CARPAL TUNNEL SYNDROME – CASE STUDY – AYURVEDIC APPROACH

BACKGROUND

39 yo female client has just undergone panchakarma treatment for detox, weight loss (was 82kg) and carpel tunnel syndrome. Panchakarma treatment went well, however client only lost 2 kg during her panchakarma, which is low compared to the normal of 2-12 kg. Client’s numbness from the carpel tunnel cleared for a few days, but returned a few days after her detox. The consultation was a follow up after the panchakarma and discussed the treatment plan for weight loss and the carpel tunnel syndrome over the coming period.

 

 

HISTORY OF PRESENTING COMPLAINTS

  • Unable to shift weight. Stopped eating dinner, but this did not help.
  • Hand goes numb whilst sleeping.
  • Blood tests done 6 months ago – all normal
  • Thyroid test also done – normal
  • Hands are cold
  • Menses – 24-26 days
  • Constipation prior to detox – can be hard sools
  • Stress levels are manageable
  • Not using contraceptives

 

PAST MEDICAL HISTORY

  • Diagnosed carpel tunnel

 

SURGICAL HISTORY

  • None

 

MEDICATIONS

  • Ayuna Joint-S
  • Ayuna Ahwaganda capsules
  • Ayuna Triphala capsules

 

FAMILY HISTORY

  • Not in case file

 

SOCIAL HISTORY

  • Not in case file

 

PHYSICAL EXAMINATION

Nadi Pariksha (Pulse Examination)

  • VP

 

Mutra Pariksha (Examination of Urine)

  • NAD

Mala Pariksha (Stool Examination)

  • Normal

Jihwa Pariksha (Tongue Examination)

  • Clear

Shabda Pariksha (Voice Examination)

  • Normal

Sparsha Pariksha (Touch Examination)

  • Normal

Drik Pariksha (Eye Examination)

  • Normal

 

Akrti Pariksha (Physical Appearance Examination)

  • Normal

Akruti (volume and tension of pulse)

  • VP

 

 

INVESTIGATION (BASED ON CURRENT CONSULTATION AFTER PANCHKARMA)

 

Prakruthi:            VP

Vikruthi:              VK

Agni:                     Normal (after detox)

 

Sub dosha Vata (Prana, Udana, Samana, Vyana, Apana):

Vyana vayu (pain, numbness, tingling)

 

Sub dosha Pitta (Sadhaka, Alochaka, Pachaka, Bhrajaka, Ranjaka):

x

 

Sub dosha Kapha (Tarpaka, Bodhaka, Kledaka, Sleshaka, Avalambaka):

Kledaka kapha (wrist joint)

 

Dhatus (Rasa, Rakta, Mamsa, Meda, Asti, Majja, Shukra):

Mamsa vruddhi (overweight)

Meda vruddhi (overweight, pain in the joints)

Meda dhatu dushti (overweight)

Majja dhatu dushti (tingling, numbness, joint pain)

 

Srotas (Annavaha {Digestive}, Pranavaha {Respiratory}, Udakavaha {Fluid}, Rasavaha, Raktavaha, Mamsavaha, Asthivaha, Majjavaha, Sukravaha, Swedavaha, Purishsvaha, Mutravaha, Manovavaha, Arthavavaha {Menstruation}, Stanyavaha {Lactation}: 

Majjavaha sroto dushti (tingling, numbness)

 

Prana, Tejas, Ojas:

Tejo visramsa – tingling and numbness

 

Pathway (Internal, external, middle): Middle (carpal tunnel)

 

Kriyakala (Accumulation (Sanchaya); Aggravation (Prakopa); Overflow (Prasara); Relocation (Sthyana Samsraya); Manifestation (Vyakti);  Complications (Bheda): Manifestation

 

Dosha gati (Direction): Tiryag kapha

 

Purvaroopa (Prodormal Signs and symptoms): numbness, overweight, struggling to lose weight

 

Roopa (Disease Manifest Signs and symptoms): Carpal tunnel syndrome

 

Ayurvedic Pathogenesis:  

Ayurveda has no single condition that refers specifically to carpal tunnel syndrome (CTS). There are however, some conditions that have a close resemblance to CTS in the upper limbs.

 

Pathogenesis is on an individual basis, but can be seen as Kapha Vata prakopa at the wrist, with a pitta involvement (inflammation) within in this client. Kapha aggravating diet and lifestyle factors, have led to kapha prakopa at the wrist. This has led to obstruction of normal gati of Vata in the hand by Kapha, which has then led to increased Vata vitiation, and manifested as carpal tunnel syndrome. After the initial stage, if not treated, Pitta can become involved causing inflammation of the tendons within the carpal tunnel.

 

Conventional Perspective:

Carpal tunnel syndrome is classified as entrapment neuropathy, and is one of the most common to occur. The cause is not usually easy determinable , trauma, repetitive strain, certain diseases, obesity and pregnancy can lead to the condition. Symptoms are related to compression of the median nerve within the wrist (within the carpal tunnel itself), which then results in pain, numbness, and tingling.

 

Ayurvedic herbs:

 

PRESCRIBED HERBS FOR THIS CLIENT:

  • Ayuna Joint-S 1—–1
  • Ayuna Ashwaganda. 2 capsules at bedtime
  • Ayuna triphala 1—–1—-1
  • Varanadi kashayam 10ml — 10ml with warm water before food
  • Vitamin D3 drops 1ug per day

 

  • Daily massage to wrists with Dhanwantaram/Karpooradi oil warmed and potli for 14 days straight. 15 minutes massage. 15 minutes potli.
  • After this then revert to 3 x weekly
  • Then after this revert to 1 x weekly
  • After this revert to 1 x fortnightly
  • After this revert to 1 x monthly

 

IN ADDTION, BENEFICIAL AYURVEDIC HERBS FOR THE FOLLWING INCLUDE:

 

OVERWEIGHT:

Vata Pitta Balancing:  Aloe vera juice, coriander, amalaka, barley water, pippali, bhibitaki,

Vata Kapha Balancing: Aloe vera juice, coriander, amalaka, barley water, ajwain, guggulu, bhibitaki, agnimantha,  shilajat, vidanga

Pitta Vata Balancing: Aloe vera juice, coriander, amalaka, barley water, bhibitaki,

Pitta Kapha Balancing: Aloe vera juice, coriander, amalaka, barley water, daruhardira, bhibitaki, gentian,

Kapha Vata Balancing: Aloe vera juice, coriander, amalaka, barley water, ajwain, pipplai, gugguli, bhibitaki, agnimantha, black pepper, vidanga

Kapha Pitta Balancing: Aloe vera juice, coriander, amalaka, barley water, dariuharidra, bhibitaki, gentian, sjhilajat,

 

CARPAL TUNNEL:

Vata Pitta Balancing: Guduchi, turmeric, punarnava, bala, shallaki, shatavari, kapikacchu

Vata Kapha Balancing: Guduchi, turmeric, punarnava, bala, shallaki, ashwaganda, rasna, gulggulu, garlic,

Pitta Vata Balancing: Guduchi, turmeric, punarnava, bala, shallaki, shatavari, kapikacchu

Pitta Kapha Balancing: Guduchi, turmeric, punarnava, bala, shallaki,

Kapha Vata Balancing: Guduchi, turmeric, punarnava, bala,  shallaki, ashwaganda, rasna, guggulu, garlic,

Kapha Pitta Balancing: Guduchi, turmeric, punarnava, bala, shallaki,

 

 

Traditional Ayurvedic Treatment(s) for these conditions:

  • Management of CTS depends  upon  the  stage  of  the  disease i.e. initial, second or third phase of development and the vitiated doshas etc.
  • Symptoms of numbness and  reduced  sensation  are   treated  with swedana  and   maintaining equilibrium by correcting metabolism).
  • The pain predominant phase should  be  treated  with  correcting  metabolism,  and  improving  the  structure  by nourishment through snehana.
  • The wasting /  functional  loss  phase  should  be  treated  through correcting  metabolism, and and brmhana (nourishing therapies).

 

 

Ayurvedic Diet for this client:

–              Client needs to be on a Vata Kapha balancing/pacifying diet, and needs to avoid all rice, wheat, sugar and milk for 6 weeks, as well as minimise intake of white and sweet potatoes. See also diet chart at the end of this advice form.

–                Client should not have any spices that are too aggravating for Pitta. See also diet chart at the end of this advice form.

–              Client also needs to take no solid foods after 2.30pm each day. Instead have vegetable soups, mung dahl etc. This also means that all the food substances should be dry and light to digest, without too much oil or fat.

–              See the general diet chart at the end of this advice form – taking onto consideration any contraindicated food that is listed here.

–              In general, you need to eat on time, keep eating healthy food, eat warm food, wholefoods, cooked food, steamed veggies, boiled eggs or whites, soaked almonds, soaked walnuts. Keep aggravating spices to a minimum and do not over-spice meals. Keep food combinations and preparation methods simple and nutritious.

–              Use small amounts of ghee in cooking.

–              Upon waking: Drink a glass of warm water with aloe vera juice, or lemon juice.

–              (Allow 6 hours between meals and snack 3 hours after a meal).

 

–              AVOID: Cold foods, raw foods, leftover foods (24 hours), frozen foods, cold water, processed and packaged foods, soft drinks, alcohol, coffee, wine, high fat foods, greasy foods, potatoes.  No rice, no wheat, No sugar. No milk for 6 weeks.

–              WATER INTAKE: Drink room temperature to warm water during the day. This will also help to keep system clear of toxins and help avoid constipation.

–              Use all of the five senses at mealtimes. Create a ritual of eating to bring back the sacredness of eating. Stop eating when ¾ full.

–              Eat in a pleasant environment. Eat seated. No TV, no electronic devices.

–              Eat slowly, eat with respect/reverence for what you are eating, chew thoroughly. Savour the food. This helps prevent overeating and helps to retrain the brains wrings in relationship to food.

 

RECIPE MUNG DAHL SOUP

INGREDIENTS

2 cups mung dal/beans (split yellow)

8 cups (approx.) water

½ to ¼ inch ginger root, finely chopped

Heaped teaspoon organic/vegan stock powder

2 tsp. ghee

¼ tsp. coriander powder

¼ tsp. cumin powder

¼ tsp. whole cumin seeds

¼ tsp. turmeric powder

1 pinch asafoetida (hing) – optional

Handful of fresh cilantro leaves – optional

Cup assorted vegetables

 

PREPARATION

Soak the mung beans overnight.

Rinse the rice and mung beans separately in at least 2 changes of water.

To a saucepan add the ghee and spices and allow to saute on low heat.

Then add 6 cups of water, rice, mung dal, veggies and organic stock powder and cook covered on low heat (preferably without lid) until it becomes soft.

If need be, add a little salt and pepper to taste.

 

 

Ayurvedic Lifestyle advice for this client:

–              Regular and consistent daily routines are essential – and stick to them.

–              Daily exercise is important (yoga, swimming, walking, tai chi etc.).

–              Start going to the gym would be helpful, and use (light) weights.

–              Add in sun salutations to your daily routine. Start on 24 and can increase slowly to 48.

–              Do not increase amount of exercise to the wrists or hands.

–              Keep hands as much as possible in neutral position.

–              Use whole hand/arm to lift and hold things.

–              Adjust movements and avoid repetitive stress. Make work modifications as much as possible to avoid any further development of the condition.

 

REVIEW: 4 weeks

 

Note: It is always advised to continue any and all prescribed conventional medicine as advised by one’s healthcare practitioner. Should one use Ayurvedic herbs alongside conventional medicines, be sure to consult with your GP and/or medical specialist and your qualified Ayurvedic practitioner about any possible drug interactions and potential side effects.

 

Case seen by : Dr kumar – Ayurvedic Practitioner Jeeva Health  : Case presented by : Fire Sanders – Ayurvedic Student