PAIN MANAGEMENT OF MAMSAVRUTA VATA – MERALGIA PARASTHETICA:
Short Case History:
A middle-aged gentleman, whose occupation is related to I.T field (sedentary lifestyle) presented with the following complaints.
Chief Complaint: Onset of Pain in the region of dakṣiṇa vaṃkṣaṇa & nitamba – 8 months.
Radiation of intolerable parasthetic – ciṃcimā type of pain alternating with numbness, intermittent in nature, from groin to the middle of thigh- 7 months.
Co Morbidities:
None. Adiabetic, non-hypertensive
Nidana Found:
Sedentary lifestyle, wearing a tighter jean trouser almost 18 hours a day, with wallet kept in his right pocket even while sitting in a chair. Aggravates when standing and feels relief when sitting.
On Examination:
Spinal & Sacro iliac tenderness – negative.
2+ tenderness in Viṭapa & in antero-superior iliac spine;
4+ tenderness in lohitākṣa;
2+ in antero-lateral part of the thigh;
SLR- B/L – 70◦
Tinel’s sign (when lightly tapped over pinched nerves) was positive with patient experiencing tingling sensation over the region of distribution of lateral femoral cutaneous nerve, when it was tapped over the nitamba & lohitākṣa.
SamprApti:
Māṃsāvṝta vāta caused by the compression of lohitākṣa sirā marma by the inguinal ligament attached in approximation to the areas of the viṭapa snāyu marma & nitamba marma presenting the clinical features of a sports injury known as Meralgia hyperasthetica.
Provisional Diagnosis:
Māṃsāvṛta vāta
or
meralgia parasthetica.
Management:
A self-adhesive vastra paṭṭikā was applied covering the viṭapa & nitamba, bypassing the course if inguinal ligament.
A second vastra paṭṭikā was applied from the lower udara, traversing the lohitākṣa moving downward to reach the mid of the anterior thigh.
The vastra paṭṭikā was changed on alternative days. Four such sittings was done in the above case.
Follow Up:
post 1st session patient felt relief over the regions of nitamba & viṭapa by 80% and over anterior thighs by 40%. Tinel’s sign was still positive.
After 2nd session nitamba and viṭapa pain – not felt completely. Anterior thigh pain reduced by 80%.
Post 3rd sitting, anterior thigh pain reduced by 90%.
On 4th sitting, while removing the vastra paṭṭikā applied on previous day, the pt was totally feeling better with cent % relief from pain. Tinel’s sign was -ve. Still, for prophylactic purpose, vastra paṭṭikā was re applied and was asked to be removed after 3 days by himself and report after removing the vastra paṭṭikā.
Three days later the patient rang up and confirmed with a sigh a relief, that there was no relapse of the pain and he was feeling energetic and enthusiastic.
He was prescribed appropriate medications addressing the āvṛtavāta for a course of one month to maintain the doṣa & dhātu sāmyatā.
Applied Principle of Management:
The pain caused by any pinching of nerves, requires addressing the compensated avakāśa (anatomical space) due to the compressing anatomical structure causing āvaraṇa.
To oversee the congestion of the mahāprāṇa (Pranic energy / bio- energy governing the normal physiological functioning of the marma which are micro-chakras of the human śarīra), through the stretch receptors present in the proprioceptor organ, the required amount of avakāśa (anatomical space) is to be enhanced. There by, self-healing of the indirect injury / insult / āghāta is augmented, where in the stagnated mahāprāṇa kick off to circulate through its normal course, passing through the minor cakrās (Marmās) & major cakrās (ṣaḍ cakrās), from the place of decongestion caused by the āvaraṇa. Consequently, the doṣa & dhātu sāmyatā is achieved and health restored.
– Vd. A. Rangaprasad Bhat