Presenting Complaints with severity and episode duration

  • Low back pain radiating to left lower limb associated with numbness & burning sensation since 4 days
  • Difficulty in walking and activities of daily life due to pain.

Brief Relevant Medical History (Onset, Duration, Ag/Rel Factors, OTT, Prior Confirmed Diagnoses if applicable):

Patient was apparently normal 4 days back when she developed pain in low back radiating to left lower limb while getting up from bed. She found it difficult to walk, sit and bend. The pain was very severe and affected her ADL. She gradually noticed heaviness in left thigh associated with numbness. She also noticed burning sensation in left hip. Pain was constant and aggravated on physical activity. Her sleep was disturbed due to pain. She noticed altered bowel habits due to pain. She was unable to pass stools for 3 days. Patient is a k/c/o hypertension since 2yrs & is under control with medication.

Current medications- Tab Stamlo 5mg 1OD.

Clinical Status

Allopathy Ayurveda
Vital Parameters

1. BP -140/90 mm of Hg.
2. Pulse-70 beats /min
3. RR-14/min
4. Weight-64
5. BMI-25

1. Nadi-70/min
2. Malam-Vibaddha
3. Mutra-samyak
4. Jihva-lipta
5. Shabda-samyak
6. Sparsha- Ushna
7. Drik-Samyak
8. Akruti- madhyama

1. GC- Fair, Afebrile.
2. CVS- S1, S2 heard
4. RS- NVBSheard
5. PA- Soft, No Organomegaly Locomotor system: O/E- No spinal deformity seen. On palpation - Ternderness +++ in L4, L5 region, Left SI joint.
Left limb-SLR +at 700.
Pain was 9 on VAS 0 -10.

1. Prakriti- kaphavata
2. Vikriti-vatadosha
3. Sara-Mamsa
4. Samhanana-Madhyama
5. Pramana-Madhyama
6. Satmya-Ushna
1. Satva-Madhyana
2. Aharashakti-Madhyana
3. Vyayam Shakti-Avara
4. Vaya-Madhyama
5. Desha-Jangala
6. Kala-
RogiBala- Madhyama
RogaBala- Uttama
DSQ findings Rating
1. ADRS 60 Medium risk
2. LUPPN 1 No severity

1. Nidana-Rukshasheetavatalaaharavihara, shoka, Divaswapna, Ratrijagarana
2. Purvaroopa-Avyakta
3. Roopa- pain, stiffness, radiating pain starting from low back to left gluteal region, thigh, knee, leg.
4. Upashaya-Rest
5. Samprapti
1. Dosha-Vata
2. Dushya-mamsa, asthi,majja
3. Agni-Jataragni, Dhatwagni
4. Ama- Jataragnimandyajanya
5. Srotas- mamsa, asthi, majjavaha
6. SrotoDushtiPrakara- Sangha
Lab Tests- Investigations- MRI lumbar spine-
  • Mild diffuse bulge of L3-4 disc with posterior circumferential annular tear, posterior central and left recessal protrusion causing marginal narrowing of lateral recess with left exiting nerve root indentation.
  • Diffuse bulge of L4-5 disc with posterior posterior central protrusion causing moderate anterior thecal sac indentation bilateral narrowing of lateral recess with mild exiting nerve root indentation.
• RogaSamprapti Flow Chart
Due to nidanasevana and Abhighata | Vata aggravates in body | Aggravtedvata fills empty srotas like Asthi and majja, mamsa at the weaker regions i.e., low back and legs | produces pain, stiffness and radiating pain at those regions

Differential Diagnosis with reasoning

Sciatica-Pain starting from low back (lumbar region) radiating to hips and down to legs till footwith burning sensation and numbness in the course of sciatic nerve. Pain and difficulty increase on standing, walking and relief on lying down.

lumbago-involves the muscles and bones of the back. Acute low back pain, pain develops after movements that involve lifting, twisting, or forward-bending are seen in the patient.Pain may range from tenderness at a particular point to diffuse pain. Pain worsens with certain movements, such as raising a leg, or positions, such as sitting or standing. Pain radiating down the legs is also present.

Differential Diagnosis with reasoning

Vatajagridhrasi- Pain and stiffness, starting from Sphik, kati radiating to thighs, knee, legs and foot. Vatakaphajagridhrasi-Vatajagridhrasi symptoms associated with Tandra (drowsiness), Gourava (heaviness) and Arochaka (Anorexia).
Evidence Based Diagnosis with References Patient has numbness, burning sensation, pain starts from low back, radiating to legs till ankle, aggravating on walking and getting relief on resting,the condition is diagnosed as Sciatica.
Diagnosis is supported by MRI findngs.
Evidence Based Diagnosis with References Since Tandra (drowsiness), Gourava (heaviness) and Arochaka (Anorexia) is not seen in patient, condition can be diagnosed as VatajaGridhrasi. (Ch Chi 28/56)
Details of allopathic medicines-
Tab Stamlo 5mg 1OD.

 Follow timely meal. Have freshly prepared warm home made food.
 Boiled- Warm jeera/ Coriander seed/ginger for Drinking water.
 Ginger, hing , Jeera, Turmeric in cooking
 Warm milk

 Refrigerated, deep oily fried, spicy, canned food items.
 Fast foods.
 Avoid fermented food preparations.
 Curd, Pickles
 Potato, Brinjal, Cabbage, Green Peas, Channa dal, Rajma,Uncooked Salads.

Vihara- REGIMEN:
 Avoid exposure to cold.
 Keep yourself warm and covered.
 Mild exercises as advised.
 Avoid bending back.
 Hot water bath.

• Tab Yogarajaguggulu 1 + Rasnairandadikashayam 9tsp + 10tsp warm water morning and evening at 7am and 6pm.
• Cap Palsineuron 1 cap thrice daily after food.
• Tab cardostab one after breakfast.
• Gandharva hasta taila 2tsp with ½ cup hot milk after food at bed time.
• Mahavishagarbhataila for external application twice daily.
Type –IPT
Duration – 15days

Primary Treatments-NIL
Main Treatments-
 Sarvangapodikizhi(Application of medicated powder)
 Kativasti (Retention of oil in low back)
 Sadyovirechana (Therapeutic Purgation)
 SarvangaElakizhi (Application of medicated leaves)
 Yogavasti (Therapeutic enema)
Post Treatments-NIL

ChikitsaPaddhati with details of dose of medicine.
1.Sarvangapodikizhi–i.e.,RukshaChoornapindasweda-inorder to reduce Ama and especially to reduce local inflammation. Kottamchukkadichoorna and Jatamayadichoorna were used to reduce Vata and shotha.
2.Kativasti-Mahavishagarbhataila - since it is indicated in Grudhrasi, Vatavyadhi.
4.Sadyovirechana- as a shodhana therapy to remove amatwa.
6.SarvangaElakizhi–Patrapindasweda with Dhanwantaramtaila on full body as Vatakaphahara line of treatment. It will help to reduce radiating pain. 5.Yogavasti –Vasti is the treatment choice for Vatavyadhi.
Anuvasana- Guggulutiktakaghrita + Dhanwantaramkuzhumbu;
Kashayavasti- ErandamoolaNiruhavasti
Referral Opinion Sought if any- No
Integrated View
  1. SamyakLakshanas achieved
    • Snehanaswedana chart-(Choornapindasweda) attached
    • Snehanaswedana chart-(Patrapindasweda) attached
    • Basti chart- attached
  2. Standardised Outcome Scales Used -Aberdeen low back pain scale
  3. Other outcomes as per following table to be duly filled
# Outcome Parameters
11/2/15 17/2/15 23/2/15 25/2
1 Appetite (Agni) Sama Nirama Nirama Nirama
2 Urination (Mutra) 1-2/ N 1/N 1/N 1/N
3 Stress (Manas) Fair Fair Good Good
4 Vitality (Ojus) Fair Good Good Good
5 Wellbeing (0-10) 3 5 7 8
6 BP 140/90 130/90 140/90 120/86
7 Pulse 70 70 72 68
8 Weight, Kg 64 64 64 64
9 W-U, cm
10 Diet (Ahara) Mixed Veg Veg Veg
11 Exercise (Vyayama) No No No No
12 Low back pain (Lt side) (0-10) VAS 9 7 2 1
13 Radiating pain to Lt leg (0-10) VAS 8 6 1 3
14 Ability to sit in minutes < 1min 15min 1hr > 1hr

Patient’s Outcome Scale
# Presenting Complaint Weightage Status_TSD Status_TED Status_1Week Status_1 Month Status_6 Months
1 Low back pain 50 1 5(Excellent)
2 Radiating pain to lt leg 50 1 3(Good)
IMPROVEMENT SCORE-----> 0.0 -2.0 -2.0 -2.0
IMPROVEMENT %ge-----> 0% -100% -100% -100%

Adverse Incident Report (Drug or Treatment): NIL Attachments
Date Before treatment Post treatment
MRI report report report
Control chart 1 report
2 report
3 report report
Aberdeen lowback pain scale 4 report report
report report

At the end of treatments patient noticed good improvement. Her low back pain and radiation of pain to left leg is reduced significantly on a VAS scale. She is able to stand, sit and also walk without much difficulty. She is advised to continue all her internal and external medicines for 15 days and review thereafter.

Follow up treatments-

  • Advised to undergo a course of Elakizhi and Yoga vasti during Jul - Aug 2015.
  • Internal medication and regular follow up at OPD