Presenting Complaints

  • Low back pain radiating to left leg since 8-9 yrs high severity.
  • Numbness in legs since 8-9 yrs
  • On and Off Vibrating feeling in both legs on standing since 2 yrs
  • Nervousness and forgetfulness
  • Burning sensation in chest
  • Irregular bowels habits(mostly constipation)
  • Rapid visual loss of in right eye 4yrs back

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

Patient was suffering from severe pain in low back since 2006 and had undergone a spinal surgery at L5-S1 level. As the symptoms reappeared, patient got hospitalized again in 2012 September and was investigated with MRI which showed Left foraminal stenosis and degenerative disc disease at L5-S1for which he underwent open foraminal decompression and fusion at L5-S1.He did not improve even after the second surgery. He then approached AyurVAID with above mentioned presenting complaints.

K/C/O Optic atrophy OD H/O Modern medicine induced Rapid visual loss 4yrs back

Current medication :

  • Pariet 20 mg 1/day
  • Rameron 50mg 0-0-1 since 5 yrs
  • Olfen 50 1-0-1 SOS
  • Tab.Inderal 10m 1-0-1 since 5yrs
  • Faverin 50 mg 0-3-1 since 5yrs

Clinical Status

Allopathy Ayurveda
Vital Parameters

  • BP:120/80 mm of hg
  • Pulse:76/min
  • Weight:89.6kg
  • Height192 cm
  • BMI:24.30
Asta Sthana Pariksha

  • Nadi:vatha pitha
  • Malam:Saama
  • Mutra:Prakrutha
  • Jihva:Swetha
  • Shabda:Sadharana
  • Sparsha:Prakrutha
  • Drik:Prakrutha
  • Akruti:Madhyama

  • GC:Fair
  • RS:NAD
  • PA:Soft, tenderness++ Epigastric region,Right iliac region
  • RS: NVBS

Gait: Antalgic SLR : Left leg – Less than 45 degree. Numbness- ++ on holding left leg for 2-3 seconds in same position Right leg- 70 degree pain starts in back of thigh and lower back CNS Examination: Sensation over right foot: Superficial sensation present Deep sensation: Altered Reflex: Ankle joint reflex absent

Dasa Vidha Pariksha

  1. Prakriti:Vatha pitha
  2. Vikriti:vatha
  3. Sara:Asthi sara
  4. Samhanana:Avara
  5. Pramana:Madhyama
  6. Satmya:Madhura,Lavana
  7. Satva:Madhyama
  8. Aharashakti:Avara
  9. Vyayam Shakti:Avara
  10. Vaya:Madhyama
  11. Desha:Jangalam
  12. Kala:Greeshma
Rogi Bala - Madhyamam
Roga Bala - Balwan
DSQ findings Rating
1. ADRS Med
2. ADSS High
  1. Nidana -Rooksha aahara,Athyayana,Athichinthanam
  2. Purvaroopa - Shoola
  3. Roopa -Shoola,Daha
  4. Updrava:Kukshishoola,Supthatha
  5. Arishta Lakshana:NA
  6. Samprapti
    1. Dosha - Vatha vrudhi Kapha kshaya
    2. Dushya - Rasa raktha mamsa asthi sira kandara
    3. Agni - Vishamagni
    4. Ama - Saama
    5. Srotas - Mamsavaha,Asthivaha
    6. Sroto Dushti Prakara - Sanga

Lab Tests: Nil

    RogaSamprapti Flow Chart

  • Rooksha, katu aahara +Athi chinthana+Athi ayana
  • Vata vrudhi
  • Kapha kshaya
  • Vata vikara

Differential Diagnosis with reasoning

Lumbago :
Pain felt in the low back area and tends to radiate into the groin, buttock and upper thigh. The pain often moves around, and radiates below the knee.

Sciatica :
Radicular pain that radiates down the leg along the specific course of a compressed spinal nerve.

Differential Diagnosis with reasoning

Vatha vyadhi-Gradhrasi

Evidence Based Diagnosis with References

Digestive disorders

Evidence Based Diagnosis with References


ChikitsaVivechana: Ahara+Vihara+Aushadh+Kriya

Details of Allopathy medicine if continued

Pariet 20 mg 1/day
Rameron 50mg 0-0-1
Tab.Inderal 10m 1-0-0
Faverin 50 mg 0-0-1

Type – IPT
Duration – 13 days

Primary Treatments: Choorna pinda sweda,Vasti poorva karmas

Main Treatments:Abhyanga,Jambeera pinda sweda,Kati vasthi,Lepa,Kayaseka,Vasthi,Shastika shali pinda sweda.

Post Treatments:

Paschatha karmas of vasthi

18/04/15 24/04/15 Sarvanga abhyanga Body-Sahacharadi taila+Narayana taila+karpasasthyadi taila, head-Dhanwantaram taila
18/04/15 18/04/15 Choornapinda sweda Kottamchukkadi choornam+ shatapushpa choorna
19/04/15 24/04/15 Jambeera pinda sweda Sahacharadi taila+Narayana taila+Karpasasthyadi taila
19/04/15 Kativasti Kottamchukkadi taila+Murivenna taila+karpasasthyadi taila
19/04/15 Lepam Murivenna taila+ Kottamchukkadi choornam+Marma gulika+ Egg white
25/04/15 Kayaseka Body-Sahacharadi taila+Narayana taila+karpasasthyadi taila, head-Dhanwantaram taila
23/04/15 25/04/15 Vasti A.V- Dhanwantaram mezupakam+Pippalyadi taila, K.V- Erandamoola kashaya+Dhanwantaram mezupakam+Pippalyadi taila+Shatapushpa kalka+madhu+saindhava lavana
25/04/15 30/4/15 Shashtikashalipinda sweda

Chikitsa Paddhati with details of dose of medicine.

Internal medicines during IP treatments:

  • Guggulu thikthakam Kashayam -15ml+Maharaja prasarinyadi thailam-10 drops at 7 AM
  • Maharasnadi kashayam-10 ml+Punarnavadi kashayam-10 ml+Yogaraja guggulu-2 11 AM
  • Dhanuantharam Kashayam-15 ml+Chandraprabha vati -2 at 6 PM
  • Manasamithra vatakam-2 warm milk at bedtime
  • Palsineuron after 2-0-2 after food

Internal medications after discharge date for 2 months:

  1. Maharasnadi kashayam -15ml+Dhanwantharm 101-10 drops+ ½ glass warm water- mixed together and to be taken at 7 a.m and 11 a.m.
  2. Dhanwantaram kashayam-15 ml+ Tab. Yogaraja guggulu -2+ ½ glass warm water- mixed together to be taken at 6 p.m or 7 p.m.
  3. Tab. Palsineuron 2-0-2, after breakfast and dinner.

External medications:

  • Mahanarayana taila+ karpasasthyadi taila- mixed together; warm the oil and aplly over low back, hip joints and legs 30 min before bath.

Integrated View
Patient has already undergone two spinal surgeries and inspite of that the complaints of backache and sciatica continue. From an Ayurveda perspective the root cause treatments on Agni and Srotas has effectively managed the presenting complaints and is leading towards sustained relief which is evident in the outcomes below. Ayurveda approach to be followed for another.

  1. Samyak Lakshanas achieved (Control Charts Summary attached)
  2. Standardised Outcome Scale-Low back Abredien Scale

Before treatment After treatment
Back pain severity score 76% 45.3 %
  • Other outcomes as per following table to be duly filled
# Outcome Parameters N R TSD T TED
1 Sleep (Nidra) Avara Pravara Pravara Pravara Pravara
2 Appetite (Agni) Fair-Vishamagni Fair Good Poor Good-Samagni
3 Bowels (Mala) Constipated-Saama Clear Clear Clear Clear-Niraama
4 Urination (Mutra) Prakrutha Prakrutha Prakrutha Prakrutha Prakrutha
5 Stress (Manas) Stressed Stressed Relaxed Relaxed
6 Vitality (Ojus) Less Less Good Good Good
7 BP 120/80 124/84 120/80 120/80 120/80
8 Pulse 76 --- 72
9 Weight, Kg 89.6 --- 85.2
10 Diet (Ahara) Poor --- Good
11 Exercise (Vyayama) No exercise --- No exersise
12 Lifestyle (Vihara) Poor --- Good

Patient’s Outcome Scale
# Presenting Complaint Weightage Status_TSD Status_TED Status_1 Week Status_1 Month
1 Low back ache radiating to LEFT LEG 60% 1 4 Awaiting -
2 Numbness legs - 1 4 Awaiting -
3 Vibrating feeling on legs 30% 1 2 Awaiting -
4 Nervousness - 1 3 Awaiting -
5 Irregular bowels 10% 1 3 Awaiting -
6 Burning sensation in chest and stomach pain - 1 3 Awaiting -
IMPROVEMENT SCORE-----> - - 0.0 2.0 2.0
IMPROVEMENT %-----> - - 0% 100% 100%

Adverse Incident Report (Drug or Treatment): No adverse incidents reported


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During treatment period he has well responded for all treatments. His pain and numbness were gradually reducing during the treatment days and he was not under NSAID during the treatment period. Basti karma has stopped on 3rd day as patient not willing to continue the same. Patient did not have any adverse events during the course of treatments. His pain in low back has reduced from 8 to 3 on VAS (0-10) along with significant reduction in numbness and no vibrations in lower limbs. His back pain severity score has reduced from 76 to 45.3%. He found overall improvement in his quality of sleep, improved digestion and general health. Further he is advised to continue all his internal medication along with diet and regimen for another 2 months for sustained relief.