E-ISSN:2456-3110

Case Report

Cervical Radiculopathy

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 2 February
Publisherwww.maharshicharaka.in

Ayurvedic management in case of Vishwachi (Cervical Radiculopathy): A Case Report

Kumar Shukla R1*, Sharma S2, Lodhi S3
DOI:10.21760/jaims.9.2.46

1* Ratnesh Kumar Shukla, First Year Post Graduate Scholar, Dept of Kayachikitsa, Pandit Khushilal Sharma Govt Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.

2 Shraddha Sharma, Assistant Professor, Dept of Kayachikitsa, Pandit Khushilal Sharma Govt Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.

3 Shrikant Lodhi, First Year Post Graduate Scholar, Dept of Kayachikitsa, Pandit Khushilal Sharma Govt Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.

Cervical problems are very similar to Vata Vyadhi disorders. Thus, in the current investigation, in Vata Dosha Janya Vyadhi management by Brimhana Chikitsa is very effective. A disease known as Vishwachi has been described in Ayurvedic Samhitas as one of these illnesses. The symptoms of Cervical Radiculopathy, such as pain in neck region which is radiating to the upper limbs and sometimes restricted neck movements, have been explained in Internal Medicine books (Davidsons, Harrison). Vishwachi is a Vataja Nanatmaja Vyadhi. According to several Acharyas Ruja, Stambhata, Todan, Karmakshaya, and Chestapaharana of Bahus are symptoms that affects the cervical region and upper extremities. According to Acharya Dalhana, the treatment of Vishwachi is similar to Gridhrasi, a disorder that affects the unilateral or bilateral lower extremities and divided into two types: Vataja and Vatakaphaja. Vishwachi has symptoms which are comparable to Cervical Radiculopathy, a degenerative disorder of the cervical spinal part. Nasya Karma has been described as the treatment of Shirogata Vyadhis. Dhatukshaya is a main contributor of disease to the development of Vishwachi. Present study is an effort made to better understanding of disease and its management.

Keywords: Vishwachi, management, Ayurvedic, Nasyakarma

Corresponding Author How to Cite this Article To Browse
Ratnesh Kumar Shukla, First Year Post Graduate Scholar, Dept of Kayachikitsa, Pandit Khushilal Sharma Govt Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.
Email: 		Kumar Shukla R, Sharma S, Lodhi S, Ayurvedic management in case of Vishwachi (Cervical Radiculopathy): A Case Report. J Ayu Int Med Sci. 2024;9(2):291-295.
Available From
https://jaims.in/jaims/article/view/3112

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-12-16 2023-12-26 2024-01-05 2024-01-15 2024-01-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 24.85

© 2024by Kumar Shukla R, Sharma S, Lodhi Sand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Ratnesh Kumar Shukla et al. Ayurvedic management in case of Vishwachi

Introduction

Vishwachi is a problem affecting the neck and upper part of the neck, with signs and symptoms similar to Ruk, Stambha, Toda, Karmakshaya[1,2] and Bahu Chestapaharana.[3] Dalhana believes that the condition is similar to Gridhrasi and has two types - Vataja and Vatakaphaja. In today’s conditions, this disease compared to cervical Radiculopathy.

Cervical radiculopathy is a condition caused by the cervical nerve roots insufficiency that causes pain from neck to the distribution of damaged nerves. Cervical radiculopathy usually has a self-healing clinical process, and the self-healing rate can reach 75%. Most pain due to neurological symptoms is associated with cervical radiculopathy, C6 and C7 are the most common level of root involvement; upper cervical radiculopathies (C2-C4) are less common. Cervical radiculopathy is characterized by discomfort from the neck to the damaged root. Pain can occur in many places and forms, and the dermatomal distribution of pain is not always clear.

The main aim of the treatment of this disease is to reduce pain so use as analgesics like NSAIDS, muscle relaxant and physical therapy due to the side effect of NSAIDS. People are turning to Ayurveda for better treatment. Ayurveda is considered to be one of the world's oldest medicinal systems in the world, Contains important information and strategies regarding lifestyle, health, and disease management. Vishwachi is a form of Vataja Nanatmaja Vikara.[5]

Nasya karma is one of the Panchakarma ailment used to treat related to treat Urdhwajatrugata Vyadhies. "Nasa Hi Shirasodwaram," means "the nose is the door to the Shiras”.[6] Shiras known as Uttamang in Ayurveda and the most important part of Urdhwajatrugata Sharir, that’s why the Nasya Karma chosen as a treatment for this case, Vishwachi.

Patient’s information:

A 50 years old male patient was clinically diagnosed as a case of cervical radiculopathy presented with the following chief complaints for 2 years.

Progression of disease

According to Patient, he was well before 15-16 months after that gradually complaining of pain and

tingling sensation in left hand and tingling sensation in left leg, lack of sleep with irregular bowel movement in the past 1 year.

Patient did get allopathy treatment for few months like NSAIDs etc but didn’t find much improvement in symptoms. Then he came in to OPD of PTKLS govt ayurveda hospital Bhopal for ayurvedic treatment.

After going through the history, the patient was diagnosed as a case of Vishwachi (Cervical Radiocylopathy). Here Line of treatment for Cervical Radiocylopathy is Snehan and Swedan with Nasya Karma.

Table 1: Chief Complaints

SNPatients ComplaintsDuration
1.Pain in right hand2years
2.Numbness in right hand2 years
3.Tingling sensation in left hand2years
4.Tingling sensation in left leg2years
5.Constipation1 year
6.Lack of sleep2 years

Family history: No any significant family history.

Past history: No such history

Personal history: Ahara - Mixed Ahar,

Vihara - Sadharana

Nidra - Disturbed Vyasan - Alcohal Vyayam - No.

Samprapti of Vishwachi

Vataprakopa arises as a result of many causes, and it moves all throughout the body, filling up Snehadirahitarikta Srotas, find Khavaigunyas and precipitate as Sarvanga or Ekangavyadhi. In Vishwachi, the Prakupitavata moves throughout the body, and making Sthansamsraya in the Greeva Adhisthan. In the same way that the Khavaigunya is in Greeva. Vata vitiated Strotas Dusti of Kandara of Bahus Prishtha and manifests Vishwachi symptoms as a resultant.[7]

Nidanasevana

↓

Vitiation of Vata

↓

Vitiated Vata leaves its adhishthan

↓


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Ratnesh Kumar Shukla et al. Ayurvedic management in case of Vishwachi

Srotodushti and Sthansamshraya in Greeva

↓

Vishwachi

Table 2: Treatment

Type of treatmentDrugDoseTime of administrationAnupan
Nasya KarmaAnu Taila21 days
SnehanVatashamak Tail
SwedanDashmool Kwath
Internal medicationTab Ashwagandha1 BDAfter foodLuke warm water
Rasnasaptak Kwa Th0 ml BD1hr Before foodLuke warm water
Vatavidhwanshaka Rasa
Sameerpannaga Rasa
Ekangveer Rasa
Sootshekhar Rasa
Khurasani Owa
Lajari Panchang		(60 mg each)
360mg BD		Before foodLuke warm water
Panchsakar Churna5gmHSLuke warm water
Brahmi Vati1 bdAt bed time onlyLuke warm water

Observation and Results

Observations: Observations are shown in table no 3.

Table 3: Observations of Nasya-Karma Results

SNObservationDay 0Day 3Day 7
1.Shiro Laghavata-++++
2.Sukha Swapnata-++++++
3.Mano Shuddhi-++++
4.Sroto Vishuddhi-++++
5.Vikaropashamanam-+++++

Assessment of results on the basis of

1. Subjective parameters

2. Objective parameters

Subjective parameters

1. Bahu Karma Kshaya (pain and restricted movement of arm)

2. Teevra Ruja of Tala Pratyanguli and Kandaras of Bahu and Prustha

Table 4: Grading for different clinical features[8]

Radiating pain
0 - no pain
1 - pain when lifting heavy objects
2 - radiating pain occasionally felt, subsided by itself
3 - radiating pain felt on movements subsides on rest
4 - continuous radiating pain
Localised Pain
0 - no pain in shoulder region
1 - pain in shoulder region only on movements
2 - pain in shoulder region with slight movements
3 - continuous pain in shoulder region
Pricking sensation
0 - no pricking sensation
1 -occasionally felt pricking sensation in arms
2 - continuous pricking sensation in arms
Tenderness
0 - no tenderness
1 - tenderness on palpation without grimace
2 - tenderness on palpation with grimace
3 - tenderness with withdrawal
4 - tenderness with withdrawal for gentle touch
Restricted movements
0 - easy movable
1 - mild difficulty in movement
2 - can move with difficulty 3-cannot move.

Table 5: Evaluation after 30 Days

SNVariableBefore TreatmentAfter Treatment
1.Radiating pain31
2.Localised pain42
3.Pricking pain21
4.Restricted movements30
5.Tenderness20

Objective parameters

Table 6: Brachioradialis reflex (Supinator)

ReflexBefore TreatmentAfter Treatment
Brachioradialis Reflex (Supinator)+++

Discussion

In Vishwachi, Sira, Snayu and Kandara of the upper limbs and Dushti of Asthivahasrotas are affected. Due to Nidana, Vyanavayu from Hrudaya is destroyed and circulates in the upper limbs and gets Stanasamshraya in Griva. Here Griva affects Amsa, Bahu, Prakasha and Hastatala, causing severe pain in Griva radiating to Amsa, Bahu and Hastatala. In Vatakaphaja


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type Rasadhatu's participation also includes Tandra, Arochaka, Agnimandya etc. also causes symptoms.

Ayurvedic literature says that there is a very strong relationship between Nasa and Shiras. Acharya Charaka explains that Nasa is a Shiras door. In other words, it can be said that the medicine dripping from the nose can reach Shiras and cause intense energy. The same view is also given in Ashtanga Sangraha and explains that the medicine used by Nasa reaches Shringataka Marma, which is Sira Marma created by Siras giving Nasa, Karna, Akshi, Jihwa. Acharya Indu believes that it is located in Shiraso Antarmadhyam, which can be considered as the middle cranial fossa.[9] The middle cranial fossa is the area connecting the ethmoid and sphenoid sinuses. The sphenoid sinus is connected to the nasopharynx below and the brain behind. The method of drug administration has its own importance in any medical treatment. From this information it can be concluded that Nasya karma is the best treatment for conditions like Vishwachi. Snehana Nasya brings Snehana effect with the product Dhatuposhaka and gives strength to all Dhatus. It supports the neck, shoulders and chest and improves vision. Vishwachi is a type of Vatavikara that arises due to Dhatukshaya (degeneration) in the Greevakasherukasandhi (cervical spine and intervertebral discs). This is best accomplished by nasal infusion of Vatashamakaoushadha. This was made by Snehana and Brimhana Nasya done using Anu Taila.[10]

Nasyakarma also have huge effect at neuro endocrine level by absorption and transportation of the drug which are administered by nasal pathway could be transported with vascular path (nasal vein, ophthalmic vein, facial vein, Cavernous veinous) and lymphatic path along with olfactory nerve. The arachnoid matter sleeve is extended to the sub mucosal area of the nose, due to which the drug can reach the cerebro-spinal-fluid.[11]

Mahavatviswanras opens neuromuscular communication and improves metabolic processes in the CNS and PNS. Sameerpannag Ras improves tissue oxygenation and regulates blood flow to the affected area; Ekangvir Ras supports the healing of damaged nerves and blood vessels. Suthekhekhar Ras provides nutritional support for rapid recovery of damaged joints. Lazari has a regenerative effect on damaged nerves. Khorasani Ova worked on neurostimulation.

Ashwagandha has neuroprotective, immunomodulatory and anti-inflammatory effects. Due to its properties, it strengthens muscles and ligaments and improves health. Ashwagandha has been reported to be immunomodulatory and anti-inflammatory. Snigdha nourishes and strengthens all qualities due to its Guruguna and Ushna Virya. It has Vikasiguna which relieves spasms and joint pain. With the help of Snigdhata it reduces the Rukshata of Vata Dosha; Ashwagandha has Katu and Tikta Rasa. Katu Rasa is called Vatakaphashamak and Tikta Rasa is called Pittakaphashamak. Ashwagandha has similar properties to Vataghna.[12]

Rasnasaptaska Kwath works as an anti- inflammatory, analgesic and Aampachaka in properties, which can reduce symptoms of Vishwachi.[13]

Conclusion

Disease Vishwachi and cervical spondylosis have similarities in etiology and clinical presentation. Individuals in their fourth and fifth decades are most affected, often exacerbated by prolonged uncomfortable posture and work type and disease precipitated with the Samprapti of Kshaya. Nasyakarma and specifically Snehana Nasya is most effected in Vishwachi disease due to its complex activities like Dhatuposhana, Vatashamana and Brimhana properties. The rising prevalence is attributed to lifestyle factors. The study aimed to prevent neurological deterioration, halt further progression, and provide symptomatic relief to the patient.

References

1. Acharya Y. T. Sushruta Samhita, Varanasi (India): ChaukambhaSurbharatiPrakashan; 2016.p 168

2. Acharya Madhavakara, MadhavaNidanam:Chaukambha Surbharati Prakashan;2016 p.539.

3. Parakara HSS, AstangaHrudayam.Varanasi (India ): ChaukambhaSurbharatiPrakashan; 2016.p 534.

4. Cervical Radiculopathy. Rhee, John M. MD; Yoon, Tim MD; Riew, K. Daniel MDJournal of the American Academy of Orthopaedic Surgeons: August 2007 - Volume 15 - Issue 8 - p 486- 494


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5. Acharya YT, Charaka Samhita. Varanasi (India): Chaukambha Surbharati Prakashan; 2016.p 621.

6. Acharya YT, Charaka Samhita, Varanasi (India): ChaukambhaSurbharati Prakashan ; 2016.p 82.

7. Sharma Anantram, SushrutSamhita.Varanasi(India); Chaukambha Publications; NidanSthan 1/35. P 12

8. A.G, Ravi Rao, Prashanth Kumar, Mahesh.T.S, Rashmi Holla. A collective clinical approach in the management of ‘Vishvachi’. Int. J. Res. Ayurveda Pharm. 2013;4(6):862-864

9. Patil Vasant, Principles and practice of panchakarma; New Delhi (India): Chaukambha publications; 2018.p562

10. Patil Vasant, Principles and practice of panchakarma; New Delhi (India): Chaukambha publications; 2018.p 563

11. http://www.slideshare.net/MONIKAGhangas1/nasya-karma-241710287

12. Acharya Sharma Priyavata, Dravyaguna Vigyan, Chaukhambha Bharti academy Varanasi : 2015

13. https://www.researchgate.net/publication/314648910_a_review_on_rasna_saptak_kwath_an_ayurvedic_polyherbal_formulation_for_arthritis


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