from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.oxml.ns import qn
from pptx.util import Pt
import copy
from lxml import etree

# ── Palette ──────────────────────────────────────────────────────────────────
SAFFRON    = RGBColor(0xD4, 0x6A, 0x00)   # deep saffron - Ayurvedic warmth
DARK_TEAL  = RGBColor(0x1A, 0x4A, 0x4A)   # header background
CREAM      = RGBColor(0xFD, 0xF6, 0xE3)   # slide background
DARK_TEXT  = RGBColor(0x1C, 0x1C, 0x1C)
WHITE      = RGBColor(0xFF, 0xFF, 0xFF)
LIGHT_GOLD = RGBColor(0xF5, 0xC5, 0x18)
MID_TEAL   = RGBColor(0x2E, 0x7D, 0x7D)
ACCENT_RED = RGBColor(0xB5, 0x2B, 0x2B)

W = Inches(13.333)
H = Inches(7.5)

prs = Presentation()
prs.slide_width  = W
prs.slide_height = H
blank = prs.slide_layouts[6]   # fully blank layout

# ─────────────────────────────────────────────────────────────────────────────
# Helper utilities
# ─────────────────────────────────────────────────────────────────────────────

def add_rect(slide, x, y, w, h, fill_rgb, alpha=None):
    shape = slide.shapes.add_shape(1, x, y, w, h)   # MSO_SHAPE_TYPE.RECTANGLE = 1
    shape.line.fill.background()
    shape.line.color.rgb = fill_rgb
    shape.fill.solid()
    shape.fill.fore_color.rgb = fill_rgb
    return shape


def add_textbox(slide, x, y, w, h, text, font_size, bold=False, color=DARK_TEXT,
                align=PP_ALIGN.LEFT, wrap=True, italic=False, anchor=MSO_ANCHOR.TOP):
    tb = slide.shapes.add_textbox(x, y, w, h)
    tf = tb.text_frame
    tf.word_wrap = wrap
    tf.vertical_anchor = anchor
    tf.margin_left = 0
    tf.margin_right = 0
    tf.margin_top = 0
    tf.margin_bottom = 0
    p = tf.paragraphs[0]
    p.alignment = align
    run = p.add_run()
    run.text = text
    run.font.size = Pt(font_size)
    run.font.bold = bold
    run.font.italic = italic
    run.font.color.rgb = color
    run.font.name = "Calibri"
    return tb


def add_multiline_textbox(slide, x, y, w, h, lines, base_size, bold_first=False,
                           color=DARK_TEXT, align=PP_ALIGN.LEFT, line_spacing=1.15,
                           anchor=MSO_ANCHOR.TOP):
    """lines = list of (text, size_delta, bold, color_override) tuples or plain strings"""
    tb = slide.shapes.add_textbox(x, y, w, h)
    tf = tb.text_frame
    tf.word_wrap = True
    tf.vertical_anchor = anchor
    tf.margin_left = 0; tf.margin_right = 0
    tf.margin_top  = 0; tf.margin_bottom = 0

    first = True
    for item in lines:
        if isinstance(item, str):
            text, delta, bld, col = item, 0, False, color
        else:
            text = item[0]
            delta = item[1] if len(item) > 1 else 0
            bld   = item[2] if len(item) > 2 else False
            col   = item[3] if len(item) > 3 else color

        if first:
            p = tf.paragraphs[0]
            first = False
        else:
            p = tf.add_paragraph()

        p.alignment = align
        from pptx.oxml.ns import qn
        from lxml import etree
        pPr = p._pPr
        if pPr is None:
            pPr = p._p.get_or_add_pPr()
        lnSpc = etree.SubElement(pPr, qn('a:lnSpc'))
        spcPct = etree.SubElement(lnSpc, qn('a:spcPct'))
        spcPct.set('val', str(int(line_spacing * 100000)))

        run = p.add_run()
        run.text = text
        run.font.size = Pt(base_size + delta)
        run.font.bold = (bold_first and text == lines[0]) or bld
        run.font.color.rgb = col
        run.font.name = "Calibri"
    return tb


def header_bar(slide, title_text, subtitle_text=None):
    """Dark teal header bar across top."""
    add_rect(slide, 0, 0, W, Inches(1.1), DARK_TEAL)
    add_textbox(slide, Inches(0.3), Inches(0.12), Inches(11), Inches(0.7),
                title_text, 26, bold=True, color=WHITE, align=PP_ALIGN.LEFT,
                anchor=MSO_ANCHOR.MIDDLE)
    if subtitle_text:
        add_textbox(slide, Inches(0.3), Inches(0.78), Inches(11), Inches(0.35),
                    subtitle_text, 13, bold=False, color=LIGHT_GOLD,
                    align=PP_ALIGN.LEFT)


def cream_bg(slide):
    add_rect(slide, 0, 0, W, H, CREAM)


def bottom_strip(slide, text="Roganidan Department | PG Synopsis | 2026"):
    add_rect(slide, 0, H - Inches(0.32), W, Inches(0.32), DARK_TEAL)
    add_textbox(slide, Inches(0.3), H - Inches(0.32), Inches(12), Inches(0.32),
                text, 9, color=LIGHT_GOLD, align=PP_ALIGN.LEFT,
                anchor=MSO_ANCHOR.MIDDLE)


def divider_line(slide, y, color=MID_TEAL, thickness=1):
    from pptx.util import Pt as Pt2
    ln = slide.shapes.add_shape(1, Inches(0.4), y, W - Inches(0.8), Inches(0.02))
    ln.fill.background()
    ln.line.color.rgb = color
    ln.line.width = Pt2(thickness)


# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 1 – Title Slide
# ─────────────────────────────────────────────────────────────────────────────
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, W, H, DARK_TEAL)                          # full dark bg
add_rect(s, 0, Inches(2.3), W, Inches(3.2), RGBColor(0x12, 0x36, 0x36))  # content panel

# Saffron top accent
add_rect(s, 0, 0, W, Inches(0.22), SAFFRON)
# Saffron bottom accent
add_rect(s, 0, H - Inches(0.22), W, Inches(0.22), SAFFRON)

# Sanskrit verse (small, gold)
add_textbox(s, Inches(0.5), Inches(0.35), Inches(12), Inches(0.5),
            '"मेदोवहानां स्रोतसां मूलं वृक्कौ वपावहनं च"  — Charaka Sharira 5/8',
            11, italic=True, color=LIGHT_GOLD, align=PP_ALIGN.CENTER)

# Main title
add_textbox(s, Inches(0.5), Inches(1.6), Inches(12.3), Inches(0.75),
            "Medovah Srotodushti Lakshana in Patients of Cholelithiasis",
            30, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

add_textbox(s, Inches(0.5), Inches(2.35), Inches(12.3), Inches(0.45),
            "An Observational Clinical Study",
            17, italic=True, color=LIGHT_GOLD, align=PP_ALIGN.CENTER)

# Divider
add_rect(s, Inches(3), Inches(2.95), Inches(7.3), Inches(0.04), SAFFRON)

# Candidate info block
info_lines = [
    ("Presented by: [Your Name], PG Scholar (1st Year)", 0, False, WHITE),
    ("Guide: Dr. _____________, M.D. (Ayu.), Roganidan", 0, False, LIGHT_GOLD),
    ("Department of Roganidan & Vikriti Vigyan", 0, False, LIGHT_GOLD),
    ("[Name of Ayurvedic College & University]", 0, False, RGBColor(0xCC, 0xCC, 0xCC)),
]
add_multiline_textbox(s, Inches(1), Inches(3.1), Inches(11.3), Inches(1.6),
                      info_lines, 14, align=PP_ALIGN.CENTER, line_spacing=1.5)

# Bottom label
add_textbox(s, Inches(0.5), H - Inches(1.1), Inches(12.3), Inches(0.5),
            "PG Synopsis Presentation | Academic Year 2026-27",
            12, color=RGBColor(0xAA, 0xAA, 0xAA), align=PP_ALIGN.CENTER)


# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 2 – Introduction
# ─────────────────────────────────────────────────────────────────────────────
s = prs.slides.add_slide(blank)
cream_bg(s)
header_bar(s, "Introduction", "Conceptual Background")
bottom_strip(s)

col1_x = Inches(0.4)
col2_x = Inches(6.9)
col_w  = Inches(6.1)
y0     = Inches(1.25)

# Left column header
add_rect(s, col1_x, y0, col_w, Inches(0.38), MID_TEAL)
add_textbox(s, col1_x + Inches(0.1), y0 + Inches(0.04), col_w - Inches(0.2), Inches(0.34),
            "Medovah Srotas — Ayurvedic Perspective", 13, bold=True, color=WHITE,
            anchor=MSO_ANCHOR.MIDDLE)

left_points = [
    ("• Meda Dhatu (adipose tissue) is the 4th Dhatu in the Sapta Dhatu sequence.", 0, False, DARK_TEXT),
    ("• Medovah Srotas: channels carrying & nourishing Meda Dhatu.", 0, False, DARK_TEXT),
    ("• Moola: Vrikka (kidneys) and Vapavahana (omentum/mesenteric fat).", 0, False, DARK_TEXT),
    ("• Dushti Hetu: Asyasukha, Divasvapna, Medura Ahara, Avyayama.", 0, False, DARK_TEXT),
    ("• Dushti Lakshana (C.Su.28): Sthaulya, Ati-sveda, Alpa-prana, Daurbalya,", 0, False, DARK_TEXT),
    ("  Chala-sphik/Udara/Stana, Kshudha-adhikya, Pipasa-adhikya.", 0, False, DARK_TEXT),
]
add_multiline_textbox(s, col1_x + Inches(0.1), y0 + Inches(0.45), col_w - Inches(0.2),
                      Inches(2.8), left_points, 12, line_spacing=1.4)

# Right column header
add_rect(s, col2_x, y0, col_w, Inches(0.38), SAFFRON)
add_textbox(s, col2_x + Inches(0.1), y0 + Inches(0.04), col_w - Inches(0.2), Inches(0.34),
            "Cholelithiasis — Modern Perspective", 13, bold=True, color=WHITE,
            anchor=MSO_ANCHOR.MIDDLE)

right_points = [
    ("• Cholelithiasis = Gallstone disease; prevalence ~10-15% in adults.", 0, False, DARK_TEXT),
    ("• Strongly associated with obesity, dyslipidemia, insulin resistance.", 0, False, DARK_TEXT),
    ("• 'Fat, Fertile, Forty, Female, Flatulent' — classic risk profile.", 0, False, DARK_TEXT),
    ("• Pathogenesis: supersaturation of bile with cholesterol, nucleation,", 0, False, DARK_TEXT),
    ("  gallbladder dysmotility.", 0, False, DARK_TEXT),
    ("• USG abdomen: gold standard for diagnosis.", 0, False, DARK_TEXT),
]
add_multiline_textbox(s, col2_x + Inches(0.1), y0 + Inches(0.45), col_w - Inches(0.2),
                      Inches(2.8), right_points, 12, line_spacing=1.4)

# Bridge statement
add_rect(s, Inches(0.4), Inches(5.25), W - Inches(0.8), Inches(0.75), RGBColor(0xE8, 0xF4, 0xF4))
add_textbox(s, Inches(0.55), Inches(5.28), W - Inches(1.1), Inches(0.65),
            "KEY LINK: Cholelithiasis shares its cardinal risk factors (obesity, fat-rich diet, "
            "sedentary habit) with the known Hetu of Medovah Srotodushti — raising the hypothesis "
            "that Medovah Srotas Dushti Lakshanas are demonstrably present in cholelithiasis patients.",
            12, italic=True, color=DARK_TEAL, align=PP_ALIGN.LEFT, anchor=MSO_ANCHOR.MIDDLE)


# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 3 – Need / Rationale
# ─────────────────────────────────────────────────────────────────────────────
s = prs.slides.add_slide(blank)
cream_bg(s)
header_bar(s, "Need for the Study", "Why This Research Matters")
bottom_strip(s)

need_items = [
    ("1", "Prevalence Gap",
     "Cholelithiasis affects millions yet is described only in modern pathology terms. "
     "No published study maps Medovah Srotodushti Lakshanas in this cohort."),
    ("2", "Diagnostic Potential",
     "If specific Ayurvedic Lakshanas consistently appear in cholelithiasis patients, "
     "they can serve as early clinical markers before gallstone formation."),
    ("3", "Preventive Scope",
     "Identifying Medovah Srotodushti early allows Nidana Parivarjana and Chikitsa "
     "before surgical intervention becomes necessary."),
    ("4", "Research Contribution",
     "This study will generate evidence-based data linking Ayurvedic Srotas theory "
     "with a common metabolic-surgical condition — a significant academic contribution."),
    ("5", "Curriculum Relevance",
     "Roganidan department aims to validate classical Nidana through clinical observation. "
     "This study directly fulfils that mandate."),
]

y_start = Inches(1.3)
box_h   = Inches(0.78)
gap     = Inches(0.1)
num_w   = Inches(0.55)
num_bg  = [DARK_TEAL, MID_TEAL, SAFFRON, DARK_TEAL, MID_TEAL]

for i, (num, heading, detail) in enumerate(need_items):
    y = y_start + i * (box_h + gap)
    # Number badge
    add_rect(s, Inches(0.4), y, num_w, box_h, num_bg[i])
    add_textbox(s, Inches(0.4), y, num_w, box_h, num, 24, bold=True,
                color=WHITE, align=PP_ALIGN.CENTER, anchor=MSO_ANCHOR.MIDDLE)
    # Content box
    add_rect(s, Inches(0.4) + num_w, y, W - Inches(0.8) - num_w, box_h,
             RGBColor(0xF0, 0xF7, 0xF7))
    add_textbox(s, Inches(0.4) + num_w + Inches(0.12), y + Inches(0.04),
                W - Inches(1.2) - num_w, Inches(0.25),
                heading, 13, bold=True, color=DARK_TEAL)
    add_textbox(s, Inches(0.4) + num_w + Inches(0.12), y + Inches(0.28),
                W - Inches(1.2) - num_w, Inches(0.45),
                detail, 11, color=DARK_TEXT)


# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 4 – Aims & Objectives
# ─────────────────────────────────────────────────────────────────────────────
s = prs.slides.add_slide(blank)
cream_bg(s)
header_bar(s, "Aims & Objectives")
bottom_strip(s)

# AIM box
add_rect(s, Inches(0.4), Inches(1.25), W - Inches(0.8), Inches(0.7), MID_TEAL)
add_textbox(s, Inches(0.55), Inches(1.28), Inches(2.2), Inches(0.64),
            "AIM", 18, bold=True, color=WHITE, anchor=MSO_ANCHOR.MIDDLE)
add_rect(s, Inches(2.75), Inches(1.25), Inches(0.03), Inches(0.7), WHITE)
add_textbox(s, Inches(2.85), Inches(1.28), W - Inches(3.2), Inches(0.64),
            "To study Medovah Srotodushti Lakshanas in patients of Cholelithiasis "
            "and to assess their prevalence and severity.",
            13, color=WHITE, anchor=MSO_ANCHOR.MIDDLE)

# Objectives header
add_textbox(s, Inches(0.4), Inches(2.15), Inches(4), Inches(0.4),
            "OBJECTIVES", 14, bold=True, color=DARK_TEAL)
divider_line(s, Inches(2.52), color=SAFFRON, thickness=1.5)

objectives = [
    ("01", "To observe & document the classical Medovah Srotodushti Lakshanas "
           "(Sthaulya, Atisveda, Daurbalya, Kshudha-Adhikya, etc.) in USG-confirmed "
           "cholelithiasis patients."),
    ("02", "To assess the frequency and severity of each Lakshana using a validated "
           "scoring scale designed for this study."),
    ("03", "To correlate findings with modern parameters: BMI, lipid profile, "
           "ultrasonographic findings (stone size, number, GB wall thickness)."),
    ("04", "To identify which Medovah Srotodushti Lakshanas are most predominant "
           "in this patient group and suggest their diagnostic utility."),
]

y0 = Inches(2.6)
for i, (num, text) in enumerate(objectives):
    y = y0 + i * Inches(1.0)
    add_rect(s, Inches(0.4), y, Inches(0.55), Inches(0.5), SAFFRON)
    add_textbox(s, Inches(0.4), y, Inches(0.55), Inches(0.5), num,
                14, bold=True, color=WHITE, align=PP_ALIGN.CENTER, anchor=MSO_ANCHOR.MIDDLE)
    add_textbox(s, Inches(1.05), y, W - Inches(1.45), Inches(0.5), text,
                12, color=DARK_TEXT, anchor=MSO_ANCHOR.MIDDLE)


# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 5 – Hypothesis
# ─────────────────────────────────────────────────────────────────────────────
s = prs.slides.add_slide(blank)
cream_bg(s)
header_bar(s, "Hypothesis")
bottom_strip(s)

# Central hypothesis card
add_rect(s, Inches(0.8), Inches(1.4), Inches(11.73), Inches(2.0), DARK_TEAL)
add_textbox(s, Inches(1.0), Inches(1.5), Inches(11.33), Inches(1.8),
            '"Patients diagnosed with Cholelithiasis will demonstrate clinically significant '
            'Medovah Srotodushti Lakshanas as described in classical Ayurvedic texts, '
            'and the severity of these Lakshanas will positively correlate with the '
            'severity of cholelithiasis on ultrasonographic parameters."',
            16, italic=True, color=WHITE, align=PP_ALIGN.CENTER, anchor=MSO_ANCHOR.MIDDLE)

# H0 / H1
add_rect(s, Inches(0.8), Inches(3.65), Inches(5.75), Inches(1.2), RGBColor(0xE8, 0xF4, 0xF4))
add_textbox(s, Inches(0.95), Inches(3.68), Inches(5.4), Inches(0.4),
            "NULL HYPOTHESIS (H\u2080)", 13, bold=True, color=ACCENT_RED)
add_textbox(s, Inches(0.95), Inches(4.08), Inches(5.4), Inches(0.7),
            "No significant Medovah Srotodushti Lakshanas will be found in "
            "cholelithiasis patients above baseline population levels.",
            11, color=DARK_TEXT)

add_rect(s, Inches(6.83), Inches(3.65), Inches(5.75), Inches(1.2), RGBColor(0xE8, 0xF4, 0xF4))
add_textbox(s, Inches(6.98), Inches(3.68), Inches(5.4), Inches(0.4),
            "ALTERNATE HYPOTHESIS (H\u2081)", 13, bold=True, color=MID_TEAL)
add_textbox(s, Inches(6.98), Inches(4.08), Inches(5.4), Inches(0.7),
            "Clinically significant Medovah Srotodushti Lakshanas will be "
            "demonstrably present and correlatable in cholelithiasis patients.",
            11, color=DARK_TEXT)

# Rationale line
add_textbox(s, Inches(0.8), Inches(5.05), Inches(11.73), Inches(0.5),
            "Basis: Shared Hetu (Atisnigdha, Guru Ahara; Avyayama; Divasvapna) link both "
            "conditions through Meda-Kha-Vaigunya and Srotorodha pathology.",
            12, italic=True, color=DARK_TEAL, align=PP_ALIGN.CENTER)


# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 6 – Materials & Methods
# ─────────────────────────────────────────────────────────────────────────────
s = prs.slides.add_slide(blank)
cream_bg(s)
header_bar(s, "Materials & Methods", "Study Design Overview")
bottom_strip(s)

# 3-column layout
cols = [
    ("Study Type", MID_TEAL, [
        "Observational, Cross-sectional Study",
        "",
        "Duration: 18 months",
        "",
        "Setting: OPD & IPD,\n[Your Institute]",
    ]),
    ("Sample", SAFFRON, [
        "Sample Size: 60 patients*",
        "",
        "Group A (Cases): 60 USG-confirmed\ncholelithiasis patients",
        "",
        "*Calculated by formula:\nn = Z\u00b2 \u00d7 P(1-P) / d\u00b2",
    ]),
    ("Tools", DARK_TEAL, [
        "1. Structured Case Proforma",
        "2. Medovah Srotodushti\n   Lakshana Scoring Sheet",
        "3. Anthropometry (BMI, WC)",
        "4. Lipid Profile, LFT, FBS",
        "5. USG Abdomen Report",
    ]),
]

col_w2 = Inches(3.9)
x_positions = [Inches(0.35), Inches(4.75), Inches(9.12)]
y0 = Inches(1.25)

for (title, color, items), xp in zip(cols, x_positions):
    add_rect(s, xp, y0, col_w2, Inches(0.45), color)
    add_textbox(s, xp + Inches(0.1), y0 + Inches(0.03), col_w2 - Inches(0.2), Inches(0.42),
                title, 14, bold=True, color=WHITE, anchor=MSO_ANCHOR.MIDDLE,
                align=PP_ALIGN.CENTER)
    add_rect(s, xp, y0 + Inches(0.45), col_w2, Inches(4.1), RGBColor(0xF2, 0xF8, 0xF8))
    y_item = y0 + Inches(0.6)
    for item in items:
        if item:
            add_textbox(s, xp + Inches(0.12), y_item, col_w2 - Inches(0.24), Inches(0.5),
                        item, 12, color=DARK_TEXT)
        y_item += Inches(0.55) if item else Inches(0.2)

# Note
add_textbox(s, Inches(0.35), Inches(6.2), Inches(12.6), Inches(0.35),
            "* Sample size subject to revision post-ethical clearance and power analysis.",
            10, italic=True, color=RGBColor(0x77, 0x77, 0x77))


# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 7 – Selection Criteria (FINER Criteria Slide)
# ─────────────────────────────────────────────────────────────────────────────
s = prs.slides.add_slide(blank)
cream_bg(s)
header_bar(s, "Selection Criteria", "Inclusion | Exclusion | Diagnostic Criteria")
bottom_strip(s)

# Three panels
panels = [
    ("INCLUSION CRITERIA", MID_TEAL, [
        "1. Age 20–60 years, either sex",
        "2. USG-confirmed cholelithiasis (single/multiple stones)",
        "3. Willing to give informed consent",
        "4. Ability to follow up for study duration",
        "5. Patients not on hypolipidemic / bariatric treatment",
    ]),
    ("EXCLUSION CRITERIA", ACCENT_RED, [
        "1. Acute cholecystitis / cholangitis (emergency)",
        "2. Post-cholecystectomy patients",
        "3. Known malignancy of biliary tract",
        "4. Pregnancy / Lactation",
        "5. Severe systemic illness (CKD, cirrhosis, heart failure)",
        "6. Patients on long-term steroids / immunosuppressants",
        "7. Age <20 or >60 years",
    ]),
    ("DIAGNOSTIC CRITERIA", DARK_TEAL, [
        "MODERN:",
        "• USG Abdomen (cholelithiasis confirmed)",
        "• BMI, Waist Circumference",
        "• Lipid Profile, FBS, LFT",
        "",
        "AYURVEDIC:",
        "• Medovah Srotodushti Lakshana",
        "  scoring sheet (researcher-designed,",
        "  validated by expert panel)",
        "• Prakriti assessment (AYU scale)",
    ]),
]

col_w3 = Inches(4.0)
x_pos3 = [Inches(0.3), Inches(4.67), Inches(9.03)]
y0 = Inches(1.25)

for (title, color, items), xp in zip(panels, x_pos3):
    add_rect(s, xp, y0, col_w3, Inches(0.42), color)
    add_textbox(s, xp + Inches(0.08), y0 + Inches(0.03), col_w3 - Inches(0.16), Inches(0.36),
                title, 12, bold=True, color=WHITE, align=PP_ALIGN.CENTER,
                anchor=MSO_ANCHOR.MIDDLE)
    add_rect(s, xp, y0 + Inches(0.42), col_w3, Inches(4.7), RGBColor(0xF5, 0xF9, 0xF9))
    y_i = y0 + Inches(0.55)
    for item in items:
        clr = DARK_TEXT
        bld = False
        if item in ("MODERN:", "AYURVEDIC:"):
            clr = color; bld = True
        add_textbox(s, xp + Inches(0.1), y_i, col_w3 - Inches(0.2), Inches(0.42),
                    item, 11, color=clr, bold=bld)
        y_i += Inches(0.44) if item else Inches(0.18)


# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 8 – Observational Parameters & Scoring
# ─────────────────────────────────────────────────────────────────────────────
s = prs.slides.add_slide(blank)
cream_bg(s)
header_bar(s, "Observational Parameters & Scoring", "Medovah Srotodushti Lakshana Assessment Tool")
bottom_strip(s)

# Table header
headers = ["Lakshana", "Classical Reference", "Clinical Equivalent", "Score (0–3)"]
col_ws = [Inches(2.8), Inches(2.8), Inches(3.5), Inches(1.5)]
x_starts = [Inches(0.35), Inches(3.15), Inches(5.95), Inches(9.45)]
y_hdr = Inches(1.28)

for hdr, xp, cw in zip(headers, x_starts, col_ws):
    add_rect(s, xp, y_hdr, cw - Inches(0.04), Inches(0.38), DARK_TEAL)
    add_textbox(s, xp + Inches(0.06), y_hdr + Inches(0.03), cw - Inches(0.14), Inches(0.32),
                hdr, 12, bold=True, color=WHITE, align=PP_ALIGN.CENTER, anchor=MSO_ANCHOR.MIDDLE)

rows = [
    ("Sthaulya", "C.Su.21/9", "BMI ≥25, abdominal obesity (WC)", "0–3"),
    ("Atisveda", "C.Su.21/9", "Excessive sweating on mild exertion", "0–3"),
    ("Daurbalya", "C.Su.21/9", "Easy fatiguability, weakness", "0–3"),
    ("Kshudha-adhikya", "C.Su.21/9", "Increased appetite, frequent hunger", "0–3"),
    ("Pipasa-adhikya", "C.Su.21/9", "Excessive thirst", "0–3"),
    ("Anga-gaurava", "A.H.Su.11", "Heaviness of body", "0–3"),
    ("Alpa-prana", "C.Su.21/9", "Low vitality / decreased stamina", "0–3"),
    ("Chala-sphik", "C.Su.21/9", "Pendulous abdomen / flanks", "0–3"),
]

row_colors = [RGBColor(0xF0, 0xF7, 0xF7), RGBColor(0xFC, 0xFC, 0xFC)]

for i, (lk, ref, eq, sc) in enumerate(rows):
    yr = Inches(1.68) + i * Inches(0.52)
    rc = row_colors[i % 2]
    data = [lk, ref, eq, sc]
    for j, (cell, xp, cw) in enumerate(zip(data, x_starts, col_ws)):
        add_rect(s, xp, yr, cw - Inches(0.04), Inches(0.5), rc)
        bld = (j == 0)
        col = MID_TEAL if j == 0 else DARK_TEXT
        add_textbox(s, xp + Inches(0.06), yr + Inches(0.04),
                    cw - Inches(0.14), Inches(0.42),
                    cell, 11, bold=bld, color=col, anchor=MSO_ANCHOR.MIDDLE)

# Scoring note
add_textbox(s, Inches(0.35), Inches(6.0), Inches(12.6), Inches(0.38),
            "Scoring: 0 = Absent | 1 = Mild | 2 = Moderate | 3 = Severe   "
            "| Maximum Total Score: 24   | Validation: Expert panel of Roganidan faculty",
            11, italic=True, color=DARK_TEAL)


# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 9 – Expected Outcome & Significance
# ─────────────────────────────────────────────────────────────────────────────
s = prs.slides.add_slide(blank)
cream_bg(s)
header_bar(s, "Expected Outcome & Significance")
bottom_strip(s)

outcomes = [
    (SAFFRON, "Clinical Finding",
     "Documentation of frequency & severity of Medovah Srotodushti Lakshanas in "
     "a well-defined cholelithiasis cohort for the first time."),
    (MID_TEAL, "Correlation Data",
     "Statistical correlation between Lakshana scores and modern markers "
     "(BMI, lipid profile, stone burden on USG)."),
    (DARK_TEAL, "Diagnostic Framework",
     "A validated Lakshana scoring sheet usable in clinical practice for "
     "early Medovah Srotas assessment."),
    (SAFFRON, "Preventive Insight",
     "Identification of high-risk individuals through Ayurvedic Nidana before "
     "stone formation — enabling Nidana Parivarjana-based prevention."),
]

y0 = Inches(1.35)
for i, (color, heading, detail) in enumerate(outcomes):
    y = y0 + i * Inches(1.25)
    add_rect(s, Inches(0.35), y, Inches(0.1), Inches(0.9), color)
    add_rect(s, Inches(0.5), y, W - Inches(0.85), Inches(0.9),
             RGBColor(0xF0, 0xF7, 0xF7))
    add_textbox(s, Inches(0.65), y + Inches(0.05), Inches(3.5), Inches(0.3),
                heading, 13, bold=True, color=color)
    add_textbox(s, Inches(0.65), y + Inches(0.35), W - Inches(1.15), Inches(0.5),
                detail, 12, color=DARK_TEXT)

# Significance footer
add_rect(s, Inches(0.35), Inches(6.25), W - Inches(0.7), Inches(0.55), DARK_TEAL)
add_textbox(s, Inches(0.5), Inches(6.28), W - Inches(1.0), Inches(0.52),
            "This study will bridge Ayurvedic Srotas Siddhanta with evidence-based clinical medicine "
            "— contributing original, publishable data to Roganidan scholarship.",
            13, italic=True, color=WHITE, align=PP_ALIGN.CENTER, anchor=MSO_ANCHOR.MIDDLE)


# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 10 – References
# ─────────────────────────────────────────────────────────────────────────────
s = prs.slides.add_slide(blank)
cream_bg(s)
header_bar(s, "References")
bottom_strip(s)

refs = [
    "1. Charaka Samhita (Acharya YT Ed.) — Sutrasthana 21/9, 28/7; Sharirasthana 5/8.",
    "2. Ashtanga Hridayam (Srikantha Murthy Ed.) — Sutrasthana 11/13-14.",
    "3. Sushruta Samhita — Sutrasthana 15 (Meda Dhatu Chikitsa).",
    "4. Agnivesha (Dridhabala revised) — Vimana Sthana 5/16 (Srotodushti Hetu).",
    "5. Longo DL et al. Harrison's Principles of Internal Medicine, 21st Ed. — Cholelithiasis, Ch. 345.",
    "6. Friedman LS. Current Diagnosis & Treatment: Gastroenterology — Biliary Tract Disorders.",
    "7. Portincasa P et al. 'Cholesterol gallstone disease.' Lancet. 2006;368(9531):230-239.",
    "8. Shaffer EA. 'Gallstone disease: epidemiology of gallbladder stone disease.' Best Pract Res Clin Gastroenterol. 2006.",
    "9. Sharma PV. Dravyaguna Vijnana, Vol. II — Medaghna Dravyas.",
    "10. Yadavji Trikamji Acharya. Commentary on Charaka Samhita (Chakrapani). Reprint 2013.",
]

y0 = Inches(1.3)
for i, ref in enumerate(refs):
    y = y0 + i * Inches(0.48)
    clr = DARK_TEAL if i % 2 == 0 else MID_TEAL
    add_rect(s, Inches(0.35), y, Inches(0.06), Inches(0.36), clr)
    add_textbox(s, Inches(0.48), y, W - Inches(0.85), Inches(0.42),
                ref, 11, color=DARK_TEXT)


# ─────────────────────────────────────────────────────────────────────────────
# SLIDE 11 – Thank You / Closing
# ─────────────────────────────────────────────────────────────────────────────
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, W, H, DARK_TEAL)
add_rect(s, 0, 0, W, Inches(0.22), SAFFRON)
add_rect(s, 0, H - Inches(0.22), W, Inches(0.22), SAFFRON)

add_textbox(s, Inches(1), Inches(1.5), Inches(11.3), Inches(1.0),
            "Thank You", 54, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

add_rect(s, Inches(3.5), Inches(2.7), Inches(6.3), Inches(0.06), SAFFRON)

add_textbox(s, Inches(1), Inches(2.95), Inches(11.3), Inches(0.6),
            '"सर्वे भवन्तु सुखिनः  |  सर्वे सन्तु निरामयाः"',
            18, italic=True, color=LIGHT_GOLD, align=PP_ALIGN.CENTER)

add_textbox(s, Inches(1), Inches(3.75), Inches(11.3), Inches(0.5),
            "I request the Honourable Scientific Committee for approval of this synopsis.",
            15, italic=True, color=RGBColor(0xDD, 0xDD, 0xDD), align=PP_ALIGN.CENTER)

add_textbox(s, Inches(1), Inches(4.55), Inches(11.3), Inches(0.5),
            "Open to all queries, suggestions, and guidance from the panel.",
            13, color=RGBColor(0xAA, 0xAA, 0xAA), align=PP_ALIGN.CENTER)

# Guide/Scholar block
add_rect(s, Inches(3.8), Inches(5.3), Inches(5.73), Inches(0.04), MID_TEAL)
add_textbox(s, Inches(1), Inches(5.5), Inches(11.3), Inches(0.38),
            "[Your Name]  |  PG Scholar, 1st Year  |  Roganidan Department  |  [Institute Name]",
            12, color=LIGHT_GOLD, align=PP_ALIGN.CENTER)


# ─────────────────────────────────────────────────────────────────────────────
# SAVE
# ─────────────────────────────────────────────────────────────────────────────
out_path = "/tmp/workspace/roganidan-synopsis/Medovah_Srotodushti_Cholelithiasis_Synopsis.pptx"
prs.save(out_path)
print(f"Saved: {out_path}")
print(f"Slides: {len(prs.slides)}")

from pptx import Presentation
from pptx.util import Inches, Pt
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from lxml import etree
from pptx.oxml.ns import qn

# ── Palette ───────────────────────────────────────────────────────────────────
SAFFRON    = RGBColor(0xD4, 0x6A, 0x00)
DARK_TEAL  = RGBColor(0x1A, 0x4A, 0x4A)
CREAM      = RGBColor(0xFD, 0xF6, 0xE3)
DARK_TEXT  = RGBColor(0x1C, 0x1C, 0x1C)
WHITE      = RGBColor(0xFF, 0xFF, 0xFF)
LIGHT_GOLD = RGBColor(0xF5, 0xC5, 0x18)
MID_TEAL   = RGBColor(0x2E, 0x7D, 0x7D)
ACCENT_RED = RGBColor(0xB5, 0x2B, 0x2B)
PALE_TEAL  = RGBColor(0xE8, 0xF4, 0xF4)
PALE_SAFFRON = RGBColor(0xFD, 0xF0, 0xDE)

W = Inches(13.333)
H = Inches(7.5)

# ─── helpers ──────────────────────────────────────────────────────────────────
def add_rect(slide, x, y, w, h, fill_rgb):
    shape = slide.shapes.add_shape(1, x, y, w, h)
    shape.line.fill.background()
    shape.line.color.rgb = fill_rgb
    shape.fill.solid()
    shape.fill.fore_color.rgb = fill_rgb
    return shape

def tb(slide, x, y, w, h, text, size, bold=False, italic=False,
       color=DARK_TEXT, align=PP_ALIGN.LEFT, anchor=MSO_ANCHOR.TOP, wrap=True):
    box = slide.shapes.add_textbox(x, y, w, h)
    tf  = box.text_frame
    tf.word_wrap = wrap
    tf.vertical_anchor = anchor
    tf.margin_left = tf.margin_right = tf.margin_top = tf.margin_bottom = 0
    p   = tf.paragraphs[0]
    p.alignment = align
    r   = p.add_run()
    r.text = text
    r.font.size  = Pt(size)
    r.font.bold  = bold
    r.font.italic = italic
    r.font.color.rgb = color
    r.font.name  = "Calibri"
    return box

def add_para(tf, text, size, bold=False, italic=False, color=DARK_TEXT,
             align=PP_ALIGN.LEFT, spacing=1.3):
    p = tf.add_paragraph()
    p.alignment = align
    pPr = p._p.get_or_add_pPr()
    lnSpc = etree.SubElement(pPr, qn('a:lnSpc'))
    spcPct = etree.SubElement(lnSpc, qn('a:spcPct'))
    spcPct.set('val', str(int(spacing * 100000)))
    r = p.add_run()
    r.text = text
    r.font.size = Pt(size)
    r.font.bold = bold
    r.font.italic = italic
    r.font.color.rgb = color
    r.font.name = "Calibri"
    return p

def header_bar(slide, title, sub=None):
    add_rect(slide, 0, 0, W, Inches(1.05), DARK_TEAL)
    tb(slide, Inches(0.3), Inches(0.1), Inches(11.5), Inches(0.65),
       title, 25, bold=True, color=WHITE, align=PP_ALIGN.LEFT, anchor=MSO_ANCHOR.MIDDLE)
    if sub:
        tb(slide, Inches(0.3), Inches(0.72), Inches(11.5), Inches(0.3),
           sub, 12, italic=True, color=LIGHT_GOLD)

def cream_bg(slide):
    add_rect(slide, 0, 0, W, H, CREAM)

def footer(slide, txt="Roganidan Department | PG Synopsis | 2026"):
    add_rect(slide, 0, H - Inches(0.3), W, Inches(0.3), DARK_TEAL)
    tb(slide, Inches(0.3), H - Inches(0.3), Inches(12), Inches(0.3),
       txt, 9, color=LIGHT_GOLD, anchor=MSO_ANCHOR.MIDDLE)

def ref_tag(slide, x, y, text):
    """Small superscript-style reference label"""
    tb(slide, x, y, Inches(3.5), Inches(0.22), text, 8.5, italic=True,
       color=MID_TEAL, align=PP_ALIGN.LEFT)

def bullet_section(slide, x, y, w, h, items):
    """items = list of (bullet_text, ref_text, is_heading)"""
    box = slide.shapes.add_textbox(x, y, w, h)
    tf  = box.text_frame
    tf.word_wrap = True
    tf.margin_left = tf.margin_right = tf.margin_top = tf.margin_bottom = 0
    first = True
    for (text, ref, is_heading) in items:
        if first:
            p = tf.paragraphs[0]; first = False
        else:
            p = tf.add_paragraph()
        pPr = p._p.get_or_add_pPr()
        lnSpc = etree.SubElement(pPr, qn('a:lnSpc'))
        spcPct = etree.SubElement(lnSpc, qn('a:spcPct'))
        spcPct.set('val', str(int(1.25 * 100000)))
        p.alignment = PP_ALIGN.LEFT
        r = p.add_run()
        r.text = text
        r.font.size  = Pt(10) if not is_heading else Pt(12)
        r.font.bold  = is_heading
        r.font.color.rgb = DARK_TEAL if is_heading else DARK_TEXT
        r.font.name  = "Calibri"
        if ref:
            r2 = p.add_run()
            r2.text = f"  [{ref}]"
            r2.font.size = Pt(8)
            r2.font.italic = True
            r2.font.color.rgb = MID_TEAL
            r2.font.name = "Calibri"
    return box

# ─────────────────────────────────────────────────────────────────────────────
# Load existing PPT and replace slide 2 (index 1) with 3 new Introduction slides
# ─────────────────────────────────────────────────────────────────────────────
# We'll build the 3 intro slides as a fresh mini-pptx, then show them separately.
# For simplicity we generate a standalone pptx with just the intro slides
# (user can copy-paste into the main deck via PPT's "Reuse Slides" feature)

prs = Presentation()
prs.slide_width  = W
prs.slide_height = H
blank = prs.slide_layouts[6]

# =============================================================================
# INTRO SLIDE A: Ayurvedic View — Medovah Srotas
# =============================================================================
s = prs.slides.add_slide(blank)
cream_bg(s)
header_bar(s, "Introduction — Ayurvedic View",
           "Medovah Srotas: Classical Conceptual Framework")
footer(s)

# Left side label bar
add_rect(s, 0, Inches(1.05), Inches(0.18), H - Inches(1.35), SAFFRON)

# ── CARD 1: Srotas Definition ──────────────────────────────────────────────
yc = Inches(1.2)
add_rect(s, Inches(0.28), yc, Inches(12.7), Inches(0.38), MID_TEAL)
tb(s, Inches(0.38), yc + Inches(0.04), Inches(12.5), Inches(0.3),
   "1.  Srotas — Definition & Concept", 12, bold=True, color=WHITE)

add_rect(s, Inches(0.28), yc + Inches(0.38), Inches(12.7), Inches(0.68), PALE_TEAL)

items_1 = [
    ("• Srotas are channels / pathways that carry dhatus, doshas, malas and rasa throughout the body.",
     "C.Vi.5/3", False),
    ("• \"Srotansi khalu sharire antatah parinaham gacchanti\" — they pervade the entire body.",
     "C.Vi.5/4", False),
    ("• Srotas are functional units of metabolism — not merely anatomical tubes.",
     "C.Vi.5/5", False),
]
bullet_section(s, Inches(0.4), yc + Inches(0.42), Inches(12.4), Inches(0.62), items_1)

# ── CARD 2: Medovah Srotas ────────────────────────────────────────────────
yc = Inches(2.38)
add_rect(s, Inches(0.28), yc, Inches(12.7), Inches(0.38), SAFFRON)
tb(s, Inches(0.38), yc + Inches(0.04), Inches(12.5), Inches(0.3),
   "2.  Medovah Srotas — Identity", 12, bold=True, color=WHITE)

add_rect(s, Inches(0.28), yc + Inches(0.38), Inches(12.7), Inches(0.72), PALE_SAFFRON)
items_2 = [
    ("• \"Medovahaanam srotasam vrikko mulam vapavahanancha\" — Moola: Kidneys (Vrikka) + Omentum (Vapavahana).",
     "C.Sha.5/8", False),
    ("• Carries and nourishes Meda Dhatu — lipid / adipose tissue, the 4th Dhatu in Sapta Dhatu Poshana Krama.",
     "C.Ci.15/17", False),
    ("• Meda Dhatu function: Sneha (lubrication), Dridhatva (structural support), Sveda (sweating), Asthipushti (bone nourishment).",
     "A.H.Su.11/5", False),
]
bullet_section(s, Inches(0.4), yc + Inches(0.42), Inches(12.4), Inches(0.68), items_2)

# ── CARD 3: Dushti Hetu ───────────────────────────────────────────────────
yc = Inches(3.28)
add_rect(s, Inches(0.28), yc, Inches(6.2), Inches(0.38), DARK_TEAL)
tb(s, Inches(0.38), yc + Inches(0.04), Inches(6.0), Inches(0.3),
   "3.  Dushti Hetu (Causative Factors)", 12, bold=True, color=WHITE)

add_rect(s, Inches(0.28), yc + Inches(0.38), Inches(6.2), Inches(1.22), PALE_TEAL)
items_3 = [
    ("• Asyasukha — excessive comfort, sedentary habits",     "C.Su.21/4", False),
    ("• Divasvapna — day sleep",                              "C.Su.21/4", False),
    ("• Atisnigdha, Atimadhu, Atiguruahara — high-fat, sweet, heavy diet", "C.Su.21/4", False),
    ("• Avyayama — lack of physical exercise",                "A.H.Su.13/25", False),
    ("• Beeja Dosha — genetic / hereditary predisposition",   "C.Vi.5/16", False),
]
bullet_section(s, Inches(0.4), yc + Inches(0.42), Inches(6.0), Inches(1.15), items_3)

# ── CARD 4: Dushti Lakshana ────────────────────────────────────────────────
add_rect(s, Inches(6.75), yc, Inches(6.23), Inches(0.38), DARK_TEAL)
tb(s, Inches(6.85), yc + Inches(0.04), Inches(6.0), Inches(0.3),
   "4.  Dushti Lakshana (Clinical Features)", 12, bold=True, color=WHITE)

add_rect(s, Inches(6.75), yc + Inches(0.38), Inches(6.23), Inches(1.22), PALE_TEAL)
items_4 = [
    ("• Sthaulya (obesity) — excessive corpulence",           "C.Su.21/9", False),
    ("• Atisveda — profuse perspiration",                     "C.Su.21/9", False),
    ("• Daurbalya — weakness, fatiguability",                 "C.Su.21/9", False),
    ("• Alpa-prana — reduced vitality / stamina",             "C.Su.21/9", False),
    ("• Kshudha / Pipasa Adhikya — polyphagia / polydipsia",  "C.Su.21/9", False),
    ("• Chala-sphik, Chala-udara — pendulous flanks, abdomen","C.Su.21/9", False),
]
bullet_section(s, Inches(6.87), yc + Inches(0.42), Inches(6.0), Inches(1.15), items_4)

# ── CARD 5: Samprapti ─────────────────────────────────────────────────────
yc = Inches(4.92)
add_rect(s, Inches(0.28), yc, Inches(12.7), Inches(0.38), MID_TEAL)
tb(s, Inches(0.38), yc + Inches(0.04), Inches(12.5), Inches(0.3),
   "5.  Samprapti (Pathogenesis) of Medovah Srotodushti", 12, bold=True, color=WHITE)

add_rect(s, Inches(0.28), yc + Inches(0.38), Inches(12.7), Inches(0.62), PALE_TEAL)

# Flow chart text (simple inline)
flow = ("Nidana (Hetu) → Kapha-Meda Vriddhi → Agni Mandya → Srotovarodha (Srotorodha) → "
        "Meda Dhatu Prasara obstruction → Dushti Lakshanas manifest → "
        "If unresolved → Medoroga / Prameha / Further Upadrava")
tb(s, Inches(0.4), yc + Inches(0.42), Inches(12.4), Inches(0.55),
   flow, 11, italic=True, color=DARK_TEAL)


# =============================================================================
# INTRO SLIDE B: Modern View — Cholelithiasis
# =============================================================================
s = prs.slides.add_slide(blank)
cream_bg(s)
header_bar(s, "Introduction — Modern View",
           "Cholelithiasis: Epidemiology, Pathogenesis & Risk Factors")
footer(s)

add_rect(s, 0, Inches(1.05), Inches(0.18), H - Inches(1.35), ACCENT_RED)

# ── CARD 1: Definition & Epidemiology ─────────────────────────────────────
yc = Inches(1.2)
add_rect(s, Inches(0.28), yc, Inches(12.7), Inches(0.38), ACCENT_RED)
tb(s, Inches(0.38), yc + Inches(0.04), Inches(12.5), Inches(0.3),
   "1.  Definition & Epidemiology", 12, bold=True, color=WHITE)

add_rect(s, Inches(0.28), yc + Inches(0.38), Inches(12.7), Inches(0.72), RGBColor(0xFD, 0xF0, 0xF0))
items_e1 = [
    ("• Cholelithiasis = presence of calculi (stones) in the gallbladder.",
     "Robbins Pathology, Ch. Gallbladder", False),
    ("• Prevalence: 10–15% in Western adults; rising in India due to urbanisation and dietary change.",
     "Clinical GI Endoscopy 3e, Ch.53", False),
    ("• >80% are cholesterol stones; remainder are pigment stones (bilirubin + calcium).",
     "Robbins Pathology, p.636", False),
]
bullet_section(s, Inches(0.4), yc + Inches(0.42), Inches(12.4), Inches(0.68), items_e1)

# ── CARD 2: Pathogenesis ──────────────────────────────────────────────────
yc = Inches(2.38)
add_rect(s, Inches(0.28), yc, Inches(12.7), Inches(0.38), RGBColor(0x8B, 0x22, 0x22))
tb(s, Inches(0.38), yc + Inches(0.04), Inches(12.5), Inches(0.3),
   "2.  Pathogenesis of Cholesterol Gallstones", 12, bold=True, color=WHITE)

add_rect(s, Inches(0.28), yc + Inches(0.38), Inches(12.7), Inches(0.72), RGBColor(0xFD, 0xF0, 0xF0))

# Three-step pathogenesis flow
flow_items = [
    ("Step 1 → Supersaturation of bile with cholesterol (↑ hepatic cholesterol secretion / ↓ bile salts)",
     "Yamada's Gastroenterology 7e", False),
    ("Step 2 → Nucleation: cholesterol monohydrate crystals form in bile; accelerated by nucleating proteins.",
     "Yamada's Gastroenterology 7e", False),
    ("Step 3 → Gallbladder dysmotility / stasis → crystal accumulation → stone formation.",
     "Yamada's Gastroenterology 7e", False),
]
bullet_section(s, Inches(0.4), yc + Inches(0.42), Inches(12.4), Inches(0.68), flow_items)

# ── CARD 3: Risk Factors ──────────────────────────────────────────────────
yc = Inches(3.28)
add_rect(s, Inches(0.28), yc, Inches(6.2), Inches(0.38), ACCENT_RED)
tb(s, Inches(0.38), yc + Inches(0.04), Inches(6.0), Inches(0.3),
   "3.  Modifiable Risk Factors", 12, bold=True, color=WHITE)

add_rect(s, Inches(0.28), yc + Inches(0.38), Inches(6.2), Inches(1.22), RGBColor(0xFD, 0xF0, 0xF0))
items_rf1 = [
    ("• Obesity (BMI >30) — strongest modifiable risk factor",         "Clinical GI Endoscopy 3e, Ch.53", False),
    ("• Sedentary lifestyle — reduced gallbladder motility",           "Clinical GI Endoscopy 3e, Ch.53", False),
    ("• High-fat, high-cholesterol diet; rapid weight loss",           "Clinical GI Endoscopy 3e, Ch.53", False),
    ("• Dyslipidaemia — elevated LDL / triglycerides",                 "Clinical GI Endoscopy 3e, Ch.53", False),
    ("• Insulin resistance / Metabolic Syndrome",                      "Sleisenger & Fordtran, 11e", False),
]
bullet_section(s, Inches(0.4), yc + Inches(0.42), Inches(6.0), Inches(1.15), items_rf1)

add_rect(s, Inches(6.75), yc, Inches(6.23), Inches(0.38), ACCENT_RED)
tb(s, Inches(6.85), yc + Inches(0.04), Inches(6.0), Inches(0.3),
   "4.  Non-Modifiable Risk Factors", 12, bold=True, color=WHITE)

add_rect(s, Inches(6.75), yc + Inches(0.38), Inches(6.23), Inches(1.22), RGBColor(0xFD, 0xF0, 0xF0))
items_rf2 = [
    ("• Age >40 years",                                                "Robbins Pathology, p.636", False),
    ("• Female sex / estrogen (4F rule: Fat, Female, Fertile, Forty)", "Robbins Pathology, p.636", False),
    ("• Genetics — LITH gene loci; family history",                    "Sleisenger & Fordtran, 11e", False),
    ("• Ethnicity (Pima Indians, Hispanic population)",                "Sleisenger & Fordtran, 11e", False),
    ("• Haemolytic disease — pigment stones",                          "Clinical GI Endoscopy 3e, Ch.53", False),
]
bullet_section(s, Inches(6.87), yc + Inches(0.42), Inches(6.0), Inches(1.15), items_rf2)

# ── CARD 5: Diagnosis ──────────────────────────────────────────────────────
yc = Inches(4.92)
add_rect(s, Inches(0.28), yc, Inches(12.7), Inches(0.38), RGBColor(0x8B, 0x22, 0x22))
tb(s, Inches(0.38), yc + Inches(0.04), Inches(12.5), Inches(0.3),
   "5.  Diagnosis & Clinical Features", 12, bold=True, color=WHITE)

add_rect(s, Inches(0.28), yc + Inches(0.38), Inches(12.7), Inches(0.62), RGBColor(0xFD, 0xF0, 0xF0))
items_dx = [
    ("• USG abdomen: gold standard — sensitivity >95% for gallstones ≥2 mm.",
     "Yamada's Gastroenterology 7e", False),
    ("• Most patients (70%) are asymptomatic; symptoms: RUQ biliary colic, nausea, fatty food intolerance.",
     "Clinical GI Endoscopy 3e, Ch.53", False),
    ("• Complications: acute cholecystitis, choledocholithiasis, cholangitis, pancreatitis, Mirizzi syndrome.",
     "Sleisenger & Fordtran, 11e", False),
]
bullet_section(s, Inches(0.4), yc + Inches(0.42), Inches(12.4), Inches(0.55), items_dx)


# =============================================================================
# INTRO SLIDE C: Relationship — Ayurveda <-> Modern (The Conceptual Bridge)
# =============================================================================
s = prs.slides.add_slide(blank)
cream_bg(s)
header_bar(s, "Introduction — Relationship Between Medovah Srotodushti & Cholelithiasis",
           "Conceptual Bridge: Ayurveda ↔ Modern Medicine")
footer(s)

add_rect(s, 0, Inches(1.05), Inches(0.18), H - Inches(1.35), LIGHT_GOLD)

# ── COMPARISON TABLE ──────────────────────────────────────────────────────
col_headers = ["Ayurvedic Concept", "Modern Equivalent", "Common Ground"]
col_xs   = [Inches(0.28), Inches(4.7), Inches(9.1)]
col_widths = [Inches(4.35), Inches(4.35), Inches(4.0)]

yh = Inches(1.2)
for hdr, cx, cw in zip(col_headers, col_xs, col_widths):
    add_rect(s, cx, yh, cw - Inches(0.05), Inches(0.4), DARK_TEAL)
    tb(s, cx + Inches(0.08), yh + Inches(0.04), cw - Inches(0.2), Inches(0.32),
       hdr, 12, bold=True, color=WHITE, align=PP_ALIGN.CENTER, anchor=MSO_ANCHOR.MIDDLE)

rows = [
    ("Atisnigdha / Guru Ahara\n(C.Su.21/4)",
     "High-fat, high-cholesterol diet\n(Clinical GI Endoscopy 3e)",
     "Dietary excess of fat → Meda Vriddhi / cholesterol supersaturation in bile"),

    ("Avyayama + Asyasukha\n(C.Su.21/4)",
     "Sedentary lifestyle\n(Clinical GI Endoscopy 3e)",
     "Physical inactivity → Kapha-Meda Sanchaya / gallbladder dysmotility"),

    ("Sthaulya (Obesity)\n(C.Su.21/9)",
     "Obesity — strongest risk factor\n(Robbins Pathology, p.636)",
     "Central obesity = shared phenotype for Medovah Srotodushti & cholelithiasis"),

    ("Medovriddhi → Kapha Prakopa\n(A.H.Ni.12)",
     "Dyslipidaemia / Metabolic Syndrome\n(Sleisenger & Fordtran)",
     "Elevated Meda (triglycerides, LDL) disrupts both Srotas function & bile chemistry"),

    ("Srotovarodha in Vapavahana\n(C.Sha.5/8)",
     "Omental / visceral fat accumulation → Gallbladder stasis\n(Yamada's GE 7e)",
     "Vapavahana (omentum) as Mula = anatomical neighbour of the gallbladder"),
]

row_bg = [PALE_TEAL, PALE_SAFFRON, PALE_TEAL, PALE_SAFFRON, PALE_TEAL]
yr = yh + Inches(0.4)
for i, (ay, mod, com) in enumerate(rows):
    rh = Inches(0.82)
    bg = row_bg[i]
    for j, (cell_text, cx, cw) in enumerate(zip([ay, mod, com], col_xs, col_widths)):
        add_rect(s, cx, yr, cw - Inches(0.05), rh, bg)
        box = slide = s.shapes.add_textbox(cx + Inches(0.07), yr + Inches(0.05),
                                           cw - Inches(0.18), rh - Inches(0.1))
        tf_c = box.text_frame; tf_c.word_wrap = True
        tf_c.margin_left = tf_c.margin_right = tf_c.margin_top = tf_c.margin_bottom = 0
        lines = cell_text.split('\n')
        first = True
        for line in lines:
            if first:
                p = tf_c.paragraphs[0]; first = False
            else:
                p = tf_c.add_paragraph()
            r = p.add_run()
            r.text = line
            r.font.size = Pt(9.5)
            r.font.color.rgb = DARK_TEXT if j < 2 else DARK_TEAL
            r.font.bold = False
            r.font.italic = (j < 2 and '\n' in cell_text and line.startswith('('))
            r.font.name = "Calibri"
    yr += rh + Inches(0.04)

# ── KEY MESSAGE BOX ──────────────────────────────────────────────────────
add_rect(s, Inches(0.28), Inches(6.12), Inches(12.7), Inches(0.68), DARK_TEAL)
tb(s, Inches(0.38), Inches(6.13), Inches(12.5), Inches(0.66),
   "KEY HYPOTHESIS:  The common Hetu of Medovah Srotodushti "
   "(Guru Ahara, Avyayama, Divasvapna) directly maps to the modifiable risk "
   "factors of cholelithiasis — suggesting that Medovah Srotas Dushti Lakshanas "
   "will be clinically demonstrable and quantifiable in cholelithiasis patients.",
   12, italic=True, color=WHITE, align=PP_ALIGN.LEFT, anchor=MSO_ANCHOR.MIDDLE)


# =============================================================================
# SAVE
# =============================================================================
out = "/tmp/workspace/roganidan-synopsis/Introduction_Slides_3panel.pptx"
prs.save(out)
print("Saved:", out)
print("Slides:", len(prs.slides))

from docx import Document
from docx.shared import Pt, Inches, RGBColor
from docx.enum.text import WD_ALIGN_PARAGRAPH
from docx.oxml.ns import qn
from docx.oxml import OxmlElement
from docx.shared import Cm

doc = Document()

# ── Page margins ──────────────────────────────────────────────────────────────
section = doc.sections[0]
section.top_margin    = Inches(1.0)
section.bottom_margin = Inches(1.0)
section.left_margin   = Inches(1.25)
section.right_margin  = Inches(1.0)

# ── Default style ─────────────────────────────────────────────────────────────
style = doc.styles['Normal']
style.font.name = 'Times New Roman'
style.font.size = Pt(12)

# ── Helper functions ─────────────────────────────────────────────────────────

def heading(text, level=1, center=False, underline=False, size=None):
    p = doc.add_paragraph()
    p.alignment = WD_ALIGN_PARAGRAPH.CENTER if center else WD_ALIGN_PARAGRAPH.LEFT
    run = p.add_run(text)
    run.bold = True
    run.underline = underline
    run.font.name = 'Times New Roman'
    run.font.size = Pt(size if size else (16 if level == 1 else 14 if level == 2 else 12))
    return p

def normal(text, bold=False, italic=False, indent=False, center=False, size=12):
    p = doc.add_paragraph()
    if indent:
        p.paragraph_format.left_indent = Inches(0.3)
    p.alignment = WD_ALIGN_PARAGRAPH.CENTER if center else WD_ALIGN_PARAGRAPH.JUSTIFY
    run = p.add_run(text)
    run.bold = bold
    run.italic = italic
    run.font.name = 'Times New Roman'
    run.font.size = Pt(size)
    return p

def bullet(text, bold_prefix=None, size=12):
    p = doc.add_paragraph(style='List Bullet')
    p.paragraph_format.left_indent = Inches(0.3)
    p.alignment = WD_ALIGN_PARAGRAPH.JUSTIFY
    if bold_prefix:
        r1 = p.add_run(bold_prefix + " ")
        r1.bold = True
        r1.font.name = 'Times New Roman'
        r1.font.size = Pt(size)
    r2 = p.add_run(text)
    r2.font.name = 'Times New Roman'
    r2.font.size = Pt(size)
    return p

def numbered(num, text, bold_prefix=None, size=12):
    p = doc.add_paragraph()
    p.paragraph_format.left_indent = Inches(0.3)
    p.alignment = WD_ALIGN_PARAGRAPH.JUSTIFY
    r0 = p.add_run(f"{num}. ")
    r0.bold = True
    r0.font.name = 'Times New Roman'
    r0.font.size = Pt(size)
    if bold_prefix:
        r1 = p.add_run(bold_prefix + ": ")
        r1.bold = True
        r1.font.name = 'Times New Roman'
        r1.font.size = Pt(size)
    r2 = p.add_run(text)
    r2.font.name = 'Times New Roman'
    r2.font.size = Pt(size)
    return p

def section_heading(text):
    p = doc.add_paragraph()
    p.alignment = WD_ALIGN_PARAGRAPH.LEFT
    run = p.add_run(text)
    run.bold = True
    run.underline = True
    run.font.name = 'Times New Roman'
    run.font.size = Pt(13)
    p.paragraph_format.space_before = Pt(10)
    p.paragraph_format.space_after  = Pt(4)
    return p

def sub_heading(text):
    p = doc.add_paragraph()
    p.alignment = WD_ALIGN_PARAGRAPH.LEFT
    run = p.add_run(text)
    run.bold = True
    run.font.name = 'Times New Roman'
    run.font.size = Pt(12)
    p.paragraph_format.space_before = Pt(6)
    return p

def spacer():
    doc.add_paragraph()

def hline():
    p = doc.add_paragraph()
    pPr = p._p.get_or_add_pPr()
    pBdr = OxmlElement('w:pBdr')
    bottom = OxmlElement('w:bottom')
    bottom.set(qn('w:val'), 'single')
    bottom.set(qn('w:sz'), '6')
    bottom.set(qn('w:space'), '1')
    bottom.set(qn('w:color'), '000000')
    pBdr.append(bottom)
    pPr.append(pBdr)
    return p

# =============================================================================
# TITLE PAGE
# =============================================================================

spacer()
heading("SYNOPSIS", level=1, center=True, size=16)
spacer()

normal("Title of Study:", bold=True, center=False)
heading(
    "A Clinical Observational Study of Medovah Srotodushti Lakshana in "
    "Patients of Cholelithiasis (Gallstone Disease)",
    level=1, center=True, underline=False, size=14
)
spacer()

normal("[Name of Your Ayurvedic College & University]", bold=True, center=True, size=13)
normal("Faculty of Ayurveda", bold=False, center=True)
spacer()

normal(
    "Synopsis submitted as partial fulfillment for the degree of",
    center=True
)
normal("Ayurveda Vachaspati (MD Ayurveda)", bold=True, center=True)
normal("Speciality – Roganidana - Vikritivijnana", bold=True, center=True)
spacer()

normal("Scholar", bold=True, center=True)
normal("[Your Full Name]", center=True)
spacer()

normal("Under the supervision of", center=True)
normal("Guide", bold=True, center=True)
normal("Dr. _________________, MD (Ayu.)", center=True)
normal("Associate Professor", center=True)
normal("Department of Roganidana - Vikritivijnana", center=True)
normal("[Name of Ayurvedic College]", center=True)
normal("[City, State - PIN]", center=True)
spacer()

doc.add_page_break()

# =============================================================================
# INTRODUCTION
# =============================================================================
section_heading("Introduction")

normal(
    "According to Ayurveda, the human body is a system of interconnected channels called Srotas, "
    "which carry and transform Dhatus, Doshas, Malas, and Rasa throughout the body. "
    "Acharya Charaka defines them as channels pervading the entire body — "
    '"Srotansi khalu sharire antatah parinaham gacchanti" (C.Vi.5/4). '
    "Among the thirteen Srotases described, Medovah Srotas is the channel responsible for "
    "carrying and nourishing Meda Dhatu — the adipose or lipid tissue, "
    "which is the 4th Dhatu in the Sapta Dhatu Poshana Krama."
)

normal(
    "Acharya Charaka clearly identifies the Moola (root origin) of Medovah Srotas as — "
    '"Medovahaanam srotasam vrikko mulam vapavahanancha" (C.Sha.5/8), '
    "i.e., the Vrikka (kidneys) and the Vapavahana (omentum / mesenteric fat). "
    "The Dushti Hetu (causative factors) of Medovah Srotas include "
    "Asyasukha (sedentary habits), Divasvapna (day sleep), Atisnigdha and Atiguruahara "
    "(high-fat, heavy diet), and Avyayama (lack of exercise) (C.Su.21/4). "
    "The resulting Dushti Lakshanas include Sthaulya (obesity), Atisveda (profuse sweating), "
    "Daurbalya (weakness), Alpa-prana (reduced vitality), Kshudha-adhikya (increased appetite), "
    "Pipasa-adhikya (increased thirst), and Chala-sphik / Chala-udara (pendulous flanks/abdomen) (C.Su.21/9)."
)

normal(
    "Cholelithiasis (gallstone disease) is the presence of calculi within the gallbladder. "
    "It is one of the most common gastrointestinal conditions worldwide, affecting 10–15% of adults. "
    "More than 80% of gallstones are cholesterol stones caused by bile cholesterol supersaturation, "
    "gallbladder dysmotility, and cholesterol crystal nucleation. "
    "The strongest modifiable risk factors for cholelithiasis are "
    "obesity, sedentary lifestyle, high-fat diet, and dyslipidaemia — "
    "precisely the same Hetu that Ayurveda identifies for Medovah Srotodushti. "
    "Ultrasonography of the abdomen is the gold standard diagnostic investigation, "
    "with sensitivity >95% for gallstones."
)

normal(
    "A careful comparative analysis reveals a striking convergence at the level of causation, "
    "anatomical territory, and metabolic substrate between Medovah Srotodushti and cholelithiasis. "
    "The Vapavahana (omentum) — identified as the Moola of Medovah Srotas — "
    "is anatomically contiguous with the gallbladder and pericholecystic fat, "
    "the same visceral adipose depot implicated in gallbladder dysmotility and bile supersaturation. "
    "Despite this clear conceptual convergence, no published study has specifically examined "
    "or quantified the Medovah Srotodushti Lakshanas in a clinically confirmed cohort of "
    "cholelithiasis patients. This gap forms the rationale for the present study."
)

spacer()

# =============================================================================
# REVIEW OF PREVIOUS RESEARCH WORKS
# =============================================================================
section_heading("Review of Previous Research Works")

sub_heading("A. Ayurvedic Literature")

bullet(
    "Acharya Charaka (C.Su.21/9) enumerates eight Medovah Srotodushti Lakshanas: "
    "Sthaulya, Atisveda, Daurbalya, Alpa-prana, Kshudha-adhikya, Pipasa-adhikya, "
    "Chala-sphik, and Chala-udara. These form the primary observational criteria for this study."
)
bullet(
    "Acharya Vagbhata (A.H.Ni.12) describes Medoroga arising from Guru Snigdha Ahara, "
    "Avyayama, and Divasvapna — the same Hetu as cholelithiasis risk factors."
)
bullet(
    "Smita Dutta Paul and Dr. A.K. Jain (J Pharmacognosy Phytochem, 2022;11(5)) "
    "conducted a pathophysiological review of Medovaha Srotas and concluded that "
    "Medovah Srotodushti manifests as Sthaulya (obesity) and Prameha-Poorvaroopa (pre-diabetes), "
    "correlated with visceral adiposity, metabolic syndrome, and arteriosclerosis."
)
bullet(
    "Londhe P.D. (IJAM, 2016;7(1):6-9) reviewed Ayurvedic texts and proposed that "
    "cholelithiasis can be understood as Pittashmari (stone in Pittashaya) with "
    "Kapha-Pitta Dushti as the predominant Samprapti. "
    "The causative factors mapped directly to high-fat diet and metabolic imbalance."
)
bullet(
    "Case reports of Ayurvedic management of Pittashmari have been published in "
    "AYUSHDHARA (2023) and IJAPR (2022), documenting stone dissolution with "
    "Ayurvedic treatment protocols in individual patients, confirming clinical feasibility."
)

sub_heading("B. Modern Literature")

bullet(
    "Lyu J. et al. (Front Endocrinol, 2022; PMID: 36506064) — Meta-analysis of 7 studies "
    "confirmed that gallstone disease patients have 45% higher risk of metabolic syndrome "
    "(OR: 1.45, 95% CI: 1.23-1.67) and that BMI shows a linear dose-response relationship "
    "with gallstone incidence (OR: 1.02 per unit BMI). "
    "The authors concluded that weight control is the principal preventive strategy for gallstone disease."
)
bullet(
    "Han X. et al. (PLoS ONE, 2024; PMID: 39052638) — Systematic review of 30 studies (2,313 participants) "
    "found that bile acid profiles are markedly altered in gallstone patients, with serum GCA, TCA, and "
    "GCDCA elevated — identifying potential early biomarkers. However, these require sophisticated "
    "laboratory equipment not available in routine clinical settings."
)
bullet(
    "Zheng H. et al. (BMC Gastroenterol, 2025; PMID: 40181266) — NHANES-based study (n=2,692) found that "
    "the Cardiometabolic Index (integrating TG:HDL ratio and waist-to-height ratio) is significantly "
    "associated with gallstone risk (OR: 1.90, 95% CI: 1.37-2.62), highlighting the need for a "
    "composite clinical metabolic risk marker in gallstone diagnosis."
)
bullet(
    "Robbins & Kumar Basic Pathology (11th Ed.) established that risk factors for cholesterol gallstones "
    "include obesity, female sex, advancing age, and heredity — the same profile as Medovah Srotodushti Hetu."
)
bullet(
    "Yamada's Textbook of Gastroenterology (7th Ed.) describes gallstone pathogenesis as a "
    "three-step process: bile supersaturation, nucleation, and gallbladder dysmotility — "
    "each driven by the same metabolic derangement Ayurveda terms Meda Dhatu Dushti."
)

sub_heading("C. Research Gap")

bullet(
    "No published study has systematically examined or quantified the Medovah Srotodushti "
    "Lakshanas in a USG-confirmed cholelithiasis cohort using a structured Ayurvedic scoring tool."
)
bullet(
    "Modern diagnosis is reactive — USG detects stones only after formation. "
    "No standardised bedside pre-lithogenic clinical scoring tool exists in routine practice."
)
bullet(
    "Emerging biomarker research (Han X., 2024; Zheng H., 2025) recognises the need for "
    "a composite metabolic risk marker for early gallstone detection but lacks a practical, "
    "cost-effective, field-applicable clinical solution."
)
bullet(
    "No validated Medovah Srotodushti Lakshana scoring scale has been published for "
    "any metabolic or biliary disease cohort in indexed Ayurvedic literature."
)

spacer()

# =============================================================================
# RELEVANCE OF PRESENT STUDY
# =============================================================================
section_heading("Relevance of Present Study")

normal(
    "Cholelithiasis shares its cardinal risk factors — high-fat diet, sedentary lifestyle, "
    "obesity, and metabolic derangement — with the classical Hetu of Medovah Srotodushti as "
    "described by Acharya Charaka. Despite this convergence, no systematic Roganidana study "
    "has documented the Medovah Srotodushti Lakshanas in cholelithiasis patients."
)
normal(
    "If Medovah Srotodushti Lakshanas are demonstrably present and correlatable in "
    "cholelithiasis patients, they can serve as early, non-invasive, cost-free clinical markers "
    "for pre-lithogenic metabolic risk — enabling Nidana Parivarjana-based prevention before "
    "stone formation. This study will generate the first clinical evidence base for "
    "this Ayurvedic diagnostic framework in biliary disease, bridging classical Srotas Siddhanta "
    "with evidence-based medicine."
)

spacer()

# =============================================================================
# NEED OF THE STUDY
# =============================================================================
section_heading("Need of the Study")

normal(
    "Cholelithiasis is a prevalent gastrointestinal condition with rising incidence in India "
    "due to dietary transition and sedentary lifestyles. Modern medicine diagnoses gallstones "
    "only after stone formation — with no validated pre-symptomatic clinical risk tool available "
    "at the bedside. Approximately 70% of patients are asymptomatic at diagnosis and are managed "
    "surgically once symptomatic, with no preventive intervention in the pre-stone phase."
)
normal(
    "Ayurveda provides a detailed clinical framework — Medovah Srotodushti Lakshanas — "
    "that represents the metabolic precursor state of gallstone disease. "
    "However, no clinical evidence currently exists correlating these Lakshanas with "
    "confirmed cholelithiasis. Establishing this association would:"
)
bullet("Fill a critical gap in Ayurvedic Roganidana scholarship.")
bullet("Provide a validated bedside clinical tool for early metabolic-biliary risk assessment.")
bullet("Enable preventive Ayurvedic intervention before gallstone formation occurs.")
bullet("Contribute original, publishable clinical data integrating Srotas Siddhanta with modern gastroenterology.")

spacer()

# =============================================================================
# RESEARCH QUESTION
# =============================================================================
section_heading("Research Question")
normal(
    "Are the classical Medovah Srotodushti Lakshanas clinically demonstrable and quantifiable "
    "in patients with USG-confirmed cholelithiasis, and do they correlate with the severity "
    "of gallstone disease and associated metabolic parameters?"
)

spacer()

# =============================================================================
# HYPOTHESIS
# =============================================================================
section_heading("Hypothesis")

sub_heading("Null Hypothesis (H\u2080):")
normal(
    "There is no significant presence of Medovah Srotodushti Lakshanas in patients "
    "with cholelithiasis above baseline clinical levels."
)

sub_heading("Alternate Hypothesis (H\u2081):")
normal(
    "Clinically significant Medovah Srotodushti Lakshanas are demonstrably present "
    "in cholelithiasis patients, and their severity positively correlates with "
    "the degree of gallstone disease on ultrasonographic parameters and metabolic markers."
)

spacer()

# =============================================================================
# AIMS AND OBJECTIVES
# =============================================================================
section_heading("Aims and Objectives")

sub_heading("Aim:")
normal(
    "To study the Medovah Srotodushti Lakshanas in patients of Cholelithiasis and "
    "to assess their prevalence, frequency, and severity."
)

sub_heading("Primary Objective:")
normal(
    "To observe and document the classical Medovah Srotodushti Lakshanas "
    "(Sthaulya, Atisveda, Daurbalya, Alpa-prana, Kshudha-adhikya, Pipasa-adhikya, "
    "Chala-sphik, Chala-udara) in USG-confirmed cholelithiasis patients using a "
    "validated scoring tool."
)

sub_heading("Secondary Objectives:")
numbered(1, "To assess the frequency and severity of each Medovah Srotodushti Lakshana "
             "individually using a standardised scoring scale (0–3).")
numbered(2, "To correlate Medovah Srotodushti Lakshana scores with modern metabolic parameters: "
             "BMI, waist circumference, lipid profile (Total Cholesterol, LDL, HDL, Triglycerides), "
             "and fasting blood sugar.")
numbered(3, "To correlate Lakshana scores with ultrasonographic parameters of cholelithiasis "
             "(stone size, stone number, gallbladder wall thickness).")
numbered(4, "To identify which Medovah Srotodushti Lakshanas are most predominant in "
             "cholelithiasis patients and assess their potential as early clinical diagnostic indicators.")

spacer()

# =============================================================================
# EXPECTED OUTCOME
# =============================================================================
section_heading("Expected Outcome")

sub_heading("Primary Outcome:")
normal("Documentation of the prevalence and severity of Medovah Srotodushti Lakshanas "
       "in USG-confirmed cholelithiasis patients.")

sub_heading("Secondary Outcomes:")
bullet("Frequency distribution of individual Medovah Srotodushti Lakshanas in the study cohort.")
bullet("Statistically significant correlation between Lakshana scoring and metabolic parameters "
       "(BMI, lipid profile, FBS, waist circumference).")
bullet("Correlation between Lakshana severity scores and USG parameters "
       "(stone burden, GB wall thickness).")
bullet("A validated Medovah Srotodushti Lakshana scoring sheet usable in clinical Ayurvedic practice.")

spacer()

# =============================================================================
# STUDY DESIGN
# =============================================================================
section_heading("Study Design")
normal("Observational, cross-sectional clinical study.")
normal("Duration of Study: 18 months from the date of IEC approval.")
normal("Setting: OPD and IPD, Department of Roganidana - Vikritivijnana, [Name of Institute].")
normal("Sample Size: 60 patients with USG-confirmed cholelithiasis.")
normal("Sample Size Justification: Calculated using n = Z² × P(1-P) / d² (prevalence-based formula); "
       "subject to revision based on IEC-approved protocol and power analysis.")

spacer()

# =============================================================================
# ETHICAL CONSIDERATIONS
# =============================================================================
section_heading("Ethical Considerations")
normal("IEC Approval: The clinical study will be commenced only after obtaining clearance "
       "from the Institutional Ethics Committee (IEC) of [Name of Institute].")
normal("Written Informed Consent: Written informed consent will be obtained from all "
       "participants prior to their enrollment in the study.")
normal("CTRI Registration: The study will be registered in the Clinical Trials Registry "
       "of India (CTRI) before commencement of data collection.")

spacer()

# =============================================================================
# SELECTION CRITERIA
# =============================================================================
section_heading("Selection Criteria of Patients")

sub_heading("Diagnostic Criteria:")
sub_heading("Modern Criteria:")
bullet("USG abdomen confirming presence of gallstone(s) in the gallbladder "
       "(single or multiple; any size ≥2 mm detectable on USG).")
bullet("Lipid profile, fasting blood sugar, and BMI recorded for all enrolled patients.")
bullet("LFT (Bilirubin, ALP, ALT, AST) to exclude choledocholithiasis and "
       "complicated biliary disease.")

sub_heading("Ayurvedic Criteria:")
bullet("Medovah Srotodushti Lakshana assessment using a structured scoring sheet "
       "(researcher-designed; validated by a panel of Roganidana faculty prior to data collection).")
bullet("Prakriti assessment using the AYU validated scale.")

spacer()

sub_heading("Inclusion Criteria:")
bullet("Age 20–60 years, either sex.")
bullet("USG abdomen confirming cholelithiasis (symptomatic or incidentally detected).")
bullet("Willing to participate and provide written informed consent.")
bullet("Ability to attend follow-up visits during the study duration.")
bullet("Not currently on hypolipidemic drugs, bariatric treatment, or Ayurvedic Shodhana therapy.")

sub_heading("Exclusion Criteria:")
bullet("Acute cholecystitis, cholangitis, or biliary pancreatitis requiring emergency management.")
bullet("Post-cholecystectomy patients.")
bullet("Known malignancy of biliary tract or gallbladder carcinoma.")
bullet("Pregnancy and lactation.")
bullet("Severe systemic illness: chronic kidney disease (CKD), cirrhosis, "
       "decompensated heart failure, malignancy.")
bullet("Age <20 or >60 years.")
bullet("Patients on long-term corticosteroids or immunosuppressant therapy.")
bullet("Patients with confirmed choledocholithiasis (CBD stones) on MRCP / ERCP.")
bullet("Individuals unwilling to provide informed consent.")

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# =============================================================================
# INVESTIGATIONS
# =============================================================================
section_heading("Investigations")

sub_heading("Modern Investigations:")
numbered(1, "Ultrasonography (USG) of Abdomen — Confirmatory diagnostic investigation "
             "(stone size, number, gallbladder wall thickness, CBD diameter).")
numbered(2, "Fasting Lipid Profile — Total Cholesterol, LDL, HDL, VLDL, Triglycerides.")
numbered(3, "Fasting Blood Sugar (FBS) and HbA1c.")
numbered(4, "Liver Function Tests (LFT) — Serum Bilirubin (total/direct), ALP, ALT, AST, GGT "
             "(to exclude choledocholithiasis and biliary obstruction).")
numbered(5, "Complete Blood Count (CBC).")
numbered(6, "Anthropometric Measurements — Height, Weight, BMI, Waist Circumference (WC), "
             "Waist-to-Hip Ratio (WHR), Waist-to-Height Ratio (WHtR).")

sub_heading("Ayurvedic Investigations:")
numbered(1, "Ashtavidha Pariksha (eightfold clinical examination): "
             "Nadi, Mutra, Mala, Jihwa, Shabda, Sparsha, Drik, Akriti.")
numbered(2, "Medovah Srotodushti Lakshana Scoring Sheet "
             "(0 = Absent, 1 = Mild, 2 = Moderate, 3 = Severe; Maximum Score = 24).")
numbered(3, "Prakriti Assessment (AYU scale).")
numbered(4, "Nidana (Hetu) documentation — dietary habits, sleep pattern, physical activity level.")

spacer()

# =============================================================================
# CRITERIA FOR ASSESSMENT
# =============================================================================
section_heading("Criteria for Assessment")

sub_heading("Medovah Srotodushti Lakshana Scoring Sheet:")

# Table
table = doc.add_table(rows=1, cols=4)
table.style = 'Table Grid'
hdr_cells = table.rows[0].cells
for cell, text in zip(hdr_cells, ['Lakshana', 'Classical Reference', 'Clinical Equivalent', 'Score (0-3)']):
    cell.text = text
    for run in cell.paragraphs[0].runs:
        run.bold = True
        run.font.name = 'Times New Roman'
        run.font.size = Pt(11)

rows_data = [
    ("Sthaulya",          "C.Su.21/9",    "BMI ≥25; central obesity (WC >90 cm M / >80 cm F)",        "0-3"),
    ("Atisveda",          "C.Su.21/9",    "Excessive sweating on minimal exertion",                     "0-3"),
    ("Daurbalya",         "C.Su.21/9",    "Easy fatiguability and muscular weakness",                   "0-3"),
    ("Alpa-prana",        "C.Su.21/9",    "Reduced vitality, poor stamina, breathlessness on exertion","0-3"),
    ("Kshudha-adhikya",   "C.Su.21/9",    "Increased appetite; frequent hunger pangs",                  "0-3"),
    ("Pipasa-adhikya",    "C.Su.21/9",    "Excessive thirst",                                          "0-3"),
    ("Anga-gaurava",      "A.H.Su.11/5",  "Heaviness of body and limbs",                               "0-3"),
    ("Chala-sphik/Udara", "C.Su.21/9",    "Pendulous/flaccid flanks, abdomen, and breasts",            "0-3"),
]

for r in rows_data:
    row_cells = table.add_row().cells
    for cell, val in zip(row_cells, r):
        cell.text = val
        for run in cell.paragraphs[0].runs:
            run.font.name = 'Times New Roman'
            run.font.size = Pt(11)

spacer()
normal("Scoring: 0 = Absent | 1 = Mild | 2 = Moderate | 3 = Severe | Maximum Total Score: 24",
       italic=True)
normal("The scoring sheet will be validated by an expert panel of minimum three Roganidana faculty "
       "members before commencement of the study.", italic=True)

spacer()

sub_heading("Modern Correlation Parameters:")
bullet("BMI (kg/m²) — Underweight <18.5 / Normal 18.5-24.9 / Overweight 25-29.9 / Obese ≥30")
bullet("Waist Circumference — Abdominal obesity: Males ≥90 cm; Females ≥80 cm (Asian cutoffs)")
bullet("Lipid Profile — Hypercholesterolaemia: TC >200 mg/dL; LDL >130 mg/dL; TG >150 mg/dL; HDL <40 mg/dL (M) / <50 mg/dL (F)")
bullet("FBS — Normal <100 mg/dL; Pre-diabetes 100-125 mg/dL; Diabetes ≥126 mg/dL")
bullet("USG Parameters — Stone size (mm), stone number, gallbladder wall thickness (mm)")

spacer()

# =============================================================================
# STATISTICAL ANALYSIS
# =============================================================================
section_heading("Statistical Analysis")

normal("Data will be entered and analysed using SPSS version 26.0 / GraphPad Prism software.")
bullet("Descriptive statistics: Mean, Standard Deviation (SD), frequency, and percentage "
       "for all demographic and clinical parameters.")
bullet("Correlation analysis: Pearson's / Spearman's correlation coefficient to assess "
       "association between Medovah Srotodushti Lakshana scores and metabolic parameters "
       "(BMI, lipid profile, FBS, WC).")
bullet("Comparison of Lakshana scores across BMI categories and stone burden: "
       "ANOVA / Kruskal-Wallis test as appropriate.")
bullet("Chi-square test for association between categorical variables "
       "(Prakriti groups and Lakshana severity).")
bullet("Statistical significance will be set at p < 0.05.")

spacer()

# =============================================================================
# COLLABORATION WITH OTHER DEPARTMENTS
# =============================================================================
section_heading("Collaboration with Other Departments")
normal("The following departments will be consulted for investigations and data analysis:")
bullet("Department of Roganidana - Vikritivijnana (Primary Department), [Institute]")
bullet("Pathology Laboratory, [Institute] — CBC, LFT")
bullet("Bio-Chemistry Laboratory, [Institute] — Lipid Profile, FBS, HbA1c")
bullet("Radiology Department, [Institute] — USG Abdomen reporting")
bullet("Department of Kayachikitsa, [Institute] — Clinical case co-assessment as required")

spacer()

# =============================================================================
# REPORTING OF ADR
# =============================================================================
section_heading("Reporting of Adverse Events")
normal(
    "This is a purely observational study with no drug administration or intervention. "
    "No adverse events are anticipated. However, if any adverse reaction or clinical "
    "deterioration is observed during the study period, it will be reported to the "
    "Institutional Ethics Committee (IEC) and, if applicable, to the "
    "Pharmacovigilance cell of [Institute]."
)

spacer()

# =============================================================================
# REFERENCES
# =============================================================================
section_heading("References")

refs = [
    "Charaka Samhita — Sutrasthana 21/4, 21/9; Vimana Sthana 5/3-5, 5/16; "
    "Sharira Sthana 5/8. Acharya YT (Ed.), Chaukhamba Surbharati Prakashan, Varanasi. Reprint 2013.",

    "Ashtanga Hridayam — Sutrasthana 11/5, 11/13-14; Nidanasthana 12. "
    "Srikantha Murthy KR (Ed.), Krishnadas Academy, Varanasi.",

    "Sushruta Samhita — Sutrasthana 15/7; Sharir Sthana 9. "
    "Acharya JT (Ed.), Chaukhamba Sanskrit Sansthan, Varanasi.",

    "Smita Dutta Paul, Ashutosh Kumar Jain. Pathophysiological understanding of "
    "Medovaha Srotas and its clinical significance. J Pharmacognosy Phytochem. "
    "2022;11(5):278-284.",

    "Londhe PD. The Concept of Cholelithiasis as Per Ayurvedic Text. "
    "Int J Ayurvedic Med. 2016;7(1):6-9.",

    "Lyu J, Lin Q, Fang Z, Xu Z, Liu Z. Complex impacts of gallstone disease on metabolic "
    "syndrome and nonalcoholic fatty liver disease. Front Endocrinol. 2022. PMID: 36506064.",

    "Han X, Wang J, Wu Y, Gu H, Zhao N, Liao X. Predictive value of bile acids as metabolite "
    "biomarkers for gallstone disease: A systematic review and meta-analysis. "
    "PLoS One. 2024. PMID: 39052638.",

    "Zheng H, Wu B, Zhuang C, Mao J, Li M, Luo Y. Cardiometabolic index as a predictor "
    "of gallstone risk: evidence from NHANES 2017-2020. BMC Gastroenterol. 2025. PMID: 40181266.",

    "Schwartz SI, Brunicardi FC (Eds.). Schwartz's Principles of Surgery, 11th Ed. "
    "New York: McGraw-Hill; 2019. Chapter 32: Gallbladder and Biliary Tract.",

    "Yamada T, Alpers DH (Eds.). Yamada's Textbook of Gastroenterology, 7th Ed. "
    "Oxford: Wiley-Blackwell; 2022. Chapter: Cholelithiasis.",

    "Townsend CM (Ed.). Sabiston Textbook of Surgery, Current Surgical Therapy, 14th Ed. "
    "Philadelphia: Elsevier; 2023. Chapter: Choledocholithiasis.",

    "Robbins SL, Kumar V. Robbins & Kumar Basic Pathology, 11th Ed. "
    "Philadelphia: Elsevier; 2023. Chapter: Gallbladder Diseases, p.636.",

    "Feldman M, Friedman LS, Brandt LJ (Eds.). Sleisenger and Fordtran's Gastrointestinal "
    "and Liver Disease, 11th Ed. Philadelphia: Elsevier; 2021.",

    "Symptom to Diagnosis: An Evidence-Based Guide, 4th Ed. New York: McGraw-Hill; 2020. "
    "Chapter: Choledocholithiasis.",
]

for i, ref in enumerate(refs, 1):
    p = doc.add_paragraph()
    p.paragraph_format.left_indent = Inches(0.3)
    p.paragraph_format.first_line_indent = Inches(-0.3)
    p.alignment = WD_ALIGN_PARAGRAPH.JUSTIFY
    r = p.add_run(f"{i}. {ref}")
    r.font.name = 'Times New Roman'
    r.font.size = Pt(11)

spacer()

# =============================================================================
# PLAN OF STUDY / GANTT CHART
# =============================================================================
section_heading("Plan of Study / Tentative Timeline (Gantt Chart)")

table2 = doc.add_table(rows=1, cols=4)
table2.style = 'Table Grid'
for cell, text in zip(table2.rows[0].cells,
                      ['Sr. No.', 'Activity', 'Duration', 'Months']):
    cell.text = text
    for run in cell.paragraphs[0].runs:
        run.bold = True
        run.font.name = 'Times New Roman'
        run.font.size = Pt(11)

gantt = [
    ("1", "IEC Approval and CTRI Registration",              "2 months",  "1-2"),
    ("2", "Literature review and tool validation",            "2 months",  "1-2"),
    ("3", "Development and validation of scoring sheet",      "1 month",   "2"),
    ("4", "Patient enrollment and data collection",           "12 months", "3-14"),
    ("5", "Data compilation and statistical analysis",        "2 months",  "15-16"),
    ("6", "Thesis writing and submission",                    "2 months",  "17-18"),
]

for row_data in gantt:
    cells = table2.add_row().cells
    for cell, val in zip(cells, row_data):
        cell.text = val
        for run in cell.paragraphs[0].runs:
            run.font.name = 'Times New Roman'
            run.font.size = Pt(11)

spacer()

# =============================================================================
# DECLARATION
# =============================================================================
section_heading("Declaration")

normal(
    "The proposed study will be completed within the stipulated time limit. "
    "All ethical guidelines will be strictly followed. "
    "The data collected will be used solely for academic and research purposes."
)

spacer()
spacer()

# Signature block
p = doc.add_paragraph()
p.alignment = WD_ALIGN_PARAGRAPH.LEFT
run = p.add_run(
    "Scholar" + " " * 60 + "Guide"
)
run.font.name = 'Times New Roman'
run.font.size = Pt(12)

spacer()
p2 = doc.add_paragraph()
p2.alignment = WD_ALIGN_PARAGRAPH.LEFT
run2 = p2.add_run(
    "[Your Name]" + " " * 48 + "Dr. ________________________"
)
run2.font.name = 'Times New Roman'
run2.font.size = Pt(12)

p3 = doc.add_paragraph()
p3.alignment = WD_ALIGN_PARAGRAPH.LEFT
run3 = p3.add_run(
    "PG Scholar, 1st Year" + " " * 38 + "MD (Ayu.), Associate Professor"
)
run3.font.name = 'Times New Roman'
run3.font.size = Pt(12)

p4 = doc.add_paragraph()
p4.alignment = WD_ALIGN_PARAGRAPH.LEFT
run4 = p4.add_run(
    "Dept. of Roganidana" + " " * 41 + "Dept. of Roganidana - Vikritivijnana"
)
run4.font.name = 'Times New Roman'
run4.font.size = Pt(12)

# =============================================================================
# SAVE
# =============================================================================
out_path = "/tmp/workspace/roganidan-synopsis/Medovah_Srotodushti_Cholelithiasis_Synopsis.docx"
doc.save(out_path)
print("Saved:", out_path)