|Year : 2018 | Volume
| Issue : 2 | Page : 104-109
Ayurvedic management of cervical spondylosis radiculopathy
Archana Kushwaha, Sarvesh Kumar Singh, Kshipra Rajoria
Department of Panchakarma, National Institute of Ayurveda, Jaipur, Rajasthan, India
|Date of Web Publication||2-May-2018|
Dr. Sarvesh Kumar Singh
Department of Panchakarma, National Institute of Ayurveda, Jaipur, Rajasthan
Source of Support: None, Conflict of Interest: None
Radiculopathy, commonly referred as pinched nerve, refers to a set of conditions in which one or more nerves are affected and their functioning is hampered. This phenomenon is termed as neuropathy. This can result in pain or more precisely in radicular pain. In a radiculopathy, the problem occurs at or near the root of the nerve, shortly after its exit from the spinal cord. However, the pain or other symptoms often radiate to the part of the body served by that nerve. The management available in the current era of medicine is not satisfactory. Here, we are presenting a case of cervical spondylosis (CS) radiculopathy which was treated with a combination of Panchkarma procedures and Ayurvedic oral drugs. Greeva stambh was considered as the Ayurvedic diagnosis for the case. The treatment protocol designed for the particular case was Panchatikta ksheera Basti (enema with medicated milk) for 16 days along with Shalishastic pind sweda. The oral medication prescribed was Ashwagandha churna (Withania somnifera Dunal), Shatavari churna (Asparagus recemosus Wild), Gokshur churna (Tribulus terrestris L.) each in a dose of 2 g, Sarpgandha churna (Rauvolfia serpentina (L) Benth. Ex Kurz) 1 grms, Shankha bhasma 500 mg with Luke warm water, Yograj guggulu-3 tablet with Dashmool kwath in a dose of 40 ml, Ashwagandha avaleha 10 g with lukewarm water. All these drugs were prescribed for twice a day. Visual analog scale and range of motion were the parameter used to assess patient and considerable improvement was noticed in the case after a month of treatment which sustained in follow-up duration of 2 months. The case study demonstrate that CS radiculopathy may be successfully managed with Ayurvedic treatment.
Keywords: Ayurveda, cervical spondylosis rediculopathy, Greevastambh, Panchkarma
|How to cite this article:|
Kushwaha A, Singh SK, Rajoria K. Ayurvedic management of cervical spondylosis radiculopathy. Int J Health Allied Sci 2018;7:104-9
|How to cite this URL:|
Kushwaha A, Singh SK, Rajoria K. Ayurvedic management of cervical spondylosis radiculopathy. Int J Health Allied Sci [serial online] 2018 [cited 2019 Sep 18];7:104-9. Available from: http://www.ijhas.in/text.asp?2018/7/2/104/231688
| Introduction|| |
Cervical spondylosis (CS) or osteoarthritis of the cervical spine produces neck pain radiating to the shoulders or arms with headache in posterior occipital region. Narrowing of the spine canal by osteophytes, ossification of the posterior longitudinal ligament, or a large central disk may compress cervical spinal cord. Age, gender, and occupation are the main risk factors for CS. The CS commonly occurred in below 30 years of age. Recent studies depicted that CS increases with aging before age 50 years and decreases with aging after age 50 years, 70% of women and 85% of men show consistent CS changes on X-ray in the age of 60 years. Corporate social responsibility (CSR) is a disease process marked by nerve compression from herniated disc material or arthritis bone spurs. This impingement typically produces neck and radiating arm pain or numbness, sensory deficits, or motor dysfunction in the neck and upper extremities. There are no satisfactory conservative and surgical procedures available in modern medicine for CSR and much limitation and complications also encountered in these procedures. The manifestations had been managed by Ayurveda, related cases are also reported in PubMed indexed journal.,,Greevastambh (~stiffness in neck) is considered as Ayurvedic diagnosis for the cases of CSR. The disease come under the umbrella of Vata-Nanatmaja Vyadhi (diseases only due to vitiation of Vata dosha). The symptoms of Vata Vyadhi (~various neurological and musculoskeletal disorders) are Sankocha (constrictions of organs), Parva stambha (stiffness in joints), Asthi bheda (pain in bones), Padi prastha shiroghraha (stiffness in lower limbs, back, and head) Spandana, and Gatrasuptta (numbness). Here, we are representing a case of CSR which was successfully managed by Ayurvedic therapy.
| Case Report|| |
A 50-year-old female patient consulted in outpatient Department of the National Institute of Ayurveda, Jaipur, with complaints of gradually progressive pain around the neck region which radiated toward bilateral shoulder joints and both upper limbs along with stiffness in neck and shoulders since 4 years. The patient had restricted movement of neck and shoulder joints since 2 years after a traumatic injury which aggravated by prolonged sitting and relieved in lying posture. She also suffered from intermittent numbness and tingling sensations in both upper limbs since a year. The patient had undergone neurological and orthopedic consultation in IndoWestern hospital of brain and spine, Jaipur. Surgical and conservatives management was recommended. She was taking some painkiller and corticosteroids for pain management as prescribed by previous consultant. The prime aim of the patient to attend our outpatient department was to seek a better nonsurgical approach of her aliment.
The case was admitted to female ward of Panchakarma Department of National Institute of Ayurveda, Jaipur, on April 18, 2017, for the treatment. On physical examination, the general condition of the patient was poor, blood pressure of the patient was 150/100 mmHg. Pulse was 70/min and often irregular. She was anxious, appetite was moderate, the tongue was coated, and bladder habits were normal and constipated bowel. The patient was assessed on Dashavidha pariksha [Table 1] patient had normal gait. The active movement of range of cervical spine was restricted. Pain aggravated on the movement of neck. On examination, flexion of the neck was 15°, extension was 10°, lateral flexion to left side was 10°, lateral flexion to the right side was 10°, lateral rotation to the left side was 20°, and lateral rotation to the right side was 25°. The visual analog scale (VAS) scoring was 70. Tenderness was examined over c4,-c5c5-c6,c6-c7 vertebras, power of biceps and triceps muscles of both upper limb were normal, lumbar spine movement was normal in range. Tenderness was absent. On neurological examination, higher functions, consciousness, orientation of time, place, person, memory, and speech were normal. The patient was right handed. All cranial nerves were well intact. On sensory examination, sensations of touch and temperature were lost in the right tip of shoulder joint, position sense, and joint vibration senses were normal bilaterally. On motor examination nutrition, power, tone, and coordination of the upper and lower limbs were normal. Deep tendon reflexes and superficial-reflexes were normal. The patient had Babinski and Hoffman sign negative bilaterally and Spurling sign positive. All biochemical and laboratory finding were normal except erythrocyte sedimentation rate (ESR). ESR was elevated up to - 75 mm/h. Magnetic resonance imaging (MRI) of cervical spine that was done on 9 February 2013, suggested posterior osteophytes at c4–c6 vertebral bodies and c5–c6. Posterior osteophytic ridges and protruding disc caused moderate spinal canal stenosis with narrowing of the left neural foramina with mildly indenting the theca. MRI scan on October 15, 2014 revealed disc bulge at c3–c4, c4–c5, c5–c6, and c6-c7, cord compression at c5-c6 due to disc bulge – which was suggestive of CSR.
Diagnostic focus and assessment
The patient was known case of CSR, and it was confirmed by previously done MRI. Greevastambha was considered as Ayurvedic diagnosis which is included in Urdhajatrugat a roga (disease above the neck region) and Nanatamaj Vatavyadhi. Hereditary spastic paraplegia, frozen shoulder, primary spinal cord tumor, muscle spasm, amytrophic lateral sclerosis, cervical sprain and strain, neoplastic brachial plexopathy, spinal cord infraction, and spinal sepsis pan coast tumors were the differential diagnosis of the case. The confirmatory diagnosis of CSR was based on MRI finding of the case. There was absence of Babinski sign and fasciculation which differentiate it from amyotrophic lateral sclerosis. Frozen shoulder was excluded from differential diagnosis on the base of physical examination. Muscle spasm, cervical sprain, and strain were rule out with Spurling test. Other conditions were excluded on the basis of MRI finding.
Greevastambha comes under Urdhjatrugat roga  and Nanatmaj Vata Vyadhi (~ various musculoskelton and neurological disorder) in Ayurveda general line of management of Urdhjatrugata roga NanatmakVatavyadi such as Abhyanga (massage), Swedan (sudation), Basti procedure (drug administration through anus) and Nasya (drug administration through the nose) were adopted for the case. Considering the Vata Kapha prakriti (specific body constitution) of the patient, Abhyanga, and Swedana in the form of Shalishastic pind Sweda and Ksheera Basti (medicated milk enema) in form of Panchtikta Ksheera Basti were adopted for the patient followed by Nasya karma.
Various Panchkarma interventions were adopted to treat this patient. Anuloman (mild anuloman) is done with Panchsakar churna in dosage of 6 g with lukewarm water a night before the commencement of interventions to the patient. For next 16 days, Shalishastic pind Sweda along with Panchatikta ksheera Basti were administered. Followed by Nasya karma by K 88 taila (oil) (Vindhynchal pharmacy) [Table 2] for 7 days. Along with these Panchkarma intervention combinations of oral medicines were prescribed-Ashwagandha churna (Withania somnifera Dunal), Shatavari churna (Asparagus recemosus Willd), Gokshur churna (Tribulus terrestris L.) each in a dose of 2 g Sarpgandha churna (Rauvolfia serpentine (L) Benth. Ex Kurz) 1 g, Shankha bhasma 500 mg with lukewarm water, Yograj guggulu-3 tablet with Dashmool kwath in a dose of 40 ml, Ashwagandha avleha 10 g with Lukewarm water. All these drugs were prescribed for twice a day [Table 3]. These oral medications were continued in following 2 months after the completion of Panchkarma schedule.
Outcome measures and follow-up
After completion of Panchkarma procedures, the patient condition was reassessed. The patient had no giddiness and neck pain improved, VAS score decreased to 20 and stiffness improved. Flexion of the neck had improved to 45° and extension to 40°. Lateral flexion to left side was improved to 30°. Lateral flexion to the right side was improved to 30°. Lateral rotation to the left side was improved to 45°. Lateral rotation to the right side was improved to 45°. Spurling sign was negative. The patient was discharged on 24 may 2017. The patient condition was stable in the follow-up period of 2 months. Details of patient case history and follow up is given in [Table 4].
| Discussion|| |
Intervertebral discs and their surrounding ligament lose their normal elasticity and hydration with age. These changes lead to cracks and fissures and collapsing of intervertebral discs causing annulus to bulge outward. Annulus fissure and herniation may complicate chronic spondylotic changes. The cross-sectional area of the canal is narrowed due to annulus bulges. The uncinate process over rides and hypertrophy compromising the ventrolateral portion of the foramen to disc degeneration marginal osteophytes start developing changes lead to radiculopathy. Other conditions aggravated the changes by trauma and heavy work., The disease has resemblance with the Greevastambh disease described in Ayurveda which is Urdhajatrugata roga and Nanatmak Vata Vyadhi. There are two type of pathology in Vata Vyadhi. First due to the Kshaya of Dhatu (diminished of body tissue) and second due to Margaavrodha (obstructive pathology). Degeneration of vertebras and discs occurs mainly due to Kshaya type of pathology in which Vata Pitta dosha are vitiated. Here, Asthi poshan chikitsa (nutrition to bone tissue) is the main treatment to treat the condition. Chikitsa of Asthigata roga (treatment of musculoskelton disease) are Panchkarma, Tikta (bitter taste herbs) sadhit ksheer basti along with oil and ghrita. According to Charak, Basti is best chikitsa for Vata and half chikitsa.Arundatta, a commentator of classics of Ayurvedic text mention that Tikta ksheera basti, is the combination of Snigdha (unctuous) and Shoshana property. It pacifies the vitiated Vata dosha and produces the Khara guna (roughness property) in Asthi dhatu (bone tissue) so Tikta ksheera basti promotes Asthi poshana (proper osteogenesis and nourishment of bone).Tikta rasa (bitter taste) itself work as Twak mansa shthirikaro (increase the durability of muscle and skin) by which it gives strength to muscles and ligaments of neck region.Ashwagandha tail a is used in basti. Ashwagandha is Balya (anabolic, provide strength), Bramhana (nourishes the bone and muscles) and Rasayana (immunomodulator).Panchtikta ghrita had been used for its Tikta rasa (taste) and useful in Asthi dhatu chikitsa. This Yapana manner is suitable for healthy persons, patients, and old age persons.Shalishastic pind swedan is mentioned in Vata vikara.Bala moola kwath which was used in Shalishastic pinda Sweda is having Balya property (provide strength).Nasya used in Urdhajatrugata roga. Nasya enter in head region and pacify the Dosha.Dashmoola kwath is Tridoshara (alleviating all deranged doshas), Vedanasthapana (pain killer), and Shothahar (subside inflammation).Gokshuru is having Mutrvirechniya (diuretics) and Shothahara property by which Gokshura lower down the blood pressure.,Sarpgandha is sleep inducer and lower the blood pressure.Shatavari is a promoter of the muscle strengths and health.Ashwagandha is gives strength to the muscles and ligaments and promotes the health. Yograja gugulu is very effective in Vata vyadhi and Asthi–majjagat vata roga. Yograj gugulu increases the Agni (digestive power) and Bala (strength). All these treatment break the pathology of disease either of kshaya by Bramhana (provide strength to bone and muscle) property and Margavrodha by Shrotoshodhak p roperty (clearance of micro channels) and give improvement in the symptoms of disease. In cases of CSR, the modern medicine considers various nonsurgical treatments such as cervical traction, cervical immobilization (collar or neck brace), skull traction and physical therapy (isometric exercise) but with limitations and at times surgical intervention are also considered necessary. The cervical laminectomy is not appropriate for all patients. It may lead to neurologic deterioration and attributed to a development of latent instability of the spine with development of kyphotic spinal deformities. Hence, this case study is important one as this shows the clinical improvement in CSR with Panchakarma and combinations of Ayurvedic medicines. There was no need to use any surgical intervention for this case.
| Conclusion|| |
The case report shows clinical improvement in a CSR with Panchakarma and Ayurvedic medicinal interventions.
Written informed consent was taken from the patient for procedures and article publications.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understand that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kasper Dennis L, Fauci Anthony S, Hauser Stephen L, Longo Dan L, Jameson J. Lorry, Loscelzo Joseph,et al
. Harrison's Principle of Internal Medicine. 19th
ed. New Delhi: McGraw Hill; 2015. p. 122.
Singh S, Kumar D, Kumar S. Risk factors in cervical spondylosis. J Clin Orthop Trauma 2014;5:221-6.
Alshami AM. Prevalence of spinal disorders and their relationships with age and gender. Saudi Med J 2015;36:725-30.
Wang C, Tian F, Zhou Y, He W, Cai Z. The incidence of cervical spondylosis decreases with aging in the elderly, and increases with aging in the young and adult population: A hospital-based clinical analysis. Clin Interv Aging 2016;11:47-53.
Binder AI. Cervical spondylosis and neck pain. BMJ 2007;334:527-31.
Eubanks JD. Cervical radiculopathy: Nonoperative management of neck pain and radicular symptoms. Am Fam Physician 2010;81:33-40.
Cheung JP, Luk KD. Complications of anterior and posterior cervical spine surgery. Asian Spine J 2016;10:385-400.
Singh SK, Rajoria K. Ayurvedic approach for management of ankylosing spondylitis: A case report. J Ayurveda Integr Med 2016;7:53-6.
Singh SK, Rajoria K. Ayurvedic management in cervical spondylotic myelopathy. J Ayurveda Integr Med 2017;8:49-53.
Singh SK, Rajoria K. Ayurvedic approach in the management of spinal cord injury: A case study. Anc Sci Life 2015;34:230-4.
Chaturvedi G. Sutra Sthan, Charaka Samhita of Agnivesha Elaborated by Charaka & Drudhabala. Reprinted. Part-1, Ch. 20. Shloka 11. Varanasi: Vidhyotini Vyakhya Choukhambha Bharti Academy Prakashan; 2008. p. 399.
Chaturvedi G. Chikitsa Sthan, Charaka Samhita of Agnivesha Elaborated by Charaka & Drudhabala. Reprinted. part-2, Ch. 28. Shloka 23. Varanasi: Vidhyotini Vyakhya Choukhambha Bharti Academy Prakashan; 2011. p. 780.
Harisadashiva Shastri Paradakara Sutra Sthan, editor. Astang Hridya of Vagbhata with Sarvang Sundar Commentary by Arundatta and Ayurveda Rasayan Commentary by Hemadri. Reprinted. Verse no-019. Ch. 20. Varanasi: Choukhambha Surbharati Prakashan; 2011. p. 287.
Chaturvedi G. Sutra Sthan, Charaka Samhita of Agnivesha Elaborated by Charaka & Drudhabala. Reprinted. Part-1, Ch. 20. Shloka 13. Varanasi: Vidhyotini Vyakhya Choukhambha Bharti Academy Prakashan; 2008. p. 402.
Chaturvedi G. Viman Sthan, Charaka Samhita of Agnivesha Elaborated by Charaka & Drudhabala. Reprinted. Part-1, Ch. 6. Shloka 16. Varanasi: Vidhyotini Vyakhya Choukhambha Bharti Academy Prakashan; 2008. p. 721.
Epstein N. Posterior approaches in the management of cervical spondylosis and ossification of the posterior longitudinal ligament. Surg Neurol 2002;58:194-207.
Epstein N. Ossification of the posterior longitudinal ligament: A review. Neurosurg Focus 2002;13:ECP1.
Trikamji Acharya VJ, editor. Charaka Samhita of Agnivesha Elaborated by Charaka & Drudhabala with Ayurveda Dipika Commentary by Chakrapanidatta. Chikitsa Sthana. Reprinted. Verse No. 59. Ch. 28. Varanasi: Choukhambha Surbharati Prakashan; 2008. p. 619.
Caturvedi G. Sutra Sthan, Charaka Samhita of Agnivesha Elaborated by Charaka & Drudhabala. Reprinted. Part-1, Ch. 28. Shloka 27. Varanasi: Vidhyotini Vyakhya Choukhambha Bharti Academy Prakashan; 2008. p. 573.
Chaturvedi G. Sutra Sthan, Charaka Samhita of Agnivesha Elaborated by Charaka & Drudhabala. Reprinted. Part-1, Ch. 25. Shloka 40. Varanasi: Vidhyotini Vyakhya Choukhambha Bharti Academy Prakashan; 2008. p. 468.
Chaturvedi G. Siddhi Sthan, Charaka Samhita of Agnivesha Elaborated by Charaka & Drudhabala. Reprinted. Part-2, Ch. 1. Shloka 39. Varanasi: Vidhyotini Vyakhya Choukhambha Bharti Academy Prakashan; 2011. p. 971.
Astanga Hridaya by Vagbhatta, with the Commentaries' Sarvangasundara' of Arunadatta and Ayurvedarasayana of Hemadri, Arunadatta on Sutrasthana. Ch. 11. Shloka 31. Varanasi: Krishnadas Academy; 2000. p. 187.
Chaturvedi G. Sutra Sthan, Charaka Samhita of Agnivesha Elaborated by Charaka & Drudhabala. Reprinted. Part-1, Ch. 26. Shloka 42. Varanarsi: Vidhyotini Vyakhya Choukhambha Bharti Academy Prakashan; 2008. p. 506.
Chaturvedi G. Sutra Sthan, Charaka Samhita of Agnivesha Elaborated by Charaka and Drudhabala. Reprinted. Part-1 Ch. 4. Shloka 17. Varanasi: Vidhyotini Vyakhya Choukhambha Bharti Academy Prakashan; 2008. p. 77.
Chaturvedi G. Siddhi Sthan, Charaka Samhita of Agnivesha Elaborated by Charaka & Drudhabala. Reprinted. Part-2, Ch. 12, Shloka 21. Varanasi: Vidhyotini Vyakhya Choukhambha Bharti Academy Prakashan; 2011. p. 1107.
Chaturvedi G. Sutra Sthan, Charaka Samhita of Agnivesha Elaborated by Charaka & Drudhabala. Reprinted. Part-1, Ch. 14. Shloka 25. Varanasi: Vidhyotini Vyakhya Choukhambha Bharti Acedemy Prakashan; 2008. p. 286.
Chaturvedi G. Sutra Sthan, Charaka Samhita of Agnivesha Elaborated by Charaka & Drudhabala. Reprinted. Part-1, Ch. 25. Shloka 40. Varanasi: Vidhyotini Vyakhya Choukhambha Bharti Academy Prakashan; 2008. p. 466.
Chaturvedi G. Siddhi Sthan. Charaka Samhita of Agnivesha Elaborated by Charaka & Drudhabala Reprinted. Part-2. Ch. 2. Shloka 22. Varanasi: Vidhyotini Vyakhya Choukhambha Bharti Academy Prakashan; 2011. p. 986.
Lochan K. Bhaisajya Ratnavali of Govinda Dasji Bhisagratna Commented upon by Vaidya Shri Ambika Datta Shastri. 2006 Edition. Verse No. 37. Vol. 2. Ch. 29. Varanasi: Chaukhambha Sanskrit Sansthana; 2006. p. 335.
Al-Ali M, Wahbi S, Twaij H, Al-Badr A. Tribulus terrestris: Preliminary study of its diuretic and contractile effects and comparison with Zea mays. J Ethnopharmacol 2003;85:257-60.
Mohd J, Akhtar AJ, Abuzer A, Javed A, Ali M, Ennus T. Pharmacological scientific evidence for the promise of Tribulusterrestris. Int Res J Pharm 2012;3:403-6.
Douglas L. Rauwolfia in the treatment of hypertension. Integr Med 2015;14:40-6.
Bhavprakash Nighantu, The Indian meteria medica of Shri Bhavmishra, commentary by Prof.K.C. Chunekar Guguchayadivarga chapter verse 187, Chaukhamba Bharti Academy Prakashan Varanasi; 2013. p
Mishra S. Bhaishjya Ratnavali of Kaviraj Shri Govind Das Sen Elaborated edited with Siddhiprada Hindi Commentary. Shloka 152-157. 1st
ed., Vol. 1, Ch. 29. Varanasi: Chaukhambha Surbharati Prakashan; 2005. p. 608.
Mikawa Y, Shikata J, Yamamuro T. Spinal deformity and instability after multilevel cervical laminectomy. Spine (Phila Pa 1976) 1987;12:6-11.
[Table 1], [Table 2], [Table 3], [Table 4]