Effective management of Vishwachi by Uttarabhaktika Nasya w.s.r. to Cervical Spondylosis - A Single Case Study

Samata; Shaila Borannavar; Ananta S Desai

Effective management of Vishwachi by Uttarabhaktika Nasya w.s.r. to Cervical Spondylosis - A Single Case Study

Samata.^1*, Borannavar S.², S Desai A.³

DOI:

^1* Samata, Post Graduate Scholar, Dept. of PG Studies in Panchakarma, Govt. Ayurveda Medical College, Bengaluru, Karnataka, India.

² Shaila Borannavar, Associate Professor, Dept. of PG Studies in Panchakarma, Govt. Ayurveda Medical College, Bengaluru, Karnataka, India.

³ Ananta S Desai, Professor and HOD, Dept. of PG Studies in Panchakarma, Govt. Ayurveda Medical College, Bengaluru, Karnataka, India.

Nasya is one among the Panchakarma which is mainly indicated in the Urdhvajatrugata Vyadhi. Vishwachi is a condition explained under the Vatavyadhi. The prevalence of cervical spondylosis was 13.76%. In this case the efficacy of Dashamoola Bala Masha Yamaka Uttarabhaktika Nasya in the dose of 8 Bindu in each nostril for 7 days has shown significant result. Materials and Methods: A 49yr old female patient with N/K/H/O DM & HTN, C/O loss of strength and radiating pain in Rt. upper limb and with restricted movements of neck since 6 months has been treated with Nasya Karma. Results: After the treatment patient had marked relief from pain and improvement was seen in range of movements. Discussion: In contemporary science it can be correlated to cervical spondylosis, a degenerative condition of the cervical spine. In treatment, administration of muscle relaxants, NSAID and corticosteroids etc. gives temporary relief from pain but at the end last option left is surgery, which has several complications and may even cause permanent disability. Acharya Yogaratnakara and Chakradatta specially mentioned Uttarabhaktika Nasya given after evening food in Vishwachi is very beneficial. Conclusion: Dashamula Bala Masha Yamaka is the drug of choice in Vishwachi which has been explained by Acharya Chakradatta and Yogaratanakara, in the form of Uttarabhaktika Nasya, which is not widely followed. Hence, an attempt is made to understand the clinical efficacy of the same. Hence, Dashamoola Bala Masha Yamaka Uttabhaktika Nasya is effective in Vishwachi.

Keywords: Uttarabhaktika Nasya, Dashamoola Bala Masha Yamaka, Vishwachi, Cervical spondylosis

Corresponding Author	How to Cite this Article	To Browse
Samata, Post Graduate Scholar, Dept. of PG Studies in Panchakarma, Govt. Ayurveda Medical College, Bengaluru, Karnataka, India. Email:	Samata, Shaila Borannavar, Ananta S Desai, Effective management of Vishwachi by Uttarabhaktika Nasya w.s.r. to Cervical Spondylosis - A Single Case Study. J Ayu Int Med Sci. 2022;7(1):343-348. Available From https://jaims.in/jaims/article/view/1696

Introduction

The suffering of the whole mankind with one or other ailment is due to improper adaptations in life style to the environmental and social order. Due to highly workaholic, target oriented and fast life style people are not able to attend the basic mental and physical healthy habits. The irregular and the non-healthy food habits, suppression of natural urges, improper sleep associated with the stressful atmosphere from working station to home, has become the part of the life. Due to which, society has become more vulnerable for vast variety of physical and mental ailments.

Among these, the musculoskeletal and neurological conditions are common in the people who are indulging continuously and excessively in activities like travelling, household work, office job, professionals; who sit in front of the computers for hours together. These etiological factors result in varieties of Vata Vyadhi. Amongst these groups of people, Vishwachi is the common most condition with signs and symptoms of Cheshtahani and Karmakshaya of Bahu due to the affliction of Khandara of Hastatala, Bahuprishtha and Anguli.^[2] In contemporary science it can be correlated to cervical spondylosis, a degenerative condition of the cervical spine.^[3]

The prevalence of cervical spondylosis was 13.76%, although it differs significantly among the urban, suburban, and rural populations (13.07%, 15.97%, and 12.25%) respectively.^[4] In Contemporary system of medicine, administration of muscle relaxants, NSAIDs, corticosteroids, etc., gives temporary relief from pain. At the end, the last option left is surgery, which has several complications and may even cause permanent disability.

Acharyas have mentioned Nasya Karma as the prime treatment modality in the management of Urdhwajatrogata Rogas. As “nose is the door to the head” so, Nasya Karma helps in relieving almost all diseases of the head and neck easily and also imparts strength to the Skandha, Greeva, Mukha and Vaksha Pradesha. The Brimhana Nasya is told for the treatment of Urdhvajatrugata Rogas like Manyagata, Bahugata and Amsagata Roga. Vishwachi is one amongst the Urdhvajaturugata Vata Vikara is also treated with Sneha Nasya. Uttarabhaktika Nasya^[5] is explained in our classics

by Chakradatta and Yogaratnakara in the context of Vishwachi in Vatavyadhichikitsa Adhyaya, which is not widely followed. Hence, an attempt is made to understand its clinical efficacy.

Case Report

The present case is about Ayurvedic management Vishwachi, considered as cervical spondylosis. A 49‑year‑old female suffering from Vishwachi reported to Panchakarma outpatient department (OPD) of SJIIM hospital, Bengaluru and got admitted on 03/07/2019 (IPD No - 1825, OPD No - 30162) with chief complaints.

Radiating pain from the nape of the neck to right upper limb and reduced strength in the right upper limb since 1 year.

Associated complaints

Associated with lethargy, reduced appetite, sleep disturbance since 6months.

Table 1: Showing personal history of the patient

Name- XYZ	Bala - Madhyama
Age - 49 years	Sleep - Disturbed
Sex - Female	Addiction - None
Marital status - Married	Bowel habit - Regular
Occupation - House maker	Appetite - Reduced
Weight - 60kg	Diet - Mixed

History of Present Illness

Patient was said to be apparently healthy 1 year before, then she developed pain first at the nape of the neck which gradually got radiating to the Rt Interphalangeal joints, forearm and arm. The disease was said to be progressive in nature later got associated with weakness of Rt upper limb, stiffness in the neck movements, disturbed sleep and generalized weakness in the body. For all these complaints she consulted many hospitals and treated with NSAIDs and muscle relaxants, from which she found relief for time being. On stopping medications the condition got aggravated. Gradually the intensity of disease increased and affected her daily routine activities. So she got admitted in SJIIM hospital, Bengaluru for further management.

History of past illness: No H/O thyroid disease/HTN/ DM
Family history: All the other family members are said to be healthy.

Menstrual history: Had her menopause 1year back , G3 P3 A0 D0 L3

Examination

General Examination

Vitals

BP - 110/70 mm of Hg

RR - 18/min

PR - 74/min

Temp - 38.5 degrees cent.

Pallor/Icterus/Cyanosis/Lymphadenopathy/Clubing - Absent

Systemic

CVS- S1, S2 heard

Resp- B/L symmetrical NVBS

P/A - soft and non tender

CNS Examination

Higher mental functions - Intact

cranial nerve examination- normal

Sensory examination: Normal

Motor examination

Table 2: Showing motor system examination

Motor System	Right upper limb	Left upper limb
Tone	Normotonic	Normotonic
Power	5/5	5/5
Bulk	B/L equal	B/L equal
Reflex
Triceps	++	++
Biceps	++	+

Musculoskeletal examination

Table 3: Showing Musculo-skeletal system examination

Joints	Bilateral Upper limb
Examination	Right upper Limb	Left upper limb
Range of movements	Painful	Normal
Radiating Pain	Present	Absent
Cervical joint
Swelling	Absent
Redness	Absent
Temperature	Warmth
Range of movements	Painful and restricted

Clinical Findings - Physical Examination

Ashta Vidha Pareeksha

Table 4: Showing Ashtha Vidha Pareeksha

Nadi: Pittaja Nadi / 74/min	Shabdha: Prakrita
Mutra: 4-5/day	Sparsha: Eeshat Ushna Sparsha in the nape of the neck
Mala: Once/day, Prakrita	Druk: Prakrita
Jiwha: Lipta	Akriti: Madhyama

Dashavidha Pareeksha

Table 4: Showing Dashavidha Pareeksha

Prakruti - Vata Pittaja	Sara - Madyama
Samhana - Madhyama	Satva - Madhyama
Saatmya - Shad Rasa Satmya	Vyayama Shakti - Madhyama
Ahara Shakti Abhyavarana Shakti - Madyama Jarana Shakti - Madhyama	Vayah - 49yrs (Madhyama )
Pramana - Madhyama

Samprapti Ghataka

Table 7: Showing Samprapti Ghataka of Vishwachi

Dosha	Vata Pradhana Tridoshaja
Dushya	Mamsa, Asthi, Snayu, Sandhi And Kandara
Agni	Jataragni, Dhatwagni
Ama	Jataragni Janya, Dhatwagni Janya
Srotas	Asthivaha And Majjavaha
Srotodushti Prakara	Sanga
Udhbhava Sthana	Amashayaotatha
Vyakta Sthana	Kandara and Snayu of Bahu, Hastatala and Anguli
Marga	Madhyam
Sadhyaasadhyata	Sadhya

Treatment Schedule

Patient got admitted on 03/07/2019, initially she was given, Hingwashtaka Churna internally and Rooksha Pinda Sweda to cervical region for 3 days, followed by Sthanika Abhyanga with Ksheerabala Taila fallowed by Bashpa Sweda and Nasya with Dashamoola Bala Masha Yamaka in the evening time at 4pm after food for 7 days has been given.

During the treatment and follow up the patient was completely on cessation of Coffee and tea.

Throughout the treatment as a part of Pathya the patient was advised to avoid spicy, oily, salty and heavy food. Along with this she was instructed to stay in warm room, not to expose to the sun and cold breeze directly.

Table 5: Showing treatment schedule

Date	Medicine	Dose
4-6/7/2019	Rooksha Pinda Sweda to Manya Pradesha Hingwashtaka Churna	1/2tsp - 1/2tsp – 1/2tsp (B/F) with Food
7-13/7/2019	Nasya Karma Poorva Karma Sthanika Abhyanga to Jatrurdhwa Pradesha with Ksheerabala Taila fallowed by Bashpa Sweda Pradhana Karma Nasya with Dashamoola Bala Masha Yamaka after food in the evening at 4pm Pashchat Karma Dhoomapana with Haridra Varti and Kavala with Ushna Jala	For 7 days For 7 days 8 Bindu in each nostril For 7 days
7-14/7/2019	Draksharishtha Ekanga Veera Rasa Trayodashanga Guggulu	15ml - 0 - 15ml (A/F) (Ushna Jala Anupana) 1 - 1 - 1 (A/F) (Ushna Jala Anupana) 2 - 2 - 2 (A/F) (Ushna Jala Anupana)

Results

Table 6: Showing the results

SN	Symptoms	Before Treatment	After Treatment
1.	Radiating pain from the nape of the neck	Present	Absent
2.	Tenderness in the nape of the neck	Present	Absent
3.	Reflexes in right upper limb	Sluggish	Normal reflexes
4.	Appetite	Reduced	Improved
5.	Generalized weakness	Present	Absent

Discussion

The disease Vishwachi is a Vatavyadhi and one among the 80 Nanatmaja Vikara of Vatadosha. The Lakshana’s of Vishwachi includes impairment in the Karmakshaya and Karmahani of Baahu which includes impairment in the function such as Utkshepana and Apakshepana of Baahu. Dalhana opines that Vishwachi resembles the Gridhrasi but difference between these two is Vishwachi occurs in the upper limb and Gridhrasi in the lower limbs.

Amongst Panchakarma Nasya Karma carries importance in the aspects of Urdhwajatru Vikaras. And we can directly find the indication of the Nasya Karma in the disease Vishwachi in our classics both in Brihat Trayees and Laghu Trayees. There are certain references which gives the idea behind

the relevance of Nasya Karma in Vishwachi (cervical spondylosis) as ‘Greeva Skandorasam Cha Bala Jananartham’.

In the present case study initially Rookshana Chikitsa along with Deeepana-Pachana has adopted, because patient had symptoms of Stiffness and difficulty in neck movement which indeed indicates Kaphadosha association as Avarana. So, in order to remove localized Avarana, Rooksha Pinda Sweda has helped because of its properties.

Brimhana and Tarpana qualities of Marsha Nasya are helpful in managing degenerative condition caused due to Vatadosha, as Dashamoola Bala Masha Yamaka^[6] is Snigdha and Brimhana in nature so, it is the drug of the choice in the present case. Dashamoola Bala Masha Yamaka as name itself says Yamaka means having two Snehas i.e., Grhita and Taila in the preparation is best in tackling Vata Dosha. Acharaya Charaka in Sutrasthana Snehadyaya has told that Yamaka Sneha is best in Vatavyadhi and Vangasena also mentioned that Yamaka means formulation having both Ghrita and Taila.^[7] So, Marsha Nasya with Dashamoola Bala Masha Yamaka has helped here to treat the Vishwachi in present case.

Why Uttarabhaktika Nasya

Administration of Nasya Kiarma after food in the evening time with the Dashamoola Bala Masha is done in the present study, as evening time^[8] is considered as the Vata Kala and Vishwachi is being a Vatavyadhi so, it helped to tackle the condition very effectively.

Uttarabhaktika Nasya is mainly explained by the Acharya Yogaratnakara, Chakradatta and in the context of Vishwachi in Vatavyadhi Chikitsadhyaya.
Acharya Vagbhata has also explained about the administration of evening time Nasya Dravya in Vataja conditons in Nasyavidhimadhyayam of Sutrasthana.

Conclusion

Viahwachi is mainly Shoola Pradhana Vata Vyadhi which is commonly associated with the Karmakshaya of Bahu. Cervical Spondylosis is a degenerative condition of the cervical spine, which affects the old age and middle age. Based on the age factor Dhatu Kshaya is a prominent

feature involved in the manifestation of the disease. As it is a Vata dominated Urdhwajatrugata Vikara the Chikitsa included is Snehana and Swedana followed by Nasyakarma. Hence, Brimhana type of Uttarabhaktika Nasya Karma has given better result in the present study.

Reference

Ashtanga Hridaya- with Sarvanga Sudari commentary of Arunadatta and Ayurvedarasayana commentary of Hemadri, Collated by Dr Anna Moreswar Kunte and Krisna Ramchandra Shastri Navre, Edited by Pt. Bhishagacharya Harishastri Paradkar Vaidya, Varanasi: Krishnadas Academy; reprint 112000, pg no 956, Su.20/1, Pn 287
Sushruta, Sushruta Samhita- with Nibandha Sangraha commentary of Dalhanacharya & Nyayachandrika of Sri Gayadasacharya on Nidanasthana edited by Vaidya Yadavj Trikamji Acharya & the rest by Narayan Ram Acharya ‘Kavyatirtha’, Varanasi: Chowkambha Orientalia; reprint 2010. Pn 824. Ni.1/75 Pn 268.
Sir Stanley Davidson- Davidson’s Principles and Practice of medicine – edited by Nicolas A Boon, Nicki R Colledge, Brian R Walker John A A Hunter 20th edition. Elsevier Limited; 2006. Pp 1381, pn1242.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6134586/
Yogaratnakara, with “Vaidyotini’’ Hindi commentary By Vaidya Lakshmipati Shastri, edited by Bhishagratna Bhramhashankar Shastri, published by Chaukhambha Sanskrit Sansthan Varanasi, 6^th Vatavyadhi chikitsa prakarana 25/145.Pn520.
Yogaratnakara, with “Vaidyotini’’ Hindi commentary By Vaidya Lakshmipati Shastri, edited by Bhishagratna Bhramhashankar Shastri, published by Chaukhambha Sanskrit Sansthan Varanasi, 6^th Vatavyadhi chikitsa prakarana 25/72 Pn511.
Vangasen Samhita, Vol-2, English Commentary of Dr. N. Saxena, Chaukhamba Sanskrit Series, Varanasi, 1st Edition, 20041.
Vagbhata. Ashtanga Hridaya- with Sarvanga Sudari commentary of Arunadatta and Ayurvedarasayana commentary of Hemadri,

Collated by Dr Anna Moreswar Kunte and Krisna Ramchandra Shastri Navre, Edited by Pt. Bhishagacharya Harishastri Paradkar Vaidya, Varanasi: Krishnadas Academy; reprint 112000, Pn 956 .Su.20/14. Pn290.

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-01-24	2022-01-26	2022-02-02	2022-02-09	2022-02-16
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	16%

Case Report

Uttarabhaktika Nasya

Journal of Ayurveda and Integrated Medical Sciences