© 2022 JETIR June 2022, Volume 9, Issue 6 www.jetir.
org (ISSN-2349-5162)
CARPAL TUNNEL SYNDROME-AN
AYURVEDIC VIEW
1Khushbu R. Prajapati, 2Ram B. Shukla
¹PG Scholar, Department of Panchakarma, Government Akhandanand Ayurveda College, Ahmedabad,Gujarat, India.
²Associate Professor, Department of Panchakarma, Government Akhandanand Ayurveda College, Ahmedabad,Gujarat, India.
Abstract:
Carpal tunnel syndrome (CTS) is one of the most common compressive, canalicular neuropathies of the upper extremities,
causing hand pain and impaired function. CTS results from compression or injury of the median nerve at the wrist within
the confines of the carpal tunnel. In some case cause remain unknown. The syndrome is however common in
hypothyroidism, DM, RA, in pregnancy. This condition may occur occasionally in myxedema, osteoarthritis,
malunited colles’ fracture. It is more common in middle aged women at the menopause. It is about 8 times more
common in women.1
Pain and needles in the fingers particularly in index and middle finger, sometimes in thumb, is the common
presenting symptoms. Such pain is usually worse at the night and wakens up the patient with the burning pain,
tingling sensation and numbness. In Ayurveda CTS can be compared with Vishwachi. Conventional medical
system using broad spectrum pain-killers, analgesics ointment, NSAIDS, Surgery. Despite of advancements in
the medical field, there are no satisfactory treatment strategies that can manage the condition completely.
Treatment approaches emphasized in Ayurveda are useful in such conditions. In Ayurveda Vatahara, Snighdha,
Balya, Rasayana Treatment is mentioned.
Key words: carpal tunnel syndrome, Viswachi, Patra Pinda Sweda
Introduction:
This is a condition in which the median nerve is compressed at the wrist as it passes through the carpal
tunnel– the space between the carpal bones posteriorly and the flexor retinaculum anteriorly. In the normal
tunnel there is exactly room for the flexor tendons and the median nerve, so any swelling here is likely to
results in compression of the nerve causes the compression can be caused by skeletal abnormalities, swelling
of other tissues within the tunnel or thickness of the retinaculum. The syndrome is however common in
hypothyroidism, DM, RA, in pregnancy. This condition may occur occasionally in myxedema, osteoarthritis,
malunited colles’ fracture. In some case cause remain unknown. This syndrome is more common in middle
aged women at the menopause. It is about 8 times more common in women.2 Conventional medical system
using broad spectrum pain-killers, analgesics ointment, NSAIDS, Surgery. Despite of advancements in the
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© 2022 JETIR June 2022, Volume 9, Issue 6 www.jetir.org (ISSN-2349-5162)
medical field, there are no satisfactory treatment strategies that can manage the condition completely
.Treatment approaches emphasized in Ayurveda are useful in such conditions.
SYMPTOMS:
Pain and needles in the fingers particularly in index and middle finger, sometimes in thumb, is the common
presenting symptoms. Such pain is usually worse at the night and wake up the Patient with the burning
pain, tingling sensation and numbness. Pain and par aesthesia occurs in the distribution of medial nerve, the
fingers may swell. Handing the arm over the side of bed or getting up or waking up about may relieve pain.
The pain may radiate from forearm to arm. The fingers may feel stiff particularly at morning. As compression
increase, the neurological symptoms appear more frequently. Patient notices that she cannot do delicate
movement and often drops small articles. There is actually no power loss of any muscles but there is loss of
fine discriminatory sensation.3
According to ayurveda, carpal tunnel syndrome can be correlates under Avabahuka, viswachi.
Abhighata, Ati Chinta, Ratrijagarana, Vishamasana, Divaswapna, Vegodharana, Ruksha, Sita Ahara, Ati-
Langhana, Ati-Chestha, Krodha, Shoka, are the etiological factors4 in manifestation of Avabahuka, viswachi.
Symptoms are more similar to the viswachi than avabahuka.
“talapratyangulinatukandarabahuprushthatah. Bahyokarmakshayakariviswachitii hi smrutah .”5
Thus, the choice of treatments is Vata Shamaka. Nirgundi Patra Pinda Sweda( Karma) and oral medicines
which are Vata Shamaka, Rasayana, as well as Balya Properties are prescribe.
Modern medical science using broad spectrum pain-killers, analgesics ointment, NSAIDS, Surgery. Despite of
advancements in the medical field, there are no satisfactory treatment strategies that can manage the condition
completely .Treatment approaches emphasized in Ayurveda are useful in such conditions. In this Current
study, Nirgundi Patra Pinda Sweada is used to manage the carpal tunnel syndrome.
CASE REPORT :
A 42 years old female visited OPD with the chief complaints of pain(~todavat-vedana) which radiating from
both shoulder to distal phalanges of both upper limbs with tingling sensation(~chimachimayan) by which
patient wake up at night 8-10 times at night . Numbness (~suptata) feels from shoulder to distal phalanges of
both upper limbs at whole day (24 hrs). Patient is not able to extend her both upper limbs in upward direction
(~akunchane- prasaranekasthata) & was not able to perform her routine activities last 6 months.
HISTORY PRESENT ILLNESS:
Patient had fallen down from the table over the ground (1 year back) and was injured at both forearm with
swelling and pain. Patient consulted orthopedic doctor. Forearms’ swelling disappeared after allopathic
medicine. All complains were disappeared after treatment. But last 6 month, she suffered for same. So she
re-consulted orthopedic doctor. He advised conservatives
treatment viz- pain- killer (Diclophenac sodium). tab BD, rest and surgery –SOS with CBC, NCS reports.
Patient dint get relief, after Allopathic treatment. So she approached to the OPD of PANCHAKARMA,
AKHANDANAND AYURVEDIC HOPITAL, BHADRA .
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Sharirika Prakriti of this patient is Vata, Pitta. Bala –Madhyama, Kostha – Madhyama with Satva-Madhyama
Satva.
No past history of tuberculosis, diabetes mellitus, hypertension, hypothyroidism. No other family history or
major chronic illness. Treatment prescribed to her by panchakarma OPD were belows:
Treatment: (1) Aushadha (orally) (2) Karma (Patra Pinda Sweda)
(1) Navajivana Ras 2……0 ...... 2 tab (after meal)
(2) Laghu Yogaraja Guggulu 2……2……2 tab
(3) Ajamodadi Churna 3 gm / 2 times (before meal)
Karma: Pinda Sweda (once a day) with locally Abhayanga (twice a day) followed by orally medicines for
90 days.
Abhayanga: firstly Abhyanga is applied over back, B/H neck, both upper limbs with the Lukewarm
Mahanarayana tail for 5-10mins. Then Nirgundipatra Pinda Sweda is applied.
Patra Pinda Sweda:
The leaves used –Viz Nirgundi (Vitex nirgundo) 500gm, Arka Patra(500gm), Dhatura Patra(500gm) chopped
in small pieces. other ingredients like-pieces of lemon(4pieces), Coconut grating(20gm), Methika(10gm),
Ajamoda(10gm), Madhuyasti Churna(5gm), Guduchi Churna(5gm), Ashwagandha Churna(5gm), Saindhav
lavana(10gm), Mahanarayana tail (as per required), clothes for placing rosted medicines, threads to tie the
clothes into bolus, heating appreatus, spoon, pan, spatula, etc. are taken for preparation of Patra Pinda Sweda.
Mahanarayana tail ( 50ml) is taken in pan. Slices of lemon are added into it. When the slices lemons becomes
slightly fried the powder of Methika(10gm), Ajamoda(10gm) scraped coconut(20gm) saindhava(20gm) are
added, when mixture was turned into brownish & stirred well Guduchi Churna, Madhuyasti churna,
Ashwagandha Churna are added. Then leaves added one by one. When leaves are fried then mixture are taken
out and tied into cloth and form potali by tied it by strong thread so as form a bolus of Patra Pinda. Four
boluses are prepared for properconduction of the procedure in undisrupted manner. The potalis are dipped in
oil which is kept on heating apparatus at a constant temperature in pan. The potali is gently rubbed over back,
behind the neck, both upper limbs for 5-10mins in each position. After procedure, patient is advised to take
rest for 1 hour and take bath after 1hour with lukewarm water.
Pathya – Apathyahara & vihara: patient was advised to avoid direct contact of wind, Divaswapna, Chinta,
Vegodharana, Ratrijagarana, Ati-vyayama. Spicy diet, cold drink was avoided.
Results:
A patient started responding to the interventions and at the end of the treatment all symptoms reduced
significantly. Satisfied observations noticed. Tingling sensations, Numbness, awaken at night due to pain was
gradually reduced. Patient was able to do her Routine activities without any problems.
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Discussion:
Selection of procedure:
Carpal tunnel syndrome is correlated with Visvachi which is Vata Pradhana Vyadhi according to Ayurvedic
texts.among Vatasyopakrama Abhyanga, Swedana are the first line Chikitsa of vata dosha.6 So Patra Pinda
Sweda is selected.
Possible mode of action of Patra Pinda Sweda:
Patra Pinda Sweda: swedana procedure has Vatahara properties. It produces Mardavata, Laghuta, Agni
vruddhi, Shrotosuddhi, Ashu Gati of Sandhi and reduces Sandhi Sthambhata, Gauravata, Shula, Shuptata,
Shitata from the body.7
Abhyanga: Abhyanga also has Vatahara Gunas and promotes Ayu, Dardhyakruta in body8.It pacifies vitiated
Vata Dosha and normalized.
Samana Aushadha:
Navajivana Rasa9:
It has Vata-Kaphahara,Shulahara, Deepan-pachana, Vatanadi poshaka, Hridhya, Balya, Rasayana Gunas. It
works directly on Vatavaha nadis and reduces Gatibhransa , sthabdhata and heaviness in the body by clearing
the obstruction from the body (~shtrotosuddhi) .It showed improvement in peripheral nerve conduction and
blood supply through Raktaposhaka Guna.
Laghu Yogaraja Guggulu10:
It acts as Vedana sthapana, Nadi balya, Sothahara, Deepana-Pachana. So it works as Vata- Kaphahara,
normalized Vata-Kapha, reduce stiffness, pain, Heaviness, Tingling sensation.
Ajamodadi Churna11:
It is works on Ama by clearing the obstruction from the joints and muscles. So it reduces stiffness and
heaviness.
Conclusion:
Based upon the symptoms and signs Carpal tunnel syndrome can be Corelated with Visvachi which is Vata
Pradhana Vyadhi according to Ayurvedic texts. Patra Pinda Sweda followed by Abhyanga with Samana
Aushadhas significanty Reduce all symptoms of carpal tunnel syndrome. No adverse effect can be noticed
during and after treatment. Though this is a single case study; further well designed studies are needed to be
conducted to establish actual efficacy and safety ofthe procedure and formulations used here.
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Examination:
(before Treatment):
Right Hand Examination:
NO. TEST TIME DURATION RESULTS
1 Tinel’s sign 30 second +ve
2 Phalen’s sign 15 second +ve
3 Durken test 20 second +ve
Left Hand Examination:
NO. TEST TIME DURATION RESULTS
1 Tinel’s sign 40 second +ve
2 Phalen’s sign 25 second +ve
3 Durken test 30 second +ve
Examination:
(after Treatment):
Right Hand Examination:
NO. TEST TIME DURATION RESULTS
1 Tinel’s sign - -ve
2 Phalen’s sign - -ve
3 Durken test 30 mins +ve
Left Hand Examination: (after Treatment)
NO. TEST TIME DURATION RESULTS
1 Tinel’s sign - -ve
2 Phalen’s sign - -ve
3 Durken test - -ve
SYMPTOMS SEVERITY SCALES (CTS):
The following questions refers to your symptoms for a typical 24 hr, period during the last 2weeks:
12
Severity and functional scale:
GRADE-1: NO OR NEVERGRADE-2:
MILD
GRADE-3: MODERATE GRADE-4:
SEVERE GRADE-5: VERY SEVERE
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No. Questions BT DT AT
1. How severe is hand or wrist pain that you have at night? 4 3 2
( patient wake up at night more than 6times/night)
2. How often hand /wrist pain wake up during a typical 5 3 1
Night in past 2 weeks?
3. Do you have typically pain in your hand /wrist during 5 4 1
day time?
4. How long /average, dose of episodes of pain last 5 4 1
daytimes?
5. Do you have typically pain in hand /wrist at daytimes? 5 4 1
6. Do you have numbness in your hand? 5 4 1
7. Do you have weakness in your hand? 4 3 1
8. Do you have tingling sensation in your hand? 5 3 1
9. How severe is numbness or tingling sensation at night? 5 3 2
10. How often did Had Numbness or tingling sensation 5 3 1
wake up during a typical night in last 15days.
11. Do you have any difficulties with grasping and use of 4 3 1
small objects such as keys or pens?
Functional stutus scale:
1 Writing 5 2 2
2 Buttoning of cloths 1 1 1
3 Holding a books while reading 3 1 1
4 Gripping of a telephone handle 3 1 1
5 Opening jars 4 1 1
6 Household chores 3 1 1
7 Carrying grocery bags 4 Pt not 1
performed
8. Bathing and dressing 3 1 1
DASHDISABILITY / SYMPTOMS SCORE:13
GARDE-1: NO DIFFICULTY GARDE-2: MILD DIFFICULTY GARDE-3:
MODERATE DIFFICULTY GARDE-4: SEVERE DIFFICULTYGARDE-5:
UNABLE
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NO Questions BT DT AT
1 Opening of jars 4 3 1
2 Do you household chores( example-walls, floor) 5 4 2
3 Carry a shopping bag/briefcase 4 3 2
4 Wash your back 3 3 1
5 Use knife to cut food 5 4 1
6 Recreational activities in which you take force or 4 4 2
Impact through your arm, shoulders/hand(example-
golf, hammering, tennis)
7 What extent has your arm/shoulder/hand problems 5 4 1
interfered with your normal social activities with
family, friends, neighbor
8 How much your arm, shoulder/hand problems limited 5 3 2
your daily/regular activities
9 Arm / shoulders /hand pain 4 2 2
10 Tingling sensation (pins & needles) in 5 4 2
arms/shoulders/hand
11 How difficulty feel during sleeping because of pain 3 2 1
1
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Susruta Samhita edited with ‘Susrutavimarsini’ Hindi Commentary along with Special Deliberation etc .by Dr. Anant Ram
Sharma, Chaukhamba Surabharati Prakashan, Varanasi-221001,Susruta Chikitsa Sthana, 32/20,page- 420
.
8
Ashtanga Hridayam, edited with ‘Nirmala’ Hindi Commentry by Dr.Brahmanand Tripathi, published by Chaukhamba
Sanskrit Pratishthana,Delhi,110007, Sutra Sthana 2/8,page-29.
9
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page-289.
10
Bhaisajya ratnavali amavat Chikitsa 29/153
11
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Prakashan 2016, Madhyama Khanda 6/113-117.
12
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13
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