“A CLINICAL STUDY ON THE EFFECT OF RASONA PINDA WITH ASTA VARGA KASHAYA ANUPANA
AND MATRA VASTI IN THE MANAGEMENT OF GRIDHRASI VATA”
DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT FOR THE
DEGREE OF DOCTOR OF MEDICINE (AYURVEDA)
GUIDE
Dr. PRAKASH CHANDER M.D. (Kaya Chikitsa.),
PROFESSOR & HEAD OF DEPARTMENT,
P.G.UNIT (K.C.)
Dr.K.SIREESHA 2007
Post Graduate Department of Kaya Chikitsa Dr.B.R.K.R.Govt.Ayurvedic College / Hospital
Hyderabad.
(Affiliated to Dr.NTR University of Health Sciences, Vijayawada)
Dr. N.T.R.UNIVERSITY OF HEALTH SCIENCES Vijayawada, A.P.
Post Graduate Department of Kaya Chikitsa
Dr.B.R.K.R.Govt.Ayurvedic College, Hyderabad Place: Hyderabad, Date: / /2007.
CERTIFICATE This is to certify that Dr. K. SIREESHA is a bonafide final year Post-
graduate scholar of M.D. (Ay) in the speciality of Kaya Chikitsa of this
institute. She has worked for her thesis on the topic titled “A clinical study on
the effect of Rasona Pinda with Asta Varga Kashaya Anupana and
Matra Vasti in the management of Gridhrasi Vata” as per the
requirements laid down by the Dr.N.T.R.University of Health Sciences,
Vijayawada, for the purpose.
I forward this thesis for further evaluation by adjudicators.
Dr. PRAKASH CHANDER M.D. (Ay.) Professor & H.O.D P.G.Unit of Kaya Chikitsa Dr.B.R.K.R.Govt.Ayurvedic College, Hyderabad, A.P.
Dr. N.T.R.UNIVERSITY OF HEALTH SCIENCES
Vijayawada, A.P.
Post Graduate Department of Kaya Chikitsa Dr.B.R.K.R.Govt.Ayurvedic College, Hyderabad
Place: Hyderabad, Date: / /2007.
CERTIFICATE This is to certify that Dr. K.SIREESHA is a final year Post-graduate
Scholar of M.D. (Ay) in the speciality of Kaya Chikitsa of this institute. She
has written the dissertation entitled “A clinical study on the effect of Rasona
Pinda with Asta Varga Kashaya Anupana and Matra Vasti in the
management of Gridhrasi Vata.” in partial fulfillment for the degree of
Doctor of medicine under my direct supervision and guidance. The candidate
has put in all her efforts in the successful completion of her studies.
Dr. PRAKASH CHANDER.
M.D. (Ay.)
“Namami Dhanvantarimadi Devam, Surasurairvandit Padapadmam | Loke Jararugbhay Mrutyunasham,
Datarmisham Vividhoushadhinam ||”
ACKNOWLEDGEMENTS The present thesis work is dedicated to Golden feet of Sri Lord Venkateswara.
It is a great privilege for me to have worked under the guidance of
Dr. PRAKASH CHANDER M.D (Ay), Professor & Head of Dept. of P.G. Unit (K.C),
who has guided and supervised my work with his valuable suggestions in this entire
dissertation work.
I offer earnest thanks to Dr.M.Srinivasulu for his timely suggestions and valuable
discussion for completion of thesis work.
It gives me a moment at great pleasure on this occasion to thank and
acknowledge the important and unforgettably needed help rendered by Dr.V.Vijaya Babu
M.D (Ay) Reader P.G Unit K .C with out which this work would not have been
completed.
I express heartful thanks to Dr. K.V.Bhaswanth Rao, Dr M.L.Naidu, Dr. Vijaya
lakshmi, Dr.Ramlingeswar, Dr Raghupathi Goud, Dr Murali Mohan, Dr.Nageswara
Babu, Dr. Srikanth Babu, for their valuable suggestions and support.
I owe my special thanks to Dr K.V.S.Prabhakaram A.D AYUSH Dept.,
Dr. P. Murali Krishna, M.D.(Ay), Assistant Professor, S.V.Ayurvedic College, Tirupati,
and Dr. G.Puroshothamacharyulu M.D and Dr.D. Ram Gopal M.D who trained me in a
right path in the field of Ayurveda .
I am highly thankful to Dr.K.Sadasiva Rao,, Principal, Dr.B.R.K.R.Govt.
Ayurvedic College, Hyderabad, Dr.L.Radha.Krishna Murthy Hospital Superintendent for
giving us the concern facilities for the successful completion this work.
My head bows at the feet of my parents who are solely responsible for my
existence. I am equally thankful to my in-laws, my husband M. Satya Srinivas, my son
Sudarsan and my brother Kishore for their valuable support.
I am very thankful to my colleagues Dr. J.Sivanarayan, Dr. G.Lavanya,, Dr. V.Laxmi
Prasoona and my senior Dr M.Padmaja for their kind co-operation.
Finally I express my thanks to all my patients who have co-operated with me at all levels in my
clinical study.
(Dr. K. SIREESHA)
Parts Index Page no.
Part-I 1. Introduction 2. Review of Historical aspect
1-4 5-9
Part-II DISEASE ASPECT 1) Gridhrasi vata meaning and definition 2) Sareeram 3) Nidanam 4) Poorva roopa 5) Roopa 6) Samprapti 7) Upadravas and Sadhyasadhyata 8) Sapeksha Nidana
10-11 12-24 25-32
33 34-44 45-52 53-54 55-56
Part-III 1) Chikitsa. 2) Pathyapathya
57-61 62-65
Part-IV DRUG ASPECT 1) Description of Individual drugs
2) Description of Matra Vasti.
66-79 80-82
Part-V CLINICAL STUDY 1) Materials and methods 2) Observations 3) Results.
83-89
90-102 103-110
Part-VI 1) Discussion 2) Summary 3) Conclusion 4) Bibliography 5) References 6) Annexure
111-115 116-117 118-119
u INTRODUCTION
Life started from a single organism and extends to more complex state
during the evolution. In this process of evolution vertebrates accomplished their
role by having a complex axial skeletal system among the other groups of living
beings. It is very much primitive in fishes, amphibians and developed in birds and
animals respectively. In the group of mammals, the animals, which move on four
legs possess cartilages between the adjacent vertebrae instead of discs as in
human. In evolutionary process man remain as the only animal, which stands in
up right posture.
During the man’s evolution the transition from the quadrupedal to bipedal
state led first to straightening and then to inversion of lumbar curvature (lumbar
lordosis). The erection of the trunk has been obtained partly by backward tilting of
pelvis and partly by the bending of the lumbar column.
The vertebral column of quadrupeds relaxes absolutely during rest. Indeed
the presence of curvatures in the vertebral column, man never attains absolute rest
in any posture and owing them to suffer with problems related to vertebral
column.
Obviously the life style of a person has changed a lot in accordance with
the time. As the advancement of busy, professional and social life, improper
sitting postures in offices and factories, continuous and over exertion, jerking
movements during traveling and sports-all these factors created un due pressure on
the spine. All these factors will result in the most common disorder in most
productive period of life. - Back pain. Out of which 40% of persons will have
radicular pain and this comes under the umbrella of Sciatica.
1
Gridhasi 1 is a shoola pradhana vataja nandmaja vyadhi affecting locomotor
system and leaving the person disable from daily routine activity. Gridhrasi 2 the
name itself indicates way of gait shown by the patient due to extreme pain i.e. like
Gridhra or Eagle.
Gridhrasi3 is a condition where vata affects the gridhrasi nadi characterized
by Ruk(pain), Sthamba(stiffness),Toda(pin prickling sensation) starting from Spik,
Kati, Prista(buttocks, lumbar and spinal column) radiating down to posterior
border of Uru (thigh), Janu(knee), Jangha, pada and impairment of lifting of thigh.
Signs and symptoms of Gridhrasi are nearly same and can be compared
with sciatica. The knowledge of this condition to the modern medical science is
just two century old while this is known to Ayurveda since last five thousand
years.
According to survey low back pain is extra ordinary common and second
ordinary to common cold with a lifetime prevalence of 60%-90% and annual
incidence of five percent. 80% of population will experience back pain at some
time in their life. In a nutshell prevalence of sciatica ranges from 11%-40%. No
population appears immune although physical fitness might maintain the health.
Back pain4 is one of the major medical, social and economic problem in our
society. The severity of the back pain ranges from minor niggles to excruciating
pain, but the problem as whole is remarkably wide spread.
A recent calculation suggested that the pre-neolithic hunter gatherer man only
performed about 5o lifts per day where as a 20th century man performs ten times
that figure.
Sciatica continues to be one of the most challenging problems in primary care.
2
It is associated with enormous costs in terms of direct health care
expenditures, and indirect work and disability related loses.
Pain often is persistent during the episode, and many patients do not have
complete resolution of their symptoms but have “flares” against a background of
chronic pain.
The incidence of sciatica in those employed in heavy industry is some 5
times than in light industry. However the information available is not entirely
consistent in that, there is also a high incidence in those who performs sedentary
work particularly if they spend a lot of time in motor vehicles.
The knowledge of cost of sciatica is essential in indicating the importance
of the problem and the need for extra resources to improve our current facilities.
A medicament, which relieves the pain, improves the functional ability
restore from functional disability and controls the condition with cost
effectiveness, is the need of the hour.
The treatment of sciatica in modern medicine comprises analgesic, bed rest
etc., Unfortunately analgesics are liable to many side effects particularly by
repeated and prolonged use.
An Ayurvedic approach is helpful to improve quality of life in the patient
of Gridhrasi and for certain extent by administering the Ayurvedic treatment
surgical intervention can be avoided or postponed.
While going through the treatments of Gridhrasi 5, sequential administration
of snehana, swedana, vasti, sira vyadha and agni karma are lines of treatment
explained in Ayurvedic classics. Apart from these procedures, certain samana
yogas for oral administration are also explained.
3
Among various treatments Vasti is a unique procedure, which eliminates
the aggravated doshas from the body, as such it was described as half of the
treatment of kaya chikitsa.
Matra vasti is a simplest type of vasti explained in classics. There is no
restricted regimen for it. It is a cost effective, and time saving procedure when
compared to other vasti karmas. Hence I selected matra vasti with Balaswagandha
tailam for my present study.
Lasuna is considered as best vatahara dravya according to vagbhata, which
is a major ingredient of swalpa rasona pindam. This yoga possesses deepana,
pachana, rasayana, vedana samaka properties. Swalpa rasona pindam6 specially
indicated for Gridhrasi in Bhaisajya Ratnavali. It is selected for my present study.
Astavarga kashaya7 is selected as anupana. It is best vatahara mentioned in sahasra
yogam kashaya prakaranam.
Different works have been carried out in different views. Still an added
effort was made by understanding the problem with available sources of literature
and tried to manage the condition, thinking that this may help in giving better
management for patient and helping them in relieving their sufferings.
The clinical study is a sincere effort to add new dimension in the treatment
of Gridhrasi. It is also hope that this work may pave new avenues for enthusiastic
workers to further advance in this field and find a better cure for this problem,
with this noble intension this theses work is selected.
4
HISTORICAL ASPECT
Historical review can be classified into
I) Vedic Kala
II) Pauranika Kala
III) Samhita Kala
IV) Sangraha Kala
I) VEDIC KALA: Historical aspect of Gridhrasi can be taken from vedic
period itself. Rigveda8 attributed medical powers to Indra who helped
the lame srona in restoring his walking power. Some commentators
consider srona as a sage, but srona also indicates a cripple and also a
disease perhaps related to sroni. But it is not clear whether this
lameness is due to a disease of sroni. There is a reference in Atharwana
veda9, which requires a special mention i.e., “the piercing pain from
feet, knee, hips and hinder parts (Sroni parinama) and spine”. So this
reference denotes the pain in the same regions of Gridhrasi though the
name of the disease has not been mentioned.
II) PAURANIKA KALA: In Garuda Purana a separate chapter is described
for Vata Vyadhi. In this Chapter Gridhrasi is described as an entity. Agni
Purana also holds identical description.
III) SAMHITA KALA:
CHARAKA SAMHITA:
In Sutrasthana -Padabhyanga 10 is indicated in Gridhrasi.
-Gridhrasi has been described as Swedya vyadhi11.
-Gridhrasi is described in Vataja nanatmaja Vyadhi 12
In Chikitasa sthana - Lakshana and Chikitsa 13 of Gridhrasi are described.
5
SUSHRUTA SAMHITA:
In Nidana Stana – symptomatology14 and Pathology of Gridhrasi has been
described.
In Chikitsthana – Siravedha15 is described for Gridhrasi.
In sarira sthana – siravedha16 site for Gridhrasi is indicated.
ASTANGA SANGRAH:
In Sutrasthana – Gridhrasi17 is included under 80 types of vata vikara.
- Site for siravedha18 in Gridhrasi has been described.
In Nidana Sthana - pathogenesis and symptomatology of Gridhrasi 19 has been
described.
ASTANGA HRIDAYA20:
– Similar description as in sangraha.
KASHYAPA SAMHITA21:
Gridhrasi considered as one among Aseetivatavikaras.
BHELA SAMHITA:
Basti and Rakta mokshana22 are indicated for Gridhrasi.
HARITA SAMHITA:
Harita23 was the first to give importance to gridhrasi by naming 22nd Chapter of
Tritiya sthana as Gridhrasi cikitsadhyaya.
IV) SANGRAHA KALA:
MADHAVA NIDANA: Description is similar as in charaka but some specific
symptoms have been highlighted i.e Dehasya pravakrta24 in Vataja
type,mukhapreseka and bhaktadwesha in vatakaphaja type.
6
SHARANGA DHARA SAMHITA:
Gridhrasi is counted under 80 Vata Nanatmaja vyadhis25 in 7th Chapter of
purva khanda chikitsa of gridhrasi is described in 2nd and 5th Chapter of
madhyamakhanda26,27.
BHAVA PRAKASHA: Gridhrasi has been described according to charaka.
Chakradutta28 suggested to burn little finger of the affected limb if
Gridhrasi is not subsided by any treatment.
VANGASENA SAMHITA:
Vangasena29 used the term vata balasa for vata kaphaja Gridhrasi. For the
first time its vishesha chikitsa has been given. Tapta taila Istika Swedana,
Upanaha, Deepana, Pachana, Vamana, Virechana, Vasti and Siraveda.
Sigerist has observed that sudden sharp nature of sciatica attack struck
primitive people as demon magic.
Hippocrates30 believed sciatica was prevalent during summer and autumn
months.
In 4th Century B.C Caelius Aurelianus31 clearly described symptoms of
Sciatica. The disease arises from observable or hidden causes eg. A sudden jerk
or movement during exercise, unaccoustomed digging in the ground, exertion on
lifting a weight from below; termination of haemorrhoidal bleeding.
The oldest of scientific surgical text is Edwin Smith surgical papyrus, this
scroll was found in a grave near Luxor, Egypt in 1862. The Papyrus describes
Sciatica, when even than was recognized as connected with vertebral problems.
Pore (1510-1590) of France observed that severe backache caused by heavy
work with spine held flexed continuously.
Fontane F of Florence 1797 observed root compression leads to Paresis in
Sciatica.
7
Domenico cotugno, Italian anatomist 1736-1822 coined the word Sciatica
in 1764. He described Sciatica as Cotugno’s disease. He was the first to describe
two types of Sciatica the nervous and the arthritic recorded in 1764. He described
etiology, pathology and clinical manifestations of Sciatica.
In his first book, Nervosa commentarious he described that dropsy of the
dual funnel enclosing the Sciatic nerve causes Sciatica. In his subsequent book
treatise on nervous Sciatica of 1775, he described cause of Sciatica as
accumulation of acrid fluid in the outer vaginae of ischiadic (Sciatic) nerve. He
pointed out that Sciatica may lead to semi parlysis and muscle wasting.
Richard Bright (1789-1858) described neuralgia in his book. He
considered Sciatica as inflammatory affection of the investing membrane of the
nerve.
C.E. Brown sequard (1817-1894) described root pain compression at the
inter vertebral foramen and recognized degeneration of the intervertebral disc.
Ernst charles Lasegue, French physician (1816-1883) described wasting of
muscles in the affected limbs will be seen in Sciatica. He demonstrated that
elevation of the extended lower extremity causes pain along Sciatic nerve in
Sciatica. Recorded by J.J. Forst, Lasegue’s pupil in 1881.
Louis T.J. Landouzy, French physician 1845-1917, described a form of
Sciatica complicated by atrophy of the muscles of the affected leg known as
Landouzy’s Sciatica.
Joel Ernest Goldthwait, American Physician suggested that inter vertebral
disc injury may be the cause of Sciatica, Lumbago, Paraplegia etc. reported in
1911.
Elsberg in 1915 operated on a patient with Sciatica, finding ruptured
ligamentum flavum compressing fourth lumbar nerve root.
8
Puttiv in 1927 regarded that variability of angle at the lumbo sacral facets
predisposes to Sciatica. Baker in 1929 reported a root compression case from
lumbo sacral disc protrusion diagnosed as neuritis affecting the Sciatic nerve.
William Jason Mixter with Joseph seaton Barr, demonstrated the role
played by inter vertebral disc herniation in the causation of Sciatica published in
1934.
In 1956 Jemonet W.D. observed the association of bladder dysfunction with
bilateral sciatica. Mathews J.A. advocated the importance of rest in bed for cases
of Sciatica in 1977.
It occurs in all ages but more frequently among the middle aged, there is
pain in one or both hips; the latter case can be called Double Sciatica.
Thus Gridhrasi or Sciatica takes origin from the vedic period in Ayurvedic
texts and described by modern scientist since a long time.
The information given in Ayurvedic texts regarding Gridhrasi clearly
indicates that the disease was not generally prevalent in those days. The particular
information also indicates that the activities of human are not prone to cause,
pressure on the nerve roots with consequent Sciatica.
In modern civilization and other related activities the prevalence of
Gridhrasi has considerably increased.
9
GRIDHRASI VATA – MEANING AND DEFINITION
UTPATTI: The word Gridhrasi1 is of feminine gender, Gridhra’ +So’
“Atonupasargakah”- adding’kah” pratyaya leads to Gridhra + So+ Ka by lopa of
‘O’ and ‘k’,”Sha” is replaced by “Sa” by rule “ Dhatwadesh sah sah”In female
gender by adding “Dis” pratyaya the word Gridhrasi is derived.
The word ‘Gridhrasi’ is derived from Dhatu “Grudhu” – to covet, desire
and strive after greedily on eager for.
Grudhra refers to bird (Eagle) that desires to eat flesh always.
Gait of the patients is said to resemble the gait of Eagle hence the name
Gridhrasi.
“Gridhyati2 maamsamabhi kankshati satatam iti”
“Grudhro mamsa lolupa manushyatam syati peedyati nashyati vaa”
Gridhrasi is a peculiar vata roga, which affects a person who is greedy of
flesh.
Gridhrasi is a nerve of the lower extremity, which is resemble to Eagle beak
in shape.
Definition: Charaka3 has given the following definition. A condition where the
pain starts initially from kati, then the waist, back, thigh, knee and calf muscle are
gradually affected with stiffness, pain and pricking sensation and associated with
frequent twitching is called “GRIDHRASI”.
Susruta4 and his commentators define, Gridhrasi limiting the affected part.
Dalhana defined Gridhrasi limiting the affected part. The condition is said
to be Gridhrasi where the movements of Sakthi are restricted due to vata vitiating
the kandaras of heel and the related toes.
All the other authors followed Charaka.
10
Synonyms of Gridhrasi:
According to Ayurveda vangmayam,
1. Gridhrasi : The patient who suffers with Gridhrasi walks like Eagle. The
Gridhrasi nadi is curved similar to the nose of Grudha i.e. Eagle.
2. Rhinghini5: Vachaspati Misra who has written commentary on Madhava
Nidana explained the word Rhinghini. This term indicates skhalana of
Tarunasthi of vertebral column.
3. Rhandrini: Dalhana used this term while commenting on Susrutha.
(Su.Ni.1/75). It means degeneration of Tarunasthis of verterbral column.
4. Radhana6: This term is used by Kashiram in Gudardha deepika commentary
on Sarangadhara Samhita. It indicates pressure. In this context it indicates
compression of Sciatic nerve.
According to Greek and Modern medicine in 15th Century the term Cyetica
and scyetyka were used to indicate this condition.
Sciatica is derived from Greek word Ischiadikas i.e., pertaining to ischium,
the term is used for the disease as well as the nerve.
Definition:
SCIATICA7 is a type of neuritis characterized by severe pain along the path
of Sciatic nerve or its tributaries. Inflammation/injury of the nerve causes pain that
passes from the back or thigh down its length into entire lower limbs. (Principles
of Anatomy and Physiology). It is also termed as contugno’s disease.
11
SHAREERA - MODERN ASPECT
Sciatica 8 is pain in the distribution of sciatic nerve. The initial pain in the
lower part of the back is known as Lumbago. The two viz. Sciatica and lumbago
are often associated.
Therefore there is a necessity of describing two anatomical structures.
1) Sciatic nerve
2) Lumbo-sacral region of the verterbral column.
Sciatic nerve: Sciatic nerve is the main terminal branch of the sacral plexus which
is formed by L5, part of L4 & S1,S2,S3 spinal nerves.
The Sciatic nerve is the largest nerve in the body measuring about 2cm in
breadth at its commencement. It consists of two separate nerves in one sheath.
1) Common peroneal nerve
2) Tibial nerve
The sciatic nerve leaves the pelvis through the greater sciatic foramen,
usually below the piriformis and descends between the greater trochanter of the
femur and ischial tuberosity along the posterior surface of the thigh to the popliteal
surface, where it divides into tibial and common peroneal nerves. Branches in the
thigh supply the hamstring muscles. Rami from tibial trunk pass to the semi
tendinosus, semi membranosus, long head of biceps, ischial head of adductor
magnus. A ramus from the common peroneal trunk supplies the short head of
Biceps.
TIBIAL NERVE:
Tibial nerve is formed by lower two lumbar (L4, L5) and upper three sacral
segments (S1, S2, S3). The tibial nerve forms the largest component of the thigh. It
begins its own course in upper part of the popliteal space. It descends vertically
through this space and the dorsum of the leg to the dorso medial aspect of the
12
ankle, from which point its terminal branches and lateral plantar nerves continue
into the foot.
Branches from the Tibial proper:
1) Motor branches: To the gastrocnemius; plantaris, soleus; popliteus, tibialis
posterior; flexor digitorum longus, flexor hallucis longus.
2) A sensory branch, the medial sural cutaneous nerve from common
popliteal to form sural which supplies the skin of the dorso lateral part of
leg and lateral side of the foot.
3) Articular branches pass to the knee and ankle joints. Terminal branches
are two.
(i) The medial plantar nerve sends motor branches to:
a) Flexor digitorum
b) Abductor hallucis
c) Flexor hallucis brevis
d) First lumbrical muscles
Sensory branches to the medial side of the sole, plantar surfaces of
the medial three and one half phalanges of the same toes.
(ii) The lateral plantar nerve sends motor branches to all the small
muscles of the foot except those innervated by the medial plantar
nerve and sensory branches to the lateral portions of the sole. The
plantar surface of the lateral one and half toes and the phalanges of
the toes.
Common Peroneal nerve (External popliteal):
Common peroneal nerve is derived from the dorsal branches of ventral rami
of the L4, L5 & S1, S2 nerves. It descends obliquely along the lateral side of the
popliteal fossa to the head of the fibula, winds round the lateral surface of the neck
13
of fibula deep to peroneus longus, and divides into the superficial and deep
peroneal nerves.
Previous to its division, it gives articular and cutaneous branches.
Branches given off the popliteal space are sensory and include the superior and
inferior articular branches to the knee joint and lateral sural cutaneous nerve,
which joins the medial sural cutaneous nerve, supplies external malleolus and the
lateral side of the foot and fifth toe.
The 3 terminal branches are the recurrent articular and the superficial and
deep peroneal nerves, the articular nerve accompanies the anterior tibial recurrent
artery, supplying the tibio fibular and knee joints and a twig to the tibialis anterior
muscle.
Superficial peroneal nerve (Musculo cutaneous):
It passes between peronei and extensor digitorum longus, pierces deep
fascia in the distal third of the leg, and divides into medial and lateral branches. In
its course it supplies muscular branches to peroneus longus and peroneus brevis
and filaments to the skin of the lower part of the leg.
Medial branch supplies the medial side of great toe, adjacent sides of the
second and third toes.
Lateral branch supply the contiguous sides of third and fourth and of fourth
and fifth toes. It also supplies skin of lateral side of the ankle.
Deep Peroneal nerve:
Muscular branches: Tibialis anterior, extensor hallucis longus extensor digitorum
longus and peroneus tertius; articular branches supply the ankle joint.
Lateral terminal branches supply extensor digitorum brevis, Interosseous
branches to tarsal and metatarso phalangeal joints of second; third and fourth toes.
14
Lumbo Sacral region:
Vertebral column is divided into
1) Cervical spine, consisting of 7 vertebrae
2) Thoracic spine with 12 vertebrae
3) Lumbar spine with 5 vertebrae
4) Sacrum: Even though it consists of five sacral vertebrae, in adult they are
fused in one known as sacrum.
5) Coccyx: It is fused structures of four coccygeal vertebrae in an adult.
Sometimes both sacrum and coccyx may even fuse with each other in later
adulthood.
CURVATURE OF THE SPINE:
During evolution 9 the transition from quadrepedal to the bipedal state led
first to the straightening and then to the inversion of the lumbar curvature. The
erection of trunk has been obtained partly by backward tilting of pelvis and partly
by bending of Lumbar column.
On the first day of life 1. The lumbar column is concave anteriorly at 5
months.
2. The lumbar curve is still slightly concave anteriorly but the concavity
disappears at 13months.
3. From 3 years onwards lumbar lordosis begins to appear.
4. Becoming obvious by 8 years.
5. And assuming the definitive adult state at 10 years.
Elongation takes place rapidly as a child learns to walk. In the average
adult lumbar region comes to form about 32% of the total length of the
spine. As well as the lumbar lordosis there are cervical, thoracic and
15
sacral curvatures, which increase its resistance to axial compression forces
10 times that of a straight column. Thoracic kyphosis is a feature
common to all mammals, where as lumbar lordosis is especially human
kind is connected with the erect posture on straight legs.
The features of the lumbar lordoses and the vertebral column are at rest.
1) The angle of the sacrum formed between the horizontal and the plane
containing the superior aspect of S1, averages 30°.
2) The lumbo sacral angle lying between the axis of L5 and the sacral axis
averages 140°.
3) The angle of pelvic tilt formed by the horizontal and the line joining the
promontory to the superior border of the pubic symphysis averages 60°.
4) The index of lumbar lordosis can be determined by joining the supero
posterior border of L1 to the posterior inferior border of L5. The
perpendicular to this line is usually maximal at L3 and represents the index
of lordosis. It is greater as Lordosis is more marked and almost
disappears when the column is straight.
Lumbar Vertebrae:
In man each typical presacral vertebra is composed of four parts.
1) The body, which is primarily for transmission of forces.
2) The lamina and pedicles, which enclose the spinal canal.
3) The spinous and transverse processes for muscle and ligament attachment.
4) The posterior facets, which guide and limit motion between vertebrae.
The vertebral body lies anteriorly and is the largest part of the vertebra. The
Vertebral arch is shaped like a Horse shoe and behind the vertebral body. It bears
on each side an articular process, which divides the arch into an anterior pedicle
16
and a posterior lamina the spinous process is attached to the midline posteriorly.
The vertebral arch therefore is attached to the vertebral body by the pedicles.
Transverse processes are attached to the arch near the articular processes.
In the vertical plane these various constituents like in anatomical
correspondence making three pillars an anterior major pillar comprising the
stacked vertebral bodies and two posterior minor pillars made up to the articular
processes.
The vertebral body has a dense bony cortex surrounding a spongy medulla.
The cortex of the superior and inferior aspects is called the vertebral plateau. The
sagittal section comprises two fans like sheaves of oblique fibres. The first arising
from the superior surface fans out at the level of the two pedicles to reach the
corresponding superior articular processes and spinous process. The second,
arising from the inferior surface, fans out at the level of the two pedicles to reach
the corresponding inferior articular processes and spinous process. The criss-
crossing of these three trabecular systems constitutes zones of maximum
resistance as well as a triangular area of minimum resistance. This triangle is
made up only of vertical trabeculae and explains the wedge-shaped compression
fractures that occur.
Each vertebra can be compared to a lever system where the articular
processes constitute the fulcrum. This lever system allows the absorption of axial
compression forces applied to the vertebral bodies and indirect absorption in the
posterior ligaments and muscles. In the lower lumbar vertebrae the diameter of
spinal canal is comparatively greater. The center of this cylinder does not coincide
with the center of the vertebral plateaux so when upper vertebra rotates on the
lower one the upper vertebral body must slide over that of the lower vertebra. The
shearing forces that ensue limit the rotation so that it is minimal both segmentally
and over the whole lumbar spine.
17
The stacked vertebral bodies of the spinal column acts as a pillar and due to
the secondary curves make the backbone some sixteen times stronger than if it
were straight. They permit spine to transmit the weight of the body to the pelvis
and reduces the muscular effort otherwise needed to keep a person upright.
Inter vertebral Disc:
The inter vertebral disc accounts for about 1/3 rd of total height of the
lumbar spine. The vertebrae in mammals articulate with another adjacent
vertebrae by means of inter vertebral discs. The mobility, and the need for
simultaneous load bearing, necessitates some form of hydrostatic structure to
convert unidirectional forces into stresses acting in all directions.
The disc has two components.
1. Anulus fibrosis
2. Nucleus pulposus.
Annulus fibrosis: Annulus forms a fibro cartilaginous ring, more fibrous and
elastic peripherally, more cartilaginous in the inner part. The Annular fibers are
gathered in concentric lamellae, successive layers overlapping in alternatively
oblique directions. Thus nucleus is enclosed in an inextensible casing formed by
the vertebral plateaux and the annulus, whose woven fibers in the young prevent
any prolapse of the nucleus.
The many elastic fibers of the young, healthy annulus gradually disappears
during the aging process.
Nucleus Pulposus: Nucleus pulposus comprises 40% of the disc and is a semi
fluid gel readily deformable but incompressible. It is the central core of the IV
Disc. Collagen fibers form a three-dimensional honeycomb network, enmeshing
the muco protein gel with its rich content of muco poly saccharides or
proteoglycans, chondroitin 6-sulfate. Nucleus pulposus acts as a perfect
hydrostatic medium. It distributes axial load radially to be absorbed by the fibers
18
of the surrounding annulus fibrosus. The hydrostatic action is predicted because
of its high water content. When a vertebral plateau presses on the IVD the nucleus
bears 75% of force and the annulus 25%. The nucleus transmits some of the force
to the annulus in the horizontal plane and the tangential tensile strain is 4-5 times
the applied external load.
With age the nucleus looses its water absorbing capacity and the pre-loaded
state tends to be lost. Hence the lack of flexibility of the vertebral column in aged.
During standing the water in the gelatinous matrix of the nucleus escapes
into the vertebral body through microscopic pores and during course of the day
disc becomes thinner. At night the water absorbing capacity of the nucleus draws
water back into the nucleus from vertebral bodies and disc regains its original
thickness. Therefore flexibility of the vertebral column greatest in the morning
and at this time the spine is longer than in evening. Nucleus is a noto chordal
remnant.
Functions of the Annulus:
1. Forms the chief structural unit between vertebral bodies and provides a
mobile segment.
2. Encloses and retains the nucleus pulposus.
3. Restricts and regulates movement. Eg. Sagittal lumbar movement is
restricted almost entirely by tough annulus. In full flexion when the
articular process are more separated, some half of the diagonal lamellae
restrict rotation to a degree and are thus under stress during this movement.
4. By virtue of an inherent elasticity, the annulus fibrosus helps to absorb the
shock of compression forces, which are sustained as a circumferential
tensile stress in the annulus. The diagonal strapping effect of the fibrous
lamellae is important here.
19
The posterior post especially the postero lateral part of the annulus is a site of
potential weakness because
Thinning and bifurcation of Annular fibers posteriorly.
Fibrous tissue is adopted to withstand tension rather than pressure and
in the lordotic lumbarspine; gravitational compression falls most heavily
on the posterior aspects of the vertebral body joints.
Posterior longitudinal ligament is attenuated, thin and expanded at the
level of the disc.
The eccentric position of the nucleus pulposus, which lies closer to
posterior aspect of the disc.
The susceptibility of this locality to succumb to under the stress of
rotation strains.
Functions of pulposus
1. Its fluid permits the formation of a mobile segment and allows an even
distribution of compression forces over the opposed surfaces of vertebral
disks.
2. The viscid gel acts like a dynamic hydraulic suspension system. This gel
spreads the pressure uniformly over the entire surfaces of the vertebral
bodies and so behaves like a shock absorber.
In a young adult the normal intervertebral disc will yield and deform only
at pressure over 1400 pounds, but in an older individual this occurs with
only about 350 pounds.
The normal disc is actually more resistant to trauma than bone and is
not what gives under extreme pressure or the vertebrae will fracture before
the disc.
20
The spinal disc serves two functions.
1. To provide mobility to the spine.
2. To act as a shock absorber.
Movements of the discs:
During extension the upper vertebra moves posteriorly reducing the
interspace posterior and driving the nucleus anteriorly. The nucleus presses on the
anterior fibers of the annulus increasing their tension and this tends to restore the
upper vertebra to its normal position.
During flexion the upper vertebra moves anteriorly reducing the interspace
anteriorly and driving the nucleus posteriorly. The nucleus now presses on the
posterior fibers of the annulus increasing their tension.
During axial rotation the central fibers of the annulus are stretched,
compressing the nucleus and causing the internal pressure to rise.
Flexion and axial rotation tend to tear the annulus and drive the nucleus
posteriorly through tears in the annulus. Whatever force is applied to the disc, the
internal pressure is increased and the fibers of the annulus are stretched. Owing to
the relative movement of the nucleus, the stretching of the annulus tends to oppose
this movement.
The hydrostatic properties of the nucleus and the relatively high pressure
that is exhibits relieves the annulus fibrosus from vertical stress, thus making
tilting movements of loaded lumbar spine easier.
Nutrition of the Disc:
The adult disc is virtually a vascular. Nutrition appears to depend upon
imbibition of fluid into it from the vertebral bodies and from spare vessels of the
annulus during the first years of life. This process must obviously be assisted by
21
the rhythmic movements and compression of daily activities and it is of interest
that there is a diurnal variation in body height.
There is a reason that active movements assists normal fluid imbibition
processes between spongiosa and pulposa, this may be a factor in delaying the
slow inevitable drying up of the discs with ageing.
The lack of directly penetrating vessels makes the intervertebral disc, the
largest avascular structures in the body. Diffusion of solutes can take place
through the central portion of the hyaline cartilaginous end plates as well as
through the annulus fibrosus. Posteriorly the areas available for diffusion are
smaller. The central part of the disc, and particularly the boundary zone between
the nucleus pulposus and annulus fibrosus is exposed to possible deficiency of
nutrition.
The disc appears to live and thrive on movement change and die slowly
through lack of it. There is now a shift of emphasis from the idea that disc
disorders result from purely mechanical derangement, to the view that nutrition
and metabolism of the disc and the biochemistry of degenerative change, are of
equal importance.
LIGAMENTS:
The ligaments of the lumbar region are stronger and denser than elsewhere.
The anterior longitudinal, posterior longitudinal ligaments are linked at
each vertebral level by the Intervertebral disc.
Other ligaments connect arches of adjacent vertebrae - ligamentum flavum,
inerspinous, supraspinous ligament, anterior and posterior ligament of articular
processes, inter transverse ligament.
Action of ligaments: The dense anterior longitudinal ligament is stronger than the
posterior ligament and limits extension of the vertebral column. The ligamenta
flava help to restore the vertebral column to its original position after bending
22
movements and is important in resisting rotation. The spinous processes are
connected by the supra spinous and infraspinous ligaments which particularly
limit, flexion.
Movements of the Vertebral column:
The mechanical stability of the column is assured by reason of the axis of
rotation passing through the bodies and not through the neural arches, so that the
bodies are not displaced from each other during movement.
The spinal column has 3 degrees of freedom; it is allowed flexion and
extension, lateral flexion and rotation. The range of these elementary movements
at each individual joint is very small but the movements are cumulative over the
whole column. Moll and wright found an initial increase in mean spinal mobility
form the 15-24 decade to the 25-34 decade followed by a progressive decrease
with advancing age of as much as 50 percent of mobility.
Flexion and extension in the anterior posterior plane occur in all regions of
the column and these movements are particularly free at the specialized atlanto-
occipital joint, free in the lumbar and cervical region and very restricted in the
thoracic region. Rotation is free in the specialized altanto – axial joints but else
where it is determined by the shape of the apophyseal joints.
Kapandji- Lumbar spine contributes 60° flexion and 35° extension to spinal
mobility. For thoraco lumbar region taken as a whole, flexion is maximally 105°
and extension 60°, to range of lateral flexion to each side is 20° in the lumbar
column. Axial rotation from side to side during standing is 20° in lumbar column
and 90° for the thoraco lumbar region taken as a whole.
The thoracic movement is most limited because these vertebrae are tied to
the ribs. All the mobility depends to a considerable extent on the muscles and
ligaments of both the spine and the back.
23
Morris (1973) – Intrinsic spinal stability is provided by intervertebral discs
and ligaments, and extrinsic stability imparted to vertebral column by the action of
muscles. The intrinsic stability is the result of pressure within the disc, which
tends to push the vertebral bodies a part and the tension provided by the ligaments
which tends to pull the bodies together. Thus the vertebral segments and discs are
firmly bound together by ligaments under tension:
1. A longitudinal system, which binds all the vertebrae together into a
mechanical unit.
2. A longitudinal system, which secures one segment to another.
This arrangement accounts for relative stability of the spine dissected free of
musculature.
Morris, Lucas, and Bresler (1961) showed that flexibility between two
vertebrae varies directly with the square of the vertical height of the disc and
indirectly with the square of the horizontal diameter of the body. Thus for a given
load and cross-section an increase in the height of the disc and the length of the
ligaments tends to increase the apparent flexibility, while an increase in the cross-
sectional size of the disc tends to reduce apparent flexibility. Because of the
proportionally greater height of the lumbar disc, the range of intervertebral motion
is somewhat greater in the lumbar region; but because of the greater horizontal
diameter, the flexibility is less than in thoracic region.
24
NIDANA
Gridhrasi is included under vatavyadhis, where specific etiological factors
are not mentioned; hence Nidana of vatavyadhi can be considered as nidana of
Gridhrasi. Charaka Samhita1 and Bhava Prakasha2 clearly mentioned the
causative factors of vatavyadhi, but in Sushruta samhita3,4, Astanga Sangraha5 and
Astanga Hridaya6,7 the causes of vatavyadhi have not been clearly described.
However, in these texts the causative factors of provoked vata dosha are available.
Since Gridhrasi is considered as Nanatmaja vatavyadhi, the provocative
factors of vata can also be taken as causes of Gridhrasi.
In addition to this, in Charaka samhita8, Ashtanga Sangraha9 and Ashtanga
Hrudaya10, two specific causes of vatavyadhi i.e., Dhatukshaya and Avarana have
been mentioned.
All the etiological factors of vatavyadhis as well as vata prakopa are taken
as Nidana of Gridhrasi and is classified as follows:
1. Viprakrista nidana: The person who steals the wealth of God11 or
Bramhana and who deceives his master or who opposes his teacher will
suffer from vatavyadhi. (Vaidya chintamani – vatavyadhi karma vipakam)
2. Sannikrista nidana: a) Aharaja
b) Viharaja
c) Kalaja
d) Agantuja
e) Anyahetu
25
a) Aharaja Nidana: The excessive intake of rasas like katu, tikta, kashaya,
laghu, rooksha gunas and seta veerya leads to vataprakopa.
“Sarvada sarva bhavanam samanyam vriddi karanam” 12
The dravya, which possess similar properties, increases the other dravya,
which is resumblant to it in properties.
Dhanya - Mudga, Masoora, Adhaki, Kalaya, Nishpava etc.
Phalas - Jambu, Bilwa, Kapitha etc.
Sakas - Kareera, Karavellaka, Patola, Rakta punarnava.
Alpasana leads to dhatu kshaya thereby causing vataprakopa. Adhyasana,
visamasana causes ama which obstructs the srotas hence aggravates vata.
As per “Vayordhatu kshayat kopo margasyavaranenacha”13
b) Viharaja : Prajagaram – increases ruksha guna in body and aggravates vata.
Langhana, plavana, athyadwa sevana, vyayama – as a result of this
excessive and continuous exertion results in dhatu kshaya and aggravates
vata. Diwaswapna14 increases pitta and kapha, which obstructs the channels
and leads to vata prakopa.
Vegavadharana is a condition when any of the natural urges are
suppressed, then vata prakopa takes place. So far Gridhrasi is concerned
malavarodha is most important to cause vataprakopa15 . This causes pain in
sacral region, pindikodwestanam, and backache and also produce many
diseases in the lower limbs like Gridhrasi etc. Vagbhata16 also stated that
avarodha of apanavata causes a variety of vatavyadhis.
c) Kalaja : Vata vitiation takes place in varsha, Grishma and Sharat ritu. It
also aggravates in Aparahnakala, Jeernannakala, Apararatra and in sheeta
kala. During vriddhavastha17 vata prakopa takes place.
26
d) Agantuja: Abhigata due to external causes are considered specially while
carrying heavy loads, wrestling with a person of superior strength, leaping
and jumping etc.
Marmabhighata particularly to kukundara, nitamba marmas leads to
Gridhrasi.
Kunkundara18 (Marma abhigata) loss of power and sensation in lower
extremities and may result in pain and difficulty in walking. (Su.Sa.6/48).
Nitamba: Injury, causes swelling, weakness, pain paresis in lower limbs
and even death in due course of time.
Falling off from back of animals and higher places also cause
marmabhigata.
The pathological19 changes in the vertebral column are mainly occurred by
physical strain. In physical activity, standing alone increases load on the disc four
fold compared to supine strengthening exercises almost double the load in the disc
over the standing posture. It illustrates the impact of physical activity on the
vertebral column.
Most of the activities we are observing in society are already described in
Ayurveda as Nidana in Vatavyadhi.
The prolonged stooped posture imposes loads on the posterior ligaments of
the spine and the fibers of inter vertebral disc, stretched ligaments increase joint
laxity, which can lead to hyper flexion injury. Ligament damage seems to occur
during traumatic sporting activity with the spine at its end range of motion. In
above conditions the tensile forces works on ligaments, which are capable of only
withstanding tensile forces, if it is excessive it ruptures ligaments.
27
Attempting to lift and twist with awkward loads so that extension and
rotatory movements are involved together produces Interverbetral disc rupture in
lumbar region. The excessive compressional load acting on the nucleus pulposus is
the basis for disc degeneration, vertical compression of spinal segments the
vertebral end plates are the first to fracture leads to osteo arthritic changes in the
inter vertebral joints
Segmental instability occurs when the normal movement between vertebrae
is lost because of degenerative changes involving any one of the components of
disc followed by Sub luxation.
Fractures, Dislocations and disc prolapse when compress the spinal cord
results in paralysis of limbs which can be attributed to injury of marmas. Hence
Agantuja nidana is a prime factor in the disorders of the vertebral column.
Anya hetu:
Dosha Asrik sravanadapi - Excessive elimination of mala, rakta during vamana,
virechana, vasti karmas leads to vata prakopa. This can be considered as
Iatrogenic cause.
28
Etiological factors of vata prakopa &vata vyadhi with reference to Gridhrasi.
NIDANA CS SS AS AH MN BP Aharaja Rasa Katu, Tikta, Kashaya + + + +
Laghu + + + + Ruksha + + + + +
Guna
Seeta + + + + Karma Vistambi + Veerya Sheeta +
Adhaki + + Bisa + Harenu + Chanaka + Kalaya + Koradusha + Masura + + Mudga + + Nivara + Nishpava + + Saluka + Suskashaka +
Dravya
Syamaka + Abhojana + + + + Alpasana + + + Visamasana + + + + Adhyasana + +
Krama
Pramitasana + + Atigamana + + + + Atihasya + + Atilanghana + + + Atiplavana + + Atipradharana + Atiprajagarana + + + + + + Ati prapatana + Ati prapidana + Ati pratarana + + Ati raktamokshana + + Ati Sharma + Ati vichestitam + + + Ati vyayam + + + + + Ati Adhyayana + + Kriyati yoga + + + + +
Kayika (atiyoga)
Padati charya +
29
Asama bhramana, chalana, vikshepa, asamotkshepa
+
Balavat vigraha + + Bhara harana + + + Diwa Swapna + + Dukhasana sayya + + Kastabhramanachalana vikshepa + Vegadharana + + + + + +
Mityayoga
Vishamapochara + Bhaya, Chinta, Soka + + + + + Krodha + +
Manasika
Mada + Aparahna + + + + Apararatra + + Grishma + + Pravata + + Shisira + Seeta kala + +
Kalaja
Varsha + + + Agantuja Abhighataja + + Gaja, Ustra, Ashwa, Shighrayana
patana + +
Marmaghata + + Dosa Asrik sravana + + + + Dhatu kshaya + + + Ama + + + Rogati karshana + + +
Anyahetuja
Margavarana +
Causes of Sciatica 20:
Sciatica is neuralgia in the distribution of Sciatic nerve or its component
nerve roots.
I. Compressive causes:
a) Congenital – Spina bifida, Spondylolisthesis.
b) Traumatic - Fracture of hip joint
Vertebral fractures
Lumbo sacral sprain and strain.
30
c) Mechanical pressure on the nerves-
In the spinal cord - Tumors of cauda equina. Arachnoiditis, Haemorrhage /
infection irritating meninges of the cord.
In the cord space – Protruded inter verterbal disc, extra medullary tumors.
In vertebral column – Sondylolisthesis, spondylosis, Bone tumor, stenosis
of intervertebral canal and lateral recess hypertrophy of apophyseal facets.
In the back - Fibrositis of posterior longitudinal ligament.
In the thigh and buttock - Neurofibroma, Hermorrhage within or adjacent
to nerve sheath.
In the pelvis - Sacro iliac arthritis, Tumors of lumbo sacral plexus.
Other destructive disease:
Neoplastic: Metastatic carinoma, multiple myeloma, Hodgkins and Non
Hodgkins lymphoma.
Infections: Infection in vertebral column due to pyogenic organisms –
staphylococci, Tubercular bacilli, Spinal epidural abscess.
Several metabolic diseases of bone such as hyper parathyroidism,
osteoporosis precipitates bone dysfunction. This in turn leads to vertebral body
weakness, leading to vertebral fractures, protrusion, herniation etc.
Inflammatory causes : - Rheumatoid arthritis - Ankylosing spondylitis - Lumbar spondylitis - Osteo arthritis of lumbar spine. - Tuberculosis of vertebral column and spine.
31
II. Non-compressive causes:
Ischaemic necrosis in Diabetes Mellitus, leprosy, direct injury due to
penetrating wounds. Eg. Gunshot or misplaced injections, claudication of sciatic
nerve, compression injury to Sciatic nerve by foetal head during delivery.
Some times over exposure to cold or sitting on chatted grass may induce
the pain.
Catamenial sciatica: The unusual developmental anamoly of implantation of
endometriosis in the Sciatic nerve at the sciatic notch may cause sensorimotor
Sciatic nerve palsies. These may be associated with peri menstrual pain in the
buttock or posterior aspect of the thigh.
32
POORVA RUPA
“Poorva rupam pragutpathi lakshanam vyadhehi” 1
For every disease certain premonitory symptoms are noted before it is
clearly established in the body. Such symptoms are called Poorva roopa.
“Avyakta lakshanam tesham poorva roopamiti smritam
Atma rupam tu yad vyaktam apayo laghuta punaha ” 2
According to Charaka Avyakta lakshanas are purvaropa of vatavyadhi.
According to Chakrapani 3commentary on Avyakta, few mild early symptoms are
to be taken as purva rupa. The very specific symptoms if manifest insignificantly
can be considered as poorvarupa of Gridhrasi. Sthamba, Ruk, Toda,
Muhuspandana, Grihnati.
Diagnosis at this stage of illness gains paramount importance. The
effective treatment at this stage reduces the degree of morbidity.
33
ROOPA
“Utpanna vyadhi bhodaka meva lingam rupam” 1
Lakshanas, which occur after the manifestation of vyadhi, known as Rupa.
Vyakta purva rupa is Rupa.2
Charaka 3classified Gridhrasi into two varieties.
1. Vataja
2. Vata shleshmaja.
Considering all the clinical manifestations of Gridhrasi, it may be subdivided into
samanya lakshnas and vishesha lakshanas.
Samanya Lakshanas:
These lakshanas are seen in both vataja and vata kaphaja type of gridhrasi.
RUK: “Ruk satatam shoolam” 4
“Ruk shoolam” 5
“Ruja vedana” 6
In Gridhrasi, Ruk-pain is starting from sphik and radiating towards kati,
prista, uru, janu, jangha and pada. Non-radiating pain felt at sites like kati, uru,
janu, jangha, pada is also considered as symptom of Gridhrasi.7
This typical radiating pain involving legs is suggestive of Sciatica where
pain is felt along the course of Sciatic nerve.
Toda: “Todah sooci vyadhanavat vyadha”8
“Toda vicchinna shoolam” 9
Intermittent pain similar to feeling of pinprick.
34
Sthamba:
“Sthamba nischalakaram”9
“Sthamba bahu uru janghadeevam sankuchanadhya bhava10
“Sthamba nishkriyatvam”11
It is stiffness at uru and jangha region in Gridhrasi, due to pain the
movement i.e., restricted in the muscles and joints of lower limb. This stiffness
affects gait of the patient.
Sakthna kshepa nigrahanyat:
“Kshepam prasaranam tam nigrahanyat avarudyat ityarthah”12
Hence, word kshepam means prasarana or extension. According to
Dalhana it is the sign of restriction during extension of leg. This is more clear by
commentary of Arunadutta on Astanga Hridaya12 explained as urdwa prerana
avarundati i.e., restriction in raising the leg. As the extension of the legs worsens
the pain patient prefers to assume the flexed position of the legs.
Kati Uru Janu madhya Bahu vedana:
A distinct feature in Gridhrasi mentioned by Harita13, severe pain at kati,
uru and Janu region.
Muhu spandana:
“Spandana Spuranam” 14
“Spandanam Hi Kinchit chalanam” 15
Spurana refers to the fasciculation. This symptom is seen in the muscle
supplied by the Sciatic nerve.
35
Pain in Payu:
Described by Vangasena16 only. This may be due to derangement of
Apanavayu. Payu is one of main sthanas of Apana vayu and Apana Vayu governs
functions of defecation. Therefore, when apana vayu is vitiated constipation
results and pain in peri anal region occurs.
Few of symptoms are exclusively mentioned in Basavarajeeyam17. These
symptoms include sopha, kara pada vidaha krit, sweda, moorcha, Bhrama and
trishna. Some of these symptoms are indicative of vitiation of pitta dosha in
Gridhrasi.
VISESHA LAKSHANAS:
Vataja Gridhrasi:
Dehasya vakrata: Madhava described this symptom, which means the patient of
Gridhrasi acquires a particular posture because of pain. The patient of Gridhrasi
keeps the leg in flexed position and tries to walk without much extension in the
affected side. Because of extreme pain, sthamba, toda etc., the patient assumes a
typical limping posture.
It can be considered as Sciatic scoliosis – maintained by reflex contraction
of the para spinal muscles.
Stabdata Brisham:
The severe degree of stiffness is seen in the patient suffering from Vataja
Gridhrasi.
Spuranam:
“Spuranam Gatra deshe swalpa chalanam”18
“Spuranam punah punah chalanam” 19
A type of muscle twitching in kati, uru, Janu, Jangha is similar to that of
spandana or muhuspandana.
36
Suptata:
The patient experiences varied degree of parasthesis or sensory loss in the
affected limb.
Vata Kaphaja Gridhrasi:
In Gridhrasi when anubanda of kapha dosha is present following lakshanas
are seen.
Vahni mardava:
Decreased abhyavaharana and jarana shakti causes loss of appetite.
Tandra:
“Tandrayantu prabhodito api klamayati nidrabheda ”20
Due to tama, vata and kapha there will be a feeling of drowsiness or
inability of sense organs to grasp followed with yawning and fatigue without any
work.
Mukha praseka:
Excessive salivation in the mouth occurs due to kapha in association with ama.
Baktadwesha:
“Dveshamayati yo jantu bhaktadvesha sa ucchate” 21
Because of loss of appetite and kapha dusti, patient feels aversion towards food.
Arochaka:
“Arochakastu prarthite apyupayoga samaye anabhilasha”22
“Aruchi prarthita Anna Bhakshana Asamarthya mucchyate”23
Dislike of consuming food. The patient fails to appreciate the taste in the
mouth irrespective of state of appetite. Vata and kapha are involved because the
seat of bodhaka kapha is jihwa, which does raso bodhana.
37
Gaurava:
Heaviness particularly occurs in the lower limb.
Staimityam:
“Staimityam gatranaam nirutsaahatvam” 24
Inertness of body, feeling of freezing sensation in the affected lower limb, due to
kapha vitiation patient feels as if his lower extremities are covered with wet cloth.
Rupa of Gridhrasi according to different Acharyas
Samanya Lakshanas CS SS AH AS HS BP MN YR VS BR Kati prista uru janu jangha pada –Ruk
+ + + + +
Kati prista uru janu jangha pada –Toda
+ + + + +
Kati prista uru janu jangha pada – Sthamba
+ + + + +
Kati prista uru janu jangha pada –Muhuspandana
+ + + + +
Sakthnaha kshepam nigrahaniyat + + + + Kati uru janu madhye bahu vedana + Parshni pratyanguleenam tu kandara yanilardita
+ + +
Pain in payu + Sopha, karapada vidaha + Specific Vataja Deha vakrata, Toda + + + Stabdata + + + Janu jangha uru sandhi spurana + + + + Suptata + Specific Vata kaphaja Tandra + + + + + Gaurava + + + + Arochaka + + + + Vahni mardava + + + + + Mukha praseka + + + + + Bhakta dwesha + + + + + Staimitya +
38
Clinical features of Sciatica:
The clinical course of Sciatica depends on the nature of the underlying
pathology.
In most patients the pains are caused by a ruptured intervertebral disc. In
some patients the symptoms are produced by Arthitis in the Sacroiliac joint or
spine, spondylolisthesis, lumbar canal stenosis that are commonly seen.
A fully developed prolapsed inter vertebral disc25 consists of
(1) Pain in the sacroiliac region, radiating into the buttock, thigh, calf and foot.
(2) A stiff or unnatural spinal posture.
(3) Some combination of paraesthesias, weakness and reflex impairment.
The most common history is that of severe low back pain after an injury.
The acute attack subsides with in a few days sciatic pain eventually develops after
the appearance of low back pain. As the Sciatic pain increases in intensity and
extent, the backache become less and occasionally may be entirely absent.
Intermittency of symptoms is characteristic, and each succeeding attack is
usually more severe.
Pain:
The pain of herniated intervertebral disc varies from severe to mild forms.
With most severe pain, patient is forced to stay in bed. The patient is usually most
comfortable lying on his back with legs flexed at the knees and hips. The pain is
frequently made worse by an activity that increases intra spinal and intra discal
pressures such as coughing, sneezing and bearing down during defecation.
When the condition is less severe walking is possible, though fatigue sets in
quickly, with a feeling of heaviness and drawing pain.
39
Sitting and standing up from a sitting position are particularly painful. Pain
is characteristically provoked by pressure over the course of the Sciatic nerve at
the classic points of valliex (Sciatic notch, retro trochanteric gutter, and posterior
surface of thigh, head of fibula. Pressure at one point may cause radiation of pain
and tingling down the leg pain is referred to the involved dermatome.
Reduced mobility: Forward bending in particular is restricted26. In acute stage
with marked muscle spasm all mobility is restricted.
List of trunk:
The lumbar spine most often deviates away from the affected side. The
disk is usually lateral to the nerve root 27, and the tilt of the spine away from the
affected side. Protrusion medial to the nerve root causes a list to the painful side.
The disk is often accentuated when bending forward.
A list or tilt will elevate one iliac crest. This asymmetry is responsible for
the commonly diagnosed “longer leg on one side” and the erroneous assignment
of the back pain to asymmetry of leg length.
The patient stands with affected leg slightly flexed at the knee and hip, so
that only the ball of the foot sets on the floor. In walking, the knee is flexed
slightly, and weight bearing on the painful leg is brief and cautious, giving a limp.
It is particularly painful for the patient to go up and down stairs.
Neurological signs: Motor signs are present in about 96% of cases and include
atrophy of leg muscles, determined by measuring leg circumferences and muscle
weakness.
Weakness of dorsi flexion of large toe and inability to walk on heels
indicate fifth lumbar root involvement by fourth lumbar disk.
40
Inability to walk on toes because of calf muscle paresis points to first sacral
root involvement by the fifth lumbar disk.
Sensory signs found in 80% of patients.
Nerve tension signs:
Straight leg – Raising Sign (S.L.R.):
It is the active attempt made by patient to raise the entire leg with the leg in
complete extension. In case of sciatica extension of the leg is below 90°.
The degree of limitation is roughly proportional to the severity of pain.
Elongation of nerve root by straight leg raising or by flexing the leg at the
hip and extending it at the nee (lasegue maneuver) is most consistent
among pain provoking signs. Crossed leg pain is pathognomic of severe
disc prolapse.
Variations of the lasegue maneuver –
Bragard sign: Accentuation of the pain by dorsi flexion of foot.
Neris sign: With patient standing, forward bending of the trunk will
cause flexion of the knee on the affected side.
Naffziger sign: Sciatica may be provoked by forced flexion of the head and
neck, coughing, or pressure on both jugular veins, all of which increase the
intra spinal pressure.
Sicard sign: The pain may be elicited by carrying out test with
dorsiflexion of big toe.
There are typical patterns of symptoms for each level of root involvement.
41
Lumbar root lesions
Disc level Root Sensory loss
Motor weakness Reflex loss Pain distribution
L3-L4 L4 Antero medial calf and shin
Quadriceps (knee extension) thigh adduction, Tibialis anterior (foot dorsiflexion)
Knee Lateral thigh.
L4-L5 L5 Antero lateral leg, Dorsum of foot, great toe
Peroneii (foot eversion), tibialis anterior (foot dorsiflexion) gluteus medius (Hip abduction) Toe dorsiflexion.
None or rarely reduced ankle reflex.
Buttock, back and side thigh, lateral lower leg.
L5-S1 S1 Lateral malleolus, lateral foot, heel and web of fourth & fifth toes.
Gastrocnemius, soleus (foot plantor flexion) Abductor hallucis (toe flexors), gluteus maximus (Hip extension)
Ankle Buttock, Back of thigh and calf to heel.
Cauda equina syndrome:
A large midline disc herniation may compress several roots of cauda
equina. Patients have bilateral leg pain. Peri anal numbness, saddle dysesthesia
and loss of anal reflex are seen or diminished rectal tone characterizes an
advanced cauda equina syndrome. Sensory deficit involves lower sacral roots.
Difficulty with urination including either frequency or overflow incontinence may
develop relatively early.
Lumbar canal stenosis and spondylotic caudal radiculopathy:
Osteo Arthritic or spondylotic changes may lead to compression of one or
more caudal roots. The problem is exaggerated if there is a congenital narrow
lumbar canal. The roots are caught between the posterior surface of the vertebral
body and the ligamentum flavum posteriorly. Lateral recess stenosis, alluded to
above, may also contribute to root compression.
42
Symptoms are of neurogenic claudication. Nonspecific low back pain and
root pains followed by paraesthesias in the lower limbs, which come on with
walking down hill, and relieved by rest. In acute condition patient gains relief by
squatting or lying down with the legs flexed at the hips and knees. Standing, and
particularly standing with the lumbar spine in extension, aggravates the condition.
Osteo Arthritis: Pain is centered in the affected part of spine, is increased by
movement, and is associated with stiffness and limitation of motion. A slightly
flexed posture is preferred. Discomfort is accentuated when the erect posture is
resumed.
Spondylolisthesis: Anterior displacement of a vertebral body in relation to
inferior adjacent vertebra can cause root compression with resultant leg pain and
weakness. Pain often aggravated by walking or standing.
Investigations
Imaging of spine:
Plain x-rays of lumbar spines: To identify the spondylotic changes and narrowing
in the lumbar spine or sacro-iliac lesion or hip joints.
Myelogram: To know the disc protrusion and to differentiate such lesions from
tumors.
Nuclear magnetic resonance imaging (NMR): To assess any root lesion.
Computed Tomography scan (C.T.Scan): Useful in the identification of a
stenosed canal, destructive lesion of vertebral bodies and posterior elements or
presence of paravertebral soft tissue mass.
Magnetic Resonance Imaging (M.R.I): Which virtually replaces C.T.Scan. study
of degenerative disc.
The symptom “Sakthnaha Kshepam Nigrahaneeyaat” is identical to S.L.R.
test described in modern classics. The symptom “Dehasya vakrata” is nothing but
the Sciatica Scoliosis” and suptata refers to the parasthesia.
43
UPASAYA AND ANUPASAYA
This may be explained as the therapeutic diagnosis of an illness. The
Involvement of the Remedial agents, regimens of diet and behavioral rules, which
are contrary to the causes of illness, providing the result is called Therapeutic
diagnosis of an illness.
Upasaya for Gridhrasi has not been mentioned separately. But, if there is
uncertainty as whether the vyadhi is urusthamba or Gridhrasi, to differentiate these
two we can adopt Upasaya. If symptoms aggravate on the application of oil, then
we consider it to be uru sthamba 28 and if the symptoms subside we can consider it
as Gridhrasi.
All the factors, which bring about the equilibrium of the vitiated vata, can
be considered as upasaya.
Samanya chikitsa sutra of vata vyadhi and chikistsa sutra mentioned in the
classics by different acharyas are the upasaya for Gridrasi.
The nidana mentioned for Vatavyadhi, Gridhrasi are considered as
Anupasaya
44
SAMPRAPTHI
“Vyadhi janaka dosha vyapara vishesha yuktam vyadhi
Jameha samprapti shabdena vachyam”1
The process of pathological changes in the body commencing from nidana
to complete manifestation of the disease is called Samprapti.
The Samprapti of Gridhrasi depends on Age, Sex, occupation and dietary
habits of the people. Estimation of Samprapti is essential to treat disease
successfully. Chikitsa is nothing but “Samprapthi Vighatanam”.
The pathogenesis of vata vyadhi takes place in two ways. When a person is
exposed to vata prakopakara nidana his dhatus will not be nourished by virtue of
soshana. Rasa dhatu kshaya takes place and further dhatus are not nourished
properly. As a result of Dhatu kshaya2, srotas become khara, ruksha, parusha and
results into sroto riktata (devoid of Snehamsa). These rikta srotas gets filled with
vata dosha and results many vata vyadhis either in the whole body or target
organs.
Vitiated kapha, Ama obstructs vata dosha. It causes srotorodha and
generates vatavyadhi at avarodha sthana.
Vatavyadhi Samanya Samprapti
Nidana
Dhatukshaya
Vataprakopa
Margavarodha
Vatavyadhi
45
Gridhrasi Visesha Samprapti
Nidana
Agantuja Abhigataja Marmagathaja
Vatavriddhi
Dhatu kshaya
Avarana
Vatavikriti
Ama
Agnimandya
Sroto avarodha
Margavarodha
Sroto Rikta
DOSHA DUSHYA SAMMURCHANA AT THE SITE OF KHAVAIGUNYA
Gridhrasi
STHANA SAMSRAYA AT KATI, PRISTA, URU, JANU, JANGHA, PADA
46
SAMPRAPTI GHATAKAAS
Dosha : Vata : Vyana vayu, Apana vayu Kapha : Sleshmaka kapha Dushya : Rasa, Rakta, Mamsa, Asthi, Kandara, Snayu Srotas : Chestavaha, Sangnavaha Sroto dusti prakara : Sangam Agni Jataragni, Dhatwagni Udbhavasthana : Pakwasaya Sanchara sthana : Prista vamsha Adhistana : Spik, Kati Prista and Adhosakha Rogamarga : Madhyama
Dosha: According to Susruta, Sakthnah kshepam nigrahaneeyat is one of the
cardinal symptoms of Gridhrasi. The kshepana and utshepana etc., activities are
attributed to vyanavata. Morbid vyana vayu is the primary cause of illness.
Apana vayu having its site in kati & sakthi is also involved. Sleshmaka kapha gets
involved as it resides in sandhi.
Dushya: Susruta3 clearly indicated the involvement of Kandara, which are
upadhatu of mamsa.
Dalhana considered kandara as mahasnayu, which starts from Gulpha to
vitapa. One of the causes of this disease is mamsa lolupatwa (according to
derivation of Gridhrasi). So mamsa dhatu is considered as one of the dushyas.
Hareeta4 points Rakta dhatu as one of the dushya in pathogenesis.
Symptoms like pain at Kati and Prista is suggestive of involvement of
Asthi. Since there is emaciation of dhatus due to lack of nourishment, rasadhatu is
also involved.
47
Srotas:
Chestavaha and sangnavaha srotas
The movements are performed by chestavaha srotas. The sensations are
perceived by Sagnavaha srotas.
Sciatic nerve composes both Sangnavaha and chestavaha srotases.
In Gridhrasi vata the leg movements are impaired along with sensory
impairment i.e., Parasthesia etc.
Agni:
Praseka, Arochaka, Bhaktadwesha are some of the distinguishing clinical
manifestation of Vatakaphaja Gridhrasi and is indicative of Jatharagni Mandya.
Udbhavasthana:
The involvement of Vata Dosha in the pathogenesis of Gridhrasi reveals
that the disease stems out from the Pakwasaya. Similar to any other Nanatmaja
type of Vatavyadhi Gridhrasi is also considered as Pakwashayodbhava vyadhi.
Sancharasthana:
Distribution of symptoms like pain in the low back region extending up to
the thigh legs and heal indicates the lower half of the body as the Sanchara sthana.
Adhishthana:
Sphik, Kati, Uru, Prushta, Jangha, Pada are the adhishtana of Gridhrasi.
To sum up, the specific etiological factors leads to the vitiation of Vyana
Vayu. Abnormal vyana vayu stemming out from the Pakwashaya circulates in the
lower part of the body and gets localized in the kati, prishta, uru, janu, jangha,
48
pada. Vyana vayu afflicts the mamsa, asthi etc. dhatu involving cheshtavaha,
sagnavaha srotas producing the severe pain originating in the Kati prushta
radiating to Jangha, Janu and Pada region.
Asthi dhatu and vata are having Ashraya Ashrayee sambandha5. Vata
prakopa leads to Asthi dhatu kshaya. Therefore vata prakopa is associated with
loss of both anatomical and physiological integrity of bone.
In vardhakya period, there is predominance of vata dosha therefore
tarunastis of pristavamsa loose the inherent snigdhata and become brittle and are
prone to fracture.
The main pathology of Gridhrasi is degenerative - leading to fracture of
Kati Kaserukasthis and pain experienced by the patient is due to pressure on the
vatavaha nadis.
Degeneration suggests deterioration or worsening of the physical properties
of a tissue with pathological changes in the cells resulting in destruction or
inhibition of function.
In aging process6 changes take place, which cause an overall decrease in the
density of bone and decrease in bony strength. There is a loss of support in the
horizontal beams of bone in the vertebral body, which leads to buckling of the
vertical beams. This creates a gradual increase of concavity of upper and lower
surfaces of the vertebral body.
Age related7 changes in bone cells and matrix have a strong impact on bone
metabolism. Osteo blast from elderly invididuals has reduced reproductive and
biosynthetic potential when compared with osteo blasts from younger individual.
Proteins deposited in the matrix lose their biological punch over time. The end
result is a skeleton populated by bone forming cells that have a diminished
capacity to make bone. Reduced physical activity increases the rate of bone loss.
49
Increased porosity results from reduction in bone mass known as
Osteoporosis.
The intervertebral disc and vertebral bodies develop grow and age together.
It is quite impossible to affect one of these structures alone, as the other must
sooner or later also be involved, even to a lesser extent.
As degenerative changes proceeds:
- Annulus fibrosus and nucleus pulposus are indistinct with fibro cartilage
replacing the nuclear area.
- Proteoglycan content and hydration decreases in the nucleus.
- Vertebral column becomes less flexible.
- Circumferential tears develop in peripheral annulus and radial tears
appear at nucleus and inner annulus. There is failure of disc to act as
the shock absorbing system. There is a consequent reduction in the
ability to withstand normal strains of movement and possibility of
increased wear and tear on all the ligaments and joint structures.
- Fissuring may occur. If there are multiple fissures a loose fragment will
develop and this causes major alteration in the disc mechanics. Torsion
and flexion cause failure of annulus into a posterior protrusion. If the
fragment displaces further the whole thickness of annulus gives way as
the fragment is extruded as a herniation. Compression affects vertebral
end plate and body. Nuclear extrusion into the vertebral body can form
schmorl’s nodes.
Small protrusion compresses the nerve root, which causes severe
pain without much loss in nerve conduction.
50
Large protrusion blocks conduction. The physical signs are marked
sensory loss and motor paralysis.
- Continued narrowing of disc occurs with osteophyte formation at end
plate annular junction. Later end plate sclerosis occurs.
- With continued dessication and cleft formation empty spaces or vacuum
may occur with in the disc.
Disc herniations8 has been shown to incite intense irritations of nerve roots
and dramatic increase in the local concentrations of biochemical agents known to
be inflammogenic.
Ex. Prostaglandin E2, Interleukin-6, Metallo proteinases etc.
As disc prolapse heals by shrinkage the thickness of the disc reduces. The
disc is only one part of the complex arrangement between vertebrae allowing
controlled movements in all directions. So derangement of this part sooner or later
affects the other parts (facet joints and posterior ligaments).
The altered mechanics leads to osteo arthritis of facet joints. With aging
the porosity of the bone of the facet increases. Concurrently there is loss in joint
space. Osteophytes begin to develop. As cartilage fails, bone looses its mass and
its normal function.
Osteophytes encroach upon Inter vertebral foramen causing pressure on
spinal nerve roots. The joint capsule is stretched by excessive movements and the
contained nerve endings give rise to pain.
The spinal nerve roots are sensitive to mechanical deformation due to
intraspinal disorders such as disc herniations or protrusions, spinal stenosis,
degenerative disorders and tumour.
51
Compression causes vascular occlusion affecting nutrition of nerve root. It
may also induce conduction block. There is an increase in neuro transmitters
related to pain.
Nucleus pulposus may elicit inflammatory reaction when outside the
intervertebral space. Proteoglycans have direct irritating effect on nerve tissue.
Disc cells produce reduction in nerve conduction velocity.
Biochemical effects of Nucleus pulposus:
1. Direct neurotoxic effect on nerve tissue.
2. Vascular impairment
3. Inflammatory reactions.
Instability across motion segment occurs as degeneration progresses. Disc
degenerate anteriorly, ligaments buckle or hypertrophy and changes with facet
arthritis progress the central canal as well as neuro foramen is less accommodating
in rotation. As body rotates because of altered anatomy and mechanics, narrowing
occurs and can lead to torsional stresses. This can produce irritation and
inflammation of nerve roots.
52
UPADRAVA AND SADHYASADHYATA
UPADRAVA:
“Roga arambaka dosha prakopa janya anya vikara”
Upadrava is the complication produced in a disease, which develops after
the formation of main disease.
When the main disease has been produced, a dosha or doshas has become
further vitiated owing to abnormal diet, behaviour etc. A secondary disease is
super added and this is known as upadrava1.
In practice the following things may be considered as Upadravas
1. Khanja vata
2. Sosha
1. Khanja vata2: As a result of stabdata and sakti utkshepa nigrahana there is
restriction in extension of leg, the patient has to keep the leg in a semi-
flexed position. This gives rise to limp in walking.
2. Sosha: Gridhrasi is vata vyadhis affecting the vata nadis, on account of
pain all movements are restricted in the affected leg. Continuous pain
restricts the patient to make minimum movements and the mamsa dhatu
under goes sosha. Inability to walk and crippling are other upadravas.
SADHYA SADHYATA
Susruta considers vata vyadhi as mahagada due to its tendency to be
incurable or fatal. Vagbhata calls it as Maharoga. Most of the Acharyas have told
that vata vyadhi, generally are very difficult to cure3, 4. A separate prognosis has
not been mentioned. On the basis of which it may be said that Gridhrasi in which
the vitiated vata is seated in majja dhatu or if Gridhrasi is accompanied with
53
kudavata, Angasosha and sthamba may or may not be cured even after careful
treatment. But if this condition occurs in a strong person, is of recent origin and
without any associated disease, then it is curable.
Susruta mentions that a patient of vatavyadhi, if develops the complications
like shota, sputa twacha, Bhagna, Kampa, Admana and pain in internal organs,
then he will not survive 5. .
The following conditions can be considered to decide sadhya sadhyatwa:
• The pain due to muscle fatigue is sadhya.
• Muscles subjected to prolonged work become fatigued as a result become
locally painful and tender and it may be relieved by rest and by adopting
measures that promote muscle blood flow.
• The pain due to muscle spasm alone is sadhya. If associated with arthritis
is kasta sadhya.
• Sciatic pain due to spondylosis in early stages can be taken as kasta sadhya.
• The spondylolisthesis, which is defined, as forward slipping of vertebral
body on the below it is also kasta sadhya.
• The degenerative disc conditions, osteo arthritis of the inter vertebral joints
are yapya.
• The disc prolapse and the fractures, which compress the spinal cord or
nerve root, can be considered as asadhya, which results in paralysis of
lower limbs.
Most of the conditions affects the vertebral column are kasta sadhyas or
yapya due to the involvement of asthidhatu, on marma, sandhis6 which are
considered under Madhyama roga marga.
54
SAPEKSHA NIDANA
Many of the diseases have resemblance with one another as the symptoms
are concerned. But their line of treatment differs basically. Chikitsa should be
started after confirmation of disease by differential diagnosis.
Cardinal symptoms of Gridhrasi are:
- Pain starting in the sphik, kati, prista radiating down the lower limb.
- Saktyukshepa nigrahanyat - Restriction in raising the leg.
Other symptoms like sthamba, toda, spurana etc., may be present.
Gridhrasi has to be differentiated from the following to arrive at a
diagnosis.
1) Urusthamba1:
- The vitiated kapha along with medha obstructs the vata and pitta in uru
pradesha producing immobilization of thigh and calf.
- The patient experiences strange feeling that leg does not belong to
himself. He is unable to perceive the cold sensation in the affected
limb.
- The movement of the lower limb is completely stopped due to severe
pain.
- Urusthamaba is associated with jwara, chardi, angamarda etc., which are
not found in Gridhrasi. In Gridhrasi the posterior aspects of thigh, calf
along with kati, janu, pada, are involved. Movement is possible.
55
2) Khanja2: Difficulty in walking with involvement of one lower limb.
Akshepana is present.
3) Pangu: Both limbs are affected resulting in total immobilization of lower
limb.
4) Kalaya kanja: The feature of muktasandhi bandhana resulting in criss
crossed manner in walking with kampana.
5) Gudagata vata3: In addition to pain symptoms like emaciation in back,
sacral region, thigh, calf, foot, retention of faeces, urine and flatus, colic,
flatulence and formation of stone may also be present.
6) Khalli: According to Gayadasa, Khalli is a severe painful state of both
Gridhrasi4 and Vishwachi. Both upper and lower limbs are affected
simultaneously.
Avamotana (Mardana like shoola) of pada jangha uru karamoola is seen.
Avamotana is not present in Gridhrasi.
56
CHIKITSA
Samprapti vighatanam is termed as chikitsa.
Charaka1 and Susruta2 recommended siravyadha as the first line of
treatment in Gridhrasi.
Chakradatta3 has given the treatment of Gridhrasi in detail. He stressed that
vasti should be administered after proper Agni deepana, Ama pachana and Urdhva
sodhana. He said that administration of Vasti before urdhvasuddhi is insignificant.
Bhava Prakasha4 advised vamana and virechana before administration of
vasti.
Bhela samhita5 has mentioned sneha unmardana and sneha vasti, Rakta
mokshana.
Vangasena6 has repeated the necessity of Urdhwa sodhana before vasti. He
mentioned deepana, pachana, vamana, virechana, vasti, ishtika sweda & Upanaha.
Chikitsa for Gridhrasi as mentioned by different authors.
Chikitsa C.S. S.S. A.H. A.S. B.P. Y.R. H.S. B.S. C.D. V.S.
Snehana + + + + +
Swedana + + +
Vamana + + + +
Virechana + + + +
Vasti + + + + + + +
Siravedana + + + + +
Agni karma + + + + + +
57
The details of these procedures are given below.
1. Snehana: Snehapana must be adopted at first in all cases of Gridhrasi,
except in cases associated with Ama, kapha. In cases of Ama, Kapha,
deepana and pachana are to be adopted preceding snehapana to facilitate
niramavastha and deepthagni.
2. Swedana: After appropriate snehana is achieved sweda karma must be
adopted. The swedas also must be used preceded by sneha abhyanga and
mixed with snehas i.e., Snigdha sweda. Sankara, prastara, Nadi7 are usually
adopted. However 13 types of swedas may be used according to the
necessity. Shoola and Sthamba can be controlled by swedana.
3. Sodhana: The disorders that are subdued by sodhana will not reoccur. The
following karmas are taken by under the sodhana karma.
a) Vamana
b) Virechana
c) Vasti
a) Vamana: After sneha sweda, vamana should be adopted if necessary.
Chakrapani mentioned urdwa sodhana followed by vasti. This will be
beneficial for vatakaphaja Gridhrasi to alleviate kapha dosha.
b) Virechana: Gridhrasi is considered as a disorder of Rakta origin by some
acharyas like Hareetha.
Sneha yukta virechana must be adopted in vata disorders which are
not subsided by sneha swedas. According to vruddha vagbhata virechana
will facilitate excretion of malas in Rakta mamsa which are brought to
pakwasaya by sneha swedas. Virechana will possess some fibrinolytic anti-
58
coagulant property by stimulation of Rasa rakta samvahana. Hence it
facilitates proper nutrition of disc and reduction of prolapsed disc.
c) Vasti karma8: The vasti karma is said to be pradhana chikitsa for vata
disorder because it immediately enters into pakwasaya, strikes at the root
of the vitiated vata dwelling in other parts of the body and so is
automatically alleviated.
Susruta9 stressed the various effects on the body. It will increase
strength, complexion, restoration and normality of dosha dhatu mala. Useful in
gridhrasi and other types of vata rogas and relieves stiffness and contractures
also.
Though vasti therapy has its scope in all kinds of ailments implicating
different types of doshas, dushyas and Adhistanas, vasti is supposed to be
principal treatment for vatic disorders.
The relative importance of vata10 is already known as it has predominant
influence on the three principal routes of diseases namely sakha, koshta and
marmasthi sandhi. Moreover vata is responsible for the formation,
communication and spread of sweda, mala, mutra, kapha and other biological
substances in the body. Vasti being the principal treatment for such and
important factor is considered the therapeutic procedure of maximum
importance. This is why vasti is said to be half of the whole treatment and
sometimes as complete treatment.
Niruha vasti, causes sodhana of malas from all parts of the body
including srotases and sushumna.
Anuvasana vasti, be adopted after niruha with appropriate taila in
Gridhrasi. It causes sneha of entire body spreading the properties of medicines
used in processing of tailas. It will first enter into pakwasaya the main seat of
59
vata. The taila acts by its snehana, guru, ushna subdues the ruksha laghu and
seeta gunas of vata.
Siravydhana:
Charaka11 opines that the sira located in between the kandara and gulpha
should be selected for the purpose of Siravyadha.
4 inches below indravasti marma12.
4 Angula below vasti 13.
Agnikarma:
Between kandara and gulpha 14
4 angulas below indra vasti marma in posterior side of leg little toe of the
affected leg should be burnt 15.
Hareeta has specified loha salaka for dahana karma16
After sodhana chikitsa, Gridhrasi patient has to be given samana chikitsa.
Shamanoushadis used in Gridhrasi according to different acharyas.
Kalpanas Y.R. S.S. B.P. B.R. C.D G.N. Churnas
Ajamodadi churnam + + Abadi churnam + Krishnadi churnam + + Rasnadi churnam + Aseethaka churnam + Kalka, lepa Mahanimba kalka + + Rasona kalka + Swalpa rasona pinda + + Gunja phala lepa +
60
Kalpanas Y.R. S.S. B.P. B.R. C.D G.N. Kashaya
Panchamula kashaya + + + + Maharasnadi qwatha + + + Sephali patra kashaya + + + + Rasna saptaka qwatha +
Gutikas Rasna guggulu + + + + + Trayodashanga guggulu + + + Yogaraja guggulu + + Mahayogaraja guggulu + Pathyadi guggulu + + + Abha guggulu + Simhanada guggulu + Vatagajankash ras + Vatarakshasa ras + Swachanda bhairava ras +
Taila Bala tailam + + Vajeegandhadi + + + Saindavadya tailam + + Vishagarbha tailam + + Prasarini tailam + + Narayana tailam + Vishnu tailam + Rasna pootika tailam +
61
PATHYAPATHYA
No separate pathyapathya has been mentioned in the Ayurvedic texts. But
some details have been stated in the upasaya, anupasaya. Since Gridhrasi is one of
the vatarogas, the pathyapthya of vata vyadhis may also be considered here.
The following are stated to be hitakara in vatavyadhi.
1. AHARA:
a. Mamsarasa of ajasiras (head of the goat), ambuja (which are bares
on water) anupa (born in marshy areas), and mamsada (which a live
on flesh) animals.
b. Milk
c. Mamsa of above stated animals
d. Fruits which are sour like dadima etc (which do not aggravate pitta)
e. Four varieties of sneha i.e., Ghee, Gingili oil, Muscle fat and bone
marrow.
f. Which are snigdha to which lavana is added.
2. VIHARA:
a. Pariseka with warm decoctions.
b. Samvahana- light massage.
c. Use of thick garments made of wool, silk and cotton.
d. Living in a warm room or in that not exposed to wind or in an inner
chamber.
e. Use of flat bed
f. Basking in the glare of fire.
g. Abstinence from sex.
Since Gridhrasi may also be caused by the vitiation of vata and kapha, the
dietary articles, which may aggravate kapha, should not be used.
62
In apathya, nidana parivarjana is important, the viharas like excessive
walking, jumping, driving which is particularly capable of causing injury to the
pristhavamsa should definitely be avoided and the patient should take complete
rest, both during the treatment and afterwards also.
The following special ahara kalpa are particularly useful:
Table showing pathya and apathya in Gridhrasi:
FACTOR PATHYA APATHYA Staple food Old red rice, wheat black gram, horse
gram Green gram, recently produced
dhanya, masura, kalaya, kodrav, yava Rasas Sweet, acidic, salty Bitter, pungent, astringent Properties All diets must be in hot state, mridu,
sthira, vrushya, pusthi Under feeding rough, unmetous, cool, light, guru, abhishyandi.
Vegetables Leafy vegetables like kasamarda, punarnava, mundi
Leafy vegetables, mrinala , kanala
Fruits Jeeraka , hingu, lasuna, dadima, parushaka, badara, draksha ,orange
---
Phala sakas Like pumpkin, brinjal, bruhati, karela, snake guard, drumstick
Bimbi, kosataki, jambu, betelnut, tola, medi.
Root vegetables
Moolak, soorana, puttagodugu All other vegetables, suskha sakas
Others All types of snehas, ghritas, vasa, taila, majja, processed in deepaneeya vatahara & virechana drugs.
----
Non-vegetarian
Horse, goat, ass, elephant, swans, chakravaka, frog, crocodile, chicken, peacock, fish, sour salt fish , juices of aquatic and marshy animals which are fatty , preparation of meat of bilesaya and prasaha animals.
----
Drinks Sura, asava , milk, coconut water, hot water be used for drinking
Udaka mandha (gruel), water of tank, honey or strea
Vihara sareeraka
Abhyaga (massage), (unaction), moordhin taila, jentaka sweda, sweda abhyanga, unmardhana, peedana, parisheka, ushna avagaha with vatahara drugs wherever possible
Viharas mentioned as nidana , coitus, sleeplessness, anxiety
Nivasa Nivata sthana, niratapasthana, ushanasadhana, hemanthokta vidhi, garbhagriha (inner heated apartmen), soft bed, agnisantapa, under ground residence, well covered bedding and seating. Particularly with heavy wrappers.
Cold atmosphere, cold air,
63
MANAGEMENT OF SCIATICA
A. Conservative Treatment:
1) Rest:
- Complete rest in bed supine position for 3-6 weeks.
- When pain relieved, plaster jacket to immobilize the lumbar spine
for 3-6 months.
- A lumbar corset worn at all times during the day.
2) Medication: Analgesic, anti-inflammatory and occasionally muscle relaxant
medication will help the patient.
3) Heat and cold:
Ice: Useful in acute phase. Slows the nerve impulses in the area, which
interrupts the pain. Ice packs decrease circulation to the area of
contact, which reduces inflammation, swelling, spasm and therefore
pain.
Heat: Heat may be superficial (hot packs / infrared) or deep (ultra sound /
short wave diathermy)
- Because of increased vasodilatation, heat should not be used in the
acute phase of injury.
- The heat increases the blood flow to the damaged or inflamed tissue,
clearing away noxious metabolites and bringing oxygen to the area.
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.
64
5) Exercise: Once the phase of acute pain has passed, gradual exercise is of
considerable value in improving the mobility of the affected portion of the spine
and power in weakened muscles.
6) Miscellaneous forms:
a. Trans cutaneous Electrical Nerve Stimulation (TENS) 17: It is a pulsed
electrical current, which is used for pain relief. TENS stimulates the large, fast
conducting nerve fibres, which override the smaller slower afferent fibers
conducting noxious stimuli thus closing the gate of pain perception.
b. Epidural steroid 18: Epidural cortico steroid injection can be recommend as
additional therapy especially in the acute phase of the conservative management of
Sciatica.
B) Surgical treatment: 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. Cauda equina syndrome: 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.
Relative indication:
a) Failure of conservative treatment.
b) Recurrent Sciatica.
c) A disc rupture into a stenotic canal
d) Recurrent neurological deficit.
65
DRUG REVIEW
SELECTION OF DRUG
Gridhrasi is a disease, which is a common problem to society because here
income-generating people are mostly affected. The patient goes on trying one
medicine after another without satisfactory or complete relief. Moreover
adversely affected by extensive use of NSAIDS, only symptomatic treatment is
suggested in Modern medicine. Therefore another type of medications has been
selected to note the effect of this problem.
In the present clinical study, I have selected Swalpa Rasona pinda with
Astavarga kashaya Anupanam and Matra vasti with Balawagandha tailam.
The drugs selected for the study are cheap, economical and easily available.
Vatakapha are the doshas involved in disease. The disease involves Asthi
and sandhis.
Though vata and kapha are the doshas in Gridhrasi, the impact of Agni is
not ignored in the pathogenesis of Gridhrasi. “Lasunah prabhanjananam” –
Lasuna is considered as best vatahara dravyas according to Vagbhata. Moreover
the ingredients of the above drugs posess Rasayana, Deepana, Pachana Properties.
Indeed Rasayana dravyas enhance the assimilation of all dhatus including asthi
dhatu.
The Deepana pachana properties of dravyas increase Jataragni perhaps
Ashti dhatwagni and also pacifies kapha.
As “Vasti vataharanam srestam” Matra vasti with Balaswagandha tailam
has been taken for trail.
Being taila-based medicine it is used for all vatarogas especially asthi
related vatarogas.
66
Swalpa Rasona Pindam:
Reference: Bhaishajya Ratnavali 26/93-97
Ingredients: Lasuna
Hingu
Jeeraka
Saindavalavanam
Souvarchala lavanam
Trikatu
Lasuna: 3 parts
Other Ingredients: 1 part
Method of preparation: The peel and middle green stalk of garlic
cloves are removed. The cloves are soaked in buttermilk over night,
dried in shade and powdered. It is mixed with powders of ghrita bharjita
hingu, jeeraka, saindavalavanam, souvarchala lavanam, trikatu.
Capsules of 500 mg each are prepared
Dose : 1 capsule t.i.d for 40 days
Anupana: Astavarga kashayam (30 ml t.i.d)
Indications: Ardita, Apatantraka, Ekanga roga, Sarvanga roga,
Urusthamba, Gridhrasi, Krimi roga, Udara roga, Kati prista roga.
67
ASTAVARGA KASHAYAM
Reference: S.Y kashayam prakaranam.125
Ingredients: “Bala sahachara eranda sunti rasna suradrumaih sa sindhuvara lasinaih astavargo anilapaha”
Bala,Sahachara, Eranda,Sunti,Rasna, Devadaru,Nirgundi,Lasuna-Kashaya
Prepared from the above drugs is vata hara
Method of Preparation: The Kashaya kalpana is done according to
Sarangadhara Samhita.
• Drug 1part
(Bala,Sahachara,Eranda,Sunti,Rasna,Devadaru,Nirgundi,Lasuna-each6
g.ms) Total Qwatha Churnam 48 g.m.s
• Water 16 parts (800 m.l )
• Drugs mixed with water then boiled, and reduced to 1/8 th part i.e 90 m.l.
Dose: 30 ml t.i.d
The ingredients of the above formulations possess Deepana, pachana,
Angamarda, prashamana, Brimhana, vatanulomanam.
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BALASWAGANDHA TAILAM
Reference: S.Y.Taila Prakaranam
Ingredients:
Kashaya dravyas
Bala Aswagandha Laksha
Kalka dravya
Rasna Musta Durva Devadaru
Madhuka Haridra Chandana Kusta
Sariba Kaunti Manjista Agaru
Shati Kumuda Usira Satahva
Tailam: 640ml
Dadi mastu : 2560ml
Method of Preparation:
Preparation of kasahaya: Bala, Aswagandha, laksha 215 gms each are
taken and 2560 m.l of water is added and boiled then reduced to 1/4th i.e. 640 m.l
The prepared kasaya (640 m.l) is added to Prastha (640 m.l) of Tila tailam,
4 parsthas (2560 m.l) of Dadhimastu (Supernetent water from the cows curd).
A bolus of 17 drugs (kalka dravyas) each 10 g.ms i.e. 170 g.ms is added to
the above mixture and boiled on mild fire till sneha paka lakshanas are attained.
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DESCRIPTION OF INDIVIDUAL DRUGS
RASONA
Sanskrit name : Lashuna
Botanical name : Allium sativum
Family : Apiaceae
Vernacular name : Telugu – Vellulli
Part used : Bulb
Properties : Rasa - Amla varjita pancharasa; Guna: Snigdha, Teekshna, Picchila, Guru, Sara
Veerya : Ushna ; Vipaka : Katu
Doshagnata : Kaphavata samaka, pitta vardhaka
Karma : Deepana, pachana, balya, brimhana, rasayana, sothahara, bhagnasthi sandhanakara, shoolehara
Chemical constituents : Alliin, Allisatin; Diallyl trisulphide, Vitamins, Enzymes (Allinase, Myrosinase, peroxidase,) Prostaglandins, proteins.
Biological activity : Anti-inflammatory, Anti-arthritic, anti-microbial bacterisidal.
• Oil Extract of garlic when given to overectomized rat promotes intestinal
transference of calcium by modulating the activities of both intestinal alkaline phosphatase and Ca +2 activated ATP ase . It also enhanced better preservation of bone mineral content. (Phytother Res 2006 May ;20(5):408-15).
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HINGU
Sanskrit name : Hingu
Botanical name : Ferula asafetida
Family : Umbelliferae
Vernacular name : Telugu – Inguva
Part used : Niryasa
Properties : Rasa - Katu; Guna: Laghu, Snigdha, Teekshna Veerya: Ushna ; Vipaka : Katu
Doshagnata : Kaphavata samaka, pitta vardhaka
Karma : Shoolaharam, Deepana, pachana, vatanulomana, sara, krimighna, rochana, chedaniya, bhedaniya, Balya, Artava jananam.
Chemical constituents : Lutcolin, a-pinene, phellandrene, aseresinotannol, Farnesiferol A..
Biological activity : Anti-inflammatory.
JEERAKA Sanskrit name : Jeeraka
Botanical name : Cuminum cyminum
Family : Umbelliferae
Vernacular name : English – Cuminum seeds; Telugu – Jeelakarra
Part used : Fruits
Properties : Rasa - Katu; Guna: Laghu, Rooksha, Teekshna Veerya: Ushna; Vipaka: Katu
Doshagnata : Kaphavata samaka, pitta vardhaka
Karma : Deepana, pachana, Balya, Grahi, shoolaprashamana
Chemical constituents : Alpha-pinene, Alpha – phellandrene, volatile oil consists of cumaldehyde.
71
SAINDAVA LAVANAM
Sanskrit name : Saindavah
Latin name : Sodii chloridum
Vernacular name : English – Rock salt
Properties : Rasa - Lavana; Guna: Laghu, Snigdha, Sukshma; Veerya: Anushna; Vipaka: Madhura
Doshagnata : Tridoshahara
Karma : Deepana, pachana, ruchya.
SOUVARCHALA LAVANA
Properties : Guna: Laghu, Sukshma, vishada
Doshagnata : Vatahara, slightly pittkara
Karma : Deepana, pachana, rochana, snehana, shoolahara.
MARICHA
Sanskrit name : Maricha
Botanical name : Piper nigrum
Family : Piperaceae
Vernacular name : English – Black pepper; Telugu – Miriyalu
Part used : Fruit
Properties : Rasa - Katu; Guna: Laghu, Ruksha, Teekshna, Sukshma; Veerya: Ushna ; Vipaka: Katu
Doshagnata : Kaphavata samaka, pitta vardhaka
Karma : Deepana, lekhana, Shoolaprashamaman, pramadhi.
Chemical constituents : Piperine, piperethine, ascorbic acid.
Biological activity : Anti-bacterial and anti-tumor activity.
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PIPPALI
Sanskrit name : Pippali Botanical name : Piper longum Family : Piperaceae Vernacular name : English- Long pepper; Telugu – Pippallu Part used : Fruit Properties : Rasa - Katu; Guna: Laghu, Snigdha, Teekshna
Veerya: Ushna; Vipaka : Madhura Doshagnata : Vatasleshmahara Karma : Dipaniya, shoolaprasamana, Vatanulomana,
sara, Rechana Chemical constituents : Pipeine, Pellitorine, piper longuimine. Biological activity : Anti-inflammatory, Anti-tubercular activity,
Anti-spasmodic, piperine-revealed a hyptensive effect, produced a non-specific blocade of contractions induced by Acetylcholine, histamine, serotonin in isolated intestine of guineapig.
SHUNTI
Sanskrit name : Shunti Botanical name : Zingiber officinale Family : Zingiberaceae Vernacular name : English-Ginger; Telugu – Sunti Part used : Rhizome Properties : Rasa - Katu; Guna: Guru, Ruksha, Teekshna
Veerya: Ushna; Vipaka: Madhura Doshagnata : Vatakaphahara Karma : Deepana, Bhedana, Sula prasamana, pachana,
sophaharam. Chemical constituents : Zingiberene, Zingiberol, sesquiterpenes,
Hydroxy aryl compounds Biological activity : Anti-inflammatory, anti-oxidant,
Bioavailability, enhancer, antihistaminic.
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BALA
Sanskrit name : Bala
Botanical name : Sida condifolia
Family : Malvaceae
Vernacular name : English – Countrymallow; Telugu – Chittamutti
Part used : Root
Properties : Rasa - Madhura; Guna: Laghu, Snigdha, picchila; Veerya: Sita; Vipaka : Madhura.
Doshagnata : Vatapittahara
Karma : Balya, Brimhana
Chemical constituents : Ephedrine, vasicinone, phytosterol etc.
Biological activity : Anti inflammatory, Analgesic, Immuno-enhancing property.
SAHACHARA
Sanskrit name : Sahachara
Botanical name : Barleria prionitis
Family : Acanthaceae
Vernacular name : Telugu – Mullugorinta
Part used : Root, leaves
Properties : Rasa - Tikta, Madhura ; Guna: Laghu Veerya: Ushna; Vipaka : Katu
Doshagnata : Kaphavatahara
Chemical constituents : Barlerin, Acetyl barlerin, Scutellarein-7-neophespe ridoside.
Biological activity : Dieuritic activity
74
ERANDA
Sanskrit name : Eranda
Botanical name : Ricinus communis
Family : Euphorbiaceae
Vernacular name : English – Castor; Telugu – Amudamu
Part used : Root
Properties : Rasa - Madhura, Katu, Kashaya ; Guna: Snigdha, Teekshna, Sukshma ; Veerya : Ushna; Vipaka : Madhura
Doshagnata : Kaphavatahara
Karma : Rechana, angamarda prasamana, bhedana, vrishya, sophahara
Chemical constituents : Lupeol, Ricinine, Palmitic, stearic acid.
Biological activity : Anti-inflammatory.
RASNA
Sanskrit name : Rasna
Botanical name : Pluchea lanceolata
Family : Zingiberaceae.
Vernacular name : English–Lesser galang; Telugu – Sannarashtram
Part used : Rhizome
Properties : Rasa - Tikta; Guna: Guru; Veerya: Ushna; Vipaka: Katu
Doshagnata : Kaphavatahara
Karma : Amapachana, shoolahara
Chemical constituents : Galangin, Diaryl-heptanoids
Biological activity : Diaryl-heptanoids exhibited prostaglandin synthesis inhibiting activity.
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DEVADARU
Sanskrit name : Devadaru
Botanical name : Cedrus deodar
Family : Pinaceae
Vernacular name : English – Himalayan cedar; Telugu- Devadaru
Part used : Bark
Properties : Rasa - Tikta, Katu, Kashaya ; Guna: Laghu, Snigdha ; Veerya : Ushna; Vipaka : Katu
Doshagnata : Kaphavatahara
Karma : Kaphavatahara, deepana, sophahara
Chemical constituents : Deodarin, toxifolin, p-methyl acetophenone
Biological activity : Anti inflammatory, anti cancer activity.
NIRGUNDI
Sanskrit name : Nirgundi
Botanical name : Vitex negundo
Family : Verbinaceae
Vernacular name : English – five leaved chaste; Telugu- Vavili
Part used : Leaf
Properties : Rasa - Katu, tikta ; Guna: Laghu, Ruksha. ; Veerya: Ushna; Vipaka: Katu.
Doshagnata : Kaphavatahara
Karma : Vatakaphahara, vishagna, vranaropana, aruchihara, sophahara, gridhrasihara, deepana, soolahara.
Chemical constituents : Ethyl acetate, phenol, camphene etc.
Biological activity : Anti inflammatory, Analgesic, anti-arthritic.
76
77
ASWAGANDHA
Sanskrit name : Aswagandha
Botanical name : Withania somnifera
Family : Solanaceae
Vernacular name : Telugu – Pennerugadda
Part used : Root
Properties : Rasa - Katu, Tikta, Kashaya; Guna: Snigdha, Laghu ; Veerya : Ushna; Vipaka : Katu
Doshagnata : Vatakaphahara
Karma : Balya, brimhana, sophahara
Chemical constituents : Withanolide, withasominiferin, nicotine, sominolide.
Biological activity : Anti inflammatory, analgesic, anti-anxiety effect, antibacterial activity against mylobacterium,tuberculae, antidepressant, immunomodulatory, immunosuppressive and antitumor activity
• The anti-inflammatory activity in rats is marked and compared to that of prednisolone.
• Being balya,when used as adjuvant,has shown low relapsing&lasting relief.
TILA TAILAM Properties : Rasa - Madhura Tikta, Kashaya ;
Guna: Guru, Sukshma, Vikasi, Vishada.; Veerya: Ushna; Vipaka: Madhura
Doshagnata : Vatakaphahara
Karma : Vikasi, vishada, Brimhana, lekhana, balya.
DADHI MASTU
Properties : Kaphavatahara, sramahara, sroto vishodaka.
DESCRIPTION OF BALASWAGANDHA TAILAM
Sl.
No.
Sanskrit name
Botanical name & family
Rasa Guna Virya Vipaka Doshagnata Karma Chemical constituents
Biological activity
1. Chandana Santalum album Santalaceae
Tikta, Madhura
Laghu, Ruksha
Sita Katu Kapha pittahara Angamarda prasamana, visaghna
α,β-santanialic acids, santalenes.
2. Majista Rubia cordifolia Rubiaceae
Madhura tikta
Guru ruksha
Ushna Katu Kapha pittahara Sophahara, vishaghna, deepana
Rubimallin, antitumour cyclic hexa peptides
Antibacterial spasmolytic antitumor activity
3. Durva Cynodon dactylon Poaceae
Kashaya, Madhura
Laghu Sita Madhura Kaphapitta hara Prajasthapana, varnya
Methoxy propionic acid, benzoic acid, sitosterol
Antiviral activity
4. Yasti Madhu
Glycirrhiza glabra Fabaceae
Madhura Guru, snigdha
Sita Madhura Trisdosha hara Sandhaniya, sonitasthapana, rasayana
Glycyrrhizin Glycyrretic acid, diacetate
Anti-arthritic, anti inflammatory, anti diuretic.
5. Kachura Hedychium spicatum Zingeberaceae
Katu, tikta, kashaya
Laghu, tikshna
Ushna Katu Kapha vatahara Grahi shulahara T-hydroxy hedychenone Hedychenone
Anti-inflammatory, Spasmolytic effect
6. Sariba Hemidesmus indicus Asclepidaceae
Madhura tikta
Guru, snighda
Sita Madhura Tridosha hara Grahi Saponin Ethyl acetate extract, Hemidesmini-ne, Hexane extract
Anti inflammatory, anti- bacterial, immuno modulator activity.
78
79
7. Usheera Veteveria
zizanoides Graminae
Tikta madhura
Rukhsa, laghu
Sita Katu Kapha pittahara Pachana, sthamabana, angamarda, prasamana
Kshusitoneol, zizanol, epizizanol
Juvinile harmone activity
8. Musta Cyperus rotundus Cyperaceae
Tikta katu kashaya
Laghu ruksha
Sita Katu Kapha pitta hara Deepana, pachana, grahi, lekhana
Triterpenoid, cyperenone, rotundone, β-sitosterol.
Spasmolytic antibacterial dieuritic tranquilising anti-inflammatory.
9. Kusta Sausurea lappa Asteraceae
Tikta Katu Madhura
Laghu Ruksha Tikshna
Ushna Katu Vata kapha hara Lekhaniya, vrishya
Sesquiterpines, Costunolide, ar -curcumene
Useful in osteo arthritis
10. Agaru Aqualaria agallocha Thymeliaceae
Katu tikta Laghu tikshna
Ushna Katu Vata kapha hara Rasayana, dusta vrana
Agarotetrol, aquilochin, agarol, kusnol
11. Haridra Curcuma longa Zingeberaceae
Tikta katu Ruksha, laghu
Ushna Katu Kapha vata hara Lekhana, visaghna
Curcumin PE extract
Antibacterial, Anti inflammatory, anti arthritic.
12. Satahwa Anetheum sowa Umbelliferae
Katu tikta Laghu tikshna
Ushna Katu Vata kapha hara Deepana, Shoolahara, adhmanahara
Carvone, dill-apial, β-sitosterol
Apetite stimulating fungi cidal property
13. Kumuda Nymphea stellata Nymphaceae
Madhura, Kashaya, tikta
Laghu, snigdha, picchila
Sita Madhura Tridoshahara Mutra virajaneeya Grahi
Luteolin Dieuritic, Hypnotic
14. Padma Prunus puddum Rosaceae
Kashaya tikta
Laghu, snigdha
Sita Katu Kaphapittahara Vedana sthapana garbha sthapana
Puddumin prunetin.
DESCRIPTION OF MATRA VASTI
Matra vasti is type of Anuvasana vasti. The quantity of matra vasti is half
the dose of anuvasana vasti. i. e. 60 ml19 (6 tola).
“Yadesta ahara chestasya sarva kalam niratyayaha”20
There are no restrictions regarding diet and activities. It can be administered
any time without any hesitation.
“Vata rugnecha matra vasti sadamata”21
It is indicated in vata rogas.
Purva karma:
Patient is advised to take light meal (3/4th quantity of usual dosage)
After having meal, the patient is made to walk 100 feet and asked to
attend natural urges (if necessary).
External oleation and fomentation is done over kati, uru, jangha
regions.
60ml bala aswagandha tailam is added to fine powders of saindavalavanam
and satapushpa and churned well. Vasti dravya is made luke warm and taken in
glycerine syringe. Rubber catheter No. 9 is joined to glycerine syringe. Oleation of
catheter is done for easy passage through anus. Air from catheter is removed by
pushing oil into catheter.
Pradhana karma:
Patient is advised to lie down in left lateral position (left lower limb straight
and right lower limb flexed at knee and hip joint). The patient is asked to keep left
80
hand below the head. Anal orifice is lubricated with oil. The catheter is slowly
introduced. While inserting the catheter patient is advised to take deep breathe to
relax the anal sphincter. The vasti dravya is pushed inside slowly with the constant
speed without shaking. Then slowly catheter is removed.
Paschat karma:
Patient is made to lie in supine position, both legs are raised, and tapping is
done on buttocks to prevent the expulsion of vasti dravya immediately.
During administration if the patient feels urge of faeces and flatus, vasti
netra is withdrawn. The process is continued after he attends the urges.
After vasti procedure, the patient is advised to lie on the bed for at least
20 minutes.
After expulsion of vasti dravya patient develops lightness of body, good
sleep, indriya prasadam, vega pravartanam22. Next matra vasti should be given
after excretion of urine and stool. This procedure is continued for 7 days.
The veerya of vasti dravya23 is conveyed from apana to samanavata may
regulate the functions of agni then to udana vyana and prana thus providing its
efficacy all over the body.
Vata is master in aggravating of three doshas. When it is much advanced
and affect the body no other remedy except vasti can check its force as coast
checks the force of tides of sea24.
Vasti dravyas lying in the pakwashaya, through its veerya25 draws the
morbid doshas lodged in the entire body from foot to head, just as the sun situated
in the sky takes up the moisture from the earth.
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As per Acharya Parashara26 Guda(Anus) is the main route of the body and
having blood vessels in it, if we administered the vasti in anus its nourishes all the
limbs and organs of the body.
The active fraction of vasti dravya spreads all over the body, just as water
poured at the route reaches all parts of the tree through the micro and macro
channels. As such it is considered as ardha chikitsa and complete treatment by
some acharyas.
Taila by its snehana, guru, ushna guna subsides ruksha laghu, seeta gunas of
vata.
Matra vasti can be given to children, women and aged people also. It has no time
regulation. It can be given at any time. So it is more beneficial at present era
wherethe people are having very busy life style.
82
MATERIALS AND METHODS
Aim of the study: The present clinical study is intended to know the effect of
swalpa Rasona pinda with Astavarga Kashaya anupanam and matra vasti in
gridrasi vata.
Location of study: The cases for the study and clinical trail were selected from
the in patients and out patients department of P.G. Unit, Kayachikitsa,
Government Ayurvedic Hospital, Erragadda, Hyderabad.
40 cases were selected and studied.
Selection of patients:
Inclusion criteria:
1. Gridhrasi diagnosed according to classical signs and symptoms.
2. Patients of age above 20 and below 60.
3. SLR test positive.
Exclusion criteria:
1. Proven cases of Malignancy
2. Congenital abnormalities in lumbar spine.
3. Known cases of Tuberculosis.
4. History of trauma causing fractures.
5. Surgical indications such as progressive neurological deficit, bilateral signs
and symptoms of bowel and bladder involvement.
83
Diagnostic Criteria:
The parameters for diagnosis are completely based on classical symptoms
like Ruk, Toda, Sthamba in the spik, kati, prista, uru, janu, Jangha and pada region
with or without other symptoms. The test for Sciatica like Straight Leg Raising
Test (SLR) was considered.
The following laboratory investigations are to be done for diagnosis of
Gridhrasi.
X-ray lumbo sacral spine AP-View, lateral view was done to exclude and
include in the study.
Investigations:
a) CBP
b) ESR
c) Routine Urine Examination for sugar and albumin.
Research Design:
The patients were divided into two groups: Group A & Group B
Group-A: 20 patients were taken for study. They were administered
• Swalpa Rasona pindam
• Dose: 1cap. t.i.d. for 40 days
• Anupana: Astavarga Kashaya 30ml tid (for 40 days) Group-B: 20 patients were taken for the study in this group also. They
were administered
• Matra Vasti with Balaswagandha tailam for 7 days
• Swalpa Rasona pindam
• Dose: 1 cap. tid for 40 days.
• Anupana: Astavarga Kashayam Dose: 30ml tid.
84
A detailed clinical history of patients, occupation, dietary habits, history of
injury, family history, etc., have been taken and recorded. They were asked to
report for every 10 days for follow up.
Depending upon the history and symptomatology, the provisional diagnosis
is made which is confirmed by S.L.R.Test. After detection, the case is registered
and all the clinical features, reports of laboratory investigations were recorded.
Diet:
All the patients selected for the study were kept on normal diet consisting
of rice, chapaties, vegetables and milk. They were given instructions from
excessive exercise, eating fleshy mutton, spices etc.
ASSESSMENT CRITERIA:
Both subjective and Objective assessments were done in all the patients
before and after treatment.
Subjective Parameters:
Separate grading has been given for subjective assessment
parameters that include the following:
1) Sthamba 2) Ruk 3) Toda 4) Spandana
5) Daha 6) Pain in payu 7) Deha vakrata 8) Sosha
9) Vibandha 10) Aruchi 11) Gourava 12) Agnimandya
13) Tandra 14) Suptata
85
RUK:
No pain : 0
Occassionally painful : 1
Pain without limping and slight difficulty in walking : 2
Pain with liming but without support : 3
Painful, can walk only with support : 4
Painful unable to walk : 5
Sthamba:
No stiffness : 0
Mild stiffness (can perform daily routine work without difficulty: 1
Moderate stiffness (difficulty in performing daily routine) : 2
Severe stiffness (Totally unable to perform daily routine) : 3
Toda:
No pricking sensation : 0
Mild pricking sensation (occasionally in a day) : 1
Moderate pricking sensation ( frequent ) : 2
Severe pricking sensation (Persistent) : 3
Spandana (Fasciculation):
No fasciculation : 0
Mild fasciculation (sometimes 5-10min.) : 1
Moderate fasciculation (Daily 10-30 min.) : 2
Severe fasciculation (Daily >30min) : 3
86
Daha (Burning):
Absent : 0
Occassionally in a day : 1
Frequent and persistent : 2
Suptata (Numbness)
Absent : 0
Occassionally in a day : 1
Frequent and persistent : 2
Aruchi
Agnimandya
Gourava Absent : 0
Tandra Present : 1
Sosha
Vibandha
Objective parameters:
1. Numerical Rating scale (NRS)
2. S.L.R. Test
3. Oswestry Disability Index (ODI)
The grading for the pain was given on the basis of numerical rating scale.
NRS shows the pain intensity on a scale of 0-10, with 0 indicating no pain
and 10 the worst pain imaginable.
0 1 2 3 4 5 6 7 8 9 10
No pain Moderate pain Worst possible pain
The patients were asked to mark their pain levels on the NRS.
87
Grade Severity Scale reading
0 No pain 0
1 Mild pain 1-3
2 Moderate pain 4-6
3 Severe pain 7-9
4 Worst possible pain (Unimaginable/Unspeakable)
10
Straight leg raising test
i) > 90° - 0
ii) 71° - 90° - 1
iii) 51° - 70° - 2
iv) 31°-50° - 3
v) Upto 30° - 4
ODI: Oswestry Disability index (Oswestry Low Back Pain Disability
Questionnaie) is use to measure patient’s functional disability.
Grade Severity Scale reading
0 Minimal disability 0-20%
1 Moderate disability 21-40%
2 Severe disability 41-60%
3 Crippled 61-80%
4 Bed bound 81-100%
88
Assessment of Results:
Classification of Response Percentage of alleviation of symptoms
1. Good 60% and above
2. Moderate 30-60%
3. Mild 0-30%
89
OBSERVATIONS
A total number of 40 patients were selected in the present clinical study.
Patients were divided into two groups.
Group A: 20 patients were given oral medicine for 40 days.
(Swalpa Rasona Pindam with Asta Varga Kashaya Anupana)
Group B: 20 patients were administered Balaswagandha taila matra vasti for
7 days along with oral medicine for 40 days.
For convenience of assessment of results the patients were classified into
various groups depending upon their age, sex, occupation, diet etc.
Method of Observation: While doing the clinical study, the signs and symptoms
of the disease mentioned in the classics were observed in each case recorded and
studied and also the SLR test, NRS, ODI are noted compulsory before and after
the treatment.
They are taken as criteria for assessment. The subsidiary symptoms if any,
were also noted during the period of treatment.
The review of signs and symptoms were noted every 10 days and changes
if any, were recorded. The signs and symptoms were finally observed at the end
of the period of treatment, other observations were also noted which are having
importance in Gridhrasi vata.
90
TABLE No. 1: INCIDENCE OF DISEASE BASED ON AGE GROUP
Group-A Group-B Age in years
No. of patients Percentage No. of patients Percentage
21-30 3 15% 2 10%
31-40 8 40% 4 20%
41-50 7 35% 6 30%
51-above 2 10% 8 40%
012345678
No.
of p
atie
nts
21-30 31-40 41-50 above 51
Age in years
Group AGroup B
In Group-A: The maximum cases recorded are in the age group of 31-40% i.e.,
40% in the age group 41-50 years the incidence is 35%
In Group-B: It is observed that the incidence of disease is more prevalent in the
age group 51-above i.e., 40%.
91
TABLE No.2: INCIDENCE OF DISEASE BASED ON SEX
Group-A Group-B Sex
No. of patients Percentage No. of patients Percentage
Male 8 40% 8 40%
Female 12 60% 12 60%
0
2
4
6
8
10
12
No.
of p
atie
nts
Male Female
Sex
Group AGroup B
According to the present clinical study 60% of patients were found to be
females and 40% are males in both groups A & B. This table reveals that females
are slightly more prone to disease than males.
92
TABLE NO. 3: INCIDENCE OF DISEASE BASED ON DIET
Group-A Group-B Diet
No. of patients Percentage No. of patients Percentage
Mixed 20 100% 19 95%
Veg 0 - 1 5%
0
5
10
15
20
No.
of p
atie
nts
Mixed Veg
Diet
Group AGroup B
This table indicates the prevalence of disease is more in mixed diet in both
groups.
93
TABLE No.4. INCIDENCE OF DISEASE BASED ON OCCUPATION
Occupation is also important factor to be considered in Gridhrasi Vata. It
was categorized into 1) Housewives 2) Workers/farmer 3) Students 4)
Sedentary group.
In Sedentary group, retired employees, software engineers, and
businessmen are included.
Group-A Group-B
Occupation No. of
patients Percentage No. of
patients Percentage
Housewife 9 45% 10 50%
Workers/Farmers 4 20% 1 5%
Students 1 5% 1 5%
Sedentary group 6 30% 8 40%
0
2
4
6
8
10
No.
of p
atie
nts
Housewives Workers/farmers Students Sedentary
Occupation
Group A Group B
The above table shows that Gridhrasi is commonly noted in Housewives
45% in Group A and 50% in Group B.
94
Table No.5. INCIDENCE BASED ON SOCIO-ECONOMICAL STATUS
Group-A Group-B Economical
status No. of patients
Percentage No. of patients
Percentage
Middle class 14 70% 6 30%
Lower class 12 60% 8 40%
02468
101214
No.
of p
atie
nts
Middle class Lower classEconomic status
Group AGroup B
40 patients were categorized into two classics according to their Socio-
Economic status as Middle & Lower class. The above table indicates Gridhrasi is
commonly noted in middle class in both groups i.e., 70% in Group-A, 60% in
Group-B.
95
Table No. 6. INCIDENCE OF DISEASE BASED ON RELIGION
Group-A Group-B
Religion No. of
patients Percentage No. of
patients Percentage
Hindu 15 75% 13 65%
Muslim 2 10% 3 15%
Christian 3 15% 4 20%
02468
10121416
No.
of p
atie
nts
Hindu Muslim ChristianReligion
Group AGroup B
Among 40 patients, disease is more prevalent in Hindus in both
groups 75% in Group-A, 65% in Group-B.
96
Table No. 7. INCIDENCE OF DISEASE BASED ON PRAKRITI
Group-A Group-B
Prakruti No. of
patients Percentage No. of
patients Percentage
Vata pitta 6 30% 8 40%
Vata kapha 13 65% 12 60%
Kapha pitta 1 5% 0 0
02468
101214
No.
of p
atie
nts
Vatapitta Vatakapha Kaphapitta
Prakruti
Group AGroup B
In Group-A, maximum number of patients was found in Vata kapha prakruti i.e.,
65%.
In Group-B, maximum number of patients was found in Vata pitta prakruti i.e.,
60%.
97
Table No. 8. INCIDENCE OF DISEASE BASED ON ADDICTIONS
Group-A Group-B
Addictions No. of
patients Percentage No. of
patients Percentage
Smoking 3 15% 3 15%
Alcohol 5 25% 5 25%
Tobacco 7 35% 10 50%
None 5 25% 2 10%
0
2
4
6
8
10
No.
of p
atie
nts
Smokng Alcohol Tobacco None
Addictions
Group AGroup B
From the above table 25% have habit of consuming alcohol, 15% had the
habit of smoking in both groups. 7 patients (35%) in Group A and 10 patients
(50%) in Group B have the habit of Tobacco chewing.
98
Table No.9. INCIDENCE BASED ON AGNI
Group-A Group-B
Agni No. of patients
Percentage No. of patients
Percentage
Vishamagni 3 15% 6 30%
Mandagni 14 70% 9 45%
Tikshnagni 3 15% 5 25%
02468
101214
No.
of p
atie
nts
Vishamagni Mandagni Tikshnagni
Agni
Group AGroup B
From the above table it was found that maximum number of patients 70%
in Group-A, 45% in Group-B belong to Mandagni.
99
Table No.10. INCIDENCE OF MODE OF ONSET
Group-A Group-B
Mode of onset No. of
patients Percentage No. of
patients Percentage
Sudden 5 25% 2 10%
Gradual 15 75% 18 90%
02468
1012141618
No.
of p
atie
nts
Sudden GraudalMode of onset
Group AGroup B
Among 40 patients, mode of onset is gradual in Group-A (75%) and Group-B
(90%)
100
Table No. 11. INCIDENCE BASED ON ETIOLOGY
Group-A Group-B
Etiology No. of patients
Percentage No. of patients
Percentage
LS 4 20% 13 65%
LS + IVDP 5 25% 2 10%
IVDP 9 45% 3 15%
Spondylolisthesis 2 10% 2 10%
LS – Lumbar spondylosis
IVDP – Inter vertebral disc prolapse
02468
101214
No.
of p
atie
nts
LS LS+IVDP IVDP Spondylolisthesis
Etiology Group AGroup-B
According to above table, maximum number of cases in Group-A belongs
to IVDP i.e., 40%.
Maximum number of cases in Group-B belongs to LS i.e., 65%.
101
Table No. 12. INCIDENCE BASED ON SYMPTOMS FOR 40 PATIENTS
Sl.No. Symptoms No. of cases Percentage
1 Pain in spik 38 95% 2 Pain in kati 39 97.5% 3 Pain in uru 40 100% 4 Pain in janu 40 100% 5 Pain in jangha 40 100% 6 Pain in pada 33 82.5% 7 Toda 35 86.5% 8 Deha vakrata 16 47.5% 9 Sthamba 33 82.5% 10. Spandana 29 72.5% 11. Mahabaddata 13 33.5% 12. Aruchi 11 27.5% 13. Agnimandya 17 42.5% 14. Gourava 19 47.5%
05
1015202530354045
Pain
in s
pik
Pain
in k
ati
Pain
in u
ru
Pain
in ja
nu
Pain
inJa
ngha
Pain
in P
ada
Toda
Deh
a va
krat
a
Stha
mba
Span
dana
Mah
abad
data
Aru
chi
Agn
iman
dya
Gou
rava
102
RESULTS
The response of the patients to the treatment done was observed according
to the subjective & objective parameters before and after the treatment.
The patients were classified into three groups Good, Moderate and Poor.
Table Showing the incidence of patients in each pain grade before and after
treatment in Group A & B
Group – A Group-B BT AT BT AT Pain
gradation No. of pts.
% No. of pts.
% No. of pts.
% No. of pts.
%
Worst 3 15% 2 10% 1 5% 0 0
Severe 10 50% 3 15% 12 60% 2 10%
Moderate 7 35% 9 45% 5 25% 7 35%
Mild 0 0 6 30% 2 10% 11 55%
No pain 0 0 0 0 0 0 0 0 Group-A: Among 20 patients, before treatment, 3 patients (15%) were presented
Worst pain, 10 patients (50%) were presented severe pain, 7 patients (35%), were
presented Moderate pain. After treatment 2 patients (10%) were presented Worst
pain, 3 patients (15%) were presented Severe pain, 9 patients (45%) were
presented Moderate pain, 6 patients (30%) were presented Mild pain.
Group-B: Among 20 patients, before treatment, 1 patent (5%) presented Worst
pain, 12 patients (60%) presented severe pain, 5 patients (25%) presented
Moderate pain 2 patients (10%) presented Mild pain. After Treatment, there were
no patients in Worst pain, 2 patients (10%) in Severe pain, 7 patients (35%) in
Moderate pain, 11 patients (55%) in Mild pain.
103
Showing the incidence of range of SLR in the patients of most affectedly.
Group – A Group-B BT AT BT AT Range of
SLR (in degrees) No. of
pts. % No. of
pts. % No. of
pts. % No. of
pts. %
31-50 11 55% 5 25% 8 40% 1 5%
51-70 9 45% 8 40% 12 60% 7 35%
71-90 0 0 7 35% 0 0 12 60%
Group-A: Among 20 patients, before treatment, 11 patients (55%) were in the
range of 31-50°, 9 patients (45%) were in the range of 51-70°. After treatment, 5
patients (25%) were in the range of 31-50°, 8 patients (40%) were in the range of
51-70°, 7 patients (35%) were in the range of 71-90°.
Group-B: Among 20 patients, before treatment, 8 patients (40%) were in the range
of at 31-50°, 12 patients (60%) were in the range of 51-70°. After treatment 1
patient (5%) was found in the range of 31-50°, 7 patients (35%) were in the range
of 51-70° and 12 patients (60%) were in the range of 71-90°.
Showing the changes in SLR after treatment
Group – A Group-B Right leg Left leg Right leg Left leg Difference
in degree No. of pts.
% No. of pts.
% No. of pts.
% No. of pts.
%
1-10 7 35% 4 20% 3 15% 3 15%
11-20 3 15% 5 25% 5 25% 3 15%
21-30 1 5% 1 5% 3 15% 2 10%
31-40 0 0 0 0 1 5% 1 5%
Group-A: Among 20 patients, 11 patients showed 1-10° difference, 8 patients
showed 11-20° difference, 2 patients showed 21-30°.
104
Group-B: Among 20 patients, 6 patients showed 1-10° difference, 8 patients
showed 11-20° difference, 5 patients showed 21-30° difference, 2 patients showed
31-40° difference.
Showing the assessment of ODI before and after treatment.
Group – A Group-B BT AT BT AT ODI No.
of pts. % No. of
pts. % No. of
pts. % No. of
pts. %
Bed bound 0 0 0 0 0 0 0 0
Crippled 3 15% 0 0 8 40% 1 5%
Severe 16 80% 9 45% 9 45% 7 35%
Moderate 1 5% 10 50% 3 15% 10 50%
Mild 0 0 1 5% 0 0 2 10%
Group-A: Before treatment, 3 patients (13%) were crippled, 16 patients (80%)
having severe disability, 1 patient (5%) had moderate disability. After treatment,
9 patients (45%) had severe disability, 10 patients (50%) had moderate disability,
1 patient (5%) had mild disability.
Group-B: Before treatment, 8 patients (40%) were crippled, 9 patients (45%)
having severe disability, 3 patients (15%) having moderate disability. After
treatment, 1 patient (5%) was crippled, 7 patients (35%) had severe disability, 10
patients (50%) had moderate disability 2 patients (10%) had mild disability.
105
SYMPTOM WISE RELIEF
Group-A Group-B Symptom BT AT Relieved % BT AT Relieved %
1. Sthamba 47 29 38% 56 10 82%2. Ruk 58 33 43% 56 20 64%3. Toda 47 32 32% 48 13 73%4. Spandana 27 10 63% 32 3 91%5. Daha 13 3 77% 26 5 81%6.Pain in payu 5 2 60% 13 4 69%7.Deha vakrata 8 5 38% 14 3 79%8.Sosha 5 5 0% 5 4 20%9.Vibandha 12 4 67% 10 2 80%10.Aruchi 12 0 100% 6 5 17%11.Gourava 12 4 67% 9 7 22%12.Agnimandya 10 0 100% 4 1 75%13.Tandra 11 1 91% 7 7 0%14.Suptata 34 17 50% 26 5 81%15.N.R.S 56 40 29% 52 31 40%16.SLR right 35 27 23% 34 21 38%17.SLR left 37 31 16% 33 23 30%18.O.D.I 42 29 31% 45 27 40%Mean
0102030405060708090
100
Rel
ieve
d pe
rcen
tage
Stha
mba
Ruk
Toda
Span
dana
Dah
a
Pain
in p
ayu
Deh
a va
krat
a
Sosh
a
Viba
ndha
Aru
chi
Gou
rava
Agn
iman
dya
Tand
ra
Supt
ata
NR
S
SLR
Rt.
SLR
Lt.
OD
I
SymptomsGroup A Group B
106
STATISTICAL ANALYSIS OF CLINICAL RECOVERY OF PARAMETRS
IN BOTH GROUPS
GROUP “A” GROUP ‘B” MEAN
MEAN
S.NO
Parameter B.T A.T
Mean difference
% of Relef
B.T A.T
Mean Difference
% of Relef
1 STAMBA 2.35 1.45 0.9 38 2.8 0.5 2.3 82
2 RUK 2.9 1.65 1.25 43 2.8 1 1.8 64
3 TODA 2.40 1.6 0.8 33 2.4 0.65 1.75 73
4 S.L.R 1.75 1.35 0.4 23 1.7 1.05 0.65 38
5 S.L.R (L) 1.85 1.55 0.3 16 1.65 1.15 0.5 30
6 N.R.S 2.8 2 0.8 28 2.6 1.55 1.05 40
7 O.D.I 2.1 1.45 0.65 31 2.25 1.35 0.90 40
Analysis: Sthamba, Ruk, Toda of subjective parameters along with objective
parameters are taken. Mean is calculated before and after treatment, mean
difference is found. Mean difference in group-B is higher than that of Group A in
all above parameters hence it can be concluded that Group B is significantly
effective i.e Matravasti along with oral medicine is more effective in relieving
symptoms than oral medicine alone.
107
OVERALL RESULT
Group A Group B Result
No. of patients Percentage No. of patients Percentage
Good 3 15% 11 55%
Moderate 12 60% 6 30%
Mild 5 25% 3 15%
Group-A: Among 20 patients, 3 patients (15%) showed good response.
12 patients (60%) responded moderately.
5 patients (25%) showed mild response,.
Group-B: Among 20 patients, 11 patients (55%) showed good response
6 patients (30%) showed moderate response.
3 patients (15%) showed mild response.
Group - A15%
60%
25%
GoodModerateMild
GROUP-B
55%30%
15%
GoodModerateMild
The results have been also presented in the form of Master Chart.
108
DISCUSSION Man is almost unique in standing up right posture balanced on two limbs. The
advantage of this posture is obvious but it also led to considerable stress on the
spine. Gridrasi is not the problem of recent origin, but it was known to man kind
since time immemorial.
Gridrasi is compared with sciatica. The under lying cause may be ruptured
intervertebral disc, arthritis in the sacro iliac joint or spine, spodylolisthesis,
lumbar canal stenosis.
The disease is seen in all ages but more frequently among middle aged.
Though the disorder appears to be benign, it causes great discomfort to the patient
and makes him temporarily disabled to perform the routine social activities, as it is
not mere discomfort but the pathological dominant factor.
Ageing process of the body after forty years is likely vulnerable to variety of
vata vyadhis, gridhrasi is one among them, which requires the attention of the
physician. In all degenerative conditions, involvement of vata is a prime factor.
Discussion on observation:
AGE: Maximum number of patients was found in 31-40 & 51-above age
groups. Today’s life style which leads to irregular exercise, more traveling
abnormal postures, and working for a long time with out proper rest may be the
reason behind this.
In age group of 51& above which is vata prakopa kala – there is progressive
decrease in hydration of inter vertebral disc that leads to degeneration resulting in
disc problem there by causing Gridhrasi No patients were found in 0-20 age group,
because in this group more elasticity is found in the spine. So it works as a good
shock absorber and does not give chance to produce gridhrasi.
111
Sex: This study reveals that higher incidence was observed in females. In many
female patients history of heavy weight lifting i.e. lifting buckets with full of water
was common. Though the male patients are less in this study due to professional
exposure to strain, trauma on the lumbo sacral region, incidence of gridhrasi was
found in significant percent.
Diet: In the present study it was observed that maximum number of patient belong
to mixed diet. In classics it has been clearly mentioned that the disease occurs in
people who are greedy for non-vegetarian food, which is supported by findings of
the present study.
Occupation: From this present study we can come to a conclusion Gridhrasi
effects the person from varied occupation with varied degree of spinal stress and
strain caused by irregular posture of sitting, standing, walking, improper lifting of
heavy weight, driving etc., however more cases observed in House wives.
Socio Economic Study: In the present study- majority of patients belong to
middle class followed by lower class.
Religion: In the present study majority of patients registered for the study were
Hindu’s; the data is only reflection of geographical predominance of the
community.
Addiction: Though addiction history is signifying sciatic neuritis, in the present
study we cannot come to any conclusion, as the sample size is small.
Prakruti: Majority of patients belong to vata kapha prakruti followed by vata pita
prakruti the observation supports the tendency of vataja disorder like gridrasi in
persons having vata prakruti and other doshik prakrutis where vata is
predominantly involoved.
Based on etiology: Lumbar spondylosis is found in Gr A 30% Gr B 65%, Inter
vertebral disc prolapse Gr A 40% Gr B 15%. Spondylolisthesis 10%in each
112
group.Asthidhatu kshaya (degenerative changes) is one of the causes for
provocation of vata. According to modern medicine lumbar spondylosis is
common cause for sciatica. So its supports the cause of Gridrasi is vata prakopa,
mainly due to degenerative changes in lumbo sacral spine both in ayurveda and
modern medicine.
As vata vyadhi becomes chronic it is difficult to treat. The same thing was proved
in the present study. The patients who came in early stage of disease have obtained
good results compared to chronic patients. From this it is clearly indicate, if
patient comes in early stage of disease, gives good result in relieving pain and as
the disease become chronic it is difficult to treat.
Ruk: Statistical analysis revealed that difference of Mean (before treatment mean
–after treatment mean) in Group A is 1.25 and Group B is 1.8. There was 64% of
reduction in pain in-group B where as in Group A it was 43%. Out of 20 cases in
group A:8 patients had good relief of pain, 8 patients moderate relief,4 patients
mild relief. In Gr B12 patients had good relief and 8patients had moderate relief.
Sthamba: Severity of Sthamba was decreased and Mean Difference in Group A is
0.9 and Group B is 2.3,and relieved 38% in Group A and 82% in Group B. Result
of Group A : 3 good ; 12 moderate and 3 mild response . In case of Group B 19
cases showed good response, one mild response.
Toda: Mean difference: Group A 0.08 Group B 1.75; and the relieved %was 33%,
73% in A and B.Result: Group A : 2 cases good relief,11-Moderate, 4 mild where
as in Group B 14 good,2 moderate and 1 mild response was observed.
Daha, Suptata are effectively relieved in Group B than Group A In case of Aruchi,
Gaurava, Agnimandya, Tandra more relief was noted with oral medicine alone.
N.R.S: The mean difference in Group A is 0.8 and 1.05 in Group B and relieved
% was 29,40 respectively in both groups. Severity of pain was relieved more in
Group B than Group A.
113
O.D.I: Mean difference in Group A is 0.65 and Group B is 0.90 and relieved %
was 31,40 in Group A and B.
S.L.R: In Group A increase of SLR angle was 23% and Group B 38% in case of
right leg and 16% in Group A, 30% in Group B in left leg.On the whole result in
Group B on the parameters is highly encouraging.
The Drug Swalpa rasona pinda, Asta varga kashaya anupana action can be
interpreted as follows.Rasona is best vata hara dravya.It also posess-deepana,
pachana, brimhana, rasayana, shoolahara, sothahara, bhagnasthisandhanakara
properties. “Sarvangam prasarati” property described for Lasuna in Saaligrama
nighantu. It enters through micro channels of body and reaches site of
pathogenesis and relieves Ruk, sthamba, kati uru janu Madhya bahu vedana,
sandhi shoola etc
Extract of garlic when given to overectomized rat promotes intestinal
transference of calcium. It also enhanced better preservation of bone mineral
content. (Phyother Res 2006 May; 20-5; 408-15).
Hingu, Jeeraka, Shunti possess anti-spasmodic, muscle relaxant, anti
inflammatory, analgesic effect there by relieving shoola, shotha, sakthi utkhepa
nigrahana etc. Apart from Angamarda prasamana property, Eranda said as
“Marga visodaka”. (Madanapala Nighantu) It causes sroto sodhana and vata
anulomana by which it restores normal circulation of vata, and acts also like
painkiller.
Rasna, Sunti, Nirgundi, Devadaru have anti-inflammatory action, it reduces
nerve inflammation added to this it also posses pain relieving effect.
All the ingredients also possess Deepana, Pachana property, which causes
Ama pacha and Agni deepana. Individual drugs possess shoolahara, sothahara,
Rasayana, Vatakaphahara properties. Combination of above drugs causes potent
Anti-inflammatory, pain relieving effect.The drugs also have effect on the
114
associated symptoms like Aruchi, Agnimandya, Bhaktadwesha, Mukha praseka,
vibanda etc.
Hemadri advised Brimhana treatment in Asthi Kshaya & Vata Vriddhi (Vayu
vriddhou Brimhanam Asthi Kshayae Brimhanam) (A.Hr.Su.11/25). In Asthi
Ashraya Vyadhis the Chikitsa sutra is vasti with tikta rasa dravyas.
Balaswagandha tailam have many herbs having bitter taste (tikta rasa) and
osteogenic action.
Balaswagandha tailam is described as “Pustikaram param” (S.Y.Taila
prakaram). Most of the ingredients of the tailam possess Brimhana snehana
property. As mentioned in Chikitsa sutra Balaswagandha tailam cuases Asthi
dhatu poshana through Brimhana, Balya properties. It also acts as nervine
stimulant.
In Vata vyadhis Brimhana with sneha is indicated. Balaswagnada taila
matra vasti is vataharam, prevents Asthi dhatu kshaya. Tila tailam by its sara,
sookshma, vikasi snigdha, mardava gunas enters into srotas relieves obstruction
causes Dhatu vriddhi (Thereby Asthi dhatu poshana).
Dadhimastu also possess, sroto visodaka,Aharam balyam property
(Bh.Pr.) Rasayana properties of the drugs enhances the proper nourishment of
dhatus. Tilatailam is said asVatagneshu uttamam balyam (C.S.SU.27/285).
Balakrit (Y.R.) The ingredients also possess sulahara, sothahara property.Anti-
inflammatory, Analgesic, Immunomodulatory, properties of Bala, Aswagandha,
Yastimadhu, Sati, Sariba, Musta are experimentally proved.
Thus Matra vasti with oral medicine Swalpa Rasona pindam, Ashta varga
Kashaya anupana helps in relieving Sthamba, Ruk, Toda, Daha, Sakti, Utkshepana
effectively.
115
CONCLUSION
After going through literary aspect and based on the clinical trial: following
conclusions are drawn:
1. Gridhrasi is shoola pradhana vataja nanatmaja vyadhi
2. Gridhrasi can be compared with sciatica based on its etiopathogenesis and
symptomatologies.
3. The pratyatma lakshana Ruk, Toda, Sthamba, Sakti utkshepa Nigraha were
the common presentation in all the patients.
4. Occupation and mainly improper posture plays an important role in the
manifestation of this disease.
5. Swalpa Rasona Pinda with Asta Varga Kasaya Anupana is effective in
management of Gridhrasi and is more effective if given along with Matra
vasti
6. Complications are not occurring during and after the course of treatment.
7. Matra vasti is easy to constitute, and gives least discomfort to both patient
and physician.
8. It is cheap compared to other conventional methods of management of
gridhrasi.
9. There is significant increase in SLR angle and decrease in disability index
and also considerable decrease in intensity of pain in Group B than in
Group A. It can also be concluded that vasti is very effective treatment
modality to provide relief in Gridhrasi with in short duration compared to
Oral medicine alone.
10. The study reveals that the disease is more prevalent in middle class and
degeneration or dhathu kshaya is the main cause i.e. lumbar spondylosis.
117
It is also claimed that this Ayurvedic remedy has its advantage over modern
analgesics, because, the Analgesics may occasionally cause allergic reactions,
gastro intestinal disturbance such as nausea, vomiting, dyspepsia and heart burn
etc, whereas this Ayurvedic medicine is totally safe.
In the present study also no such adverse toxic effects are found. This drug
is proved to be well tolerated.
RECOMMENDATIONS FOR FURTHER STUDY
1) Matra Basti can also be recommended for longer period with other Sneha
Dravya also.
2) Sciatica is present in different pathological conditions as a symptom. So
specific condition can be taken for the further studies and the exact effect of
the treatment can be assessed in the particular condition.
3) Same study can be conducted on a large sample to evaluate the efficacy of
matra vasti.
4) Recent technology like M.R.I, C.T, Myelogram, Nerve conduction studies are
adopted for accurate diagnostics and treatment.
5) A detailed study on the Nidanas and the samprapti of the vata vyadhis is
essential to support the etio pathogenesis of Gridhrasi
118
SUMMARY
The present study entitled “A CLINICAL STUDY ON THE EFFECT OF
RASONA PINDA WITH ASTA VARGA KASHAYA ANUPANA AND MATRA
VASTI IN THE MANAGEMENT OF GRIDHRASI VATA” Can be summarized as
below:
Gridrasi is a condition, characterized by severe radiating pain down the leg,
may be considered as sciatica. The global cost of sciatica to our society is
important in indicating the importance of the problem and the need for extra
resources to be directed to improve treatment facilities. The prevalence of
sciatica was described in part-1.
The structure of vertebral bodies, inter vertebral discs, mobility of the
spine, sciatic nerve and its branches are described in detail.
Nidana of gridhrasi was considered as per vata vyadhis. Poorava roopa,
roopa sadhya sadhyata are elaborated in part two.
The drugs in this present study are swalpa rasona pinda, asta varga kashaya
and balaswagandha tailam. The guna karmas for each drugs and their chemical
composition are emphasized in detail in part three.
40 Patients were selected for the study. They are divided in to two groups.
Group A- 20 patients were taken.and given swalpa rasona pinda 1 t.i.d with asta
varga kashaya anupana 30 ml t.i.d.
Group B-20 patients were included in the study. They were administered matra
vasti along with swalpa rasona pinda and asta varga kasaya anupana.
119
The parameters for diagnosis are completely based on classical symptoms
like Ruk, Toda, Stamba in the spik, kati, Prusta, Janu, Jangha and pada region with
or without other symptoms. The test for sciatica like Straight Leg Rasing (S.L.R)
was done. The grading for the pain was given on the basis of numerical rating
scale. Functional disability was measured using Oswestry disability index.
In order to establish the incidence of the disease, the profile of the patients
studied are classified after considering various factors, which are presented
through different tables. Results are given in the form of tables along with short
description in part-5.
It has been observed that patients treated in Group B 60% (Matra vasti
with swalpa rasona pinda and asta varga kasaya anupana) have shown significant
relief when compared to Group A 43% (Swalpa rasona pinda with asta varga
kasaya anupana)
Thus it can be inferred that Vasti with oral medicine shows significant
beneficial action in relieving the symptoms of Gridrasi.
120
BIBLIOGRAPHY
1. Adams and Victor’s Principles of Neurology by Allen H Rooper Robert H Brown 8th edition.
2. Amarakosam – By Viswanath Jha – Published Mothilala, Banarasi, 1975
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4. Astanga Sangraha with Hindi Vyakarana By Kavirah Atridev Gupta,Reprinted edition 1993,Published by Krishnadas Academy Varanasi.
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6. Ayurvedeeya pancha karma vignanam by Kastoori, Published by Baidyanath Ayurvedic Bhavan, Calcutta, 1970.
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8. Backache – Its evaluation and conservative treatment by David P.Erans, M.T.P. Press Ltd., Lancaster, 1982.
9. Baishajya Ratnavali – By kaviraja Ambikadatta Sasthri - Published by Chowkamba Sanskrit Series office, Varanasi, 1961
10. Bhava Prakasam – By Brahma Sankara Sastry and Roopa lal Vaishya 8 th Edition 1997.
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13. Chakra Datta – By Jagadiswara Prasad Tripati, Published by Chowkambha Sanskrit Series, 1949
14. Charaka Samhita – Edited by Ganga Saha Pandeya Published by Chaukhamba Sanskrit Sanstan Varagal.
15. David Son’s Principles and practice of Medicine, Published by Churchill living stone, Edinburg, 1984
121
16. Dravya Guna - A Text book of Medicinal Plants with illustrations by Dr. Muralidhar Rao. 1st Edition 2005.
17. Dravyaguna vignanum – By Dr J.L.N Sasthry Vol II.
18. Gray’s Anatomy – Published by Longmans, Greece and Company London.
19. Haritha Samhita by Sri Kshema Raj – Sri Krishna Das Mumbai.
20. Indian Medicinal Plants- Orient Long mann Edited by A.VS. Kottakal.
21. Indian Meteria Medica – By Nadakarni.
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23. Medical Discovery Who and When By Charles Schmidt J.E Spring Field Elinose.
24. Orthopaedic principles and their application by Turek Vol II 4th Edition
25. Principles of Anatomy and Physiology Tortora 8th edition.
26. Sahasra Yogam By Vempati Koteswara Sashastry Ayurveda Parishat Vijayawada 1961.
27. Sarangadhara Samhita – Published by Prof Sri Kantamurthy Published by Chowkamba Orientalia Varanasi.
28. Susrutha Samhitha, Edited by Yadavji Trikomji Acharya and Narayana Ram Acharya Reprinted in 1998 Krishanadas Acadamy Varanasi.
29. The Doctrine of Nerves.By Spilline John D Oxford University press New York ,1981.
30. The Spine Rothman and Simeone 4th Edition Saunders.
31. Vaidya Chintamani – Publsied by Vavilla Ramasastry & sons – 1952.
32. Vangasena – Published by Sri Venkateswara Mudranalaya, Mumbai, 1876.
33. Yogaratnakaram – By laxmipati Sastry 7th Edition 1999 Published by Chowkambha Sanskrit Sansthan Varanasi.
122
123
REFERENCES
PART –I
1. C.S.Su.20/11.
2. Sabda kalpa druma Vol 2 page no 348-349.
3. C.S.Chi 28/56,57.
4. Backpain the facts-Pg no 19,23.
5. C.S. Chi 28/99.
6. B.R.26/93-97.
7. S.Y.125.
8. Rig veda (R. V.2-15.7).
9. Adharvana Veda (9-8-21).
10. CS Su 5/90,92.
11. CS Su14/20-24.
12. CS Su 20/111.
13. CS Chi 28/55,56.
14. SS Ni 1/74.
15. SS Chi5/23.
16. SS Sa8/17.
17. AS Su 20/13.
18. AS Ni 15/56.
19. A S Ni15/56.
20. A.H. Ni 15/54.
21. K S Su27/21.
22. BS Chi24/44,45.
23. H S T Chapter 22/1-12.
24. M N 22/55- 56.
25. Sa.S. Poorva Khanda 7/108.
26. Sa.S.Madhayana Kanda 2/93.
27. Sa.S.Madhayana Kanda 5/6.
28. C.K.22/53.
29. V.S.Vata Vyadhi Adhikar 571,574-575.
30. Medical Discoveries Who and When Pg 433,434.
31. A History of Nuerological Survey Pg 393.
PART 2 1. Amara Kosha Sloka no 2015.
2. Sabda Kalpa Druma Vol II pg no 348,349.
3. C.S.Chi.28/56.
4. S.S.Ni. 1/74.
5. M. N 22/54.
6. Sa. S.Poorva Kandha 7/108.
7. Principles of Anatomy and Physiology-Tortora P no 381.
8. Gray’s Anatomy Pg 1182 to 1189.
9. Back ache its evolution and conservative treatment Pg 53-57.
NIDANA: 1. C.S.Chi.28/15,17.
2. B.P,Utt.Ka .24/1,2.
3. S..S.Su..21/19,20.
4. S.S.Ni 1/67,68,79.
5. A.S.Ni.15/31,34,41.
6. A.H. Ni 1/14,15.
7. A.H. Ni 15/29,32,33,47
8.C.S.Chi 28/59
9.A.S.Ni 15/7,8.
10.A.H.Ni15/5,6.
11.V.C.Vata Vyadhi.Sloka:2
12. C.S.Su.1/44.
13.C.S.Chi.28/58.
14.C.S.Su.21/24.
15.C.Chi.28/18.
16.A.H.Su.4/2.
17. S.S.Su.21/19.
18. S.S.Sa.6/48.
19. Back Ache Its Evolution & Conservative Treatment pg
20. Medicine for Students –Golwalla-pg 621,622
POORVA ROOPA 1. C.S.Ni.1/7.
2. C.S.Chi.28/19.
3. Chakrapani on C.S.Chi.11/12.
ROOPA: 1. Madhu Kosha on M.N.1/7.
2. A.H.Ni.1/5.
3. C.S.Chi.28/56.
4. Aruna Datta on A.H.Su.12/49.
5. Hemadri on A.H.Su.12/49.
6. Dalhana on S.S.Ni.5/13.
7. Madhukosha on M.N.22/54,55.
8. Yogendranath Sen on C.S.Chi. 7/14.
9. Arunadatta on A.H.Su.12/49.
10. Arunadatta on A.H.Su 12/50.
11. Hemadri on A.H.Su.12/50.
12. Dalhana on S.S.Su.Ni 1/74.,Arunadatta on A.H.Ni.15/4.
13. H.S.Tri.22/1,2.
14. Hemadri on A.H.Su.12/50.
15. Arunadatta on A.H.Su.12/49.
16. V.S.Vatavyadhi adhikar-Sloka 571.
17. Basavarajeeyam . Sh.Pr. Vataroga Nidanam/80.
18. Indu on A.S.Su.19/5.
19. Dalhana on S.S. Chi.1/7.
20. Dalhana S.S.Su.45/3.
21. Madhukosha on M..N.14/4.
22. Chakrapani on C.S.Chi.9/20.
23. Chakrapani on C.S.Chi 16/41.
24. Indu on A.S.Su 9/89.
25. Principles of Neurology Adams and Victor Pg 213,14.
26. Arthopadic Principles and their application pg no 1489.
27. Merits Text boom of Neurology pg 439.
28. C.S.CHI.27/20.
SAMPRAPTI: 1. Chakrapani on C.S.Ni.1/11.
2. C.S.Chi.28/18.
3. S.S.Ni.1/74.
4. H.S.Tri.20/2.
5. A.H.Su.11/26.
6. The back functions malfunctions and care Chap II pg 22.
7. Spine and Medical negligence’s Chap X pg 83,84.
8. The Spine Chap VIII Pg 159 to169.
SAPEKSHA NIDANA: 1. C.S.Chi.27/13,14,17,18.
2. M.N.22/59-60.
3. C.S.Chi.28/25.
4. M.N.22/74. UPADRAVA AND SADHYA SADHYATA:
1. C.S.Chi.21/40.
2. S.S.Ni.1/77.
3. A.H.Ni.8/30.
4. S.S.Su.33/4.
5. S.S.Su.33/7.
6. C.S.Su.10/17.
PART 3- CHIKITSA: 1. C.S.Chi.28/120.
2. S.S.Chi.5/49.
3. C.K.23/54.
4. Bh.Pr.II.2/131,132.
5. B.S.Chi.26.
6. V.S.Vata Vyadhi.574-576.
7. C.S.Su.14/13,39-40.
8. C.S.Si.10/6.
9. S.S.Chi.38/116.
10. C.S.Si.1/38-41.
11. C.S.Chi.28/120.
12. C.D.23/54.
13. V.S.Vata Vyadhi.584-587.
14. C.S.Chi.28/120.
15. C.D.22/53-55.
16. H.S.Tri.22/6-12.
17. The Back functions malfunctions and care Chap 19 Pg 216.
18. Back Pain the Facts Chap VII Pg 110.
19. Gayadas on S.S.Chi 35/18.
20. C.S.Si.4/53.
21. C.S.Si 4/52.
22. A.S.Su.28/30.
23. C.S.Si.1/44.
24. S.S.Chi.35/26.
25. S.S.Chi.35/27,28.
26. C.S.Si.1/32.
POST GRADUATE DEPARTMENT OF KAYA CHIKITSA Dr. B.R.K.R. Govt. Ayurvedic College/Hospital, Hyderabad-38
SPECIAL CASE SHEET FOR GRIDHRASI “A clinical study on the effect of RASŌNA PINDAM WITH ASTAVARGA KAŞAYA
Anupanam and MĀTRA VASTI in the Management of Gridhrasi vata”
Name: ` OP NO:
Age / Sex: IP No:
Occupation: DOA:
Address: DOD: Chief Complaints: Associated Complaints: H/O Present illness:
Onset Radiation Duration Type
Intensity Relieving Factors Aggravating Factors Sleep disturbances
H/O Past illness: Trauma □ Fractures □ T.B □ Pelvic Infection □
Malignant Diseases of Spine □ H/O Previous treatment:
Medical Surgical
Personal History:
Diet Height Weight Addictions
Asta staana pariksha:
Nadi Mutra Mala Jihwa
Sabdha Sparsa Drik Akruti
Dasa vidha pariksha :
Prakriti Satvam Samhanana Ahara sakti Pramana
Vikriti Satmyam Saram Vyayama sakti Vayah
General examination: Gait: Local examination: Inspection: Swelling □ Emaciation / Atrophy □ Palpation: Tenderness Spik Prista Kati Uru Janu Jangha Pada 15
days 30 days
40 days
Sthamba
Ruk
Toda
Grihnati
Spandatae Muhu
Kandara Soshana
Parnshni pratyanguli (SU) □ Pain in payu □ Deha Vakrata □
Tandra □ Agnimandya □ Mukha praseka □ Sandhi shula □
Bhakta dwesham □ Gouravam □ Specific test: S.L.R. Lassegue sign AP view Investigations: X-ray L.S. Spine Lat view
C.U.E
C.B.P. Diagnosis: Vataja □ Vata kaphaja □ Treatment: Swalpa Rasōna Pindam with Astavarga Kaşaya Anupanam 1 Cap.tid 30ml.tid Matra Vasti : Balaswagandha Tailam (60ml) – 7 days
Chief complaints Date Time of administr-
ation
Pratyaga-mana kala
Retention period
Results Complications
Before After
S.L.R : Before Degree 15 days 30 days 40 days
R L R L R L R L < 30 30 – 60 60 – 90 > 90
Lassegue sign :
Before 15 days 30 days 40 days R L R L R L R L
Signature Signature Signature P.G. Scholar Co-guide Guide
10
9
N 8
7
R 6
5
S 4
3
2
1
0
15 30 40 Days
0
100% O 80% D 60% I 40% 20%
15 30
40 Days
Functional Disability Oswestry Disability assessment Questionnaire: Questionnaire description: 10 sections describing the pain and its impact with
each section scored from 0-5, with higher values indicating more severe impact.
Section 1: Pain Intensity
• I can tolerate the pain I have without having to use pain killers. [0 points]
• The pain is bad but I manage without taking pain killers. [1 point]
• Pain killers give complete relief from pain. [2 points]
• Pain killers give moderate relief from pain. [3 points]
• Pain killers give very little relief from pain. [4 points]
• Pain killers have no effect on the pain and I do not use them. [5 points]
Section 2: Personal Care
• I can look after myself normally without causing extra pain. [0 points]
• I can look after myself normally but it causes extra pain. [1 point]
• It is painful to look after myself and I am slow and careful. [2 points]
• I need some help but manage most of my personal care. [3 points]
• I need help every day in most aspects of self care. [4 points]
• I do not get dressed, wash with difficulty and stay in bed. [5 points]
Section 3: Lifting
• I can lift heavy weights without extra pain. [0 points]
• I can lift heavy weights but it gives extra pain. [1 point]
• Pain prevents me from lifting heavy weights off the floor, but I can manage
if they are conveniently positioned, for example, on a table. [2 points]
• Pain prevents me from lifting heavy weights but I can manage light to
medium weights if they are conveniently positioned. [3 points]
• I can lift only very light weights. [4 points]
• I cannot lift or carry anything at all. [5 points]
Section 4: Walking
• Pain does not prevent me walking any distance. [0 points]
• Pain prevents me walking more than 1 mile. [1 point]
• Pain prevents me walking more than 0.5 miles. [2 points]
• Pain prevents me walking more than 0.25 miles. [3 points]
• I can only walk using a stick or crutches. [4 points]
• I am in bed most of the time and have to crawl to the toilet. [5 points]
Section 5: Sitting
• I can sit in any chair as long as I like. [0 points]
• I can only sit in my favourite chair as long as I like. [1 point]
• Pain prevents me sitting more than 1 hour. [2 points]
• Pain prevents me from sitting more than 0.5 hours. [3 points]
• Pain prevents me from sitting more than 10 minutes. [4 points]
• Pain prevents me from sitting at all. [5 points]
Section 6: Standing
• I can stand as long as I want without extra pain. [0 points]
• I can stand as long as I want but it gives me extra pain. [1 point]
• Pain prevents me from standing for more than 1 hour. [2 points]
• Pain prevents me from standing for more than 30 minutes. [3 points]
• Pain prevents me from standing for more than 10 minutes. [4 points]
• Pain prevents me from standing at all. [5 points]
Section 7: Sleeping
• Pain does not prevent me from sleeping well. [0 points]
• I can sleep well only by using tablets. [1 point]
• Even when I take tablets I have less than 6 hours sleep. [2 points]
• Even when I take tablets I have less than 4 hours sleep. [3 points]
• Even when I take tablets I have less than 2 hours of sleep. [4 points]
• Pain prevents me from sleeping at all. [5 points]
Section 8: Sex Life
• My sex life is normal and causes no extra pain. [0 points]
• My sex life is normal but causes some extra pain. [1 point]
• My sex life is nearly normal but is very painful. [2 points]
• My sex life is severely restricted by pain. [3 points]
• My sex life is nearly absent because of pain. [4 points]
• Pain prevents any sex life at all. [5 points]
Section 9: Social Life
• My social life is normal and gives me no extra pain. [0 points]
• My social life is normal but increases the degree of pain. [1 point]
• Pain has no significant effect on my social life apart from limiting my more
energetic interests such as dancing. [2 points]
• Pain has restricted my social life and I do not go out as often. [3 points]
• Pain has restricted my social life to my home. [4 points]
• I have no social life because of pain. [5 points]
Section 10: Traveling
• I can travel anywhere without extra pain. [0 points]
• I can travel anywhere but it gives me extra pain. [1 point]
• Pain is bad but I manage journeys over 2 hours. [2 points]
• Pain restricts me to journeys of less than 1 hour. [3 points]
• Pain restricts me to short necessary journeys under 30 minutes. [4 points]
• Pain prevents me from travelling except to the doctor or hospital. [5 points]