Ayurvedic management of Hirayama disease

Abstract

Hirayama disease (HD), also known as monomelic amyotrophy, is rare cervical myelopathy due to spinal cord compression by forward displacement of the posterior dural sac during neck flexion that manifests itself as asymmetrical, slowly progressive atrophic weakness of the forearms and hands predominantly in young males. A 23-year-old man came to the outpatient department with a complaint of weakness of the right upper limb for the past 3 years which started in the right hand and forearm along with tremors in both hands. Considering the clinical history, physical examination, and electromyography, the condition was diagnosed as HD by an allopathic consultant two years ago. The symptoms can be included under Vata vyadhi. Some of the symptoms such as Asthibheda (~splitting type of pain in the bones), Sandhishoola (~pain in joints), Mamsa kshaya (~diminution of muscle mass), and Bala kshaya (~diminished strength) come under Asthimajjagata vata. Following the symptomatology and its resemblance with Asthimajjagata vata, the patient was treated with Snehapana (~internal oleation) with Ashwagandha ghrita followed by Virechana karma (~purgation therapy). Anuvasana basti with Panchatikta kshira along with Shalishastika pinda svedana was done after Virechana. Rasayana kalpa ksheera chikitsa was given after completion of Basti procedure. After 40 days of treatment, the patient showed significant improvement in muscle bulk. The magnetic resonance imaging shows no neural compression. This case shows that Ayurveda treatment may be helpful in pathologies like HD. Further, better results may be obtained if Ayurvedic therapies start at an earlier stage and continued for a longer duration.