gaMdakIvALI vastu-jagyAthI dUra rahevuM ane pANI ukALIne pIvuM vagere rogapratikAraka zakti jALavI rAkhavA mATe ati jarUrI che. A uparAMta gharamAM ke kAma karavAnI jagyAe cepI roganA dardI hoya to tenAthI sAcavavuM. dardInAM sagAMvahAlAMne DaoNkTara sAvacetInA pagalAMrUpe kyAreka enTibAyoTika athavA bIjI davA ApatA hoya che jethI vyaktinI rogapratikAraka-zakti vadhe che mATe AvI davAo mATe AnAkAnI karavI joIe nahIM. khUba vadhAre paDato zArIrika zrama (zarIra ghasAI javuM) karavo nahIM ane mAnasika thAka lAge nahIM te jovuM. eiDragsane aTakAvavAnA upAyo have pachInA prakaraNamAM joIzuM. temAM jaNAvyA pramANe sAvacetI rAkhavI joIe. A uparAMta bahAranA asvaccha ane halakI guNavattAvALA khorAka tema ja pravAhIothI dUra rahevuM. | vividha rogo mATenI rasI (vaccine) dA.ta. bIsIjI, poliyonI rasI, TrIpala veksIna vi. tabIbI salAha pramANe levA joIe. A vize vadhAre jAgRtinI jarUra che. aMtamAM, rogapratikAraka-zaktimAM vRddhi thAya tevA prayatno karavA ane jarUrI sAvacetI rAkhavI te atyaMta jarUrI che. aMgrejImAM ukti che ke "Prevention is better than cure" (sAravAra karatAM sAvacetI vadhAre sArI)

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magajanA cepI rogo meninjAITisa, ensephelAITisa 163 ATaluM jarUra jANo - zarIranAM anya aMgonI sarakhAmaNImAM magaja ghaNI vAra khUba ja jhaDapathI cepI rogano bhoga banI zake che. khAsa karIne magajano TI.bI. pAyojenika meninjAiTisa, parunI gAMTha, ensephelAITisa, jherI maleriyA, sisTisarakosisa vagere roga cepathI thAya che. * magajanI bahAranAM AvaraNomAM TI.bI.no cepa thAya to tene TI.bI. meninjAiTisa kahe che. magajanAM korTeksamAM cepa thAya to tene ensephelAITisa kahe che. sTrepTomAyasIna, AIsonAyAjhIDa, rIphAmapIsIna, pAyarejhInAmAiDa, ithAbyuTola, lIvopaloksAsIna vagere davAo TI.bI.nI sAravAra mATe akasIra che. pAyojenika meninjAITisamAM cepI jaMtu magajamAM paru banAvIne khUba ja jhaDapI phelAya che, AthI te atyaMta jokhamI roga che. kripTokokasa, koksIDIosIsa, kenDIDA, esparajilasa vagere prakAranI phUgathI magajamAM thatI bimArIne phaMgala meninjAiTisa kahe che. vAyarala ensephelAITisa - vAyarasa jema ke, harpisa simpaleksa, mammasanAM vAyarasa, veriselA, esTinabAra vAyarasa, enTerovAyarasa, eIDjhanAM vAyarasa vagerethI thAya che. vAyarasa ensephelAITisamAM samayasara sAcuM nidAna thavAthI dardInI jiMdagI bacAvI zakAya che. phAlsIperama maleriyAmAM enophilisa mAdA macchara manuSyane khe te sAthe phAlsIperama nAmanAM paropajIvI jaMtuo lohImAM praveze che.

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164 magaja ane jJAnataMtunA rogo salADa dhoyA vagara khAvAthI athavA mAMsAhAra karavAthI sisTisarakasa | nAmanAM peresAITa magajamAM pahoMcIne cepa lagADe che. TiTenasamAM klorRiDiyama TITenI nAmanAM jaMtu zarIra paranAM ghAmAMthI aMdara praveza kare che ane atyaMta jherI padArthano strAva kare che. A rogamAM sAravAra karAvavA chatAM mRtyu dara lagabhaga 60% jeTalo che. cetAtaMtramAM enTarovAyarasanAM cepathI poliyomAyelAiTisa thAya che, paraMtu rasIkaraNanAM abhiyAnathI A bimArI vizvabharamAMthI adRzya thaI rahI che. rebIsa - kUtaruM, vAMdaro, ziyALa ane garama lohIvALAM anya prANIo tathA cAmAciDiyuM vagerenAM karaDavAthI thAya che. A bImArI thayA pachI kadAca ja koI dardI bacI zake che. tethI ja prANI karaDyuM hoya to tarata ja rasI lagAvavI joIe.

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(13)( eijha (tenI cetAtaMtra para asara) ) eisa eTale ke ekvAyarDa ImyunoDephiziyansI sinDroma. A roga eca.AI.vI (HIV) eTale ke hyumana Imyuno-DephiziyansI vAyarasathI thAya che. A vAIrasanAM kAraNe zarIranI rogapratikArakazakti ghaTI javAthI takalIpho UbhI thAya che, e bImArIne eIDjha (AIDS) kahevAya che. eiDjha e eka ja roga nathI paraMtu eka karatAM vadhAre rogonA samUhanuM nirdezana kare che. sAmAnyataH ApaNA zarIramAM vividha rogo sAme laDavA mATe be prakAranI kSamatA hoya che (1) sela miDieTeDa-koSaprerita eTale ke zvetakaNolimphosAiTathI maLatI ane (2) hayumorala rogapratikArakazakti imyuniTI eTale ke pratidravyo-eNnTibaoNDIjha mAraphate maLatI kSamatA. eca.AI.vI viSANu lohImAM rahelA TI-limphosAITa prakAranA zvetakaNone cepa lagADI tenI saMkhyAmAM ane kSamatAmAM ghaTADo kare che. zarIranI rogapratikAraka zaktinA mukhya AdhArarUpa zvetakaNo ghaTavAthI zarIranI rogapratikArakazaktimAM kramazaH ghaTADo thAya che. tenA kAraNe je sUkSma jIvothI anya taMdurasta mANasane cepa na lAge te ja sUkSma jIvothI eiDresano roga dharAvatI vyaktine sahelAIthI-AsAnIthI cepa lAgI zake che. * eiTsa kevI rIte phelAya che (1) sajAtIya ke ajANI vyakti sAthe bemAMthI eka pAtra jo pojhITIva hoya to) vijAtIya saMbhogathI (2) eca.AI.vI. cepa dharAvatI vyaktie ApeluM lohI bIjA dardIne ApavAthI (3) eca.AI.vI.no cepa dharAvatI mAtAthI tenA bALakane garbhAvasthA daramiyAna, suvAvaDa vakhate tathA prasUti bAda stanapAna dvArA A cepa lAgavAnI 30thI 40% zakyatA rahelI che

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166 magaja ane jJAnataMtunA rogo (4) iMjekzananI soya, siriMja tathA anya oNparezananAM sAdhanothI (5) nasa dvArA kaeNphI dravyonuM sevana karanAra vyakti jo rogiSTa hoya to eka ja soyanA sAmUhika upayogathI A roga thaI zake. eiDsanA cepa aMge samAjamAM hajI Aje paNa keTalIka geramAnyatAo pravarte che, jema ke dardI sAthe rahevAthI, tenI sAthe hAtha milAvavAthI, ramavAthI ane jamavAthI A rogano cepa phelAya che je khoTuM che; eTaluM ja nahi paNa A roga khorAka, pANI, jaMtu, maLa ke havAthI phelAto nathI. tethI eiDsanA dardInA sAmAjika saMparkathI DaravuM joIe nahIM, balake temane vadhu hUMphanI temaja sAmAjika svIkRti maLe tevA vyavahAravAtAvaraNanI AvazyakatA che. eiDsa phelAto aTakAvavA mATe ATaluM dhyAnamAM rAkho : 1. iMjekzana levA mATe bajAramAM maLatI pramANita Dispojhebala siriMja vAparavI tathA sAmAnya bImArImAM iMjekzana levAnuM TALavuM. 2. ajANI vyakti sAthe zArIrika saMbaMdha na bAMdho. 3. konDomano upayoga karavo. 4. jo lohI levAnI paristhiti UbhI thAya to eca.Ai.vI.nI laeNboreTarI-tapAsa karAvIne ja lohI upayogamAM levuM. zakyataH sagAMsaMbaMdhInuM lohI meLavI zakAya to vadhu sAruM. dhaMdhAdArI raktadAtAnuM lohI levuM nahIM. 5. potAnuM rejhara tathA bleDa alAyadAM rAkhavAM, bIjAnAM vAparavAM nahIM. bIjAMne ApavA paNa nahIM. 6. eca.AI.vI.grasta mahilA dvArA tenAM bALakane roga thavAnI zakyatA nIce jaNAvela upAyo dvArA ghaTADI zakAya che. (1) eca.AI.vI. davAo (enTirITrovAyarala) ApavI. A davAo DaoNkTaranI salAha pramANe ja ApavI. (ii) suvAvaDa daramiyAna kALajI rAkhavI.

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eIDjha (tenI cetAtaMtra para asara) 1. 2. 167 (iii) bALakane stanapAna karAvavuM nahIM. (iv) bALakane 45 divasa sudhI jhIDovuDIna (Zidovudine) pramANasaranA DojhamAM ApavI. A upAyothI bALakane cepa lAgavAnI zakyatA 5 TakA karatAM paNa ochI karI zakAya che. (v) hospITala sTAphe paNa AIDSnA dardIonI sAravAra karatI vakhate takedArI rAkhavAnI hoya che. eiDsanAM lakSaNo : prathama bImArI 6thI 8 aThavADiyAMmAM thAya che. AmAM dardIne tAva Ave, hAthapaganA snAyuono dukhAvo thAya, lasikAgraMthi para sojo Ave, cAmaDI para lAla cakAmAM paDe, gaLAmAM sojo Ave. A bImArImAMthI aThavADiyAmAM davA vagara dardIne sAruM thaI jAya che. A prathama bImArIne ekyuTa sirokanvarjhana ilanesa kahe che. A prathama bImArI bAda eca.Ai.vI.nI tapAsa pojhiTiva batAve che. zarUAtanAM A 6thI 8 aThavADiyAM daramiyAna eca.Ai.vI.nI laeNboreTarI-tapAsamAM nakArAtmaka pariNAma batAve che paraMtu dardI teno cepa anya vyaktine A samayagALA daramiyAna phelAvI zake che. A samayagALAne vinDo piriyaDa kahe che. A prathama bImArI bAda dardI cihno vagaranA eca.Ai.vI.vAhaka tabakkAmAM praveze che. A tabakko 5thI 10 varSa jeTalo lAMbo hoI zake che. A tabakkAno samayagALo dardInI taMdurastI, dardInI Adato vagere upara AdhAra rAkhe che. 3. A tabakkA bAda dardIne roganAM anekavidha lakSaNo dekhAya che, jema ke lasikAgraMthi phUlavI, vAraMvAra yA to saLaMga tAva rahevo, moDhAmAM, gaLAmAM cAMdAM paDavAM, khorAkanI aruca thavI, baroLa moTI thavI, lAMbA samaya sudhI khAMsI AvavI, vAraMvAra jhADA thavA, vajana ochuM thavuM vagere. A lakSaNo dardIne vAraMvAra ke saLaMga rahe to tenA Jain EducatilohInI e eca.AI.vI nI tapAsa karAvavAthI nidAna thaI zake che.

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168 magaja ane jJAnataMtunA rogo vizva Arogya-saMsthA (WHO) dvArA eca. AI. vI. (Human Immunodeficiency virus disease, AIDS) mATe nakkI thayelAM mukhya lakSaNo mujaba 1. eka mAsathI vadhAre samaya mATe tAva. 2. eka mAsathI vadhAre samaya mATe jhADA thavA tathA vajanamAM 10thI vadhAre ghaTADo jaNAvo. 3. A uparAMta khAMsI AvavI, zarIre khaMjavALa AvavI, moM, gaLAmAM athavA gudA ke gupta bhAgamAM cAMdA thavAM, be-traNa jagyAethI lasikAgraMthi phUlI javI, avAranavAra harpisa jhosTara thAya to eca.AI.vI. parIkSaNa karAvavuM joIe. eiDasanA rogamAM nyuraoNlaoNjikala sisTama eTale ke magaja ane cetAtaMtramAM lakSaNo-cihno jaNAtAM hoya che. evuM kahevAya che ke eiTsanA 33% dardIone spaSTa rIte nyuraoNlaoNjikala bImArI hoya che ane vatteoche aMze dareka dardInA magaja ke cetApezIne nukasAna thatuM ja hoya che. * leboreTarI parIkSaNa : dardInA zarIramAM eca.AI.vI.nAM jIvANuonI hAjarI elIsAELISA TesTa dvArA jANI zakAya che. A TesTa skriniMga TesTa che. mATe jo A TesTamAM eca.AI.vI nI hAjarI (pojhiTiva) jovA maLe to tenI 'vesTarna bloTa" (Western Bot) TesTa dvArA cokasAI karavI jarUrI che. cepa lAgyA bAda moTe bhAge 6 aThavADiyAMthI 6 mahinA sudhImAM A TesTa dvArA dardInA zarIramAM eca.AI.vI nI hAjarI jANI zakAya che. paraMtu zarUAtanA A samayagALA daramiyAna (Window Period) A TesTa naeNgeTiva ke inaDiTaramineTa (acokkasa) pariNAma batAve che. dardInA lohImAM vAirasanI mAtrA ane cp4 nAmanA koSonI saMkhyA (jenAthI zarIranI rogapratikAraka zakti jANI zakAya) vividha parIkSaNa dvArA jANI zakAya che je dardInI sAravAramAM upayogI che. jo A AMkaDo-kAunTa 100thI nIco hoya to mRtyu najIka che tema samajavuM. A uparAMta vAirasa bhAra-loDa TesTa dvArA rogane keTalo kAbUmAM laI zakyA chIe te jANI zakAya che.

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169 * 1 eIDjha (tenI cetAtaMtra para asara) * magaja ane cetAtaMtranA eIsa saMbaMdhI rogo mukhyatve pAMca bhAgamAM vaheMcI zakAyaH (1) magajamAM ensephelAiTisa, harpisa sipleksa, veriselA jhosTara inphakazana, eiDresa DimenziyA (yAdadAstano roga) kaoNpleksa, magajanA cayApacaya saMbaMdhI rogo, magajano TI.bI., limphomA, ToksoplAjhamosisa, pI.ema.ela., parunI gAMTha, magajamAM siphilisa, eca.AI.vI. ensephelAITisa magajamAM phUga vagere rogo dvArA atyaMta nukasAna thaI zake che. spAInala kaoNrDa (karoDarajaju)mAM sojo eTale ke mAilAiTisa, mAilopathI vagere rogo thaI zake jethI dardInuM halanacalana sthagita thaI jAya. (3) magajanAM AvaraNo eTale ke maeNnijisamAM cepa thavAthI maeNninjAiTisa lAgu paDe. temAM TI.bI., siphilisa ke phUganAM jaMtuo hoI zake jenA kAraNe dardI bebhAna thaI zake, kheMca AvI zake ke lakavo thaI zake. (4) cetAo-jJAnataMtuomAM sojo AvavAthI nyurAiTisa thaI zake che cepI jaMtuo dA.ta. harpisa vagerene kAraNe thAya che. tenAthI pagamAM baLatarA, cAlavAnI takalIpha ane duHkhAvo vagere thaI zake. (5) paoNlimAyosAiTisa ane snAyuone lagatI bIjI bImArIo jemAM snAyuo kamajora thatA jAya. Ama eilsa dvArA zarIramAM lasikAgraMthithI mAMDIne cetAtaMtra sudhInA aneka rogo thaI zake che, jyAre hRdaya saMbaMdhI bImArIo eiDresanA dardIomAM pramANamAM ghaNI ochI jovA maLe che.

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170 magaja ane jJAnataMtunA rogo * sAravAra : eiTsanA dardInI sAravAra thaI zake che chatAM paNa tene saMpUrNa maTADI zakAya tevI sAravAra hajI zodhAI nathI. vartamAna davAo tathA sAravAra paddhatithI A rogane AgaLa vadhato kaMIka aMze aTakAvI zakAya che tema ja rogapratikArakazakti (CD4 count) sudhArI zakAya che. eiTsanA roganAM vAyarasanAM jaMtuono nAza karavA mATenI davAo traNa davAonAM saMyojana rUpe levAnI hoya che. A davAo daradInA zarIramAM rahelAM anya cepo jevAM ke TI.bI.no roga, kamaLAnAM vAyarasanI upasthiti tathA daradInAM lIvara, kiDanI, magaja vagere avayavonI kAryakSamatAne AdhAre niSNAta DaoNkTara nakkI karatAM hoya che. davAonI TUMkA gALAnI ane lAMbA gALAnI ADaasaro eka mahattvanI bAbata che je mATe daradIe niyamita rIte DaoNkTarane batAvIne tabiyata mATe tathA ADaasaro mATe jarUrI pagalAM levA joIe. enTirITrovAyarala davAo niyamita levAthI daradI lAMbA samaya sudhI taMdurasta ane svastha jIvana gujArI zake che. davAo niyamita levAmAM Ave to tenI asarakArakatA lAMbA gALA sudhI jaLavAI rahe che. paraMtu jo daradI davAo levAmAM aniyamitatA dAkhave to davAo binaasarakAraka puravAra thAya che ane tethI AvA kissAmAM rogane kAbUmAM rAkhavAnuM kAma bahu ja agharuM thaI paDe che. AvI davAono mAsika aMdAjita kharca eka hajArathI dasa hajAra rUpiyA jeTalo hoya che. - eca.AI.vI.nA cepanA kAraNe prAthamika avasthAmAM dardInuM mRtyu moTe bhAge thatuM nathI paNa e khAsa yAda rAkhavuM joIe ke eisanA dardInuM mRtyu moTA bhAge sUkSma jIvANuothI ane cepI jIvANuothI thatuM hoya che. ethI jo A baMne jAtanAM jaMtuonuM yogya nidAna jhaDapathI thAya ane tAkIde sAravAra levAmAM Ave to tene maTADI zakAya che. keTalIka mahattvanI bAbato (1) eca.AI.vI.nA dardIo niyamita tapAsa karAve ane niyamita davAo le to lAMbA samaya sudhI svastha jIvana gujArI zake che. sarakArI

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eIDjha (tenI cetAtaMtra para asara) 171 hospiTalomAM A roganI davA maphata ApavAmAM Ave che. hAlamAM gujarAta sahita ghaNAMbadhAM rAjyonI meDikala kaoNlejomAM ART Centre hoya che. A roganI prAthamika tapAsa mATe judA-judA vCTC Centre paNa kAryarata che, jyAM dardI parIkSaNa karAvIne roga vizenI mAhitI paNa meLavI zake che. (2) eca.AI.vI. rogagrasta sagarbhA mahilAo mATe MTCT Programme`paNa ART CentremAM kAryarata hoya che, jyAM temanI sArI dekharekha thAya che. temAM navajAta zizumAM cepa lAgavAnI mAtrA ghaTADavA mATe paNa prayatno karavAmAM Ave che. (3) eca.AI.vI. roganAM dardImAM CRF (kiDanInI niSphaLatA-phelya2) thaI jAya to temanA mATe kiDanI TrAnsaplAnTa jevAM moTAM oparezano paNa saphaLatApUrvaka pAra pADI zakAya che. (4) A rogonA dardIonI sevA mATe judA judA sarakArI, khAnagI saMsthAo tathA NGO paNa kAryarata che. (5) ARTnA Agamana bAda A roganA dardIo traNa dazakA sudhI svastha jIvana jIvI zake che. A davAone tabIbI dekharekha heThaLa ja levI joIe kAraNa ke A davAthI judI judI ADaasaro paNa thaI zake che. (6) eca.AI.vI. grasta strI-puruSa paraspara lagna paNa karI zake che tathA sukhI kauTuMbika jiMdagI paNa vitAvI zake che. TUMkamAM, tarata-jhaDapI nidAna, yogya sAravAra, mAvajata, cepI rogathI dUra rahevAnI jIvanapaddhati vagere dvArA dardInuM jIvanadhoraNa ane AyuSya sudhArI zakAya che, ane dardI mAnasika rIte svastha rahI zake che. A roganI jANakArI mATe keTalIka sarakArI haoNspiTalomAM maphata salAhakendro hoya che ane have to inTaraneTa mAraphate paNa mAhitI upalabdha thAya che. eIDajhathI bacavA mATe jarUrI sAvacetI - sAvadhAnI rAkhavI e vidhAna maMtranI jema sadA yAda rAkhavA jevuM che. surakSita jAtIya saMbaMdha mATe konDomano upayoga hitAvaha che.

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172 magaja ane jJAnataMtunA rogo ATaluM jarUra jANo eca.AI.vI. nAmanA vAyarasathI thato A AIDS nAmano roga, eka roga nahi paraMtu ghaNI badhI bImArIonA samUhano nirdeza kare che, je zarIramAM roga pratikAraka zakti ghaTI javAne lIdhe thAya che. dareka eca.AI.vI., pojhITIva vyaktine eIDsa hoya te jarUrI nathI. eIDsa ghaNA prakArathI phelAya che, jemAM mukhya che - sajAtIya athavA anaitika vijAtIya saMbhoga, rogI potAnuM lohI anya vyaktine de tyAre, rogI mahilA garbhAvasthA dhAraNa kare to tenAM bALakane A roga thavAnI saMbhAvanA che. injekazananI sAthe athavA asurakSita sarjikala upakaraNathI paNa A roga phelAI zake che. enTIrITrovAyarala davAnAM niyamita sevanathI dardI lAMbA samaya sudhI taMdurasta ane svastha jIvana vyatita karI zake che. A roganI jANakArI mATe keTalIka sarakArI haoNspiTalomAM maphata salAha tathA sAravAra kendra che ane inTaraneTa para paNa tenA vize jANakArI prApta thaI zake che.

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(14)( magajamAM thatI gAMTha (breina Tyumara)) magajamAM thatI gAMTha (breina Tyumara) e nyuraoNlaoNjInuM eka gaMbhIra prakaraNa che ane te aMgenI jANakArI ati agatyanI che. magajanI gAMTho aneka prakAranI hoya che. tenAM kada, prakAra, sthAna ane guNavattA tema ja hisTolaoNjI pramANe teo aneka sAmAnya ane vizeSa lakSaNo- cihno pedA kare che. keTalIka gaTho magajane UdhaInI jema kotare che, keTalIka magajane dabAve che ane magajamAM sojA (increased intracranial pressure)nAM lakSaNo-cihno UbhAM thavAnuM A eka agatyanuM kAraNa che. jo ke have sarjikala paddhatimAM tathA enesthesiyAmAM sudhAro thavAthI, adyatana sTIrIoTeksisa paddhati ane mAIkro nyuraoN-sarjikala Tekaniko vadhavAthI, temaja reDiezana tathA kImotherapImAM noMdhapAtra vikAsa thavAthI breina TyumaranA dardInuM bhaviSya jhaDapathI sudharI rahyuM che. breIna Tyumara e magajano jANIto roga che ane yu.esa.e. jevA dezamAM dara varSe Azare 1,00,000 lokone te thAya che, to ApaNA dezanI sthitinI kalpanA karI lo. temAMnI keTalIka gAMTha kensaranI hoya che, je magajamAMthI udbhavatI (prAimarI) hoya che, jema ke glAyomAM athavA zarIranA bIjA bhAgamAMthI magajamAM pahoMcI jatI - prasaratI (sekanDarijha) hoya che. bAkInI gAMTho pramANamAM ochI upadravI, sAdI (benign) hoya che, jema ke menijIomAM, piyUTarI Tyumara vagere. cepI rogathI udbhavatI gAMTha jema ke TyubarakyulomA, parunI gAMTha, sisTIsarakosisa, eIsano paNa ullekha karavo joIe, joke tenAM lakSaNo, nidAna ane sAravAranA hoina Tyumara prakAra alaga alaga hoya che. - na

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174 magaja ane jJAnataMtunA rogo lakSaNo cilo ? magajanI gAMThane lagatAM lakSaNo-cihno dhIme dhIme paNa cokkasa rIte vadhatA jatA prakAranAM hoya che je te gAMThanI guNavattA, sthAna, kada, prakAra ane sAthenA sojA upara AdhArita hoya che. (1) magajamAM dabANa vadhavuM: (increased intracranial pressure): 'dareka gAMThanuM kada vadhatAM magajamAM dabANa vadhe jethI eka bAjunuM ke baMne bAjunuM mAthuM duHkhavuM, UlaTI-UbakA thavAM, aMdhArAM AvavAM, becenI lAgavI, cIjo ekane badale be dekhAvI (diplopia). mAthAnA duHkhAvAnA kesamAM badhA ja dardIone breina Tyumara hotuM nathI, balake 1 TakA kesamAM ja breina Tyumara hoya che paraMtu koI paNa svAthyapUrNa vyaktine dhIre dhIre vadhato jato mAthAno dukhAvo thato hoya to Tyumara viSe niSNAta pAse tapAsa karAvI levI joIe. (2) gAMTha magajamAM je sthAna para hoya te pramANe lakSaNo dekhAya che. tethI dardIne dhIme dhIme vadhatA jatA lakavAnI asara AvI zake, bolavAnI zakti, yAdazakti athavA zarIranuM samatolana bagaDI zake. keTalAka dardImAM phakta vyaktitva ke vartaNUkamAM ja pharaka paDe che athavA jhADA pezAbano kAbU jato rahe tevuM thaI zake. (3) kheMco AvavI ke bebhAna thavuM e paNa eka agatyanuM lakSaNa hoI, khAsa karIne sAthe mAthAno dukhAvo ke lakavAnI asara hoya to tAtkAlika tapAsa karAvI levI paDe. (4) kyAreka gAMThamAM hemareja thavAthI dardInI paristhiti acAnaka ja vaNasI jAya. moTe bhAge upara jaNAvela eka karatAM vadhu lakSaNo-cihno hoya tevA dardIone gAMTha hovAnI vadhAre zakyatA hoI zake che.

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175 magajamAM thatI gAMTho (breIna Tyumara) nidAna: sacoTa nidAna mATe moTA bhAganA kesomAM, (1) magajano sI.TI. skena (kaoNnTrAsTa sAthe) e pUratI tapAsa che. paNa jo gAMTha nAnI hoya, magajanA pAchaLanA bhAgamAM hoya athavA sI.TI. skena dvArA tenI upasthiti tathA prakAranI khabara na paDI zake to magajano ema.Ara.AI. karAvI levo joIe. (2) emaAra.AI. (megneTika | rejhonansa ImejiMga) nAmano TesTa karAvI khAtarI karI zakAya ane keTalAka kesamAM te jarUrI paNa bane che. cokkasa nidAna mATe kyAreka sAthesAthe eNnjiyogrAphI ke ema.Ara. spekTrokopI paNa karAvavI paDe che. zarIramAM pesamekara hoya, dhAtu-meTalanuM koI ImplAnTa hoya to 1 glAsomA kensaranI gAMTha ema.Ara.AI. karI zakAya nahi ane tevA saMjogomAM sI.TI. skenathI ja calAvavuM paDe. to vaLI keTalAka dardIone ema.Ara.AI.nI kaeNbinamAM 20thI 30 miniTa sUvAnuM atyaMta muzkela paDe che, jene kalosTrophobiA kahe che. AvA saMjogomAM athavA to nAnAM bALakone kyAreka ghenanI davA ke haLavo enesthesiyA ApIne AvA phoTA pADavAmAM Ave che. (3) laMbara paMkyara : magajamAM sojo vadhAre hoya to A tapAsa hAnikAraka banI zake che. breIna TyumaranA T mainijiomA: sAdI gAMTha For Private & Personalberom www instars.org

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176 magaja ane jJAnataMtunA rogo ema.Ara.AI, jevA TesTa upalabdha hovAthI A prakAranI tapAsano avakAza ocho hoya che. magajanI cepanuM nidAna jema ke meninjAiTisa, ensephelAITisa vageremAM A tapAsa ati upayogI hoya che. magajanI gAMThonA prakAra : agAu jaNAvyA mujaba magajanI gAMTha kaeNnsarayukta athavA kensara vagaranI (nirdoSa) ema be jAtanI hoya che. je gAMTha magajanA uparanA bhAgamAM hoya che tene suprAsToriala kahe che, pAchaLanA ke nIcenA bhAgamAM AvelI gAMThane InphoTenToriala kahe che. A sivAya karoDarajajumAM paNa AvI baMne jAtanI eTale ke kensarayukta athavA kensara vagaranI (nirdoSa) gAMTho thatI hoya che. kaeNnsaranI gAMThomAM keTalIka gAMTha khUba ja jhaDapathI vadhatI gaMbhIra prakAranI hoya che, jemAM dardInuM AyuSya moTe bhAge 6 mahinAthI 3 varSa jeTaluM ja hoya che, jema ke melignanTa glAyomA (enAplAsTika glAyomA, glAyablAsTomAM malTiphormI vagere). kaeNnsaranI keTalIka gAMTho pramANamAM dhImI gatithI prasaratI hoya che jema ke oNsTraoNsAyaTomA (astrocytoma), oNligoDenDroglAyomA vagere. A sivAya magajamAM limphomA prakAranI gAMTho paNa thAya che je eivALA dardImAM vizeSa pramANamAM jovA maLe che. - sAdI, kensara sivAyanI gAMThomAM mukhyatve maeNniniomAM, zvAnomA ane piyUiTarI graMthinI gAMTha mukhya che. jo tenuM zarUAtamAM ja jhaDapathI nidAna thayuM hoya ane yogya sarjana pAse sArI rIte tenI sarjarI thaI hoya to dardInuM AyuSya yathAvat rahe che, teTaluM ja nahi paNa thoDIka sAmAnya takalIpho ke azaktine bAda karatAM mukhyatve normala meTAsTeTika Tyumara jevI ja jiMdagI rahe. kadAca kheMcanI davA 10 Jai EDCEEEEEEEEEEEEEP

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magajamAM thatI gAMTho (breIna Tyumara) 177 jiMdagIbhara levI paDe. zarIranA bIjA bhAgomAMthI prasarIne kensara magajamAM Ave tene meTAsTeTika Tyumara kahevAya. ghaNI vAra breIna TyumaranAM cihno dvArA dardIne bIje kyAMka kensara che tevI khabara paDe che tyAre ghaNuM moDuM thaI gayuM hoya che. tema chatAM prAimarI kensara zodhI tenI TrITamenTa karAvavAthI AyuSya laMbAvI zakAya che. sAravAra : nina thayA pachI breina TyumaranI sAravAramAM nyuraoNlaoNjisTa karatAM vadhu aMgatyanuM yogadAna nyurosarjananuM hoya che. jo gAMTha kaeNnsaranI nIkaLe to oNnkolaoNjisTa ane reDiezana ApanAra reDiezana phijhiziyananI paNa khUba jarUra paDe che. oNparezana ane bIjI sAravAra pachI magajanAM bAkI rahelAM lakSaNo jevAM ke kheMca, sojo ane lakavo vageremAM nyurolaoNjisTanI vakhatovakhata salAha laI zakAya. TyubarakyulomA, sisTisarakosIsa, parunI gAMTha hoya to yogya davAothI, oparezana vagara ja, saMpUrNataH maTI javAnI sArI evI zakyatAo hoya che. breIna TyumaranAM oNparezano eTalAM sarasa vikasyAM che ke keTalAka prakAranI gAMThamAM magajane kholyA vagara gAmA reDiezanathI gAMThane AgaLa vadhatI aTakAvI pachI sUkavI nAkhI zakAya. e oNparezana niSphaLa jAya to magaja kholIne pharIthI oparezana karI zakAya. keTalIka nAnI ane bahAranI gAMThone phakta sTirioTeksika Tenika dvArA viziSTa soya dvArA kADhI nAkhI zakAya to keTalAkamAM amuka viziSTa kiraNo dvArA ogALI ke bALI zakAya. bAkInA kesomAM oparezanathI magaja ke karoDarajju kholIne zakya teTalo gAMThano bhAga sarjano kADhI nAkhatA hoya che. kyAreka mAIkroskopanI madada laI jhINavaTabharI sUkSma prakAranI sarjarI karI zakAya jenAthI pariNAmo sArAM Ave ane naoNrmala bhAgone koI viparIta asara thAya nahIM. AnA kAraNe breinanAM keTalAMka oNparezano 6thI 12 kalAka sudhI lAMbAM cAlatAM hoya che. enesthesiyAnA vikAsane lIdhe oNparezananuM jokhama paNa pahelAM karatAM ghaNuM ghaTyuM che. AvAM kuzaLa sarjana, sArAM sAdhano ane sArA enesthesiolaoNjisTa For Private & Personal use only jainelibrary.org

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178 magaja ane jJAnataMtunA rogo DaoNkTaro bhAratadezamAM TheraThera che ane amadAvAdamAM paNa che e ApaNuM sadbhAgya che. oNparezana pachI phijhiotheMrapInI jarUra paDe che. koI prakAranI ADaasara hoya to tenI sAravAra karavAmAM Ave che. gAMThanI bAyopsImAM jo kensara jaNAI Ave to, kemotheMrepI, reDiezana vagere dvArA zakya teTalI rIte dardIne bane teTalo sAjo karavAnA prayatno karavAmAM Ave che. Ama, breina Tyumara e cokkasa takalIpha ApanAro roga che tenI nA nahi paNa moTA bhAganA ane khAsa karIne kaeNnsara vagaranA dardIomAM pariNAma ghaNuM ja sAruM maLI zake. te mATe jarUra che tenAM lakSaNo-citone jhaDapathI oLakhI, temanuM vizleSaNa karIne, tAtkAlika niSNAta pAse nidAna karAvI jhaDapI sAravAra karavAnI; evA samayasaranA kesomAM saMpUrNa (ke vadhAre-vipula pramANamAM) saphaLatA maLI zake che. | ATaluM jarUra jANo magajamAM bhinna-bhinna kAraNothI alaga-alaga prakAranI gAMTha thAya che, je kada, AkAra, sthAna, guNavattA ane hisTolojI pramANe khAsa prakAranAM lakSaNo-cihno utpanna kare che. mAthAmAM dukhAvo thavo, aMdhArAM AvavAM, becenI thavI, pakSAghAtanI asara thavI, yAdazakita para asara thavI, bebhAnAvasthA, kheMca AvavI vagere magajamAM thatI gAMThanAM lakSaNo hoI zake che. Adhunika sTirioTeksika paddhati ane mAIkro nyuro sarjikala paddhatimAM sudhArA thavAthI tathA reDiyezana kimotherApImAM vikAsa thavAthI magajanI gAMThanA dardIonuM vartamAna tathA bhaviSya ujvaLa che. Fii . (0 For private Personal Use Only

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(15)( seribrala pAlsI (sI.pI.) dara hajAre Azare 2(be) bALakone thato A lagabhaga janmajAta prakArano magajano evo roga che ke jemAM kAM to baMne paga athavA to hAthapagano vikAsa khUba dhImo paDI jAya che, sAthe sAthe, kAMIka aMze mAnasika khoDakhAMpaNa ane magajamAMthI udbhavatI kheMca paNa Ave che. tene kAraNe A rogane seribrala pAlsI evuM nAma ApavAmAM AvyuM che. Ama seribrala pAlsIno kharo artha che - vikasatA magajane nukasAna thavuM. ApaNe agAunAM prakaraNomAM joyuM che ke magajanA vividha bhAgo amuka cokkasa manozArIrika kriyAono prAraMbha tathA niyaMtraNa kare che. have, magajanA je bhAgane nukasAna thayuM hoya te bhAga dvArA niyaMtrita kriyAo thavAmAM muzkelI UbhI thAya che. A hakIkatanA kAraNe ja seribrala pAlsIvALA bALakamAM eka ke vadhAre pramANamAM takalIpha hoya che. AthI be seribrala pAlsIvALAM bALakone taddana alaga alaga prakAranI takalIpha hoya te zakya che. A roganI lAkSaNikatA e che ke te uMmara vadhatAM temAM dhIre dhIre sudhAro thato jAya che, roga vadhato ke vakarato nathI. Ama je roga dhIre dhIre vadhato-bagaDato jAya che te roga seribrala pAlsI hoto nathI. kAraNa: keTalAka kesomAM A roga janmasamaye apUratA oksijananA kAraNe thAya che. bAkInA moTA bhAganA kesomAM garbhanA vAtAvaraNa athavA vikAsamAM khAmI utpanna thavAthI AvuM thaI zake che. javalle ja AnuvaMzika kAraNa hoI zake. ApaNe joyuM tema seribrala pAlsI e magajane thayelA nukasAnane kAraNe che. A kAraNone ApaNe mukhyatve traNa bhAgamAM vaheMcI zakIe : (a) janma pahelAM (garbhAvasthA daramiyAna): (1) adhUrA mahine bALakano janma thavo. (2) garbhAvasthAnI zarUAtamAM mAtAne vAyarasano cepa lAgavo.

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180 magaja ane jJAnataMtunA rogo (3) mA-bApanA lohInAM blaDa-grUpa-Rh (mAtAnuM blaDagrupa-Rh negeTiva tathA pitAnuM pojhiTIva hovAthI) prakAramAM asamAnatA (4) AnuvaMzika bImArIo, tamAku-dArUnuM sevana. (5) mAtAnI potAnI ja bIpI, DAyAbITIsanI bImArI ane garbhanAM vAtAvaraNa tathA vikAsamAM khAmI, apUratuM poSaNa, be-traNa garbha sAthe rahevAM... vagere (ba) janmasamayeH (1) khUba lAMbo samaya prasUtinI pIDA rahe ane bALakanA dhabakArA ochA thAya athavA vadhI jAya. (2) ojArothI bALakano janma karAvatI vakhate magaja para dabANa (3) bALakanA gaLA pharate nAyaDo-garbhanALa vIMTaLAyela hoya to magajane apUratuM lohI-oNksijana maLe. (4) adhUrA mahine janma thavo. (ka) janma pachI tarataH (1) AMcakI AvavI. (2) vadhu paDato pILiyo thaI javo. (3) lohImAM khAMDa (zugara) ochI thavI. (4) lohImAM cepa (5) lohImAM kelziyamanI ochapa-UNapa (6) magaja upara sojo ke breIna hemareja (7) meninjAiTisa, ensephelAITisa vagere AthI ja yogya kesomAM navajAta bALakane yogya nirIkSaNa-sAravAra mATe IkyubeTaramAM rAkhavAmAM Ave che. paraMtu dareka bALakamAM kAraNa maLI ja jAya tevuM banatuM nathI. upara jaNAvelAM ghaNAM kAraNone rokI zakAya che paraMtu te mATe sajAgatA khAsa jarUrI che. te mATe yogya janajAgRtinI tAtI jarUra che. mATe ja zizunI DilivarI vividha suvidhAvALI hospiTalamAM niSNAta tabIba dvArA ja karAvavI joIe. Us On

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181 paribrala pAlsI (sI.pI.) seribrala pAlsInA prakAraH (1) spAsTika seribrala pAlsI : sI.pI.no A sauthI sAmAnya prakAra che. A prakAramAM snAyuo kheMcAyelA ane kaDaka rahe che, pariNAme asara pAmelA hAtha-pagane vALavAmAM ke sIdhA karavAmAM jora karavuM paDe che. paganI AMTI ke cokaDI paDe che. UbhA rahevAmAM ke cAlatI vakhate bALaka mAtra paMjAno ja upayoga kare che ane eDI UMcI rAkhe che. AnI asara zarIranA kyA aMgamAM thayelI che tenA AdhAre peTAprakAra nIce mujaba che : hemIplejiyA jyAre aDadhuM aMga eTale ke eka bAjunA hAtha, te ja bAjunA paga ane te ja bAjunA dhaDanA snAyuomAM asara dekhAya che. DAIplejiyA baMne paganA snAyuo para asara hoya ane kvacit hAthamAM thoDI asara jaNAya. kvoDrIplejiyA : jyAre baMne hAtha ane baMne paga tathA dhaDanA snAyuone asara dekhAya che. (2) DisakAIneTika (DisaTonika, ethiTaoNiDa) seribrala pAlsIH zarIranA aMgomAM icchA vagara ja halanacalana thayA kare che; tethI icchA mujaba kArya karavAmAM takalIpha thAya che. zarIra dhanuSanI jema vaLI jAya che ane magajanA niyaMtraNamAM rahetuM nathI. (3) eTeksika seribrala pAlsI ane hAIpoTonika seribrala pAlsI: zarIranuM samatolana jaLavAtuM nathI ane zarIranA snAyuo khUba DhIlA rahe che. zarIra jANe ke rabaranuM baneluM hoya tema lAge che.

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magaja ane jJAnataMtunA rogo sI. pI.vALA bALakamAM upara jaNAvela koI eka ke vadhAre khoDa DoI zake che. A sivAya nIce jaNAvelI keTalIka takalIpho sAmAnya rIte jovA maLe che : 182 (1) trAMsI AMkha - 50thI 60% bALakomAM jovA maLe che. (2) jovAnI takalIpha (3) kheMca (epilepsI) (4) sAMbhaLavAnI takalIpha (5) maMdabuddhi - 66% (6) svabhAvamAM jiddIpaNuM vagere 66% sAmAnya mAhitI janmathI ja seribrala pAlsI hovI e khUba ja duHkhadAyaka ghaTanA che paNa temAM sudhAro thato ja nathI tema hotuM nathI. keTalAMka bALakone sAmAnya takalIpha hoya to temAM sudhAro jhaDapathI thAya che. bAkInA kesamAM khUba kasarata (phijhiyothaeNrapI)thI tathA yogya davAonA saMyojanathI lAMbA gALe thoDo phAyado thaI zake che. A prakAranA rogamAM Azare trIsa TakA dardIone tIvra roga hoya che jemAM sAruM thavAnI zakyatA ochI hoya che. janma pachInA prathama mAsa sudhI naoNrmala dekhAtuM bALaka dhIme dhIme tenA vikAsamAM khUba pAchaLa che tevuM jaNAI Ave che athavA to besavAnuM zIkhI zakatuM nathI. te ja prakAre cAlavAnI kriyA je sAmAnya saMjogomAM eka varSanI uMmare AvavI joIe te ghaNI moDI Ave che ane cAlavAnuM zIkhe to paganA paMjA upara UbhA rahevAno prayatna kare che ane cAlavAmAM khUba takalIpha paDe che. A ja rIte magajanA vikAsamAM ane buddhizaktimAM ghaNAM bALako kamajora rahe che, bolavAnuM moDuM zIkhe che tathA uccAro spaSTa hotA nathI. keTalAka tIvra kesamAM caherA uparathI bALaka maMdabuddhinuM hoya tema jaNAI Ave che. AmAMnAM keTalAMka bALako khUba tophAnI

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seribrala pAlsI (sI.pI.) 183 ane jiddI paNa hoI zake ane keTalAkane kheMca paNa Ave che. paraMtu e yAda rAkhavuM ghaTe ke ghaNAM bALakone A roga haLavA prakArano hovAthI thoDo samaya jatAM bALaka lagabhaga sAmAnya thaI zake che. paraMtu je bALakonA cAreya hAthapaga asara pAmelA hoya, magajamAM vadhAre nukasAna hoya ane buddhiAMka ocho hoya temanI sAravAra atizaya agharI hoya che. nidAna: janma pachI bALakanI uMmara pramANe vikAsa thato nathI te mAtApitAne sauthI pahelAM khyAla Ave che. garadana TaTTAra rAkhavI, najara pheravavI, paDakhuM pheravavuM, besavuM, cAlavuM vagere bALaka zIkhatuM nathI. bALaka jo maMdabuddhinuM hoya to mAtA-pitAne ke gharanAM sabhyone oLakhatAM paNa zIkhatuM nathI. bALakanI vigata jANIne tathA tapAsa karIne mahadaMze DaoNkTara nidAna karI zake che. bALakanA janmasamayanI mAhitI jema ke, bALakanA raDavAmAM vAra lAgavI, janma pachI zvAsocchavAsamAM takalIpha athavA to bALaka janmIne bhUruM paDI gayuM hoya tevI koI mAhitI hoya to nidAnamAM saraLatA rahe che. javalle ja ema.Ara.AI. ke bIjI tapAsa karAvavI paDe che. sAravAra : seribrala pAlsI mATe koI jAduI ke camatkArika davA ke oparezana nathI paraMtu AthI hatAza thaI javAnI paNa jarUra nathI. AvA bALakane vahelAmAM vahelI take khAsa prakAranI tAlIma cAlu karavI paDe che. pAMca varSathI nIcenI uMmaranAM bALakone apAtI tAlImane ala inTaravenzana (Early Intervention) kahe che. A tAlImamAM bALakanI paristhitine dhyAnamAM rAkhI nIce jaNAvelA niSNAtono samanvaya ane phALo jarUrI che : (1) DevalapamenTala phijhiyotherApisTa (2) cAilDa sAikolaoNjisTa (3) spIca gherApisTa ane oNDiyolaoNjisTa

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184 magaja ane jJAnataMtunA rogo (4) oNkyupezanala therApisTa (5) speziyala TIcara (6) A uparAMta jarUra paDe to hADakAnA DaoNkTara, AMkhanA DaoNkTara ane nyurolaoNjisTano abhiprAya levo paDe che. davAomAM kaDaka snAyuone narama eTale ke DhIlAM karavAnI davA vAparI zakAya. yogya kissAmAM boTyulinIyama ToksinanAM ijekzana yogya mAtrAmAM snAyuomAM ApavAthI keTalIka vAra saMtoSakAraka pariNAma maLI zake che ane keTalAka daradI potAnI jAte kAma karatA ane haratA pharatA paNa thaI zake che. kheMca hoya to yogya davA karavI. (7) yogya kesomAM hAthapaganI nAnImoTI sarjarI * A sAravAra-tAlImanuM lakSya hoya che ? dararojanAM kAryomAM svAvalaMbana sAmAjika yogyatA zaikSaNika yogyatA Arthika svAvalaMbana A roganI sAravAramAM maryAdAo che tethI ApaNuM mukhya lakSya A roganA aTakAva (privenzana) tarapha hovuM joIe. garbhAvasthA daramiyAna gAyanekolojisTa dvArA niyamita tapAsa tathA parIkSaNa, prasUti haoNspiTalamAM karAvavI tathA janma daramiyAna tathA navajAta zizunI yogya sAravAra karAvavAthI roganuM pramANa 70 TakA jeTaluM rokI zakAya. jJAnataMturakSaka davAo (nyuroproTekTiva davAo), megneziyama salphaTa, inDomezAsina tathA yogya samaye sijheriyana oparezanano nirNaya A saMdarbhamAM upayogI banI zake. | _| | _|

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seribrala pAlsI (sI.pI.) upasaMhAra : sI.pI.vALAM bALakomAM 33% sudhI bALakono buddhiAMka sAro hoya che. teo praNAligata zALAmAM jaI zake che. A sivAyanAM bAkInAM bALakone speziyala skUlamAM tAlIma ApavI paDe che. 185 khedanI vAta che ke AvAM bALakono janma thavo tene kudaratano abhizApa gaNavAmAM Ave che. samAja ane kuTuMba mATe te eka javAbadArI ane samasyA banI rahe che. tabIbIvijJAnano ATalo vikAsa thayo hovA chatAM ApaNe AvA keso aTakAvI zakatA nathI ke naMthI tenI yogya sAravAra thaI zakatI. tethI ApaNA sahunI e sAmAjika, naitika ane mAnavIya pharaja bane che ke AvAM bALakonI sAravAraane prazikSaNa ApatI saMsthAo athavA phijhiyothaeNrapI senTarone yogya Arthika sahAya karavI athavA AvI navI saMsthAo UbhI karavI ane zakya hoya to AvI saMsthAmAM thoDAka kalAko phALavI bALakonA vikAsamAM madada karavI tema ja temane yogya hUMpha ane prema Apavo. AvAM bALakone dayAnI nahi, sneha ane sahayoganI vadhAre jarUra hoya che.

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186 magaja ane jJAnataMtunA rogo ATaluM jarUra jANo bALakomAM thatA A rogamAM baMne paga athavA hAtha-pagano vikAsa atyaMta dhImo thaI jAya che. kyAreka kheMcanI sAthe mAnasika vikalAMgatA paNa jovA maLe che. A rogano dara 0.2% che. A roganAM kAraNomAM janma samaye oNksijananI achata, garbhano vikAsa barAbara na thavo, janma samaye sAdhananA upayogathI thatI hAni, janma pachI tarata ja kheMca AvavI athavA kamaLo thaI javo vagere che. spAsTika seribrala pAlsI, DikasAIneTika seribrala pAlsI, eTeksika seribrala pAlsI ane hAyapoTonika seribrala pAlsI, A badhAM seribrala pAlsInA prakAra che. uMmara vadhavAnI sAthe A rogamAM sudhAro jovA maLe che. 33% bALako sArA buddhiAMkavALAM hoya che, je sAmAnya zALAmAM jaI zake che, bAkInAM bALakone speziyala skUlamAM tAlIma ApavAmAM Ave che.

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(1)( karoDarajjunA rogo (mAyalopathI) ) r ET, T.;*: -hola koDa atyAra sudhI ApaNe magajane moTuM magaja lagatA rogo vize joyuM. have cetAo-jJAnataMtuo ane snAyuonA rogo vize jotAM pahelAM ApaNe TUMkamAM karoDarajjunA nAnuM magaja | rogo viSe joIzuM. - sarvAIkala koDa magajamAMthI jatI ane AvatI saMvedanAone cetAo ane snAyuo sudhI pahoMcADavAnuM mukhya karoDaraju rile sTezana (prasAraNakendra) eTale karoDarajaju (spinal cord). karoDanA maNakAonI vacce sahIsalAmata rIte sacavAyelI karoDarajju e cetAtaMtranuM eka khUba meDyUlArisa agatyanuM aMga che. karoDarajjune Azare 30 prakAranA rogo thaI zake che, je karoDarajajunI kAryapaddhati ane tenI racanA, tenA saMvedanA Spinal Column -parivahananuM kArya, tenI laMbAI, teno naLA (silinDara) jevo AkAra, khUba ochI pahoLAI tathA parigha, tenAM AvaraNo, tenI lohInI naLIo tema ja karoDanA maNakA sAtheno teno saMbaMdha vagerenA anusaMdhAnamAM samajAvI zakAya. 0 karoDarajjunA rogone lagatAM lakSaNo : * AkhA page khAlI caDhI javI, jhaNajhaNATI thavI. hAtha-pagamAM kamajorI AvavI. - konasa lebara vibhAga .

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188 magaja ane jJAnataMtunA rogo * pezAba ane/athavA jhADAno aTakAva thavo ke te parano kAbU gumAvavo. * hAtha-paganA koI bhAgamAM satata dukhAvo thavo. * cAlatI vakhate pagamAMthI caMpala nIkaLI jAya to khabara na paDavI athavA paga nIce gAdI jevuM lAgavuM, baLatarA thavI, hAthe ke page kIDIo caDatI hoya tema lAgavuM. * hAtha-paganA snAyuo sukAvA vagere. karoDarajajunA rogo mukhyatve lakSaNo-cihnasamUha (syndrome) rUpe dekhA de che ane te cokkasa prakAranA hoI nidAna paNa ghaNI vakhata spaSTa hoya che. karoDarajjunA A badhA rogone Myelopathy kahe che. - jo garadananA maNakAnI vacce spAInala kenAlamAM AvelI karoDarajajune nukasAna thayuM hoya to tene cervical Myelopathy (sarvAikala mAyalopathI) kahe che, jemAM paga uparAMta hAthanA halanacalananI kriyAne tathA saMvedanAone paNa asara pahoMce che. - jo pIThanA maNakA vacce spAInala kenAlamAM AvelI karoDarajjune nukasAna thayuM hoya to phakta paganA (eka athavA baMne) halanacalanane tathA saMvedanAne asara thAya che, vadhumAM jhADA-pezAbanI kriyA para asara AvI zake. Ane Dorsal Myelopathy (DaoNjhala mAyalopathI) kahe che. e noMdhavuM joIe ke : 1. karoDaraju keDanA maNakAomAM sAmAnya saMte hotI nathI. eTale ke Lumbar one (1) maNakAthI karoDarajaju samApta thAya che, jene kosa meDyulArisa kahe che. tyAMthI te cetAomAM parivartita thAya che, jene cauda Equina (ghoDAnA pUMchaDA jevuM jJAnataMtuonuM jhUmakhuM)kahe che. 2. phakta karoDarajjunA rogomAM magajane lagatAM cihno hotAM nathI, jema ke bolavA-samajavAnI kriyA, AMkha, kAna, sugaMdha

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karoDarajjunA rogo (mAyalopathI) Back Front * karoDarajjunA rogonAM lakSaNoH Cross Section of the Spinal Cord karoDarajjuno ADacheda vagere jJAnendriyonI kriyAo, kheMca, eka bAjunAM aMgono lakavo, moDhAno lakavo. A badhAM cihno hoya to karoDarajju sivAyano koI roga hoI zake. 189 (1) karoDarajjunI tamAma saMvedanA eka cokkasa levala pachI kapAI javI, sAthe baMne paga taddana khoTA paDI javA, temanuM halanacalana baMdha thavuM, jhADo-pezAba aTakI javA, jema ke mArgaakasmAtathI thayeluM maNakAnuM phrekacara. (2) amuka saMvedanAvAhaka nasonI kAryavAhI baMdha thavI ane sAthe nasomAM dukhAvo thaI tenuM kAma ghaTavuM. (Myelo Radiculopathy), jema ke spaoNnDilosisa. (3) aDadhoaDadha eTale ke karoDarajjunI 50 TakA kAryavAhI Thappa thavI (brAuna-sikavarDa sinDroma). enAthI eka bAjunA paganuM halanacalana baMdha thAya, jyAre bIjI bAjunA paganI saMvedanA baMdha thAya. (4) karoDarajjuno Agalo bhAga kAma karato baMdha thavo (jema ke lohInI naLI baMdha thaI javI).

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190 magaja ane jJAnataMtunA rogo (5) karoDarajju cheka uparanA bhAgamAM dabAI javI (Foramen Magnum Compression). Jain (6) siriMgomAyeliA H karoDarajjunoM vacceno bhAga polo thaI pravAhI bharAvuM, jenAthI hAthanI naso ane snAyuo sukAya, pezAba aTake. (7) konasa meDyulArIsa sinDromaH karoDarajjune cheka nIcale cheDe dabANa ke gAMTha thavI. (8) kaoNDA IkvAinA sinDroma H karoDamAMthI nIkaLatA cheka chellA jJAnataMtuonA jhUmakhAnA rogo Ama bIjI rIte joIe to karoDarajjunA rogone sahelAIthI be bhAgamAM vaheMcI zakAya : (1) karoDarajju upara dabANanI asara thavI H (Compressive Myelopathy) : dA.ta., gAMTha, paru vagerethI thatuM dabANa karoDarajju para dabANa (2) karoDarajju para dabANa na hoya tevA rogo : (Noncompressive Myelopathy), jemAM karoDanA cepa, viTAminanI UNapa, sojo, ghasAro (degeneration), rasAyaNo, ane davA vagerene lIdhe thatI ADaasarono samAve thAya. A badhAmAM, ema.Ara.AI.. mAyalogrAphI, laMbara paMkacara (kamaranA pANInI tapAsa) vagere dvArA khAtarIthI nidAna thaI zake. (1) have ApaNe karoDarajaju 52 dabANa vize joIzuM. Fate & Personal Use Only

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191 *** karoDarajjunA rogo (mAyalopathI) (1) karoDarajjumAM vaccovaca gAMTha thAya athavA vacce pANI bharAya tene ImelarI prakAranA karoDarajajunA rogo kahevAya, je meDikala nyuraoNlaoNjI tapAsamAM tarata pakaDI zakAya ane ema.Ara.AI. dvArA khAtarI karI zakAya. (2) karoDarajajunAM AvaraNonI gAMTha (manijiomA) ke karoDarajjumAMthI nIkaLatI caitAnI gAMTha (zvAnomA). (3) karoDarajjunAM AvaraNo para kaeNnsara athavA limphomanI gAMTho. (4) karoDarajjunAM AvaraNonI bahAranI gAMTha : lApomA vagere. (5) karoDanA maNakAnuM phrekacara, maNakAnI gAMTho (bona Tyumara), sarvAikala sponDilosisa, maNakAmAM paru thavuM, jema ke TI.bI., be maNakA vaccenI gAdI khasavI (Diska prolepsa), phUlorosisathI maNako ghasAvo. A badhA dvArA karoDarajju para dabANa thAya che je nIcenA citramAM joI zakAya che. A badhAmAM vAhana-akasmAtomAM thatI karoDarajjunI IjA sauthI vadhu jovA maLe che ane tenI sAravAra ghaNI vAra muzkela thatI hoya che. te pachI sarvAikala sponDilosisane lIdhe karoDarajju tathA nasomAM thatA dabANanAM lakSaNo-cihno khUba pracalita che, jene mATe oNparezananI jarUra paDI zake che. te moTe bhAge vayaska vyaktiomAM thAya che. (1) sarvAIkala sponDilosisa ? uMmara vadhatAM karoDanA maNakAmAM ghasAro pedA thAya che ane eka prakArano sojo utpanna thAya che. ghasArAnI pratikriyA sAme keTalIka jagyAe hADakAno vadhArovRddhi osteophyte thAya che ane be maNakA vaccenI gAdI ghasAtI jAya che. temAMnuM jileTIna maTiriyala gAdI ghasAtAM | *sarvAIkala sponDilosisa -- jain lib. y.org

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192 magaja ane jJAnataMtunA rogo bahAra nIkaLe che. te samayAMtare karoDarajju para dabANa kare che ane lakSaNacihnasamUho UbhAM kare che. jo dabANa sIdhuM karoDarajju para Ave to tene mAyalopathI kahe che. moTAbhAganA kesomAM garadananI (sarvAikala) karoDarajjune dabANa thatuM hoya che. jemake C5-C6; C4-C5 jagyAe thatI bImArIne sarvAikala mAyalopathI kahe che. tevI ja rIte Dorsala (pITha) mAyalopathI paNa thaI zake. jo dabANa cetA-nasa para Ave eTale ke sAiDamAM Ave to tene reDikyulopathI kahe che, jemAM je te nasa 52 jhaNajhaNATI ke baLatarA ane dukhAvo thAya che ane tyAM saMvedanA ghaTI zake (sensarI reDikyulopathI) ane tenAthI uttejita thatA snAyuonI kAmagIrI ghaTatI jAya, teTalA snAyu kamajora thaI jAya, sukAI jAya (moTara reDikyulopathI). lambara (kamara) vibhAgamAM karoDarajju hotI nathI tethI naso para ja asara Ave che, jema ke reDikyulopathI ke kaoNDA IkvAInA sinDroma. bAkInA keTalAka kesomAM garadana ke karoDamAM anya jagyAe phakta dukhAvo ja thAya che. A darda ghaNuM pIDAkAraka ane koIka vAra haThIluM paNa hoya che. yogya tapAsathI AnuM nidAna thAya. mukhya TesTa ema. Ara. AI. che. ghaNI vAra AkhI karoDano ema. Ara. AI. karavo paDe che kema ke sponDilosisa ghaNI vAra eka sAthe eka karatAM vadhAre jagyAe thaI zake che, jema ke sarvAikala (garadana) tathA lambara (kamara) sponDilosisa. A darda uMmara ane ghasArAne saMbaMdhita hovAthI teno aTakAva karavo agharo che paNa garadanane jhaTakA na lAge, garadana para jo bahu boja uThAvavAmAM na Ave ane jarUra paDye kaoNlara paherI garadananuM halanacalana ghaTADavAmAM Ave to ghasAro jarUra ocho thAya. jyAre cetA-nasa 52 ke karoDarajju para dabANa vadhu Ave tyAre sAdI kasarato tathA dukhAvAnI davAo tema ja jarUra paDye yogya kesomAM Trekzana(kheMcANa)vALI kasarato karAvI zakAya. kvacit sTIroiDa grUpanI davAo paNa anubhavI DaoNkTaro upayogamAM letA hoya che. sarjarIthI ghaNIvAra

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193 karoDarajajunA rogo (mAyalopathI) khUba sArA pariNAmo Ave, jema ke dukhAvo jato rahe, cAlavAmAM saraLatA thAya ane agAu jaNAvelAM reDikyulopathI tathA mAyalopathInAM lakSaNocihno mahadaMze ghaTI jAya. (2) karoDarajjunA anya prakAranA rogone nonakoeNsiva mAyalopathI kahe che. jenAM ghaNAM kAraNo che. temAMnAM mukhya nIce mujaba che : (1) karoDerajjunA aneka jAtanA vAirasanA rogo jemAM harpisa, rebisa ane eiTsanA vAirasa paNa AvI jAya. Ane vAirala mAyalAITisa kahe che. (2) TI.bI., parunAM cepI jaMtuo, phUga, siphilisa vagere aneka jAtanA anya prakAranA cepI rogo. A paNa mAyalAITisa ja che. maNakAno TI.bI. hajI paNa pracalita che. (3) karoDarajjunA anya prakAranA sojA jema ke haDakavAnI rasInI ADaasarathI karoDarajjunI kAryavAhI aTakI javI. (have, A jUnA prakAranI rasI have bhAgye ja vaparAya che. - malTipala skUlaeNrosisa. (DimAyalIneTiMga DijhIjha) - kolejana dA.ta. lyupasanA karoDarajajunA rogo - zarIramAM anyatra kensara hoya ane karoDarajjumAM sojo Ave. - reDiezana(vikiraNa)thI karoDarajajune nukasAna thavuM. uparanA traNeya (1), (2), (3) e mAilAiTisa (myelitis) eTale ke karoDarajajunA sojA ja kahevAya. (4) karoDarajjumAM lohIno puravaTho kapAI javo. (5) karoDarajjumAM hemareja thavuM, jema ke lohInI naLIno guccho phATavo. (6) viTAmina bI12 ke pholIka eNsiDanI UNapathI karoDarajjune . nukasAna thavuM. kyAreka-kyAreka Vit. EnI UNapathI paNa nukasAna na thaI zake.

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194 magaja ane jJAnataMtunA rogo (7) masUranI dALa niyamita ane lAMbo samaya khAvAthI thatuM Lathyrism tathA anya khorAka tathA davAo, rasAyaNothI thatI ADaasarane lagatA karoDarajajunA jherI rogo (Toxic Myelopathy) karoDarajjunA vArasAgata ghasArAnA rogo jema ke phemilIala 2411225 url 241 (Familial Spastic Paraplegia), spAInoserIbelara Disijha vagere. (9) moTara nyuraoNna Disijha jevA ajJAta kAraNasara thatA ghasArAnA rogo. (10) pralaMba samayanI lIvara ke kiDanInI bImArIne lIdhe karoDarajjumAM thatA roga (11) ajANyA kAraNosara karoDarajjune nukasAnanA lakSaNo-cihno thavAM. - karoDarajjunA A badhA rogonuM nidAna eTaluM badhuM agharuM nathI, balake eka jAtanA gANita jevuM ja che. jarUrI anubhava ane aMtarasUjha hoya to laMbANapUrvakanI meDikala vigatanoMdha ane paddhatisaranI nyurolaoNjikala tapAsa dvArA khAtarIpUrvaka nidAna thaI zake. nidAnanI khAtarI mATe karoDarajajunA mukhya riporTsa(tapAsa) nIce mujaba che : (1) karoDarajjunI ema.Ara.AI. tapAsa athavA kyAreka sI.TI. na. (2) kamaranA pANInI tapAsa (3) mAyalogrAphI (4) viziSTa leboreTarI tapAsa, bAyokemisTrI vagere. (5) kvacita I.ema.jI., ena.sI.vI., vI.I.pI. ane jineTika tapAsa vagerenI jarUra paNa paDI zake.

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karoDarajjunA rogo (mAyalopathI) sAravAra: yogya sAravAra mATe saMpUrNa nidAna thavuM khUba jarUrI che. jo karoDarajjumAM dabANane lIdhe roganI paristhitinuM nirmANa thayuM hoya to, sau prathama e jovuM joIe ke zastrakriyA zakya che ke kema ? khUba lAMbA, jiTala athavA mAikroskopanI madadathI thatA oNparezanathI mAMDIne alTrAsAunDanI madadathI gAMTha kADhavAnA (CUSA) oNparezana have ApaNA dezamAM upalabdha che. karoDarajjunI sarjarI sAmAnya rIte eTalI jokhamI nathI paraMtu te paNa eTaluM ja sAcuM che ke te nAjukatAthI, kuzaLatAthI, khUba jahematapUrvaka ane saMpUrNa-bilakula vyavasthita rIte karavI paDe, kema ke khUba ochI pahoLAIvALA A aMgamAM atyaMta ThAMsIThAMsIne cetAtaMtuo bharelA hoya che tethI koI paNa jAtanuM nukasAna na thAya te mATe sarjane zastrakriyA samaye pUrI sAvadhAnI rAkhavI paDe. A sivAyanA dabANa vagaranA rogomAM cikitsA roga pramANe karavAmAM Ave che, jema ke : 195 (1) TI.bI.nI sAravAra (2) malTipala skUoNraoNsisa ane tevA bIjA DimAilineTiMga rogomAM tathA kolejananA rogomAM sTiraoNiDsa davAo (3) viTAminanI UNapamAM enI UNapa pUrI karavI vagere. (4) navI sAravAranI paddhatiomAM sTemaselatherApI AzAspada che. khAsa karIne, akasmAtathI karoDarajjune nukasAna thayuM hoya tevA kesamAM enAM pariNAmo khUba sArAM Ave che. sAmAnya rIte vArasAgata rogonI athavA ghasArAne lagatA rogonI (jemake moTara nyuraoNna DisijhaM) koI khAsa davAo hajI zodhAI nathI. A sarva rogomAM, vizeSamAM yogya phijhiyotherepI (kasarata) karavI jarUrI rahe che. sAthe pauSTika khorAka levo tathA baraDA para cAmaDImAM bhAThAM na paDe tenI takedArI rAkhavI temaja jo jhADA-pezAbanI takalIpha hoya to tenI yogya sAravAra karavAnI rahe che. karoDarajjunA sarva rogo viSe lakhavuM sthaLasaMkocane lIdhe zakya nathI.

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196 magaja ane jJAnataMtunA rogo ATaluM jarUra jANo karoDarajju, magajamAMthI pasAra thatI saMvedanAone cetA ane snAyuo sudhI pahoMcADatuM prasAraNa kendra che. temAM thatI bImArIonA samUhane mAyalopathI kahe che. sarvAIkala mAyalopathI, Dorsala mAyalopathI vagere mAyalopathInA prakAra che. karoDarajjunI ema.Ara.AI.nI tapAsa athavA sITI skena, kamaranA pANInI tapAsa, mAyalogrAphI, viziSTa leboreTarI tapAsa, I.ema.jI. vagere tapAsa dvArA roganI bAbatomAM sArI rIte jANakArI meLavI zakAya che. karoDarajjunI sarjarI niSNAta nyurosarjana mATe sAmAnya rIte saraLa che, eTale saphaLatAthI thaI zake che.

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(10) ( malTipala skUlairosisa (MS) ) magaja ane karoDarajjunA rogo ke jemAM mAyalinanA paDane ke vahAITa meTarane nukasAna thayuM hoya tevA rogane DimAyalineTiMga DisIjha kahe che. manuSyanA zarIranA cetAtaMtranA koSone kArya tathA racanAkIya dRSTie gre meTara tema ja vhAiTa meTaramAM vibhAjita karavAmAM Ave che. vhAiTa meTarane ilekTrisiTInA vAyara sAthe sarakhAvI zakAya je gre meTaranA koSomAMthI udbhavelAM spaMdano athavA AjJAo cetAtaMtranA anya bhAgo sudhI pahoMcADavAnuM agatyanuM kAma kare che. jema vIjaLInA tAramAM Isyulezana mATe bahAra paDa hoya che, tema vhAiTa meTaramAM mAyalinanuM paDa hoya che. vhAITa meTara mAyalinane nukasAna karatA rogone DimAyalineTiMga Disijha kahe che. temAM sauthI mukhya, ati jaTila ane takalIphajanaka roga te malTipala phlerosisa. sAdI bhASAmAM kahIe to koI ajJAta prakAranI elarjI athavA cetAtaMtranI cayApacayanI prakriyAmAM garabaDa UbhI thavAthI hAITa meTarane nukasAna thAya tene DimAyalinezana ane glAosisa kahe che. ahIM khAsa prakAranA, magaja, karoDarajju ane savizeSa AMkhanA jJAnataMtuonI takalIphanAM lakSaNo-cihno UbhAM thAya che. roga vize sAmAnya mAhitI : - strIomAM A roganuM pramANa puruSo karatAM bamaNuM che. - te sAmAnya rIte 15thI 50nI uMmaranI vyaktiomAM jovA maLe che. bahu nAnAM bALakone tathA vRddhone sAmAnya rIte thato nathI. - A roga skaoNTalaeNnDa, uttara yuropa ane amerikAmAM vizeSa jovA maLe che. viSuvavRttathI dUranA pradezomAM te vadhu pracalita che tethI ApaNA dezamAM tenuM pramANa ochuM che, temaja jApAna tathA dakSiNa AphrikAmAM nahivat che. kadAca, badalAyelI jIvanazailInA kAraNe ApaNA tyAM A roga vadhI rahyo che.

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198 magaja ane jJAnataMtunA rogo A roganAM kAraNo magajanA ghaNAbadhA rogonI jema aTapaTAM che ane hajI paNa barAbara jANI zakAyAM nathI. keTalAka kesomAM roga AnuvaMzika che paNa keTalAya kesomAM vArasAgata kAraNa jaNAtuM nathI hotuM. vAyarasanI elarjI tathA paryAvaraNanAM kAraNo temaja kadAca AhAra-vihAranI garabaDane lIdhe A roga thaI zake. roganAM lakSaNo * eka athavA vadhAre aMgono lakavo thavo : 35% kesomAM * dRSTinI khAmI ke eka vastu be dekhAvI : 36% kesomAM * zarIranA amuka bhAgomAM saMvedanA jatI rahevI (37% kesomAM) athavA khoTI saMvedanA thavI jema ke soyo bhoMkAtI hoya tevuM lAgavuM (26% kesomAM) * zarIranA saMtulanamAM vikSepa, cakkara AvavA, jhADA-pezAbanI takalIpho thavI. * yAdadAsta ochI thatI javI tathA kheMco AvavI. * A uparAMta hAthapaganI dhrujArI, du:khAvo, jAtIya jIvananI takalIpho temaja unmAdathI mAMDIne hatAzA jevA mAnasika prakAranA lakSaNo jovA maLe che. A badhAMmAMthI koI eka athavA vadhAre lakSaNo sAthe A roga zarU thaIne kAM to..... (a) saMpUrNa maTI jAya ane pachI vAre vAre UthalA mAre (RRMS, Relapsing and Remitting MS) athavA (ba) eka vAra lakSaNa zarU thayA pachI roga kAyama mATe vadhato jAya (PPMS, Primary Progressive MS) athavA (ka) (a) kakSAvALo roga thoDAM varSo pachI kAyamI thaI jAya (SPMS, Secondary Progressive MS) athavA (Da) ekavAra lakSaNa zarU thayA pachI roga kAyama mATe vadhato jAya ane vacce uthalA mAre (PRMS, Progressive Relapsing MS)

Page #216
199 bakama + . 5 malTipala skulerosisa roganuM nidAna upara mujabanAM lakSaNomAMthI 1 koI paNa lakSaNa jema ke, dRSTine lagatAM athavA lakavA ke saMtulanane lagatAM dekhAya to nyurolaoNjisTaphijhiziyanano saMparka karavo ati mahattvano che. - roganA nidAnamAM lohInI amuka tapAsa uparAMta khAsa to maeNgneTika resonansa ImejiMga (ema.Ara.AI.)nA phoTAnI malTipala skalerosisa jarUra paDe che. AMkhanI tapAsa (Fundoscopy)mAM AMkhanA paDadAmAM "lAkSaNika phIkAza" jovAmAM Ave che. A uparAMta sI.esa.epha. (lambara paMkyara) tapAsanI paNa khUba jarUra paDe che. sI.esa.epha mAM koSonI saMkhyAmAM vadhArAnA pramANamAM, proTIna vizeSa vadheluM hoya che. ane temAMye gAmA globyulina (IgG) khAsa vadhe che. olIgoklonala baeNnDa dekhAya che ane mAyalina bejhika proTInanI mAtrA vadhAre hoya che. keTalAMka viziSTa kesomAM, cs enTI ena.ema.o. enTIboDInI paNa tapAsa karavAmAM Ave che. VE.P, s.s.E.P, B.E.R.A. tapAsa e nidAnanA samarthanamAM khUba sahAyarUpa thAya che. - Ama zArIrika tabIbI tapAsa ane upara mujabanI tapAsa dvArA roganuM nidAna sacoTa rIte thaI zake che. sAravAra: thoDAMka varSo pahelAM asAdhya gaNAtA A roganI sAravAramAM Adhunika tabIbI vijJAne AMzika saphaLatA prApta karI che.

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200 magaja ane jJAnataMtunA rogo (1) rogano humalo Uthalo Ave tyAre tarata ja sTiraoNiDjha khAsa karIne mithAila preDUnisolonake esITIeca(A.C.T.H.) ane preniolona nAmanI davA upayogamAM levAmAM Ave che. (2) jyAre dhIme dhIme vadhato jato roga kAyamI bane tyAre methokSeTa athavA ejhAthAyoprIna vagere davAo vAparavAmAM Ave che. paNa A bahu upayogI sAbita nathI thaI. (3) inTarapherona B1b, (bITA serona)- inTarapherona B1a (bITA evonekSaM, rebIpha SIC), kopekSona (gleTirAmara) athavA kaoNpaoNlimara (Copolymer) jevI davAo humalo Avato aTakAvavA mATe upayogI che. A davAo sAravAra mATenI mULabhUta davAo kahI zakAya. A davAo khAssI moMghI hoya che ane niSNAta DaoNkTaranI dekharekha heThaLa ja ApavAmAM Ave che. (4) Mitoxantrone tathA Natalizumab davA paNa vAraMvAra humalo thato hoya tevA dardIo mATe asarakAraka che. (5) navAM saMzodhano mujaba keTalAka kissAmAM gAmA-globyulina nAmanI moMghI davA asarakAraka sAbita thaI che. (6) sTemasela therepIthI ghaNA kesomAM sArI saphaLatA maLI che, paNa hajI vadhAre saMzodhananI jarUra che. 4 (7) A uparAMta A rogamAM bIjAM ghaNAM lakSaNo hoya che. sakhata dukhAvo, hAthapaganuM kaDakapaNuM athavA dhrujArI, yAdadAsta ghaTI javI, jhADApezAbanI takalIpha, azakti, thAka, jAtIyajIvananI takalIpho; hatAzA jevI mAnasika vyathAo jevAM lakSaNo hoya che jenI je te yogya sAravAra karavAnI hoya che. malTipala skalerosisanI sAravAranA keTalAka siddhAMto : (1) jyAre rogano navo humalo thAya ane te bhAre pramANamAM hoya to sTIroIDsa (intravenous) ApavuM joIe.

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201 malTipala skulerosisa (2) RRMS EElanla immunomodulatory Uslaul Eat ApavI joIe (inTarapherona, kopejhona, mAITojekTrona vagere). (3) sekanDarI progresIva roganA dardIone bahu ja jhaDapathI sauthI vadhAre asarakAraka sAravAra ApavI joIe. (4) prAImarI progresIva prakAranA rogIone sAmAnya rIte koI davAthI phAyado thato hoto nathI. (5) malTipala skalerosisa eka jiMdagIbhara cAlanAro roga che; mATe enI sAravAra paNa baMdha na karavI joIe. (6) vArevAre - niyata samaye dardInI zArIrika tapAsa tathA niyamita rIte ema.Ara.AI.nI tapAsa karAvavI joIe. magaja ane karoDarajjuno konTrAsTa ema.Ara.AI. thoDAthoDA samayanA aMtare karAvatA rahevuM joIe. * nyuraoNmAyalAITisa oNpTikA (NMO, Neuromyelitis optica) bilakula malTipala skalerosisa jevI dekhAtI A bImArImAM karoDarajjunAM traNathI vadhAre semenTsamAM DimAyalinezana thAya che, jene mAyalAITisa kahI zakAya. sAthe sAthe AMkhanI dRSTine paNa kSati pahoMce che. AnA nidAna mATe magaja, oNpTika cetA tathA karoDarajjuno konTrAsTa ema.Ara.AI. tathA csFmAM enTI ena.ema.o. enTIboDInI tapAsa karavAmAM Ave che. . A roga sTiroIsaddhArA kAbUmAM AvI zake che, paNa gAmoglobyulina tathA plAjhamA eksaceMjathI paNa ghaNo badho phAyado thAya che, je sAravAra malTipala skalerosisamAM eTalI upayogI nathI. ekyuTa DisemIneTeDa enasaphelomAyAITisa ADEM (Acute Disseminated Encephalomyelitis) koI prakAranA vAyarasanA cepa (jema ke orI, achabaDA ke anya) thaI JvA gayA pachI thoDAka divasomAM jyAre cetAtaMtranI bImArI Ave tyAre mahadaMze.org

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202 magaja ane jJAnataMtunA rogo te ADEM nAmanI bImArI hoI zake. temAM moTA ke nAnA magajane lagatA athavA karoDarajjune lagatA athavA baMnene lagatAM lakSaNa-cihnasamUho jovA maLe. vAyarasanI bImArImAM sapaDAyelA be hajAramAMthI eka athavA be dardIne AvI takalIpha thaI zake. orI ke haDakavAnI (pahelAM vaparAtI) rasI pachI paNa kyAreka Avo roga thaI zake. kvacit dhanurvAnI rasIthI paNa A roga ADEM thavAnA kesa noMdhAyA che. nAnAM bALakomAM ghaNI vAra A roganuM pramANa vadhAre hoya che ane keTalAka kesomAM haMmeza mATe yAdadAsta para asara, vartaNUkanI khoDa rahI jAya kAM to kheMca-vAInI bImArI cAlu thaI jAya. pukhta uMmaranA lokone AmAM jaladI ane vadhu phAyado thaI jato hoya che. nAnA magajanI takalIphamAM sudhAro vadhu sAro thato hoya che. A roga vAyarasathI thatA magajanA sIdhesIdhA nukasAnathI judo che, kema ke magajanI mAIkroskopika ke anya tapAsamAM vAyarasa pakaDAto nathI. sAmAnyataH vAyarasano roga thayA pachI thoDAka divaso (2thI 20 divasa) pachI A roga zarU thAya che. A badhA parathI evuM manAya che ke A roga zarIranI rogapratikAraka-zaktimAM udbhavela khAmIne lIdhe thato roga che (immune-mediated), joke navI atyAdhunika paddhatithI DNAnA ghaTakonI vAyarasa sAthenI kaDI sAMkaLI zakAya che. lakSaNo-cihanoH (1) ensephelAITisa prakAranI A bImArImAM atizaya becenI, mUMjhavaNa-asamaMjasa, vadhu paDatI UMgha ane kheMca AvI zake. sAthe sAthe mAthuM duHkhavuM, tAva Avavo vagere thAya. halanacalanamAM asthiratA ane jhaTakA paNa Ave. gaMbhIra kesomAM bhAna-satarkatA ghaTe, dardI behoza thaI jAya tathA zvAsocchavAsanI prakriyA aniyamita thaI jAya. WWW.jainelibrary.org ::

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malTipala haeNrosisa 203 (2) mAyalAiTisa prakAranI bImArImAM karoDarajjune lagatAM lakSaNocihno Ave. tene Postinfective Myelitis ke Transverse Myelitis kahe che. temAM baMne paga athavA cAreya hAtha-paga kamajora thAya, tyAM saMvedanA ghaTI jAya, jhADo-pezAba aTake. orI, achabaDAnA kesamAM tAva Ave - zaradI-khAMsI thAya, AkhA zarIre cAThAM (rash) dekhAya; ane te pachI 2-20 divaso pachI ADEM bImArI Ave ane bALakane pharI tAva Ave; kheMca Ave ane bALaka bebhAna thaI jAya. orI pachI nAnA magajanI bImArI vadhu jovA maLe che, jemAM zArIrika saMtulana bagaDe. bIjA keTalAka vAyarasa, jema ke empTIna-bAra temaja mAyakoplAjhamA pachI paNa AvI bImArI thaI zake, jemAM nAnA magaja upara mukhya cihno Ave. A roga nAnA magajanA cepI vAyarasathI thatA rogathI judo paDe che (viral cerebellitis), e noMdhavuM joIe kema ke ahIM vAirasathI thatI eNlarjI e roganuM kAraNa che. agAu jaNAvyA mujaba, haDakavA athavA orInI rasI pachI paNa AvI ensephelomAyalAiTisa prakAranI bImArI thaI zake. haDakavAnI (jUnA prakAranI) rasImAM dara 750mAM eka vyaktine AvI eNlarjI thaI zake ane tema thAya to teno mRtyudara UMco hovAthI AvI 25% vyakti mRtyu pAmatI hoya che.. haDakavAnI navI rasI vAparavAthI AvAM nyuraoNlaoNjikala cihno thatAM jovA maLatAM nathI. AthI HDCV prakAranI haDakavAnI rasI ja vAparavI joIe. AvA badhA kesomAM noMdhanIya pramANamAM dardIo mRtyu pAme che paNa jo roga kAbUmAM Ave to sudhAro paNa ghaNo sAro thAya che. ADEMnI TriTamenTamAM High potency Steroids' vAparavAM joIe. koI koI gaMbhIra kesamAM plAjhamA ekSacenja athavA moMghA evA imyunoglobyulina vAparI zakAya, jenAthI jiMdagI bacI zake che.

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204 magaja ane jJAnataMtunA rogo { ATaluM jarUra jANo | magajanA vahAITa meTaramAM thatA DimAyelineTiMga rogomAM malTipala skalerosisa mukhya che. strIomAM A roganuM pramANa puruSo karatAM vadhu jovA maLe che. A rogamAM pakSAghAta (lakavo) thAya che, dRSTi ochI thaI jAya che, athavA Dabala dekhAya che. zarIranA keTalAka bhAgamAM saMvedanA jatI rahevI, zarIranuM asaMtulana thavuM, yAdazakti ghaTI javI, Diprezana AvavuM vagere. A roganAM anya lakSaNa che. kyAreka - kyAreka A rogamAM vAraMvAra humalA Ave che (RRMS) athavA eka vAra takalIpha zarU thayA pachI haMmezA vadhatI rahe che (PPMS). keTalAMka varSo pahelAM sudhI asAdhya manAtI A bImArInAM upacAra mATe Adhunika cikitsA vijJAnane AMzika saphaLatA maLI che. kyAreka koI vAyarasanAM cepa pachI ADEM nAmanI nyuraoNlojikala bImArI thaI zake che. achabaDA athavA haDakavAnI (jUnA prakAranI) rasI lIdhA pachI paNa A bImArI thaI zake che. hAI poTansI sTIroiDanA upayogathI ADEMmAM sAruM pariNAma maLe che.

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(18)( moTara nyuraoNna DisIjha ) snAyupezIone dhImedhIme kRza karato nyuraoNlaoNjIno A krUra kahI zakAya tevo mahadaMze ajJAta kAraNothI thato roga che, jemAM aneka saMzodhano karAyA - karAtA hovA chatAM paNa koI cokkasa sAravArapaddhati ke akasIra ilAja hajI paNa kaMpalabdha nathI ane dardIne varasovarasa vadhu ne vadhu kamajora tathA kSINa thaI motanA mukhamAM dhakelAto, tenA DaoNkTara tathA sagAMvahAlAM nisahAyapaNe joI rahe che. temAM kamanasIbe, chevaTa sudhI magaja, pramANamAM vyavasthita rIte kAma karatuM hovAthI vicAro, Urmio, sabhAnatA ane pIDAono anubhava TakI rahe che. * moTara nyurona DisIjhanA prakAro : 1. ApaNe prathama ajJAta kAraNa-kAraNothI thatAM prAImarI (iDIopethika moTara nyuraoNna DisIjha vize joIe. A prakAramAM mULa khAmI moTara nyuraoNnsamAM hoya che, jethI karoDarajjumAM jyAMthI cetAo nIkaLe che te enTiriara horna selsa (koSo) tathA magajamAM laMbamajjA- breina sTemamAM ke jayAMthI mastiSka cetAo nIkaLe che te balbara vibhAganA nyuronsa koI vicitra ane agamya kAraNosara kramazaH nAza pAmatAM jAya che; tethI hAthapaganA snAyuo pharake che ane sukAvA-gaLavA mAMDe che, halanacalana ochuM thavA mAMDe che. hAthamAM vastu pakaDavA ke lakhavAnI kriyAmAM ke hAtha UMconIco karavAmAM muzkelI paDe che, te pachI uparanIce caDhavA-UtaravAmAM tathA caMpala paheravAmAM muzkelIo zarU thAya che. chevaTe, roganI zarUAta thayA pachI 3thI 7 varSamAM dardI taddana pathArIvaza thaI jAya che, vajana ghaTI jAya che. roganA A prakArane "emAyoTrophika leTarala skulerosisa (e. ela.esa) kahe che. ahIM karoDarajjunA enTiriara horna koSo-selsa tema ja temane

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206 2. progresiva maskyulara eTrophI : moTara nyuraoNna DisIjhano eka evo prakAra che jemAM pirAmiDala phAibarsane asara thatI nathI tethI apara moTara nyuraoNna prakAranAM nyuraoNlaoNjikala cihno (jevAM ke khrIska jarka, ekSaTensara plAnTara vagere) jaNAtAM nathI. pramANamAM dhImo prasarato A roga che. hAthapaganA snAyuo sukAtA jAya che ane tethI uThavA-besavAmAM, cAlavAmAM takalIpha paDe che. 3. magaja ane jJAnataMtunA rogo kaMTrola karatI uparathI AvatI cetAo (pirAmiDala phAibarsa)ne asara pahoMcI hoya che, jethI A dardIomAM nyuraoNlaoNjInI bhASAmAM apara moTara nyuraoNna tathA loara moTara nyuraoNna ema baMne prakAranI asara (tapAsa parathI) jaNAya che. 5. balbara moTara nyurona DisIjha : agAu jaNAvyA mujaba, mastiSkanI cetAonA janika koSone asara thAya che tethI khorAka gaLavo, bolavuM vagere agatyanI kriyAone asara thAya che ane zvAsanI takalIpha thAya che. AmAM mRtyu jhaDapathI eTale ke 1thI 3 varSamAM thAya che. 4. cUDobabbara pAlsI H A e.ela.esa. sAthe saMkaLAyelo mastiSka cetAono roga che ane temAM upara mujaba khorAka gaLavo, bolavuM vagere kriyAo para asara thAya che ane sAthe anaicchika rIte jarUra karatAM vadhAre svayaMbhU hasavuM - raDavuM evAM vicitra lakSaNo zarU thAya che. pramANamAM nasIbadAra evAM keTalAka dardIomAM A roga ekAda hAtha ke paga pUrato sImita rahe che jene maoNnopereTika moTara nyuraoNna DisIjha kahe che. madrAsa moTara nyuraoNna DisIjha mAM baherAza paNa sAthe joDAya che, je sAmAnya rIte bIjA prakAranA moTara nyuraoNna DisIjhamAM hotI nathI.

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moTara nyuraoNna DisIjha 207 nidAna : A roganuM nidAna I.ema.jI. tapAsathI sacoTa rIte thaI zake che. eka vAra A roganuM nidAna nyurolaoNjisTa pAse khAtarIpUrvaka karAvavuM jarUrI che kema ke A nidAna pachI dardI pAse samaya ocho rahe che, tethI teNe tenI bAkInI jiMdagInuM Arthika, tabIbI, sAmAjika pAsAMnuM oyojana jhaDapathI karI levuM e eka vyAvahArika vAta banI jAya che. keTalIka vAra moTara nyuraoNna DisIjhanAM ja lakSaNo keTalAka bIjA rogothI thAya che, jema ke - perAthAiroiDa hormonanI khAmI, karoDarajjunI IjA (hIpaleza InjarI), keTalIka dhAtuonI zarIra para asara (jema ke sIsuM), reDiezana, rasAyaNonI ADaasara, mAyalomA tathA anya prakAranA kensara athavA eisanI bImArIthI thatA moTara nyuraoNna DisIjha paNa hoya che. AvA rogane sekanDarI moTara nyurona DisIjha kahevAya. . AthI kyAreya paNa moTara nyuraoNna DisIjhanuM nidAna/lebala karatAM pahelAM koI sekanDarI upara mujabanA khAsa karIne TrITamenTathI sArA thaI zake tevA roga to nathI ne te cakAsavuM bahu ja jarUrI che. sAravAra : * dardIne ane sagAMvahAlAMne yogya samaye roganI gaMbhIratA jaNAvI bAkInI jiMdagInA Ayojana mATe sUcavavuM joIe. phijhiyotherapI, snAyuonI tAlIma-TreniMga ane cAlavAnI kasarato vagerethI snAyuone jeTalA zakya hoya teTalA sakSama rAkhI zakAya che. sAthe sAthe, sAdhanonI madadathI cAlavAnI tathA hAthanI kriyAomAM phAyado thAya te jovuM joIe, jema ke TekaNa ghoDI, keliparsa.

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208 magaja ane jJAnataMtunA rogo A roganI koI sacoTa sAravAra nathI. aneka jAtanI davAnAM saMzodhano pachI hAlamAM eka davA jene rAITyUjhola kahe che te pracalita banI che. teno Azare 6thI 12 mAsano sAravArano korsa hoya che. teno kharca rU. 20thI 30 hajAra Ave che paraMtu tenAthI roga phakta 3thI 6 mAsa mATe dhImo paDI zake. tenAthI phakta vedanA laMbAya che ane sAmAnya anubhava pramANe tenuM koI khAsa jAduI yogadAna nathI chatAM amuka, yogya kesamAM te ApI zakAya. bIjI davAomAM rAsAjilina, mAInosAyaklina paNa prayogamAM che. 2008nA navA saMzodhano mujaba lithiyama davAthI A rogamAM sArAM pariNAmo maLyAM che. khorAka gaLavo, bolavAnI prakriyA vagerene asara thAya to tenI paNa TreniMga amuka hada sudhI kAma lAge. pachI khorAka gaLavA rAilsa TyUba athavA vadhu sArI rIte gesTrosTomI phIDiMga karI zakAya, jemAM cAmaDInI nIce Tanala banAvI, hojarImAM TyUba utArI poSaNa pUruM pADavAmAM Ave che. roganI aMtima sthitimAM jayAre imozanala lebiliTI (asaMtulita, asthira lAgaNIzIlatA), Diprezana, anaicchika hasavuM - raDavuM vagere thAya tyAre tene lagatI meDikala sAravAra paNa karavI joIe. zvAsanA snAyunI kasarato zarUAtathI ja cAlu karI devI joIe. kvacit chevaTe venTileTara mazInathI zvAsamAM madada karI dardInuM AyuSya thoDuM laMbAvI zakAya. narsiga sAravAra, sagAMvahAlAMno sneha, DaoNkTarano uSmAbharyo abhigama vagere A dardIonI pIDAmAM eka suMdara TekAnI garaja sAre che, je A kaSTadAyaka, asAdhya rogamAM dardInI bAkInI jiMdagImAM duHkhone sahana karavAnI tAkAta Ape che.

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moTara nyuraoNna DisIjha 209 vizeSamAM, AjakAla sTemasela therapI A roganA dardIo mATe bhaviSyanI AzAnuM kiraNa che. kadAca AnAthI A roga kAbUmAM AvI jAya. joke haju sudhI koI nakkara pariNAma maLyuM nathI. A roganA dardIonuM "moTara nyuraoNna DisIjha eNsosiyezana nAmanuM eka saMgaThana paNa astitvamAM che, je dardIonI jANakArI mATe che.

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210 magaja ane jJAnataMtunA rogo ATaluM jarUra jANo mAMsapezIone dhIre dhIre zithila-kRza karanArAM A rogamAM nizcita upacArapaddhatinA abhAvathI dardInAM saMbaMdhI ane DaoNkaTara niHsahAya rIte dardIne dhIre dhIre motanAM mukhamAM jatAM joI rahe che. prAImarI moTara nyuraoNna DisIjha, progresIva maskyulara eTrophI, balbara moTara nyuraoNna DisIjha, syuDobabbara pAlsI, monopereTika moTara nyuraoNna DisIjha, madrAsa moTara nyuraoNna DisIjha vagere A roganAM alaga-alaga prakAra che. kasarata, snAyuonI TreniMga ane cAlavAno vyAyAma, A rogamAM mahattvapUrNa sAbita thaI zake che. Adhunika saMzodhana anusAra rAIlyujhola nAmanI davA A rogamAM AMzika upayogI thaI zake che. A bImArInAM dardIonuM saMgaThana - moTara nyuraoNna DisIjha esoziyezana - astitvamAM che.

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nyuropathI A prakaraNamAM ApaNe magaja ane karoDarajjumAMthI nIkaLI caherA, garadana, hAtha, paga temaja chAtI ane peTa ema judA judA snAyuo sudhI saMdezA laI jatI ane cAmaDI tathA anya saMvedanazIla avayavo tathA agatyanAM aMgomAMthI karoDarajju tathA magaja tarapha saMvedanA lAvatI nasocetAo (Nerves)nA rogo vize vAta karIzuM. saMdezA laI jatI nasone moTara cetAo kahevAmAM Ave che, saMvedanA lAvatI nasone sensarI cetAo kahevAmAM Ave che. karoDarajjumAMthI nIkaLatA zarUAtanA bhAgane reDikalsa kahe che je paNa moTara ane sensarI ema be prakAranA hoya che. tenA rogone reDikyulopathI kahe che. jyAre upara jaNAvela nasonA rogone perIpherala nyuraoNpathI kahe che. 19 Dorsal root ganglion Cell body of sensory neuron Dendrite of sansory neuron Dorsal root Synapse Receptor Interneuron Central canal Ventral root Axon of motor neuron Synaptic knobs Effector muscle Dorsal column Corticospinal treet' Rubrospinal tract Spinothcramic tract White matter Grey matter Cell body of motor neuron karoDarajjuno ADocheda ane dUragAmI - paridhi (peripheral) cetAonuM taMtra

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212 magaja ane jJAnataMtunA rogo perIpherala nyuropathInA paNa keTalAka mukhya prakAra che jene ApaNe paoNlInyuraoNpathI, mononyuropathI, maoNnonyuraoNpathI malTipleksa ane enTepamenTa nyuropathI ema kahIzuM. aneka rogo ane anya kAraNothI AvI perIpherala nyuropathI thAya che. keTalIka nyuropathI evI hoya che jemAM prAthamika rIte cetAtaMtranI bImArI hoya che jema ke vArasAgata nyuraoNpathI (HMSN-1 to HMSN-VI) athavA to e.AI.DI.pI. keTalAkamAM cetAtaMtrIya temaja bIjAM taMtranA rogo hoya che, jema ke kensarane lagatI nyuropathI, to keTalAkamAM anya roganA pariNAme cetAo para asara Ave che, jema ke DAyAbiTIsa. ekadama jhaDapathI thatI ane prasaratI nyuropathImAM ghaNI vAra haoNspiTalamAM dAkhala thavuM jarUrI bane che, jema ke e.AI.DI.pI. mononyuropathImAM eka athavA vadhu judI judI cetAonI kAryazakti bagaDe che. sAmAnyataH temAM sAthe duHkhAvo paNa hoya che. enTepamenTa nyuropathImAM eka ke vadhu nasa tenA nirdhArita mArgamAM vacce kyAMka dabAtI hoya che, jema ke kArpala Tanala sinDromamAM mIDIana narva hatheLInA mULa AgaLa dabAya. paoNlInyuropathImAM sAmAnya rIte zarIranI be bAju sarakhA pramANamAM saMvedanAo ghaTe, snAyuonI kAryazakti ghaTe ane bIjI keTalIka muzkelIo paNa AvI zake, jema ke pezAba-jhADAnI takalIpho UbhI thAya. nyuropathI sAmAnyataH be prakAranI che : (a) ekSonala nyuropathI: paganAM taLiyAM ane hAthanI hatheLIthI jhaNajhaNATI, baLatarAnI zarUAta thaI, roga dhIme dhIme uparanI bAju prasare ane snAyuo paNa kamajora thAya ane saMvedanAo ghaTatI jAya. mukhyatve cayApacayanI prakriyAonA rogo (metabolic diseases), jema ke DAyAbiTIsa, kiDanI, livara vagerenI takalIpho tema ja keTalAMka viTAminonI UNapo temaja bhAre dhAtuo, jherI padArtho ke rasAyaNo tema ja mukhyatve davAonI ADaasara(keTalAMka enTibAyoTika, kaeNnsara www.jalnelibrary.org

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yuropathI (e.AI.DI.pI.) 213 kemotherapI, enTimelerIala davAo vagere)thI AvI ekSonala nyuropathI thaI zake. moTe bhAge A dhImethI AvatI ane lAMbo samaya cAlatI bImArI che ane kaSTasAdhya che. (ba) DimAyalineTiMga nyuropathI : temAM nasonI upara AvelA isyuleTarI mAyalinanA paDamAM vikRti pedA thAya che. Ane eka jAtanI eNlarjI gaNI zakAya. vAirasathI mAMDIne bIjAM anya kAraNothI cetAo para Avela mAyalina nAza pAme tenAthI nasonI kSamatA para asara thAya ane khAsa karIne khabhA tathA AjubAjunA snAyuomAM prathama kamajorI Ave ane pachI te jhaDapathI phelAya. AmAMnI keTalIka nyuropathIo tIvra jhaDapathI AvI, jhaDapathI jatI rahe che, to keTalIka jiMdagIne jokhamamAM mUkI de che, jema ke e.AI.DI.pI., je vize ApaNe A ja prakaraNamAM AgaLa jatAM vistArathI joIzuM. keTalIka nyuropathI eka vAra maTyA pachI pharIthI paNa thatI hoya che. keTalAkamAM snAyunI bImArI ane nasonI bImArI sAthe jovA maLe che, jema ke mAyoTaoNnika DisTrophI. nyuropathInuM vargIkaraNa : (1) cetAonA sojA ke elarjIthI thatI nyuraoNpathI jemake e.AI.DI.pI., sI.AI.DI.pI. (2) cepathI thatI nyuropathI, jemake kuSTha roga-leprasI, pitheriyA, TIka perelisisa. (3) viTAmInanI UNapane kAraNe thatI nyuropathI - berIberI - pelAgrA - viTAmIna bI-12nI UNapa (esa.sI.DI.) (4) Toksina (jherI dravya)thI thatI nyuropathI bhAre dhAtu jema ke Arsenika, sIsu, pArA (madhUrI) rasAyaNo jevA ke theliyama, oNrgenophospharasa davAnI ADa asara, jevI ke AIsoniyAjhIDa, kensaranI davAo, Desona, amuka enTIbAyoTriksa

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214 magaja ane jJAnataMtunA rogo (5) DAyAbiTIsathI thatI nyuropathI ke zarIranA anya rogothI thatI nyuropathI - kiDanInI bImArI - vAkyulAITisa (kolejana DisIjha) (6) kensarathI pratyakSa ke parokSa rIte thatI nyuropathI (7) mAyalomA jevA rogothI thatI perAproTInimika nyuropathI (8) AnuvAMzika nyuropathI (heriDiTarI moTara sensarI nyuropathI) (9) nasa para dabANa AvavAthI thatI nyuropathI (enTepamenTa nyuropathI) (10) oNTonomika nyuropathI TUMkamAM kahevuM hoya to vArasAgata kAraNothI zarU karIne vAyarasa sudhI ane kensarathI zarU karIne davAonI ADaasara sudhI, zarIranA koI paNa aMganA rogonA kAraNathI zarU karIne poSaka tattvonI UNapa sudhI ke leprasIthI mAMDIne DAyAbiTIsa sudhI ema anekAneka kAraNothI naso-narsa para asara AvI zake athavA bIjI rIte kahIe to narsa upara asara thaI hoya to kvacit AkhA zarIramAM zodhakhoLa karavI paDe ke roganuM mULa kyAM che ane tema chatAM 20thI 30% paoNlIbyuropathInA kesamAM nyuropathInuM sacoTa kAraNa pakaDI zakAtuM nathI, te adyatana cikitsA paddhati mATe eka paDakArarUpa samasyA che. Ama to yuraoNpathInA asaMkhya kAraNo che paNa ApaNA dezamAM pracalita ane mahattvanI nyuropathI vize saMkSiptamAM nirUpaNa karavAno prayAsa karyo che. (1) e.AI.DI.pI. : e.Ai.DI.pI. eTale aMkyuTa InphalemeTarI DimAlineTiMga paoNlireDikyulonyuropathI. A sivAya tene jI.-bI.-esa. athavA gulIyanabAre-sTrohala sinDroma paNa kahevAya che. A rogamAM koI kAraNasara

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215 nyuraoNpathI (e.AI.DI.pI.) jJAnataMtuomAM nabaLAI Ave che. dardInA paga para pahelI asara thatI hovAthI pagamAM jhaNajhaNATI ke baherAza ane sAmAnya nabaLAI AvavAthI mAMDIne hAthapagano lakavo uparAMta zvAsocchvAsanI jIvaleNa takalIpha sudhInAM lakSaNo paNa A roganA dardIomAM jovA maLe che. jJAnataMtuo(naso)mAM koI kAraNasara sojo AvavAthI monosAiTa mekropheja nAmanA koSonuM pramANa vadhe che. enI pratikriyA rUpe nasonuM mAyalina nAmanuM AvaraNa naSTa thaI jAya che ane jJAnataMtuo nabaLA paDI jAya che. evuM manAya che ke jJAnataMtuonA AvaraNa 'mAyalina'ne pratikULa evA enTibaoNDI (pratidravyo) utpanna thavAthI naso nabaLI paDavAnI prakriyA zarU thAya che. uparyukta jaNAvela prakriyA zarU thavAnAM kAraNo hajI spaSTa thaI zakyAM nathI, chatAMya 50%thI 60% dardIomAM e.Ai.DI.pI. thayA pahelAM gaLA ke jaTharamAM ke AMtaraDAnA vAyarasano cepa lAgyo hovAnuM jovA maLe che. taduparAMta haDakavA, dhanuvaoN ke poliyo jevA rogonI rasI lIdhA pachI paNa amuka dardIomAM A rogane maLato Avato roga jovA maLe che. A sivAya kyAreka nAnI zastrakriyAo pachInA amuka saptAha sudhImAM e.Ai.DI.pI. thaI zake che. koI paNa uMmare jovA maLatA A roganuM pramANa 40thI 55 varSa sudhImAM vadhu jovA maLyuM che; eTaluM ja nahIM paNa amuka Rtuo sAthe A rogane saMbaMdha hovAnuM saMzodhanonA AdhAre kahI zakAya che. roganI tIvratAugratA mujaba A rogane sAmAnya, madhyama ane atitIvra (gaMbhIra) ema traNa prakAramAM vaheMcI zakAya. A roganI zarUAtamAM dardIne pagamAM jhaNajhaNATI anubhavAya che, khAlI caDI jAya che; kyAreka pagano dukhAvo thAya che, to ghaNAM dardIone cAlatAM cAlatAM acAnaka lathaDiyAM AvavA lAge che. baMne page lagabhaga ekasAthe ja asara thAya athavA kramazaH vadhatI nabaLAIthI chevaTe baMne paga ane hAtha saMpUrNapaNe zithila thaIne lakavAmAM pheravAI jAya che.

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216 magaja ane jJAnataMtunA rogo becAra divasathI mAMDI be cAra aThavADiyAM sudhImAM AvuM thatuM jovA maLe che. keTalAka dardIomAM jhaNajhaNATInI takalIpha nathI hotI. magajamAMthI nIkaLatA amuka jJAnataMtuone jayAre asara thAya che tyAre dardInA caherAnA snAyuo (eka yA baMne bAjunA) kAma karatA nathI. avAjamAM pharaka paDI jAya che, khorAka gaLe utAravAmAM takalIpha thAya che. pANI pItAM nAka vATe pravAhI bahAra AvI jAya che ane zvAsocchavAsamAM takalIpha paDI zake che. dasa TakA dardIone zvAsocchavAsanI takalIpha thAya che, je jIvanane jokhamamAM mUkI zake che. evA dardIone 'venTileTara' dvArA kRtrima zvAsozvAsa ApavAnI jarUra paDe che. A roganAM anya lakSaNomAM hRdayanA dhabakArAnI aniyamitatA jovA maLe che. kyAreka bI.pI. ghaTI jAya athavA vadhI jAya, athavA atizaya parasevo vaLI jAya che. lohImAM soDiyamanuM pramANa ghaTI paNa zake che. dardI saMpUrNapaNe bhAnamAM hoya che ane kvacit koI koI dardIone jhADo-pezAbano kaMTrola jALavavAmAM paNa takalIpha paDe che paNa AvuM bhAgye ja bane che. A roga AIDP Sensory, AMAN, AMSAN, MMN evAM alaga-alaga prakAro che. roganuM nidAnaH uparokta lakSaNo dharAvatA dardInI cetAtaMtranI prAthamika tapAsamAM roganA nidAnane samarthana ApatI kaDIo maLI zake che jemAM mukhyatve TenDana japha" (snAyunA cheDA para hathoDI mAravAthI snAyu kheMcAIne ja-AMcako utpanna thato hoya che te) A rogamAM nAbUda thaI jAya che. snAyuo DhIlA paDI gayA hoya che, hAthapaganI cAmaDI baherI thaI nathI hotI. bIjI tapAsamAM dardInI kamaramAMthI pANI kheMcI tapAsa karavAmAM Ave che. te pravAhInI tapAsa karatAM temAM proTinanuM tattva (khAsa karIne lg G)vadheluM jaNAya che jyAre koSomAM koI pharaka jaNAto nathI.

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nyuraoNpathI (e.AI.DI.pI.) I.ema.jI./ena.sI.vI. AmAM I.ema.jI. (snAyumAM soya nAkhI karavAmAM AvatI tapAsa) ane ena.sI.vI.(cetAonI saMvedanAvahananI gati)nI tapAsa sAmela che. (A tapAsa nyuraoNpathI uparAMta mAyopathI tathA nyuraoNmaskyulara jaMkzananA rogo mATe khUba ja mahattvanI che). 217 AmAM narsone vIjaLInA mAdhyamathI uttejita karIne tathA snAyuone sAdhAraNa darda ApanAra soya dvArA tapAsa karIne baMne vize sArI evI mAhitI prApta karI zakAya che. | nyuraoNpathI ekjhonala che ke DimAyalineTiMga e khabara paDe che, jethI sAravAramAM ghaNo pharaka paDe che. nyuraoNpathI eka cetAthI che, ghaNIbadhI alaga-alaga cetAothI che ke janaralAIjhaDa nyuraoNpathI che e khabara paDe che. koI eka cetAmAM ja roga hoya to cetAnA kayA bhAgamAM roga che e khabara paDe che. cetA ane snAyuone joDatA nyuraoN-maskyulara jaMkzananA roganuM nidAna paNa thaI zake che. sAravAraH roga prAthamika rIte cetAno che ke snAyuno e paNa khabara paDI zake che. e.Ai.DI.pI.nI sAravAra mATe badhA ja dardIone zarUAtanAM eka-be aThavADiyAM mATe haoNspiTalamAM dAkhala karavAnuM salAhabharyuM che. A roganI sAravAMra mATe 'sTiraoNiDa' jUthanI davA dA.ta., mithAIla prenisolona, e.sI.TI.eca. nAmanI davAnA upayogathI thatA phAyadA viSe matamatAMtara Ubho thavAthI tenA upayogane badale navI davAo ApavAmAM Ave che.

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218 magaja ane jJAnataMtunA rogo plAjhamApheresisa nAmanI paddhatimAM DAyAlisIsanI mAphaka dardInA zarIramAMthI eka samaye 1500thI 3000 mi.li. jeTaluM lohI kADhI tene zuddha karavAmAM Ave che. sela separeTara dvArA koSone alaga karI, tene zuddha karI raktamAMnA hAnikAraka eNnTibaoNDijha (pratidravyo) dUra karI, zuddha lohI pharIthI dardInA zarIramAM caDAvavAmAM Ave che. A paddhatithI roga AgaLa vadhato aTakAvI zakAya che tathA zvAsocchavAsanI takalIpha nivArI zakAya che ane sudhAro jhaDapI banAvI zakAya che. A prakriyA AMtare divase eka vAra ema kula pAMceka vakhata karavAmAM Ave che. A roganI bIjI vadhu sacoTa davA che gAmA globyulIna. lohInI nasamAM iMjekzanarUpe apAtI A davAthI hAnikAraka eNnTibaoNDijha dUra thAya che. rojanAM 400 mi.grA./ki.grA. (zarIranA vajana anusAra) A davA pAMca divasa ApavAmAM Ave che. A davAnI ADaasaro paNa khUba ochI che. A davA bALako tathA hRdayanA dardIone paNa ApI zakAya che paraMtu A sAravAra atizaya moMghI hovAthI badhA dardIo teno lAbha laI zakatA nathI. AvI sAravAra uparAMta e.Ai.DI.pI.nA dardIomAM bIjI keTalIka kALajI rAkhavI jarUrI che. A dardIone pUratuM poSaNa maLI rahe, zarIre bhAThAM na paDe, koI prakArano cepa lAge nahi tenI khUba kALajI levI joIe. zvAsocchavAsamAM saheja paNa takalIpha paDe to DaoNkTarane jANa karavI joIe. jarUra paDe venTileTara mazIna para mUkI zvAsa TakAvI zakAya che, je kharcALa che paNa te jiMdagI bacAvI zake che. A sivAya kasarata (phijhiyotherapI)thI paNa A rogamAM khUba phAyado thato jovA maLe che, je sAravAranuM eka ati mahattvanuM aMga che. zarUAtanA paMdareka divasamAM roga AgaLa na vadhe ane khAsa karIne zvAsanI takalIpha na thaI hoya to roga pUrepUro maTavAnI zakyatA khUba vadhI jAya che. joke saMpUrNa rIte sAruM thatAM kadAca mahinAo vItI jAya che.

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nyuraoNpathI (e.AI.DI.pI.) (2) sI.Ai.DI.pI. : e.Ai.DI.pI. jyAre lAMbA samaya sudhI vadhatI rahe (2 mahinA) athavA vAreghaDIe UthalA mAratI rahe tyAre tene sI.Ai.DI.pI. (Chronic Inflammatory Demyelinating Polyneuropathy) kahe che. 219 jo phakta caitAtaMtranA kAraNathI A roga thayo hoya to ghaNIvAra te moTara nyuraoNna Disijha jevo jaNAya che. keTalIka vAra eca.AI.vI. inphekzana, esa.ela.I., plAjhmA sela DiscejhIA jevAM kAraNothI paNa sI.AI.DI.pI. jevAM lakSaNo thAya che. sAravAraH (1) mukhyatve koI upara mujabano roga hoya to te zodhIne TriTamenTa karavAmAM Ave che ane vizeSamAM sTIraoNiDa, plAjhamA ekscenja, ejhAthAyoprIna athavA mAyakophinoleTa vAparavAmAM Ave che. e.Ai.DI.pI.nI TriTamenTa mAphaka kvacit imyunoglobyulina paNa vAparI zakAya. (2) A ane AvI aneka nyuraoNpathImAM kasarata (phijhiyotha2pI) e atyaMta mahattvanuM aMga che. jarUra paDye bresisa, spliTa, bUTsa ane anya sahAyaka sAdhanathI dardInuM kAmakAja saraLa bane tevuM karI zakAya. (3) du:khAvo thato hoya to dardazAmaka davAo jarUra mujaba ApI zakAya. (4) lAMbe gALe kyAreka nAnI-moTI sarjarI karIne dardInA snAyuone vadhu kAryAnvita karI zakAya jethI kamajora rahI gayelA snAyumAM vadhu phAyado karI zakAya.

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220 magaja ane jJAnataMtunA rogo (3) malTIphokala moTara nyuraoNpathI : moTara nyuraoNna Disijha jevI dekhAtI A bImArImAM zarIranI baMne bAju alaga-alaga cetAomAM asamAna asara thAya che. A rogamAM gAmA globyulina tathA sAiklophosphAmAIDathI phAyado thAya che, paNa sTiroIDsa tathA plAjhamA eksaceMjathI nahIM. moTara nyuraoNna DisijhamAM koI sAravAra kAma nathI lAgatI. (4) belsa pAlsI tathA bIjI nyuraoNpathI : A eka vAirasathI thato roga che je phakta caherAnA snAyuono lakavo kare che jene belsa pAlsI kahe che. AmAM magajamAMthI nIkaLatI sAta naMbaranI cetA para sojo Ave che, je mahadaMze pavana lAgavAthI, cepa lAgavAthI ke kAnamAM saDo thavAthI thAya che. lakSaNo : AMkha pUrI baMdha na thavI, moM vAMkuM thavuM ane moDhAmAMthI eka bAju parathI lALa paDavI. gAla barAbara na phulAvI zakAya. kyAreka kAnanI buTa pAchaLa darda thavuM, avAja vadhu saMbhaLAvo tathA jIbha parano svAda ocho thaI javo tevuM paNa thAya che. jo tarata sAravAra zarU ka2vAmAM Ave to 90thI 95 TakA dardIone 1thI 2 mahinAmAM lagabhaga saMpUrNa sAruM thaI zake che. AnA vAyarasa sAmAnya rIte epasTIna bA2, harpisa ane sAyaTomegAla vagere hoya che. kyAreka baMne bAjunI sAta naMba2nI nasane sAthe ja asara thAya che paNa moTe bhAge eka ja bAjune asara thAya che. koI kesamAM asara lAMbo samaya rahI jAya che athavA e ja roga vAreghaDIe Uthalo mAre che ane pharI pharIne moDhAno lakavo thAya che. (5) DAyAbiTIsathI thatI nyuraoNpathI : DAyAbiTIsanA dardIne lAMbe gALe nyuraoNpathI thaI zake. jeTalo DAyAbiTIsa vadhAre jUno ane jeTaluM tenuM niyamana ochuM teTalI jaladI nyuraoNpathI Ave. DAyAbiTIsamAM aneka prakAranI nyuraoNpathI thAya jenAM lakSaNo nIce mujaba che H

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nyuraoNpathI (e.AI.DI.pI.) 221 (1) paganI naso kamajora thavAthI cAlavAmAM ke pagathiyAM caDhavAmAM takalIpha paDe che. pagamAMthI caMpala nIkaLI jAya to khabara na paDe tevuM thAya che. sAthaLamAM ke pagamAM khUba dukhAvo thAya. (2) paga nIce gAdI jevuM lAge. pagamAM khUba baLatarA thAya. hAtha-pagamAM kAM to jhaNajhaNATI ke bUThApaNuM lAge, vAge to khaMbara na paDe, nahAtAM garama-ThaMDA pANIno bheda khabara na paDe, hatheLI ane paganI saMvedanA ghaTatI jAya. (3) pezAbamAM takalIpha thAya, jAtIya azakti, jhADA thAya, parasevo khUba thAya ke ocho thaI jAya, ubhA thatA bIpI bahu ghaTI javAthI cakkara Ave, hRdayanA dhabakArAmAM vadhaghaTa thAya. (4) chAtI ke peTa para ekAdI nasamAM khUba baLatarA thAya. DAyAbiTIsane saMpUrNa kAbUmAM rAkhavAthI ane insyulinano upayoga karavAthI rAhata maLe paNa sudhAro ghaNo dhImo thAya che. nyuraoNpathInAM lakSaNo-cihnone kAbUmAM rAkhavA paNa yogya davAo che, jenAthI vatteoche aMze phAyado thAya. (6) kuSTharoga-leprasI : ApaNA dezamAM leprasI (kuSTharoga)nuM pramANa ghaTyuM che, chatAM hajI paNa teno vyApa noMdhapAtra to che ja. mAyakobekTirIama leprI nAmanA jaMtuthI te thAya che ane mukhyatve saMvedanA lAvatI cetAo (sensarI narsa)ne te nukasAna kare che jethI AMgaLAMnI saMvedanA jatI rahe che. IjAnI khabara paDatI nathI ane hAthapaganAM AMgaLAM dhIredhIre kharI paDe che. tenA mukhyatve be prakAra che: (1) lepraoNmeTasa laeNprasI jemAM cAmaDI para vadhAre asara hoya che. (2) TyubarakyulaoNiDa leprasI jemAM cAmaDInuM nukasAna pramANamAM ochuM hoya che paNa nyuraoNlaoNjikala nukasAna vadhu hoya che. lepromeTasa prakAra vadhu cepI che.

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2 2 2 magaja ane jJAnataMtunA rogo Desona, riphASpIsIna, klophAjhImIna vagere davAo tathA yogya DresiMga dvArA mahadaMze roga kAbUmAM Ave che paNa sAravAra doDha ke be varSathI daza varSa sudhI cAle che. A rogane thato rokavA mATenI rasI have upalabdha che. (7) kensara : - zarIranA anya bhAgamAM kensara hoya to paNa nasone asara thaI zake che, jene perAnIoplAsTika sinDroma kahe che. phephasAMnA kensaramAM AvI nyuraoNpathI vizeSa jovA maLe che. perAproTinImIA athavA mAyalomA nAmathI jANItA eka prakAranA blaDakensaramAM paNa ghaNI vakhata jovA maLe che. AthI nyuropathInA tamAma kesomAM saghana tapAsanI khAsa AvazyakatA che te spaSTa jaNAya che. (2) oTonomika nyuropathI : keTalAka kesomAM oNTonomika nyuropathI thaI zake jema ke DAyAbiTIsa. temAM blaDaprezaranI tophAnI vadhaghaTa, nADInA dhabakArAnI vadhaghaTa, parasevo, jhADA ane yurinanI takalIpho vagere aneka prakAranI anaicchika cetAtaMtranI nasonI takalIpho thatI hoya che, je ghaNIvAra A roganI pUratI vaijJAnika mAhitI na hovAthI DaoNkTarothI paNa pakaDAtI nathI ane roganuM nidAna laMbAya che. (9) esTrepamenTa nyuropathI : A vibhAgamAM sauthI pracalita esTrepamenTa nyuropathI che kApelA Tanela sinDroma, jemAM mIDIana narva, hatheLInI nIce AvelA volara lIgAmenTamAM dabAya che jenAthI hatheLImAM darda ane jhaNajhaNATI thAya che ane kvacit cheka khabhA ane hAtha sudhI darda phelAya che. AgaLa vadhatAM aMgUThAnI nIcenA snAyu nabaLA paDe che ane snAyu sukAya che. - kAMDA para paTTo paheravAthI temaja thoDoka vakhata sTiroiDa vagere davAo levAthI pharaka na paDe to kAMDAmAM yogya jagyAe sTiroiDanuM iMjekzana ApI zakAya. chevaTe nAnI zastrakriyA karI nasa paranuM dabANa dUra karI zakAya. Jamnefbrary.org

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2 23 nyuropathI (e.AI.DI.pI) A sivAya judI judI naso tenA mArgamAM judI judI jagyAe dabAvAthI Azare 30 jAtanAM enTrapamenTa sinDroma thaI zake che. (1) mIDIana narvano proneTara sinDroma (2) TArDiva arbara pAlsI (koNI pAse) (3) reDiala pAlsI (khabhA ane koNInI vaccovacca). UMgha daramiyAna reDiala narva dabANamAM AvI javI, je "seTara-De nAiTa pAlsI'nA nAmathI jANItI pracalita che. AmAM hAthano paMjo kamajora thAya che. (4) merAjIA peretheTikA : leTarala kyuTenIasa narva dabAvAthI sAthaLamAM bahAranA bhAgamAM jhINo dukhAvo ane jhaNajhaNATI pedA thAya. (5) TArsala Tanala sinDroma jemAM posTIrIara TIbIala nasa paganI ghUMTInI nIce pasAra thatI vakhate dabAvAthI paganA taLiyAmAM dukhAvo ke jhaNajhaNATI thAya che. nAnakaDI sarjarIthI bAmAMthI chuTakAro maLe che. anubhave jaNAya che ke A badhA enTepamenTa khUba pracalita che. paNa moTe bhAge nidAna vagara lAMbo samaya dardI herAna thato ja rahe che. tene mATe jAgRti keLavavI joIe. (10) oTonomika nyuropathI oTonomika (anaicchika) taMtranA jJAnataMtuone asara thavAthI hRdayanA dhabakArA, blaDa prezaramAM ekadama vadhaghaTa thAya, jhADA-pezAbanI takalIpha thAya vagere muzkelIo thAya. DAyAbiTIsa tathA keTalAka anya rogomAM Ama thaI zake nyuropathInA anya prakAro : viTAminonI UNapathI thatI nyuropathImAM mukhyatve viTAmina B tathA folic acidnI nyuropathI Ave che (A roga karoDarajjune asara kare tyAre tene scp-subacute combined Jain Education international

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224 magaja ane jJAnataMtunA rogo degeneration kahe che.) te uparAMta dArUnuM vadhu sevana karanArane viTAmina B,nI UNapa thAya, jenAthI berIberI nAmano roga thAya jemAM pIDAdAyaka nyuropathI thAya. davAothI thatI nyuropathImAM eNnTibAyoTika nAiTroyrAnTAina, kaeNnsaranI davA vinjhIsTIna, kheMcanI davA phinAIToina ane TIbInI davA AisonAyAjhAiDa vagere che. davAne pAchI kheMcI levAthI dhIme dhIme nyuraoNpathI sudharI jAya che. e yAda rAkhavuM joIe ke A davA lenAra darekane nyuropathI thatI hotI nathI temaja tene aTakAvavA mATe keTalAka rastA paNa hoya che, jema ke TI.bI.nI davA AisonAyAjhAiDa sAthe viTAmina B ApavuM joIe. bhAre dhAtu jevI ke sIsuM, sonuM, pAro, Arsenika vagerenA sevanathI temaja keTalAMka rAsAyaNo jevA ke theliyama, hekjhAkArbana, organo phosphaTa vagerethI paNa nyuraoNpathI thaI zake che. eka vAta e paNa dhyAnamAM rAkhavI joIe ke 20thI 30% nyuropathImAM koI kAraNa nathI maLatuM. aMtamAM, A badhI nyuropathImAM ApaNA dezamAM sauthI vadhu jovA maLatA nyuropathI DAyAbiTIsa, leprasI, eIsa (eca.AI.vI.) tathA AlkoholathI thatI viTAmina bI, tema ja anya poSaka viTAminonI UNapathI thatI nyuropathI, temaja bI tema ja phaoNlika eNsiDanI nyuropathI mukhya che. jyAre jhaDapathI prasaratI e.AI.DI.pI. tema ja dhImethI prasaratI kensara ane mAyalomAnI nyuropathI e ati khataranAka che tenI noMdha levI ghaTe; tethI sacoTa tapAsa, jhaDapI nidAna, ane pUratI sAravAra ane yogya phijhiyotherapI e tamAma nyuropathInI sAravAranA agatyanAM pAsAM che. + :

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nyuropathI (e.AI.DI.pI.) 2 25 | ATaluM jarUra jANo magaja ane karoDarajjumAMthI nIkaLIne cahero, garadana tathA hAtha-paga ema anya snAyuo sudhI saMdezo laI jatI tathA anya saMvedanazIla aMgomAMthI karoDarajjunI ane magajanI tarapha saMvedanA lAvatI cetAonAM rogone peripherala nyuropathI kahe che. mononyuropathImAM eka athavA bhinna bhinna cetAonI kAryazakti bagaDe che, jyAre polIbyuropathImAM zarIranI baMne bAju ekasarakhA pramANamAM saMvedanA ghaTI jAya che. te be prakAranI hoya che, ejhonala nyuraoNpathI tathA DimAvelineTiMga nyuropathI. e.AI.DI.pI.ne guliyana-bAre sinDroma paNa kahe che, jemAM dardInAM jJAnataMtuonI kamajorIne kAraNe pagamAM jhaNajhaNATI thAya che, pachI hAtha pagamAM pakSAghAta tathA koIvAra zvAsocchavAsamAM muzkelI Ave che. e.AI.DI.pI.mAM plAjhamApheresIsa nAmaka paddhatithI dardInAM lohIne zuddha karavAmAM Ave che ane gAmoglobyulinanI madadathI paNa ghaNI rAhata maLe che. jyAre A roga lAMbA samaya sudhI cAle che tyAre tene sI.AI.DI.pI. kahe che. phakta moDhAmAM snAyuonAM pakSAghAtane belsa pAlsI kahe che. DAyAbiTIsanA dardIne lAMbA samaya pachI thatI nyuropathIne DAyAbiTIka nyuropathI kahe che. kuSTharoganAM jaMtu mukhyatve saMvedanAvAhaka cetAomAM nukasAna kare che

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2 26 magaja ane jJAnataMtunA rogo * kensara zarIranA anya bhAgamAM hoya to paNa cetAone asara thAya che, jene perAniyoplAsTika nyuropathI kahe che. enTrapamenTa nyuropathI - kArpala Tanala sinDromamAM miDiyana narva hathelInI nIce rahelA volara ligAmenTamAM dabAya che, jenAthI hatheLImAM pIDA thAya che, je khabhA ane hAtha sudhI phelAya che, AvA alaga-alaga lagabhaga 30 prakAranAM enTepamenTa sinDroma che. viTAminanI khAmIthI, dArUnAM vadhAre paDatAM sevanathI, davAnI ADaasara vagere kAraNothI paNa nyuropathI thaI zake che. ApaNA dezamAM sauthI vadhu jovA maLatI DAyAbiTIsa, kuSTharoga, eIsa tathA dArUthI thatI viTAmina-bI, nI khAmI ane viTAmIna-bI, tathA pholika esiDanI khAmIthI thatI nyuropathI mukhya che. tarata nidAna, vyavasthita tapAsa, paryApta upacAra tathA yogya kasaratathI moTA bhAganI nyuropathInI sArI rIte sAravAra thaI zake che.

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mAyestheniyA grevisa mAyestheniyA grevisa eka kaSTasAdhya, AjIvana cAlato jJAnataMtu tema ja snAyuono roga che. A rogamAM snAyuomAM vakhatovakhata nabaLAI AvI jAya che. aicchika snAyuo asAdhAraNa jhaDapathI thAkI jAya che, asthitaMtra sAthe saMkaLAyelA snAyuo ke je AMkho, mukha, jIbha tathA hAthapaganA halannacalananuM niyaMtraNa kare te snAyuo A rogamAM asara pAme che. cetA ane snAyunI vaccenI kaDIne nyuraoNmaskyulara jaMkazana kahe che je taraMgone snAyu sudhI pahoMcADe che. jJAnataMtuomAMthI snAyuo sudhI pahoMcatAM A taraMgonA prasAraNanI khAmIne lIdhe A roga thAya che, joke temAM jJAnataMtuo ane snAyuo pote to khAmIrahita hoya che. 20 A roganI prAthamika zarUAta mukhyatve strIomAM 40 varSanI uMmara pahelAM ane puruSomAM 40 varSa pachI thAya che, jo ke bAlikAomAM A roga bhAgye ja jovA maLe che. A vyAdhi cepI ke vArasAgata nathI. tabIbI dRSTie cAra tabakkAomAM vaheMcAyela A rogamAM sau prathama dhyAna para AvatuM lakSaNa AMkhonA snAyuonI nabaLAI che (Grade-1). aMzataH dardIomAM A roga AMkha pUrato sImita rahe che paNa moTe bhAge samaya jatAM te hasavAnI, cAvavAnI, gaLavAnI, bolavAnI ane hAthapaganA halanacalananI kriyA karatA snAyuone asara kare che ane aMte zvAsocchvAsanI kriyA karatA snAyuo A rogano zikAra bane che ane jIvananuM jokhama UbhuM thAya che (Grade-4). mukhya lakSaNo: (1) eka athavA banne popacAM DhaLI javAM (2) AMkha-najara Amatema pharakAvavAmAM muzkelI

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2 2.8 magaja ane jJAnataMtunA rogo (3) cAlamAM asthiratA, azakti, thAka (4) hAtha tathA AMgaLAMmAM nabaLAI (5) khorAka gaLe utAravAmAM takalIpha (6) bolavAmAM takalIpha, bolatAM bolatAM avAja dhImo paDavo, nAkamAMthI avAja nIkaLavo (7) zvAsocchavAsanI kriyAmAM takalIpha mAyaspeniyA grevisanA dardIo mATe zvAsocchavAsanI takalIpha khUba ja jokhamakAraka pUravAra thaI zake che. A takalIpha thAya tyAre dardIne haoNspiTalamAM dAkhala karavAnuM pharajiyAta bane che. roga AgaLa vadhe tyAre athavA zarIramAM cepa athavA garbhAvasthA jevA zArIrika tANa UbhA karatA saMjogomAM zvAsanI takalIpha thaI zake che. A rogamAM avAranavAra snAyuonI nabaLAI jaNAya che, je pAchI maTI paNa jAya che athavA to thoDA samaya pachI vadhI zake che athavA lAMbA samaya sudhI yathAvat paNa rahI zake che, jo ke A roganI ugratA dardIe dardIe ane kalAke kalAke paNa badalAI zake che. vadhAre paDatA zramane kAraNe divasane aMte dardI vadhu nabaLo dekhAya ane ArAma karavAthI A paristhitimAM AMzika sudhAro maLe che. AvA saMjogomAM Adhunika sAravArathI dardIo mahadaMze rAhata meLavIne sAmAnya jIvana jIvI zake che. A rogamAM thAyamasa graMthi paNa agatyano bhAga majave che. tenA koSo zarIranI rogapratikArakataMtrano eka hisso gaNAya che. chAtImAM AvelI A graMthi zaizavamAM moTI hoya che, je kramazaH nAnI thatI jAya che ane pukhtavayanI sAmAnya vyaktimAM to tene zodhavI paNa muzkela banI jAya che paraMtu mAyasthaniyA grevisanA dardIomAM mahadaMze thAyamasa graMthi moTI jovA maLe che. 10thI 15% dardIomAM thAyamomA nAmanI thAyamasa graMthinI gAMTha hoya che je Ama to sAdI (eTale ke kensaranI nahi) hoya che paraMtu

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mAyestheniyA grevisa 229 kyAreka temAM kaeNnsara thavAnI zakyatA rahelI che. uparAMta Azare 5 TakA dardIone thAiraoNiDa graMthinI bImArI jovA maLe che. koI koI dardIomAM mAyestheniyA grevisanI zarUAta acAnaka thaI zake che je badhAM ja snAyuomAM ugratAthI nabaLAI lAve che. ghaNI vAra prAthamika lakSaNo parathI A roganuM nidAna karavuM muzkela hoya che paraMtu niSNAta DaoNkTara roganuM nidAna tenAM lakSaNa ane cihno parathI karI zake che. khAsa dhyAna AMkho ane hAthapaganA snAyuo para thAkanAM lakSaNo mATe apAya che. e noMdhavuM joIe ke A roga jevAM cihno-lakSaNo keTalIka vAra koI davAnI ADaasarathI paNa thaI zake. boTulInama nAmanA jherathI paNa thaI zake. nidAna (1) TIlasTIgmIna TesTa H TIlasTIgmInanA iMjekzanathI jo roganAM cihnomAM tAtkAlika phAyado jovA maLe to tenA AdhAre nidAna karI zakAya che. (2) i.ema.jI. : jJAnataMtuone vidyutazaktithI vAraMvA2e uttejita karavAthI tenA taraMgonA prasAraNamAM khAmI jANI zakAya che. (3) raktaparIkSaNamAM esiTAIlakolina risepTara enTiboDI pramANa TesTa mukhya che, jo ke roganI gaMbhIratA darzAvavA tathA roganA tabakkAnI pheratapAsa (follow-up)mAM A pramANa keTaluM vizvasanIya che e vAta cokkasa nathI. kyAreka-kyAreka enTImaska enTIboDI TesTa paNa karAya che. (4) sI.TI.skena thoreksa : 'thAyamomA' nAmanI gAMTha zodhavA mATeno A chAtIno TesTa che. (5) thAiraoNiDano TesTa tathA anya jarUrI blaDa TesTa.

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230 magaja ane jJAnataMtunA rogo sAravAra : A roganI sAravAramAM enTikolInesTaresa davAo vaparAya che, jevI ke nIosTizmIna ke pAyariDosTimmIna, je jJAnataMtuomAMthI snAyuo tarapha jatA taraMgonA prasAraNane majabUta kare che. AthI esiTAila kolina nAmanuM tattva vadhu samaya upalabdha rahe che ane tenAthI snAyuonI saMkocanazakti vadhe che. A davAnI asara dardI mATe ghaNI phAyadAkAraka hoya che paNa tenAthI dardI tenI badhI ja kriyAo pUrvavata kSamatAthI karI zakato nathI. thAyamasa graMthine oparezana dvArA kADhI levAthI vadhu phAyado thAya che. jo roganA prAraMbhika tabakkAmAM A oNparezana thAya to 50thI vadhu dardIone phAyado thAya che, dardInI uMmara 45 varSathI ochI hoya tyAre A oparezananI khAsa salAha apAya che. tenAthI urdu, pa0% jeTalA dardIomAM sTiroiDa jUthanI davAothI phAyado thAya che. keTalAka dardIone ejhAthAyoprina nAmanI davAthI rAhata thAya che paraMtu lAMbo samaya levAthI tenI ADaasaro paNa jovA maLe che. navI davAomAM mAyakophinoleTa davA mukhya che. A roganI vadhu paDatI asara dharAvatA dardIomAM plAjhamApheresisa nAmano upacAra karavAmAM Ave che. temAM dardInuM lohI zuddha karI tene pAchuM zarIramAM caDhAvavAmAM Ave che. A kriyAthI snAyu tarapha jatA taraMgonA prasAraNamAM khAmI utpanna karatA esiTAila kolina pratidravyo(enTibaoNDijha) tathA anya padArtho dUra thAya che. vAstavamAM roganA koIpaNa tabakkAmAM A sAravAranI paddhatithI dardIne phAyado thAya che. nyurolojisTa nakkI kare che ke kyA dardImAM kyAre Ano upayoga karavo. roganI gaMbhIra sthitimAM koI davAo asara kare nahIM tyAre A upacAra karavAmAM Ave che. kyAreka dardI

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mAyestheniyA grevisa 231 'mAyestheniyA krAisisa'(kaTokaTInI sthiti)mAM AvI jAya che ane roga trIjI, cothI ke aMtima kakSAmAM Ave tyAre A upacAra eTale ke plAjhamApheresisa dvArA dardInI jiMdagI bacAvI zakAya che. keTalAka dardIomAM plAjhamopheresisa ekathI vadhu vakhata ka2vAnI paNa jarUra paDe che. ' evo ja ati sacoTa paNa khUba ja kharcALa upacAra imyUnoglobyuline sA2vA2no che jemAM svastha zarIravALA manuSyonA lohImAMthI athavA sintheTika rIte ekatra kareluM rogapratikAraka dravya jene imyUnoglobyulina kahe che te dardIne pracUra mAtrAmAM ApavAmAM Ave che. sAmAnya rIte 400 mi.grA. ki.grA. dararojanAM lekhe Azare traNathI pAMca divasa A davA ApavAmAM Ave che. teno aMdAjIta kharca Azare rU. doDhathI aDhI lAkha sudhI thaI zake che. A prakAranI sAravAra dvArA paNa rogane jhaDapathI kAbUmAM lAvI jiMdagI bacAvI zakAya che. A sAravAra paNa vAraMvAra karI zakAya che. sarjarI mAyestheniyA rogamAM sarjarI be hetuthI karAya che : (1) eka to AgaLa jaNAvyA mujaba thAyamomA nAmanI gAMTha hoya to. (2) gAMTha na hoya paNa vyaktinI uMmara 45 varSathI ochI hoya to. A sarjarIne thAyamekTomI kahe che. ane lAMbA gALe AnA pariNAma paNa bahu sArAM maLe che. e pachI davAo kramazaH baMdha paNa thaI zake che. Ama 'mAyestheniyA grevisa' e pramANamAM agharo ane vikaTa roga che. dardIe dardIe tenI mAtrA ane vadhaghaTa judIjudI rahetI hovAthI jo tarata nidAna karIne niSNAta tabIbanI dekharekha heThaLa sAravAra karavAmAM

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232 magaja ane jJAnataMtunA rogo Ave to moTA bhAganA dardIone jarUra phAyado thAya che ane temanI jiMdagI bacAvI zakAya che. kayA dardIne kaI davA ke upacArapaddhati ApavI te je te niSNAta DokTaranI dekharekha heThaLa ja nakkI karavuM jarUrI che. lembarTa-ITana mATe sthanika sinDroma (LEMS): A paNa mAyaspeniyA jevo nyurokyulara jaMkazanano roga che. 85 TakA dardIo 40 varSathI vadhunI uMmaranA hoya che. 67 TakA dadIomAM A roga phephasAnA kensarathI thatA perAniyoplAsTika DisorDaranA rUpe hoya che. * mAyaspeniyAthI A roga judo paDe che kAraNa ke...... (1) khabhA ane sAthaLanI kamajorI A roganAM mukhya lakSaNo che. (2) AMkhonA snAyuonI kamajorI bahu mAmUlI hoya che. (3) keTalAMka dardIone bolavAmAM ane khorAka gaLavAmAM paNa takalIpha thAya che. (4) anukaMpI-parAnukaMpI cetAtaMtranI takalIpha, jemake AMkho sukAI javI, ochuM dekhAvuM, kabajiyAta, parasevo ocho vaLavo vagere paNa AmAM jovA maLe che. Electrophysiology (I.ema.jI. tathA Ara.ena.esa.) tapAsamAM A roga mATe sthaniyAthI tarata ja alaga tAravI zakAya che. A roganI zakyatAvALA dardIonI saMpUrNa tapAsa thavI joIe ane ene koI prakAranuM kensara, mukhyatve phephasAMnuM che ke nahIM, te paNa barAbara cakAsavuM joIe. jo dardIne kensara hoya to enI sAravAra karavAthI LEMSnA lakSaNomAM lAbha thaI zake che.

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mAyelveniyA grevisa mAyelveniyAmAM vaparAtI davAo jevI ke mesTinona, sTIroIDresa, ejhAthAyoprina, mAyakophinoleTa, vagere A rogamAM mAmetheniyA jevI akasIra sAbita nathI thaI. DAIamAInopAyariDina nAmanI davA AmAM madadarUpa thaI zake che.

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234 - magaja ane jJAnataMtunA rogo ATaluM jarUra jANo jJAnataMtuomAMthI snAyu sudhI pahoMcatA taraMgonA pramANamAM kSati thavAthI A roga thAya che. jemAM snAyumAM vakhatovakhata asAdhAraNa azakti Ave che. AMkhonA, caherAnA, gaLAnA tathA hAthapaganA snAyuo zrama karavAthI, athavA ApoApa nabaLA paDe che. zvAsocchavAsanI kriyA karatA snAyu paNa kamajora thaI zake che, tyAre paristhiti bagaDI paNa zake che. esITAIla kolina risepTara enTiboDI TesTa, i.ema.jI., TilasTizmIna TesTa, thorekasa sI.TI. skena ane thAIroIDano TesTa karAvavAthI roganuM nidAna thAya che. sTiroiDa, ejhAthAyoprIna vagere davAo; plAjhamA pheresisa nAmaka upacAra paddhati ane imyunoglobyulinanAM ijekazana vagerethI A roga kAbUmAM AvI zake che. jyAre ke snAyuono thAka dUra karavA mATe pAyariDosTimIna ane niyosTizmInano upayoga thAya che. moTA bhAge kensara sAthe joDAyelI nyuraoNmakyulara jaMkazananI bImArI LEMS, mAyaspeniyA jevI dekhAya che, paraMtu alaga che.

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21 snAyunA rogo atyAra sudhI ApaNe magaja ane cetAtaMtranA ghaNA rogo vize jANyuM. have ApaNe snAyunA rogo vize thoDuM jANIe. snAyuonA rogane mAyopathI (myopathy) kahe che. ApaNe jANIe chIe tema ApaNA zarIranA dareka avayava ke dareka bhAganuM saMcAlana magajathI thAya che. A taMtramAM magaja, nAnuM magaja, karoDarajju, temAMthI nIkaLatI cetAo, cetA ane snAyu vaccenI kaDI eTale ke 'nyuraoNmaskyulara jaMkzana' ane chelle snAyuno samAveza thAya che. nyuraoNmaskyulara jaMkzananA roga mAyastheniyA grevisa vize ApaNe AgaLa vistArathI joyuM che. snAyuonI bImArIonuM vargIkaraNa : mukhyatve A rIte karI zakAya (A) maskyulara DisTrophIjha : snAyuonA koSonI AnuvAMzika bImArI jevI ke Dazena maskyulara DisTrophI (B) cenalopathI : jema ke hAyapokelemika ke hAyaparakelemika pIriyoDika perelisisa (C) maeNTAbolika mAyopathI : zarkarA, carabI vagerenA cayApacayamAM khAmInA kAraNe thatI snAyuonI kamajorI (D) mAITokonDriyala mAyopathI : zarIranA dareka koSanA UrjAsrota evA, mAITokonDriAmAM khAmInA kAraNe thatI snAyuonI kamajorI jevI ke karna sayAre sinDroma (E) janmajAta (konjenAiTala) mAyopathI : jemake senTrala kora Disijha

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236 magaja ane jJAnataMtunA rogo (F) InphalemeTarI mAyopathI : jema ke paoNlImAyosAyaTisa, DarmeTomAyosAyaTisa vagere (G) ekvAyarDa mAyopathI : jema ke davAonI ADaasara, homonanI garabaDa have ApaNe snAyuonA rogomAM mukhya evA vArasAgata eTale ke heriDiTarI mAyopathIjha vize jANIe. (A) marakyulara DisTraoNphIma 1. Darzana marakyulara DioNphI (Duchenne Muscular Dystrophy) : eksa' (8) raMgasUtra prerita sexlinked recessive rIte saMkaLAyelo A vArasAgata roga lAkhe 30 chokarAomAM jovA maLe. strI jAti A rogamAMthI bAkAta che, joke roganuM vahana temanA dvArA thAya che. tethI tene sex-inked recessive prakArano roga kahe che. Ama to A roga janmathI ja hoya che paNa tenAM cihano 3-5 varSanI uMmare dhyAna para Ave che. bALaka cAlatAM cAlatAM paDI jAya, besIne UbhA thavAmAM ke dAdara caDhavAmAM takalIpha anubhave ane kramazaH snAyuonI nabaLAImAM vadhAro thAya. pIMDInA snAyuo phUlI jAya jene "sUDo hAyaparaTrophI' kahe che. 10-12 varSanI uMmara sudhImAM to moTA bhAganA dardIone vhIlacerano sahAro levo paDato hoya che. AvA dardIomAM ugra ane kyAreka jIvaleNa evuM phephasAMno cepa lAgavAnI paNa zakyatA hoya che. AvAM bALakomAM mAnasika vikAsa maMda hoya che ane hRdayanI bImArI paNa jovA maLe che. * nidAnaH A roganuM nidAna nIce mujaba karavAmAM Ave che: (1) lohInA namUnAmAM sI.pI.ke., esa.jI.o.TI., Alkolejha jevA udIpako (enjhAimsa)nuM pramANa vadheluM jaNAya che.

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237 (2) i.ema.jI. tapAsamAM amuka cokkasa lAkSaNika pheraphAro dekhAya (mAyopathika paeNTarna). snAyunA rogo (3) snAyu bAyaoNpsI karI mAikroskopa tapAsamAM khAtarIpUrvaka nidAna thAya. (4) kuTuMbanAM anya puruSa bALako ane mAtAnA bhAIo ke temanA putromAM AvI bImArInAM lakSaNo jovA maLavAnI pUrI saMbhAvanA che. upacAra : sTiraoNiDathI A roga upara thoDoghaNo aMkuza lAvI zakAya chatAM teno koI kAyamI ilAja hajI sudhI zodhAyo nathI. chatAM paNa kasarata ane mAnasika sahAnubhUti A dardIone TakAvI rAkhavAmAM ghaNo agatyano bhAga bhajave che. tene mATe maskyulara DisTraoNphI eNsosiyezana ane DI.ema.DI. sapaoNrTa grUpa jevI saMsthAo kAryarata che. navI paddhatiomAM jIna thaeNrepI, sTemasela therepI AzAspada jaNAya che. 2. bekara maskyulara DisTraoNphI 'eNksa' raMgasUtravALA A rogamAM snAyuonI nabaLAI Dazena maskyulara DisTraoNphI jevI ja hoya che paNa nabaLAInI tIvratA ane roga vadhavAnI gati dhImI hoya che. roganAM prathama cihno pathI 15 varSanI uMmara sudhImAM dekhAya che ane dardI 4thI 5 dAyakA jIve che. 3. lImba-garDala DisTraoNphI : snAyuono A roga strI puruSa bannemAM jovA maLe che. te jiMdagInA pahelAthI mAMDI cothA dAyakA sudhImAM thato jovA maLe che. kramazaH vadhato A roga kamara ane khabhAnA snAyuomAM nabaLAI UbhI kare che. udarapaTalanI nabaLAIthI kyAreka zvAsocchvAsanI gaMbhIra takalIpha UbhI thaI zake che.A sivAya hRdayanI takalIpha paNa thaI zake che.

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238 magaja ane jJAnataMtunA rogo 4. mAyoTonika DisTrophI A rogamAM caherAnA snAyuonI nabaLAI Ave che. dardIno cahero A roganI cADI khAya che. A sivAya gaLA ane hAthanA snAyuone paNa asara thAya che. mAyoTaoNniyA jovA maLe che, jemAM muThThI baMdha karyA bAda te sahelAIthI kholI zakAtI nathI. dardIomAM alpa mAnasika vikAsa, hRdayanI bImArI ane motiyo vagere jovA maLe che. A dardamAM mAyoTaoNniyA mATe pheniToina nAmanI davA ApavAmAM Ave che. A sivAya phresiyoskayulosUmarala makyulara DisTrophImAM caherAnA, khabhAnA snAyu ane hAthanA snAyuomAM nabaLAI jovA maLe che. (B) cenalopathI : Ayana cenala ne snAyuomAM koSo vacce hoya che emAM khAmI sarjAvAthI thatI mAyopathI mukhyatve nIce mujaba che. (1) hAyapokelemika pIriyoDika parilisisa ? lohImAM poTeziyama tattva ghaTavAthI hAIpothelemika pIriyoDika perelisisa thaI zake che jemAM hAthamAM khabhA taraphanA ane pagamAM thApA taraphanA snAyuomAM nabaLAI Ave che. A roga vAraMvAra Uthalo mArI zake che. kyAreka AMkho ane zvAsocchavAsanA snAyuo para paNa asara thaI zake che je yogya sAravAra na maLatAM jIvaleNa nIvaDI zake che. hRdayanA dhabakArAmAM aniyamitatA jovA maLe che. lohImAM poTeziyamanuM pramANa ghaTeluM jovA maLe che. TenDana jasa dhImA paDI gayelA mAlUma paDe che. AmAM mukhyatve kelziyamanI cenalamAM UNapa hoya che. poTeziyama nasamAM iMjekzana dvArA bATalA mAraphate athavA moM vATe ApavAthI snAyuonI nabaLAI dUra thAya che. AmAM DaoNkTarI dekharekha atyaMta jarUrI che kAraNa ke poTeziyamanI mAtrAmAM vadhaghaTa thavAthI gaMbhIra - ADaasaro thaI zake che. te

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snAyunA rogo 239 (2) hAIparakelemika pIriyoDika paeNraeNlisisaH lohImAM poTeziyamanI mAtrA vadhavAthI paNa A ja prakAranI snAyuonI nabaLAI jovA maLe che. AmAM mukhyatve soDiyama cenalamAM khAmI jovA maLatI hoya che. A roganA dardIe ochA poTeziyama ane vadhAre zarkarAyukta khorAka levo joIe. vadhAre paDatA zrama, upavAsa ane ThaMDIthI bacavuM joIe. eNsiTAjholAmAIDa tathA kloravAyAjhAIDa davAothI phAyado thaI zake che. (3) perAmAyoToniyA kojenAITAH A rogamAM ThaMDA vAtAvaraNathI athavA to koI paNa kAraNa sivAya nabaLAI AvI zake che ane zArIrika pravRttithI nabaLAI vadhe che. lUkojha ke anya kArbodita padArtho khAvAthI A nabaLAI dUra thaI jAya che. thAyAjhAiDa DAIyureTika tathA mekjhileTina nAmanI davAthI lAMbA gALe phAyado thAya che. (C) Heights Hulejl (Metabolic Myopathy). snAyuonI janmajAta cayApacayanI takalIpha jevI ke glAyakojana sToreja, mAyo phosphorIlejha, lipiDa sToreja tathA keTalIka mAyaTokonDriyala mAyopathI A prakAramAM sAmela che. AmAM dardIone zarUAtamAM thoDuMka kAma karavAthI paNa thAka lAge che. kasarata karatI vakhate snAyuomAM duHkhAvo thAya che, je sAmAnya vyaktiomAM nathI thato. snAyuonI kamajorI nAnI uMmarathI ja dekhAvA lAge che. pezAbano raMga paNa kokA-kolAnAM raMga jevo dekhAya che. lohImAM zarkarA, carabI vagere pAcanamAM upayogI thanArA udIpakanI mAtrA ghaTatI jAya che. cayApacayanI-je khAmAthA A rAga thAya che, anI sAravAra karavAthI keTalAka rogomAM phAyado thAya che. uparAMta niyamita kasarata (Physiotheraphy) to jarUrI che ja.

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240 magaja ane jJAnataMtunA rogo (D) mAITokonDriyala mAyopathI : A rogamAM mAITokonDriyA je zarIranA pratyeka koSano UrjAsrota che emAM khAmI jovA maLe che, jema ke mAITokonDriAnA DI.ena.e.nI vikRti-myUTezana, uddIpakanI khAmI athavA enI racanAmAM khAmI. AmA mukhyatve AMkhanA snAyuo upara vadhAre asa2 jovA maLe che. sAthe sAthe, hAthapaganAM snAyuomAM paNa kamajorI Ave che. A uparAMta dUbaLApaNuM, karoDarajjunA maNakA vAMkA thaI javA, hADakAnuM vAMkuM thavuM, hRdayanAM snAyuonI kamajorI, nyuraoNpathI, baherAza, hormonsanI khAmI, kheMca, cAlavAmAM takalIpha thavI, mAthuM duHkhavuM, lakavA vagere jevI takalIpho paNa thatI hoya che. A badhAM ja lakSaNa cihna samUho parathI kayA prakAranI mAITokonDriyala mAyopathI che enI jANakArI meLavI zakAya che, jema ke.... karna sayAre sinDroma - ema.I.Ara.Ara.epha. - ema.I.ela.e.esa. janInonI vizeSa tapAsa (jInomano abhyAsa) karavAthI mAITokonDriyala DI.ena.e. myUTezana jovA maLe che. niyamita kasarata sivAya AnI koI sAravAra nathI. kaoN-enjhAIma kyu-10 ane viTAminsa ApavAthI snAyuonI kamajorImAM alpa samaya mATe thoDo phAyado jarUra thAya che. dardIne azakti sivAya paNa bIjI koI phariyAda hoya to enI sAravAra karavI joIe. (E) janmajAta konjenAITala mAyopathI : navajAta zizuomAM jovA maLatI A snAyuonI bImArImAM senTrala kora, nimelAIna tathA senTronyukliara mAyopathIno samAveza thAya che. AmAM moTe bhAge janmathI ja snAyuonI bImArI jovA maLe che. Ja navajAta zizu halana-calana vagara paDyuM rahe che, ke pachI enuM halana-calana

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snAyunA rogo 241 sAmAnya bALakonI sarakhAmaNImAM ochuM hoya che. jema jema bALaka moTuM thAya che tema tema tenA snAyuo ghaNI vAra kaDaka thaI jatA hoya che ane bALakano mAnasika vikAsa dhImo paDI jAya che. snAyuo sukAyelA (atrophy) jovA maLe che. ghaNAM bALakomAM vadhatI uMmara sAthe sAthe snAyuomAM paNa sAmAnya bALaka jevo ja vikAsa thAya che tathA mAnasika vikAsa paNa barAbara thAya che. A rogamAM bALakone ramatagamata mATe protsAhita karavA joIe, jethI emanA snAyuomAM tAkAta vadhe ane eno yogya rIte vikAsa thAya. jarUra paDe vyavasAyika niSNAtanI salAha paNa laI zakAya. (F) inphalemeTarI mAyopathI : snAyuonA sojAthI thatA keTalAka muzkelIbharyA rogo vize have ApaNe savistara joIzuM. paoNlImAyosAyaTisa ane DarmeTomAyosAyaTisa : paoNlImAyosAyaTisa ane DarmeTomAyosAyaTisa zuM che? A rogomAM prathama snAyuomAM sojAnI-inphalemezananI prakriyA thAya che ane tethI snAyuo DhIlA ane kamajora thatA jAya che. A roganuM mukhya lakSaNa snAyuonI nabaLAI che je kramazaH vadhIne dardIne pAMgaLo banAvI de che. DarmeTomAyosAiTisanA rogIomAM caherA, pITha, chAtI, koNI ane DhIMcaNanA bhAga para lAlAza paDatAM cAThAM paNa jovA maLe che. kAraNa: A rogo vArasAgata nathI. zarIranA rakSaNAtmaka pratikArataMtra (snAyunI imyuna sisTama)mAM pheraphAra thavAthI snAyuono nAza karatA koSo pedA thAya che je A rogane mATe javAbadAra che. ahIM e noMdhavuM jarUrI che ke A roga cepI nathI.

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242 magaja ane jJAnataMtunA rogo lakSaNo : 18 varSanI uMmara AsapAsa thatI bImArImAM A roganAM lakSaNa, tenI tIvratA ane vadhavAnI gati vageremAM ghaNI vividhatA jovA maLe. che. thoDA mahinAnI aMdara ja snAyuomAM nabaLAI prasare che. ghaNI vakhata te aTake che paNa moTA bhAge, jo yogya upacAra na karavAmAM Ave to, nabaLAI kramazaH vadhatI ja jAya che. dardInI cAla asthira thaI jAya che ane te vAraMvAra paDI jAya che. samaya jatAM cAlavAnuM sadaMtara baMdha thaI jAya che ane dardI pathArIvaza thaI jAya che. jhaDapathI vadhatA rogamAM dardIne sudhAro thavAnI vadhu zakyatA hoya che. Azare 50% dardIomAM davAthI sudhAro thaI zake che. A dardIomAM snAyuono duHkhAvo khAsa karIne sIDI caDavAmAM ke khurazImAMthI UbhA thavAmAM thAya che. hAtha UMcA karavAmAM paNa takalIpha paDe che. gaLAnA snAyuomAM paNa takalIpha jovA maLe che. jema jema roga vadhato jAya che tema tema gaMbhIra lakSaNo jemake khorAka, pravAhI gaLavAmAM ane zvAsa levAmAM paNa takalIpha thAya che. nidAna : upara jaNAvela lakSaNa sAthe H (1) lohImAM sI.pI.ke.nuM vadheluM pramANa (serum cPK level) (2) I.ema.jI., ena.sI.vI. jevI tapAsathI roganI cokasAI thAya che. (3) snAyunI bAyaoNsImAM jovA maLatA cokkasa pheraphArothI nidAna sacoTa thAya. upacAra : (a) davAo : (1) sTiraoNiDa grUpamAM enIsolona, mithAila prenIsolona, DelAmethAsIna

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243 snAyunA rogo (2) Imyunosapresiva davAo jevI ke ejhAthAyoprIna, mAyakophiloneTa, mithoTrekseTa (3) sAyaklosporina jevI davAothI A roga mahadaMze kAbUmAM laI zakAya, chatAM lAMbA gALe A davAonI ADaasaro thatI jovA maLe che. (ba) plAjhamAphresisa ? dardInA lohImAMthI kharAba proTIna dUra karavAnI prakriyA dvArA roga para kAbU meLavI zakAya. (ka) ImyunoglobyulinaH A davA zirA (nasa)mAM ApavAthI paNa phAyado thAya paNa A sAravAra khUba moMghI hoya che. A sAthe phijhiyotherapInuM mahattva paNa ochuM AMkI zakAya nahIM. roja niyamita phijhiyotherapI (kasarata) karavAthI amuka aMze snAyuone kRza thatA aTakAvI zakAya. A rogamAM mAtra sAmAnya dukhAvo thAya che. tema mAnI roga vakaravAnI rAha joyA karatAM satvare yogya tabIbanI salAha levI vadhAre agatyanI che. (G) ekavAyarDa mAyopathI : A prakAramAM snAyuomAM janmajAta garabaDa hAtA nathI paraMtu thAiroiDa hormona vadhavA ke ghaTavAthI, perAthAiroiDa hormona vadhavAthI, vadhu paDatA sTiroiDanA sevanathI ke anya davAonI ADaasarathI, DAyAbiTIsanI apUratI sAravArathI, mUtrapiMDa (kiDanI), yakRta (livara)nI lAMbI bImArIthI ke vadhu paDatA dArUnA sevanathI ane viTAminonI khAmIthI ema aneka kAraNothI snAyuo kamajora paDI zake. yogya nidAnathI khAtarI karI sAravAra karavAthI A rogamAM sudhAro thaI zake.

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magaja ane jJAnataMtunA rogo melignanTa hAyaparatharmiyA : A roganAM lakSaNo sAmAnya rIte koI dardIne oparezana mATe janarala enesthesiyA (saksinAIla kolina, hailothena) apAya tyAre jaNAya che. 244 A eka AnuvaMzika roga che. enesthesiyA ApatI vakhate snAyuo acanAka kaDaka thaI jAya che. pezAbano raMga kolA jevo thaI jAya che. sakhata tAva Ave, dhabakArA vadhI jAya, zarIra bhUruM paDI jAya tathA hRdayanA dhabakArAmAM aniyamitatA Ave vagere lakSaNo jovA maLe che. AnA nidAna mATenI mukhya tapAsa (TesTa) che lohImAM sI.pI.ke.nI mAtrA (Serum CPK level), je noMdhanIya pramANamAM vadhI jAya che. A bImArImAM dardI moTe bhAge mRtyu pAme che. mATe koI paNa dardIne janarala enesthesiyA ApatAM pahelA e jANI levuM joIe kuTuMbamAM koIne enesthesiyA daramiyAna AvI koI takalIpha ke mRtyu to nahotuM thayuM ne ? tAva utAravAnA ghaniSTha upacAra sAthe sAthe tAtkAlika DenDrolina nAmanI davA AmAM jIva bacAvI zake che.

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snAyunA rogo 245 ATaluM jarUra jANo | snAyuonI bImArIomAM mukhyatve AnuvaMzika arthAt heriDiTarI mAyopathI hoya che. Dazena makyulara DisTrophI phakata puruSomAM thAya che, jemAM cAlavAmAM athavA caDhavA - UtaravAmAM muzkelIthI laIne jIvaleNa phephasAMnuM saMkramaNa thavAnI paNa saMbhAvanA rahelI che. liMba garvala DisTrophImAM kamara ane khabhAnA snAyuo kamajora thaI jAya che ane kyAreka zvAsocchavAsamAM takalIpha thAya che. A roga strI-puruSa baMnemAM thAya che. lohImAM poTeziyamanuM pramANa ghaTI javAthI hAthamAM khabhA tarapha ane pagamAM sAthaLa taraphanAM snAyuomAM azakti Ave che. jene hAIpothelemika piriyoDika perAlisIsa kahe che. lohImAM poTeziyamanuM pramANa vadhavAthI thatI snAyuonI kamajorIne hAIpara kelemika piriyoDika perAlisIsa kahe che. snAyuonI janmajAta cayApacayanI garabaDathI thatI mAyopathIne meTAbolika mAyopathI kahe che. navajAta zizumAM jovA maLatI snAyuonI bImArIne kojenAITala mAyopathI kahe che. paoNlImAyosAyaTImAM snAyuomAM sAjo Ave che, te kamajora thaI jAya che ane dardI vikalAMga banI jAya che. DarameTomAyosAyaTImAM snAyuonA sojAnI sAthe dardInAM caherA, pITha, chAtI, koNI ane ghUMTaNanAM bhAga para lAlAzavALA cAThA paDI jAya che.

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246 magaja ane jJAnataMtunA rogo sTiroiDa grUpanI davA, imyunosapresiva davA, sAIklosporina, plAjhamA pheresisanI prakriyA ane imyunoglobyulinanAM injakazanathI A rogamAM ghaNI rAhata maLI zake che. ekavAyarDa mAyopathImAM aMtaHstrAvonAM asaMtulanathI, davAnI ADaasarathI, DAyAbiTIsanA apUrNa upacArathI, kiDanI athavA yakRtanI lAMbI bImArIthI athavA dArUnA vadhu paDatA sevanathI ane viTAminanI khAmIne lIdhe athavA anya aneka kAraNothI snAyu kamajora thaI jAya che. janarala enesthesiyA daramyAna keTalAMka dardIonuM acAnaka sakhata tAva sAthe mRtyu thaI jAya che, tenuM kAraNa melignanTa hAIparatharmiyA nAmano khUba ja ochA pramANamAM jovA maLato roga che.

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22 tanAva (sTresa) tanAva eTale zuM ? tanAva eTale zarIranA koI paNa taMtra upara paDato dabAva ane tenAthI utpanna thatI sthiti. ApaNI jIvanazailI ke ApaNA manosAmAjika vAtAvaraNamAM UbhA thatA paDakAro jhIlavA ApaNuM zarIra ane mana je pratikriyAo utpanna kare che tene sTresa athavA tanAva kahe che. tanAva phakta nakArAtmaka ke hAnikAraka ja hoya tevuM nathI te hakArAtmaka paNa hoI zake. tanAvathI aNadhArI paristhitiono sAmano karavAnI kSamatA vadhe che. paDakArarUpa paristhitio jevI ke spardhA, parIkSA vageremAM tanAvanI prakriyAthI mANasa satarka ane sajAga bane che. 'sAmano karo athavA bhAgI chUTo' pratikriyA zuM che ? tanAvanI paristhiti UbhI thatAM ja ApaNA zarIramAM keTalAka jaivika-rAsAyaNika pheraphAro thAya che, je be prakAranI pratikriyA utpanna kare che, laDavuM athavA bhAgI chUTavuM A prakriyA daramiyAna zarIramAM vAstavamAM kayA pheraphAra thAya che te ApaNe joIe. tanAvamAM ApaNA zarIranuM svayaMsaMcAlita evuM anukaMpI jJAnataMtra (sympathetic nervous system) uttejita thAya che, jenA pariNAme eDrinala graMthimAMthI eDrinalina, naoNra-eDrinalina nAmanA rasano srAva thAya che ane AnA kAraNe zarIramAM cokkasa prakriyAo jovA maLe che. tanAvanA kAraNe zarIra ane magaja para thatI vividha tatkAlIna asaro (1) zvAsocchavAsa jhaDapI ane TUMkA bane cha. (2) (3) hRdayanA dhabakArA vadhI jAya tathA lohInuM dabANa vadhe. hAtha-paganA lohInA puravaThAmAM ghaTADo thAya jyAre snAyuomAM lohInuM paribhramaNa vadhe che.

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248 (pa) lAgu magaja ane jJAnataMtunA rogo (4) zarIranA snAyuo taMga bane, hAtha-paga ThaMDA thaI jAya, zarIre parasevo vaLI jAya, rUMvADAM UbhAM thAya, koI vAra dhrujArI paNa thAya. lohI jAmI javAnI prakriyA jhaDapI bane che (6) AMkhanI kIkIo pahoLI bane che. (7) indriyo sateja bane, temaja sAMbhaLavAnI, jovAnI ane suMghavAnI tIvratA vadhe. (8) zarIranI cayApacayanI prakriyA meTAbolijhama) jhaDapI bane che. (9) magajanI vicArazakti jhaDapI bane. (10) nirNayazakti tathA paristhitine pArakhavAnI sUjhamAM tejI- vedhakatA Ave ane smaraNazakti sateja bane. koI vAra "zuM thaze? tevI bIka paNa lAge. lAMbA samayanA tanAvanI zarIra para thatI nakArAtmaka asaroH (1) vartananI samasyAo gussAvALo tathA cIDiyo svabhAva thaI javo, kAryazaktimAM ghaTADo thavo, svabhAva bhulakaNo thaI javo, vivekahIna ane bedhyAna thavuM, kharAba AdatonA zikAra thavuM, jAtIya jIvananI samasyAo pedA thavI, khorAkamAM aruci athavA to atizaya khAvAnI Teva paDavI. lAMbo samaya tanAvanA kAraNe UbhI thatI vartananI samasyAonAM A badhAM vividha lakSaNo che (2) ravAthyanI samasyAo : mAthAno dukhAvo, dama, hAI bI.pI., saMdhivA, cAmaDInA rogo, hRdayaroga, jaTharanI cAMdI, cakkara AvavAM, anidrA ane Diprezana vagereno samAveza thAya che. eka aMdAja mujaba Azare 80 TakA rogo mAnasika tanAvane lIdhe zarIramAM pedA thAya che jene manodaihika rogo kahe che. A sivAya tanAvathI rogapratikAraka-zakti ghaTe che. sArI :

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tanAva (sTresa) tanAva utpanna karanArAM paribaLo : tanAva pedA karanArI paristhiti saMjogo dareka vyaktie bhinna bhinna hoya che dA.ta. kauTuMbika tathA aMgata kAraNo : kuTuMbanA sabhyomAM matabheda jIvanazailImAM bhinnatA aNabanAva, IrSA saMpatti bAbatanA jhaghaDA kuTuMbamAM koInI bImArI athavA mRtyu Arthika samasyA bALakonI samasyA premamAM ke lagnamAM maLatI niSphaLatA, vivAda-lagnaviccheda dAmpatyajIvananA prazno vyavasAya ane kArakirdIne lagatAM paribaLo kAmano atizaya boja ati UMco kAryalakSyAMka takono abhAva, bekArI, ochI Avaka parIkSA, inTarvyu, badalI, tAlIma nokarInA sthAne sattAnuM rAjakAraNa, bhraSTAcAra sahakarmacArIo sAthe gharSaNa nokarI - vyavasAyathI maLavA joItA saMtoSano abhAva sAmAjika paribaLo garIbI anyAya bhedabhAva jAtibheda gunAkhorI 249 :

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250 magaja ane jJAnataMtunA rogo AtaMkavAda akasmAtano bhoga banela athavA to tene najare jonAra vyakti paNa tanAvano zikAra thaI zake che. "e" prakAranuM ('TAipa e') vyaktitva jemAM mANasa vadhu paDato mahattvAkAMkSI, ugra, abhimAnI hoya che tevI paristhiti paNa tanAvajanaka sthiti pedA kare che. janma, vivAha, lagna, sagarbhAsthA, chUTAcheDA, nivRtti, mRtyu jevA jIvananA prasaMgo paNa tanAva janmAve che. A sAthe Adhunika jIvanazailI, vadhu kamAvA mATe tathA Adhunika jIvananI hoDamAM ane uMdara doDamAM TakI rahevA - jItavA mATe valakhAM mArato mAnava AsAnIthI tanAva ane tanAvajanya rogono zikAra thAya che. * tanAva para kAbU meLavavAnA ane tenAthI dUra rahevAnA upAyoH sau prathama to ApaNe tanAva utpanna karanArAM paribaLone pArakhavAM paDe ane teno zAMta citte yogya ukela lAvavAno prayatna karavo paDe. A sivAya tanAvanAM cihnone sAvacetInA saMketarUpa gaNI tanAva para kAbU meLavavA tAtkAlika yogya pagalAM levAM joIe. * upacAraH tanAva pedA karanArI paristhiti ane paribaLonuM mUlyAMkana karI enA ukelanA vikalpo nakkI karavA. pravartamAna paristhiti- saMjogo aMge H (1) paristhitino samajapUrvaka ane ravarathatAthI sAmano karavoH udAharaNa tarIke parIkSA samaye dinacaryAmAM pheraphAra karI, vAMcavAnuM samayapatraka banAvI yogya mArgadarzana sAthe taiyArI karavI.

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tanAva (sTresa) - 251 (2) paristhitithI dUra khasI javuM udAharaNa tarIke koInI sAthenA aNabanAvathI tanAva pedA thato hoya ane saMbaMdha sudhare ema na ja hoya to saMbaMdhano aMta ANI devo. navA saMbaMdho ADedhaDa vadhAravA nahi, navI javAbadArIo svIkAravI nahi. thoDA samaya mATe ekAMtamAM jatA rahevuM. jeTalA navA mANasono saMparka thAya athavA jeTalA navA saMjogo UbhA karIe teTalo tanAva vadhe. tethI DAhyA mANaso A badhuM TALatA rahe che athavA tene sImita pramANamAM ja rAkhe che. (3) kaMI ja na karavuMH mAtra yogya samayanI rAha jovI dA.ta., parIkSAnA pariNAmanI svastha citte rAha jovI. je thavAnuM haze te thaze tevo abhigama rAkhavo. * manozArIrika paribaLo aMgeH niyamita dhyAna : dhyAna aneka prakAre thaI zake che. bhAratamAM aneka dhyAnapaddhatio vikasI che. A dhyAnapaddhatiomAM pAtaMjala, anApana sati ane smRti upasthAna mukhya che. te ja pramANe vipazyanA ane prekSA dhyAna paNa che je kaMIka aMze uparanI paddhationuM yogya saMvardhana che. bIjI ghaNI paddhatio uparanI paddhationA ekAda aMga parathI racAyelI che. manana, maMtrajApa, zvAsocchavAsa paranuM dhyAna, pUrNayoga dhyAna, spaMdadhyAna, nAbhidhyAna, svapnadhyAna, nAdadhyAna, yoganidrA, nyAsa, trATaka, sUryasaMyama, arUpadhyAna, kAyotsargadhyAna, jainadhyAna, tathAtAdhyAna, sahaja dhyAna, sAdhumauna, hU dhyAna vagere aneka dhyAnapaddhatio che. paNa badhI paddhationo hetu, aMtima dhyeya, aMtima sAdhyabiMdu eka ja che, ane e che mananI zAMti tathA eno vikAsa. koIpaNa dhyAna paddhatimAM ekAda cIja para manane kendrita karavAnuM hoya che. pachI e zvAsa hoya, vicAra hoya, darzanIya cIja (chabI, mUrti vagere) hoya, avAja-nAda hoya ke pachI koI AnaMdadAyaka smRti ke kalpanA hoya.

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252 magaja ane jJAnataMtunA rogo zAMtacitta, samatAbharyuM citta tathA sajAgatAbharyuM citta A traNeya, koI paNa dhyAnanI saphaLatA mATenI anivArya jarUriyAta che. AvA cittathI jovuM ane jANavuM e dhyAna che. ApaNuM mana haMmezAM bhUtakALa ane bhaviSyakALamAM ja bhaTakatuM hoya che. vartamAnamAM rahevAnI tene Adata nathI. bhUtakALanAM du:kho, niSphaLatAo ane bhUlo mAnavIne pIDA Ape che. jyAre bhaviSyanI ciMtAo ane apekSAo paNa mAnavInAM sukha-zAMti harI le che. vartamAnanI pratyeka kSaNane AnaMdathI jovI-mANavI ane teno sadupayoga karavo e sukhanI cAvI che ane sAce ja dhyAnanI dareka paddhati ApaNane vartamAnamAM rahetA zIkhave che. pratyeka kSaNane jAgRtipUrvaka-hozamAM jotA zIkhave che, jethI mana, vacana ke karmathI koI bhUla na thAya. jAgRti (apramAda) rahe to traNeyanI zuddhi rahe, kemake ApaNI bhUlo behozImAM-pramAdamAM ja thAya che. manane bhaTakatA aTakAvavuM hoya to, za2I2 jyAM hoya, manane tyAM ja rAkhavAno abhyAsa karavo paDe. zarIra je kriyA karatuM hoya temAMja manane parovavAnI keLavaNI e ja vAstavamAM dhyAnanuM prathama caraNa ane badhI ja dhyAna sAdhanAnI prathama pArAzIzI A ja che. dhyAnanA bIjA caraNamAM dRSTAbhAva-sAkSIbhAva Ave ane chellA caraNamAM dRSTA (cetanA-Atmatattva) ja potAne jue ane tyAM bIjuM kAMI ja na hoya - na rahe tyAM samAdhi niSpanna thAya. amana avasthA rahe. potAnI zArIrika tathA mAnasika pravRtti tathA potAnA Atmika vikAsane lakSyamAM rAkhI potAne je yogya lAge te ekAda dhyAnano niyamita abhyAsa karavo. dhyAna e tanAvanuM zreSTha auSadha gaNAya che. roja dhyAna karavuM hitAvaha che. tanAvayukta paristhitimAM to vizeSa karavuM joIe. roja trIsa miniTa dhyAna karavAnI bhalAmaNa karAtI hoya che.

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tanAva (sTresa) 253 2. prANAyAma : prANAyAma tema ja zvAsocchavAsanI kasarato (brIdhiMga eksarasAijha)e tvarita tanAvanI kSaNomAM tema ja haMmezanA tanAva sAmenA rakSaNamAM saraLa upAya gaNI zakAya. 3. kasarataH cAlavuM, doDavuM, eNrobika kasarato, jimnesTika, yogAsano, ramato ramavI, taravuM vagere yogya mAtrAmAM niyamita karavAthI sTresa jarUra ochuM thaI zake. AvI kasaratono samaya 5 miniTathI zarU karI 40 miniTa sudhI vadhArI zakAya. aThavADiyAmAM 4thI 5 divasa niyamita kasarata karavI joIe. nAnI nAnI kasarato to kAmanI vacce paNa 2-5 miniTa mATe karI zakAya, jema ke garadana pheravavI, hAtha ane kAMDAnI kasarato, caherAnI kasarato athavA ghaDIka UbhA thaI ra-3 pagathiyAM caDhavA-UtaravAM. 4. bAyophIDabeMka ? kramazaH zithilIkaraNa (progresiva rileksezana), hAsyacikitsA (lAphaTaratherapI), prekSAdhyAna, vipazyanA, selphIhipnoTijhama, sisTemeTika DisensiTAIjhezana vagerethI paNa ghaNo phAyado thAya che, e eka vaijJAnika satya che. saMgIta cikitsA mananI zAMti, zithilIkaraNa, AnaMdanI anubhUti tathA taNAvathI mukti mATe saMgIta sAMbhaLavuM ke gAvuM ke koI vAdya vagADavuM)thI zreSTha bIjuM zuM hoI zake ? AhAramAM yogya pheraphAro : pauSTika khorAka, proTInayukta khorAka, phaLaphaLAdi, yogya nAsto ane khorAkamAM resAvALA khorAkano vadhAre upayoga tanAva (sTresa) sAme rAhata Ape che. prajIvako (viTAminsa) tema ja eNnTioksiDanTa dravyo yogya pramANamAM levAthI paNa phAyado thaI zake. carabIyukta, tIkhAM ane ati garama khorAkathI ke phAsTaphUDathI nukasAna thAya che. "jevo AhAra tevo vicAra' e ukti ahIM yathArtha Thare che. G. jarUra paDye DokTaranI ke anyanI sahAyaH prophezanala vyaktinI madada laI zakAya. sTresane dUra karavA judAjudA korsa karI zakAya, jema

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254 magaja ane jJAnataMtunA rogo ke jIvana jIvavAnI kaLA (ArTa opha liviMga), siddha samAdhiyoga ane lenDamArka phaoNrama vagere paNa sAro evo phAyado karI zake. svaupacAra : A uparAMta nIce darzAvelA keTalAka rojiMdA upayogamAM AvI zake tevA upAyo paNa ajamAvI zakAya che. A upAyomAM anya vyaktinI sahAyanI jarUra paDatI nathI ane te mATe 10-15 divasanI rajA laI, hilasTezana para javAnI ke, A aMge khAsa kharca karavAnI paNa jarUra nathI. * cAlavA nIkaLI paDo ke sAikala para pharavA jAva. * bAgakAma (gArDaniMga) karo ke bagIcAmAM laTAre jatA raho. * Tenisa ke beDaminTana ke TebalaTenisanI ramata ramo. mitrane patra lakho athavA tene phona karo (phone a friend) athavA tenI sAthe jamavA jAva. koI zokhanI vastu ke udyoga (krAphTa)mAM samaya pasAra karo. divasamAM be vakhata 10thI 15 miniTa prArthanA karI. te eka jabaradasta preraka baLa che jemAM manane saMpUrNapaNe svastha karI zakavAnI tAkAta che. muzkelIno - samasyAno vadhAre paDato vicAra na karo, teno upAya zuM thaI zake tenA para vicAro kendrita karo. mAnada sevA jevI sAmAjika pravRtti karo, anAtha Azrama mATe samaya phALavo, mitrane ke kuTuMbIne maLavA jAo. koI sArA grUpamAM sabhya thAva. calacitra ke nATaka jovA jAva suMdara pustaka ke sAmayika vAMco, satsaMgI sajjanone maLo. dhArmika vAcana karo. bALako sAthe 15-30 miniTa ramata ramavA jevI uttama ane nirdoSa AnaMdanI kSaNo bahu ochI hoya che. bALaka jevA banI temanI sAthe ramo.

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255 tanAva (sTresa) * saMgrahAlaya (myujhiyama) - ArTa gelerImAM jAo. * masAja, pheziyala, babalabAtha ke sTImabAtha lo. phona bAju para mUkI, bArIbAraNAM baMdha karI, lAITo tathA AMkho baMdha karIne saMgIta sAMbhaLo. A samaye phona vAge to uThAvo nahi, AnsariMga mazInano upayoga karo. mananuM valaNa yAne atitude sudhAravuM, tene hakArAtmaka banAvavuM ane samAdhAnakArI banAvavuM e gurucAvI che. yogya vAcana, satsaMga ane mananathI ja valaNa-abhigama badalAya che ane tema thAya to game tevI paristhitimAM svasthatA raheze. upasaMhAra : sTresa daramiyAna acAnaka kazuM ja na karo, tatkAla utAvaLiyo, dUragAmI nirNaya na lezo. zavAsana karo. saMpUrNa ArAma ane UMDA zvAsa kadAca zreSThatama upAya che. zakya hoya to prekSAdhyAna, progresiva rileksezana athavA yoganidrA zIkhIne teno te daramiyAna abhyAsa karavo. koI vyakti ke jagyAthI acAnaka sTresa thayo hoya to te vyakti ke jagyAne choDI dUra jatA raho. maMdiramAM ke mitrane tyAM jAva. darpaNamAM tamAruM pratibiMba juo. bhUlecUke gussA dvArA pratibhAva Apazo nahi. gusso Ave to moTethI 1thI 10 sudhI gaNavuM e eka siddha prayoga che. tenAthI gusso phaMTAI jaze. te kSaNane sAcavI levI te ja khAsa mahattvanuM che. thoDI miniTo pachI sTresa zAMta thaI jaze. tyAM sudhI zakya hoya to dhyAna ke zavAsana karo. eTale ke TUMkamAM jenAthI sTresa thato hoya te saMjogo ke vyaktiothI dUra jatA rahevuM ane mananI khoTA pratyAghAta ApavAnI vRttine vALIne, zAMta karI, zubha dhyAnamAM, zubha pravRttimAM ane sArA vicAromAM joDI devAnI kaLA hastagata karavI joIe ane pratyeka kSaNamAM jAgRta rahIne AnaMdamAM jIvatAM zIkhavuM joIe.

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256 magaja ane jJAnataMtunA rogo sAthe rojiMdI jIvanazailImAM prArthanA, dhyAna, yoga, kasarata ane prANAyAma niyamita rIte joDI devA joIe. A sAthe sAttvika pauSTika khorAka, phaLaphaLAdi niyamita levAM joIe. Ama jIvanazailI tathA ApaNA mananuM valaNa (attitude) badalavAthI sTresa sAva ja ocho thaI jaze ane sTresa AvI paDe topaNa teno sAmano karavAnI kSamatA Avaze-vadhaze.

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tanAva (sTresa) 257 ATaluM jarUra jANo ApaNI jIvanazailImAM utpanna thatI samasyAo ane takalIphothI zarIra ane mana je pratikriyAo utpanna kare che tene sTresa (tanAva) kahe che. sTresa phakta nakArAtmaka nathI hoto, te kyAreka sakArAtmaka paNa hoI zake che. tanAvane lIdhe hRdayanA dhabakArA vadhI jAya che, zvAsocchavAsa jhaDapI thaI jAya che, indriyo sateja thaI jAya che, zarIranI cayApacayanI kriyAmAM vega Ave che, zarIre parasevo thaI jAya che, rUMvADAM UbhAM thaI jAya che, dhrujArI Ave che, magajanI vicArazakti vadhe che ane nirNayazakti sateja thAya che. lAMbA samayanAM tanAvathI keTalIka vartaNUka saMbaMdhI samasyAo tathA svAthya saMbaMdhI samasyAo AvI zake che. tanAva utpanna karatI paristhiti pratyeka vyakti anusAra alaga-alaga hoya che, jema ke pArivArika ane aMgata samasyAo, vyavasAya ane kArakirdI saMbaMdhI samasyAo athavA sAmAjika samasyAo. tanAvanAM upAyamAM tene utpana karatI paristhitino svasthatAthI sAmano karavo, paristhitithI dUra javuM athavA kaMI paNa na karavuM. A badhA vikalpomAMthI yogya vikalpanI pasaMdagI karavAnI rahe niyamita dhyAna, prArthanA, prANAyAma, vyAyAma ane bAyophIDabekanI madadathI paNa tanAva para kAbU meLavI zakAya

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258 magaja ane jJAnataMtunA rogo sAtvika-pauSTika AhAra ane phaLaphaLAdi niyamita levAM joIe. jIvanazailI sudhAravAthI ane potAno abhigama hakArAtmaka karavAthI sTresa avazya ghaTaze ane paristhitino sAmano karavAnI kSamatA vadhaze.

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(23)( magajanI zastrakriyA - nyurosarjarI) atyAra sudhInA tamAma prakaraNo parathI e samajAI gayuM haze ke magaja ane cetAtaMtra e ati agatyanuM ane ati nAjuka taMtra che ane tenI kAryapaddhati taddana alaga ane viziSTa che. tenA je je bhAgane kSati pahoMce te mujaba judA judA lakSaNo-cihnasamUho uddabhave che, jenA nidAna mATe meDikala tapAsa tathA ema.Ara.AI., sI.TI. skena, i.ema.jI., lohInI tapAsa, kamaranA pANInI tapAsa ema alaga-alaga TesTa karAvavA paDe che, je mATe nyuraoNphijhiziyananI (ke anubhavI phijhiziyananI) madada laI zakAya. A tabIbo A dardInI sAravAra davA-upacArathI mahadaMze karatA hoya che. jyAre amuka saMjogomAM davA-upacAra vaDe rogano niveDo na Ave to athavA khAsa to magajamAM ke karoDarajajumAM gAMTha hoya, karoDarajju para dabANa hoya, lohInI naLImAM rukAvaTa hoya athavA paDavA-vAgavA-akasmAtathI magaja ke karoDarajjune koI IjA thaI hoya to sarjarI-vADhakApanI jarUriyAta UbhI thAya che ane tyAre nyurosarjananuM kAma paDe che. Ama cetAtaMtranI zastrakriyAmAM magaja, khoparI, maNakA, karoDarajju, jJAnataMtuo tathA magajamAM lohI pahoMcADatI naLIonI sarjarIno samAveza thAya che. - A badhAM aMgo, agAu jaNAvyA mujaba atinAjuka hoI, kudarate khuba surakSita rIte rAkhelAM che, tethI tenI zastrakriyAmAM paNa nipuNatA, sAvacetI tathA sAvadhAnI khUba agatyanAM che. eka vAra A aMgone nukasAna thAya to sAmAnya rIte te bharapAI thatuM hotuM nathI. keTalAka rogomAM mAtra davAo dvArA ja sAravAranI khAsa agatya hotI nathI kema ke amuka prakAranA breIna Tyumara ke jemAM oparezana karyuM ja chUTako, jyAre keTalAka rogomAM meDikala ane sarjikala sAravAra, sAthe sAthe, athavA kramazaH Ayojita karavI paDe che.

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260 sarjarInI jarUra paDe tevA keTalAka rogo nIce pramANe che : : (1) magajanI ke karoDarajjunI IjA (akasmAtathI ke anya rIte) khoparI ke maNakAnuM phrekcara eksTrADyurala ke sabarala hImeTomA (magajanAM AvaraNomAM lohI jAmavuM) magajane ke karoDarajjune ghasarako thavo ke ujharaDo thavo. (contusion) nAkamAMthI magajanAM pANIno srAva thavo. (CSF rhinorhoea) magaja ane jJAnataMtunA rogo magajanI IjAthI thato ekasTrA DyUrala raktasrAva (2) magajamAM cepa phelAvo parunI gAMTha (abscess) TI.bI.nI moTI gAMTha (TyubarakyulomA) magajanA pANInI kothaLI phUlI javI (hAIDrosIphelasa) (3) magaja ke karoDarajjumAM gAMTha thavI sAdI gAMTho jema ke maeNninjiomA, nyuraoNphAIbromA, epIDaramoiDa ke DaramoiDa-rasoLI (Cyst), piTyuTarI graMthinI gAMTha kaeNnsaranI gAMTha jema ke glAyomA, meTAsTesisa

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magajanI zastrakriyA-nyuraoNsarjarI (4) lohInI naLImAM khAmI ke vikRti naLI para phuggo thavo (enyurijhama) - --- - (5) janmajAta khoDa naLImAM gUMcaLuM thavuM (e-vI, mAlaphaoNrmezana) kaeNroTiDa naLImAM carabI-kSAra jAmavAthI rasto avaruddha thavo (sTinosisa) breina haeNmarejanA amuka dardIo - khoparInI vikRti dA.ta. krenIosTInosisa hAIDrosIphelasa 261 (6) cetAtaMtranA ghasArAnA rogo magajanI janmajAta gAMTho maNakAnI janmajAta khoDa hovAne lIdhe karoDarajju khullI rahevI (maeNningomAyalosIla) krenIovarTibrala enomalI garadana ke kamaranA maNakAnI gAdI ghasAvI - khasI javI (Diska prolepsa) sarvAIvala sponDilosIsa laMbara kenAla sTinosisa (kamaranA maNakAmAM jagyAnI saMkaDAza) (7) nasa-cetA dabANamAM AvI javI, jema ke kArpala Tanala sinDroma athavA nasa kapAI gaI hoya to narva ripara ke narva TrAnslAnTanI sarjarI (8) pArkinsonijhama (kaMpavAta), kheMca vagere mATe phaMkzanala nyuraoNsarjarI (A sivAya anya rogomAM paNa sarjarInI jarUra paDI zake). sAmAnya mAhitI : e kahevuM taddana yathArtha che ke AvI koI paNa sarjarI karAvatAM pahelAM cokasAIbharyuM nidAna anivArya che, ane te sarjarIthI keTalo phAyado thaze

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262 magaja ane jJAnataMtunA rogo teno kyAsa kADhI dardI tathA tenA sagAMne yogya rIte mAhitagAra karavAM je te nyurosarjananI pharaja che tathA sarjarInAM jo koI bhayasthAno hoya to tenI paNa mAhitI ApavI joIe. Ama to ApaNI prathA-paddhati pramANe dardanuM nidAna ane oparezananI jarUriyAtano nirNaya nyurophijhiziyana DaoNkTaranA hAthamAM hoya che paraMtu e jarUrI che ke oNparezana pahelAM pratyeka kesamAM nyuraoNphijhiziyana ane nyurosarjane sAthe besIne carcA karavI joIe ane jayAM zaMkA lAge tyAM vadhu tapAsa karAvI, nidAna ane sarjarInI AvazyakatA aMge pUrNa saMtoSa thayA pachI ja oNparezana karavuM joIe. oparezananI paddhatio aneka jAtanI che. eNnesthesiyAmAM khUba vikAsa thayo hovAthI, have ema kahI zakAya ke ghaNA lAMbA cAlatA ane jaTila kesomAM paNa oNparezanane lIdhe thatuM jiMdagInuM jokhama nahivata thaI gayuM che. tema chatAM bIjI sarjarInA pramANamAM magajanI sarjarI thoDI vadhu jokhamI to che ja che, tevuM kahevuM ayogya nathI. magajanI sarjarIo Azare 2 thI 4 kalAka cAle che paNa kyAreka 16thI 20 kalAka ke vadhu paNa cAlatI hoya che. sAmAnya rIte sArA phijhiziyana pAse oNparezana mATe phiTanesa nakkI karAvyA bAda, enesthesiyAnA DaoNkTara dardIne tapAsIne dardI eNnesthesiyAne lAyaka che ke nahi tenI khAtarI kare che paraMtu mRtyuno khataro toLAto hoya ane samaya ocho hoya tyAre badhuM bAjue mUkI nyurosarjana DaoNkTaro jokhama vahorIne paNa mAnavatAne khAtara imarajansI oparezana karatA hoya che dA.ta., mArga akasmAtamAM magajamAM hemareja thavuM. magajanA kayA bhAgamAM ane emAM keTaluM UMDuM ane keTalA vistAramAM oparezana karavuM paDaze eno triparimANIya rekhAcitra-skeca banAvIne tathA najIkanI koI raktanaLIne nukasAna na thAya enuM dhyAna rAkhavAnuM hoya che. A badhAM ja pAsAMonuM Ayojana pahelethI ja karAtuM hoya che, jema ke : (1) magajanI bahAranAM AvaraNo sudhI ja javAnuM hoya to tene Burn-hole (bara hola) kahe che jemAM khoparImAM kANuM pADavAmAM Ave che. sabaDyurala hImeTomAmAM Ama karavAmAM Ave che.

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magajanI zastrakriyA-nyuraoNsarjarI 263 (2) khoparIno bhAga kApIne kholavAnAM oNparezano krenIoTaoNmI ane krenIekTamI hoya che. tenA dvArA magaja sudhI sIdhA pahoMcI javAya che. (3) karoDano maNako aDadho kholI nAMkhavAmAM Ave tene haeNmIlemInekTamI kahevAya, Akho kholI nAMkhavAmAM Ave tene lemInekTamI kahevAya (4) karor3enA maNakAmAM kANuM pADI nAnImoTI sarjarI karI zakAya che. magaja ane karoDarajju jeTalAM nAjuka ane saMvedanazIla che teTalAM ja surakSita che te agAu kahyuM che. tene lIdhe tyAM pahoMcavAnAM sAdhano paNa judI rIte vikasAvavAM paDe che. susajja oNparezana thiyeTarathI mAMDIne yogya oNparezana Tebala, suyojita prakAza-vyavasthA A badhAMnI ja jarUra paDe che. ghaNAM oNparezano mAikroskopanI madadathI vadhu sArI rIte pAra paDe che. kANuM pADavAnI jhaDapI Drila, sArA riTrekTara ane yogya kaoNTarI (lohI baMdha karavA) jarUrI hoya che. keTalIka gAMTho pigALavA jhaDapI alTrAsonika sisTama vaparAya che. oNparezana daramyAna paNa alTrAsAunDathI maoNniTariMga karavAthI magajanA UMDANamAM AvelI kharAbI tathA tenI cokkasa jagyAno khyAla Ave che. sTIrIoTeksIkanAM sAdhano magaja tathA karoDarajjumAM UMDe AvelI gAMThonI bAyaoNpsI karavA temaja tene dUra karavA vAparavAmAM Ave che. navI zodhakhoLa mujaba pArkinsonijhama, epilepsI jevA rogomAM A sTIrIoTeksIka paddhatie to kamAla karI nAkhI che. magajane AkheAkhuM kholyA vagara, khoparImAM eka nAnuM kANuM (Burr-hole) karIne tenA dvArA dvArA magajanA cheka UMDANamAM soya ane ilekTraoNDanI madadathI ati jaTila evA rogonI sAravAra thaI zake che. epilepsI mATe mAikrosarjarI dvArA saMtoSakAraka pariNAmo maLe che, khAsa karIne Temporala loba epilepsImAM. A rIte sTIrIoTeksIka sarjarI epilepsImAM paNa kAma lAge che. vegala sTimyulezana paNa eka AvI ja nAnI praoNsijara che jemAM mAikroilekTraoNDa ane sTimyuleTara dvArA magajamAM

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magaja ane jJAnataMtunA rogo udbhavatA vidyutakIya AMcakAone kampyuTarAijhDa paddhatithI rokI zakAya che. te uparAMta jarUra paDe lobekaTamI, kamIsaroTaoNmI tathA korpasakelojhoTaoNmI jevI moTI sarjarI karI zakAya ane eka cetAsamUhathI bIjA cetAsamUha sudhI prasaratA taraMgone aTakAvavA karAtI TrAnjhekzana sarjarI jevI anekavidha prakAranI sarjarI karavAmAM Ave che. 264 lesara : eno vyApa have dhImedhIme vadhato jaze tema lAge che. je aMgone chedI na zakAya tene bALI nAkhI zakAya tevo A rasto che. proTonabIma paNa AvI paddhati che jenAthI lohInAM gUMcaLAM (A-V Malformations) bALI zakAya. reDiophrikvansI lIjhana janareTara : TrAijeminala nyuraoNlphiA tathA evAM bIjA pIDAkArI rogomAM tema ja pArkinsonijhama prakAranA mUvamenTa DioNrDarsamAM A paddhita asarakAraka puravAra thaI che jemAM nAma mujaba reDiophrikvansI karanTathI koI cetAnI kAmagIrI sthagita karI daI athavA bALI daI rogamAM rAhata meLavavAmAM Ave che. gAmA-nAipha ane lInIara eksalareTara : oNparezana vagara gAMTha athavA bIjA evA rogone nAthavAnI A paddhati jhaDapathI prasarI rahI che. te ghaNI kharcALa hoI, bhAratamAM bahu ochI jagyAe upalabdha che. paNa tenAthI oNparezananAM jokhamathI ghaNe aMze bacI javAya che. paNa temAM niSphaLatAno AMka paNa hoya che. maeNninjiomA ane zvAnomA vagere prakAranI sAdI gAMThomAM A ilAja khUba pracalita che. teno kharca Azare 1thI 2 lAkha rUpiyA Ave. enDoskopika nyuraoNsarjarI H A paNa eka jAtanI minimama invejhiva sarjarI che. arthAt, AmAM magajane AkhuM kholyA vagara UMDANamAM AvelA rogo khAsa karIne gAMTha kADhavAmAM Ave che. tema ja lohInI naLInA enyurijhama(phuggA)ne nAthavAmAM Ave che. tenAthI oNparezananuM jokhama ghaNuM ochuM thaI jAya che. paNa khUba nAnI jagyAmAMthI dUrabIna dvArA oNparezana karavAnuM hovAthI te mATe khUba anubhava jarUrI bane che. tharDa ke phaoNrtha venTrikala

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265 magajanI zastrakriyA-nyuraoNsarjarI Tyumara, enyurijhama vageremAM Ano vyApa sAro che. A sarjarIne hArTanI 'bITiMga hArTa sarjarI' sAthe sarakhAvI zakAya. te ja rIte oNpareTiMga mAikroskopanI madadathI sarjarI karavAthI, ati jhINavaTathI kuzaLatApUrvaka phakta rogISTa bhAga ja dUra karavAmAM Ave che. bIjA bhAgone nukasAna thatuM AnAthI aTake che. A sarjarI lAMbI cAle che. dhIraja ane kuzaLatA temAM khAsa jarUrI rahe che dA.ta. epilepsI mATenI Temporala lobanI sarjarI. have to enesthesiyA dvArA bebhAna karyA vagara 'aveka krenIoTaoNmI' dvArA jAgatA-bhAnamAM hoya tevA dardIonAM oNparezano paNa karavAmAM ApaNAM nyUraoNsarjanoe paTutA keLavI che. jyAre roga khUba phelAI gayo hoya, kAbU bahAra prasaryo hoya tyAre, DahApaNa vAparI sarjano thoDo-ghaNo bhAga kADhI laI madada karyAno saMtoSa le che. gAMThano badho bhAga kApavo zakya na hoya athavA tema ka2vAthI oNparezana Tebala 52 ke tarata thoDAka vakhatamAM mRtyuno Dara hoya athavA to oNparezanathI zarIranAM aMgono moTo bhAga nirjIva thavAno Dara hoya tyAre vyAvahArika abhigama apanAvIne thoDo bhAga kApI mRtyumAMthI bacAvIne dardIne thoDIka rAhata ApavAno hetu hoya che. Ane pelieTiva sarjarI kahe che. Ama nyuraoNsarjarInA 3 prakAra che : (1) risekTiva sarjarI : jemAM zakya teTalo bagADa vADhakApathI kADhI nAkhavAmAM Ave che. (2) paeNlieTiva sarjarI H jemAM upara mujaba thoDoka bhAga dUra karavAmAM Ave che. (3) phaMkzanala nyuraoNsarjarI H jemAM kApakUpa khAsa nathI paraMtu magajano je bhAga kAryarata nathI tene koI navatara rIte kAryAnvita karavAmAM Ave che. temAM jarUra paDye navA korSAnuM ropaNa (Grafting) karavAthI mAMDIne magajamAM sTimyuleTara mUkavAmAM Ave che athavA to rasAyaNa ke davAno upayoga karavAmAM Ave che. agara to nAnA-nAnA cheda karI navA rastA banAvI zakAya che.

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magaja ane jJAnataMtunA rogo e jaNAvatAM AnaMda thAya che ke AmAMnI badhI ja sarjarI have bhArata dezamAM thAya che ane AmAMnI lagabhaga 90% sarjarI amadAvAdamAM paNa thAya che. muMbAI, dilhI jevAM mahAnagaromAM badhI ja jAtanI sarjarI upalabdha che ane uttama zikSaNa pAmelA tathA vikhyAta sarjano jeonuM vizvastare paNa nAma che tevA nyuraoNsarjanonI sevA bhArata dezane upalabdha che, e ApaNA dezanuM gaurava che. 266 moTA bhAganAM oNparezanonuM jokhama uttama senTaromAM phakta 2thI 4 TakA jeTaluM hoya che. paraMtu dardI jo vayaska hoya, sAthe DAyAbiTIsa ke hRdayaroga ke blaDaprezara hoya athavA imarajansImAM oNparezana karavuM paDyuM hoya to jokhama 10 thI 20 TakA jeTaluM paNa pahoMce che. jo sarjana ane enestheTisTane jokhama vadhAre lAge to zastrakriyA karatAM sAmAnya rIte meDikala TriTamenTane bharose ja dardIne rAkhavo joIe tevo mata paDe che. chatAMya dardInAM sagAMonI icchA cAnsa levAnI hoya to sarjana temAM paNa sahakAra ApI zake, jema ke moTo breina eNTeka hoya ane magajamAM haeNmareja sAthe puSkaLa sojo hoya, mRtyunI saMbhAvanA ativizeSa hoya to khoparI kholI nAkhI, magajane bahAranI bAju UpasavAnI taka ApavAmAM Ave athavA haeNmarejane kheMcI levAnI koziza karavAmAM Ave che. A rIte pathI 25 TakAne jIvana maLe tevuM vyavahArika anumAna karI zakAya. oNparezana sArI rIte patyuM hoya tevA kesamAM je te oNparezananA pramANamAM dardIne ghare javAnI rajA apAya che. moTe bhAge 6thI 9mA divase dardI ghera jaI zake. jokhamI oNparezanamAM sAmAnya rIte rajA ApavAmAM vAra lAge, ghera gayA pachI dardI jhaDapathI cAlato thAya, kAryarata thAya te upara vizeSa dhyAna ApavAmAM Ave che. phijhiyothaeNrapI to haoNspiTalamAM ja zarU karI devAmAM Ave che ane pachI ghera paNa jyAM sudhI dardI taddana sAjo na thAya tyAM sudhI cAlu rAkhavAmAM Ave che. oNparezana pachInI meDikala davAonI sA2vA2mAM nyuraoNphijhiziyananI pharI jarUra paDatI hoya che, paNa dareka kissAmAM tema hovuM jarUrI nathI.

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magajanI zastrakriyA-nyurosarjarI 267 sarjarIthI keTalAka rogo sAva maTI jAya che, keTalAkamAM rAhata maLe che, keTalAkamAM oNparezana pachI paNa davAo thoDA samaya ke lAMbo samaya cAlu rAkhavI paDatI hoya che. oNparezana pahelAM jema nidAna mATe sI.TI. skena, ema.Ara.AI. nI jarUra hoya che tema oNparezananuM pariNAma keTaluM AvyuM che te jANavA amuka kesomAM (khAsa karIne gAMThanA kesomAM), oparezana pachI sI.TI. skena ke ema.Ara.AI.nI jarUra paDe che. A badhI prakriyAmAM dardI tathA tenAM sagAM mUMjhAtAM jovA maLe che. Arthika-sAmAjika prazno temane parezAna karatA hoya che. sAcI vAta to e che ke oNparezana pahelAM ane pachI DaoNkTaro sAthe khullA dile carcA karI levI joIe ane DaoNkTaroe paNa spaSTa citra pahelethI rajU karavuM joIe ane ekamekanA vizvAsa, prema ane sahakArathI A kaThina mizana pUruM pADavuM joIe. Ama nyurosarjarI e mAtra nyurosarjananuM ja kSetra che tevuM nathI. temAM nyurophijhiziyana, nyurosarjana, phijhiyotherapisTa, okyupezanala therapisTa, phijhiziyananuM TImavarka hovuM joIe. to ja dardInI saMpUrNa ane yathArtha sAravAra thAya. nyurosarjarIno kharca alaga alaga kesamAM alaga alaga Ave e samajI zakAya tevI vAta che. temAM rogano prakAra, roganI gaMbhIratA, imarajansI sarjarInI AvazyakatA, sarjanano anubhava, sarjarInuM zahera-sthaLa, haoNspiTalanI susajjatA ane enesthesiyAnuM jokhama (jema ke vayaska loko tema ja hRdayaroga-DAyAbiTIsavALA dardIne jokhama vadhu hoya che, ema aneka jAtanAM paribaLo para kharcano AdhAra rahe che. paradezamAM to moTe bhAge kharca Inzyoransa ejansI para hoI, dardI ke DaoNkTarane A prazno para samaya ke zakti veDaphavAM paDatAM nathI. AzA rAkhIe ke ApaNo samAja paNa e rIte jAgRta thAya.

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268 magaja ane jJAnataMtunA rogo ATaluM jarUra jANo mArga akasmAta athavA anya koI rIte magaja athavA karoDarajjune IjA thAya to tAtkAlika nyuraoNsarjikala sAravAranI jarUra paDe che. AjakAla magajanI gAMThathI laIne cetA sudhInI nyuraoNsarjarI atyAdhunika prakriyAthI karavAmAM Ave che ane tenAM khUba sArAM pariNAma jovA maLe che. bIjAM oparezana karatAM magaja-karoDarajjunAM oparezano vadhAre aTapaTAMne kaMIka vadhAre jokhamI kahI zakAya paraMtu have tabIbI vijJAnanA vadhatA vikAsa ane suvidhAo tathA sUkSma oparezano karavAnI paNa sagavaDo thaI hovAthI saphaLatAno AMka vadhyo che ane hajI paNa vadhato javAno te vAta nizcita che. dardI jeTalo samayasara phijhiziyana ke nyuraoNlojisTa pAse pahoMce teTalo phAyado vadhAre thAya kAraNa ke magajanA rogomAM vilaMba karavo, e khUba jokhamI puravAra thaI zake.

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(24) lAMbA samaya sudhI vAparavI paDe tevI nyurolojInI davAo vize samajaNa), agAunAM prakaraNomAM Ape joyuM haze tema, nyurolaoNjInA keTalAka rogo haThIlA che ane temAM sAravAra ghaNI vAra lAMbA samaya sudhI eTale ke 6-12 mahinA ke amuka rogomAM jIvanaparyata paNa levI paDe che. A davAonI sArI asaro paNa hoya che ane kvacit ADaasaro paNa hoya che. AvI davAo viSe yogya samaja hoya to keTalIka muzkelIo ane mUMjhavaNo samayasara nivArI zakAya. A prakaraNano hetu AvI davAonI asara ane ADaasaranI sAcI samajaNa ApavAno che. atre e spaSTatA karavAnI ke sAravAra ApanAra DaoNkTaranI salAha vagara koI paNa davA jAte levI ati jokhamakAraka che ane tamAma davAo DaoNkTaranI dekharekha heThaLa ja levI. * sTiroIDa davAo (steroids) sTiroIDa davAo nyurolaoNjImAM keTalAka agatyanA athavA haThIlA, gaMbhIra rogomAM vAparavAmAM Ave che. A davAo "bedhArI talavAra' jevI che. eTale ke yogya rIte, yogya mAtrAmAM, yogya samaya sudhI vAparavAthI sAruM pariNAma Ape che, te jiMdagI bacAve ane rogamAMthI saMpUrNapaNe bahAra kADhI zake, je kAma bIjI koI davA ATalI sArI rIte na paNa karI zake. paraMtu ayogya rIte, ADedhaDa athavA DaoNkTaranI dekharekha vagara lAMbA samaya sudhI levAmAM Ave to sTiroIDa davA gaMbhIra muzkelIo paNa sarjI zake che. duHkhada vAta e che ke avAranavAra tenA sAcA upayoga karatAM teno khoTo ane binajarUrI upayoga (durupayoga, Abuse) vadhu thayo che, thato jovAmAM Ave che. sTiroIDa kharekhara to zarIranI eDrinala graMthimAM viTAmina sImAMthI pedA thatA kudaratI aMtasrAvanI zreNInI ja pedAza che, jema ke korTikosTero , minaralo korTikosTeroisa. zarIranI graMthio, aMgo ane sisTamsa

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270 .. magaja ane jJAnataMtunA rogo (vividha taMtro)nA kudaratI niyaMtraNamAM tathA mukhya kAryo jALavavAmAM, rogapratikAraka zakti TakAvavAmAM ane sTresa sAme zarIrane sakSama rAkhavAmAM sTiraoNiDano rola mukhya kalAkArano che. samajI zakAya che ke sTiraoNiDanI UNapathI thatA gaMbhIra rogomAM bahArathI sintheTika taiyAra karelA sTiraoNiDa ApavA paDe. blaDaprezara ghaTI jaI zaoNka thavAthI mAMDIne mAyestheniA krAisisa sudhI ke viziSTa AdhAzIzI (klasTara heDaeNka)thI mAMDIne magajanA sojA (breina iDimA) sudhI tema ja aneka judI judI paristhitimAM nyuraoNlaoNjimAM sTiraoNiDa jarUra mujaba vAparIne dhAryuM pariNAma meLavI zakAya. keTalIka nyuraoNpathI, DimAilineTiMga rogo (malTipala haeNrosisa), breina Tyumara, paoNlimAyosAiTisa, keTalAka TI.bI., maeNninjAiTisanA keso - ema bIjAM aneka rogomAM sTiraoNiDa davAnI jarUra paDe che. sTiraoNiDsa jUthamAM prenisolona, DeksAmithAsona, mithAila prenisolona e mukhya che. keTalAka goLInA svarUpe, keTalAMka IMjekzana svarUpe to keTalAka pravAhI svarUpamAM Ave che. A sTiraoNiDsa davAono aniyaMtrita upayoga keTalAMka gaMbhIra pariNAmo paNa lAvI zake che. lAMbA samaya sudhI levAtI sTiroIDa davAonI ADaasaro : 1. eNsiDiTI (peTa tathA chAtImAM lAhya baLavI) thAya ane jaTharamAM cAMdI paDe athavA vakare. 2. lohImAM sAkara (zugara)nuM pramANa vadhe, DAyAbiTIsa thAya - vadhe. 3. blaDaprezaramAM vadhAro. 4. phaMgasa (phUga)no cepa jaladIthI lAgI jAya ane pariNAme kenDiDiAsisa ane riMgavarma inphekzana jevA rogo thaI zake. 5. 6. atizaya bhUkha lAge, UMgha AvavAmAM takalIpha thAya ane svabhAva cIDiyo thaI jAya. zarIra phUlI jAya, vajana atizaya vadhI jAya ane cahero, peTa tema ja garadananI pAchaLanA bhAgamAM carabI jamA thAya.

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lAMbA samaya sudhI vAparavI paDe tevI nyuraoNlaoNjInI davAo vize samajaNa 271 7. kamaranA ane jAMghanA bhAgamAM snAyuonI nabaLAI AvavAthI jamIna parathI UbhA thavAmAM takalIpha paDe. 8. hADakAM pocAM paDavAthI maNakA ane kamarano dukhAvo thAya. 9. thApAnuM hADakuM nabaLuM paDavAthI tyAM dukhAvo thAya che ane kyAreka tenA agra bhAgamAM phrekTara thavAthI sarjarI paNa Avazyaka bane che. 10. TI.bI., harpisa jevA cepa sahelAIthI lAgI zake che. 11. pezAbamAM paru thaI zake. 12. svAdupiMDamAM sojo AvI zake. 13. lohImAM poTeziyamanuM tattva ghaTI jAya. 14. sTiroiDa acAnaka baMdha karavAthI bI.pI. bhayajanaka rIte ghaTI jAya. A kAraNosara sTiroiDa vadhAre mAtrAmAM phakta thoDAM aThavADiyAM ja ApavAmAM Ave che, chatAM amuka rogomAM thoDIka ja mAtrAmAM ApavAthI paNa phAyado thato hoya che. amuka rogomAM lAMbo samaya sTiroiDa davA levI paDe che. A mATe niyamita DaoNkTarI salAha atyaMta jarUrI che ane dekharekha tathA niyamita leboreTarI tapAsa paNa jarUrI bane che. AvA saMjogomAM lAMbA gALAnA sTiroiDa korsamAM niSNAta DaoNkTaro sTiraoNiDanI ADaasara aTakAvavA, sAthe sAthe niyamita rIte kelziyama, poTeziyama, esIDITInI davA, viTAminsa tathA sojA aTakAvavA mATe DAiyureTika davAo cokkasa mAtrAmAM ApatA hoya che. dardIne cepa na lAge (khAsa karIne, TIbIno) te mATe yogya salAhasUcano apAtAM hoya che. khorAka mATe yogya mArgadarzana apAtuM hoya che. vakhatovakhata DAyAbiTIsanI tapAsa, kelziyama, lohImAM poTeziyamanuM pramANa, blaDaprezaranI tapAsa A badhuM paNa niSNAta DaoNkTaro karatA hoya che ane temAM dardIe sahakAra Apavo jarUrI bane che. A sivAya bIjI keTalIka davAo nyuraoNlaoNjInA kesomAM lAMbA samaya sudhI vAparavAmAM Ave che, jema ke epilepsI (kheMca) mATe vaparAtI davAo, mAthAnA dukhAvA mATenI davAo, pArkinsonijhama mATenI davAo vagere. temAMnI keTalIka davAo vize TUMkamAM joIzuM. On

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272 magaja ane jJAnataMtunA rogo (a) epilepsI (phiTa(vAI) : (1) DAIphinAIla hAIDenTAIna (Diphenyl Hydantoin) : A davAthI javalle ja atizaya gaMbhIra prakAranI elarjI UbhI thAya che, jene sTIvansa-jahonsana sinDroma kahe che. AmAM cAmaDImAM cAThAMthI zarUAta thaI tAva Ave che. jiMdagInuM jokhama UbhuM thAya che. A sivAya A davAnI pracalita ADaasaromAM peDhAM phUlI javAM, caherAnI suMdaratA-komaLatA ochI thavI, binajarUrI vALa UgavA, kvacit yAdadAsta ghaTavI, gaLAmAM gAMTho thavI, nAnA magajanI kAryazIlatAne asara thavI, ke evI jJAnataMtuonI sAmAnya takalIpho thatI jovAmAM Ave che. jo Dojha vadhu paDato hoya to dardIne Dabala dekhAya, lathaDiyAM AvavAM zarU thAya. tethI A davAnuM blaDamAM keTaluM pramANa che te vakhatovakhata jovuM joIe, jene blaDa phinAITIIna levala kahe che. A TesTa mATe lohIno namUno cokkasa samaye levo joIe (davA levAnAM pahelA) nahIMtara teno artha nathI. sagarbhA strIone bIjI davA para pheravavAmAM Ave che, kema ke A davAthI phavacit (0.7 TakA) bALako khoDavALAM pedA thAya che. (2) kArlAmejhepinaH (Carbamazepin) - A davA paNa upara mujaba, chatAM javalle ja jovA maLatI sTivansa-jahonsana nAmanI jiMdagIne jokhama kare tevI cAmaDI ane myuksa membenanI gaMbhIra elarjI karI zake che. te uparAMta zvetakaNo khAsa karIne nyuTrophilsa ghaTI zake, jethI gaLAmAM tathA jIbha para chAlAM paDe ane cepa lAgI zake. tethI A davA lenAranA lohInA vividha kaNo niyamita 3-4 mahine tapAsatA rahevA joIe. A davA sagarbhAvasthAmAM pramANamAM nirdoSa che. bALakane koI ADaasara thatI hoya tevA ahevAlo nathI.

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273. lAMbA samaya sudhI vAparavI paDe tevI nyuraoNlaoNjInI davAo vize samajaNa (3) vAtroIka eNsiDa : (Valeroic Acid) A davA ghaNA prakAranI epilepsImAM vAparavAmAM Ave che. tenAthI vajana vadhe, vALa khare te sAmAnya che paraMtu te kvacit yakRta(livara)ne nukasAna kare che tethI A davA cAlu hoya tyAre niyamita 3thI 4 mahine esa.jI.pI.TI. nAmanI lohInI tapAsa karAvatA rahevuM joIe, joke A salAhamAM keTalIka gUMcavaNo paNa che, jema ke aThavADiyA pahelAM esa.jI.pI.TI. naoNrmala hoya ane pachI acAnaka livara bagaDavA mAMDe tevuM banI zake, tema lAge to pharIthI TesTa karAvI davA baMdha karavI paDe. garbhavatI strIne A davA ApavAthI bALakanI karoDarajju vageremAM takalIpha UbhI thavAnA ahevAlo che, jo ke tenuM pramANa 1000mAMthI Azare 10 bALaka jeTaluM ja che. A mAhitI garbhAvasthA daramiyAna niyamita rIte sonogrAphI dvArA ane AlphA-phiToproTIna nAmanA lohInA TesTa dvArA ke egniosenTesisa dvArA maLe che. temAM garabaDa hoya to pregnansI aTakAvavI paDe mATe zakya hoya tyAM sudhI garbhAvasthAmAM A davA na ApavI joIe. (4) phinobArbITona: (Phenobarbitone) A davA bahu jUnI ane asarakAraka che paraMtu nAnAM bALakone te vadhu samaya ApavAthI te jiddI ane tophAnI thaI zake. kyAreka A davAthI yAdadAsta paNa bagaDe che tema manAya che, ghena caDhe te paNa tenI ADaasara che tethI A davA AjakAla ochI vaparAya che. have tenA badale have teno pheraphAra karI ITarobArmiTona davA yuropamAM vaparAya che jenAthI ADaasaro ochI thaI jAya che. (ba) pArkinsonijhamanI davAonI ADaasaro : A haThIlA roganI davA paNa moTe bhAge jiMdagIbhara levI paDe che tethI tenI ADaasarono vicAra karavo jarUrI bane che.

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274 magaja ane jJAnataMtunA rogo (1) TI.eca.pI.eca. (pesiTena) - TH.P.H. (Pacitane) : - A davA 65 varSathI vadhu uMmaranI vyaktine ApavAmAM jokhama vadhe che. pezAbano aTakAva thAya, mUMjhavaNa (confusion) thAya ane yAdadAsta bagaDe te eka khUba sAmAnya eTale ke jANItI ADaasara che. tethI A davA mahadaMze 40thI 60 varSanI vyakti ane jene prosTeTanI takalIpha nathI tevA dardIne ja ApavI joIe. (2) livoDopA - (Levodopa) : sinemeTa, TAIDomeTa ane sinaDopA vagere nAmathI pracalita evI A davA pArkinsonijhama roganI AdhArastaMbha davA che paNa te hRdayaroganA dardI mATe vAparavAmAM khUba sAvacetI rAkhavI paDe. dardI ekadama Ubho thavA jAya to tenuM bI.pI. ghaTI jAya ane dardI paDI jAya tevuM ghaNI vAra bane che jene poscarala hAIpoTenzana kahe che. kvacit jAtIya vRtti vadhI jAya tevuM bane che. lAMbA samayanA upayogathI hAthapaganI vicitra hilacAla zarU thAya che jene DiskAInesiyA, DisToniyA tathA koriA kahe che. Ama thAya to A mukhya davA judA rUpamAM ApavI paDe, badalavI paDe athavA nA chUTake zastrakriyAno Azaro levo paDe. (3) emenTiDina (Amantidin) mULabhUta rIte phalUnA rogamAM vaparAtI A davA Akasmika rIte ja pArkinsonijhamamAM asarakAraka che tema 1934mAM zodhAyuM ane te pachI te kharekhara ghaNI asarakAraka che tema pharIpharIne puravAra thayuM che. paraMtu, tenAthI paNa pagamAM cAmaDIno roga (liviDo reTikyulArisa), hRdayanI takalIpha, page sojA, mAnasika mUMjhavaNa ane Diprezana vagere ADaasaro thAya che. tethI A davA vacce vacce baMdha karavAmAM Ave che.

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lAMbA samaya sudhI vAparavI paDe tevI nyuraoNlaoNjInI davAo vize samajaNa (4) bromokripTina (Bromocriptine) : A eka upayogI davA che paraMtu tenA vadhAre DojhanA sevanathI UlaTI-UbakA ke lo bI.pI. vagere thAya che ane lAMbA samaye mUMjhavaNa, bhramaNA, page sojA ane lAlAza ema vicitra takalIpho thatI hoya che. navAM davAo jevI ke premipeksola (Pramipexole), ropinirola (Ropinirole), Tolakepona (Tolcapone) vagerenI ADaasara ochI che ane pramANamAM vadhu asarakAraka sAbita thaI che paraMtu lAMbA samayanI ADaasaro mATe bArIka nirIkSaNa karatA rahevuM paDaze, hajI ApaNe pratIkSA karavI paDe. anya davAo: 275 (ka) (1) lohI pAtaLuM karavAnI davAo : chUTathI vaparAzamAM AvatI AvI mukhya davAomAM espirina (aspirin) che jeno mukhya upayoga nyuraoNlaoNjisTa DaoNkTaro dardIne lakavo aTakAvavA, lohI pAtaLuM karavAmAM ghaNIvAra jiMdagIbhara vApare che ane te yogya rIte vAparavAmAM Ave to kharekhara sauthI vadhu asarakAraka che. paraMtu, tenAthI kyAreka sakhata eNlarjIthI mRtyu thayAnA kesa paNa noMdhAyA che. UlaTI-UbakA, eNsiDiTI e to khUba jANItI ADaasara che ane pepTika alsara (hojarImAM cAMduM) thaI lohInI UlaTI paNa thaI zake. A sivAya ADaasara A davAnA lAMbA upayoga daramiyAna zarIramAMthI lohI vahevuM tema ja bIjI ghaNI thatI hoI DaoNkTare bahu kALajI rAkhI jotAM rahevuM paDe. lakavo aTakAvavAnI AvI bIjI davA che TiklopiDina (Ticlopidine), tenAthI Azare 2thI 3 TakA kesamAM zvetakaNo ghaTI javAnI gaMbhIra samasyA thAya che. vizeSamAM eNlarjI, peTamAM garabaDa ane jhADA vagere thaI zake. A ja kAraNasara,

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276 magaja ane jJAnataMtunA rogo TIklopiDInanI jagA AjakAla klopIDojela nAmanI davAe laI lIdhI che. je dardIo Daasarane kAraNe espirIna nathI laI zakatA athavA espirIna uparAMta eka bIjI davAnI jarUra paDatI hoya to klopIDojelano upayoga karavAmAM Ave che. A sivAya khAsa saMjogomAM orala enTIkoegyulanTa (vorapherIna, esiTroma) davAo paNa lohI pAtaLuM pADavA khAsa saMjogomAM vAparavI paDe che. dardIno Prothrombin Time A davA ApatA pahelAM levAmAM Ave che. bAdamAM dara 2-3 divase Prothrombin Time (blaDa TesTa) laIne lohI yogya mAtrAmAM pAtaLuM thayuM che ke nahIM te cakAsavAmAM Ave che. lohI vadhAre mAtrAmAM pAtaLuM paDI javAthI Prothrombin Time jarUratathI vadhAre vadhI jAya ane kyArekakyAreka to gaMbhIra prakAranuM hemareja paNa thaI zake che. DaoNkTaranI sUcanA mujaba Prothrombin Time cakAsatA rahevuM paDe che. koIpaNa prakArano raktasrAva (bliDiMga) thAya to davA baMdha karavI paDe che. (2) siradarda-mAIgrenanI davAo : mAthAnA dukhAvA - mAigrena aTakAvavA tathA blaDaprezara vageremAM khUba vaparAtI bITAblokara davA progrenolola (Propranolol) (inDirAla, siplAra) damanI vyAdhivALA dardIne jo ApavAmAM Ave to damano humalo AvI zake che. kyAreka klaDaprezara vadhAre paDatuM ghaTI jAya, nADInA dhabakArA ghaTI jAya. vadhu mAtrAmAM lAMbo samaya levAthI puruSomAM kyAreka napuMsakatA AvI zake ane paganI ArTarIjhamAM lohInuM paribhramaNa ghaTI zake. A uparAMta anya asaro mATe paNa DaoNkTare satarka rahevAnuM hoya che. mAigrenamAM vaparAtI bIjI asarakAraka davA phalunArijhina (Elunarizine) che. tenA lAMbA vaparAzathI Diprezana, pArkinsonijhama thaI zake, vajana vadhe, vALa khare tathA strIomAM mAsika aniyamita thaI zake.

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lAMbA samaya sudhI vAparavI paDe tevI nyuraoNlaoNjInI davAo vize samajaNa (3) anTibAyoTika davAo : 277 xgajanA bhayaMkara cepI rogo jevA ke maeNninjAiTisa vageremAM yogya DojhamAM jarUra mujaba vAparavAthI jiMdagI bacAvavA A davAo anahada asarakAraka-upakAraka sAbita thaI che. paraMtu AjakAla evuM jovAmAM Ave che ke A davAo ADedhaDa ane ayogya-phrejha (mAtrA)mAM game tevA sAdA rogamAM paNa ghaNI vAra binajarUrI rIte vAparavAmAM Ave che. temAMnI keTalIka livara (yakRta) athavA kiDanI (mUtrapiMDa)ne nukasAna kare che, jemake emAInaoNglAIkaoNsAIDa davA. keTalIka davAthI koIne zravaNazakti bagaDe ane laDiyAM zarU thAya (sTrepTomAisina), kyAreka lohI pAtaLuM paDI jaI bliDiMga rArU thaI jAya (siphelosporina). penisilIna jUthanI keTalIka davAthI koIka dardIone injekzana lIdhA pachI miniTomAM ja bhayaMkara riekzana Ave ane tethI DaoNkTaranI sAme ja dardInuM mRtyu thaI zake che. penisilInanI goLI ke malamathI paNa AvuM eNlarjika riekzana AvI zake. tethI penisilIna ke tenA jevI davAo vAparatAM pahelAM dardIne pUchIne pokasAI karavI paDe ke tene bhUtakALamAM AvI eNlarjI thaI hatI ? tethI yogya jagyAe ja AvI eNnTibAyaoNTika vAparavI ane cAmaDI para TesTaDojha ApI aDadho kalAka sudhImAM rieNkzana to nathI AvatuM ne tevI rAha joyA pachI ja pUro Dojha Apavo. sadbhAgye AvA keso javalle ja bane che. vaLI, binajarUrI eNnTibAyaoNTika davAthI rejhisTansa Ave ane pachI bhAre davA ja vAparavI paDe. (4) kvinAIna (Quinine) : kvinAina jherI maleriyAnA upAya mATe vaparAya che. tenAthI kAnamAM sisoTI jevo avAja Avavo, dhAka paDavI, cakkara AvavAM, mUMjhavaNathI mAMDIne kheMca AvavI ke kiDanI kAma karatI baMdha thaI javI

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208 magaja ane jJAnataMtunA rogo rInala phelyora (blekavaoNTara phivara) jevAM bhayaMkara pariNAmo AvI zake che. joke sArA nasIbe AvI ghaTanA ati ochI bane che. G-6-PD Deficiency nAmano blaDaTesTa kvinAina ApatAM pahelAM * karavo e khUba ja hitAvaha che. aMtamAM pharI eka vAra dhyAna doruM chuM ke upara jaNAvela davAo tabIbIsalAha ane dekharekha sivAya kadApi levI nahi. uparyukta mAhitI phakta jANakArI mATe ja che.

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(5)(davAkhAnAmAM dAkhala karela dardI aMge jarUrI sUcano) dardIne nyurolaoNjikala athavA anya rogonI sAravAraarthe davAkhAnAmAM dAkhala karyA pachI tenI sArasaMbhALa mATe je kuTuMbIjana | svajana dardI sAthe rahe, temanI keTalIka pharajo hoya che. khAsa karIne, dardI behoza hoya, sthiti gaMbhIra hoya ke te atizaya nabaLAI dharAvato hoya tyAre temanI vizeSa kALajI levAnI jarUra paDe che. haoNspiTalamAM AvA dardInI nIce darzAvelI vividha sAravAra aMgenI jANakArI sAmAnya rIte dardInA kuTuMbIjanane paNa hovI joIe, jenA kAraNe sAravAramAM saraLatA rahe. oNksIjana TyUba, nasamAM pravAhI ApavuM, yurInarI ketheTara, nAka dvArA TyUbathI phiDIMga vagere narsiMga sTAphanuM kAma che. chatAM paNa sagAMsaMbaMdhIo A badhuM dhyAnamAM rAkhIne sahakAra ApI zake che. (1) oksijana - 0 dardIne jarUra hoya tyAre satata athavA AMtare kalAke oksijana apAto hoya che. te mATe nAkamAM bharAvela TyUba barAbara rahI che ke kema te jotAM rahevuM joIe. oNksijananA silinDaranI bAjumAM goThavelI baoNTalamAM jovA maLatA parapoTA darzAve che ke dardIne oNksijana maLI rahyo che. AthI A baoNTala tarapha vacce vacce najara rAkhavI joIe. te khalAsa thavA Ave e pahelAM vaoNrDanA sTAphane jANa karavI joIe. ghaNI jagyAe have jo ke senTrala lAIna dvArA oNksijana apAto hoya che jemAM A takedArInI jarUra paDatI nathI. (2) bATalA caDhAvavA : (V Fluid) dardIne jo bATalA caDhAvavAmAM AvyA hoya to dardInAM sagAMe nIcenI bAbatonuM khAsa dhyAna rAkhavuM

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280 magaja ane jJAnataMtunA rogo T sagAsaMbaMdhIe dardInI pAse besI dardI bATalAnI naLIvALo hAtha ke paga vadhu paDato halAve nahi tenuM dhyAna rAkhavuM. T bATalAmAMthI pravAhI davA dara miniTe amuka TIpAM Tapake tevI vyavasthA karelI hoya che. temAM jo khAmI jaNAya to tarata sisTarane bolAvavAM. pravAhI baMdha ke lIka thaI jAya, pravAhI TapakavAnI gati vadhI jAya ke ghaTI jAya athavA jyAM bATalo caDAvyo hoya tyAM sojo Ave ke cAmaDI lAla thAya athavA dardIne TADha caDe ke tAva Ave to paNa sisTaranuM dhyAna doravuM. (3) nAka dvArA pravAhI khorAka ApavAnI TyUba - (Ryle'sTube) (1) dardIne TyUba dvArA nAka vATe phIDiMga (pravAhI khorAka) ApavAnuM kArya sisTara(narsa) karatAM hoya che. kyAreka dardInAM sagAMe te kAma saMbhALavAnuM Ave to A prakriyA spaSTa rIte samajI levI joIe. (2) DaoNkTaranI sUcanA bAda phIDiMga (pravAhI khorAka) zarU karavAnuM hoya che. (3) A phIDiMga mATe cA, dUdha, kaoNphI, lIMbupANI, nALiyerapANI, ilekTrAla pAuDaranuM pANI, miksara vaDe ekarasa karela bhAta, khIcaDI, proTina pAuDara ke zakti-kelarI mATe taiyAra pekeTa jevAM ke rekyUpeksa, esyora ke gALIne taiyAra kareluM dALanuM pANI, vejiTebala sUpa ke phUTa jyusa - phUTa zeIka vagere pravAhI, tabIbanI salAha mujaba niyata mAtrAmAM niyeta samaye ApavAM joIe. A pravAhI jeTalA pramANamAM ApavA jaNAvyuM hoya teTaluM ja ane dara be ke traNa kalAke ApavuM joIe ane tenI noMdha rAkhI te noMdha DaoNkTarane batAvavI. (4) dardIne moDhethI ke TyUbathI pravAhI apAtuM hoya te samaye aMtarAla Ave ke zvAsa caDhI jAya to pravAhI ApavAnuM tarata baMdha karavuM ane DaoNkTarane tarata jANa karavI.

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davAkhAnAmAM dAkhala karela dardI aMge jarUrI sUcano 281 (5) jyAre jyAre pravAhI ApavAnuM hoya tyAre sau prathama siriMjathI peTamAMthI TyUba vATe pravAhI pAchuM kheMcI khAtarI karI levI. jo pravAhI 50 milithI vadhu nIkaLe to te vakhate phIDiMga ApI na zakAya. kalAka pachI pharIthI te pramANe khAtarI karI lIdhA bAda ja phIDiMga ApavuM. pAchuM kheMcela pravAhI lohInA raMganuM ke kaoNphInA raMganuM hoya to tarata ja DaoNkTaranuM dhyAna kheMcavuM joIe. (6) koI paNa pravAhI ApyA bAda TyUbamAM 10-15 mili jeTaluM pANI nAkhIne tene ekadama sApha karavI. (7) TyUbane dara paMdara divase badalavI jarUrI che. (8) koI kAraNathI TyUbanI pojhizana khasI jAya ke TyUba thoDI bahAra AvI jAya to tene ja pharIthI pAchI na nAMkhatAM TyUba badalIne bIjI nAMkhavI joIe. na (9) jo dardI lAMbo samaya behoza ke ardhajAgrata rahe to nAka vATe TyUba phIDiMga ApavAmAM keTalAMka jokhamo vadhe che. khAsa karIne phephasAMno nyumoniyA thAya che jene espirezana nyumoniyA kahe che. bebhAna dardInA mRtyu thavAnAM agatyanAM pAMca kAraNomAM mukhya e A prakArano nyumoniyA che. tene aTakAvavA nAkanI TyUba kADhI nAMkhI, gaeNsTrosTraoNmI TyUbathI phIDiMga ApavuM. AmAM peTanI cAmaDI para Tanala banAvI, khAsa prakAranI lAMbo samaya (mahinAo sudhI) cAle tevI TyUba mUkavAmAM Ave che. sAmAnya rIte 1thI 2 aThavADiyAMthI vizeSa samaya sudhI dardI behoza,rahe to A prakAre gaeNsTrosTaoNmI TyUba (pega) mukAvavAthI jokhamo nivArIne jiMdagI bacAvI zakAya che. (4) pezAba karAvavAnI TyUba - ketheTara (Urinary Catheter) (1) dardIne covIsa kalAkamAM keTalo pezAba thAya che tenuM dhyAna rAkhavuM ane noMdha karIne te DaoNkTarane batAvavI.

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282 magaja ane jJAnataMtunA rogo (2) dardIne covIsa kalAkamAM jo pezAba ra500 mi.li.thI vadhu thAya athavA 1000 mi.li.thI ocho thAya tema ja pezAba atizaya pILo(haLadaranA raMgano), lAla ke paru jevo thato dekhAya to DaoNkTarane jANa karavI. (3) dara kalAke dardIne thatA pezAbanI mAtrA jotA rahevI. jo te ocho thato jaNAya to DaoNkTara ke sisTaranuM dhyAna doravuM. (4) sAmAnya rIte jo ketheTara aMdaranuM Indwelling) hoya to tene paMdara divase badalavuM joIe agara te bahAranuM ketheTara hoya to dara trIjA divase badalI nAkhavuM. (5) jo aMdara silikonanuM (silAsTika) ketheTara mUkavAmAM Ave to te lAMbo samaya cAlI zake. (6) ketheTara lagADela bhAga DresiMgathI sApha rAkhavAnI kALajI rAkhavI. (5) maLatyAga (Bowel Motion) dardIne peTa roja sApha thAya te hitAvaha che. paNa be divasa pachI paNa jo jhADo (maLatyAga) na thAya to DaoNkTaranuM dhyAna doravuM. DaoNkTara phIDiMga TyUba dvArA davA athavA gudA vATe enimA ApavA ke sapojhiTarI mUkavAnuM sUcana kare te mujaba karavuM. () AMkhanI saMbhALa bebhAna dardInI AMkha khullI ja rahetI hoya to te lAla thAya ane korniAnA nAjuka bhAga upara cAMduM (ulcer) thavAthI AMkhe aMdhApo AvI zake. tethI DaoNkTaranI salAha mujaba paiDathI AMkho DhAMkavI tathA Moisol vagere yogya TIpAM nAkhavAM tathA jarUra paDe enTibAyoTika TIpAM nAkhavAM. () moDhAnI kALajI (mAutharkera) | moDhAmAM cAMdI, photarI paDe nahi te mATe dararoja moDhAmAM In Edue tapAsa karavI. divasamAM be vAra meDikeTeDa glisarina tathA Private & Personal Use On ww.jainelibrary.org

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283 davAkhAnAmAM dAkhala karela dardI aMge jarUrI sUcano mAuthaphrezanara lagAvavuM, Ula utAravI, dAMta sApha karavA te bahu jarUrI che. dardI bhAnamAM hoya to kogaLA karAvavA. (8) kasarata (physiotherapy) | dardIe ghaNI vakhata lAMbA samaya sudhI kasarata cAlu rAkhavI paDe che. dardIne e kAmagIrImAM madada thAya te mATe ane ghera gayA pachI kasarata cAlu rAkhI zakAya te mATe phijhiyotherapisTa ke DaoNkTara pAsethI te aMgenI samaja meLavI levI. temAM kaI kasarata kyAre, keTalA samaya mATe karavAnI che tenI noMdha rAkhavI joIe, tema ja te mujaba ja kasarata karAvavI joIe. (1) jo dardIne lakavo hoya to te mATenI te aMganI te kasarata karAvavI. (2) dardI jo bebhAna hoya to tenA banne hAtha-paga dara be kalAke paMdareka miniTa halAvI kasarata karAvavI. (3) sAmAnya rIte kasarata divasamAM cArathI cha vakhata ane dasa thI vIsa miniTa mATe karAvavAnI hoya che. thAka na lAge tema karAvavI. (4) dardInA paga sUjI jAya, paga para lAlAza jaNAya to DokTarane jANa karavI. kyAreka te khUba bhayajanaka (DVT) roganI nizAnI hoI zake. (9) chAtImAMthI kapha kADhavo (suction) jyAre dardIne lAMbo samaya sUI rahevAnuM hoya tyAre zvasanataMtramAM paNa muzkelI Ave che. chAtImAM kapha bharAI jAya, chAtImAMthI avAja Ave. nyumoniyA thavAno paNa Dara rahe che. vaLI zvAsanI kriyA paNa tenAthI bagaDe che. AvA dardIne vAraMvAra pAtaLI TyUba dvArA gaLAmAMthI ane chAtImAMthI sakzana kaMrI zvAsamArga cokhkho rAkhavo joIe. tenI vidhi sAmAnya rIte sTApha karato hoya che, paraMtu dardInAM jAgRta sagAMo paNa sArI rIte karI zake. kharekhara

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284 magaja ane jJAnataMtunA rogo to A mATe Dispojhebala kaeNtheTara vAparavuM vadhu yogya che. dardIne zvAsamAM takalIpha rahetI hoya ke kapha vadhAre hoya athavA bebhAnAvasthAmAM rahe to porTekSanI enDroTrekIala TyUba mUkavAmAM Ave che. tene 7thI 14 divasa sudhI rAkhI zakAya. tenAthI sakzana vadhu sArI rIte thAya che. zvAsocchavAsamAM rAhata rahe che. Tracheostomy : dardIne chAtImAM kapha vizeSa bharAyA kare athavA tenI bebhAna avasthA jaladI sudhare tevuM lAgatuM na hoya tevA saMjogomAM DaoNkTaro tracheostomyno nirNaya letA hoya che. A prakriyAmAM gaLAnI upara AgaLanA bhAge nAno cheda pADI nAnI plAsTika ke maeNTala TyUba nAkhI te dvArA zvAsanI AvanajAvananI prakriyA normala karavAmAM Ave che. teno vizeSa phAyado e che ke kapha jamA thayo hoya to sahelAIthI kADhI zakAya che ane tethI nyumoniyAnuM jokhama ochuM thaI jAya che. zvasanakriyAmAM rAhata thAya che. jyAre zvAsocchavAsa sudhare, dardI bhAnamAM Ave, kapha ocho thavA mAMDe tyAre chidra nAnuM karavA TyUbanI pahoLAI ochI karatA javAnuM; tethI chevaTe chidra baMdha thaI jatuM hoya che, ghA rujhAI jAya che. zvAsocchvAsa sAro rahe, kapha na bharAya tathA hAiposTeTika nyumoniyA na thAya te mATe zarUAtathI ja Chest physiotherapy zarU karI devI joIe. vaLI jarUra mujaba dardIne nebyulAijharathI zvAsamArgamAM yogya davAo tathA varALa pahoMcADI zvAsano rasto khullo, svaccha ane hUMphALo rAkhIne kapha jAmato aTakAvI zakAya. (10) sAmAnya dekhabhALa (Nursing Care) (1) dardInI pathArI svaccha ane karacalI vagaranI rAkhavI. pathArImAM jarUra lAge tyAre pAuDara chAMTavo joIe. svajanoe dardInI pathArImAM zakyataH besavuM joIe nahi. cepa lAge tevI zakyatA hoya to sagAMone moDhA 52 mAska tathA mAthA para kaeNpa rAkhavAnI salAha DaoNkTaro ApatA hoya che.

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davAkhAnAmAM dAkhala karela dardI aMge jarUrI sUcano 285 (2) dardI behoza hoya tyAre dardInuM mAthuM 30thI 40 DigrI UMcuM rahe tevI rIte tene suvADavo joIe. (11) (3) dardIne eka paDakhe suvADavo (lateral semiprone position), temaja dara eka-be kalAke tenuM paDakhuM badalatA rahevuM joIe. (4) dardIne bhAThAM ke cAMdAM na paDe tenuM satata dhyAna rAkhavuM joIe. cAmar3Ino raMga badalAya, cAmaDI ghasAya ke cholAya to DaoNkTara ane narsanuM dhyAna doravuM. (5) jo lAMbA samayanI bImArI hoya ane dardI taddana pathArIvaza hoya to evA saMjogomAM dardI mATe pANI bharelI pathArI (water-bed)nI jarUra paDe che. tabIbanI salAha mujaba ja dardIne vaoNTara-beDa para suvADavAnI vyavasthA karI zakAya. kyAreka havA bharelI pathArI(eNra-beDa) athavA spaMjabeDa vAparI zakAya. (6) dardIne dararoja spaMja (bhInA potAthI zarIra sApha) karAvavuM. (7) divasamAM be vakhata dardInuM moDhuM sisTara pAse sApha karAvavuM. A kAma dardInA sagAM paNa karI zake. (8) dardI bhAnamAM hoya tyAre zakya hoya to tene besADIne ja khorAka Apavo. agatyanA muddA (Vital Points) dardInA hRdayanA ke nADInA dhabakArA vadhu jaNAya to tarata DaoNkTarane jANa karavI. dardInAM sagAM kArDiyAka maoNniTara jovAnuM prAthamika kakSAe zIkhI le te hitAvaha che. dardIne zvAsa vadhu lAge athavA te acAnaka phikko ke bhUro paDI jAya athavA tene kheMca Ave to DaoNkTarane / sisTarane tarata jANa karavI. tAva vadhu jaNAya tyAre DaoNkTaranuM / sisTaranuM dhyAna doravuM.

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286 kuTuMbIjanonI viziSTa pharajo H magaja ane jJAnataMtunA rogo dardIne sAjo karavAmAM ghaNAM paribaLo bhAga bhajave che. temAM kuTuMbIjano dvArA apAtI sevA-zuzrUSA bRhattvanI che. dardInI cikitsA uparAMta premabharI lAgaNI paNa jAduI kAma kare che. tenAthI dardInA manobaLamAM vadhAro thavAthI sAjA thavAnI dardInI AMtarika zaktimAM vadhAro thAya che. haoNspiTalamAM svajanoe dardInI pAse vArApharatI divasa-rAta saMbhALa mATe rahevuM joIe ane tenuM satata dhyAna rAkhavuM joIe. dardIne kyAreya ekalo mUkavo nahi. evA samaye kyAreka dardI palaMgamAMthI nIce paDI javAnI zakyatA rahelI che. jarUra paDye palaMgane reliMga mukAvI zakAya. dardIne zAMti ane ArAmanI jarUra hovAthI tenA palaMga pAse moTethI vAto karavI nahi ke ghoMghATa thavA devo nahi. rUmamAM svacchatA jALavavI. dardI pAse vadhu vyaktione bhegI thavA na devI, kAraNake dardIne cepa lAgI javAno bhaya rahelo che. rogiSTa svajana dardInI tabiyata pUchavA AvyAM hoya to tene dardIthI acUka dUra rAkhavAM. dardInI khabara kADhavA AvanAra vyaktie dardI sAMbhaLe tema bImArI, mRtyu ke bIjI AghAtajanaka vAto na karavI joIe. AvI koI paNa vAta dardInA manobaLane ghaTADe che. AvA loko dardI pAse jAya nahi tenI khAsa kALajI rAkhavI. evI ja rIte darda, davA, DaoNkTara ke davAkhAnA aMge jANelAsAMbhaLelA kharAba anubhavo, mAnyatAonI vAto paNa dardI ke tenA parivAranA sabhyo, tenI sAravAramAM rokAyelAM svajana samakSa karavI joIe nahi. dardInA roga vizenI AgAhIo, apAtI davA barAbara che ke nahi, DaoNkTara sArA che ke nahi te saMbaMdhI vAto karavI nahIM. tenAM kAraNe dardI ane sagAM

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287 mUMjhavaNamAM mukAya che, je dardInA svAsthya-sAravAramAM vikSepa Ubho kare che. davAkhAnAmAM dAkhala karela dardI aMge jarUrI sUcano dardInI khabara kADhavA javAnI prathAmAM temaja tyAMnA vAtAvaraNamAM keTalAka pheraphAra karavAnI have khAsa jarUra jaNAya che. jUtha (grUpa)mAM bhegAM thaIne dardI mATe phaLo athavA puSpaguccha, pustaka, gaeNTa vaeNla-kArDa arpaNa karIne zubhecchAnI lAgaNI darzAvI zakAya, ghare ke dhArmika sthaLe prArthanA karI zakAya, dardIne paNa prArthanA karavA mATe samajAvI zakAya. prArthanAmAM sAjA karavAnuM ghaNuM baLa raheluM che. dardIne pasaMda hoya tevA sumadhura saMgItanI kaeNseTa dhImA avAje vagADI zakAya. e ApaNuM kamanasIba che ke meDikala insyaoNransanI prathA pratye ApaNI prajAmAM joIe teTalI jAgRti nathI ane bIjI bAju meDikala sAravAra dinapratidina moMghI thatI jAya che. evI paristhitimAM jemano insyaoNransa na hoya ane Arthika rIte dardI nabaLo hoya tevA dardInI sAravAranA kharca mATe Arthika sahAyanI jarUra hoya to DaoNkTaranuM acUka dhyAna doravuM. temanA mArgadarzanathI sAmAjika saMsthAo dvArA davAo sastA dare meLavI zakAya che. AvI keTalIka saMsthAo moTAM zaheromAM kAma kare che. haoNspiTalanAM sAmAjika kAryakara ahIM mArgadarzana ApI zake. keTalAka rogomAM viziSTa, ghaniSTha tema ja kharcALa sAravAranI jarUra paDe che, jema ke AIDPmAM plAjhamA eksacenja, AIDP ke mAryestheniyAmAM gAmAglobyulina, zvasanayaMtra (venTileTara) vagere A badhAno kharca rU. 50 hajArathI rU. 3-4 lAkha upara pahoMcIM jato hoya che. evA samaye rAhatadare sAravAra ke vadhu mAhitI ke pachI sAravAranA kharca mATenI madada mATe tabIba kadAca madadarUpa thaI zake.

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288 (2) magaja ane jJAnataMtunA rogo DaoNkTara pAse jAo tyAre (1) DaoNkTara pAse jatA pahelAM tamArI epoInTamenTa nakkI karI levI hitAvaha che. tamArI tamAma takalIphonI yAdI te darekanA samayagALA sAthe cokkasa kramamAM TUMkamAM noMdhIne laI jazo. ? (3) DaoNkTara samakSa tamArI takalIphonI rajUAta TUMkamAM muddAsara karazo. DaoNkTarane tamArI phariyAdonuM varNana karazo, tamAruM mAnI lIdheluM nidAna jaNAvazo nahIM. (jema ke "mane gaLAnI aMdara duHkhe che" ema kaho, "Tonsila thaI gayA che" ema nahIM). (4) tamArI agAunI tamAma mahattvanI bImArIo, tene lagatAM tabIbI parIkSaNo, sAravAra, zastrakriyAo ane noMdhonI vyavasthita phAIla taiyAra karI sAthe rAkhazo. jo tamArI vartamAna takalIphane agAunI bImArI ke bImArIo sAthe saMbaMdha hoya to tenI vigato DaoNkTarane batAvavI bhUlazo nahIM. koI vAra lohI caDhAvyuM hoya to paNa khAsa jaNAvavuM. tamArA kuTuMbamAM najIkanA sagapaNamAM koIne kSaya, hAI blaDa prezara, DAyAbiTIsa, hRdayaroga, kheMca, yakRta ke mUtrapiMDanI bImArI, janmajAta khoDakhAMpaNa, asthamA, saMdhivA ke anya koI vizeSa bImArI hoya to te vyaktinAM tamArI sAthenAM sagapaNa sAthe tenI noMdha rAkhazo. (6) saMkoca rAkhIne DaoNkTarathI koI paNa vigata ke mAhitI chupAvazo nahIM. khAsa karIne Ayurveda, homIyopathI, yunAnI vagerenI paNa koI davA cAlatI hoya te vigatavAra jaNAvavI. zakya hoya to davAo sAthe laIne javI.

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(9) , magaja ane jJAnataMtunA rogo 289 (7) tamArI marajI pramANenI sAravAra, davAo ke leboreTarI parIkSaNano Agraha rAkhazo nahIM. DaoNkTarane maLatAM pahelAM tamArI jAte ja koI davAo levAnuM ke leboreTarI parIkSaNo karAvavAnuM paNa TALazo. (8) jo tamane koI davAonI pratikriyA thatI hoya (riekzana AvatuM hoya) to DaoNkTarane enI acUka jANa karazo. tamArI bImArI ane tenI sAravAra vize tamArA DaoNkTara sAthe mukta ane mudAra carcA karI lezo. enA vize mAhitI meLavavI tamArA mATe upayogI che. (10) tamArA DaoNkTara para pUrepUro vizvAsa rAkho. cokkasa kAraNa vinA DaoNkTara badalazo nahIM. jo tamArI bImArInA saMdarbhamAM tame anya koI DokTarano abhiprAya levA mAgatA ho to potAnA DaoNkTaranI jANamAM ane salAha pramANe karazo ane bane to temanI ciThThI lezo. (11)jo tamArI takalIpho lAMbA gALAnI hoya to nIcenAM lakSaNo-cihno, tenA samayagALA sAthe khAsa noMdhazo : (12)nIce lakhelAM lakSaNo- cihno hoya to kensara hovAnI zakyatA prabaLa bane che : vajanamAM ghaTADo zarIramAM koI paNa ThekANe gAMTha ke sojo avAjamAM pheraphAra zarIranA koI paNa kudaratI mArgamAMthI lohI vahevuM lAMbA gALAnI khAMsI lAMbA gALAthI Avato tAva. lAMbA samayathI na rUjhAtuM cAMduM stanamAM gAMTha athavA stananI DiMTaDImAMthI paDatuM lohI yonimAMthI paDatuM durgadhavALuM pravAhI jhADA-pezAbanI hAjatamAM asAmAnya pheraphAra tala ke masAnA kadamAM ekadama vadhAro. Ama upara jaNAvyA mujabanI mAhitI sAthe rAkhI DaoNkTarane maLavAthI DaoNkTarane ApanI takalIphanI sAravAra karavAmAM saraLatA raheze tathA Apane paNa roganI yogya sAravAra maLI raheze.

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290 ALZHEIMER'S DISEASE Alzheimer's Association 225 North Michigam Avenue Suite 1700 Chicago, IL 60601-7633 312-335-8700 800-272-3900 info@alz.org www.alz.org AMYOTROPHIC LATERAL SCLEROSIS The ALS Association (ALSA) 27001 Agoura Road Suite 150 Calabasas Hills, CA 91301-5104 818-880-9007 800-782-4747 Patient Information Guide info@alsanational.org www.alsa.org. ATAXIA National Ataxia Foundation 2600 Fernbrook Lane North Suite 119 Minneapolis, MN 55447-4752 763-553-0020 naf@ataxia.org www.ataxia.org ATTENTION DEFICIT DISORDER Attention deficit Disorder Association P.O. Box 543 Pottstown, PA 19464 484-945-2101 mail@add.org www.add.org Jain Education totemnational magaja ane jJAnataMtunA rogo AUTISM AUTISM Research Institute (ARI) 4182 Adams Avenue San Diego, CA 92116. 619-281-7165 www.autismeresearchinstitute.com.or www.austin.com/ari BRAIN TUMOR American Brain Tumor Association 2720 River Road Suite 146 Des Plaines, IL 60018-4117 847-827-9910 800-886-2282 info@abta.org www.abta.org CEREBRAL PALSY United Cerebral Palsy (UCP)/ UCP Research & Education Foundation 1660 L Street, NW Suite 700 Washington, DC 20036 202-973-7140 800-USA-5UCP (872-5827) national@ucp.org www.wcp.org and www.ucpresearch.org. DISABILITY National Institute of Disability & Rehabilitation Research (NIDRR) Department of Education Office of Special Education and Rehabilitative Services 400 Maryland Avenue, SW Washington, DC 20202-7100 202-245-7460 202-245-7316 (TTY) www.ed.gov/about/offices/list/orders/nidrr For Private & Per annema org

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magaja ane jJAnataMtunA rogo COMA Coma Recovery Association 8300 Republic Airport, Suite 106 Farmingdale, NY 11735 631-756-1826 inquiry@comarecovery.org www.comarecovery.org EPILEPSY Epilepsy Foundation 8301 Professional Place Landover, MD 20785-2267 301-459-3700 800-EFA-1000 (332-1000) postmaster@efa.org www.epilepsyfoundation.org FIBROMYALGIA American Autoimmune Related Diseases Association 22100 Gratiot Avenue Eastpointe Ease Detroit, MI 48201-2227 586-776-3900 800-598-4668 aarda@aarda.org www.aarda.org Mt. Royal, NJ 08061. 856-423-0258 800-255-ACHE (2243) achehq@talley.com www.achenet.org HUNTINGTON'S DISEASE Huntington's Disease Society of America 505 Eighth Avenue Suite 902 New York, NY 10018 212-242-1968 800-345-HDSA (4372) hdsainfo@hdsa.org www.hdsa.org INDIAN EPILEPSY ASSOCIATION Indian Epilepsy Association 37, State Bank of India Road, Banglore - 560001 Phone: 080-255 88 274, 255 88 390 ieablr@vsnl.net HEADACHE MENTAL RETARDATION (see also pain) The ARC of the United States American Council for Headache Education 500, East Border Street, Suite-300 19 Mantua Road Arlington, TX-76010 Contact: Alan Abeson, Ed.D., Executive Director Phone: 817-216-6003, TTY: 817-277-055; Fax: 817-277-3491 Website: http///thearc.com Email: thearc@metronet.com 291 INDIAN EPILEPSY ASSOCIATION (Ahmedabad Chapter) 19, Saumitranagar Soc., Krushna nagar, Vyas Vadi Road, Nava Wadaj, Ahmedabad INDIAN EPILEPSY SOCIETY C-1/10, AIMS Campus, Ansari Nagar New Delhi-110029 LANGUAGE & LEARNING DISABILITIES International Dyslexia Society 8600 LaSalle Road Chester Building, Suite 382 410-296-0232 800-ABCD123 (222-3123) info@interdys.org www.interdys.org

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212 MOVEMENT DISORDERS We move (Worldwide Education & Awareness for Movement Disorders) 204 West 84th Street New York, NY 10024 212-875-8312 wemove @wemove.org wemove@wemove.org MULTIPLE SCLEROSIS Multiple Sclerosis Association of America 706 Haddonfield Road Cherry Hill, NJ 08002 856-488-4500 800-532-7667 msaa@msaa.com www.msaa.com MUSCULAR DYSTROPHY Muscular Dystrophy Association 3300 East Sunrise Drive Tucson, AZ 85718-3208 520-529-2000 800-344-4863 mda@mdausa.org www.mda.org MYASTHENIA GRAVIS Myasthenia Gravis Foundation of America, Inc 1821 University Avenue West Suite S256 St. Paul, MN 55104 651-917-6256 800-541-5454 mgfa@myasthenia.org www.myasthenia.org For Private magaja ane jJAnataMtunA rogo MYOSITIS The Myositis Association 1233 Twentieth Street, NW Suite 402 Washington, DC 20036 202-887-0088 800-821-7356 tma@myositis.org www.myositis.org MYOTONIC DYSTROPHY International Myotonic Dystrophy Organization P.O. Box 1121 Sunland, CA 91041-1121 818-951-2311 866-679-7954 (toll-free in USA and Canada) mytonicdystrophy@yahoo.com www.mytonicdystrophy.org PAIN Americam Chromic Pain Association P.O. Box 850 Rocklin, CA 95677-0850 916-632-0922 800-533-3231 ACPA@pacbell.net www.theacpa.org PARALYSIS American Paralysis Association (APA) 500, Morris Avenue Springfield, NJ-07081 Toll Free: 800-255-0292 Phone: 201-912-9433 Fax: 201-912-9433 VIOLACHDCary.org

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magaja ane jJAnataMtunA rogo 293 PARKINSON'S DISEASE American Parkinson Disease Association 135 Parkinson Avenue Staten Island, NY 10305-1425 718-981-8001 800-223-2732 Califormia : 800-908-2732 apda@apdaparkinson.org www.apdaparkinson.org STROKE American Stroke Association: A Division of American Heart Association 7272 Greenville Avenue Dallas, TX 75231-4596 888-4stroke (478-7653) strokeassociation@heart.org www.strokeassociation.org PERIPHERAL NEUROPATHY Neuropathy Association 60 East 42nd Street Suite 942 New York, NY 10165-0999 212-692-0662 info@neuropathy.org www.neuropathy.org STROKE National Stroke Association 9707 East Eastler Lane Englewood, CO 80112-3747 303-649-9299 800-STROKES (787-6537) info@stroke.org www.stroke.org SHY-DRAGER SYNDROME Shy-Drager/Multiple System Atrophy Support Group, Inc. P.O. Box 279 Coupland, TX 78615 866-SDS-4999 (737-4999) shy-drager.oprg TRANSVERSE MYELITIS Transverse Myelitis Association 1787 Sutter Parkway Powell, OH 43065-8806 614-766-1806 info@myelitis.org www.myelitis.org SLEEP DISORDERS American Sleep Apnea Association 1424 K Street, NW, Suite 302 Washington, DC 20005 202-293-3650 asaa@sleepapnea.org www.sleepapnea.org TRAUMA Brain Injury Association of America, Inc. 8201 Greensboro Drive Suite 611 McLean, VA 22102 703-236-6000 800-444-6443 family helpline@biausa.org www.biausa.org STEM CELL RESEARCH National Institutes of Health 1 Center Drive Bethesda, MD 20892 www.nih.gov/news/stemcell Jain . mennyorg

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294 magaja ane jJAnataMtunA rogo Attitude "The Longer I live, the more I realize the impact of attitude on life. Attitude, to me, is more important than facts. It is more important than the past, than education, successes, than what other people think or say or do. It is more important than appearance, giftedness or skill. It will make or break a company....... a church...... a home. The remarkable thing is we have a choice every day regarding the attitude we will embrace for that day. We can not change our past.... we cannot change the fact that people will act in a certain way. We cannot change the inevitable. The only thing we can do is to play on the one string we have, and that is our attitude........I am convinced that life is 10% what happens to me and 90% how I react to it. And so it is with you... we are in charge of our Attitudes", Charles Swindoll - valaNa - abhigama huM jeTaluM lAMbuM jIvuM chuM teTaluM ja jIvana upara valaNa-abhigamanI asaronI mahattA anubhavuM chuM. mArA mATe valaNa e koI hakIkato karatAM vadhAre mahattvanuM che. te bhUtakALa, zikSaNa, saphaLatA ane anya vyaktio zuM kahe che, kare che ke vicAre che tenAM karatAM paNa ati mahattvanuM che. te bAhya dekhAva, cAturya ke pratibhA karatAM paNa vadhAre mahattvanuM che, te koI kaMpanI.... carca...... ke ghara banAvaze ke toDI zakaze. eka noMdhapAtra vAta e che ke dararoja ApaNI pAse te divase kevo abhigama rAkhIzuM te aMge pasaMdagI karavAnuM zakya che. ApaNe ApaNo bhUtakALa badalI zakatA nathI.... loko amuka cokkasa prakAre vartana karaze te hakIkata badalI zakatA nathI. je banavAnuM che te ApaNe badalI zakatAM nathI, ApaNI pAse ApaNe karI zakIe tevo mAtra eka ja rasto che ane te che ApaNuM valaNa-abhigama... huM mAnuM chuM ke jiMdagI e ApaNane zuM thAya che te mAtra 10% che ane 90% tenA tarapha huM kevo pratibhAva ApuM chuM te che; ane te ApanI sAthe paNa tevuM ja che... ApaNe ApaNA abhigamanA adhiSThAtA chIe - niyAmaka chIe. - cArlsa svi'oNla

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magaja ane jJAnataMtunA rogo 295 Prof. Martin Brown INTE Prof. of Stroke Medicine NHN & N, Queensquare, London, UK. Dear Dr. Shah It was a great pleasure to meet you again at the meeting in Mumbai. Thank you very much for giving me a copy of your excellent book, which I enjoyed reading. It provides an excellent introduction to neurology. I realise you wrote it for the lay person, but I think medical students would also profit from reading it. Prof. Louis R Caplan Prof. of Neurology, Harvard medical school, Director of stroke service : Boston, USA. I liked the book very much. The writing is clear and concise. It was a honor to read and review this book. It is badly needed for the public. Prof. David Bates Prof. of Neurology, Multiple Sclerosis New Castle, UK Dr. Shah, pleasure to meet you last week, I am impressed by your useful little book. "The book is a readable explanation of Neurology which can be easily understood by layman and medical student. The distilled wisdom and explanation in each chapter will help allay worries in, the family of those with neurological disorders and in the student fearful of questions in neurological examinations. It provides a succinct summary of the nervous system and its common disorders, Dr. Sudhir V. Shah is to be complemented in the clarity of his writing."

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296 magaja ane jJAnataMtunA rogo Prof. James C Grotta Chair, Stroke medicine U.T. Medical School Houston, USA Thank you very much for the book - we will use it for our resident and nursing education. Prof. Amado M. San Luis President, Asia-oceanic association of Neurology Manila, Philipines Your book is very informative, simplified and indeed friendly for medical students and residents who are often intimidated by the subjects, neuroanatomy and neurology. I Prof. Mauriedavid Emeritus Clinical Professor of Psychiatry Temple University, Health Science Center Philadelphia, Pa. 19106 . This is a book of that times. It is an important book, delivering a message of clear understanding, to the peoples (not only of his country of origin, India) but also in its very clear translation, to the community of the Western World." Importantly, Dr. Shah is a Neurological physician of considerable reputation, This makes his message all the more compelling and significant. His work is complete in scope and very, very clear in the messages delivered as to the nature of neurological diseases. These messages are accompanied with advice as to their origins (so far as they are known) and as to their treatment. This is a book, also, which is completely in attune with Dr. Shah's very humanistic desire to help the world. Knowing him as I do, his intention to promote the welfare of all humanity is successfully and well delivered. Maurie D. Pressman, MD. Romeo Chu Philipines Thank you very much for the book you gave me. It is indeed an excellent book ! The topics covered were quite comprehensive and represents the most common cases that are encountered in clinical practice. The clear photographs and illustrations makes it easier for the reader to appreciate the subject matter as well. .... ... .. ...... ........ .... ...........

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pustaka vize gujarAtI bhASAmAM tathA anyatra, Thera Thera hRdayaroga, blaDaprezara, sthULatA, DAyAbaTiIsa vagere rogo vize vipula mAhitI upalabdha che. magaja ane cetAtaMtranA rogo vize mAhitI khAsa kyAMya che nahi tethI A pustakamAM magaja ane cetAtaMtrane lagatA, khUba sAmAnya jovA maLatA rogo aMge ane temanA nidAna-sAravAra ane eTakAva mATe dardI ane tenA sagAo samajI zake tevI mAhitI pUrI pADavAno eka namra prayAsa karyo che. pustakanA prathama prakaraNamAM magaja ane cetAtaMtra vize mULabhUta | mAhitI ApI che. tyAra bAda magajanA rogonuM kAraNa zodhavA mATe jarUrI evI nyuraoN-reDiyolojikala tapAsa aMge vistRta mAhitI ApavAmAM Avela che. te pachInA 7 prakaraNamAM magaja aMgenA agatyanA tathA savizeSa jovA maLatA rogonuM nirUpaNa karavAmAM AvyuM che. prakaraNa 10 thI 14mAM tabIbI vijJAnane paDakAra rUpa evA magajanA rogonuM vivaraNa karavAmAM AvyuM che. karoDarajajunA rogonI vigato prakaraNa 15mAM Apela che. pramANamAM ochA jANItA chatAM dardInI jiMdagIne kramaza: paravaza banAvatA viziSTha rogonI mAhitI prakaraNa 16 thI 20mAM ApavAmAM AvI che. 21mI sadIno, dareka vyaktine sparzato prazna tanAva hoI, tenA aMge vaijJAnika carcA prakaraNa 21mAM saMkSiptamAM AlekhI che. jyAre davA-upacAra vaDe rogano niveDo na Ave ane jarUrI jaNAya tyAre sAravAra mATe sarjarI-zastrakriyAno upayoga karavAmAM Ave che, zastrakriyA aMge rasaprada mAhitI prakaraNa 22mAMka ApavAmAM AvI che. 23 ane 24 A be prakaraNomAM rogo aMgenI davAo tathA haoNspiTalamAM ApavAmAM AvatI sAravAra aMge sUcano AvarI lIdhA che. viSaya-vastunI samajUtI saraLa banAvavA sAru, AkRtiono yathAyogya AdhAra lIdho che. jyAM kyAreka yogya gujarAtI zabdo maLI zakyA nathI tyAM aMgrejI mULa zabdo rAkhyA che te badala sujJa vAcako daragujara karaze. vaLI, keTalIka davAo jenerika nAma uparAMta kvacit bajAranAmathI vizeSa pracalita hoI te nAmano mAtra vAcakonI samajaNa mATe upayoga karavo paDyo che. A pustakamAM paryApta ane prApta mAhitInA AdhAre vigato pUrI pADavAmAM AvelI che; paraMtu, tabIbI vijJAnamAM avirata vikAsa temaja saMzodhananI prakriyA cAlu ja rahe che, te vAcake lakSyamAM rAkhavuM joIe. aMtamAM, A pustaka janatAne upayogI nIvaDe tevI paramakRpALu paramAtmAne prArthanA. ISBN 13800651-5. DaoN. sudhIra vI. zAha ema.DI., DI.ema. (nyuraoNlojI) ' nyuraoNlojI senTara, 206-208, saMginI kompaleksa, parimala relave krosiMga pAse, elisabrija, phona : 26467052, 26467467 amadAvAda-380 006, ull7 93 8 nlp b 5] raghall. website : www.sudhirneuro.org I),