A retrospective study on

Padabhyanga in the management

of GhrudhrasiDr. Gayatri Gandhe,

Prof & HOD, Panchkarma Dept

G J Patel Ayurveda College & Research Centre

Ghrudhrasi

Ghrudhrasi analogous with lumbago & Sciatica

Presentation of Ghrudhrasi

Don’ts as per to Sadvrutta• Kuchelasthi-kantak-amedhya-kesha-tusha-utkara-bhasma-kapala-snana-bali-

bhuminam pariharta/18

• Prak shramat vyayamvarji syat/18

• Na dushtayanani arohet/

• Na janusamam kathinam asanam adhyasita/

• Na anastirnam anupahitam avishalam asamam va shayanam prapadyet/

• Na giri-vishama-mastakeshu anucharet/

• Na drumama arohet/

• Na jalogravegam avagahet/

• Na asthini abhihanyat/

• Na vigunam angaihi cheshtet/

• Na sahasa-atiswapna-prajagara-snana-pana-ashanani asevet/

• Na urdhwajanu chiram tishthet/

• Na paryushitam anyatra mamsa-haritaka-shushkashaka-phal-bhakshebhyo/

• Na asheshabhuk syat anyatra dadhi-madhu-lavan-saktu-sarpibhyo/

• Na anruju kshuyat na adyat na shayita/

Importance of Pada region

• ‘Conditions such as arthritis, diabetes,

nerve & circulatory disorders can show

their initial symptoms in the feet. So foot

ailments can be your first sign of more

serious medical problems’ American

Podiatric Society

Abhyanga everyday….

• Kleshasahatva: kumbha, charma, aksha

• Vyayama-samsaha

• Drudha

• Sutvak

• Prashanta marutabhadham

• Susparsha

• Upachitanga

• Balavan

• Priyadarshana

• Alpajara

Na cha abhighatabhihatam gatram abhyangasevino/ Vikaram bhajate atyartham bala-karmani va kvachit

Padabhyanga

Shiro-shravana-padeshu visheshena

Sheelayet / C.Su.5

Padabhyanga- scope of actions

Local effects

Kharatva

Rauskhya

Sphutana

Sukumarata

Bala

Local & distal effects

Supti

Stabdhata

Ghrudhrasivata

Sira-Snayu sankoch

Sthairya

Distal & pervasive effect

Drushti-prasada

Prashanta-vatatva

Marma- the vital points

• Junctions of Mamsa-Sira-Snayu-Asthi-Sandhi.

( Su.Sha.6/16)

• Marma - vital energy centers (Vishesha Prana-

sthana, Su.Sha.6/16) or remote points of energy

control located all through the body

• Mostly all four types of Sira in the body are

located in Marma region. (Su.Sha.6/ 19)

• They directly influence the functions of the

internal organs in the body

Padabhyanga & PadamarmaSr.

No.

Marma Type Description Marmaghata parinama

1 Kshipra Snayu Padasya angushtha-angulyo madhye

(deep peroneal nerve branch to great toe, combined tendon of abductor

hallusis & flexor hallusis brevis, bifurcation of first common digital nerve,

bifurcation of first metatarsal artery)

akshepen maranam

2 Talahrudaya Mamsa Madhyamangulim anupurven madhye Padatalasya

(lateral plantar artery, medial & lateral plantar nerves, oblique head of

abductor hallusis muscle, quadrates plantaris muscle, flexor digitorum

brevis)

rujabhi maranam

3 Kurcha Snayu Kshiprasya uparishtat ubhayato

(Tarso metatarsal & inter-tarsal ligaments, extensor digitorum brevis,

dorsalis pedis & dorsal inter-tarsal arteries, tendons of extensor

digitorum longus, extensor hallusis longus & peroneus tertious muscles,

branches of deep peroneal nerve)

padasya bhramana-

vepane

4 Kurchashira Snayu Gulfasandhe adho ubhayato

(Deltoid, talo-calcaneal & calcaneo-fibular ligaments, annular ligaments,

tendon of tibialis anterior

ruja-shofau

5 Gulfa Sandhi Pada-jnghayo sandhane

(Ankle joint & distal tibio-fibular articulation, medial malleolar ligament,

anterior ligament, longus ligament, deltoid ligament, posterior ligament,

anterior talo-fibular ligament, posterior talo-calcaneal ligament, fibulo-

calcaneal ligament, lateral talo-calcaneal ligament

ruja, stabdhapadata,

khanjata

Abhyanga Matra kala (Dalhana)

Reflexology

Reflexology is a

science that seems to

be derived from the

core of the ancient

Ayurvedic knowledge.

“Reflexology"

‘As above, so below’

• It is a kind of foot massage based on the

principles of Chinese medicine,

• According to reflexologists, the entire body

is mapped onto the foot

Reflexology – peripheral neuropathy

• Helps to improve metabolism & energy releasing process in the body

• Stimulates blood circulation in the body

• Aids in elimination of toxins from the body

(fMRI -increase in blood flow to kidneys and to the intestines)

• Beneficial in stimulating nervous system (EEGs

measure alpha and theta waves, blood pressure was decreased, and anxiety was lowered)

• Helps to improve cognitive health

• Beneficial effects in stress, anxiety, insomnia, migraine, chemotherapy in cancer etc

(Kunz & Kunz 2008, Song, 2015Yadav, 2015)

Reflexology – peripheral neuropathy

• Dr. Jesus Manzanares, a physician from Spain, has

spent years studying the neurophysiological basis

for reflexology. Dr. Manzanares' research has

identified and biopsied deposits ("crystals") that

were located in reflex areas of the feet. These

deposits are associated with pain, contain nervous

fibers, and have different characteristics based

upon their degree of acuity or chronicity

(Manzanares, 2007).

Reflexology – peripheral neuropathy• Using thermographic pictures of the soles of the feet before

and after reflexotherapy, along with similar pictures of the

spinal column, Dr. Piquemal was able to show a change in

the thermal pattern on the sole of the feet "that was

reflected on the skin of the back for each of the five

selected [cutaneous] zones" (2005). The importance of this

research is that it ties reflexology work on the feet to blood

flow of inner organs (lung, liver, stomach, pancreas, and

small intestine), either through vasoconstriction or

vasodilation via the autonomic nervous system. It appears

that reflexology may be able to play a role in regulating

blood flow disturbance, at least to these organs.

An ancient answer to modern illnesses

• The Nervous System which is made up of the brain, spinal chord and the nerves and their minute nerve endings, works hand in hand with the Endocrine System

• They regulate all the functions of the entire body by releasing hormones, or chemicals that produce the desired physical response in our bodies in order to achieve homeostasis

• Research has shown that therapeutic massage stimulates the nervous system to produce hormones that have tremendous benefit on the entire body (eg. Dopamine, Serotonin, Endomorphins)while at the same time reduces unwanted or out of balance levels of chemicals that can have a detrimental effect on us (eg cortisol)

Skin permeability & percutaneous

absorption Concentration

Molecular Weight of the molecule

Duration of contact

Solubility of medication

Physical condition of the skin

Part of the body exposed including the amount of hair on the skin.

Intercellular lipid pathway Transcellular permeationThrough the appendages

(hair follicles, glands)

Absorption of fats through skin

• The stratum corneum is the outermost layer of the epidermis and the rate-limiting barrier in absorption of an agent.

• Thus, how quickly something passes through this thicker outer layer determines the overall absorption.

• The stratum corneum is primarily composed of lipophilic cholesterol, cholesterol esters and ceramides.

• Thus lipid-soluble chemicals make it through the layer and into the circulation faster, however nearly all molecules penetrate it to some minimal degree.

• Toxins and toxicants can move through the layers by passive diffusion.

Studies done on Padabhyanga

• Extensive work on Padabhyanga & Drushtiprasada

• Various studies done on Abhyanga & Ghrudhrasi

separately

• Huge number of studies done worldwide to observe

correlation of foot massage or foot reflexology in pain

management, low backache, sciatica, rheumatoid arthritis,

cerebral palsy etc.

• Branches like ‘Padaveda’ also cropping

up considering the importance of Pada

Probable mode of actionNa cha syat Ghrudhrasivato padabhyangen padayo/ C

Ghrudhrasivato shamam yati padabhyangen padayo?

Tvak = seat of Sparshanendriya

Vata

Governing & controlling factor of the body

Voluntary & involuntary movements under its jurisdiction

Constitutional ground for Shrotra & Sparsha

Motive of touch & hearing sensationsVata-sthanani

Basti

Purishadhanam

Kati

Sakthini

Padau

Asthini

Pakvashaya

Padabhyanga in Ghrudhrasi

Abhyanga Therapy done through skin (Tvak) of Pada region

as a media,

for adequate time period,

using Vata & Kapha Shamak drugs,

could be an easy, quick & suitable

access for the management of pure Vatavyadhi like Ghrudhrasi

Tvak - Sparshanendriya controlled by Vata

Taila, Vasa, Majja = excellent Vatashamaka drugs

• Upasnehana nyaya – circulatory &

neurological mechanisms (C.Sha.6)

• Based on mentioned references, it appears

that Padabhyanga could prove to be a

valuable treatment in the management of

Ghrudhrasi which needs a strong clinical

correlation

Stability, Steadiness &

Strength