An Integrative Approach including Panchakarma and Marma Therapy, administered in a Spiritual Environment, for the Management of Symptoms Associated with Prolapsed Intervertebral Disc (PIVD) and Polyarthritis—A Case Study (Case Study 11)

1. Introduction

This case report is about a female patient (age 44 years) who had symptoms of Polyarthritis, and some other complaints including:

• Lower back ache (which radiates to left leg, with tingling sensation) (since more than 15 years)
• Pain in B/L calf muscles, with excessive stiffness, with swelling
• Pain aggravates after exertion/ long standing/ long walking
• Pain in left elbow joint, with stiffness
• Mode present at right neck region (pea size node)
• No menses (since about 20 years)
• Pain in B/L wrist joints
• Fingers get swollen and severe pain, during winter seasonal

The patient had past history of Typhoid – 1 year back

The patient had no past history of diabetes mellitus, hypertension, asthma, ischemic heart disease (IHD), hypothyroidism.

The patient had on and off constipation and gastric upset.

The patient had allergy of more sensitivity towards exposure to cold.

The patient had no acidity, no weakness; had normal appetite, and normal sleep.

Based on the above mentioned medical history, and further discussion with the doctor, the diagnosis for the patient was Prolapsed Intervertebral Disc (PIVD), with Polyarthritis, with Cold Allergy.

2. Methodology

Informed consent was obtained from the patient before the start of the therapy.

The prescribed therapeutic interventions were as follows:

2.1. Therapeutic Intervention

As mentioned above, the diagnosis of the patient was Prolapsed Intervertebral Disc (PIVD), with Polyarthritis, with Cold Allergy. Furthermore, the patient had come to the Out Patient section, and had limited time to take the therapy; hence, the therapeutic intervention was planned accordingly.

Based on Ayurvedic principles, the therapeutic intervention included Panchakarma and Marma Therapy, which was administered to the patient, in a Spiritual Environment, over a period of 11 days (wherein no therapy was administered on the 7^th day), as given in Table 1. Details about the method of administration of different therapeutic procedures, given in Table 1, can be found in these references [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25]. Botanical names of medicinal plants used in the present study can be found in these references [9,11,12,13,14,15,16,17,18,19].

Some other associated methodologies that were administered, and the advice that was rendered along with the above therapeutic procedure, are as follows.

Dietary restrictions were prescribed. Other behavioral regimen were also prescribed, such as, do not indulge in fear, anxiety, stress, anger, and any other negative thought; do not roam around too much; do not obstruct your natural urges like hunger, thirst, sleep, yawning, tears, etc. Try to keep your mind calm and happy, try to be silent, go early to bed and wake up early in the morning.

The doctor regularly talked to the patient about her condition, and provided both clinical and motivational guidance, i.e. did regular counseling with positive thoughts. Gayatri Mantra was chanted before the start of each therapeutic procedure, as well as played continuously during the therapy. The therapy was administered within the spiritual environment of Dev Sanskriti Vishwavidyalaya, Haridwar.

3. Results

In this case report, the outcomes were assessed in a qualitative (subjective) manner based on the doctor's pre and post examination, and patient's experiential feedback, as given in Table 2.

Overall, the patient was feeling light and relaxed after the completion of the therapy.

4. Discussion

The present study illustrates the potential of an integrative approach including Panchakarma and Marma Therapy, administered in a Spiritual Environment, for the management of symptoms associated with Prolapsed Intervertebral Disc (PIVD) and Polyarthritis, as well as some other ailments.

According to Ayurveda, a healthy human body is supposed to have a relatively stable equilibrium (congenial homeostasis) of Dosha (psycho-biological rhythm - Vata, Pitta, Kapha), Dhatu (body tissues and their nourishing elements) and Mala (excreta) [9,26]; Acharya Sushruta defines health as an equilibrium of Dosha (psycho-biological rhythm), Agni (digestion and metabolism), Dhatu (body tissues), Malakriya (excretory function), as well as the well-being of soul, senses and mind [9,26]. Imbalance in this equilibrium leads to disease, and the aim of the therapy is to restore this balance [9,10,11]. In view of these Ayurvedic principles, clinical diagnosis of the patient was made, and the integrative approach including Panchakarma and Marma Therapy, was administered to the patient, in a Spiritual Environment.

The results given in Table 2 indicate that the integrative approach including Panchakarma and Marma Therapy, administered in a Spiritual Environment, gives encouraging outcomes, even in short duration. These results may be attributed to the therapeutic action of various Ayurvedic procedures administered to the patient, as well as the effect of Spiritual practices and environment. The mode of action of the Ayurvedic therapeutic procedures have been described in detail in the following references [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,27,28,29,30].

Each therapy was started with the chanting of Gayatri Mantra, which causes beneficial effects with regards to various physical and mental conditions like attention, concentration, etc. [31,32,33,34,35,36]. The patient must also have benefited from the spiritually charged environment (which induces constructive inspirations and immense enthusiasm within an individual [37,38,39,40]) of Dev Sanskriti Vishwavidyalaya, Haridwar.

Almost daily the doctor talked to the patient about her condition, and provided both clinical and motivational guidance; the purpose was to instill confidence in the patient that her condition can be improved, and she has to herself take responsibility of bringing about this change by diligently following the prescribed treatment and guidelines.

During Panchakarma therapy, it is advised to avoid 'Ashta-Maha-Doshkar-Bhav' (eight types of behavioral and dietetic practices that cause obstructions in micro-channels, srotas, leading to aggravation of the diseases) so that better results can be observed. The following of these practices must also have contributed in providing the observed relief.

In place of using a single therapy, a combination of different therapeutic procedures, along with multiple herbs, were used, in order to achieve simultaneous management of the symptoms associated with multiple ailments. Based on Ayurvedic principles, the administered therapeutic procedures and medicinal herbs also had tissue nourishing (vrinhan), strengthening (balya), and rejuvenating (rasayan) effects [2,3,4,5,6,7,8,9,11,12,13,14,15], which must have caused the amount of relief experienced by the patient in such a short duration of therapy.

Although the results are qualitative in nature, yet the degree of benefit attained in addressing the chronic ailments is noteworthy, especially considering the fact that the patient was an Outdoor Patient, had genuine limitations in following the dietary restrictions, and the therapy was administered for quite short duration.

Further in-depth quantitative study would definitely be worthwhile to establish the mode of operation of the administered therapeutic procedure in the light of modern scientific understanding.

5. Conclusions

In the present study, an integrative approach including Panchakarma and Marma Therapy, was administered in a Spiritual Environment, for the management of symptoms associated with Prolapsed Intervertebral Disc (PIVD) and Polyarthritis, as well as some other ailments. A single case study involving female patient was presented. Various therapeutic procedures were administered to the Out Patient section patient over a period of 11 days (wherein no therapy was administered on the 7^th day). Qualitative analysis showed encouraging results, with the patient experiencing notable relief in various symptoms associated with chronic complaints, in a short duration of time.