Case 7: Carpal Tunnel Syndrome – Case Study – Ayurvedic Approach

• Prakruthi: VP
• Vikruthi: VK
• Agni: Normal (after detox)

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

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.

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.

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

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,

• 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).

• 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.

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

• 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.

• 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