This document discusses a clinical study on the Ayurvedic treatment of occupational disorders using Swalparasona Pinda (internal medicine) and Mahamasha taila Nasya (nasal administration of oil) for brachial neuritis, which resembles the Ayurvedic condition of Viswachi. The study involved 20 patients who received Swalparasona Pinda twice daily for 40 days and Mahamasha taila Nasya daily for 7 days. Results showed significant reduction in pain levels and functional disability, with 80% of patients experiencing marked relief of symptoms.

1. OCCUPATIONAL DISORDERS AYURVEDIC TREATMENT
Management of Viswachi with Swalparasona Pinda
(Internal) and Mahamasha taila Nasya with special
reference to Brachial Neuritis. A C l i nical study
Dr . Rajimunnisa Begam .Shaik
P.G Scholar.
,
Dept . of K.C. GUIDED BY,
dr.razia.sk@gmail.com
Dr. E. Venkateswarlu (M.D)
Reader.
Kaya Chikitsa P.G Dept

2. INDEX
1.INTRODUCTION
2.DISEASE REVIEW
Nidana
Samprapthi- Aetiopatogensis
Roopa – clinical features
Examinations
Investigations
Chikitsa
3.CLINICAL STUDY
Materials & Methods
Mode of action of Nasya or Nasya Karma
Observations
Results
Discussions
Conclusion
References
Key Words :
Viswachi , Brachial Neuritis, Swalpa rasona Pinda ,
Mahamasha taila,Nasya.

3. INTRODUCTION
•Ancient Ayurveda is having lot of importance in treating several diseases successfully using
various potential drugs and apt methods. Even though there are certain remidies Explained in
our classics , now after thousand years there is a need to evaluate the above diseases according
to present conditions with proper parameter s and measures.
•Pain is the most complicated area of human experience.
•Pain is defined as an impleasant sensory and emotional experience associated with tissue
damage.
•Viswachi is one of such diseases commonly seen affecting around 90% of adults above 50yrs of
age and nearly same percentage of adults above 70yrs of age . In this disease severe and
throbbing type of pain which radiates from neck , shoulder , arm, forearm, & digits is
experienced . It is also associated with numbness and emaciation of upper limbs and its muscles.
•It resembles with brachial neuritis . It is also known as Neuralgic amyotrophy is a rare
syndrome of unknown etiology affecting mainly the lower motor neurons of brachial plexus.
symptoms are sudden onset of pain in neck , shoulder & arm. Weakness & numbness in
shoulder, arm & hand . Fatigue , malaise , head ache, muscle aches & pains.
•Because of present day life style , food ,habits ,excessive stress strain and anxiety more people
are getting these problems and the incidence of the disease viswachi is drastically increased day
by day .
•Hence the study has been initiated to evaluate the successive management of viswachi using
swalpa rasona panda (internal ) and Mahamasha taila, Nasya . In this yoga all selected drugs
are having properties which effective in treating viswachi.

4. DISEASE REVIEW
•NIDANA:
There are no separate nidanas described for viswachi . The general nidana of vatavyadhi and
factors causing vataprokopa are applicable .
•AHARAJA HETUS :
Gunas :
Excessive intake of ruksha , laghu , seta ahara increases the vata all these three factors which get
increased by excessive intake ruksha guna causes dhatu kshaya
Rasa:
Kashaya , katu tikta rasasare vata prokapa .
Sevana vidhi :
Decreased quantity of food , food taken in irregular fashion , eating incompatible foods.
affects agni and malnourishment of the dhatus kshaya this leads to vata prakopa.
Visharaja hetus :
1.Primary one is ativyayama which also includes .
A.Langhana C.Dhavana
B .Plavana D.Utkshepa
2. Dukha sayya and asana are specially described by Caraka improper posrure gives& more presuure
over the spine and disturbs the muscular integrity provoking vata which also includes Diwaswapna .
Ratri Jagarana Veganirodha . Ati vyavaya.
Mansika hetus:
Chinta ,soka , bhaya, krodha are due to rajas guna where as vata is also rajo guna pradhana .
Thus all these aggrevate vata.

5. SAMPRAPTHI (Aetiopathogensis)
Due to the naidanika factors , vata prakopa occurs and it moves all over the
body and where it comes in contact with snehadirahita rikta srotas it fills
them up producing either Sarvanga or Ekanga vyadhi.
In Viswachi diseases the prakupita vata while moving all over the
body settles in the greeva making in the adhisthana . As the kha vai gunya is
in greeva .
Vata fills those srotases doing soshana of the sleshaka sleshma of
grivakaseruka sandhies & causing grivakaseruka vikara. This inturn leads
to dusti of kandara of bahus manifesting the symptom of viswchi
SAMPRAPTHI GHATAKAS :
Dosha: Vata , Vyanavata.
Dushya : Kandara of baahu & prista
Srotas: Chestavaha Srotas
Sroto Dusti: Sanga
Adhistana: Greeva
Vyakastana : Baahu,talapratyanguli.
Rogamarga :Madhyama
Vyadhi Swabhava: Chirakari

6. Roopa – Clinical features
•In description of viswachi susrutha mentioned Bahu karma kshaya as the only symptom.
•Vagbhata quoted bahu chestapaharana as the lakshana .
•Where Madhavakara also described bahu karma kshaya as the only symptom.
•While commenting on the verses of Acharyas , various commentators have described in the
following way.
•Dalhana opines that this diseases resembles Grdhrasi affects one arm
•Other commentators like Gayadas , Vijayarakshita and Arunadatta stressed the point of
occurrence of pain as the cardinal feature in this disease.
The clinical symptoms of viswachi as follows :
“Talaprathyangulinam thu kandara bahu prustatah
Bahvah karma kshayakari viswachi hi sa smruthah”
The word Viswachi is derived from two words .
visvat + anc
•viswa means entire / whole all pervading .
•Anc means turned to directed towards / to move / wander about.
•Thus Viswachi literally means spread through out
•Pain often has a neuritic quality – described as throbbing , burning , stabbing , electric shock like
and aching .Sometimes it is cramping paraesthesia often felt in fingers . These description of pain
are available in our classics as vyaddha bhedana etc weakness and occasional tenderness occurs.
•The pratyatmika lakshana of viswachi is radiating pain from the bahu , pristha to the hastha
talam and pratyanguli.
•Teevra ruja Dalhana.
•Stambha
•Ruk , Todha & Spandana

7. MODERN VIEW OF BRACHIAL NEURITIS
Brachial neuritis (BN), also known as neuralgic amyotrophy, is a rare syndrome of
unknown etiology affecting mainly the lower motor neurons of the brachial plexus
and/or individual nerves or nerve branches. BN usually is characterized by the
acute onset of excruciating unilateral shoulder pain, followed by flaccid paralysis
of shoulder and parascapular muscles several days later. The syndrome can vary
greatly in presentation and nerve involvement.
Brachial neuritis (BN) exists in an inherited and an idiopathic form. In the idiopathic
version, the pathophysiology is unknown, but the condition is generally thought to
be an immune system – mediated inflammatory reaction against nerve fibers of the
brachial plexus. Axonopathy with subsequent Wallerian degeneration appears to
predominate, but proximal conduction block has also been described in over 33% of
cases in the series by Lo and Mills.[8] The inherited form is autosomal dominant and
has been linked to mutations in the SEPT9 gene on chromosome 17q. Septins are
involved in the formation of the cytoskeleton and in cell division, but how these
mutations result in BN is unknown.
Symptoms are sudden onset of pain in neck shoulder , arm. weakness
& difficulty in moving arm & shoulder , numbness in shoulder , arm, hand . fatigue,
malaise head ache muscle aches & pains.

8. EXAMINATION.
Examination of Neck :
First active movements are assessed,
Next passive movements starting with extension.
Functional assessement :
Is done by performing a series of functional tests or movements to determine the functional
capacity, keeping in mind the patients age and health.
Investigations :
Blood tests – CBP, ESR , RBS Serum proteins , CRP ( C – reactive proteins )
X-rays - Cervical Spine Ap view
Lateral view
Imaging – MRI – Excellent for cord ,root lesions .
- CT –with contrast , Intrathecal for root , cord lesions .
-CT – for bony lesions.
Electro diagnostic : Nerve conduction studies
Isotope scans : Bone ( metastases).
Infective lesions.
CSF - Presence of lesions infection / inflammation .

9. CHIKITSA
Ayurvedic classics explain the chikitsa of viswaci as follows.
Caraka advised nasyam for diseases affecting bahu and siras along with uttara
bakti snehapana.
Susrutha advised siravyadhana in the affected parts along with vatavyadhi
samanya chikitsa and also mentioned vamana and nasya in diseases .
Sarangadhara advised gunjadhi lepam external application.
From the above all statements line of treatment of viswachi can be evolved as
Abyanga
Sweda
Uttarabhaktika snehapana.
Nasya karma
Shamanoushadhi
Nidanaparivarjana

10. CLINICAL STUDY
Materials & methods :
1.Swalparasonapinda
Rasona – 2 00 mg
hingu -200mg
Jiraka -200 mg
Saindhavam -200 mg
Sauvarchala lavana – 200 mg
Trikatu -200 mg
Total 1200 mg – per dose
All the above drugs are to be taken in the equal quantity and 600mg of vati is prepared
Dose -2 tab tid
2.Mahamasha tailam ( Niramisham)
Dasamoola -3kg
Water -13 lit
Masha -3 kgs
Murchita tailam -750 ml
Goksheeram -750ml
Kalka drugs
Aswagandha , karcura , devadaru , bala , rasona , prasarini , kustha , parusaka , bhargi , vidarikanda ,
kshiravidari , punarnava , seed pulp of matulunga , ramatam , satapushphi , satavari , chitraka ,
pippalimula, jivaneeya gana.
Each 6 gms make into kalka
Taila is prepared using above drugs through tailapaka vidhi .
Dose : 4 drops on each nostril
Duration : 7 days

11. SELECTION OF PATIENTS :
20 Patients for the present study , suffering with viswachi were selected from the opd
of P.g Kaya Chikitsa unit of Dr . B.R.K.R Govt . Ayurvedic hospital , Hyderabad .
Duration of the treatment -40 days
Diagnostic criteria : 1. Bahu karma kshaya 2.Teevra ruja.
Inclusive criteria :
Patients of viswachi
Age group 30- 70 yrs
Both male and female are included .
E xclusive criteria :
As the disease like diabetes mellitus other major systemic disorders like hypothyroidism .
Malignancy, tuberculosis , and trauma .
Parameters required :
Subjective Objective ;X- ray, CT, MRI (OPTIONAL)
Bahukarma kshaya
Follow up : - Once in 10 day
Teevra ruja
Pre assessment – 0 days
Weakness in multiple different muscles,
numbness 1st assessment -10 th day
2nd assessment -20th day
3rd assessment -30th day
Weakness 4th assessment-40th day

12. MODE OF ACTION OF NASYA KARMA
NASYA DRAVYA
ADMINISTERED THROUGH NASALA ROUTE
REACHES SRINGATAKA MARMA (LOCAL SURFACE OF BRAIN )
i.e ., cavernous sinuses
SPREADS IN MURDHA (ENTERS INTO THE INTRA CRANIAL CIRCULATION)
REACHES AT A JUNCTION PLACE OF SROTA ,KANTA ,SIRAMUKHAS

13. EXAMINATION.
Examination of Neck :
First active movements are assessed,
Next passive movements starting with extension.
Functional assessement :
Is done by performing a series of functional tests or movements .Determine the functional
capacity keeping in mind the patients age and health.
Investigations :
Blood tests – CBP, ESR , RBS Serum proteins Crp , C – reactive proteins
X-rays - Cervical Spine Ap view
Laterall view
Imaging – MRI – Excellent for cord ,root lesions .
- CT –with contrast , intra thecal for root , cord lesions .
-CT – for bony lesions.
Electro diagnostic : Nerve conduction studies
Isoto pescans : Bone ( metastases).
Infective lesions.
CSF - Presence of lesions infection / inflammation .

14. RESULTS
After collecting the data , it is subjected to statistical analysis basing on the subjective & objective
parameters.
The following tables show the scores obtained before and after treatment .
Table showing the results of intensity of pain after treatment
S.no Intensity of pain No.of
Patients
Percentage
1. No Pain 16 80
2. Mild Pain 3 15
3. Moderate Pain 1 5
4. Severe Pain 0 0

15. Table showing results of subjective symptoms.
SYMPTOMS B.T SCORE A.T SCORE
BAHUKARMA
30 12
KSHAYA
THEEVRA RUJA 40 22
WEAKNESS IN
MULTIPLE
DIFFERENT
MUSCLES OF THE
ARM
32 30
NUMBNESS 33 10
GRADINGS;
SEVERE-3
MODERATE-2
MILD-1
NO PAIN-0

16. Table showing results of functional disability after treatment
S.no Functional Disability No. of patients Percentace
1. No Disability 15 75
2. Mild Disability 3 15
3. Moderate Disability 2 10
4. Severe Disability 0 0
All the 15 patients had No disability (bahu karma kshaya)3 patients reported mild
disability 2patients still have moderate disabilty and no patients have severe
disability after treatment .
Table showing outcome after the treatment
S.no Result No. of patients Percentace
1. Marked relief 16 80
2. Moderate relief 3 15
3. Mild relief 1 5
4. No relief 0 0

17. DISCUSSION
Ayurveda being an ancient medical science is formulated on scientific parameters available in
those times. Research is the only way available to re – establish old facts through modern
methodolgy . It is not only useful to expand the area of knowledge but can also help to develop
and advance in new direction.
Viswachi is a pain predominat disease pain in viswachi is caused by partial damage to nerve
membranes which become sensitive to mechanical and chemical stimuli .Such afferentiation
pain may either be burning superficial (dysaesthetic) type or of stabbing character .So
evolving a potent Vedanahara Yoga is very needful in the management of viswachi.
All Ayurvedic classics included Nasya in the management of vatavyadhis .Bahu having its
moolam in greeva gets affected in viswachi . Thus Nasya becomes the line of treatment.
Discussion on inclusive & exclusive criteria:
As Viswachi occurs in both sexes without bias both gender were selected for the study. As the
diseases like Diabetes Mellitus and other major systematic disorders patients with history of
trauma are excluded
Discussion on diagnostic & assessment criteria
As the key goals of pain management programe are reduction of incapacity and
increase in physical function to the maximum achievable as a declared outcome. It
becomes incumbent upon the clinician to monitor and measure the level of
function and disability .

18. Conclusions
Viswachi is an disorder affecting upper limbs it is identified by
Radiating pain in all through the limb and dysfunction of the limb.
Viswachi is a neurological disorder occur commonly due to
Inflammation of lower motor neurons of the brachial plexus
Disease is gaining importance due to its crippling nature.
Prevalence of Viswachi is more in the age group of 30-70yrs.
Occupations involving the upper limbs usage continuously are resulting in increased
disease precipitation / prevalence.
More women are suffering than men.
More desk workers are prone to the disease.
Clinical features are not always correlative to radiological
findings
Swalparasona pinda yoga along with Nasya karma showed marked relief
in the blown up degenerative conditions.
To create awareness in the public about the ayurvedic therapies which
shows marked relief in occupational disorders like Viswachi etc.

19. REFERENCES
1.Su. Ni 1/35
2.A.S Hr Ni 1st chapter
3. Ca. Ci 28/18
4. B.R – 26TH /578-584
5. Chakradatta – 22nd /172-180
6. Harrisons text book of medicine
7. David sons text book of medicine
8.Dravyaguna vol -2 Dr . Nisteswar