Viswachi PPT

MUSCULO SKELETAL DISORDER

1. OCCUPATIONAL DISORDERS AYURVEDIC TREATMENT Management of Viswach i with Swalparasona Pinda (Internal) and Mahamasha taila Nasya with special reference to Brachial Neuritis. A Clinical study Dr . Rajimunnisa Begam . Shaik P.G Scholar. Dept . of K.C. GUIDED BY, [email protected] Dr. E. Venkateswarlu (M.D) Reader. Kaya Chikitsa P.G Dept ,

2. INDEX   1.INTRODUCTION 2.DISEASE REVIEW Nidana Samprapthi - Aetiopatogensis Roopa – clinical features Examinations Investigations Chikitsa   3.CLINICAL STUDY Materials & Methods Mode of action of Nasya or Nasya Karma Observations Results Discussions Conclusion References   Key Words : Viswachi , Brachial Neuritis, Swalpa rasona Pinda , Mahamasha taila,Nasya .

3. INTRODUCTION Ancient Ayurveda is having lot of importance in treating several diseases successfully using various potential drugs and apt methods. Even though there are certain remidies Explained in our classics , now after thousand years there is a need to evaluate the above diseases according to present conditions with proper parameter s and measures. Pain is the most complicated area of human experience. Pain is defined as an impleasant sensory and emotional experience associated with tissue damage. Viswachi is one of such diseases commonly seen affecting around 90% of adults above 50yrs of age and nearly same percentage of adults above 70yrs of age . In this disease severe and throbbing type of pain which radiates from neck , shoulder , arm, forearm, & digits is experienced . It is also associated with numbness and emaciation of upper limbs and its muscles. It resembles with brachial neuritis . It is also known as Neuralgic amyotrophy is a rare syndrome of unknown etiology affecting mainly the lower motor neurons of brachial plexus. symptoms are sudden onset of pain in neck , shoulder & arm. Weakness & numbness in shoulder, arm & hand . Fatigue , malaise , head ache, muscle aches & pains. Because of present day life style , food ,habits ,excessive stress strain and anxiety more people are getting these problems and the incidence of the disease viswachi is drastically increased day by day . Hence the study has been initiated to evaluate the successive management of viswachi using swalpa rasona panda (internal ) and Mahamasha taila , Nasya . In this yoga a ll selected drugs are having properties which effective in treating viswachi .

4. DISEASE REVIEW   NIDANA: There are no separate nidanas described for viswachi . The general nidana of vatavyadhi and factors causing vataprokopa are applicable . AHARAJA HETUS : Gunas : Excessive intake of ruksha , laghu , seta ahara increases the vata all these three factors which get increased by excessive intake ruksha guna causes dhatu kshaya Rasa: Kashaya , katu tikta rasasare vata prokapa . Sevana vidhi : Decreased quantity of food , food taken in irregular fashion , eating incompatible foods. affects agni and malnourishment of the dhatus kshaya this leads to vata prakopa . Visharaja hetus : 1.Primary one is ativyayama which also includes . A. Langhana C .Dhavana B . Plavana D .Utkshepa 2. Dukha sayya and asana are specially described by Caraka improper posrure gives& more presuure over the spine and disturbs the muscular integrity provoking vata which also includes Diwaswapna . Ratri Jagarana Veganirodha . Ati vyavaya . Mansika hetus : Chinta , soka , bhaya , krodha are due to rajas guna where as vata is also rajo guna pradhana . Thus all these aggrevate vata .

5. SAMPRAPTHI ( Aetiopathogensis ) Due to the naidanika factors , vata prakopa occurs and it moves all over the body and where it comes in contact with snehadirahita rikta srotas it fills them up producing either Sarvanga or Ekanga vyadhi . In Viswachi diseases the prakupita vata while moving all over the body settles in the greeva making in the adhisthana . As the kha vai gunya is in greeva . Vata fills those srotases doing soshana of the sleshaka sleshma of grivakaseruka sandhies & causing grivakaseruka vikara . This inturn leads to dusti of kandara of bahus manifesting the symptom of viswchi   SAMPRAPTHI GHATAKAS : Dosha : Vata , Vyanavata . Dushya : Kandara of baahu & prista Srotas : Chestavaha Srotas Sroto Dusti : Sanga Adhistana : Greeva Vyakastana : Baahu,talapratyanguli . Rogamarga : Madhyama Vyadhi Swabhava : Chirakari

6. Roopa – Clinical features In description of viswachi susrutha mentioned Bahu karma kshaya as the only symptom. Vagbhata quoted bahu chestapaharana as the lakshana . Where Madhavakara also described bahu karma kshaya as the only symptom. While commenting on the verses of Acharyas , various commentators have described in the following way. Dalhana opines that this diseases resembles Grdhrasi affects one arm Other commentators like Gayadas , Vijayarakshita and Arunadatta stressed the point of occurrence of pain as the cardinal feature in this disease. The clinical symptoms of viswachi as follows : “ Talaprathyangulinam thu kandara bahu prustatah Bahvah karma kshayakari viswachi hi sa smruthah ” The word Viswachi is derived from two words . visvat + anc viswa means entire / whole all pervading . Anc means turned to directed towards / to move / wander about. Thus Viswachi literally means spread through out Pain often has a neuritic quality – described as throbbing , burning , stabbing , electric shock like and aching .Sometimes it is cramping paraesthesia often felt in fingers . These description of pain are available in our classics as vyaddha bhedana etc weakness and occasional tenderness occurs. The pratyatmika lakshana of viswachi is radiating pain from the bahu , pristha to the hastha talam and pratyanguli . Teevra ruja Dalhana . Stambha Ruk , Todha & Spandana

7. MODERN VIEW OF BRACHIAL NEURITIS   Brachial neuritis (BN), also known as neuralgic amyotrophy , is a rare syndrome of unknown etiology affecting mainly the lower motor neurons of the brachial plexus and/or individual nerves or nerve branches. BN usually is characterized by the acute onset of excruciating unilateral shoulder pain, followed by flaccid paralysis of shoulder and parascapular muscles several days later. The syndrome can vary greatly in presentation and nerve involvement. Brachial neuritis (BN) exists in an inherited and an idiopathic form. In the idiopathic version, the pathophysiology is unknown, but the condition is generally thought to be an immune system – mediated inflammatory reaction against nerve fibers of the brachial plexus.   Axonopathy with subsequent Wallerian degeneration appears to predominate, but proximal  conduction block  has also been described in over 33% of cases in the series by Lo and Mills. [8]  The inherited form is autosomal dominant and has been linked to mutations in the  SEPT9  gene on chromosome 17q.   Septins are involved in the formation of the cytoskeleton and in cell division, but how these mutations result in BN is unknown. Symptoms are sudden onset of pain in neck shoulder , arm. weakness & difficulty in moving arm & shoulder , numbness in shoulder , arm, hand . fatigue, malaise head ache muscle aches & pains.

8. EXAMINATION.   Examination of Neck : First active movements are assessed, Next passive movements starting with extension. Functional assessement : Is done by performing a series of functional tests or movements to determine the functional capacity, keeping in mind the patients age and health. Investigations : Blood tests – CBP, ESR , RBS Serum proteins , CRP ( C – reactive proteins ) X-rays - Cervical Spine Ap view Lateral view Imaging – MRI – Excellent for cord ,root lesions . - CT –with contrast , Intrathecal for root , cord lesions . -CT – for bony lesions. Electro diagnostic : Nerve conduction studies Isotope scans : Bone ( metastases). Infective lesions. CSF - Presence of lesions infection / inflammation .

9. CHIKITSA   Ayurvedic classics explain the chikitsa of viswaci as follows . Caraka advised nasyam for diseases affecting bahu and siras along with uttara bakti snehapana . Susrutha advised siravyadhana in the affected parts along with vatavyadhi samanya chikitsa and also mentioned vamana and nasya in diseases . Sarangadhara advised gunjadhi lepam external application. From the above all statements line of treatment of viswachi can be evolved as Abyanga Sweda Uttarabhaktika snehapana . Nasya karma Shamanoushadhi Nidanaparivarjana  

10. CLINICAL STUDY Materials & methods : 1.Swalparasonapinda Rasona – 2 00 mg hingu -200mg Jiraka -200 mg Saindhavam -200 mg Sauvarchala lavana – 200 mg Trikatu -200 mg Total 1200 mg – per dose All the above drugs are to be taken in the equal quantity and 600mg of vati is prepared Dose -2 tab tid 2.Mahamasha tailam ( Niramisham ) Dasamoola -3kg Water -13 lit Masha -3 kgs Murchita tailam -750 ml Goksheeram -750ml   Kalka drugs Aswagandha , karcura , devadaru , bala , rasona , prasarini , kustha , parusaka , bhargi , vidarikanda , kshiravidari , punarnava , seed pulp of matulunga , ramatam , satapushphi , satavari , chitraka , pippalimula , jivaneeya gana . Each 6 gms make into kalka Taila is prepared using above drugs through tailapaka vidhi . Dose : 4 drops on each nostril Duration : 7 days  

11. SELECTION OF PATIENTS : 20 Patients for the present study , suffering with viswachi were selected from the opd of P.g Kaya Chikitsa unit of Dr . B.R.K.R Govt . Ayurvedic hospital , Hyderabad . Duration of the treatment -40 days Diagnostic criteria : 1. Bahu karma kshaya 2.Teevra ruja . Inclusive criteria : Patients of viswachi Age group 30- 70 yrs Both male and female are included . E xclusive criteria : As the disease like diabetes mellitus other major systemic disorders like hypothyroidism . Malignancy, tuberculosis , and trauma . Parameters required : Subjective Objective ;X- ray, CT, MRI (OPTIONAL) Bahukarma kshaya Follow up : - Once in 10 day Teevra ruja Pre assessment – 0 days Weakness in multiple different muscles, numbness 1 st assessment -10 th day 2 nd assessment -20 th day 3 rd assessment -30 th day Weakness 4 th assessment-40 th day  

12. MODE OF ACTION OF NASYA KARMA   NASYA DRAVYA   ADMINISTERED THROUGH NASALA ROUTE   REACHES SRINGATAKA MARMA (LOCAL SURFACE OF BRAIN ) i.e ., cavernous sinuses   SPREADS IN MURDHA (ENTERS INTO THE INTRA CRANIAL CIRCULATION)     REACHES AT A JUNCTION PLACE OF SROTA ,KANTA ,SIRAMUKHAS

13. EXAMINATION.   Examination of Neck : First active movements are assessed, Next passive movements starting with extension. Functional assessement : Is done by performing a series of functional tests or movements .Determine the functional capacity keeping in mind the patients age and health. Investigations : Blood tests – CBP, ESR , RBS Serum proteins Crp , C – reactive proteins X-rays - Cervical Spine Ap view Laterall view Imaging – MRI – Excellent for cord ,root lesions . - CT –with contrast , intra thecal for root , cord lesions . -CT – for bony lesions. Electro diagnostic : Nerve conduction studies Isoto pescans : Bone ( metastases). Infective lesions. CSF - Presence of lesions infection / inflammation .

14. RESULTS After collecting the data , it is subjected to statistical analysis basing on the subjective & objective parameters. The following tables show the scores obtained before and after treatment . Table showing the results of intensity of pain after treatment S.no Intensity of pain No.of Patients Percentage 1. No Pain 16 80 2. Mild Pain 3 15 3. Moderate Pain 1 5 4. Severe Pain

15. Table showing results of subjective symptoms . SYMPTOMS B.T SCORE A.T SCORE BAHUKARMA KSHAYA 30 12 THEEVRA RUJA 40 22 WEAKNESS IN MULTIPLE DIFFERENT MUSCLES OF THE ARM 32 30 NUMBNESS 33 10 GRADINGS; SEVERE-3 MODERATE-2 NO PAIN-0 MILD-1

16. S.no Functional Disability No. of patients Percentace 1. No Disability 15 75 2. Mild Disability 3 15 3. Moderate Disability 2 10 4. Severe Disability S.no Result No. of patients Percentace 1. Marked relief 16 80 2. Moderate relief 3 15 3. Mild relief 1 5 4. No relief Table showing results of functional disability after treatment All the 15 patients had No disability ( bahu karma kshaya )3 patients reported mild disability 2patients still have moderate disabilty and no patients have severe disability after treatment . Table showing outcome after the treatment

17. DISCUSSION Ayurveda being an ancient medical science is formulated on scientific parameters available in those times. Research is the only way available to re – establish old facts through modern methodolgy . It is not only useful to expand the area of knowledge but can also help to develop and advance in new direction. Viswachi is a pain predominat disease pain in viswachi is caused by partial damage to nerve membranes which become sensitive to mechanical and chemical stimuli .Such afferentiation pain may either be burning superficial ( dysaesthetic ) type or of stabbing character .So evolving a potent Vedanahara Yoga is very needful in the management of viswachi . All Ayurvedic classics included Nasya in the management of vatavyadhis . Bahu having its moolam in greeva gets affected in viswachi . Thus Nasya becomes the line of treatment. Discussion on inclusive & exclusive criteria: As Viswachi occurs in both sexes without bias both gender were selected for the study. As the diseases like Diabetes Mellitus and other major systematic disorders patients with history of trauma are excluded Discussion on diagnostic & assessment criteria As the key goals of pain management programe are reduction of incapacity and increase in physical function to the maximum achievable as a declared outcome. It becomes incumbent upon the clinician to monitor and measure the level of function and disability .

18. Conclusions Viswachi is an disorder affecting upper limbs it is identified by Radiating pain in all through the limb and dysfunction of the limb. Viswachi is a neurological disorder occur commonly due to Inflammation of lower motor neurons of the brachial plexus Disease is gaining importance due to its crippling nature. Prevalence of Viswachi is more in the age group of 30-70yrs. Occupations involving the upper limbs usage continuously are resulting in increased disease precipitation / prevalence. More women are suffering than men. More desk workers are prone to the disease. Clinical features are not always correlative to radiological findings Swalparasona pinda yoga along with Nasya karma showed marked relief in the blown up degenerative conditions. To create awareness in the public about the ayurvedic therapies which shows marked relief in occupational disorders like Viswachi etc.

19. 1.Su. Ni 1/35 2.A.S Hr Ni 1 st chapter 3. Ca. Ci 28/18 4. B.R – 26 TH /578-584 5. Chakradatta – 22 nd /172-180 6. Harrisons text book of medicine 7. David sons text book of medicine 8.Dravyaguna vol -2 Dr . Nisteswar REFERENCES