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VOL 5

ISSUE 6 (2017) INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE eISSN-2348-0173 pISSN-2395-3985

Zade K., Parwe S., The Efficacy of Swadamshtradi Taila Katibasti in Katishoola (IVDP), Int. J. Ayu. Alt. Med., 2017; 5(6): 262-267

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RESEARCH ARTICLE Scientific Journal Impact Factor 5.733 (2015) by InnoSpace Sci. Res., Morocco

Index Copernicus Value (2016) – 86.00

THE EFFICACY OF SWADAMSHTRADI TAILA KATIBASTI IN KATISHOOLA (IVDP)

Kshitij Zade1, Shweta Parwe 2*

1. PG Scholar, Dept. of Panchakarma, MGACH & RC, Salod (H), Wardha. 442001, Contact No.

+919730582075 Email- [email protected]

2. Associate Professor, Dept. of Panchakarma, MGACH & RC, Salod (H), Wardha. 442001, Contact No. +919403142270, Email- [email protected]

Article Received on - 18th Nov 2017 Article Revised on - 17th Dec 2017 Article Accepted on - 25th Jan 2018

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RESEARCH ARTICLE *Corresponding Author Shweta Parwe Associate Professor, Dept. of Panchakarma, MGACH & RC, Salod (H), Wardha. 442001, Contact No. +919403142270, Email- [email protected]

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ABSTRACT: Katishoola (Low back pain) is a very common symptom in early adult life and

middle age. It is the commonest symptom complex related to the musculo-skeletal system. About 60-80% of world’s population experience low back pain at some time in their lives. The highest prevalence is among people aged 30-50 years, with a male to female ratio of 2:1. In people aged 25-55 years, about 95% of herniated discs occur at the lower lumbar spine (L4/5 and L5/S1 level); disc herniation above this level is more common in people aged over 55 years. Swadamshtraditaila used for the Katibasti which exert Vatahara, Vedanasthapak action. A clinical study was conducted on 15 patients irrespective of sex in the age group of 20 to 60 yrs.A diagnosed case of Inter-vertebral Disc Prolapse (IVDP) with the Clinical symptoms from 6 months to 1 year without neurological deficit. Follow up was planned every 9 days till 1 month to assess if there is any recurrence of symptoms. Results: Highly significant results were observed and improvement in cardinal symptoms of Katishoola was observed. Conclusion: This procedure appears to provide good clinical improvement in patients with Katishoola.

Key Words: Katishoola, Swadamshtraditaila, Katibasti, IVDP

INTRODUCTION Katishoola is a disease which is mainly caused by vitiation of Vata Dosha. Some ancient texts also describe Katishoola as a symptom of some disorders such as Katigraha, Trikagraha, Prushtagraha, Kativayu, Trikashoola, Prushtashool, Vataja Shoola, Trika Vedana, and Grudrasi Vata[1,2,3]. Katishoola (Low back pain) is a very common symptom in early adult life and middle age. It is the commonest symptom complex related to the musculo-skeletal system. Almost all adult can remember of having suffered from backache at least once in their life time [4]. Low back pain is a clinical condition in which lot of conditions can be interpreted ranging from spondylolysis, space occupying lesions, tuberculosis of spine, inter vertebral disc prolapse [IVDP], etc. The term “prolapsed disc” means the protrusion or extrusion of the nucleus pulpous through a rent in the annulus fibrous. It is not a onetime phenomenon; rather it is a sequence of changes in the disc, which ultimately lead to its prolapse. It is characterized by the commonest presenting symptom is low back pain with or without the pain radiating down the back of the leg (sciatica) [5]. Maintenance of equilibrium of dosha, dhatu and mala is prime aim of the tantra and vaidyas [6]. And for this Panchakarma plays an important role in the chikitsa aspects of each and every disease. Hence in present study Katibasti is selected. Swadamshtradi taila mentioned by Vangasena

Samhita & Bharat Bhaishajya Ratanakar used for the basti karma which contain Gokshur, Tila Tail, Kshir, Guda (Jaggery) and Adrak (Shunthi) [7,8]. Which exert vatahara, vedanasthapak action [9]. Gokshur acts as a vatahara, shothahar and also causes defensive action on pain [10, 11]. Traditional medicine of Swadamshtradi taila is in various vataj disorders including Katigraha [12]. Thus the present clinical study is designed to evaluate the efficacy of Swadamshtradi taila using Katibasti with the hypothesis that these basti may prove beneficial in combating the disease pathogenesis by brumhana and vatahara property [13]. Incidence and Prevalence: About 60-80% of world’s population experience low back pain at some time in their lives [14]. The highest prevalence is among people aged 30-50 years, with a male to female ratio of 2:1. In people aged 25-55 years, about 95% of herniated discs occur at the lower lumbar spine (L4/5 and L5/S1 level); disc herniation above this level is more common in people aged over 55 years [15]. AIMS AND OBJECTIVES “Evaluation of the efficacy of Swadamshtradi taila Katibasti in Katishoola (IVDP) MATERIAL AND METHODS Case Definition: - A diagnosed case of Intervertebral Disc Prolapse (IVDP) with the

THE EFFICACY OF SWADAMSHTRADI TAILA KATIBASTI IN KATISHOOLA (IVDP)

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Clinical symptoms from 6 months to 1 year without neurological deficit. Criteria of Diagnosis The signs & symptoms of Katishoola mentioned in the Ayurveda will be basis of diagnosis in addition to the criteria laid down for IVDP is as follows.

Shoola in katipradesha. Sthambana in katipradesha. A diagnosed case of IVDP (MRI

Diagnosed). Inclusion criteria

Age of the patients between 20 to 60 years.

Patients suffering from the Katishoola (Lumbago due to displacement of intervertebral disc).

A diagnosed case of IVDP with the Clinical symptoms from 6 months to 1 year without neurological deficit.

Patients showing early positive S.L.R.T. (straight leg rising test) at 40 degree or less.

Patients irrespective of their sex, religion, occupation and economic status.

Exclusion criteria Patients having neurological deficit. Other intervertebral disc disorders. Lumbar and other intervertebral disc

disorders with myelopathy. Lumbar and other intervertebral disc

disorders with radiculopathy. Other specified intervertebral disc

degeneration. Schmorl nodes. Other specified intervertebral disc

disorders. Intervertebral disc disorder, unspecified. Patients with other systemic condition

such as Spondylisthesis, Spina Bifida, Vertebral Fracture, Malignant disorder.

Traumatic patients, pregnant women. Associated with simple and compound

fractures. With any local skin disease on Lumber

excluded as the oil is stored on lumber directly.

Sample size -15 Study Duration: Katibasti: 09 days Follow up days: 18 days Last follow up: 27th day Total Study Duration: 27 days IEC letter No - DMIMSDU/IEC/2015-16/1323 Source of Data -Patients of either sex attending the OPD & IPD of Department of Panchakarma of

Mahatma Gandhi Ayurved Hospital were selected for the study with preset criteria set for Katishoola (IVDP) vis-à-vis Lumbago due to displacement of intervertebral disc. Type of study- Interventional Preparation of drug: The oil for the present clinical study is prepared in pharmacy attached to Mahatma Gandhi Ayurved collage as per the classical references with the following ingredients –

1. Swadamshtra or Gokshurakvatha(2.56 Parts) – 42 liters 2. Tilataila(1.28 Parts) – 21 liters 3. Kshira(2.56 Parts) – 42 liters 4. Sringaveraor Ardraka(1 part) – 1 kg 5. Guda(4 parts) – 4 kg

The above mentioned drugs mixed together. Tila taila and godugdha added, boiled and stirred well continuously so that the kalka will not adhere to pot. When all the dravadravya have evaporated and samyaka sneha siddhi lakshan observed, Madhyama snehapaka is done. The oil residue is filtered and preserved for the usage. Method of administration of Katibasti Purva Karma: Patient was let to lie down on the table in prone position. The lumbosacral area was then stroked with Swadamshtradi Taila. After Abhyanga patient was subjected to Swedana prior to the application of Kativasti. Pradhana Karma: After local Snehana and Swedana Karma the area of basti. Apply the brim of black gram powder & filled with Swadamshtradi taila using cotton piece and is allowed to keep there for 30 minutes. Pashchat Karma: Remove the oil & in a relax position the patient is then allowed to take rest. Methods of Assessment of clinical response Clinical parameters and functional parameters were made out to assess the clinical response in both the groups. Subjective Parameters

1. Shoola (Pain) Grade 1 – No pain Grade 2 – Mild pain Grade 3 – Moderate pain Grade 4 – Severe pain

2. Sthambha (Stiffness)

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Grade 0 – Normal movement Grade 1 – 0 to 25% restricted Grade 2 – 25% to 50% restricted Grade 3 – 50% to 75% restricted Grade 4 – 75% to 100% restricted.

Objective Parameters Straight Leg Raising Test (SLRT) - 40 degree or less. Schober’s Test - >20 cm Modified Oswestry Low Back Pain Disability Questionnaire - This questionnaire is also designed to assess the patient’s condition.

Overall Assessment of Clinical Response Major Improvement - ˃30%

improvement in clinical and functional parameters

Moderate Improvement- 15% to 30% improvement in clinical and functional parameters

Mild Improvement - 05% to 15% improvement in clinical and functional parameters

Unchanged - 0% to 05 % improvement in clinical and functional parameters

OBSERVATION & RESULT In the present study 66.66% of the male patients were registered and 33.33% of female patient. It is observed that the 80% of patients were belonging to Hindu religion, 6.66% belongs to Muslim religion and 13.33% belongs to other religion. Age group was divided into sub in the present study 20% of the patients were of 20-29 years age group, 20% of the patients were of 30-39 years age group, 20% of the patients were of 40-49 years age group and 40% of >50 years age group. 26.67% were poor, 53.33% of the patients were middle class, and 20% were having higher middle economic status. Subjective Parameters Mean pain in patients at 1st day was 3.46±0.51, at 5th day it was 2.93±0.70 at 9th day it was 2.66±0.72, at 18th day it was 1.80±0.67 and at 28th day it was 1.80±1.01. By using students paired t test statistically significant difference was found in pain between 1st-5th day (t=3.228, p=0.006), 1st-9th day(8.876, p=0.0001), 1st-18th day (t=8.919, p=0.0001) and at 1st-28th day (t=6.614,p=0.0001) Mean stiffness in patients at 1st day was 3.00±0.00, at 5th day it was 2.40±0.50, at 9th day it was 1.20±0.94, at 18th day it was 0.73±1.03 and at 28th day it was 0.66±0.9. By using students paired

t test statistically significant difference was found in stiffness between 1st-5th day (t=4.58,p=0.0001), 1st-9th day (t=7.40, p=0.0001),1st-18th day(t=8.50, p=0.0001) and at 1st-28th day(t=9.26, p=0.0001) Mean restricted movement in patients at 1st day was 2.93±0.25, at 5th day it was 2.26±0.45, at 9th day it was 0.93±0.88, at 18th day it was 0.66±0.97 and at 28th day it was 0.66±0.97. By using students paired t test statistically significant difference was found in restricted movement between 1st-5th day (t=5.292,p=0.0001), 1st-9th day (t=8.367, p=0.0001), 1st-18th day(t=8.500,p=0.0001) and at 1st-28th day (t=8.500, p=0.0001) Objective Parameters Mean Schober’s Test in patients at 1st day was 16.40±0.25, at 5th day it was 2.26±0.45, at 9th day it was 0.93±0.88, at 18th day it was 0.66±0.97 and at 28th day it was 0.66±0.97. By using students paired t test statistically significant difference was found in Schober’s Test between 1st-5th day (t=5.292,p=0.0001), 1st-9th day (t=15.043, p=0.0001),1st-18th day (t=11.000,p=0.0001) and at 1st-28th day (t=8.984,p=0.0001) Mean Oswestry low back pain disability questionnaire in patients at before treatment was 45.65±5.20, and after treatment it was 29.86±8.12. By using students paired t test statistically significant difference was found in Oswestry low back pain disability questionnaire between before and after treatment (t=10.51, p=0.0001) Mean SLRT (degrees)Rt Leg in patients at 1st day was 55.33±17.67, at 5th day it was 65.33±16.30, at 9th day it was 76.66±12.90, at 18th day it was 82.66±14.37 and at 28th day it was 84.00±13.52. By using students paired t test statistically significant difference was found in SLRT (degrees) between 1st-5th day (t=3.944, p=0.001), 1st-9th day (t=5.323, p=0.0001), 1st-18th day (t=5.323, p=0.0001) and at 1st-28th day (t=5.667, p=0.0001) Mean SLRT (degrees) Lt. Leg in patients at 1st day was 73.66±16.52, at 5th day it was 77.33±15.33, at 9th day it was 84.00±9.85, at 18th day it was 86.66±7.23 and at 28th day it was 87.33±7.98. By using students paired t test statistically no significant difference was found in SLRT (degrees) between 1st-5th day (t=2.128,p=0.052), and statistically significant difference was found in SLRT (degrees) between 1st-9th day (t=3.507, p=0.003), 1st-18th day(t=3.702, p=0.002) and at 1st-28th day (t=3.795, p=0.002)

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Table No. 1 - Statistical Analysis

Parameter Mean BT Mean AT Improvement % t-value P value Pain 3.46±0.51 2.00±0.53 42.19% 8.876 <0.0001 Stiffness 3.00±0.00 1.20±0.94 60.00% 7.40 <0.0001 Restricted movement of back 2.93±0.25 0.93±0.88 68.26% 8.367 <0.0001

The overall effect of treatment on subjective parameters for Pain radiating from back to thigh, knee & calf shows t=8.876, p value is equals to 0.0001 which shows statistical significant difference before and after treatment. Stiffness radiating from back to thigh, knee & calf shows

t=7.40, p value is equals to 0.0001 which shows statistical significant difference before and after treatment. Restricted movement of back shows t=8.367, p value is equals to 0.0001 which shows statistical significant difference before and after treatment.

Table No. 2 - Statistical Analysis

Parameter Mean BT Mean AT Improvement % t-value P value

Schober’s Test 16.40±0.50 19.13±0.74 16.65% 15.043 0.0001,S Oswestry low back questionnaire 45.65±5.20 29.86±8.12 34.59% 10.51 0.0001,S

SLRT Right Side 55.33±17.67 76.66±12.90 38.55% 5.323 0.0001,S Left Side 73.66±16.52 84.00±9.85 14.04% 3.507 0.003, S

The overall improvement of the objective parameters shows statistically significance difference before treatment and after treatment. DISCUSSION In human body, the lumbar spine is the site of most expensive orthopedic problem for the world’s industrialized countries. Back pain is a symptom. Common causes of back pain involve disease or injury to the muscles, bones, and/or nerves of the spine. Nerve root syndromes are those that produce symptoms of nerve impingement, often due to a herniation (or bulging) of the disc between the lower back bones. As Acharya Vangasen mentioned Swadamshtradi taila in all types of vatavyadhi. So Swadanshtradi taila can be used in basti. Taila has got Usna, Snigdha, Sukshma, Snigdha properties by virtue of which it reaches deeper dhatus like asthi and majja by penetrating through minute channels. CONCLUSION Katishoola (IVDP) has been considered as a

major health problem of modern day life style which is expected to be increase in coming years

Swadamhradi taila mentioned in Vatavyadhiadhikara of Vangasena Samhita is selected for Katibasti in the present study to evaluate its efficacy in the management of Katishoola. The oil contains only five ingredients, all of which are having vata pacifying property, easily available and also cost effective.

Katibasti is a procedure in which both the properties of snehana & swedana are

incorporated. The reason behind selection of Katibasti is that it comes under direct contact with painful region. In this disease, Samprapti is at Kati-region and is mostly associated with structural changes of lumbar vertebral column.

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