Introduction

The cervical and lumbar regions of the spine are the most vulnerable to repeated stress, as they play a crucial role in supporting and facilitating everyday movements and activities. the most common pathologies affecting the cervical spine and lumbar spine are cervical spondylosis and lumbar spondylosis. about 13.76% of the population are affected with cervical spondylosis^[1] whereas 76.7% of the people are afflicted with lumbar spondylosis^[2] the primary causes of spondylosis include age-related degeneration, trauma, poor posture, and occupational factors. With sedentary lifestyles, poor posture, and prolonged screen time becoming increasingly prevalent, even younger individuals are now experiencing early signs of spondylosis. Clinically, spondylosis manifests as neck or lower back pain, which may radiate to the hands or legs, often accompanied by numbness - a characteristic symptom of cervical and lumbar spondylosis, respectively. While many individuals experience either cervical or lumbar spondylosis separately, some suffer from a more complex condition where both regions are involved simultaneously. This dual involvement can lead to widespread pain, stiffness, nerve compression, and mobility issues, significantly impacting daily life. In Ayurveda, cervical spine pathologies are referred to as Vishwachi, characterized by symptoms such as Ruk (pain), Thoda (pricking sensation), Sthamba (stiffness), Karmakshaya (loss of function), and Chestapaharana (restricted movement) of arm.^[3]

Lumbar spine conditions are identified as Gridhrasi, presenting with Ruja (pain), Toda (shooting pain), Spandana (throbbing sensation), and Graha (stiffness or immobility), originating in the Spik (gluteal region) and radiating through the Kati-Prusta (lower back), Uru (thigh), Janu (knee), Janga (calf), and extending to the Pada (foot).^[4] When both Gridhrasi and Vishwachi occur simultaneously, the condition is termed Khalli.^[5]

Case Report

A female patient aged 43 years, from a middle socioeconomic background n/k/c/o Hypertension and Type 2 Diabetes Mellites known case of hypothyroidism for the past 8 years under medication Thyronorm 50 mcg, who was conscious and oriented to time,

Palpation: temperature - warmth, tenderness at C-5, C-6, C-7 region.

Range of movements: flexion - painful (at 50 degrees), extension - painful restricted.

Table 3: Cervical spine Special tests:

Spurling test +ve

Lumbar Spine Examination

Inspection: No swelling and no surgical scar marks

Palpation: Temperature - warmth, tenderness at L-4, L-5 region

Range of movements: flexion restricted and painful, extension - restricted and painful

Table 4: Lumbar spine special test

Coin pick test + ve

Ashtasthana Pariksha

Nadi - Vatakapha
Mootra - Prakrutha
Mala - Prakrutha
Jihwa - Lipta
Druk - Prakrutha
Shabda - Prakrutha
Sparsha  - Anushna Sheetha
Akruthi - Madhyama

Dashavidha Pariksha

Prakruthi - Vatakapha
Vikruthi - Vatakapha
Sara - Madhyama
Samhanana - Madhyama
Satva - Avara Satva
Satmya  - Katu Rasa Pradhana
Aharashakti –

Follow-up medicines

1. Mahanarayana Thaila E/A
2. Nuro XT 1-0-1 A/F with luke warm water
3. Rasna Saptaka Kashaya 15-0-15ml B/F with Luke warm water
4. Ksheerabala 101 drops 10-0-10drops with milk B/F for the period of 30 days

Table 6: Assessment parameters before and after treatment

Later on, Mustadi Yapana Basti was planned after assuring condition free from Kapha-Avarana. Mustadi Yapana Basti is effective in addressing conditions such as Katishoola (backache), pain in thighs and calves, headaches, and Vatarakta (various rheumatic disorders). Its Rasayana property supports rejuvenation, while its ability to address Vata Vyadhi involves breaking pathogenesis by purifying channels (removing Margavarodha) and nourishing tissues (Brihmana property) to counter Dhatukshaya.^[8] Patra Pottali Sweda relieves pain, stiffness and swelling associated with arthritis and other painful conditions, pacifies morbidity of Vata, Pitta and Kapha in they affected joints, muscles and soft tissues.^[9] Patra Pinda Swedana may help in increasing blood circulation to affected area, gets rid of Dosha imbalances, strengthens muscles in area, helps release of toxins and reduces inflammation also helps to tone muscles and improve working of tissues within body. Jambira Pinda Sweda Potali are Vata-Kaphashamaka, Shoolaghana (analgesic), and Shothahara (anti-inflammatory). Sahacharadi Taila is having Teekshna and Ushna qualities, Helpful in mitigating Vata and Kapha.^[10] Mahanarayana Taila is composed of 33 Dravyas which are having Vata Kaphahara Guna and Vedanasthapaka in action.^[11] Rasna Saptak Kashaya, used for Jangha, Uru, Pristha, Trika and Prashashula^[12] as Trika is affected in Khalli hence Rasna Saptaka Kashaya was used. Nuro xt has Ekangaveera Rasa as main ingredient which is having Brimhana and Rasayana properties helps in mitigating Vata Dosha. Ksheerabala 101 Avarti Taila is Vata-Pitta Samana It is having properties like Rasayana, Brimhana, helps in degenerative conditions of spine.

Conclusion

Khalli is one among the Vatavyadhi which is having both Gridrasi and Vishwachi Lakshana and the treatment modality of Vatavyadhi includes Snehana, Swedana, Basti and Raktamokshana. In the modern parameters it can be equated to spondylosis of spine which is characterized by degeneration that makes a person difficult to perform daily activities. This case study showed that Panchakarma chikitsa is effective in the management of Khalli. It has provided significant improvements in subjective and objective parameters indicating that the patient has improved in presenting the features and significant improvement found in the patient’s quality of life.