Ayurvedic Approach in the Management of Lumbar Intervertebral Disc Annular tear – A Case Study

About Author

Correspondence Address

43/A Ramana Maroti Nagar , Nagpur
Contact No. : 9923760624, Email : shivaniraut009@gmail.com

Date of Acceptance : 11 Sep 2024

Date of Publication : 27 Sep 2024

Article ID : SD-IJAY_110

How to cite this article : http://doi.org/10.55552/SDNJAY.2024.2313

Abstract

An annular tear refers to a condition where the tough exterior of the spinal disc, known as the annulus fibrosus, develops a tear or rip. When an annular tear occurs, it can lead to localised pain, inflammation, and, in some cases, compression of nearby nerves. Treatment options range from conservative approaches such as rest, physical therapy, and medications like non-steroidal anti-inflammatory drugs (NSAIDs), injections, depending on the severity of symptoms and the extent of the tear. In Ayurveda, an annular tear is conceptualised as Abhighatjanya Katigatvata. The present case study focusses on the management of an annular tear in the lumbar intervertebral disc using ayurvedic principles.
A 48-year-old female, suffering from an annular tear of lumbar intervertebral disc desiccation and bulge, was treated with Panchtikta Kshira Basti for 15 days. Simultaneously, kati basti, Shashtishali Pinda Sweda, Agnikarma, and internal medicines were also given. Relief was noticeable in all symptoms of patient,so here presented a single case Study.

KEY WORDS:-  Annular tear, Abhighata Janya Katigatvata,Panchatikta kshira Basti, Kati Basti, Shashtishali pinda Sweda,Agnikarma

Introduction

The majority of a person's weight is carried by their neck and back, which are highly vulnerable to degeneration. Intervertebral discs are fibrocartilaginous structures that give shape to the vertebral column. Each intervertebral disc is surrounded by a tough, shock-absorbing layer known as the annulus (1). Annular tear incidence is common of age-related natural deterioration of the spine. An intervertebral disc annular tear refers to a condition where there is a tear or rupture in the outer fibrous ring (annulus fibrosus) of an intervertebral disc in the spine (1). These discs are located between each vertebra and act as cushions that absorb shock and allow for flexibility of the spine.

The annular tear can occur due to degeneration, trauma, or repetitive stress on the spine. When the annulus fibrosus tears, the inner jelly-like substance (NNucleus Pulposus) may protrude through the tear, potentially leading to disc herniation or bulging (2). This condition can cause localised pain in the affected area of the spine, and in some cases, pain may radiate to other parts of the body if nerve roots are affected.

Annular tears can be correlated in Ayurveda with Abhighatjanya Katigatwata. Abhighata (injury) may lead to Rasa Raktadi Dhatus and Vata dosha, which leads to vikruti in Asthi, Snayu, and Kandara and symptoms like pain, swelling, tingling sensation, etc. occur (1). For vitiated Vata Basti is the best treatment. For Asthipradoshaja, vyadhi tikta kshir basti is indicated (1).

Current treatment Opinion:

conservative measures such as rest, physical therapy, NSAIDs, selective nerve root block injections, epidural steroid injections, and surgery. These medications give immediate relief to pain, but they also cause side effects also. So people favoured Ayurveda more (3)

An Ayurvedic Approach : A cost effective Opinion

Efforts have been made in this case study to manage annular tears based on Abhighatjanya Katigatvata. Treatment protocol comprises Tikta Kshira Basti, Kati Basti, Shashtishali Pinda Sweda, Agnikarma, and internal medications (3).

Discussion

Annular tears can be correlated in Ayurveda with Abhighatjanya Katigatwata. Abhighata (injury) may lead to Rasa Raktadi Dhatus and Vata dosha, which leads to vikruti in Asthi, Snayu, and Kandara. For vitiated Vata Basti is the best treatment (1). Acharya Charka has mentioned Tikta Kshira Basti in Asthipradoshjanya Vikara(4), along with that snehana, Kati basti, Shashtishali pinda sweda, Agnikarma, and internal medications planned for this patient. The probable mechanism of action of the planned treatment protocol can be explained as follows:

Mode of action of Panchakarma Chikitsa :

1. Snehana:

Abhyanga : In this process, taila was applied to the body, and massage was done due to this mechanical pressure exerted on muscles, which helps to increase arterial pressure as well as muscle temperature from rubbing. Ayurvedic properties of taila are Snigdha, Guru, and Ushna, which are totally opposite to vata dosha. So, taila helps to reduce the vitiated Vata Dosha(5). Here Abhyanga was done with Sahacharadi taila, which has the indication of Krichra Anilamaya and was practically found to be very effective in radicular pain (6).

2. Swedana:

Shashtishali Pinda Sweda : It is a type of Snigdha Sweda that has lipid in it. In this Swedana type, drugs Pottali are applied to body parts; capillaries at that site get dilated due to warmth and allow the absorption of drugs locally and get absorbed into the Dhamani and apparently reach the strotas, leading to the santarpana (7). Here, due to Abhighata (injury), Vikruti of Asthi,Snayu, and Kandara was found. So, as a Santarpana aspect it was given.

3. Basti:

Panchtikta kshir basti: Acharya Charaka has mentioned Tikta Kshir Basti in Asthi Pradoshajanya Vikara.They haven’t mentioned specific ingredients. So, Ashwagandha and Shatavari possess Tikta Rasa and Rasayana properties, and along with that, Asthishrunkhala has been selected as Kalka dravya. Shatavari has vata, pitta, and rakta shamaka properties and naturally contains formed phytoestrogens that increase bone mineral density, and Asthishrunkhala is vata kapha shamak and helps to bone healing process. All these medicines have bone-healing properties along with anti-inflammatory, anti-ageing, and sedative roperties (4). So it was found to be very effective in degenerative changes of Asthi, which leads to annular tears.

4. Katibasti:

In this process, warm taila is poured on the lumbar region in a circular ring. According to Ayurveda, affected parts of the skin absorb taila through Sushma, which is situated in lomakoopa, and pachan is done by Bhrajak Pitta, located in the skin, which helps to reduce pain and stiffness. According to modern science, due to poured warm tail, blood flow increases on the affected site, so that part gets more nutrition and strengthens muscles and nerves. It relaxes muscles and relieves pain (8). Here Murivenna taila is used; it is well known for reducing pain and faster healing (4). So, with Murivenna taila, Katibasti becomes very useful in this type of condition.

5. Agnikarma :

It is a thermal parasurgical procedure to subside all types of pain. In Ayurveda, red hot shalaka was used, which is Ushnagunatmaka, and vata is opposite to that. So due to that, if vata was reduced, pain would also subside. According to modern science, blood supply increased and more nutrition was given to the affected part, which helped with pain reduction (5). So, for local pain reduction, this parasurgical procedure was found to be effective.

Mode of action of Shaman Chikitsa :

1. Yograj Guggul: 

Yograj guggul has a total of 29 ingredients; among these, most of the drugs have tikta, kashaya, katu rasa, ushna veerya, ushna-Ruksha guna, and Vata-Kapha hara. It acts as Vednasthapaka,nadibalya(6).

2. Rasnasaptak Kwath :

This polyherbal decoction contains a total main ingredients. These herbs are known for their anti-inflammatory, anti-arthritic, and analgesic activity. Properties of these drugs are Katu rasa, Katu Vipaka, and Ushna Veerya. This decree is used for aam pachana, vata shamaka, and mridu virechana (9).

3. Agnitundi Vati:

Agnitundi vati has properties like Katu, Kashaya Rasa, Ushna Veerya, and Katu vipaka. It balances Kapha and improves Pitta. It corrects digestive power and induces Pachana at the Dhatugata level. It helps to treat indigestion (9).

4. Dashmool Kwath:

This polyherbal decoction contains a total 10 ingredients. It is used for Tridoshshamaka and Shotahara (4).

5. Gandharvahastyadi Kashaya :

It has Malashodhana, Vata Kaphahara, and Deepan Pachan properties. Chitrak and Sunthi have Ushna Veerya, Stotoshodhana, and Deepan Pachan action. Haritaki, Punarnava, and Chiravilwa hepls in Vatanulomana(6).

6. Ashwadandha and Shatavari Churna :

These drugs are explained in the Balya gana of Charak Samhita. These drugs intake increased strength of body.Ashwagandha is Ushna Gunatmaka, which helps to reduce vata, and Shatavari helps to reduce pain (10).

Conclusion

This case study reveals the effectiveness of Ayurveda treatment modalities in the management of lumbar intervertebral disc desiccation with posterior annular tear. In which Kati basti, Tiktakshir basti, Agnikarma, Shashtishali pind Sweda, and Shaman treatment is effective to relieve symptoms like pain, tingling sensation, difficulty in walking occurring due to annular tear, and posterior paracentral disc bulge without compression of spinal canal.

If these medications are continued, reversible changes may be found in an MRI.

References

1. Sheetal Tokle,Sweety Ruparel,Akanksha Sharma,Hetal Ramani,An Ayurvedic management of annular tear of lumbar intervertebral disc-A case study, journal of Ayurveda and integrated medical science,july-Aug 2017,vol-2,issue 4,page no.337.
2. Piyush Mathariya,Shweta Dethe,Rajesh Dakhare and Pooja Shaha,Ayurvedic management of intervertebral disk prolapse (IVDP)-case study,WJPR,voi 8,issue 10,2019,page no.1504.
3. Sheetal Tokle,Sweety Ruparel,Akanksha Sharma,Hetal Ramani,An Ayurvedic management of annular tear of lumbar intervertebral disc-A case study, journal of Ayurveda and integrated medical science,july-Aug 2017,vol-2,issue 4,page no.338.
4. Sheetal Tokle,Sweety Ruparel,Akanksha Sharma,Hetal Ramani,An Ayurvedic management of annular tear of lumbar intervertebral disc-A case study, journal of Ayurveda and integrated medical science,july-Aug 2017,vol-2,issue 4,page no.339.
5. Piyush Mathariya,Shweta Dethe,Rajesh Dakhare and Pooja Shaha,Ayurvedic management of intervertebral disk prolapse (IVDP)-case study,WJPR,voi 8,issue 10,2019,page no.1508.
6. Lekshmipriya,P.Benedict,M.S Deepa,Management of Lumbar disc herniation with Radiculopathy through Ayurveda-A case Study,IJAPR,Sept-2022,Vol-10,Issue 9,page no.41.
7. Vd.Rutuja Tembhekar and Vd.Sachin S.Chandaliya, Mode of action of Shalishashtiki Pinda Sweda- A Review,WJPR, Vol 10,issue 13,2021,Page no. 356-357.
8.  Piyush Mathariya,Shweta Dethe,Rajesh Dakhare and Pooja Shaha,Ayurvedic management of intervertebral disk prolapse (IVDP)-case study,WJPR,voi 8,issue 10,2019,page no.1509.
9. Shreya Parkhi,Dr.Punam Sawarkar,Dr.Gaurav Sawarkar, Management of intervertebral disc prolapse (IVDP) through Panchakarma and Shaman Chikitsa- A Case Report, Drugs and Cell therapies in Hematology, vol 10,issue 1,2021,page no.3430.
10. Piyush Mathariya,Shweta Dethe,Rajesh Dakhare and Pooja Shaha,Ayurvedic management of intervertebral disk prolapse (IVDP)-case study,WJPR,voi 8,issue 10,2019,page no.1509.