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MANAGEMENT OF LOW BACKACHE DUE TO PIVD THROUGH PANCHAKARMA: A CASE STUDY

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Tiwari Swati et al / Int. J. Res. Ayurveda Pharm. 9 (1), 2018
84
Research Article
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MANAGEMENT OF LOW BACKACHE DUE TO PIVD THROUGH PANCHAKARMA: A CASE STUDY
Tiwari Swati 1*, Singh Shipra 1, Sharma Parul 2, Sharma Ved Bhushan 3
1M.D. Scholar, Dept. of Panchakarma, Rishikul Campus (Haridwar), U.A.U, India
2Associate Professor, Dept. of Panchakarma, Rishikul Campus (Haridwar), U.A.U, India
3Assistant Professor, Dept. of Agad Tantra, Rishikul Campus (Haridwar), U.A.U, India
Received on: 10/10/17 Accepted on: 22/12/17
*Corresponding author
E-mail: dr.swatitiwari91@gmail.com
DOI: 10.7897/2277-4343.09117
ABSTRACT
Back pain is an affliction that affects a substantial proportion of entire population, at least at some point in their life. About 80% of population suffer
from low backache a nd it is medically and economically devastating and is the major cause for disability. Patient’s main complaint was severe l ow
backache radiating to right leg, stiffness in back due to which he was unable to sit and walk. On physical examination, the straight leg raising (SLR)
test was 30° on right leg and 45° on left leg, Lasegue Test, Bowstring Test and Femoral Stretch Test was positive in B/L lower limbs. Patient was
diagnosed as Prolapsed inter-vertebral disc (PIVD) which can be correlated to Kativata (low backache) which comes under Vatavyadhi in Ayurveda.
Panchakarma therapies like Ruksha Pottali sweda (dry bolus fomentation), Patra Pottali sweda (bolus fomentation), Abhyanga (massage), Swedana
(sudation), Vasti (therapeutic enema), Kati vasti (procedure where specified medicated oil is retained for a stipulated period in kati region) etc. along
with vata shamak drugs were given orally to the patient and found to be very effective. Panchakarma procedures along with Shaman therapy (oral
medicines) as per Ayurveda act on vata dosha which is responsible for Kativata. The General condition of patient becomes better than previously. So
this case shows the efficacy of Ayurveda specially Panchakarma in low backache with good follow up results and without any adverse effects.
Keywords: Prolapsed inter-vertebral disc, Kativata, Ruksha Pottali sweda, Patra Pottali sweda, Abhyanga.
INTRODUCTION
Disc herniation accounts for 30% of low back pain particularly
in most productive period of life1. PIVD means the protrusion
from the nucleus pulposus through a rent within the annulus
fibrosus2. In 95% of the lumbar disc herniations, L4-L5, L5-S1
discs are most commonly affected3. NSAID, steroids etc. are the
main management of patients as they provide symptomatic
relief. Therefore a variety of Ayurvedic Panchakarma therapies
may be useful in decreasing the symptoms of PIVD. Here a
male patient with PIVD not responding to any allopathic
medicines is planned for different Sthanik (local) and
Sarvadaihik chikitsa (generalised treatment) which resulted in
wonderful response.
CASE REPORT
A male patient of age 35 years from Haridwar visited O.P.D. of
Rishikul Campus, Haridwar.
Chief complaints
1. Severe low backache radiating to right leg since last six
months.
2. Stiffness in back and inability to sit in erect posture for long
duration since six months.
3. Unable to walk without support, limping while walking
since one month.
H/O present illness: Patient was asymptomatic one year ago.
Gradually he developed pain in his lower back region radiating
to right leg, with tingling and numbness, with no history of any
injury. There was also stiffness in lower back and thighs with
increasing difficulty in walking and leads to limping. He took
allopathic treatment but did not get any relief so he came to
Rishikul hospital.
Past history: Normotensive, Non-diabetic patient with no
history of any injury.
Family history: Not significant
Treatment history: Patient has a history of Allopathic
medicines but had no relief.
Personal History
G.C Poor
Appetite Decreased
Diet -Vegetarian
Urine - Normal frequency and amount
Bowel Constipated
Thirst - Normal
Sleep - disturbed due to severe pain
On Examination
General Examination
Pulse Rate- 72/min,
B.P. - 120/84mmHg
Pallor- P+
Tongue- Coated
Icterus - Not present
Lymph nodes - Not enlarged
Cyanosis - Not present
Oedema- Not present
JVP Not raised
Height - 5’10”
Weight 70 kg
Tiwari Swati et al / Int. J. Res. Ayurveda Pharm. 9 (1), 2018
85
Clinical Findings
SLR - The straight leg raising (SLR) test was 30° on right leg
and 45° on left leg.
Lasegue Test- Positive B/L lower limb
Bowstring Test Positive B/L lower limb
Femoral Stretch Test Positive B/L lower limb
Diagnostic Assessment
MRI LS spine suggestive of degenerative disc disease L3/L4,
L4/L5 and L5/S1 with significant large median and large
paramedian disc protrusion at L4/L5 levels and mild disc bulge
at L3/L4 and L5/S1.
All other routine investigations were in normal limits.
Differential Diagnosis
MRI findings do not show Lumbar canal stenosis and
Spondylolisthesis. The pattern of pain has no resemblance with
pain of sciatica so the case can be provisionally diagnosed as
PIVD.
Prognosis was good because patient was young and came in his
early stage of disease and there was mild disc bulge therefore
Ayurvedic treatment was so effective. If the prognosis was bad
then surgery will be the only treatment left.
Assessment Criteria Table 1: Criteria of Assessment for Low Back Pain
Sl. No
Symptoms
Parameters
Gradation
1
Pricking Pain
Absent
Mild
Moderate
Severe
0
2
4
6
2
Stiffness
Absent
Mild
Moderate
Severe
0
2
4
6
3
SLR scoring
0
10
20
30
40
50
60
70
80
90
54
48
44
36
30
24
13
12
6
0
4
Posture
No Complaints
Patient walks without difficulty but experiences
difficulty from getting up from squatting
Difficulty To Squat
Difficulty In Climbing Up Stairs
Limping Gait
0
1
2
3
4
Table 2: Observations According to Criteria of Assessment Before Treatment
Sl. No.
Symptoms
1
Pricking Pain
2
Stiffness
3
SLR scoring Rt
SLR scoring Lt
4
Posture
Therapeutic Intervention
Shodhana chikitsa: The patient is planned for panchakarma
therapy in 4 steps.
Step 1-
Ruksha Pottali sweda (dry bolus fomentation with Erandbeej
and saindhav lavana) in katipradesh (low back region) and pada
(legs) for 4 days.
Step 2-
Further Kati-vasti (procedure where specified medicated oil is
retained for a stipulated period in kati region) with Panchaguna
tail, with Sarvang Patra-Pottali sweda (full body bolus
fomentation) and Nadi sweda (local sudation) for 8 days.
Step 3-
Further for next 8 days Kati vasti with Panchaguna tail, Sarvang
abhyanga (full body massage) with Dhanvantar tail and Sarvang
swedana (full body sudation) was given.
Step 4-
Finally, the patient is treated with Yoga vasti (therapeutic enema
with group of 8 enemas) of Panchatikta Ksheer Niruha vasti and
Matra vasti (oil enema) with Panchguna tail while prior
application of Kati-Pichu (local oil paddling), and Sarvang
Abhyanga (full body massage) with Sahacharadi tail and
Swedana (full body sudation) for 8 days.
Shamana Chikitsa
1. Maharasnadi kwatha 40 ml BD empty stomach twice a day.
2. Swarnayograj Guggulu 1 OD with milk after breakfast.
3. Cap Ashwagandha 1 HS with milk at night.
4. Panchguna taila for Local application at bed time.
Tiwari Swati et al / Int. J. Res. Ayurveda Pharm. 9 (1), 2018
86
Table 3: Observations According to Criteria of Assessment
Sl. No.
Symptoms
Before Treatment
After treatment
Follow up
% of result
1
Pricking Pain
4
2
0
100.00%
2
Stiffness
4
2
2
50.00%
3
SLR scoring (Right)
36
12
12
44.43%
SLR scoring (Left)
33
6
6
50.00%
4
Posture
4
1
1
75.00%
Follow up: Patient was followed for the period of two months
after the intervention of panchakarma therapy.
Present study was carried out in accordance with ethical
principles by following International conference of
Harmonization-Good Clinical Practices Guidelines (ICH-GCP).
RESULTS
Besides the above mentioned percentage improvement, the other
features as disturbed sleep, decreased appetite etc. were also
improved. The bowel habit is changed from constipated to
complete evacuation daily. The total G.C. becomes fairer than
previous one. There were no any adverse effects of the given
treatment found in the patient.
DISCUSSION
The general principle of treatment of vata dosha is adopted in
case of Kativata (low back pain). First of all, Ruksha Pottali
sweda (dry bolus fomentation) was done for digestion of Ama
(undigested toxic waste created due to poor digestion) and to
remove stiffness in katipradesh (low back region) and pada
(legs). When there was lightness and no stiffness than Kati vasti
(procedure where specified medicated oil is retained for a
stipulated period in kati region) was given as it is Bahya Sthanik
Snehana (external local oleation) and Swedana (sudation)
procedure which mainly acts against the ruksha guna (dryness)
and sheeta guna (coldness)respectively of Vata5.
Panchguna taila balances vata and pitta6and have analgesic as
well as anti-inflammatory activity.
Patra Pinda sweda (bolus fomentation) is used mainly to provide
relief from pain, inflammation, swelling and stiffness (catch)
associated with bone, joint and or musculoskeletal pains7.
Abhyanga (massage) acts on the root of mamsavaha srotas
(channels carrying muscle nutrients and wastes) i.e. snayu, twak
and raktavahini. It may thus nourish the superficial and deep
muscles and make the joints stable. Swedana (sudation) is
sthambhagna (removes stiffness), sandhichestakar (increases
joints mobility), srotoshuddhikar (cleaning the micro channels)
and kapha-vata nirodhana (removing excess vata and
kaphadosha). Thus by its action, the srotosangavighatana
(breakdown the pathogenesis by removing obstruction in the
micro channels) may take place and stiffness of the joints
relieved8.Dhanvantaram taila9is also vataghna( removing excess
vata) with pitta and raktaposhana(increasing blood) qualities
which help in improving the strength of muscles, thus
nourishing mansa (muscles)and majja dhatu (marrow).
Charaka and Hemadri have said that Vasti (therapeutic enema)
is useful in kshina dhatus (depleted tissues) and bhagna
(fractures) of the asthi (bones) and sandhi10 (joints).Sushruta has
mentioned 6th Vasti (therapeutic enema) nourishes mamsa dhatu
(muscular tissue), 8th Vasti nourishes asthi dhatu (bony tissues)
and 9th Vasti nourishes majjadhatu (marrow tissues). Thus, by
Vasti we achieve vata dosha shaman and snehana of sandhis11
(oleation of joints).Charaka12 and Vagbhata13 mention the use of
Vasti prepared with the tikta dravya (bitter taste materials),
ksheera (milk) and ghrita (ghee) as the treatment of asthigata
dosha (bony tissue) along with the use of swayoni dravyas
(similar substance). Sushruta also mentioned the use of similar
substances in case of diminished dhatus14 (tissues).
In Kati Pichu (local oil paddling), sukhoshna taila (luke warm
oil) is used over the Kati Pradesh. Sneha (oil) by its snigdha
(smoothness), guru (heaviness) and ushna Guna (hotness)
counteracts vata and by ushna guna counteracts kapha also15.
The properties of Sahacharadi taila such as Snigdha, Guru, and
Ushna are Vata shamaka.
The medicines used in Shamana chikitsa (oral medicine) like
Maharasnadi kwatha, Swarna Yograja guggulu, Aswagandha is
potent vata nashaka (normalising excess vata), rasayan
(rejuvenating), balya (strength promoting activities), vata
shamak and tarpak (providing nutrition and support).
CONCLUSION
The result shows that the Ayurvedic treatment modalities were
found quite effective and reliable for the treatment of PIVD
which can be well correlated to Kativata. However, further work
should be done on large samples to draw the final conclusion.
Key message: PIVD being one of the frequent causes of low
back ache. The medical system often fails to identify this disease
early and thus leads to disproportionate amount of medical and
economic expenses. Ayurveda explains this disease as Kativata
under Vatavyadhi.
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Cite this article as:
Tiwari Swati et al. Management of low backache due to PIVD
through Panchakarma: A case study. Int. J. Res. Ayurveda
Pharm. 2018;9(1):84-87 http://dx.doi.org/10.7897/2277-
4343.09117
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... L4-L5, L5-S1 discs are most commonly affected in 95 percent of lumbar disc herniations. (1) . As we grow older the discs which are present in our vertebral column, become less flexible and begin to harden, making it more susceptible to tears. ...
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PIVD is the protrusion from the nucleus pulposus through the rent within the annulus fibrosis. L4-L5, L5-S1 discs are most commonly affected in 95 percent of lumbar disc herniation. As we grow older the discs which are present in our vertebral column, become less flexible and begin to harden, making it more susceptible to tears. The herniated disc may be caused by a single undue strain or injury. However, as disc degeneration progresses with age, a few people may suffer herniated discs from more minor activities or twists. The patient was a 38-year-old female who presented with a complaint of pain in the neck & back which was 8 on Vas, pain in both limbs ( upper & lower) which was 7 on Vas, Numbness present in Upper limb fingers, Stiffness in all joints along with pedal edema. The patient also had a varicose vein on both lower limbs grade 3. She was admitted to the hospital because she was not able to even get up from the bed due to pain. She was working in a mess for 8 years the work included prolonged standing, bending down, lifting heavy weights, and sitting on the floor for a long period. Due to pain, she was not able to continue her work. Ayurvedic treatment along with physiotherapy treatment was going on. The patient had the same complaints before 12 months she was relieved by physiotherapy. The patient had three laser sessions done for a varicose vein but was not relieved before 1 year. According to the clinical presentation and Radiological findings the patient was diagnosed with PIVD. This case study shows that regular exercise, traction, back strengthening exercise, use of modalities such as IFT, and following proper ergonomics would reduce the symptoms associated with PIVD and varicose veins
... This Yoga shows actions at different levels and works on the disease arise due to Ama. [11] Panchguna Taila used for local application in the form of massage helps in balancing Vata and has analgesic as well as anti-inflammatory action. [12] conclusIon Marked reduction in pain and tenderness was noticed after the treatment by (Raktamokshana), followed by oral Ayurveda medication in the case of PF (Vatakantaka). The same can be assessed in a large sample to evaluate the efficacy of holistic Ayurveda management approach in the patients of PF. ...
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... [25] Nadisweda: Swedana (sudation) is Sthambhaghna (removes stiffness), Sandhicheshtakar (increases joint mobility), Srotoshuddhikar (clearing the micro channels), and Kapha-vata nirodhana (removing excess vata and kapha dosha). [26] Thus, it liquefies the Doshas and expand the srotas, helping the doshas to travel toward their own sthana leading to the Srotosanga vighatana (breakdown the pathogenesis by removing obstruction in the micro channels) and stiffness of the joint relieved. [23] Sarwanga Patrapindapottali Sweda with Nirgundi, Arka, Eranda, Shigru, Karpooradi taila: Patrapinda pottali sweda consisting of medicated leaves with oil pacifies Vata without increasing kapha due to its snigdha and ruksha gunas. ...
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In India, nearly 80% of people have significant back pain due to lumbar pathology. In this case study patient’s main complaint was severe low backache, stiffness in the back due to which he was unable to do his routine activ- ities. He was diagnosed with Prolapsed intervertebral disc (PIVD) which can be correlated to katigatvata (low backache) which comes under vatavyadhi. Panchkarma therapies like katibasti and panchtikta ksheer basti in ka- la basti format are given with oral vatashamak medicines. In course of treatment satisfactory improvement was noted. Keywords: Katigatavata, Vatavyadhi, Katibasti, PTKB.
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Management of Low Backache with Ayurveda -A Case Study
  • Akm Singh
  • Jain Anup
Singh AKM, Jain Anup. Management of Low Backache with Ayurveda -A Case Study. Global Journal For Research Analysis 2016; 5(6):220-22
];[about 17 p]Available from http://jahm.in/index
  • Gupta Sanjay
  • Sharma Radheyshyam
Gupta Sanjay, Sharma Radheyshyam. Comparative clinical study of Kati vasti, Patrapinda Sveda and Matra Vasti in Kati Shoola (low backache). J of Ayurveda and Hol Med (JAHM) 2015;3(6):19-35.[cited 2017 June 21];[about 17 p].Available from http://jahm.in/index.php/JAHM /article/viewFile/424/pdf_162 6. ayurmedinfo.com [homepage on internet].India:2015 [cited 2017 june 18]. Available from http://ayurmedinfo.com /2012/07/23/panchgun-tail-benefits-dosage-ingredients-sideeffects/ 7. easyayurveda.com [homepage on internet].India [cited 2017 june 21]. Available from http://easyayurveda.com/2016/01/ 29/patra-pinda-sweda-ela-kizhi/
Role Of Matra Vasti (Enema) Over Abhyanga (Massage) And Sweda (Sudation) In
  • B T Kurubar A Deepti
  • D Munnoli
  • Arbar Vijay Kumar
  • Patil Aziz
  • Amol
Kurubar A Deepti, B. T. Munnoli, D. Vijay kumar, Arbar Aziz, Patil Amol. Role Of Matra Vasti (Enema) Over Abhyanga (Massage) And Sweda (Sudation) In Reducing Spasticity In Cerebral Palsy With Suddha Bala Taila-A
Sutra sthana, Vatavyadhi chikitsa adhyaya chapter 28 verse 27. p.180. 13. Vagbhata, Ashtanga Hridayam edited by Arundatta, Sutra sthana, Doshadi Vijnaniya Adhyaya
  • Charaka Agnivesha
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