Sciatica: Radiating pain, numbness resolved; she began to walk again

Vital Parameters

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

Astasthana Pariksha

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

Examinations

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

Dasavidha Pariksha

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

NidanaPanchaka

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 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

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

2. 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

1. Vatajagridhrasi- Pain and stiffness, starting from Sphik, kati radiating to thighs, knee, legs, and foot.

2. 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 findings.

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 5 mg 1OD.

ChikitsaVivechana:

1. Ahara- INCLUDE:
i. Follow timely meal. Have freshly prepared warm homemade food.
ii. Boiled – Warm jeera/ Coriander seed/ginger for Drinking water.
iii. Ginger, hing , Jeera, Turmeric in cooking
iv. Warm milk

2. AVOID:
i. Refrigerated, deep oily fried, spicy, canned food items.
ii. Fast foods.
iii. Avoid fermented food preparations.
iv. Curd, Pickles
v. Potato, Brinjal, Cabbage, Green Peas, Channa dal, Rajma,Uncooked Salads.

3. Vihara- REGIMEN:
i. Avoid exposure to cold.
ii. Keep yourself warm and covered.
iii. Mild exercises as advised.
iv. Avoid bending back.
v. Hot water bath.

4. Aushadha-
• 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.

Kriya-
Type –IPT
Duration – 15 days

Primary Treatments- NIL
Main Treatments-
i. Sarvangapodikizhi (Application of medicated powder)
ii. Kativasti (Retention of oil in low back)
iii. Sadyovirechana (Therapeutic Purgation)
iv. SarvangaElakizhi (Application of medicated leaves)
v. Yogavasti (Therapeutic enema)


Post Treatments- NIL
Chikitsa Paddhati 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