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Table of Contents
CASE REPORT
Year : 2020  |  Volume : 8  |  Issue : 2  |  Page : 137-140

Clinical efficacy of Raktamokshana by cupping method in the management of chronic cervical spondylosis: A case study


Department of Shalya Tantra, Institute for Postgraduate Training & Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India

Date of Submission09-Jun-2020
Date of Decision16-Jun-2020
Date of Acceptance25-Jun-2020
Date of Web Publication07-Sep-2020

Correspondence Address:
Dr. Ekta D Patel
Department of Shalya Tantra, Institute for Postgraduate Training & Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISM.JISM_57_20

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  Abstract 

Cervical spondylosis is a common condition affecting the neck. In Ayurveda, several methods such as Snehana (massage), Nasya (nasal insufflation), and Raktamokshana (therapeutic bloodletting) are indicated in the management of Sandhigatvata. The aim of this study was to evaluate the clinical efficacy Raktamokshana in the management of chronic cervical spondylosis. A 47-year-old male patient visited outpatient department (OPD) with the complaint of cervical pain radiating to hand, stiffness, and difficulty in neck movement since 4 years. On Examination, Spurling’s test and Lhermitte’s sign were positive. Along with the support of X-ray and magnetic resonance imaging investigations, the patient was diagnosed with degenerative cervical spondylosis due to cervical stenosis. Considering the cervical spondylosis as Sandhigatvata, the patient was treated with Raktamokshana in two sittings at 15-day interval. Before treatment, the pain score (visual analog scale) and Neck Disability Index percentage were 7% and 67.5%, respectively, and that was reduced to 2% and 12.5% within 1 month after intervention. Hence it concludes that, Raktamokshana plays a major role in the management of pain due to muscular spasm.

Keywords: Cervical spondylosis, cupping, Neck Disability Index, Raktamokshana, Sandhigatvata


How to cite this article:
Patel ED, Tukaram DS. Clinical efficacy of Raktamokshana by cupping method in the management of chronic cervical spondylosis: A case study. J Indian Sys Medicine 2020;8:137-40

How to cite this URL:
Patel ED, Tukaram DS. Clinical efficacy of Raktamokshana by cupping method in the management of chronic cervical spondylosis: A case study. J Indian Sys Medicine [serial online] 2020 [cited 2020 Oct 20];8:137-40. Available from: https://www.joinsysmed.com/text.asp?2020/8/2/137/294438




  Background Top


Cervical spondylosis is a degenerative osteoarthritis of cervical spine that can be correlated with Sandhigatvata in Ayurveda.[1] The chances of cervical spondylosis are seen more due to excessive use of mobiles and computer in incorrect posture. The mainstay treatment in spondylosis is the use of cervical collar, analgesics, and if needed local cervical fusion and cervical foraminotomy with their known side effect.[2]Raktamokshana (therapeutic bloodletting) is a unique para-surgical measure indicated in various diseases where Rakta (blood) is grossly vitiated. It is also one of the Shodhana procedures mentioned by Acharya Sushruta. Previous research work on lumbar spondylosis with Raktamokshana (cupping) showed encouraging results in pain management, so here Raktamokshana has been selected as the treatment modality.[3]Shringaavcharana (bloodletting by cow horn) type of Raktamokshana is mainly used for removing the Vata vitiated blood. Some previous research studies showed that fiber cups are found equally effective as Shringa.[4] Thus, fiber cups were selected for the study.


  Case History Top


A 47-year-old male patient visited outpatient department (OPD) with complaints of pain over the neck region since 4 years, radiating to both upper limbs, tingling sensation up to the tip of fingers, and difficulty in neck movement due to muscle stiffness.

The patient was a labor worker so had to do a lot of weight lifting. There was no history of associate disorder, relevant hereditary, congenital, and surgical illness reported by the patient. General condition was moderate, and his appetite was slightly decreased with regular bowel habit and micturition. Sleep was disturbed due to pain at night. Previously, the patient had taken analgesics and four sittings of intravertebral corticosteroid injections, and got 30% relief in pain, but the symptoms reoccurred within 2 months with excruciating pain. So, he presented to OPD for Ayurveda management.


  Clinical Findings Top


No systemic deformity was found. All vitals were stable. Active ranges of motion (ROM) were painful. On cervical compression, the pain increased, which radiates toward patient’s arms (Spurling’s test positive).[5] During flexion of neck, the patient felt electric shock toward arms (Lhermitte’s sign).[6] The patient was of Vata–Kapha body constitution with the predominance of Vatadosha, involving Asthimajja as a Dushya.


  Investigations Top


X-ray cervical spine showed osteophyte formation with normal intervertebral disc [Figure 1]. Magnetic resonance imaging (MRI) of cervical spine is shown in [Figure 2]. Routine blood investigations were in normal limits. The patient was diagnosed with cervical spondylosis due to cervical canal stenosis.
Figure 1: X-ray of cervical spine

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Figure 2: MRI of cervical spine

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  Treatment Planned Top


On the basis of the pain in the cervical joint (visual analog scale [VAS] score), cervical stiffness, tingling sensation in hand, Neck Disability Index (NDI) (Vernon and Mior NDI),[7] and range of movement of cervical spine, two sittings of Raktamokshana by fiber cups were performed on OPD basis at 15-day interval on June 21, 2019, and July 5, 2019 [Figure 3].
Figure 3: Raktamokshana by cupping

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  Procedure Top


Poorva Karma

Before 1h of procedure, the patient was advised to take Mudgayusha. Local Abhayang (massage) by Bala (Sida cordifolia) taila and Nadiswedana (fomentation) by Dashmoola decoction was done. Written informed consent of the patient was obtained before the procedure, and the vitals were checked.

Pradhana Karma

In the sitting position (semi-flexed neck), cups were applied on the most painful points, and a negative pressure was created and maintained for 3–5 min. Then, the cups were released. Incisions of 3–4 mm long and less than 0.1 mm deep were made on the site of demarcated area of cups. Then, the cups were reapplied on incision marked area, and negative pressure was created [Figure 3].

Paschyata Karma

After the cessation of bleeding, the cupping site was cleaned with povidone–iodine solution followed by dusting of turmeric powder. Patient was advised to avoid water contact for 24h. The procedure was repeated after 15 days at different sites.


  Result Top


Outcome of the therapy is mentioned in [Table 1].
Table 1: Outcome of therapy

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  Discussion Top


Cervical spondylosis most of the time occurs due to compression of cervical nerve root. In this case, posterior disc osteophytes caused mild compression on bilateral foramina with mild stenosis. Pain occurred due to compression of nerve by osteophytes. Muscular spasm occurred due to pain at cervical region, leading to difficulty in the movement of cervical spine, and compression of nerve root caused tingling sensation.[8] Any degenerative type of pathological condition in the body can be considered under the Vata Vyadhi. Sandhigatvata involves the degeneration of Asthi (bone), Sandhi (joint), and vitiation of Vata. So, cervical spondylosis can be correlated with Sandhigatvata.

The effect of therapy was analyzed on the basis of primary outcome (pain) and secondary outcome (stiffness, ROM, and NDI). In pain, 42.85% relief was noted. During Raktamokshana, the vitiated blood comes out having characters of Vata Dushta Rakta (vitiated blood) mentioned by Acharya Sushruta, such as Fenila (frothy), Aruna (reddish black), and Krushna (blackish red).[9] Thus, it can be considered that Raktamokshana removes vitiated Vata Dosha, which is responsible for pain, hence the pain subsides.

In cervical stiffness, 33.33% relief was noted. In pathogenesis, Kaphavrita Vyana Vayu obstructs the circulation of Rasa and Rakta Dhatu, and gradually structural changes are seen in Griva Pradesha (neck region). Raktamokshana removes Avarana (obstruction), which helps to reestablish Prakrita Rasa-Rakta Samvahana (natural circulation of Rasa and blood) and provides nutritional support to the affected parts. This process might have reduced the inflammatory pathology by flushing out the inflammatory chemical mediators, and it ultimately provides relief to the patient from pain and stiffness.[10]

There was 32.59% relief in NDI. This index depends on questionnaires related to neck pain, thus relief in pain decreased the NDI. In range of movement, 50% improvement was seen in forward flexion, 14.28% in backward extension, 50% in lateral flexion, and 14.28% in lateral rotation. Relief in pain resulted in the reduction of muscular spasm, causing decreased stiffness and improvement of ROM of cervical spine.

After 30 days, 71.42% relief was observed in pain, 66.66% in cervical stiffness and tingling sensation in hand, and 81.48% improvement in NDI. In the range of movement, 62.5% improvement was observed in forward flexion, 28.57% in backward extension was noted, and no more improvement was noted in lateral flexion and lateral rotation.

As the aim of study was to evaluate the efficacy of Raktamokshana, the data were collected on the basis of questionnaires, X-ray, MRI, and ROM. The result was interpreted in percentage. Previously many research works were carried out on the cupping method in cervical spondylosis in traditional Chinese medicine.[11] But as per Ayurvedic management, to the best of our knowledge, no study was performed on Raktamokshana in cervical spondylosis.

Limitation of the study was the complete remission of the pathology (osteophyte reduction) did not occur. But symptomatic relief to the patient can be achieved by Raktamokshana.


  Take Home Message Top


The case of cervical spondylosis (mild to moderate symptomatic) can be well managed with the cupping type of Raktamokshana as an OPD procedure.


  Conclusion Top


Raktamokshana by cupping can be effectively used in cervical spondylosis. With this treatment, patients can avoid the use of analgesic medicines, which cause harmful side effects, and can improve their quality of life. This single-case study showed encouraging result, and this needed further study for its scientific validation in a greater number of patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Acharya JT, editor. Chikitsa Sthana, Vatavyadhi Chikitsa 4/8. In: Sushruta Samhita. Varanasi, India: Chaukhambh Surbharti Prakashan;2009. p. 421.  Back to cited text no. 1
    
2.
Payne R. Limitation of NSAIDs for pain management: Toxicity or lack of efficacy. J Pain 2000;1:14-8.  Back to cited text no. 2
    
3.
Joshi F, Vyasdev M, Dudhamal TS, Gupta S. Effect of Agnikarma (therapeutic heat burn) and Raktamokshana (therapeutic bloodletting) in management of Katisandhigata vata. Ayu 2019;40:79-88.  Back to cited text no. 3
  [Full text]  
4.
Sonaje M, Dhiman KS, Bhuyan C. Improvise Shringayantra for Raktamokshana: A new technique. Int J Res Ayurveda Pharm 2011;2:2-7.  Back to cited text no. 4
    
5.
Tong HC, Haig AJ, Yamakawa K. The Spurling test and cervical radiculopathy. Spine 2002;27:156-9.  Back to cited text no. 5
    
6.
Lhermitte J, Bollak N. Les douleurs à type de déchargeélectrique consecutives a la flexion céphalique dans la scléroseen plaque. Revista de Neurologia 1924;2:36-52.  Back to cited text no. 6
    
7.
Vernon H, Miro S. The neck disability index: A study of reliability and validity. J Manipulative Physiol Therapeutics 1991;14:409-15.  Back to cited text no. 7
    
8.
Canale ST, Daygetory K, Jones L. editors. Chapter-39. The Spine. In: Campbell’s Operative Orthopaedics. Part-2. 10th ed. Mosby publisher;2003. p.1985.  Back to cited text no. 8
    
9.
Acharya YT, editor. Sutra Sthana, Amapakvaisaniya adhyaya, 17/7. In:Sushruta Samhita. Reprint. Varanasi, India: Chaukhamba Surbharti Prakashana;2010. p. 83.  Back to cited text no. 9
    
10.
Lin ML, Lin CW, Hsieh YH, Wu HC, Shih HC, et al. Evaluating the effectiveness of low-level laser and cupping in low back pain by checking plasma cortisol level. 2014 Int Sympos Bioelectron Bioinformat (IEEE ISBB)2014:1-4.  Back to cited text no. 10
    
11.
Meng X, Wang Y, Piao S. Wet cupping therapy improves the local blood perfusion and analgesic effects in patients with nerve root type cervical spondylosis. Chinese J Integrated Med 2018;24:830-4.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]



 

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  In this article
Abstract
Background
Case History
Clinical Findings
Investigations
Treatment Planned
Procedure
Result
Discussion
Take Home Message
Conclusion
References
Article Figures
Article Tables

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