Good afternoon Dr Shraddha ,

Digoxin is cardiotonic that means it increases the force of contraction of heart muscles,

this drug acts by increasing Ca concentration inside heart muscles.

but the bad thing about this drug is it is associated with some serious side effects that is called digoxin toxicity, ( nausea , vomiting, weakness, bradycardia, conduction block )

this drug has a long half-life hence it can accumulate in blood if consumed in long run, hence this drug is advised 5 days in week.

about replacement to this drug in Ayurveda yes we do have strong cardiotonic like arjuna which is there in HFRT treatment and our cardiac range of prescription.

you can refer to this paper for further details.

http://www.iosrjournals.org/iosr-jdms/papers/Vol7-issue2/M0724851.pdf

about precautions other than a fluid restriction

yes we need to consider the following points too

1.  minimizing sympathetic activation by Yoga and respiratory exercises like bhramary , anulom vilom and chandranuloma ,
2. assessing liver function and accordingly using liver tonics like Linolive  or Aloori as per need.
3. decide whether liquid or semiliquid or solid food is good based on patients’ feedback to diet chart .
4. use M vita to provide micronutrition.
5. monitor weight periodically to assess fluid retention
   monitor steps per day
   monitor abdominal girth
6. monitor NT probnp
7. monitor EDV on 2 d echo monthly for the first 3 months and then once in 6 months
8. don’t forget to check for Hb in case of heart failure

if you follow all these guidelines properly then you can easily improve patients of heart failure with our therapy.

High plasma uric acid (UA) is a precipitating factor for gout and renal calculi as well as a strong risk factor for Metabolic Syndrome and cardiovascular disease. The main causes for higher plasma UA are either lower excretion, higher synthesis or both. Higher waist circumference and the BMI are associated with higher insulin resistance and leptin production, and both reduce uric acid excretion. The synthesis of fatty acids (tryglicerides) in the liver is associated with the de novo synthesis of purine, accelerating UA production. high intake of fructose-rich industrialized food and high alcohol intake (particularly beer) seem to influence uricemia. It is not known whether UA would be a causal factor or an antioxidant protective response. Most authors do not consider the UA as a risk factor but as presenting antioxidant function. UA contributes to > 50% of the antioxidant capacity of the blood. hence while treating patients with high uric acid we must take care of Obesity, High carb intake and oxidative stress .

all our diet kits are efficient in reducing weight, reducing abdominal girth and rich source of antioxidants. also, we don’t allow Nonveg consumption during diet kit .

hence in such cases, you can start any of the above-mentioned diet kits.

Milk and salads are indicated in gout , some vegetables like spinach may have high purine, but studies show they don’t raise the risk of gout or gout attacks.

if your patient has completed a diet kit then you can start with the following diet chart which will help him to control uric acid.

this chart is designed by RD, Payal Banka (Registered Dietitian).

PVD and Neuropathy indicate damaged blood vessles.

PVD itself is a vascular problem and neuropathy in diabetics is generally associated with damaged vasa Nervosa( blood supply to nerves ) .

this damage is caused by high blood sugars which causes obstructive changes in blood vessels.

high blood sugar enters in vascular endothelium and then it affects operations of Endothelial  Mitochondria producing free radicals in blood.

so in both cases, if you plan Prameha diet kit you will be able to reverse diabetes by reducing down insulin resistance. while starting prameha diet kit see to it that you explain all content of the diet kit to the patient in detail and explain  how it is going to solve his problem associated with his legs.

along with a diet kit panchakarma is also essential.

snehan swedan can improve health of blood vessels and improves blood circulation.

best of luck .