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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 9  |  Issue : 1  |  Page : 108-110

Clinical profile of a case of axonal sensory neuropathy: An Ayurvedic management


Department of Kayachikitsa, KLE University's Shri B M Kankanawadi Ayurveda Mahavidyalaya, Belgaum, Karnataka, India

Date of Web Publication8-Jun-2016

Correspondence Address:
Dr. Vittal G Huddar
Department of Kayachikitsa, KLE University's Shri B M Kankanawadi Ayurveda Mahavidyalaya, Shahapur, Belgaum, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2349-5006.183679

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  Abstract 

A 19-year-old female diagnosed as asymmetrical axonal sensory neuropathy by nerve conduction study, with the complaints of severe burning, sweating, and pricking type of pain in both the feet more in right foot, for 5 months attended the Kayachikitsa (General medicine) OPD. Based on clinical presentation, it was diagnosed as burning feet syndrome, a condition that causes severe burning and aching of the feet, hyperesthesia, and vasomotor changes of the feet that lead to excessive sweating. This condition occurs more frequently in women and usually manifests itself when a person is between 20 and 40-year-old. The pathophysiology of burning feet syndrome is not very clear and treatment varies depending on the etiology. According to Ayurveda, this condition is akin to padadaha. Padadaha is explained in vata vyadhi adhyaya (neurological diseases) where there is an association of pitta and Rakta. In the present paper, we are presenting a case successfully treated with two courses of mrudu virechana (purgation therapy) each of 9 days duration at the interval of 30 days. Then follow-up after 30 days. During follow-up, the patient was on oral medicine. Total duration of the treatment including follow-up was 90 days. After the treatment, the symptoms of burning and pricking pain were completely reduced.

Keywords: Asymmetrical axonal sensory neuropathy, burning feet syndrome, padadaha


How to cite this article:
Huddar VG, Sharma N, Lahoti R. Clinical profile of a case of axonal sensory neuropathy: An Ayurvedic management. Indian J Health Sci Biomed Res 2016;9:108-10

How to cite this URL:
Huddar VG, Sharma N, Lahoti R. Clinical profile of a case of axonal sensory neuropathy: An Ayurvedic management. Indian J Health Sci Biomed Res [serial online] 2016 [cited 2021 Nov 29];9:108-10. Available from: https://www.ijournalhs.org/text.asp?2016/9/1/108/183679


  Introduction Top


Axonal neuropathy is a condition in which the nerve cells begin to function abnormally because the axons are degenerating. The effects of the condition can be felt as tingling, burning, weakness, numbness, or as a loss of motor function.[1] However, based on clinical presentation it can also be diagnosed as burning feet syndrome. Burning feet syndrome, also known as  Grierson-Gopalan syndrome More Details, is a condition that causes severe burning and aching of the feet, hyperesthesia, and vasomotor changes of the feet that lead to excessive sweating. The condition occurs more frequently in women and usually manifests itself when a person is between 20 and 40 years old. The burning heat is usually limited to the soles of the feet, but may extend up to the ankles or lower legs of some patients. The burning can sometimes be accompanied by feelings of “pins and needles” or tingling in these regions. Night time is when almost all sufferers of this syndrome report the heat symptoms being the worst, with the condition getting better as morning comes. It can be inherited, or it can be caused by pressure being put on the nerves.[2] The pathophysiology of burning feet syndrome is not very clear, and treatment varies depending on the etiology.

According to Ayurveda, this condition is akin to padadaha (burning feet). Padadaha is explained in vata vyadhi adhyaya [3] where there is an association of pitta and Rakta. This condition is also categorized under the heading of Pittaja nanatmaja vyadhi [4] (ailments caused due to Pitta dosha). Here, presenting a case successfully treated with two courses of mrudu virechana (mild purgation) each of 9 days duration at the interval of 30 days. Then follow-up after 30 days. During follow-up, the patient was on oral medicine. Total duration of the treatment including follow-up was 90 days.


  Case Report Top


A 19-year-old female, moderately built student, presented with the complaints of severe burning and pricking sensation in both feet more in the right foot associated with mild sweating for 2 months. The symptoms used to get aggravated in the night time and comparatively less in the daytime. The patient used to cry whole night due to this and would feel a little relief after exposing to manual fanning from her mother. She was not in a position to keep the feet on the ground leading to difficulty in walking. She was intolerant for a touch of even a blanket. Because of this, she was an anxious and worried state at her marriage age. Two months prior, she was admitted under the care of a neurophysician and nerve conduction study revealed asymmetrical axonal sensory neuropathy and treated with standard of care for 2 months (details are not available). The patient did not notice any improvement and consulted for Ayurveda management in the above-said condition for further management. The patient was admitted for 20 days.

On examination

HMF: The patient is alert and tries to answer a question with anxiety and worry.

Motor system examination: Deep tendon reflexes [Table 1].
Table 1: Examination findings

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Strength was 5/5 in both upper and lower limbs, Babinski – negative, Bulk and tone – normal and difficulty in walking observed because of severe pain on touching the feet to the ground were observed.

Sensory system examination: Hyperesthesia on light touch – symmetrical. Local examination: No change in color and mild sweating was seen on both the foot. Peripheral pulse (popliteal, posterior tibial, and dorsalis) was normal in both limbs. Visual analog scale (VAS) for pricking type of pain was nine. Burning sensation was severe grade.

Investigations

Laboratory tests: Blood routine, blood glucose levels, and thyroid profile were within normal limits.

Nerve conduction study revealed asymmetrical axonal sensory neuropathy.

Treatment: Both bahirparimarjana (external treatment) and Antahparimarjana chikitsa (internal treatment) were administered as shown in [Table 2].
Table 2: Treatment details

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Advise on discharge for 30 days:

  • Tablet Brihat vata chintamani rasa 1 tid
  • Shatavari grita 3tsf BD
  • Application of Nagakeshara and Rakta chandana churna mixed in Navaneeta to both feet for 30 min.


The second course of treatment was similar to that the first course of virechana for 9 days. The medications during discharge were also same and were given for 1 month.


  Observation and Results Top


During discharge, the patient was slightly feeling better in pricking pain and mild reduction in burning sensation. She was kept on oral medicine for 30 days. After 1st follow-up of 30 days, there was a considerable reduction in pricking pain from 9 to 6 on VAS scale and burning sensation reduced from severe to mild. The patient was admitted for the second course of Virechana for 9 days. Then, the patient was done follow-up after 30 days. The pain completely reduced from 6 to 0 and occasional burning sensation was noticed by the patient. The total duration of the treatment was 90 days.


  Discussion Top


The symptoms seen are in favor of the diagnosis of burning feet syndrome with findings of Asymmetrical axonal sensory neuropathy. The condition is akin to Padadaha, whose treatment is explained in the context of Vatavyadhi by Chakradatta. This condition is one of the Pittaja Nanatmaja Vikaras. Hence, this is condition where Vata and Pitta plays a major role in the causation of the disease. The symptoms of severe hyperesthesia and superficial tenderness indicate the involvement of the Rakta in the Samprapti too. Hence, keeping this in mind Vata, Pittashamaka (alleviate pitta) abhyantara (internal), and bahirparimarjana chikitsa was adopted as explained above including Raktamokshana to combat the Raktadushti (vitiation of blood). It was observed in this patient that the too cold and too hot preparations used for bahir parimarjana chikitsa aggreviated the condition. The sukhoshna (warm deocoction) parisheka helped in relieving the symptoms. Ati sheeta (too cold) might have aggreviated the Vata and the ati ushna (too hot) might have increased pitta. Hence, the balanced treatment with ushana and sheeta i.e., sukhoshna helped in the treatment. The Virechana karma greatly helped in pittashodhana (eliminating pitta dosha from the body) and raktamokshana by taking care of raktadushti even though the sufficient quantity of bloodletting was not possible because of thin veins. The drugs used in the treatment, i.e., Brahat vata chintamani rasa,[5] Ksheerabala taila,[6] Nagakeshara,[7] Shatavari,[8] Dashamoola, Trivrit,[9] Rakta Chandana,[10] Navaneeta etc., are having Vata, Pitta, and Raktashamaka (alleviation of vitiation of blood) properties. Hence, the modalities executed successfully, in this case, can be used in similar cases of Padadaha. However, this is a single case study; further study can be extended to original research work on a significant number of patients to establish a definitive protocol for the management of Padadaha.

Acknowledgment

I express my deep sense of gratitude to Dr. B S Prasad, MD, PhD, Principal, KLE University's Shri B M Kankanawadi Ayurveda Mahavidyalaya, Shahapur, Belgaum for his encouragement and support.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Available from: http://www.wisegeekhealth.com/what-is-axonal-neuropathy.htmCached. [Last assessed on 2016 Apr 11].  Back to cited text no. 1
    
2.
Available from: http://www.en.wikipedia.org/wiki/Burning_feet_syndrome. [Last assessed on 2016 Apr 11].  Back to cited text no. 2
    
3.
Tripathi I, Dwivedy R. Chakradatta of Sri Chakrapani Datta with Vaidyaprabha Commentary. 4th ed., Ch. 22, Shloka No. 58-59. Varanasi: Chaukambha Sanskrit Sansthan; 2002. p. 138.  Back to cited text no. 3
    
4.
Kushwaha HC. Agnivesha Samhita Redacted by Acharya Charaka and Acharya Drudabala. Reprint Edition. Chapter 20, Sutra Sthana Shloka No. 15. Varanasi: Chaukambha Sanskrit Sansthan; 2009. p. 304.  Back to cited text no. 4
    
5.
Pandey G. Bhaisajya Ratnavali of Sri Vinodlalsens. 1st ed., Vol. 3, Ch. 28, Shloka No. 72. Varanasi: Chowkhambha Sanskrit Series Office; 2008. p. 549.  Back to cited text no. 5
    
6.
Murthy KR. Vagbhattas Astanga Hrdayam. 2nd ed., Vol. 2, Ch. 22, Shloka No. 45-46. Varanasi: Chowkhambha Sanskrit Series Office; 1995. p. 521.  Back to cited text no. 6
    
7.
Ojha J, Mishra U. Dhanwantari Nighantu. Reprint Edition. Shatapusphadi Varga. Drug No. 22, Shloka No. 49. Varanasi: Chowkambha Sanskrit Series Office; 2004. p. 106.  Back to cited text no. 7
    
8.
Ojha J, Mishra U. Dhanwantari Nighantu. Reprint Edition. Guduchaydi Varga. Drug No. 88, Shloka No. 292. Varanasi: Chowkambha Sanskrit Series Office; 2004. p. 90.  Back to cited text no. 8
    
9.
Ojha J, Mishra U. Dhanwantari Nighantu. Reprint Edition. Guduchaydi Varga. Drug No. 73, Shloka No. 247. Varanasi: Chowkambha Sanskrit Series Office; 2004. p. 78.  Back to cited text no. 9
    
10.
Ojha J, Mishra U. Dhanwantari Nighantu. Reprint Edition. Chandanadi Varga. Drug No. 2, Shloka No. 5. Varanasi: Chowkambha Sanskrit Series Office; 2004. p. 123.  Back to cited text no. 10
    



 
 
    Tables

  [Table 1], [Table 2]



 

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