Gridhrasi kc001 jam

Date : /03/2004

C E R T I F I C A T E

This is to certify that Dr. Rita V. Khagram, a final year M.D.(Ayu.)Scholar of department of Kayachikitsa (Speciality -Panchakarma) hassuccessfully completed her thesis entitled “A comparative study of Kati Bastiand Matra Basti in the management of Gridhrasi (Sciatica)” under my directguidance and supervision.

The scholar has put sincere and hard efforts in bringing out this thesisafter making copious contemplation of the subject by keeping the dictionintact. This dissertation contains original ideas and data, which is a definiteadvancement over the existing knowledge of the subject. All the findingsreported in the thesis have been checked by me time to time.

I am fully satisfied with the research work of the scholar, which is beingpresented by her. I, therefore, strongly recommend and forward this thesis to besubmitted for adjudication for the award of Doctor of Medicine (Ayu.) ofGujarat Ayurved University.

Forwarded :

Prof. Dr. V.D. ShuklaProfessor & Head –Department of KayachikitsaI.P.G.T. & R.A.Gujarat Ayurved UniversityJamnagar

Guide

Prof. Dr. V. D. ShuklaProfessor & Head – Dept. of KayachikitsaI.P.G.T. & R.A.Gujarat Ayurved UniversityJamnagar

Gujarat Ayurved UniversityInstitute of Post Graduate Teaching & Research in Ayurveda

Jamnagar – 361 008

Gram : ‘Ayu’

Aknowledgement

A C K N O W L E D G E M E N T

On the eve of completion of this thesis, I bow my head to the great

almighty who is always showering blessings upon me and without whose

blessing, I would not have been able to attain this stage in my life.

I take this opportunity to express my deep indebtedness towards

my esteemed and lovable parents Mr. Vinodrai T. Khagram and Mrs.

Rasila V. Khagram and my family members. Their incessant love,

affection, encouragement and blessings were the driving force behind my

progress and success.

This dissertation will be of no value if I do not express my sincere

and hearty gratitude to my respected Guide Prof. Dr. V. D. Shukla,

H.O.D. of Kayachikitsa who has been the main source that prompted me

for undertaken this tenacious task. He always kept giving me new ideas,

new concepts and new methodology to work on my subject. He is a

personality having an ocean of scientific thinking which truly proved to

be a powerful guiding force towards the pursuance of my research work.

I also express my deepest gratitude to my co-guide Dr. Anup B.

Thakar for his valuable suggestions, ideas and help throughout my study.

Again, I express my special thanks to departmental teachers Dr. N.

N. Bhatt, Dr. H. M. Chandola, Dr. M. S. Baghel, Dr. S. N. Vyas and Dr.

A.R. Dave, for their kind co-operation and help whenever I approached

them.

My departmental colleagues Dr. Dhamini, Dr. Chinmayi, Dr.

Devangi, Dr. Antony, Dr. Pavan, Dr. Atul, Dr. Alpesh, Dr. Gautam, Dr.

Somraj, Dr. Harish, Dr. Shrilekha, Dr. Mandala and seniors deserves

special thanks for their constant coordinate support.

Aknowledgement

I also sincerely thanks to my batchmates Dr. Umang, Dr. Shailesh,

Dr. Pashmina, Dr. Upendra, Dr. Tushar, Dr. Bharvi, Dr. Devangi, and Dr.

Anuradha for rendered help directly or indirectly in successfully

completion of my study.

I am very much thankful to Mr. Sanjay and his family for his

respectable sense and beautiful computer coverage of my research work

neatly, efficiently, quickly and timely.

Last but not the least, I sincerely thank to all my well wishers and

friends for their directly or indirectly help and cooperation in my present

work in any way.

|| Jay Shri Krishna ||

- Rita V. Khagram

Ayurmitra

TAyComprehended

C O N T E N T S

AcknowledgementAbbreviations Introduction - 01 - 05Conceptual Contrive

- Historical Review- Disease Review

---

06 - 8904

Drug Contrive - 80-90Clinical Contrive - 91-115

Discussion - 116-129Summary & Conclusion - 130-134Bibliography - i – iii

A B B R E V I A T I O N S

A. H. : Ashtanga Hridaya

A. S. : Ashtanga Samgraha

B.P. : Bhavaprakasha

Ch. : Charaka Samhita

Chi. : Chikitsa Sthana

D. M. : Diabetes Mellitus

Dal. : Dalhana

In. : Indriyasthana

Kal. : Kalpasthana

M.N. : Madhava Nidana

Ni. : Nidanasthana

Sha. : Sharirasthana

Su. : Sushruta Samhita

Su. : Sutrasthana

Ut. : Uttarsthana

Vi. : Vimana Sthana

S.D. : Standard Deviation

S. E. : Standard Error

B.T. : Before Treatment

A.T. : After Treatment

‘P’ : Probability of occurrence

M.A.P.A. : Medicinal And Aromatic Plant Abstracts

A.A.M.R.A. : Allied Ayurvedic Medical Research Abstracts

M. N. : Madhava Nidana

F. B. S. : Fasting Blood Sugar

P.P.B.S. : Postprandial Blood Sugar

Introduction

1

I N T R O D U C T I O N

Changing of life style of modern human being has created

several disharmonies in his biological system. As the advancement of

busy, professional and social life, improper sitting posture in offices,

factories, continuous and overexertion, jerking movements during

traveling and sports – all these factors create undue pressure to the

spinal cord and play an important role in producing low backache and

sciatica. Likewise, progressive disorders affecting the pelvis and nearer

structures are also precipitating this condition. In this way, this

disease is now becoming a significant threat to the working

population.

According to Ayurveda simple freedom from disease is not

health. For a person, to be healthy he should be mentally and

spiritually happy. An imbalance in Doshic equilibrium is termed as

‘Roga’. Among Tridosha, Vata is responsible for all Cheshta and all the

diseases. As having the properties of locomotor, its dynamic entity, its

intensity and majority of its specific disorders in number more

importance and attention is given to the Vata Dosha.

A variety of Vatavyadhi described in Charaka Samhita are

divided into Samanyaja and Nanatmaja group. Gridhrasi comes under

80 types of Nanatmaja Vatavyadhi though, occasionally there is

Kaphanubandha. The name itself indicates the way of gate shown by

the patients due to extreme pain just like a Gridhra (vulture), it is

clear that this disease not only inflicts pain but also causes difficulty

in walking, which is very much frustrating and embracing to the

patient. Though, the disease is present in leg, it disturbs the daily

routine and overall life of the patient. The cardinal sings and

symptoms of Gridhrasi (Sciatica) are Ruka (pain), Toda (pricking

sensation), Stambha (stiffness) and Muhuspandana (twitching) in the

Sphika, Kati, Uru, Janu, Jangha and Pada in order and Sakthikshepa

Nigraha i.e. restricted lifting of the leg. In Kaphanubandha, Tandra,

Gaurva, Arochaka are present.

Introduction

2

“Sciatic Syndrome” - a condition described in modern medicine

resembles with Gridhrasi. In sciatica there is pain in the distribution

of sciatic nerve which begins from

buttock and radiates downwards

to the posterior aspect of thigh,

calf and to the outer boarder of

foot. Herniation or degenerative

changes in intervertebral disc is

the most common cause. There is

often history of trauma, as

twisting of the spine, lifting heavy

objects or exposure to cold.

In Ayurveda, Gridhrasi is

given as a Vatavyadhi and it is

also believed that any type of

pain can not be without presence

of Vata. Gridhrasi is a severely

painful condition so, Vata

Pradhanya in its pathogenesis is

clear. In Ayurvedic classics, our

Acharyas have given so many

special therapeutical procedures

for specific disease along with

thousands of medicaments.

Panchakarma is a very unique

therapeutic procedure because of its preventive, promotive,

prophylactic and rejuvinative properties as well as providing a radical

cure.

Among these Panchakarmas; Basti Karma is such a Chikitsa

that is applicable in all the Vatavyadhis. According to Sushruta, it can

also be used in Kaphaja and Pittaja disorders by using different

ingredients.

Introduction

3

The disease Gridhrasi as being a Vatavyadhi and Vata is also

controller and regulator of other two Dosha, Dhatu and Mala and also

all the body activities. Therefore, once Vata is controlled by Basti, all

these factors are automatically regulated and total body equilibrium is

achieved. Hence, Basti is called as “Sarvarthakari” and it seems to be

the radical treatment of this disease also.

Basti can be of many types on the basis of ingredients and

needs. The simplest type of Basti – Matra Basti is selected for the

present study, which can easily be administered in all the patients

with irrespective of age, sex, time etc. and is harmless. As the local

Samprapti Sthanasanshraya is having quiet major importance in

Gridhrasi local simultaneous Sneha Sweda procedures called Kati

Basti has been selected for the present study. For purpose of Matra

Basti and Kati Basti, Sahacharadi Taila was selected as it has been

recommended in Vata Vyadhi Chikitsa by Acharya Vagbhatta. Rasna

Guggulu was given for control drug. So the aim of this study is to

compare the efficacy of Matra Basti with a localized management

protocol known as Kati Basti.

32 patients of Gridhrasi with irrespective of their age, sex,

religion were registered for this study. These patients were randomly

divided into three groups viz. Kati Basti group (8 patients), Matra

Basti (13 patients) and Rasna Guggulu group (11 patients).

In this study, the best relief in the amelioration of cardinal signs

and symptoms was recorded among patients of Matra Basti group.

Overall effect was better in Matra Basti group in comparison to other

two groups. Out of remaining two groups, control therapy i.e. Rasna

Guggulu group provided better relief in signs and symptoms than Kati

Basti group. Comparatively poor relief was observed among patients of

Kati Basti group.

The present study has yielded encouraging result and it is hope

that outcome of this study will form the guideline for the enthusiastic

research worker for further advancement in this avenue and the

knowledge obtained will be useful in day to day practice.

Conceptual Contrive

4

H I S T O R I C A L R E V I E W

History is a part of description of any object. In this way before

going in detail about the Gridhrasi, an attempt has been made to trace

the reference regarding Gridhrasi in particular and Vatavyadhi in

general available till now beginning right from Vedic period. For the

total coverage of historical aspect, it has been divided into four

sections viz. –

Vedic Period

Pauranika Period

Samhita Period

Sangraha Period

VEDIC PERIOD : (2500 BC to 500 BC)

The Vedas are considered as the oldest recorded knowledge in

our culture. Gridhrasi is not mentioned in any form of Vedas.

However, in the Atharvaveda, the word ‘Vatikrita’ is mentioned. Here,

‘Vatikrita’ word denotes Vata Vyadhi. In same Pippali (Ath. 6/109/3)

and Visanika (Ath. 6/44/3) have been claimed as ‘Vatikritasya’

Bhesaja and Vatikritanashini respectively.

PAURANIKA PERIOD

In Garuda Purana, Ayurveda related subjects are described in

details. In this treatise a separate chapter is available as Vatavyadhi

Nidana where Gridhrasi is descried as an entity.

SAMHITA PERIOD

Detailed description regarding Gridhrasi is available in different

Samhitas.

Charaka Samhita : Charaka Samhita is the first and foremost

Ayurvedic source for the detailed description of Gridhrasi.

In 20th chapter of Sutrasthana – Maharogadhyaya, Gridhrasi is

enumerated in 80 types of Nanatmaja Vatavyadhi (Ch. Su.

20/111).

Conceptual Contrive

5

In 19th chapter of Sutrasthana – Astodariya Adhyaya, description of

two types of Gridhrasi viz. Vataja and Vata-kaphaja has been

mentioned. (Ch. Su. 19/7)

In 5th chapter of Sutrasthana, Matrashiteeya Adhyaya, Gridhrasi is

indicated as an indication of Taila Abhyanga in Pada (Ch. Su.

5/90-92).

In 28th chapter of ChikitsaSthana – Vatavyadhi Chikitsa, the

detailed symptomatology and treatment of Gridhrasi have been

given.

Sushruta Samhita : (600 BC to 400 BC)

In Sushruta NidanaSthana 1st chapter, Vatavyadhi Nidana,

symptomatology and pathology of Gridhrasi have been described.

(Su. Ni. 1/74). He mentioned a symptom ‘Sakthikshepa Nigraha’

means unable to lift the leg straight as pain is produced as like

SLR test in modern science.

In ChikitsaSthana 25th chapter, Mahavatavyadhi Chikitsa and 8th

chapter of Sharirasthana, Siiravedha chikitsa for Gridhrasi is

indicted.

Ashtanga Sangraha : (5th century)

After Charaka and Sushruta, the next importance is given to

Ashtanga Sangraha. In Sutrasthana 20th chapter- Doshabhediya

Adhdhyaya, Gridhrasi is included under 80 types of Vata Vikara. (A.

S. Su. 20/13).

In Nidanasthana 15th chapter- Vatavyadhi Nidana, pathogenesis

and symptomatology of Gridhrasi has been described. (A. S. Ni.

15/56).

In Sutrasthana 36th chapter, Siravedha Chikitsa in Gridhrasi

has been mentioned. (A. S. Su. 36/9)

Ashtanga Hridaya : (5th century)

In Nidanasthana 15th chapter Vatavyadhi Nidana

symptomatology and pathogenesis of Gridhrasi is described. (A. H. Ni.

15/54).

Conceptual Contrive

6

In Sutrasthana 27th chapter, site of Siravedha in Gridhrasi has

been mentioned.

Kashyapa Samhita : (7th Century)

In Kashyapa Samhita, which is not complete at present,

Gridhrasi is counted under 80 types of Vata Vikara, but no other

details are available. (Ka. Su. 27/21).

Bhela Samhita : (7th century)

26th chapter of this Samhita deals with Basti and

Raktamokshana Chikitsa for Gridhrasi.

Sangraha Kala :

Different texts of Sangraha Kala containing description

regarding, the Gridhrasi.

Madhava Nidana : (7th Century)

In chapter VataVyadhi Nidana, some specific symptoms of two

types of Gridhrasi has been highlighted i.e. Dehasya Pravakrat (Sciatic

scoliosis) in Vataja type, Mukhapraseka and Bhaktadvesha in Vata-

kaphaja type.

Kalyanakaraka : (8th Century)

The 8th chapter termed as Vatarogadhikara deals with pathology

and symptomatology of Gridhrasi and its treatment is given in the 12th

chapter named Vata Roga Chikitsa.

Chakradatta ; (12th Century)

This text deals with treatment part only. Some herbal

preparation Snehana Chikitsa, Basti Chikitsa and Sashtra Chikitsa

are described in detail first time under the heading of Vatavyadhi

Chikitsa. Chakradatta has indicated Rasna Guggulu Vati in the

treatment of Gridhrasi which is selected for the study.

Arundatta : (12th century)

Arundatta in his Sarvanga Sundari commentary on Ashtanga

Hridaya defined clearly that due to Vata in Kandara, the pain is

produced at the time of raising leg straight and it restricts the

movement of thigh. This is an important clinical test nowadays for the

diagnosis of Sciatica, known as SLR.

Conceptual Contrive

7

Gadanigraha : (12th century)

In this text, treatment part of Gridhrasi has been explained at

two places.

1) In 4th chapter of Prayoga Khanda termed as Gutikadhikara.

2) In 19th chapter of Kayachikitsa Khanda named as

Varogadhika describes Basti chikitsa for its treatment along

with Agnikarma and Raktamokshana.

Dalhana : (12th Century)

According to Dalhana, Gridhrasi is commonly known as

Randhini in which severe pain occurs.

Vangasena : (12th Century)

In this text, its line of treatment has been more clearly explained

by mentioning that Deepana, Pachana, Vamana, Virechana, Basti and

Siravedha should be done in Gridhrasi. Rasna Guggulu is mentioned

for the treatment of Gridhrasi.

Indu (13th Century)

In Shashilekha commentary of Ashtanga Sangraha, Indu has

described that in Gridhrasi, the symptoms are similar to Vishwachi. If

restricted movement and pain occurs in upper limb, the disease is

called as Vishwachi. Whereas pain and restricted movement occurs in

lower limb then it is termed as Gridhrasi.

Sharangadhara Samhita : (13th Century)

In 7th chapter of Purvakhanda termed as Rogaganana Gridhrasi

is counted under 80 types of Nanatmaja Vatavyadhi. Treatment of

Gridhrasi is described in 2nd and 5th chapter of Madhyama Khanda.

Rasaratna Samuchchaya : (13th Century)

30th chapter of Rasaratna Samuchchaya deals with treatment of

Gridhrasi.

Bhavaprakasha : (16th Century)

In Bhavaprakasha – a text book of Laghutrayi, Gridhrasi is

described under Vatavyadhi Nidana.

Conceptual Contrive

8

Yogaratnakara : (17th Century)

In Yogaratnakara symptomatology and classification of

Gridhrasi has been mentioned under Vatavyadhi Nidana. Few

preparations have also been described which are useful in Gridhrasi.

Bhaishajya Ratnavali : (18th Century)

In this text treatment of Gridhrasi is described as per

Chakradatta.

PREVIOUS RESEARCH WORKS DONE AT VARIOUS INSTITUTE ON GRIDHRASI

JAMNAGAR –

Arya M.P.S. (1965) : Vatavyadhi – Gridhrasi (sciatica).

Nair P.R. (1968) : Gridhrasi Chikitsa with Rasa Taila Eranda and

Rasna – I.A.S.R., Jamngar.

Notani H.G. (1979) : Snigdha Sweda Ka Vata Shamana Prabhava

Ka Adhyayana Gridhrasi mein Kati Basti Ke Paripekshya mein,

I.P.G.T.& R.A, Jamngar..

Srikant U. (1984) : Studies on some systemic effect of Basti w.s.r.

to Gridhrasi Vishwachi and Pakshaghata, I.P.G.T. & R.A.,

Jamnagar.

Moradia Ghanashyama (1990) : A comparative study on the role

of Shodhana and Shamana therapies of Gridhrasi, I.P.G.T. & R.A.,

Jamnagar.

Shridhar Bairy T. (1997) : Phytochemica and

pharmacotherapeutic evaluation of Parijata (N. arbortristis Linn.)

w.s.r. to its effect on Gridhrasi, I.P.G.T. & R.A., Jamnagar.

R. Shahi (2002) : A comparative study of Agnikarma and Matra

Basti in the management of Gridhrasi (Sciatica). I.P.G.T. & R.A.,

Jamnagar.

Manoranjan Sahu (2002) : A critical study on aetiopathogenesis of

Gridhrasi and its management by Rasna Guggulu along with

Shodhana Therapy”

Conceptual Contrive

9

AHMEDABAD –

Pradeep S. Nandgaonkar (1991) : The management of Gridhrasi

(sciatica) with Sephalika Ghanavati (N. arbortristis Linn), G.A. Ayu.

College.

Urmila S. Bedekar (1995) : A comparative study of Nirgundi

Patrapinda sweda and Basti Chikitsa in the management of

Gridhrasi (Sciatica) , G.A. Ayu. College.

JAIPUR :

Sharma Loknatha (1975) : Gridhrasi Roga Ka Naidanika evam

Chikitsatmaka Adhyayana (Rasna Prayoga), NIA Jaipur.

Sharma R. M. (1981) : A clinical study of Gridhrasi and trial of

Eranda Paka, NIA Jaipur..

Mishra Murlidhara (1986) : A pharmacological study of Sephalika

w.s.r. to Gridhrasi, NIA Jaipur.

Pandya Surendra Kumar (1988) : Gridhrasi Mein Basti Karma Ka

Chikitsatmaka Adhyayana, NIA Jaipur.

Varma R. K. (1992) : Gridhrasi Roga par Agnikarma Ki Karmukta,

NIA Jaipur.

B.H.U. –

Pandey Pradyuman (1973) : Gridhrasi Evam Amavata Mein

Bhallataka Ka Prabhava, B.H. U. Varanasi.

MYSORE –

Gokaranakor D. J. (1983) : Gridhrasi and its management with

Shuddha Guggulu - G.C. I.C, Mysore.

Shridhr B. S. (1991) : Managemnt of Gridhrasi w.s.r. to Basti-

G.C.I.M. Mysore.

TRIVENDRUM –

Pillai Muralidharana K. (1978) : Clinical study on Gridhrasi w.s.r.

o Virechana – G. A. College, Trivendrum.

LUCKNOW –

Arora R. L. (1982) : Role of Sephalika Patra Kwatha on Gridhrasi.

Conceptual Contrive

10

HARIDWAR –

Sunil Kumar (1983) : Clinical study of Sephalika decoction in case

of Gridhrasi – R. S. College, Hridwar.

VIJAYAWADA –

Rao M. K. (1986) : A clinical trial of Parijata in Gridhrasi – Dr.

N.R.S.G. Ayu. College, Vijayawada.

RAJPUR –

Lalchand (1987) : Clinical effect of Sephalika on Sciatica – A. Ayu.

College, Rajpur.

HYDERABAD –

Narasimnachari T. (1987) : A study of the effect of Chaturbija in

Gridhrasi – A. Ayu. College, Hyderabad.

PREVIOUS RESEARCH WORKS ON DONE ON MATRA BASTI

Murthy N. A. (1977) : A study on the Rasayana effects of

Matrabasti – I.P.G.T. & R.A., G.A.U., Jamnagar.

Sharma V. P. (1986) : A clinical study on the role of Matrabasti

with Himasagar Taila in the management of Pangulya - Jamnagar

Sharma R. N. (1985) : Chikitsa Mein Basti Ka Mahatva Evam

Mamsakshaya Mein Matra Basti Ka Mamsa Vriddhikara Karma –

Jaipur.

S. S. Patil (1985) : A study on Matra basti w.s.r. to its effect on

Vatavyadhi, Mysore.

Murlidhara (1994) : Effect of Matra Basti in Mamsakshaya,

Mysore.

Routaray R. (1994) : A study on Panchakarma w.s.r. to Matra

Basti on Pravahaika, Puri.

Kortikara (1992) : Effect of Matra Basti of Karanaja Taila in

Purishaja Krimi, Pune.



Jamnagar.

Conceptual Contrive

11

WORKS CARRIED OUT AT C.C.R.A.S. CENTER

1) Clinical evaluation of Prabhanjah Vimardnam Taila and Shodhana

Therapy – P. R. Nair, N.P. Vijayan and P. Madhavikutty – XII-19-32.

2) Clinical evaluation of drug therapy associated with Panchakarma

in the management of Gridhrasi (Sciatica) – R. D. Prasan and M. K.

Tyagi– XX - 78-82.

3) Comparative clinical study on Gridhrasi with Sahacharadi Taila viz

Bhadradarvadi taila – P. R. Nair, N. P. Vijayan, P. Madhvikutty,

N.A., Prabhakarana and S. Indira Kuamari – VI -121-131.

4) Effect of Siravedha in Gridhrasi (sciatica) – S. Singh, M. V. Acharya

and M. R Uniyal – XX-173-177.

5) Effect of Trayodashanga Guggulu and Vistinduka Vati along with

Abhyanga and Swedana in the management of Gridhrasi (sciatica)

– P. R. Nair, N.P. Vijayan, S. Indira Kumari, P. Madhavikutti, N. A.

Prabhakaran – VI – 149-162.

6) Shuddha Bhallataka Dwara Gridhrasi Roga Par Ki Gayee

Anusandhana Parakha Chikitsa ka Prabhava – S. D. Jtha and V.

N. Pandey – VII-158-170.

7) The role of Hingutriguna Taila in the treatment of Gridhrasi

(sciatica) – Premkishor, M.M. Patdhi – VI-36-43.

8) The role of Shodhana therapy in Gridhrasi - P. R. Nair, N. P.

Vijayan, K. C. Bhagavathy Amma, P. Madhavikutti – I-529-549.

GRIDHRASI AS A DISEASE - AYURVEDIC CONCEPT

Etymology of Gridhrasi :

Gridhra + so – atonupasargitcha – Adding ‘kah’ pratya leads to

Gridhra + so + ka by lopa of ‘o’ and ‘k’, ‘s’ is replaced by ‘sa’ by rule

‘Dhatvadeh’ ‘sah sah’ ‘Gridhrasi’ derived.

Gridhasi word is derived from ‘gridhna’ dhatu, meaning to

desire, to strive after greedily or to be eager for. By the rule of

‘Susudhangridhangridhi bhyaha kran’ (Unadi 2/24) by adding

‘karana’ pratyaya i.e. ‘gridh + kran’ by lope ‘k’ and ‘n’ the word ‘gridh +

ra’ the word ‘gridhra’ is derived.

Conceptual Contrive

12

Gridharam and Syati so Antakarmani Atonupasargakah,

Chanhva Gridhra Iva Syati Pidayati, Gridhra Iva Syati Bhaksati.

Gridra is bird called as vulture in English. This bird is fond of

meat and he eats flesh of an animal in such a fashion that he deeply

pierce his beak in the flesh then draws it out forcefully, exactly such

type of pain occurs in Gridhrasi and hence the name.

Another meaning is a man who is striving after meat greedily

like Gridhra (vulture) is prone to get it and hence the name Gridhrasi.

Further as in this disease the patient walks like the bird

Gridhra and his legs become tense and slightly curved so due to the

resemblance with the gait of a vulture, Gridhrasi term might have

been given to this disease.

Introduction :

In Ayurveda Gridhrasi is counted under 80 types of Nanatmaja

Vatavyadhi. Acharya Charaka has mentioned in Chikitsasthana 28th

chapter that in Gridhrasi, there is Ruka (pain), Toda (pricking

sensation), Stambha (stiffness) and Mruhuspandana (twitching) in

waist, hip, back of the thigh, knee, calf and foot respectively found in

Vataja type and Tandra, Gaurava and Arochaka in addition to Vata-

kaphaja type.

(Ch Chi. 28/56-

57)

Acharya Sushruta has given the main symptom of this disease.

He says that when the Kandara i.e. ligament of heel and all the toes

are afflicted by vitiated Vata, movements of the lower limbs get

restricted, that is known as Gridhrasi. It is important sign for the

diagnosis of this disease.

Conceptual Contrive

13

(Su

. Ni. 1/174)

According to Harita, in Gridhrasi Vyana and Apana Vata

especially vitiated out of 5 types of Vata. Gati (movement), Prasarana

(extension), Akunchana (flexion), Utkshepana (lifting) etc. are function

of Prakrut Vyana Vayu. The hampered Sakthikshepa Karma indicates

Vyana Dushti.

On the basis of sign and symptoms of Gridhrasi given in

Ayurvedic text, it can be correlated with modern disease sciatica,

because in sciatica pain is found along the course of sciatica nerve

that is to say in the buttock, back of the thigh, out side and back of

the leg and outer border of the foot. Here one thing is noticeable that,

symptomatology of sciatica is same as given in Charaka Samhita. In

sciatica, pricking pain is specific symptom which is aggravated by

coughing, sneezing and by sleeping in night due to stretching of

muscles and nerve. Patient is unable to keep the leg straight that is

Sakthikshepa Nigraha.

Gridhrasi is a disorder, results from vitiation of Vata and this

Vata of Ayurveda can be correlated with nervous system of modern

science. Because in Ayurveda, it has been said that Vata is

responsible for the act of body viz. Praspandana, Udvahana, Purana,

Viveka, Dhrana (Su. Su. 15/1) and same on other hand according to

modern science, nervous system is responsible for all these body acts.

On account of aforementioned description, it is clear that

Gridhrasi is result of vitiation of Vyana Vayu and can be broadly

correlate with sciatica in latest medical science.

Nidana Panchaka of Gridhrasi

Nidana Panchaka is the combination of parameters, which are

used in the diagnosis of the disease. They are –

1) Nidana

2) Purvarupa

3) Rupa

4) Upashaya-Anupashaya

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14

5) Samprapti

Similarity in the symptoms makes it difficult to diagnose a

disease. Sometimes at those places, it is mandatory to consider whole

Nidana Panchaka to reach diagnosis. Here, a brief account of Nidana

Panchaka of Gridhrasi is presented –

Nidana of Gridhrasi vis-à-vis Vatavyadhi

In Ayurvedic classics, Nidana word is used in a wide sense. The

word ‘Nidana’ is derived from the ‘Ni-dhatu’, which carries the

meaning to decide a problem that is a causative factors of disease is

called Nidana (etiology). According to the treatment point of view,

Nidana is the most important because the basic principle of treatment

is to avoid the Nidana first then treat according to the character of

disease.

The causative factors explained in the classics may be divided

into many groups, but for the sake of convenience this can be grouped

into two types viz. 1) General (samanya) Nidana and

2) Specific (Vishesa) Nidana

In some disease, Samanya Nidana of concerned Dosha or group

of diseases have been explained and in some disease Vishesa Nidana

for that particular disease have been listed. In case of Gridhrasi

specific Nidana has not been mentioned, so the causative factors

producing Vatavyadhi are given here. Actually, there is not much

difference in case of Nidana in all Vatavyadhi mainly the difference is

only in Samprapti. Vataprakopaka Karmas are almost same and the

difference like Gridhrasi, Pakshaghata etc. are only due to the

Samprapti Vishesa.

In regard to causative factors of Vatavyadhi, only Charaka (Ch.

Chi. 20/15-17) and Bavaprakasha (B.P. U. 24/1-2) has explained in

detail, while in Sushruta Samhita, Ashtanga Sangraha and Ashtanga

Hridaya etc. the causes of Vatavyadhi have not been clearly described.

However in these texts, the causative factors provoking Vata Dosha

are described. (Su. Su. 21/19-20; Su. Ni. 1/67-69; A.S. Ni. 15/31-34;

A. H. Ni. 1/14-15; Ni. 15/29, 32, 33, 47).

Conceptual Contrive

15

Here, Gridhrasi is considered as a Nanatmaja type Vatavyadhi.

The provoking factors of Vata can also be taken as a cause of

Gridhrasi.

All the etiological factors given either of Vatavyadhi or

Vataprakopaka in the Ayurvedic classics can be classified into four

groups.

Aharataha

Viharataha

Agantuka

Anya Hetu

Nidana (Aetiological Factors) of Vata Vyadhi and Vata Prakopa

Causes Ch. Su. A.H. A.S. B.P.

(i) AHARATAHA

1 Adhaki (Cajanus cajan) - + - - -

2 Bisa (Nelumba nucifera) - + + - -

3 Chanaka (Cicer arietinum) - - + - -

4 Chir bhata (Cuccumus melo) - - + - -

5 Harenu (Pisum sativum) - + - - -

Jamva (Egenia jam bolana) - - + - -

6 Kalaya (Lathyrus Sativas) - + + - -

7 Kalingu (H. -antidysentrica) - - + - -

8 Karira (Capparis decidua) - - + - -

9 Koradusha (P. scrobiculatum) - + - - -

10 Masura (lens culinaris) - + - - -

11 Mudga (phaseolus mungo) - + - - -

12 Nisha pava (Dolichos lablab) - + - - -

13 Neevara (H. aristata) - + - - -

14 Saluka (Nelumbium speciosum) - - + - -

15 Shyamaka (Setari italica) - + - - -

16 Tinduka (Diospyrostomentosa) - - + - -

17 Tumba (langenaria vulgaris) - - + - -

18 Varaka (Carthamus tinctorius) - + - - -

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16


19 Sushka saka (Dry Vegetables) - + - - -

20 Trunadhanya (Grassy grains) - - + - -

21 Vrudhaka (Germinated seeda) - - + - -

22 Rukshanna (ununctuous diet) + + + + +

23 Laghvanna (Light diet) + + + - +

24 Gurvanna (Heavy diet) - - + + -

25 Sheetanna (Cold diet) + + + - -

26 Kashayanna (Astringent taste) - + + + +

27 Katuanna (Acrid taste) - + + + +

28 Tiktanna (Bitter taste) - + + + +

29 Vishtambhi (Constipative diet) - + - - -

30 Sheet Veerya (cold potency) - - - - -

31 Abhojana (Fasting) + + - - +

32 Alpasana (dieting) + - + + -

33 Vishmashana (Uneuqal food) - + - - -

34 Adhyasana (eating before

digestion of perious meal) - + - - -

35 Jirnataha (After digestion) - + + + +

36 Pramitashana (Taking food in

improper time) - - + + +

(ii) VIHARATAHA

37 Asham bhramna (Whirling stone) - - + - -

38 Ashamchalana (shaking of stone) - + - -

39 Ashamavikshepa (Throwing of stone) - - + - -

40 Ashamotkshepa (Pulling down stone) - - + - -

41 Balvata Vighraha (Wrestling with

superior healthy one) - + + - -

42 Damya aza Nigraha (Subduing

untamable elephant, crow and horse) - - + - -

43 Diva swapna (Day sleep) + + - - -

44 Dukhasana (Uncomfortable sitting) + - - - -

45 Dukhashayya (Uncomfortable sleep) + - - - -

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17


46 Ghadhotsadana (Strong rubbing) - - + - -

47 Kashtabhramana (Whirling of wood) - - + - -

48 Kashta vikshepa (shaking of wood) - - + - -

49 Kashta vikshepa (Throwing of wood) - - + - -

50 Kashokshepa (Pulling down wood) - - + - -

51 Lohbhramana (whirling of metal) - - + - -

52 Lohachalana (Shaking of metal) - - + - -

53 Lohavikshepa (Throwing of metal) - - + - -

54 Lohatkshepa (Pulling down metal) - - + - -

55 Paragatana (Strike with other) - - + - -

56 Shilabhramana (Whirling of rock) - - + - -

57 Shilachalana (Shaking of rock) - - + - -

58 Shilavikshepa (Throwing of rock) - - + - -

59 Shilotkshepa (Pulling down rock) - - + - -

60 Bharaharana (Head loading) - + + - -

61 Vegadharana (Voluntary suppres-

sion of natural urges) + + + + +

62 Vegadeerna (Forceful drive of

natural urges) - - + + -

63 Vishamopachara (Abnormal gestures) + - - - -

64 Atigamna (Excessive walking) + - + - -

65 Atihasya (Loud laughing) - + + + -

66 Atijrimbha (Loud yawing) - + + + -

67 Ati Khar Chapkarshanal - - + + -

(Violent streching of the bow)

68 Atilanghana (Leaping over ditch) + + + - -

69 Ati palvana (Excessive bounding) + + - - -

70 Ati Prabhashana (Contineous talking) + + - - -

71 Ati Pradhavana (Excessive running) + + - - -

72 Ati Prajagrana (Excessive awaking) + + + + +

73 Ati Prapatana (Leaping from height) - + - - -

74 Ati Prapidinam (Violent pressing blow) - + - - -

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18


75 Ati Pratarana (Excessive swimming) - + + - -

76 Ati Raktamokshana (Excessive

blood letting) - - - - +

77 Ati Shrama (Over Exertion) - - - - +

78 Ati Sthana (Standing for a long period) - + - - -

79 Ati Vyatan (Violent exercise) + + + + +

80 Ati Vyavaya (Excessive sexual intercourse) + + + +

+

81 Ati Adhyayana (Excessive Study) - + + - -

82 Atiyasana (sitting for a long period) - + - - -

83 Atiyuchchabhashana - - + + -

84 Gajaticharya (Excessive riding on

elephant) - - + + -

85 Kriyatiyoga (Excessive purification

therapy) - - + + +

86 Padaticharya (Walking long distance) - + - - -

87 Rathaticharya (Excessive riding

on chariot) - + - - -

88 Truangaticharya (Excessive riding

on horse) - + - - -

89 Bhaya (Fear) + - + + +

90 Chinta (Worry) + - + - -

91 Krodha (Anger) + - - - -

92 Madana (Intoxication) - - - - +

93 Shoka (Grief) + - + + +

94 Utkantha (Anxiety) - - + - -

95 Abhra (Cloudy season) - + - - -

96 Apranha (Evening) - + + + +

97 Apararatra (The end of the night) - - + + -

98 Grishma (Summer season) - - + + -

99 Shishira (Winter season) - - - - +

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19


100 Pravata (Windy day) - + + - -

101 Sheetkala (Early winter) - + - - -

102 Varsha (Rainy season) - + + - -

iii) AGANTUKA

103 Abhighata (Truma) + - - - -

104 Gaja, Ustra, Ashvasighray- + - - - -

Anapatamsara falling from

speady running elephant,

camel and horse)

iv) Anya Hetu

105 Ama (Undigested article) + - - +

106 Asrikshaya (Loss of blood) + + + - -

107 Dhatukshaya (Loss of body elements) + - - - -

108 Doshakshaya (Loss of excertion) + - - - -

109 Rogatikarshana + - - - -

(Emaciation due to disease)

110 Gadkrita Mamskshaya - - - - +

(Wasting due to disease)

- Ch. Chi. – 28/15-18 - As. Ni. - 1/13

- A.H. Ni. – 1/14-15 - Su. Su. – 21/19-20

Aforementioned etiological factor of the Vatavyadhi may lead to

pathological conditions of ‘Dhatukshaya’ or ‘Margavarana’ or both at a

time, which in turn cause the provocation and vitiation of Vata dosha.

It is well known fact that the intake of food which is having excessive

dry, cold, light properties may provoke the Vata Dosha.

o The dryness property (Ruksha guna) adversely affects to

viscosity, softness, strength and complexion of the body

elements.

o The coldness has a tendency of arresting and causes stiffness of

the body similarly lightness (laghu guna) is able for the

reduction of body elements i.e. tissue (dhatu) as it has Lekhana

Conceptual Contrive

20

characteristic because these properties are similar to the

properties of Vata.

o The alteration starvation of food and scanty diet will provoke the

Vata dosha as to fill up the vacuum – thus caused.

o Due to all these factors, Vata may get provoked and vitiated

simultaneously.

The excessive sexual indulgence (Ativyavaya) augments the Vata

Dosha in the body, because the loss of semen (Shukra dhatu) which is

cold in nature and the seat of Prana, possesses and antagonistic

property to the Vata dosha. This factor leads to reduction of body

elements (dhatu kshaya), which eventually leads to provocation of

Vata dosha.

Maharshi Charaka emphasis that the sleep, diet and sexual

urge are the three great pillar of the life – Trayopastambha. If a person

is habituated to irregular sleep and awakening, it may definitely cause

the vitiation of Vata dosha as a result dryness increase and

diminishing in the viscosity of the body occurs, while oppositely this

will lead to the diminishing the body elements (tissue). When Vata

dosha is vitiated, it impairs the digestion (Jatharagnidushti) and

undigested product (Ama) may obstruct the channels of the body. In

the different manner as the obstruction of the body channels i.e.

Margavarana then Ama associated with Vata dosha circulates all over

the body, wherever the body channels are present the pathogenesis

(Samprapti) starts. This may result in the production of the any type

of Vatavyadhi. The psychic factors like worry, grief, fear, anger etc. are

responsible for the vitiation of Vata dosha, which also has the ‘Rajo

Guna’. So it may be possible that Vatavyadhi will be produced by the

above stated psychic factors on account of vitiation of Vata dosha.

On the basis of aforementioned description, it is easy to

understand the phenomenon of Vataprakopa, by using of above said

factors and on other hand it can be easily said that these factors are

also responsible for manifestation of the disease Gridhrasi because it

is also vataja type of disease.

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21

Purvarupa of Gridhrasi :

The specific premonitory symptom (Purvarupa) of Vatavyadhi

which include Gridhrasi, Pakshaghata etc. also are not found in the

classics. However, its indistinct symptom present prior to the

manifestation of Gridhrasi or any type of Vatavyadhi may be taken as

its premonitory signs and symptoms. These Purvarupa usually are

exhibited during the stage of ‘Sthana Samshraya’ of the

‘Shadkriyakala’ (Su. Su. 21). At that time when Dosha-Dushya-

Sammurcchana takes place, some specific sign and symptoms are

observed in particular disease which may be clear or not, they are

termed as Purvarupa. It is important to diagnose and treat the disease

at this stage so that patient may be saved from the functional or

organic damage which may be created during complete manifestation

of the disease.

Charaka has mentioned that Avyakta Lakshana are the

Purvarupa of the Vatavyadhi.

(Ch. Chi.

28/19)

Chakrapanidatta commenting on the word Avyakta mentions

that few mild symptoms are to be taken as the Purvarupa (Ch. Chi.

11/12 - Chakrapani). Gangadhara has also the same opinion (Ch.

Chi. 11/12 - Gangadhara). But Vijayarakshita, the commentator of

Madhava Nidana has given the clear meaning of the term Avyakta,

according to which symptoms not exhibited clearly are Purvarupa and

they are due to- 1) Weak causative factors.

2) Very less or mild symptoms.

3) Less Avarana of Doshas

It is obvious from the above reference that Avyakta is Alpa

Vyakta or less manifested. So, in Gridhrasi also Purvarupa can be

taken as minor symptoms produced before the actual manifestation of

the disease.

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22

Rupa of Gridhrasi

The signs & symptoms present during the manifestation of

disease is termed as Rupa. Its synonyms are -

Akriti Chinha Linga

Lakshana Rupa Sansthana

Vyanjana

The manifestation of the particular disease is the fifth stage of

Kriya-Kala e.g. Vyakti. After Dosha-Dushya-Sammurcchna the body

channels are impaired by the morbid Doshas leading to the

production of specific features of the disease, whereas it is collectively

known as Lakshana-Sammucchaya. On the basis of signs &

symptoms diagnosis of the disease is possible.

Charaka mentioned Ruka (Pain), Toda (Pricking sensation),

Stambha (Stiffness), and Muhuspandana (Twitching) in Sphika and

radiating towards the Kati, Pristha, Uru, Janu, Jangha and Pada

respectively. These are the cardinal symptoms of Vataja Gridhrasi. In

Vata-kaphaja type of Gridhrasi in addition to the above symptoms,

Tandra (Torpor), Gaurava (Heaviness) and Arochaka (Anorexia) are

also present.

Sushruta and Vagbhatta have given ‘Sakthanahkshepa

Nigrahayat’ i.e. restriction in lifting the leg as the cardinal sign of the

Gridhrasi (Su. Ni. 1/74; A. H. Ni. 15/54; A. S. Ni. 15/16), whereas

Madhava has described the same symptoms as mentioned by

Charaka. In addition one more Sloka is available in Madhava Nidana

according to which the forward bending of the body (Dehasya

Pravakrata), quevering sensation and stiffness in Janu, Kati and Uru

Sandhi (Janu Kati Uru Sandhinam Sphuranam and Stabdhata) may

also be found in Vatika Gridhrasi and Vata Sleshma Gridhrasi may

associated with loss of appetite (Agnimandya), drowsiness (Tandra),

excessive salivation (Mukha Praseka) and aversion for food

(Bhaktadwesha) (Ma. Ni. 22/55, 56).

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23

Symptoms Ch Su AH AS BP MN YR SS HS

General

Sphika Purva Kati, Pristha,

Uru, Janu, Jangha, Pada

Kramat Vedana

+ - - - + + + - -

Ruka + - - - + + + + -

Toda + - - - + + + + -

Stambha + - - - + + + + -

Muhuspandana + - - - + + - + -

Sakthikshepanigraha - + - - - - - - -

Sakthiutkshepanigraha - - + + - - - - -

Janu Madhya Vedana - - - - - - - - +

Uru Madhya Vedana - - - - - - - - +

Kati Madhya Vedana - - - - - - - - +

Vataja

Dehasyapravakrat - - - - + + + - -

Janusandhispurana - - - - + + + - -

Urusandhispurana - - - - + - - - -

Katisandhispurana - - - - + + + - -

Janghaspurana - - - - - + - - -

Suptata - - - - + - + - -

Vata-kaphaja

Tandra + - - - + + + + -

Gaurava + - - - + - + + -

Arochaka + - - - - - + + -

Vahani Mardava - - - - + + + - -

Mukhapraseka - - - - + + + - -

Bhaktadwesha - - - - + + + - -

Staimitya - - - - - - - - +

Some of the important symptoms of Gridhrasi are being

discussed here in detail.

Conceptual Contrive

24

1) Ruka (Pain)

Charaka mentions the pain as a main symptom of Gridhrasi.

Commenting upon this, chakrapani opines that this pain starts firstly

at Sphika (hip) and later on, if affects Kati (waist), Pristha (back), Uru

(thigh), Janu (knee), Jangha (calf) and Pad (foot) respectively.

Obviously this pain is present along the area distributed by sciatica

nerve.

2) Toda (Pricking sensation)

Charaka and Madhava have mentioned this symptom. It is a

pricking type of pain and may be present along the sciatica have

distribution. In modern medicine also while mentioning the signs and

symptoms of sciatica due to the lesion in 5th lumbar root, it has been

described that sensory impairment in the foot may also occur.

3) Stambha (Stiffness)

According to Charaka, the patient of Gridhrasi feels Stambha in

the affected part. Stambha is a feeling of tightness or rigidity

throughout the leg. On account of this pain, the person tries to make

as little movement as he can. As a result, the muscles of the leg

become rigid and this sort of Stambha is experienced. This symptom

can be also manifested by restriction of movements and even if the

patient is able to walk, he is unable to make full free movements of

the affected leg. It occurs due to Sheeta Guna of Vata.

4) Muhuspandana (Twitching)

Muhuspandana is a sensation of something pulsating or

throbbing. This also occur along the distribution of Gridhrasi Nadi

(sciatica nerve), which starts from Sphika (hip) towards the Jangha

(calf).

5) Sakthanaha Kshepanam Nigrhaniyat (SLR - Test)

Sushruta has mentioned this symptom commenting upon this,

Dalhana opines that the Kandara that restrict the movement of the

limb called Gridhrasi. The word ‘Kapha’ means Prasarana (extension).

The patient has to keep the legs in the pain is more increase.

Conceptual Contrive

25

Acharya Vagbhatta has used the word ‘Utkshepana’ in the place

of ‘Kshepa’ which means that the patient is unable to lift the leg

(flexion of the hip joint). Arundatta has very clearly defined this by

using the term “Pada Uddharne Ashakti” means the patient is unable

to elevate or lift the leg as like SLR Test in sciatica.

6) Deha Pravakrat (Sciatic scoliosis)

Madhava has mentioned these symptoms of Gridhrasi meaning

that lateral or forward bending of the body. On account of pain patient

tries to keep the leg in flexed position and to put his body weight on

normal leg and gives a typical posture. This symptom may be taken as

sciatica scoliosis mentioned in modern medical texts.

7) Tandra (Torpor)

Tandra is one of the symptoms of Vata-kaphaja Gridhrasi

mentioned by Charaka, Madhava and Bhavaprakasha. Sushruta and

Vagbhatta have given the definition of Tandra. According to them,

Tandra is the outcome of the vitiated Vata and Kapha and in case of

Gridhrasi also, domination of Vata and Kapha causes Tandra.

8) Gaurava (Heaviness)

Only Charaka has mentioned this symptom. Gaurava is feeling

of heaviness of the body. It is due to Kapha Desa so, when the Kapha

is vitiated in the Vatakaphaja type of Gridhrasi, Gaurava occurs.

9) Arochaka

Charaka, Madhava and Bhavaprakasha have mentioned this

symptom in Vata-kaphaja type of Gridhrasi. It is a subjective

symptom where the patient loses that but the appetite remains intact.

Comparing to Vata, Kapha has got some more role in the

manifestation of Arochaka because Jihva is an organ of taste and seat

of Bodhaka Kapha. So, it is deal that the symptom Arochaka is due to

the vitiation of Kapha, especially Bodhaka Kapha.

10) Agnimandya (Anorexia)

Agni is referred to as the state of Pachaka Pitta in the body and

when it is affected by the vitiated Kapha, Pachaka Pitta fails to

perform its normal function. This may be due to the antagonistic

Conceptual Contrive

26

properties of Pitta and Kapha. So, in the case of Gridhrasi also where

Kapha is dominant, role of Ama must be taken into consideration of

Agnimandya leads to the formation of Ama which in turn produces

further Agnimandya.

11) Mukha Praseka (Excessive salivation)

Madhava and Bhavaprakasha have mentioned these symptoms

in Vata-kaphaja type of Gridhrasi. This is a condition of excessive

salivation and caused by Kapha. According to some Acharyas it is

caused by involvement of Ama.

12) Bhaktadwesha (Aversion of food)

Madhava and Bhavaprakasha have mentioned this symptom in

case of Vata-kaphaja type of Gridhrasi. Aversion towards food

substances in consider as Bhaktadvesha, it is produced due to the

involvement of Kapha and Ama. Its psychological aspect may also be

kept in mind while dealing with this symptom.

13) Staimitya

Only Harita has described this symptom. Staimitya is the feeling

of wet cloth wrapped around body part. This is due to Kapha vitiation.

This can be compared with cold or clamp hand and feet due to

vasomotor instability.

Upashaya-Anupashaya

Upashaya is the suitable use of drug, diet and behavior which

are contrary to the etiology or disease or which produce effect of

contrary to them on the other hand Anupashaya aggravates the

disease. Satmya, Pathya and Upashaya have the same meaning.

As being a Vatavyadhi, the general Upashaya and Anupashaya

are applicable to Gridhrasi also. They are as follow –

Upashaya Anupashaya

Ahara : Godhuma, Masha,

Puranashali, Patol, Vartak, Kilata,

Rasona, Taila, Ghrita, Kshira, Tila,

Draksha, Dadima etc.

Mudga, Kalaya, Brihatshali,

Yava, Rajmasha, Kodrava,

Kshara, bitter & astringent

taste etc

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27

Vihara : Abhyanga, Tarpana,

Swedana, Nirvata Sthana, Atapa

Sevana, Nasya, Ushnapravarana,

Basti etc.

Chinta, Bhaya, Shoka,

Krodha, Vegavidharana,

Chankramana, Annasana,

Ativyavaya, Jagarana etc.

SAMPRAPTI OF GRIDHRASI

The term Samprapti is applied to express the course of the

appearance of disease rightfrom Nidanasevana to Vyadhi Utpatti. The

knowledge of Samprapti helps in the comprehension of the specific

features of a disease like Dosha, Dushya, Srotodushti, Ama and Agni

etc. The study of Samprapti Vighatana is said to be done by

treatment.

Charkacharya has described six types of ‘Samprapti’ namely

Sankhya, Vidhi, Vikalpa, Prudhnya, Bala, Kala (Ch. Chi. 1/11).

Sushruta has described Samprapti process in six stages Sanchaya,

Prakopa, Prasara, Sthanasanshraya, Vyakti and Bheda known as

Satkriyakala. During Sthansanshraya Avastha the vitiated Dosha are

said to have reached to particular Sthana and get obstructed here and

intimately mix with and vitiate one, two or more Dushyas in that

particular portion of body. This is the reason that though Nidana of all

the Vatavyadhi are same but only due to the Samprapti Vishesha of

disease Vata can produce so many Vata disorders. If vitiated Vata is

accumulated in Kati and lower extremities by Srotosanga it produces

Gridhrasi.

Ashtanga Sangrahakara has mentioned that –

(A.

S. Ni. 15/15)

Except that no specific Samprapti of Gridhrasi is mentioned in

classics. It is enlisted under the 80 types of Nanatmaja Vatavyadhi,

thereafter its Samprapti Vyapara is on the similar lines of Vatavyadhis

hence predominance of Vata Dosha in its Samprapti is clear.

Gridhrasi is Shula Pradhana Vatavyadhi and Shula (pain) can not be

produced without involvement of Vata Dosha. In its normal state Vata

governs Utsaha (enthusiasm), Swasa-Nishwasa (respiration), Cheshta

Conceptual Contrive

28

(all motor activities), Vegapravartana (regulation of natural urges),

Dhatunam Samyakgati (the regulation of circulation and functioning

of seven fold dhatu) Akshapatav (proper functioning of sensory

organs). Thus the function ascribed to Sharira Vayu in the ancient

medical classics are exactly those which modern physiology ascribed

to the nervous system. It has been observed that in all Vatavyadhis

some nervous disorder present. As in Gridhrasi spinal nerves of the

lumbo-sacral plexus and mainly sciatic nerve is hampered.

On the basis of symptomatology given in classics, the probable

Samprapti of Gridhrasi can be traced out as below –

Dosha - Vata – Especially Vyana and Apana, Kapha

Dushya - Rakta, Mamsa, Meda, Asthi, Majja, Sira,

Kandara, Snayu

Srotasa - Raktavaha, Mamsavaha, Medovaha,

Asthivaha, Majjavaha

Srotodushti Prakara - Sanga, Margavarodha

Agni - Jatharagni and Dhatwagni

Ama - Jatharagnijanya and Dhatwagnijanya

Udbhavasthana - Pakwashaya

Sanchara Sthana - Rasayanis

Adhisthana - Kandaras of Parsani and Pratyanguli and

Sphika, Kati, Uru, Janu, Jangham, Pada

Vyakta Rupa - Ruka, Toda, Stambha in Adhosakthi, Uru,

Janu, Jangha and Pada, Arochaka, Tandra,

Gaurava

For better understanding of involved factors, it is desire to like

look at individual factor.

1) Dosha :

According to the texts, Vata is the essential dosha for the

manifestation of disease ‘Gridhrasi’. Kapha is in the form of

Anubandha. It is also well known that the Prakopa of Vata may occur

in two ways - due to Dhatukshaya and Margavarodha (Ch. Chi.

28/50). In case of Dhatukshaya, continuous ingestion of food

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29

materials which are Ruksha, Laghu, Sheeta, Sushka in nature

Ratrijagarana, Vegavidharana, Pramitasana and all such causes lead

to Dhatukshaya and it leads direct Sanchaya and Prakopa of Vayu. In

the case of Margavarna, Kapha is an important factor, particularly for

producing Vata-kaphaja type of Gridhrasi. According to the

commentators Pittaja Gridhrasi is not found. However in rare cases,

there may be burning sensation along with pain.

According to Sushruta, in Gridhrasi Sakthanah Kshepam

Nigrahaniyat is found. The Kshepana, Utkshepana etc. are the Karma

of Prakruta Vyana Vayu. Causes and Adhisthana of Gridhrasi are

resembling to causes and Adhisthana of Apana Dushti. Hence, out of

five types of Vata, Vyana and Apana are the especially vitiated.

2) Dushya

Acharya Sushruta says that, in Gridhrasi the vitiated Doshas

affects the Kandara and thus manifestation of the disease occurs.

According to Charaka, Kandaras ar the Upadhatu of Rakta dhatu (Ch.

Chi. 15/17). Chakrapani mentions that Sthula Snayu may be taken

as Kandara (tendon) (Ch. Su. 11/48). Now, according to Charaka,

Mulasthana of Mamsa is Snayu and Snayu is an Upadhatu of Meda.

(Ch. Vi. 5/10; Ch. Chi. 15/17).

On the other hand Sthana of Vayu has been mentioned as Asthi

and there is an inverse relation between Vayu and Asthi. For example,

increasing Vayu causes Asthikshaya and it leads to the further

Prakopa of Vata.

As Gridhrasi Nadi vitiated in this disease, some Acharyas

correlate nervous tissue with Mastulunga and thus to Majja. So, in

disease Gridhrasi Rakta, Mamsa, Meda, Asthi, Majja, Sira, Kandara

and Snayu may be taken as Dushya.

3) Srotasa

As mentioned above, here Rakta, Mamsa, Meda, Asthi and Majja

Dhatus are vitiated. So, their respective srotasa may also be vitiated in

this disease. Hence, the Srotasa involved may be taken as Raktavaha,

Mamsavaha, Medavaha, Asthivaha and Majjavha Srotasa.

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30

4) Srotodushti Prakar :

Sanga and Margavarodha type of Srotodushti is found in

Gridhrasi. Sanga of Dosha produces Stambha, Gaurava, Sphurana,

etc. lakshana of Vata-kaphaja types of Gridhrasi and Margavarodha

leads to Toda, Ruka etc. symptoms of Vatika type of Gridhrasi.

5) Agni :

Jatharagni and Dhatwagni of Rakta, Mamsa, Meda, Asthi and

Majja Dhatu may be vitiated in this disease.

6) Ama :

When the Agni is vitiated automatically respective Ama is

formed. So, in this disease Jatharagnijanya and Dhatwagnijanya Ama

of Rakta, Mamsa, Meda, Asthi and Majja Dhatu is produced.

7) Udbhavasthana :

The main Udbhavasthana of this disease is Pakvashaya because

it is a Nanatmaja Vatavyadhi – Amashaya may be considered as an

Udbhavasthana of Vatakaphaja type of Gridhrasi.

8) Sanchara Sthana

Here, Sancharasthana of the vitiated Dosha is the Kandara

which is situated in either side of the limb between Parshni and

Anguli as mentioned by Sushruta.

9) Adhisthana :

According to Charaka, Kati and Sphika are the initial sites from

where the disease starts and then respectively affects Uru, Janu,

Jangha and Pada. According to Sushruta, vitiated Dosha affects

Kandara of Parshani, Pada and Anguli.

Thus, Sphika, Kati, uru, Janu, Jangha, Pada and Kandara of

Parshani, Pada and Anguli may be taken as Adhisthana of the disease

Gridhrasi.

SAPEKSHA NIDANA OF GRIDHRASI

Sapeksha Nidana is the comparison of similar features, which

are found in many diseases. Here in case of Gridhrasi, there is no

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confusion in diagnosis, because Gridhrasi shows a very clear cut

Lakshana Sammucchaya of radiating pain in the lower extremities,

but there are some disease which resembles with Gridhrasi. They are

as follow –

1) Uru Stambha

2) Khalli

3) Khanja

4) Pangu

5) Gudagata Vata

The Sapeksha Nidana of Gridhrasi from the above said disease

can be made by considering the following points :

In Uru Stambha, there is affection of one or both the legs. The

leg becomes painful, cold, motionless and the patient feels that the

legs are not the part of his own body. The patient is unable to stand,

to step or to walk. There is also Supti or numbness. The condition is

acute with fever and swelling of the legs. Though the patient is unable

to lift the legs and the legs are painful but the pain is neither radiating

nor it is restricted to the posterior portion of the legs, which is in case

of Gridhrasi. In Gridhrasi, symptoms like Jwara and Shotha are not

found which are generally present in Urustambha. A patient of

Gridhrasi possesses sensation and does not have that strange feeling

that the legs do not belong to himself. So, from the typical pain

Gridhrasi can be easily diagnosed from Urustambha.

In Khalli, the severity of pain is more than Gridhrasi and

generally it is proximal in nature.

In Khanja and Pangu, the cardinal symptoms are Shosha

(wasting) and paralysis which may present in the Gridhrasi as a late

complication.

In Gudagata Vata, in addition to pain in the foot additional

symptoms like Shosha, retention of faeces, urine and flatus, colic,

flatulence and formation of stone (Ashmari) may also be present which

are not present in Gridhrasi.

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SADHYATA – ASADHYATA

The Sadhyata-asadhyata or prognosis of a disease depends on

many factors such as the Bala of Nidana or Hetu, the strength of

Dosha Prakopa, the Sthana of the disease, severity of signs and

symptoms, duration of the disease etc. It also depends upon the age,

sex, Rogamarga, Dhatudushti etc. These common rules are applicable

in the case of Gridhrasi. In addition, Gridhrasi is a Vatavyadhi and

the Svabhava or natural trend of Vayu is also an important factor.

Acharya Sushruta has counted Vatavyadhi as Mahavyadhi which is

cured with difficulty. He also says that if the patient of Vatavyadhi

develops the complication like Sunam (edema/inflammatory),

Suptatvachan (tactile senselessness), Bhagna (Fracture), Kampa

(tremors), Adhamana (distention of abdomen with tenderness) and

pain in internal organs, then he doesn’t survive (Su. Su. 33/7).

According to Acharya Charaka, if Vatavyadhi is connected with

Sandhichuti, Kunjanam, Kubjata, Ardita, Pakshaghata, Anshashosha,

Panguta and those which are Majja and Asthigata are usually cured

with difficulty or even incurable.

In disease Gridhrasi, the vitiation occurs in the Sphika, Kati,

Prishtha regions involving the Sandhi and Sandhibandhana in these

area which will ultimately give rise to the vitiation of the Gridhrasi

Nadi which is a structure developing from the Majja. So, Gridhrasi by

nature is Kashtasadhya. Still however if the patient comes earlier for

the treatment and if given prompt proper treatment in sufficient dose

and duration, then the patient is likely to be cured or less likely to

suffer from a subsequent attack of pain. In case the changes in the

spinal joints or an advanced nature of the disease or if the Gridhrasi

Nadi got intense vitiation, then even the best treatment is not likely to

be cured.

When the Gridhrasi is associated with Vata and Kapha Dosha,

the Chances of cure are easier than that when it is occurred due to

keval Vata Dosha.

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33

UPADRAVAS

The Upadravas of the Gridhrasi are not described in the texts.

In practice, the following things may be considered as Upadravas.

Khanjata : It has been already mentioned that on account of

the inability of complete extension and lifting the leg, the patient has

to keep the leg in a semi-flexed and averted portion. This gives rise to

limp in walking.

Shosha : Gridhrasi is a Vatavyadhi affecting the Vata Nadi on

account of pain, all movements are restricted in the affected leg.

Continuous pain restricts the patient to make minimum movement

and the Mamsa undergoes Shosha. Dehapravakrata, inability to walk

and crippling are the other Upadravas.

CHIKITSA SIDDHANTA OF VATAVYADHI W.S.R. TO GRIDHRASI

The treatment of the disease is called Chikitsa. The first and the

foremost principle to be adopted in the treatment of each and every

disease is to avoid the Nidana of the disease i.e. Nidana Parivarjana.

Secondary the intensity of the Dosha Prakopa should be

considered before deciding the line of treatment.

If the Dosha Prakopa is minimum Langhana Chikitsa is enough,

if the intensity of Dosha Prakopa is moderate Langhana and Pachana

treatment is given. If however dosha Prakopa is maximum, Shodhana

treatment is decided.

Gridhrasi being a Vatavyadhi, the general treatment of

Vatavyadhi is applicable to Gridhrasi also. In the Upkrama of Vata,

Snehana, Swedana, Mrudu Samshodhana and Basti has been

advised. Vagbhattacharya, in the Sutra of Vatopakrama has advised

Madhura, Amla, Lavana and Ushna Ahara. Oils ndd Ghrita with

jaggery and starch, Abhyanga, Parisheka, Mardana and Basti. There

are different types of Snehana, Swedana only. Lastly ‘Trasana’- a type

of psychological treatment is mentioned to bring the Prakupita Vata to

its normal Sthana. Thus, this is the general treatment applicable in all

Vatavyadhi.

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SPECIFIC TREATMENT OF GRIDHRASI

Generally Snehana, Swedana, Vamana, Virechana, Niruha and

Anuvasana Basti, Siravedha, Raktamokshana, Agnikarma and

Shastrkarma are advised by different Acharyas. The following table

shows as to which Karmas are advocated by which classics.

Treatment Ch. Su. A.H. B.P. Y.R. H.S. B.S. C.D.

Snehana - - - - - + + +

Swedana - - - - - + - +

Vamana - - - + - - - +

Virechana - - - + - - - +

Niruha Basti + - - - - - - -

Anuvasana Basti + - + + + - + +

Siravedha + + + - + - - +

Raktamokshana - - - - - + + -

Agnikarma + - + - + + - +

Shastrakarma - - - - - - - +

In Charaka Samhita, Basti Karma – Niruha and Anuvasana

Basti, Siravedha and Agnikarma (between Kandara and Gulfa) has

been mentioned in the treatment of Gridhrasi. sushruta has advised

Siravedha at Janu after Sankochana (flexion) in Gridhrasi.

Ashtanga Sangraha and Ashtanga Hridaya have also advised

Siravedha four Angula above and below the Janu. They mentioned

Agnikarma and Anuvasana Basti also. Chakradatta has given the

treatment of Gridhrasi in details. He has stressed that Basti should be

administered after proper Agni Dipana, Pachana and Urdhva

shodhana. He has said that administration of Basti before

Urdhvashuddhi (purification by Vamana, Virechana etc.) is

meaningless. He has mentioned a small operation with prior Snehana

and Swedana to remove Granthi in Gridhrasi and also Siravedha four

Angula below Indrabasti Marma. If not relieved by this treatment then

Agnikarma at Kanishthika Anguli of Pada has been suggested. He has

given number of formulations like Churna (powder) of Dashmoola,

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Bala, Rasna, Guduchi and Sunthi along with eranda taila. Decoction

of Sephalika or decoction of Panchamool with eranda taila and Trivrita

Ghrita, Rasnadi Guggulu, Trayodashanga Guggulu, Chyagaladya

Ghrita, Saindhavadya taila, Kubjaprasarani taila. Also recipes like

Erandaphala Payas and Vartaku Prayoga (vegetable of Bringles in

castor oil) etc. are suggested.

Bhavaprakasha has advised Vamana and Virechana before

administration of Basti. The patient should take Gomutra with castor

oil for one month. Also Taila, Ghrita, Matolonga and ginger Swarasa

taken with Chukra and Guda are useful in Shula of Kati, Uru,

Prishtha, Trika and Gulma, Gridhrasi and Udavarta. Eranda churna

boiled with milk and the decoction of Erandamoola, Bilva, Brihati and

Kantakari is mentioned for the chronic Gridhrasi. The decoction of

Sinhasya, Danti and Krutamalaka along with Eranda Taila is advised

for the Gridhrasi patients who can not walk. Specific treatment for

Vata-kaphaja Gridhrasi has been given. He has advised Gomutra +

castor oil + Pippali churna to be taken for a long period to eliminate

Vata-kaphaja Gridhrasi.

The external Twak of Bakana is useful for chronic Gridhrasi.

Beside decoction of Sephalika leaves, Rasna Guggulu is also advised

in Gridhrasi.

Yogaratnakara has advised Siravedha in the area of four Angula

around Basti and Mutrendriy. If this fails Agnikarma in the little finger

is advised. He has mentioned Mahavishagarbha Taila, Vajigandhadi

Taila, Lasuna (garlic), Panchamula Kashaya for Basti or for oral use

and Saindhava oil for oral use Mahanimba Kalka and Rasnadi

Guggulu are also advised. Besides, Eranda Taila is also useful with

Gomutra.

Sharangadhara has described decoction of Dashmula or

Nirdundi with Pushkaramula and Hingu, decoction of Rasna Saptaka,

Mahanimba and Rasna Kalka, Prasarane, Mashadi or Narayana Taila.

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Harita has advised Raktamokshana followed by Snehana,

Swedana, and if there is no response then Agnikarma four fingers

above the Gulfa with iron rod is advised. Fanta of Dravya like

Shatavari, Bala, Atibala, Pippali and Pushkarmoola if taken with

Eranda Taila cures Gridhrasi. He has also mentioned that whatever

Pathya in Vata Vikara is Pathya in this disease also.

Bhela has mentioned Sneha Unmardana and Sneha Basti,

Raktamokshana is mentioned as the best treatment of Gridhrasi. He

has also mentioned Bala Taila, Mullaka Taila and Sahacharadi Taila

for local application.

Chakradatta has described decoction of Sephalika leaves as best

for chronic Gridhrasi.

Bhaishajya Ratnavali has given treatment similar to

Chakradatta.

Besides the above remedies Akangavira Rasa Vatagajankusha

Rasa, Trayodashanga Guggulu, Ajmodadi Churna, Narayana Taila,

Mahavishagarbha Taila etc. have been mentioned by different authors

in the treatment of Gridhrasi.

REPRESENTATION OF PROBABLE SAMPRAPTI OF GRIDHRASI

NIDANA

Kha-vaigunyakaraka AgnimandyakaraVata Prakopaka

Nija(Dhatukshayajanya

Ahara Vihara)

Agantuka(Abhighata,

Prapatana, etc.)

Vata Prakopa

Kha-vaigunya(Sphika, Kati, Prishtha,Asthi, Majja & Kandara)(Ch. Vi. 5; Su. Su. 15)

Dhatukshaya & KandaraDushti (Vyana produceKharatva, Rukshatva,

Laghutva)

Sthanasanshraya(in Sphika, Kati,Prishtha, etc.)

Dosha DushyaSammurchchhana

Vataja Gridhrasi Vata-kaphaja Gridhrasi

Agni Daurbalya

Production of Ama

Production ofAvaraka DoshaSu. Ut. 56/20

Vata Prakopa dueto Avarana

AchayapurvakaSanchayapurvaka

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SCIATICA – A MODERN CONCEPT

Gridhrasi, according to its sign and symptoms can be compared

to sciatica in modern medical science and numbers of Ayurvedic

authors also recently have combined Gridhrasi as sciatica. Hence, the

disease sciatica will be discussed in detail in this chapter.

History of The Disease

Modern knowledge of the disease sciatica seems to be only four

centuries old. First time in 1608 Shakespeare William has wrote about

sciatica in Limon of Athen – IV (Armstrong J. R. 65). In 1764, an

Italian Dominico described sciatica as a clinical entity. In 1805, the

full account of the anatomical structure of the disc and their

pathological changes were published by Virchow and Vanluschka. The

close association between sciatica and low back pain was not clearly

recognized until 1864, when Lasegue – a Paris Neurologist drew

attention to the importance of straight leg raising sign in sciatica.

Later shown to be due to stretching of the sciatic nerve. The

characteristic posture of the patient with sciatica and sciatic scoliosis

were described by Chartcot in 1888. In 1927, Putti suggested that

irritation or inflammation of the sciatic nerve can be classified

according to the site of casual lesion and would be correlated with

associated low back disorders.

In 1933, Mixter and Barr pointed out that compression of

caudaequina or nerve roots were caused by herniation of inter

vertebral disc which is also cause of unilateral sciatica. Though,

Schmoral had extensively done anatomical and radiological

investigations on 3000 vertebral column removed at autopsy, it didn’t

lead him to think the herniation of disc material posteriorily had any

significance. He was more impressed with the herniation of the disc

material in the vertebral body, the famous Schmoral’s node. In1941,

lumbar disc protrusion was reported in the patients with relapsing of

low back ache and sciatica by American neuro-surgeon Walter Dandy.

Mental stress was suggested as a precipitating factor of low back pain

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by Lindbloom and Scott in 1952. in 1970, Cotunnius Somenico,

Nepolitan anatomist described the condition sciatica as neuralgia of

the sciatic nerve. Neuralgia is a modern term for somewhat indefinite

pain in the area supplied by one nerve. The term seems to have come

in use about the beginning of the 19th century, entering English from

French. (Henary Alana Skinnre, 1949).

Introduction & Definition :

Aches and pains in the musculoskeletal system are common

features of every day life. Each year about 40% of the population

develop some symptoms relating to their locomotor system. The

commonest locomotor system is low back pain.

Sciatica is a symptom of a problem at some point along the

sciatic nerve rather than an ailment in and of itself. In sciatica there is

pain, weakness, numbness and other discomfort along the path of the

sciatic nerve. A herniated disc in the back, spinal stenosis and

piriformis syndrome are medical disorders that can cause sciatica.

Individuals who have sciatica are often crippled by it, and are driven

to seek relief from conventional medical treatment, alternative

therapies and miracle cures.

Sciati (Si-at-ik) (L-Sciaticus, Gr – ischiadikas) – pertaining to or

located near the ischium, as the sciatic nerve or vein. (Dorland’s

Medical Dictionary).

Sciatica “A syndrome characterized by pain radiating from the back

into the buttock and into the lower extremities along its posterior

or lateral aspect and most commonly caused by prolapsed of the

intervertebral disc, the term is also used to refer to pain anywhere

along course of sciatic nerve. (Dorland’s Medical Dictionary).

Sciatic – (Si-at’ik) (Mediew-L-Sciaticus, a corruption of Gr –

Ischiadikos Fr – ischion, the hip joint, ISCHI).

1) Relating to or situated in the neighborhood of the ischium

or hip joint.

2) Relating to sciatica.

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Sciatica – Sciatica is the name given to a painful condition,

commencing from the buttock and radiates posterior surface of the

thigh, outer and posterior surface of the leg and outer side of the

foot, more or less comprising of the area of distribution of great

sciatic nerve. This affection is often unilateral but may occasionally

bilateral also. (Bed side Medicine).

Anatomy And Physiology Of Sciatic Nerve :

The sciatic nerve is the largest and longest nerve in the human

body, about as big around as a thumb (2 cm) at its largest point. The

nerve arises from the sacral

plexus which is situated largely

anterior to the sacral and formed

by the ventral rami of the spinal

nerves L4 – L5 and the 1st, 2nd

and 3rd (S1, S2, S3) sacral spinal

nerves. Thus, the five nerves

group together on the front

surface of the piriformis muscle

(in the buttocks) and become

one large nerve – The Sciatic

Nerve. This nerve travels then

down the back of each leg,

branching out to innervate

specific regions of the leg and

the foot. Though the two main

divisions of sciatic nerve i.e. the

tibial nerve (medial popliteal)

and the common peroneal nerve

(lateral popliteal) are bound

together by common sheath of

connective tissue, they are

separable upto the sacral plexus

because of its different root value.

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Root Value :

The tibial part of the sciatic nerve derives its fibers from the

ventral division of the ventral rami of L4 – L5 and S1, S2, S3 whereas

the common peroneal part of the sciatic nerve derives its fibers from

the dorsal division of the ventral rami of L4, L5, S1 and S2.

Course And Relation :

1) In The Pelvis :

The nerve lies in front of the piriformis, under cover of its fascia.

2) In The Glueteal Region :

The sciatic nerve enters the gluteal region through greater

sciatic foramen (below the piriformis). It runs downwards with a slight

lateral convexity, passing between the ischial tuberosity and the

greater trochanter. It has a following relation in the gluteal region.

a) Superficial (Posterior) : Gluteal maximus and sometimes the

posterior cutaneous nerve of the thigh.

b) Deep (Anterior) : i) Body of the ischium and nerve to the

quadratus femoris; ii) Tendon of the obturator internus with

the gemelli; iii) Quadratus femoris, obturator externus, and

ascending branch of the medial circumflex femoral artery; iv)

The capsule of the hip joint which lies deep to the

forementioned muscles and v) the upper, transverse fibers of

the adductors magnus.

c) Medial : i) Inferior gluteal nerve and vessels, ii) Sometimes the

posterior cutaneous nerve of the thigh.

3) In The Thigh :

The sciatic nerve enters the back of the thigh at the lower

border of the gluteus maximum, and runs vertically downward upto

the superior angle of the popliteal fossa (at the junction of the upper

2/3rd and lower 1/3rd of the thigh) where it terminates by dividing into

the tibial and the common peroneal nerve. It has the following

relations in the thigh.

a) Superficial (Posterior) : The sciatic nerve is crossed by the

long head of the biceps femoris.

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41

b) Deep (Anterior) : The nerve lies on the adductor magnus.

c) Medial : The posterior cutaneous nerve of the thigh, the semi-

membranous and the semi-tendinosus.

d) Lateral : Biceps femoris.

The division into tibial and common peronneal takes place

usually at knee or at any point between the pelvis and the lower 3rd of

the thigh.

Tibial Nerve (Medial Popliteal Nerve) :

This is the longer terminal branch of the sciatic nerve. It

supplies the skin of the lateral and posterior part of the lower 1/3rd of

the leg. It runs downward through the popliteal fossa, lying first on

the lateral side of the popliteal artery, then posterior to it and finally

medial to it. The popliteal vein lies in between the nerve and artery

throughout its course. The nerve enters the posterior compartment of

the leg by passing beneath the soleus muscle. It’s branches are as

below :

1) Medial Planter : It supplies the abductor hallusis, flexor

digitorum brevis and flexure hallucis brevis muscles; skin

over medial 2/3rd of planter surface of the foot.

2) Lateral Planter : It supplies remaining muscles of a foot not

supplied by medial planter nerve. Skin over lateral 3rd of

planter surface of food.

Common Peroneal Nerve (Lateral Popliteal Nerve) :

This is the smaller terminal branch of the sciatic nerver arises

in the lower 3rd of the thigh. It runs downward through the popliteal

fossa, closely following the medial border of the biceps muscle. It

leaves the fossa by crossing superficially the lateral head of the gastro

nemius muscle. It then passes behind the head of the fibula, winds

laterally around the neck of the bone, pierce the peroneus longus

muscle and divides in two terminal branches.

1) Superficial peroneal nerve : It supplies the peroneus longus

and pernoneus brevis muscles; skin over distal 3rd of anterior

aspect of leg and dorsum of foot.

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42

2) Deep peroneal nerve : It supplies tibialis anterior, extensor

hallucis longus, peroneus tertius and extensor digitorum

longus and brevis muscles; skin on adjacent side of great

and second toes.

SCIATIC NERVE INJURY

Complete lesion of this nerve is very rare and will cause

complete paralysis of hamstring muscles and all the muscles below

the knee. Subtrachanteric fracture of femur or posterior dislocation of

the hip are most common cause of incomplete lesion of this nerve.

Common peroneal part of this nerve is most often affected than the

medial tibial part in injury to the sciatic nerve.

1) Common Peroneal Nerve (Lateral Popliteal) :

This nerve supplies the extensor and peroneal groups of

muscles of the leg as also through its musculo-cutaneous branch it

supplies the anterior and lateral aspect of the leg and whole of the foot

and toes except the skin between the great and second toe which is

supplied by its deep peroneal nerve. So, injury to this nerve will result

in the foot drop and talipes equinovarus deformity. The patient will be

unable to dorsiflex and evert the foot. The sensory loss will affect the

anterior and lateral aspect of the leg, dorsum of the foot and toes.

2) Tibial Nerve (Medial Popliteal) :

This nerve is rarely injured except in open wounds. This nerve

supplies the muscles of the calf e.g., the soleus, the gastronemius, the

popliteus, the plantaris, the tibialis posterior, the flexor digitorum

longus and the flexor hallucis longus. Through sural nerve it supplies

the lateral part of the leg and sole and through plantar nerve it

supplies the sole. So, injury to this nerve will make the patient unable

to plantar flex his ankle with loss of sensation of the whole of the sole.

Thus, this deformity is known as talipus calcaneovalgus or claw foot.

Causes of Sciatica :

Sciatica can occur due to variety of pathological lesions, the vast

majority of all cases of sciatica is due to herniation or degenerative

changes in lumbar intervertebral disc, spondylosis or sacroiliac

Conceptual Contrive

43

diseases. But there are some predisposing causes towards herniation

and degenerative changes such as there is often history of trauma as

twisting of the spine, lifting heavy objects or exposure to cold. Motor

vehicle driving is also positively associated with HNP and sciatica. Age,

sex, body weight, occupation, environmental factors etc. also play an

important role in producing such type of conditions. In females

Instrumental delivery may be a cause of sciatica. There are many such

diseases of spinal cord, cord space, vertebral column, pelvis etc. which

exert mechanical pressure on the nerve root or nerve and presents as

sciatica. The causes are grossly divided in the following manner.

1) Intraspinal causes :

Prolapsed intervertebral disc

Arachanoiditis

Intraspinal tumor

Osteoarthritis

Tuberculosis of the lumbar spine

Osteomyelitis

Developmental narrowing of the lumbar canal.

Malformation of lumbar root

2) Pressure or irritation at intervertebral foramina :

Osteoarthritis

Spondylolisthesis

Ankylosing spondylitis

Paget’s disease

3) Pressure or irritation in course of nerve

Inflammation or malignant disease of pelvic viscera

Injury to nerve itself

Tumor of nerve sheath

Peripheral neuritis

4) True sciatic neuritis :

Leprosy

Polyarteritis nodosa

Nerve injury due to injection or trauma

Post herpatic neuralgia.

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44

PATHOLOGY

The intervertebral discs serve the purpose of “shock absorbers”.

Each disc is composed of three distinct morphological parts namely,

the cartilaginous plates, the annulus fibrosus situated peripherally

and the nucleus pulposus held in position by the annulus fibrosus.

The cartilaginous plates cover the superior and inferior surfaces of the

disc and are connected to the intervertebral surfaces of adjacent

vertebral bodies by calcified cartilage. The

cartilaginous plates and the annulus

fibrosis enclose the semi-gelatinous

nucleus pulposus which does not lie free in

the disc but is formed by interlacing fibers

in which is embedded the semigelatinous

matrix of mucoid material, interspersed

with cartilage cells. The nucleus pulposus

is held in position by the annulus fibrosus and the cartilaginous

plates under tension; it is incompressible, tough and plastic in

character. On the other hand, the annulus fibrosus is compressible

and elastic.

The intact disc is very resistant to injuries and is not damaged

under conditions of compression which are adequate to fracture the

vertebral bodies. However, the disc is liable to degenerate becoming

more rigid and drier with advanced in age; it may become soft during

pregnancy or may be damaged by repeated injuries. Progressive

degeneration of the disc with loss of elasticity and resilience may lead

to its thinning or to a partial posterior rupture; the rupture may be

the result of a severe trauma or may occur during the course of

ordinary activities of a person. The nucleus usually ruptures postero-

laterally, but sometimes it may herniate through the superior or

inferior cartilaginous plate (vertical ruptures), in which case it

herniates into the adjoining vertebral body and gives characteristic X-

ray picture known as Schmorl’s node. Usually, prolapse of the

intervertebral disc takes place when the nucleus pulposus appears

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45

through a tear in the annulus fibrosus under the posterior

longitudinal ligaments. Midline protrusion of the disc is possible

though rare and, when it occurs in the lumber region depending on its

size, it may cause compression of one root, the roots of both sides of

one segment of cord or on all roots of the cauda equina. Herniation of

more than one disc has also been occasionally observed.

The incidence of herniation of the disc is by far the highest in

the lumber region and of 500 cases analyzed by Love and Walsh, 96

percent showed lumber prolapse and only 4% cervical or thoracic

prolapse. Of the lumber discs, the commonest to

herniate is the one between the 4th lumber and 5th

(about 90%), less commonly between the 5th lumbar

and the first sacral, or the one between the 3rd and

the 4th lumbar vertebra. The reason why the

incidence is so high in the lumbosacral region is on

account of mechanical factors. The annulus firbrosus

is weakest posteriorly and the first change in the disk

is a posterior herniation of the annulus, soon followed

by its rupture and then a prolapse of the nucleus pulposus through

the postero-lateral tear, separated from the vertebral canal and its

contents by the posterior longitudinal ligament. It is due to the

pressure of this prolapsed nucleus pulposus on the adjacent nerve

root or roots that the symptoms of sciatica arise. Moreover, the

nucleus contains nerve fibers and is sensitive to pain. The intra-spinal

extra-dural nerve roots are relatively fixed in position and hence are

vulnerable by pressure from the prolapsed nucleus pulposus.

A spontaneous rupture of the annulus is a rare phenomenon

and the normal anatomy is never restored. The nucleus pulposus also

does not regain its elasticity and the tear in the annulus fibrosus is

also not likely to heal completely. However, it is pertinent to state that

Falconer, McGeorge, and Begg and Dandy pointed out that sometimes

the protrusion of the nucleus pulposus through a tear in the annulus

fibrosus under the posterior longitudinal ligament is likely to return

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46

through the same tear and this condition has been known as “mobile

prolapse”, “concealed ruptured disc” or “intermittent prolapse”.

Herniation of the nucleus pulposus arises in a hyper-extended

position of the vertebral column. A severe trauma can cause

herniation of a disc even in a younger individual where changes of

degeneration may not have set in. This, however, is a rare occurrence

and, in most of the cases of disc herniation, degenerative changes in

the disc are supposed to have preceded the trauma, the later being a

predisposing or precipitating factor. It has been stated that in some

cases an infection of the disc rather than trauma is the responsible

factor.

Signs And Symptoms :

Sciatica doesn’t have symptoms. It is a symptom itself

consisting of pain, burning, tingling or electric shock like feelings in

the path of the sciatic nerve. It usully results from injury to the fibers

that make up the sciatic nerve. So in sciatica there is a pain which

begins in the lower back and radiates through the buttock, thigh, leg,

calf and occasionally the foot. There may be the symptoms in all these

areas or only in a few of these areas. The order in which the symptoms

appear may vary. Sometimes the back pain comes before the sciatica

and sometimes it will follow. The initial complaint of the patients is

usually acute severe pain in the lumbar region, rigidity, immobility of

the lumbar spine, tenderness over the region – in fact, characteristic

features of lumbago. The course of such symptoms runs for months or

years and during one of such episodes typical pain of sciatica may

make its appearance. Usually the pain is unilateral since, as soon as

the nucleus pulposus herniates through at postero-lateral tear on one

side, it is no longer held under tension as in a normal subject where it

is completely surrounded by the annulus fibrosus. The unilateral

herniation presses upon the spinal nerve roots on the affected side.

Bilateral herniation through postero-lateral tear is possible, though

not common, and may give rise to bilateral sciatica.

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47

The typical symptoms of sciatica usually arise when the disc

between the 4th and 5th lumbar vertebra or the disk between the 5th

lumbar and the 1st sacral is displaced whereas if the disc between the

3rd and the 4th vertebra is involved, there is pain along the medial

aspect of the leg and diminution of sensation in the same region.

It is convenient to divide the symptoms of disc herniation into

two group namely - Spinal symptoms and Radicular symptoms.

Accordingly, the symptoms may be categorized as follows –

1) Spinal symptoms :

A reduction of the normal lordosis in the region of the lumbar

spine or even a lumbar kyphosis. Sometimes there may be even

appearance of a lumbar scoliosis.

Diminished mobility of the lumbar spine. The patient may be

asked to bend backwards and forwards without flexion at the

knee joints.

Pain particularly localized over the region of the displaced disc;

tenderness on percussion.

Muscle spasm and rigidity.

2) Radicular symptoms :

Presence of Laseague’s and straight leg raising (S.L.R.) signs

or any test purported to stretch the sciatic nerve.

Tenderness over the course of the sciatic nerve after it exit

from the pelvis.

Sciatic pain aggravated by coughing, sneezing, straining or

pressure on the jugular veins; sometimes by movements of

the head, trunk or legs.

Paraesthesia in the region of the affected dermatomes.

Sensory loss in the region of the distribution of the nerve

roots pressed upon.

Paresis or weakness of dorsiflexion of the foot on the affected

side in the case of displacement of L4, L5 disc and weakness

of planter flexion, when the disc between L5 and S1 is

herniated.

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48

Loss of deep reflexes, in case of L3, L4 displacement, there is

absence or depression of knee jerk, whereas the herniation of

L4/L5 or L5/S1 tends to diminish the ankle jerk or to abolish

it entirely.

Objective signs met with following herniation of the various lumbar

discs.

Rootcompression

Painreferred

Motorweakness

Reflexchanges

Sensorychanges

Musclewasting

L2Upper

anteriorthigh

Flexion andadduction of hip

None orreduced

knee reflex

None orupper

lateral andanteriorthigh

None

L3Anterior

thighknee

Knee extensionhip flexion and

adduction

Reduced orabsent knee

reflex

None orlower

anterior &medial

Thigh

L4

Lateralthigh,medial

calf

Foot inversion &ankle

dorsiflexion,knee extension

Reduced orabsent knee

reflex

Anteromedial calf Thigh

L5

Buttock,backside

thigh,lower leg

Extension andadductor of hip.Flexion of knee,dorsiflexion ofankle, foot andtoes eversion

Reducedankle reflex

Lateral calfdorsal &medialfood

especiallyhallux

Calf

S1

Buttock,back ofthigh

and calfto heel

Flexion knee,foot eversion

and ankleplantar flexion

Reduced orabsent

ankle reflex

Lateralfoot ankleand lowercalf back

of heel andsole of foot

Calf

Aggravation of Pain :

Back and sciatic discomfort is spondylogenic in nature. That is

to say, the pain is aggravated by general and specific activities and

relieved by rest. Bedding, stooping, lifting, coughing, sneezing,

straining at stool and on jugular compression will intensify the pain.

In short, when the sciatic nerve is put on stretch, these particular

activities vary from patient to patient. Most of the patients with

sciatica find difficulty in sitting, especially in a soft lounge chair,

including most automobile seats. Standing and walking although not

comfortable are usually more tolerable.

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49

Relief of The Pain :

Most patients get some relief from lying in the hip – knee flexed

position. Sleeping is a more comfortable position for most of the

patients when it is done with a pillow under the knees or on the

asymptomatic side in the fetal position. Some patients have so much

sciatic discomfort that there is no position of comfort. This is

especially true for the high lumbar root lesion.

Clinical Picture of Sciatica In Different Age Groups

SymptomsAdolescence (<25

years)

Adult

(30- 50 years)

Senior Adult

(55 – 80 Years)

Pain

Typical radicular

pattern, may not be

below knee.

Typical radicular

pattern, almost

always below

knee.

Typical radicular

pattern, most

severe below knee.

Paraesthesia50% chances of

being presentCommon Most common

SLR reduction Profound <50% of normalMost often >50%

of normal

Neurological signs>50% chance of

being absent

>50% chance of

being presentMost often present

Associated

degenerative

changes (spinal

stenosis)

Rare Occasional Common

Response to

conservative care

Recurrence rate of

symptoms very high

Good response to

conservative care

Limited tolerance

for prolonged care

Protrusion/

Extrusion

Protrusion very

common

Protrusion less

commonProtrusion rare

Physical Signs :

A) Lumbar Spine :

Shape, mobility, muscle spasm, list to one or other side

on standing (sciatic scoliosis), local tenderness and presence of

trigger points in back and limbs. Sciatica may be the first

symptom of spinal caries.

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50

B) Special Sign :

1) SLR (Straight Leg Raising) Test :

The patient is asked to lie down in completely

relaxed position. Now the raising of the entire leg,

with the knee joint fully extended, by holding the

knee with one hand. Limitations of raising is

found in sciatica, the degree of limitation being

roughly proportional to the severity of the pain.

Restriction of SLR is usually much more marked in lesions

affecting the nerve roots than in purely skeletal affections. This test

gives a useful indication of the severity of the sciatica and increased

capacity for painless straight leg raising is a helpful objective measure

of improvement.

2) Laseague’s Sign :

The knee and the hip joints are flexed to about 900 and then the

leg is extended at the knee joint; with such extension, the patient

experiences paint in the thigh along the course of the sciatic nerve. At

this stage one can passively dorsiflex the foot or even the great toe,

which is followed by further aggravation of pain.

3) Browstring Sign :

This sign is an important indication of root tension or irritation.

The examiner carries out SLR to the point at which the patient

experiences some discomfort in the distribution of the sciatic nerve. At

this level the knee is allowed to flex, and the patient’s foot is allowed

to rest on the examiner’s shoulder. The test demands sudden firm

pressure applied to the popliteal nerve in the popliteal fossa.

4) Sciatic Nerved Stretch Test :

At the limit of SLR; increasing the pressure on the irritated

sciatic nerve by sharply dorsiflexing the foot produces extra pain.

5) Naffziger’s Sign :

Pain is produced in the lower part of the back and legs on

pressure over the jugular vein.

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Femoral nerve stretch test, sitting test, popliteal compression

test, knee-jerk and ankle jerks are also useful test for diagnosis of a

disease.

DIAGNOSIS

The diagnosis of the sciatica is a clinical diagnosis. It is made

after a history and physical examination before expensive testing such

as MRI, C.T. Scan etc. when only a patient fails to respond to

conservative care or presents with severe neurological compromise, it

is time to start investigating.

Investigations :

1) Laboratory Investigations :

A complete blood count (C.B.C.), erythrocyte sedimentation rate

(E.S.R. specially helpful in screening for infection or myeloma).

Measurement of serum protein, calcium phosphate, uric acid, alkaline

phosphate, acid phosphate (if one suspect metastasis, C.A. prostate),

tuberculin test, test for Rheumatoid arthritis factor, cerebrospinal

fluid examination (C.S.F. proteins raised in intraspinal neoplasm),

serum protein electrophoresis (myeloma proteins), agglutination test

for brucella.

2) Radiological findings :

X-ray examination should be carried out in all the cases of

sciatica since many cases of sciatic pain are associated with bony

changes visible in radiographs. Roentgenograms of lumbar spine in AP

and lateral view gives differential diagnosis of narrowing of disc space,

spondylolisthesis, sclerosis of vertebral body, disc herniation, prolapse

etc.

3) Myelogram :

Examination of the spinal canal with a contrast medium –

myelogram may demonstrate a filling defect and is only indicated if

pain is persistent despite of adequate rest, immobilization and

surgical treatment is contemplated. Lumbar disc herniataion and

prolapse, lesions or fissuring of annulus, protrusion of the lumbar

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posterior longitudinal ligaments, cyst on sacral nerve roots, lumbar

canal stenosis is often apparent on myelography. Epidurography can

be done for the diagnosis of intraspinal lesions not visualized by

conventional myelography. Injections of contrast medium directly into

the intervertebral disc (discogram) is a procedure but difficult to

interpret and carries the risk of damage and infection.

4) C.T. Scan :

Computed tomography (C.T.) if combined with instillation of

water soluble contrast media provides excellent definition of a narrow

canal, destructive lesion of vertebral bodies and posterior elements or

presence of para-vertebral soft tissue mass. Appropriate computerized

reconstruction techniques can also identify disc herniation, sometimes

with greater accuracy than the myelogram.

5) M.R.I. :

Nowadays M.R.I. virtually replaces C.T. for the study of

degenerative disc and its relation to the adjacent roots, definition of

soft tissue alteration.

Others :

Confirmation of proximal motor and sensory nerve root disease

can be obtained by nerve conduction studies, H & F response (H-

reflexes of the tibialis posterior nerve and F- reflexes of peroneous

profunolus nerve) and electromyography (E.M.G.). Aortic

arteriography, intravenous pyelography and barium enema may be

necessary to find out aortic aneurism or any pelvic or rectal pathology.

Criteria For The Diagnosis Of The Acute Radicular Syndrome

(Sciatica Due To An HNP)

1. Leg pain (including buttock) is the dominant complaint when

compared with back pain.

2. Neurological symptoms that are specific (e.g. paraesthesia in a

typical dermatomal distribution).

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3. Significant SLR changes

o SLR less than 50% of normal Any one or a

o Bowstring discomfort combination of these

o Crossover pain

4. Neurological Signs : weakness, wasting, sensory loss or reflex

alteration (at least 2 or 4).

Three or four of these criteria must be present, the only exception being young

patients who are very resistant to the effects of nerve root compression and thus

may not have neurological symptoms (criteria 2) nor signs (criteria 4).

DIFFERENTIAL DIAGNOSIS OF SCIATICA

1) Intraspinal Causes

Proximal to disc : conus and cauda equina lesions (e.g.

neurofibroma, ependymoma)

Disc level :

Herniated nucleus pulposus

Stenosis (canal or recess)

Infection : osteomyelitis or discitis (with nerve root

pressure)

Neoplasm : benign or malignant with nerve root pressure

2) Extraspinal Causes

Pelvis

Cardiovascular conditions (e.g. peripheral vascular

disease)

Gynecological conditions

Orthopedic conditions (e.g. osteoarthritis of hip)

Neoplasm (invading or compressing lumbosacral plexus

Peripheral nerve lesions

Neuropathy (diabetic, tumor, alcohol)

Local sciatic nerve conditions (trauma, tumor)

Inflammation (herpes zoster)

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Conditions that mimic as sciatica include –

1) Lumbar Herniated Disc :

A herniated disc occurs when the soft inner core of the disc

(nucleus pulposus) extrudes through the fibrous outer core (annulus)

and the bulge places pressure on the contiguous nerve root. In

general, it is thought that a sudden twisting motion or injury can lead

to an eventual disc herniation. A herniated disc is sometimes referred

to as a slipped, ruptured, bulging, protruding disc for a pinched nerve.

X-ray – L.S. Spine taken in AP and lateral view is diagnostic.

2) Lumber Spinal Stenosis :

This condition involves a narrowing of the spinal canal. It is

more common in adult over 60 and typically results from enlarged

facet joints placing pressure on the nerve roots as they exit the spine.

There is absence of abnormal SLR and spinal stiffness which is

present in sciatica. Spinal stenosis may manifest itself as a disorder of

micturition.

3) Cauda Equina Syndrome :

Cauda equina compression is most serious condition.

Sometimes massive derangement of disc or the extrusion of large free

fragments into the spinal canal causes compression of cauda equina

usually at the level of L4, L5 or L5, S1. Pain may be mild or severe,

usually bilateral sciatica, weakness and numbness of lower limbs are

the main features. Involvement of all the nerves may occur with

profound motor and sensory changes in the legs. Saddle anaesthesia

and absence of buttock muscle tone are sign of S2, S3 root damage.

Further, involvement of sacral nerves will produce additional sensory

changes but more importantly sphincter disturbance with retention of

urine and feaces.

4) Degenerative Disc Disease

While disc degeneration is a natural process that occurs with

aging, in some cases it can also lead to pain along the sciatic nerve.

The condition is diagnosed when a weakened disc results in excessive

micro-motion at the corresponding vertebral level and inflammatory

proteins from inside the disc can become exposed and irritate the

area.

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5) Spondylolisthesis :

In spondylolisthesis, signs of disc lesions together with lumber

deformity. There is back ache after prolonged standing or bilateral

sciatica. X-ray taken with the patients in standing position is

diagnostic.

6) Piriformis Syndrome :

The patient with piriformis syndrome typically complaints of the

sciatic pain, tenderness in the buttock and more difficulty in sitting

than standing. Physical findings include tenderness of the buttock

region, increased pain with adduction and negative S.L.R. test.

7) Sacroiliac Joint Arthritis :

Alteration of pain is significant i.e. pain comes in one buttock

and posterior thigh and then it transfers itself to the other side. Sign

of involvement of 1st and 2nd sacral segments. No lumbar signs

pressure on anterior iliac spine provokes pain in the buttock, S.L.R.

normal.

8) Arthritis Of Hip :

Hip movements restricted and pain provoked by passive

movements. Radiograph of pelvis is diagnostic.

9) Secondary Deposit In Spine :

Gradually increasing central back ache, tendency to radiate to

lower limb soon to both. Marked limitation of movements at lumber

spine. S.L.R. of full range though painful at the extreme.

Multiradicular sings in lower limbs, muscle weakness bilateral,

unequal and marked.

10) Benign Spinal Tumour :

Progressive increase in symptoms, neurological signs are more

severe and progressive than disc lesion. The diagnosis should be done

by C.S.F. examination.

11) Major Lesions In The Buttock :

Such as acute osteomyelitis of ilium or upper femur, ischiorectal

abscess pointing into buttock, septic gluteal bursitis, S.L.R. and hip

flexion both very painful.

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12) Intermittent Claudication :

When internal iliac artery is affected alone, claudication in

gluteus maximus on walking may be the only symptom. Diagnostic

signs – patient lies prone and his hip is extended passively; this

causes no pain. He is then asked to keep the leg extended for a

minute. This brings on the claudication. Spinal claudication is to be

suspected when the patient gets pins and needles type of pain in both

lower limbs on walking a certain distance. Examination shows all

arteries of the lower limbs to be patent. The cause is intra-spinal

ischaemia of the nerve roots compressed by a disc lesion or involved in

arachnoiditis.

13) Dissecting Aneurism :

A rare cause of sciatica is a slowly expanding aneurism at the

bifurcation of aorta compressing 3rd and 4th lumber nerves and

causing local pain and accompanied by paraesthesia and weakness in

left lower limb, patient complaints of severe back ache.

PROGNOSIS OF SCIATICA

In most cases of sciatica, spontaneous recovery occurs rather

slowly with some liability to recurrence. In mild cases, the stage of

severe pain lasts only for 2 - 3 weeks and a patient recovers within

one or two months but, he may time to time experience aching along

the course of the nerve and stooping may still excite some pain in the

affected leg.

In more severe cases there may be slight improvement after

several weeks, but the condition then becomes stationary and the

patient continues to suffer from considerable pain which is fluctuating

in severity and sustains for months or years together. Finally the

recovery occurs in most cases but some symptoms remains as

residue. Though, there is symptomatic relief but relapses are very

common as underlying pathology i.e. disc protrusion, osteophytes,

spurs etc. hardly change without surgical interventions. In some

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57

cases, relapse occurs at frequent intervals and in some, second attack

may be developed ten or more years after the first.

Surgery gives good result in 90% patients. After surgery

relapses can be seen in 10% patients. Such cases are difficult to

manage. In such cases C.T. and Myelogram is repeated to see any

rupture or disc disease at any other level or all the disc material might

not be removed at previous operation, in which another operation

gives success. If there is evidence of radiculopathy but not disc

material or scar tissue, one does not know whether the pain is due to

injury from initially rupture or from the surgery. Various hypothetical

explanations are then evoked e.g. radiculitis, facet syndrome, lumber

arachnoditis etc. which for the most part are unstable. In such cases

prognosis is doubtful/bad. Occupational injuries in which workman’s

compensation or litigation are factors, make the patient report of

therapeutic effects almost worthless.

MANAGEMENT OF SCIATICA

A) Conservative treatment

Choices in conservative treatment can be classified as below :

1) Rest :

The first essential of conservative treatment is rest in bed

and avoidance of movement which would prevent the recession of

the disc in its corresponding space. The patient is required to lie

down on a hard mattress. Bony has suggested the extension of the

spinal column with exertion of a pull on the pelvis. A special

apparatus has been advised and used in some countries for this

purpose. A plaster jacket has been suggested by some.

2) Medication :

Obviously analgesic, anti-inflammatory and occasionally

muscle relaxant medication will help the patient. Comply with the

prescription for bed rest.

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COMMONLY USED NSAIDs

Class Chemical Name Trade Name

Salicylates Aspirin

Enteric coated ASA

Numerous

Ecotrin

Salicylates substitutes Diflunisal

Salsalate

Dolobid

Disolcid

Propionic acid derivatives Ibuprofen

Naproxen

Ketoprofen

Flubiprofen

Ketorolac Tromethamine

Motrin

Naprosyn

Orudis

Ansaid

Toradol

Indoles (acetic acid) Sulindac

Indomethacin

Tolmetin

Clinoril

Indocin

Tolectin

Oxicam Piroxicam Feldene

Pyrazolones Phenylbutazone Butazolidin

3) Modalities :

Ice :

Ice can provide relief from lower back pain in a number of ways,

including –

Ice packs decrease circulation to the area of contact, which

reduces inflammation, swelling, spasm and therefore pain.

Numbs sore tissue (providing pain relief like a local anaesthetic).

Slow the nerve impulses in the area, which interrupts the pain –

pain-spasm reaction between the nerves.

It decrease tissue damage.

It is only useful in acute phase.

Heat :

Heat may be superficial (hot packs/infrared) or deep

(ultrasound or short wave diathermy).

The heat increases the blood flow to the damaged or inflamed

tissue, claring away noxious metabolites and bringing oxygen

to the area.

It also increases the stretchability of collegen tissue.

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Because of the increased vasodilatation, heat should not be

used in the acute phase of injury.

4) Traction :

Traction has also been used over the centuries to treat low

back pain on the theory that stretching the muscles and separating

the vertebra will have a positive effects on the disc. Some therorize

that pulling the vertebra apart will allow a “dislocated” disc to

recede back into the disc space.

5) Exercise :

Once the phase of acute pain has passed, gradual exercises

are of considerable value in improving the mobility of the affected

portion of the spine and power in weakened muscles.

The two popular low back floor exercise programs are the

Williams flexion program and the Mckenzie hyperextension

program. The William program is designed to strengthen abdominal

muscles and reduce lumber lordosis, which in turn opens the facet

joints and widens the exiting foramen. The Mckenzie program is

designed to shift the nucleus pulposus forward in the disc cavity,

reducing its pressure effects on the posterior annulus and nerve

roots. An effective extension program “centralizes” pain, that is

reduces leg pain and increases central back pain. This transfer of

pain location can then be treated with a William program. The

William flexion program tends to be more effective for back pain

that occurs with walking and standing, whereas the Mckenzie

program is more effective for leg pain that is increased by sitting.

6) Miscellaneous forms :

a. Transcutaneous electrical nerve stimulation (TENS) unit:

TENS unit is attached to the patient’s right belt line, it will

stimulate electrode pads on the patient’s low back and right

thigh. Theoretically it closes gates in the CNS. By

transcutaneously sending an electrical impulses into the

peripheral nerve, the large (fast conducting) myelinated A-

alpha nerve fibers are stimulated such that the smaller (slower

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conducting) unmyelinated C-fibers are blocked at the gate

from transmitting their nociceptor impulses.

b. Epidural Steroid : Epidural corticosteroid injection can be

recommended as additional therapy especially in the acute

phase of the conservative management of sciatica. It is given at

the sacral hiatus.

B) Surgical treatment :

Successful surgical outcome depends 90% on proper patient

selection and 10% on surgical technique. Therefore, before considering

surgical interventions C.T. scan, M.R.I., Myelogram or other useful

investigation must be done to localize the lesion.

Absolute indication :

1) The cauda equina syndrome (bladder and bowel

involvement) : The acute massive disc herniation that causes

bladder and bowel paralysis is usually a sequestered disc that

requires immediate surgical excision for the best prognosis.

2) Increasing neurological deficit : In the face of progressing

weakness, it is wised to intervene early with surgical excision of

the disc rupture.

Relative indication :

1) Failure of conservative treatment

2) Recurrent sciatica

3) Significant neurological deficit with significant S.L.R. reduction

4) A disc rupture into a stenotic canal

5) Recurrent neurological deficit.

C) Treatment Options :

1) Para-radicular Infiltration : In this procedure the

pharmaceutical agents are injected between the nerve root and

the epiradicular sheath, depicting the nerve root in tubular

fashion which permits precise applications of steroid into the

vicinity of the irritated nerve root resulting in a massive

concentration of the agent at the site. Indication of

pararadicular infiltration include radicular pain and/or

intermittent claudication without neurologic findings atypical

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leg pain, multiple nerve root signs, intra and extra foraminal

lestions etc. The mechanism of this procedure may be blocking

of afferent impulses from the periphery or increased

intraradicular blood flow.

2) Chemonucleolysis : Chymopapain is an extract of latex of the

tropical fruit papaya of the proteolyic enzymes in Papaya,

chymopapine is the most specific in its activity on the nucleus

pulposus and the least antigenic. Despite the fact that it is less

antigenic then papin, it is still a foreign protein to the human

body and can precipitate allergic reactions.

There is only one indication for chymonucleolysis with

chymopapapin, herniated nucleus pulposus, causing sciatica and

unresponsive to conservative care.

Preventive Measures :

Once the pain of sciatica has passed, there are exercise,

stretches and other measures that may prevent its return. A physical

therapist can develop a complete, personalized program. Here are

some steps that one can take in the mean time.

Loss of weight where indicated

Practice good posture

Practice abdominal crunches

Walk – gentle exercise such as walking and swimming can help to

strengthen the lower back.

Lift object safely – Always lift from a squatting position, using hips

and legs to do the heavy work. Never bend over and lift with a

straight back.

Avoid sitting or standing for extended period of time.

Use proper sleeping posture

Stretch – Sit in a chair and bend down towards the floor. Stop

when he feels just slight discomfort, hold for 30 seconds then

release. Repeat 6 – 8 times.

Avoid wearing high heels

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B A S T I R E V I E W

According to Ayurveda, Vyadhi has been defined as the state in

which both the body and mind are subjected to pain and misery. This

is the state of imbalance of three Doshas – the three basic

constituents of the living body. The measures undertaken to restore

the Doshika equilibrium is called Chikitsa (Ch. Su. 16/34). The

ayurvedic approach to the treatment of a disease comprises of mainly

two procedures.

1) Shodhana

2) Shamana

Shodhana Chikitsa is supposed to eliminate vitiated Doshas

completely and thus prevents the recurring of the diseases. On the

other hand Shamana is the conservative treatment as it doesn’t

eliminate vitiated Dosha but subside them. It is believed that there is

no possibility of relapse of the disease cured by Shodhana Chikitsa

while the disease cured by Shamana may recur as Acharya Charaka

has mentioned :

(

Ch. Su. 16/20)

The term Panchakarma is frequently used as synonyms of

Shodhana. It consists of Vamana, Virechana, Anuvasana Basti,

Niruha Basti and Nasya Karma (but it is not only Shodhana Chikitsa)

out of the above five Karmas Basti is the most important constituent

of the Panchkarma due to its multiple effects. According to Ayurvedic

physiology Pitta and Kapha are dependant on Vata as it governs their

functions. Basti eradication morbid Vata from the root along with

other Dosha and in addition it gives nutrients to the body tissue (A. S.

Su. 28/3). Therefore, Basti therapy covers more than half of the

treatment of all the disease (Ch. Si. 1/40), while some authors

consider it as the complete remedy for all the ailments. Therefore,

Basti is considered the best remedy for morbid Vata, but according to

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Sushruta, it can also be used in Kaphaja and Pittaja disorders by

using different ingredients (Su. Chi. 35/34).

Further it has both Samshodhana as well as Samshamana

effects also. It performs the functions of restoration of semen,

Brimhana in emaciated person, Karshana in obese person,

improvement in vision, prevention of aging process improvement in

lusture, strength and helpful longevity. Thus, Basti in its different

forms has a very wide application.

In modern medicine, enema is mainly given to remove the faeces

from the large intestine while in Ayurveda, Basti is given as a route of

administration of the drugs for multiple action, which acts locally on

large intestine as well as systematically on the body tissue.

Historical Aspect of Basti

History study is important to know about the systemic

development and progress of the subject to determine the future plans

for further establishment and research designing. History and

medicine starts from the very moment when the human being came

into existence that’s why the ancient treatises are full with description

of disease and their treatment.

The evolution of Basti can be traced from Vedic era e.g. Rigveda

and Atharvaveda which is considered as the oldest authentic

manuscripts.

Veda : The Kaushika Sutra of Atharvaveda, Basti is indicated as a

substitute for minor operation. (K.S. Darila 25/127).

Purana : In Agnipurana, Basti is indicated as a principle treatment in

complaints marked by predominance of Vata (A. P. 279/63).

In Ashwa Chikitsa Kathana, Taila Basti is recommended in

horses to relieve their fatigue immediately (A. P. 284/14).

It is also stated that according to season different Sneha should

be used for Basti (A. P. 289/46).

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Yogic Literature : In Gheranda Samhita, Basti is included in

Satkarma. Two kind of Basti are described there.

1) Jala Basti – To be done in water

2) Sushka Basti – To be done always on land.

Charaka Samhita : The scattered references regarding Basti are

available in various chapters of Charaka Samhita, but in

Siddhisthana out of 12 chapters, 8 chapters contribute to Basti.

First two chapters of Siddhisthana deals with properties of Basti

Samyakayoga, Ayoga Lakshanas, indications and contraindications of

Basti. This denotes the importance of Basti in the field of

Kayachikitsa.

Sushruta Samhita : In Sushruta Samhita, four chapters have been

devoted completely for the description of the Basti in Chikitsasthana.

In these chapters, detailed information regarding Bastinetra,

indication, contra-indications, complications, classification of Basti

etc. are available. Other numerous references of Basti are also

available in this Samhita.

Ashtanga Sangraha : 19th chapter of Sutrasthana has been devoted to

Basti only. In this chapter, classification, indication, contra-

indication, dosage, process of administration etc. have been described

in detail. Also four chapters of Kalpasthana have been contributed to

Basti. In these chapters, description regarding importance of Basti,

different types of Basti, Sneha Basti Vyapada etc. are available.

Ashtanga Hridaya : In this Samhita, 19th chapter of Sutrasthana

Basti Vidhi and 4th and 5th chapter of Kalpasthana named as Basti

Kalpa and Basti Vyapada Siddhi explain the every aspect of Basti.

Kashyapa Samhita : In Kashyapa Samhita, Basti has been explained

in detail in Siddhisthana and Khilasthana.

Bhela Samhita : In Bhela Samhita, description of Basti is available in

four chapters of Siddhisthana namely Bastimatriya Siddhi, Upakalpa

Siddhi, Phalamatra Siddhi and Dosha Vyapadika Basti Siddhi.

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Harita Samhita : In this text, only 3rd chapter of Sutrasthana deals

with Basti.

Chakradatta : In this text, two chapters named Anuvasanadhikara

and Niruhadhikara are dealt with Anuvasana and Niruha Basti

respectively.

Vangasena : In Chikitsa Sarasangraha, Vangasena has devoted “Basti

Karmadhikara” chapter for description of Basti.

Sharangadhara Samhita : Three chapters of Uttarakhanda namely

Basti Kalpana Vidhi, Niruha Basti Kalpana Vidhi and Uttara Basti

Kalpana Vidhi described various aspects of Anuvasana Basti, Niruha

Basti and Uttara Basti respectively.

Bhavaprakasha : In this Grantha, 5th chapter of Purvakhanda has

been contributed to description of Basti. Vrana Basti – the type of

Basti has been explained in this Grantha.

Kalyanakaraka : In this text, Basti is described in Vatarogadhikara

only.

Todarananda : In this text, Basti is described in this chapter Basti

Vidhi.

BASTI

Etymology Of Basti :

According to Vachaspatyam, the word ‘Basti’ has its origin from

the root ‘Vas’ with the suffix of Pratyaya ‘Tich’ gives rise to the word

‘Basti’ and it belongs to masculine gender.

According to Siddhanta Kaumdi, the root ‘Vas’ has four

meanings as follow :

1) - This means to stay, to reside and to dwell.

2) – It means to cover.

3) – It means to oil which is

thrown up from the hole and removing blemishes.

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4) – The verb ‘Ardane’ is derived from “Arda

Gatau Yachane Cha”. Thus Arda gives two meanings, one is to

move or in motion and other is to beg or seek. Hence, Ardane

indicates motion to Basti drug, which are introduced through

rectum.

Hence, Basti conveys the following meanings.

BASTI

Medicine stays in large intestine for sometime after its introduction

through the rectum, which causes movements in large intestine

and waste materials there in which are begged for their

elimination.

An organ where urine is collected i.e. urinary bladder, which is

situated below the umbilicus.

An instrument which is used to introduce Basti drugs in the

rectum.

Definition of Basti :

1) (A. H. Su. 9/1)

The apparatus used for introducing the medicated materials is

made up of Basti or animal urinary bladder.

2) (Su.

Ut. 5/1)

The procedure in which the medicaments are introduced inside

the body through the rectum with the help of animal urinary bladder

is termed as Basti.

3) Apte

The bag made by animal bladder is termed as Basti.

4)

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(Ch. Si. 1/40)

Acharya Charaka has defined the Basti as the procedure in

which the drug prepared according to classical reference is

administered through rectal canal reaches upto the Nabhi Pradesha,

Kati, Parshva, Kukshi churns the accumulated Dosha and Purisha

spreads the unctuousness (potency of the drugs) all over the body and

easily comes out along with the churned Purisha and Doshas is called

Basti.

According to modern science, enema is the procedure in which

any liquid preparation is introduced through rectum by means of

adequate instruments (Ghosh) or injection as liquid or gas into the

rectum.

EFFECT OF BASTI

It purifies all the systems and make a

clear passage upto microchannel level (Charaka)

It acts on various disorders

because of the selection of the drug according to disease.

(Charaka.)

Curative. (Charaka)

Uncomplicated. (Charaka)

Basti can be administered

at any age and at any stage of disorder after proper examination. It

also can be given in normal persons too. (Charaka)

A) Promotive Aspects :

Sustains Age.

Provides better life,

improves strength, digestive Power, voice and complexion.

Perform all functions.

Provide firmness.

Corpulence quality.

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Lightness in viscera / systems because removal of

morbid matter from all over the body.

Restores normalcy .

Increases Relish.

B) Curative Aspect :

Relieves Stiffness.

Relieves contractions and adhesions.

Effective in paralytic conditions.

Effective in dislocation and fracture conditions.

Effective in those conditions where

vata aggravated in Shakha/extremities.

Relieves pain.

Effective in disorders of GI tract.

Effective in diseases of Shakha and

Kostha.

Effective in the diseases of vital

parts, upper extremities and Localized or General part.

Beneficial to debilitated and weak

persons.

Arrest premature old age and the

progress of white hair.

C) Preventive Aspects :

Beneficial in constipation.

Effective to purify various systems of

the body.

D) Rejuvinative Aspect :

Increases the quantity and quality of sperm.

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Effective to restore the normal functions of blood

and other Dhatu.

It provides strength by increasing muscle

power.

Beneficial as geriatrics.

E) Effect On Brain And Psychology :

Improves intellectual power.

Provides clarity of mind.

Improves clarity of sense organs.

Induces sound sleep.

Lightness.

Exhilaration.

Invigorates eyesight.

Spright lightness of mind.

F) Effective At Any Age And In Any Season :

Basti is

non antagonistic to healthy, diseased and old persons.

Applicable in all seasons.

Bast

i can be administered in child and older person too. Because it is

free from complications.

CLASSIFICATION OF BASTI

In Ayurveda, there are many varieties of the Basti which are

dependant on the amount of the drug, the quality of the substance

and the expected action of the Basti, so it can be classified as follows :

A) Classification Of Basti According To Drugs Used :

a. Niruha Basti (Evacuative or Un-unctuous Enema) :

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In Niruha Basti, Kashaya (decoction) is the predominant

content. With the Kashaya, Madhu, Saindhava, Sneha and Kalka

are the ingredients commonly used. Its synonyms are Asthapana

Basti, Kashaya Basti etc.

The Basti which eliminate the vitiated Dosha from the body

and increase the strength of the body because of its potency is

called Niruha Basti.

Because of this enema stabilizes the age (Vaya), stabilizes the

normal functions of Dosha and Dhatu and stabilizes Deha i.e.

strength of the body, is called Asthapana Basti (Su. Ni. 35/18).

Depending upon drugs and preparations used in Basti it may

be classified as follows : (Su. Ni. 35/18)

Madhutailaika Basti

Yuktaratha Basti

Yapana Basti

Siddha Basti

b. Anuvasana Basti (Unctuous Enema) :

In this type of Basti only Sneha is used. According to the

quantity of oil given, it is subdivide as follows :

The Sneha Basti which will not cause any harm even if it is

retained for one day and can be administered after taking food,

therefore it is called Anuvasana Basti (A. S. Su. 28/18; Su. Chi.

35/18)

Sneha Basti : 1/4th to the quantity of Niruha i.e. 6 Pala

(298ml).

Anuvasana Basti : The quantity of Sneha is half of the Sneha

Basti i.e. 3 Pala (144ml).

Matra Basti : This is the minimum quantity of Sneha Basti

(½ of Anuvasana Basti) i.e. 1½ Pala (72ml).

B) Anatomical Classification :

It depends upon the part of the body used for the

administration of Basti.

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Internal Application :

Pakvashayagata Basti Garbhashayagata Basti

Uttara Basti

Mutrashayagata Basti

External Application :

Vranagata Basti Kati Basti

Shiro Basti Netra Basti

C) According To The Number Of Basti To Be Used :

Karma Basti - 30 Basti - 12 Niruha & 18 Anuvasna Basti

Kala Basti - 16 Basti - 6 Niruha & 10 Anuvasana Basti

Yoga Basti - 8 Basti - 3 Niruha & 5 Anuvasana Basti

In the above types fixed sequence of Niruha and Anuvasana

Basti is followed.

D) Pharmacological Classification :

On the basis of pharmacodyamics, the Basti may be classified

as follows:

a. According to its effects after administration

Shodhana Basti

Lekhana Basti

Brumhana Basti

b. According to action on Dosha

Utkleshana Basti Vataghna Basti

Doshahara Basti Pittaghna Basti

Shamana Basti Kaphaghna Basti

Shonitaghna Basti

c. According to potency and property

Ushna Basti Ruksha Basti Laghu Basti

Sheeta Basti Snigdha Basti Guru Basti

d. According to intensity

Mrudu Basti Tikshna Basti

Madhyama Basti Picchchha Basti

E) According To Dose :

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Dvadasha Prasritaki Basti

Ekadasha Prasritaki Basti

Nava Prasritaki Basti

Pancha Prasritaki Basti

Chatuha Prasritaki Basti

Ekaika Prasritaki Basti

Padahina Prasritaki Basti

F) Miscellaneous Classification :

Rakta Basti Vaitarana Basti

Kshara Basti Mutra Basti

Mamsa Basti Kshira Basti

In general approximately 216 kinds of Basti are mentioned by

Acharya Charaka in various chapters of Siddhisthana.

MATRA BASTI

Matra Basti is a type of Sneha Basti described by the Acharya.

It is termed so because of the dose of Sneha used in it is very less as

compared to the dose of Sneha Basti (Ch. Si. 4/52-53; Su. Chi.

35/18; A. H. Su. 19/67)

Definition :

Acharya Vagbhatta has defined the Matra Basti as the Basti in

which the dose of Sneha is equal to Hrsva Matra of Snehapana (A. H.

Su. 19/68-69; A. S. Su. 28/9).

Indication :

According to Acharya Charaka, Matra Basti is always applicable

to those emaciated due to overwork, physical exercise, weight lifting,

way faring, journey on vehicles and indulgence in women in

debilitated person as well as in those afflicted with Vata disorders (Ch.

Si. 4/52-54).

Ashtanga Samgrahakara, emphasized on regular administration

of the Matra Basti and it can be administered at all times and in all

seasons just as Madhu Tailika Basti.

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Sr. Indications Ch. A.H. A.S.

1) Karma karshita + - -

2) Bhara karshita + + +

3) Adhva karshita + + +

Sr. Indications Ch. A.H. A.S.

4) Vyayama karshita + + +

5) Yana karshita + - +

6) Stri karshita + + +

7) Durbala + + +

8) Vata Rogi + + +

9) Bala - + +

10) Vriddha - + +

11) Chintatur - + +

12) Stri - - +

13) Nripa - + +

14) Sukumar - - +

15) Alpagni - + +

16) Sukhatma - + -

Contraindication :

In classics, there are no major contraindications mentioned for

matra Basti, but Ashtanga Sangrahakara has stated that Matra Basti

should not be administered in the persons having Ajirna.

Qualities :

The Matra Basti is promotive of strength without any demand of

strict regimen of diet, causes easy elimination of Mala and Mutra. It

performs the function of Brimhana and cures Vatavyadhi. It can be

administered at all times in all seasons and is harmless (Ch. Si. 4/52-

54). Vagbhatta has mentioned that Matra Basti improves Varna and

Bala.

Dose :

According to Vagbhatta, Matra Basti is recommended in the

dose equal to the dose of Hrsva Snehapana. The Matra which gets

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digested in 2 Yama i.e. 6 hours is called as Hrsva Matra of

Snehapana, but the dose required to get digested in 2 Yama is not

mentioned (A. S. 28/9).

Acharya Sushruta has given the dose as ½ of the dose of

Anuvasana Basti and according to him the dose of Anuvasana Basti is

½ of the dose of Sneha Basti. In Sneha Basti, the dose given is ¼ of

the total dose of Niruha Basti i.e. 6 Pala (24 Tola). Hence, the does of

Matra Basti is 1½ Pala = 6 Tola = 72ml. (Su. Chi. 38/18).

According to Chakrapani, commentary on Charaka the dose of

Sneha Basti is 6 Pala, dose of Anuvasana Basti is 3 Pala and of Matra

basti is 1½ Pala (Ch. Si. 4/54).

On the basis of above references, it can be said that the dose of

Matra Basti is 1½ Pala of Sneha i.e. 6 Tola = 72ml.

Food Before Basti Procedure :

Matra Basti should not be given after the patient has consumed

excessively Snigdha Ahara because Sneha taken in double quantity

gives rise to Mada and Murccha. Before Matra Basti, the patient

should avoid the intake of excessively Ruksha Ahara because it

causes depletion of Bala and Varna. Therefore, patients should be

given low Sneha diet before Matra Basti (Su. Chi. 37/55-56).

Pathya – Apathya :

The Matra Basti does not demand any regimen of diet or

behaviour. It can be given at all times and in all seasons without any

restriction. However, Ashtanga Samgrahakara has restricted the day

sleep after being treated with Matra Basti (A. S. Su. 28/9).

Retention of Matra Basti :

The normal Pratyagamana Kala of Sneha Basti is 3 Yama i.e. 9

hours. Being a type of Sneha Basti, the Pratyagamana Kala of Matra

Basti is also 3 Yama i.e. 9 hours. There is no harm if Matra Basti

retains in the body because, while describing Anuvasana Basti it has

been said that it is not harmful to body even in the event of its being

retained in the body for a whole day. Also the dose of Sneha in Matra

Basti is very small, which can get easily absorbed in the body without

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coming out. It is believed that Sneha Basti should be retained in the

body. If Basti material returns much earlier, it can not produce the

desire effect in the body (A. H. Su. 19/29-30).

Samyaka Yoga Lakshana of Matra Basti :

Being a type of Sneha Basti, Samyaka Yoga Lakshana of Sneha

Basti are to be taken as Samyaka Yoga Lakshana of Matra Basti. The

Lakshana of Samyaka Anuvasana are the return of Sneha with the

fecal matter without being stuck up anywhere, the clarity of Rakta,

Mamsa etc. Dhatus and sense organs, good sleep, lightness of body,

increase of strength and regulation of the excretory urges.

Complication of Sneha Basti :

Though it is said that there is no major complication by the use

of Matra Basti but sometimes complication may be produced due to

obstruction of Sneha by Vata, Pitta, Kapha or by excess of Mala or

food and when given to a person on empty stomach. These are six

conditions of complications likely to arise during the use of Sneha

Basti (Ch. Si. 4/25).

1) Vata Avrita Sneha :

If in a condition of excess of Vata, Sneha is given in cold

condition or in small quantity, it gets Avrita by Vata and will not be

able to return as its course is obstructed by Vata. Such Sneha

produce Agnimandya, Jwara, Adhmana, Stambha, Urupida,

Parshvashula.

Treatment : In this condition Niruha Basti prepared by Rasna,

Pitadaru, Tilvak, Sura, Sauviraka, Kola, Kulattha, Yava, Gomutra,

Panchamula should be administered to eliminate the Vatavrita Sneha.

2) Pitta Avrita Sneha :

If excessive Ushna Basti is given in the condition of excess Pitta,

it produces Daha, Raga, Trasa, Moha, Tamaka and Jwara.

Treatment : This condition should be cured with the enema

prepared with Madhura and Tikta Dravyas.

3) Kapha Avrita Sneha :

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If Mrudu Basti is given in condition of excess Kapha, it causes

Tandra, Sheeta Jwara, Alasya, Praseka, Aruchi, Gaurva, Murccha and

Glani.

Treatment : It should be corrected with Basti prepared with

Kashaya, Katu, Tikshna and Ushna Dravya and with Sura and

Gomutra and mixed with Madana Phala and Amla Dravya.

4) Anna Avrita Sneha :

If Basti prepared with Guru Dravya and given after a heavy meal

it gets obstructed by Anna. This Annavrita Sneha, leads to Chhardi,

Murccha, Aruchi, Glani, Shula, Nidra, Agnimandya and Ama

Lakshanas with Daha.

Treatment : Such condition is treated by stimulating digestion

with decoction and powders of Katu and Lavana Dravyas. Also Mrudu

Virechana and the treatment advised for Ama should be adopted.

5) Purisha Avrita Sneha :

In case of accumulation of Mala, if Basti having Alpa Bala is

administered it produces symptoms like Purisha Sanga, Mutra Sanga,

Vata Sanga, Shula Gaurava, Adhmana and Hridaroga.

Treatment : This condition should be treated with Snehana,

Swedana along with Phalavarti. The Anuvasana Basti and Niruha

Basti prepared with Shyama, Bilva etc. should be used. Also the

treatment indicated in Udavarta should be followed.

6) Abhukta Prani Basti :

If Basti is given in a person with empty stomach it reaches

upwards due to absence of any obstruction. Also if Basti is

administered in a person with empty bowel with great force it reaches

up very high and from there it may reach the throat and may come

out from the upper orifice of the body.

Treatment : In this condition, Niruha Basti and Anuvasana

basti of Sneha prepared with Gomutra, Shyama, Trivritta, Yava, Kola,

Kulattha should be given and the condition where it is coming out the

throat, it should be treated by Kashaya Dravyas, pressure on the

throat and by Virechana and Chhardighna measures.

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KATI BASTIThe word Kati Basti is formed by combining two letter ‘Kati’ and

‘Basti’. According to authentic scriptures the meaning of Kati is

determined as lumbar part of the body.

Two connotation could be elucidated from the word Basti.

1) – This means to stay, to reside and to dwell.

2) – It means to cover.

Thus, Kati Basti can be defined as the process in which the oil

is detained locally upon the lumbar part of the body, by means of

‘Masha Pishti’.

Introduction :

Generally two types of Sneha Chikitsa are there. This include

Abhyantara Snehana and Bahya Snehana. Kati basti is a type of

Bahya Snehana. It yields immediate result and safe in all aspects.

This safety can be accounted to its external mode of action but the

therapeutic efficacy is almost temporary. Since it pacifies the Dosha

aggravation by acting upon the site of pathology and site of

Doshasthana.

Indication :

Katishula Gridhrasi

P.I.D. Katishotha

Degeneration of vertebral body Osteophytes

Sacralization Spondylitis

Listhesis of vertebra

Apparatus :

o Paste of black gram powder, 250gm/day.

o Sahacharadi Taila 200 – 250ml.

Duration : 30 minutes for 14 days.

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Procedure : The procedure of Kati Basti can be divided into three

stages such as – Purva Karma, Pradhana Karma and Pashchat

Karma.

First of all x-ray of L-S spine in A.P. and Lat. view should be

taken before starting the treatment and the site of Basti application

should be determined in advance.

Purva Karma : Patient was let to lie down on the table in prone

position having confirmed, he has passed the stool and voided

properly. Then the patient was asked to drape the clothes so that

lumbosacral area could be exposed properly. The lumbosacral area

was then stroked with Bala Taila by applying fingers in a very gentle

way without giving much pressure. After Abhyanga patient was

subjected to Mrudu Swedana prior to the application of Kati Basti.

Pradhana Karma : After local Snehana and Swedana Karma, the area

of Basti application should be cleaned with cotton so that the paste of

black gram powder should be fixed properly. Taking ample quantity of

water, the paste of black gram powder is prepared around well of two

inches height and four inches diameter is made on the lumbosacral

area. This well is to be filled with Sahacharadi Taila using cotton piece

and is allowed to detain there for 20 – 30 minutes. To ensure the

constancy of temperature, a little portion of oil can be taken out and

mixed with warm oil.

Pashchat Karma : To remove the oil, a spoon can be used and the oil

can be collected in a separate vessel. Then the paste is detached from

the body. In a relax position the patient is then allowed to take rest

i.e. patients is instructed to lie down in supine position without having

any contact with external environment. The table should have either

thin bedding or uniform plain and wooden.

Precautions :

During the course of treatment, patient should keep complete rest.

A patient should be advised to take rest on uniformly plain wooden

table shrouded by suitable blanket.

Conceptual Contrive

80

The patients should not be allowed forward and backward

bending.

Patient is advised to avoid lifting heavy objects.

Patient should be advised conscious while sitting and standing.

Merits :

o As in the case of Parisheka and Abhyanga it doesn’t cause the

spreading of medicated oil.

o Accumulation of the medicated oil on the affected area can be

availed through this process.

o Maintenance of the temperature throughout can be attained

since the re-heated oil is transferred to the well.

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D R U G C O N T R I V EIn Ayurveda, the success of Chikitsa depends totally upon four

important factors - 1) Physician, 2) Drug, 3) Attendant and 4) Patient.

They are termed as ‘Chikitsa Chatuspada’ and all are responsible for

the cure of disease (Ch. Su. 9/3). Though the physician occupies the

most important position in these four, he became lame without drug.

Hence, the drug is a second important factor for the cure of disease.

In Ayurvedic literature, the actions of the drugs have been

explained on the theory of Rasa (taste), Guna (properties of drug),

Virya (potency), Vipaka (after effects) and Prabhava (specific action).

Thus, Ayurveda has given importance for considering the drug as a

whole because the action of the whole drug is often different from that

of its constituents when considered separately.

World Health Organization (W.H.O.) defines drug as “Any

substance or product that is used or intended to be used to modify or

explore physiological system or pathological state for the benefit of the

recipient”. This definition appears more in compliance with the terms

of Ayurveda, which aims at the preservation of the good health from

mitigation of diseases.

In Ayurveda, Gridhrasi is described under 80 types of

Nanatmaja Vatavyadhis and most of the Acharyas have said that

Vatavyadhis generally are very difficult to cure and according to

modern science also it is a burning problem as a byproduct of fast life

style and line of treatment of sciatica is a range of analgesic and

sedative type of medication and finally surgery, which is also not

ultimate solution and have many hazards.

Basti is indicated especially in Vatavyadhis in Ayurvedic texts,

so the two types of Basti – Kati Basti and Matra Basti are selected for

the present study to compare its efficacy.

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81

For the purpose of Kat Basti and Matra Basti, Sahacharadi Taila

has been selected as it has Vatashamaka properties and

recommended in Vata vyadhi Chikitsa by Acharya Vagbhatta. The

efficacy of Rasna Guggulu has already been proved by many scholars

and is indicated in the management of Gridhrasi by Chakradatta,

Gadanigraha, Bhavaprakasha and Yogaratnakara. So this has been

opted for the present study as standard control drug.

Method For Preparation of Sahacharadi Taila :

The drug has been prepared in the pharmacy department of

I.P.G.T. & R.A., G.A.U., Jamnagar.

Contents Proportion

Sahachara - 1 part

Devadaru - 1 part

Nagara (Sunthi) - 1 part

Tila Taila - 4 parts

Sahacharadi Taila was prepared by volumetric method and

Snehapaka Vidhi i.e. Tila Taila and Kwatha were taken into liter

(volume) and ratio of Kalka, Sneha and Kwatha was 1:4:16.

First 1 part of Kalka of Sahachara, Devadaru and Nagara, 4 part

Tila taila and 16 part Kwatha of Sahachara, Devadaru and Nagara

were taken then the mixture was boiled on mild flame and stirred well

continuously during its preparation. The Tailapaka was done in the

method of five days. After the whole preparation of Taila it was filtered

and preserved in container.

Description of The Drugs Used In Sahacharadi Taila

1) SAHACHARA

Latin Name : Barleria prionitis

Family : Acanthaceae

Gana : Kantaka Panchamula (Su.)

Synonyms : Saireyaka, Zinti, Katasarika, Kurantaka

Part used : Panchanga especially leaves

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82

Rasapanchaka (Pharmacodynamics) :

Rasa : Tikta, Madhura

Guna : Laghu

Virya : Ushna

Vipaka : Katu

Doshaghnata : Kapha-vatashamaka

Chemical Constituents :

Two new irridoids barlerin and acetylbarlerin, scutellarein-7-

neohesperidoside, scutellarein-7-rhamnosylglucoside and a new

acylated flavonoid glycoside luteolin-7-0-(2”-0-p-coumaroyal)--D-

glycopyranoside are reported.

Action And Use :

The plant has antiseptic property its decoction is used as a

wash in dropsy. Roots are used as febrifuge and as a paste to relieve

toothache. They are applied over boils and glandular swellings. The

dried bark is given in whooping cough. Fresh juice of bark is

diaphoretic and expectorant and is given in Anasarca. The leaves and

flowering tops are rich in soluble potassium salts and are valued as

diuretic. The leaf juice mixed with honey or sugar is given to children

in fever and catarrh, also in urinary and paralytic affections and

stomach disorders. Leaf juice is often applied to lacerated soles of feet

in wet season, with coconut oil it is applied on the face for pimples.

Fresh leaves are crushed and tied on the wounds, caused by sharp

edged tools. They are also used for rheumatic pains and itch.

Pharmacological Study :

Hypoglycemic, diuretic, spasmogenic, hypotensive, hypothermic

and CNS depressant.

2) DEVADARU

Latin Name : Cedrus deodara

Family : Pinaceae

Gana : Stanya Shodhana, Anuvasanopaga,

Katukaskandha (Ch.) Vata Samshamana (Su.)

Synonyms : Devadaru, Bhadradaru

Drug Contrive

83

Part used : Wood, bark, leaves and oil


Rasa : Tikta

Guna : Laghu, Snigdha

Virya : Ushna

Vipaka : Katu

Doshaghnata : Kapha, Vatashamaka


The leaf wax has a large ester number. The chief components

are estoloids of juniperic acid and sebinic acid. The wood yields on

essential oil reddish brown in color with a characterisitic balsamic

odor. 50 – 60% of the oil contains sesquiterpenes. Hydrolysis of the oil

gives hexoic, hepoic and stearic acid (Simonson et al. 1922). The seed

also gives oil (33.50%) (Saxena et al. 1964) and the needles give an

essential oil (0.056%) (Narayana Moorthy et al. 1965). Adinarayana et

al, 1965 have fist isolated from the ether extract of the stem bark, a

compound and identified it as 3,4,5,6 tetrahydroxy – 8C – methyl –

dihydroflavonol and named it as Deodarin. Later it was found to be a

mixture of toxifolin and 3,4,5,7 – tetra hydroxy – 8C – methyl –

dihydroflavonol for which the name Deodarin is retained (Raghunatha

et al. 1971).

Action And Use :

Vedana Sthapana, Shothahara, Kusthaghna, Kaphanisaraka,

Vranashodhana, Vranaropana. It is used in Mutra Roga, Krimi Roga,

Sthaulya, Jwara etc.


Alcoholic extract of the stem of the C. deodara was found to

have anti-cancerous activity against the human epidermal carcinoma

of the nasopharynx in the tissue culture (Dhar et al. 1968).

Antibacterial and antifungal activities of the needle and the bark was

studied by Vitgeft et al. 1953. They arrested the growth of the

diphtheria bacteria. Essential oil was studied for the same purpose by

Garg et al. 1980 and Kishor et al. 1981.

Drug Contrive

84

The essential oil from the wood can be used as an insecticidal

according to the reports of the central institute of the medicinal and

aromatic plant, Lucknow. Antispasmodic activity of various

sesquiterpenes have been studied (Kar et al. 1975). Stem of the plant

showed anti-inflammatory activity (Rastogi and Dhar).

3) NAGARA (SUNTHI)

Latin Name : Zingiber officinalis

Family : Zingiberaceae

Gana : Truptighna, Arshoghna, Deepaniya, Shula

Prashamana, Trushna Nigrahana (Ch.)

Pipalyadi, Trikatu (Su.)

Synonyms : Sunthi, Nagara, Mahausadha, Vishwabhaisaja

Part used : Kanda


Rasa : Katu

Guna : Laghu, Snigdha

Virya : Ushna

Vipaka : Madhura

Doshaghnata : Kapha-vatashamaka.

Chemical Composition :

An aromatic volatile oil containing zingiberine, cineol, borneol,

gingoral, oleoresisns and starch, potassium, oxalate, essential oil etc.

Action And Use :

Shwasahara, Shothahara, Shulahara. Internally it is digestive,

carminative and local stimulant and externally a rubefacient,

aromatic, stomachic, stimulant, use as Sheeta Prashamanam and

Vedana Sthapana.


An ethanolic extract of the rhizomes of ginger reduced

carragenan induced paw-swelling and yeast induced fever in rats. It

was successful in suppressing the writing induced by intraperitoneal

acetic acid. The extract produced blood glucose lowering in rabbits.

Growth of gram +ve and gram –ve bacteria was significantly inhibited.

Drug Contrive

85

A desedependant inhibition of prostaglandin release effect was

observed using rat peritoneal leucocytes.

Acetone extract of ginger and its fractions having galano loctine

diterpenoid as one of the active constituents have anti 5-HT property

(M.A.P.A. 1105-2774 Pg. 417 Q Huanz, Kyoto, Japan)

4) TILA TAILA

Latin Name : Sesamum indicum

Family : Pedaliaceae

Part used : Seeds and oil


Rasa : Madhura, Kashaya, Tikta

Guna : Guru, Snigdha

Virya : Ushna

Vipaka : Madhura

Doshaghnata : Vatashamaka


Sesamum oil is rich in oleic and unoleic acids which together

account of 85% of the total fatty acid, myristic, palmitic, stearic,

arachidic, hexadeceneic, lenoleic, lignoceric acid is present in trace.

Sesamin, sesamolin and sterol are found in the oil (Wealth of India).

Action and Use :

This drug subside Vata Dosha. It is Tvachya, Vedana Sthapana,

Balya, Vrishya and Shulaprashaman. Seeds are laxative emollient and

demulcent, diuretic, nourishing, lactogogue and emmenagogue.

It relieves aching pain in head, ears and female organs

generation (yoni) act as purifying agents in respect of the uterus and

prove curative in urticaria. The use of sesamum oil is recommended in

case of cut, cleft, punctured, severed, lacerated, blistered, thrashed or

contused wounds and ulcers. Also in burns and scalds whether due to

the application of heat or any vesicant alkaline solution as well as in

bite of wild beasts and birds etc. and act beneficially in baths,

unguents and lubrication (Bhavaprakasha).

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86

PHARACODYNAMICS OF SHACHARADI TAILA

Drug Rasa Guna Virya Vipaka Doshghnata Karma

SahacharaTikta,

MadhuraLaghu Ushna Katu KV↓

Shothahara,

Vedana-

prashamana

Devadaru TiktaLaghu,

SnigdhaUshna Katu KV↓ Shothahara

Nagara KatuLaghu,

SnigdhaUshna Madhura KV↓

Shulahara,

Shothahara

Tila Taila

Madhura,

Kashaya,

Tikta

Guru,

SnigdhaUshna Madhura V↓

Vatahara,

Vedana –

sthapana,

antidiuretic,

Yonidoshahara

PHARACODYNAMICS OF RASNA GUGGULU

Drug Rasa Guna Virya Vipaka Doshghnata Karma

Rasna Tikta Guru Ushna Katu VK↓

Vatahara,

Shulahara,

Shothahara

GugguluTikta,

Katu

Laghu,

Ruksha,

Tikshna,

Sukshma,

Khara

Ushna Katu VPK↓

Shophahara,

Vedanasthap-

ana, Lekhana,

Jantughna,

Nervine tonic

Nirgundi

Tiktu,

Katu,

Kashaya

Laghu,

RukshaUshna Katu VK↓

Shopha-

nashaka,

Shulanashana,

Deepana,

Krimighna

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87

RASNA GUGGULU

In this study, Rasna Guggulu is selected for the control drug.

Rasna Guggulu contains Rasna (1part) and Shuddha Guggulu (5

parts). The tablets were prepared with the help of Nirgundi Patra

Swarasa as per routine method. So Rasna Guggulu consists –

Rasna 1 part

Shuddha Guggulu 5 parts

Nirgundi Patra Swarasa – as per requirement.

1) RASNA

Latin Name : Pluchea lanceolata

Family : Compositae

Gana : Anuvasanopaga, Vayahsthaapa (Ch.)

Arkadigana, Sleshma Samshamana Varga (Su.)

Synonyms : Yukta, Rasna, Elaparani

Part used : Root


Rasa : Tikta

Guna : Guru

Virya : Ushna

Vipaka : Katu

Doshaghnata : Vatakapha shamaka


Preliminary studies on the plant revealed the pressure of

glycoside and sterol. In a recent investigation, quertecin and

isarhamnetin were identified in the air dried leaves (wealth of India).

Petroleum ether extract of the drug afforded three compounds,

while alcohol extract gave choline, chloride and a new quantenrary

bare chloride called pluchine and characterized betanine

hydrochloride, ether compounds isolated are laraxasterol, Beta and

Gama ristosterol and flavone glycoside (CCRAS).

Actions And Use :

Shothahara, Sheetahara, Vedanashamaka, Amapachaka, CNS

disease, inflammation, toothache. It is mainly used in disease similar

Drug Contrive

88

to rheumatoid arthritis. A decoction of the plant has been reported to

prevent the swelling of joints in experimental arthritis.


This drug has two primary actions Acetylcholine like action and

smooth muscle relaxant action on different muscle preparation.

Petroleum ether extract of roots showing 45.5% anti-

inflammatory activity. Sorghumol and chloroform soluble fraction of

methanolic extract showing 54.5% anti-inflammatory activity

(M.A.P.A. 9102 – 1006 – Chawla, Chandrigarh).

Extract of stem and leaves of pul. Exhibited 31.9% and 54.5%

antioedema activity with petroleum ether extract and chloroform

soluble portion of methanolic extract respectively. On fractionation,

these extracts yielded moretenol acetate, moretenol, neolupenol in

addition to other aliphatic compounds (M.A.P.A. 9105 – 2939 Chawla

Chandigarh)

2) GUGGULU

Latin Name : Commiphora mukul

Family : Burseraceae

Gana : Eladi (Su.)

Synonyms : Guggulu, Devadhoopa, Kaushika, Mahisaksha

Part used : Exudate (gum resin)


Rasa : Tikta, Katu

Guna : Laghu, Ruksha, Tikshna, Sukshma, Sara

Virya : Ushna

Vipaka : Katu

Doshaghnata : Tridoshaghna


From the gum resin, sesamin, essential oil which contains

steroidal ketones, alcohol and oliophaetic triols are obtained. Two new

sterol viz. Guggulu sterol IV and V along with guggulusterol I, II, III, I

– E guggulu stereos isolated from it. It also contains about 1.45% of

an essential oil having a faintly aromatic odour.

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Actions And Uses :

It is Shulahara, Vedanasthapana, Lekhana, Jantughna and

nervine tonic. It is useful in obesity, osteoarthritis, rheumatism,

sciatica, paralysis etc. It heals fractures, ulcers, fistula, piles,

discharge from the ear and ointment is used locally as a stimulant to

indolent ulcers, to painful joints.


The effects of crude guggulu as well as its two fractions were

found to cause or significant fall in serum cholesterol and serum

turbidity with a concomitant increase in clotting time and

prothrombin time (Shastri et al. 1967 and Tripathi et al. 1981). The

experimental study showed significant anti-inflammatory, anti-

rheumatic and hypo-cholesterolaemic and hypo-lipidemic activity.

3) NIRGUNDI

Latin Name : Vitex negundo

Family : Verbenaceae

Gana : Vishaghna, Krimighna (Ch.), Sursadi (Su.)

Synonyms : Shephali, Sindhuvara, Sinduka

Part used : Leaves, roots, fruits and their extracts


Rasa : Tikta, Katu, Kashaya

Guna : Laghu, Ruksha

Virya : Ushna

Vipaka : Katu

Doshaghnata : Vata-kapha shamaka


Vanillin, nishindhine, hydrocotyleneternic acid.

Action And Uses :

It is beneficial for ears and eyes. It is having action against pain,

inflammation, Amavata, Krimi, Kustha, Aruchi, Kaphajawara. Flowers

of Nirgundi having property to destroy bacteria (Jantu), Kapha and

Vata (B.P. Guduchyadi Varga).

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90


Ethyl acetate extract of leaves of Vitex negundo produced anti-

inflammatory effect against carragenin bradykinia and 5-HT induced

rat hind paw edema. The extract exhibited significant anti-

inflammatory effect on subacute, chronic and immunological studies.

A compound isolated form V. negundo leaves showed significant anti-

inflammatory property on acute inflammation. The seed extracts were

found less potent than leaf extract.

Ether and saline extracts of the leaves exhibited antibacterial

effect against staphylococcus aurous and E. coli infection. Butanol

extract of root possessed anti-inflammatory and analgesics effect. Pet,

ether, butanol, chloroform extract of root and leaf produced

antispasmodic effect.

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C L I N I C A L C O N T R I V EClinical study plays a very important role in the evaluation of

efficacy, potency and mode of action of the drug.

Gridhrasi is such a disease, which carry little threat to life and

interfere greatly with living also. The person who suffers from this

disease is particularly handicapped, as he can not walk, stand or sit

properly and the painful limb continuously draws his attention. The

management provided by modern medicine for this condition is either

conservative like rest, immobilization, analgesic and anti-

inflammatory drugs, physiotherapy, manipulation etc. or surgical. If

the pain and neurological findings do not disappear on prolonged

conservative treatment, finally they go on surgery, which is also not

the ultimate solution as there is a common problem of recurrence or

some patients lose their working capabilities.

As described earlier, Gridhrasi is one of the 80 types of Vata

Vyadhi and Basti is the best and ultimate treatment for it. Gridhrasi is

a disease having its origin in Pakvashaya and seat in Sphika and Kati

(lumbar spine). Hence, Basti is the best mode of administration of the

drug as Acharya Charaka has quoted “the medicine administered

through anus is more effective in the disorder of Pakvashaya” (Ch.

Chi. 30/295). Hence, out of different types of Basti given in classics –

the simplest type of Basti - Matra Basti, which can be used in O.P.D.

patients also and is harmless was taken for the study. As the local

Samprapti Sthana Samshraya is having quite major importance in

Gridhrasi local simultaneous Sneha, Sweda procedures called Kati

Basti has been selected. Rasna Guggulu was given orally for control

therapy.

For the purpose of Kati Basti and Matra Basti, Sahacharadi

Taila, which is indicated in the management of Vata Vyadhi by

Acharya Vagbhatta (A. H. Chi. 21/56) was selected. All the drugs

included in Sahacharadi Taila were having Vata-kapha shamaka,

Shulahara and Vedanasthapana properties. Taking all these points

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92

into consideration, this study was planned with following aims and

objectives.

AIMS AND OBJECTIVES

1) To study the aetiopathogenesis of Gridhrasi in the light of

both Ayurvedic and modern perspective.

2) To evaluate the mode of action of Kati Basti and Matra Basti

in the management of Gridhrasi.

3) To compare the efficacy of Kati Basti and Matra Basti in the

management of Gridhrasi.

MATERIALS AND METHODS

Patients of Gridhrasi consulting the O.P.D. & I.P.D. of

Kayachikitsa department of I.P.G.T. & R.A., Jamnagar were selected

for the present study with irrespective of their age, sex, religion,

occupation etc. Detailed history was taken according to the proforma

prepared for the study incorporating all the relevant points from both

Ayurvedic and modern views.

Criteria For Diagnosis :

Criteria for diagnosis were done on the basis of sign and

symptom available in the Ayurvedic and Modern texts as well as with

the help of following parameters.

1) Presence of Ruka, Toda, Stambha and Spandana in the

Sphika, Kati, Uru, Janu, Jangha and Pada.

2) Tenderness along the course of sciatic nerve.

3) S.L.R. test in affected leg as objective measure for diagnosis

as well as for improvement of the treatment.

4) Popliteal compression test.

5) Foot flexion test.

6) Knee-jerks and ankle-jerks.

Routine hematological urine and biochemical investigations like

R.B.S. were carried out to exclude the possibility of any other disease

as well as to know the present condition of the patients.

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93

Radiological assessment, X-ray, L.S. spine, AP & lateral view

was carried out in patients where necessary to ascertain the diagnosis

as well as the differential diagnosis.

Exclusion Criteria :

The patients suffering from following conditions were excluded

from the study.

1) Ca. of spine

2) Fibrositis of sacral ligaments

3) Tumor of cauda equina

4) Pregnancy

5) Tuberculosis of spine

6) Uncontrolled Diabetes mellitus

Plan of Study :

After diagnosis, total 32 patients of Gridhrasi were randomly

divided into following three groups.

1) Group A – Kati Basti (KB) Group : In this group, KB was

performed with Sahacharadi Taila once a day for 14 days.

Procedure : The procedure of Kati Basti can be divided into three

stages such as – Purva Karma, Pradhana Karma and Pashchat

Karma.

First of all x-ray of L-S spine in A.P. and Lat. view should be

taken before starting the treatment and the site of Basti application

should be determined in advance.

Purva Karma :

Patient was let to lie down on the table in prone position having

confirmed, he has passed the stool and voided properly. Then the

patient was asked to drape the clothes so that lumbosacral area could

be exposed properly. The lumbosacral area was then stroked with

Bala Taila by applying fingers in a very gentle way without giving

much pressure. After Abhyanga patient was subjected to Mrudu

Swedana prior to the application of Kati Basti.

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Pradhana Karma :

After local Snehana and Swedana Karma, the area of Basti

application should be cleaned with cotton. So that the paste of black

gram powder should be fixed properly. Taking ample quantity of

water, the paste of black gram powder is prepared around well of two

inches high and four inches diameter is made on the lumbosacral

area. This well is to be filled with Sahacharadi Taila using cotton piece

and is allowed to detain there for 20 – 30 minutes. To ensure the

constancy of temperature, a little portion of oil can be taken out and

mixed with warm oil.

Pashchat Karma :

To remove the oil, a spoon can be used and the oil can be

collected in a separate vessel. Then the paste is detached from the

body. In a relax position the patient is then allowed to take rest i.e.

patients is instructed to lie down in supine position without having

any contact with external environment. The table should have either

thin bedding or uniform plain and wooden.

2) Group B – Matra Basti (MB) Group : The patients of this group

were administered Matra Basti of Sahacharadi Taila in the dose of

60 -70 ml once a day for 14 days.

Method of Administration of Matra Basti :

The procedure of administration of Basti in general can be

divided into three stages

Purva Karma :

The patients were instructed to come after taking light diet

(neither too Snigdha nor too Ruksha) and after elimination of stool

and urine. The patients were also advised not to take diet more than

3/4th of routine quantity. The patients were mainly subjected for local

Abhyanga and Mrudu Swedana prior to the administration of Matra

Basti.

Abhyanga : The local Abhyanga over abdomen, buttock and

thighs for 5 – 10 minutes was done by lukewarm Bala taila.

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Swedana : After Snehana, the patients were subjected for local

Mrudu Sweda, by using Nadi Sweda or wet towel soaked in hot water.

Swedana was done on abdomen, buttocks and on thighs for 5 – 10

minutes.

Pradhana Karma :

After this Purva Karma the patient was advised to lie down on

left lateral position on the Basti (enema) table with left lower extremity

straight and right lower extremity flexed on knee and hip joint. The

patient was asked to keep his left hand below the head. Sahacharadi

Taila was applied to anus in small amount. 60 – 70ml of lukewarm

Sahacharadi Taila (as per built of the patient) was taken in enema

syringe. Rubber catheter oleated with Sahacharadi Taila was attached

to enema syringe. After removing the air from enema syringe, rubber

catheter was administered into the anus of the patients upto the

length of 4 inches. The patient was asked to take deep breath and not

to shake his body while introducing the catheter and the drug. The

total Taila was not administered in order to avoid entrance of Vayu

into the Pakvashaya which may produce pain.

Pashchat Karma :

After the administration of Basti, the patient was advised to lie

in supine position with hand and legs freely spread over the tale.

Thereafter patient’s both legs were raised few times so as to raise the

waist and gently tapped over the hips. Simultaneously taps were also

given on his soles, over elbow and palms, so that the Matra Basti may

spread throughout the body and may be retained for the required

period. After sometime patient was advised to get up from the table

and take rest in his bed and also not to take day sleep. Basti

Pratyagamana Kala was noted in each case.

3) Group C – Rasna Guggulu (RG) Group : The patients of this group

were given Rasna Guggulu 500mg of 2 tablets twice a day for 30

days.

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Diet And Restrictions :

In all the groups any special diet was not mentioned. Patients

were kept on their routine diet in home and in routine hospital light

diet when they get admitted.

Criteria For Assessment :

The improvement in the patients was assessed mainly on the

basis of relief in the cardinal symptoms of the disease. To assess the

effect of therapy objectively, all the sign and symptoms were given

scoring pattern depending upon their severity as below :

Ruka (Pain)

No pain - 0

Occasional pain - 1

Mild pain but no difficulty in walking - 2

Moderate pain and slight difficulty in walking - 3

Sever pain with sever difficulty in walking - 4

Toda (Pricking Sensation)

No pricking sensation - 0

Occasional pricking sensation - 1

Mild pricking sensation - 2

Moderate pricking sensation - 3

Severe pricking sensation - 4

Stambha (Stiffness)

No stiffness - 0

Sometimes for 5 – 10 minutes - 1

Daily for 10 – 30 minutes - 2

Daily for 30 – 60 minutes - 3

Daily more than 1 hour - 4

Spandana (Twitching)

No Twitching - 0

Sometimes for 5-10 minutes - 1

Daily for 10-30 minutes - 2

Daily for 30-60 minutes - 3

Daily more than 1 hour - 4

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Aruchi (Anorexia)

No anorexia - 0

Mild anorexia - 1

Moderate anorexia - 2

Severe anorexia - 3

Tandra (Drowsiness)

No Tandra - 0

Mild Tandra - 1

Moderate Tandra - 2

Severe Tandra - 3

Gaurava (Heaviness)

No heaviness - 0

Mild heaviness - 1

Moderate heaviness - 2

Severe heaviness - 3

S.L.R. Test

More than 900 - 0

710 – 900 - 1

510 – 700 - 2

310 – 500 - 3

Up to 300 - 4

Scoliosis

No scoliosis - 0

Mild scoliosis - 1

Moderate scoliosis - 2

Severe scoliosis - 3

Reflex

Normal - 0

Just normal (diminished) - 1

Exaggerated - 2

Absent - 3STATISTICAL ANALYSIS

Mean, percentage, S.D., S.E., ‘t’ and P value were calculated.

Paired ‘t’ test was used for calculating the ‘t’ value.

Clinical Contrive

98

CRITERIA FOR ASSESSING THE TOTAL EFFECT

Considering the overall improvement had shown by the patient

in sign and symptoms, the total effect of the therapy has been

assessed as below.

Cured 100% relief in sign and symptoms

Markedly Improved More than 50% relief in sign and symptoms

Improved 25% – 50% relief in sign and symptoms

Unchanged Up to 25% relief in sign and symptoms

O B S E R V T I O N S & R E S U L T S

In this study, 32 patients were registered irrespective of their

age, sex, religion, etc. They were randomly divided into three groups.

1) Kati Basti group

2) Matra Basti group

3) Rasna Guggulu group

Table : 1

No. of PatientsGroup KB Group MB Group RG

Total %

Completed 08 10 08 26 81.25

LAMA 00 03 03 06 18.75

Total 32 patients were registered for the present study, among

them 26 i.e. 81.25% patients have completed their treatment and

remaining 6 i.e. 18.75% (3 – group MB & 03 – group RG) patient Left

Against Medical Advice.

Table – 2 : Age wise distribution of 32 patients of Gridhrasi

No. of PatientsAge(Years) Group KB Group MB Group RG

Total %

20 – 30 00 01 04 05 15.62

31 – 40 04 03 00 07 21.87

41 – 50 02 04 02 08 25.00

51 – 60 00 04 02 06 18.75

61 – 70 02 01 03 06 18.75

Clinical Contrive

99

Out of 32 patients maximum i.e. 25% were belong to 41 – 50

years, 21.87% patients were belong to 31 – 40, 18.75% patients each

were in 51 – 60 and 61 – 70 years of age group, while 15.62% were

from 21 – 30 year of age group.

Table – 3 : Sex wise distribution of 32 patients of Gridhrasi

No. of PatientsSexGroup KB Group MB Group RG

Total %

Male 03 06 06 15 46.87

Female 05 07 05 17 53.12

The above table shows that maximum i.e. 53.12% patients were

female while rest of the patients i.e. 46.87% were male.

Table – 4 : Religion wise distribution of 32 patients of Gridhrasi

No. of PatientsReligionGroup KB Group MB Group RG

Total %

Hindu 06 11 07 24 75.0

Muslim 02 02 04 08 25.00

Other 00 00 00 00 00.00

Out of 32 patients, maximum i.e. 75% patients were Hindu

while 25% patients were Muslim.

Table - 5 : Education wise distribution of 32 patients of Gridhrasi

No. of PatientsEducationGroup KB Group MB Group RG

Total %

Illiterate 00 02 03 05 15.62

Primary 05 03 02 10 31.25

Secondary 02 02 05 09 28.12

Graduate 01 05 01 07 21.87

Post graduate 00 01 00 01 03.12

Out of 32 patients, maximum i.e. 31.25% patients were having

primary education, 28.12% patients were having secondary education,

21.87% patients were graduate, 15.62% patients were illiterate and

only 03.12% patients were having post graduation.

Clinical Contrive

100

Table - 6 : Socio-economic status wise distribution of 32 patients

of Gridhrasi

No. of PatientsSocio-economicStatus Group KB Group MB Group RG

Total %

Rich 00 04 00 04 12.50

Middle 08 06 10 24 75.00

Poor 00 03 01 04 12.50

Out of 32 patients, maximum 75% were of middle class while

12.50% patients each were rich and poor.

Table– 7 : Occupation wise distribution of 32 patients of Gridhrasi

No. of PatientsOccupationGroup KB Group MB Group RG

Total %

Business man 00 03 00 03 09.37

Serviceman 01 03 01 05 15.62

Household 05 05 05 15 46.87

Labour 02 02 02 06 18.75

Other 00 00 03 03 09.37

The above table depicts that the majority of the patients i.e.

46.8% were householder, 18.75% patients were labour, 15.62%

patients were serviceman, 09.37% patients were business man and

the same percentage also found in other occupation.

Table – 8 : Marital status wise distribution of 32 patients of

Gridhrasi

No. of PatientsMaritalStatus Group KB Group MB Group RG

Total %

Married 08 13 10 31 96.87

Unmarried 00 00 01 00 03.12

The above data shows that 96.87% patients were married an

only 03.12% patients were unmarried.

Clinical Contrive

101

Table - 9 : Habitat wise distribution of 32 patients of Gridhrasi

No. of PatientsHabitatGroup KB Group MB Group RG

Total %

Urban 04 09 04 20 62.50

Rural 04 04 04 12 37.50

Out of 32 patients, maximum 62.50% patients were from urban

area and remaining 37.50% patients were rural area.

Table - 10 : Diet wise distribution of 32 patients of Gridhrasi

No. of PatientsDietGroup KB Group MB Group RG

Total %

Vegetarian 06 11 07 24 75.00

Mixed 02 02 04 08 25.00

Out of 32 patients, maximum i.e. 75% patients were vegetarian

while rest of the 25% patients were having mixed diet habit.

Table – 11 : Appetite wise distribution of 32 patients of Gridhrasi

No. of PatientsAppetiteGroup KB Group MB Group RG

Total %

Good 04 06 04 14 43.75

Low 03 06 05 14 43.75

Disturbed 01 01 02 04 12.50

Out of 32 patients, maximum 43.75% patients each were having

good and low appetite, while 12.50% patients were having disturbed

appetite.

Table – 12 : Sleep (Nidra) wise distribution of 32 patients of

Gridhrasi

No. of PatientsSleepGroup KB Group MB Group RG

Total %

Sound 06 05 07 18 56.25

Disturbed 02 08 04 14 43.75


sound sleep while rest of the 43.75% patients were having disturbed

sleep.

Clinical Contrive

102

Table – 13 : Chronicity wise distribution of 32 patients of

Gridhrasi

No. of PatientsChronicity(Years) Group KB Group MB Group RG

Total %

0 – 1 05 08 06 19 59.37

1 – 2 00 03 04 07 21.87

> 2 03 02 01 06 18.75

The above table shows that maximum 59.37% patients were

having the chronicity 0 – 1 year, 21.87% patients were having 1 – 2

years chronicity and 18.75% patients were having more than 2 years

chronicity.

Table - 14 : Distribution of 32 patients according to Type of

Gridhrasi

No. of PatientsType ofGridhrasi Group KB Group MB Group RG

Total %

Vataja 05 09 08 22 68.75

Vata-Kaphaja 03 04 03 10 31.25


Vataja type of Gridhrasi while 31.25% patients were having Vata-

kaphaja type Gridhrasi.

Table – 15 : Prakriti wise distribution of 32 patients of Gridhrasi

No. of PatientsPrakritiGroup KB Group MB Group RG

Total %

Vata-Pitta 03 04 06 13 40.62

Vata-Kapha 05 05 03 13 40.62

Pitta-Kapha 00 04 02 06 18.75

The above table shows that maximum i.e. 40.62% patients each

were of Vata-pittaja and Vata-kaphaja Prakriti, while 18.75% patients

were of Pitta-kaphaja Prakriti.

Clinical Contrive

103

Table – 16 : Sara wise distribution of 32 patients of Gridhrasi

No. of PatientsSaraGroup KB Group MB Group RG

Total %

Pravara 00 02 00 02 06.25

Madhyama 08 10 11 29 90.62

Avara 00 01 00 01 03.12

The above table shows that the majority of the patients i.e.

90.62% were of Madhyama Sara, while 6.25% patients were of Pravara

Sara whereas 03.12% patients were of Avara Sara.

Table – 17 : Samhanana wise distribution of 32 patients of

Gridhrasi

No. of PatientsSamhananaGroup KB Group MB Group RG

Total %

Pravara 00 01 00 01 03.12

Madhyama 08 12 11 31 96.87

Avara 00 00 00 00 00.00


96.872% were of Madhyama Samhanana, while 03.12% patients were

of Pravara Sara. No patients were found in Avara Samhanana.

Table – 18 : Satmya wise distribution of 32 patients of Gridhrasi

No. of PatientsSatmyaGroup KB Group MB Group RG

Total %

Pravara 00 02 00 02 06.25

Madhyama 08 11 11 30 93.75

Avara 00 00 00 00 00.00


93.75% were of Madhyama Satmya and 06.25% patients were of

Pravara Satmya.

Clinical Contrive

104

Table – 19 : Satva wise distribution of 32 patients of Gridhrasi

No. of PatientsSatvaGroup KB Group MB Group RG

Total %

Pravara 00 03 00 03 09.37

Madhyama 08 10 11 29 90.62

Avara 00 00 00 00 00.00


90.62% were of Madhyama Satva and 09.37% patients were of Pravara

Satva.

Table - 20 : Abhyavaharana Shakti wise distribution of 32 patients

of Gridhrasi

No. of PatientsAbhyavaharanaShakti Group KB Group MB Group RG

Total %

Pravara 01 01 00 02 06.25

Madhyama 06 12 11 29 90.62

Avara 01 00 00 01 03.12


90.62% were having Madhyama Abhyavaharana Shakti, while 6.25%

patients were having Pravara and 03.12% patients were of Avara

Abhyavaharana Shakti.

Table – 21: Jarana Shakti wise distribution of 32 patients of

Gridhrasi

No. of PatientsJaranaShakti Group KB Group MB Group RG

Total %

Pravara 01 02 02 05 15.62

Madhyama 06 11 08 25 78.12

Avara 01 00 01 02 06.25


78.12% were having Madhyama Jarana Shakti, while 15.62% patients

were having Pravara Jarana Shakti and 06.25% patients were having

Avara Jarana Shakti.

Clinical Contrive

105

Table - 22 : Vyayama Shakti wise distribution of 32 patients of

Gridhrasi

No. of PatientsVyayama ShaktiGroup KB Group MB Group RG

Total %

Pravara 01 01 01 03 09.37

Madhyama 06 09 06 21 65.62

Avara 01 03 04 08 25.00


65.62% were having Madhyama Vyayama Shakti, while 25.00%

patients were having Avara and 09.37% were having Pravara Vyayama

Shakti.

Table - 23 : Kostha wise distribution of 32 patients of Gridhrasi

No. of PatientsKosthaGroup KB Group MB Group RG

Total %

Mrudu 00 01 00 01 03.12

Madhyama 07 11 10 28 87.50

Krura 01 01 01 03 09.37


Madhyama Kostha, 09.37% patients were having Krura Kostha and

03.12% patients were having Mrudu Kostha.

Table – 24 : Desha wise distribution of 32 patients of Gridhrasi

No. of PatientsDeshaGroup KB Group MB Group RG

Total %

Anupa 00 00 00 00 00.00

Jangala 07 13 11 31 96.87

Sadharana 01 00 00 01 03.12

Out of 32 patients, maximum i.e. 96.87% patients were

belonged to Jangala Desha, while only 03.12% patients were belonged

to Sadharana Desha.

Clinical Contrive

106

Table – 25 : Agni wise distribution of 32 patients of Gridhrasi

No. of PatientsAgniGroup KB Group MB Group RG

Total %

Sama 02 03 01 06 18.75

Visama 02 03 3 08 25.00

Manda 03 07 07 17 53.12

Tikshna 01 00 00 01 03.12

Out of 32 patients, the majority of the patients i.e. 53.12% were

having Mandagni, 25.00% were having Visama, 18.75 were having

Samagni and 03.12% were having Tikshnagni.

Table – 26 : Nidana wise distribution of 32 patients of Gridhrasi

No. of PatientsNidana Group

KBGroup

MBGroup

RGTotal %

AHARAJA

Shuskamansa 02 02 04 08 25.00

Kathina Bhojana 04 06 07 17 53.12

Dhatukshayakara Ahara 05 08 09 22 68.75

Ati Katu Rasa Sevana 06 09 06 21 65.62

Ati Kashaya Rasa Sevana 02 05 02 09 28.12

Laghu Dravyati Sevana 02 06 04 12 37.50

Sheeta Dravyati Sevana 04 06 04 14 43.70

Vishtambhi Dravyati Sevana 02 03 01 06 18.75

Annasana 00 02 02 04 12.50

Alpasana 02 03 03 08 25.00

Visamasana 03 04 04 11 34.75

VIHARAJA

Bharaharana 03 09 05 17 53.12

Ratri Jagarana 02 04 01 07 21.87

Diwaswapna 01 01 04 06 18.75

Visama Cheshta 03 04 03 10 31.25

Dukha Shayya 01 02 02 05 15.62

MANASIKA

Chinta 04 04 03 11 34.75

Shoka 00 00 01 01 0.12

Clinical Contrive

107

No. of PatientsNidana Group

KBGroup

MBGroup

RGTotal %

AGANTUJA

Abhighata 03 04 06 13 40.62

Prapatana 02 02 02 06 18.75

The above table reveals that out of 32 patients, maximum

68.75% patients were having Dhatukshayakara Ahara as Nidana.

65.62% patients were having Ati-katu Rasa Sevana, Kathina Bhojana

and Bharaharana were found in 53.12% patients, 40.62% patients

were having Abhighata as Nidana, 34.75% patients were having

Visamasana and Chinta, Shuskamansa and Alpasana both were

present in 25% patients while Vishtambhidravyati Sevana,

Diwaswapna and Prapatana were present in 18.75% of the patients.

Table – 27 : Associated condition found in 32 patients of

Gridhrasi

No. of PatientsAssociated Condition Group

KBGroup

MBGroup

RGTotal %

Obesity 03 02 00 05 15.62

Habitual constipation 01 01 01 03 09.37

Osteo-arthritis 03 00 02 05 15.62

Spondylosis 00 00 00 00 00.00

Multiple pregnancy 00 01 02 03 09.37

Diabetes mellitus 00 00 00 00 00.00

The above table shows that out of 32 patients, obesity and

spondylosis were present in 15.62% patients, while habitual

constipation and multiple pregnancy were found in 09.37% patients.

Clinical Contrive

108

Table - 28 : Cardinal symptom wise distribution of 32 patients of

Gridhrasi

No. of PatientsSigns & Symptoms Group

KBGroup

MBGroup

RGTotal %

Ruka 08 13 11 32 100

Toda 05 10 11 26 81.25

Stambha 05 12 08 25 78.12

Spandana 03 03 07 13 40.62

Aruchi 03 05 06 14 43.75

Tandra 02 02 02 06 18.75

Gaurava 03 03 04 10 31.25

Sakthanah Kshepam

Nigrahaniyat (SLR test)08 13 11 32 100

Dehasyapi Pravakra

(scoliosis)00 03 00 03 09.37

The above table shows that out of 32 patients, Ruka (pain in

sciatica nerve distribution) and SLR test positive were found in all the

patients i.e. 100%. 81.25% patients were having complaint of Toda.

Stambha was present in 78.12% patients. Spandana was present in

40.62% patients. Aruchi, Tandra and Gaurava were present in

43.75%, 18.75% and 31.25% of patients respectively. Dehasyati

Pravakrat (scoliosis) was noticed in 09.37% of the patients.

NEUROLOGICAL FINDINGS

Table - 29

No. of PatientsKnee JerkGroup KB Group MB Group RG

Total %

Normal 05 09 08 22 68.75

Diminished 03 04 03 10 31.25

Exaggerated 00 00 00 00 00.00

Absent 00 00 00 00 00.00

Clinical Contrive

109


normal knee jerk and 31.25% patients were having diminished knee

jerk.

Table - 30

No. of PatientsAnkle JerkGroup KB Group MB Group RG

Total %

Normal 06 09 08 23 71.87

Diminished 02 04 03 09 28.12

Exaggerated 00 00 00 00 00.00

Absent 00 00 00 00 00.00


normal ankle jerk and 28.12% patients were having diminished ankle

jerk.

Table : 31

No. of PatientsSignsGroup KB Group MB Group RG

Total %

Hyper-asthesia 00 00 00 00 00.00

Hypo-asthesia 02 06 02 10 31.25

Loss of Sensation 00 01 00 01 03.12

Muscle Wasting 00 01 00 01 03.12

Muscle Power (40) 00 01 00 01 03.12

Foot Flexion Test 06 10 09 25 78.12

Popliteal

compression test

08 13 11 32 100

Tenderness at root

of sciatic nerve

08 13 11 32 100

Out of 32 patients, 100% patients were having positive popliteal

compression test and presence of tenderness at root of sciatica nerve.

Foot flexion test was positive in 78.12% patients. 31.25% patients

were having hypoesthesia and 03.12% patients were having loss of

sensation in different dermatose in affected limbs.

Clinical Contrive

110

EFFECT OF THERAPY

Table - 32 : Effect of Therapy according to sign and symptoms

Kati Basti Group

Mean ScoreSigns &Symptoms

nB.T. A.T.

X % S.D. S.E. ‘t’ P

Ruka 8 2.75 0.87 1.87 68.36 0.834 0.294 6.377 <0.001

Toda 5 1.37 0.37 1.00 72.99 1.060 0.370 2.700 <0.02

Stambha 6 1.75 0.62 1.12 64.57 0.830 0.293 3.822 <0.01

Spandana 3 0.50 0.25 0.25 50.00 0.463 0.164 1.524 >0.05

Aruchi 3 0.75 0.25 0.50 66.66 0.756 0.267 1.873 >0.05

Tandra 2 0.25 0.12 0.12 52.00 0.354 0.125 1.000 >0.05

Gaurava 3 0.50 0.25 0.25 50.00 0.463 0.164 1.524 >0.05

SLR Test 8 2.62 0.75 0.87 71.37 0.641 0.227 8.259 <0.001

Scoliosis 0 0.00 0.00 0.00 00.00 0.000 0.000 0.000 -

The above table reveals effect of the therapy as below :

Ruka : The mean score of Ruka was 2.75 before treatment which

reduced upto 0.87 after treatment with 68.36% relief, which

statistically highly significant (P<0.001)

Toda : Initially the mean score of Toda was 1.37 before treatment

which reduced upto 0.37 after treatment with 72.99% relief, which

was statistically significant (P<0.02).

Stambha : The mean score of Stambha was 2.0 before treatment


was statistically highly significant (P<0.001).

Spandana : It was reported that initial mean score of Spandana in

this group was 0.5 and after treatment it reduced upto 0.25. This 50%

relief was statistically insignificant (P>0.05).

Aruchi : It was found that the mean score of Aruchi was 0.75 before

treatment and after the completion of the course it was reduced upto

0.25. This 66.66% relief was statistically insignificant (P>0.05).

Clinical Contrive

111

Tandra : It was observed that the mean score of Tandra was 0.25

before treatment and after treatment it was reduced upto 0.12. But

this reduction of 52% was statistically insignificant (P>0.05)

Gaurava : The mean score of Gaurava before treatment was 0.50

which was reduced to 0.25 after treatment with 50% relief but it was

statistically insignificant (P>0.05)

S.L.R. Test : Before treatment mean score of S.L.R. test was 2.62

which was reduced upto 0.75 after treatment, this way treatment

provided 71.37% relief, which was statistically highly significant

(P<0.001).

Scoliosis : In this group, none of the patients were having scoliosis.

Table : 33

Matra Basti Group


nB.T. A.T.

X % S.D. S.E. ‘t’ P

Ruka 10 3.20 0.40 2.80 87.50 0.789 0.249 11.24 <0.001

Toda 7 1.60 0.20 1.40 87.50 1.174 0.371 3.773 <0.01

Stambha 9 2.00 0.30 1.70 85.00 1.059 0.335 5.075 <0.001

Spandana 1 0.10 0.10 0.00 00.00 0.000 0.000 0.000 -

Aruchi 3 0.40 0.00 0.40 100 0.699 0.221 1.809 >0.05

Tandra 1 0.10 0.00 0.10 100 0.316 0.100 1.000 >0.05

Gaurava 2 0.30 0.10 0.20 66.66 0.632 0.200 1.000 >0.05

SLR Test 10 2.80 0.50 2.30 82.14 0.675 0.214 10.75 <0.001

Scoliosis 3 0.50 0.20 0.30 60.00 0.483 0.153 1.961 >0.05






was statistically significant (P<0.01).




Clinical Contrive

112


this group which was remains as it is after treatment. So no

conclusion can be drawn.



0.00. but, this 100% relief was statistically insignificant (P>0.05).


before treatment and after treatment it was reduced upto 0.00. But,



which was reduced to 0.10 after treatment with 66.66% relief but it

was statistically insignificant (P>0.05)




(P<0.001).

Scoliosis : Initially, the mean score of scoliosis was 0.5, this was

reduced to 0.20 after treatment with 60% relief but it was statistically

insignificant (P<0.05).

Table : 34

Rasna Guggulu Group


nB.T. A.T.

X % S.D. S.E. ‘t’ P

Ruka 8 2.62 0.75 1.87 71.37 0.835 0.295 6.356 <0.001

Toda 8 1.87 0.62 1.25 66.84 0.886 0.313 3.994 <0.001

Stambha 6 1.50 0.40 1.12 73.33 0.991 0.350 3.214 <0.02

Spandana 7 1.25 0.25 1.00 80.00 0.756 0.267 3.745 <0.01

Aruchi 5 1.00 0.25 0.75 75.00 0.707 0.249 3.012 <0.02

Tandra 1 0.12 0.00 0.13 100 0.354 0.125 1.000 >0.05

Gaurava 3 0.37 0.12 0.25 67.56 0.463 0.164 1.524 >0.05

SLR Test 8 2.12 0.75 1.38 64.62 0.744 0.263 5.228 <0.01

Scoliosis 0 0.00 0.00 0.00 - - - - -

Clinical Contrive

113








which reduced upto 0.40 after treatment with 73.33. relief, which was

statistically significant (P<0.02).


this group was 1.25 and after treatment it reduced upto 0.25. This

80.00% relief was statistically highly significant (P<0.01).



0.25. This 75.00% relief was statistically significant (P<0.02).


before treatment and after treatment it was reduced to 0.00. However



which was reduced to 0.12 after treatment with 67.56% relief but it

was statistically insignificant (P>0.05)




(P<0.01).

Scoliosis : In this group, none of the patients were found with sign

scoliosis.

Clinical Contrive

114

Table - 35 : Effect of Therapy according to type of disease

Kati Basti Group

Type of disease Cured MarkedImproved

Improved Unchanged

Vataja 02 02 01 00

Vata-kaphaja 00 03 00 00

The above table shows that maximum result was found in

Vataja type of Gridhrasi.

Table - 36

Matra Basti Group

Type of disease CuredMarked

Improved Improved Unchanged

Vataja 01 06 00 00




Table - 37

Rasna Guggulu Group

Type of disease CuredMarked

Improved Improved Unchanged

Vataja 02 04 00 00




Table – 38 : Effect Of Therapy According To Chronicity

CuredMarkedlyImproved Improved UnchangedChronicity

KB MB RG KB MB RG KB MB RG KB MB RG

0 – 1 year 2 1 2 2 6 0 1 0 1 0 0 0

1 – 2 year 0 0 0 0 2 4 0 0 0 0 0 0

>2 year 0 0 0 3 1 1 0 0 0 0 0 0

The above table shows maximum effect of therapy on chronicity

of 0 – 1 year.

Clinical Contrive

115

Table – 39 : OVERALL EFFECT OF THERAPIES IN ALL GROUPS

Kati Basti Matra Basti Rasna Guggulu

Cured 02 (25%) 1 (10%) 2 (25%)

Markedly improved 05 (62.50%) 9 (90%) 6 (75%)

Improved 01 (12.50%) 0 0

Unchanged 0 0 0

Total 08 10 8

The above table depicts the total effect of therapies in all groups:

Kati Basti Group : In this group, out of 8 patients after the

completion of treatment 2 (25%) were cured, 5 (62.50%) patients were

markedly improved and remaining 1 (12.5%) patients was reported as

improved. None of the patient was found unchanged.

Matra Basti Group : In this group, out of 10 patients after the

completion of treatment 1 (10%) was cured and 9 (90.00%) patients

showed markedly improvement. None of the patient was found

improved and unchanged.

Rasna Guggulu Group : In this group, out of 8 patients after the

completion of treatment 2 (25%) were cured, 5 (62.50%) patients were

markedly improved and remaining 1 (12.5%) patients was reported as

improved. None of the patient was found unchanged.

Table – 40 : Comparative study of results in all groups

Result in percentageCardinal Sign &Symptoms KB MB RG

Ruka 68.36 87.50 71.37

Toda 72.99 87.50 66.84

Stambha 64.57 85.00 73.33

Spandana 50.00 00.00 80.00

Aruchi 66.66 100 75.00

Tandra 52.00 100 100

Gaurava 50.00 66.66 67.56

SLR test 71.37 82.14 64.62

Scoliosis 0.00 60.00 00.00

Clinical Contrive

116

Discussion

116

D I S C U S S I O N

In human body, the lumber spine is the site of most expensive

orthopedic problem for the world’s industrialized countries. It is the

seat of miracles. The central nervous system as well as autonomic

nervous system work through the spine and the entire nervous system

dependant upon the spine. So the diseases affecting lumber spine are

handled very carefully.

Gridhrasi is such a disease having its origin in Pakvashaya and

seat in Sphika and Kati i.e. lumber spine. In classics, Gridhrasi is

included under 80 types of Nanatmaja Vata Vikara under the heading

of Vatavyadhi as a separate clinical entity. Acharya Sushruta has

emphasized the involvement of Kandara from Pasrsni to Anguli in

producing the disease Gridhrasi. He also added an important sign

Sakthanaha-kshepam-nigraniyat i.e. restriction in lifting the affected

leg. Nowadays, this sign known as S.L.R. test. It plays a major role in

diagnosis of the disease and assessment of effect of therapy as an

objective parameter.

Sciatica or sciatic syndrome – a condition described in modern

medicine resembles with Gridhrasi. In sciatica, there is pain in

distribution of sciatic nerve which begins in the lower back and

radiates through the posterior aspect of the thigh and calf and to the

outer boarder of foot. Herniation and degenerative changes in the disc

are the most common causes. There is often history of trauma as

twisting of the spine, lifting heavy objects or exposure to cold. The

disability caused by this disease hampers day to day activity of the

patients and makes the patients crippled.

There is no need to state that modern medical treatment has its

own limitation in managing this type of disease. Modern medical

treatment either conservative or surgical and is highly symptomatic

and with troublesome side effects. This suggests special need of an

ayurvedic management for this type of conditions.

Discussion

117

As the number of patients suffering from this disease are

increasing day by day. Ayurvedic physician should also make effort

continuously to find out effective remedy for the patients of Gridhrasi

from Ayurvedic classics. Basti is the best treatment of disorder of Vata

(A. H. Su. 1/25) and is considered to be half of the treatment and

some Acharya has considered it as complete treatment (Ch. Si. 1/38).

Gridhrasi is one of the Nanatmaja Vatavyadhi and occasionally

Kapha is also associated with the Vata Dosha and produce Vata-

kaphaja type of Gridhrasi. So, the drugs having Vatahara, Shulahara

and Srotoshodhaka properties may be very useful in the treatment of

Gridhrasi.

Sahacharadi Taila described by Acharya Vagbhatta (A. H. Chi.

21/56) in Vatavyadhi Chikitsa has been selected for the Matra Basti

as well as for the Kati Basti. Sahacharadi Taila contains mainly

Sahachara, Devadaru, Sunthi and Tila taila which possesses Vata-

kapha shaaka as well as anti-inflammatory, analgesic and muscle

relaxant properties, which give relief from the disease.

The efficacy of Rasna Guggulu has already been proved by many

scholars and it is indicated in the management of Gridhrasi by

Chakradatta, Gadanigraha, Bhavaprakasha and Yogaratnakara. So,

this has been opted as standard control drug for the present study.

With the above concept a clinical study was undertaken into

three groups viz. Kati Basti (KB) group, Matra Basti (MB) group and

Rasna Guggulu (RG) group. Amongst them in MB group 13 patients

were registered and from them 3 patients left the therapy without

completing total course. In KB group 8 patients were registered and all

have completed the treatment while in RG group 11 patients were

registered and out of them three patients have left the treatment

without completing total course.

Discussion on obtained observations and results of therapy is

follows as under :

Discussion

118

Age : 32 patients of this study were between the age of 20 – 70

years of age group. Maximum numbers of patients i.e. 25% were

belonging to 40 – 50 years which was followed by age group 30 – 40

years.

Highest incidence of Gridhrasi reported in age group of 40 – 50

years that is 4th decade of life. This is Vata Prakopaka Kala and

according to modern science there is progressive decrease in degree

of hydration of the intervertebral disc with age that lead to the

cycle of degeneration resulting in disc problems and causing

Gridhrasi. Moreover, young adults are more expose to strong

biochemical force and heavy work in comparison to children, which

may also create this condition. Hence, prevalence of sciatica is high

in young and middle aged people, which is supported by the

findings of the present study. No patients were found in 0 – 20 yeas

of age group, because in this group more elasticity is found in

spine. So it works as a good shock absorber and doesn’t give the

chance to produce Gridhrasi.

Sex : In present study, maximum number of patients were female

i.e. 53.12% followed by male (46.87%). Highest incidence was

observed in female because female are tend to more physical work

like lifting, bending, sitting and sustained non-neutral postures

predispose to sciatica. Similarly in male who are at hard physical

jobs and in particular frequent lifting and postural stress are

known to increase the risk of sciatica.

Religion : The majority of the patients i.e. 75% were found to be of

Hindu community followed by Muslims (25%) community. The

religion doesn’t seen to have any significant relationship with the

disease Gridhrasi. So, geographical proportion of Hindus in the city

may be the reason for its higher incidence in Hindu.

Education & Socio-Economic Status : Maximum number of

patients i.e. 31.25% were having primary education 28.12% of the

patients were having secondary education, 21.87% patient were

Discussion

119

graduate, 15.62% were illiterate and only 3.12% were having post

graduation.

In the present study, most of the patients i.e. 75% were from

middle class and equal number of patients i.e. 12.50% were rich

and poor.

This data reflects that, physically strainful activities found in

less educated people and the people who are from middle class.

Occupation : Maximum number of patients i.e. 46.87% were

households followed by labourers i.e. 18.75%. It is because of the

more incidences of the female patients. They have to lift many and

varied weights and have to stand or work in unusual postures for

long periods.

Various surveys suggest that physical workers or labourer have

relatively high prevalence of sciatica because they have to sustain

higher load on their spine.

Marital Status : In present study, most of the patients i.e. 96.87%

patients were married as most of they were of middle aged group.

3.12% patients were unmarried. No conclusion can be drawn on

this data.

Habitat : Most of the patients i.e. 62.50% belonged to urban area

while remaining 37.50% patients were belonged to rural area. This

is because of fast life style of the people who belonged to urban

area.

Diet : Maximum number of patients i.e. 75% were vegetarians

while remaining 25% patients were taking mix diet. This is because

of this hospital is located in Hindu locality and Hindus are

vegetarians in this area.

Appetite : Equal number of patients i.e. 43.75% were having good

and low appetite while remaining 12.50% patients were having

disturbed appetite. This data is supportive to Vataja and Vata-

kaphaja type of Gridhrasi.

Discussion

120

Sleep : In this study, maximum number of patients i.e. 56.25%

were having sound sleep followed by disturbed sleep i.e. 43.75%. It

does not show any relation with this disease.

Chronicity : In the present study, 59.37% patients were having 0 –

1 year chronicity followed by 21.87% patients were having

chronicity of 1 – 2 years and remaining 18.75% patient were having

chronicity of more than 2 years. This study again shows health

awareness of the people.

Type Of Disease : In this study, maximum number of patients i.e.

68.75% Vataja type of Gridhrasi followed by Vata-kaphaja type i.e.

31.25%. As Vata is the main factor involved in Samprapti of

Gridhrasi.

Prakriti : All the patients of this study were having Dwandaja

Prakriti. Equal number of patients i.e. 40.62% were having Vata-

pittaja and Vata-kaphaja Prakriti and 18.75% were having Pitta-

kaphaja Prakriti. This study suggests that Vata plays a major role

in the manifestation of the disease.

Sara : Maximum number of patients i.e. 90.62% were having

Madhyama Sara followed by 6.25% of Uttama Sara and remaining

3.12% patients of Avara Sara. Saratva of Dhatu provides resistance

to disease.

Samhanana : In this study, maximum number of patients i.e.

96.87% were of Madhyama Samhanana while remaining 3.12% of

patients of Pravara Samhanana. It does not show any relationship

with the disease.

Satmya : In the present study, maximum number of patients i.e.

93.75% were having Madhyama Satmya while remaining 6.25%

patient were having Pravara Satmya. It does not show any

relationship with the disease.

Satva : Maximum number of patients i.e. 90.62% were of

Madhyama Satva followed by Pravara Satva i.e. 9.37%. Various

study suggested that psychological factors play an important role

Discussion

121

in low back pain. The patients having Avara Satva are said to be

more prone to mental stress.

Abhyavaharana Shakti and Jarana Shakti : Higher number of

patients i.e. 90.62% were having Madhyama Abhyavaharana

Shakti followed by Pravara Abhyavaharana Shakti i.e. 6.25% and

3.12% patients were having Avara Abhyavaharana Shakti.

Maximum number of patients i.e. 78.12% were having

Madhyama Jarana Shakti, 15.62% patients were having Pravara

Jarana Shakti while remaining 6.25% patients were having Avara

Jarana Shakti.

Abhyavaharana and Jarana Shakti does not show any

relationship with the disease.

Vyayama Shakti : Maximum number of patients i.e. 65.62% were

having Madhyama Vyayama Shakti followed by Avara Vyayama

Shakti i.e. 25% and remaining 9.37% patients were having Pravara

Vyayama Shakti.

It does not show any relationship with the disease.

Kostha : In this study, maximum number of patients i.e. 87.50%

were having Madhyama Kostha, 9.37% patients were having Krura

Kostha and remaining 3.12% patients were having Mrudu Kostha.

In this context, constipation may have some role in the production

of sciatica.

Desha : In this study, 96.87% patients were from Jangala

pradesha and remaining 3.12% were from Sadharana Desha. This

incidence is due to geographical status of this area particular.

Nidana : In Aharaja Nidana, maximum number of patients i.e.

68.75% were having Dhatukshayakara Ahara as Nidana. 65.62%

patients were having Ati Katu Rasa Sevana, Kathina Bhojana and

Sheeta Dravyati Sevana were found as Nidana in 53.12% and

43.70% patients respectively. These all are responsible for Vata

Prakopa and degeneration.

Discussion

122

In Viharaja, history of Bharaharana (weight lifting) was observed

in 53.12% of the patients and in 31.25% patients were having Visama

Cheshta as Nidana. Bharaharana and Visama Cheshta may be

precipitative factor of Gridhrasi as they cause strain on spine.

In Manasika Nidana, Chinta was found in 34.75% of patients,

which is also plays an important role in production of low backache by

Vata Prakopa.

History of Abhighata (trauma) was found in 40.62% of the

patients as Agantuka Nidana, which is one of the causes to produce

the disease Gridhrasi.

Associated Conditions : While having looked at the data collected

of related disease present, along with Gridhrasi 15.62% of the

patients were having obesity and spondylosis while habitual

constipation and multiple pregnancy were found in 9.37% of

patients. All these conditions give support to the hypothesis that

presence of a prior Kha-vaigunya increases the incidence of

acquiring disease of that Srotasa.

Cardinal Sign And Symptoms : Out of 32 patients, Ruka (pain in

sciatic nerve distribution) and SLR test positive were found in all

the patients i.e. 100%. 81.25% patients were having complaint of

Toda. Stambha and Spandana were present in 78.12% and 40.62%

of the patients respectively. Aruchi, Tandra and Gaurava were

present in 43.75%, 18.75% and 31.25% of the patients

respectively. Scoliosis was noticed in 9.37% of patients.

Above data shows that maximum presence of Vataja type of

symptoms and followed by Vata-kaphaja type of symptoms. Here,

predominance of Vataja type of Gridhrasi is again being proved in

present study. SLR test was used as objective parameter in diagnosis

of severity of disease and also as parameter for assessment of effect of

therapy.

Discussion

123

Neurological Findings :

In present study, out of 32 patients equal number of patients

i.e. 100% were having positive popliteal compression test and

tenderness at root of sciatic nerve. Foot flexion test was positive in

78.12% of the patients, while hyposthesia and loss of sensation were

observed in 31.25% and 30.12% of patients respectively in related

dermatome.

Knee Jerk & Ankle Jerk : Diminished knee jerk was present in

31.25% of the patients and 28.12% of the patients were having

diminished ankle jerk.

This observation shows involvement of 3rd and 4th lumber root

and involvement of 5th lumber and 1st sacral root respectively in

diminished knee jerk and ankle jerk.

Effect Of Therapy On Cardinal Sign And Symptoms :

The effect of therapy was assessed on each sign and symptom of

the disease. These sign and symptoms were given scoring pattern

before treatment and after treatment and were assessed statistically to

see the significance. The effect of therapy in all the groups in each

sign and symptom is below.

Ruka : In KB group, initial mean score of Ruka was 2.75 before

treatment which reduced up to 0.87 after treatment; with 68.36%

relief which was statistically highly significant (P<0.001). In MB

group, the means score of Ruka was 3.20 before treatment which

reduced to 0.40 after treatment with 87.50% relief which was

statistically highly significant (P<0.001), while relief produced by

RG group was 71.37%, which was also statistically highly

significant (P<0.001).

This is clear from the above discussion that all the therapies

have reduced the pain in the patients of Gridhrasi, but it was more in

MB group in comparison to KB and RG groups. Pain is produced

mainly by Vata Prakopa and the Basti is the best treatment for Vata.

So this may be one of the reasons that the better relief has been found

in MB group in comparison to KB and RG group.

Discussion

124

Toda : The mean score of Toda before Kati Basti was 1.37 which

was reduce to 0.37 with 72.99% relief. it was statistically

significant (P<0.02). MB provided 87.50% relief which was

statistically highly significant (P<0.01), while relief obtained by RG

was 66.84% which was also statistically highly significant

(P<0.001).

Toda is also one of the important symptom produced by vitiation

of Vata. MB and RG groups have shown highly significant

improvement in this symptom. But from the percentage point of view

the better relief was in MB group.

Stambha : Initial mean score of Stambha in KB group was 1.75

which was reduced to 0.62 with 64.57% relief and it was

statistically highly significant (P<0.01), while MB provided 85%

relief in symptom Stambha which was statistically highly

significant (P<0.001). RG group provided 73.33% relief which was

statistically significant (P<0.02).

Thus, MB provided better relief in symptom Stambha than KB

and RG groups and KB provided more relief in comparison to RG

group but percentage of relief was more in RG group than KB group.

Muhuspandana : Initial mean score of Muhuspandana in KB group

was 0.50 which was reduced to 0.25 with 50% relief and it was

statistically insignificant (P>0.05), whereas in RG group it was

reduced to 0.25 from the initial score 1.25 with 80% relief and it

was statistically highly significant (P<0.001). In MB group

Muhuspandana was found in only one patient which was remained

unchanged after treatment.

Obviously relief provided by RG group was better than KB

group.

Aruchi : In KB Group, the initial mean score of Aruchi was 0.75

which was reduced to 0.25 with 66.66% relief, which was

statistically insignificant (P>0.05), whereas in MB group mean

Discussion

125

score was reduced to 0.00 from the initial score 0.4 with 100% but

it was also statistically insignificant (P>0.05). however, RG group

provided 75% relief in Aruchi which was statistically significant

(P<0.02)

So it can be said that because of its Ushna Virya relief provided

by RG group was better in comparison to KB and MB group.

Tandra : In KB group, Tandra was found in only 2 patents. Initial

score of Tandra was 0.25 which was reduced to 0.12 after Kati

Basti treatment provided 52% relief. But It was statistically

insignificant. However only one patient was having symptom of

Tandra in each MB and RG group and each group provided 100%

relief but it was statistically insignificant (P>0.05). So here no

conclusion can be drawn.

Gaurava : In KB group, the initial score of Gaurava was 0.5 which

was reduced to 0.25 with 50% relief but it was statistically

insignificant (p<0.05), while both MB and RG group also provided

statistically insignificant result (P<0.05) with 66.66% and 67.56%

relief respectively. So here no conclusion can be drawn. However,

percentage of relief was better in MB group than KB and RG

groups.

SLR Test : Sushruta has mentioned that in this condition lifting of

leg is restricted. Nowadays, Skathikshepanigraha is measured by

Straight Leg Raising Test in degree with the help of Goniometer. In

KB group, the initial mean score of this test was 2.62 which was

reduced to 0.75 with providing 71.37% relief, whereas in MB group

mean score was reduced to 0.50 from the initial score 2.8 with

82.14% relief and RG provided 64.62% relief. All were statistically

highly significant (P<0.001). Thus, improvement provided by MB

was better in comparison to KB and RG group.

It is obvious that after Matra Basti, all the patients got the

power to lift the leg to more height. In KB and RG group also patients

Discussion

126

were able to lift the leg more efficiently, but low improvement in

comparison to MB group. It is the main clinical test for the assessing

of Gridhrasi.

Scoliosis : Out of the three groups, the scoliosis was observed only

in MB group. Initial mean score of scoliosis was 0.50, which was

reduced to 0.20 after treatment with 60% relief, but it was

statistically insignificant (P>0.05).

TOTAL EFFECT OF TEHRAPY

In KB group 2 patients (25%), in MB group only 1 patient (10%)

and in RG group 2 patients (25%) were cured, while 9 patients (90%)

in MB group and 2 patients (62.50%) in each KB and RG group

showed markedly improvement whereas 1 patient (12.50%) in each KB

and RG group showed improved result. None of the patient was

unchanged in any group.

Hence it can be said that overall effect of MB was better on the

patients of Gridhrasi in comparison to KB and RG group.

Comparison Of The Effects :

It is obvious from the foregoing that MB provided significant and

better relief in the symptoms of Ruka (87.50%), Toda (87.50%),

Stambha (85%) and increase in SLR test (82.14%), whereas out of

remaining 2 groups i.e. KB and RG. Control therapy provided better

relief in signs and symptoms than KB group.

So it can be concluded that MB provided better relief in the

amelioration of almost signs and symptoms of disease Gridhrasi. Next

in the order of efficacy was control therapy i.e. RG group.

Comparatively poor relief was obtained in KB therapy, but if it had

been done for longer period on a longer sample of the patient than the

result would have been better. Hence this regimen may be tried for a

long period.

Discussion

127

Mode Of Action Of Basti Karma :

Samprapti Vighatanameva Chikitsa. In the pathogenesis of

Gridhrasi, Vata is invariably present particularly Vyana and Apana

vayu. Gridhrasi is a disease having its origin in Pakvashaya and seat

in Kati that is lumber spine. So in addition to it Basti may be the best

mode of drug administration so far as taste of drug, dosage and Agni

is concerned, in comparison to oral drug administration.

Now the question arises that how the drug given through the

Basti reaches at the site of the lesion. The only possible answer seems

that Sushruta mentioned that the Virya of the Basti medicines

spreads all over the body just as water poured at the root reaches all

parts of the tree through the micro and macro channels (Su. Chi.

35/24-25). While Charaka mentions that Basti by reaching up to the

umbilical region (transverse colon), sacroiliac region (rectum), flanks

and hypochondrial regions (ascending and descending colon) and

churning of the faecal and morbid matters present there in and at the

same time by spreading its unctuous effect in whole body, drawn out

the faecal and morbid matter with ease (Ch. Si. 1/41).

While dealing with the action of Basti Vagbhatta says, the Virya

of Basti being conveyed to Apana to Samana Vata which may regulate

the function of Agni then to Udana, Vyana and Apana thus providing

its efficacy all over the body. At the same time this effect of Basti by

specifying Vata, restores the displaced Kapha and Pitta at their

original seats. The control gained over Vata leads to the Vighatana of

Samprapti Ghataka of disease Gridhrasi (A. S. Si. 5/68-70).

The same action of Basti drugs has been described by Acharya

Charaka as the Basti, when lying in the Pakvashaya drawn by its

Virya and morbid Dosha lodged in the entire body from the foot to the

head, just as the sun situated in the sky sucks up the moisture from

the earth.

Discussion

128

Thus, according to Ayurveda the Virya of ingredients used in the

Basti, gets absorbed and then through general circulation reaches at

the site of lesion and relieves the disease. That’s why Acharya

Sushruta has mentioned that by using the different ingredients, Basti

can be cured Paittika, Kaphaja, Raktaja, Sansargaja and

Sannipaittika disorders also though, it is the best treatment for Vata

Dosha.

MB of Sahacharadi Taila comprises mainly Sahachara,

Devadaru, Sunthi and Tila Taila. All these drugs possess mainly

Snigdha Guna, Ushna Virya and Vata-kaphashamaka properties, thus

provided significant effect on almost all the symptoms of Gridhrasi.

Pharmacological study also shows that it possesses anti-inflammatory

and analgesic properties. Hence, by relieving the inflammatory

change in nerve, it might have reduced the nerve root compression

symptoms.

In addition to it patients of oral group were given Rasna

Guggulu comprises of 1 part Rasna Churna and 5 parts Nirgundi

Patrabhavita Guggulu. Guggulu is one of the best drugs, which is

useful in Vatavyadhi in classics. It is Tridoshashamaka, Shulahara,

Vedanasthapana, Shothahara and Rasayana. Anti-inflammatory and

analgesic effect of Guggulu is proved. Rasna is also having

Shothahara and Vedanasthapana properties.

According to modern science, as per Basti/Enema concerned, in

transrectal route, the rectum has a rich blood and lymph supply and

drugs can cross the rectal mucosa like other lipid membrane. Thus,

unionized and lipid soluble substances are readily abosorbed from the

rectum. The portion absorbed from the upper rectal mucosa is carried

by the superior haemorrhoidal vein in to the portal circulation,

whereas that absorbed from the lower rectum enters directly into the

systemic circulation via the middle and inferior haemorrhoidal veins.

Pharmacologically factors affecting the drug absorption and its bio-

availability are –

Discussion

129

1) Physical properties i.e. high lipid solubility of the unionized drug

favors its absorption.

2) Nature of the dosage form.

3) Physiological factors –

a. pH of the gastro intestinal fluid and blood

b. ionization

The advantages of this route are total gastric irritation is

avoided and that by using a suitable solvent the duration of action

can be controlled. Moreover, it is often more convenient to use drugs

rectally in the long time in case of Geriatic and terminally ill patients.

Apart from its various therapeutic effects, or uses, the Basti is

administered as a part of diagnosis for certain diseases of Gastro

Intestinal tract. “The Barium Meal Enema” is one of such example,

which is given before the X-ray/screening examination.

Summary & Conclusion

130

S U M M A R Y & C O N C L U S I O N

The present study entitled “A comparative study of Kati Basti

and Matra Basti in the management of Gridhrasi (Sciatica)” comprises

of five sections viz –

1) Conceptual Contrive

2) Drug Contrive

3) Clinical contrive

4) Discussion

5) Summary & Conclusion

The first section is sub-classified by two chapters namely

‘Disease review’ and ‘Basti review’. The first chapter deals with

Ayurvedic and Modern concept of the disease. In this chapter first of

all a detail description regarding Gridhrasi according to Ayurvedic

point of view has been given which deals with Historical review,

Etymology, Nidana Panchaka, Sapeksha Nidana, Sadhya-Asadhyata

and Upadrava of Gridhrasi. At last Chikitsasutra of general

Vatavyadhi w.s.r. to Gridhrasi has been discussed. Then description

of Sciatica from modern point of view presented with the history of the

disease, definition, anatomy and physiology of sciatic nerve, etiology,

pathology, signs and symptoms, differential diagnosis and the

diagnosis of the sciatica and in the last prognosis, management and

preventive measures of sciatica has been discussed.

This study deals with Panchakarma. So, the Karma performed

i.e. Kati Basti and matra basti have been described in detail under the

heading of Basti review in second chapter. In this chapter, historical

aspect of Basti, etymology, definition and classification of Basti and

Particularly Matra Basti along with its indications, contra indications,

Pathya -Apathya, action, dose, retention and Samyaka Yoga Lakshana

and complication of Sneha Basti and in last description of Kati Basti

has been given.


131

The second section termed as “Drug Contrive” commences with

a description of properties along with pharmaco-dynamics of the drug

selected for the study.

The third section entitled “Clinical Contrive” commences with a

detailed description of the selection of the patients and methods

adopted for the research work. Thereafter, the results obtained with

statistical analysis in this study have been presented in the form of

tables and graphs along with brief description of the same.

The fourth section entitled “Discussion” describes the logical

interpretation of the results obtained in the clinical study, based on

Ayurvedic principles.

The conclusion thus drawn from the observations are presented

as below :

Gridhrasi is commonly seen in society as a prominent problem.

Gridhrasi comes under 80 types of Nanatmaja Vatavyadhi.

Vyana Vayu is an essential factor for manifestation of the disease

Gridhrasi.

Gridhrasi is a painful condition and so far there is no established

therapy. Mainly Vatavyadhi Chikitsa has bee advocated in

Gridhrasi.

There is no direct reference regarding Nidana and Samprapti of

Gridhrasi.

Gridhrasi can be equated with Sciatica in modern medicine.

Allopathic management is far away from the perfect treatment.


132

OBSERVATIONS

Majority of the patient i.e. 25% were belonging to 40 – 50 years of

age group. Both female (53.12%) and male (46.87%) were recorded

for this study. Maximum number of patient i.e. 75% were Hindu,

96.87% were married, 46.87% were households, 31.25% were

having primary education, 75% were belonging to middle class and

62.5% were dwelling in urban area.

Maximum number of patients i.e. 59.37% had 0 - 1 year

chronicity, 68.75% patient were having Vataja-type of Gridhrasi,

56.25% were having sound sleep and 96.87% patients were

belonged Jangala Desha.

Dietetic pattern of 32 patients revealed that maximum number of

patients i.e. 75% were vegetarian, equal number of patients i.e.

43.75% were having good and low appetite, 53.12% were having

Mandagni and 87.5% were having Madhyama Kostha.

All the patients were having Dwandaja Prakriti with equal number

of patients i.e. 40.62% patients were having Vata-pittaja and Vata-

kaphaja Prakriti. Most of the patients i.e. 90.62% were having

Madhyama Sara, Madhyama Samhanana (96.87%), Madhyama

Satmya (93.75%), Madhyama Satva (90.62%), Madhyama

Abhyavaharana Shakti (90.62%), Madhyama Jaranan Shakti

(78.12%) and Madhyama Vyayama Shakti (65.62%).

Evaluation of Nidana showed that maximum number of patients

i.e. 68.75% had history of Dhatukshayakara Ahara followed by

65.62% patients were having Katu Rasa dominant diet. History of

Kathina Bhojana and Sheeta Dravyati Sevana was found in 53.12%

and 43.70% of the patients respectively.

Bharaharana was observed in 53.12% and history of Visama

Cheshta was found in 31.25% of the patients. Anxiety was

observed in 34.75% and 40.62% of the patients gave the history of

trauma.


133

Out of 32 patents, Ruka and Sakthikshepa Nigraha were found in

all the patients. 81.25% of patients were having complaint of Toda.

Stambha and Muhuspandana were present in 78.12 and 4.62% of

the patients respectively. Scoliosis was noticed only in 3 (9.37%)

patients.

Positive popliteal compression test and tenderness at root of sciatic

nerve were found in all the patients while foot flexion test was

positive in 78.12% of the patients. Diminished knee jerk and ankle

jerk were observed in 31.25% and 28.12% of the patients

respectively. 31.25% were observed with hypotonia and 30.12% of

the patients were observed with loss of sensation in related

dermatome.

EFFECT OF THERAPIES

8 patients of Gridhrasi were treated with Kati Basti of Sahacharadi

Taila for 14 days showed that this therapy provided highly

significant relief in the symptoms of Ruka (68.36%) and SLR test.

The therapy also provided significant relief in the symptoms of

Stambha (64.57%) and Toda (72.99%).

Statistically insignificant relief (P>0.05) was observed in the

symptoms of Spandana (50%), Aruchi (66.66%), Tandra (52%) and

Gaurava (50%).

10 patients were treated with Matra Basti of Sahacharadi Taila for

14 days. This therapy has provided highly significant relief in the

symptoms of Ruka (87.50%), Stambha (85%) and SLR test 82.14%.

the significant relief was noted in case of Toda with 87.50%.

Though, percentage of relief was good in case of Aruchi (100%),

Tandra (100%), Gaurava (66.66%) and scoliosis (60%), it was

statistically insignificant P>0.05.

8 patients were treated with Rasna Guggulu in the dose of 2 tablets

(500mg each) twice/day for 30 days. This control therapy provided

highly significant relief in the symptoms of Ruka (71.37%), Toda


134

(66.84%), Spandana (80%) and SLR test (64.62%). The effect of

therapy was statistically significant in the symptom of Stambha

(73.33%) and Aruchi (75%) (P<0.02).

This control therapy provided insignificant relief (P>0.05) in the

symptoms of Tandra (100%) and Gaurava (67.56%).

In assessing overall effect of therapy it was seen that –

In KB group, out of 8 patients, 2 patients (25%) were cured,

5 patients (62.50%) got markedly improvement and only 1

patient (12.50%) got improved result.

In MB group out of 10 patients, only 1 patient (10%) was

cured while remaining 9 patients (90%) got markedly

improved results.

In RG group, out of 8 patients, 2 patients (25%) were cured,

and remaining 6 patients (75%) were got markedly improved

results.

So, it is well observed that MB provided better relief in the

amelioration of signs and symptoms in comparison to other two

groups. Next in the order of efficacy was control therapy, while

comparatively poor result was observed in KB group, but it had

been done for longer period on a longer sample of the patient than

the result would have been better. Hence, this regimen may be

tried for a long period.

Bibliography

i

BIBLIOGRAPHY AYURVEDIC TEXTS

Ashtanga Hridaya – With Sarvanga Sundari commentary Nirnaya

Sagar press – Bombay (1993).

Atharva Veda – 1929 Subhoda Bhashya, Sripad Damodar

Satwalekar.

Bhavaprakasha – 1945, Chankambha Sanskrit series Varanasi.

Bhela Samhita- Girijadaya Shukla, chowkambha Press, Varanasi.

Chakrapani – Chakradatta with Bhavarth Sandipani Comm. IV

Edi. by Shashtri Bramhshnakr, Chaukhambha, 1976, Varanasi.

Charaka Samhita – By Chakrapani with Ayurveda Dipika

commentary Nirnaya Sagar Press - Bombay.

Charaka Samhita – English Translation, Gulab Kunverba Ayurved

Society, Jamnagar.

Chopra’s Indigenous drugs of India – By Karna Chopra, 2nd, edi.,

Published –1956.

Dravyaguna Vianana, XIII Edi. - P.V.Sharma, Chaukhambha

Bharti Academy, Varanasi, 1991.

Harita Samhita – Khemaraja Shri Krishnadas, Shri Venkateswarea

Press, Bombay.

Indian drugs 21(9) - Dahanukar S.A. and Karandikar S.M. -1984.

Indu Sashilekha comm. on Ashtanga Samgraha of Vriddha

Vagbhatta, ed. A. D. Athavale, Pub. M. A. Athavale, Poona, 1980.

Kashyapa Samhita – Vidhyotini Hindi commentary – by Satyapal

2nd edition - 1976.

Kasture H. S. – Ayurvediya Panchakarma Vijnana, 5th edition,

Baidhyanatha Ayurved Bhavan, Nagpur, 1997.

Madhava Nidana – Uttarardha, Madhukosha with Vidyotini, Hindi

comm. by Sudarshna Shastri 1954.

Madhukoshatika of Madhava Nidana - Vijaya Rakshita and

Srikanthadatta-, by Shastri S. and Upadhyaya V., Chaukhambha

Sanskrit Samsthana, Varanasi.

Bibliography

ii

Panchakarma - Combination of Shodhana & Shamana Divakar.

Panchakarma Therapy by Prof. R. H. Singh, Chaukhambha

Sanskrit Studies, Varanasi. Vol. CIV.

Pathogenesis in Ayurveda -V.B. Athavale - Sion Bombay.

Sarngadhara – Sarngadhara Gudhartha Dipika comm., edi.

Parshuram Shastri, Varanasi, 1985.

Shabdakalpadruma, III Edi. - Chaukhambha Sanskrit Series,

1961,

Sharangdhara Samhita, 2nd edi - Adhamalla and Kashiram –

comm., 1985, editor Parshuram Shastry, Pub. Krishnadas

Academy, Oriental pub., Varanasi.

Subodha Bhasya Atharvaveda - Sripeda Damodar Satwalekar -

1929.

Sushruta Samhita – Sushruta Samhita edited by Yadavaji Trikamji

Acharya, Chaukhambha.

Sushruta Samhita – Sushruta Samhita translated by Ambika Datt

Sashtri, Chaukhambha Orientallia Publication, Varanasi.

Textbook of clinical Panchakarma edited by Dr. P. Jaya Yadayya,

1st edition, March 2000, Akola.

Wealth of India- Raw materials vol. I & II published by council of

scientific & Industrial research, 1959.

Yoga Ratnakar – Chowkhamba Sanskrit series, Varanasi.

MODERN TEXTS

Campbell’s operative orthopedic by S. T. Canale, 9th edition.

Davidson (1991) : Principles and practice of medicine, 16th edition.

Dorland-Medial Dictionary, Oxford, I.B.H. Pub., XXI ed. 1968.

Dornard : Pocket medical dictionary, Oxford and IBH Publishing

Company Pvt. Ltd., 25th edition.

Golwala A.F. & Golwala S.A. (1988): Medicine for Students, 24th

edition, India.

Guyton & Hall (1996) : Textbook of medical physiology, 9th edition,

A PRISM Indian edition, Bangalore.

Bibliography

iii

Harrison : Principles of Internal Medicines, 15th International

Edition, edited by Eugene Braunwald, Anthony S. Fanci, Stephen

L. Hauser, Dennis L. Kasper, Dan L. Longo, J. Larry Jameson and

McGraw-Hill – Medical Publishing Division, Vol.- I.

Human Anatomy by B. D. Chaurasia, Vol. II, 3rd edition, 1995.

Low Back Pain – Medical Diagnosis and Comprehensive

Management, 2nd edition, 1989.

MacNab’s Backache by J. A. Meer, 3rd edition, 1997.

Physical Sign in Orthopedics by H. J. Walsh, 1st edition, 1995.

Savill (1998) : System of clinical medicine, 14th edition.

Textbook of spinal surgery by P. S. Ramani, 1st edition, 1995.

Tortora & Graybowski : Principles of anatomy and physiology, 10th

edition.

Thesis :

Moradia Ghanashyama (1990) : A comparative study on the role

of Shodhana and Shamana therapies of Gridhrasi, I.P.G.T. & R.A.,

Jamnagar.

Shridhar Bairy T. (1997) : Phytochemica and pharmacothera-

peutic evaluation of Parijata (N. arbortristis Linn.) w.s.r. to its effect

on Gridhrasi, I.P.G.T. & R.A., Jamnagar.



Jamnagar.

Manoranjan Sahu (2002) : A critical study on aetiopathogenesis of

Gridhrasi and its management by Rasna Guggulu along with

Shodhana Therapy”

Pradeep S. Nandgaonkar (1991) : The management of Gridhrasi

(sciatica) with Sephalika Ghanavati (N. arbortristis Linn), G.A. Ayu.

College, Ahmedabad.

Urmila S. Bedekar (1995) : A comparative study of Nirgundi

Patrapinda sweda and Basti Chikitsa in the management of

Gridhrasi (Sciatica) , G.A. Ayu. College, Ahmedabad.

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