‘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]

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