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| CASE STUDY |
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| Year : 2012 | Volume
: 33
| Issue : 3 | Page : 402-405 |
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Importance of Rookshana Karma (dehydrating therapy) in the management of transverse myelitis
Nitin Jindal1, Manoj K Shamkuwar2, Sadhan Berry3
1 Lecturer, Department of Panchakarma, Ayurveda and Unani Tibbia College and Hospital, New Delhi, India
2 Associate Professor, Department of Panchakarma, Government Ayurveda College, Nagpur, Maharashtra, India
3 Assitant Professor, ISIC Institute of Rehabilitation Sciences, Vasant Kunj, New Delhi, India
| Date of Web Publication | 16-Mar-2013 |
Correspondence Address:
Nitin Jindal
Department of Panchakarma, Ayurveda and Unani, Tibbia College and Hospital, Karol Bagh, New Delhi - 110 005, Delhi
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0974-8520.108852
 Abstract | | |
In Charak Samhita, all the treatment modalities have been classified broadly into six types, i.e., Langhana (depleting therapy), Brimhana (nourishing therapy), Rookshana (dehydrating therapy), Snehana (oleation therapy), Swedana (sudation therapy) and Stambhana (astringent therapy). Out of these six types, Rookshana is of the same importance as others but is used less frequently as main line of treatment. Since decades, Ayurveda treatment is considered most promising treatment for neurological disorders. Most of the neurological disorders are generally considered to be Vata Vyadhis in which Snehana Karma is recommended. In case of neurological disorders if symptoms are suggestive of Kapha dominance, then Rookshana must be done initially. Transverse myelitis is a neurological disease, which has an autoimmune process involved in its pathology. It is an acute, subacute, generally monophasic inflammatory disease of the spinal cord. In the present case of transverse myelitis, the patient was found having Kapha dominant symptoms such as coldness of feet, loss of appetite etc., and so the patient was subjected to Rookshana Karma in various forms. Just after 15 days, all these symptoms were subsided and tremendous improvement was found thereafter. The paraplegic patient under study was able to walk independently in just two and half months of treatment. All other typical features related to the disease were also improved. This particular case has proved the importance of Rookshana therapy in neurological disorders. Keywords: Ayurveda, Rookshana Karma, transverse myelitis, Urustambha
How to cite this article:
Jindal N, Shamkuwar MK, Berry S. Importance of Rookshana Karma (dehydrating therapy) in the management of transverse myelitis
. AYU 2012;33:402-5 |
| Introduction | |  |
Transverse myelitis is a neurological disease, which has an autoimmune process involved in its pathology. [1] In autoimmune diseases, the immune system, which normally protects the body from foreign organisms, mistakenly attacks the body's own tissue, causing inflammation and, in some cases, damage to myelin within the spinal cord. It is a neurological disorder caused by inflammation across both sides of one level, or segment, of the spinal cord. The term myelitis refers to inflammation of the spinal cord; transverse simply describes the position of the inflammation, that is, across the width of the spinal cord. [2] Attacks of inflammation can damage or destroy myelin, the fatty insulating substance that covers nerve cell fibers. This damage causes nervous system scars that interrupt communications between the nerves in the spinal cord and the rest of the body. Recovery from transverse myelitis usually begins within 2-12 weeks of the onset of symptoms and may continue for up to 2 years. However, if there is no improvement within the first 3-6 months, significant recovery is unlikely. [2]
| Case Report | | |
An 18-year-old male patient having indwelling catheter in situ reported with the complaint of inability to move his legs and no sensation below his navel [Figure 1]. He also told that his legs seemed to be cold. He was having loss of appetite. He could not hold the urge of defecation.
On asking about the history of the same, he stated that he was alright till evening of 8 April 2010 and then he felt feverish and developed pain all over the body. He took some medicine for the same from his family doctor. He woke up late in the morning and was unable to stand up by himself. He stood with support and tried to walk. During the walk, he felt that his legs were not in his full control. He had not voided any urine since morning. In the evening, along with his relatives, he again consulted the other doctor who then referred him to higher center.
He got admitted to the hospital on the next day with the complaint of no sensation in lower half of the body as well as insensitivity to touch from lower part of neck to toe. He was also having the feeling of tightness around the abdomen.
Lumbar puncture was done on the same day, which showed increased polymorphs. On 15 April 2010, CT-head was done and it was normal. He also faced some respiratory problems and so was on intermittent oxygen inhalation therapy from 12 to 18 April 2010. On 17 April 2010, MRI cervico-dorsal spine with MRI brain was done, findings of which were as follows.
Long segment T2 hyper intensity of the cervicodorsal spinal cord from the C3 level onward. Suggestive of myelitis.
Therefore, the present case had been diagnosed as that of transverse myelitis and came to us after two months of acute attack. At that time, he was having total paraplegia, no sensation below umbilicus, and other typical features of transverse myelitis such as bladder-bowel dysfunction, feeling of tightness around abdomen, and a bed sore on the sacral region.
Some of the above-mentioned presentations of the patient resembled the sign and symptoms of a disease named as Urustambha (spasticity of thighs) in Ayurvedic classics. [3] On having a critical view, some of the features of transverse myelitis and Urustambha are found very close to each other and can be correlated [2],[4],[5],[6],[7],[8],[9],[10] [Table 1]. On the other hand, many other features of transverse myelitis and Urushtambha are also there that cannot be correlated [2],[4],[5],[8] [Table 2]. | Table 1: Comparable features of transverse myelitis and Urustambha (spasticity of thighs)
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 | Table 2: Non-comparable features of transverse myelitis and Urustambha (spasticity of thighs)
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| Treatment and Results | | |
This known case of transverse myelitis, when reported to us was having some signs and symptoms like that of Urustambha, as well as other due to dominance of Kapha. Therefore, as per Charaka Samhita, Rookshana Karma (dehydrating therapy) was selected as choice of treatment. [11] In accordance with the line of treatment of Urustambha, Kshapana and Shoshana (complete extraction and absorption of liquid fraction) were desired so the patient was treated as follows. [12]
The treatment was started with a special type of the fomentation procedure known as Baluka Sweda which is a Rooksha (dry) type of Swedana. It is used in the dominance of Kapha and Aama (undigested metabolites) in the body. In this type of fomentation, prior massage of oil was not done. This procedure includes the application of heated bolus (poultice) of sand on the body part where fomentation is required. This type of fomentation quickly reduces the Kapha and digests the Aama. After 3 days of this Baluka Swedana, the patient reported that he felt warmth in legs and he could sense the variation in the temperature of Swedana (fomentation) room and outside the room. This therapeutic test confirmed the Kapha dominance and guided us to treat the case in the same line. Therefore, in the next step Vachadi Yoga [consisting of equal amounts of self-prepared powders of Vacha (Acorus calamus), Devadaru (Cedrus deodara), Pippali (Piper longum), Gajapippali (Scindapsus officinalis), Haritaki (Terminalia chebula), and Katuki (Picrorhiza kurroa)] in a dose of 3 g twice a day along with honey was started. [13] Besides that, Kaishora[14] Guggulu in a dose of two tablets soaked in water and two tablets of Chandraprabha Vati[15] along with water were started twice a day as oral medicine. All the Kapha Vardhaka Aahara-Vihara were restricted and Yava (barley) along with Karvellaka (bitter gourd) was advised in diet. [16]
With above said treatment, the patient started responding well and within 10 days he was able to move all the fingers of the left foot. The treatment was continued as such and on 15 th day, the patient was able to dorsi-flex his left foot. On 18 th day, he started to flex his left knee. After 2-3 days, his right foot also started moving. On 34 th day from date of admission, the patient successfully raised his hip on his feet in lying position [Figure 2]. So, he was advised some exercises of knee and hip by the physiotherapist. In next 4-5 days, the patient was told to stand on his feet and clonus was observed in both legs. So, Abhyanga (massage) with Saindhavadya Taila and Nadi Swedana (fomentation with steam) were given [17] [Table 3]. This particular oil was prepared with a classical method for Taila Paka (processing of oil). [18] It was used for massage as its ingredients are mainly Ushna Veerya (hot in nature) that would have alleviated Vayu without increasing Kapha or Aama. Clonus was subsided and the patient was able to stand with support on 42 nd day [Figure 3]. Then, he was again referred to physiotherapist who started the gait training and the patient started walking with the help of stick just within 2 months of treatment. Initially, there was spasticity in his thighs which got reduced by physiotherapy and in next 15 days, the patient could walk almost normally [Figure 4].
A follow-up MRI was done which reported as follows.
- Visualized spinal cord is normal in caliber and signal intensity .
- 903; As compared to the previous study dated 17-4-2010, there is complete resolution of intramedullary T2/STIR hyper intensity of cervico-dorsal spinal cord.
| Conclusion | | |
On the basis of above study, it can be concluded that if the patient with transverse myelitis shows the sign and symptoms like that of Urustambha along with dominance of Kapha then the choice of treatment must be Rookshana Karma which must be followed till Kapha is decreased. After that, the treatment must be planned as per the situation arises. [19] By managing a single case, the authors cannot arrive to the conclusion that Rookhsana Karma (dehydrating therapy) is the ultimate treatment in transverse myelitis. The study should be carried out in several similar cases.
| References | | |
| 1. | Hauser SL. Diseases of the spinal cord. Ch. 373. In: Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, et al., editors. Harrison's Principles of Internal Medicine. 14 th ed. New York, NY: McGraw-Hill; 1998. p. 2386. 
[PUBMED] |
| 2. | National Institute of Neurological Disorders and Stroke (home page on Internet) Transeverse myelitis fact sheet, Uploaded on 6 th May 2010. Available from: http://www.ninds.nih.gov/. [Last cited on 2010 Nov 10].
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| 3. | Agnivesha, Charaka, Dridhabala, Charaka Samhita, Chikitsa Sthana, Urustambha Chikitsa, 27/7, translated by R.K. Sharma and Bhagwan Dash, 2 nd ed., vol. 5. Chaukhamaba Sanskrit Series Office, Varanasi; 2005, p. 2.
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| 4. | Ibidem. Charaka Samhita, Urustambha Chikitsa, 27/13; p. 4.
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| 5. | Ibidem. Charaka Samhita, Urustambha Chikitsa, 27/15; p. 5.
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| 6. | Ibidem. Charaka Samhita, Urustambha Chikitsa, 27/11; p. 3.
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| 7. | Ibidem. Charaka Samhita, Urustambha Chikitsa, 27/16; p. 5.
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| 8. | Srimad Vagbhatta, Astanga Hridayam with Nirmala hindi commentary, Nidana Sthana, Vatavyadhi Nidana Adhayaya, 15/50. In: Tripathi B, editor. Chaukhamba Sanskrit Pratisthan, Delhi; 2009, p. 543.
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| 9. | Agnivesha, Charaka, Dridhabala, Charaka Samhita, Chikitsa Sthana, Urustambha Chikitsa, 27/18, translated by R.K. Sharma and Bhagwan Dash, 2 nd ed., vol. 5. Chaukhamaba Sanskrit Series Office, Varanasi; 2005. p. 6.
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| 10. | Christopher and Dana Reeva Foundation (home page on Internet), Transeverse myelitis, Paralysis Resource Centre. Available from: http://www.christopherreev.org. [Last cited on 2010 Nov 10].
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| 11. | Agnivesha, Charaka, Dridhabala, Charaka samhita, Sutra Sthana, Langhana-Bruhaniya Adhyaya, 22/30. translated by Kushwaha HS. 1 st ed. Chaukhamaba Orientalia, Varanasi; 2005. p. 324.
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| 12. | Ibidem. Charaka Samhita, Urustambha Chikitsa, 27/25, p. 8.
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| 13. | Ibidem. Charaka Samhita, Urustambha Chikitsa, 27/30-32, p. 10.
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| 14. | Govind Das, Bhaishajyaratnawali, Vatraktaadhikar, 97/106, Lalchandraji Vaidya editor. 8 th ed. Motilal Banarsidas, New Delhi; 2007. p. 373.
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| 15. | Vd. Yadavji T Acharya, Siddha yoga Sangraha, Pramehaadhikar, 17. 13 th ed. Shri Vaidyanath Ayurveda Bhawan Limited, Naini, Allahabad; 2007. p. 93.
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| 16. | Agnivesha, Charaka, Dridhabala, Charaka Samhita, Chikitsa Sthana, Urustambha Chikitsa, 27/26-27, translated by R.K. Sharma and Bhagwan Dash, 2 nd ed., vol. 5. Chaukhamaba Sanskrit Series Office, Varanasi; 2005. p. 9.
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| 17. | Ibidem. Charaka Samhita, Urustambha Chikitsa, 27/45-46. p. 13.
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| 18. | Sarangdhara, Sarangdhara Samhita, Madhya Khanda, Sneha Kalpna Adyaya, 9. Translated by Brhmanand Tripathi. Chaukhamba Subharti Prakashan, Varanasi; 2008.
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| 19. | Srimad Vagbhatta, Astanga Hridayam with Nirmala hindi commentary, Chikitsa Sthana, Vatavyadhi Chikitsa Adhayaya, 21/55. In: Tripathi B, editor. Chaukhamba Sanskrit Pratisthan, Delhi; 2009. p. 811.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3]
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