Sciatica-3

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Casestudies of Contents

Brief Medical History

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 50 mg 0-0-1 since 5 yrs
  • Olfen 50 1-0-1 SOS
  • Tab.Inderal 10 m 1-0-1 since 5yrs
  • Faverin 50 mg 0-3-1 since 5yrs

Integrated Summary

Clinical Status
Allopathy Ayurveda
Vital Parameters

1. BP:120/80 mm of hg
2. Pulse:76/min
3. Weight:89.6 kg
4. Height192 cm
5. BMI:24.30
Astasthana Pariksha

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

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

Gait: AntalgicSLR :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
NidanaPanchaka

1. Nidana - Rooksha aahara, Athyayana, Athichinthanam
2. Purvaroopa - Shoola
3. Roopa - Shoola, Daha
4. Updrava:Kukshishoola, Supthatha
5. Arishta Lakshana:NA
6. Samprapti
A. Dosha - Vatha vrudhi Kapha kshaya
B. Dushya - Rasa raktha mamsa asthi sira kandara
C. Agni - Vishamagni
D. Ama - Saama
E. Srotas - Mamsavaha, Asthivaha
F. 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
Khanja
Pangu
Evidence Based Diagnosis with References
Lumbago
Digestive disorders
Evidence Based Diagnosis with References
Vatavyadhi-Gradhrasi
Agnimandhya
ChikitsaVivechana: Ahara+Vihara+Aushadh+Kriya
Details of Allopathy medicine if continued

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

FROM DATE TO DATE PROCEDURE TREATMENT MEDICINES
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.

Outcome

  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.