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‘A Rare Entity Trigeminal Neuralgia V3 Treated With Algorithmic Treatment Vamana, Virechana, Basti and Nasya - A Case Report’
BASELINE
A 60 year old female case wasreported to Kayachikitsadepartment in Jan 2011 with thecomplaints of episodic mosthorrible, shocking and burningpain in lower jaw beginning fromimplanted tooth at the time oftalking and taking food.
BASELINE…Subjective parameters of assessment
Episodic most horrible shocking and burning pain in lower jaw.
Heaviness in lower jaw.
Pain triggered at the time of talking and taking food.
Objective parameters of assessment.
MRI was showing vascular adhesion totrigeminal nerve.
BASELINE…. Investigations conducted by Neurologist
and results
MRI was showing vascular adhesion to trigeminal nerve.
Other general investigations and clinical evaluations are within normal limits.
Implant surgeon, neurologist and neurosurgeon treated this case for thirteen months but case was not responding. Hence neurosurgeon advised surgery.
Description of Patient
Name of Patient-Vimal Ramdas Jaybhaye
Age-62 yrs
Gender-F
Nationality-Indian
State-Maharashtra
District-Parbhani
Appearance - First-class
Physical and mental disposition – standard
Occupation – House wife
Socio-economic status – higher
Mob.09421085610
Complaints
Presenting Complaints as perceivedby the patient
Doctor I am suffering fromepisodic horrible, shocking andburning pain in lower jawbeginning from implanted tooth atthe time of talking and taking foodand I am not able to take food aswell as afraid of food intake.
FindingsSubjective parameters of assessment
Episodic Severe shocking and burning pain in lower jaw.
Heaviness in lower jaw.
Pain triggered at the time of talking and taking food.
Objective parameters of assessment
MRI was showing vascular adhesion to trigeminal nerve.
Histories
Relevant personal and family history-
Tooth implant on date Oct. 2011
No other relevant personal and family history to this disease.
Diagnosis
Allopathy Diagnosis
Patient is already diagnosed astrigeminal neuralgia V3 by Implantsurgeon, neurologist andneurosurgeon treated this case forthirteen months but case was notresponding. Hence neurosurgeon
advised surgery.
Diagnosis….
Ayurveda view of diagnosis
Patients diagnosis was considered as tridoshaja disease of anantvata category.
Treatment Plan
Patient convinced for algorithmic treatment vamana, virechana, basti and nasya.
Treatment Plan-purvakarmaLanghanaFor initial 3 days
Krishara Yavagu of shastik shali mixed with dadimrasa
Snehapana withMahanarayana taila
100 ml daily for 7 days with leukwarm water at 8 am
Yavagu of shastik shali after hunger sensation
Treatment Plan- Vamana karmaAfter complete snehapana Abhyanga with Mahanarayanatailam at 9am and at 4pm twice for one day with Dashmula kwath nadi sweda
Shali mixed with sugar andmilk diet before a day of vamana.
Madanaphala 20gm+Madhu 20gm+ Sharkara20gm=Mantha
Mungadalyusha 1 lit.Early morning 7am.
Treatment Plan-samsarjana kramaDay
1st
2nd
3rd
4th
5th
Lunch
--PeyaVilepiKrita yavaguKrita yavagu
Dinner
PeyaVilepiAkritaYavaguAkritaYavaguNormal diet.
Observations at the midpointsSubjective parameters of assessment
As per patients assessment episodic pain, burning and heaviness was reduced upto 5% only and negligible.
Pain triggered at the time of talking and taking food was same as before.
Objective parameters of assessment.
MRI report was not advised.
Treatment Plan-purvakarma
Snehapana withMahanarayana taila
100 ml daily for 7 days with leukwarm water at 8 am
Yavagu of shastik shali after hunger sensation
Treatment Plan- Virechana karmaAfter complete snehapana Abhyanga with Mahanarayana Taila at 9am and at 4pm twice for 03 days and Dasmula kwath baspa sweda
Krishara Trivrittavaleha 100gm at 9.30 am.
Treatment Plan-samsarjana kramaDay
1st
2nd
3rd
4th
5th
Lunch
--PeyaVilepiKrita yavaguKrita yavagu
Dinner
PeyaVilepiAkritaYavaguAkritaYavaguNormal diet.
Observations at the midpointsSubjective parameters of assessment
As per patients assessment pain and heaviness was reduced upto 10% only and burning was reduced up to 25%.
Pain Triggered at the time of talking and taking food was same as before.
Objective parameters of assessment.
MRI report was not advised.
Treatment Plan-purvakarma
Snehapana withMahanarayana taila
100 ml daily for 05 days with lukewarm water at 8 am
Yavagu of shastik shali after hunger sensation
Treatment Plan- Basti karmaAfter complete snehapana Abhyanga with Mahanarayana Taila at 4pm and Dasmula kwath baspa sweda.
Krishara Yoga BastiMahanarayana taila Matrabasti 60 ml andDashmuladi niruha basti
Treatment Plan-samsarjana kramaDay
1st
2nd
3rd
Lunch
PeyaVilepi
Krita yavagu
Dinner
VilepiAkritaYavaguNormal diet.
Observations at the midpointsSubjective parameters of assessment
As per patients assessment pain and heaviness was reduced upto 40% only and burning was reduced up to 50%.
Pain triggered at the time of talking and taking food was reduced to 30% only.
Objective parameters of assessment.
MRI report was not advised.
Treatment Plan- Nasya karmaAbhyanga with Mahanarayana Taila at 4pm and Dasmula kwath baspa sweda.
Krishara Pratimarsha Nasya with Anu tailaFor seven Days
Treatment Plan-shamanaMahanarayana oil
30 ml early morning with luke warm water regularly
Ashvagandha ghrita
30 ml before dinner with luke warm water regularly
Progress of the treatment After treatment, frequency of episodes was
reduced up to 50% only.
As per patients assessment pain and heaviness was reduced upto 40% and burning was reduced up to 50% only.
Pain triggered at the time of talking and taking food was reduced to 30% only.
Patient is asked to reduce the allopathic medicine doses tid to bid to od and stopped.
Patient was able to take lukewarm liquid diet.
Progress of the treatment Oral shamana treatment was advised along with
anu taila pratimarsha nasya.
After six months same panchakarma procedureswere performed and patient relieved 90% in hercomplaints.
Same panchakarma treatment was repeated afterone year and patient relived completely.
Shamana treatment was discontinued exceptpratimarsha nasya.
Virechana and basti karma was repeated afterone year to prevent the recurrance.
Outcomes at Endpoint Patients complaints were completely
relived after regular treatment as per schedule.
Recurrance is not observed up to June 2016.
Patient was not ready for MRI hence objective parameter is aviated.
BT AT ComparisonBT
Episodic Severe shocking and burning pain in lower jaw.
Heaviness in lower jaw.
Pain triggered at the time of talking and taking food.
AT
No episodic Severe shocking and burning pain in lower jaw.
No heaviness in lower jaw.
No pain triggered at the time of talking and taking food.
Conclusions Algorithmic management vamana, virechana,
basti and nasya is showing positive effects in most horrible case Trigeminal neuralgia V3
Long term treatment plan along with regular follow-up is required to improve such irremediable disease.
Recurrence is very common in this disease hence long term treatment and follow up is required.
Patient is not receiving any Allopath medications for this disease. Hence treatment efficacy is not suspicious.
Acknowledgements
I am thankful to Sow Vimal Jaybhaye , highly cooperative, sincere and obedient patient.
I am highly thankful to Charutar Vidya Mandal for providing such complete hospital along with keen administration of Principal and Kayachikitsa and Panchakarma Departmental staff.
References
Pandit Kashinath shastri,Pandit Gangadhar Pandeya,editors.Charaka samhita (part II) with Ayurved Dipika Commentary of Chakrapani datta & with ‘Vidyotini’ Hindi commentary, Chaukhambha Sanskrit Sansthan, Delhi, edition 2006, chikitsa sthana 28-99.
Tatli M, Satici O, Kanpolat Y, Sindou M. Various surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes. Acta Neurochir (Wien) 2008; 150(3):243–255. [PubMed]
Thank you
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