Ayurvedic Intervention in the Management of Anantavata W.S.R. to Trigeminal Neuralgia

Introduction

Trigeminal neuralgia is a neuropathic condition characterized by intense, stabbing, electric shock-like pain in the lower face and jaw due to irritation of the trigeminal nerve. Pain is usually restricted  to half side of the face. It sometimes involves the area around the nose and above the eye. Pain occurs in the area of distribution of CN V, which sends branches to the forehead, cheek and lower jaw. The pain is triggered by touching the painful area of the face, as well as activities such as shaving, rubbing, brushing teeth, moving face to talk, cold wind on the face, etc [1]. It has an annual incidence of approximately 4.3 in 100,000 in the general population and only 3% of those cases present with bilateral involvement [2]. The annual incidence for women is approximately 5.9 cases/100,000 women [3]. For men, it is approximately 3.4 cases/100,000.Persons with multiple sclerosis, hypertension, herpes zoster are more commonly suspected to develop TN. In 80-90% of cases, the pain is usually caused by compression of the Trigeminal nerve route [4]. Anantavata is a disease of head in which all three doshas are instantaneously vitiated which produce severe pain in unilateral side of face [5]. Anantavata is among 11 types of sirorogas explained by Acharya Susruta. It is Vatapradhana sannipatika but sadhya type of disease. The

vitiated tridoshas get lodged in manya or greevaparshwa and produce severe intolerable pain at the back of neck, in the eye ball, frontal region, and root of nose and in temporal region. It also causes hanugraha, netrarogas and gandaparswakampa [6]. These clinical features indicate involvement of all three branches of CNV.

Anti-convulsants like carbamazepine provide at least partial pain relief in about 80 to 90 percent of patients. Side effects like dizziness, drowsiness, forgetfulness, unsteadiness and nausea are experienced by most of the patients. They are sometimes more troubling than the pain itself, sometimes to the extent that patient has to discontinue them. Moreover, these drugs do not always remain effective in due course of time. Higher doses or more medicines have to be taken together. Patients who become unresponsive to medications are treated surgically. Experts find that symptoms worsen over time and become less responsive to medication, despite increasing dose and adding further agents [7]. Its need of the hour to adopt harmless and effective treatment modalities in such patients. Ayurveda, through Panchakarma and by use of various drug formulations, has much to offer in that regard. In Ayurveda, Trigeminal neuralgia can be managed by pacifying tridosha [8]. Pacification of tridoshas is successfully achieved through external therapies and internal medications followed by Vata- Pittahara diet [9]. Siravedha and Vata-Pitta Shamana is mainly indicated in the management of Anantavata by Acharya Susruta. Line of treatment of Anantavata is similar to that of Suryavarta. Nasyakarma, lepa, parisheka, kavalagraha and shirovasti are effective in Suryavarta [10]. Food processed with large quantity of milk and ghee should be consumed by the patient. To balance the dryness, larger amounts of oil are used. Nasya karma, ksheera dhooma, ghrita pana, lepa and karna poorana are effective in reducing acute pain episodes of trigeminal neuralgia. Ratrijagarana, cold exposure, intake of cold and Vatavardhaka ahara should be avoided by the patient. Dashamoola yavagu and ghrita bhojana nourishes all body tissues. Rasayana drugs work by correcting the dhatu vyapara (tissue nutrition). Dhatu is primarily responsible for the transportation of nutrients to all body cells.

Methodology

Anantavata predominantly involves Vata dosha. Shamana treatment including use of Pathyadi kwatha, Saptavinshati Guggulu, Brihata vata chintamani rasa is very effective in its management. Deepana, pachana, teekshna, shoolahara property of Pathyadi kwatha effectively reduce diseases of head [11]. Brihat vata chintamani rasa has Vatahara, shoolahara property due to which it reduces frequent pain. Use of Ekangveer Rasa and Rasayana like Brahmi vati (swarna yukta) prevents relapse of disease by nourishing all bodily tissues starting from rasa dhatu.

Shodhana Nasya

Nasal route is said to be the doorway to head [18]. Nasya with karpasasthyadi taila, ksheerbala taila, ashwagandhaadi taila anutaila is the best treatment of choice for anantavata. Shodhana nasya followed by brumhana nasya helps in alleviating pain and preventing its recurrence. Pratimarsha nasya with ksheerabala 101 avartita taila pacify all doshas of urdhwajatrugata part.

Results

TN with mild pain can be cured through shamana chikitsa while in bahudoshawastha Panchakarma is effective. The sense organ of touch is the most pervading of all the sense organs, and has an inseparable association with the mind. Thus, massage is not only useful for controlling Vata dosha, but also has an effect on the brain, from where all activities of nerves are controlled. According to gate-control theory, mukhabhyanga can reduce the pain perceived by the brain. Naadi swedana in mridu form reduces pressure on nerves by initiating a relaxation of local muscles, increasing blood flow, and removal of chemicals that stimulate pain receptors.

Discussion

Vatahara, balya, brumhana, tridoshahara dravya along with vata -pittahara pathya play a major role in the crucial line of treatment of TN. Various Panchakarma therapies give dramatic results in patients suffering from debilitating pain, thereby improving the quality of life of patient. These Ayurvedic treatment modalities must be adopted widely for further scientific validation and standardization.