Presenting Complaints

  • Pain on lower back radiating to both lower limbs
  • Stiffness on low back region
  • Numbness on both toes

Brief Relevant Medical History:

A male patient, aged 37yrs not a known DM / HTN came to AyurVAID hospital with severe pain and stiffness on lower back region since one month. The pain was radiating to both lower limbs. Pain usually aggrevate during activities and travelling long distances on bike. Pain relieves on rest. Pain was of shooting type. He had numbness on both toes. He took ayurvedic medicines internally but there was no relief. Advised MRI of lumbar spine. (Reports attatched).

History of past illness:

Patient explained a history of low back pain since three years, for which he is continously taking Inpatient treatments from this centre every year and got good results. Now the symptoms aggrevated again due to over strain and he came for further treatments.

Aggravating factor- Cold, Strenous activities

Relieving factors: Rest

Current medication: Nothing

Clinical Status

Clinical Status

Allopathy Ayurveda
Vital Parameters

  • BP:120/80
  • Pulse;72
  • RR:19
  • Weight:66kg
  • Height:163cm
  • BMI:24.84

  • Nadi:Manda
  • Malam:
    • Pravruthi: 1 times
    • Varna - Haridhra
    • Akriti: Samhat
  • Mutra: 6 times / day
  • Jihva: nirama
  • Shabda: Sadharan
  • Sparsha: Anushnaa seetha
  • Drik: Sadhrana
  • Akruti: Sama

  • GC-Normal
  • CVS-Normal
  • CNS-Normal
  • RS-Normal
  • PA-soft,no organomegaly

Relevant systemic examinations:

Hip: Flexion and Extension painful

SLR - positive

Lassegues sign - positive


Antalgic gait


  • Prakriti - Kapha vata
  • Vikriti - Vata Kapha
  • Sara - Mamsa sara
  • Samhanana - Madhyama
  • Pramana - Madhyama
  • Satmya - Madhura rasa
  • Satva - Uthama
  • Aharashakti - Madhyama
  • Vyayam Shakti - Avara
  • Vaya - Madhyama
Rogi Bala - Madhyama
Roga Bala - Balawan
DSQ findings Rating
1. ADRS Medium
2. LUPPN Medium
  • Nidana-Rookshahara, ativicheshtitha, vishamadhupacharam, Athi adhwa.
  • Purvaroopa-Shoola
  • Roopa- Sthamba(stiffness of lower back region), supthatha(numbness of both toes) , thoda(pricking pain).
  • Upashaya-Rest
  • Samprapti
    • Dosha-Vata
    • Dushya-mamsa, asthi,majja
    • Agni-Jataragni, Dhatwagni
    • Ama- Jataragnimandyajanya
    • Srotas- mamsa, asthi, majjavaha
    • SrotoDushtiPrakara- Sangha


MRI of Lumbar Spine:(12/2/2015)

Mild osteophytes are seen at lower lumbar levels.

The IV disc at L4/5 shows loss of its normal signals.

Diffuse annular disc bulge is seen at L3/4 levels.

Postero-central IV disc protrusion at L4/5 levels levels causing bilateral nerve root compression and bilateral neural foraminal narrowing.

    RogaSamprapti Flow Chart

“Sphikpoorvakatiprushta ooru janujankha
padam kramaat
Gridhrasi stambharuktodairgrahanati muhur vatat” (Madhava nidana)

Vatavardhakaaharavihara(rookshahara, atiadhwa, vishsmadhupachara, athivicheshtitha)

Vatha prakopa

dhatu gata(mamsa,asthi,majja)
(lodges in jankha, Kati,Sphik)

leads to sthamba, Ruk, spandata

Differential Diagnosis with reaso ning

  • Sciatica-Severe low back pain radiating to both lower limbs. SLRT and Lassegue's sign is positive.
  • Ankylosing Spondilitis: Severe low back pain is the main symptom of ankylosing spondilitis is similar in this case.The pain present at rest time also which is absent in this case and no significant spinal changes is seen in the report.
  • Lumbar Spondylosis:Low back pain is the symptom seen in this condition. Mild osteophyte changes is seen in the report which is the initial changes of lumbar spondylosis.
  • Lumbar Spondylolisthesis: In lumbar spondylolisthesis a leaning forward or semi kyphotic posture is seen .Also low back pain with intermittent pain from buttocks to posterior thigh is seen in spondylolisthesis.

The patient was provisionally diagnosed with Sciatica with differential diagnosis of anklosing spondilitis and Spondylolisthesis.

Differential Diagnosis with reasoning

  • Katigraham
  • Pakwasaya gata vata
  • Gridhrasi.
  • Khalwi

1.Pakwashayagata vata-
“Tatra pakwashaye krudhah soolanahaantrakoojanam
Malarodhasmavardhmarsa trikaprushtakatigraham”
Katigaraha is seen when vata gets vitiated in pakwashaya. All other symptoms are absent in this case.

2. Gridhrasi-
“Parshnim pratyangulinam ya kandara marutharditha
Sakthyuthkshepam nigrahnathi
gridhrasi tam prachakshate”
In gridhrasi the pain is radiating to lower limbs and difficult to raise the lower limbs.

3. Khalwi-
“Viswachi gridhrasi choktha khalwi
In khalwi both the symptoms of gridhrasi and vishwachi is present. In this case only the signs of gridhrasi is present.

Evidence Based Diagnosis with References

Report lead to the diagnosis of Mild Lumbar spondylosis with sciatica.

Evidence Based Diagnosis with References
Gridrasi: “Sphikpoorvakatiprushtoorujanujankh
Gridhrasi stambharuktodairgrahanati spandate muhur vatat”(Madhava nidana)

  • Stambha(stiffness of lower bck region)
  • Toda(shooting pain)
  • Spandana(numbness of both toes)
Details of Allopathy medicine if continued

Gridhrasi vishesha chikithsa:>

“Gridrasyartham naram samyak pachanadair
visodhitamnjatva naram pradeepthagnim vasthibhir samupachareth”

”chakra dhatha vatha vyadhi chikithsa)

“Vasthi vatha haranam”
Objective of treatment:
Our goal was to reduce pain,stiffness and numbness.
Line of Treatment:
1.Reduce pain,stiffness and numbness by allevating vata with Marma kizhi.
2.Allevate vata with vaitarana vasthi.
3.Vatha harana-mathravasthi,Kati vasthi
4.Balya-shashtika shali pinda sweda.
(Once the inflammation and pain has been reduced, nourishing and strengthening the muscle tissue and surrounding area was done).
Type – IPT
Duration – two weeks.

Chikitsa Paddhati with details of dose of medicine.

19/2/15 21/2/15 Choorna Pinda Sweda Kolakulattadi churnam+Kottamchukkadi churnam with Murivenna
20/2/15 21/2/15 Vaitharana vasthi Pippalyadi anuvasana thaia-100ml
22/2/2015 22/2/2015 Virechanm Sindhuvarerandam(25ml+Induppu(1/4 tsp)
22/2/15 22/2/15 Marma kizhi Murivenna
24/2/2015 24/2/2015 Virechanm Sinduvarerandam+Induppu
25/2/2015 1/3/15 Sashtika shali pinda sweda
26/2/2015 4/3/2015 Traction

Samana chikithsa:

  • Amrithotharam kashaya – 3tsp + 9tsp water +shaddhrana churnam 1tsp+Lumbaton(1)
  • Balarishtam+Punarnavasavam – 30ml thrice daily after food.
  • Sallaki XT-1 tablet thrice daily after food
  • Cystone-2 tablet thrice daily after food.

Integrated View
Disc protrusion is most often the result of a gradual ageing related wear and tear called disc degeneration.As you age, spinal disc lose some ot their water content and makes them less flexible and more prone to tearing or rupturing with even a minor strain or twist.Exercise for strengthening the trunk muscles helps stablilse and support the spine.Good posture reduces the pressure on spine and disk.Maintain a healthy weight because excess weight puts more pressure on the spine and disks.There should be prevention of affected joints from trauma,injuries and physical stress.
Standardised Outcome Scales Used

LBP Scale
Before treatment Post treatment
30.56 23.61

Patient’s Outcome Scale:

Poor(1); Fair(2); Good(3); Very Good(4); Excellent(5).

# Presenting Complaint Weightage Status_TSD Status_TED Status_1Week Status_1 Month Status_6 Months
1 Pain and stiffness of low back region. 40 1 3
2 Pain in right lower limb 20 1 3
3 Pain in left lower limb 20 2 4
4 Numbness on both toes 20 2 4

After the course of treatment vitiation of vata and kapha is reduced.Pain and stiffness of low back region is significantly reduced.Numbness on both toes is reduced.He is advised to follow up after two weeks and continue oral medicines for these two weeks.