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pres.title = "Understanding Immunotolerance and Management of Autoimmune Conditions in Children";
pres.author = "PG Scholar, Department of Kaumarabhritya";

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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 1 — Title Slide
// ═══════════════════════════════════════════════════════════════════════════
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  sl.addText("UNDERSTANDING IMMUNOTOLERANCE", {
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  sl.addText("ॐ  Kashyapa Samhita  |  Charaka Samhita  |  Ashtanga Hridayam", {
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 2 — Introduction
// ═══════════════════════════════════════════════════════════════════════════
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    { text: "Rising incidence of JIA, pSLE, Type 1 DM, autoimmune thyroiditis", options: { bullet: { code: "2022" }, fontSize: 10.5, color: C.ivory, breakLine: true } },
    { text: "Immunotolerance = the immune system's ability to distinguish self from non-self", options: { bullet: { code: "25B6" }, fontSize: 11, color: C.ivory, bold: true, breakLine: true } },
    { text: "Failure of central/peripheral tolerance → autoimmunity", options: { bullet: { code: "2022" }, fontSize: 10.5, color: C.ivory, breakLine: true } },
    { text: "Children's immune system is dynamic and developing — uniquely vulnerable", options: { bullet: { code: "25B6" }, fontSize: 11, color: C.ivory, breakLine: true } },
    { text: "Gut dysbiosis, epigenetics, and environmental triggers implicated", options: { bullet: { code: "2022" }, fontSize: 10.5, color: C.ivory } }
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    { text: "Kashyapa: First Ayurvedic scholar to detail child immunity & Samskaras", options: { bullet: { code: "25B6" }, fontSize: 10.5, color: C.deepSlate } }
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 3 — Aims & Objectives
// ═══════════════════════════════════════════════════════════════════════════
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  sl.addText("To explore the concept of immunotolerance through classical Ayurvedic principles and evaluate integrative management strategies for autoimmune conditions in Bala (children)", {
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    ["02", "To correlate Ayurvedic immunological theory with modern mechanisms of immune tolerance (Tregs, central/peripheral tolerance)"],
    ["03", "To identify common autoimmune conditions in children (JIA, pSLE, T1DM) and their classical Ayurvedic correlates"],
    ["04", "To evaluate evidence-based Ayurvedic interventions: Swarnaprashana, Rasayana drugs, and Panchakarma in autoimmune management"],
    ["05", "To propose an integrative treatment framework for pediatric autoimmune conditions"],
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 4 — Methodology (Review Design)
// ═══════════════════════════════════════════════════════════════════════════
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    { label: "Comparative\nAnalysis", color: C.saffron, items: ["Mapping Ayurvedic concepts to modern immunology", "Ojas Vikruti → Immune dysregulation", "Ama → Oxidative stress / gut dysbiosis", "Sahaja/Kalaja Bala → Innate/Adaptive immunity"] },
    { label: "Integrative\nFramework", color: C.sage, items: ["Ayurvedic + Modern management protocols", "Evidence appraisal of Rasayana drugs", "Swarnaprashana clinical studies reviewed", "Outcome parameters defined"] },
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 5 — Vyadhikshamatva & Immunotolerance: Conceptual Correlation
// ═══════════════════════════════════════════════════════════════════════════
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      { text: "Classical Reference", options: { bold: true, color: C.white, fill: C.tealDark, fontSize: 12 } },
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      { text: "Charaka Su. 9/4", options: { color: "555555", fill: "E8F4F7", fontSize: 10.5 } },
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      { text: "Charaka Su. 9/4", options: { color: "555555", fill: C.white, fontSize: 10.5 } },
      { text: "Adaptive Immunity — T/B lymphocytes, immunological memory", options: { color: C.tealDark, fill: C.white, fontSize: 10.5 } },
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      { text: "Charaka Su. 30/26", options: { color: "555555", fill: "E8F4F7", fontSize: 10.5 } },
      { text: "Immune dysregulation: reduced Treg activity, cytokine imbalance", options: { color: C.tealDark, fill: "E8F4F7", fontSize: 10.5 } },
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      { text: "Charaka Chi. 15/40", options: { color: "555555", fill: C.white, fontSize: 10.5 } },
      { text: "Oxidative stress, gut dysbiosis, molecular mimicry triggering autoimmunity", options: { color: C.tealDark, fill: C.white, fontSize: 10.5 } },
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    [
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      { text: "Kashyapa Samhita\nSu. Lehaadhyaya", options: { color: "555555", fill: "FFF4E6", fontSize: 10.5 } },
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      { text: "Vata-Pitta Dushti\n(Humoral imbalance)", options: { color: C.tealDark, fill: "E8F4F7", fontSize: 11 } },
      { text: "A.H. Su. 11/1-5", options: { color: "555555", fill: "E8F4F7", fontSize: 10.5 } },
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 6 — Pediatric Autoimmune Conditions & Classical Correlates
// ═══════════════════════════════════════════════════════════════════════════
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  addSlideHeader(sl, "Pediatric Autoimmune Conditions & Ayurvedic Correlates", "Modern diagnoses mapped to classical descriptions");

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    { title: "Juvenile Idiopathic Arthritis (JIA)", modern: "Synovial inflammation, IL-1β/IL-6/TNF-α mediated; anti-CCP, RF positive subtypes", ayur: "Amavata (Madhavakara Nidana, Ch.25); Ama depositing in joints → Vata-Kapha vitiation", ref: "Madhava Nidana 25/1-4; Yogaratnakara" },
    { title: "Pediatric SLE (pSLE)", modern: "ANA+, dsDNA antibodies; multi-system involvement; Type I interferon signature", ayur: "Visarpa / Raktaja Vikara with Tridosha involvement; Ojas Vyapat (Charaka Su.30)", ref: "Charaka Su.30/26; Sushruta Chi.5" },
    { title: "Type 1 Diabetes Mellitus", modern: "T-cell mediated beta-cell destruction; HLA-DR3/DR4; GAD65/IA2 antibodies", ayur: "Madhumeha (Prameha Samprapti); Ojas Kshaya leading to Kapha-Vata imbalance", ref: "Charaka Chi.6/12-15; Ashtanga Hridayam Ni.10" },
    { title: "Autoimmune Thyroiditis\n(Hashimoto's)", modern: "Anti-TPO, anti-thyroglobulin; CD4+ T-cell infiltration of thyroid", ayur: "Galaganda (Charaka Chi.11); Kapha-Meda involvement; Ojas Visransa", ref: "Charaka Chi.11/31; A.H. Chi.17" },
  ];

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}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 7 — Pathogenesis: Ojas Vikruti & Immune Breakdown
// ═══════════════════════════════════════════════════════════════════════════
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    "Nidana: Ahara Dosha, Viruddha Anna,\nManas Abhighata (trigger factors)",
    "Agni Mandya\n(impaired metabolic fire)",
    "Ama Formation\n(undigested metabolic waste)",
    "Ojas Visransa → Ojas Vyapat\n→ Ojas Kshaya",
    "Vyadhikshamatva Kshaya\n(loss of immune tolerance)",
    "AUTOIMMUNE VIKARA\n(Amavata / Madhumeha / Visarpa)"
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    "Trigger: Infection, gut dysbiosis,\nenvironmental antigens, genetics",
    "Failure of Central Tolerance\n(thymic negative selection defect)",
    "Escape of autoreactive\nT/B lymphocytes",
    "Treg dysfunction,\nTh1/Th17 skewing",
    "Loss of Peripheral Tolerance\n(AIRE mutations, CTLA-4 defects)",
    "AUTOIMMUNE DISEASE\n(JIA / pSLE / T1DM)"
  ];
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 8 — Swarnaprashana & Rasayana: Evidence Review
// ═══════════════════════════════════════════════════════════════════════════
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  addSlideHeader(sl, "Swarnaprashana & Rasayana Therapy: Evidence Review", "Key Kaumarabhritya interventions for immunomodulation");

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  sl.addText([
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    { text: "K.S. Sutrasthana 18/26 — Swarna rubbed with honey & ghrita given to neonate", options: { fontSize: 10, color: "444444", italic: true, breakLine: true } },
    { text: "A.H. Uttara 1/47-48 — Hemadiprashana at sunrise for intelligence & immunity", options: { fontSize: 10, color: "444444", italic: true, breakLine: true } },
    { text: "\nProposed Mechanisms:", options: { bold: true, fontSize: 10.5, color: C.tealDark, breakLine: true } },
    { text: "▶ Gold nanoparticles — immunomodulatory & anti-inflammatory activity", options: { fontSize: 10, color: C.tealDark, breakLine: true } },
    { text: "▶ Upregulates IFN-γ, IL-2 (Th1 enhancement)", options: { fontSize: 10, color: C.tealDark, breakLine: true } },
    { text: "▶ Honey: prebiotic — supports gut microbiome", options: { fontSize: 10, color: C.tealDark, breakLine: true } },
    { text: "▶ Ghrita (medicated ghee): lipid carrier, enhances bioavailability", options: { fontSize: 10, color: C.tealDark, breakLine: true } },
    { text: "\nClinical Evidence:", options: { bold: true, fontSize: 10.5, color: C.tealDark, breakLine: true } },
    { text: "▶ Observational studies show improved immune markers in children given Swarnaprashana (Joshi V et al., 2017)", options: { fontSize: 9.5, color: "444444", breakLine: true } },
    { text: "▶ Reduced respiratory infections, improved WBC response (Mangal et al., 2019)", options: { fontSize: 9.5, color: "444444", breakLine: true } },
    { text: "▶ Limitation: RCTs lacking; blinding difficult", options: { fontSize: 9.5, color: C.saffron, italic: true } },
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    ["Guduchi (Tinospora cordifolia)", "Anti-inflammatory; upregulates Tregs; inhibits IL-6/TNF-α; used in JIA", "Charaka Chi.1; Singh et al. J Ethnopharmacol 2021"],
    ["Ashwagandha (Withania somnifera)", "Adaptogen; cortisol regulation; NF-κB inhibition; immunomodulatory in T1DM", "A.H. Chi.39; Pratte et al. J Alt Med 2014"],
    ["Yashtimadhu (Glycyrrhiza glabra)", "Anti-inflammatory; mucosal immunity support; COX inhibition", "Charaka Su.25; Fiore et al. Food Chem Toxicol 2005"],
    ["Amalaki (Phyllanthus emblica)", "Rich in Vitamin C; Rasayana in Charaka Ch.1; enhances lymphocyte proliferation", "Charaka Chi.1/1; Zhao et al. J Ethnopharmacol 2015"],
  ];
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 9 — Panchakarma & Shodhana in Autoimmune Management
// ═══════════════════════════════════════════════════════════════════════════
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  addSlideHeader(sl, "Panchakarma & Shodhana Chikitsa in Pediatric Autoimmune Conditions", "Purification as immune recalibration");

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    { name: "Virechana\n(Purgation)", desc: "Removes Ama & Pitta toxins; reduces inflammatory load; indicated in Amavata, Visarpa", mod: "Comparable to microbiome modulation; reduces systemic inflammation; lowers IL-1β/TNF-α", ref: "Charaka Ka.1; Ashtanga Hridayam Su.18" },
    { name: "Basti\n(Medicated Enema)", desc: "Vata-pacifying; most important Panchakarma for children (Bala Basti); immune recalibration via gut", mod: "Gut-immune axis modulation; Treg induction via short-chain fatty acids; microbiota restoration", ref: "Charaka Si.1; Kashyapa Samhita Kalpasthana" },
    { name: "Abhyanga +\nSteam (Swedana)", desc: "Sneha karma strengthens Ojas; opens Srotas (channels); reduces Vata-Kapha imbalance", mod: "Lymphatic drainage; cortisol reduction; skin barrier reinforcement reducing allergen sensitization", ref: "A.H. Su.2/8-9; Kashyapa Samhita Sutrasthana" },
    { name: "Dhoopana\n(Fumigation)", desc: "Antiseptic, Rakshoghna quality; Kashyapa's 40 Dhoopana formulations for pediatric protection", mod: "Aerial antimicrobials; phytochemical oxides; prevent microbial triggers of molecular mimicry", ref: "K.S. Kalpa Sthana — dedicated chapter" },
    { name: "Nasya\n(Nasal instillation)", desc: "Suitable form in children; clears Urdhvajatru Vikara; Prana Vata balance", mod: "Nasal mucosal immunity; IgA stimulation; reduces upper respiratory infections triggering flares", ref: "Charaka Si.9; A.H. Chi.20" },
  ];

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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 10 — Integrative Management Framework
// ═══════════════════════════════════════════════════════════════════════════
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  addSlideHeader(sl, "Integrative Management Framework", "Kaumarabhritya + Modern Medicine: A Synergistic Approach");

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    { label: "Prevention &\nImmune Programming", items: ["Swarnaprashana (monthly on Pushya Nakshatra)", "Maternal Ahara (prenatal care)", "Samskaras (16 rites); Neonatal care — Lehana"], color: C.saffron, x: 0.15, y: 1.05 },
    { label: "Immunomodulatory\nRasayana Therapy", items: ["Guduchi — Treg upregulation, JIA", "Ashwagandha — T1DM, SLE", "Cyavanaprasha — Ojas restoration"], color: C.sage, x: 5.8, y: 1.05 },
    { label: "Shodhana\n(Detox & Purification)", items: ["Basti — gut-immune axis", "Virechana — Ama clearance", "Dhoopana, Abhyanga"], color: C.teal, x: 0.15, y: 3.0 },
    { label: "Modern Medical\nManagement", items: ["NSAIDs, DMARDs (Methotrexate)", "Biologics: Anti-TNF, IL-6i, Belimumab", "Hydroxychloroquine, Steroids"], color: C.tealMid, x: 5.8, y: 3.0 },
    { label: "Diet & Lifestyle\n(Pathya-Apathya)", items: ["Tridosha-balancing Ahara", "Avoid Viruddha Anna (incompatible foods)", "Yoga, Pranayama, Dinacharya"], color: "9B6EC8", x: 1.2, y: 4.5 },
    { label: "Regular Monitoring\n& Follow-Up", items: ["ANA, anti-dsDNA, ESR, CRP monitoring", "Ojas bala assessment tools", "Integration of CHAQ / ACR scores"], color: "C06060", x: 5.0, y: 4.5 },
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 11 — Discussion
// ═══════════════════════════════════════════════════════════════════════════
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    { head: "Scientific Validity of Vyadhikshamatva", body: "The dual classification of Sahaja/Kalaja Bala maps convincingly onto innate/adaptive immunity. Breakdown in Ojas parallels Treg dysfunction seen in JIA and SLE, validating classical immunological thinking (Charaka Su.9/4).", color: C.tealDark },
    { head: "Ama & Gut-Immune Axis", body: "Ama-related concepts predate modern understanding of gut dysbiosis as an autoimmune trigger. Basti (medicated enema) offers a gut-targeted therapeutic option that merits RCT-level investigation (Charaka Si.1).", color: C.teal },
    { head: "Swarnaprashana as Immune Programming", body: "Gold nanoparticles show immunomodulatory properties in animal studies. Clinical observational studies (Mangal et al., 2019) report fewer infections. Controlled trials needed for autoimmune-specific outcomes.", color: C.saffron },
    { head: "Rasayana Drugs & Biologics: Complementary Roles", body: "Guduchi (anti-TNF-like activity) and Ashwagandha (NF-κB inhibition) may reduce biologic dosage and long-term corticosteroid burden. Integration has cost and safety advantages in resource-limited settings.", color: C.sage },
    { head: "Limitations & Research Gaps", body: "Most Ayurvedic studies are observational. Standardization of classical formulations, outcome metrics (CHAQ, ACR, Ojas scoring), and double-blind RCTs remain critical unmet needs.", color: "9B6EC8" },
  ];

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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 12 — Conclusion & References
// ═══════════════════════════════════════════════════════════════════════════
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    { text: "▶ Well-designed RCTs integrating classical and modern outcome measures are the critical next step for evidence validation", options: { fontSize: 10, color: C.gold } },
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    "1. Kashyapa Samhita — Sutrasthana (Lehaadhyaya 18/26; Suvarnaprashana); Kalpasthana (Dhoopana); Chaukhambha Sanskrit Pratishthan, Varanasi.",
    "2. Charaka Samhita — Sutrasthana 9/4 (Vyadhikshamatva); Su.30/26 (Ojas); Chi.6 (Prameha); Chi.15/40 (Ama). Chaukhambha Orientalia.",
    "3. Ashtanga Hridayam — Uttarasthana 1/47-48 (Swarnaprashana); Sutrasthana 11 (Doshas); Chi.17 (Galaganda). Chaukhambha Krishnadas Academy.",
    "4. Madhava Nidana — Chapter 25 (Amavata). Chaukhambha Medical Publishers, Varanasi.",
    "5. Singh N et al. Tinospora cordifolia (Guduchi) — A review of its immunomodulatory properties. J Ethnopharmacol. 2021;265:113188.",
    "6. Mangal G et al. Clinical study on Swarnaprashana in children. J Ayurveda Integr Med. 2019;10(3):178-184.",
    "7. Amale DJ, Ban KK. Conceptual study of Ojas in autoimmune disorder. J Phytopharmacol. 2024;13(5):819-823.",
    "8. Pratte MA et al. Ashwagandha (Withania somnifera) — A systematic review. J Altern Complement Med. 2014;20(12):901-908.",
    "9. Joshi V et al. Effect of Swarnaprashana on immune parameters. Anc Sci Life. 2017;36(4):201-206.",
  ];

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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ═══════════════════════════════════════════════════════════════════════════
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  sl.addText("IMMUNOTOLERANCE", { x:0.5, y:0.68, w:9.2, h:0.72, fontSize:26, bold:true, color:C.amber, align:"center", charSpacing:3, margin:0 });
  sl.addText("and Management of Autoimmune Conditions in Children", { x:0.5, y:1.36, w:9.2, h:0.3, fontSize:13, color:C.ivory, align:"center", margin:0 });

  sl.addText("An Integrative Seminar Presentation from Kaumarabhritya", { x:0.5, y:1.68, w:9.2, h:0.32, fontSize:10, italic:true, color:C.sageLight, align:"center", margin:0 });

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    { text: "Presented by: PG Scholar (MD Kaumarabhritya)", options:{ bold:true, fontSize:12, color:C.ivory, breakLine:true } },
    { text: "Department of Kaumarabhritya, [Institute Name]", options:{ fontSize:11, color:C.sageLight, breakLine:true } },
    { text: "Guided by: [Professor / HOD Name]", options:{ fontSize:10.5, italic:true, color:C.amber } },
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  sl.addText("ॐ  Kashyapa Samhita  ·  Charaka Samhita  ·  Ashtanga Hridayam  ·  Modern Immunology", {
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 2 — INTRODUCTION & BURDEN OF DISEASE
// ═══════════════════════════════════════════════════════════════════════════
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  topBar(sl, "Introduction: Why This Topic Matters", "Setting the clinical and classical context");
  footBar(sl);

  // Stats strip
  const stats = [
    { val:"3–5%", label:"Global burden of\nautoimmune diseases" },
    { val:"↑2x", label:"Rise in pediatric\nautoimmune cases since 2000" },
    { val:"16+", label:"Years average delay\nfrom symptom to diagnosis" },
    { val:"50%", label:"Adult autoimmune diseases\nbegin in childhood" },
  ];
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  sectionLabel(sl, "Modern Context", 0.25, 2.18, 4.55, 0.38, C.navyMid, C.white);
  sl.addText([
    { text:"The pediatric immune system is uniquely vulnerable. Unlike adults, children undergo active thymic education and immune maturation throughout childhood. This developmental window means:\n", options:{ fontSize:9.5, color:C.slate, breakLine:true } },
    { text:"▶ Central tolerance mechanisms are still maturing\n", options:{ fontSize:9.5, color:C.navyMid, bold:true, breakLine:true } },
    { text:"Autoreactive T-cells escaping thymic deletion are not yet fully suppressed by peripheral tolerance mechanisms (Tregs, CTLA-4, PD-1 pathways).\n\n", options:{ fontSize:9, color:C.slate, breakLine:true } },
    { text:"▶ Gut microbiome is being established\n", options:{ fontSize:9.5, color:C.navyMid, bold:true, breakLine:true } },
    { text:"Dysbiosis in early life — due to antibiotics, formula feeding, c-section birth — disrupts immune programming and is a major autoimmune trigger.\n\n", options:{ fontSize:9, color:C.slate, breakLine:true } },
    { text:"▶ Key pediatric autoimmune diseases:\n", options:{ fontSize:9.5, color:C.navyMid, bold:true, breakLine:true } },
    { text:"JIA · pSLE · T1DM · Autoimmune thyroiditis · AIHA · IBD · Celiac Disease", options:{ fontSize:9, color:C.navy, italic:true } },
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  sectionLabel(sl, "Kaumarabhritya Context", 5.0, 2.18, 4.75, 0.38, C.saffron, C.navyDark);
  sl.addText([
    { text:"Kaumarabhritya (कौमारभृत्य) is one of the eight branches (Ashtanga Ayurveda) dedicated to pediatric care from conception to 16 years. Kashyapa is considered its founding authority.\n\n", options:{ fontSize:9.5, color:C.slate, breakLine:true } },
    { text:"▶ Vyadhikshamatva (व्याधिक्षमत्व)\n", options:{ fontSize:10, bold:true, color:C.saffron, breakLine:true } },
    { text:"\"Vyadhibalavirodhitva\" and \"Vyadhyutpadapratibandhakatva\" — Charaka Su.9/4. The capacity to resist disease onset AND oppose disease progression. Two perfectly parallel arms to modern innate + adaptive immunity.\n\n", options:{ fontSize:9, color:C.slate, breakLine:true } },
    { text:"▶ Bala Vaya (Pediatric Age Classification)\n", options:{ fontSize:10, bold:true, color:C.saffron, breakLine:true } },
    { text:"Kshirapa (0–1 yr) · Kshirannada (1–2 yr) · Annada (2–16 yr). Each stage has different immune maturity and treatment protocols as per Kashyapa Samhita.", options:{ fontSize:9, color:C.slate } },
  ], { x:5.13, y:2.6, w:4.48, h:2.62, valign:"top", margin:[3,2,0,2] });
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 3 — IMMUNOTOLERANCE: THE CORE CONCEPT
// ═══════════════════════════════════════════════════════════════════════════
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  topBar(sl, "Immunotolerance: Understanding the Core Concept", "What is immune tolerance and why does it fail?");
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    { text:"Definition: ", options:{ bold:true, fontSize:11.5, color:C.gold } },
    { text:"Immunological tolerance is the state of unresponsiveness of the immune system to substances or tissues that would otherwise elicit an immune response — including self-antigens — preventing autoimmune destruction.", options:{ fontSize:11, color:C.ivory } }
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  sectionLabel(sl, "CENTRAL TOLERANCE (Thymus & Bone Marrow)", 0.25, 1.9, 4.55, 0.38, C.navyMid, C.white);
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    { text:"Thymus (T-cells) and Bone Marrow (B-cells)\n\n", options:{ fontSize:9.5, color:C.slate, breakLine:true } },
    { text:"Mechanism — Clonal Deletion:\n", options:{ bold:true, fontSize:10, color:C.navyMid, breakLine:true } },
    { text:"▶ T-cells are educated in the thymus. Those that react too strongly to self-antigens (presented by AIRE protein) are deleted — \"negative selection.\"\n", options:{ fontSize:9.5, color:C.slate, breakLine:true } },
    { text:"▶ Failure of AIRE gene (Autoimmune Regulator) → escape of autoreactive T-cells → APS-1 syndrome.\n\n", options:{ fontSize:9.5, color:C.slate, breakLine:true } },
    { text:"Mechanism — Clonal Anergy:\n", options:{ bold:true, fontSize:10, color:C.navyMid, breakLine:true } },
    { text:"▶ B-cells with too-strong self-reactivity are either deleted or rendered anergic (unresponsive) in bone marrow.\n\n", options:{ fontSize:9.5, color:C.slate, breakLine:true } },
    { text:"Ref: Abbas AK, Lichtman AH. Cellular and Molecular Immunology, 9th Ed.", options:{ fontSize:8.5, color:C.midGray, italic:true } },
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    { text:"Where it happens:\n", options:{ bold:true, fontSize:10, color:C.navyDark, breakLine:true } },
    { text:"Peripheral lymphoid tissues, circulation, end organs\n\n", options:{ fontSize:9.5, color:C.slate, breakLine:true } },
    { text:"Mechanisms:\n", options:{ bold:true, fontSize:10, color:C.sage, breakLine:true } },
    { text:"▶ Regulatory T-cells (Tregs / CD4+CD25+FOXP3+): Suppress autoreactive cells via IL-10, TGF-β, CTLA-4. Most important in children.\n", options:{ fontSize:9.5, color:C.slate, breakLine:true } },
    { text:"▶ Clonal Ignorance: Self-antigens in immune-privileged sites (eye, brain, testes) are never seen by immune cells.\n", options:{ fontSize:9.5, color:C.slate, breakLine:true } },
    { text:"▶ Co-stimulatory Blockade: T-cells need TWO signals to activate. Absence of signal 2 (B7-CD28) → anergy.\n", options:{ fontSize:9.5, color:C.slate, breakLine:true } },
    { text:"▶ PD-1 / PD-L1 Checkpoint: Turns off activated T-cells in tissues.\n\n", options:{ fontSize:9.5, color:C.slate, breakLine:true } },
    { text:"Ref: Bluestone JA et al. Science. 2010;328:605-611.", options:{ fontSize:8.5, color:C.midGray, italic:true } },
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}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 4 — VYADHIKSHAMATVA: THE AYURVEDIC IMMUNE SYSTEM
// ═══════════════════════════════════════════════════════════════════════════
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  bg(sl, C.cream);
  topBar(sl, "Vyadhikshamatva: The Ayurvedic Science of Immune Tolerance", "Classical concepts from Kashyapa, Charaka, and Ashtanga Hridayam");
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    { text:"\"व्याधिबलविरोधित्वं व्याध्युत्पादप्रतिबन्धकत्वं च\" — ", options:{ bold:true, fontSize:11, color:C.saffron } },
    { text:"Charaka Samhita, Sutrasthana 9/4\n", options:{ fontSize:10, color:C.navyDark, italic:true, breakLine:true } },
    { text:"\"Vyadhibalavirodhitva\" = Opposing the strength of existing disease (Immunotherapy analogy) | \"Vyadhyutpadapratibandhakatva\" = Preventing new disease onset (Vaccination analogy)", options:{ fontSize:9.5, color:C.slate, italic:true } },
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      title:"Types of Vyadhikshamatva (Charaka Su.9/4)",
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        ["Sahaja Bala","Innate immunity — present from birth. Corresponds to NK cells, macrophages, neutrophils, complement system. Determined by Prakriti (genetic constitution) and parents' health."],
        ["Kalaja Bala","Seasonal and age-acquired immunity. Corresponds to adaptive immunity — acquired through infections, vaccines, seasonal adaptations. Builds with age."],
        ["Yukti-krita Bala","Artificially acquired immunity through medicines, Rasayana, Samskaras. Corresponds to active immunization and immunotherapy."],
      ]
    },
    {
      title:"Ojas: Seat of Immunity (Charaka Su.30/26)",
      color: C.saffron,
      items:[
        ["Para Ojas (8 drops)","Located in the heart (Hridaya). Seat of life and consciousness. Its complete loss causes death. Corresponds to essential immune stem cells."],
        ["Apara Ojas (half anjali)","Distributed throughout the body. Maintains strength, complexion, and immunity. Corresponds to circulating immune mediators, antibodies, lymphocytes."],
        ["Ojas Vikruti in Children","Children have Apakva (immature) Ojas. Susceptibility is high. Kashyapa describes Bala as \"Alpa Vyadhikshamatva\" — the fundamental reason for pediatric immunology."],
      ]
    },
  ];

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  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 5 — COMMON AUTOIMMUNE CONDITIONS IN CHILDREN
// ═══════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  bg(sl, C.cream);
  topBar(sl, "Common Autoimmune Conditions in Children", "Clinical features, epidemiology and Ayurvedic disease correlates");
  footBar(sl);

  const diseases = [
    {
      name:"Juvenile Idiopathic Arthritis (JIA)",
      epi:"Most common pediatric rheumatic disease. Prevalence: 1/1000 children. Oligoarticular subtype most common (50%).",
      mod:"IL-1β, IL-6, TNF-α driven synovial inflammation. RF+/ANA+ subtypes. Diagnosed by arthritis >6 weeks, onset <16 years.",
      ayu:"AMAVATA — Ama (undigested toxins) lodges in joints causing Vata-Kapha vitiation. Madhava Nidana 25/1-4: \"Amavata\" description mirrors JIA pathology.",
      ref:"Madhava Nidana 25/1-4; Yogaratnakara; Petty RE et al, J Rheumatol 2004",
      col:C.navyMid
    },
    {
      name:"Pediatric SLE (pSLE)",
      epi:"10-20% of all SLE cases. More severe than adult onset. Female preponderance after puberty. Prevalence: 6–24/100,000 children.",
      mod:"ANA+, anti-dsDNA+. Complement (C3/C4) low. Type I IFN signature. Nephritis in 50–75% of children. Multi-system.",
      ayu:"VISARPA / RAKTAJA VIKARA — spreading rash + multi-system involvement with Tridosha vitiation. Ojas Vyapat (Charaka Su.30) describes loss of immune self-recognition.",
      ref:"Charaka Su.30/26; Sushruta Chi.5; Levy DM, Kamphuis S. Pediatr Clin N Am 2012",
      col:C.purple
    },
    {
      name:"Type 1 Diabetes Mellitus",
      epi:"Incidence rising 3% annually worldwide. Peak onset 10–14 years. HLA-DR3/DR4 genotype in 90% of cases.",
      mod:"CD4+/CD8+ T-cell mediated autoimmune destruction of pancreatic beta-cells. Autoantibodies: GADA, IA-2A, ZnT8A. Absolute insulin deficiency.",
      ayu:"MADHUMEHA (Kshaudrameha subtype) — Ojas Kshaya leading to Kapha-Vata dominant Prameha with sweet urine. Charaka Chi.6/12-15 describes pathology of Prameha affecting youth.",
      ref:"Charaka Chi.6/12-15; A.H. Nidana.10; Atkinson MA, NEJM 2014",
      col:C.sage
    },
    {
      name:"Autoimmune Thyroiditis (Hashimoto's)",
      epi:"Most common pediatric thyroid disorder. Prevalence 1.2–3.5% in school-age children. Often presents with goitre.",
      mod:"Anti-TPO, anti-thyroglobulin antibodies. CD4+ T-cell infiltration. Destruction of follicular cells. TSH elevated with low T3/T4.",
      ayu:"GALAGANDA (Charaka Chi.11/31) — Neck swelling with Kapha-Meda vitiation. Ojas Visransa correlates to initial antibody-mediated destruction phase.",
      ref:"Charaka Chi.11/31; A.H. Chi.17; Cappa M et al, JCRPE 2011",
      col:C.saffron
    },
  ];

  diseases.forEach((d, i) => {
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    sl.addShape(pres.ShapeType.rect, { x, y, w, h:0.34, fill:{ color:d.col }, line:{ color:d.col }, rounding:"0.1" });
    sl.addText(d.name, { x:x+0.08, y, w:w-0.16, h:0.34, fontSize:10, bold:true, color:C.white, valign:"middle", margin:0 });
    sl.addText([
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      { text:d.epi+"\n", options:{ fontSize:8.5, color:C.slate, breakLine:true } },
      { text:"Modern: ", options:{ bold:true, fontSize:8.5, color:C.navyMid } },
      { text:d.mod+"\n", options:{ fontSize:8.5, color:C.slate, breakLine:true } },
      { text:"Ayurvedic: ", options:{ bold:true, fontSize:8.5, color:C.saffron } },
      { text:d.ayu+"\n", options:{ fontSize:8.5, color:"444444", breakLine:true } },
      { text:"Ref: "+d.ref, options:{ fontSize:7.5, color:C.midGray, italic:true } },
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  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 6 — PATHOGENESIS: DUAL PATHWAY (OJAS VIKRUTI & TOLERANCE FAILURE)
// ═══════════════════════════════════════════════════════════════════════════
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  const sl = pres.addSlide();
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  topBar(sl, "Pathogenesis: Parallel Frameworks of Autoimmune Disease", "Ojas Vikruti (Ayurveda) vs. Immune Dysregulation (Modern Immunology)");
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  // Ayurvedic chain
  sl.addShape(pres.ShapeType.rect, { x:0.2, y:0.95, w:4.2, h:0.36, fill:{ color:C.saffron }, line:{ color:C.saffron }, rounding:"0.09" });
  sl.addText("AYURVEDIC PATHWAY (Ojas Vikruti)", { x:0.2, y:0.95, w:4.2, h:0.36, fontSize:10, bold:true, color:C.navyDark, align:"center", valign:"middle", margin:0 });

  const ayurPath = [
    { step:"NIDANA (Causative Factors)", detail:"Viruddha Ahara (incompatible foods), Vegadharan (suppression of urges),\nAtisheeta/Ushna (extreme climates), Manasika Dosha (stress),\nAncestral factors — Sahaja Dosha" },
    { step:"AGNI MANDYA (Impaired Digestion)", detail:"Weakening of Jatharagni (digestive fire) and Dhatvagni (tissue fire).\nImpairs proper Dhatu formation and immune substrate." },
    { step:"AMA FORMATION", detail:"Undigested, sticky, toxic metabolic by-product.\nBlocks Srotas (channels), lodges in Dhatus, triggers inflammatory cascade.\nModern parallel: endotoxemia, gut dysbiosis, LPS translocation." },
    { step:"OJAS VISRANSA → VYAPAT → KSHAYA", detail:"Progressive depletion of vital immune essence.\nVisransa=displaced, Vyapat=dysfunctional, Kshaya=depleted.\nCharaka Sutrasthana 30/26-31" },
    { step:"VYADHIKSHAMATVA KSHAYA", detail:"Loss of immune self-recognition capacity.\nSystem attacks Svadravya (self-tissue) → Autoimmune Vikara." },
    { step:"AUTOIMMUNE DISEASE MANIFESTATION", detail:"Amavata · Madhumeha · Visarpa · Galaganda\ndepending on dominant Dosha & afflicted Dhatu." },
  ];

  ayurPath.forEach((s, i) => {
    const y = 1.4 + i * 0.67;
    const isLast = i === ayurPath.length - 1;
    sl.addShape(pres.ShapeType.rect, { x:0.2, y, w:4.2, h:0.55, fill:{ color: isLast ? C.saffron : "1A3A5C" }, line:{ color: isLast ? C.gold : C.skyBlue, pt:0.75 }, rounding:"0.07" });
    sl.addText(s.step, { x:0.3, y:y+0.02, w:4.0, h:0.22, fontSize:9.5, bold:true, color: isLast ? C.navyDark : C.amber, margin:0 });
    sl.addText(s.detail, { x:0.3, y:y+0.22, w:4.0, h:0.3, fontSize:8, color: isLast ? C.navyDark : C.ivory, margin:0 });
    if (!isLast) sl.addText("▼", { x:1.8, y:y+0.55, w:0.6, h:0.11, fontSize:10, color:C.saffron, align:"center", margin:0 });
  });

  // Modern chain
  sl.addShape(pres.ShapeType.rect, { x:5.6, y:0.95, w:4.2, h:0.36, fill:{ color:C.skyBlue }, line:{ color:C.skyBlue }, rounding:"0.09" });
  sl.addText("MODERN PATHWAY (Tolerance Failure)", { x:5.6, y:0.95, w:4.2, h:0.36, fontSize:10, bold:true, color:C.navyDark, align:"center", valign:"middle", margin:0 });

  const modPath = [
    { step:"TRIGGERING EVENTS", detail:"Genetic susceptibility (HLA-DR, PTPN22, CTLA-4 variants),\nmolecular mimicry (streptococcal M protein vs cardiac myosin),\ngut dysbiosis, viral infections (EBV, Coxsackievirus B4)" },
    { step:"FAILURE OF CENTRAL TOLERANCE", detail:"AIRE gene mutations → escape of autoreactive T-cells\nfrom thymic deletion. B-cells with strong self-reactivity\nescape bone marrow checkpoints." },
    { step:"PERIPHERAL TOLERANCE BREAKDOWN", detail:"Treg (CD4+CD25+FOXP3+) dysfunction → reduced IL-10, TGF-β.\nCTLA-4 and PD-1 checkpoint failures.\nTh1/Th17 skewing → IFN-γ, IL-17 excess." },
    { step:"AUTOREACTIVE EFFECTOR RESPONSES", detail:"CD4+ Th1 cells activate macrophages → TNF-α, IL-1β.\nCD8+ CTLs directly kill self-cells (β-cell in T1DM).\nB-cells produce autoantibodies (ANA, anti-dsDNA, anti-TPO)." },
    { step:"CYTOKINE STORM & TISSUE DESTRUCTION", detail:"Positive feedback loops amplify inflammation.\nComplement activation → MAC-mediated lysis.\nNeutrophil NETosis → further autoantigen exposure." },
    { step:"ESTABLISHED AUTOIMMUNE DISEASE", detail:"JIA · pSLE · T1DM · Autoimmune Thyroiditis\nChronic inflammation → organ damage → disability." },
  ];

  modPath.forEach((s, i) => {
    const y = 1.4 + i * 0.67;
    const isLast = i === modPath.length - 1;
    sl.addShape(pres.ShapeType.rect, { x:5.6, y, w:4.2, h:0.55, fill:{ color: isLast ? C.skyBlue : "1A3A5C" }, line:{ color: isLast ? C.white : C.skyBlue, pt:0.75 }, rounding:"0.07" });
    sl.addText(s.step, { x:5.7, y:y+0.02, w:4.0, h:0.22, fontSize:9.5, bold:true, color: isLast ? C.navyDark : C.sageLight, margin:0 });
    sl.addText(s.detail, { x:5.7, y:y+0.22, w:4.0, h:0.3, fontSize:8, color: isLast ? C.navyDark : C.ivory, margin:0 });
    if (!isLast) sl.addText("▼", { x:7.2, y:y+0.55, w:0.6, h:0.11, fontSize:10, color:C.skyBlue, align:"center", margin:0 });
  });

  // Centre bridge
  sl.addText("⟷\nParallel\nPathways", { x:4.45, y:2.5, w:1.05, h:1.1, fontSize:9, bold:true, color:C.gold, align:"center", valign:"middle", margin:0 });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 7 — CONCEPT CORRELATION TABLE
// ═══════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  bg(sl, C.cream);
  topBar(sl, "Conceptual Correlation: Ayurvedic Immunology ↔ Modern Immunology", "Bridging classical wisdom with molecular science");
  footBar(sl);

  const tbl = [
    [
      { text:"Ayurvedic Concept", options:{ bold:true, color:C.white, fill:C.navyDark, fontSize:10.5, align:"center" } },
      { text:"Classical Reference", options:{ bold:true, color:C.white, fill:C.navyDark, fontSize:10.5, align:"center" } },
      { text:"Modern Immunological Correlate", options:{ bold:true, color:C.white, fill:C.navyDark, fontSize:10.5, align:"center" } },
      { text:"Clinical Significance", options:{ bold:true, color:C.white, fill:C.navyDark, fontSize:10.5, align:"center" } },
    ],
    [
      { text:"Sahaja Vyadhikshamatva\n(Innate resistance)", options:{ color:C.navyDark, fill:"EDF5F8", fontSize:9.5 } },
      { text:"Charaka Su.9/4\nAshtanga Hridayam Su.11", options:{ color:C.slate, fill:"EDF5F8", fontSize:9 } },
      { text:"Innate immunity: NK cells, macrophages, neutrophils, complement, TLR pattern recognition", options:{ color:C.navyDark, fill:"EDF5F8", fontSize:9.5 } },
      { text:"Genetic predisposition to autoimmunity; Prakriti screening", options:{ color:C.slate, fill:"EDF5F8", fontSize:9 } },
    ],
    [
      { text:"Kalaja Vyadhikshamatva\n(Acquired resistance)", options:{ color:C.navyDark, fill:C.white, fontSize:9.5 } },
      { text:"Charaka Su.9/4\nKashyapa Sutrasthana", options:{ color:C.slate, fill:C.white, fontSize:9 } },
      { text:"Adaptive immunity: T/B lymphocytes, MHC presentation, immunological memory, antibody production", options:{ color:C.navyDark, fill:C.white, fontSize:9.5 } },
      { text:"Samskaras, Swarnaprashana build Kalaja Bala — comparable to active immunization", options:{ color:C.slate, fill:C.white, fontSize:9 } },
    ],
    [
      { text:"Ojas Kshaya\n(Immune depletion)", options:{ color:C.navyDark, fill:"FFF8EE", fontSize:9.5 } },
      { text:"Charaka Su.30/26-31\nKashyapa Sutrasthana", options:{ color:C.slate, fill:"FFF8EE", fontSize:9 } },
      { text:"Treg dysfunction, lymphopenia, hypogammaglobulinemia, reduced complement levels", options:{ color:C.navyDark, fill:"FFF8EE", fontSize:9.5 } },
      { text:"Target for Rasayana therapy in JIA, pSLE — restore Ojas = restore immune homeostasis", options:{ color:C.slate, fill:"FFF8EE", fontSize:9 } },
    ],
    [
      { text:"Ama (Metabolic toxin)\nformation", options:{ color:C.navyDark, fill:"EDF5F8", fontSize:9.5 } },
      { text:"Charaka Chi.15/40\nMadhava Nidana 25", options:{ color:C.slate, fill:"EDF5F8", fontSize:9 } },
      { text:"Gut dysbiosis, endotoxemia, LPS-mediated TLR4 activation, oxidative stress triggering molecular mimicry", options:{ color:C.navyDark, fill:"EDF5F8", fontSize:9.5 } },
      { text:"Ama-pachana (Digestion of toxins) via Deepana-Pachana drugs before Shodhana", options:{ color:C.slate, fill:"EDF5F8", fontSize:9 } },
    ],
    [
      { text:"Vata-Pitta Dushti\n(Humoral imbalance)", options:{ color:C.navyDark, fill:C.white, fontSize:9.5 } },
      { text:"A.H. Su.11/1-5\nCharaka Ni.4", options:{ color:C.slate, fill:C.white, fontSize:9 } },
      { text:"Th1/Th17 dominance → elevated IFN-γ, IL-17, TNF-α, IL-6 (Pitta=inflammation; Vata=pain, movement disorder)", options:{ color:C.navyDark, fill:C.white, fontSize:9.5 } },
      { text:"Anti-Pitta, Vata-pacifying herbs (Guduchi, Ashwagandha) mirror biologic mechanism", options:{ color:C.slate, fill:C.white, fontSize:9 } },
    ],
    [
      { text:"Apakva Ojas in Bala\n(Immature immunity)", options:{ color:C.navyDark, fill:"FFF8EE", fontSize:9.5 } },
      { text:"K.S. Sutrasthana\nLehaadhyaya; K.S. Su.18", options:{ color:C.slate, fill:"FFF8EE", fontSize:9 } },
      { text:"Immature thymic education, reduced Treg numbers in neonates, incomplete gut microbiome establishment", options:{ color:C.navyDark, fill:"FFF8EE", fontSize:9.5 } },
      { text:"Justification for Kaumarabhritya-specific interventions: Swarnaprashana, Dhoopana, neonatal Samskaras", options:{ color:C.slate, fill:"FFF8EE", fontSize:9 } },
    ],
  ];

  sl.addTable(tbl, {
    x:0.2, y:1.08, w:9.6, h:4.27,
    colW:[2.1, 1.6, 3.0, 2.9],
    rowH:0.55,
    border:{ type:"solid", pt:0.5, color:"CCCCCC" },
    valign:"middle",
    margin:[3,4,3,4],
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 8 — SWARNAPRASHANA & LEHANA: KAUMARABHRITYA'S UNIQUE CONTRIBUTION
// ═══════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  bg(sl, C.cream);
  topBar(sl, "Swarnaprashana & Lehana: Kaumarabhritya's Unique Immunological Intervention", "Classical procedure, mechanism, and current evidence");
  footBar(sl);

  // Classical definition
  sl.addShape(pres.ShapeType.rect, { x:0.22, y:1.08, w:9.56, h:0.6, fill:{ color:"FFF3DB" }, line:{ color:C.saffron, pt:1.5 }, rounding:"0.1" });
  sl.addText([
    { text:"K.S. Su.18/26: ", options:{ bold:true, fontSize:10.5, color:C.saffron } },
    { text:"\"ध्यृष्य शिले दृषाद्दृष्ट्वा प्रात: मुखी लघुनाम्बुना। आमथ्य मधु सर्पिभ्यां लेहयेत् कनकं शिशुम्\" — Gold rubbed on a clean stone with water, churned with honey and ghrita, given to the child at sunrise facing east.", options:{ fontSize:10, italic:true, color:C.navyDark } },
  ], { x:0.35, y:1.1, w:9.3, h:0.56, valign:"middle", margin:[2,4,0,4] });

  // Left: Composition & Method
  sl.addShape(pres.ShapeType.rect, { x:0.22, y:1.78, w:3.1, h:3.55, fill:{ color:C.lightGray }, line:{ color:C.saffron, pt:1 }, rounding:"0.1" });
  sectionLabel(sl, "Composition & Method", 0.22, 1.78, 3.1, 0.36, C.saffron, C.navyDark);
  sl.addText([
    { text:"Components:\n", options:{ bold:true, fontSize:9.5, color:C.navyDark, breakLine:true } },
    { text:"▶ Swarna (Gold) — purified gold rubbed on stone with water\n", options:{ fontSize:9, color:C.slate, breakLine:true } },
    { text:"▶ Madhu (Honey) — prebiotic, antimicrobial, bioavailability enhancer\n", options:{ fontSize:9, color:C.slate, breakLine:true } },
    { text:"▶ Ghrita (Clarified butter) — lipid carrier for fat-soluble compounds\n\n", options:{ fontSize:9, color:C.slate, breakLine:true } },
    { text:"Timing & Schedule:\n", options:{ bold:true, fontSize:9.5, color:C.navyDark, breakLine:true } },
    { text:"▶ At sunrise (Pratar kala)\n▶ Facing East\n▶ Traditionally on Pushya Nakshatra (monthly) — believed to potentiate gold's bioactivity\n▶ Given from birth through childhood (Neonatal to Annada period)\n\n", options:{ fontSize:9, color:C.slate, breakLine:true } },
    { text:"Indications per Kashyapa:\n", options:{ bold:true, fontSize:9.5, color:C.navyDark, breakLine:true } },
    { text:"Medha (intelligence), Bala (strength), Ayu (longevity), Varna (complexion). Protection against Graha Rogas (infectious/immune diseases of children).", options:{ fontSize:9, color:C.slate } },
  ], { x:0.32, y:2.18, w:2.88, h:3.05, valign:"top", margin:[2,2,0,2] });

  // Middle: Mechanism
  sl.addShape(pres.ShapeType.rect, { x:3.48, y:1.78, w:3.1, h:3.55, fill:{ color:C.lightGray }, line:{ color:C.skyBlue, pt:1 }, rounding:"0.1" });
  sectionLabel(sl, "Proposed Mechanisms", 3.48, 1.78, 3.1, 0.36, C.navyMid, C.white);
  sl.addText([
    { text:"Gold Nanoparticles (AuNPs):\n", options:{ bold:true, fontSize:9.5, color:C.navyMid, breakLine:true } },
    { text:"▶ Anti-inflammatory: Inhibit NF-κB signalling → reduces TNF-α, IL-6 production\n", options:{ fontSize:9, color:C.slate, breakLine:true } },
    { text:"▶ Immunomodulatory: Upregulate Th1 cytokines (IFN-γ, IL-2) → strengthen adaptive immunity\n", options:{ fontSize:9, color:C.slate, breakLine:true } },
    { text:"▶ Antioxidant: Scavenge ROS, reduce oxidative Ama formation\n", options:{ fontSize:9, color:C.slate, breakLine:true } },
    { text:"▶ Neuroprotective: Cross BBB, support cognitive development (Medha effect)\n\n", options:{ fontSize:9, color:C.slate, breakLine:true } },
    { text:"Honey:\n", options:{ bold:true, fontSize:9.5, color:C.navyMid, breakLine:true } },
    { text:"▶ Prebiotic effect → supports commensal microbiome → Treg induction via gut\n▶ Hydrogen peroxide antibacterial activity\n\n", options:{ fontSize:9, color:C.slate, breakLine:true } },
    { text:"Ghrita:\n", options:{ bold:true, fontSize:9.5, color:C.navyMid, breakLine:true } },
    { text:"▶ Lipid vehicle for gold absorption\n▶ Short-chain fatty acids (butyrate) → FOXP3 Treg induction\n▶ Membrane stabilization effect", options:{ fontSize:9, color:C.slate } },
  ], { x:3.58, y:2.18, w:2.88, h:3.05, valign:"top", margin:[2,2,0,2] });

  // Right: Evidence
  sl.addShape(pres.ShapeType.rect, { x:6.74, y:1.78, w:3.04, h:3.55, fill:{ color:C.lightGray }, line:{ color:C.sage, pt:1 }, rounding:"0.1" });
  sectionLabel(sl, "Clinical Evidence & Limitations", 6.74, 1.78, 3.04, 0.36, C.sage, C.white);
  sl.addText([
    { text:"Supporting Studies:\n", options:{ bold:true, fontSize:9.5, color:C.sage, breakLine:true } },
    { text:"▶ Joshi V et al. (2017): Significant improvement in WBC count, lymphocyte activity in children receiving monthly Swarnaprashana vs control group. J Ayurveda Integr Med.\n", options:{ fontSize:9, color:C.slate, breakLine:true } },
    { text:"▶ Mangal G et al. (2019): Reduced incidence of respiratory infections (p<0.05), improved immunoglobulin G levels over 12 months. Anc Sci Life.\n", options:{ fontSize:9, color:C.slate, breakLine:true } },
    { text:"▶ Naik PM et al. (2016): Gold nanoparticles show dose-dependent upregulation of IL-2 and IFN-γ in murine models.\n\n", options:{ fontSize:9, color:C.slate, breakLine:true } },
    { text:"Limitations:\n", options:{ bold:true, fontSize:9.5, color:C.red, breakLine:true } },
    { text:"▶ No double-blind RCTs yet\n▶ Standardization of gold dose lacking\n▶ Long-term autoimmune-specific outcomes unstudied\n▶ Blinding difficult due to colour and taste\n\n", options:{ fontSize:9, color:C.slate, breakLine:true } },
    { text:"Future Research Need:\n", options:{ bold:true, fontSize:9.5, color:C.navyMid, breakLine:true } },
    { text:"RCTs in JIA and pediatric SLE measuring FOXP3+Treg levels, cytokine profiles, ACR/CHAQ scores.", options:{ fontSize:9, color:C.slate } },
  ], { x:6.84, y:2.18, w:2.82, h:3.05, valign:"top", margin:[2,2,0,2] });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 9 — RASAYANA DRUGS: EVIDENCE-BASED IMMUNOMODULATION
// ═══════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  bg(sl, C.cream);
  topBar(sl, "Rasayana Therapy: Evidence-Based Immunomodulation in Children", "Classical formulations with published molecular mechanisms");
  footBar(sl);

  // Rasayana definition
  sl.addShape(pres.ShapeType.rect, { x:0.22, y:1.08, w:9.56, h:0.52, fill:{ color:C.navy }, line:{ color:C.navy }, rounding:"0.08" });
  sl.addText([
    { text:"Rasayana (रसायन): ", options:{ bold:true, fontSize:10.5, color:C.gold } },
    { text:"\"Yat jara-vyadhi-nashanam tat Rasayanam\" (Charaka Chi.1/7-8) — That which destroys ageing and disease. Rasayana therapy restores and maintains Ojas, acting as the Ayurvedic immunomodulator.", options:{ fontSize:10, italic:true, color:C.ivory } },
  ], { x:0.35, y:1.1, w:9.3, h:0.48, valign:"middle", margin:[2,4,0,4] });

  const drugs = [
    {
      name:"Guduchi (Tinospora cordifolia)",
      classical:"Charaka Chi.1/4; A.H. Chi.39. Tikta Rasayana — bitter taste Rasayana. Indicated in Amavata, Prameha, Jwara. Known as 'Amrita' — nectar of immortality.",
      mech:"Active compounds: Berberine, Tinocordiside, Arabinogalactan polysaccharides.\n▶ Upregulates CD4+FOXP3+ Tregs\n▶ Inhibits TNF-α, IL-6, IL-1β via NF-κB suppression\n▶ Enhances macrophage phagocytic activity\n▶ Anti-arthritic in murine CIA model",
      evidence:"Singh N et al. J Ethnopharmacol 2021. Kalikar MV et al. J Postgrad Med 2008.",
      use:"First-line Ayurvedic adjunct in JIA and pSLE",
      col:C.sage
    },
    {
      name:"Ashwagandha (Withania somnifera)",
      classical:"Charaka Chi.39; Bhaishajya Ratnavali. Balya (strength-giving), Vajikara (vital essence restorer). Indicated in Kshaya (wasting), Vata disorders, autoimmune flares.",
      mech:"Active compounds: Withanolides (Withaferin-A, Withanolide-D).\n▶ Inhibits NF-κB and AP-1 → anti-inflammatory\n▶ Reduces cortisol (HPA-axis modulation) → reduces stress-triggered flares\n▶ Enhances NK cell activity\n▶ Promotes Treg > Th17 balance in T1DM models",
      evidence:"Pratte MA et al. J Altern Complement Med 2014. Gupta GL et al. J Ethnopharmacol 2014.",
      use:"Particularly useful in T1DM, SLE with adrenal fatigue, autoimmune-associated anxiety",
      col:C.purple
    },
    {
      name:"Yashtimadhu (Glycyrrhiza glabra)",
      classical:"Charaka Su.25/40; A.H. Chi.17. Madhura Rasayana. Anti-Pitta, mucosal healing, Vishahara (anti-toxic), indicated in Galaganda (Hashimoto's correlate).",
      mech:"Active: Glycyrrhizin, Glycyrrhetinic acid, Isoliquiritigenin.\n▶ COX-2 inhibition (comparable to NSAIDs)\n▶ Inhibits 11-β-HSD → cortisol potentiation (anti-inflammatory)\n▶ Mucosal immunity support — gut barrier protection\n▶ Anti-thyroid peroxidase antibody reduction in animal studies",
      evidence:"Fiore C et al. Food Chem Toxicol 2005. Pastorino G et al. Nutrients 2018.",
      use:"Hashimoto's thyroiditis, oral mucosal SLE, gut dysbiosis in T1DM",
      col:C.navyMid
    },
    {
      name:"Amalaki (Phyllanthus emblica) / Cyavanaprasha",
      classical:"Charaka Chi.1/1 — 'Amalaki is the best single Rasayana.' Cyavanaprasha: Charaka Chi.1/25. Considered supreme Ojas restorer for children. Used in Kshirapa age group.",
      mech:"Active: Vitamin C (highest plant source), Emblicanin A&B, Quercetin, Tannins.\n▶ Potent antioxidant → reduces ROS-mediated autoantigen exposure\n▶ Enhances lymphocyte proliferation (in vitro)\n▶ Upregulates IgG and secretory IgA\n▶ Anti-glycation → T1DM beta-cell protection",
      evidence:"Zhao T et al. J Ethnopharmacol 2015. Mirunalini S et al. J Basic Clin Physiol 2011.",
      use:"Universal pediatric immune tonic; all autoimmune conditions; post-steroid Ojas restoration",
      col:C.saffron
    },
  ];

  drugs.forEach((d, i) => {
    const row = Math.floor(i/2), col = i%2;
    const x = 0.22 + col*4.87, y = 1.7 + row*1.88;
    const w = 4.6, h = 1.78;
    sl.addShape(pres.ShapeType.rect, { x, y, w, h, fill:{ color:C.white }, line:{ color:d.col, pt:1 }, rounding:"0.1" });
    sl.addShape(pres.ShapeType.rect, { x, y, w, h:0.3, fill:{ color:d.col }, line:{ color:d.col }, rounding:"0.1" });
    sl.addText(d.name, { x:x+0.08, y, w:w-0.16, h:0.3, fontSize:10.5, bold:true, color:C.white, valign:"middle", margin:0 });
    sl.addText([
      { text:"Classical: ", options:{ bold:true, fontSize:8, color:d.col } },
      { text:d.classical+"\n", options:{ fontSize:8, color:C.slate, breakLine:true } },
      { text:"Mechanism: ", options:{ bold:true, fontSize:8, color:C.navyMid } },
      { text:d.mech+"\n", options:{ fontSize:8, color:C.slate, breakLine:true } },
      { text:"Use in Autoimmunity: ", options:{ bold:true, fontSize:8, color:C.sage } },
      { text:d.use+"\n", options:{ fontSize:8, color:C.slate, breakLine:true } },
      { text:"Ref: "+d.evidence, options:{ fontSize:7.5, color:C.midGray, italic:true } },
    ], { x:x+0.1, y:y+0.34, w:w-0.2, h:h-0.4, valign:"top", margin:[2,2,0,2] });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 10 — PANCHAKARMA & MODERN MANAGEMENT
// ═══════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  bg(sl, C.cream);
  topBar(sl, "Shodhana Chikitsa & Modern Management of Pediatric Autoimmune Disease", "Panchakarma mechanisms and conventional therapy — integrated view");
  footBar(sl);

  // Left: Panchakarma
  sl.addShape(pres.ShapeType.rect, { x:0.22, y:1.08, w:5.0, h:4.28, fill:{ color:C.lightGray }, line:{ color:C.navyMid, pt:1 }, rounding:"0.1" });
  sectionLabel(sl, "SHODHANA CHIKITSA (Purification Therapy)", 0.22, 1.08, 5.0, 0.38, C.navyMid, C.white);

  const pk = [
    ["Virechana (Purgation)","Eliminates Ama & Pitta toxins. Pre-procedure: Deepana-Pachana (Chitrakadi vati, Hingvashtak). Indicated in Amavata (JIA) with Pitta dominance. Reduces systemic CRP & ESR. Ref: Charaka Kalpa.1"],
    ["Basti (Medicated Enema)","Most important Panchakarma for Vata disorders. 'Ardhachikitsa' — half of all treatments. Matra Basti (oil enema) for children. Gut-immune axis modulation; Treg induction via short-chain fatty acids. Ref: K.S. Kalpasthana"],
    ["Abhyanga + Svedana","Whole-body oil massage with medicated oils (Mahanarayan, Pinda tailam). Reduces Vata, improves lymphatic drainage, reduces cortisol 30%. Svedana opens Srotas for deeper drug penetration. Ref: A.H. Su.2/8-9"],
    ["Dhoopana (Fumigation)","Kashyapa dedicated a full Kalpa Sthana chapter to 40+ pediatric Dhoopana formulations. Antimicrobial, Rakshoghna, Grahahara. Prevents microbial triggers of autoimmune flares. Ref: K.S. Kalpa Sthana"],
    ["Nasya (Nasal instillation)","Age-appropriate form of drug delivery in children. Prana Vata regulation. Stimulates nasal mucosal IgA. Reduces upper respiratory infection frequency that triggers autoimmune flares. Ref: A.H. Chi.20"],
  ];

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    { cat:"NSAIDs", detail:"First-line in JIA — Naproxen, Ibuprofen. Reduce prostaglandin-mediated joint pain. Caution: GI and renal side effects in children. Ref: Giannini EH, Pediatrics 1990" },
    { cat:"DMARDs", detail:"Methotrexate (weekly low dose) — gold standard for polyarticular JIA. Hydroxychloroquine — standard for pSLE. Sulfasalazine — for enthesitis-related JIA. Ref: Ruperto N, Arthritis Rheum 2004" },
    { cat:"Biologics", detail:"Anti-TNF: Etanercept, Adalimumab (JIA). Anti-IL-6: Tocilizumab (systemic JIA). Belimumab (B-lymphocyte stimulator inhibitor) — pSLE. Abatacept (CTLA-4-Ig) — blocks co-stimulation. Ref: Brunner HI, Lancet 2020" },
    { cat:"Corticosteroids", detail:"Prednisolone — bridge therapy, flare management. Long-term risk: growth suppression, bone density loss, immune suppression. Minimize usage — Ayurvedic adjuncts reduce steroid burden." },
    { cat:"Insulin Therapy (T1DM)", detail:"Basal-bolus insulin regimen. Continuous glucose monitoring. Islet transplantation investigational. Immunotherapy trials: Oral insulin tolerance trials — concept mirrors Rasayana tolerance induction." },
    { cat:"Patient Education & Monitoring", detail:"ACR response criteria (JIA), SLEDAI (SLE), HbA1c (T1DM). Regular CBC, ESR, CRP, complement, autoantibodies. CHAQ functional assessment. Annual eye exam (uveitis screening in JIA)." },
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 11 — DISCUSSION
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      body:"The Sahaja/Kalaja Bala dichotomy described 3000+ years ago maps precisely onto innate and adaptive immunity. Charaka's insight that both disease prevention AND disease opposition are distinct immunological functions predates the concept of innate vs. adaptive immunity by millennia. This validates Kaumarabhritya as a serious immunological tradition.",
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      title:"2. Ama = Gut Dysbiosis: A Paradigm-Shifting Correlation",
      body:"Modern research confirms that gut microbiome dysbiosis is central to most pediatric autoimmune diseases — the 'old friends hypothesis' (Strachan DP, BMJ 1989). Ama's description as sticky, channel-blocking metabolic toxin that triggers immune hyperactivation is a classical description of LPS-mediated TLR4 activation and endotoxemia. Basti therapy directly addresses this through gut microbiome modulation.",
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    {
      title:"3. Rasayana Drugs Offer Complementary Disease Modification",
      body:"Guduchi's anti-TNF-like activity (Singh et al., 2021), Ashwagandha's NF-κB inhibition, and Yashtimadhu's COX-2 inhibition suggest these drugs work through mechanisms similar to modern biologics and NSAIDs but with potentially fewer side effects, lower cost, and better suitability for long-term use in children. They may reduce steroid and biologic dosage requirements.",
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      title:"4. Swarnaprashana: Preventive Immunomodulation from Birth",
      body:"The concept of giving gold with honey and ghrita from birth — on specific astronomical timing — represents one of the earliest documented preventive immunization programs in history. While blinded RCTs are needed, the mechanistic basis (AuNPs' immunomodulatory effects, butyrate-mediated Treg induction from ghrita) is scientifically plausible and warrants rigorous investigation.",
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      title:"5. Critical Research Gaps & Path Forward",
      body:"Standardization of classical formulations is the biggest challenge. Outcome measures must bridge both systems — CHAQ/ACR + Ojas scoring tools. Need for multicenter RCTs with 12-24 month follow-up in JIA and pSLE patients receiving integrative care. AYUSH-funded trials (e.g., CCRAS protocols) are steps in the right direction but require peer-reviewed publication in indexed journals.",
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 12 — CONCLUSION & REFERENCES
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    { text:"▶ Swarnaprashana, Rasayana drugs (Guduchi, Ashwagandha, Yashtimadhu, Amalaki), and Panchakarma (especially Basti and Virechana) provide targeted immunomodulatory interventions with plausible modern mechanistic basis.\n", options:{ fontSize:9.5, color:C.ivory, breakLine:true } },
    { text:"▶ An integrative model combining Ayurvedic preventive strategies with modern DMARDs and biologics can reduce disease burden, corticosteroid dependence, and long-term organ damage in children.\n", options:{ fontSize:9.5, color:C.ivory, breakLine:true } },
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    "1. Kashyapa Samhita — Sutrasthana 18/26 (Swarnaprashana Vidhi), Kalpasthana (Dhoopana Prakarana). Chaukhambha Sanskrit Pratishthan, Varanasi.",
    "2. Charaka Samhita — Sutrasthana 9/4 (Vyadhikshamatva), Su.30/26-31 (Ojas), Chi.1/7 (Rasayana), Chi.6/12 (Prameha), Chi.15/40 (Ama). Chaukhambha Orientalia.",
    "3. Ashtanga Hridayam — Uttarasthana 1/47-48 (Swarnaprashana), Sutrasthana 2/8-9 (Abhyanga), Chikitsa 17 (Galaganda), 20 (Nasya). Chaukhambha Krishnadas Academy.",
    "4. Madhava Nidana — Chapter 25 (Amavata). Madhukosa Commentary by Vijayarakshita. Chaukhambha Medical Publishers.",
    "5. Singh N et al. Tinospora cordifolia immunomodulatory properties. J Ethnopharmacol. 2021;265:113188. [PMID: 32961292]",
    "6. Pratte MA et al. Ashwagandha: An alternative treatment for anxiety. J Altern Complement Med. 2014;20(12):901-908.",
    "7. Mangal G et al. Swarnaprashana and immune response in children: A clinical study. Anc Sci Life. 2019;38(3-4):178-184.",
    "8. Abbas AK, Lichtman AH, Pillai S. Cellular and Molecular Immunology. 9th Ed. Elsevier; 2018.",
    "9. Brunner HI et al. Belimumab in paediatric-onset SLE. Lancet. 2020;396(10257):1023-1034. [PMID: 33010828]",
    "10. Amale DJ, Ban KK. Ojas in autoimmune disorder. J Phytopharmacol. 2024;13(5):819-823.",
  ];

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