|Year : 2023 | Volume
| Issue : 1 | Page : 36-40
Ayurvedic management of quadriparesis (Sarvanga roga) due to cervical disc herniation: A case report
Mohita Bohra1, KK Sharma2
1 Department of Panchakarma, Himalayiya Ayurvedic Medical College and Hospital, Dehradun, Uttarakhand, India
2 Uttrakhand Ayurved University, Rishikul Campus, Haridwar, Uttarakhand, India
|Date of Submission||01-Apr-2022|
|Date of Acceptance||14-Feb-2023|
|Date of Web Publication||21-Mar-2023|
Dr. Mohita Bohra
Department of Panchakarma, Himalayiya Ayurvedic Medical College and Hospital, Dehradun, Uttarakhand
Source of Support: None, Conflict of Interest: None
Cervical disc herniation is most common after lumbar disc herniation. Nerve impingement due to cervical disc herniation causes symptoms that correlate with Sarvanga roga (~quadriparesis). The present case is of a 44-year-old male who reported neck pain, stiffness, and reduced power in bilateral upper and lower limbs, due to which he was unable to walk on his own and unable to perform daily living activities. Ayurveda holds bountiful resources for the management of Vata (~Dosha responsible for movement and cognition) disorders. This patient was treated with oral medicines along with Panchakarma therapy on the line of treatment of Vatavyadhi (~disorders due to Vata). The result was assessed using the Modified Ashworth scale for muscle tone, Medical Research Council scale for muscle power, National Institute for Neurological Disorders and Stroke grading for deep tendon reflex, and Katz Index of Independence in Activities of Daily Living. The result obtained after 45 days of treatment helped the patient to walk and perform activities of daily living independently. Treatment provided relief by reducing pain, stiffness, and cervical cord edema and providing strength to local muscles, bones, tendons, and ligaments. This case provided positive hope for serious cases like this, where patients are left with the only option of surgery.
Keywords: Cervical disc herniation, Quadriparesis, Sarvanga roga, Vatavyadhi
|How to cite this article:|
Bohra M, Sharma K K. Ayurvedic management of quadriparesis (Sarvanga roga) due to cervical disc herniation: A case report. J Ayurveda Case Rep 2023;6:36-40
|How to cite this URL:|
Bohra M, Sharma K K. Ayurvedic management of quadriparesis (Sarvanga roga) due to cervical disc herniation: A case report. J Ayurveda Case Rep [serial online] 2023 [cited 2023 May 30];6:36-40. Available from: http://www.ayucare.org/text.asp?2023/6/1/36/372246
| Introduction|| |
The vertebral column is formed of 33 vertebrae along with the intervertebral disc, and it extends from the base of the skull to the coccyx. The vertebral column serves important functions such as protection, support, axis, and movement. Each vertebra consists of an anterior vertebral body and a posterior vertebral arch. The intervertebral disc is a fibro-cartilaginous structure serving as a shock absorber for vertebrae, brain, and spinal nerves. The intervertebral discs make up one-fourth of the spinal column's length. The intervertebral disc is composed of a thick outer annulus fibrosus that surrounds a soft gel-like nucleus pulposus. A herniated disc is a condition affecting the spine, in which the annulus fibrosus is damaged, enabling the nucleus pulposus to herniate. This can compress the nerves or spinal cord, causing pain and spinal cord dysfunction. The most common cause of disc herniation is a degenerative process; the second most common cause of disc herniation is trauma. Disc herniation is most common in the lumbar spine, followed by the cervical spine. There is a higher rate of disc herniation in the lumbar and cervical spine due to the biomechanical forces in the flexible part of the spine. A herniated cervical disc may cause cervical pain and, due to nerve impingement may produce symptoms such as a tingling sensation and numbness in hands, weakness in limbs, and in severe cases may lead to quadriparesis. The present case is of a patient who is a driver by occupation. Occupational driving might be associated with disc degeneration and herniation due to constant whole-body vibration and a constant driving posture.
The diseases which are manifested majorly due to Vata are described under Vatavyadhi in Ayurveda. When Vata causes wasting of muscles and tendons, degeneration in nerves, pricking pain, and aches in the whole body (all limbs), this condition is called Sarvanga roga. Due to its similarity with Sarvanga roga, this case was treated on the general line of treatment of Vatavyadhi. Ayurvedic medicines along with Panchakarma therapy have proven effective in managing such cases and reducing the need for surgery, which has happened in the present case.
| Patient Information|| |
A 44-year-old male patient belonging to a lower socio-economic class presented in out-patient department with complaints of reduced power in the bilateral upper and lower extremities (more in the left leg), reduced sensation in bilateral lower extremities, tingling sensation in bilateral upper extremities (more in the left side) for five months. He was unable to walk without support. The patient was a driver by occupation. He had a history of neck pain and stiffness for the past 2–3 years, for which the patient had not taken any definitive treatment. He took random painkillers, as prescribed by the local medical store when the pain used to increase. Five months back, the patient had only complained of neck pain and stiffness, then gradually he felt decreasing power in all extremities with tingling sensations in both hands, due to which he had to discontinue his job. His condition continued to deteriorate with time. He also developed weakness in both lower limbs. He has to take the support of others for performing his daily activities such as walking, bathing, and changing clothes. He was then taken to a multispecialty hospital in Dehradun, where an Magnetic Resonance Imaging (MRI) was done, and he was advised for discectomy surgery. The patient was not willing to opt for surgery and he visited to the Department of Panchakarma for possible treatment. Other associated complaints were mild constipation and mild urinary incontinence. The patient was nondiabetic and nonhypertensive. Plasma lipid levels were increased. He does not have any relevant family history. He was a chronic smoker for 8–10 years (12–15 bidis/day).
| Clinical Findings|| |
Pallor, icterus, cyanosis, clubbing, and edema were not present. Weight was 90 kg. Blood pressure and pulse were within normal limits. The patient had Vata-kapha prakriti (~physical constitution), Madhyama sara (~excellence of tissue elements), Madhyama samhanana (~compactness of tissue or organ), Madhyama satwa (~psychic condition), Madhyama satmya (~homologation), Avara vyayama shakti (~power of performing exercise), Madhyama ahara shakti (~power of intake of food), Avara jarana shakti (~power of digestion of food), and Hina bala (~physical power). Tenderness was present at the C3–C4 level. A locomotor system examination was done. Rest other system examination revealed no significant findings. The patient was conscious and well-oriented to time, place, and person. Memory was not impaired.
| Timeline|| |
The timeline of the development of symptoms and intervention is depicted in [Table 1].
| Diagnostic assessment|| |
On the basis of signs, symptoms, and available MRI findings, the patient was diagnosed with cervical spondylosis with posterior disc protrusion and annular tear at C3-C7 level.
| Therapeutic intervention|| |
The details of the treatment given to the patient are placed in [Table 2]. Observations were made after giving Panchakarma therapies along with oral medicines for a total duration of 45 days.
| Follow-up and Outcome|| |
The patient was admitted to Inpatient Department (IPD) for a period of 15 days where he was treated with Panchakarma therapy along with oral medicines. Thereafter, the patient was discharged after examination and oral medicines were prescribed for a period of a month. The patient was assessed after a month of taking medicines. After a total duration of 45 days, improvement was noticed in gait, muscle tone, reflexes, and muscle power, grading improved from point 0 to point 6 in Katz Index of Independence in Activities of Daily Living [Table 3] and [Table 4].
| Discussion|| |
As the disease correlates with Sarvanga roga, the generalized line of treatment of Vatavyadhi can be adopted according to the symptoms of the disease. Swedana (~sudation therapy) is best to relieve stiffness, heaviness, and cold and its action is also proved in several studies. Due to spasticity and stiffness, Sarvanga ruksha pottali swedana (~ whole body dry sudation with bolus of sand and rock salt) with Baluka and Lavana for 30 min/day and Nadi swedana (~sudation with steam using pipe-like instrument) for 10 min/day with Dashamoola kwatha was given for three days which helped in reducing spasticity and heaviness. After this, Snigdha patra pottali swedana (prepared from leaves of Eranda [Ricinus communis L.], Nirgundi [Vitex negundo L.], Arka [Calotropis gigantea (L.) Dryand.], Chincha [Tamarindus indica L.], lemon [Citrus limon L. Osbeck], salt, Rasna [Pluchea lanceolate (DC) C. B. Clarke] powder, and Dashamoola taila) for 30 min per day was done for four days along with Sarvanga sweda with Kwatha for 10 min/day. This helped in the reduction of stiffness and pain. Because of Vata alleviating properties, Dashamoola was chosen as an ingredient in decoction used for Nadi swedana and oil. Greeva basti (~therapeutic retention of oil over cervical region) with Dashamoola oil and Vishagarbha oil (1:1) and Yoga basti (course of eight therapeutic enemas) were simultaneously done for eight days. After Greeva basti (done for 30 minutes per day at around 11 am) patient reported a reduction in neck pain, stiffness, and tingling sensation in both hands and improvement in muscle power and tone in bilateral upper extremities. The efficacy of Greeva basti in reducing neck pain, stiffness, and tingling sensation and improving strength in hands is supported by other studies. Yoga basti as Erandamuladi niruha basti (600 ml.) and Dashamoola taila anuvasana basti (100 ml.) was planned as Dashamoola has Vata alleviating properties. This formulation is already in use in the form of Basti for the treatment of Vata disorders. Erandamuladi basti was prepared as indicated by Acharya Charaka, by mixing the drugs in specified proportions (honey: 100 ml, rock salt: 10 g, Sneha (Dashamoola oil): 120 ml, Kalka: 20 g, and Kwatha: 350 ml). After completion of Basti treatment, the patient reported improvement in muscle tone and power in all extremities. Satisfactory control over urination was reported. After 15 days of completion of Panchakarma procedures, the patient was able to walk unassisted, though moderate limping was present, he was able to perform some daily activities, gained proper control over urination, and constipation was relieved. He was feeling much better and more confident and was discharged from IPD. Further, oral medicines were prescribed for a month. After taking one month of medicine, improvement was noticed in neck pain, mobility, sensation, and muscle strength [Table 3]. During the entire course of the treatment, no adverse effects of the treatment were observed. The patient did not show up for further treatment after that. In a telephonic conversation after a month of completion of the treatment, he revealed that he is feeling no difficulties in his routine activities.
| Conclusion|| |
Panchakarma therapies, along with oral Ayurvedic medicines, can be a better alternative option for patients developing symptoms due to cervical disc protrusion. The therapies help in improving symptoms by reducing local inflammation and adding strength to muscles, tendons, ligaments, and bony structures. In the present case, the improvement in the patient is noticeable. The patient was able to walk on his own with mild limping as compared to the condition before treatment. There was an improvement in muscle tone, power, and deep tendon reflexes. This case study suggests that Ayurveda treatment can provide great benefits in improving symptoms developed due to disc protrusion.
Declaration of patient consent
Authors certify that they have obtained patient consent form, where the patient has given his consent for reporting the case along with the images and other clinical information in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Huang JS, Fan BK, Liu JM. Overview of risk factors for failed percutaneous transforaminal endoscopic discectomy in lumbar disc herniation. Zhongguo Gu Shang 2019;32:186-9.
Pandey K, Chaturvedi G, editors. Commentary Vidyotini on Charaka Samhita of Agnivesha, Chikitsa Sthan. Ch. 28, Ver. 54-55. Varanasi: Chaukhambha Bharati Academy; 2009. p. 787.
Brorsson B, Asberg KH. Katz index of independence in ADL. Reliability and validity in short-term care. Scand J Rehabil Med 1984;16:125-32.
Pandey K, Chaturvedi G, editors. Commentary Vidyotini on Charaka Samhita of Agnivesha, Sutra Sthan. Ch. 22, Ver. 11. Varanasi: Chaukhambha Bharati Academy; 2009. p. 424.
Akhtar B, Mahto RR, Dave AR, Shukla VD. Clinical study on Sandhigata vata w.s.r. to osteoarthritis and its management by Panchatikta Ghrita Guggulu. Ayu 2010;31:53-7.
Bharti, Katyal S, Kumar A, Makhija R, Devalla RB. Clinical observation on Greeva Stambha (cervical spondylosis) Chikitsa. Ayu 2010;31:218-22.
Pandey YK, Shalini, Sharma AK. Effect of Greeva vasti in management of Greeva Asthi Sandhi Gata Vata (Cervical Spondylosis). Anc Sci Life 2013;33:71-5.
Pandey K, Chaturvedi G, editors. Commentary Vidyotini on Charaka Samhita of Agnivesha, Siddhi Sthana. Ch. 3, Ver. 38-42. Varanasi: Chaukhambha Bharati Academy; 2009. p. 999.
[Table 1], [Table 2], [Table 3], [Table 4]