Panchkarma in peripheral neuropathy

1. PANCHAKARMA IN PERIPHERAL
NEUROPATHY
Vd. RAJASHREE SUKHDEV SURYAVANSHI
PG Scholar

2. ANATOMY=

4. POINTS CNS PNS
1. Grey matter Nuclei Ganglion
2. White matter Tract Nerve
Grey matter= collection
of cell body of neurons
White matter=collection
of axon of neurons

6. Spinal nerve= originate from anterior horn to receptors or
neuromuscular junction.

7. There are 31 pairs of spinal
nerves.

9. HEALTHY NERVE & ITS FUNCTION

12. CAUSES OF NERVE DAMAGE=
1.DM
2.Vitamin deficiency
3.Alcohol
4.Toxic drugs i.e lead, arsenic
5.Infections
6.Stretching or traction
7.Lacerations
8.Compressions

16. NERVE RECOVERY AND REGENERATION=
After nerve injury, the nerve will try to repair itself by sprouting regenerating nerve units
These regenerating units will then try to grow down the nerve to reinnervate (restore nervous
function to)muscle or skin.
If they make correct connection- motor nerve to muscle or sensory nerve to skin- then recovery
of muscle function and skin sensation will occur.
If the regenerating nerve fibers do not make a correct connection, then no recovery will occure

17. WHAT IS PERIPHERAL
NEUROPATHY?????

18. • Definition :
Peripheral neuropathy is a disease due to lesion of the peripheral
nerve.

19. • CAUSES:
1.Metabolic DM, Porphyria( a rare hereditary disease
in which there is abnormal metabolism
of haemoglobin)
2.Toxic Alcohol, Arsenic , Lead
3.Infections HIV , Leprosy
4.Collagen disorders SLE, Polyarteritis nodosa, RA
5.Vitamin deficiency B2, B6, B12, A, E
6.Genetic -
7.Idiopathic -

20. • CLASSIFICATION:
A) Axonal degeneration & Segmental Demyelination,
B) Motor , Sensory & Autonomic ,
C) Mononeuropathy ,Mononeuritis Multiplex, Polyneuropathy etc ,
D) Acute , Subacute & Chronic .

21. A) AXONAL DEGENERATION & SEGMENTAL DEMYELINATION =
POINTS AXONAL DEGENERATION SEGMENTAL
DEMYELINATION
1.Aetiology Toxic Usually Metabolic
2.Wasting ++ Nil
3.Fibrillation ++ Nil
4.Distribution Distal Proximal & Distal
5.Reflexes May be present in milder
cases
Absent even if power is
fair
6.Recovery Slow More Rapid

22. B) MOTOR , SENSORY & AUTONOMIC =
MOTOR SENSORY AUTONOMIC
Muscle wasting, muscle
weakness, muscle cramps,
tremors , distal muscles
and extensors are more
affected.
Pain, Burning ,
Dysaesthesia,
Paraesthesia.
Fainting, Anorexia,
Nausea, Gastroparesis,
Reduced or excess
sweating.

23. c)MONONEUROPATHY, MONONEURITIS MULTIPLEX & POLYNEUROPATHY =
1. Mononeuropathy- (involvement of single nerve) trauma, neoplastic infiltration.
2. Multiple mononeuropathy or mononeuritis multiplex – (damage to multiple
nerves) ischaemia, DM.
3. Polyneuropathy- (symmetrical distal and sensory deficits)

24. • Pathophysiology = 1. Axonal degeneration
Axonal degeneration originate at the most distal extent of the axon.
Axonal degenerative polyneuropathies are usually symmetrical
distal-to-proximal
Axonal degeneration is the most common type of pathologic reaction in generalized
polyneuropathies, and it is often attributed to a metabolic cause.
disorder progresses

25. 2. Segmental demyelination
Segmental demyelination refers to focal degeneration of the myelin sheath with
sparing of the axon
seen in focal mononeuropathies and in generalized sensorimotor or predominantly
motor neuropathies
Acquired segmental demyelinating polyneuropathies are immune-mediated or
inflammatory in origin also occur in some hereditary polyneuropathies.

26. • In peripheral nerve disorders that are characterized by axonal
degeneration, prognosis is less favorable because the axon must
regenerate and reinnervate muscle, the sensory organ, blood vessels, and
other structures before clinical recovery is noted.
• Recovery may be more rapid with segmental demyelination because
remyelination is accomplished more quickly, thereby re-establishing
normal conductivity of the axon and return of function.

27. • INVESTIGATIONS :
1. Nerve conduction study
2. Nerve biopsy
3. CBC with ESR
4. Thyroid function test
5. Blood sugar
6. Vitamin B12

28. • TREATMENT :
1. Analgesics - Aspirin, NSAID
2. Antidepressant – Amitriptyline, Nortriptyline
3. Anticonvulsants – Carbamazepine, gabapentin
4. Sodium channel blocker – Mexiletine is effective in painful diabetic neuropathy
5. Acupuncture, Meditation, Transcutaneous electrical nerve stimulation

29. AYURVED POINT OFVIEW
OF PERIPHERAL
NEUROPATHY

30. In Ayurveda peripheral neuropathy can be correlated with VATAVYADHI.
COMMON SYMPTOMS IN PERIPHERAL NEUROPATHY
1. Daha ( burning sensation)
2. Kampa ( tremors )
3. Shool ( pain )
4. Mamsa shosha ( muscle wasting )
5. Angamarda ( malaise )
6. Stambha ( stiffness )
7. Suptata ( numbness )
8. Chimchimayan ( tingling numbness )

31. • NIDANPANCHAK=
HETU PURVAROOPA
ROOPA
UPASHAY-
ANUPASHAY
SAMPRAPTI

32. NIDAN PANCHAK:
• HETU:VATAVYADHI HETU (Ch. Chi 28/15-19)

33. • PURVAROOPA: Ch. Chi. 28/19
अव्यक्त लक्षणं तेष ं पूर्वरूपमितत स्िृति ्।
• ROOPA: Ch. Chi 28/20-23
Sankocha, stambha , khanja, pangu , shosha ,suptata, ojanasha, toda , bheda..
• Twakagata vata – rukshata, suptata, krusha, tanyata, parvaruka
• Raktagata vata – ruja, krushata , aruchi
• Mamsagata medogat vata- ruka, angamarda, gaurava
• Majjagata Asthigata vata – bheda, mamsabala kshaya, parva sandhi shoola, ruja
• Snayugata vata – khalli, sarvang vata, ekanga vata
• Siragata vata – ruka, shosha, kampa, suptata

34. • Avaruta vata lakshan=
• Pitta avruta vata- Daha, shoola , trusha
• Rakta avruta vata- Twak-mamsa daha, vedana
• Mamsa avruta vata- Pipalika sancharvat vedana, shotha
• Asthi avruta vata- Suchibhiriv vedana
• Majja avruta vata- Vedana, pariveshtan , jrumbha

35. VYADHI LAKSHAN
1.VATA RAKTA
2.PADAHARSHA
3.PADADAHA
4.GRUDHRASI
5.VISHWACHI
6.KHANJ
7.PANGU
8.AWABAHUK
9.PRAMEH
10.KUSHTHA
11.AMAVATA
Toda, bheda, shosha, swapa, daha
Hrushyata( tingling), suptata
Daha
Vedana, stambha, ruka , toda
spandan
Bahu karma kshaya
Kandara akshep in one lower limb
And akshep in both lower limb
Bahu Sira akunchan, shosha
Karapaad daha
Daha, suptata, asweda or
atisweda, toda, shoola
Angamarda, shoola, ruja, daha,
aruchi, sandhisankoch.
ROOPA=

36. • UPASHAY-ANUPASHYA=
UPASHYA- Abhyang , swedan, pidan paschat upashay
ANUPASHAY- Vata vrudhikar ahar vihar
• SAMPRAPTI GHATAK=
Dosha=Vata Pradhan tridosha
Dushya=Rasa, rakta ,mamsa, meda, asthi, majja, sira, snayu, oja
Strotas=Rasa, rakta, mamsa, majja, asthi
Adhishthan=Majjavaha strotas
Rogamarga=Madhyam

37. • Samparapti :
Hetu sevan ( vata vrudhikar ahar-vihar, dhatukshay, vyadhi janit karshya, aghata )
Dosha prakopa (mainly vata)
Sthansamshraya
Asthi parva sthani pida , suptata , mamsashosha , chimachimayan , kampa , daha ,
amgamarda , stambha
Peripheral neuropathy

38. VATA DOSHA PRAKOP KARMA (A.H.Su. 12/49-51)
PITTA DOSHA PRAKOP KARMA (A.H.Su. 12/51-52)

39. KAPHA DOSHA PRAKOP KARMA (A.H.Su 12/ 53-54 )

40. VATA GUNA (A.H.Su 1/11)
9
PITTA GUNA (A.H.Su 1/11)
KAPHA GUNA (A.H.Su 1/12)

41. VATA DOSHA SAMANYA CHIKITSA (A.H.Su 12/1-3)
SNEHAN, SWEDAN, MRIDU SAMSHODHAN, ABHYANG, MARDAN,
BASTI

42. PITTA DOSHA SAMANYA CHIKITSA(A.H.Su 12/4-9)
VIRECHAN, GHRITAPAN

43. KAPHA DOSHA SAMANYA CHIKITSA(A.H.Su 12/10-12)
MARDAN,VYAYAM, UPAVAS, GANDUSH,TIKSHNAVAMAN-VIRECHAN

44. VATAVYADHI CHIKITSA=
Snehan , Swedan , Samshodhan , Basti , Anuloman , Nasya & Dhomapan.
VATA DOSHA-DHATUGATA CHIKITSA=
Twakgata vata – Swedan , Abhyang , Avagaha
Raktagata vata –Virechan , Raktamokshan
Mamsa-Medogata vata –Virechan , Niruha , Shaman
Majja-Asthigata vata – Abhyang , Ghritapan , Shaman
Anga sankocha- Abhyang, Swedan, Upanaha
Bahu-Shirsha gata vata- Nasya, Ghritapana
Udveshtan karak vata- Upanaha
Siragata vata- Sneha, Abhyang, Upanah, Mardan, Raktamokshan, Lepa

45. AVRUTAVATA CHIKITSA=
Pitta avruta vata- Yapan basti, virechan, ksheer basti, parisechan
Rakta avruta vata- Vatarakta chikitsa
Mamsa avruta vata- Abhyang, swedan
Asthi-majja avrut vata- Chatur Sneha prayoga
VYADHI ANUSAR CHIKITSA=
1.Vata rakta- Upanaha, Prisheka, Pradeha, Mrudu Savahan
2.Padaharsha- Pada abhyanga, Siravedhan
3.Pada daha- Siravedhan, Pada abhyang
4.Ghrudhrasi- Snehan, Swedan , Basti, Aganikarma, Siravedhan

46. 5.Vishwachi-Snehan, Dahan, Swedan, Basti, Siravedhan
6.Khanj- Siravedhan , Snehan, Swedan , Basti , Shaman
7.Pangu- Siravedhan , Swedan, Snehan , Basti , Shaman
8.Awabahuk- Snehan, Dahan ,Swedan, Basti, Siravedhan
9.Kushta- Samshodhan, Raktamokshan, Shaman
10.Prameha- Santarpan, Sanshaman,Apatarpan
11.Amavata- Langhan , Swedan, Dipan,Virechan ,Snehapan, Basti, Upanaha

47. • CHIKITSA :
1. Pada abhyanga , Abhyanga , Savahan
2. Swedan- Patra pottali sweda, Shashti shali pinda sweda , Jambir pinda sweda ,
Churna pinda sweda , Bashpa sweda , salvan upanaha
3. Udvartan- Udgharshan
4. Basti
5. Nasya
6. Murdha taila
7. Parishek
8. Raktamokshan , Siravedha
9. Samshodhan- Mridu virechan, vaman.

48. • MODE OF ACTION of Pada abhyanga, Abhyanga, Savahan =
Lack of blood circulation is one of the reason for impaired sensations and the altered
blood flow causes improper oxygen and nutrient supply to the nerves. Abhyanga by its
mechanical maneuver produces heat and causes vasodilation which improves circulation
there by gives symptomatic relief.
Dravya=Tila taila, Narayan taila, Mahanarayan taila, Maha vishagarbha taila, Dhanvantar
taila, Bala taila, Nirgundi taila etc
Chimchimayan – ksheerabala taila and pinda taila can be used – vata pitta shamak
Suptata- sahacharadi taila , maha vishagarbha taila –vata kapha shamak can be used.

49. MODE OF ACTION OF SWEDAN=

51. 1.Jambir pinda sweda- muscular cramps, stiffness.(nimbuk, methika, shatavha, haridra, rason,
saindhav, eranda taila)
2.Shashti shali pinda sweda- mostly indicated in disorders of nervous system.
3.Churna pinda sweda- Neurological disorders, muscle stiffness.(kullatha, tila, shatavha, devdaru,
rasna, methika, haridra etc.)
4.Mamsa kizhi- Muscle wasting, weakness of muscle.( balamoola kwath, godugdha, Navara,
vatanashak taila)
5.Salvan upanah- kakolyadi gana dravya, amla and vatahara dravya, anup mamsa, Sneha, lavan in
excess quantity.
6.Dhanya pottali sweda- involuntary painful contraction of muscle.(vatanashak drvaya like
methika, kulatha, rasna ,shatavha, saindhav)
7.Patra potali sweda- patra & taila of vata nashak dravya , nimbuk, narikel, haridra.

52. MODE OF ACTION OF UDVARTAN =
• Udvartan therapy is the transmission of energy in the form of motion with pressure.
Deep pressure massage helps the interchange of tissue fluids by increasing the circulation in the
superficial vein and lymphatic’s and helps in mechanical stimulation causing muscles to contract
It increases circulation mainly in the veins, the alternate pressure and relaxation brings fresh blood
to the part and improves the nutrition of the particular area
Increased blood supply because of the vasodilatation stimulates both motor and sensory nerve
endings to various parts of the body and increase metabolism by which the toxins and free radicals
which are responsible for the formation of the disease are excreted out of the body.

53. Types of udvartan=
1.Udgharshan( churna with out Sneha ) sira mukha visaran , twakasta agni vardhan
2.Utsadan(churna + Sneha )
Dravya= Kolkulathadi churna, Musta churna, triphala churna, rasna churna.

54. MODE OF ACTION OF BASTI=
Basti is called as ardha chikitsa( Ch. Si 1/ 38-39)

57. Anuvasan-Tila taila, bala taila, masha taila, sahachar taila, dashamooladi ghrita, tikta ghrita,
mahatikta ghrita, nirgundi taila, saindhav ghrita, shatavhadi ghrita…
Niruha- Dashamooladi niruha, erandamooladi niruha, baladi yapan basti, sahacharadi yapan
basti, guduchyadi niruha, rasanadi niruha, mamsarasa basti, navprastrutik basti, tikta basti,
panchtikta ksheer basti, majja basti…

58. MODE OF ACTION OF NASYA=
Dravya=
1.Anu taila
2.Goghrita
3.Yashtimadhu
ghrita
4.Amrutadi taila
5.Ashwagandha
taila
6.Vacha churna
etc

59. MODE OF ACTION OF PARISHEK=
Its dual action of Snehan-Swedan assists in alleviatingVata effectively.
TheVata Dosha is responsible for many type of Shool (Pain) has almost opposite qualities to Sneha.
Thus Parishek Sweda normalizes the vitiatedVata Dosha and helps in SampraptiVighatana of Shoola
As Parisheka avails the effect of both Snehan and Swedan, Snehan corrects the Shushkata of the Dhatu
(which is the root cause forVata vitiation), imparts strength and provides platform for performing Swedan
Swedan relieves Ruka ( symptoms ofVata ) and soften the body parts
Repeated uses of Parishek Swedan are essential for controlling theVata and to restore in its normal
functions.

60. Useful in neurological symptoms, vataharan & dhatuposhan.
Dravya =
Dashamoola siddha jala ,Tila taila, Nirgundi taila , Dashamoola siddha ksheer, sahachar taila,
dashamoola taila, Narayan taila, mahanarayan taila, dhanvantar taila etc

61. MODE OF ACTION OF SHIRODHARA=

62. Dravya=
Tila taila,Takra , Vatahar Kwatha

63. RAKTAMOKSHAN & SIRAVEDHAN=
Raktamokshan=
SIRAVEDHAN=
1.Padaharsha, Pada daha,Vata rakta- 2 angula above the shipra marma
2.Khanj-Pangu, Vata vedana- 4 angula above the gulpha
3.Ghrudhrasi- 4 angula above or below the janu sandhi
4.Vishwachi- 4 angula above or below the kurpar sandhi
5.Awabahuk- Skandha Madhya sira vedhan.
DOSHA RAKTAMOKSHAN
VATA SHRUNG
PITTA JALAUKA
KAPHA ALABU

64. THANKYOU