jpuk 'kkjhj (vk;qoZsnh; 'kjhj jpuk foKku)

jpuk 'kkjhj (vk;qoZsnh; 'kjhj jpuk foKku) ys[kd vkpk;Z oS| rkjkpUn 'kekZ

,eúMhúvk;qosZn

iwoZ ofj"B vuqla/ku vf/dkjh ,oa ofj"B fpfdRld Jh ewypUn [kSjkrhjke gkWLihVy] fnYyh vk;qosZn foHkkxkè;{k] ekWMy vkbZ gkWfLiVy yktir uxj] ubZ fnYyh

MkW- vejh'k pkuuk

MkW- vuwi tSu

,eúMhúvk;qosZn

,eúMhúvk;qosZn

lgk;d izkè;kid lgk;d izkè;kid pkSú czã izdk'k vk;qosZn pjd laLFkku pkSú czã izdk'k vk;qosZn pjd laLFkku [ksM+k Mkcj] ubZ fnYyh [ksM+k Mkcj] ubZ fnYyh

Hkwfedk ys[kd oS| f'kodqekj feJ iwoZ vk;qosZn lykgdkj] Hkkjr ljdkj

JAYPEE BROTHERS MEDICAL PUBLISHERS The Health Sciences Publisher New Delhi | London | Panama

Jaypee Brothers Medical Publishers (P) Ltd Headquarters Jaypee Brothers Medical Publishers (P) Ltd 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 Fax: +91-11-43574314 Email: [email protected] Overseas Offices J.P. Medical Ltd 83 Victoria Street, London SW1H 0HW (UK) Phone: +44 20 3170 8910 Fax: +44 (0)20 3008 6180 Email: [email protected]

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Jaypee Brothers Medical Publishers (P) Ltd Bhotahity, Kathmandu, Nepal Phone: +977-9741283608 Email: [email protected] Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2019, Jaypee Brothers Medical Publishers The views and opinions expressed in this book are solely those of the original contributor(s)/ author(s) and do not necessarily represent those of editor(s) of the book. All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book. This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought. Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. The CD/DVD-ROM (if any) provided in the sealed envelope with this book is complimentary and free of cost. Not meant for sale. Inquiries for bulk sales may be solicited at: [email protected] jpuk 'kkjhj (vk;qoZsnh; 'kjhj jpuk foKku) First Edition: 2019 ISBN 978-93-88958-78-3

Printed at Repro India Limited

Hkwfedk osn fo'o ds lcls izkphure xzUFk gSaA pkjksa osnksa esa Hkh ½Xosn dh jpuk lcls igys gqbZ vkSj mlds ckn Øe'k% lkeosn] ;tqosZn ,oa vFkoZosn dk ladyu fd;k x;kA bu osnksa dh jpuk dk dky bZLoh iwoZ 2500 ls ysdj 1500 ds vklikl gksxk] ,slk vusd bfrgkldkjksa dk er gSA bu pkjksa osnksa ds Kku ds vk/kj ij pkj miosnksa dk l`tu gqvkA osn miosn ½Xosn vk;qosZn lkeosn xkU/oZosn ;tqosZn /uqosZn vFkoZosn LFkkiR;osn vk;qosZnks /uqosZnks xkU/oZ'psfr rs =k;%A LFkkiR;osneijeqiosn'prqfoZ/%AA ½Xosn esa LokLF; ,oa fpfdRlk fo"k;d Kku dk Hkh izfriknu fd;k x;k gS ijUrq vFkoZosn esa vk;qosZn lEcU/h Kku dh vf/drk dks ns[krs gq, vusd vkpk;ks± us vk;qosZn dks vFkoZosn dk Hkh miosn ekuk gSA bg [kYok;qosZnks ukeksikÄ~xeFkoZosnL;kuqRik|So iztk% 'yksd'krlglzeè;k; lglza p d`roku~ Lo;aHkw%A lqJqr lafgrk] lw=k LFkku&1 osn eU=kksa esa jksx] vkS"k/ vkSj 'kjhj ,oa eu ds fo"k; esa Hkh xw dj uO; 'kkjhj dk fuekZ.k fd;kA bl Øe esa vkpk;Z x.kukFk lsu th }kjk iz.khr ^izR;{k 'kkjhje~* 1950 ds vklikl vk;qosZn egkfo|ky;ksa ds ikB~;Øe esa lekfo"V gqvk vkSj blh fof/ ls 'koPNsnu dh izfØ;k vkSj 'kkjhj Kku vk;qosZn ds Nk=kksa vkSj vè;kidksa us Hkh viuk;kA izR;{k 'kkjhje~ dh izLrkouk esa lqJqr lafgrk ds le; ds ckn bl fo"k; esa gqbZ izxfr dk lekos'k u gksus ds dkj.k vkpk;Z x.kukFk lsu th dk ;g fy[kuk gS fd ^^bnkuha rq 'kkjhjs lqJqrks u"V ,o** ;g dbZ fo}kuksa dks vPNk ugha yxkA cukjl fgUnw fo'ofo|ky; ds iz[;kr fo}ku~ vkSj izkè;kid vkpk;Z HkkLdj xksfoUn ?kk.ksdj th us blds izfrokn esa fy[kk& 'kkjhjs lqJqrks Js"B u p u"V% dFk×puA O;k[;kus rq ija d"V% bfr es fuf'prk efr%AA vLrq] oSKkfud vkSj fpfdRlk {ks=k ds izR;sd fo"k; esa gks jgh fujUrj [kkst dk vk;qosZn ds Nk=kksa dks Hkh v|ru Kku gksuk vko';d gSA blh fu.kZ; ds vk/ kj ij Hkkjrh; fpfdRlk dsUnzh; ifj"kn~ }kjk fu/kZfjr 'kkjhj ('kjhj jpuk foKku vkSj 'kjhj fØ;k foKku) ds ikB~;Øe esa vk/qfud ijh{k.kksa }kjk ijhf{kr bu fo"k;ksa ds Kku dk lekos'k fd;k x;k gS vkSj le;≤ ij blesa ifjorZu vkSj ifjo/Zu Hkh gqvk gSA lu~ 2012 esa xqtjkr vk;qosZn fo'ofo|ky;] tkeuxj esa ikB~;Øe fo"k; fu/kZj.k ds fy;s rhu fnolh; vk;ksftr xks"Bh esa izR;sd fo"k; ds vè;kidksa vkSj fo}kuksa dks vkefU=kr fd;k x;k FkkA bl xks"Bh }kjk vuqeksfnr ikB~;Øe dks Lohdkj dj Hkkjrh; fpfdRlk dsUnzh; ifj"kn~ us bls ykxw fd;k gSA blls iwoZ lu~ 2009 esa Hkh caxyq# esa iwoZ ikB~;Øe ij fopkj dj la'kks/u& ifjo/Zu fd;k x;k FkkA oS| rkjkpUn 'kekZ th vk;qosZn ds izdk.M iafMr vkSj lHkh fo"k;ksa ds Kkrk rks gSa gh] fl¼gLr fpfdRld Hkh gSaA bl fo"k; ij iwoZ esa Hkh mUgkasus xzUFk dk fuekZ.k fd;k Fkk tks fujUrj izdkf'kr gksrk jgk gS] vkSj vc ifj"kn~ }kjk fu/kZfjr u;s ikB~;Øe ds vuqlkj blesa ifjorZu ifjo/Zu dj bls u;s :i esa izLrqr fd;k gSA oS| rkjkpUn 'kekZ th us lu~ 2009 rFkk 2012 eas Hkkjrh; fpfdRlk dsUnzh; ifj"kn~ }kjk bl fo"k; ds fy;s fu/kZfjr ikB~;Øe ds lHkh va'kks dk bl xUFk esa

ix

Hkwfedk

foLrkj ls o.kZu fd;k gSA blds lkFk gh mi;qDr LFkyksa ij fo"k; ls lEcfU/r uohu Kku vkSj 'kks/ dk Hkh vusd LFkyksa ij fooj.k nsdj Nk=kksa ,oa vè;kidksa ds fy;s ekxZn'kZu fd;k gSA eq>s iw.kZ fo'okl gS fd bl uohu ifjofrZr ,oa ifjof/Zr xzUFk ds ekè;e ls 'kkjhj Kku ds lkFk gh uohu 'koPNsnu fof/;ksa dks viuk dj Nk=kx.k 'kjhj jpuk foKku esa iw.kZ Kkuoku gks ldsaxsA izR;{krksa fg ;n`"Va 'kkL=kn`"Va p ;n~Hkosr~A leklrLrnqHk;a Hkw;ksKku foo/Zue~AA fot;kn'keh&2018

oS| f'kodqekj feJ iwoZ vk;qosZn lykgdkj] Hkkjr ljdkj

vkeq[k fpfdRlk esa fuiq.krk izkIr djus dk izFke vkSj vko';d lksiku ^^'kjhj foKku** gSA fpfdRldksa ds izeq[k nks oxZ gSaA ,d dk;fpfdRld oxZ vkSj nwljk 'kY; fpfdRld oxZA vk;qosZn fo"k; dk egkfo|ky; ls vè;;u dj Lukrd fudyus okys fpfdRldksa dks nks izdkj dh fpfdRlk iz.kkfy;ksa dk izJ; ysuk gksrk gSA bu fpfdRlk iz.kkfy;ksa esa fl¼&gLrrk izkIr djuh gS rks fpfdRldksa dks 'kkjhj fo"k; dk izR;{k Kku gksuk vko';d gSA blh vk'k; ls egf"kZ vk=ks; dk ;g dFku loZFkk lR; gS fd& 'kjhja loZFkk lo± loZnk osn ;ks fHk"kd~A vk;qosZna l dkRLU;sZu osn yskdlq[kizne~AA (pú'kkúvú 1) lalkj ds jksx :ih nq%[k dks gj.k djus okyk vk;qosZnh; fl¼gLr fpfdRld ogh cu ldrk gS ftlus 'kjhj ds vax&izR;axksa dh fLFkfr] mudk 'kjhj dh n`f"V ls lw{eLFkwyko;o Kku] ifjHkk"kk] vax&izR;axksa ds ijLij lEcU/] fØ;kRed 'kjhj ,oa nks"kkRed 'kjhj vkfn 'kkjhj ('kjhj lEcU/h) dk izR;{k dekZH;kl }kjk vè;;u fd;k gksA ftl izdkj jksx dh fpfdRlk djus ls igys jksx fofu'p; vFkkZr~ jksx funku vko';d gksrk gS mlh izdkj jksx funku ls iwoZ 'kkjhj fo"k; dk Kku Hkh vko';d gSA dgus dk rkRi;Z ;g gS fd 'kkjhj Kku ds fcuk jksx funku ugha gks ldrk vkSj jskx funku ds fcuk fpfdRlk vlEHko gSA vr% fpfdRlk dk ewy vk/kj 'kkjhj fo"k; dk lE;d~ Kku gSA vk;qosZn dWkystksa ds Nk=kksa ,oa fpfdRldksa ds ikl vHkh rd ,slk dksbZ 'kkjhj fo"k; dk xzUFk miyC/ ugha Fkk ftlls os bl fo"k; esa fuiq.krk izkIr dj ldsaA fo'ks"k :i ls vk;qosZnh; 'kkjhj ;=k r=k lafgrk ,oa vk"kZ xzUFkksa esa fc[kjk gqvk Fkk ftldk vè;;u djus esa fo|kfFkZ;ksa ,oa vè;kidksa dks Hkkjh vlqfo/k dk lkeuk djuk iM+rk FkkA bl vlqfo/k dk ,d dkj.k fofHkUu jkT;ksa esa vk;qosZn ikB~;Øe dh fofHkUurk Hkh FkhA lHkh izkUrksa esa izpfyr vkSj Hkkjrh; fpfdRlk dsUnzh; ifj"kn~ }kjk fufeZr ikB~;Øe dks è;ku esa j[krs gq, MkWú rkjkpUn 'kekZ chú,ú vk;qosZnkpk;Z ,eúMhúvk;qú }kjk 'kjhj fo"k; dk ladyu] O;k[;kRed :i esa fyf[kr ^^vk;qosZnh; 'kjhj jpuk foKku** :ih xzUFk vk;qosZn txr ds fy, vR;Ur mi;skxh fl¼ gksxk] ,slk esjk fo'okl gSA

xii

jpuk 'kkjhj (vk;qoZsnh; 'kjhj jpuk foKku)

blls iwoZ Hkh eSaus bl ys[kd }kjk fy[kh xbZ Nk=kksi;ksxh d`fr;ksa ^inkFkZ n'kZu* o ^nzO; xq.k foKku*] ^vk;qosZn dk ifjp;kRed bfrgkl* dk voyksdu ,oa vè;;u fd;k gSA 'kjhj fo"k; es budk ;g lkef;d iz;kl izFke rks vo'; gS ijUrq iz'kaluh; gSA ftl izdkj fofHkUu xzUFkksa ls funku dk ladyu dj ek/o funku xzUFk loksZRd`"V funku xzUFk gks x;k gS (funkus ek/o% Js"B%) mlh izdkj Hkfo"; esa 'kkjhj fo"k; ds fy, ;g xzUFk Hkh vuqdj.kh; ,oa vè;;u rFkk Nk=kksi;ksxh gksxk] blesa ys'kek=k Hkh lUnsg ugha gSA vUr esa eSa ys[kd ds Nk=ki;ksxh ys[ku iz;kl ds fy, fd;s x, ifjJe dh iz'kalk djrk gqvk liQyrk dh dkeuk djrk gw¡A MkWú czãLo:i 'kekZ HkwriwoZ fizafliy Jh Ñ".k jktdh; vk;qosZfnd egkfo|ky; DqQ#{ks=k] gfj;k.kk

izkDdFku Hkxoku /UoUrjh dh vlhe vuqdEik ls ^jpuk 'kkjhj* uohu ikB~;Øekuqlkj uohu laLdj.k ds lkFk vkids gkFk esa gSA bl laLdj.k esa ;Fkko';d ikB~;Øe ds uohu fcUnqvksa dks lfEefyr dj iqLrd ds vè;k; Hkh ;FkkØe yxk;s gSaA ;|fi vk/qfud jpuk 'kkjhj fo"k;d vusd xzUFk miyC/ gSa rFkkfi dqN vk/qfud fo"k; ftudk vk;qosZn fcUnqvksa ds lkFk laca/ Fkk mudk la{ksi esa o.kZu fd;k x;k gSA Nk=kksa }kjk ijh{kksi;ksxh n`f"Vdks.k ls viuk;s tkus ds dkj.k 1973 ls vkt rd fujUrj uohu la'kks/uksa ds lkFk izdkf'kr gksrh jgh gSA ikB~;Øe eas ifjorZu ,oa ifjo/Zu gksus ij iqLrd dks mlh ds vuq:i izdkf'kr djus dk iz;kl djrk jgk gwaA uohu ikB~;Øe ds vuqlkj izFke ,oa f}rh; iz'u i=k ds fo"k;ksa dks ,d gh iqLrd esa fy[kk x;k gSA le;≤ ij fof'k"V fo}ku bl ij viuh lEefr;ka Hkstrs jgs gSa ;Fkk vkpk;Z eqdqUnh yky f}osnh] Mk- czãLo:i (dq#{ks=k)] Mk- fou;dqekj 'kekZ (ifV;kyk)] vkpk;Z ujsUnzukFk 'kkL=kh (jksgrd)] egUr eqjyh euksgj 'kj.k ,oa oS| oklqnso 'kkL=kh (mn;iqj)] izkpk;Z gfj'kadj 'kekZ (jksgrd)] oS| gjhUnz 'kkL=kh (p.Mhx