grudhrasi kc034 gdg

Evaluation of the Efficacy of Punarnavadiguggulu

& Mahamashadi Taila Kati Basti in the

Management of Gridhrasi (Sciatica)

By

Dr. Gavisiddanagouda. G. Patil

Dissertation Submitted to the Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore.

In partial fulfillment of the requirements for the degree of

AYURVEDA VACHASPATHI M.D. (KAYA CHIKITSA)

In

KAYACHIKITSA

Under the guidance of

Dr. V. VARADA CHARYULU, M.D. (Ayu)

And co-guidance of

Dr. RAGAVENDRA. V. SHETTER, M.D. (Ayu)

Post graduate department of Kayachikitsa, Shri D. G. Melmalagi Ayurvedic Medical College, Gadag – 582103.

2006.

Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore.

1

Ayurmitra

TAyComprehended

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation / thesis entitled

“Evaluation of the Efficacy of Punarnavadiguggulu & Mahamashadi

Taila Kati Basti in the Management of Gridhrasi (Sciatica).” is a bonafide

and genuine research work carried out by me under the guidance of DR. V.

VaradaCharyulu, M.D. (Ayu), Professor and H.O.D, Post-graduate department

of Kayachikitsa and co-guidance of Dr. Ragavendra. V. Shetter, M.D.(Ayu), Post

graduate department of Kayachikitsa.

Date: Signature of Scholar

Place: Gadag Dr.Gavisiddanagouda. G. Patil

2

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “Evaluation of

the Efficacy of Punarnavadiguggulu & Mahamashadi Taila Kati Basti in

the Management of Gridhrasi (Sciatica).”is a bonafide research work done

by Dr. Gavisiddanagouda. G. Patil in partial fulfillment of the requirement

for the degree of Ayurveda Vachaspathi. M.D. (Kayachikitsa).

Date:

Place: DR. V. VaradaCharyulu, M.D. (Ayu).

Professor & H.O.D

Post graduate department of Kayachikitsa.

3

CERTIFICATE BY THE CO- GUIDE



the Management of Gridhrasi (Sciatica).”is a bonafide research work done

by Dr. Gavisiddanagouda. G. Patil in partial fulfillment of the requirement

for the degree of Ayurveda Vachaspathi. M.D. (Kayachikitsa).

Date: Dr. RAGAVENDRA. V. SHETTER,

M.D. (Ayu)

Place: Assistant Professor, Post graduate Department of Kayachikitsa

4

ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF

THE INSTITUTION



the Management of Gridhrasi (Sciatica).” is a bonafide research work

done by Dr. Gavisiddanagouda. G. Patil under the guidance of DR. V.

VaradaCharyulu, M.D. (Ayu), Professor and H.O.D, Postgraduate department of

Kayachikitsa and co-guidance of Dr. Ragavendra. V. Shetter, M.D.(Ayu),

assistant professor Post graduate department of Kayachikitsa.

DR. V. VaradaCharyulu, M.D. (Ayu) Dr. G. B. Patil.

Professor & H.O.D, Principal.

Post graduate department of Kayachikitsa.

5

COPYRIGHT

Declaration by the candidate

I hereby declare that the Rajiv Gandhi University of Health

Sciences, Karnataka shall have the rights to preserve, use and disseminate

this dissertation / thesis in print or electronic format for academic / research

purpose.

Date: Signature of Scholar

Place: Gadag

Dr.Gavisiddanagouda. G. Patil

© Rajiv Gandhi University of Health Sciences, Karnataka.

6

Acknowledgement

“Many hands make light work”. I take this opportunity to mention my deep gratitude to

several personalities who have helped me in the successful completion of this work.

I express my obligation to my honorable Guide Dr. V. Varadacharyulu M.D (Ayu),

H.O.D., P.G. Department of Kayachikitsa, P.G.S&R, D.G.M.A.M.C, Gadag for his

critical suggestions and expert guidance for the completion of this work.

I am extremely grateful and obliged to my co-guide Dr. Ragvendra.V.Shettttar, Asst.

Professor, P.G.S.&R, D.G.M.A.M.C, Gadag for his guidance and encouragement at every

step of this work.

I express my sincere gratitude to Dr. K. S. R. Prasad M.D (Ayu), Professor for their

sincere advices and assistance.

I express my deep gratitude to Dr .G.B Patil, Principal, D.G.M.A.M.C, Gadag, for his

encouragement as well as providing all necessary facilities for this research work.

I express my sincere gratitude to Dr. G. Purushothamacharyulu M.D. (Ayu), Dr.M.C.Patil

M.D (Ayu), Dr. Mulgund M.D (Ayu) and Dr. Santhosh. N.Belavadi MD (Ayu) and other

PG staff for their constant encouragement.

My modest gratitude to Dr. S.D.Yerageri, R.M.O. D.G.M.A.M.C.&H, Gadag, Dr. U.V.

Purad, Dr. K. S. Paraddi, Dr. S.H. Redder, Dr. S. A. Patil and other undergraduate

teachers for the their support in the clinical work. I thank to Shri.Nandakumar

(Statistician), Shri. V.M. Mundinamani (Librarian), Shri. Sureban, Shri Syavi, Shri. B.S.

Tippanagoudar (lab technician), Shri. Basavaraj (X-ray technician) and other hospital and

office staff for their kind support in my study.

I express my sincere thanks to my colleagues and friends Dr. B. L. Kalmat, Dr.

Venkareddy, Dr. Uday Kumar, Dr. Ratna Kumar, Dr. S. C. Sarvi, Dr. Krishna. J, Dr.

Umesh, Dr. Ashok. Akki, Dr. Ashok. M. G, Dr. Shekar Sharma, Dr. Shivaleela, Dr. K.

M. Angandi, Dr. Sulochana, Dr. Sanjeeva, Dr.Niraj kumar, Dr. Prasanna Joshi, Dr.

Vijaylakshmi, Dr. Veena. J, Dr. Manjunath. Akki, Dr. Suresh. N. Hakkandi, Dr. Ashwini

Dev, Dr. Vijay Hiremath, Dr. L.R.Biradar, Dr. Santhosh.L.Y, Dr. Satish. R, Dr.

Sharnbasappa Angadi, Dr. Anand H, Dr. Rudrakshi. D, Dr. Anitha, Dr. Jagadisha and

other post graduate scholars for their support.

LIST OF ABBREVIATIONS USED

A S – Ashtanga Sangraha

A H – Ashtanga Hridaya

Aru. – Arunadatta

A.T – After treatment

B.T – Before Treatment

B.P – Bhavaprakasha

B.R – Bavarajeeyam

Bh.S – Bhela Samhita

Ca.S – Charaka Samhita

Chi. – Chikitsa Sthana

Chak. – Chakrapani

Dal. – Dalhana

S.L.R - Straight leg raising

Gang. – Gangadhara

K.S – Kashyap Samhita

M.N – Madhav Nidana

Ni. – Nidana Sthana

N.S – Not Significant

SU.S – Sushruta Samhita

Sa.S – Sharangadhara Samhita

Sha.S – Shareera Sthana

Su. – Sutra Sthana

Si. – Siddhi Sthana

Vi. – Vimana Sthana

Y.R. – Yoga Ratnakara

List of tables Page no.

1. Table showing Lakshanas of Gridhrasi by different acharyas. 26 2. Table showing Vyavachhedaka Nidana of Gridrasi 28 3. Table showing the line of treatment of Gridrasi by different 31

Acharyas. 4. Table showing the clinical features of sciatica. 47 5. Table showing the differential diagnosis in sciatica 55 6. Table showing the properties of ingredients of Mahamasadi taila 80 - 83 7. Table showing the properties of ingredients of Dashmoola 84 8. Table showing the Demographic data related to Evaluation of 86

Punarnavadi guggulu in Gridrasi 9. Table showing the Demographic data related to 87

Evaluation of Mahamasadi taila Kati basti in Gridrasi. 10. Table Showing the Pain related chief complications 88

of patients in the study. Group A 11. Table Showing the Pain related chief complications 89

of patients in the study. Group B 12. Table Showing the Distribution of patient according 90

to age & sex among groups 13. Table Showing the Distribution of patient according 91

to occupation 14. Table Showing the Distribution of patient according 92

to Economical status 15. Table Showing the Distribution of patient according 93

to Religion 16. Table Showing the Distribution of patient according to Diet 94 17. Table Showing the Distribution of patient according 95

to type of Gridrasi 18. Table Showing the Distribution of patient according 96

to affected to leg of Sciatica 19. Table Showing the Distribution of patient according to Agni 97 20. Table Showing the Distribution of patient according to Koshta 98 21. Table Showing the Distribution of patient according to 99

Position of work in patients 22. Table Showing the Distribution of patient according to 100

Habits in patients. 23. Table Showing the Distribution of patient according to 101

Prakriti of patients 24. Table Showing the Distribution of patient on the basis 102

of age of the patient. 25. Table Showing the Distribution of patient according to 103

Chronicity of the disease among groups 26. Table Showing the Showing the incidence of range of 104

SLR in the patients 27. Table Showing the Change in the Lumbar movement in 105

the patients of group A 28. Table Showing the Change in the Lumbar movement in 106

the patients of group B 29. Table Showing the Showing the incidence of Walking time 108

in the patients 30. Table Showing the Master Chart of Subjective Parameter 109

of Group- A 31. Table Showing the Master Chart of Subjective Parameter 110

of Group- B 32. Table Showing the Master Chart of Objective Parameter 111

of Group- A 33. Table Showing the Master Chart of Objective Parameter 112

of Group- B 34. Table Showing the Statistical Assessment of Individual 113

Study Group – A (Objective Parameter) 35. Table Showing the Table Showing the Statistical Assessment 113

of Individual Study Group – B (Objective Parameter)

36. Statistical Assessment of Individual Study Group – A 113 (Objective Parameter)

37. Statistical Assessment of Individual Study Group – B 113 (Objective Parameter)

38. Table Showing the Statistical Assessment of Comparative study 114 of Group – A with Group – B, After Treatment. (Objective Parameter)

39. Statistical Assessment of Comparative study of 114 Group – A with Group – B, After Treatment. (Objective Parameter)

40. Table Showing the Statistical Assessment of Individual 116 Study Group – A (Subjective Parameter)

41. Table Showing the Statistical Assessment of Individual 115 Study Group – B (Subjective Parameter)

42. Table Showing the Statistical Assessment of Comparative 115 study of Group – A with Group – B, After Treatment. (Subjective Parameter)

43. Table Showing the Showing the Overall assessment 118 List of Chart, Figures, Photographs & Graphs Page no.

1. Showing figure of Straight leg raising test 50 2. Photo showing ingredients of Punarnavadi guggulu 3. Photo showing of procedure of Katibasti 4. Photo showing the Sacral plexus (posterior view) 5. Graph Showing the Distribution of patient according to age

& sex among groups 90 6. Graph Showing the Distribution of patient according to 91

occupation 7. Graph Showing the Distribution of patient according to 92

Economical status 8. Graph Showing the Distribution of patient according to Religion 93 9. Graph Showing the Distribution of patient according to Diet 94 10. Graph Showing the Distribution of patient according to 95

type of Gridrasi 11. Graph Showing the Distribution of patient according to 96

affected to leg of Sciatica 12. Graph Showing the Distribution of patient according to Agni 97 13. Graph Showing the Distribution of patient according to Koshta 98 14. Graph Showing the Distribution of patient according to Position 99

of work in patients 15. Graph Showing the Distribution of patient according to 100

Habits in patients. 16. Graph Showing the Distribution of patient according to 101

Prakriti of patients 17. Graph Showing the Distribution of patient on the basis of 102

age of the patient. 18. Graph Showing the Distribution of patient according to 103

Chronicity of the disease among groups 19. Graph Showing the Showing the incidence of range of 104

SLR in the patients 20. Graph Showing the Change in the Lumbar movement 106

in the patients of group A 21. Graph Showing the Change in the Lumbar movement 107

in the patients of group B 22. Graph Showing the Showing the incidence of Walking time 108

in the patients 23. Graph Showing the Showing the Overall assessment 118

TABLE OF CONTENTS Page no.

1. Introduction 1 - 3 2. Objectives 4 3. Literary review

a. Historical review of Gridrasi in ayurveda 5 - 37 b. Historical review of Gridrasi in modern science 38 - 59

4. Methodology 60 - 84 5. Observations and results 85 - 118 6. Discussion 119 - 129 7. Conclusion 130 - 132 8. Summary 133 - 135 9. Bibliography 136 - 152 10. Annexure

INTRODUCTION

INTRODUCTION

Health is the supreme foundation of virtue, wealth, enjoyment and salvation.

Diseases are the destroyers of health. Ayurveda is one such system, which prevailed 5000

years ago, which has its chief objects – preservation of health and prevention of disease.

And so this gifted science was considered the most advanced and scientifically proven in

those days and still continues it’s shining. A constant re-examination or re-evaluation of

every theory or fact is therefore, the very essence of science. Aacaarya Caraka says,

“Pa eekshaam abhiprasamsanti kusalaah”r 1

In a normal daily life, living without ambulation is almost impossible for any

human being, from the time immemorial to ultramodern life. Though the movements of

legs are so important, these are the most neglected parts of the body and vulnerable to

many diseases. The most common disorder, which affects the movement of leg

particularly in most productive period of life, is low back pain, out of which 40% of

persons will have radicular pain and this comes under the umbrella of Sciatica syndrome.

Such presentations were common in olden period too and ancient science of life named it

as Gridhrasi. It is considered as Soola Pradhaana Vaatavyaadhi. Ample description is

available in Bhrhatrayee and later treatises as well. Many researches were also conducted

on this disease still the complete cure of this is still a mirage

The physical strain of modern life, adoption of erect posture & lack of physical

exercise made a civilized human liable to backache. Backache is a national personal &

clinical problem because it is experienced by most of the population at some time & is

drain to national sources. It is a personal problem & also clinical problem as it is often

difficult to diagnose & treatment measures are conflicting & often unrewarding. It is a

Evaluation Of The Efficacy Of Punarnavadiguggulu & Mahamashadi Taila Kati Basti In The Management Of Gridhrasi (Sciatica)

1

INTRODUCTION

problem because of severity of pain, its persistence, its disabling effects the fear of its

origin & apprehension about future. Changing of life style of modern human being has

created several disharmonies in his biological system. As the advancement of busy,

professional and social life, improper sitting posture in offices, factories, continuous and

overexertion, jerking movements during traveling and sports – all these factors create

undue pressure to the spinal cord and play an important role in producing low backache

and sciatica.

According to Ayurveda simple freedom from disease is not health. For a person,

to be healthy he should be mentally and spiritually happy. An imbalance in Doshic

equilibrium is termed as ‘Roga’. Among Tridosha, Vata is responsible for all Cheshta and

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

and majority of its specific disorder in number more importance and attention is given to

the Vata Dosha.

A variety of Vatavyadhi described in Charaka Samhita are divided into

Samanyaja and Nanatmaja group. Gridhrasi comes under 80 types of Nanatmaja

Vatavyadhi though, occasionally there is Kaphanubandha. The name itself indicates the

way of gate shown by the patients due to extreme pain just like a Gridhra (vulture), it is

clear that this disease not only inflicts pain but also causes difficulty in walking, which is

very much frustrating and embracing to the patient. It disturbs the daily routine and

overall life of the patient.

As the medical science recognized the severity, a medicament, which relieve the

pain, improves the functional ability, restore from functional disability and controls the

condition with cost effectiveness is the need of the century.


2

INTRODUCTION

The term Gridhrasi and sciatica of modern medicine can be termed synonymous

as much as they refer to the same singular presentation – pain along the course of leg

irrespective of etiological variations.

Now the whole scientific world has high hopes in Ayurveda as capable to provide

proper and safer methods of management in disorders where the efforts with modern

medicine have failed to achieve the desired results. Already the efficacy of the Ayurvedic

drugs and techniques has gained global popularity in musculo-skeletal disorders like

rheumatoid arthritis. Sequential administration of the Snehana, Svedana, Basti,

Siraavyadha and Agnikarma are lines of treatment of Gridhrasi as expounded in the

Ayurvedic literature.2, 3, 4 Apart from these procedures, the Samana line of treatment that

includes oral administration of medicine is of utmost importance as the administration is

very easy and also effective. But only few of research works have been carried out in

relation to the Samana treatment. Many herbal and herbo-mineral combinations are

described in Ayurveda and their therapeutic effect in Gridhrasi is yet to be explored.

Punarnavadi guggulu is one such herbo-mineral combination mentioned in the

Vangasena, prescribed by eminent scholars since many decades for a wide range of

diseases including Gridhrasi.

By looking at the individual herbal and mineral constituents, it appears that this

combination should be very proficient in combating the Gridhrasi.

As the local Samprapti Sthanasanshraya is having quiet major importance in

Gridhrasi local simultaneous Sneha Sweda procedures called Kati Basti has been selected

for the present study.


3

Objectives

Objectives

Gridhrasi is a common entity encountered in clinical practice. It is one of the

Vataja Nanatmaja Vyadhi classified by Charaka5 .The term Gridhrasi and Sciatica of the

modern science can be considered synonymous in as much as they refer to singular

similar presentation. Back pain (Sciatica) is as much a part of the human condition as the

common cold. In fact, eight out of ten adults will experience an acute episode of back

pain at some point in their lifetime. Back pain is the second most common cause of

missed workdays due to illness and the most common cause of disability.6

Back Pain is a human condition with 60 % to 80% of the world’s population

experiencing pain at sometime in their lives.7 Pain along the course of leg irrespective of

the etiological variations i.e., pain in the sciatic nerve which is felt in the back of the

thigh, leg and foot.8 The disease ranges from simple back ache to severe complications

like deformities and ultimately cripples the patient. Scientific world has conducted

extensive studies on NSAID’s analgesics and other physiotherapies, but could not find a

suitable medication or technique, which is safe and effective.9 so the present study is

undertaken.

Objectives of the study:

1. To evaluate the role of Punarnavadi guggulu in Gridhrasi.

2. To evaluate the efficacy of Kati basti with Mahamasadi thaila.


4

Historical Review

Historical Review

Ayurveda is the ancient medical science; History is a part of description of

any object. It is the footstep or a story from where the object comes. The origin

and progressive development of any disease is incomplete without considering its

historical background. In this way before going in detail about the Gridhrasi, an

attempt has been made to trace the reference regarding Gridhrasi in particular and

Vata Vyadhi in general. For the total coverage of historical aspect, it has been

divided in 4 parts as below:

• Vedic Period

• Pauranika Period

• Samhita Period

• Sangraha Period

Vedic period:

The Vedas are considered as the oldest recorded knowledge in our culture.

Ayurveda is the upaveda of Atharvaveda. The references of vatavyadhi are found

in Atharvaveda only. The word ‘Vatakrita’10 is used for vatavyadhi. But there is

no any specific mentioning of Gridhrasi.

Pauranika Period:

In Garuda Puraana, 11 healths related subjects are described in details. A

separate chapter is available as Vaatavyaadhi Nidaana and Gridhrasi is described

as an entity there.

Agni Puraana12 also holds identical description.

Samhita period:

Caraka Samhita:

Caraka Samhita is the first and foremost treatise, which elaborates Vaata,

Vaatavyaadhi and Gridhrasi completely. The role of Vaata Dosha in health and


5

Historical Review

disease is described in the first chapter itself. In 12th chapter, Vaatakalaakaleeya

of sutrasthana, Charaka has described detail about Vaata, its normal functions and

both intrinsic and extrinsic factors for its aggravation. In 17th Kiyantasiraseeya

chapter the two modes of morbidity of Vaata i.e., Caya and Prakopa as well as

different courses of Doshas in the pathogenesis of disease are described. In 20th

chapter Mahaarogadhyaaya, of Sootrasthaana, 80 types of Vaataja Naanaatmaja

Vikaaras are mentioned. Where Gridhrasi is also mentioned along with other

diseased conditions involving the legs like Paada soola, Paada bhramsa,

Paadasuptataa, Vaatakhuddataa, Oorusaada etc. In 28th chapter of Cikitsa Sthaana,

Acharya Charaka described five varieties of Vaata and etiology of its morbidity

along with its clinical features. The description of morbidity of Vaata included the

different clinical manifestation according to the site of involvement. The unique

pathogenesis of vaata vitiation due to the obstruction to its passage or functioning

is elucidated in full detail. Also the elaborate description of treatment of

imbalance of Vaata. This chapter also includes the complete description of certain

common Vaatavyaadhees in regards its etiology, pathogenesis, general principles

of treatment as well as treatment in particular.

In Caraka, at different places references related to Gridhrasi are available,

In Caraka Sootra Sthaana 5th chapter Maatraaseeteeya Adhyaaya, Paadaabhyanga

is indicated in Gridhrasi.13

In Caraka Sootra Sthaana 14th chapter Svedaadhyaaya Gridhrasi is said to be

treated by Svedana procedure.14

Two distinct clinical varieties of Gridhrasi is mentioned in 19th chapter of

Sootrasthaana entitled Ashtodareeya Adhyaaya.15

An elaborate description of symptomatology16 and treatment17 of Gridhrasi is

given in the 28th chapter of Cikitsa Sthaana.


6

Historical Review

Sushrut Samhita:

In Saareera Sthaana, Susruta has described the structure of Prushta, Paada

and its joints. He clearly mentioned in Marma Saareera that trauma to Kukundara

Marma leads to sensory and motor loss of lower limbs and leads to disability

(Vaikalyataa).

Susruta has given much importance by allotting the first chapter of

Nidaana Sthaana itself for Vaatavyaadhees. He described the clinical features of

Gridhrasi in the same chapter. He portrayed some allied conditions like Khanja,

Pangu, Kalaayakhanja etc. but classifications not made. In Bhagna Nidaana

chapter he made many original observations pertaining to Sandhimukta

(dislocation or herniation) Kaandabhgna (fracture). His description pertaining to

classification, clinical features, prognosis etc, of Sandhimukta suits for lumbar

disc prolapse that is responsible for majority of sciatica cases.

He described identical treatment for Gridhrasi, Khanja, Pangu,

Vaatakantaka, Paadadaaha, Paadaharsha, Dhamaneegata Vaataroga etc, which is

Siraavyadha along with general measures of Vaataroga. It appears that Dhamani

indicates nerves in this context and stressed the adaptation of general Vaataroga

therapies for Gridhrasi.

In Sushrut Samhita, the description of Gridhrasi is found at following places.

In Vatavyadhi nidan- Symptomatology and pathogenesis have been described.

The symptom ‘Sakthikshepa nigraha’ has been described for the first time, which

can be correlated to the SLR test in Modern medicine. 18

In Mahavatavyadhi chikitsitam – Siraveda is described as chikitsa for Gridhrasi 19

In Siravyadhavidhi Sharira – The site of siravedha in Gridhrasi is indicated.20


7

Historical Review

Bhela Samhita:

The description of Vaata its normal and morbid states in Bhela Samhita

are almost analogous to Caraka Samhita in many respects.

He described the association of destruction or Heenaanga (degeneration?) and

Adhikaanga (osteophytes?) with Vaata Rogas.

In this chapter basti and raktamokshana chikitsa are described for Gridhrasi. 21

Kashyapa samhita:

In Kaasyapa Samhita there is no specific chapter for Vaata Vyaadhi

Cikitsa. However the general aspects of Vaata and its aetiopathogenesis are

discussed in Sootrasthaana in similar lines as that of Caraka.

In this samhita, Gridhrasi is considered one among 80 types of vatavikaras, but no

details are described. 22

SANGRAHA PERIOD:

Ashtanga Samgraha:

After Charaka and Sushruta, the next importance is given to Ashtanga

Sangraha.

In Doshabhediya adhyaya – Gridhrasi is included under 80 types of vatavikaras.23

In Siravyadhavidhirnama adhyaya – The site of siravedha in Gridhrasi has been

indicated.24

In Vatavyadhi Nidan – Gridhrasi is described with its symptoms. 25

Ashtang Hridaya:

In Siravyadhavidhi adhyay, Site for siravedha in Gridhrasi has been mentioned. 26

In Vatavyadhi Nidan – Symptomatology and pathogenesis of Gridhrasi is

described which is similar to that of Ashtang Samgraha. 27


8

Historical Review

Maadhava Nidaana:

Maadhavakara described Vaata Vyaadhees in 4 chapters i.e., Vaata

Vyaadhees, Vaatarakta, Oorusthambha and Aamavaata, a pattern that had been

adopted by many of his subsequent authors. Gridhrasi finds place in the chapter of

Vaatavyaadhi Nidaana. He described the varieties of Gridhrasi i.e., Vaataja and

Vaatakaphaja more elaborately. In chapter VataVyadhi Nidana, some specific

symptoms of two types of Gridhrasi has been highlighted i.e. Dehasya Pravakrat28

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

kaphaja type.

Chakradatta:

This text deals with treatment part only. Cakrapaanidatta, the author of

this tretise & main commentator of Charaka samhitha, gives some herbal

preparation Snehana Chikitsa, Basti Chikitsa and Sashtra Chikitsa described in

detail under the heading of Vatavyadhi Chikitsa in the book Chakradatta.29 While

commenting on Caraka he made the following important observations pertaining

to Vaata in general with special reference to Gridhrasi. In the description of

Gridhrasi Cikitsa in Caraka, Cakrapaani commeted “Antara Kantaraangulyo Sira

Vastyagni Karma Ca”.30 He commented basing on the above that, Siraavyadana to

be performed in between Kandara and Anguli.

Gangaadhara:

Gangaadhara one of commentator of Charaka Samhita made some

importance observations particularly in Gridhrasi Cikitsa. He has taken into

consideration a Pathaantara of Caraka in the particular context i.e., “An ara

Kandaraangulyo Sirovastyagnikarma Ca”.

t

31 He indicated Sirovasti in Gridhrasi

and Agnikarma.


9

Historical Review

Dalhana:

Dalhanaacaarya made some observations pertaining to Gridhrasi while

commenting on Susruta samhita as follows: -

He considered Gridhrasi naadi as Kandara stated by Susruta. He termed it

as Mahaasnaayu that runs from lumbar region to Gulpha. He mentioned that

Gridhrasi is termed as “Randhrini”32 by lay people. While commenting on

Gridhrasi Cikitsa he indicated Sonita Mokshana is to be performed only after

adopting general therapies of Vaata disorders.33

Indu: 34

Indu mentioned in his Sasilekha Vyaakhyaa on Ashtaanga Sangraha that

in Gridhrasi the symptoms are alike to Visvaaci. If pain and restriction of

movement occurs in the upper limb the disease is called Visvaaci and similar

presentation in lower limb termed as Gridhrasi.

Arunadutta:35

Arundatta in his Sarvanga Sundari commentary on Ashtanga Hridaya

defined clearly that due to Vata in Kandara the pain is produced at the time of

raising leg straight and it restricts the movement of thigh. This is an important

clinical test nowadays for the diagnosis of Sciatica, known as SLR.

Gadanigraha: 36

Vaidya Sothala had mentioned at the introduction of Vaata Rogaadhikaara

that Vaatavyaadhees leads to all other disorders. He described Vaatavyaadhees in

four separate chapters i.e., Vaatavyaadhi, Vaatarakta, Oorusthambha and

Aamavaata.

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

In 4th chapter Prayoga Khanda termed as gutikadikara.37


10

Historical Review

In 14th chapter of Kayachikitsa Khanda named as Varogadhika describes Basti

chikitsa & Raktamokshana.38

Saarangdhara Samhita:

Saarangdhara mentioned Gridhrasi in 7th chapter of Purvakarama &

counted under 80 types of Vata Nanatmaja Vyadhi.39 He mentioned that the

disorder of Carana i.e., legs are forty-two like Vaataraktaja etc. Aadhamalla

commenting on varieties of disorders of Paada stated that these are Paadasuptataa,

Paadastambha, Paadaharsha, Padasphurana etc. But total forty-two varieties were

described neither by Saarangdhara nor by the commentators. Saarangdhara

appears to be one of the earliest authors to include Rasoushadhas also for the

treatment of various disorders.

Bhaavaprakaasa:

Bhaavamisra told the symptoms and treatment of Gridhrasi including the

disease in eighty types of Vaatavikaaras. Here he has told to give Shodana

Chikitsa before giving Samana Chikitsa, which will give more beneficial results.40

Even he has told to take Go- Mutra with Eranda thaila for the duration of one

month, which will cure the disease with out fail.41

Vangasena Samhita:

Vangasena followed Maadhavakara in description Nidana and Cakradatta

in describing Cikitsa. In this text, its line of treatment has been more clearly

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

Siravedha should be done in Gridhrasi. Vangasena has indicated Punarnavadi

Guggulu42 in the treatment of Gridhrasi, which is selected for the study, & even

he mentioned Mahamasadi thaila43 for Gridhrasi, which is taken for Kati basti in

the present study.


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Historical Review

Yogaratnakara: 44

In Yogaratnakara symptomatology and classification of Gridhrasi has been

mentioned under Vatavyadhi Nidana. Few preparations have also been described

which are useful in Gridhrasi.

Basavaraajeeyam: 45

He explained many Lakshanas of Vaata along with specific Rasoushadhi

prescription for the treatment.

He included Kalaaya Khanja, Gridhrasi, Visvaaci, Khalli, Pangu, Khanja

and Oorusthambha in the list of Balavattara Vaata disorders.

PREVIOUS RESEARCH WORKS DONE AT VARIOUS INSTITUTES

JAMNAGAR –

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

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

I.A.S.R., Jamngar.

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

Adhyayana Gridhrasi mein Kati Basti Ke Paripekshya mein, I.P.G.T.&

R.A, Jamngar..

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

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

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

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

• Shridhar Bairy T. (1997) : Phytochemica and pharmacotherapeutic

evaluation of Parijata (N. arbortristis Linn.) w.s.r. to its effect on

Gridhrasi, I.P.G.T. & R.A., Jamnagar.


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Historical Review

• R. Shahi (2002) : A comparative study on Aetiopathogenesis of Gridhrasi

and its management by Rasna Guggulu along with Shodhana Therapy,

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

AHMEDABAD –

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

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

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

sweda and Basti Chikitsa in the management of Gridhrasi (Sciatica) , G.A.

Ayu. College.

JAIPUR:

• Sharma Loknatha (1975) : Gridhrasi Roga Ka Naidanika evam

Chikitsatmaka Adhyayana (Rasna Prayoga), NIA Jaipur.

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

Paka, NIA Jaipur..

• Mishra Murlidhara (1986) : A pharmacological study of Sephalika w.s.r.

to Gridhrasi, NIA Jaipur.

• Pandya Surendra Kumar (1986) : A pharmacological study of Sephalika

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

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

Jaipur.

B.H.U. –

• Pandey Pradyuman (1973) : Gridhrasi Evam Amavata Mein Bhallataka Ka

Prabhava, B.H. U. Varanasi.

MYSORE –

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

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


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Historical Review

• Shridhr B. S. (1991) : Managemnt of Gridhrasi w.s.r. to Basti- G.C.I.M.

Mysore.

TRIVENDRUM –

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

Virechana – G. A. College, Trivendrum.

LUCKNOW –

• Arora R. L. (1982) : A role of Sephalika Patra Kwatha on Gridhrasi.

HARIDWAR –

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

Gridhrasi – R. S. College, Hridwar.

VIJAYAWADA –

• Rao M. K. (1986) : A clinical trial of Prijata in Gridhrasi – Dr. N.R.S.G.

Ayu. College, Vijayawada.

RAJPUR –

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

College, Rajpur.

HYDERABAD –

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

– A. Ayu. College, Hyderabad.

Vyutpatti of Gridhrasi:

The word Gridhrasi is in feminine gender46 which is derived from the

Dhaatu “Gridhu” that means to covet, desire, and strive after greedily on eager

for. By the rule of “Susudhadhri Dhibhyah Krammam” as well as by adding

“Run” Pratyaya i.e., Grudh + Krun followed by Lopa of “K” and “N” the word

Grudh + Ru i.e., “Grudhr” is derived. This word is also formed in another

grammatical method as “Grudhr+ So Atonupasargah” – Adding “Kah” Pratyaya


14

Historical Review

leads to Gridhra + So + Ka, further by Lopa of ‘O’ and ‘K’ and ‘Sha’ is replaced

by ‘S’a’ by the rule ‘Dhaatvaadeshu Sah Sah’ to get the word Gridhraus. Finally

for this word Gridhraus which is in female gender by adding ‘DisPratyaya the

word ‘Gridhrasi’ is derived. Gridhra refers to the bird Vulture.

It is opined that, in this disease the patients gait becomes altered as his

legs becomes tense and slightly curved due to pain resembling walk of the

vulture, hence the name Gridhrasi is given.

Gridhra means vulture. Vulture is fond of meat & has a particular fashion of

eating meat. It pierces its beak deeply in the flesh & then draws it forcefully,

causing severe pain. The pain in Gridhrasi is also of the same kind, hence the

name.

Niruktti of Gridhrasi:

Following are the niruktti of Gridhrasi-

• Gridhramapisyati, ‘Syati-as-Kshepana’. 47

i i

i

• “Oorusandhau Vaatarogah” 48

• “Gr dhraam va Syaati Gacchati”. 49

The disease Gridhrasi is said to cause an abnormal throwing action in the affected

leg. The Sanskrit word Syaati in Gridhrasi means throwing action. By this

abnormality the gait of the patients is said to resemble the gait of bird vulture and

hence the name Gridhrasi to this unique illness.

“Gr dhyati Maamsamabhikankshati Satatam Iti. Grudh+Krun. Gridhro

Maamsalolupa Manushyatam. Syati Peedayati Nashyati vaa”

The above reference from Sabdakalpadruma50 states that, the word Gridh

refers to a person who is crazy of eating meat. The word Syaati in Sanskrit means

to cause suffering. Thus the word Gridhrasi applies to an illness that mostly

attacks the persons who are greedy of consuming meat.


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Historical Review

Paribhaasha of Gridhrasi:

As described by Aacaarya Caraka Gridhrasi is a Vaatavyaadhi

characterized by Stambha (stiffness), Ruk (pain), Toda (pricking pain) and

Spandana (frequents switching). These symptoms initially affects Sphik (buttock)

as well as posterior aspect of Kati (waist) and then gradually radiates to posterior

aspects of Ooru (thigh), Jaanu (knee), Jangha (calf) and Paada (foot).51

Paryaaya of Gridhrasi:

Following are the Paryaaya of Gridhrasi.

1. Ringhinee -by Vacaspatimisra52

The word Ringhinee means the disease that cause to creep or crawling or

that makes a person to go slowly. More over according to the Sabdakalpadruma

this term refers to Skhalana meaning displacement.

2. Randhrinee -by Dalhana53

This term is used by Dalhana while commenting on Susruta, indicates

weak point or rupture.

3. Radhina -by Aadamalla & Kaasiraama54

Aadhamalla and Kaasirama use this term in their Deepika and

Goodhaartha Deepika commentary on Saarangdhara Samhita. It indicates

pressing, compressing or destroying.

NIDAANA:

The Nidaana factors of Vaatavyaadhi in general are also the Nidaana of

the Gridhrasi, as the exclusive Nidaana of Gridhrasi is not elaborated. These vata

disorders are caused by almost the same vata prakopaka nidanas, but the different

diseases are due to the samprapti vishesh of the vitiated vayu. Caraka55 and

Bhaavaprakaasa56 clearly mention the causative factors of Vaatavyaadhi, but in

Susruta Samhita, Ashtaanga Sangraha and Ashtaanga Hridaya etc. the causes of


16

Historical Review

Vaatavyaadhi have not been clearly described. In addition to this, in Caraka

Samhita, Ashtaanga Sangraha and Ashtaanga Hridaya, the root cause of

Vaatavyaadhi is mentioned as either Dhaatu Kshaya or Maargaavarana.57, 58,59

The nidana mentioned in the context of vatavyadhi holds good to all types of

vatavyadhis. So, nidana can be classified under following subheading.

1. Swaprakopaka Nidana

2. Margavarodhaka Nidana

3. Marmaghatakara Nidana

4. Dhatukshayakaraka Nidana

1. Swaprakopaka nidana

a. Aharaja nidana – Excess and continuous intake of rooksha, laghu, sheeta and

rasas like katu, tikta, kashaya, and irregular food habits, insufficient diet,

exclusive diet, repeated intake of diet, intake of dried leafy vegetables, dried food

articles, cereals like varaka, kodrava, nishpava, pulses like syamaka, mudga,

kalaya, chanaka, harenu cause vata aggravation. 60

b. Viharaja nidana – Excessive or improper activities of an individual leads to

vata vitiation e.g. exercise, walking, swimming, riding on vehicles, ratrijagarana,

ativyavaya, prapatana, bharavahana, ativyayama, balavat vigraha.61

c. Kalaja nidana – Excessive exposure to air, cloudy atmosphere, rainy season and

part of summer, day, night and digestion and in old age vata vitiates.62

d. Psychological factors – Worry, grief, anger, fear, anxiety, and timidity are

mental factors. These causes vata prakopa as vata is said to be controller and

conductor of mind.63

2. Margavarodhaka nidana

Vatavyadhi manifests due to vataprakopa by dhatukshaya or

margavarodha. 64 The vegadharana and udeerana bhavas causing provocation of


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Historical Review

sthanika dosha, 65 the obstruction by amadosha due to hypo functioning of agni

comes under this aspect of nidana. Kapha vitiating factors should also be

considered here as vatakaphaja Gridhrasi, causing obstruction in the normal

movement of vata.

3. Marmaghatakara nidana

Lifting of heavy weights habitual use of uncomfortable bed and

seat, fall from heights etc causes injury to katiprishtavamsha and

kukundaramarma resulting in the loss of functioning of lower limbs. 66

4. Dhatukshayakaraka nidana

The diminutions of dhatus owing to various etiological factors are also

considered as dhatukshaya increases rookshata then provoke vata.67

Samprapti:

To treat a disease, the complete knowledge of its pathogenesis is must.

The word ‘Samprapti’ means ‘Samyak Prapti of Roga’ that is the proper

understanding of the disease process. The process of manifestation of the disease

by the morbid doshas, which are circulating all over, the body is known as

Samprapti, Jati or Agati.68According to Acharya Sushrut ‘Dosha-dushya

sammurchhana janitovyadhi’. A proper understanding of Sampraapti is vital in

the planning of the treatment of any disease, since Cikitsa as enunciated in

Ayurvedic texts is nothing but Sampraapti Vighatana. 69

Charkacharya has described six types of ‘Samprapti’ namely Sankhya,

Vidhi, Vikalpa, Prudhnya, Bala, Kala. 70 Sushruta has described Samprapti

process in six stages Sanchaya, Prakopa, Prasara, Sthanasanshraya, Vyakti and

Bheda known as Satkriyakala. During Sthansanshraya Avastha the vitiated Dosha

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

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


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Historical Review

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

same but only due to the Samprapti Vishesha of disease Vata can produce so

many Vata disorders. If vitiated Vata is accumulated in Katu and lower

extremities by Srotosanga it produces Gridhrasi. Gridhrasi is Shoolapradhana

Vatavyadhi as Shula (pain) can not be produced without involvement of Vata

Dosha. On the basis of symptomatology given in classics, the probable Samprapti

of Gridhrasi can be treated out as below –

Samprapti ghatak:

Dosha : Vata – Apana and Vyana vayu, Kapha.

Dushya : Kandara, asthi, majja, rasa, rakta, mansa, sira, snayu.

Agni : Jatharagni

Ama :Jatharagnimandyajanita

Udbhavasthana : Pakwashaya

Samcharasthana : Rasayani

Adhisthana : Prishtha,kati, sphik

Srotas : Asthi, majja, rasa, rakta, mansa, meda

Srotodushti : Sanga

Rogamarga : Madhyam

Vyakti : Sphik, kati, prishtha, uru, janu, jangha, pada.

Bheda : Vataj and Vatakaphaj

Swabhav : Chirkari

Poorvaroopa:

Poorvaroopa are indications of impending diseases. They occur prior to

complete manifestation of disease and may suggest the forthcoming illness.71

These Purvarupa usually are exhibited during the stage of ‘Sthana Samshraya’ of

the ‘Shadkriyakala’ These Purvarupa usually are exhibited during the stage of


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Historical Review

‘Sthana Samshraya’ of the ‘Shadkriyakala.’72At that time when Dosha-Dushya-

Sammurcchana takes place, some specific sign and symptoms are observed in

particular disease which may be clear or not, they are termed as Purvarupa. The

poorvarupas which can predict the following disease alone are called samanya

poorvarupa, where as those which can predict the forthcoming disease along with

the predominant dosha concerned is called vishesha poorvarupa. According to

Madhukosh, poorvarupa are the symptoms which are exhibited clearly because of

having less severe causative factors, being mild or less in number and having

avarana of doshas .73

Gridhrasi being a vatavyadhi, the samanya poorvarupa of vatavyadhi are

the poorvarupa of Gridhrasi. Charak has mentioned that Avyakta lakshana are the

poorvarupa of vatavyadhi .74 While clarifying the word ‘Avyakta’ Chakrapani

states that few mild symptoms can be considered as poorvarupa.75 Thus, the

symptoms of Gridhrasi such as ruk, toda, spandana, stabdhata, tandra, arochaka

etc. when manifested slightly can be called as poorvarupa of Gridhrasi.

Roopa:

Complete manifestation of the disease is called as Rupa. 76 Roopa appears

in the Vyaktaavastha i.e., fifth Kriyaakaala of the disease. While decribing

Gridhrasi, Acharya Charak has listed ruk, toda, stambha and muhuspandana as the

cardinal symptoms. 77 To be more precise about the track of pain, Chakrapani says

that the pain starts at sphik and then radiates to kati, prishtha, uru, janu, jangha

and pada in order. Whereas Aacaarya Sus’ruta and Aacaarya Vaagbhat’a have

added Sakthyutkshepanigraha to the cardinal signs. 78,79,80 Some signs and

symptoms like Dehasyaapi Pravakrataa, Jaanu Ooru Sandhi Spurana etc, are

specially categorized as Vaatika Lakshanas in Bhaavaprakaasa, Maadhava

Nidaana and Yogaratnaakara. 81,82 Other lakshanas like Tandra, Gaurava, Arocaka,


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Historical Review

Mukhapraseka, Bhaktadwesha etc, have been stated as symptoms of Vaatakaphaja

Gridhrasi by Aacaarya Caraka. Similar references are available in textbooks like

Maadhava Nidaana, Bhaavaprakaasa and Yogaratnaakara.

Considering all the clinical manifestations of Gridhrasi, it may be sub divided into

two distinct categories

1. Saamaanya Lakshanas

2. Vis’esha Lakshanas

1. Saamaanya Lakshanas:

These clinical manifestations are seen in both Kevala Vaataja and

Vaatakaphaja type of Gridhrasi. Following are the Saamaanaya Lakshana of

Gridhrasi.

Ruk:

‘Ruk Satatam Soolam’83

‘Ruk Soolam’84

‘Ruja Vedana.’85

In Gridhrasi Ruk or Soola i.e., pain is one of the prime symptoms and is

felt throughout the lower limb, pain starts from Sphik region and radiates till the

Paada. Non radiating pain felt at sites like, Kati, Ooru, Jaanu, Jangha and Paada

region is also considered as the symptom of Gridhrasi.86 This typical radiating

pain involving the legs is suggestive of sciatica syndrome modern parlance where

pain is felt along the course of the sciatic nerve.

Toda:

‘Todah Soocivyadhanavat Vyadhaa’87

‘Toda Vicchinna Soolam’88

Intermittent pain similar to the feeling of pinprick is known as Toda, the

site of Toda is similar to the site of Soola i.e., from buttock to heal.


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Historical Review

Stambha:

‘Stambha Niscalakaram’89

‘Stambha Baahu Ooru Jangha Deenaam Sankochanaadhya Bhaavah’90

‘Stambha Nishkriyatvam’91

Stambha refers to the stiffness or rigidity felt at the thigh and legs and is

another symptom of Gridhrasi. As the movement of the legs worsen the pain, stiff

muscles prevent this and there by manifesting as the symptom Stambha. The

restriction to move the legs also affects the gait of the patient, as his steps are

short, cautious and slow.

Sakthnaaha Kshepam Nigrahanyat:

‘Kshepam Prasaaranam Tam Nigrahanyat Avarudhyaat Ityarthah’92

The movement Kshepana refers to extension. Patient of Gridhrasi is

unable to extend his legs as extending the legs worsens the pain. Aacaarya

Vaagbhat’a opines that it is the Utksepana i.e., lifting of the legs is affected in

Gridhrasi. Further the commentator Arunadutta very clearly defines this symptom

as ‘Paada Udharane Asakti’ 93 expressing the inability of the patient to elevate the

legs. As the extension of the legs worsens the pain patient prefers to assume the

flexed position of the legs.

Muhu Spandana:

‘Spandana Spuranam’94

‘Spandanam Hi Kincit Calanam’95

Sphurana refers to the fasciculation. Fasciculation may be present in lower

extremities in patients of Gridhrasi. To be more precise this symptom is seen in

the muscle supplied by the sciatic nerve.

Few of the symptoms of Gridhrasi are exclusively mentioned In

Basavaraajeeyam. These symptoms include Sopha, Kara Paada Vidaaha Krit,


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Historical Review

Sveda, Moorcha, Bhrama and Trishna. Some of these symptoms are indicative of

vitiation of Pitta Dosha in Gridhrasi.96

2. Visesha Lakshanas:

The unique symptoms of Gridhrasi that indicate either Vaataja or

Vaatakaphaja Gridhrasi are described as Visesha Lakshana. It is evident that the

predominance of Vaata Dosha or Vaatakapha Dosha in the Sampraaptti of

Gridhrasi leads to the manifestation of Visesha Lakshana.

Vaataja Gridhrasi:

Here the Sampraaptti of the Gridhrasi is characterized by the sole

involvement of Vaata Dosha. Evidently there will not be association of Kapha

Dosha in the Sampraapti. Following are the Visesha Lakshana of Vaataja

Gridhrasi.97,98,99,100

Dehasya Vakrata:101

Maadhava described this symptom which means that patient of Gridhrasi

acquires a particular posture due to pain. It may be lateral and forward bending of

body. The patient of Gridhrasi keeps the leg in flexed position and tries to walk

without much extension in the affected side. Hence the whole body is tilted on the

affected side and he assumes the bending posture or limping. This gait is also

typical in Gridhrasi.

Stabdata Brisam: 102

The severe degree of stiffness is seen in patient suffering from Vaataja

Gridhrasi.

Sphuranam:

‘Sphuranam Gatra Dese Swalpa Calanam’103

‘Sphuranam Punah Punah Calanam’104


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Historical Review

The symptom of fasciculation in Kati, Ooru, Jaanu and Jangha are similar

to the Spandana or Muhuspandana is characteristic of Vaataja Gridhrasi.

Suptata:

The patient experiences varied degree of parasthesia or sensory loss in the

affected limb.

Vaatakaphaja Gridhrasi:

Involvement of Kapha Dosha in the Sampraaptti of Gridhrasi cause the

below mentioned unique features.105, 106,107,108

Vahni Maardava:

Sluggishness of the Jatharaagni resulting in impairment of both

Abhyavaharana as well as Jarana Sakti

Tandra:

t

“Tandrayaantu Prabhodhito Api Klamayati Nidrabheda”109

This occurs due to Kapha and Tama Dosha, manifests as a feeling of

drowsiness or inability of sense organs to grasp their respective objects followed

with yawning or even fatigue without doing any labour.110, 111

Mukha Praseka:112

Mukhapraseka means excessive salivation in mouth is due to Kapha in

associated with Aama.

Bhaktadvesha:

‘Dveshamayati Yo Jan u Bhaktadvesha Sa Ucchate’113

Secondary to the sluggishness of Jaatharaagni and Kaphadusti patient of

Gridhrasi develops aversion towards food. Association of Aama is also contended

in the causation of this aversion towards food.


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Historical Review

Arocaka:

‘Arocakaastu Prarthite Apyupayogasamaye Anannaabhilaasha’114

‘Aruci Prarthita Anna Bhakshana Asamarthyamucchyte’115

It is a subjective symptom where patient fails to appreciate the taste in the

mouth irrespective of state of appetite. In comparison to the role of Vaata Dosha

involvement of Kapha Dosha has much to with the manifestation of Arocaka,

because the seat of Bodhaka Kapha is Jiwha which does Rasa Bodhana.

Gaurava:

‘Aardra Charmavanaddham Mivetyartha’116

Patient feels heaviness particularly in the lower limb or limbs.

Gaurava is the feeling of heaviness of the body in general or lower

extremities particular. Needless to say this symptom is due to the morbid Kapha

Dosha.

Staimityam:

‘Staimityam Gatranaam Nirutsaahatvam’117

Inertness of the body, feeling of freezing sensation in the affected lower

limb. Staimitya means timidness or frozen sensation. Due to Kapha vitiation

patient feels as if his lower extremities are covered with wet cloth.


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Historical Review

Table no. 1- Lakshanas of Gridhrasi:

No Lakshana C.S. S.S. A.S. A.H. M.N B.P Y.R. V.S. General 1 Ruk + - - - + + + + 2 Toda + - - - + + + + 3 Stambha + - - - + + + + 4 Spandana + - - - + + + + 5 Parshnipratyangul

i vedana - + + + - - - -

6 Sakthikshepa nigraha

- + + + - - - -

Vataj 1 Dehasya

pravakrata - - - - + + + +

2 Janusandhisphurana

- - - - + + + +

3 Jangha sandhisphurana

- - - - - + + +

4 Urusandhisphurana

- - - - + + + +

5 Katisandhisphurana

- - - - + - +

6 Suptata - - - - - - + 7 Stabdhata - - - - + + - + Vatakaphaj 1 Tandra + - - - + + + + 2 Gaurav + - - - + + + - 3 Arochak + - - - + + + + 4 Mukhapraseka - - - - + + + + 5 Bhaktadwesha - - - - + + + + 6 Agniandya - - - - + + + + 7 Staimitya - - - - - - + -

Upasaya, anupasaya:

Upasaya are the medicines, diets and regimens, which brings about

happiness either by acting directly against the cause of the disease or it may

produce such effect on the disease indirectly. It is essential to know the

Saadhyaasaadhyataa of a disease before the treatment & even to differentiate to

come to an accurate diagnosis. Caraka says, “A physician who can distinguish

between curable and incurable diseases and initiate treatment in time with the full

knowledge about the various aspects of the therapeutics can certainly accomplish


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Historical Review

his object of curing the disease.118 When identical symptoms having two or more

disease are meet hostilely (or encountered) in such conditions, disease could be

best differentiated by adopting Upasaya & Anupasaya.

Upasaya for Gridhrasi has not been mentioned particularly. But, if there is

uncertainty as whether the disease is Oorusthambha or Gridhrasi, to differentiate

these two we can adopt Upasaya. If symptoms aggravate on the application of oil,

then we can consider it to be Oorusthambha and if the symptoms alleviate we can

consider it as Gridhrasi. The Nidaana mentioned for Vaatavyaadhi, Gridhrasi are

considered as Anupasaya.

Saapeksha Nidaana:

Every disease has its own cardinal signs and symptoms. But certain

diseases have resemblance in their clinical signs and symptoms. For the correct

line of treatment it is very important to make the accurate diagnosis of a particular

disease and differentiate from other similar disorders. Hence it is essential for a

physician to make differential diagnosis of the disease. Gridhrasi, also presents

with a clear picture of shifting pain in lower limbs radiating from sphik, kati,

prishtha and affecting uru, janu, jangha and pada in order.

‘sakthiutkshepanigraha’ is mentioned as a cardinal sign by Sushrut and Vagbhat.

But certain other symptoms such as stambha, toda, sphurana, ruk etc. are also

found in some other disease. Diseases like urustambha, khalli kalaykhanja,

vatakantaka can make confusion with Gridhrasi.


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Historical Review

Table no. 2- Vyavachhedaka Nidana:

Sl. No.

Lakshanas Gridhrasi Uru-stambha

Kalay-khanja

Vata kantak

Khalli Pada-harsha

Amavata

1 Sphikpoorvakatikramat vedana

+ - - - - - -

2 Stambha + + - - - - - 3 Ruk + + - + + - + 4 Toda + + - + - - - 5 Muhu spandana + - - - - - - 6 Sakthiutkshepa

nigraha + - - - - - -

7 Janu sphuran + - + - - - - 8 Dehasyapravakr

ata + - + - - - -

9 Kati sandhi sphurana

+ - + - - - -

10 Stabdhata + + - - - - - 11 Parshni vedana + - - + - - - 12 Difficulty in

walking + - - + - - -

13 Sandhi mukta - - + - - - - 14 Supti + - - - - + -

Sadhya – Asadhyata:

While mentioning the importance of sadhyasadhyata Charak mentions,

‘The physician who knows the differential diagnosis between the curable and the

incurable among diseases and begins treatment in time with full knowledge of the

case obtains success in his effort with certainty. But if he fails in the same he will

suffer loss of money and will tarnish his learning and fame’. 119 The separate

prognosis of Gridhrasi is not mentioned in the classics. Hence the general

principles of Sadhyasadhyata can be applied to Gridhrasi. Sadhyasadhyata of a

disease depends on various factors such as involvement of dosha, dushya, number

of premonitory and monitory symptoms, prakruti, bala and age of the patient,

sthana and kala of the vyadhi, presence of upadravas and also the qualities of

Chatushpada


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Historical Review

Pathya – Apathya:

According to Ayurveda, various diseases are caused by the sanchay,

prakopa etc. of the three humours i.e. tridoshas. In person who indulges in

pathyakara ahara and vihara, the dosha sanchay doesn’t occur to such an extent as

to cause dreadful diseases. 120 Various Acharyas praise the importance of pathya.

Gridhrasi, being a vatavyadhi, the pathyapathya mentioned for vatavyadhies

should be followed. The pathya can be considered as to the ahara, aushadhi and

vihara. Ahara, vihara and aushadhi having properties opposite to vata and have

vataghna effects should be taken as pathya for vatavyadhi.

Pathya Ahara:

The patient should consume Ahara dravyas having Madhur, Amla and Lavana

rasa, Snigdha, Ushna guna and Brihana property. 121,122 Chakradatta, Bhaishajya

ratnavali and Yogaratnakar have the description of pathyapathya in details. It can

be presented here as under.123

Anna varga: Rakta shali, purana shashtika shali, kulatha, maasha, godhum, navin

tila, lavana.

Dugdha varga: Dugdha, ghrita, dadhi, matsyandika, dadhikurchika.

Shaka varga: Patola, shigru, vartaka, lashuna, tambula

Phala varga: Dadima, parushaka, badar, draksha, jambira

Mansa varga: Gramya, anupa, audaka mansa, Chataka, Kukkuta, Barhi, Tittira,

Nakra Mansa.

Drava Varga: Taila, vasa, majja, yusha, mansarasa, sura, naladambu

Aushadha: Prasarini, gokshur, neem, kshirkakoli.

Pathya Vihara:

Snigdha swedana, abhyanga, basti, shirobasti, shirahsneha, snaihik dhuma, sneha

nasya, sneha gandusha, sukhoshna parisheka, samvahana are the upakramas to be


29

Historical Review

followed . Also patient should reside at a place where direct wind is avoided and

sunlight is present. Patient should use soft beds and abstinence should be

followed.

Apathya Ahara:124

Chanak, kalaya, shyamak, nivar, kangu, mudga, rajmashak, all trina dhanyas,

katthilaka, nishpavabija, bimbi, kasheruka etc. should be avoided. Also tadag,

tatini jala, sheetambu, viruddhanna. Dravyas having kashaya, katu, tikta rasa

should not be consumed by a patient having vatavyadhi.

Apathya Vihara:

Indulgence in sex, excessive riding on vehicles, excessive walking,

sleeping on hard beds should be avoided. Chinta, ratrijagarana, vegavidharana,

shrama, vaman and upavasa should be avoided.

Chikitsa:

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

principle to be adopted in the treatment of each and every disease is to avoid the

Nidana of the disease i.e. Nidana Parivarjana as said by acharya Sustruta. 125

Chikitsa is the couteraction of ruja. (Amarkosha). It is the process of breaking

down the pathogenesis of a disease. Diseases are caused due to vitiated doshas

involving dhatus etc. The process, which establishes equilibrium in these body

elements, is Chikitsa. 126 Gridhrasi being a Vatavyadhi, the general treatment of

Vatavyadhi is applicable to Gridhrasi also. Charak has advised dravyas having

madhur, amla, lavana, snigdha, ushna properties and upakramas like snehana,

swedana, asthapana and anuvasana basti, nasya, abhyanga, utsadana, parisheka

etc. 127 Vagbhat has stated that sneha, sweda, mruda samshodhana along with

madhur, amla, lavana dravyas. Veshtana, trasana, madya, sneha siddha with

deepan and pachan drugs, mansarasa and anuvasana basti pacify the vata. 128 In


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Historical Review

Ashtang Samgraha Hemant ritucharya is indicated in vatavyadies. 129 Similarly

Sushrut has advised shirobasti, shirosneha, snaihik dhumapana, sukhoshna

gandusha for the treatment of vatavyadhies. 130

Specific Treatment of Gridhrasi:

The effective treatment of Gridhrasi can not be unified, as the pathology

involves multiple varying factors. Vitiated Vaata and association of Kapha Dosha

afflicting the Asthi Dhaatu vitiating Snaayu and Kand’ara affecting in the Asthi

produces the illness. Therefore, the procedures mainly aimed at the rectification

of the imbalances of Vaata Dosha as well as Kapha Dosha if associated.

Generally Snehana, Swedana, Vamana, Virechana, Niruha and Anuvasana

Basti, Siravedha, Raktamokshana, Agnikarma and Shastrkarma are advised by

different Acharyas.

The following table shows the line of treatment of Gridrasi by different

Acharyas.:

Table no. 3 showing the line of treatment of Gridrasi by different Acharyas

Treatment Ch. Su. A.H. B.P. Y.R. C.D. Snehana - - - - - + Swedana - - - - - + Vamana - - - + - + Virechana - - - + - + Niruha Basti + - - - - - Anuvasana Basti + - + + + + Siravedha + + + - + + Raktamokshana - - - - - - Agnikarma + - + - + + Shastrakarma - - - - - +

1. Snehana:

Snehana or oleation therapy is used externally and internally in

case of Gridhrasi. Externally snehana may be performed in the form Abhyanga,

Pizhiccil, Avagaaha, Parisheka etc. One should remember that if the Kapha Dosha


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Historical Review

in involved in the pathogenesis as in case of Vaatakaphaja Gridhrasi, Snehana

Cikitsa should be restricted, as this treatment tend to worsen the imbalance of

Kapha Dosha. Taila is said to be best in vatavyadhi as it is having exactly

opposite properties as that of vata. 131 Sneha pacifies vata, brings out softness in

the body and removes malasanga. 132. It acts on sparshanendriya, which is the seat

of vayu. While mentioning the kala of abhyanga, Sushrut has stated that after 900

matras the sneha can reach majjadhatu 133 It signifies the action of sneha on asthi

& majja dhatus, which are involved in Gridhrasi.

2. Swedana:

Snehanapurvak swedana is indicated in nirama vatavyadhies while only

swedana is indicated in samavatavyadhies. Nadi, prastara, sankara etc. are the

various types of sweda. 134 Swedana activates agni, creates komalata, ruchi, clears

srotasas, diminishes tandra 135 Snehanapurvak swedana relieves the symptoms

such as harsha, toda, ruk, shotha, stambha, graha etc. It produces mruduta in the

body. Charak says that proper snehan and swedana can make even dry wood

flexible. 136

In Gridhrasi stambha, ruk, toda etc. are the main symptoms. Snehana and

swedana by virtue of their vatashamak and dhatuposhak properties are useful in

relieving the symptoms.

3. Vamana:

After the Snehana and Svedana, Sodhana is indicated in Gridhrasi.

The authors like Cakrapaani and Bhaavamisra opine that without Sodhana of

body Basti Cikitsa will not give desired effect in patients of Gridhrasi.137 Sodhana

in the form of Vamana is advised in patients suffering Gridhrasi and is specially

preferred in Vaatakaphaja Gridhrasi for evident reasons.


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Historical Review

4. Virecana:

Virecana has an important role in Gridhrasi. The doshas, which are not

pacified by snehana and swedana, should be removed from the body. Hence

mrudu virechana is advised for this purpose. 138 Snigdha virechana is advised for

vatavyadhies. The action of Virecana is not only limited to particular site, it has

effects on the whole body. In Vaatavyaadhi most of the authors mentioned Mridu

Virecana.139Oral administration of ‘Erand’a Sneha’ along with milk is ideal for

the Virecana purpose.140 This will help in both Vaata Anulomana as well as

smooth excretion of Mala. The Sneha Virecana clears obstruction in the Srotas

and relieves Vaata vitiation very quickly.141Vatanulomana is necessary for the

vayu obstructed by malas lodged in srotasas. It is to be done by snigdha, amla,

lavana, ushna drugs. 142

5. Basti:

Basti is the best treatment for vata. In patients who are weak or avirechya,

Niruhaa basti is advised for removal of doshas by Acharya charak. 143 Basti is

considered as param vatahara, because it makes the vata to move in its natural

paths and channels. Also it has systemic effect in eliminating doshas from the

body gradually by pakwashaya shodhana. 144. Asthapana basti is srotovishodhan

and malapahara, while anuvasana performs the function of malashodhana and

vatashaman. 145 While explaining the importance of basti, Charak says that there

is no therapeutic procedure comparable to that of basti, in as much as it possesses

rapid and useful properties of cleansing, in addition to its being a quick agent of

impletion and depletion and is unattended with danger 146

KATI BASTI

Literary Katibasti is made up of two words as such – Kati & Basti


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Historical Review

1.Kati: It is a femine gender, in Caraka samhita he as told as

Sariram vatasthaneshvekam |147

i.e. it is the sthana of vata. In Susruta samhita, he as explained the pramana of kati

as, 18 angulis.148

2. Basti: The word Basti is having the meaning of

“Vas Nivase”149

“Vas Aachhadane”

“Vas Surabhikarane”150.

Here the word “Vas Aachhadane” holds good for Kati Basti. The word meaning is

“to cover” “that which surrounds” or “Aavaranam”. Hence “Dharana” or

maintainence of certain substances in the Kati Pradesha for a stipulated time may

be considered as Basti.

The word ‘Vas Nivase’ means, “to reside”. Specifically this holds good

for Niruha or Anuvasana or Uttara Basti. But in case of Kati Basti when oil is

retained for certain time it may also be considered for the definition.

Kati basti is a unique procedure, where both Snehana & Swedana, i.e.

Snehayukta swedana is done. The bassti is performed in the katipradesha so it is

called as katibasti. It is adopted procedure of Shirobasti, there is no any direct

reference of katibasti in any classics. It is the modified procedure of shirobasti. In

this procedure oil is used for the purpose of treatment, hence this may be

considered under the type of drava sweda. In case of Caraka Samhita Sankara ,

Prastara , Pariseka etc 13 types of Sweda are told.151 In the view of above said

sweda types, kati basti can put in the form of Avagaha. Avagaha means

immersion. In case of katibasti immersion/ covering of the kati region with oil

may force us to consider it as avagaha sweda. While dealing with the Drava

sweda Cakradatta mentioned it is useful in case of Vataja disorders & Kaohayukta


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Historical Review

Vataja disorders.152 For the severe condition of gridrasi (sciatica) and osteo-

arthritis of the hip, a disease condition characterized by severe pain radiating

down the leg, a combination of shamana (palliative) and shodhana (eliminatory)

measures is necessary if a relapse is to be avoided.153

According to different types of classifications Kati Basti may be put under

following groups:

I According to Agni Bheda: it is Saagni sweda

II. According to Sthaana Bheda: Ekaanga Sweda

III. According to Guna Bheda: Snigdha Sweda

IV. According to Roga And Rogi Bala: Madyama Sweda

V. According to Taapaadi 4 Bhedas: Drava Sweda

VI. According to Sankaraadi 13 types: Avagaaha

While defining Swedana it has been said that Ruk, Stambha, Gaurava, Sheeta are

reduced. Katibasti also does the samething. While dealing with the Samyak

Sweda Lakshanas 154 and uses of Swedana certain things are quoted 155,156. All of

them are not exactly fitting into the context of Kati Basti.

Few of them may be summarized as below.

1. Induces Twak MardaVaata and Twak Prasaadana.

2. Restoration of functions of Sandhi by removing Stambha.

3. Reduces Gaurava and Tandra.

4. Reduces Seeta quality locally.

5. Induces Swedana locally.

Among Samyak and Asamyak Sweda Lakshanas following may be attributed to

Kati Basti.

Samyak:

S’ula Uparama


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Historical Review

Seeta Uparama

Stambha Nigraha

Gaurava Nigraha

Mardhava

Sweda Srava

Vyadhiharatwa

Laghutwa

Ati Sweda :

Pitta Prakopa

Ati Sweda

Asamyak:

No S’ula Uparama

Feeling of coldness

Stambha

Gaurava

Procedure of Katibasti:

Poorva Karma:

The patient was advised to avoid Vaatakara Aahara and Vihara.

The Taila was made into lukewarm indirectly by placing it in a vessel containing

water.

Oushadha:

Mahamasadi taila

Upakarana:

Table, vessels, spoon, gas stove, wheat floor, cotton, water.

Pradhana Karma:


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Historical Review

The patient was made to lie prone position on the table and Kati Pradesha

is exposed. Meanwhile sufficient quantity of masha floor was taken and made into

dough by adding required quantity of water. The dough was made into a shape of

circular ring corresponding to the area of tenderness in the lumbo-sacral region.

The inner and outer walls of the circular ring were properly sealed over the skin

so as to prevent the leakage of the Taila from the circular ring. Before pouring the

oil first check the heated oil by immersing our finger to rule out the temperature

into it. Then the heated Taila was poured in little amount to check the tolerance of

heat by the patient. According to the tolerance of the lukewarm oil, it is slowly

poured inside the circular ring with a help of a spoon. Constant temperature of the

oil was maintained inside the circular ring by rotating the oil with a finger. Once

the temperature of the oil is decreased, it was replaced with lukewarm oil again.

The procedure was continued till the patient attains Samyak Swinna Lakshanas or

upto 30 to 45 minutes. The procedure is done for 14 days in increasing order of

time i.e. initially kati basti is started with 30 minutes, then increased by 5 minutes

per day upto 45 minutes, then maintained for 7 days & decreased the time by 5

minutes per day upto 30 minutes of procedures i.e. for 14th day.

Paschat Karma:

After the procedure, oil was completely removed out from the

circular ring with the help of a cotton or spoon. The dough ring was also removed

from the back. Mild massage over the area was done. Then the patient was

advised to take lukewarm water bath after 15 to 20 minutes.


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Historical Review

MODERN REVIEW OF SCIATICA157

Due to the dynamics of the human spine, lumbar disc syndrome and

accompanying complaints of sciatica are long-standing afflictions of our species.

Although Greco–Roman physicians eruditely described this ailment, their uneven

diagnostic and therapeutic acumen hampered an understanding of the disorder for many

centuries. It was not until 1934, with the landmark publication of Mixter and Barr, 14 that

the herniated lumbar disc was shown to be a major cause of sciatica. This reflects only

one of many scientific discrepancies that have surrounded the concept of sciatica as a

distinct clinic pathological entity. Although quadrupeds can have disc problems, it is

probable that human’s upright posture and relative longevity have exposed our species to

a special, unwelcome affinity for lumbar disc syndrome and associated sciatica

Increasing axial somatic weight bearing, long periods of standing and walking, and the

additive stresses associated with running, bending, weight lifting, or merely jumping, can

exact a toll on the spinal column, resulting in substantial degenerative sequelae.

Anatomy And Physiology of Sciatic Nerve:

The parts affected in Gridrsi are kati, prishta (lumbo-sacral region) posterior

aspect of uru, janu, jangha and pada region.

24 asthisandhis, slightly movable constitutes lumbo-sacral region.158 The

bones of katiprushta pradesha are firmly united by mamsarajju (ligaments).159 60 peshis

are situated in prishtabhaga and each 5 peshis are situated in buttocks.160 The union of 5

sacral vertebrae, trika, the seat of avalambaka kapha and kati is one among the vata

sthanas.161,162 The lower limbs are considered as one karmendriya 163,164 and the motor


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Historical Review

functions are carried by 100 peshis, 150 snayus, 2 koorchas, 2 kandaras, 30 asthis and 17

asthisandhis situated in each limb. 165

Katikatharunamarma (asthi), kukundaramarma (sandhi) and nitamba (asthi) are

situated in the shroni (pelvis), below the pelvis and on the hip region respectively.166

Sciatica nerve or Gridhrasi nadi / snayu167

The sciatic nerve is the largest and longest nerve in the human body, about as big

around as a thumb (2 cm) at its largest point. The nerve arises from the sacral plexus,

which is situated largely anterior to the sacral and formed by the ventral rami of the

spinal nerves L4 – L5 and the 1st, 2nd and 3rd (S1, S2, S3) sacral spinal nerves. Thus, the

five nerves group together on the front surface of the piriformis muscle (in the buttocks)

and become one large nerve – The Sciatic Nerve. This nerve travels then down the back

of each leg, branching out to innervate specific regions of the leg and the foot. Though

the two main divisions of sciatic nerve i.e. the tibial nerve (medial popliteal) and the

common peroneal nerve (lateral popliteal) are bound together by common sheath of

connective tissue, they are separable upto the sacral plexus because of its different root

value.

Root Value:

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

the ventral rami of L4 – L5 and S1, S2, S3 whereas the common peroneal part of the sciatic

nerve derives its fibers from the dorsal division of the ventral rami of L4, L5, S1 and S2.

Course And Relation:

1. In The Pelvis:

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


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Historical Review

2. In The Glueteal Region:

The sciatic nerve enters the gluteal region through greater sciatic foramen (below

the piriformis). It runs downwards with a slight lateral convexity, passing between the

ischial tuberosity and the greater trochanter. It has a following relation in the gluteal

region.

Superficial (Posterior): Gluteal maximus and sometimes the posterior cutaneous nerve of

the thigh.

Deep (Anterior): i) Body of the ischium and nerve to the quadratus femoris; ii) Tendon of

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

ascending branch of the medial circumflex femoral artery; iv) The capsule of the hip joint

which lies deep to the forementioned muscles and v) the upper, transverse fibers of the

adductors magnus.

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

of the thigh.

3. In The Thigh:

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

maximum, and runs vertically downward upto the superior angle of the popliteal fossa (at

the junction of the upper 2/3rd and lower 1/3rd of the thigh) where it terminates by

dividing into the tibial and the common peroneal nerve. It has the following relations in

the thigh.

Superficial (Posterior): The sciatic nerve is crossed by the long head of the biceps

femoris.

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


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Historical Review

Medial: The posterior cutaneous nerve of the thigh, the semi-membranous and the semi-

tendinosus.

Lateral: Biceps femoris.

The division into tibial and common peronneal takes place usually at knee or at any point

between the pelvis and the lower 3rd of the thigh.

Tibial Nerve (Medial Popliteal Nerve): This is the longer terminal branch of the sciatic

nerve. It supplies the skin of the lateral and posterior part of the lower 1/3rd of the leg. It

runs downward through the popliteal fossa, lying first on the lateral side of the popliteal

artery, then posterior to it and finally medial to it. The popliteal vein lies in between the

nerve and artery throughout its course. The nerve enters the posterior compartment of the

leg by passing beneath the soleus muscle.

Its branches are as below:

Medial Planter: It supplies the abductor hallusis, flexor digitorum brevis and flexure

hallucis brevis muscles; skin over medial 2/3rd of planter surface of the foot.

Lateral Planter: It supplies remaining muscles of a foot not supplied by medial planter

nerve. Skin over lateral 3rd of planter surface of food.

Common Peroneal Nerve (Lateral Popliteal Nerve): This is the smaller terminal branch of

the sciatic nerver arises in the lower 3rd of the thigh. It runs downward through the

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

fossa by crossing superficially the lateral head of the gastro nemius muscle. It then passes

behind the head of the fibula, winds laterally around the neck of the bone; pierce the

peroneus longus muscle and divides in two terminal branches.


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Historical Review

Superficial peroneal nerve: It supplies the peroneus longus and pernoneus brevis muscles;

skin over distal 3rd of anterior aspect of leg and dorsum of foot.

Deep peroneal nerve: It supplies tibialis anterior, extensor hallucis longus, peroneus

tertius and extensor digitorum longus and brevis muscles; skin on adjacent side of great

and second toes.

Sciatic Nerve Injury

Complete lesion of this nerve is very rare and will cause complete paralysis of

hamstring muscles and all the muscles below the knee. Subtrachanteric fracture of femur

or posterior dislocations of the hip are most common cause of incomplete lesion of this

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

part in injury to the sciatic nerve.

1. Common Peroneal Nerve (Lateral Popliteal):

This nerve supplies the extensor and peroneal groups of muscles of the leg as also

through its musculo-cutaneous branch it supplies the anterior and lateral aspect of the leg

and whole of the foot and toes except the skin between the great and second toe which is

supplied by its deep peroneal nerve. So, injury to this nerve will result in the foot drop

and talipes equinovarus deformity. The patient will be unable to dorsiflex and evert the

foot. The sensory loss will affect the anterior and lateral aspect of the leg, dorsum of the

foot and toes.

2. Tibial Nerve (Medial Popliteal):

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

muscles of the calf e.g., the soleus, the gastronemius, the popliteus, the plantaris, the

tibialis posterior, the flexor digitorum longus and the flexor hallucis longus. Through


42

Historical Review

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

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

ankle with loss of sensation of the whole of the sole. Thus, this deformity is known as

talipus calcaneovalgus or claw foot.

Sciatica

Sciatic – (Si-at’ik) (Mediv L – Sciaticus, a corrupt form of Gr- Ischiodicus from –

ischion, the hip joint, ISHI) which means,

Affecting the hip or the sciatic nerve

Of or belonging to the ischium or hip (The Oxford English Dictionary)

Sciatica is an extremely painful condition that often accompanies low back pain

and can affect either one or both lower extremities. Sciatica commonly refers to pain that

radiates along the sciatic nerve and is typically felt in the rear, down the back of the leg

and possibly to the foot. Sciatica is one of the most common forms of pain caused by

compression of the spinal nerves, and the leg pain often feels much worse than the back

pain.

Irritation of the fourth and fifth lumber and first sacral roots, which form the

sciatic nerve, causes pain that extends mainly down the postero and anterolateral aspects

of leg and into the foot termed sciatica.168 (Harrison’s Principles of Internal Medicine)

Causes of Sciatica169

I. True Sciatica Neuritis –

1. Leprosy

2. Polyartritis nodosa

3. Nerve injury due to injections or trauma


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Historical Review

4. Post – herpetic neuralgia

II. Mechanical pressure on nerves or roots or referred pain –

1. In the spinal cord –

a. Tumors of cauda equina

b. Arachnoiditis

c. Rarely thrombosis

d. Hemorrhage or infection irritating meninges of the cord

2. In the cord space –

a. Protruded intervertebral disc

b. Extramedullary tumors

3. In the vertebral column –

a. Arthriris

b. Tuberculosis

c. Spondylolisthesis

d. Ankylosing spondylitis

e. Primary bone tumors

f. Secondary carcinoma

4. In the back –

a. Fibrositis of posterior sacral ligaments

b. Compression where the nerve leaves the pelvis in those who lie immobile on a

hard surface for long time (a form of Saturday night palsy)

5. In the thigh & buttock –

a. Fibrositis


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Historical Review

b. Sacro – sciatic band

c. Hip joint or sacroiliac joint disease

d. Neurofibroma

e. Hemorrhage within or adjacent to nerve sheath in blood dyscrasias &

anticoagulant therapy

f. Misplaced therapeutic injection

6. In the pelvis –

a. Sacroiliac arthritis or strain

b. Hip disease

c. Infection of prostate or female genital tract

d. Rectal impactions

e. Tumors of lumbo –sacral plexus

Pathology

Pressure or irritation on the sciatica nerve in the spinal area results in the sciatica

syndrome. These mechanical irritations are mainly due to pathological changes in the

intervertebral disc of lumbosacral region. Intervertebral disc is the part, which contains

maximum strains and having more movements. It has annulus fibrosus – outer casing and

nucleus pulposus – inner softer jelly. As disc age, they fragment, dissociate and collapse

of gradual diminution in the concentration of hyaluronic acid. Initially this starts in the

nucleus pulposus, resulting in the central annular lamellae buckling inward while the

external concentric bands of the annular fibrosis bulge outwards, resulting in increased

mechanical stress at cartilaginous end plates at the vertical body lip.


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Historical Review

Degenerative changes can also affect the facet joints that lie behind and on

either side of vertebral canal and are known as oesteoarthritic changes spondylosis and

usually occur together. Extra bony growth on the vertebrae called osteophytes, may

present can press on nerve roots causing pain and irritation. As a disc degenerates it can

herniate back into the spinal canal. The weakest spot in a disc is directly under the nerve

root, and a herniation in this area puts direct pressure on the nerve which causes pain to

radiate all the ways down the patients leg to the foot.

Yet another pathological change will be lumbar spondylitis where

inflammation of the vertebral joint inturn leads to pain along the nerves. Mechanical

pressure over the nerve will happen in other changes the lumbar spinal stenosis, isthemic

spondylolisthesis causing sciatic syndrome. 170

Clinical features of sciatica 171

The characteristic feature of sciatic syndrome is that the pain originates in

lumbosacral region radiating downwards form buttock, posterolateral aspect of thigh and

the calf to the outer aspect / border of foot. Usually gradual onset but can be sudden also.

So pain is felt in the back, the buttock, the thigh, the leg and the foot - together or as

involvement of few areas.

The pain may immediately follow an injury such as strain or a fall or there

may be latent interval of 4 days or even weeks. After 2-3 days of pain in the lumbar

spine, the pain radiates down the back of one leg form buttock to ankle and sometimes to

the foot.


46

Historical Review

Table 11

Table no. 4- Showing the clinical features of sciatica

Disc

level

Root Sensory

loss

Motor weakness Reflex

loss

Pain distribution

L3-

L4

L4

Medial calf

Quadriceps (knee

extension), thigh

adduction, tibialis

anterior (foot

dorsiflexion)

Knee

Knee medial calf

L4-

L5

L5

Lateral calf,

dorsum of

foot

Peroneii (foot eversion),

Tibialis anterior (foot

dorsiflexion), Gluteus

medius (hip abduction),

Toe dorsiflexion

Hamstring

Lateral calf, dorsal

foot, posterolateral

thigh, and

buttocks.

L5-

S1

S1

Plantar

surface of

foot lateral

aspect of

foot

Gastronemus / soleus

(foot planter flexion)

abductor hallucis (toe

flexors), gluteus

maximus (hip extension)

Ankle

Bottom foot,

posterior calf,

posterior thigh,

and buttocks.


47

Historical Review

Symptoms - Different types of sciatica pain:172

Sciatica from L4 nerve root (usually the L3-L4 level)

The patient may have reduced knee-jerk reflex. Symptoms of sciatica stemming

from this level of the lower back may include: pain and/or numbness to the medial lower

leg and foot; weakness may include the inability to bring the foot upwards (heel walk).

Sciatica from L5 nerve root (usually the L4-L5 level)

The patient may have weakness in extension of the big toe and potentially in the

ankle called foot drop. Symptoms of sciatica originating at this level of the lower back

may include: pain and/or numbness to the top of the foot, particularly in the web between

the great toe (big toe) and the second toe.

Sciatica from S1 nerve root (the L5-S1 level)

The patient may have reduced ankle-jerk reflex. Symptoms of sciatica originating

at this level of the spine may include: pain and/or numbness to the lateral or outer foot;

weakness that results in difficulty raising the heel off the ground or walking on the

tiptoes.

Pressure on the sacral nerve roots from sacroiliac joint dysfunction

Symptoms may include: a sciatica-like pain or numbness that is often described as

a deep ache, inside the leg more so than a linear, well-defined geographic area of pain

numbness found in true sciatica.

Pressure on the sciatic nerve from the piriformis muscle

This pressure on the sciatic nerve can tighten and irritate the sciatic nerve called

piriformis syndrome. Symptoms of piriformis syndrome may include: a sciatica-like pain

and/or numbness in the leg, usually more intense above the knee, which usually starts in


48

Historical Review

the rear rather than the low back, often sparing the low back of symptoms or signs.

Piriformis syndrome can mimic the signs and symptoms of sciatica pain from a disc

herniation and is part of the differential diagnosis of possible causes of sciatica.

Clinical Diagnosis173

History

A detailed history regarding the nature, character of pain, its distribution, mode of

onset, chronicity, aggravating factors etc. should be taken. Also history of trauma,

infectious diseases, personal history, past medical history, any associated diseases and

also family history, obstetric history and occupational history should be inquired.

General examination

Any clues for systemic diseases should be looked for e.g. fever etc. They help for

differential diagnosis as well as treatment decisions.

Musculoskeletal Examination

Gait : The patient of sciatica has a very typical limping gait while walking.

Posture : The shape of the lumber spine is altered and the mobility is restricted. The

spinal mobility is checked by the ability to bend forwards. There may be loss of normal

lordosis. Te muscular spasm produces list to one or other side on standing, known as

sciatic scoliosis.

Tenderness : Local tenderness and presence of trigger points in the back and limb should

be identified. The following signs are helpful to confirm the diagnosis of sciatica.


49

Historical Review

• Straight leg raising test (SLR)

There is no universal agreement about

the correct way to perform the straight

leg raising test. One method is that

when the patient is in the horizontal

position, on a counch or on the floor,

asks him to do straight leg raising.

Another method is to support the heel

in the cupped hand of the

examiner and having explained the method

to the patient, gently lift the heel from the cou

Normally the leg can be raised up to 80o - 90o w

rests on the pelvis to limit pelvic rotation. The ele

complains of pain, which is due to stretching of

assessed using goniometer. The patient is asked ab

although a little uncomfortable for the patient,

lifting the leg to the maximum permitted level.

This test is most useful diagnostically to asse

prognostically to assess the results of treatment. C

disc herniation and suggests a poor prognosis.

• Lasegue test : It elicits pain in the leg or back, whe

the knee is slightly flexed, the hip further flexed an

Evaluation Of The Efficacy Of PunarnavadigugguluBasti In The Management Of Gridhrasi (Sciatica)

Straight leg raising test. After the limb has beenraised to the position which produces pain (1), dorsiflexion at the ankle (2) exacerbates that

nch with the knee still extended.

ithout any pain. The opposite hand

vation is stopped when the patient

the affected root, and the angle is

out the site of that pain. However,

better repeatability is obtained by

ss the severity of the pain and

rossed leg pain is pathognomic of a

n at the limit of straight leg raising

d the knee then extended.

& Mahamashadi Taila Kati 50

Historical Review

• Bragaad’s test : At maximum straight leg raising, the foot is dorsiflexed to see if

tension on the posterior tibial nerve increases the sensation of pain. In the same

position, the limb is extremely rotated, relaxing the sacral plexus and then internally

rotated, increasing root tension, the experience of pain is recorded.

• Bow-string test: At the limit of straight leg raising, the knee is first flexed and then

extended and the tibial nerve compressed at the popliteal fossa with the examining

fingers of one hand, the ‘bow string test’.

• Sciatic Nerved Stretch Test: At the limit of SLR; increasing the pressure on the

irritated sciatic nerve by sharply dorsiflexing the foot producing extra pain.

• Naffziger’s Sign: Pain in the lower part of the back and legs on pressure over the

jugular vein.

Femoral nerve stretch test, sitting test, popliteal compression test, knee-jerk and ankle

jerks are also useful test for diagnosis of a disease. All the above mentioned tension signs

are generally present when a lower lumber or sacral root is involved in the pathological

process of pain. They are marked with acute root involvement from a disc protrusion, but

mild or absent with nerve root irritation from long standing degenerative change.

Also pelvic rotation and testing of sacroiliac joints by pressure on two anterior superior

iliac spines should be done.


51

Historical Review

Neurological Examination

• The knee, ankle and plantar reflexes should be examined and they should be

symmetrical on both the sides.

• The motor power of selected muscles i.e. extensor hallucis longus (L5 or S1),

peronei (S1), quadriceps (L4 and 5) should be recorded.

• Wasting of muscles of the leg especially quadriceps should be measured.

• The sensation should be recorded by using a sharp pin. Areas of numbness,

hypoasthesias should be marked.

Others

• The dorsalis pedis and ant. tibial arteries should be palpated because claudication

pain can be confused with the redicular pain.

• Palpation of the abdomen is also mandatory, as an abdominal mass may explain

the cause of pain.

• Rectal examination should be carried out and in women vaginal examination also.

All the above signs have got some clinical value but it is not always that one or more of

them may be present and the diagnosis has to be confirmed by other measures.

Investigations

Laboratory investigations

• Urine examination for sugar etc.

• Complete blood count (C.B.C.), Erythrocyte sedimentation rate (E.S.R.) These are

especially helpful in screeing for infection or myeloma.

• Rheumatoid factor for rheumatoid arthritis, serum calcium, phosphorus, uric acid,

alkaline phosphatase in suspected hyperparathyroidism, malignancy, osteoporosis,


52

Historical Review

Paget’s disease and acid phosphate in suspected case of metastatic carcinoma of

prostate.

• Immunoglobulin electrophoresis is useful in diagnosis of multiple myeloma,

lymphomas and connective tissue disorders.

• Cerebrospinal fluid examination for the diagnosis of disease of the central nervous

system and spinal cord.

Other Diagnostic Techniques

• Plain radiographs : No assessment of spine is complete without radiographs.

Many causes of sciatic pain are associated with bony changes visible in

radiographs Roentgenograms of lumber spine (L4,L5,S1) in anteroposterior,

lateral and oblique planes gives differential diagnosis of narrowing of disc space,

spondylolisthesis, sclerosis of vertebral bodies, disc herniations, prolapse etc.

• Myelography : Myelography is radiography after injection of an opaque

substance into the lumber spinal subarachnoid space, usually at the L2-L3 level.

The purpose is to outline the spinal cord and nerve root in order to demonstrate

pathological lesions such as lesions or fissuring of annulus, cyst on sacral nerve

roots etc. It is obviously contraindicated if lumber puncture is contraindicated

Epidurography can be done for the diagnosis of intraspinal lesions not visualized

by conventional myelography. Discography may be done by injecting contrast

medium directly into the intervertebral disc but it is pain-provocating, carrying

risk of damage and infection. Also it is difficult to interprete.

• C.T. Scan : An important advance in radiological investigation of post fossa and

spinal lesions, from syringomyelia to lesions of the lumbosacral nerve roots and


53

Historical Review

cauda equina, has been the combination of CT scan with myelography using a

non-ionic water soluble medium such as iohexol. Reconstruction techniques can

be used to outline the spinal cord and nerve roots with a precision hitherto

impossible.

• MRI : MRI has several advantage over CT scanning in the assessment of cervical

and lumbosacral spines. No ionising radiations involved and intradural soft

tissue lesions can be visualized without the need for intrathecal contrast.

• Procaine Injection Test : Disappearance of the pain following local injection of

procaine or lidocaine into the tender spot is both diagnostic and therapeutic of

fibrositic pain.

• EMG: Electromyographic studies help to confirm the presence of impaired nerve

functions. Selective muscle degeneration can be identified and can suggest the

nerve root responsible.

• Nerve conduction tests support a diagnosis of peripheral nerve entrapment of the

common peroneal nerve at the neck of the fibula and of the post tibial nerve in

tarsal tunnel syndrome.

• Radionuclide Bone Scanning : Bone scanning is currently used to investigate a

wide range of spinal disorders, both benign and malignant. It is a highly sensitive

method for demonstrating bone disease, often providing an earlier diagnosis and

demonstrating more lesions than are found on X-ray.

• Aortic arteriography, intravenous pyelography and barium enema may be

necessary to find out aortic aneurysm or pelvic or rectal pathology.


54

Historical Review

Differential diagnosis 174

Differentiation in sciatica is made on the basis of variety of

aetiopathological events, which cause compression over nerve roots or sciatic nerve.

Table No: - 5

Showing the differential diagnosis in sciatica

No Disease / condition

Age In

yrs.

Location of pain

Quality of pain

Aggravating / relieving factors

Signs

1.

Back strain

20-40

Low back, buttock posterior thigh

Ache, spasm

Increased with activity or bending

Local tenderness, limited spinal motion.

2.

Acute disc herniation

30-40

Low back to lower leg

Sharp, shooting or burning pain, parasthesia in leg.

Decreased with standing; increased with bending or sitting

Positive SLR test, weakness, asymmetric reflexes.

3.

Spondylolisthesis

Any age

Back, posterior thigh

Ache

Increased with activity a bending

Exaggeration of lumbar curve, palpable ‘step off’ tight hamstring

4.

Ankylosing spondylitis

15-40

Sacro iliac joints, lumbar spine

Ache

Morning stiffness

Decreased back motions, tenderness over sacroiliac joints.

5.

Infections

Any age

Lumbar spine, sacrum

Sharp pain, ache

Varies

Fever, percussive tenderness; may have neurologic abnormalities or decreased motion.

6.

Malignancy

>50

Affected bone(s)

Dull ache, throbbing pain, slowly progressive

Increased with recumbency or cough

May have localized tenderness neurologic signs or fever.


55

Historical Review

Treatment: 175

The treatment is of two types –

1. Conservative Treatment

2. Surgical Treatment

Conservative Treatment

It is important to know and convey to the patient that the pain in the lower back is

very common. It can be related to certain activities, poor posture, physical stress, or

psychological stress. 90% of back pain patients improve within 4-6 weeks. Reassure

patient that 70% of acute patients will improve within 2 weeks and 90% of acute patients

will improve within 4 weeks.

Rest –

(a) Bed rest (supine position) with pillow under the knees/ Semi fowler position for 2-3

days.

(b) Modification of activities: No lifting of weights or bending forwards.

(c) Braces – Reminds the patients to be cautious, increases intra-abdominal pressure,

which in turn supports the lumbar spine. Simple abdominal corset may be used

temporarily. Discontinue as soon as possible as it encourages muscle wasting.

(d) Traction is not recommended anymore as a means of treatment. However may help

restricting the patient to the bed and to relieve musle spasm. Commonly used techniques

are:

(1) Continous traction in the hospital

(2) Intermittent in the physical therapy


56

Historical Review

The amount of weight required to affect the disc space is at least 25% of the body weight.

It is important to add counter-traction.

(e) Analgesics – Non-narcotics & Narcotics.

Non-narcotics: acetaminophen, ibuprofen, diclofenac, piroxicam, etoricoxib etc.

Narcotic analgesics. Codeine, propoxyphene, tramadol, morphine.

Muscle relaxants are sometimes helpful for a few days but can cause drowsiness.

Antidepressants: Are helpful but need to be mentioned for side effects and drug

interactions.

Cold and hot therapies – ice packs, superficial heat (packs/ infra red), deep (Ultrasonics

and SWD).

Injections – Epidural cortisone- It is a combination of a long –acting steroid with an

epidural anesthetic ,is a method of symptomatic treatment of leg and back pain from

discogenic diseases. Fluoroscopy control enhanced success rate. Not proved to be

effective in the treatment of acute radicular pain – useful in the management of chronic

pain of spinal stenosis. Minimum of 6 weeks of conservative treatment is recommended

for lumbar degenerative conditions.

Activity Recommendations to prevent recurrence:

Patients with acute low back pain should be advised to stay active and continue ordinary

daily activity within the limits permitted by the pain. For patients with chronic back pain,

there is evidence that exercise therapy is effective. A gradual return to normal activities is

more effective and leads to more rapid improvement. Continue routine activity while

paying attention to correct posture. Patients with acute low back problems may be more

comfortable if they temporarily limit or avoid specific activities known to increase


57

Historical Review

mechanical stress on the spine, especially prolonged unsupported sitting, heavy lifting

and bending or twisting the back especially while lifting.

Low stress aerobic exercise can prevent debilitation due to inactivity during the

first month of symptoms and thereafter may help to return patients to the highest level of

functioning appropriate to their circumstances. Aerobic (endurance) programs, which

minimally stress the back (walking, biking, or swimming), can be started during the first

2 weeks for most patients with acute low back problems. Conditioning exercise for trunk

muscles (especially back extensors) gradually increased, are helpful for patients with

acute low back problems, especially if symptoms persist. During the first 2 weeks these

exercises may aggravate the symptoms since they mechanically stress the back more than

endurance exercise. These exercises should not be forced in the face of increased pain.

Surgical disc removal*- Indications for Surgery 176

Mandatory and Urgent indication-

Cauda Equina syndrome with neurologicalinvolvement.

Elective indication-

• Failure of conservative treatment, trial of at least six weeks.

• Progressive or severe neuro-motor deficit.

• Persistent neuro-motor deficit > 4-6 weeks of conservative treatment

• Chronic Sciatica with positive SLR 4-6 weeks

*Disc surgery is not a cure, only provides symptomatic reliefof leg pain, it does not

restore the normal state.


58

Historical Review

Active exercise is important for sciatica relief 177

Although it may seem counterintuitive, exercise is usually better for healing sciatic pain

than bed rest. Patients may rest for a day or two after their sciatica flares up, but after that

time period, inactivity will usually make the pain worse. Without exercise and

movement, the back muscles and spinal structures become deconditioned and less able to

support the back. The deconditioning and weakening can lead to back injury and strain,

which causes additional back pain. Exercise is also important for the health of the spinal

discs. Movement helps exchange nutrients and fluids within the discs to keep them

healthy. Many sciatica exercises focus on strengthening the abdominal and back muscles

in order to give more support for the back. Stretching exercises for sciatica target muscles

that cause pain when they are tight and inflexible. When patients engage in a regular

program of gentle strengthening and stretching exercises, they can recover more quickly

from a flare up of sciatica and can help to prevent future episodes of pain.


59

MAHAMASADI TAILA Table no. 6 - showing the properties of ingredients of Mahamasadi taila Sl. No

Name Latin name Rasa Virya Vipaka Guna Doshaghnata Karma & Rogaghnata

1 Masha193 Phaseolus mungo

Madhura Ushna Madura Guru,Snigdha

Vata shamaka Shoolahara, balya, pakshagata, gridrasi

2 Dugda 194 Madhura Sheeta Madura Snigdha Tridosahara Brimhana, Vrishya,Balya. Vataroga, Swasa, Kasa, Pandu, Daha.

3 Tila taila195 Sesamum indicum

Madhura,Katu,Tikta, Kashaya

Ushna Madura Guru Vatanashaka Vrana,Shotha, Kushta,Vata vyadhi.

4 ChagaMamsa196

Madhura Naatisheeta

NaatiguruNaati snigda

Tridosahara Bruhmana, raktapittahara, peenasahara.

5 Manjista197 Rubia cardifolia

Madhura Tikta

Ushna Katu Guru Kapha pittanashaka

Kushta, Raktatisara, Raktaja vikara

6 Chaya198 Piper retrofractum

Katu Ushna Katu

Laghurooksha

Kaphavatha shamak

Deepana, pachana, krimignha

7 Chitraka199 Plumbago zeylanica

Katu Ushna Katu

Laghurooksha teekshna

Kaphavatha shamak

Deepana, pachana, krimignha,shothahas (yakritplecharoga) jeernapratishyayahara

80

8 Katphala200 Myrica esculenta

Kashaya, Tikta, Katu

Ushna Katu Laghu,Tikshana

Kapha Vatahara

Shootahara, Krimigna, Shoolahar, pakshagata, gridrasi

9 Shunti201 Zingiber officinale

Katu Ushna Madura Laghu,Snigdha, Guru

Kapha-vata hara

rochana, rakta shodhaka, srotovishodhaka

10 Marica202 Piper nigrum

Katu Ushna Katu Laghu,Teekshna

Kapha-vata hara

krimigna, deepana, pachana

11 Pippali203 Piper longum

Katu Anushnasheeta

Madura Laghu,Snigdha, Teekshna

Kapha-vata hara

mridu rechaka, kushtagna, deepana, yakrit uttejaka

12 Pippalimula204 Root of Piper longum

Katu Anushna MaduraSheeta

Laghu Snigdha

Kapha Vataghna

Deepana, Truptighna, Vatanulomana, Mridu rechana, Rasayana, Balya

13 Rasna205 Pluchea lanceolata

Katu Ushna Katu Guru Kaphavatashamaka

Vedanasthapana Amapachana Rasayana

14 Amalaki206 Emblica officinalis

Amlapradhanapancharasa lavana rahita

Sheeta Madura GuruRuksha Sheeta

Tridosha hara Rochana, deepana anulomana rasayana

15 Gokshura207 Tribulus terrestris

Madhura Sheeta Madhura Guru,Snigdha

Vata-Pitta shamaka

Ashmarinashana, Mutrala, Bastishothahara

16 Athmagupta208 Mucuna prurita

Madhura, Tikta

Ushana Madhura Guru,Snigdha

Vatashamaka Brumana, shoolahara

81

17 Eranda209 Ricinus cumminus

Madhura, Katu, Kashaya

Ushna Madhura Snigdha,Teekshna,Sookshm

Kapha-Vata shamaka

Mutravishodhaka

Shothahara, Krimigna

18 Shataavha210 Anethumsowa

Katu Tikta

Ushna Katu Laghu Ruksha Teekshna

Kaphavata Shamaka

Rochana, deepana, pachana anulomana shothahara

19 Saindhavalavana211

Madhura,Lavana

Sheeta Madhura Laghu,

Snigda,

Sukshma

Tridosha Shamaka

Deepana,Pachana,Rechana,Ruchikara, Hridya,

Chakshushya

20 Vida212 Kshara

Katu

Ushna Katu Ushna,

Tikshna,Suksma,

Vyavahi

Deepana,

Rochana, Vatanulomana, Hridya

21 Suvacchal213 Katu Ushna Katu Vishada Laghu

Sukshma

Pachana,RochnaBhedana, Hridya Vatanulomana

22 Ashwaghanda214 Withania somnifra

Katu, Tiktha, Kashaya

Ushna Madhura Laghu,Snigda

Kaphavata shamaka

Balya, Hridroga, Ksaya, Shoosa

23 Amruta215 Tinospara cardifolia

Tikta Kashaya

Ushna Madhura GuruSnigdha

Tridosha shamaka

Vedanasthapana, Trishnanigrahana anulomana, jwaragna rasayana

24 Yavani216 Trachyspermum ammi

Katu, Tiktha Ushna Katu Laghu,Ruksh,Thikshna

Kaphavatahara Deepaniya, Hrudya,Shoola hara

82

25 Vacha217 Acorus calamus

Katu Tikta

Ushna Katu LaghuTeekshna

Kapha Vata shamaka

Raktabhara shamaka, Vatahara, Medhya, Nidrajanana, Manovikara hara

26 Shati218 Hedychium spicatium

Katu, Tikta, Kashaya

Ushna Katu LaghuTeekshna

Kapha Vata shamaka

Vatahara, Medhya, Nidrajanana, Manovikara hara

27 Amalaki219 Emblica officinalis

Lavanavarjita pancharasa (Amlpradhan)

Sheeta Madhura Guru Ruksha Sheeta

Tridoshahara (Pitta shamaka)

Hridya,Shonitasthapana, Rasayana, Mutrala

28 Mudgaparni220 Phaseblus trilobus

Madura, Tikta Sheeta Madhura Laghu, Rookha

Vata pittagna Vataroga,Shota, Deepaneeya & Grahi

29 Masaparni221 Teramnus labialis

Madura, Tikta Sheeta Madhura Laghu, Rookha

Vata pittagna Vatanuloma, Deepaneeya, Shoota

30 Jeevanti222 Leptadenia reticulata

Madura, Sheeta Madhura Laghu,Rookha

Vata pittagna Vatanuloma, Rasayana

31 Maduka223 Glycyrhiza glabra

Madura, Sheeta Madhura Guru,snighda

Vata pittagna Vatanuloma,Nadi daurbalya

83

Dashmoola – Table no. 7 - showing the properties of ingredients of Dashmoola No. Name Latin name Rasa Virya Vipaka Guna Doshaghnata Karma & Rogaghnata 1. Bilwa224 Aegle marmelos Kashaya,

Tikta Madhur Ushna Katu Laghu,

Ruksha Vata, Kapha Balya, dipan, pachana

2. Gambhari225 Gmelina arborea Tikta, Kashaya, Madhur

Ushna Madhur Guru Tridoshashamak Deepan, pachan,medhya, shothahara, shoolahara

3. Patala226 Stereospermum suaveolens Tikta, Kashaya

Ushna Katu Laghu,Ruksha

Tridoshashamak Shothahara, shwasa,aruchi, hikka

4. Agnimanth227 Premna integrifolia Tikta, Katu Kashya, Madhur

Ushna Katu Laghu,Ruksha

Kaphavatashamak Deepan, pachan,shothahara, anulomana

5. Shyonaka228 Oroxylum indicum Tikta, Kashaya

Sheeta Katu Laghu,Ruksha

Tridoshashamak Deepan, grahi, kasa, atisara, aruchi

6. Shalaparni229 Desmodium gangeticum Madhur, Tikta

Ushna Madhur Guru,Snigdha

Tridoshashamak Vrushya, brihana,rasayana, shothahara, jwara, daha

7. Prishniparni230 Uraria picta Madhur, Tikta

Ushna Madhur Laghu,Snigdha

Tridoshashamak Deepan, Vrushya, Daha, Jwara, Shwasa.

8. Brihati231 Solanumindicum Katu, Tikta Ushna Katu Laghu,Ruksha, Tikshna

Kaphavatashamak Grahi, pachan, shoola, shwasa, kushtha

9. Kantakari232 Solanum xanthocarpum Tikta, Katu Ushna Katu Laghu, Ruksha

Kaphavatashamak Sara, deepan, pachan kasa, shwasa, parshwashoola

10. Gokshura233 Tribulus terrestris Madhura Sheeta Madhur Guru, Snigdha

Vatapittashamak Balya, deepan, ashmari, prameha, shwasa, kasa.

84

Methodology

Methodology

Ayurveda is a science with ageless concrete fundamentals and with a

holistic approach. Some centuries ago, Ayurveda was the main stream in the

society. Various factors such as the attack on India by foreigners etc. made

Ayurveda to lag behind in the race. It became alternative system of medicine. But

now, people have started realizing advantages of it over other systems of

medicine. Efforts are being made to rejuvenate this science. For revival and

progress of any science, research is an essential practice. Research is the process

of finding out the old hidden facts and from old theories and concepts, also

discovering new facts.

The therapeutic measures, drugs and procedures of Ayurveda have

remained in the practice since long on the basis of methodology prevalent in

ancient times. This is the time that the rationality of Ayurvedic therapeutic

approach is explained on modern scientific lines. Clinical trial is a way of

research and its best method to evaluate any drug or line of treatment. The trial is

a carefully designed experiment with the aim of solving unrewarding problems

conducted on scientific line and is the only way to achieve the objectives.

Research Approach.

Experimentation is the most powerful research approach. In the

present study, the objectives are to ‘Evaluate the efficacy of Punarnavadi guggulu

in the management of Gridhrasi with special reference to Sciatica’ & to ‘Evaluate

the efficacy of Mahamasadi taila kati basti in the management of Gridhrasi with

special reference to Sciatica’. The efficacy can be determined by finding out the

difference between the baseline data and after follow up data.

Evaluation Of The Efficacy Of Punarnavadiguggulu & Mahamashadi Taila Kati Basti In The Management Of Gridhrasi (Sciatica

60

Methodology

Source of data:

a. Patients suffering from Gridhrasi will be selected from PG S&R PG O.P.D

of DGM Ayurvedic medical college and hospital by pre-set inclusion and

exclusion criteria.

b. Trial Drug: Orally - Punarnavadi guggulu, & Katibasti – Mahamasadi taila

c. Method of collection of Data:

1. Study Design: The study design set for the present study is ‘Prospective

clinical trial’. The study was done in double group.

2. Sample Size: A minimum of total 30 patients of Gridhrasi disease will be

the sizes, which are made of 2 groups.

a. Group A: A minimum of 15 patient of Gridhrasi disease will be

treated by PUNARNAVADI GUGGULU orally.

b. Group B: A minimum of 15 patient of Gridhrasi will be treated by

Mahamasadi.thaila Kati basti.

3. Selection Criteria :

Patients suffering from Gridhrasi were selected from the Post-

graduation and Research Center OPD of D.G.Melmalagi Ayurvedic Medical

College Hospital, Gadag. The criteria for inclusion and exclusion are as follows.

a. Inclusion Criteria:

1. Presence of clinical features of Gridhrasi.

2. Patient with back pain radiating to thigh, foot.

b. Exclusion Criteria:

1. Patient below 18 and above 60 years of age.

2. Patient with other systemic disorders and malignancy.

3. Degenerative disorders with marked deformity.

4. Pregnant women and lactating mother.


61

Methodology

5. History of major trauma causing fractures.

6. Patient of Cauda equina syndrome and other Surgical

Emergencies.

4.Posology:

1. Punarnavadi guggulu taken orally : 3 grams in divided

doses.

Anupana : Hot water

2. Katibasti by Mahamasadithaila : qs

5.Study Duration:

• 30 - days medicine given orally and follow-up for 30 days

• 14 - days of kati basti and follow-up for 30 days.

6.Data Collection

Patients selected were thoroughly examined by both subjective

and objective parameters. Detailed history and physical examination findings

were noted. Laboratory and radiological investigations such as a complete blood

count, ESR, RBS, Urine routine along with X-ray AP and Lateral views of

lumbosacral regions were done, to exclude and include in the study.

7.Assessment of Result:

Subjective and objective parameters of base line data to post medication

data comparison are used for assessment of results.

i. Subjective Parameters:

As designated in the classical ayurvedic and modern texts.

Method of assessment of Grading:

The assessment of results, by observing the severity of symptomatology.

The severities of the symptoms are assessed before and after the treatment.


62

Methodology

Grading of parameters:

The results were evaluated by observing subjective and objective

parameters by grading method. The grading was done in the following manner.

SUBJECTIVE PARAMETERS:

A) Ruk (pain) -

The grading for the pain was given on the basis of Visual Analogue Scale

(VAS)178. Scale of 0 to 10, with 10 indicating most severe pain (visual analogue

scale, VAS).

Scale

No Pain 0 1 Mild, annoying pain 2 3 Nagging, Uncomfortable, 4 Troublesome pain 5 Distressing, miserable pain 6 7 Intense, dreadful, horrible pain 8 9 Grade 0 - No pain - No Pain

Grade 1 - Trival pain - Mild, annoying pain

Grade 2 - Mild pain - Nagging, Uncomfortable, Troublesome

pain Grade 3 - Moderate pain - Distressing, miserable pain

Grade 4 - Severe pain - Intense, dreadful, horrible pain

B) Sthambha (Stiffness)

Grade 0- No stiffness

Grade 1- With up to 25% impairment in the range of movement of joints. Patient

can perform daily routine work without any difficulty.

Grade 2 – With 25-50% impairment in the range of movement of joints. Pt has

moderate to severe difficulty in performing daily routine.


63

Methodology

Grade 3 – With 50-75% impairment in the range of movement of joints. Pt has

moderate to severe difficulty in performing daily routine.

Grade 4 – With more than 75% impairement in the range of movements of the

joints patient totally unable to perform daily routine.

C) Toda (Piercing pain)

Grade 0- Absent

Grade 1 – Mild, occasionally in a day

Grade 2 – Moderate, after movement, daily frequent not persistent.

Grade 3 – Moderate, after movement, daily frequent and persistent.

Grade 4 – Severe, persistent

Objective Parameters:

1. SLR Test: is assessed as positive at 00 to 900 with pain, negative at 900 (without

pain)

Grade 0 - up to 900 with out pain.

Grade 1 - up to 900 with pain.

Grade 2 - can be raised more than 400 with pain.

Grade 3 - cannot be raised more than 400 with pain.

2. Movements of lumbar spine:

1. Forward Flexion :Assessed by measuring the distance between the tip

of middle finger and floor in cms.

2. Rt. Lat Flexion :Assessed by measuring the distance between the tip

of right middle finger and floor in cms

3. Left Lat flexion :Assessed by measuring the distance between the tip

of left middle finger and floor in cms.


64

Methodology

3. Walking time - to cover 21 meters

Grade 0 - upto 20 sec

Grade 1 - upto 21-30 sec.

Grade 2 - upto 31-40 sec

Grade 3 -upto 41-50 sec.

Grade 4 - upto 51-60 sec.

9. Investigation for Exclusion:

3. X-ray of lumbo-sacral region with anterior-posterior and lateral

views

4. Hb%

5. Total WBC count

6. Differential count

7. Erythrocyte sedimentation rate

8. RBS

9. Urine routine examination

10. Overall assessment

Good relief - 100% relief

Marked response - more than 75% relief in signs and symptoms.

Moderate response - 50-75% relief in signs and symptoms.

Mild response - Below 50% relief in signs and symptoms

Not relief - No relief.


65

Methodology

Drug Review

PUNARNAVADI GUGGULU

Punarnava179

Latin name : Boerhaavia diffusa

Family : Nyctagineae

Synonyms : Punarnava, Shothaghni

Gana : Ca-Vayah sthapana, Kasahara, Anuvasanopaga

Su- Vidarigandadi

Rasa : Madhura, Tiktha, Kashya

Guna : Laghu, Ruksha

Virya : Ushna

Vipaka : Madhura

Doshaghnata : Tridoshahara

Parts used : Moola, Beeja, Panchanga

Karma : Dipaneeya, balya,

Rogaghnata : Shootagna, Pandu, Shoolahara

Chemical Composition:

Punarnavine, Patassium nitrate, Sulphur, Chloride, Nitrate

Action and Uses:

It is bitter, Stomatic, laxative, diuretic, expectorant, diaphoretic & emetic.

Root is purgative, anthelmintic & febrifuge. Juice of the leaves is used in hepatic

disorders of jaundice, with honey.

Eranda180

Latin name : Ricinus communis

Family : Euphorbiaceae


66

Methodology

Synonyms : Urubuka, Gandharvahasta, Vatari, Snehaprada.

Gana : Ch.: Bhedaniya, Swedopaga, Angamarda prashamana,

Madhurskandha.

Su : Vidarigandhadi, Adhobhagahara, Vatasamshaman.

Rasa : Madhur, Kashay, Katu

Guna : Guru, Snigdha, Tikshna, Sukshma

Virya : Ushna

Vipaka : Madhur

Prabhav : Vatahara

Doshaghnata : Vatakaphaghna

Karma : Dipan, Vrushya, Shoolaghna, Shothaghna, Adhobhagadoshahara.

Rogaghnata : Vatarakta, Gulma, Hridroga, Jirnajvara, Gridhrasi, Pakshaghata.


Castor oil consists of the glycerides of ricinolecis, isoricinoleic, stearic and

dihydroxy-stearic acids (Wallis 1967)

Action and Uses:

Root and root bark is recommended as a fabrifuge, purgative in nervous

diseases, rheumatic affections such as lumbago and sciatica. (Pharmacognosy-

CCRAS) Banerjee et al (1978) have also reported that apart from its purgative

action, the plant possesses efficacy in chronic rheumatic affections. After oral

administration, it is converted into ricinoleic acid by the pancreatic lipase, which

irritates the bowel, stimulates the intestinal glands and muscular coat to cause

purgation. It acts in 4 to 5 hrs causing liquid stools without gripping pain.

Use of erandtaila in vatavyadhies specially katishla, prishthashoola,

Gridhrasi, Sandhishoola is praised by the Acharyas. Erandtaila with its snigdha,

guru and ushna guna pacifies vata and thus vatavyadhies. With its tikshna,


67

Methodology

sukshma guna, katu, rasa and ushna virya it mitigates kapha dosha. Also when

vata is vitiated due to avarana of kapha, in such conditions also erand taila is

useful as it does both the functions i.e. removes the avarana and pacifies vata.

Erandtaila scrapes out the tridoshas as well as malas accumulated in pakwashaya

by sransana karma. Erand taila is both snigdha and ushna, thus has pachan and

snehanakarma. It is seen that most of the substances which perform the pachan

karma are not snigdha but erandtaila is utilized for both virechana and amapachan

property.

Neurons are made up of myelin sheath, 65% to 85% water, 16.5% grey

matter, 30% white matter. The grey matter consists of nucleoproteins. These

proteins are fatlike substances and are more abundant in non-medullated. In view

of Ayurveda, these are noting but substances having snigdha, guru, picchila etc.

gunas. Defeciency of these nucleoproteins may lead to demyelination. Such

degenerative changes in sciatic nerve cause sciatica. Hence administration of

snigdha dravyas like errand taila may provide nourishment to nervous tissue,

establishing the equilibrium of neucleoproteins. Thus process of demyelination

can be checked.

So, erandtaila is helpful in breaking down the pathology of Gridhrasi in

view of both Ayurvedic and modern medicine.

Shunthi181

Latin name : Zingiber officinale

Family : Zingiberaceae

Gana : Ch.: Truptighna, Arshoghna, Deepaniya, Shoolaprashamana,

Sheetaprashamana,Trishna Nigrahana.

Su.: Pippalyadi, Trikatu


68

Methodology

B.P. Panchkola, Shadushana

Synonyms : Vishwa, Nagar, Shrungavera, Katubhadra

Rasa : Katu

Guna : Laghu, Snigdha

Virya : Ushna

Vipaka : Madhur

Doshaghnata : Kaphavataghna

Part Used : Dried Vhizome

Karma : Pachan, Ruchya, Shothaghna, Shoolaghna,Anulomana.


Camphene, Phellandrene, Zingiberine, Cineol and borneol, ginerol.

Gingerin is the active principle. Other resins and starch, K-Oxalate are also

present (M.M.)

Action and Uses:

It is aromatic, carminative, stimulant to the gastrointestinal tract and

stomachic. It removes viscid matter, strengthens memory, and removes

obstruction in the vessels. It is used is nervous diseases, incontinence of urine.

Shudda Guggulu182

Latin name : Commiphora mukul

Family : Burseraceae

Synonyms : Guggulu, Devagupta, kaushika, Pura, Mahishaaksha, Palmkasa,

Kumba, Ullukhala

Gana : Su - Eladigana

Rasa : Tiktha, Katu

Guna : Laghu, Ruksha, Vishada, Suksma, Sara, Sugandhi - Purana

Guggulu


69

Methodology

Snigda – Pichila – Naveena Guggulu

Virya : Ushna

Vipaka : Katu

Prabava : Tridosha hara

Doshaghnata : Tridosha hara

Parts used : Niryasa

Karma : Vedanastapaka, Rasayaniya

Rogaghnata : All Vata vikaras.


Volatile oil, Gum – resin & Bitter principle

Action and Uses:

It acts as dipanam, ruksham, balyam, rasayanam, vrishyam,

bhagnasanthana karam. It is used in vranam, apachi, arasa, granti, skin diseases &

in vata vikaras.

Trivruth choorna183

Latin name : Operculina turpethum

Family : Convolvuaceae

Synonyms : Nishota, Trivruth, Triputa, Tribandi, Sarala, Suvaha, Rechani

Gana : Ca – Bedaniya

Su – Adobagahara, Syamadi

Rasa : Tikta, Katu

Guna : Laghu,Ruksha,Teekshna

Virya : Ushna

Vipaka : Katu

Doshaghnata : Kapha-Pittahara

Parts used : Bark of root


70

Methodology

Karma : Bhedana,Rechana,Lekhana,Jwaragna,Shothahara

Rogaghnata : Anaha, Vibhanda, Arasa’s, Udararoga, etc,.


Turpethin, vol.oil, glycosoides

Action and Uses:

As it is rechaka it used in Virechanakarma, it relives Jeerna anaha,

Vibhanda, & used in the diseases as Aras’s, Udara roga, Amavata, Vatarakta,

Shoota etc,.

Nikumba choorna184

Latin name : Baliospermum monantum

Family : Euphorbiaceae

Synonyms : Danti, Udumbara, Erandaphala, Shigra, Nikumba, Pratyakshani

Gana : Ca – Virecana, Mulini, Mulasava

Su - Adobhagahara

Rasa : Katu

Guna : Guru,Teekshna

Virya : Ushna

Vipaka : Katu

Doshaghnata : K-P

Parts used : Leaves,Seedf,Root

Karma : Teekshnavirechaka,Shothahara,Jwaragna,Ashmarinashana

Rogaghnata : Shootahara, Shoolahara,

Action & Uses:

By doing lepa of Dantimula, it relives Shoota, Shoola etc,. The oil of beeja

is used as abhyanga in Vata vyadhi.


71

Methodology

Guduchi185

Latin name : Tinospora cordifolia

Family : Menispermaceae

Synonyms : Amrita, Madhuparni, Chhinna, Rasayani

Gana : Ch - Vayasthapana, Dahaprashaman, Trishnanigrahana,

Stanyashodhan, Truptighna.

Su.:Guduchyadi, Patoladi, Aragvadhadi, Kakolyadi,

Vallipanchmoola

Rasa : Tikta, Kashaya

Guna : Laghu, Snigdha

Virya : Ushna

Vipaka : Madhur

Doshaghnata : Tridoshashamak

Parts used : Stem

Karma : Rasayan, Dipan, Balya, Samgrahi

Rogaghnata : Jvara, Pandu, Kushtha, Vatarakta, Krimi


Giloin, a glycoside, Gilenin a non-glycoside and Gilosterol are found in

stem. Presence of bitter principles of columbin, chasmonthin and palmarin in the

drug has been reported (Chopra et al 1958). Tinosporin, tinosporic acid and

tinosporal have been reported in the stem. (Anon 1976)

Action and Uses:

Guduchi is considered as bitter tonic, astringent, diuretic and a potent

aphrodisiac. Its use has been indicated in heart diseases, hypertension and

rheumatoid arthritis.


72

Methodology

The drug has been observed to relax smooth muscles of intenstine, uterus and

inhibit constrictor response of histamine and acetylcholine on smooth muscles

(Gupta et al, 1967). The drug has proved to be effective as antirheumatic and

diuretic as well as having anti-inflammatory properties. (Rai and Gupta, 1966).

The drug is reported to possess one fifth of the analgesic effect of sodium

salicylate.

Trikatu

Maricha186

Latin name : Piper nigrum

Family : Piperaceae

Synonyms : Maricha, Vellaja, krushna, Ushana, Suvruta

Gana : Ca – Dipaniya, Sulaprasamana, Krumigna, Sirovirecana

Su – Pippalyadi, Tryushana

Rasa : Katu

Guna : Laghu, Teekshna

Virya : Ushna

Vipaka : Katu

Doshaghnata : Kapha-Vathara

Parts used : Black pepper

Karma : Deepana,Pachana,Krimigna,Kushtagna,Jwaragna

Rogaghnata : Agnimandya, Ajeerna, Switra, Kilasa, Pama, etc


Piperine,Piperidine,Chavicin,Lignin,Gum Volatile oil


73

Methodology

Action and Uses:

Pepper is acrid, pungent, hot, carminative, also used as Dipaniya.

Externally it is rubefacient & stimulant to the skin & resolvent. It acts on Swasam,

Soolam, Krimi, etc,.

Pippali187

Latin name : Piper longum

Family : Piperaceae

Synonyms : Pippali, Trikana, Tikshnatandula, Maghadhi, Vaidehikana

Gana : Ca - Kasahara, Hikkanigrahana, Sirovirechana, Vamana,

Truptigna, Dipaniya, Shoolaprashama

Su – Pippalyadi, Urdvabaghahara, Sirovirecaniya

Rasa : Katu

Guna : Laghu,Snigdha,Teekshna

Virya : Anushna shita

Vipaka : Madhura


Parts used : Fruit, Leaves, Root, bark

Karma : Pachana,Medhya,Triptigna,Kasahara,Rakta shodhaka

Rogaghnata : Vatahara, Shoolahara, Kasahara, Swasa hara, Kustagna


Embelicacid,Tannin,Christembine,

Action and Uses:

Infusion is stimulant, carminative & alterative tonic also aphrodisiac,

diuretic, vermifuge & emmenagogue. Root is stimulant.


74

Methodology

Chitraka188

Latin name : Plumbago zeylanica

Family : Plumbaginaceae

Synonyms : Chitraka, Agni - shikha

Gana : Ca – Dipaniya, Truptigna, Sulaprasamana, Bedaniya, Arasogan,

Lekaniya, Katukaskanda

Su – Pippalyadi, Mustadi, Amalakyadi, Mushkadi, Varunadi,

Aragvadaadi

Rasa : Katu

Guna : Laghu,Rukshna,Teekshna

Virya : Ushna

Vipaka : Katu


Parts used : Root

Karma : Deepana,Pachana,Grahi,Kantya,Twachya,Shothahara,Vajikar

Rogaghnata : Slipada, Switra, Vatavyadhi, Ajeerana, Udarashoola, Krimigna


Plumbagin, Protinage

Action and Uses:

Root increases the digestive power & promotes the appetite.


75

Methodology

Saindhav Lavana189

Latin name : Sodium chloride

Rasa : Lavana, Madhur

Virya : Sheeta

Vipaka : Madhur

Guna : Laghu, Snigdha, Sukshma

Doshaghnata : Tridoshaghna

Karma : Dipan, Pachan, Ruchya, Vrushya, Hridya.


Sodium Chloride : 62.85 %

Calcium Chloride : 0.53 %

Magnesium Chloride : 0.43 %

Sodium Bicarbonate : 0.74 %

Insoluble matter : 30.34 %

Action and Uses:

It is mainly used in aruchi, ajirna, vibandha and agnimandya. In small doses it is

highly carminative, stomachic and digestive. In large doses it is cathartic, in still

larger doses it is emetic. Saindhav plays the role of carrier and helps to act the

basti at deep level. It also helps in the pratyagama of basti in proper time.

Bhallathaka190

Latin name : Semecarpus anacardium

Family : Anacardiaceae

Synonyms : Bhallataka, Bhallatamu, Agnimukhi, Arushkara

Gana : Ca – Kustagna, Dipaniya, Mutrasangraniya

Su – Nyagrodaadi, Mustadi


76

Methodology

Rasa : Katu,Tikta,Kashaya

Guna : Laghu,Snigdha,Teekshna

Virya : Ushna

Vipaka : Madhura

Doshaghnata : Kapha-Vata

Parts used : Fruit

Karma : Kushtagna,Shothahara,Medhya,Vajikara,Swedajanana, Hrudya

Utyaja,

Rogaghnata : It is a best Rasayana. Shota, Kusta, Krimi, Gulma, Gridrasi, etc,.

Chemical Composition: Bhilawanol, Semecarpol

Action and Uses:

Juice of the pericarp & the oil are powerful escharotics. Oil is a powerful

antiseptic & cholagogue. Kernel is a good nutritive food, also appetizer, digestive

& carminative.

Vidanga191

Latin name : Embelia ribes

Family : Myrsinaceae

Synonyms : Vidanga, Vrishanasana, Chitra – tandula, Janthunashana

Gana : Ca – Krimigna, Truptigna, Shirovirecana

Su – Surasaadi, Pippalyadi

Rasa : Katu Kashaya

Guna : Laghu,Ruksha,Teekshna

Virya : Ushna

Vipaka : Katu

Doshaghnata : Kapha-Vatahara

Parts used : FruitLeaves RootBark


77

Methodology

Karma : Anulomana,Deepana,Pachana,Krimigna,Kushtagna,

Rogaghnata : Shoolahara, Krimigna, Kustagna,etc.


Embelicacid,Tannin,Christembine, Crystalline compounds of embolic acid

with Soda, Potash & Ammonia are obtained.

Action and Uses:

Fruits or dried berries (Seeds) are carminative, anthelmintic, stimulant &

alterative. Pulp is purgative. Fresh juice is cooling, diuretic & Laxative. So these

are used as shoolahara, krimigna etc.

Makshika dhatu192

Sanskrit name : Makshika

English name : Chalcopyrite

Rasa : Madhura, Tiktha

Guna : Snigdha, Guru

Virya : Sheeta

Dosagnata : Tridosha

Rogaghnata : Madhumeha, Pandu, Kustha, Jeerna jwara, etc.

Method of preparation of guggulu

Punarnava moola, Erandamoola & Shunti are made into yavakuta churna

and its kwatha is prepared. This kwatha is taken into lohapatra & sodhita guggula

is added and boiled over mandagni. While heating contents are stirred properply,

when guggulu completely gets dissolved in the above kwatha, little by little

eranda taila is added & stirred when the mass begins to solidify, add fine powder

of the prakshepaka dravyas and mixed well uniformly. The mass is then

transferred to a vessel with gritha lipta & then guggulu of 500mg are made.


78

Methodology

Method of preparation of taila

Masa & dasamula are prepared in to yavakuta curna & dissolved in

mentioned quantity of water in a kasaya patra and kept as it is for one night &

next day these contents are reduced into 1/4th quantity over madhyamagni

according to kwtha vidhi. Kwatha is filtered & kept ready. Ajamamasa is

collected & mixed with mentioned quantity of water till it gets reduced to 1/4th

part then mamsa ras is filtered and kept ready. Murchita tila taila is taken in a

sneha patra & heated over madhyamagni then already prepared kwatha is added &

mixed well, after that cows – milk is added. While adding kwatha etc.

dravadravyas. Kalka of above mentioned drugs are to be added and mixed well,

then taila is prepared according to tailapaka vidhi. After attaining paka pariksa,

sneha patra has to be taken out from the fire & taila is filtered immediately and

obtained taila is preserved.


79

Results

Observation and Results

In the present clinical study subjective and objective changes were

considered for the assessment of Ayurvedic management of Gridhrasi (Sciatica)

with Punarnavadi guggulu taken orally & Mahamasadi taila kati basti. Thirty

patients were selected for the study, and were divided into two groups viz. in

group A, 15 patients were administered with Punarnavadi guggulu taken orally &

in group B, 15 patients were given kati basti with Mahamasaditaila. All the

patients were assessed before and after the treatment. Both subjective and

objective changes were recorded according to the guidelines of proforma of case

sheet.

The data were collected as follows: -

1. Demographic data

2. Data related to etiological factors, type and duration of chief complaints.

3. Data related to subjective and objective parameters before and after

treatment.

4. Data related to incidence of disease.

5. Statistical analysis and assessment for response.


85

Table No. 8 Demographic data related to Evaluation of Punarnavadi guggulu in Gridrasi.

Sex Religion Occupation Eco. status Diet Vyasana Prakriti ResponseSl.

OPD Age

M F 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

1 3827 24 + + + + + + + +

2 3160 41 + + + + + + + +

3 3967 60 + + + + + + + +

4 4095 40 + + + + + + + + +

5 4090 55 + + + + + + + +

6 4164 30 + + + + + + + +

7 4238 55 + + + + + + + +

8 4242 42 + + + + + + + +

9 4508 40 + + + + + + + +

10 4495 50 + + + + + + + +

11 4646 24 + + + + + + + +

12 4675 43 + + + + + + + +

13 72 36 + + + + + + + + +

14 226 54 + + + + + + + + +

15 439 42 + + + + + + + +

1 – Hindu, 2 – Muslim, 3 – Christian, 4 – Sedentary, 5 – Active, 6 – Labour, 7 – Poor, 8 – Middle class, 9 – Highclass, 10 – Vegetarian, 11 – Mixed, 12 – Smoking, 13 – Tobacco, 14 – Alcohol, 15 – None, 16 – Vatapitta, 17 – Vatakapha, 18 – Kaphapitta, 19 – Marked response, 20 – Moderate response, 21 – Mild response.

86

Table No. 9 Demographic data related to Evaluation of Mahamasadi taila Kati basti in Gridrasi.

Sex Religion Occupation Eco. status Diet Vyasana Prakriti ResponseSl.

OPD Age

M F 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

1 3867 65 + + + + + + + + +

2 3972 41 + + + + + + + +

3 4094 59 + + + + + + + +

4 4181 45 + + + + + + + +

5 4201 28 + + + + + + + +

6 4664 55 + + + + + + + +

7 4611 35 + + + + + + + +

8 59 45 + + + + + + + +

9 81 65 + + + + + + + +

10 4728 35 + + + + + + + +

11 669 20 + + + + + + + +

12 962 55 + + + + + + + +

13 1008 30 + + + + + + + +

14 1030 33 + + + + + + + +

15 1238 45 + + + + + + + +

1 – Hindu, 2 – Muslim, 3 – Christian, 4 – Sedentary, 5 – Active, 6 – Labour, 7 – Poor, 8 – Middle class, 9 – Highclass, 10 – Vegetarian, 11 – Mixed, 12 – Smoking, 13 – Tobacco, 14 – Alcohol, 15 – None, 16 – Vatapitta, 17 – Vatakapha, 18 – Kaphapitta, 19 – Marked response, 20 – Moderate response, 21 – Mild response.

87

Table No. 10

Showing the Pain related chief complications of patients in the study. Group A On set Variety Nature Relieving factors Site Pain at Sl.No

A B C D E F G H I J K L M N O P Q R S T

1 + + + + + + +2 + + + + + + + +3 + + + + + + + +4 + + + + + + + + + +5 + + + + + + +6 + + + + + + + + + +7 + + + + + + + +8 + + + + + + + +9 + + + + + + + +10 + + + + + + + +11 + + + + + + + +12 + + + + + + + +13 + + + + + + + +14 + + + + + + + +15 + + + + + + + + A – Sudden, B – Gradual, C – Acute, D – Chronic, E – Local, F – General, G – Radiating, H – Rest, I – Pain relievers, J – Pressure, K – Lumbodorsal, L – Lumbar, M – Lumbo sacral, N – Spik, O – Kati, P – Prushta, Q – Uru, R – Janu, S – Jangha, T – Pada.

88

Table No. 11

Showing the etiological factors and chief complications of patients in the study. Group B

On set Variety Nature Relieving factors Site Pain at Sl.No

A B C D E F G H I J K L M N O P Q R S T

1 + + + + + + + +2 + + + + + + + +3 + + + + + + + +4 + + + + + + + +5 + + + + + + + +6 + + + + + + + +7 + + + + + + + +8 + + + + + + + +9 + + + + + + +10 + + + + + + + +11 + + + + + + + +12 + + + + + + + +13 + + + + + + + +14 + + + + + + + +15 + + + + + + + + A – Sudden, B – Gradual, C – Acute, D – Chronic, E – Local, F – General, G – Radiating, H – Rest, I – Pain relievers, J – Pressure, K – Lumbodorsal, L – Lumbar, M – Lumbo sacral, N – Spik, O – Kati, P – Prushta, Q – Uru, R – Janu, S – Jangha, T – Pada.

89

Results

Table no. 12- Distribution of patient according to age & sex among groups.

Group A Group B Age in Yrs

No. of Patient

%

M % F % M % F %

20-29 4 13.33% 1 6.66% 1 6.66% 1 6.66% 1 6.66% 30 -39 6 20% 1 6.66% 1 6.66% 1 6.66% 3 20% 40 -49 10 33.33% 2 13.33% 4 26.66% 0 0% 4 26.66% 50 -59 7 23.33% 2 13.33% 2 13.33% 3 20% 0 0% 60 -69 3 10% 1 6.66% 0 0% 2 13.33% 0 0% Above chart shows most of the patients were of age group of 40 – 49 yrs is of 10

(33.33%) in number. In that female patients were predominant in study i.e. 4

(26.66%) in group A & 4 (26.66%) in group B. Minimum number of patients

were of age groups of 60 – 69 yrs is of 3(10%) in number. In that 1(6.66%)

patient is male of Grade A & 2(13.33%) is in Group B.

Sex

7 7

8 8

6.57

7.58

8.5

No. of Patient No. of Patient

Group A Group B

No.

of P

atie

nt

MaleFemale

Age of the patient

1 1 1 11 1 1

32

4

0

4

2 23

01

0

2

0012345

No. of Patient No. of Patient No. of Patient No. of Patient

Male Female Male Female

Group A Group B

Num

ber o

f pat

ient

20 – 29 30 – 39 40 – 49 50 – 59 60 – 69


90

Results

Table no. 13 Distribution of patient according to occupation.

Group A Group B Occupation

No. of Patient % No. of Patient %

Sedentary 2 13.33% 2 13.33% Active 11 73.33% 12 80% Labour 2 13.33% 1 6.66% Others 0 0% 0 0%

Table shows among 15 patients in Group A, maximum are active 11(73.33%),

minimum 2(13.33%) was sedentary & rest 2(13.33%) are labours. In Group B

maximum patient were active 12(80%), minimum were labour 1(6.66%) & rest

2(13.33%) were Sedentary.

Distribution of patient according to occupation.

2

11

20

2

12

1 00

5

10

15

Sedentary Active Labour Others

Occupation

Num

ber o

f pa

tient

Group A No. of Patient Group B No. of Patient


91

Results

Table no.14 Distribution of patient according to Economical status

Group A Group B Economical status


Poor 2 13.33% 1 6.66% Middle class 13 86.66% 14 93.33% High class 0 0% 0 0%

Among 15 patient in Group A, maximum patient belongs to middle class,

13(86.66%) whereas no patients were of higher class & only 2(13.33%) patient

were of poor class. In Group B maximum patient belongs to middle class,

14(93.33%), where as no patient were of higher class & only 1(6.66%) were of

poor class.

Distribution of patient according to Economical status

2 1

13 14

0 00

5

10

15


Group A Group B

Groups

Num

ber o

f pat

iient

Poor Middle class High class


92

Results

Table no. 15 Distribution of patient according to Religion

Group A Group B Religion


Hindu 13 86.66% 14 93.33% Muslim 2 13.33% 1 6.66%

Christian 0 0% 0 0% Others 0 0% 0 0%

Among 15 patient in Group A maximum patient belongs to Hindu, 13(86.66%)

where as 2(13.33%) patients were of Muslim, Christians & other religions were

not reported in present study. In Group B maximum patient belongs to Hindu,

14(93.33%), where as 1(6.66%) patient is of Muslim, Christians & other religions

were not reported in present study.

Distribution of patient according to Religion

13 14

2 10 00 00

5

10

15


Group A Group B

Groups

Num

ber o

f pa

tient

s

Hindu Muslim Christian Others


93

Results

Table no. 16 Distribution of patient according to Diet

Group A Group B Diet


Vegetarian diet 12 80% 11 73.33% Mixed diet 3 20% 4 26.66%

In the above table it was observed that maximum patients were of Vegetarian diet,

12(80%) & 3(20%) were of Mixed diet in Group A. the maximum patients were

of Vegetarian diet, 11(73.33%) & 4(26.66%) were of Mixed diet in Group B.

Distribution of patient according to Diet

12 11

3 4

05

1015


Group A Group B

Groups

Num

ber o

f pa

tient

s

Vegetarian diet Mixed diet


94

Results

Table no.17 Distribution of patient according to type of Gridrasi

Group A Group B Type of Gridhrasi


Vataja 10 66.66% 4 26.66% Vatakaphaja 5 33.33% 11 73.33%

In the above table it was observed that maximum patients were of Vataja types,

10(66.66%) & 5(33.33%) is of Vatakaphaja in Group A. the maximum patient

were of Vatajakaphaja, 11(73.33%) & 4(26.66%) is of Vataja in Group B.

Distribution of patient according to type of Gridrasi

10

45

11

05

1015


Group A Group B

Groups

Num

ber o

f Pa

tient

s

Vataja Vatakaphaja


95

Results

Table no.18 Distribution of patient according to affected to leg of Sciatica.

Group A Group B Leg affected


Right 4 26.66% 6 40% Left 11 73.33% 9 60% Both 0 0% 0 0%

From above table it shows that among 15 Patient in Group A, maximum of

11(73.33%) patient presented with Sciatica to the Left legs, 4(26.66%) patients to

Right leg. In Group B maximum 9(60%) patients presented with Sciatica to left

leg, 6(40%) patients to right leg.

Distribution of patient according to affected to leg of Sciatica.

4 611 9

0 005

1015


Group A Group B

Groups

Num

ber o

f pa

tient

s

Right Left Both


96

Results

Table no.19 Distribution of patient according to Agni

Group A Group B Agni


Manda 3 20% 2 13.33% Vishama 8 53.33% 11 73.33% Teekshna 3 20% 2 13.33%

Sama 1 6.66% 0 0%


8(53.33%) patient presented with Vishama agni, 3(20%) patients were of Manda

& Teekshna agni & only 1(6.66) was of Sama agni. In Group B maximum

11(73.33%) patients presented with Vishama agni, 2(13.33%) patients were of

Manda & Teekshna agni.

Distribution of patient according to Agni

3 2

811

3 21 005

1015


Group A Group B

Groups

Num

ber o

f Pat

ient

s

Manda Vishama Teekshna Sama


97

Results

Table no.20 Distribution of patient according to Koshta

Group A Group B Koshta


Mridu 1 6.66% 1 6.66% Madhya 4 26.66% 8 53.33% Kroora 10 66.66% 6 40% Sama 0 0% 0 0%


10(66.66)% patient presented with Kroora kostha, 4(26.66%) patients were of

Madhya kostha, 1(6.66) was of Mridu kostha. In Group B maximum 8(53.33%)

patients presented with Madhya kosta, 6(40%) patients were of Kroora kostha &

1(6.66%) wass of Mridu kostha.

Distribution of patient according to Koshta

1 14

8106

0 005

1015


Group A Group B

Groups

Num

ber o

f Pa

tient

s

Mridu Madhya Kroora Sama


98

Results

Table no.21 Distribution of patient according to Position of work in patients.

Group A Group B Position of work


Sitting 13 86.66% 13 86.66% Standing 12 80% 10 66.66% Stooping 2 13.33% 0 0% Squatting 0 0% 0 0%


13(86.66)% patient presented with sitting position, 12(80%) patients were

presentment with standing position, 2(13.33) was presentment with Stooping

position. In Group B maximum 13(86.66%) patients presented with Sitting

position, 10(66.66%) patients were presented with Standing position.

Distribution of patient according to Position of work in patients.

13 1312 102 00 0

05

1015


Group A Group B

Groups

Num

ber o

f Pa

tient

s

Sitting Standing Stooping Squatting


99

Results

Table no.22 Distribution of patient according to Habits in patients.

Group A Group B Types of Habits


Smoking 5 33.33% 1 6.66% Tobacco 4 26.66% 2 13.33% Alcohol 0 0% 0 0%

None 9 60% 13 86.66%


9(60%) patient were not having any habits, 5(33.33%) patients were having of

Smoking habits, 4(26.66%) were having Tobacco eating habits. In Group B

maximum of 13(86.66%) patients were not having any habits, 2(13.33%) were

having Tobacco eating habits, & 1(6.66%) was having Smoking habits.

Distribution of patient according to Habits in patients.

51

4 20 0

913

05

1015


Group A Group B

Groups

Num

ber o

f Pa

tient

s

Smoking Tobacco Alcohol None


100

Results

Table no.23 Distribution of patient according to Prakriti of patients.

Group A Group B Prakriti


Vatapitta 7 46.66% 7 46.66% Vatakapha 6 40% 6 40% Kaphapitta 2 13.33% 2 13.33%

From above table it shows that among 15 Patient in Group A & Group B,

maximum of 7(46.66)% patient were of Vatapitta prakriti, 6(40%) patients were

patient were of Vatakapha prakriti & 2(13.33%) patient were of Kaphapitta

prakriti.

Distribution of patient according to Prakriti of patients.

7 76 6

2 2

02468


Group A Group BGroups

Num

ber o

f Pa

tient

s

Vatapitta Vatakapha Kaphapitta


101

Results

Table no. 24 Distribution of patient on the basis of age of the patient.

Group A Group B Age in years


20 – 29 2 13.33% 2 13.33% 30 – 39 2 13.33% 4 26.66% 40 – 49 6 40% 4 26.66% 50 – 59 4 26.66% 3 20% 60 – 69 1 6.66% 2 13.33%


6(40%) patient were of 40 – 49years of age, 4(26.66%) patients were of 50 –59

years of age, 2(13.33%) were of 20 – 29years & 30 –39 years of age. In Group B

maximum of 4(26.66%) patient were of 40 – 49years & 30 – 39 years of age,

3(20%) patients were of 50 –59 years of age, 2(13.33%) were of 20 – 29years &

60 – 69 years of age.

Distribution of patient on the basis of age of the patient

2 224

644 3

1 2

02468


Group A Group B

Groups

Num

ber o

f Pa

tient

s

20 – 29 30 – 39 40 – 49 50 – 59 60 – 69


102

Results

Table no.25 Distribution of patient according to Chronicity of the disease among groups.

Group A Group B Duration in months


Up to 1 5 33.33% 5 33.33% 2 – 6 3 20% 5 33.33% 7 – 11 1 6.66% 0 0% 12 – 16 3 20% 3 20% 17 – 21 1 6.66% 1 6.66% 22 – 26 2 13.33% 0 0%

27 – 31 0 0% 0 0% 32 – 36 0 0% 1 6.66%


5(33.33%) patient were of acute i.e., Up to 1 month chronicity of the disease,

3(20%) patient were of 2 – 6 months & 12 - 16months of chronicity of the

disease, 2(13.33%) patient were of 22 –26 months of chronicity of the disease &

1(6.66%) patient were of 7 - 11 months & 17 – 21 months of chronicity of the

disease. In Group B, maximum of 5(33.33%) patient were of acute i.e., Up to 1

month & 2 – 6 months of chronicity of the disease, 3(20%) patient were of 12 -

16months of chronicity of the disease, & 1(6.66%) patient were of 17 - 21 months

& 32 – 36 months of chronicity of the disease.

Distribution of patient according to Chronicity of the disease among groups

5 53

5

10

3 31 1

200 00

1

0246


Group A Group B

Groups

Num

ber

of P

atie

nts

Up to 1 month 2 – 6 months7 – 11 months 12 – 16 months17 – 21 months 22 – 26 months


103

Results

Table no. 26 Showing the incidence of range of SLR in the patients.

Group A Group B SLR range in degrees


Grade 0 0 0% 0 0% Grade 1 3 20% 0 0% Grade 2 4 26.66% 11 73.33% Grade 3 8 53.33% 4 26.66%


8(53.33%) patient were at grade 3, 4(26.66%) patients were grade 2, 3(20%) were

at grade 1. In Group B maximum of 11(73.33%) patients were at grade 2,

4(26.66%) were at grade 3.

Showing the incidence of range of SLR in the patients

0 03

04

118

4

05

1015


Group A Group B

Groups

Num

ber o

f Pa

tient

s

Grade 0 Grade 1 Grade 2 Grade 3


104

Results

Table no.27 Change in the Lumbar movement in the patients of group A.

Forward flexion Rt. Lateral flexion Lt. Lateral flexion

Difference in cms

No. % No. % No. % 0 – 5 cms 11 73.33% 11 73.33% 13 86.66% 6 – 10 cms 4 26.66% 4 26.66% 2 13.33% 11 – 15 cms 0 0% 0 0% 0 0% 16 – 20 cms 0 0% 0 0% 0 0% 21 – 25 cms 0 0% 0 0% 0 0% 26 – 30 cms 0 0% 0 0% 0 0% 31 – 35 cms 0 0% 0 0% 0 0% 36 – 40 cms 0 0% 0 0% 0 0% 41 – 45 cms 0 0% 0 0% 0 0% 46 – 50 cms 0 0% 0 0% 0 0%

Forward flexion –

Among 15 patients of group A, 4(26.66%) of patients had increased in

forward flexion of 6 – 10 cms & 11(73.33%) of patient had increased in forward

flexion of 0 – 5 cms.

Right lateral flexion –


Right lateral flexion of 6 – 10 cms & 11(73.33%) of patients had increased in

Right lateral flexion of 0 – 5 cms only.

Left lateral flexion –


Left lateral flexion of 0 – 5 cms only & 2(13.33%) of patients had increased in

Left lateral flexion of 6 – 10 cms only.


105

Results

Change in the Lumbar movement in the patients of group A

11 11 13

4 4 20 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 005

1015

No. No. No.

Forward flexion Rt. Lateral Lt. LateralLumbar movement

Num

ber o

f pat

ient

s

0 – 5 cms6 – 10 cms11 – 15 cms16 – 20 cms21 – 25 cms26 – 30 cms31 – 35 cms36 – 40 cms41 – 45 cms46 – 50 cms

Table no.28 Change in the Lumbar movement in the patients of group B Difference in cms Forward flexion Rt. Lateral flexion Lt. Lateral flexion

No. % No. % No. %

1 6.66% 2 13.33% 4 26.66% 0 – 5 cms 4 26.66% 6 40% 5 33.33% 6 – 10 cms 6 40% 6 40% 6 40% 11 – 15 cms 3 20% 1 6.6% 0 0% 16 – 20 cms 0 0% 0 0% 0 0% 21 – 25 cms 1 6.66% 0 0% 0 0% 26 – 30 cms 0 0% 0 0% 0 0% 31 – 35 cms 0 0% 0 0% 0 0% 36 – 40 cms 0 0% 0 0% 0 0% 41 – 45 cms 0 0% 0 0% 0 0%

46 – 50 cms 0 0% 0 0% 0 0%

Forward flexion –

Among 15 patients of group B, 1(6.66%) of patients had increased in

forward flexion of 0 – 5 cms & 26 – 30 cms. 4(26.66%) of patient had increased

in forward flexion of 6 – 10 cms, 6(40%) of patient had increased in forward

flexion of 11 – 15 cms & 3(20%) of patient had increased in forward flexion of 16

– 20 cms.


106

Results

Right lateral flexion –


Right lateral flexion of 0 – 5 cms & 6(40%) of patients had increased in Right

lateral flexion of 6 – 10 cms & 11 – 15cms & 1(6.66%) of patients had increased

in Right lateral flexion of 16 – 20 cms.

Left lateral flexion –


Left lateral flexion of 0 – 5 cms, 5(33.33%) of patients had increased in Left

lateral flexion of 6 – 10 cms & 6(40%) of patients had increased in Left lateral

flexion of 11 – 15cms.

Change in the Lumbar movement in the patients of group B

1 244

6 56 6 6

31 00 0 01 0 00 0 00 0 00 0 00 0 0

02468

No. No. No.

Forward flexion Rt. Lateralflexion

Lt. Lateralflexion

Lumbar movement

Num

ber

of P

atie

nts 0 – 5 cms

6 – 10 cms11 – 15 cms16 – 20 cms21 – 25 cms26 – 30 cms31 – 35 cms36 – 40 cms41 – 45 cms46 – 50 cms


107

Results

Table no.29 Showing the incidence of Walking time in the patients.

Group A Group B Walking time in Grade


Grade 0 2 13.33% 1 6.66% Grade 1 2 13.33% 4 26.66% Grade 2 8 53.33% 5 33.33% Grade 3 3 20% 5 33.33% Grade 4 0 0% 0 0%


8(53.33%) patient were at grade 2, 2(13.33%) patients were grade 1 & grade 0,

3(20%) were at grade 3. In Group B maximum of 5(33.33%) patient were at grade

2 & grade 3, 4(26.66%) patients were grade 1, 1(6.66%) were at grade 0.

Showing the incidence of Walking time in the patients

2 124

8

53

5

0 002468

10


Group A Group B

Groups

Num

ber o

f Pat

ient

s

Grade 0Grade 1Grade 2Grade 3Grade 4


108

Table no. 30 MASTER CHART – SUBJECTIVE PARAMETER – GROUP- A

Ruk Sthambha Toda Spandana Ayama Gourava Suptata Shosha Vibhandha DahaSl. No

O.P.D B A B A B A B A B A B A B A B A B A B A

1 3827 3 2 0 0 2 2 - - - - + - + + - - - - - -2 3160 3 2 0 0 2 1 - - - - - - + - - - + - - -3 3967 4 2 0 0 0 0 - - - - - - + + - - - - - -4 4095 3 2 1 1 0 0 - - - - - - - - - - + - - -5 4090 2 1 0 0 2 1 - - - - - - + + - - - - - -6 4164 3 2 0 0 3 2 - - - - - - - - - - - - - -7 4238 3 2 2 2 0 0 - - - - - - - - - - + - - -8 4242 2 1 0 0 1 0 - - - - - - - - - - + - - -9 4508 2 1 1 0 0 0 - - - - + - - - - - + - - -10 4495 3 2 2 2 0 0 - - - - - - - - - - + - - -11 4646 4 3 0 0 2 1 - - - - - - - - - - + - - -12 4675 3 2 2 2 2 1 - - - - + - - - - - + - - -13 72 2 1 0 0 2 2 - - - - - - - - - - - - - -14 226 2 1 1 1 0 0 - - - - + - - - - - + - - -15 439 3 3 3 3 2 2 - - - - + - + + - - + - - -

109

Table no. 31 MASTER CHART – SUBJECTIVE PARAMETER – GROUP- B

Ruk Sthambha Toda Spandana Ayama Gourava Suptata Shosha Vibhandha DahaSl. No

O.P.D B A B A B A B A B A B A B A B A B A B A

1 3867 3 1 0 0 2 1 - - - - + - + - + + - - - -2 3972 4 2 2 2 2 1 - - - - + - + - + + + - - -3 4094 3 1 0 0 0 0 - - - - + - - - - - + - - -4 4181 3 1 2 0 2 1 - - - - + - + - - - + - - -5 4201 3 0 0 0 3 0 - - - - + - - - - - + - - -6 4664 3 1 2 0 2 0 - - - - + - + - - - + - - -7 4611 3 1 1 0 1 0 - - - - - - - - - - + - - -8 59 2 0 1 0 1 0 - - - - + - - - + + + - - -9 81 3 0 2 0 0 0 - - - - + - + - - - + - - -10 4728 4 1 3 0 0 0 - - - - + - - - - - + - - -11 669 3 0 2 0 0 0 - - - - + - - - - - - - - -12 962 3 0 3 1 0 0 - - - - + - + + - - - - - -13 1008 3 1 0 0 2 0 - - - - - - - - - - - - - -14 1030 3 1 2 1 1 0 - - - - + - - - - - + - - -15 1238 3 0 0 0 1 0 - - - - - - - - - - - - - -

110

Table no.32 MASTER CHART – OBJECTIVE PARAMETER – GROUP- A

S.L.R Movement of Lumbar spine Movement of Hip Walking time

Sl. No.

O.P.D Rt. Left 1 2 3 4 5 6 7 8 9a 9b 10a

10b

11

B A B A B A B A B A B A B A B A B A B A B A B A B A B A B A B A1 3827 2 1 28 25 42 33 40 35 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 35 242 3160 3 2 30 26 42 36 40 36 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 40 203 3967 3 2 29 26 45 43 40 36 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 31 224 4095 3 2 30 20 41 38 45 40 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 25 205 4090 3 2 29 25 42 40 40 38 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 32 256 4164 3 3 28 23 45 38 39 33 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 46 407 4238 3 2 30 28 40 38 41 40 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50 408 4242 1 0 15 8 40 36 41 38 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20 209 4508 1 0 15 5 35 30 35 30 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 22 2010 4495 2 2 25 20 32 25 34 28 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 33 2611 4646 3 3 25 20 32 28 32 28 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 34 3012 4675 2 2 15 10 23 20 24 21 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 31 2513 72 2 1 40 37 41 39 40 38 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 33 2514 226 1 0 0 0 15 15 15 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20 2015 439 3 3 45 40 48 46 45 43 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 42 38

1 – Forward flexion, 2 – Right Lateral flexion, 3 - Left Lateral flexion, 4 – Extension, 5 – Rotation, 6 – Flexion, 7 – Abduction, 8 – Adduction, 9 – Rotation in flexion: a) Internal rotation, b) External rotation, 10 – Rotation in Extension: a) Internal rotation, b) External rotation, 11 - Extension

111

Table no.33 MASTER CHART – OBJECTIVE PARAMETER – GROUP- B

S.L.R Movement of Lumbar spine Movement of Hip Walking time

Sl. No.

O.P.D

Rt Lt 1 2 3 4 5 6 7 8 9a 9b 10a

10b

11

B A B A B A B A B A B A B A B A B A B A B A B A B A B A B A B A1 3867 2 1 15 5 35 25 36 27 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 41 302 3972 3 2 45 40 48 46 45 43 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 45 303 4094 2 0 8 0 20 15 20 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20 154 4181 2 1 20 10 30 20 30 20 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 31 205 4201 2 0 25 10 30 15 31 17 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 41 286 4664 3 1 30 20 40 28 41 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 33 237 4611 3 1 25 10 30 20 30 21 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 25 158 59 2 0 25 12 33 25 30 24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 28 209 81 3 1 32 15 40 28 39 25 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 35 2610 4728 2 0 30 15 40 28 41 36 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 42 2811 669 2 0 15 5 23 13 24 14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 22 1612 962 2 1 32 13 40 28 39 24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 41 2913 1008 2 0 28 10 37 27 41 30 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 31 1914 1030 2 0 20 7 38 25 34 29 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 23 1515 1238 2 1 36 9 38 20 34 19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 35 20

1 – Forward flexion, 2 – Right Lateral flexion, 3 - Left Lateral flexion, 4 – Extension, 5 – Rotation, 6 – Flexion, 7 – Abduction, 8 – Adduction, 9 – Rotation in flexion: a) Internal rotation, b) External rotation, 10 – Rotation in Extension: a) Internal rotation, b) External rotation, 11 - Extension

112

Table no.34 Statistical Assessment of Individual Study Group – A (Objective Parameter)

Sl.No Parameters Mean S.D S.E t- value P - value RemarksS.L.R Right 0.5 0.577 0.149 3.355 <0.05 H.S 1

S.L.R Left 0.724 0.467 0.120 6.058 <0.001 H.S

2 Forward flexion

4.733 2.685 0.693 6.83 <0.001 H.S

3 Right Lateral flexion

3.866 2.477 0.638 6.059 <0.001 H.S

4 Left Lateral flexion

3.4666 1.807 0.466 7.437 <0.001 H.S

5 Extension 0.666 0.487 0.125 5.328 <0.001 H.S 6 Rotation 0.1333 0.351 0.090 1.481 >0.05 N.S 7 Walking

time 6.6 4.95 1.279 5.16 <0.001 H.S

Table no.35 Statistical Assessment of Individual Study Group – B (Objective Parameter)

Sl.No Parameters Mean S.D S.E t- value P - value Remarks S.L.R Right 1.666 0.516 0.133 12.52 <0.001 H.S 1

S.L.R Left 1.666 0.5 0.129 12.29 <0.001 H.S

2 Forward flexion

13.666 5.367 1.385 9.867 <0.001 H.S

3 Right Lateral flexion

10.6 3.794 0.979 10.827 <0.001 H.S

4 Left Lateral flexion

9.266 4.078 1.053 8.8 <0.001 H.S

5 Extension 0.533 0516 0.133 4.00 <0.01 H.S 6 Rotation 0.133 0.351 0.090 1.47 >0.05 N.S 7 Walking time 6.6 4.95 1.279 5.16 <0.001 H.S

Table no.36 Statistical Assessment of Individual Study Group – A (Objective Parameter)

Sl.No Parameters Mean S.D S.E t- value P - value Remarks1 V.A.S 1.6 0.828 0.213 7.511 <0.001 H.S

Table no. 37 Statistical Assessment of Individual Study Group – B (Objective Parameter)

Sl.No Parameters Mean S.D S.E t- value P - value Remarks1 V.A.S 3.933 0.961 0.248 15.858 <0.001 H.S

113

Table no 38 Statistical Assessment of Comparative study of Group – A with Group – B, After Treatment. (Objective Parameter)

Sl.No Parameters Group Mean S.D S.E P.S.E t- value P - value

Remarks

A 2.0 1.414 0.365 S.L.R Right B 0.5 0.547 0.141

0.391 1.278 >0.05 N.S

A 1.545 0.934 0.241

1

S.L.R Left

B 0.666 0.707 0.182

0.302 2.91 <0.02 H.S

A 20.866 11.15 2.879 2 Forward flexion

B 12.066 9.098 2.349

3.716 2.368 <0.02 H.S

A 33.666 8.582 2.216 3 Right Lateral flexion B 24.2 7.97 2.059

3.024 3.13 <0.01 H.S

A 33.266 1.977 1.977 4 Left Lateral flexion B 24.93 2.045 2.045

2.844 2.931 <0.01 H.S

A - - - 5 Extension

B 0.0666 0.258 0.0666

0.0666 1.000 >0.05 N.S

A - - - 6 Rotation B 0.0666 0.258 0.0666

0.0666 1.000 >0.05 N.S

A 26.33 7.333 1.894 7 Walking time

B 22.26 5.787 1.494

2.412 1.687 >0.05 N.S

Table no 39 Statistical Assessment of Comparative study of Group – A with Group – B, After Treatment. (Objective Parameter)

Sl.No Parameters Group Mean S.D S.E P.S.E t- value P - value

Remarks

A 3.733 2.016 0.52 1 V.A.S

B 2.2 1.32 0.341

0.624 2.46 <0.05 H.S

114

Table no 40 Statistical Assessment of Individual Study Group – A (Subjective Parameter)

Sl.No Parameters Mean S.D S.E t- value P - value

Remarks

1 Ruk 1.0 0.377 0.097 10.309 <0.001 H.S

2 Sthamba 0.0666 0.258 0.066 1.000 >0.05 N. S

3 Toda 0.4 0.507 0.1309 3.055 <0.01 H.S

Table no 41 Statistical Assessment of Individual Study Group – B (Subjective Parameter)

Sl.No Parameters Mean S.D S.E t- value P - value

Remarks

1 Ruk 2.4 0.507 0.130 18.461 <0.001 H.S

2 Sthamba 1.0 1.0 0.258 3.875 <0.01 H.S

3 Toda 0.933 0.883 0.228 4.093 <0.01 H.S

Table no 42 Statistical Assessment of Comparative study of Group – A with Group – B, After Treatment. (Subjective Parameter)

Sl.No

Parameters Group Mean S.D S.E P.S.E t- value

P - value

Remarks

A 1.733 0.593 0.153 1 Ruk

B 0.666 0.617 0.159

0.22 4.806 <0.001 H.S

A 0.733 1.032 0.266 2 Sthamba

B 0.266 0.593 0.153

0.306 1.526 >0.05 N.S

A 0.8 0.861 0.222 3 Toda

B 0.2 0.414 0.106

0.246 2.439 <0.05 H.S

Table

To compare the mean effect of 2 groups, the analysis is done by using un

paired t – test by assuming that the mean effect of 2 groups is same after the

treatment. From the analysis the objective parameter forward flexion, right lateral

flexion, left lateral flexion & VAS shows highly significant & other parameter

shows non – significant. In the parameter SLR, right leg which shows not

significant the analysis done by using 4 patients in group A & 6 patients in group

115

B, those have symptoms. In SLR of left leg the analysis done for 11 patients in

group A and 9 patients in group B those have the symptoms of the parameter

which shows highly significant. By comparing p value & t value. (Table III)

In the subjective parameters, the Ruk and Toda shows highly significant,

but Sthamba shows non significant.

To know the effect of drug individually the analysis done by using paired t

test by assuming that drug is not responsible for changes in the observation before

& after the treatment. Over all the group B shows more highly significant in all

the objective parameter except extension, where as the Rotation shows not

significant in both the groups. The parameter VAS shows more highly significant

in group B with more mean & more variation.

In subjective parameters in group B shows highly significant but in the

parameter Sthambha is not significant in group A. There is a much highly

significant in parameter Ruk, Toda & Sthamba in group B with more mean &

more variation. By comparing p value, t value, mean & standard deviation. (From

table I & II)

Individual Parameter

Objective parameter –

In group B the parameter SLR right & left shows more net mean effect

with less variation.

In group B the parameter Forward flexion shows more net mean effect

with more variation.

The parameter right lateral flexion in group B is having more net mean

effect with more variation.

The parameter left lateral flexion in group B is having more net mean

effect with more variation.

116

The parameter extension in group B is shows less net mean effect with

less variation.

The parameter rotation in both groups is shows same net mean effect with

same variation.

In the parameter, walking time in both groups shows same net mean effect

with same variation.

In group B the parameter, VAS shows more net mean effect with more

variation.

Subjective parameter –

The parameter Ruk in group B shows more net mean effect with more

variation.

The parameter Sthambha in group B shows more net mean effect with

more variation.

The parameter Toda in group B shows more net mean effect with more

variation.

117

Table no 43 Showing the Overall assessment

Group A Group B Response


Good relief 0 0% 0 0% Marked response

0 0% 10 66.66%

Moderate response

3 20% 5 33.33%

Mild response 12 80% 0 0% Not relief 0 0% 0 0%

The above table shows the assessment of result among groups. In group A,

12(80%) patient have got mild response, 3(20%) patient have got moderate

response. In group B, 10(66.66%) patients have got marked response &

5(33.33%) patient have got moderately relieved.

Showing the over all assessment

0 00

10

35

12

00 00

5

10

15


Group A Group B

Groups

Num

ber o

f Pat

ient

s

Good Marked Moderate Mild Not relief

118

Discussion

Discussion

Main intention of any research is to re-examine the established facts in modern

light, clarify the doubts and filling in the lacunas. The study process starts with forming

of the hypothesis, detailed planning of research, at prefinal stage clubbing the

observations and results on which certain conclusions can be drawn. This section titled

‘discussion’ analyzes and contemplates the observations made during project and results

obtained post therapeutically on the selected problem, Gridhrasi.

In human body, the lumber spine is the site of most expensive orthopedic problem

for the world’s industrialized countries. It is the seat of miracles. The central nervous

system as well as autonomic nervous system work through the spine and the entire

nervous system dependant upon the spine. So the diseases affecting lumber spine are

handled very carefully. Gridhrasi is such a disease having its origin in Pakvashaya and

seat in Sphika and Kati i.e. lumber spine. In classics, Gridhrasi is included under 80 types

of Nanatmaja Vata Vikara under the heading of Vatavyadhi as a separate clinical entity

There is no need to state that modern medical treatment has its own limitation in

managing this type of disease. Modern medical treatment either conservative or surgical

and is highly symptomatic and with troublesome side effects. This suggests special need

of an ayurvedic management for this type of conditions.

As the number of patients suffering from this disease are increasing day by day.

Ayurvedic physician should also make effort continuously to find out effective remedy

for the patients of Gridhrasi from Ayurvedic classics.

Gridhrasi is one of the Nanatmaja Vatavyadhi and occasionally Kapha is also

associated with the Vata Dosha and produce Vata-kaphaja type of Gridhrasi. So, the


119

Discussion

drugs having Vatahara, Shulahara and Srotoshodhaka properties may be very useful in

the treatment of Gridhrasi.

Discussion part is divided into four sections.

1. Discussion on Gridhrasi and Sciatica.

2. Discussion on Clinical study & Observation.

3. Discussion on probable mode of action of Punarnavadi guggulu in Gridhrasi

4. Discussion on probable mode of action of Mahamasaditaila kati basti in Gridhrasi

Discussion on Gridhrasi and Sciatica.

Gridrasi is one of the Nannatmaja vyadhi of vata vyadhi. The pain starts from

Spik, and radiates to down to leg, which is a classical condition in Gradrasi & even

Sciatica.

Sciatica, a clinical entity that is described in modern science, has a striking

resemblance to the symptomatology of Gridrasi. It can be better compared through a

discussion made from the shareera (Anatomy) to the Roopa(clinical presentation) of the

diseases.

On a closer look into the shareera, the parts, which are affected in the Gridhrasi

disease, are Spik, kati prishta pradesa, kandaras of parshni and angulis, kukundara

marma, katikatharunamarma and the Gridhrasi snayu / nadi. While discussing the modern

aspect, the anatomical structures, which are affected in Gridhrasi disease, are lumbar

vertebrae, intervertebral joints, lumbo-sacral plexus and sciatic nerve.

A better comparision can be made from the review of Nidana, The

swaprakopakara nidanas, marmaghatakara nidans and margavarodhaka nidanas

eventually leads to dhatukshaya and there by producing vataja type of Gridhrasi in the


120

Discussion

body. Another type is the vatakaphaja Gridhrasi where the margavarodha janya nidana

bhavas can be considered because the presenting complaints include tandra, gourava, and

aruchi along with Gridhrasi shoola. Taking the kaphavrita vata symptoms into

considerations, both the condition go in parallel confirming the margavarodha.

Considering the etiological factors for the sciatica we can find the similar types of factors

responsible for the condition. Avitaminosis, nutritional deficiencies leading to calcium

deficiency were observed to lead inflammation of sciatic nerve resulting to sciatica by

modern scientists. Intake of excessive and heavy fatty meals was observed to lead to

accelerate degenerative process and can be considered as kapha provocation diet. The

posture at work of sitting, stooping, squatting, standing etc are considered as the cause for

sciatica. The psychological factors anxiety, tension, fear etc leads to prolonged

contraction of back muscles. So all these factors can be considered as the swprakopakara

nidana factors of Ayurveda. Trauma is observed to be the single most important causative

factor for disc prolapse. Trauma / abhighata to the marmas are to be interpreted here.

Almost all the patients of Gridhrasi have a history of trauma. Here the term to be

considered much is the abhighata i.e. the acute injuries, fall from the height, heavy

manual works, heavy blow on the low back etc further leads to degenerative changes in

the particular area. Even this can also trigger the condition in degenerated vertebrae also.

The degenerative changes can be correlated with the dhatukshaya features. For this

degeneration to happen all other causative factors are the reason. The lumbar spondylosis,

where marked degeneration of the vertebrae happen, can be considered, which inturn

leads to the disc prolapse causing sciatica.


121

Discussion

In the samprapthi review, two opinions can be put forward as- Gridhrasi dhamani

and Gridhrasi snayu / nadi. Commenting on to the context Dalhana has considered it as

kandara and termed as Mahasnayu. He has also used the term kandaradwayam indicating

the sciatic nerve of both legs. The mahasnayu starts from gulpha to vitapa. In Vriddha

Vagbhata’s Astanga sangraha, Gridhrasi occurs due to vata sited at snayu. So basing on

these commentaries, the concept of Gridhrasi dhamani can be rejected and the Gridhrasi

snayu / nadi is the apropriate term for the sciatic nerve that also starts from the gulpha to

vitapa on both legs.

Dhamanis are having the property of dhmana (pulse vibrations) as each spurt of

fluid impinges on the wall of arteries and so dhamani is considered as a part of the

circulatory system. Snayus are the nadis that conduct vayu as per vaidyasabdasindhu. It is

also noted that snayu binds the dehamamsa (muscles), asthi (bones), medas (fat tissue)

and strengthens the joint. So by conducting the vayu through out the body, snayu helps in

prasarana, akunchana etc. So here by we can assume that the snayu is more connected to

the musculo-skeletal system and so the sciatic nerve can be considered as Gridhrasi nadi /

snayu.

Vitiated vata especially apana and vyana vayu are involved in the samprapti of

Gridhrasi. Kapha may be the anubandhi dosha. The samprati takes place either by

dhatukshaya or margavarana or due to agantunja causes like abhighata. In dhatukshayaja

samprapti, due to improper nourishment of rasadi dhatus, these dhatu land into kshaya

avastha. Dhatukshaya further vitiates vata causing Gridhrasi. This type of samprapti can

be correlated to the Sciatica caused by degenerative changes. These changes are

osteoporosis, spondylosis etc. which lead to Sciatica.


122

Discussion

When vayu is obstructed by kapha, ama etc. it gets vitiated leading to

margavaranajanya samprapti of Gridhrasi. Agantuja factors are mentioned as a cause of

Gridhrasi by both the systems of medicine.

Considering the roopa, the similarities in both Gridhrasi and sciatica can be found.

Both have the same singular presentations - pain along the course of leg. The pain over

the spik, kati, prishta etc and can be considered as low backache. When the pain extends

to uru, janu, jangha pada and angulees the roopavastha happens. The same way the

typical sciatic nerve pain is radiating type, where the low backache turns to a radiating

one through the course of sciatic nerve as the prolapsed disc compresses the nerve root.

On the later stages the dehavakratha (scoliosis) and the abnormal sensations like toda,

spandana, ayama etc happens. Further it leads to the impairment in uplifting of the leg

and loss of sensations, which can be termed as sakthi utkshepana nigrahana and suptatha

in turn leads to neurological deficit. This is a clinical sign for the diagnosis of Sciatica

known as SLR in modern science. It also has prognostic value. Regarding the gait of the

patient it will be of limping nature in sciatica, which can be considered as gridhramaiva

syati.

Snehana, Svedana and Mrdu Sodhana are the line of treatment in all

Vaatavyaadhees. Even though, Snaayu and Rakta are involved as Dooshya, Agnikarma

and Siraavyadha are also the chief lines of treatment. These therapeutic measures

disintegrate the union of Dosha and Dooshya. From the Samana point of view, any

medication which soothe the magnitude of pain, improves the functional ability along

with Sampraapti Vighatana is best in patients of Gridhrasi. An added advantage will be

achieved if it can re-establish the Dhaatu equilibrium along with Vaataanulomana.


123

Discussion

Considering all these aspects, Punarnavadi gugglu having all these therapeutic effects had

been taken for this study.

Discussion on Clinical study & Observation

The patients were selected incidentally from exclusively conducted medical

camps in the premise of Shri .D. G. Melamalagi Ayurvedic Medical College and Hospital

Gadag. Both the types of Gridhrasi were taken. Patients of both sexes were selected for

the clinical study between the age group 18 to 65 years.

In total 30 patients were selected for the study. Two groups were divided of 15

patients for each group, i.e., Group A of 15 patients were treated by Punarnavadi guggulu

orally for 1 month & Group B of 15 patients were treated by Kati basti with Mahamasadi

taila for 14 days. All the patients were subjected to thorough clinical, laboratory and

radiological examinations. There is no drop out in the study and all the 30 patients were

appeared for the assessment of results. The laboratory tests like total blood count,

differential count and ESR were carried out to exclude infections, disorders like

tuberculosis of spine, the RBS was carried out to rule out diabetes, Hb% was carried out

to rule out anemia. The radiology of LS spine is also a diagnostic criteria to exclude the

conditions like severe osteoporosis, fractures, osteophytes etc. But in the present study,

among all the 30 patients, not a single patient has shown the above exclusion conditions.

The straight leg-raising test is a good objective parameter to diagnose the Gridhrasi

disease in western medicine. The authorities of Ayurveda mentioned that kshepana and

utkshepana are the salient features of Gridhrasi disease. The other objective parameters

taken were movements of lumbar spine and walking time. The Hip movement is also one

of the parameter taken to rule out any ristriction of Hip due Hip arthritis.


124

Discussion

Assessments of response were done both subjectively and objectively. After

recording the baseline data and post treatment data of the factors, ruk, sthamba, & toda in

grading as the subjective parameters and the factors such as straight leg raising test in

degrees, the movements of the spine viz, forward flexion, right and left lateral flexions in

centimeters and walking time in second as the objective parameters, the assessments were

done. The statistical analyses of the subjective and objective parameters were made on

these assessments.

As Gridhrasi is a shoola pradhana vatavyadhi, eventhough the other subjective

parameters are taken for assessment, the effect was more concentrated on ruk (pain).

Among 15 patients of Group A, 53.33% of patients were at grade 3, 13.33% of patients

were at grade 4, 33.33% of patients were at grade 2. After treatment 53.33% patients

were at grade 2, 33.33% patients were at Grade 1 & 13.33% patients were at grade 3.

In 15 patients of Group B, 80% of patients were at grade 3, 13.33% patients were at grade

4, 6.66% patient was at grade 2. After treatment 53.33% patients were at grade !, 40%

patients were at grade 0, i.e., completely the pain was reduced. 6.66% patient was at

grade2. This shows that there was marked variation in the grades of pain in the patients of

both groups. But there was very good response in group B than group A. So in the

statistical analysis the parameters pain showed highly significant with t – value 10.309 in

group A & 18.461 in group B, the corresponding P value < 0.001in both the groups.

The parameter Sthambha shows not significant with t – value 1.00, the corresponding P

value > 0.05 in group A & in group B Sthambha shows highly significant with t value

3.875 & corresponding P value < 0.01.


125

Discussion

The parameter Toda shows highly significant in both groups with t – value 3.055 in

group A, 4.093 in group B & the corresponding P value < 0.01. Among Ruk, Sthamba &

Toda, in group A Ruk & Toda are significant & Sthamba is not significant. In group B

Ruk is highly significant than Sthamba & Toda.

In group A 5 patients & in group B 12 patients were with symptom Gourava,

which was relived completely. In group A & group B 10 patients were with Vibhanda ,

all were relived completely after treatment. In both groups , Suptata was relieved very

minutely but Shosha was not responded.

Considering the response in some of the individual categories in the duration,

33.33% patients were of acute onset (up to 1month) in both groups. 20% patients were of

group A & 33.33% patients were of group B were of 2 – 6 months of duration.

Regarding the Objective Parameters

In 15 patients of group A, 53.33% of patients were at grade 3, 26.66% of patients

were at grade 2, 20% of patients were at grade 1. after treatment 46.66% of patients were

at grade 2, 20% patients were at grade 3, 13.33% patients were at grade 1, 20% of

patients were at grade 0. In this group 4 patients were affected with right leg & 11

patients were affected with left leg.

In 15 patients of group B, 73% patients were at grade 2, 26.66% of patients were

at grade 3. after treatment 46.66% of patients were at grade 0, 46.66% were at grade 1 &

1 patient was at grade 2. in this group 6 patients were affected with right leg & 9 patients

were affected with left leg.


126

Discussion

Seeing the statistical analysis, in both group it was highly significant P value <

0.05 in right leg affecting & P value < 0.001 in left leg. But the observation shows group

B is highly significant than group A.

In the parameter Lumbar movement –

In Forward flexion, among 15 patients of Grade A, 26.66% of patients had increased to 6

– 10 cms in flexion, 73.33% of patients increased to 0 – 5 cms only. In group B, 40% of

patients were increased to 11 – 15 cms, 26.66% of patients were increased to 6 – 10 cms,

20% of patients increased to 16 – 20 cms,6.66% of patient increased to 0 – 5 cms & 26 –

30 cms improved. This shows that there was improvement in the forward flexion in both

groups . but there was very good response in group B than group A. In the statistical

analysis the parameter showed highly significant with t value 6.83 in group A & 9.867 in

group B, the corresponding p value < 0.001 in both groups.

In right lateral flexion, in 15 patients of group A, 26.66% patients increased in flexion of

6 – 10 cms & 73.33% patients increased in movement of 0 – 5 cms. In group B, 13.33%

of patients increased in movement of 0 – 5 cms, 40% of patients increased to 6 – 10 cms

& 11 – 15 cms & 6.66% of patient’s increased to 16 -20 cms.

In left lateral flexion, among 15 patients of group A, 86.66% of patients increased of 0 –

5 cms & 13.33% of patients were increased to 6 – 10 cms. In group B, 26.66% of patients

were increased to 0 – 5 cms, 3.66% of patient increased to 6 – 10 cms & 40% of patients

increased to 11 – 15 cms in flexion.

Walking time –

In goup A of 15 patients, 53.33% patients were at grade 2, 13.33% of patients

were at grade 0 & grade 1& 20% of patients were at grade 3. after treatment 46.66% of


127

Discussion

patients were at grade 1, 33.33% of patients were at grade 0 & 20% of patients were at

grade 3. In group B of 15 patients 33.33% patients were at grade3 & grade 2, 26.66% of

patients were at grade 1 & 6.66% of patient was at grade 0. After treatment 53.33% of

patients were at grade 0 & 46.66% of patients were at grade 1. This shows that there was

a good variation in the grading of walking time in the patients of both groups. But there

was good response in group B then group A. In the statistical analysis the parameter

walking time showed highly significant with t value 5.16 in group A & group B, the

corresponding p value < 0.001 in the both groups.

In the overall assessment among 30 patients, 8 patients showed moderately

response, 10 patients showed marked response & 12 patients showed mild response. But

seeing the assessment of individual groups, in group A 12 patients showed mild response

& 3 patients showed moderately response, in group B 10 patients showed marked

response & 5 patients showed moderately response.

This shows that group B(Mahamasadi taila katibasti) has highly significant the

group A(Punarnavadi guggulu orally).

The statistical evaluation showed all parameters in Subjective & Objective has

shown highly significant except the parameter Sthmba in group A, Rotation in lumbar

movement in group A & group B.

Discussion on probable mode of action of Punarnavadi guggulu in Gridhrasi

The materials in the nature including the human body as well as drugs are

composed of panchamahabutha. In drug compositions of these mahabuthas are known by

inferred on the basis of their properties like Rasa, Guna, Viryaa, Vipaka, Prabhava etc,

which are inherent in drug on which the pharmacodyanmic depends.


128

Discussion

Punarnavadi Guggulu described by Acharya Vangasena in Vatarakthaadikara

Adyyaya has been selected for the Shamana in the study. Punarnavadi Guggulu contains

mainly Punaranava, Erandamoola, Sunthi, Guggulu, Eranda taila, Makshika dathu etc,

which possesses Vata-kaphahara, Anulomaka & Shoolahara property as well as anti-

inflammatory, analgesic, muscle relaxant properties & even regenerative properties

which give relief from the disease.

Discussion on probable mode of action of Mahamasaditaila kati basti in Gridhrasi

Mahamasadi taila described by Acharya Vangasena in Vatavyadhadhikara

Adyyaya has been selected for the Kati Basti. Mahamasadi taila contains mainly Masha,

Trikatu, Tila taila, Eranda, Dugda, Chagamamsa, Dasamula, Gokshura, Amalaki etc

drugs which possesses Vata-kaphahara property.

Snehana, Swedana and Mrdu Sodhana are the Principles of treatment in all

Vaatavyadhi. Even though Snaayu and Rakta are involved as Dooshya, Agnikarma and

Siravyadha are also the chief lines of treatment. Mrdu Sodhana in the form of Basti or

mrudu Virechana plays the major treatment of Gridhrasi. From the Samana point of view,

various medication which soothe the severity of pain, improves functional ability is best

in Gridhrasi. An added advantage will be achieved if Snehana and Swedana are done

which relieves Stambha, Gaurava, Seeta and which reduces the intensity of pain.

Considering this aspect Katibasti is adopted for this study.


129

Conclusion

Conclusion

At the end of the study, following conclusions can be drawn on the basis of observations

made, results achieved and thorough discussions in the present context.

• Historical glimpses reveal that though the knowledge of Sciatica is just two

centuries old for the modern medicine, Ayurveda has concise but exact

description of the disease in the samhitas. The anatomical, pathological, clinical

and even diagnostic aspects of the disease are well covered in our texts.

• Our classics have described vata dosha as the main culprit in the disease

Gridhrasi. Sometimes kapha is the anubandhi dosha. This is supported clinically

as maximum no. of the patients showed vataprakopaka hetus as the cause.

Physical as well as mental stress was observed as the common causes along with

trauma.

• There is no direct reference regarding Nidana and Samprapti of Gridhrasi.

• Gridhrasi can be equated with Sciatica in modern medicine.

• Majority of the patients had dwandwaj prakruti i.e. vatapitta or vatakapha. Also

majority of patients had vishamagni and krura koshtha. All these finding support

the dominance of vata dosha.

• In the present study, majority of the patients suffered from vatakaphaj Gridhrasi

(53.33%) with 46.66% suffering from vataj Gridhrasi.


130

Conclusion

• In the present study both the therapies were effective in combating the disease.

Major improvement was observed on all signs and symptoms as well as on SLR

in both the groups.

• On comparing the overall effect of the therapies, Kati basti showed more effective

than only Shaman Therapy. This proves the importance of kati basti therapy in the

management of Gridrasi.

• The drugs administered in Guggulu form gave overwhelming response in treating

Gridhrasi. Only shaman therapy cured 3 patients were moderately responded and

12 patients showed Mild improvement. This proves the efficacy of Guggulu

kalpana in mitigating vata and kapha and also potentiating agni.

• Another reason behind the effectiveness of the therapy might be that the

combination was with erand taila. Erand taila effectively conquers vata and kapha

dosha. It clears the srotasas by removing mala and avarana. It conquers the

rukshata of vayu with snigdha guna and also normalizes apana vayu, which is the

main culprit.

• No major adverse or side effects were encountered during this treatment period.

• Preventive aspect and patient’s education play an important role in the

management of Gridhrasi. Proper guidelines about posture etc along with

exercises strengthening the spine are helpful for effective management.

• Allopathic management is far away from the perfect treatment.


131

Conclusion

Suggestions for future study

Study is better to be conducted on a large sample

Shodana followed by Katibasti.

Katibasti followed by samana yoga.


132

Summary

Summary

In spite of the spine’s excellent form and function, back pain is a national,

personal and clinical problem: national because it is experienced by most of the

population at some time and is a drain on the nation’s resources, personal because it can

remain a major unresolved dilemma, and clinical because not only is diagnosis difficult,

but methods of treatment are conflicting and often unrewarding. Sciatica is one of the

many conditions causing back pain and pain in the lower limb. This condition causes

great discomfort to the patient and affects his daily routine as it is directly related to the

locomotor system.

It would be a great achievement, if we are able to treat such an agonizing

condition with principles laid by our ancient acharyas. Keeping this view in mind, the

project titled ‘Evaluation of the Efficacy of Punarnavadiguggulu & Mahamashadi Taila

Kati Basti in the Management of Gridhrasi (Sciatica)’ was undertaken.

The present study entitled’ consists of 7 parts.

1. Introduction

2. Objectives

3. Review of literature

4. Methodology

5. Results

6. Discussion

7. Conclusion


133

Summary

The introduction consists of the general description of Ayurveda, the incidence of the

disease Gridrasi, brief description of Gridrasi disease with its treatment.

The objectives consist of the need for the study and objectives of the study and

studies conducted on the related topic in the past and recent times.

Review of literature consists of the historical review, vyutpatti and nirukthi of

Gridhrasi. The shareera part deals with both anatomy and physiology related to the

disease Gridhrasi. In the karma review, the procedure, indications and contraindications

etc of kati basti, the drugs used and the probable mode of action of basti are discussed. In

the disease review, nidana, samprapthi, poorvaroopa, roopa, vyavachedaka nidana etc are

elaborated.

Methodology part deals with the preparation of the patients for performing kati basti

& even the method of preparation of the selected medicine Punarnavadi guggulu taken

orally & even the preparation of the Mahamasadi taila for kati basti as said in classic even

it properties are also mentioned. The study design was done on the basis of subjective and

objective parameters with their grading and tests to assess the parameters are explained.

The observations and results are dealt in the result section. The demographic data,

response to treatment and overall response are also dealt. Results are given in the form of

tables along with a short description. The improvements in selected parameters are

statistically analyzed and presented in the form of tables and graphs.

Discussion part is divided into four sections. First section entitled – discussion on

Gridhrasi and Sciatica – deals with the correlation between Gridhrasi and Sciatica

through the anatomical aspect to the roopavastha. The second section discuss about the

Clinical study & Observation. Discussion on clinical study deals with the analysis of


134

Summary

clinical response to the treatment with logical interpretation. The third section deals with

the Discussion on probable mode of action of Punarnavadi guggulu in Gridhrasi and

lastly the fourth section deals the probable mode of action of Mahamasaditaila kati basti

in Gridhrasi. Lastly the Conclusion is given on the present study.


135

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153

SPECIAL CASE SHEET FOR GRIDHRASI Post Graduate Research and Studies Centre (Kayachikitsa) Shri. D.G.M.Ayurvedic Medical College, Gadag.

Guide : Dr. Vardhacharula M. D (Ayu) Co-Guide : Dr. R. V. Shettar M. D.(Ayu) P.G.S Scholar : Gavisiddanagouda. Patil

1. Name of the patient : Sl. No.

2. Father’s/Husband’s Name : OPD No.

3. Age : ………... yrs IPD No.

4. Sex : Male/Female Bed No.

5. Religion :

Hindu Muslim Christian Others 6. Occupation :

Sedentary Active Labor Others 7. Economical Status :

Poor Middle class Higher class 8. Address : …………………………. Phone No. …………………………. E- Mail: …………………………. Pin code:

9. Date of Schedule Initiation:

10. Date of Schedule Completion:

11. Result :

Good relief

Marked Response

Moderate Response

Mild Response

Not relief

12. Consent : I here by agree that, I have been fully

educated with the disease and treatment.

Here by satisfied whole-heartedly, and

accept the medical trial over me.

Investigator’s Signature Patient’s Signature

1

1) Chief Complaints a) RUK (Pain)

Onset : Sudden Gradual

Varity : Acute Chronic

Nature : Local General Radiated

At Postural Change : Yes No

Aggravating Factors : Physical Exercise Emotion Exposure to cold Exposure to heat

Any other causes Relieving factors :

Rest Pain relievers Pressure Severity of pain :

Gr.0 Gr.1 Gr.2 Gr.3 Gr.4 Lumbar region :

Lumbodorsal Lumbar Lumbosacral

Leg : Right Left Both

Duration :

b) STHAMBHA(Stiffness) : Present Absent

Site : Thigh Calf Foot

Severity : Gr.0 Gr.1 Gr.2 Gr.3 Gr.4

Relieving factors :

Rest Walking Pain relivers

Time :

Early morning After noon Night Duration :

c) ABNORMAL SANSATIONS :

Toda Spandana Ayama d) GOURAVA(Heaviness) :

Present Absent e) DEHAVAKRATHA :

Scoliosis Khyphoscoliosis Right Right Left Left

2

2.Associated Complaints. a) Numbness :

R. Lower limb

L. Lower limb

Bilateral

b) Wasting (muscular) : Present Absent

R. Lower limb

L. Lower limb

Bilateral

c) Constipation : Present Absent

d) Burning sensation : Present Absent

e) Sleeplessness : Present Absent

Daily ……hrs. 3.History of present illness Mode of onset :

Lifting up weight Trauma Sudden jerk

Part first affected : Spik Janu Kati Jangha Prushta Pada Uru

Direction of spread : Back and outer side of thigh, leg & foot

Sacroiliac joints

R. Lower limb

L. Lower limb

Bilateral

Routine activities affected : Yes No

4. History of past illness Episodes of same illness Yes No Obesity Yes No Tuberculosis Yes No Other Vata Vyadhees Yes No Diabetes Mellitus Yes No Trauma/Fracture involved of lumbar region

Yes No

Others Yes No 5. Treatment History

Modern Ayurvedic Others Relief with previous treatment :

Partially relieved No relief at all 6. Family history – relevant :

Yes No

3

7. Personal HistoryAhara :

Veg Mixed Agni :

Manda Teekshn Vishama Sama

Koshta : Mrudu Madhya Kroora

Mutra pravurti- frequency : Day Night

Vyasana : Smoking Tobacco

chewing Alcohol None

Malapravurthi- frequency : 1 time 2 time More Constipated

Aarthavapravurti : Alpa Ati Vishama Rajonivrutti

History of previous Operation : ……………… Type of Anesthesia :

Spinal General Position during daily working hours :

Standing Sitting Stooping Squatting

Nature of work : Hard manual

Moderate manual

Sedentary

House work Office work Others Nature of field work : i) Work in standing : ………. in hrs ii) Work in bending position : ………. in hrs iii) Traveling in vehicles : ………. in kms Specify type of vehicle :

2 wheelers

4 wheeler

Horse riding

Bullock cart

iv) Type of chair used for sitting : Cushion chair

Hard chair

With back rest

Without back rest

v) Sleeping pattern : Korlon Cotton Zuote Carpet Others

vi) Using pillows :

Moderate High Psychological status :

Anxious Grief Depressed Broody Irritable Normal Angry

4

8.Samanya Pareeksha A. Asta sthāna Pareeksha : B. Vital examination :

1 Nadi /Min

2 Mala

Frequency 3 Mootra

Day Night

4 Jihwa

5 Shabda

6 Sparsha

7 Druk

8 Akruti

1 Temp /0F

2 Pulse /min

3 Resp.rate /min

4 B.P ______mm of Hg

5 Height cms

6 Weight Kgs.

C. Dasha vidha Pareekshā :

1 Prakruti V ( ) P ( ) K ( ) VP ( ) VK ( ) PK ( ) Tridoshaja ( )

2 Sāra Pravara. ( ) Madhyama. ( ) Avara ( )

3 Samhanana Pravara ( ) Madhyama. ( ) Avara ( )

4 Pramana Pravara ( ) Madhyama. ( ) Avara ( )

5 Sātmya Ekarasa. ( ) Sarva rasa ( ) Vyamishra ( )

Rooksha satmya ( ) Snigda satmya ( )

6 Satva Pravara ( ) Madhyama ( ) Avara ( )

7 Ahara Shakti a) Abhyavaharana shakti P ( ) M ( ) A ( )

b) Jarana shakti P ( ) M ( ) A ( )

8 Vyayam Shakti Pravara ( ) Madhyama ( ) Avara ( )

9 Vaya Bala ( ) Yuva ( ) Vrudda ( )

10. Srotopareeksha

SROTAS OBSERVED LAKSHNA

Rasavaha Raktavaha Astivaha Mamsavaha Majjavaha Pureeshvaha

5

11. Nidana 1) Swaprakopakara nidana : a) Ahara Guna :

Seeta Rooksha Laghu Rasa :

Katu Tiktha Kashaya Shuskanna :

Yes No Upavasa :

Yes No b) Vihara

Ratrijagarana

Yanam Bharavahana

Vyayama

Pradhavana

Jumping

Pratarana

Walking

c)Manasika : Chinta (worry)

Shoka (grief)

Bhaya (fear)

Krodha (anger)

2) Marmaghatakara nidana : 3) Dhatukshayakaraka nidana : 12. Special Examination

a) Visual analogue scale (VAS)

No Pain 0 1

Mild, annoying pain 2 3

Nagging, Uncomfortable, Troublesome pain

4 5

Distressing, miserable pain 6 7

Intense, dreadful, horrible pain

8 9

6

b) Spinal root examination Root involved Pain Sensory loss Motor weakness Reflex change 2nd Lumbar Front of

mid thigh

Front of mid thigh

Quadriceps Diminished knee jerk

3rd Lumbar Front of lower thigh

Front of lower thigh

Quadriceps Diminished knee jerk

4th Lumbar Side of thigh

Side of thigh Quadriceps Diminished knee jerk

Front of inner thigh

Front of inner thigh

Anterior tibialis

Weak dorsiflexion of foot

5th Lumbar Back of thigh Lateral leg Dorsum of foot to big toe

Back of thigh Lateral leg Dorsum of foot to big toe

Anterior tibialis Weak plantar flexion of big toe

Absent/ Diminished ankle jerk

1st Sacral Base of leg sole and side of foot

Base of leg sole and side of foot

Gastronimus Weak Planter flexion of Big toe and foot

Absent ankle jerk

c) Gait :

Normal Abnormal If abnormal …………………………….type of gait d) Straight Leg Raising (SLR) :

Active Right-Negative /positive At……………..Degrees Left-Negative/Positive At…………….. Degrees Passive Right-Negative/Positive At………………Degrees Left-Negative/Positive At……………….Degrees

e) Reflexes :

7

Knee jerk Leg Absent Diminished Brisk Right

Left Ankle jerks Right Left Babinski’s sign Leg Positive Negative

Right Left

f) Movement of lumbar spine : Type of movements Nil Limited Full Forward flexion Right lateral flexion Left lateral flexion Extension Rotations g) Walking time : Time taken to cover 21 meters Gr.0 Gr.1 Gr.2 Gr.3 Gr.4 h) Movement of hip : Type of movement Nil Limited full Flexion Abduction Abduction Rotation in flexion Internal rotation External rotation

Rotation in Extension Internal rotation External rotation

Extension i) Other Investigations :

Hb% TC

DC P L E M B

ESR

Blood

RBS

Sugar Albumin

Urine

Microscope

X-ray (Lumbosacral) AP & Lat view

13. Treatment Shedule : a. Punarnavadi Guggulu given internally : Date of initiation :

Date of completion :

b. Kati Basti nireekshana : Date of basti initiation :

Date of basti completion :

8

14. Assessment of Results : Chief and Associated Complaints Before 14th Day 30th day After follow up Ruk Sthambha Toda Spandana Ayama Gourava Suptata Shosha Vibandha Daha Assessment of Objective parameter: a) SLR passive Before 14th Day 30th Day After follow up Right Left b) Movements of lumbar spine

i) Forward flexion in cms

ii) Right lateral flexion in cms

iii) Left lateral flexion in cms

Nil Limi Full Nil Limi Full Nil Limi Full Nil Limi Full Ted ted ted ted iv) Extension v) Rotation c) Movement of hip

Nil Limited Full

Flexion Abduction Adduction Rotation in flexion Internal rotation External rotation

Rotation in Extension Internal rotation External rotation

Extension

9

d) Walking time

Before 14th day 30th day After follow up

Gr

.0

Gr

.1

Gr

.2

Gr

.3

Gr

.4

Gr

.0

Gr

.1

Gr

.2

Gr

.3

Gr

.4

Gr

.0

Gr

.1

Gr

.2

Gr

.3

Gr

.4

Gr

.0

Gr

.1

Gr

.2

Gr

.3

Gr

.4

Signature of Scholar Signature of Supervisor

10

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