E-ISSN:2456-3110

Case Report

Cervical Spondylosis

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 6 JUNE
Publisherwww.maharshicharaka.in

Management of Vishwachi w.s.r. to Cervical Spondylosis with Dashmoola Kawath and Yograja Guggulu with Anu Tailam Nasayam - A Case Study

Chandel R1*, Gupta P2, Sharma H3
DOI:10.21760/jaims.9.6.55

1* Riya Chandel, Post Graduate Scholar, Dept of Kayachikitsa, Jammu Institute of Ayurveda and Research, Nardani, Jammu, India.

2 Poonam Gupta, Associate Professor, Dept of Kayachikitsa, Jammu Institute of Ayurveda and Research, Nardani, Jammu, India.

3 Hanika Sharma, Post Graduate Scholar, Dept of Kayachikitsa, Jammu Institute of Ayurveda and Research, Nardani, Jammu, India.

Cervical Spondylosis may be a degenerative condition of cervical spine related to pain, stiffness, and tingling sensation radiating pain from shoulder to digits along the course of the nerve indicates nerve root Compression. It is also associated with numbness and emaciation of upper limbs and its muscles. Pain from posterior part of finger and anterior side of Prakoshtha and Kandara affect motor function. Disease spreading from posterior part of fingers and anterior part of Prakoshtha and Kandara and which affects the nerve in hand and by affecting the motor function known as Vishwachi. Vishwachi is one among the Vataja Nanatmaja Vyadhi. It affects the neck and upper extremities with signs and symptoms like Ruk, Stambha, Toda, Karmakshaya and Chestaharana of Bahu as explained by different Acharyas. The clinical presentation of Vishwachi is similar to that of cervical Spondolysis, which is an acute painful condition of upper arm, shoulder joint and upper chest region. A 55 years old female approached the JIAR with the chief complaints of: Severe pain in right upper arm, shoulder joint, and neck region along with difficulty in movement of right hand. All the above complaints were since 6 months. The patients were completely on Ayurvedic medicine for 45 days and the results were remarkably seen. The medication given were Yograja Guggulu (1 TDS) and Dashmoola Kawath (20ml BID) along with Anu Tailam Nasya. Hence this study was taken to prove that Ayurvedic management has remarkable result in Viswachi (Cervical Spondylosis). Observation and results were drawn on the basis of assessment criteria. Discussion was done on the basis of entire observation during the research. Conclusion was drawn on the basis of research.

Keywords: Vishwachi, Cervical Spondylosis, Vata Vyadhi, Anu Tailam Nasyam, Yograja Guggulu

Corresponding Author How to Cite this Article To Browse
Riya Chandel, Post Graduate Scholar, Dept of Kayachikitsa, Jammu Institute of Ayurveda and Research, Nardani, Jammu, India.
Email: 		Chandel R, Gupta P, Sharma H, Management of Vishwachi w.s.r. to Cervical Spondylosis with Dashmoola Kawath and Yograja Guggulu with Anu Tailam Nasayam - A Case Study. J Ayu Int Med Sci. 2024;9(6):334-338.
Available From
https://jaims.in/jaims/article/view/3516

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-04-09 2024-04-18 2024-04-26 2024-05-06 2024-05-19
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Authors state no conflict of interest. Non Funded. The conducted research is not related to either human or animals use. 13.01 All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

© 2024by Chandel R, Gupta P, Sharma Hand 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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Riya Chandel et al. Management of Vishwachi w.s.r. to Cervical Spondylosis

Introduction

Vishwachi is a sickness that affects the neck and upper extremities and has signs and symptoms similar to Ruk, Stambha, Toda, Karmakshaya and Bahu's Chestapaharana. Dalhana believes that the condition is similar to Gridhrasi and has two types - Vataja and Vata-Kaphaja. In modern science Vishwachi is compared with cervical spondylosis. Cervical Spondylosis is essentially a degenerative disorder starting in the intervertebral disc and progressing with advancement in age to involve more than one disc.

The term covers the pathology in the spine and the neurological syndrome associated with it. Nearly 50% of people over the age of 50 and 75% of those over the age of 65 have typical radiographic changes of cervical spondylosis.

It is important to realize that radiological changes with age only represent structural changes in the vertebrae but such changes do not necessarily cause symptoms. The main aim of treatment in this condition is to relieve the pain and stiffness; hence analgesics are prescribed along with muscle relaxants and physiotherapy.

But as there is no permanent cure of the symptom, people are approaching towards Ayurveda to find a better solution. In Ayurveda the condition comes under Vataja Nanatmaja Vikara. Here the involvement of Vata in the clinical manifestation of Vishwachi also being an Urdhwajatrugata Vikara, Nasya Karma is mentioned as a main line of treatment.

Samprapti Ghatakas
1. Dosha: Vata, Vyanavata.
2. Dushya: Kandra of Bahu and Pristha.
3. Srotas: Asthivaha and Majjavaha
4. Sroto Dusti: Sanga.
5. Adhistana: Greeva
6. Vyakastana: Baahu,Talapratyanguli.
7. Rogamarga: Madhyama
8. Vyadhiswabhava: Chirakari

Case Study

A 55 years old female patient registered in JIAR OPD of Kayachikitsa in Jammu Institute of Ayurveda and Research Nardani, Jammu. She presented herself with the following complaints:

Chief Complaints with duration
Severe pain in right upper arm, shoulder joint, and neck region along with difficulty in movements of right hand from last 15 days. Patient noticed pain 6 month before in same area but she got relieved with allopathic analgesic medicine.

Other complaints
Not any associated complain is seen.

History of Present illness
Patient was normal 6 months before and then gradually developed above symptoms. So, for the proper treatment she came to Jammu Institute of Ayurveda and Research OPD.

Family History
Not any Family illness of such history to any relatives.

Past History
No H/o DM-II, HTN, TB, thyroid disorder, and no past surgical H/o

Table 1: Showing Personal History

AppetiteNormal
BowelNormal
MicturitionRegular ( 5/6 times- Day/ Night)
SleepDisturbed
DietVegetarian
AddictionNo Addiction

On Examination
1. General condition - Moderate, A febrile.
2. Pulse Rate - 78/min
3. P. - 130/80mmhg.
4. Respiratory Rate - 18/min
5. Pallor/Icterus/Cyanosis/Lymphadenopathy/Clubbing - Absent
6. P/A - soft and non-tender
7. CVS - S1, S2 heard
8. Resp - B/L symmetrical NVBS
9. Range of Motion
10. Adduction - Up to 20 degree (Right hand)
11. Abduction - up to 15 degrees (Right hand)
12. Neck movements and Shoulder joint movement restricted.

Examination for Vischwachi

Examination of Neck
1. First active movements are assessed.
2. Next passive movements starting with extension.


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Special Test for Assessment
1. Spurling Test.- Positive (Right hand)
2. Cervical Distraction Test. - Positive
3. Shoulder Abduction Test. (Positive towards right shoulder)
4. Neck disability Index. (5-14 points shows mild disability)

Criteria

  1. Clinical Assessment Criteria
GradePainStiffnessTinglingVertigoMovement
0No painNo stiffnessNo painAbsentPainful movement
1Mild painFor 5 mins to hrsMild pain/ OccasionalPresent on neck movement occasionallyRestricted movement
2Slight Difficulty in moving due to painFor 2-8 hrsModerate pain/ continuousPresent on neck movementSevere Restricted Movement
3More difficulty in moving due to painMore than 8 hrsSevere/ disturbed sleepPresent Continuous.No movement

Investigations

1. Hb - 10mg/dl.
2. uric acid - 5mg/dl
3. S.R. - 20mm/hr
4. A. Factor - Negative.

Intervention (Treatment Given)

1. Dashmoola Kawath (20 ml BID) before meals. - Reference of Dashmoola Kwatha is taken from Charak Samitha[1]

2. Yograja Guggulu (1 tab TDS) with hot water.; after meals. - Ingredients: Guggulu (Commiphora mukul), Triphala (Terminalia chebulla, Terminalia Bellirica, Emblica Officinalis), Gokshura (Tribulus Terrestris), Rasna (Pluchea lanceolata), Twak (Cinnamon), Dhanyaka (Coriandrum Sativum), Taleesapatra (Abbies webbiana), Trikatu (Pepper, long pepper and ginger). - Reference of Yograj Guggulu is taken from Baishajya Ratnawalli[2]

3. Anu Tailam Nasyam (2-3 drops) both the nostrils. For 7 days. - Ingredients: Jivanti (Leptadenia reticulata), Devdaru (Cedrus deodara), Twak (Cinnamon), Usheera (Vetiveria zizaniodes), Madhuka (Glycyrrhiza glabra), Agaru (Aquilaria agallocha), Shatavari (Asparagus), Renuka (Vitex nigundo), Tilla Thailam (Sesame oil). - Reference of Anu Tailam - Ashtanga Hrudaya Sutrasthana.[3]

Pathyapathya (Do’s and Don’t):
Dietary guidelines were advised to follow throughout the lifetime.

Pathya (Do’s):
One of the best regimens uses ingredients like Yava (Hordeum vulgare) powder and Amalaki (Emblica officinalis) powder. In order to preserve health, he also suggested Prashatika, Priyanguka (Setaria italica), Shyamak (Echinochloa frumentacea), Yavaka & Madhumeha (Avena sativa Linn.), Yava (Hordeum vulgare), Joornaahva (Sorghum vulgare Pers), Kodrava (Paspalum scrobiculatum), Mudga, Cheese, yogurt, soybeans, beans, tofu, etc.

Apathya (Don’t):
Rooksha Laghu, non-nourishing diet, Excessive Weight lifting, Ati Chankramana, Vata Karaka Ahara Vihara, Kaphahara Ahara Vihara., Toor Dal, Urad Dal, Vegetables like Capsicum, Patato, Cabbage, Spinach, Tomato and non - vegetarian food.

Observations

On the basis of Assessment Criteria Observations are as follows-

Clinical Observation

SNSymptomsBefore TreatmentAfter Treatment
1.Severe pain in right upper arm30
2.Pain in shoulder joint and neck region30
3.Difficulty in movement of right hand20
4.AppetiteReducedImproved
5.Generalized weaknessPresentAbsent

Results

Total study period was 45 days with medicine along with 7 days Anu Tailam Nasyam in morning. It was observed that almost 60% of her symptoms disappeared in 1 month and patient was free from complaints at the end of 45 days. There is no pain and no difficulty in the movement of right hand.

Discussion

The disease Vishwachi is a Vatavyadhiandya 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.


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Dalhana opines that Vishwachi resembles the but difference between these two is Vishwachi occurs in the upper limb and Gridhrasi in the lower limbs. Some patients having psychological stress and conflicts in the mind are benefitted by the use of Ayurvedic hypnotics, CNS Depressants, Sedatives, Anxiolytics, Tranquilizers, Immune-modulators, Jeevaniya and Ojaskara formulations.

Rasayanas, Poshaka, and nutritive formulations reduce the degenerative changes in the joints. Amongst Panchakarma, Nasya Karma carries importance in the aspects of Urdhwa Jatru 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’ Dashamooladhya Kashaya which was given internally had encouraging results are due to the combination of drugs that are having Vata Kapha Hara, Shoolahara, Deepana, Pachana and Rasayana properties. With this understanding the study is planned to evaluate the therapeutic effect of Dashamuladhya Kashaya and Anu Taila Nasya in Vishwachi showed marked iimprovement.

The study gives more scope for further clinical studies in patients of Vishwachi and other Vatavyadhi too. Yograja Guggulu is frequently used in treatment of lumber and cervical spondylosis. With herbs such as Amla and Ghee, it has some amount of cell and disc tissue regeneration.

With anti-inflammatory and analgesics such as Rasna, Tribulus, Guggulu, it relieves pain. It acts as a pain reliever then disc rejuvenation in this case. It is one of the commonly prescribed drugs in disc prolapse.

Conclusion

Vishwachi 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 Vikarathe Chikitsa included is Snehana and Swedana followed by Nasya Karma.

Disease Vishwachi and Cervical Spondylosis have similarities in etiology and clinical presentation. 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. All Ayurvedic classics included Abyanga, Swedan, Nasya, and Niruha Basti, Matrabasti in the management of Vatavyadhis. Bahu having its Moolam in Greeva gets affected in Vishwachi. Thus, Nasya, Abyanga, Swedana, Nasya and Niruha, Matrabasti becomes the line of treatment.

References

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2. Bhaishajya Ratnavali, Amavatarogadhikara 90–95, Rasaratnasamucchayam.

3. 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

4. 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.

5. Yogaratnakara, with “Vaidyotini’’ Hindi commentary By Vaidya Lakshmipati Shastri, edited by Bhishagratna Bhramhashankar Shastri, published by Chaukhambha Sanskrit Sansthan Varanasi, 6thedition. Vatavyadhi chikitsa prakarana 25/72 Pn511.

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7. Acharya Madhavakara, MadhavaNidanam:Chaukambha Surbharati Prakashan;2016 p.539. Rageeb M. Anti-Inflammatory, Analgesic And

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

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